FALLS IN THE NURSING-HOME

Objective: To review the epidemiology and causes of falls and fall-rel ated injuries in nursing homes and to provide clinicians with a struct ured framework to evaluate and treat nursing home residents at risk fo r falls. Data Sources: All large-scale published studies documenting i ncidence, causes, risk factors, and preventive strategies for falls in nursing homes were reviewed. Results: The mean incidence of falls in nursing homes is 1.5 falls per bed per year (range, 0.2 to 3.6 falls). The most common precipitating causes include gait and balance disorde rs, weakness, dizziness, environmental hazards, confusion, visual impa irment, and postural hypotension. The most important underlying risk f actors for falls and injuries include some of these same items and oth ers, such as lower-extremity weakness, gait and balance instability, p oor vision, cognitive and functional impairment, and sedating and psyc hoactive medications. Many strategies for the prevention of falls have been tried, with mixed success. The most successful consider the mult ifactorial causes of falls and include interventions to improve streng th and functional status, reduce environmental hazards, and allow staf f to identify and monitor high-risk residents. Strategies that reduce mobility through use of restraints have been shown to be more harmful than beneficial and should be avoided. Conclusions: A focused history and physical examination after a fall can usually determine both the i mmediate underlying causes of the fall and contributing risk factors. In addition, regular evaluations in the nursing home can help identify patients at high risk who can then be targeted for specific treatment and prevention strategies.