Falls in a Nursing Home Setting
Nanette Lavoie-Vaughan, M.S.N., APN
Multidimensional Fall Assessment
  • General health history
  • Fall history
  • Vital signs
  • Gait and balance
  • Cardiovascular condition
  • Visual acuity
  • Neurologic condition
  • Musculoskeletal condition
  • Grip strength
  • Range of motion
  • Condition of skin
  • Polypharmacy
  • Medication side effects

Fall Triggers on MDS
  • Alzheimer’s dementia
  • Arthritis
  • Cane/walker/crutch
  • Cardiovascular medication
  • CVA
  • Decline in cognition
  • Decline in functional status
  • Delirium
  • Device/restraint
  • Diuretics
  • Dizziness/Vertigo
  • Fracture of hip
  • Incontinence
  • Hemiplegia
  • Hypertension
  • Impaired hearing
  • Impaired vision
  • Joint pain
  • Loss of arm/leg movement
  • Manic depression
  • Missing limb
  • Osteoporosis
  • Other dementia
  • Pacemaker
  • Parkinson’s disease
  • Psychotropic medications
  • Seizures
  • Syncope
  • Unstable chronic/acute condition
  • Unsteady gait
  • Wandering

Measures to Prevent Falls
  • Encourage regular eye exams
  • Provide proper lighting
  • Furnish proper assistive walking devices
  • Furnish hip protectors
  • Provide handrails, raised toilet seats/shower benches in bathrooms
  • Display visual reminders in areas of caution
  • Provide adjustable chairs and beds
  • Provide access to call lights and bed alarms
  • Increase in toileting to at least every 4 hours
  • Decrease distance from bed to chair and toilets
  • Provide exercise program to increase strength
  • Identify at risk residents
  • Encourage a prompt staff response
  • Educate family and staff

Hip Fractures
  • 300,000 per year
  • 20-30% die in one year
  • 30-50% will not regain pre-fracture function
  • 50% never able to walk unassisted again

Prevention of hip fracture
  • Assessment and treatment on decreased bone density
  • Fall precautions
  • Hip protectors