Prevention of fall injuries in nursing homes: Effective strategies for increased safety

This article is written from a Swedish perspective. Hopefully, it can inspire those interested from other countries.

By working systematically and proactively with fall prevention, nursing homes can create a safer and more supportive environment for their residents. This work is crucial for improving the health and quality of life of the residents, as well as for reducing the burden on the healthcare staff and the health care system.

Foto: Mostphotos

Preventing Fall Injuries for Residents in Elderly Care


Every day, people die from fall injuries and even more suffer from fractures that lead to suffering and reduced quality of life. Many fall accidents are preceded by acute confusion states. These should always be investigated to prevent fall injuries.

Fall injuries are one of the most common and serious risks for elderly people in nursing homes. By implementing effective preventive measures, nursing homes can reduce the risk of falls and improve the quality of life for their residents.

Risk Assessment and Individualized Measures


Regular risk assessments: A thorough risk assessment of each resident should be performed regularly to identify individual risk factors for falls. This includes assessing physical, medical, and environmental factors.
Individualized measures: Based on the risk assessment, individualized measures should be implemented. This can include adapting the environment, using aids, and changing care routines.

Medication Management


To prevent falls, medication reviews are the single most important factor. Blood pressure medication is an example of a treatment that needs to be reviewed and the blood pressure checked regularly as incorrect medication can lead to dizziness and hypotension. Many use painkillers and sedatives which also increase the risk of falls.

Review of medication: Regular review of the residents' medication is important to identify drugs that may increase the risk of falls. Medications that cause dizziness, fatigue, or impaired balance should be avoided or adjusted if possible.
Training of staff: Educate the staff about the potential risks of certain medications and the importance of reporting side effects that can affect the residents' balance and mobility.

Physical Activity and Exercise


An important measure to prevent falls is to keep the resident physically active. Exercise in everyday life counteracts osteoporosis and slows down the breakdown of muscle mass. Daylight is important both physically and for mental well-being. We need daylight to feel good and for the formation of vitamin D which counteracts osteoporosis.

Regular exercise: Encourage residents to participate in regular exercise programs that focus on strength, balance, and mobility. Exercise can reduce the risk of falls by improving muscle strength and coordination.
Physiotherapy: Collaborate with physiotherapists to develop individual exercise programs for the residents. Physiotherapists can help identify specific needs and recommend exercises that are safe and effective.

Even up to the age of 90, it is possible to improve muscle function through active training. Studies show that muscle ability can be significantly improved with the help of active strength training. Balance training is a good measure to reduce the risk of falls.

Walking ability deteriorates quickly when the elderly move to care homes. Too often they end up sitting or lying in their room which is devastating. Muscle breakdown happens quickly. Many who previously could walk end up in a wheelchair. Some have diseases that mean they have to sit in a wheelchair, and then it is important with contracture prophylaxis (preventive movement training) to avoid malpositions in arms, legs, and hands. Here, the team has an important task to together find solutions to prevent care-related injuries.

Special individual training programs need to be developed as soon as possible in connection with the move-in as previously mentioned. Also, look at environmental factors that can lead to falls. Proper shoes, slip protection in the bathroom, remove rugs that pose a fall risk, poor lighting, being able to reach things without climbing, having the phone nearby, handrails, clearly marked stairs, handrail, slip socks at night and cleats outside in winter are examples of measures that can prevent falls. Hip protection pants may also be needed.

Adapted food, drink, and good sleep habits that work should not be forgotten. Already on the first day of moving into the accommodation, a first risk assessment needs to be made to avoid falls, pressure ulcers, and malnutrition.

Environmental Adjustments


Safe environment: Create a safe environment by eliminating fall risks such as loose rugs, uneven floors, and poor lighting. Ensure that all walkways are free from obstacles and that floor surfaces are slip-resistant.
Adapted furniture and equipment: Use furniture and equipment that are adapted for elderly people. This includes stable chairs and beds with adjustable height, as well as slip protection in bathrooms and showers.

Education


Training of staff: Provide the staff with regular training on fall prevention, including how to identify fall risks and implement safety measures.
Understanding among residents and relatives: Inform the residents and their relatives about the importance of fall prevention and how they themselves can contribute to reducing the risk of falls. This can include information about safe movement patterns, using aids, and the importance of following medical recommendations.

6. Follow-up and Evaluation


Continuous follow-up: Regularly follow up on the effects of implemented measures to ensure they are effective. Adjust strategies as needed based on feedback and new risk assessments.
Documentation and reporting: Document all fall incidents and analyze them to identify patterns and improve future preventive efforts. Encourage a culture of open reporting and learning from each incident.

Reflection Questions – Fall Injury Prevention Work:
Care Staff:
- Do you have a clear routine for when you should contact a nurse?
- Do you get good support when you contact a nurse?
- Do you always write a deviation when someone has fallen?
- Do the residents receive contracture prophylaxis?
- Are prescriptions from occupational therapists and physiotherapists carried out correctly?

Manager and Licensed Staff:
- Do you know which drugs lead to an increased fall risk for the elderly?
- Do you have a good routine for examining fall injuries?
- Is it also known by nurses on duty?

Relatives:
- Are you aware if a fall risk assessment has been done on your relative?

Erland Olsson
Specialist Nurse
Sofrosyne – better care every day

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