Continuing Education—March 2014
Falls Prevention
(Adapted from The Tribute, a monthly newsletter published by AHHC, and Helping You Prevent Falls at Home, published by Duke HomeCare and Hospice)
Among the many goals Duke Hospice strives for is a reduction in the rate of rehospitalization of our patients. Our interdisciplinary team works to prevent the causes (including pain, distressing symptoms, and falls) of many rehospitalizations. Toward this end each family receives educational material at the start of service to help identify, prevent, or resolve issues before they become dangerous: Your Toolkit for Controlling Pain and Helping You Prevent Falls at Home. Our clinical staff continues to offer education to patients and families during the course of caring for our patients. While pain and symptom screening should be part of every home visit, you may have to hand off the “fix” to a clinician. But fall preventions may be well within your scope of practice.
Why is a fall in older adults so serious? According to the NC Department of Public Health and Division of Health and Human Services, falls are the third leading cause of unintentional injury death for North Carolinians of all ages. From 1999 to 2000 falls were the leading cause of injury death for people 65 and older. From 2000-2011, the death rate from falls increased 65.9 percent in people 65 and older. Cost estimates from 2005 show that hospital-admitted unintentional falls cost North Carolinians more than $3.8 billion in the 65 and older age group.
Falls are not just the result of getting older. Many falls can be prevented. There may be things in in the home that can be changed to lower the chance that your patient will fall and get injured. An investment in safety pays big dividends.
Some HEALTH FACTORS that can increase the risk of falls:
• Illness
• Eyesight problems
• Hearing problems
• Ringing in the ears
• Numbness in the feet
• Muscle weakness
• Trouble getting up and down from a chair
• Feeling off balance when standing or walking
• Medications
Some ENVIRONMENTAL FACTORS that can increase the risk of falls:
• Slippery steps or floors
• Not enough lighting
• Floors or steps that are not level
• Being in a hurry
Some suggestions to help reduce ENVIRONMENTAL RISK FACTORS:
Floors, Furniture and Steps:
• Remove unsafe rugs or furniture
• Rugs should have rubber backs or double stick carpet tape that keep them from sliding
• Keep the home uncluttered (at least the areas where the patient walks)
• Watch out for pets that can get underfoot
• Clean up spills right away
• Put a non-skid mat in the tub or shower
• Avoid chairs that swivel or rock
• Use chairs with arms. They are easier to get out of.
• Have rails installed on both sides of the steps
• Fix broken or uneven floors or steps
• Paint outside steps with a mixture of sand and paint to make them less slippery
• Store things where the patient can reach them
Lighting:
• Make sure there is good lighting on all steps and stairs
• Use night lights especially in the bathroom and near steps
• Add yellow or white tape to the edge of steps to help the patient see them better
• Keep a flashlight handy in case of power loss
• Use motion detectors or bedside lights for areas the patient might use at night
What else can you do?
· Report all falls (even unwitnessed) to the Volunteer Services office (Carolyn or Laura). The patient may report a fall to you but be hesitant to tell the nurse or another team member.
· Report any changes in balance or gait that you observe.
· Report any symptom that could lead to falls (e.g., “I can’t see as well as I used to.”)
· Report any environmental problems that could cause falls.
· Please be mindful of potential safety risks when you are working with patients and families and let your team know if you have any concerns. Our goal is to prevent falls at home, wherever home may be.