It is estimated that over one-half of nursing home residents will fall in any given year. While many risk factors for falling are not amenable to modification (e.g., age, chronic disease, dementia), many falls are caused by modifiable risk factors such as footwear, environment and design factors, and the side effects of medication. Recently, researchers have been drawing attention to the possibility that some strategies that may reduce falls risk in the short term—particularly strategies that reduce levels of physical activity—may, in the long term, worsen the consequences of falls. An article in the Gerontologist evaluates a fall management program designed to encourage mobility and minimize the impact of falls.
The article contrasts this fall management approach, which prioritizes physical strength over the prevention of falls, with falls reduction approaches that discourage mobility, such as the use of physical restraints or medications that reduce “wandering.”
For this program, the research team educated and trained staff, residents, and residents’ families in nursing homes in Manitoba, Canada. The education involved information about rates of falls and risk factors for both falls and injuries resulting from falls. The goal of the educational program was to increase resident mobility, through the collaboration of nurses, activity directors, occupational therapists, maintenance workers, and other staff.
The researchers compared the falls, fall-related injuries, and fall-related hospitalizations before and after the educational training. They also compared the post-training rates of these incidents with nursing homes that were not implementing the fall management program. For purposes of clarity and statistical control, relevant data was collected on all the nursing homes involved in the comparisons, including polypharmacy, rates of dementia, ages, and levels of care.
Those nursing homes that completed the training program reported (when adjusting for relevant factors) a lower rate of falls-related injuries than the other nursing homes, despite no significant difference in overall falls rate. There were significantly fewer falls-related hospitalizations in nursing homes that had undergone the training program as well. While this topic requires further research, this study suggests that falls reduction programs that encourage the maintenance of physical strength and activity may reduce the negative impact of falls.
Burland E, Martens P, Brownell M, et al. The evaluation of a fall management program in a nursing home population. The Gerontologist (2013); doi:10.1093/geront/gns197