For nursing home and hospital patients, insomnia is an important risk factor for falls and injury. Sedative-hypnotic medication, often used to treat insomnia, is a leading cause of falling. Sleep medications produce significant balance and cognitive impairments upon awakening from sleep. While drugs can impair balance and contribute to falls, untreated sleep problems are also a risk factor for falls. In fact, patients with untreated or inadequately treated insomnia may have a higher risk for falls than those who use hypnotics. Lastly, there are multiple mental and physical factors that, when combined with insomnia, can lead to falls. Consequently, managing fall risk in patients with insomnia can be challenging. Aside from, designing behavioral approaches to treat insomnia (such as, regular exercise, exposure to light during the day, an environment that is conducive to sleep, avoidance of caffeine, etc.), the use of a fall alarm or monitor (FALLGUARD® SAFETY AUTO-RESET™ FALL PROTECTION & MOBILITY MONITOR) to detect and alert staff of unsafe mobility in patients with insomnia can be beneficial.
Elderly women with osteoarthritis (OA) have a 20% higher risk of bone fractures and experience 30% more falls than those without arthritis. OA results in changes that include bony overgrowth, fluid accumulation, and loosening and weakness of muscles and tendons; all of which may cause pain/swelling, limit movement, and increased fall risk. An increase in the number of falls is the cause of a higher number of fractures (i.e., the more falls one has, the greater the likelihood of a fracture). To guard against fractures, patients with OA should be:
It’s often assumed that restricting patient activity can reduce the risk of falling. This, however, is a mistaken belief. According to recent research (*), hospital patients who fall do not walk around anymore than patients who don’t fall. In fact, keeping patients immobile can backfire; not moving enough can lead to poor muscle tone/decreased balance and increased fall risk.
To examine the incidence of falls among ambulatory and non-ambulatory elderly patients, researchers equipped 35 elderly patients with small electronic devices that recorded every step they took. They determined that there was no difference in the amount of walking between the two groups.
Nevertheless, they did find that falls were associated with delirium and/or poor cognitive function. Additionally, all of the falls took place at night, with 60% of falls related to trips to the bathroom.
Using a fall alarm is a good way to reduce the risk of ‘toileting falls’ at night. Nurses often rely on toileting rounds to detect patients needing to use the toilet. This strategy, however, is not very effective at night (no one wants to wake a sleeping patient and ask them if they need to use the bathroom) or in patients with poor cognition who may not be able to communicate their needs.
(*) Fisher SR, Galloway RV, Kuo YF, et al. Pilot study examining the association between ambulatory activity and falls among hospitalized older adults. Archives of Physical Medicine and Rehabilitation, 2011.
In hospitals and nursing homes across the country, many falls occur during nursing shift changes. The majority of falls occur to patients who are already identified as being at fall risk; those with poor mobility (e.g., gait/balance impairment) and cognitive impairment. The reason for falling? During shift changes, patients are generally left alone and without the supervision, monitoring and care they need. These mishaps create a tremendous liability for management. Key strategies to eliminate falls during shift changes include:
- Provide nurse rounding of high-risk patients during shift changes.
- Discussing high fall risk patients during shift change handoffs.
- Promoting communication between nursing staff, which includes addressing the patient’s:
- Identified fall risk factors
- Current risk condition /fall precautions
- Current fall management care plan
Utilizing fall alarms during shift changes as a safety measure; alarms detect unsafe patient activity/send a signal to nurses that patient’s are engaging in unsafe behavior.
The risk of skin trauma (bruises, abrasions and tears) is great in patients with sensitive skin. Skin trauma frequently occurs during:
- A fall against or bump into furnishings with sharp edges, such as dressers, tabletops, chair frames, wheelchairs, unpadded side rails, and other objects.
- Caregiver assistance with mobility (lifting, turning, positioning and transferring techniques).
Injured Body Part
- The upper extremities (forearm and hand) are most frequently the site of injury, followed by the leg.
- Advanced age
- High fall risk status
- Sensory loss
- Compromised nutrition
- History of previous skin trauma
- Cognitive impairment
- Poor mobility
- Use of an assistive device
- Decreased vision
- Patients should be encouraged to wear long arm sleeves or pants for protection against injury.
- Educate staff on the importance of carefully handling elderly patients with frail skin.
- Encourage proper positioning, turning, lifting, and transferring techniques.
- Provide padding to bed rails, wheelchair arm and leg supports, and any other equipment that may be utilized to protect the patient from accidentally bumping into a hard surface.
- Provide a well-lit environment to minimize the risk of patients/residents bumping into equipment or furniture.
Do you have a problem with skin tears in your fall risk patients? What methods do you use to reduce the risk of skin tears? Your comments are most welcome.