3.6 Fall Risk Management Practices

Falls are a major health problem in older adults. A combination of health and environmental factors are associated with the risk of falling including: advancing age, medication use, cognitive impairment, and sensory defects (e.g., hearing loss and balance impairment). Sixty percent of residents in nursing facilities in the United States fall each year (Fuller, 2008).

Preventing Falls: The Fall Risk Assessment

Most falls can and should be prevented (Scott & Rajabai, 2007). Successful fall prevention requires a thorough clinical assessment of residents who fall (or who have a history of falls) and their environment. DADS Quality Monitoring Program (QMP) Resources, Managing Fall Risk states that every resident should have a fall risk assessment upon admission to a long-term care facility (DADS, 2008). Traditional approaches to fall reduction include: education, exercise, medication review, and reduction of fall hazards. Performing assessments to measure the risk of falling is important to develop individualized care plans to reduce the risk of fractures and other fall-related injuries.

NFQR results indicate that nursing facilities in Texas have greatly improved their efforts to assess residents for fall risks over the past several years. This year, 79% of all residents were assessed for fall risks within 14 days of admission or within 14 days of an annual assessment:

2004 — 60%
2005 — 65%
2006 — 58%
2007 — 64%
2008 — 79%

Significantly more residents were assessed for fall risks upon admission to the facility or annually in 2008 than in any other year (11).

Fall and Fracture Rates

Seven percent of residents in nursing facilities fell during the past 30 days (Figure 3.6). The proportion of nursing facility residents who fell during the past 30 days declined from 10% in 2005 to 7% this year:

2004 — 9%
2005 — 10%
2006 — 8%
2007 — 8%
2008 — 7%

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Reassessment after a fall

Of the 7% of residents who fell within the past 30 days, 51% were reassessed for fall risks within 24 hours to determine if contributing factors for falling were resolved (Figure 3.6):

2004 — 31%
2005 — 48%
2006 — 36%
2007 — 46%
2008 — 51%

Significantly more residents were reassessed within 24 hours of a fall in 2008 compared to 2004 (12). While the proportion of residents who were reassessed after a fall has increased during the past 3 years, these results indicate that 39% of all residents still need to be reassessed after a fall.

Figure 3.6 – Fall Risk Management

Fall risk

Older people have decreased bone densities and are more prone to fracture if they fall. [Centers for Disease Control (www.cdc.gov/nceh/dls/osteoporosis.htm)]
Fall prevention strategies can reduce suffering and save money. [Centers for Disease Control (www.cdc.gov/nceh/dls/osteoporosis.htm)]
The 2008 fall rate in Texas nursing facilities is 10.8%. (Minimum Data Set)

For residents admitted to nursing facility [Q6.1]

Was fall risk assessed within 14 days of admission?

Yes — 79%
No — 21%

For current residents in nursing facilities [Q6.2]

Has there been a fall in the past 30 days?

Yes — 7%
No — 93%

Of residents who fell in the past 30 days (7%) [Q6.3]

Was a fall assessment done within 24 hours of the fall?

Yes — 51%
No — 39%
Sent to hospital — 10%

Survey conducted: February – July 2008 [Q#.#] = Survey question number (Appendix A) Survey sample: 2,129 from 128,971 residents (Medicare, Medicaid, or any other payer source) living in the 1,044 Medicaid certified nursing facilities in Texas. For further information, contact the NFQR Project Lead at 512-438-3472.

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Footnotes

11. Statistically significant at p<.01.

12. Statistically significant at p<.01

Updated: June 8, 2010