I found a recent article about falls by short-term nursing home patients both revealing and disturbing (see: 21 percent of short-stay nursing home patients fall). Below is an excerpt from it:
Researchers from the University of Southern California and Brown University analyzed the 2006 Minimum Data Set (MDS) assessments of all Medicare/Medicaid patients admitted to a nursing home for the first time. Among more than 230,000 patients in nearly 10,000 nursing homes across the country, the researchers found that 21% of newly admitted nursing home residents sustained at least one fall during their first 30 days in the facility....While fall rates among long-term nursing home populations are well documented, the nationwide study is believed to be the first of its kind to specifically analyze fall rates among newly admitted nursing home residents. Because newly admitted nursing home residents are in a novel environment and are unfamiliar to staff, identification and management of fall risk poses a particular challenge.“A fall can delay or permanently prevent the patient from returning to the community, and identifying risk of falling is essential for implementing fall prevention strategies and facilitating successful discharge back to the community.”
No irony intended, here's a passage from a legal firm's web site about slips and falls in nursing homes (see: Slip and Fall Injuries in Nursing Homes and Long Term Care Facilities):
The CDC has reported that approximately 1,800 nursing home residents die each year as a result of a slip and fall accident. Thousands more suffer serious and disabling injuries as a result of a slip and fall accident. The CDC report finds that the most common causes of nursing home falls are:
- Muscle weakness and walking or gait problems account for about 24% of the falls in nursing homes.
- Environmental hazards in nursing homes cause 16% to 27% of falls among residents. Such hazards include wet floors, poor lighting, incorrect bed height, and improperly fitted or maintained wheelchairs.
- Medications can increase the risk of falls and fall-related injuries. Drugs that affect the central nervous system, such as sedatives and anti-anxiety drugs, are of particular concern.
- Other causes of falls include difficulty in moving from one place to another (for example, from the bed to a chair), poor foot care, poorly fitting shoes, and improper or incorrect use of walking aids.
The mention of fall prevention strategies in the first quote caught my eye. It's clearly impossible in most nursing home settings to have attendants providing constant surveillance for residence. As noted above, patients newly admitted to a nursing home are encountering a novel environment and the risk of falls is much higher. The multifactorial causes for nursing home falls suggest that no one solution to this problem will suffice.