Falls are a serious public health concern within long-term care settings. Between 50% and 75% of nursing home residents experience a fall annually, a rate significantly higher than for older adults living in the community.
The consequences of these incidents are severe, often leading to serious injury in 10% to 20% of cases, including fractures and head trauma. Approximately 1,800 nursing home residents die each year due to fall-related injuries.
A fall can initiate a decline in health, mobility, and independence, and can also lead to a fear of falling, which further restricts activity. Proactive fall prevention requires a systemic, multifaceted approach addressing resident health, the physical environment, and staff procedures.
Comprehensive Resident Risk Assessment
The foundation of effective fall prevention is the systematic identification of individuals most susceptible to falling. This process begins with an initial evaluation upon admission and must be repeated regularly or whenever a resident experiences a change in condition or a fall. Standardized tools are utilized to ensure an objective and consistent evaluation of multiple risk factors.
Tools like the Morse Fall Scale or the Hendrich II Fall Risk Model assign numerical scores based on a resident’s profile. These assessments specifically look for a history of prior falls, which is one of the strongest predictors of future falls. They also evaluate intrinsic factors such as gait abnormalities, muscle weakness, and the use of ambulatory aids like canes or walkers.
Cognitive status is another element, as conditions like dementia or delirium can impair judgment, spatial awareness, and the ability to safely use mobility devices. Because a resident’s health status is dynamic, these evaluations must be routinely updated, such as quarterly or after any acute event, to ensure interventions remain appropriate.
Optimizing the Physical Environment
The resident’s immediate surroundings can significantly contribute to, or mitigate, the risk of a fall. Environmental hazards account for an estimated 16% to 27% of nursing home falls.
Adequate lighting is important, and it should be glare-free, particularly in hallways, stairwells, and bathrooms. Nightlights or motion-sensitive lighting should be installed to assist residents who mobilize during the night. Floors must be kept free of clutter, and all rugs should be non-slip or removed entirely to eliminate tripping hazards.
Structural changes involve ensuring that handrails and secure grab bars are correctly installed in all bathrooms and along corridors. Beds should be kept at the lowest possible height when a resident is resting to minimize the distance of a potential fall. Furthermore, call bells must be functioning and placed within easy reach of the resident at all times.
Clinical Interventions and Medication Review
Beyond the physical setting, clinical strategies focusing on a resident’s health status are central to fall prevention. Managing the medications a resident takes is often the most effective intervention. Polypharmacy, defined as taking four or more prescription drugs, significantly increases fall risk.
Specific classes of medications are known to affect balance, cognition, and blood pressure, thereby elevating fall risk. Sedatives, hypnotics, and anti-anxiety drugs can cause excessive drowsiness and slowed reaction times. Antidepressants, antipsychotics, and certain blood pressure medications can induce orthostatic hypotension, a sudden drop in blood pressure upon standing that causes dizziness and fainting.
A pharmacist, in collaboration with the physician, should conduct regular medication reviews, at least annually and after any fall, to identify potentially inappropriate or high-risk drugs. The goal of this review is deprescribing—safely reducing the dosage or discontinuing medications that are no longer necessary or whose risks outweigh their benefits.
Non-pharmacological interventions are also applied, such as physical therapy programs focused on strength, balance, and gait training to improve mobility. The proper fit and use of mobility aids like walkers and canes must be checked regularly.
Staff Education and Protocol Adherence
The human element, driven by consistent staff training and adherence to protocols, is the final component of a prevention strategy. Staff members need continuous education covering fall risk factors, the correct use of assistive devices, and safe patient transfer techniques. This training ensures that caregivers are equipped to identify subtle signs of increased fall risk.
Clear protocols must be in place for rapid response and systematic investigation following a fall. After a resident falls, a post-fall assessment is necessary not only to check for injuries but also to initiate a Root Cause Analysis (RCA). RCA is a systematic process to determine the underlying reasons the fall occurred, identifying contributing factors related to the environment, medication, or care processes.
The findings from the RCA are used to adjust the individual resident’s care plan and to inform systemic changes across the facility to prevent future recurrence. This proactive, non-punitive approach fosters a facility-wide culture of safety, empowering staff to report hazards and intervene without fear of blame.