Falls happen to older adults. That's a fact but Physical Therapist and fall prevention expert, Shelly Denes explains her perspective on what we can do as caregivers and healthcare professionals to mitigate the risk of falls and injuries.
According to Shelly Denes, a comprehensive evaluation of all intrinsic and extrinsic fall risk factors is vital in the prevention of falls and injuries as well as involving all persons and teams participating in that person's care.
"Look, we're not going to prevent every fall. We want to try to minimize the risk going forward and the risk of another fall. We need every clinician, every family member, every caregiver to be involved but we also want to make sure we're using the right tools to assess balance and risk of falls."1
This is certainly a view that other subject matter experts in the field of fall prevention share.
"Whatever role you have; if you're a nursing assistant, or an LPN, or nurses, or therapists, all that are taking care of residents, you should know what those individual risk factors are, not just that they're a high fall risk." - Dr Patricia Quiqley2
So, what are those facets to include in your fall risk analysis? Let's talk about some of them and outline resources available to us to help prevent falls in the older adult long-term care population.
STEADI3 (Stopping Elderly Accidents, Deaths & Injuries) is a CDC resource bank all around preventing falls and fall-related injuries for the elderly population. Whatever your role in preventing falls is, there will be something here for you. If you're a health care provider, you may already be familiar with these resources, but if you haven't come across them yet, then do take a look.
"In the United States, one of the big initiatives for falls reduction is STEADI which is part of the CDC. It's very user-friendly for patients, for staff, for caregivers so I encourage you to go there if you haven't been there before."1
From a clinical point of view, STEADI promotes a Screen, Assess and Intervene approach to fall prevention. If you're struggling with falls in your facility, that's a great place to start.
Eye health, vision and eyewear are all vital components in the reduction of falls. In terms of older adults' eye health, Shelly Denes advises, "Almost all healthcare associations recommend an annual eye exam for anyone over the age of 50."1
So, adults need to be getting their vision checked regularly and their eyewear prescription changed promptly where appropriate. Multifocal lenses may blur or distort vision, especially when looking down. So descending stairs or steps or watching your path for obstacles can be especially worrisome.
When your residents get new glasses, it's a good idea to walk with them down the hall, outside and up and down stairs to help them get used to how the eye and brain now interpret the space and their position in it.
One thing that can make an instantaneous and significant difference to fall risk is the state of their eyewear.
"Are the glasses clean? How often in long-term care facilities or rehab clinicians who do home care, they go see a patient and the glasses are filthy? Because they haven't noticed, cleaning the glasses might be the best intervention you ever did."1
One of the fall risk factors that we can work to modify is balance. If a resident has an issue with balance, then they are extremely likely to have an issue with falls. One thing we can do to address this is to work on strengthening the Vestibulo-Ocular Reflex (VOR).
The VOR is responsible for three things related to balance:
Shelly Denes explains a way to test the coordination of the VOR for residents in the recent webinar she presented in partnership with Accora. If stabilizing balance and vision, is of particular interest to you, we recommend you watch the full session on-demand.
Shelly Denes explains that "Proprioception is our ability to know where we are in space. So, if I'm sitting or standing and I close my eyes I should know where I am, I know where my feet are, and I can feel them."1
Proprioception affects three distinct posture elements, all of which can either mitigate or exacerbate the risk of falling depending on the strength of these senses. Proprioception impacts:
In addition, posture impacts proprioception.
Physical Therapist Shelly Denes advises, "If our clients are standing with their head forward so they have non-erect posture, that's going to impact on their proprioception because they're going to be leaning forward. This means the joint receptors have to accommodate for that. Their posture is going to affect proprioception."1
Because proprioception is really just a picture of how the brain maps the body a confused map will affect fall risk. If your brain doesn't have a true understanding of where you are in space it cannot help you navigate around obstacles efficiently.
To restore and improve proprioception we want to focus on the following objectives:
The main thing a person can do to improve their proprioception is to move. Movement through space is what builds the body map. In contrast, inactivity is the enemy of a reliable and accurate body map. Touch is another vital tool for restoring proprioception.
Tapping or touching the joints, the toes, the head, arms, etc. will create sensation and this will alert the brain to where the body is in space. Residents may be able to do this themselves if educated to do so but the important thing is to encourage safe and regular movement and sensation.
Multi-sensory activities are a great way to improve proprioception and re-educate the muscle sensors and brain. Anything that engages multiple senses such as touch, sound, and sight at once will strengthen the body's ability to accurately map the body.
The benefits of engaging in physical activity for older adults are widely known by healthcare professionals. Some aspects that can be improved upon by engaging in exercise are:
Physical Therapist Shelly Denes says that the magic combination of fall-risk-reducing activities should involve these three things: balance, strength and endurance1. If balance exercises are sufficiently challenging, the second two will automatically take care of themselves.
While we know the various benefits of exercise for older adults, it can be difficult to explain the value to residents and strength, aerobic or other exercise programs can be met with resistance. Shelly recommends using phrases like "Motion is lotion" when discussing the rationale for these challenging activities. To get better and feel better they need to be engaging in motion/movement and in turn this will eventually reduce the risk of falling.
According to the Centers for Disease Control and Prevention (CDC), falls are serious and costly. Here's why.
In addition to this, one fall increases the risk of further falls, often known as the cycle of falls.
The Centers for Disease Control and Prevention advises that "many people who fall, even if they're not injured, become afraid of falling. This fear may cause a person to cut down on their everyday activities. When a person is less active, they become weaker, and this increases their chances of falling."2
So, we see that one fall can lead to another and the fear of falling is likely to exacerbate the risk, becoming in effect a self-fulfilling prophecy. We also know that a notable fall-related injury like a hip fracture can significantly reduce life expectancy in older adults.
"There is a vicious cycle of falls: They have a fall then they have fear of falling, then they become inactive because they're scared, they get weak and they have more falls. Somewhere we need to change this cycle."1
Reducing fall risk in older adults is essential not only for preserving health and independence but also for enhancing their overall quality of life. The statistics highlight the severity of the issue: with millions of emergency department visits and hospitalizations each year due to falls, it is clear that intervention is imperative.
To combat these alarming trends, it is necessary to adopt proactive strategies aimed at fall prevention. This can include the use of assistive devices, medication reviews, and engaging in regular physical activity designed to enhance strength and balance. Additionally, education and support for both older adults and their caregivers can help break the cycle of fear associated with falling, further mitigating the future risk of falls.
By focusing on preventative measures and fostering an acceptance of innovative practices for health care providers, we can mitigate fall risks and improve overall health outcomes. Empowerment through knowledge and innovation is key to ensuring that older adults in our care continue to live full, active lives, free from the fear of falling.
Interested in best-practice fall interventions for long-term care settings? Then, we think you'll like this article - 7 ways to mitigate fall risk in senior care communities. Or, for more detail on the issues discussed in this article, you can watch the full, live training session on-demand, right now.
1 - https://us.accora.care/webinars/reducing-fall-risk-in-older-adults-beyond-just-gait-and-balance
2 - https://us.accora.care/blog/fall-prevention-for-nurses-and-caregivers-lets-get-clinical
3 - https://www.cdc.gov/steadi/index.html
4 - https://www.cdc.gov/falls/data-research/facts-stats/index.html
