Elderly Fall Prevention in Assisted Living Facilities

One of the biggest challenges facing assisted living facilities is the prevention of elderly falls. While highly preventable, falls continue to be the leading cause of both fatal and nonfatal injuries in older adults. According to the National Council on Aging, 1 in 4 Americans over the age of 65 falls each year, resulting in approximately 30,000 deaths per year. Those who survive their falls are often left to manage numerous serious injuries, including hip and wrist fractures, that directly limit their mobility and reduce their quality of life.

The Centers for Disease Control and Prevention (CDC) expects that the number of elderly falls will only increase as the U.S. population ages. According to the organization, there were 52 million older adults in 2018 and 36 million falls among them. By 2030, they anticipate 52 million falls among a projected 73 million older adults.

In the face of such stark data, it is more important than ever that assisted living professionals strive to protect their residents from undue harm. Fortunately, an estimated 20-30% of elderly falls in long-term care facilities are preventable, underscoring the importance of standardized fall prevention assessments and strategies in assisted living facilities. With a comprehensive fall prevention plan in place, assisted living administrators can improve the health and well-being of those they serve.

Why Are Falls Common Among the Elderly?

While numerous factors can contribute to an individual’s risk of falling, the single best predictor for falls is a previous fall. Beyond that, a range of factors, including the medication an individual consumes and the activities they perform, can play a part.

Falls are particularly common in assisted living facilities, where many of the residents can no longer independently perform activities of daily living. While many assisted living facilities strive to implement fall interventions, it’s nearly impossible to account for all the factors that can contribute to an individual’s risk of falling, including:

• Fear and Movement Challenges: Elderly individuals often develop a fear of falling — even if they have never fallen before — and start limiting their activities as a result. This can lead to stiff joints and weak muscles, potentially increasing their risk of falling.
• Chronic Conditions: Chronic conditions that impact an individual’s mobility or cognitive functioning, including arthritis, diabetes, stroke, Parkinson’s disease, incontinence, and dementia, can contribute to falls among elderly individuals.
• Vision and Hearing Loss: Sight and sound help us navigate life on a daily basis. Losing these senses can be extremely disorienting and reduce a person’s ability to perceive and safely interact with their surroundings.
• Blood Pressure: Individuals with fluctuating blood pressure — particularly those with orthostatic hypotension — or cardiac arrhythmias often experience dizziness when they stand, which can significantly heighten their risk of falling.
• Medications: Medications that suppress the central nervous system can reduce alertness and responsiveness, making some individuals more prone to falling than others. Taking more than one of these medications at a time can further heighten an individual’s chances of falling.
• Environmental Factors: All individuals, not just the elderly, are subject to falling if certain environmental factors are present. Dim lighting, loose rugs, slippery, uneven floors, and living spaces that are overcrowded with furniture are all examples of environmental hazards that increase an individual’s risk of falling.

How Do Falls Impact the Elderly?

A single fall can be life-changing for an elderly individual. As the body ages, it can no longer recover from an injury as quickly and efficiently as it once could. Fractures and sprains that take several months to heal for a young adult can take much longer for an elderly individual, significantly limiting their mobility indefinitely.

Falls can also be emotionally devastating for the elderly. Once a fall has occurred within an assisted living facility, the individual impacted becomes a “fall risk,” resulting in additional care and attention. This limits the individual’s independence and may cause them to feel more restricted.

While the primary goal of any fall prevention initiative is to protect the health and safety of residents, it also protects an assisted living facility’s reputation. Numerous falls reported within an assisted living facility signify that safety is not a top priority, which can lead potential new residents to look elsewhere for a facility to call home.

Can an Individual’s Fall Risk Be Calculated?

Yes, assisted living facilities can conduct standardized fall risk assessments for every resident, helping them identify strategies to limit falls and enhance independence. During a fall risk assessment, healthcare practitioners working within an assisted living facility will conduct numerous fall risk tests, including:

• The 30-Second Chair Stand Test: This test assesses leg strength and endurance by counting how many times within 30 seconds a person can stand from a seated position without using their hands for support. A low score indicates a fall risk.
• The Timed Up and Go (TUG) Test: The TUG test assesses how long it takes a person to stand from a seated position and then walk ten feet while moving at their normal pace. If it takes them longer than 12 seconds to complete this task, it increases their fall risk.
• The 4-Stage Balance Test: This test assesses static balance — the ability to stay balanced while stationary — by measuring a person’s ability to hold four progressively challenging balancing positions for at least ten seconds each. If a person cannot hold the final stance for more than 10 seconds, they are at a higher risk of falling.
• Orthostatic Blood Pressure Test: The orthostatic blood pressure test seeks to identify orthostatic hypotension, a type of blood pressure that drops suddenly when an individual stands up. The test involves three consecutive blood pressure checks: one after the individual has been lying down for five minutes, a second test one minute after they stand up, and a third test after approximately three minutes of standing.
• Allen Cognitive Screen: Also called the “leather lacing tool,” this test assesses fall risk related to functional cognition. During the screening, an individual is asked to stitch three increasingly difficult stitches through pre-punched holes in a piece of leather. Test evaluators then assess the individual’s results using the Allen Cognitive Levels and Modes of Performance.

A comprehensive fall strategy for assisted living facilities will encompass all these tests while also turning the assessment process into a truly collaborative endeavor. Physicians, nurses, and therapists — both physical and occupational — all have a part to play in the assessment process. By working together, these healthcare professionals are better equipped to calculate a resident’s fall risk and create highly personalized fall prevention plans.

What Interventions Protect Patients From Falling in a Long-Term Care Setting?

While there is no way to completely prevent residents from falling, numerous interventions can help reduce the likelihood that a fall will occur. As part of these interventions, several fall policies must be defined, including those outlining:

• How risk assessments are performed, when, and by whom.
• Preventive measures that must be taken for all residents, regardless of their fall risk level.
• Best practices for reporting falls in assisted living facilities.
• How to report concerns about a resident’s fall risk.
• What to do if a fall occurs.

In addition to these fall policies, assisted living facilities must implement several safety initiatives to protect all residents — even those who are at low risk — from falling. As part of these initiatives, assisted living professionals will:

• Implement Exercise Programs: Senior exercise programs that focus on improving residents’ agility, strength, balance, and coordination have been proven to help prevent falls in elderly individuals. Exercise also improves a resident’s overall health and well-being, enhancing their quality of life.
• Inspect the Environment Regularly: Even in an assisted living facility designed to promote safety, environmental factors can contribute to falls. Routinely checking for slippery or uneven surfaces, loose rugs, poor lighting, and clutter can reduce the risk of an accidental fall. It’s also important for facility staff to speak with families about the items they bring into a resident’s room to ensure that seemingly harmless objects, including ottomans, coffee tables, or area rugs, don’t inadvertently increase a resident’s fall risk.
• Monitor Residents’ Medications and Overall Health: Monitoring residents’ medications — especially those that increase fall risk — is an essential part of any fall prevention strategy. Residents should also receive regular eye exams and hearing tests to help determine if additional interventions are needed to promote their safety.

Prevent Falls and Protect Your Residents

Preventing falls within an assisted living facility is an ongoing process requiring focus, commitment, and an upfront investment of time and resources. Those who apply this level of effort and energy are rarely disappointed—with the right plan in place, administrators can improve the quality of care they provide and even save lives.