Falls rank in the top 3 of accidents affecting the elderly in care facilities and is, therefore, the source of many lawsuits. According to WebMD’s, Alzheimer’s News falls are the leading cause of disability, premature nursing home placement, and death among older adults. It is believed that people with Dementia fall two to three times more frequently than people without the illness
To the laid person, a fall is simply a slip, a trip or a stumble that result in a person hitting the ground hard. The dictionary definition of a fall is, “move downward, typically rapidly and freely without control, from higher to a lower level.
The Center for Medicare and Medicaid Services(CMS) defines a fall as an unplanned descent to the floor with or without injury.
In most nursing homes today, the definition of a fall is much broader. Even an assisted fall, where the patient stumbles and is caught by staff and gently lowered to the floor is considered a fall. A fall may result in fractures, lacerations, or internal bleeding, leading to an increase in health care utilization.
The Center for Disease Control and Prevention(CDC) estimated the cost of falls, among older adults, at a staggering 50 billion dollars in 2015. The average hospital cost, per person, for a fall injury comes around 30 thousand dollars. It is estimated that 1 in 4 older adults 65 and older fall each year. In the U.S. alone, 800,000 patients a year are hospitalized because of a fall injury most often a broken hip or head injury. Fall injuries are among the 20 most expensive medical condition.
As mentioned above, Patients with Dementia are two to three times more likely to fall than the average person. Some things that may cause falls in Patients with Dementia are:
Lack of Physical Exercise
Gait abnormality is a deviation from normal walking. Normal gait requires that many systems, including strength and coordination function in an integrated fashion. An unsteady gait may occur as a result of an injury or an infection or damage to the nervous system that controls the movements necessary for walking. Muscle weakness, joint pain can also contribute to falls. Treatments for unsteady gait depends on the underlying cause.
Environmental factors such as a new facility, clutter, poor lighting, and slippery surfaces can contribute significantly to an increased risk in falling for an individual with Dementia. For a person with memory problems, learning the ins and outs of a new facility could turn out to be overwhelming. Taking away that old familiar setting and replacing it with a completely new setting can lead to missteps.
The use of certain drugs can be a contributing factor in falls even in people without Dementia. Some medications may cause lightheadedness, others may cause dizziness, while others may cause problems with balance
The benefits of physical exercise in Dementia are many and can include increased daily functioning and improved cognition Some people with Dementia may have moderate to severe gait disturbance but when living alone or with family, these individuals can continue to ambulate using furniture to assist with balance. As these patients move to a nursing facility they are classified as high-risk individuals. Dementia patients that are classified as high risk may unintentionally have a lack of physical exercise. Partly due to the high rate of lawsuits related to falls acquired in nursing homes, a person that is at high risk for falls is closely monitored.
Something to think about-
Your Mom or your Dad, recently diagnosed with mild Dementia, lives alone. He or she is independent. You live in another State so you don’t get a chance to visit very often. From the last visit to this visit, you are noticing a decline. For the sake of conversation and to avoid having to keep saying he or she, or Mom or Dad, let’s just make it Dad. You are noticing that Dad’s gait is not strong and steady anymore. He is getting around the home by holding on to furniture. This concerns you. You are asking yourself, what if he falls and no one is here to help him. You are thinking about your Dad’s welfare, you know that this is not safe and it is only a matter of time before he falls. So, you’ve come to the conclusion that Dad has to go to a place where there will be help for him 24/7. It is a safe option
Your number one reason for placing Dad in a facility is to avoid him falling at home and not able to get help. You have communicated this message to the new caretakers. For you, it is a bitter-sweet moment. You are sad because you have to place your Dad in a Nursing Home, but you are comforted by the fact that he is now in a safe place.
The staff at the facility now has the daunting task to keep Dad from falling. Every single person attached to this facility will be doing everything possible to keep Dad safe from falling. The facility on a whole has to keep Dad safe for three major reasons:
The direct care staff put just as much effort into preventing a fall for a few more personal reasons:
Of course, everything possible, including physical therapy, will be done to help Dad regain a steady gait. A walker or cane may be tried but please, remember that you are also dealing with Dementia. Dad will most likely forget or refuse to use either. Let’s assume that none of these interventions have improved Dad’s gait. Staff can’t just allow Dad to stumble around the facility holding on to furniture, knowing that sooner or later a fall will occur.
Remember, the job of the direct care staff is the keep Dad safe. This will mean eyes on Dad almost constantly. Since there is never one staff to each resident, the staff will need to get creative. A safe place for Dad could be a nice comfortable chair near the nurses’ station or in the day room. The goal is to prevent Dad from falling. Having to call a family member to inform them that Dad has fallen, especially when there are injuries, is not an easy job. So, every time Dad attempts to get up there will most likely be someone there to say, please sit sir or please sit Mr. E before you fall. Dad may only get to walk short distances assisted by staff 10-15 times daily. Remember, Dad was at home alone, cooking, cleaning, and everything else.
Because you are living in another state, you haven’t visited but you’ve called at least twice a week to find out how Dad is doing. He hasn’t fallen so you are happy about that. Now two months have passed and you dropped into town to give Dad a look-up. You are very surprised to see that Dad can no longer walk without the assistance of staff.
Now you have questions:
I know there are family members out there with similar stories and similar questions so please send me some feedback or try to answer some of the above questions.