My Loved One in a Nursing Home Frequently Falls

1. My Loved One in a NursingHome Frequently Falls

2. Falls in the nursing home resident • What are Falls? • Unexpectedly hitting the ground • Under the effect of gravity

3. Why are they important?? Very common among nursing home residents Mortality: One of the major causes of death, even with treatment. Morbidity: falls often lead to hip fractures and worsened walking among residents in the nursing facility.

4. Who Falls in the Nursing Home?? • Risk increased with: • stroke, Parkinson’s, dementia - all affect strength and position sense • certain medications • visual Impairment • dehydration • previous falls

5. What are common characteristics of nursing home residents who fall? • Impaired Gait • Mental change, especially increased confusion.

6. How will the doctor or nurse practitioner evaluate the resident who falls?? • Physical exam is most important then possibly: • Blood/urine tests • Xrays • CT scan • EKG

7. Where will the doctor or nurse practitioner suggest that treatment be given? • Most falls can be safely evaluated and treated in the nursing facility. Some, however, may require transfer to a hospital, either for ER treatment or admission

8. Nursing Home Evaluation and Treatment of Falls • Almost always as effective as hospital treatment • Starts with treatment of the underlying problem, i.e. infection, dehydration, medication change • May involve physical therapy if weakness causing falls

9. Reasons to Hospitalize nursing home residents who fall:laceration or fracture requiring ER treatment; severe infections or certain strokes

10. What about physical measures in the prevention of further falls?? • Each time your loved one falls, the NH staff will consider some intervention to prevent the next fall, which may be more serious. • Examples include a lower bed to minimize injury, a tray to support a upright sitting in a wheelchair, a reclining chair to prevent forward falling, or a movement alarm to alert staff.

11. How will I Know When the Falls are Less Likely to Occur? • Difficult to predict • When an underlying problem is found and treated: • improved vision with glasses, strengthening with exercise, decreasing confusion

12. Things to Remember Your loved one may not get entirely back to his or her previous “normal” again after one or several falls, even if treated correctly. The injuries from a single fall can change a nursing home patient’s life forever.

13. Other treatment Decisions; what about restraining my loved one? Restraining a NH resident usually, but not always, causes more problems than it solves. • If you are a Health Care Proxy/Durable POA agent, try to think from the patient’s point of view;

14. Other treatment decisions, cont. • If your loved one had been able 5 years ago to look forward and see his or her current situation, would she want aggressive treatment? Would she have accepted a restraint, even if it reduced her risk of injury?

15. Consider This Remember, in approaching decisions about how to treat your loved one…. It is always best to try to imagine what one would have wanted if one could be making the decision on their own. If you have a good idea about what one would want, please tell it to your loved one’s care givers. Remember, in approaching decisions about how to treat your loved one, it is always best to try to imagine what one would have wanted if one could be making the decision on their own. If you have a good idea about what one would want, please tell it to your loved one’s physician or nurse.

16. Final Thought • While falls can have serious consequences, you and your loved one’s caregivers must search for a balance between promoting independent, free movement with the desire to avoid falls.