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Topic 1 - Posted January 17, 2019

 

All you need to know about falls!

by Amy, Home Health Clinical Manager

Falls are considered an epidemic in our country.  According to the Center for Disease Control and Prevention the following holds true:

 

  • Fall deaths rose by 30% during the years of 2007-2016.  It is anticipated that by 2030, there will be 7 fall deaths every hour.
  • One out of five falls causes a serious injury such as broken bones or a head injury,4,5
  • Each year, 3 million older people are treated in emergency departments for fall injuries.6
  • Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.6
  • More than 95% of hip fractures are caused by falling,8 usually by falling sideways.9
  • Falls are the most common cause of traumatic brain injuries (TBI).10
  • In 2015, the total medical costs for falls totaled more than $50 billion.11 Medicare and Medicaid shouldered 75% of these costs. These costs are anticipated to rise as the population age increases.

 

The above statistics are staggering.  At St. Camillus, we do have a falls committee for Skilled Nursing, Assisted Living and Independent Living.  It is all of our job to help to keep our residents safe and help to prevent falls.  Through initiatives and measurements taken, Assisted Living and Memory Care has been able to reduce the falls that they have had by almost half in the last couple of months.

 

What has been done and what is being done differently?

  • Building awareness through inservicing, immediate and ongoing education. ALF and Memory Care staff have been required to attend a falls inservice in the last couple of months with ongoing inservicing to be completed to include topics that have been identified as trends through falls tracking.
  • A falls tracking tool has been developed to be able to identify trends.  The tracking tool includes where the fall happened, when it happened, staff involved.
  • Staff have been educated what they can do to help to prevent falls.  Posters have been hung near all of the medication/laundry rooms as reminders to be checking for these key things when having an interaction with the resident:  1.  Did you toilet the resident?  2.  Does the resident need something to eat or drink?  3.  Are all items within reach?  4.  Is the room free of clutter?
  • Communication is identified as key.  Leaving residents in the common area, especially in Memory Care is not recommended.  Staff have been educated, that when possible, to be communicating with each other to ensure that one of them is providing supervision to the residents in the common area while the other staff may be helping in other resident apartments.
  • Extra activity programming hours have been added to ensure that residents are being stimulated during the evening hours, especially after dinner.
  • Ongoing work is needed to help to prevent falls across campus.  Building team awareness and providing education is key.  We may not be able to prevent all falls from happening, but by anticipating the needs of the resident/client, falls prevention is possible.

 

References

1. Bergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged ≥65 Years — United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65:993–998. DOI: http://dx.doi.org/10.15585/mmwr.mm6537a2

2. Stevens JA, Ballesteros MF, Mack KA, Rudd RA, DeCaro E, Adler G. Gender differences in seeking care for falls in the aged Medicare Population. Am J Prev Med 2012;43:59–62.

3. O’Loughlin J et al. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. American journal of epidemiology, 1993, 137:342-54.

4. Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall–related injuries in older adults. American Journal of Public Health 1992;82(7):1020–3.

5. Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. Journal of Trauma–Injury, Infection and Critical Care 2001;50(1):116–9

6. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed August 5, 2016.

7. Healthcare Cost and Utilization Project (HCUP). 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://hcupnet.ahrq.gov. Accessed 5 August 2016..

8. Hayes WC, Myers ER, Morris JN, Gerhart TN, Yett HS, Lipsitz LA. Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcif Tissue Int 1993;52:192-198.

9. Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Järvinen M. Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int, 1999;65:183–7.

10. Jager TE, Weiss HB, Coben JH, Pepe PE. Traumatic brain injuries evaluated in U.S. emergency departments, 1992–1994. Academic Emergency Medicine 2000&359;7(2):134–40.

11. Florence CS, Bergen G, Atherly A, Burns ER, Stevens JA, Drake C. Medical Costs of Fatal and Nonfatal Falls in Older Adults. Journal of the American Geriatrics Society, 2018 March, DOI:10.1111/jgs.15304

12. Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age and Ageing 1997;26:189–193

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