Coordinated Fall Prevention in Long-Term Care Adults

I. Health Concern Overview

Health Issue: Falls are the leading cause of injury-related morbidity and mortality among adults aged 65+, especially in long-term care (LTC) settings. Patient Population: Older adults (65+) residing in skilled nursing or assisted living facilities.

Prevalence & Impact:

50–75% of LTC residents experience at least one fall annually.

30% of these falls result in serious injury (hip fractures, head trauma).

Falls increase hospitalizations, loss of independence, and mortality (Jung et al., 2024).

II. Evidence-Based Best Practices for Fall Prevention in Long-Term Care Adults

1. Implement Multifactorial Fall risk assessments Conducting multifactorial fall risk assessments on admission and regularly thereafter helps identify individuals at high risk for falls. Tools like the Morse Fall Scale and Timed Up and Go test support standardized, evidence-based evaluations (Albasha et al., 2023).

2. Medication Review and Deprescribing Older adults often take multiple medications that can increase dizziness, sedation, or hypotension. Regular review by pharmacists allows for deprescribing high-risk medications to reduce fall incidents (Jung et al., 2024).

3. Strength and balance Training (e.g., Tai Chi, PT programs) Evidence-based exercise programs such as Otago or Tai Chi help improve lower-body strength, balance, and coordination. These interventions are proven to reduce fall rates and improve residents’ confidence in mobility (Montero-Odasso et al., 2021).

4. Modify Environment (non-slip floors, adequate lighting, grab bars) Maintaining a safe environment by removing tripping hazards, installing grab bars, and ensuring proper lighting reduces environmental fall risks. Environmental audits can help identify and correct potential dangers in resident rooms and hallways (Jung et al., 2024).

5. Vision and Hearing Screening Impaired vision or hearing affects spatial awareness and balance, leading to increased fall risk. Annual screenings and timely interventions such as glasses or hearing aids are essential preventive steps (McCrum, 2020).

6. Interdisciplinary Team Communication and Staff Education Effective fall prevention requires coordinated efforts from nurses, physicians, therapists, and aides. Ongoing staff training enhances awareness of fall risks and reinforces consistent prevention strategies (Montero-Odasso et al., 2021).

7. Technology-Enhanced Monitoring Technologies like bed alarms, motion detectors, and wearable sensors provide real-time alerts and enhance monitoring. These tools complement staff efforts, especially during nighttime or in high-risk situations (Jung et al., 2024).

III. Physical Considerations

Comorbidities (arthritis, neuropathy, osteoporosis) increase fall risk.

Use of mobility aids (e.g., walkers) must be supervised and regularly assessed.

Chronic pain and fear of movement may reduce activity, weakening muscles.

Ensure hydration and nutrition to support strength and cognition (McCrum, 2020).

Monitor orthostatic hypotension, especially during medication changes.

IV. Psychosocial Considerations

Fear of falling (FOF) can lead to social withdrawal and reduced mobility.

Depression, cognitive impairment, or dementia may impair safety awareness.

Residents may feel shame or embarrassment, reducing fall reporting.

Staff-patient rapport is crucial for consistent participation in fall interventions (Albasha et al., 2023).

Provide emotional support and involve family in reassurance and education.

V. Cultural Considerations

Some cultures view falling as a “natural” part of aging—may minimize the risk.

Tailor fall prevention education to respect cultural health beliefs.

Offer materials in the resident’s preferred language and reading level.

Understand modesty and gender considerations in physical therapy.

Involve family decision-makers in planning, especially in collectivist cultures.

VI. SMART Goals

1. Goal 1: Specific: Reduce the incidence of falls among LTC residents by 25% within 6 months. Measurable: Track fall-related incident reports monthly. Achievable: Use interdisciplinary interventions including pwhysical therapy, medication review, and environmental audits. Relevant: Reduces injuries and improves quality of life. Time-bound: 6-month implementation and evaluation. Evidence: Facilities with fall prevention programs have shown 20–30% reduction in falls (Colón-Emeric et al., 2024).

2. Goal 2: Specific: Increase resident participation in weekly strength/balance exercise programs to 75% within 3 months. Measurable: Monitor attendance records and PT progress notes. Achievable: Use engaging, culturally appropriate group activities like chair yoga or music-assisted movement. Relevant: Prevents muscle weakness and improves gait. Time-bound: 3 months. Evidence: Group exercise has been linked to improved mobility and reduced fall fear (Montero-Odasso et al., 2021).

Community Resources

References

Albasha, N., Ahern, L., O’Mahony, L., McCullagh, R., Cornally, N., McHugh, S., & Timmons, S. (2023). Implementation strategies to support fall prevention interventions in long-term care facilities for older persons: a systematic review. BMC geriatrics, 23(1), 47.

Colón-Emeric, C. S., McDermott, C. L., Lee, D. S., & Berry, S. D. (2024). Risk assessment and prevention of falls in older community-dwelling adults: a review. Jama, 331(16), 1397-1406.

Jung, W., Lim, S., Wi, D., Ustach, A., & Thompson, H. J. (2024). Person-focused interventions for fall risk assessment, fall prevention and fall injury prevention in long-term care facilities: a scoping review. Injury Prevention.

McCrum, C. (2020). Fall prevention in community-dwelling older adults. New England Journal of Medicine, 382(26), 2579-2580.

Montero-Odasso, M. M., Kamkar, N., Pieruccini-Faria, F., Osman, A., Sarquis-Adamson, Y., Close, J., … &Kobusingye, O. (2021). Evaluation of clinical practice guidelines on fall prevention and management for older adults: a systematic review. JAMA network open, 4(12), e2138911-e2138911.

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