Fall Prevention in Nursing Homes: Safeguarding the Well-Being of Seniors

As the population in the United States ages, ensuring the safety and well-being of seniors becomes an increasingly significant concern, especially in nursing homes where residents may be more vulnerable to falls. Falls can lead to severe injuries, reduced mobility, and a decline in the overall quality of life for elderly individuals. However, with the right approach and preventive measures, nursing homes can significantly reduce the risk of falls. 

Facts about falling from the CDC:

• One out of five falls causes a serious injury such as broken bones or a head injury.
• Each year, 3 million older people are treated in emergency departments for fall injuries.
• Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.
• Each year at least 300,000 older people are hospitalized for hip fractures.
• More than 95% of hip fractures are caused by falling, usually by falling sideways.
• Falls are the most common cause of traumatic brain injuries (TBI).

Falls among adults aged 65 and older are very costly. Each year about $50 billion is spent on medical costs related to non-fatal fall injuries and $754 million is spent related to fatal falls.

Qsource is committed to assisting nursing homes and their staff to reduce falls among seniors. Let’s explore some common hazards associated with falls and some tips that can help reduce incidents in facilities. 

Common fall hazards in nursing homes.

Hazard: Poor Lighting
Inadequate lighting can reduce visibility, making it difficult for seniors to see obstacles and potential tripping hazards. Dimly lit areas, especially during nighttime, can lead to accidents.

Helpful Tips:
Ensure all areas are well-lit, particularly hallways, staircases, common areas, and bathrooms.
Use nightlights or motion-activated lights in bedrooms and hallways to guide residents during nighttime trips to the restroom.
Regularly check and replace burnt-out bulbs promptly.

• Ensure all areas are well-lit, particularly hallways, staircases, common areas, and bathrooms.
• Use nightlights or motion-activated lights in bedrooms and hallways to guide residents during nighttime trips to the restroom.
• Regularly check and replace burnt-out bulbs promptly.

Hazard: Uneven Flooring
Carpets, rugs, and uneven surfaces can be problematic for seniors, especially those with mobility issues or using assistive devices like walkers or wheelchairs.

Helpful Tips:

• Use non-slip flooring materials in high-traffic areas and consider replacing old, worn-out carpets and rugs.
  Secure edges of carpets and rugs with double-sided tape to prevent them from curling up.
• Regularly inspect flooring for signs of wear and tear and address any issues promptly. 
• Clear mark uneven floors in the facility to assist the residents with transitions during ambulation.  
• Ensure the resident is utilizing the most appropriate device to assist in ambulation or locomotion to promote safety. 

Hazard: Lack of Handrails
The absence of handrails or improperly positioned handrails can leave seniors without necessary support, leading to instability and potential falls.

Helpful Tips:

• Install sturdy handrails on both sides of hallways, staircases to provide support for residents while walking or transferring.
• Ensure that handrails are securely anchored to the walls and can withstand a person's weight.
• Ensure that handrails are easily identifiable to assist with vision impairment that is associated with decrease in depth prospection, and blurred vision.  

Hazard: Wet Floors
Slippery floors due to spills, leaks, or cleaning can be treacherous for elderly residents, increasing the likelihood of falls.

Helpful Tips:

• Implement clear procedures for prompt spill cleanup and communicate these protocols to all staff members.
• Place "wet floor" signs in visible locations to warn both residents and staff of potential hazards.
• Encourage the use of wet mops with appropriate cleaning solutions that dry quickly.
• Ensure that “wet floor signs” are visible to facility dementia residents, draw areas to show which side of the sign the resident needs to move too due to decrease cognitive impairments.  

Hazard: Cluttered Walkways
Clutter and obstacles in walkways hinder mobility and create hazardous conditions for seniors, who may not have the agility to navigate around them easily.

Helpful Tips:

• Train staff to keep walkways clear and organize furniture and equipment in a way that allows for easy movement.
• Use cord organizers or tape to secure electrical cords along the walls to prevent tripping.
• Store items on the hallway to one side of the hallway while in use on the hall to assist with keeping the hallway uncluttered. 

Hazard: Incorrect Bed Heights
Beds that are too high or too low can make it challenging for residents to get in and out safely, increasing the risk of falls during transfers.

Helpful Tips:

• Adjust bed heights to a level that allows residents to sit and stand comfortably without excessive strain.
• Educate staff on proper transfer techniques and the use of assistive devices, like bed rails and bed-assist poles. 

Hazard: Inadequate Footwear
Ill-fitting or non-supportive footwear can contribute to balance problems and increase the likelihood of falls.

Helpful Tips:

• Encourage residents to wear well-fitted, non-slip footwear with sufficient grip and support.
• Provide slip-resistant socks or footwear for residents who prefer not to wear shoes inside. 
• Encourage families to be involved in assisting with shoe wear to help promote continued safety when new shoes are brought for the resident by the family.

Research has identified other conditions that contribute to falling including:

• Lower body weakness
• Vitamin D deficiency
• Difficulties with walking and balance
• Use of medicines, such as tranquilizers, sedatives, antidepressants, anxiolytics, antipsychotics, mood stabilizers, antiseizure, and cardiovascular medications. Even some over-the-counter medicines can affect balance and how steady you are on your feet. 
• Vision problems
• Foot pain or poor footwear
• Acute Infections 
• Cognitive Impairment 

Most falls are caused by a combination of risk factors. The more risk factors a person has, the greater their chances of falling.1

How Nursing Home Staff Can Help Reduce Falls

Regular Risk Assessments: Conduct regular and comprehensive risk assessments of the nursing home environment, involving staff members from different departments to gain a holistic perspective. Utilize checklists to identify potential hazards in various areas, including resident rooms, common areas, and outdoor spaces. Review and update risk assessments periodically or whenever significant changes are made to the facility layout.

Assessment of Individual Risk Factors: Each resident may have unique risk factors contributing to their falls. Conduct individual assessments to identify specific needs and risks. Involve healthcare professionals, such as physical therapists and occupational therapists, in assessing residents' mobility and fall risks. Tailor fall prevention strategies based on individual assessments.

Staff Training and Education: Educate staff members on fall prevention techniques, recognizing fall risk factors, and implementing preventive measures. Organize regular training sessions and workshops for staff to stay updated on best practices in fall prevention. Foster a culture of fall prevention awareness among all staff members.

Exercise Programs: Implement regular exercise programs focused on improving strength, balance, and flexibility in residents. Offer a variety of exercise options suitable for different levels of mobility and abilities. Involve residents in group exercises to encourage social engagement and motivation.

Environmental Modifications: Make necessary modifications to the facility to reduce fall risks and enhance safety. Install grab bars in bathrooms, especially near toilets and showers. Ensure that handrails and grab bars are at an appropriate height and securely anchored. Consider installing ramps and elevators to facilitate safe movement between levels.

Medication Review: Regularly review residents' medications to identify any drugs that could contribute to falls, such as those causing dizziness or drowsiness. Work with healthcare professionals to adjust medications if necessary and monitor their effects.

Engaging Activities: Offer engaging activities and social opportunities to keep residents active and reduce the risk of falls due to inactivity. Organize group outings or events that encourage participation and social interaction. Provide mentally stimulating activities to enhance cognitive function.

Preventing falls in nursing homes is a shared responsibility that requires vigilance from both staff and residents. By proactively identifying potential hazards and implementing effective fall prevention measures, nursing homes can create a safer living environment for their elderly residents.

Additionally, promoting an active lifestyle, educating residents about fall risks, and fostering a supportive community can further contribute to a reduced risk of falls and an improved quality of life for seniors in nursing homes. Together, we can safeguard the well-being of our beloved elderly and make their golden years safer and more enjoyable.

Qsource Related Downloads & Resources:
Decision Tree for Types of Falls
Falls Compliance Audit Tool
Fall Risk and Prevention in Long-Term Care

Video:
Medication Considerations for Fall and Risk Prevention

Sources:
1 https://www.cdc.gov/falls/about/index.html 
2 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