Falls and Fractures

Falls and Fractures in the Nursing Home

There are frequent falls among the elderly who reside in nursing homes. About 1,800 elderly people living in nursing facilities die each year from injuries related to falls. Those who survive their injuries often have a reduced quality of life and suffer from some form of permanent disability.

Statistics On Falls and Fractures In Nursing Homes

Here are some important statistics on falls in nursing facilities (1):

  • There are more than 1.4 million Americans aged 65 years and older who reside in nursing homes. This number will reach 3 million people by the year 2030.
  • About 5 percent of U.S. adults aged 65 and older reside in nursing homes, but deaths due to falls by nursing home residents make up 20 percent of deaths in the same age group.
  • About 35 percent of injuries due to falls occur in residents who do not ambulate.
  • The average rate of falls is 2.6 falls per person in any given year.
  • Between 50 and 75 percent of nursing facility residents fall each year. This is twice the chances of falling if the senior lives in the community.
  • In a typical year, a nursing home with 100 residents reports about 100-200 falls.
  • About 10-20 percent of nursing home falls result in serious injuries.
  • About 2-6 percent result in some type of fracture.
  • About 1,800 individuals living in nursing facilities die from falls in any given year.

Falls can result in functional decline of the patient, disability and a reduced quality of life. The fear of falling can cause depression, social isolation, feelings of helplessness and further decreases in function.

Why are Falls More Common in Nursing Homes?

Falling is often an indicate of other types of health conditions. Those living in nursing homes are usually frailer than senior adults living in a community setting. Nursing home residents are older, have an increased difficulty in walking and suffer from more chronic conditions when compared to community-associated seniors.

Nursing home residents also have an increased rate of memory and thought problems, issues conducting daily activities and need assistance taking care of themselves and getting around. These are the main considerations linked to rates of falls in the nursing home.

Common Causes of Falls in the Nursing Home

Common causes of falls in the nursing home include the following:

  • Muscle weakness and gait problems are the most common causes of falls among elderly nursing home residents. They account for about 24 percent of falls in nursing facilities.
  • Environmental hazards, such as equipment in the hallways, cause 16-27 percent of falls among nursing home residents.
  • Hazards that cause falls include poor lighting, wet floors, poorly fitted wheelchairs, poorly maintained wheelchairs and beds that are set too high.
  • Medications including anti-anxiety drugs and sedatives can increase the risk of falls and fall-related injuries, particularly those that affect the central nervous system. The risk of falls is greatly elevated within 3 days of taking any of these types of medications.
  • Other types of falls are related to difficulty in getting from one place to another, such as walking from the chair to the bed, poorly fitted shoes, poor care of the feet and the improper use of walking aids like walkers and canes.

Can Physical Restraints Prevent Falls?

The routine use of restraints in the nursing home does not decrease the risk of falls or of injuries related to falls. They should not be made use of as a strategy to prevent falls. In some cases, restraints can actually increase the risk of injuries related to falls and deaths from falls.

If the patient is given freedom to ambulate as well as they can, this increases muscle strength and physical functioning. The average use of physical restraints in nursing homes has declined from greater than 40 percent in the 1980s to less than 10 percent. Some nursing facilities have indicated an increase in falls since restraint regulations have taken effect, but there has been an overall decrease in injuries related to falls.

Injuries from bedrails seems to be related to outdated designs or incorrectly assembling the bed. Overall, bedrails do not appear to decrease the risk of falls or injuries from falls.

Spontaneous Fractures in Nursing Home Patients

In one study, it was found that the average age of patients with these types of fractures was 84 years of age. Of those who sustained fractures, 22 patients were confined to their bed, 21 patients needed long term tube feeding, 19 had a history of a stroke and 18 had a fracture of a long bone on the side of a previous stroke. 15 of the residents had dementia and 18 of the residents suffered from contractures.

Many of the fractures were hip fractures that created deformities in the hip on the affected side. These patients were often treated using hinged braces. In the study, five patients had fractures that were complicated by bed sores in the sacrum or heel area. In 28 residents, the fractures were healed without complications. Some of the bedridden patients were later able to sit after the fractures they sustained had healed.

Preventing Falls in Nursing Homes

There can be many challenges in preventing falls in nursing homes. Interventions related to fall prevention can begin at the patient, staff and organizational levels. The most effective interventions address the myriad of factors related to falls and involve the use of a multidisciplinary team.

Interventions to prevent falls include:

  • Teaching residents who have no cognitive impairment certain behavioral strategies that can help them avoid hazardous situations in the nursing facility
  • Exercise activities can be done to improve, strength, balance, walking ability and physical functioning
  • Giving residents hip pads to prevent a hip fracture if the resident falls
  • Changing the environment of the nursing home to make it easier for residents to get around safely.  This can include having raised toilet seats, grab bars, decreased bed heights and handrails in the hallways.
  • Reviewing the residents’ medications to see if they have potential risks for falling and attempting to minimize their use
  • Educating staff members about falls, risk factors for falls and prevention of falls
  • Assessing patients following a fall in order to identify risk factors and treat the underlying health conditions contributing to falls

 References:

  1. Falls in Nursing Homes. http://www.cdc.gov/homeandrecreationalsafety/falls/nursing.html.  Accessed 3/18/16.
  2. Wong TC, et al. “Spontaneous fractures in nursing home residents”.  Hong Kong Med J. 2007. Dec; 13(6): 427-9.
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Dr. Christine Traxler

Christine Traxler, MD is a retired family practice physician, graduate of the University of Minnesota School of Medicine in 1986, and freelance writer, having worked with patients in rural Minnesota for two decades. She has written several books on medical topics and currently resides in Minneapolis, MN, where she works as a freelance writer on medical topics.

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