Falls: A closer look

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Dr. Eleanor Barbera
Dr. Eleanor Barbera

Part of my job as a geropsychologist is to conduct reviews of falls with my patients after they occur.

Through discussion with the resident, I analyze what happened and assess how they're doing after what can be a traumatic event. Together, we identify ways they can prevent future falls.

This exercise can be very revealing not only about the particulars of a situation but also about why falls occur in general.

The trauma of falls

Falls can be traumatic for a number of reasons. Sometimes an individual is badly hurt in the event, leading to a hospitalization and/or a decline in their physical and mental condition.

Occasionally, a person isn't found immediately, resulting in a period of time on the floor in pain with negative thoughts about themselves, staff, the facility and life in general. A spill can also trigger thoughts about similar past distressing episodes, such as a reminder of a fall at home that precipitated hospitalization and placement.

In addition, falls can decrease residents' confidence in their physical abilities, leading them to become overly cautious in rehab and resulting in increased physical dependence.

Why residents fall

There are many reasons that people fall, including forgetting their inability to walk, dizziness due to medication side effects, pain and restlessness.

This 2014 article in Managed Healthcare Connect provides excellent examples of how to conduct a thorough “root cause analysis” and a discussion of many of the elements that contribute to falls and how to address them.

Falls are typically multifactorial, but my own experience with residents over the years — bearing in mind that I speak only with residents who are cognitively intact and able to benefit from psychological services — suggests one major cause of falls in this cohort: not getting help in a timely fashion.

Of course, what is for one resident a timely interlude is to another individual an infuriating and anxiety-provoking wait. Nevertheless, it's a reasonable expectation that when a person in a healthcare facility presses a button for help, relief will arrive quickly. When this doesn't occur, residents try to help themselves.

Recommendations

While speedy assistance should be the norm, the reality is that it's frequently a rarity. The staff is often stretched too thin; one person in need can't be abandoned to attend to another.

What can be done, aside from ensuring adequate staffing, is to reduce residents' anxiety, frustration and impatience and therefore make it less likely that they'll try to get up on their own if they're unable to do so.

1.    The most essential action is to train nurses to answer the call bell immediately, preferably through an intercom system that makes it easy to communicate with residents while continuing with their other tasks. This allows nurses to quickly reassure residents that help is available, direct aides to the most urgent situations and to answer questions that don't necessitate the time and attention of the aides. The bell is pressed, the response comes and the resident is reassured and can tolerate a wait.

2.    Train workers to answer requests for help with a pleasant demeanor and the understanding that their demeanor affects the likelihood of an incident. In my experience, the second most-likely reason that a resident doesn't wait for help is that they don't want to “bother” the staff, particularly if the staff tends to seem bothered.

3.    Refer cognitively intact residents for psychological services, especially after a fall. While virtually all residents find admission to a rehab or nursing home stressful and can benefit from psychological support, residents who have had a fall at home or in the facility should be evaluated for psychological trauma and to address the personal components that contributed to the incident.

4.    Enlist other residents as mentors. A resident who fell and was injured because they didn't wait for help can be as much of a mentor as a resident who patiently and successfully made it through rehab. See if they'll share their stories. Hold a group for residents to discuss techniques they've used to be as independent as possible considering their need for help, or use the “Working with the Staff” chapter or the “Don't be foolishly independent” section in the Rehab chapter of my book as conversation starters. Empowering residents to support each other can minimize the powerlessness they feel waiting in bed for assistance.

Given the damage falls can bring to residents, families, staff and facilities, it's worth investing time in staff training and in employing creative approaches to fall prevention.

Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with over 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.

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