How Can Nurses Prevent Falls in the Elderly Patient Population?

• Falls are the leading causes of injury and mortality among older adults in the United States. 
• Fall prevention nursing interventions must be utilized in settings like home health, hospitals, and skilled nursing. 
• Author and expert, Katy Luggar-Schmit, shares her insight on nursing considerations surrounding fall prevention. 

Importance of Fall Prevention

Falls are the leading causes of injury and mortality among older adults in the United States.  

As a nurse, whether caring for patients in their home, in a hospital or long-term care facility, it is important to be aware of the increased likelihood of falling in the aging population, so proper interventions can be implemented to prevent as many falls as possible.  

Much of my nursing career has been spent taking care of the elderly. I have learned the most common medical conditions that make patients more prone to falling and the best interventions to use.

Why Do Elderly Patients Fall?

As patients age, they may experience stiffened joints, decreased muscle strength, and impaired judgment.  

This increases the likelihood of falls. The strongest risk factors are previous falls, weakness, balance impairments, and certain medications.  

Medications that are used for sleep or have a side effect of drowsiness also increase the likelihood of falls.  

Along with these risk factors there are also several medical conditions that can increase the likelihood of falling: 

Diabetes

If the patient has a diagnosis of diabetes, it is important to closely monitor blood sugar levels. Especially if blood sugar levels fall too low, the patient is at an increased risk of falling. Low blood sugar causes weakness, fatigue, and a patient can faint.  

If the patient’s blood sugar is low, make sure they are given a snack and stay seated until their blood sugar is rechecked after they eat.  

Parkinson’s

Parkinson’s disease is a disease of the nervous system. Patients with Parkinson’s have involuntary movements such as tremors which can cause them to be unsteady and more prone to falls. There are medications to help minimize the symptoms of Parkinson’s, but it is still important to observe for unsteady gait in these patient’s and aid as needed. 

Alzheimer’s & Dementia

If the patient has memory loss they can frequently forget where they are or what they are doing which can make them more prone to falls. Patients with memory loss often wander and get up frequently. It is important to re-orientate them to their environment as much as possible and to complete frequent checks on them. 

Bowel and Bladder Conditions

If a patient struggles with bowel and bladder problems, they may need to use the restroom more often than other patients. Aging patient’s often struggle with incontinence as well due to the decreased ability to hold their urine.  

The urgency that is sometimes caused by having to use the bathroom can increase the likelihood of falling as the patient is in a hurry.  

If appropriate, the patient may need to have a bedside urinal, so they do not have as far to walk to use the bathroom. It may also be necessary for the patient to wear briefs. Always make sure the patient has their call light so they can call for assistance when needed. 

Vision Issues Such as Glaucoma and Cataracts

Cataracts cause clouding of the lens of the eye which makes it difficult to see clearly. Glaucoma occurs when the nerve connecting the eye to the brain is damaged. Glaucoma causes blurred vision, eye pain, and halos around lights.  

Both of these vision issues can significantly reduce the ability to see and make the patient more prone to falls. Ensure the patient with these conditions are being treated and taking any prescribed eye medication as ordered to help manage vision problems. 

What Actions Can Be Taken Towards Fall Prevention

Fall prevention starts with a complete understanding of the patient’s health history and risk factors. Anticipating possible risks factors and making adjustments to the patient’s room are the first step. 

Fall prevention actions include: 

• Ask about history of falls 
• Review medications and medical history 
• Perform gait assessment and physical examination 
• Evaluate feet and footwear; non-slip footwear is helpful in fall prevention 
• Make sure patient is oriented to environment 
• Call light is within reach 
• Ensure patient always has access to personal items 
• Check on patient frequently 
• Keep bed in lowest position 
• Ensure floor is free from debris or other obstacles 
• Physical therapy may help in developing a treatment plan with exercises to improve mobility, strength, and balance.
  

Assistive Devices Helpful for Fall Prevention

Cane- A long bar that assists in providing balance and support when walking or standing. 

Walker- Four-legged frame that allows a person to lean on for balance, support, and rest. 

Raised Toilet Seat- Elevated toilet seat that is used to decrease the distance a person has to move to sit on the toilet. 

Grab Bars- Safety devices that can be installed on walls, inside showers and tubs, by toilets, etc., in order for a patient to grab for balance and support. 

Shower Chair- Waterproof chair that can be used in the shower for a patient to sit on instead of standing.  

Reacher- A bar-shaped device much like a cane with grippers at the end that allow a patient to reach things further away without getting up.

The Bottom Line on Fall Prevention

In conclusion, falls are a common occurrence in the elderly population whether they are being cared for at their home, at the hospital, or at a long-term care facility.  

Fall prevention starts with nursing and support staff being vigilant and proactive with their patients. Anticipating a patient’s needs and having what they need readily available to them at all times is a huge step in the right direction when it comes to fall prevention. Frequent nursing rounds is also a significant way to reduce falls and ensure patient comfort and safety.  

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