Assessing risk of falls for elderly patients
Nurses, aides represent the first line of defense
Falls continue to be one of the more common and expensive problems with elderly home care patients, and prevention is the best way to reduce your costs.
An Iowa physical therapist, who has taught home care agencies how to assess a patient’s potential for falling, says home care nurses and aides could be the first line of defense in protecting patients from falls.
"Falls are very costly problems among the elderly, and they lead to their decrease in independence, institutionalization, and loss of function," says Paul Schomberg, PT, a physical therapist with Amicare Home Health Services of Dubuque, IA. The agency is affiliated with Mercy Health Services of Farmington Hills, MI.
Schomberg offers these guidelines to assessing a patient’s risk factors for falling:
• Assess the patient’s ability to handle stairs.
Amicare Home Health uses an assessment form that rates the risk factors as 0, 1, or 2, Schomberg says. A patient who cannot go up and down the stairs alone is rated 0; a patient who can go up and down using a railing or a device that assists with mobility receives a rating of 1; if the patient is strong enough to walk up and down the stairs without holding onto anything for at least three or four steps, a 2 rating is given.
• Assess how far the patient can reach in a standing position.
Again, Schomberg refers to a 0 to 2 scale. A reach of less than six inches rates a 0; a reach between six and 10 inches is a 1 rating; and if the patient can reach beyond 10 inches, a 2 rating is given.
• Look at the patient’s other risk factors.
Schomberg suggests nurses ask these questions:
Does the patient have a history of previous falls?
Does the patient have neurological problems or other cognitive issues?
Is the patient taking medication that could affect balance, such as multiple medicines or a hypotension medicine that causes blood pressure to fall with changing postures?
A common cognitive tool is a mini-mental exam that includes questions that ask the patient to remember three things and to state the date and time.
"If someone looks like they’re having some problems in that area, then you can refer them to another therapist," Schomberg says.
• Check out the environmental factors.
Nurses should note whether the patient’s bathroom has a night light, and safety bars and other equipment. "They need to look at the steps to see if there are railings, and can the person get in and out of the bathtub," Schomberg says. "Are there throw rugs? Is the area cluttered? Is the home well-lit, and do the floors have slick surfaces or safe surfaces?"
• Observe the patient’s movements.
Schomberg suggests agencies ask aides to watch patients to see if they have difficulty transferring in or out of the bathtub or shower, for example.
Aides also should note whether the patient complains of dizziness when first getting up in the morning, or whether the patient appears to be unsteady at different times of the day or in different situations.
• Assess the patient’s emotional health.
Nurses could check for signs that a patient is depressed, using a geriatric depression scale. "The reason you check all these things out is because there is good research that suggests people who have cognitive problems or are depressed have more problems with falling," Schomberg says. "Falling is a combination of many areas that have a cumulative effect."
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