Fall. The word sends shivers down the spine of any caregiver but especially in memory care facilities. Yet, due to the advancement and innovation of healthcare that is sustaining patients for longer and the subsequent advanced diseases increasing the acuity and fall risk ofolder adults, it can feel like falls are an unfortunate inevitability. Thankfully, they don’t have to be.
According to the CDC, more than one out of every four older adults will fall each year equating to millions of falls nationwide1. Out of those falls, 1 in 10 results in a serious injury1. Unfortunately, those suffering from cognitive decline fall eight times more often than their peers2 beginning as early as the four years leading up to their diagnosis3.
The number of falls that occur within facility settings is staggering. This equates to increased patient health risk and escalating organizational costs. While establishments work to create strategies to mitigate the risk of falls, there’s still a long way to go to ensure total patient safety.
The risks and causes associated with patient falls are multifactorial. Therefore, it is imperative that memory care organizations address the issues of falls from a multifaceted perspective. Physical limitations, cognitive impairment, behaviors and environmental factors all contribute to the fall risk.
Dementias and related disorders increasingly lead to falls due to primary symptoms and comorbidities related to the disease. There is known to be a strong correlation between Orthostatic Hypotension (OH), which causes symptoms of dizziness and fatigue upon standing, and some dementia-causing diseases4. Combined with the symptoms of OH, the gait disorders and disturbances that commonly occur with cognitive decline compound the already high and serious fall risk.
In many patients with cognitive decline, a circle of disorientation, orthostatic hypotension and gait disorders escalates patient fall risk and drives the need for innovative fall mitigation strategies5. Additional considerations must also be made for other comorbidities, risk factors and medication side effects.
Cognitive factors, such as confusion, memory loss, impaired judgment, poor decision-making and a lack of physical awareness, are evident causes of falls in memory care. Patients cannot understand and remember their limitations, believing they can safely act independently. Many will resist assistance or care due to this lack of awareness and, even with regular reminders, will attempt to ambulate independently. If intervention is delayed, the patient may become fatigued, lost or disoriented, leading to a fall. It’s a difficult situation for caregivers in memory care as well as other types of care facilities.
People suffering from dementia experience extensive brain changes, and thus, their personalities and behaviors change. Often unpredictable, dementia-related behaviors can range from various levels of demeanor shifts to motor behaviors, such as fidgeting. Some patients display disinhibition or agitation, while others experience hallucinations, delusions, or euphoria6. The symptoms are often inconsistent and occur in conjunction with one another, leaving caregivers to manage multiple behaviors simultaneously.
While most memory care institutions are designed with patients in mind, environmental factors must still be considered. Functional lighting, even surfaces, a lack of clutter, open halls and doorways and access to adaptive equipment such as grab bars and specially designed furniture should all play a part in a facility's fall prevention program. One poorly designed space could mean serious injury to a patient, so every area must be considered. For more details on creating and optimizing healthcare environments for reduced falls risk, our whitepaper Falls Prevention by Design gives a comprehensive view of best practices.
Understanding the risk factors associated with increased falls paired with appropriate planning and interventions is the key to mitigating fall risk in memory care. The CDC recommends the STEADI (Stopping Elderly Accidents, Deaths, & Injuries) program7. The STEADI program utilizes a three-step approach to screen for fall risk, assess modifiable risk factors, and intervene using effective clinical and community strategies7.
The STEADI program begins with a thorough screening of fall risk factors. Patients should be screened upon admission, yearly or any time they have experienced a fall. Most organizations will have additional fall assessment requirements, such as when a patient's condition has changed. Always maintain close adherence to these fall screening policies.
The screening tool used in the STEADI program rates a patient’s risk level based on factors such as a history of falls, gait disturbances, cognitive impairment, incontinence, medication side effects, orthostatic hypotension and more8. Whether your facility chooses to use STEADI’s assessment tool or another version, screening each resident at regular intervals is key to understanding the risk level present within the facility.
Keep in mind that screened patients who fall under the “not at risk” category should still be educated on fall prevention and monitored closely for changes that lead to risk.
Thoroughly assess each at-risk patient for modifiable risk factors and fall history. Be mindful of risk factors that can be modified immediately, such as removing loose throw rugs, and those that must be taken to the medical team for review, such as gait disturbance and medication side effects. Address each element individually, keeping the patient’s overall care needs in mind, and clearly communicate changes and needs to the patient and care team.
The final step in fall risk mitigation is intervention. Interventions must always be customized to the patient’s specific needs. Some patients may benefit from adjustments in their medications, while others require a detailed toileting schedule to eliminate incontinence-related behaviors. Whatever the interventions, make them specific, document expectations carefully in the patient care plan and track results.
Many patients benefit from the use of adaptive equipment, specifically items designed for older adults. Handrails throughout the building facilitate safe movement, while adaptive furniture allows caregivers to safely position patients who may struggle to stay situated in standard pieces.
Accora’s Configura Advance chair is one such example. The reclining chair is designed with patient comfort in mind and features the ability to recline in several positions. This keeps the patient safe and secure while making it less likely they will attempt independent repositioning. The chair easily rolls from place to place, eliminating the need for the patient to ambulate as frequently.
An independent study found that patients who sleep in floor beds are less likely to fall and have a decreased incidence of injury when they exit the bed9. Using an Accora Empresa FloorBed can lead to a 77% decrease in falls from the bed and a 100% decrease in the incidence of injury when exiting the bed. With the ability to raise for care and lower to the floor when finished, the bed positions the patient so that a “fall” from the bed simply means rolling to the floor from the mattress.
Falls are an ongoing concern in all care establishments, but especially in memory care facilities that care for patients with dementia and other cognitive impairments. Despite the multifactorial nature of the risks associated with falls, the implementation of proper screening, assessment and interventions can nearly eliminate falls and associated injuries.
