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Falls and Fractures

Falls and Fractures in the Nursing Home

Quick Answer

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:

  • 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% of U.S. adults aged 65 and older reside in nursing homes, but deaths due to falls by nursing home residents make up 20% of deaths in the same age group.
  • About 35% 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% 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% of nursing home falls result in serious injuries.
  • About 2%-6% 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 a functional decline of the patient, disability and 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 indication 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% of falls in nursing facilities.
  • Environmental hazards, such as equipment in the hallways, cause 16%-27% 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 seem 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 bedsores 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

Nursing homes have a duty to keep senior residents safe. However, there can be many challenges in preventing falls in nursing homes.

To combat these issues, most nursing homes follow protocols to prevent seniors from falling and to quickly help those who do.

Nursing Home Falls Protocol

Nursing home protocols are specific rules, systems or guidelines the staff must follow to ensure the residents remain safe. These guidelines may vary with each nursing home, but the most effective facilities approach the issue of falling from multiple angles.

Protocols to prevent falls can include:

  • Watching seniors closely and walking with those who are at risk
  • Providing residents with walkers or wheelchairs
  • Reviewing the medications the resident uses, as some may increase the risk of dizziness and falling
  • Giving residents hip pads to prevent a hip fracture if the resident falls
  • Assessing patients after a fall to identify the causes and treat them, if possible

Nursing home staff members can take note of residents who have a hard time getting around and specifically help those residents.

Staff members should also keep track of how a resident’s walk changes over time. If it gets harder for the resident to walk, the staff should provide them with a walker or wheelchair.

In particular, the staff should keep a closer watch on residents with Alzheimer’s or dementia who use walkers or wheelchairs. These residents may forget that they cannot walk, and, therefore, should use a walker.

Outside of watching the residents, the staff can take broader steps to prevent falls by educating seniors about the risk of falls and how to avoid them. Adaptive equipment such as raised toilet seats, handrails and lowered beds can also be installed to make it easier for residents to get around.

In some cases, nursing home staff can organize senior exercise programs. These programs can help improve the residents’ strength, balance and walking abilities.

Nursing Home Abuse Support Team

The Nursing Home Abuse Center (NHAC) was founded to bring justice to those affected by nursing home and elder abuse. Our mission is to educate and empower victims of abuse and their families to take a stand against this unlawful mistreatment. We work to return dignity back to those who have been broken down by nursing home abuse and neglect.

View Sources
  1. Falls in Nursing Homes.  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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