Fall Prevention and Injury Protection for Nursing Home Residents
Journal of the American Medical Directors Association
Recognizing that risk factors for falls are multifactorial and interacting, providers require guidance on the components, intensity, dose, and duration for an effective fall and fall injury prevention program. Administrators of health care facilities require guidance on resources needed for these programs. Clear guidance does not exist for specifying the right combination of interventions to adequately protect specific at-risk populations, such as nursing home residents with dementia or
... dementia or osteoporosis. Staff education about fall prevention and resident fall risk assessment and reassessments has become part of standards of practice; however, the selection, specificity, and combination of fall prevention and injury protection interventions are not standardized. To address these gaps, this team of researchers conducted a critical examination of selected intervention studies relevant to nursing home populations. The objectives of this literature review were to (1) examine the selection and specificity of fall prevention and injury protection interventions described in the literature since 1990; (2) evaluate the strength of evidence for interventions that both prevent falls and protect residents from fall-related injury; and, (3) provide clinical and policy guidance to integrate specific interventions into practice. (J Am Med Dir Assoc 2010; 11: 284-293) Falls and fall-related injuries among nursing home residents are serious concerns for health care providers, administrators, nursing home residents, and families. Falls among nursing home residents occur frequently and repeatedly. Among published studies of falls in nursing homes, the mean number of falls per bed per year was about 1.5 with a range of 0.2 to 3.6. 1 Prevention is most effective when based on a thorough understanding of fall and injury risk factors at individual, staff, and organizational levels. A vast literature exists about fall risk factors, and there are a number of intervention studies for fall prevention in the institutional setting, 2 although little is known about the risk for and prevention of fall-related injuries, such as hip fractures and head traumas. Research findings have shown that factors contributing to falls are multifactorial, complex, and interrelated, and can be fixed or transient. Fixed intrinsic factors (eg, visual changes, comorbidities, muscle weakness, and impaired balance) by definition do not change rapidly over time and are therefore poor indicators for change in risk status. Transient factors that change over time (eg, elevated temperature, dehydration, room change, or a medication change) may be more sensitive to changes in fall risk for nursing home residents and indicators for the need for additional interventions. 3 Recognizing the multifactorial and complex interaction of fall risk factors, the dose, intensity, duration, and components of an effective fall and fall injury prevention program are not clear. Although a considerable body of knowledge exists on fall prevention, little firm evidence demonstrates the cost benefit or return on investment of fall prevention and injury protection programs in nursing homes. Clear guidance does not exist for specifying the right combination of interventions to adequately protect specific at-risk populations, such as nursing home residents with dementia or osteoporosis. Staff education about fall prevention and resident fall risk assessment and reassessments is a standard of practice; however, the selection, specificity, and combination of fall prevention and injury protection interventions are not standardized.