In the United States, falls are the most frequent cause of accidental death in older adults; more than 1,800 nursing home residents die each year due to injuries sustained from falls. While about 5 percent of adults over the age of 65 live in nursing facilities, they account for nearly 20 percent of fall-related deaths in this age group. Up to 20 percent of residents who fall sustain serious injuries that can lead to a decline in functional ability and mobility impairment. Fear of future falls can lead to self-imposed restrictions in mobility and other activities, increasing the risk of subsequent falls.
Most falls occur as a result of multiple contributing factors; therefore, managing the risk of falling begins with identifying the factors that contribute to fall risk. A successful fall risk management program requires a thorough clinical assessment of residents and their environment, with input from all members of the interdisciplinary team. Each resident should be assessed for fall risk on admission and with an acute change in condition, as well as at least quarterly thereafter. When a fall occurs, the initial fall risk assessment should be repeated, along with a thorough investigation of the circumstances of the fall.
The care planning process requires development of resident-centered interventions for preventing falls and fall-related injuries, based on the findings of fall risk assessment and/or post-fall investigations. The use of any particular intervention should be based on the strength of the evidence provided by existing clinical trials or literature reviews. The effectiveness of fall risk management interventions should be evaluated periodically, and the care plan revised as necessary to reflect changes in the fall risk assessment.
Implementing a fall risk management system using evidence-based best practice can reduce the prevalence of falls in the nursing facility, while limiting the potential for fall-related injuries. The toolkit below includes evidence-based resources that will assist facility staff in developing effective systems for fall risk management.
Resources Created by DADS
- Evidence-based Best Practice for Nursing Fall Risk Management (PDF) summarizes the key elements of an effective fall risk management program.
- Best Practice System Summary/Technical Assistance Worksheet (PDF) identifies key elements of an effective fall risk management system, and can be used by facility staff to identify opportunities for improvement.
- Measuring Orthostatic Hypotension (PDF) provides instructions for measuring orthostatic vital signs and interpreting the findings.
- Fall Risk Management Care Plan Highlights (PDF) can assist facility staff in developing individualized care plans for fall risk management.
- Medications with Fall Risk Precautions (PDF) identifies medications that may contribute to an increased risk for falls.
Resources from Other Organizations
- American Geriatrics Society (AGS) Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults provides access to the 2015 revision to the Beers Criteria and related resources. Note: Access to these resources requires registration at the AGS website.
- American Geriatrics Society (AGS) and the British Geriatrics Society AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons 2010. This guideline is designed to assist health care providers in developing a system for fall risk management. Originally published in 2001, the recommendations in this update are based on an analysis of the most current evidence available.
- Falls Among Older Adults: An Overview includes fact sheets, graphs, podcasts and brochures about falls and fall prevention for older adults.
- Fall Prevention Center of Excellence provides information to consumers and professionals on topics relating to falls and fall prevention.
- Falls Toolkit provides information for designing a system for fall risk management, along with interventions for preventing falls in high-risk individuals. The toolkit also includes educational information for residents, their families and facility staff on managing fall risk and preventing injuries.
- Timed Up and Go Test (PDF) is an assessment of mobility, used to identify individuals at risk for falls. The assessor times the individual as he or she completes the test, with times of 12 seconds or more indicating a high risk for falls.
- Tinetti Assessment Tool (PDF) is used to evaluate gait and balance. A score is assigned based on the resident's ability to complete tasks as instructed, with scores below 19 indicating a high risk for falls.
- Berg Balance Scale is an evaluation of static balance and fall risk, with 14 separate tasks that are scored based on the resident's ability to complete the activity. A resident with a score 20 or below is considered to be at high risk for falls, and an eight point difference between any two assessments is considered a change in function.
- Orthostatic Hypotension discusses how a change in blood pressure when assuming an upright position can result in a fall. Information about this topic is available in for both professionals and consumers.
- Falls in the Elderly is an overview of fall risks and how to avoid them. Information about this topic is available for both professionals and consumers.
- AMDA – The Society for Post-Acute and Long-Term Care Medicine (formerly known as the American Medical Directors Association) is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PA/LTC) settings. The Falls and Fall Risk Clinical Practice Guideline is available for purchase.
- Prevention of Falls and Fall Injuries in Older Adults, Registered Nurses' Association of Ontario, will help increase knowledge, skills and abilities in identifying adults at risk of