Falls

Falls: Psychological Impact and Prevention Methods

April 16, 2012 | by Law Offices of Ben Yeroushalmi

According to the American Geriatrics Society Foundation for Health in Aging, approximately half of nursing home residents experience falls each year. Because falls are such a common accident, it is important that nursing homes understand how to handle the situation immediately after a fall, and the best ways to prevent falls. An article by the Assisted Living Column emphasizes that falls not only cause physical injury, but also psychological damage that may lead to more falls in the future. The article also stresses the importance of caregivers at nursing homes to be educated about the nature and impact of falls.

The psychological impact of falls is important as it almost always leads to more falls. After falling once, older adults become fearful of falling again, and so engage in less physical activity. This reduction of physical activity results in reduced mobility, which is a risk factor for a second fall. In a long-term residential facility such as a nursing home where residents are unfortunately at a risk of experiencing falls, staff should be trained on preventative measures.

The article emphasizes the importance of proper prevention methods. The staff at the nursing home should be aware of all the risk factors and work to eliminate as many of these risk factors as possible. Many of the risk factors for falls are environmental factors; the floor may be too smooth or slippery, rooms and hallways may have inadequate lighting, or furniture placement might be dangerous. All of these factors are things that can be easily fixed with an observant and knowledgeable staff. Unfortunately, a problem in many nursing homes is that the nurses often give a lack of direct care. Direct care involves physical and psychological treatment of the patients, while indirect care mostly involves administrative tasks. If there is a lack of direct care for the residents, it becomes increasingly difficult for staff to take notice of the environmental hazards that the nursing home may have.

Another major risk factor is the type and amount of medication that the patient is on. A study done by the Yale FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) found that those who were on psychoactive medications were more likely to experience a fall due to the medication’s side effects. Unfortunately, psychoactive drugs are one of the most frequently used drugs in nursing homes. Nursing homes often find it more convenient to use psychoactive drugs to prevent episodes of agitation. However, rather than using psychoactive drugs, nursing homes should provide more direct care and should not be using chemical restraints to subdue their residents as this is a direct violation of the Patients’ Bill of Rights.

A Patient Safety Culture and Reduced Use of Physical Constraints Leads to Better Safety Care

March 30, 2012 | by Law Offices of Ben Yeroushalmi

A study published by The Gerontologist found that nursing homes that focused on creating a culture of patient safety which involves using less physical restraints, resulted in lower mortality rates, lower rates of failure to rescue, decreased chances of medical errors, and more days between serious safety events. A culture of patient safety involves ensuring that the nursing home or hospital is engineered both physically and systematically to enhance the safety of the patients and residents. It also involves a blame-free environment in which individuals are able to report errors with fear of punishment. Lack of a culture of patient safety can lead to staff that is afraid of reporting mistakes, which leads to the increased use of physical restraints.

Physical restraints are a controversial care process used on individuals with difficulties transferring and with behavioral disorders. Nursing homes often resort to the simple method of using physical restraints to limit falls rather than attempting to fix the underlying problems in management that lead to these falls in the first place. In reality, physical restraints do not prevent falls. In fact, the study found that nursing homes that use less physical restraints report less falls per year. Physical restraints have also been shown to increase the likelihood of death, injuries, and functional decline. Nursing homes often resort to physical restraints because they are uneducated about better safety methods. Staff should be trained in teamwork, documentation, and reporting and discussing safety issues. Each resident has different health needs, and so a specific care plan should be adopted for each individual to prevent falls, rather than resorting to the use of physical restraints.

The study also found that the nursing homes that heavily rely on physical restraints and less on a patient safety culture also tend to be understaffed. Unfortunately, understaffing is a problem in most nursing homes, and so many nursing homes are not providing the proper quality of care for their residents to ensure their safety from falls and critical errors made by staff. The use of physical restraints due to understaffing is also a direct violation of a patient’s rights, and is simply inexcusable.

The results from this study show that there needs to be an obvious push in nursing homes towards building and the importance of adopting a proper patient safety culture and hiring enough properly trained staff to give quality care to the residents. A nursing home should not only provide resident autonomy, and a comfortable living environment, but also a safe culture to ensure that its residents are kept at the highest level of physical and mental well-being as possible.

Recent Study Shows that in addition to the Physical Health Benefits, Resistance Training also Promotes Mental Well-Being among the Elderly

February 20, 2012 | by Law Offices of Ben Yeroushalmi

Falls are becoming an increasingly prevalent problem in today’s skilled nursing facilities. Because the consequences of fall-related injuries are so detrimental to the health of elder adults and the costs associated with treating these injuries are so high, many recent studies have focused on fall prevention techniques. Many of these techniques center on improving the muscle strength of patients, since cardiovascular deterioration is one cause of falls in the elderly population.

The 2012 issue of The Journal of Nutrition, Health & Aging recently published an article titled “Physical Function Predicts Improvement in Quality of Life in Elderly Icelanders after 12 Weeks of Resistance Exercise.” The study reinforces the benefits of resistance training in elderly adults, while discovering some additional advantages that this new treatment has to offer. Before progressing with the study, however, the article outlines the underlying causes of the decline in muscle strength that is experienced by all elderly adults.

Although a weakening of muscles is inherent with old age, especially after the age of sixty, certain factors can accelerate this condition. One of the most basic causes is malnutrition. Because the body receives its energy and strength from nutrients that are in food, it is very important that your loved one is receiving nutritional meals at his or her skilled nursing facility. However, even in nursing homes with the healthiest meals, malnutrition is a likely possibility in understaffed facilities. In choosing a home for your loved one, we advise that you visit at various times throughout the day, as there is often a discrepancy between the staffing levels of different shifts. As it is one of the busiest and most hectic times of the day, it is crucial for you to ensure that your loved one’s facility is employing an adequate level of staff during mealtimes.

Another cause of muscle deterioration is inactivity, which is the area studied by the article. The study proposes the use of resistance training, in which participants perform exercises against an opposing force. As muscle strength improves, the opposing force is increased. While some studies have already proven that resistance exercises improve muscle strength, this study focuses on the effect of this treatment on overall health-related quality of life.

With 204 participants, the study proceeded by enrolling each individual into resistance training classes. The study was conducted over a period of twelve weeks. For three nonconsecutive days of each week, the participants attended their resistance exercise classes in groups of twenty to thirty. Three sets of exercises were repeated six to eight times and increased by five to ten percent each week. Over the course of the study, some tests, such as a walk that recorded the distance that the participant could walk in six minutes, were used to measure improvements in muscle strength.

Health-related quality of life was determined by a questionnaire that inquired about both psychological and physical functions, including functional status, vitality, social function, physical pain, emotions, general health, and mental health. The results of the study show that resistance training does more than simply improve the muscle strength of elderly adults. Overall, participants experienced an increase in health-related quality of life. This included improvements in mental health, such as an alleviation of mild depressive symptoms and anxiety symptoms.

While most nursing homes install railings in hallways to prevent falls and call buttons in case falls do happen, rehabilitation exercises are often overlooked as fall prevention techniques. However, these exercises are actually very effective in preventing falls because they directly address the loss of muscle strength experienced by the elderly that is one of the fundamental contributing causes of falls.

Recent Study Identifies Pharmaceuticals that May Increase the Risk of Adverse Drug Reactions Among Los Angeles Nursing Home Patients

January 27, 2012 | by Law Offices of Ben Yeroushalmi

While polypharmacy, the use of multiple drugs simultaneously, is known to have dangerous effects on the physical and psychological health of patients, other causes of adverse drug reactions among the elderly population are lesser known. A study, titled “Geriatric Conditions and Adverse Drug Reaction in Elderly Hospitalized Patients,” published in the February 2012 issue of the Journal of American Medical Directors Association, seeks to discover another explanation for the occurrence of adverse drug reactions, focusing on the relationship to geriatric conditions.

After assessing 506 patients, the study concluded that hematologic, neuropsychiatric, and respiratory drugs are the most likely to lead to adverse drug reactions. With respect to geriatric conditions, patients who experienced adverse drug reactions suffered from cardiovascular, dermatologic, gastrointestinal, and psychiatric disorders. They also experienced a loss of independence, including incontinence and an inability to perform other activities of daily living.

Fortunately, incontinence is not a disease, but a symptom, that can be improved with the proper care. One treatment technique is called prompted voiding and involves the coordination of a patient’s bathroom schedule with a schedule of food and liquid intake. Nurses and dieticians also need to manage the nutrition and fluid intake of their residents. According to Patients’ Rights, the nursing staff is obligated to maintain the hygiene and dignity of your loved one if he or she suffers from incontinence. When proper care is not provided and patients who soil themselves are not changed immediately, incontinence can have serious consequences, such as the development of pressure ulcers. Needless to say, adequate staffing is absolutely necessary in order for treatment to be successfully executed and for hygiene and dignity to be preserved.

According to the study, falls, in particular, were strongly linked to the usage of neuropsychiatric drugs. Because falls are so dangerous, as they can lead to injuries, such as hip fractures and head trauma, and sometimes death, caregivers need to be even more careful with patients who are using neuropsychiatric drugs. This requires communication between the patient’s physician and the nursing staff. Unfortunately, the nursing staff does not always have your loved one’s best interest at heart, so it is important for you to ensure that such communications are taking place and that physician’s orders are being followed.

On the contrary, nurses sometimes use drugs as restraints, in an attempt to prevent falls. Often, antipsychotic drugs are used as chemical restraints to sedate patients. The use of chemical restraints is not only a violation of rights, but is also dangerous, as it puts patients at a higher risk for death. You should check that your loved one’s medications are prescribed for medically sound reasons, and also ensure that your loved one is not being physically restrained either.

Recent Study Identifies Risk Factors that Increase the Chance of Falling in Los Angeles Nursing Homes and Determines that Most Falls are Preventable with Proper Staffing

January 25, 2012 | by Law Offices of Ben Yeroushalmi

Each year, approximately 1.7 falls occur per nursing home bed. Because falls can lead to hip fractures, head trauma, and other injuries that may lead to death, analyzing the causes of falls and establishing prevention techniques is extremely important in assuring that your loved one’s nursing home is promoting the safety and well-being of its residents. With this goal in mind, the Journal of American Medical Directors Association published an editorial titled “Increasing Awareness of Factors Producing Falls: The Mini Falls Assessment” in its February 2012 issue.

The Mini Falls Assessment is a questionnaire that was developed at Saint Louis University. With just seventeen basic question categories, the assessment determines individuals who are at a higher risk of falling. The assessment inquires about polypharmacy, vitamin D use, blood pressure, sitting and standing balance, strength and gait, fear of falling, falls in the past six months, foot deformity, physical ability, weight loss, and frailty. Points are assigned to each question, and each patient is given a score, which, depending upon their answers, can total to thirty. The developers emphasize, however, that the scores are relatively unimportant because an answer of “no” to even just one question already puts the patient at a higher risk for falling.

Of all the risk factors that increase the likelihood of nursing home residents falling, the two that are most preventable are related to diet and exercise. In your search for the ideal nursing home, make sure that the facility not only employs a qualified nursing staff, but that there is also an adequate amount of indirect care staff. During mealtimes, a dietician should always be present. Malnutrition and dehydration can lead to weight loss, fatigue, dizziness, and frail joints and bones. These are all factors that significantly increase the risk of falls in elderly adults. Physical therapists should also be present to guide residents in exercises and activities that will improve their muscle strength. A recent therapy that has proven to be extremely effective is progressive resistance training, in which participants perform exercises against an external, opposing force that increases as the patient’s muscle strength improves.

It is no secret that patients who are susceptible to falls require additional care and assistance from nurses. Recent studies have discovered that elderly adults who reside in nursing homes fall three times more frequently than those who live independently. Inadequate staffing explains this shocking statistic. Many skilled nursing facilities are understaffed and are therefore unable to give each and every individual patient the attention that he or she needs and deserves from a skilled nursing facility. Consequently, residents fall, and even more shocking is the fact that they often are not found until much later, after they have already suffered the pain of their injuries for hours on end. If your loved one has died from a fall-related injury as a direct result of understaffing and nursing home neglect, you may be able to make a Wrongful Death claim.

Sometimes, instead of using fall prevention techniques, understaffed facilities employ the use of physical restraints. This is a direct violation of Patients’ Rights, which state that patients can only be restrained for medical purposes, and even then, they may refuse treatment. You must be cautious, for nurses often justify the use of physical restraints by claiming that they promote the safety of patients, as well as everyone around them. However, physical restraints are actually a direct cause of many health ailments, such as pressure ulcers and incontinence and also lead to a decline in independence and mobility.

Of all liability cases filed against skilled nursing facilities, 60 percent are a result of fall-related injuries. With the proper staffing and a hazard-free environment, the occurrence of falls in nursing homes can be avoided. If your loved one has sustained any fall-related injuries, he or she may likely be a victim of nursing home neglect because such injuries are preventable.

Department of Health and Human Services Now Providing Incentives to Los Angeles Health Agencies in an Attempt to Stop Preventable Injuries

December 17, 2011 | by Law Offices of Ben Yeroushalmi

On December 14, 2011, Modern Healthcare reported that the Department of Health and Human Services is implementing an incentive program to award up to $216 million to health agencies in an attempt to reduce preventable injuries. Despite the honorable intentions of the program, the truth of the matter is that health agencies will now be receiving awards for following procedures that they should have been following all along. A similar problem can be found in nursing homes. Often, skilled nursing facilities are careless in their caretaking processes due to a lack of incentive. Unfortunately, most of the injuries that occur in nursing homes are usually avoidable, but nurses are just too understaffed or unmotivated to take measures to prevent them.

Most injuries in nursing homes occur when patients fall. Common injuries include, but are not limited to, hip fractures and head trauma. Even when elderly adults survive these injuries, they often are unable to make a full recovery. Because one injury has the ability to trigger a gradual decline in the overall health of elderly adults, it is extremely important to take every measure possible to prevent an injury from occurring in the first place. Nursing homes need to create individualized care plans for all their patients, especially those that have conditions that increase their risk of falling. Even more important is that these care plans are carried out by nurses every day.

Unfortunately, it is not rare that these care plans are drafted and then completely disregarded by nurses in their daily caretaking procedures. When nurses are unable to follow care plans, it is usually because they are understaffed and simply do not have the time to provide each patient with the specialized, one-on-one care that they need.

Sometimes, in an attempt to prevent falls, nurses will justify the use of physical restraints. This is, however, a direct violation of Patients’ Rights, which assert that a patient is not to be restrained in any way, except for when medical reasons require it. However, even under these circumstances, patients have the right to refuse treatment. Physical restraints actually incur more harm than they do benefit. In fact, a recent study has confirmed that the use of physical restraints does not decrease the likelihood of falls in nursing homes. However, the use of physical restraints is linked to incontinence, depression, isolation, pressure ulcers, and an overall decline in mobility.

Recent Study Suggests Use of Physical Restraints in Nursing Homes Is Linked to Further Immobility and Dependence of Residents

November 21, 2011 | by Law Offices of Ben Yeroushalmi

The use of physical restraints in nursing homes is a very controversial issue because it presents a situation in which a person’s fundamental rights may be violated and elder abuse may be taking place. According to the Joanna Briggs Institute, a physical restraint is defined as “any device, material or equipment attached to or near a person’s body and which cannot be controlled or easily removed by the person and which deliberately prevents or is deliberately intended to prevent a person’s free body movement to a position of choice and/or a position of person’s normal access to their body.”

Caretakers argue that physical restraints are necessary to maintain the safety of the staff and other residents and are only used on residents who have a high risk of falling, display signs of cognitive decline, or are impaired in their activities of daily living. While some of these reasons may appear to be valid, evidence from past studies have shown that over an extended period of time, restraints actually do not have any effect on the prevention of falls in nursing homes.

There is also evidence that suggests restraint-free nursing homes, on average, do not have an additional amount of staff in comparison to those that use physical restraints. Therefore, the use of physical restraints in some facilities may be a result of a lack of motivation and training on how to properly supervise residents with high risks of falling on the part of the caretakers. This presents issues not only of adequate staffing, but also brings to light issues concerning quality of care.

A recent study in the February 2011 volume of the Journal of the American Geriatrics Society titled “Effectiveness of a Multifactorial Intervention to Reduce Physical Restraints in Nursing Home Residents” took residents from forty-five different nursing homes and examined three hundred and thirty three elderly adults, all of whom were using physical restraints. They divided the residents into two different groups. In the intervention group, the residents were no longer physically restrained, while the control group consisted of those who continued to use physical restraints. The study found that after three months without using physical restraints, the intervention group was more than two times likelier than the control group to permanently be free of restraints. Additionally, the intervention group also experienced a twice as likely chance of reducing their use of physical restraints by 25-75%.

Study Finds that Regular Exercise and A Hazard Free Environment Reduces the Risk of Falls in Nursing Homes

September 17, 2011 | by Law Offices of Ben Yeroushalmi

One of the most serious health risks facing the elderly today are fall related injuries. The National Safety Council estimates that people over the age of 65 have the highest death rate from fall related injuries. In a recent research article entitled “Effectiveness of Intervention Programs in Preventing Falls: A Systematic Review of Recent 10 Years and Meta-Analysis”(available on Pubmed), the authors attempted to derive scientific evidence of the effectiveness of newly developed intervention programs and to make recommendations to health care providers on the subject of fall prevention. According to the meta-sensitivity analysis used in the study, the results revealed that randomized controlled trials of fall-prevention programs conducted within 2000-2009 are effective in overall reduction of fall rates of 9%, with a reduction of fall rates of 10% in multifactorial interventions, and 9% in community settings.

The study suggests that besides implementing intervention programs to prevent falls by the elderly, health care providers can also help reduce the rate of falling by taking various preventative measures. For instance, the care providers can identify individual’s risk factors for falls. Further, the health service providers can implement intervention programs and physical activity focusing on lower-extremity balance and strengthening. They should also beware of psychological factors such as fear of falling and classify injuries which have occurred based on the International Classification of Diseases. The study reveals that nursing homes can actually contribute in fall prevention by taking effective measures for their residents.

Indeed, nursing facilities in San Francisco and San Mateo can help reduce fall rates by removing environmental hazards and taking other proactive measures such as installing lights in bathrooms and corridors as well as avoiding wet and slippery floors. The best way to prevent a fall, according to our experience, is to answer a resident’s call light when the resident signals for help, so that the resident does not attempt to get up unassisted. Prompt response to call lights, of course, requires an adequately staffed facility.

Furthermore, by creating a safer environment, the risk of falls is greatly reduced. In addition to the environmental aspect, there should also be adequate nursing staff in the nursing home to supervise residents and assist them with daily activities and exercise, which can strengthen their muscles and reduce the risk of falls. Simple physical activities such as walking around the common areas and stretching can strengthen muscles and improve the balance of residents, thus lowering the risk of falling. Moreover, some residents who experienced a fall before may become less active since they are lacking in confidence and fear falling again. The nursing staff and their families should show support and encourage them to do some easy exercises in order to avoid this fear mentality.

The Occurrence of Falls in Nursing Homes Can be Reduced With Proper Training, Sufficient Staff, and a Safe Environment

September 16, 2011 | by Law Offices of Ben Yeroushalmi

A recent study published by the Journal of the American Medical Directors Association on fall rates in Bavarian nursing homes provides helpful insight on preventing falls in Los Angeles Nursing Homes. The study showed, for example, that the fall rate of men was higher than that of women (2.18 and 1.49 falls per person-year respectively). Most falls occurred between 10am to 12pm and 2pm to 8pm. 75% of all falls occurred in the residents’ rooms and bathrooms while 22% were observed in common areas. Among all falls, 41% occurred during a transfer and 46% occurred while walking. Residents with less functional limitations have a higher fall rate at night, in the residents’ rooms and while walking. On the other hand, residents who have more functional limitations and need more care have higher falls during the day, in the common area and when being transferred.

Several important conclusions may be drawn from this study, which can assist the public in not only choosing a proper nursing home, but also in properly supervising the care of their loved ones once they are placed in a nursing home. First, residents who need a higher level of care have a greater risk of falling in the common areas since they are brought to the common areas without sufficient nursing staff to supervise and look after their activities. Second, the high fall rate during a transfer highlights the need for professional staff trained and experienced in taking care of residents and particularly trained in assisting with transfers. Third, most of the falls happened in residents’ rooms and bathrooms, which reveals the nursing homes studied were not equipped sufficiently and failed to provide a safe environment to their residents. All these issues reveal the problems plaguing nursing homes despite their legal responsibility to create a safe environment free of hazards and to prevent accidents.

In order to prevent falls, nursing homes must provide adequate staffing. In the state of California, nursing homes are required to provide a minimum of 3.2 nursing hours per patient, per day. Sufficient staffing is essential so that the residents can receive help and care instantly. The nurses also need to communicate efficiently and effectively during shift changes so as to ensure that residents are not neglected. Further, nursing homes should provide professional and well-trained nurses to their residents. Nurses should receive specific training on subjects such as assisting with a transfer and fall prevention. A skillful and experienced nursing staff that is provided with the necessary resources and training could definitely help reduce fall rates in nursing homes. In addition to the nursing staff, the nursing homes’ owner should also improve the physical plant by adding sufficient handrails and skid-proof mats to prevent the risk of falling, and ridding the facility of unnecessary safety hazards.