Make a Move

Early Intervention

While management depends on the underlying etiology of the fall, some generally acceptable practices are effective:

• Maintain a safe physical environment. Making sure spills are cleaned up quickly and walkways are kept free of obstruction is as important as maintaining adequate lighting in all areas where older adults will walk;
• Avoid use of restraints. Though restraints are often employed to prevent falls, they have not proved effective in medical trials. It has been demonstrated that their use increases the injury associated with falls, and several restraint-reduction projects have demonstrated that restraints can be removed without a significant increase in falls or injuries;
• Deal with medication side effects. The side effects of CNS altering drugs, and drugs affecting postural blood pressure, balance, and gait should be expected and addressed. Polypharmacy should be minimized;
• Watch patients closely. High risk patients should be positioned by the nursing station so that their visibility to the staff is maximized; and
• Promote mobility. There has been considerable research demonstrating the positive effect of exercise on reducing fall risk among community-residing older adults. While no study to date has addressed the impact of exercise in the hospital-based community, improved balance, mobility, and flexibility have been documented in nursing home residents receiving aggressive physical therapy. TH

Dr. Landis is a frequent contributor to The Hospitalist.

References

1. Hoogerduijn JG, Schuurmans MJ, Duijnstee MS, et al. A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline. J Clin Nurs. 2007 Jan;16(1):46-57.
2. Callen BL, Mahoney JE, Wells TJ, et al. Admission and discharge mobility of frail hospitalized older adults. MedSurg Nursing 2004:13(3):156-163. 
3. Resnick NM, Marcantonio ER. How should clinical care of the aged differ? Lancet 2002; 350:1157-1167.
4. Watters JM, McClaran JC, Man-Son-Hing M. The elderly surgical patient. ACS surgery: principles and practice. Medscape 2005.
5. Miller KE, Zylstra RG, Standridge JB. The geriatric patient: a systematic approach to maintaining health. Am Fam Physician. 2000;61(4):1080-1098.
6. Rydwik E, Frändin K, Akner G. Effects of physical training on physical performance in institutionalized elderly patients with multiple diagnoses. Age Ageing. 2004 Jan;33(1):13-23.
7. Kuys SS , Brauer SG. Validation and reliability of the Modified Elderly Mobility Scale. Australas J Ageing 2006; 25(3):140-144.
8. Spilg EG, Martin BJ, Mitchell SL, et al. A comparison of mobility assessments in a geriatric day hospital. Clin Rehabil. 2001 Jun;15(3):296-300.
9. Thomas EJ, Brennan TA. Incidence and types of preventable adverse events in elderly patients: population based review of medical records. BMJ 2000;320(7237):741-744
10. Gray-Miceli DL, Capezuti E. A nursing guide to the prevention and management of falls in geriatric patients in long-term care settings. Medscape; May 19, 2005.