One of the biggest concerns for caregivers, especially those working with older clients are falls. Unfortunately, falls are far from uncommon. The statistics are concerning: every year, over a quarter of the older population falls at least once.
It’s estimated that there are around 30 million falls a year, which result in around 7 million injuries. Out of those, around 800,000 are serious enough to require hospitalization. The number of annual fall-related deaths is in the tens of thousands.
Women are especially at risk of getting seriously injured by a fall because hormone fluctuations that happen around menopause can lead to osteoporosis – a weakening of the bones which makes a person more susceptible to fractures. However, falls can be dangerous for anyone.
As a caregiver, it’s important to know that falls do not have to be a regular part of the aging process. In many cases, they are entirely preventable. So, what are some steps that you, as a caregiver or a long-term care facility owner, can take to minimize your clients’ risk of falling?
Step 1: Assess the Risks
Assessing the risks for your clients is the first necessary step – especially when taking on new clients. A risk assessment needs to be done for every client individually. In general, all clients can be divided into three categories – low, high, or medium risk for falls.
Let’s look at some of the factors to take into consideration when doing your assessment.
General Mobility and Balance
The main and most obvious factor that you can start with is a person’s general mobility. Do they use a walker? Are they able to walk on their own? Assess their overall balance and take into account anything that might impact it – such as medication that might cause dizziness.
Urinary Tract Infections
One of the leading causes of falls in elderly people are urinary tract infections (UTIs). A UTI can cause a sudden drop in blood pressure or contribute to the risk by adding to a sense of confusion in patients suffering from dementia.
Vision Problems
Another possible cause for falls is deterioration of vision. Vision loss and glaucoma can both elevate the risk. If the client wears glasses, make sure they wear them regularly and that they are always clean.
Acute Incidents
Sometimes, a sudden, acute issue may lead to a fall. These incidents can sometimes be quite serious. Most commonly, they involve either a sudden injury – such as a spontaneous hip fracture, or a serious cardio-vascular incident, such as a stroke or a myocardial infarction.
Brain Degeneration
Old age is sometimes accompanied by degenerative changes in the brain, such as dementia. These changes can often affect the centers in the brain that control balance and coordination. If this happens, the risk of falls increases.
Urge Incontinence
Urge incontinence is a type of incontinence that most commonly affects older people. It’s characterized by a sudden and uncontrollable urge to urinate. This can happen any time of day or night, and usually occurs several times a day. It can cause a sense of panic. The person is focused only on getting to the restroom in time, so that they don’t have an accident and embarrass themselves. This haste often results in a fall.
Environmental Risks
Apart from medical issues, the environment can sometimes pose the biggest danger. That is why it's so important to look carefully at the conditions around where the client lives, especially if they have already experienced a fall.
The obvious place to start is the floor:
Is it even?
Is there any danger of tripping or slipping?
Are the floors slick, or is there a carpet on the floors?
Are there any cords for electronics or devices lying on the floor in a place where the client would walk?
Are there any raised carpet edges that could cause a person to trip?
Another thing that is important to consider is the lighting.
Make sure that the space is appropriately lit. This doesn’t always mean maximum brightness – it should be bright enough to navigate safely, but not so bright that it causes glare. This is especially important for clients who already suffer from eyesight issues.
A bathroom is a place where many falls occur. Check it to make sure that the bottom of the tub or shower has non-slip surfacing.
If a client has already had a fall (or several of them), make sure that all of the staff is up to speed with their particular needs and condition and that there isn’t a communication issue between the caregivers and the client.
Sometimes unclear instructions or the client’s inability to understand them fully (for instance due to a language barrier) can lead to accidents.
Other Factors
Sometimes, other factors that are a little less obvious can contribute to the fall risk. Those factors can be cultural – for instance, clients from cultures where it’s unacceptable to appear weak might refuse help from staff, or refuse to use a walker or a cane.
The mental state of the client can also play a role – people are more prone to falls when they are upset or overly excited.
Visits can also be a contributing factor, especially if the visitors are unaware of the client’s limitations or the need for assistance.
Step 2: Form a Fall Committee
Individuals providing care in a home setting by themselves will probably go through this process alone, but if you work at an adult family home or an assisted living community, a fall committee is the right way to handle this issue.
A fall committee is a group of people who meet at regular intervals – usually once a month – to review the fall situation at the facility, assess the risks, and find solutions to prevent these kinds of accidents.
The members of the committee don’t need special training – all they need is a keen eye and logical thinking. They should analyze all fall incidents and establish possible root causes, trends and patterns, as well as find a way to prevent the same thing from happening again.
Step 3: Create a Plan
Now that you have a clear picture of risks for all of your clients, it’s time to make a plan that will help you keep them safe and prevent falls. Consider all of the risks you have uncovered and create a plan for every individual client.
This plan should be revised regularly, taking into consideration any changes in the environment, the circumstances, or the state of the client's health. All caregivers that work with a client should be familiar with the fall prevention plan for that particular client.
Step 4: If a Fall Happens
With a carefully thought out plan, falls are preventable in most cases. However, if a fall does happen it’s important that you know what to do in advance.
If you are present when a client starts to fall, do not try to grab them to try and stop the fall. That can cause injury to you or the client with quick forceful movement.
Instead, go to them and try to position your body to help lower them to the ground as safely as possible to reduce the impact. Then follow the protocol that your employer has in place for assessing and reporting the fall.
The policy about what to do in these situations will often vary, depending on the setting you work in. A private home, an assisted living community, and an adult family home may have different policies, so make sure you understand the policy for your particular work environment.
Depending on the setting, you will need to notify different people of the incident. That could be family members, your supervisor, the RN, the doctor, or other people.
With proper care and planning, your clients may not ever have to experience a fall as they age. Preventing falls is a crucial component of care that will greatly improve your clients’ quality of life.
The first step toward a safer environment for your clients is well-trained caregivers. One of Cornerstone's DSHS-approved Continuing Education courses is about Falls and Fall prevention. Click on the image below to learn more.
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