Towards Towards Fall PreventionFall Prevention

You need to know that…You need to know that…

falling is falling is notnot a a normal part of normal part of aging.aging.

the risk of falling the risk of falling can be minimized.can be minimized.

falling may be an falling may be an early sign of illness.early sign of illness.

What causes falls?What causes falls?

Person FactorsPerson Factors Poor balancePoor balance Postural hypotensionPostural hypotension WeaknessWeakness Functional, cognitive, Functional, cognitive,

and sensory, and sensory, changeschanges

Medication effectsMedication effects PainPain

Environment FactorsEnvironment Factors Poor lightingPoor lighting Slippery or uneven Slippery or uneven

flooring or sidewalksflooring or sidewalks Unexpected objects Unexpected objects

(tubing, pets)(tubing, pets) RestraintsRestraints Lack of structural Lack of structural

supportssupports

Can you think of some other causes of falls?

Falls & Person-Environment FitFalls & Person-Environment Fit

We must always assess We must always assess both the individual person both the individual person and the environment.and the environment.

However, at any given However, at any given time or in any giventime or in any givensetting, our focus may be greater on setting, our focus may be greater on one than on the other.one than on the other.

In the acute care setting…In the acute care setting…Factors related to falls involve both the Factors related to falls involve both the

person and the environment. For example:person and the environment. For example: ImmobilityImmobility Medication effectsMedication effects Weakness and painWeakness and pain Tubing ( Tubing ( e.g.e.g., IVs, catheters, oxygen), IVs, catheters, oxygen) Lack of familiar supports (Lack of familiar supports (e.g.e.g., eyeglasses, , eyeglasses,

ambulation devices)ambulation devices) Unfamiliar setting, people, and routinesUnfamiliar setting, people, and routines

Person Person FactorsFactors

Environment Environment FactorsFactors

What other factors have you observed?What other factors have you observed?

In the home setting…In the home setting…

The focus of fall prevention tends to beThe focus of fall prevention tends to be

more on the environment. For example:more on the environment. For example: Lack of grab bars in bathroomsLack of grab bars in bathrooms LightingLighting Scatter rugsScatter rugs PetsPets Cluttered walkwaysCluttered walkways Stairs Stairs

Person Factors:Person Factors:• Medication effectsMedication effects• Decreased ability to Decreased ability to manage personal caremanage personal care• Functional, cognitive, and Functional, cognitive, and sensory changessensory changes

What other factors have you observed?What other factors have you observed?

Take a walk Take a walk through your through your living living environment.environment.

What environmental What environmental hazards could hazards could cause a fall?cause a fall?

Prevention: In the Prevention: In the HospitalHospital

Assess history of falls on admission.Assess history of falls on admission. Minimize restraint use.Minimize restraint use. Ensure use of glasses and hearing aids.Ensure use of glasses and hearing aids. Frequently assess elimination, pain, and Frequently assess elimination, pain, and

cognitive status, making individualized cognitive status, making individualized adaptations.adaptations.

Keep patient area clutter-free.Keep patient area clutter-free. Monitor effects of medications.Monitor effects of medications.

In the Hospital In the Hospital (continued)(continued)

Lock wheels on wheeled tables and other Lock wheels on wheeled tables and other devices that may be used as supports. devices that may be used as supports.

Use alert system to notify staff about individual Use alert system to notify staff about individual fall risk.fall risk.

Move patient closer to nursing station.Move patient closer to nursing station. Restore and maintain functional status.Restore and maintain functional status. Use assistive devices.Use assistive devices. Educate regarding safe transfers.Educate regarding safe transfers. Obtain referrals for OT, PT, Obtain referrals for OT, PT,

Home Health.Home Health.

Prevention: In the HomePrevention: In the Home

Secure or eliminate loose rugsSecure or eliminate loose rugs Remove clutterRemove clutter Assess for adequate lighting Assess for adequate lighting (inside (inside

and outside, especially on stairs)and outside, especially on stairs) Assess bathroom for grab barsAssess bathroom for grab bars Obtain referrals for OT and PTObtain referrals for OT and PT

(What can OT and PT do in the home (What can OT and PT do in the home

to prevent falls?)to prevent falls?)

Fall Prevention: Fall Prevention: Occupational Therapy (OT)Occupational Therapy (OT)

Evaluate need for:Evaluate need for: Assistive devices (especially those for Assistive devices (especially those for

bathing, toileting, eating and dressing)bathing, toileting, eating and dressing) Home modificationsHome modifications

Fall Prevention: Fall Prevention: Physical Therapy (PT)Physical Therapy (PT)

Transfer training Transfer training Balance training Balance training

StandingStanding Uneven surfacesUneven surfaces Curbs and stepsCurbs and steps

Gait trainingGait training Assistive device trainingAssistive device training

Canes, crutches, walkersCanes, crutches, walkers Strengthening exercisesStrengthening exercises

Fall Prevention: Fall Prevention: Additional Nursing InterventionsAdditional Nursing Interventions

Encourage to take classes in Tai ChiEncourage to take classes in Tai Chi Encourage the use of assistive devicesEncourage the use of assistive devices Monitor medications Monitor medications Monitor elimination and Monitor elimination and

pain issuespain issues Instruct to change positions Instruct to change positions

slowlyslowly Instruct regarding non-slip Instruct regarding non-slip

footwearfootwear

Fall Prevention: InterdisciplinaryFall Prevention: Interdisciplinary

Nursing has a Nursing has a KEYKEY role in role in facilitating referrals for facilitating referrals for evaluations in both the acute care evaluations in both the acute care and home settings. and home settings.

Primary in fall prevention are the Primary in fall prevention are the interdisciplinary team and interdisciplinary team and coordination between settings.coordination between settings.

Older adults benefit most from the collective Older adults benefit most from the collective expertise of all related disciplinesexpertise of all related disciplines..

Towards Fall Prevention was created Towards Fall Prevention was created by Catherine Van Son, Ph.D., R.N. by Catherine Van Son, Ph.D., R.N. for the Older Adult Focus Project, for the Older Adult Focus Project, OHSU School of Nursing.OHSU School of Nursing.