Assessing risk factors reduces patient falls
November 1, 1997 3 minutes read
Assessing risk factors reduces patient falls
Give nurses these quick tips on preventing falls
Falls continue to be one of the most common and costly problems with elderly patients, which makes prevention the only smart way to reduce medical expenses resulting from falls.
An Iowa physical therapist, who has taught home care staff 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 breaks the risk factors into a 0, 1, or 2, Schomberg says.
If the patient cannot go up and down the stairs by himself, it’s a 0; if he can go up and down using a railing or a device that assists with mobility, then it’s a 1 rating; if the patient is strong enough to walk up and down the stairs without holding onto anything for at least three or four steps, it’s a 2 rating.
What’s your patient’s reach?
• Assess how far the patient can reach in a standing position.
Again, Schomberg refers to a 0 to 2 scale: If the patient’s reach is less than six inches, it rates a 0; if it’s between six and 10 inches, it’s a 1 rating; and if the patient can reach beyond 10 inches, it’s a 2.
• 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 the 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.
Other factors to consider
• 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 with 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 comb-ination of many areas that have a cumulative effect."
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