What are the causes of falls in nursing homes?

From the Guidelines

Falls in nursing homes are primarily caused by a combination of physical limitations, environmental hazards, medication effects, and underlying health conditions, which can be addressed through comprehensive assessment and targeted interventions. According to the guidelines for the prevention of falls in people over 65, published in the BMJ in 2000 1, individual assessment of subjects at high risk followed by recommendations to their primary care physicians or nursing home staff, including changes to drugs and the environment, can lead to a reduction in admissions to hospital and rates of falls. Some key factors that contribute to falls in nursing homes include:

• Physical limitations such as muscle weakness, balance problems, gait disturbances, and reduced mobility associated with aging and chronic conditions
• Environmental hazards like poor lighting, slippery floors, uneven surfaces, cluttered walkways, and inadequate handrails
• Medication effects, particularly sedatives, antipsychotics, antihypertensives, and diuretics, which can cause dizziness, orthostatic hypotension, or altered mental status
• Underlying health conditions like dementia, Parkinson's disease, stroke, arthritis, and vision impairments
• Staffing issues, including inadequate supervision during transfers or ambulation The use of external hip protectors has also been found to be beneficial in the prevention of hip fractures in residents of nursing homes, although compliance can be a problem 1. Prevention of falls in nursing homes requires a multifaceted approach that includes comprehensive assessment of each resident's risk factors, medication reviews, environmental modifications, strength and balance training, appropriate assistive devices, and adequate staffing to ensure proper supervision and timely response to residents' needs.

From the Research

Reasons for Falls in Nursing Homes

• Falls in nursing homes are a significant concern, affecting residents' health and quality of life 2
• Various factors contribute to the risk of falls, including:
  • History of falls 3, 4
  • Impaired mobility, balance, and gait problems 5, 3, 4
  • Medications, such as antidepressants, benzodiazepines, antipsychotics, and anxiolytics 3
  • Medical conditions, such as dementia, insomnia, and depression 3, 6
  • Sensory and environmental factors, such as poor lighting and lack of handrails 5, 3
  • Fear of falling 5

Risk Factors for Falls

• The incidence of falls in nursing homes is high, with a pooled incidence of 43% 3
• Risk factors for falls can be categorized into:
  • Intrinsic factors, such as age, gender, and medical conditions 3, 4
  • Extrinsic factors, such as environmental hazards and medication use 5, 3
• The use of walking aids, such as canes and walkers, is also a strong predictor of falls 4

Prevention Strategies

• Fall prevention strategies in nursing homes should include:
  • Regular fall risk assessments 2, 6
  • Tailored interventions, such as exercise programs and environmental modifications 2, 3
  • Staff education and organizational initiatives 2
  • Use of technology, such as electronic health records and wearable devices, to monitor and prevent falls 2