Falls conference focuses on prevention
D. Stephen Robins, M.D.
At the recent national Safe Patient Handling and Mobility conference, held in Glendale, AZ, the primary purpose of fall prevention –reducing fall-induced injuries, in particular hip fractures and head injuries – was once again emphasized by keynote speaker Patricia Quigley, PhD, MPH, ARNP, CRRN, FAAN, FAANP. She is a leading member of the Veterans Administration in Tampa. The highly regarded and research-oriented Tampa VA Sunshine Healthcare Network has long been committed to reducing falls and preventing injuries in a variety of long term care settings.
Quigley stressed the importance of focusing not just on the deployment of risk assessment tools and strategies for fall prevention, but also on mitigating the likelihood of their serious and all too often fatal injury outcomes.
A hip fracture occurs in the U.S. about every two minutes. Despite years of fall-prevention efforts, the Centers for Disease Control and Prevention reports that falls continue to occur frequently and repeatedly among nursing home residents due to advanced age, comorbidities such as osteoporosis and dementia, and prescription medications. How often? One out of every three adults age 65+ falls each year. The significance? Falls remain the leading cause of both fatal and nonfatal injuries among seniors, leading to profound loss of function and independence, and often death.
Among the leading patient safety entities represented at the conference, the VA has also been particularly prominent in efforts to prevent hip fractures by promoting the use of hip protectors in its facilities. Recommendations include practice guidelines to ensure that at-risk residents are prescribed the use of hip protectors, as well as educating patients and their relatives on risks for hip fracture and the protective properties of hip protectors. Efforts to increase the use of hip protectors also focus on staff members, who are in a key position to advise and influence residents and their relatives. Quigley also gave a presentation on the VA's updated falls toolkit, which includes recommendations on the implementation of hip protector protocols.
In addition to the VA, the CDC and National Osteoporosis Foundation also promote using hip protectors as a preemptive hip fracture prevention strategy for at-risk individuals both in elder care facilities and at home. In an age of evidence-based assessment of more complex preventative and therapeutic interventions, it's gratifying to see organizations like these remembering and endorsing simple, affordable solutions such as the use of hip protectors.
Hip fracture facts:
- Studies in nursing homes indicate that the mean number of falls per bed per year is 1.5, and ranges up to 3.6.
- The problem is not limited to ambulatory patients—about 35% of fall-related injuries occur in residents who are non-ambulatory, such as those using wheelchairs.
- A 2012 study found that hip fractures represent anywhere from approximately 40% to as much as 60% of fall-related injuries in nursing homes.
- A 2014 study of 60,111 Medicare beneficiaries in nursing homes found that 36.2% of patients died within six months after a hip fracture, and among patients not totally dependent at baseline, 53.5% died within six months or became totally dependent after hip fracture.
- A 2014 analysis by insurer CNA found that between 2012 and 2013, 41.5% of closed professional liability claims against CNA-insured non profit skilled nursing facilities were due to falls. In 2014, 45.6%of falls were associated with failure to monitor the patient, 66% of falls occurred in the resident's room or bathroom, and 40.4% of falls resulted in death.
- In an eight month study supported by the VA, 37 teams of VA hospitals and nursing homes implemented evidence-based interventions to reduce falls and related injuries in facilities, tracking fall and injury rates, and using performance evaluations. They found that the interventions allowed participants to remain active, which did little to decrease the fall rate, but the overall major injury rate decreased by 6%. The most successful interventions included use of hip protectors, toileting, and post-fall assessments, as well as other methods.
D. Stephen Robins, M.D., is co-founder of Medical Protection Technologies, which distributes Fall-Safe® Hip Protectors. Dr. Robins has championed numerous patient safety issues over his 35-year medical career in clinical practice, clinical research, and standards of practice development. He can be reached at firstname.lastname@example.org.