GENI - Geriatric Emergency Nursing Initiative

Falls: Harm Reduction

Purpose

Background

One in three older adults over the age of 65 years fall at least once a year (Campbell, Bowie & Spears, 1989). Fifty per cent of older adults who experience a hip fracture from a fall that results in nursing home admission will die within the year.  Harmful falls amongst the older adult population result in their own loss of independence; increased costs to the health care system and socioeconomic burden to families and society.  The impact of injurious falls is not just physical.  They have considerable negative consequences on elders' lifestyle and productivity.  It is estimated that fall-related injuries in 1994 cost Canadians $2.8 billion. (Asche, Gallagher & Coyte, 1997)

The ENCON system of reporting falls throughout the Fraser Health Authority provides statistical tracking of falls. This system; however, does not provide the caregivers and administrators with qualitative data that could assist in the prevention of harmful falls.

The community under The First Step: Fall Prevention Starts With You, Fall Prevention Coalition, currently have taken up the gauntlet to prevent falls both environmentally as well as individual responsibility for their own health. Programs include peer/volunteer lead fall prevention screening, supportive interventions and awareness-raising education.

Acute and sub acute care settings receive the patients with injuries resulting from a harmful fall. They also have within their settings the highest risk patients for all types of falls due to acute illness and concurrent deconditioning. The perceived need to protect patients is viewed as responsible and accountable care; however, this frequently leads to the use of restraints. Research has demonstrated that restraints can actually cause the harmful fall or lead to harming patients. With the OBRA legislation in the USA and Ontario's recent legislation that restricts restraint use, there was notable initial increase in falls within facilities; however, even more notable was that there were far fewer harmful falls. For every day that an older adult is bed-ridden, that person loses 0.5% - 1% of muscle strength. (Voyer, P. and Sych-Norrena, L. 2003) Additionally done density from being non-weight bearing decreases equally as rapidly. By keeping older adults immobile, it increases their risk for a harmful fall.

For the latest Clinical Practice Guideline on falls, contact awestervelt@providencehealth.bc.ca.