Date Presented 04/05/19
The purpose of this study was to identify the causes of falls in Skilled-Nursing (SNF) and Long-Term Care (LTC) facilities. Data was acquired via fall reports and staff surveys in four facilities. Staff perceived that most falls occurred due to general weakness (96%) and between 8 pm and 8 am (52%). Fall reports indicated that most falls occurred due to unsafe transfers (58%) and the majority occurred between 8 pm and 8 am (42%). This study provides a basis for the development of fall-prevention programs.
Primary Author and Speaker: Patti Calk
Additional Authors and Speakers: Whitney Francis, Jonann Arrant, Mary Doss
Contributing Authors: Linda Jones
PURPOSE: The purpose of this study was to identify the causes of falls in Skilled Nursing Facilities (SNF) and Long-Term Care (LTC) facilities and compare identified causes with nursing staff perceptions.
BACKGROUND: According to the Center for Disease Control and Prevention (CDC, 2017), falls are the number one cause of injuries and deaths from injury among older Americans and this number is expected to surge unless preventive measures are taken. In 2015, falls resulted in costs of over $50 billion (CDC, 2017). Healthcare costs related to falls continue to rise. It is imperative that SNF and LTC staff increase their understanding of falls to improve intervention strategies to decrease fall risk and to develop successful fall prevention programs.
DESIGN: A multi-center, descriptive design utilizing fall reports and staff surveys was used. Nursing staff and retrospective fall report data were sourced from St. Clare Manor (Baton Rouge, LA), Twin Pines North Nursing & Rehabilitation (Victoria, TX), Twin Rivers Health & Rehabilitation (Arkadelphia, AR), and Ukiah Post-Acute (Ukiah, CA).
METHODS: Fall reports were collected from four SNF facilities on residents age 365 who had fallen between March 01, 2016 - May 31, 2016. Incomplete fall reports were excluded. All paid nursing staff who attended a mandatory in-service meeting were recruited to participate in a survey. Non-paid nursing staff or those who were not literate in English were excluded from the study. Information was gathered from 192 fall reports to identify the cause of the fall, time of day the fall occurred, and type of injury, if any, that resulted from the fall. The anonymous surveys (n=120) ascertained staff's experience and perceptions of most common causes, location, and time of falls.
ANALYSIS: Descriptive statistics were used for data analysis. Specific counts were totaled and percentages calculated.
RESULTS: Per staff surveys, the top four perceived causes of falls were general weakness (96%), impaired cognitive status (95%), altered mental status (93%), and failure to press call light (91%); and the most commonly perceived location was the bathroom (60%). Staff also reported that improper footwear, impaired balance, and delayed response to call light were believed to be significant causes. These findings were consistent with results from Chapman and Newenhouse (2013) and Struksnes et al. (2011), which also inferred that better understanding of falls leads to better fall management. Per fall reports, the resultant top four causes were unsafe transfers (58%), failure to call for help (55%), impaired cognitive status (24%), and equipment related (10%); the primary location of falls was in the resident’s room near bed (73%).
CONCLUSION: Falls contribute to significant injuries, deaths, and healthcare costs within SNFs and LTCs. By understanding the most common causes, risk factors, and locations of falls, therapeutic intervention and fall prevention programs can be developed. Based on the differences between staff perceptions and fall data, staff education is needed to promote a greater understanding.
IMPACT STATEMENT: By identifying the causes of falls, recommendations can be made to decrease falls and associated co-morbidities, thereby improving residents’ safety and reducing healthcare and institutional costs related to falls.
RELATION TO RESEARCH PRIORITIES: This study relates to AOTA’s Priority: Effectiveness in that it will allow OT practitioners to apply the information on falls to create effective evidence-based fall prevention programs.
References
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2017). Important facts about falls. Retrieved from http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html
Chapman, L. J. & Newenhouse, A. C. (2013). Nursing home staff perception of a falls management intervention. Wisconsin Medical Society. 112(4), 162-168.
Struksnes, S., Bachrach-Lindstrom, M., Hall-Lord, M., Slaasletten, R., & Johansson, I. (2011).The nursing staff’s opinion of falls among older persons with dementia: A cross-sectional study. BMC Nursing, 10(13), 13-21. https://doi.org/10.1186/1472-6955-10-13
