In order to minimise falls in the home, it is important for healthcare staff to provide appropriate education to vulnerable clients and implement falls-prevention strategies in the home where possible (Roo, Johnston & Petersen 2015).
Most falls occur due to a combination of both intrinsic (personal) and extrinsic (environmental) factors. The more risk factors that are present, the more likely the person is to fall (Clay, Yap & Melder 2018). Some common risk factors include:
Intrinsic risk factors
Extrinsic risk factors
Prior history of falls
Acute or chronic illness
Delirium, disorientation or confusion
Use of mobility assistance
Fear of falling
Bathroom location and accessibility
Cords and tubing
Time of day
(Clay, Yap & Melder 2018; ACSQHC 2009; Canadian Patient Safety Institute 2015)
Older Adults and Falls
Changes to the body due to the normal ageing process can worsen existing risk factors or cause new ones to arise. Inadequate physical fitness, nutrition or hydration, and illnesses or other conditions may compound this risk further (Healthdirect 2020).
Older adults are 12 times more likely to fall than have a motor vehicle or pedestrian accident (Better Health Channel 2016). Falls are the biggest cause of unintentional injury in older adults over 65, accounting for about 75% of injury-related hospitalisations (Healthdirect 2020; Roo, Johnston & Petersen 2015).
Overall, about one-third of older adults fall every year, with one in five of these incidents resulting in hospitalisation (Healthdirect 2020).
Risk factors associated with age include:
Balance issues and unsteadiness;
Muscle weakness and joint stiffness;
Medication side effects;
Slower reaction time;
New health problems (e.g. incontinence or dementia).
(Healthdirect 2020; Better Health Channel 2016)
Consequences of Falling
Even in cases where an injury does not occur, the person may develop a fear of falling that reduces their confidence and independence. This, in turn, only increases their risk of falling again in the future, as reduced physical activity can lead to poor balance, muscle weakness and stiff joints (Rubenstein 2019; Healthdirect 2020).
Falls can lead to a variety of physical, emotional, social, short-term and long-term consequences including:
Bruises, sprained ligaments, strained muscles and other minor injuries;
Hip fracture (the most common injury caused by falls);
Loss of consciousness;
Loss of confidence and independence;
Stiff joints and weak muscles due to lack of activity;
Increased risk of future falls;
Admission into an aged care or assisted living facility; and
(Rubenstein 2019; Better Health Channel 2016; Healthdirect 2020)
Minimising Falls in the Home
About two-thirds of falls occur inside the home, most commonly in outdoor areas, bathrooms, bedrooms and kitchens. Falls are more likely to occur while the person is mobilising, for example, getting out of bed, going to the toilet or using a staircase (Rubenstein 2019; Stathakis, Gray & Berecki-Gisolf 2015).
Managing falls risk requires a multifactorial approach that addresses the person’s modifiable risk factors (Clay, Yap & Melder 2018).
Using a validated falls risk assessment tool, vulnerable clients should be identified and appropriate interventions should be put into place. It is likely that multiple solutions will need to be implemented in order to target several individual risk factors (Clay, Yap & Melder 2018).
The following strategies may help clients minimise different risk factors around the home:
Ensure lighting is adequate and switched on
Turn on hallway lights at night
Reduce glare with curtains or blinds
Implement nightlights or motion-activated lights
Ensure light switches are easily accessible
Change lights if they are not bright enough
Use non-slip mats in wet areas (e.g. bathroom, kitchen)
Implement non-slip flooring
Implement handrails, seats or handheld nozzles in the shower and bath
Place non-skid tape on the edges of steps and stairs
Ensure footwear is firm, non-slip and properly-fitting
Keep floors dry
Clean any spills immediately
Ensure walkways are free from clutter
Remove or tape down electrical cords
Mark changes in the floor level with a bright colour
Secure mats and rugs with adhesive strips; remove any that are torn or wrinkled
Ensure tables and benches do not have sharp corners
Ensure clothing does not touch the ground (e.g. dressing gown)
Ensure beds and chairs are sturdy, appropriate height and easy to get in and out of
Keep frequently-used items between waist and eye level
Repair damaged floorboards or carpeting
Remove debris from outdoor walkways (e.g. moss, slime, leaves)
Refrain from using ladders
Mark steps so that they are easy to see
Implement handrails next to steps
Repair broken, cracked or uneven walking surfaces
Wear sunglasses and hats to avoid sun glare
Ensure adequate nutrition and hydration
Maintain oral hygiene (e.g. well-fitted dentures)
Exercise to improve strength, balance and flexibility
Stay physically active
Manage acute and chronic conditions
Undergo regular eye checks
Visit the podiatrist regularly
Maintain Vitamin D levels
Manage cognitive impairment
Ensure toileting is safe and regular
Ensure regular mobilising
Ensure personal belongings such as glasses are in reach
Ensure sensory aids are worn and are suitable
(Healthdirect 2020; Better Health Channel 2016; Canadian Patient Safety Institute 2015; Rubenstein 2019; Mayo Clinic 2019)
Managing Falls in the Home
Clients should be informed about what to do if they are alone when a fall occurs. Remaining on the floor for a long period of time can be highly distressing and lead to complications such as:
Appropriate education should advise the client on how to get up on their own or call for help. Knowing how to manage a fall may also help to reduce fear of falling, as the client will be more confident in their ability to cope with a fall situation (Rubenstein 2019).
The specific advice given should be based on the client’s physical capacity.
Clients who can Independently Mobilise
The client should be advised to:
Roll onto their stomach and get into a crawling position.
Crawl to a stable piece of furniture (e.g. lounge chair).
Try to get onto their knees.
Hold onto the furniture and push upwards.
Sit down on the furniture.
(Better Health Channel 2016)
Clients who are Physically Impaired
The client should be advised to:
Crawl to a carpeted area and use clothes, a towel or anything else in reach to keep warm.
Use their personal alarm, if they have one.
Use a nearby object to make a loud noise to alert a neighbour (if they do not have a personal alarm).
Keep warm and try to get up again later if they know nobody will hear them.
(Better Health Channel 2016)
Falls in the home can result in functional decline, reduced quality of life, loss of independence and in severe cases, even death (Rubenstein 2019).
Addressing and managing potential risk factors in the home is essential in preventing falls and their associated complications, and ensuring clients are able to maintain their confidence and independence.