Written by Yolande Brand
A fall is defined as “an event which results in a person coming to rest inadvertently on the ground or floor or other lower level” (World Health Organisation).
The quick answer to the question above:
1. When last did YOU fall?
2. How old are you?
Although falling is a normal part of life for ALL, the impact and possible injuries associated with older age have a serious impact on quality of life. More than one third of people over the age of 65 years have at least one fall a year. Injuries sustained in a fall could range from minor bruises to serious injuries. Even falls that do not lead to injury can, and often do, have a negative effect on an older person’s confidence and can be a potential threat to the person’s independence.
The ‘Fall Cycle’ is depicted in the diagram below – demonstrating the negative consequences a fall might have for an older person.
The personal consequence for individuals can be devastating and half of those who sustain a hip fracture never regain their former level of functioning. The consequences of falls can be of a physical nature and include pain and inability to care for oneself resulting in long term disability. Social consequences include loss of social independence and social contact, loss of home, decrease in quality of life and changes to daily life. Psychological consequences, as depicted above, may be loss of confidence, fear, distress and anxiety.
The prevention of falls is therefore critical to the health of older people including those without a history of falling.
Simple and practical fall prevention interventions contributed to 38% reduction in falls in one care home (Hoffmann, 2003). A reduction in the number of falls should be evident if the unit or home follows a structured approach which includes:
- Implementing a research-based falls assessment tool forming the base of any falls prevention programme
- A person-centred approach to high risk residents
- Preventative resident education
- Staff education
- Audits to effectively analyse fall incidents as they occur
- Adjustments to the environment as needed
1. Assessment tool forming the base
of any falls prevention programme
The diagram below depicts the Fall prevention process:
Conducting a risk assessment for falls is a critical first step in implementing a falls prevention programme. This assessment should be conducted in a setting that is comfortable and accessible to the individual.
Three categories of risk factors have been identified that need to form part of the assessment:
- Physical and psychological factors specific to the individual
- Behavioural factors specific to the individual
- Environmental factors
The Hendrich II Falls Risk Model is a standardised assessment tool, focussing on the physical and psychological factors that put an individual at risk of falling. This assessment has been incorporated in the GERATEC Falls Prevention Assessment with additional questions relating to the behavioural and environmental factors mentioned above.
Once the assessment has been completed, an intervention plan is required to act on the risk factors identified in order to reduce the risk, but also to put in place measures to prevent individuals developing risks in future, as far as possible. There is space on the assessment form to document the plan. This should also be negotiated with and transferred to the individual’s care plan to ensure all role players are aware of the action required.Please remember that the plans need to be attractive to the resident in order to promote participation and progress. A recommended method for writing the plan, is setting ‘SMART’ goals.
The implementation aspect is crucial to the prevention of falls. It is important that the tasks identified in the planning process, are assigned to specific individuals who will take responsibility for implementation.
The cycle is concluded by reviewing the impact of the plan implemented by re-assessing the risk for falling. The outcomes must be discussed with the individual. This will lead you into a new planning and implementation stage to address any remaining or new risks.
It is recommended that a re-assessment be completed every 3 months, or immediately if any change is observed relating to any of the risk factors.
2. Person-centred approach
A person-centred approach ensures that the resident is the most important team member in this falls prevention process and he or she should participate in and preferably direct each step of this process. All other role players, including family should be involved as far as possible.
3. Resident education
As part of a person-centred approach, resident education is crucial to ensure that the individual understands what poses a risk of falls and why and how this risk can be reduced. This can be done as part of the assessment by explaining each question to the person and why it is included in the risk assessment. More formal training sessions can be presented for groups of residents.
The GERATEC Preventing Falls poster is a visual aid to assist with resident education.
4. Staff education
Ensuring that the conditions for empowerment: information, knowledge, acquiring skills, access to resources and a supportive environment are available to staff to not only identify risk factors, but to support them in the implementation of the falls prevention programme, will have a significant impact on the success of this programme.
5. Analysing falls incidents
An in-depth analysis of an incident where a resident fell has to be completed. An incident form should prompt the person completing the form to stipulate if any environmental factors contributed to the incident with space for a detailed description of the event.
It is also recommended that a reassessment of the falls risk be completed to incorporate any new actions in the planning and implementation process.
6. Adjustments to the environment as needed
Specific aspects within the individuals’ immediate environment will be taken into account as part of the Fall Prevention Assessment. It is important that communal areas are also assessed and action taken to reduce the risk factors.
Falling is a normal part of life for ALL but as the impact and possible injuries associated with older age can have such a serious impact on quality of life of the individual, it is very important to be pro-active instead of re-active.