Falls assessment and prevention in the nursing home and community

Care home residents are three times more likely to fall than their community-dwelling peers and as a result, are 10 times more likely to sustain a significant injury (Department of Health (DoH), 2009; Cooper, 2017). One in three people over the age of 65 years, and one in two over the age of 85 years fall every year (World Health Organization (WHO), 2008; Craig, Murray, Mitchell, Clark, Saunders, Burleigh; 2013; Cooper, 2017;). Some 40% of care home admissions are falls-related and unfortunately, there is a culture and belief that falls are inevitable, and maintaining safety can result in the restriction of mobility (WHO, 2008; Cooper, 2017; Almeida et al, 2019).

The care home population is rising and notwithstanding the growing impact on unscheduled care. Falls also lead to pain, fear, loss of independence, a poorer quality of life and can ultimately contribute to death (Cooper, 2017; Almeida et al, 2019). As discussed above, there are multiple consequences of a fall, but we could divide these into two main categories: physical and psychological. In the physical consequences, we can understand immobility, incontinence, cuts, bruises, soft tissue injuries, fractures, respiratory infections, head injuries, dislocations, pressure injuries, dehydration, hypothermia and death (Care Inspectorate and NHS Scotland, 2016; Cooper, 2017). In the psychological consequences, we could discuss having feelings of uselessness, increased dependency, emotional stress, loss of control, social isolation/withdrawal, fear of further falls, low self-esteem, embarrassment, anxiety/depression, loss of confidence and carer stress (Care Inspectorate and NHS Scotland, 2016; Cooper, 2017; Almeida et al, 2019). There is a vicious cycle in the phenomena of falls (Figure 1).