Don’t underestimate the danger of falls
Falls are by far the most common cause of trauma in the elderly, reports Stephen Meldon, MD, an attending physician in the ED at MetroHealth Medical Center in Cleveland.
"A fall is a marker of frailty and functional decline, and can result in serious injuries such as hip fractures," he says.
Falls may be caused by extrinsic factors including home environment, loose rugs, poor lighting, handrails, or oversized clothing like robes, and intrinsic or physiologic factors such as impaired balance, reduced strength, and decreased visual acuity, notes Meldon.
Here are some statistics about elderly patients and injuries caused by falls:
— One-third of people over 65 will have a fall, and 10% to 15% result in a serious injury.
— About 1% of falls in elderly Caucasian women result in a hip fracture.
— Fifty percent of elderly patients who are hospitalized after a fall die within one year.
One program identified the following four ways to reduce risks of falls in nursing homes by 30%:1
• Strength training.
"Exercise programs and light resistance training really makes a difference in muscle mass," notes Meldon.
• Review of medications.
"A lot of medicines can cause hypotension, and sedatives and cholinergic medicines are linked to falls," Meldon says.
• Education about sedatives.
"Nurses should review medications with the patient and also discuss them with the patient’s family members."
• Environmental modification.
Contact local community agencies to have someone inspect the patient’s home. "They can make sure it’s a safe environment, get rid of throw rugs, [and] make sure extension cords aren’t across the hallway," says Meldon.
When an elderly patient comes in after a fall, focus on the bigger picture.
"Falls are a sign of functional decline in the elderly. You need to have a different approach than with a 20-year-old who trips and falls but didn’t break anything," Meldon says. "You need to find out why the patient fell and recognize that it may be a sign of a serious functional problem." Examples include syncope, stroke, or serious infection. (See information on assessment for hidden pathology after falls, p. 126; and physical exam for falls, above.)
Watch for patients who live alone
Be especially concerned about elderly patients who live alone. "We see 85- and 90-year-old patients who live by themselves, [and] tend to be women who outlive their husbands," notes Meldon. "You need to be very concerned about those patients, because it’s not uncommon for them to fall and have no assistance for days."
Ask elderly patients who live alone if they have problems with walking or keeping their balance, suggests Meldon. A simple screening in the ED is the "get-up-and-go test." Simply observing the patient get off the bed and ambulate can help you assess the risk for falling, he recommends. "Those patients may need to get a call for help’ button, which is an intervention that nursing can do," Meldon suggests.
Perform a functional assessment to see if the patient is fit for discharge, Hogan recommends. "We send a lot of older people home with a sling on or crutches, but maybe now they’ve lost their ability to balance themselves and they’ll fall," she warns. "We need to ask ourselves: Can this person function at their baseline, and with the added illness or injury that caused them to come to the ED?"
Address the fallen elderly patient’s well-being. The patient may worry about loss of independence and significant deterioration of their overall health, notes Kari Nash, RN, CEN, MICN, associate trauma coordinator at Loma Linda (CA) University Medical Center. "They may worry incessantly over seemingly insignificant issues in relation to current events such as pets at home alone or groceries in the car," she explains. "It is very beneficial to the patient if the nurse can reassure them and get in touch with family early, to provide them with much-needed support."
Reference
1. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319:1,701-1,707.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content