FALLS AND FALL PREVENTION IN THE NURSING-HOME

The mean incidence of falls in nursing homes is 1.5 falls per bed per year (range 0.2-3.6). The most common precipitating causes include gai t and balance disorders, weakness, dizziness, environmental hazards, c onfusion, Visual impairment, and postural hypotension. The most import ant underlying risk factors for falls and injuries include some of the se same items as well as others: leg weakness, gait and balance instab ility, poor vision, cognitive and functional impairment, and sedating and psychoactive medications. A focused history and physical examinati on after a fall can usually determine the immediate underlying cause(s ) of the fail and contributory risk factors. Many strategies for fall prevention have been tried with mixed success. The most successful tak e into account the multifactorial causes of falls, and include interve ntions to improve strength and functional status, reduce environmental hazards, and allow staff to identify and monitor high-risk residents. Regular evaluations in the nursing home can help identify patients at high risk who can then be targeted for specific treatment and prevent ion strategies. Strategies that reduce mobility through use of restrai nts have been shown to be more harmful than beneficial and should be a voided. A number of promising fall prevention strategies, involving bo th specific quality assurance programs and technologic devices, are be ing evaluated currrently.