Problem of falls in nursing homes

Falls in Nursing Homes

How big is the problem?

In 2003, 1.5 million people 65 and older lived in nursing homes (National Center for Health Statistics 2005). If current rates continue, by 2030 this number will rise to about 3 million (Sahyoun et al. 2002).
Each year, a typical nursing home with 100 beds reports 100 to 200 falls. Many falls go unreported (Rubenstein 1997).
As many as 3 out of 4 people in nursing homes fall each year (Rubenstein et al. 1994). That’s twice the rate of falls for older adults living in the community.
Patients often fall more than once. The average is 2.6 falls per person per year (Rubenstein et al. 1990).
About 35% of fall injuries occur among residents who cannot walk (Thapa et al. 1996).
About 5% of adults 65 and older live in nursing homes. But people in nursing homes account for about 20% of deaths from falls in this age group (Rubenstein 1997).

How serious are these falls?

About 1,800 people living in U.S. nursing homes die each year from falls (Rubenstein et al. 1988).
About 10% to 20% of nursing home falls cause serious injuries; 2% to 6% cause fractures (Rubenstein et al. 1988).
Falls can make it hard for a person to get around, cause disability, and reduce quality of life. Fear of falling can cause further loss of function, depression, feelings of helplessness, and social isolation (Rubenstein et al. 1994).

Why do falls occur more often in nursing homes?

Falling can be a sign of other health problems. People in nursing homes are generally more frail than older adults living in the community. They tend to be older, have more chronic illnesses, and have difficulty walking. They also tend to have problems with thinking or memory, to have difficulty with activities of daily living, and to need help getting around or taking care of themselves (Bedsine et al. 1996). All of these factors are linked to falling (Ejaz et al. 1994).

What are the most common causes of nursing home falls?

Muscle weakness and walking or gait problems are the most common causes of falls among nursing home residents. These problems account for about 24% of the falls in nursing homes (Rubenstein et al. 1994).
Hazards in the nursing home cause 16% to 27% of falls among residents (Ejaz et al. 1994; Rubenstein et al. 1994). Such hazards include wet floors, poor lighting, incorrect bed height, and improperly fitted or maintained wheelchairs (Rubenstein et al. 1994; Ray et al. 1997).
Medications can increase the risk of falls and fall-related injuries. Drugs that affect the central nervous system, such as sedatives and anti-anxiety drugs, are of particular concern (Mustard et al. 1997; Ray et al. 2000).
Other causes of falls include difficulty in moving from one place to another (for example, from the bed to a chair), poor foot care (Ray et al. 1997), poorly fitting shoes, and improper or incorrect use of walking aids (Tinetti 1987).

How can we prevent falls in nursing homes?

Fall prevention takes a combination of medical treatment, rehabilitation, and environmental changes. The most effective interventions address multiple factors. Interventions include:

Assessing patients after a fall to identify and address risk factors and treat the underlying medical conditions (Rubenstein et al. 1990).
Making changes in the nursing home environment to make it easier for residents to move around safely. Such changes include putting in grab bars, adding raised toilet seats, lowering bed heights, and installing handrails in the hallways (Ray et al. 1997).
Reviewing prescribed medicines to assess their potential risks and benefits and to minimize use (Cooper 1994; Cooper 1997).
Providing patients with hip pads that can effectively prevent most hip fractures if a fall occurs (Kannus et al. 2000).
Using devices such as alarms that go off when patients try to get out of bed or move without help (Rubenstein et al. 1994).
Exercise programs can improve balance, strength, walking ability, and physical functioning among nursing home residents. However, it is unclear whether such programs can reduce falls (Nowalk et al. 2001; Vu et al. 2005).

Do physical restraints help prevent falls?

Routine use of restraints does not lower the risk of falls or fall injuries. They should NOT be used as a fall prevention strategy (Capezuti et al. 1996).
Restraints can actually add to the risk of fall-related injuries and deaths (Rubenstein et al. 1994). Limiting a patien’s freedom to move around leads to muscle weakness and reduces physical function (Rubenstein et al. 1997).
Since federal regulations took effect in 1990, nursing homes have reduced the use of physical restraints (Rubenstein et al. 1994). Some nursing homes have reported an increase in falls since the regulations took effect, but most have seen a drop in fall-related injuries (Ejaz et al. 1994).


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