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When People Fall:
Prevention for
Those at Risk
by
Ingrid Sidorov, MSN, RN
Brian H. Kim, MD
and
Carol A. Maritz, PT, EdD, GCS
Geriatric Education Center of Greater Philadelphia
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Why Talk About
Falls?
Falls happen often

1 in 3 older adults fall each year; 1 in 2
in long term care fall each year

Falls are dangerous

25% of falls cause minor injury

11% of falls cause major injury
such as hip fracture

88% of falls are related to medical and or
physical conditions

Many (about 2/3) fall associated injuries
and deaths can be prevented

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Seriousness of Falls
After older adults fall
 40% become less active
 40- 70% report fear of falling
Almost 10% go to the ER for
treatment after falling
 Falls may be a warning sign of
new or worsening illness.
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Objectives
At the end of this program you will
be able to:
1. Identify risk factors and common
causes for falls.
2. Describe proper assessment after
a fall.
3. Discuss intervention and
prevention strategies.
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Who Falls?
 Older adults who are acutely ill.
 Older adults admitted to a new
setting.
 Those with functional loss.
 Elders with problems walking,
hearing, vision and memory.
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Where do Falls Happen?
» 10% in long term care
» 30% in public places
» 60% at home
Geriatric Education Center of Greater Philadelphia
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Age-Related Risk Factors
Consider age-related changes:
 Gait
 Posture
 Muscle
Strength
 Balance issues
 Response to medication
 Response to stress
 Reduced vision or hearing
 Urinary frequency/incontinence
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Fear of Falling
• About 30% of older adults have a fear of
falling.
• This includes people who have NOT fallen.
• Fear of falling affects how people react to
their environment and actually increases the
risk of falling.
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Should a Single Fall be of
Concern?
• ABSOLUTELY!
• Every fall has the potential for being
serious.
• Consider changes in health, risk factors.
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Health Problems As Risk
Factors
1. Heart disease and stroke
2. Diabetes
3. Osteoporosis
4. Gait disorders
5. Depression
6. Polypharmacy
7. Dementia
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Cognitive Loss As a Risk
Factor




Anxiety from not recognizing
environment
Lack of insight and judgment
about safety
Sundowning
Behavior issues
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Environmental Risk
Factors
 Lighting
 Flooring/Pavement
Stairs
 Furniture
 Equipment/Physical
Obstruction
 Improperly fitted clothing
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Assessment After a Fall:
What Should Staff Do?

Assess all skin and joints for
injuries

Check vital signs

Move to a safe location off floor

Notify nurse supervisor

Notify family member
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Strategies to Compensate for
Physical Impairment:
Impairment
Approach
Sensory loss
Eyeglasses and hearing
aids
Exercise – Physical
therapy consult
Restorative mobility
program
Assistive devices
Muscle weakness
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Strategies for Cognitive
Loss
 Biographical profiles
Communication/re-direction
 Structured daily routine
 A security system
Exercise
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Strategies for
Incontinence
 Medical evaluation
 A consistent toileting program
 Proper bathroom equipment
Constipation may be the cause
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Prevention and
Management Program
 Assess each person in your care
 Provide a safe and enabling
environment
Implement balance and fitness
programs designed by PT
 Educate families and staff about
falls and a restraint-free
environment
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SAFE ENVIRONMENT
•
•
•
•
•
•
Lighting
Handrails
Chair height
Equipment and items in reach
Shoes that fit
Carpeting
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THE BATHROOM
•
•
•
•
Grab bars by shower and toilet
Rubber mats in bathtub/shower
Raised toilet seat
Drawers kept closed
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Prevention and Management:
Fitness & Activity Programs



Individual programs: Exercise, selfcare, walking
Group programs: Exercise, yoga,
walkercise, games/sports,
dance/movement, tai chi
Other activity: Art, cooking,
gardening, “mental gymnastics”
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Prevention and Management:
Fitness & Activity Programs
• Exercise programs
– Incorporate both balance and strength training
– Balance training should include both static and
dynamic activities performed at moderate to
high challenge
– Ideal program duration – 3-12 months
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Education Program
Staff education for each
caregiver role
 Safety education and
fall/injury prevention for all:
Staff, older adults, and
family
 Relaxation techniques

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Education Program

Education of the person at risk
for falls

Nurses are responsible for
education programs of older adults.
CNAs should remind older adults of
safe techniques as they complete
assigned tasks.
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Objectives Review
Can you now
1. Identify risks factors and
common causes for falls?
2. Describe proper
assessment after a fall?
3. Discuss intervention and
prevention strategies?
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Thank you for your
attention!
The End
Geriatric Education Center of Greater Philadelphia