Falls are a frequent and serious concern within nursing homes, affecting 50% to 75% of residents annually. This rate is notably higher than for older adults living in the community. Approximately 10% to 20% of falls result in serious injuries, such as fractures or head trauma, and falls contribute to an estimated 1,800 deaths each year. Pinpointing the specific locations and times where these incidents happen most often is key to minimizing risk.
Highest Risk Zones: Resident Rooms and Bathrooms
The single most frequent location for fall-related injuries is the resident’s own private space. Data indicates that as many as 81% of falls resulting in injury happen within the resident’s room. Falls most often occur near the bed, typically during attempts to get in or out unassisted.
This risk often relates to residents trying to ambulate without waiting for staff assistance, particularly at night or in the early morning. Incorrect bed height significantly impedes safe transfer, as a bed that is too high or too low makes standing or sitting a struggle. Furthermore, clutter or improperly positioned mobility aids like walkers can become tripping hazards next to the bed.
The attached bathroom presents a concentrated set of hazards, primarily centered around toileting and bathing activities. Wet or slippery floors from showers or spills dramatically increase the risk of a slip. The small maneuvering space in a standard bathroom makes it difficult for residents to manage a walker or wheelchair safely.
The most hazardous activity in this space is transferring on or off the toilet. This movement requires shifting body weight and relying on lower body strength, which is frequently compromised in this population. If grab bars are improperly placed or the toilet height is not adjusted, the risk of falling during this transfer is significantly elevated.
Navigating Public and Communal Spaces
Falls occurring outside the resident’s room are often linked to environmental hazards in shared areas. Hallways, used to travel between rooms, dining areas, and activity spaces, become hazardous with poor lighting or temporary obstructions. Equipment such as cleaning carts or medical devices left unsecured in the walkway present a significant tripping hazard for residents using assistive devices.
Flooring changes pose a risk in transitional areas, especially where worn carpet meets tile or surfaces are unevenly maintained. Inadequate lighting, particularly in long corridors or at night, can obscure these changes, making it difficult for residents to judge distances or spot obstacles. The absence of securely anchored handrails along the hallway leaves residents without necessary support during ambulation.
Communal areas, such as dining rooms and activity spaces, introduce hazards related to high traffic and seating. Falls frequently happen when residents attempt to stand up from or sit down in chairs. Seating that is too low or lacks sturdy armrests makes this transfer difficult and unstable.
Food or drink spills are common in dining areas and, if not cleaned promptly, create slippery surfaces causing residents to lose footing. Crowded conditions during mealtimes or group activities can lead to accidental bumps or loss of balance.
The Temporal Dimension: Falls During Transfers and Low-Staffing Hours
Transferring between surfaces represents one of the highest-risk actions for a fall, regardless of location. Transfers, such as moving from a bed to a wheelchair or to a toilet, are complex movements requiring balance, muscle strength, and coordination. When staff assist, failure to follow proper lifting mechanics or neglecting to lock wheelchair wheels can result in a fall.
A significant proportion of falls, sometimes nearly half, are associated with elimination activities, highlighting the urgency that drives movement. This urgency often intersects with periods of reduced staffing, creating a dangerous temporal dimension. Falls occur more frequently during evenings, overnight, and shift changes when fewer staff members are on duty.
During the night, residents woken by the urgent need to use the bathroom may attempt to get up unassisted rather than wait for a delayed response. In understaffed facilities, residents may wait 15 minutes or longer for assistance, prompting them to overestimate their ability to complete the transfer. This attempt to move unassisted, driven by the need for toileting, is a primary reason why serious falls from the bed occur during low-staffing hours.