Journal of the American Medical Directors Association
Controversies in long-term careFalls in the Nursing Home: Are They Preventable?
Section snippets
Community-dwelling versus nursing home residents
Several studies have identified preventive interventions that are effective in reducing the incidence of falls in community-dwelling geriatric patients. These interventions include risk factor detection and abatement programs, exercise interventions,3, 4, 5, 6 environmental modification, or multifactorial intervention programs that include fall-risk assessments, medication adjustments, exercise intervention, environmental hazard adjustments, and fall-risk education.7, 8 Unfortunately, clinical
Multifaceted interventions
Because falls are the end result of synergistic interactions between multiple intrinsic and extrinsic risk factors, it is reasonable that multifaceted intervention programs addressing multiple risk factors would be most successful in preventing falls in nursing home residents. Results from several randomized, controlled clinical trials involving multifaceted fall prevention programs have yielded encouraging, if not uniform, results. Ray et al.10 found that a falls consultation service
Environmental assessment/modification
Environmental risk factors are important contributors to falls in nursing home residents. Specific factors that have been reported to be associated with falls include area rugs, loose electrical cords, wet flooring, multiple transitions in flooring surfaces, improper furniture height, poor lighting, and patient restraints. Much emphasis has been placed on the evaluation and modification of environmental contributors to falls within nursing homes in recent years. Although attention to
Exercise intervention
There are multiple trials that assess the effect of different exercise programs on nursing home residents. A recent trial (Toulotte et al.21) found that an exercise program consisting of 1 hour of strength, balance, and flexibility training twice a week for 16 weeks in 20 demented nursing home patients with a history of falls resulted in improved balance, flexibility, and gait speed in the intervention subjects compared with the control subjects. Fiatarone et al.22 examined 100 frail nursing
Hip protectors
Although the primary focus of this article is to assess the efficacy of fall prevention interventions, the ultimate goal of any fall prevention program is to reduce fall-related morbidity. A common yet serious adverse effect of falls in the elderly patient is fracture of the proximal femur. The efficacy of hip protectors in preventing hip fractures in elderly patients has been well established.26, 27, 28, 29, 30, 31 Various different models of hip protectors are currently available, but there
Medication assessment/modification
Iatrogenic contributors to falls are often present in elderly patients, in whom comorbid conditions require treatment with multiple medications that could increase fall risks either independently or in combination. In a metaanalysis of 25 observational studies, Leipzig et al.32 found that patients taking psychotropic agents (odds ration [OR], 1.73; 95% CI, 1.52–1.97), diuretics (OR, 1.08; 95% CI, 1.02–1.16), type la antiarrhythmics (OR, 1.59; 95% CI, 1.05–1.42), and digoxin (OR, 1.22; 95% CI,
Conclusion
Resident falls are rightfully a concern both for primary care providers practicing in nursing homes and for nursing home administrators. As summarized previously, falls result from the synergistic interaction of multiple fall-risk factors acting on elderly patients. A review of the literature revealed that multifaceted fall prevention programs were effective in reducing falls in nursing home residents. Although fall-risk assessment on admission to long-term care facilities and then quarterly
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Randomized clinical trial of a fall-prevention strategy for institutionalized elderly based on the Mini Falls Assessment Instrument
2016, Revista Espanola de Geriatria y GerontologiaPredictors of Mortality, Rehospitalization for Syncope, and Cardiac Syncope in 352 Consecutive Elderly Patients With Syncope
2013, Journal of the American Medical Directors AssociationCitation Excerpt :Falls are common in a nursing home population. Approximately 1.5 falls occur per nursing home bed years, and 10% to 25% of falls result in hospital admissions and/or fractures.14,15 Orthostatic hypotension is a common reason for falls in this population.16
Journal of the American Medical Directors Association: The State of the Journal
2012, Journal of the American Medical Directors AssociationOutcomes of Polypharmacy in Nursing Home Residents
2012, Clinics in Geriatric MedicineCitation Excerpt :Falls account for over 80% of injury-related hospital admissions in people older than 65 years.41 Between 10% and 25% of nursing home falls result in fractures or hospital admissions.42 Studies about the association between polypharmacy and falls/fractures have had mixed results.
Falls
2010, Brocklehurst's Textbook of Geriatric Medicine and Gerontology