While falls are a common cause of injury, particularly in older, hospitalized patients, some falls may not be as preventable as once thought. According to a new literature review published in the Journal of the American Academy of Orthopaedic Surgeons, many of the risks that frequently cause falls are not adequately addressed with the fall prevention initiatives used in health care facilities.
Falls are the leading cause of fatal and nonfatal injuries to older people in the United States. Each year, more than 11 million people older than 65 years of age fall—one in three senior citizens.
In hospitals, approximately 3% to 20% of inpatients fall at least once during their stay. These falls are considered preventable by the Centers for Medicare & Medicaid Services and, therefore, health care facilities are held accountable for the costs of treating any resulting injuries. However, in this literature review, the authors found that hospitals may not be able to prevent most falls, as many risk factors are not under the caregivers’ direct control.
For example, one study examined in the review found that comprehensive fall prevention programs, including patient education, vision assessments and walking aids did not reduce the incidence of falls for patients undergoing a typical inpatient hospital stay (median of 7 days). Such strategies are more effective in long-term care (i.e., 20 days or 30 days) or carefully managed home care settings.
“Of course, hospitals should educate patients and the families, use bed rails, keep beds low, keep floors dry and clear of clutter — all the common sense things that can reduce the risk of falls,” Terry A. Clyburn, MD, orthopaedic surgeon, University of Texas Medical School at Houston and co-author of the literature review, stated in a press release. “But we found no proof that falls in hospitals are, in fact, preventable. And if not, they should not be categorized as a preventable occurrence and the burden should not be borne by hospitals.”
The methods currently used by health care settings to reduce falls are either less harmful or do not increase risk and may be safely continued. Many patients who suffer falls in the hospital have internal risk factors, other conditions, or disabilities that increase their likelihood of falling, such as diabetes, Parkinson’s disease, osteoporosis or arthritis, history of stroke, vision or hearing problems, malnutrition, dizziness and vertigo, incontinence and the use of medications that can alter a person’s mental status. Medication for internal medical risk factors may be modified to reduce falls, but evidence suggests there is no conclusive difference in the number of falls during typical, shorter length hospital stays at institutions with or without multifaceted falls prevention programs.