Elderly/Long-term Care

A fall management program in nursing homes improves care and reduces use of physical restraints

About half of the 1.6 million nursing home (NH) residents in the United States fall each year, and 30 to 40 percent of them fall 2 or more times. These falls can result in painful and costly injuries, fear of falling, less participation in activities, and lower quality of life. Implementing a fall management program (FMP) can keep fall rates stable and substantially decrease restraint use among nursing home residents, according to a new study. Emory University researcher Kimberly Rask, M.D., Ph.D., and colleagues examined nursing homes in Georgia that were owned and operated by a single nonprofit organization.

A convenience sample of 19 nursing homes implemented the FMP. The FMP falls assessment targets five common risk factors: medications (for example, use of antianxiety drugs or hypnotics), gait and mobility problems, vision problems, orthostatic hypotension (very low blood pressure that can cause dizziness), and unsafe behavior. The assessment leads to a fall intervention plan to minimize the risk of falling. A flow chart guides staff through the process, from entering a resident into the FMP through followup assessments.

The researchers examined documentation of 24 process of care items related to fall prevention. Successful implementation of the FMP was associated with improvements in the documentation of recommended care processes for fall prevention. Restraint use decreased 44 percent from 7.9 to 4.4 percent in the FMP NHs, but only 30 percent from 7 to 4.9 percent in the non-FMP NHs during the study period.

Fall rates remained stable in the FMP NHs during the study period (from 17.3 to 16.4 falls/100 residents per month). However, fall rates increased 26 percent in the NHs not implementing the FMP (from 15 to 18.9 falls/100 residents per month). The study was supported in part by the Agency for Healthcare Research and Quality (Contract No. 290-00-0011).

See "Implementation and evaluation of a nursing home fall management program," by Dr. Rask, Patricia A. Parmelee, Ph.D., Jo A. Taylor, R.N., M.P.H., and others in the March 2007 Journal of the American Geriatrics Society 55, pp. 342-349.

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