For full disclosure, we need to embrace that falls will happen. Not even the best long-term communities can claim that their residents don’t fall or that they don’t allow their residents to fall. The resident actually has a right to fall, so interventions that would guarantee no fall are generally considered to be restraints, some of which may be administered in chemical form if medications are being used to reduce fall risk.
Falls in the senior population are common. Seniors are at a higher risk for increased falls due to any, or a combination of, atrophied or weaker muscles, poor balance, foot problems, vision and hearing problems, and medication side effects. It is not uncommon for the senior to hide the fall from the physician, family, and/or loved ones. They may be embarrassed or concerned about a perceived stigma associated with the fall. According to the Centers for Disease Control, roughly 25% of older adults fall every year, yet less than half of those falls are reported to doctors. However, every fall should be seen as a red flag and investigated. Investigation of the circumstances surrounding any fall is important because, for seniors, most falls can be a precursor or a warning sign of a new or declining healthcare condition. Even a brief, non-clinical evaluation of the environment and the conditions could reveal valuable information, informing interventions that, if implemented, could reduce the likelihood of a future fall or injury.
Licensed assisted living and memory care communities are required to investigate falls, offer interventions, and update the care plan if injuries from the fall or the results of the investigation will impact the resident’s daily life. In addition to extrinsic environmental factors, such as poor lighting, slippery floors, area rugs, and/or unfamiliarity with new surroundings, a post-fall evaluation may help diagnose intrinsic factors, such as an infection (especially a urinary tract infection), dehydration, or issues with medication(s). An investigation will ask questions like: Was there a recent change in medications? Was there recent weight loss that affected the efficacy of blood pressure medication? Have there been any changes in vision or to the environment? Was there an emotional trigger that created a psychical reaction?
The chart below outlines some of the intrinsic vs. extrinsic factors that can contribute to falls among seniors:
Intrinsic Factors to falls
Extrinsic Factors to falls
People who experience falls often have anxiety associated with falling, and this can lead to unhealthy behavioral changes. For a person who is prone to falling or has experienced a traumatic fall, the anxiety of simply walking in public for fear of falling can lead to increased social isolation and/or self-imposed wheelchair use. Bathing is one Activity of Daily Living (ADL) that is commonly impacted. Naturally, a person who has experienced a fall in the shower may become anxious and fearful regarding transfers into and out of the bathtub or shower. These emotions can lead to a refusal to bathe, which raises issues regarding hygiene and can impact skin health and integrity.
What can be done to help prevent falls?
Self-realization for the resident and engagement in dialogue with the loved one must be among the first steps in the process to reduce falls, as they allow for subsequent steps to be taken toward a solution. It is important that family members engage in candid dialogue with the resident and the community.
Families and residents must also embrace that falls will occur. It is unrealistic for residents and families to expect that a transition into a senior living community will eliminate the likelihood of falls entirely. While Assisted Living and Memory Care Communities offer environmental designs and safety features, clinical resources to oversee medications, and assistance in the event of fall, the same rules of gravity apply inside these communities and out. If the resident experiences a fall (and statistics indicate that most seniors will), it should be a time for open communication about the circumstances and implementation of a plan to minimize the potential for future falls, not an opportunity for allegations of wrongdoing and/or defensive measures from the community staff.
How do Assisted Living Communities handle elderly falls?
Assisted Living and Memory Care Communities should have systems in place to discuss and review falls, including post-fall interventions. Family members should be notified after every fall. (If the fall occurs at night and there is no injury, it is reasonable to notify the family members during business hours, but families should be clear about their communication preferences during care plan meetings.) In Virginia, the regulations require that a fall risk rating is completed for all residents by the time a comprehensive care plan is drafted. The fall risk rating should also be reviewed annually and after a fall or if the resident’s condition changes.
Repeated falls, even after following interventions, could strengthen the argument of an underlying clinical concern. The best question to ask for repeat falls is, “Is there a common theme to falls (same place, same time of day, same activity, same shoes)?” This detective work is worth the time and effort, and any commonalities should be discussed with your physician.
How can the resident reduce the likelihood of falls?
Diet and Exercise
As always, it starts with diet and exercise. A healthy diet is a starting point to managing blood sugar levels and reducing the likelihood of surprise dizziness. Additionally, staying physically active is a very important and successful measure to reduce falls, as exercise reduces muscle atrophy. This could mean walking with a friend, participating in exercise programs, or working with Physical and/or Occupational therapists.
Light is the enemy of falls! Dark floors or hallways are often a contributing variable to falls, so the entire environment should have ample lighting. Reducing clutter and tripping hazards will make a noticeable difference. Occupational Therapists can offer an environmental safety evaluation and help adjust the height of the bed or couch, advise on grab bars, etc. And while it may require the most sacrifice, reducing the number of pets or limiting them to certain rooms in the house can decrease the likelihood of experiencing a fall.
A longitudinal study on aging conducted by Harvard concluded that socialization is the single most important variable for healthy, successful aging. This in part explains why communities continue to focus on engaging activities and social programs. However, the precautions implemented during the height of the COVID-19 pandemic required that we limit the amount of time spent around others. This isolation has not only increased psychological concerns like depression but also created measurable physiological problems for seniors and is already being correlated with increased fall rates.
Socialization also allows those around us to observe any changes that can occur as we age, including balance and gait problems. Therefore, it is important to socialize to create an unscientific but accurate picture of the resident’s fall risk.
This blog is intended to get you thinking about questions to ask and solutions to explore regarding falls. If this blog caught your attention, it may be time to research living options with increased safety features and more resources. Bear in mind that Assisted Living and Memory Care Communities by design and the availability of resources can significantly reduce the likelihood of a fall with injury.