Falls in the Nursing Home: A Collaborative Approach

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Problem solving using a collaborative approach may reduce the risk of falls in the nursing home. Interventions need to be tailored to the individual's cognitive and physical impairments as well as be feasible in the particular long-term care setting. Polypharmacy, Vitamin D deficiency, delirium, and urinary incontinence are among several risks for falls that are discussed in this article.

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Background

About 40% of NH residents fall yearly, and many fall more than once.1, 2 About 35% of falls in NHs occur among patients who cannot walk.3 Many of the residents in NHs had a history of falls and fall-related injury in the community before admission, often resulting in NH admission. Persons who fall are at risk of future falls. Thus, the prevalence of falls in nursing is much higher than it is in the community.

Consequences of falls can be significant even when there is no apparent injury. Among

Polypharmacy

Polypharmacy, a result of multiple comorbidities, is associated with falls in multiple studies. Drugs from specific classes, including antidepressants, neuroleptic agents, benzodiazepines, anticonvulsants, and class IA antiarrhythmic medications, appear associated with falls fairly consistently.10 Although hypnotics are classically implicated in falls in older adults, recent evidence suggests that insomnia itself may increase the risk for falls.11 Moreover, although the older, tricyclic

Comprehensive approach to the fall during rehabilitation

After a patient's fall, the nurse is legally required to notify the medical director or nurse practitioner on call, as well as the family. Nursing intervention after a fall should include an immediate, problem-focused assessment to determine if it was witnessed, whether the resident is injured, if he hit his head, the location of pain, and a passive range of motion to assess for fracture or dislocation. Head trauma and hip fracture are serious consequences of falls.6 Either can lead to

Primary, Secondary, and Tertiary Prevention

An important question is how do we change the culture of NHs to improve safety and bring best practice to everyday life in the facility?6 One of the best ways is through nursing and nurse assistant education on a regular basis. The medical director, director of nursing, and nurse educator should implement an ongoing series of patient-focused seminars on causes, consequences, and prevention of falls in the NH. Quality indicators should be identified and complied with. Preventive strategies

Summary

In this article, falls were discussed with a team approach by a geriatrician and a geriatric nurse practitioner. Improving the quality of lives in NHs, maximizing safety, managing pain, and educating NH nurses and staff about fall safety and prevention are the nursing objectives for the residents of LTC. Collaborative approaches that are individualized and “creative” make sense, as the body of evidence-based interventions in the NH grows.34

Most are evidence based; a few just make good sense.

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