Towards Fall Prevention

1. Towards Fall Prevention

2. You need to know that… • falling is not a normal part of aging. • the risk of falling can be minimized. • falling may be an early sign of illness.

3. Person Factors Poor balance Postural hypotension Weakness Functional, cognitive, and sensory, changes Medication effects Pain Environment Factors Poor lighting Slippery or uneven flooring or sidewalks Unexpected objects (tubing, pets) Restraints Lack of structural supports What causes falls? Can you think of some other causes of falls?

4. Falls & Person-Environment Fit We must always assess both the individual person and the environment. However, at any given time or in any given setting, our focus may be greater on one than on the other.

5. Person Factors Environment Factors In the acute care setting… Factors related to falls involve both the person and the environment. For example: • Immobility • Medication effects • Weakness and pain • Tubing ( e.g., IVs, catheters, oxygen) • Lack of familiar supports (e.g., eyeglasses, ambulation devices) • Unfamiliar setting, people, and routines What other factors have you observed?

6. In the home setting… The focus of fall prevention tends to be more on the environment. For example: • Lack of grab bars in bathrooms • Lighting • Scatter rugs • Pets • Cluttered walkways • Stairs • Person Factors: • Medication effects • Decreased ability to manage personal care • Functional, cognitive, and sensory changes What other factors have you observed?

7. Take a walk through your living environment. What environmental hazards could cause a fall?

8. Prevention: In the Hospital • Assess history of falls on admission. • Minimize restraint use. • Ensure use of glasses and hearing aids. • Frequently assess elimination, pain, and cognitive status, making individualized adaptations. • Keep patient area clutter-free. • Monitor effects of medications.

9. In the Hospital (continued) • Lock wheels on wheeled tables and other devices that may be used as supports. • Use alert system to notify staff about individual fall risk. • Move patient closer to nursing station. • Restore and maintain functional status. • Use assistive devices. • Educate regarding safe transfers. • Obtain referrals for OT, PT, Home Health.

10. Prevention: In the Home • Secure or eliminate loose rugs • Remove clutter • Assess for adequate lighting (inside and outside, especially on stairs) • Assess bathroom for grab bars • Obtain referrals for OT and PT (What can OT and PT do in the home to prevent falls?)

11. Fall Prevention: Occupational Therapy (OT) • Evaluate need for: • Assistive devices (especially those for bathing, toileting, eating and dressing) • Home modifications

12. Fall Prevention: Physical Therapy (PT) • Transfer training • Balance training • Standing • Uneven surfaces • Curbs and steps • Gait training • Assistive device training • Canes, crutches, walkers • Strengthening exercises

13. Fall Prevention: Additional Nursing Interventions • Encourage to take classes in Tai Chi • Encourage the use of assistive devices • Monitor medications • Monitor elimination and pain issues • Instruct to change positions slowly • Instruct regarding non-slip footwear

14. Fall Prevention: Interdisciplinary • Nursing has a KEY role in facilitating referrals for evaluations in both the acute care and home settings. • Primary in fall prevention are the interdisciplinary team and coordination between settings. Older adults benefit most from the collective expertise of all related disciplines.

15. Towards Fall Prevention was created by Catherine Van Son, Ph.D., R.N. for the Older Adult Focus Project, OHSU School of Nursing.