Minimising Falls Risk in the Home

CPD
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Published: 30 August 2020

Most falls are preventable.

In order to minimise falls in the home, it is important for healthcare staff to provide appropriate education to vulnerable clients and implement falls-prevention strategies in the home where possible (Roo, Johnston & Petersen 2015).

Also read: Managing Falls Risk After Discharge

Falls Risk Factors

Most falls occur due to a combination of both intrinsic (personal) and extrinsic (environmental) factors. The more risk factors that are present, the more likely the person is to fall (Clay, Yap & Melder 2018). Some common risk factors include:

Intrinsic risk factors Extrinsic risk factors
  • Prior history of falls
  • Age
  • Sleep disturbances
  • Comorbidities
  • Acute or chronic illness
  • Cognitive impairment
  • Delirium, disorientation or confusion
  • Incontinence
  • Impaired mobility
  • Balance issues
  • Use of mobility assistance
  • Muscle weakness
  • Medicines
  • Fear of falling
  • Tripping hazards
  • Lighting
  • Bathroom location and accessibility
  • Floor surfaces
  • Doors
  • Cords and tubing
  • Room layout
  • Noise
  • Furniture
  • Footwear
  • Time of day

(Clay, Yap & Melder 2018; ACSQHC 2009; Canadian Patient Safety Institute 2015)

Older Adults and Falls

Changes to the body due to the normal ageing process can worsen existing risk factors or cause new ones to arise. Inadequate physical fitness, nutrition or hydration, and illnesses or other conditions may compound this risk further (Healthdirect 2020).

Older adults are 12 times more likely to fall than have a motor vehicle or pedestrian accident (Better Health Channel 2016). Falls are the biggest cause of unintentional injury in older adults over 65, accounting for about 75% of injury-related hospitalisations (Healthdirect 2020; Roo, Johnston & Petersen 2015).

Overall, about one-third of older adults fall every year, with one in five of these incidents resulting in hospitalisation (Healthdirect 2020).

Risk factors associated with age include:

  • Balance issues and unsteadiness;
  • Muscle weakness and joint stiffness;
  • Poor eyesight;
  • Medication side effects;
  • Slower reaction time;
  • New health problems (e.g. incontinence or dementia).

(Healthdirect 2020; Better Health Channel 2016)

Consequences of Falling

socially isolated woman looking out window
Fear of falling increases the risk of falling again in the future.

Even in cases where an injury does not occur, the person may develop a fear of falling that reduces their confidence and independence. This, in turn, only increases their risk of falling again in the future, as reduced physical activity can lead to poor balance, muscle weakness and stiff joints (Rubenstein 2019; Healthdirect 2020).

Falls in can lead to a variety of physical, emotional, social, short-term and long-term consequences including:

  • Bruises, sprained ligaments, strained muscles and other minor injuries;
  • Hip fracture (the most common injury caused by falls);
  • Dislocations;
  • Broken bones;
  • Torn ligaments;
  • Deep cuts;
  • Organ damage;
  • Loss of consciousness;
  • Head injury;
  • Impaired mobility;
  • Social isolation;
  • Loss of confidence and independence;
  • Functional decline;
  • Stiff joints and weak muscles due to lack of activity;
  • Increased risk of future falls;
  • Admission into an aged care or assisted living facility; and Death.

(Rubenstein 2019; Better Health Channel 2016; Healthdirect 2020)

Minimising Falls in the Home

sweeping leaves in backyard to prevent falls outside

About two-thirds of falls occur inside the home, most commonly in outdoor areas, bathrooms, bedrooms and kitchens. Falls are more likely to occur while the person is mobilising, for example, getting out of bed, going to the toilet or using a staircase (Rubenstein 2019; Stathakis, Gray & Berecki-Gisolf 2015).

Managing falls risk requires a multifactorial approach that addresses the person’s modifiable risk factors (Clay, Yap & Melder 2018).

Using a validated falls risk assessment tool, vulnerable clients should be identified and appropriate interventions should be put into place. It is likely that multiple solutions will need to be implemented in order to target several individual risk factors (Clay, Yap & Melder 2018).

The following strategies may help clients minimise different risk factors around the home:

Lighting
  • Ensure lighting is adequate and switched on
  • Turn on hallway lights at night
  • Reduce glare with curtains or blinds
  • Implement nightlights or motion-activated lights
  • Ensure light switches are easily accessible
  • Change lights if they are not bright enough
Slipping
  • Use non-slip mats in wet areas (e.g. bathroom, kitchen)
  • Implement non-slip flooring
  • Implement handrails, seats or handheld nozzles in the shower and bath
  • Place non-skid tape on the edges of steps and stairs
  • Ensure footwear is firm, non-slip and properly-fitting
  • Keep floors dry
  • Clean any spills immediately
Tripping
  • Ensure walkways are free from clutter
  • Remove or tape down electrical cords
  • Mark changes in the floor level with a bright colour
  • Secure mats and rugs with adhesive strips; remove any that are torn or wrinkled
  • Ensure tables and benches do not have sharp corners
  • Ensure clothing does not touch the ground (e.g. dressing gown)
  • Ensure beds and chairs are sturdy, appropriate height and easy to get in and out of
  • Keep frequently-used items between waist and eye level
  • Repair damaged floorboards or carpeting
Outside Areas
  • Remove debris from outdoor walkways (e.g. moss, slime, leaves)
  • Refrain from using ladders
  • Mark steps so that they are easy to see
  • Implement handrails next to steps
  • Repair broken, cracked or uneven walking surfaces
  • Wear sunglasses and hats to avoid sun glare
Health
  • Ensure adequate nutrition and hydration
  • Maintain oral hygiene (e.g. well-fitted dentures)
  • Exercise to improve strength, balance and flexibility
  • Stay physically active
  • Review medications
  • Manage acute and chronic conditions
  • Undergo regular eye checks
  • Visit the podiatrist regularly
  • Maintain Vitamin D levels
  • Manage cognitive impairment
  • Ensure toileting is safe and regular
  • Ensure regular mobilising
Sensory impairment
  • Ensure personal belongings such as glasses are in reach
  • Ensure sensory aids are worn and are suitable

(Healthdirect 2020; Better Health Channel 2016; Canadian Patient Safety Institute 2015; Rubenstein 2019; Mayo Clinic 2019)

Managing Falls in the Home

woman falling in bathroom
Appropriate education should advise the client on how to get up on their own or call for help in the event of a fall.

Clients should be informed about what to do if they are alone when a fall occurs. Remaining on the floor for a long period of time can be highly distressing and lead to complications such as:

  • Dehydration;
  • Hypothermia;
  • Pneumonia;
  • Rhabdomyolysis; and
  • Pressure injury.

(Rubenstein 2019)

Appropriate education should advise the client on how to get up on their own or call for help. Knowing how to manage a fall may also help to reduce fear of falling, as the client will be more confident in their ability to cope with a fall situation (Rubenstein 2019).

The specific advice given should be based on the client’s physical capacity.

Clients who can Independently Mobilise

The client should be advised to:

  1. Roll onto their stomach and get into a crawling position.
  2. Crawl to a stable piece of furniture (e.g. lounge chair).
  3. Try to get onto their knees.
  4. Hold onto the furniture and push upwards.
  5. Sit down on the furniture.

(Better Health Channel 2016)

Clients who are Physically Impaired

The client should be advised to:

  1. Crawl to a carpeted area and use clothes, a towel or anything else in reach to keep warm.
  2. Use their personal alarm, if they have one.
  3. Use a nearby object to make a loud noise to alert a neighbour (if they do not have a personal alarm).
  4. Keep warm and try to get up again later if they know nobody will hear them.

(Better Health Channel 2016)

Conclusion

Falls in the home can result in functional decline, reduced quality of life, loss of independence and in severe cases, even death (Rubenstein 2019).

Addressing and managing potential risk factors in the home is essential in preventing falls and their associated complications, and ensuring clients are able to maintain their confidence and independence.

Additional Resources


References

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Ausmed’s Editorial team is committed to providing high-quality and thoroughly researched content to our readers, free of any commercial bias or conflict of interest. All articles are developed in consultation with healthcare professionals and peer reviewed where necessary, undergoing a yearly review to ensure all healthcare information is kept up to date. See Educator Profile

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