Every facility that cares for or interacts with seniors has a fall-risk management system in place. Yet, one in every four seniors are expected to experience a fall. Evidence suggests that most falls are not only predictable, but preventable. So if our organizations have plans in place to prevent falls, why are they so prevalent?
The truth is that most fall management plans are underutilized and out-of-date, contributing to the status-quo of high fall rates. Not exactly confidence-inspiring, right?
But there’s hope: several evidence-based efforts can be made to improve fall management programs and reduce the prevalence of falls. So, without further ado, here are 4 building blocks for more successful fall management systems.
Building Blocks for More Successful Fall Management Systems
1. Objective Measurements of Mobility
Many fall-prevention plans include assessments of fall risk in the form of paper-based surveys, patient-reported symptoms, or visual physical assessments. Evidence-based is great, but objective – not subjective – assessments of someone’s fall risk are ideal.
Paper-based self-assessments from patients may misrepresent symptoms and risk factors. Visual assessments, even when performed by a healthcare professional, may miss subtle, key indicators that could indicate a future risk of falling.
Another issue with fall-risk assessments is the framing of them solely as fall-risk. More and more, the link between mobility and fall-risk is being documented in the growing field of senior-centric research. Understanding that fall-risk is a spectrum and that mobility- functional gait and balance- performance can gauge individuals' risk of falling is a good place to start.
As our scientific understanding of fall-risk has grown, several mobility-tracking technologies have moved out of laboratories and into clinical settings, reimagined as tools for evaluating fall-risk. The benefits of these high-tech approaches are plentiful, but most notable is that they offer objective measures of fall-risk and can be continually updated to account for the latest research on fall-risk indicators.
2. Regular Assessments
One of the pillars of the World Health Organization's Falls Prevention Model is “identifying and implementing realistic and effective interventions.” That starts with accurate and timely medical assessments, since a problem must be identified for it to be solved.
Changes in medication or footwear, dietary deficiencies, and activity/inactivity levels can all impact individuals’ fall risk. Fall management systems should include regular assessments which enable care providers to track changes in mobility function over time. Routine, regularly scheduled assessments that identify changes in fall-risk over time can notify healthcare teams about areas of potential concern and give them time to mitigate fall-risk.
3. Active Prevention
It should go without saying that senior care facilities should be actively working to prevent falls. But what does that look like within a fall management plan?
One way to mitigate fall events is to offer evidence-based courses and activities that reduce or minimize fall-risk. The WHO recommends that fall prevention programs include “muscle strengthening and balance retraining prescribed by a trained health professional” and suggests that community-based group programs that incorporate fall prevention education may also be beneficial. The National Council on Aging’s National Falls Prevention Resource Center also supports the implementation of evidence-based falls prevention programs.
Another crucial time for senior care facilities to practice active prevention is after a fall incident. After a fall occurs, facilities should have a clearly defined process for investigating the incident. The investigation should lead to increased learning and actionable outcomes which will help to increase staff understanding and contribute to the safety of all seniors who use the facility.
Follow-up, or post-fall care for seniors who experience a fall should also be a part of the post-fall process. This may include:
- Balance and gait training,
- Appropriate assistive devices,
- Environmental risk assessment and modification,
- Medication review and modification,
- Fall-risk awareness training,
- Footwear or eyewear adjustments, or
- Addressing other health concerns (i.e. orthostatic hypotension or cardiovascular issues).
These measures will not only encourage recovery but help to prevent the individual from falling again in the future.
The fourth and final building block to any successful fall-prevention plan is collaboration. There are many stakeholders in senior care. Residents/patients and their families/advocates, government bodies, healthcare-providers, community-service providers, policymakers, staff, and researchers, are all partners in the development, formation, and maintenance of fall-prevention plans. Finding ways to bring all interests and knowledge to the table through consistent, multi-level communication is a hallmark of a successful fall-prevention plan.
Our healthcare system has tried to address the problem of accidental falls with 100 percent of facilities having a fall management program in place. Not all programs are successful and accidental falls are a persistent problem in the senior care industry.
“Fall prevention strategies should be comprehensive and multifaceted. They should prioritize research and public health initiatives to further define the burden, explore variable risk factors and utilize effective prevention strategies.”
Hopefully this article has you thinking about the building blocks of a successful fall management program and reflecting on how yours can be improved.
The following resources may provide valuable information about fall prevention and fall-risk management:
National Council on Aging: a valuable resource for tools and best practices to be implemented into senior care facilities.