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Understanding the Nursing Diagnosis for the Risk of Falls in the Elderly

Thursday, July 2, 2020

Older adults are at an increased risk of falls due to a wide variety of age-related factors. According to the Center for Disease Control and Prevention (CDC), one out of four seniors above the age of 65 falls each year.


Seniors are also more likely to sustain severe injuries and complications after a fall. Each year more than 3 million older adults are treated in the emergency room because of falling injuries.


If you have an elderly parent or loved one, you might be worried about their safety, and you’re wondering how you can help them reduce their risk of falls.


In this article, we’ll discuss how to assess your family member’s risk of falling through a nursing diagnosis.


We’ll talk about how to lower their chances of getting injured because of a fall. We’ll also discuss what to do if your family member suffers a fall.


What is a nursing diagnosis for the risk of falls?


The North American Nursing Diagnosis Association (NANDA), also known as NANDA International (NANDA-I), is the primary organization when it comes to defining standardized nursing diagnoses for various risks and ailments, and distributing them to nurses and nursing homes around the world. 


For the risk of falling, NANDA has an approved diagnosis procedure that will help a nurse determine whether your family member is at an increased risk of falling. If their score falls in the risk range, then there are recommended nursing interventions available to minimize the risk.


We’ll also discuss various ways to prevent and lower the risk of falls for your elderly loved ones in this article.


Why use a nursing diagnosis for the risk of falls?


You’re most likely already aware of the potential dangers of a fall, but let’s take a quick look at why it is vital that you assess your family members' risk level.


According to the CDC, falls are one of the leading causes of severe injury, and even death, among seniors above the age of 65. 


A fall can lead to various injuries like the following.


  • Fractures (hip, arm, spine, wrist)
  • Muscle injury
  • Traumatic brain injury (TBI)


A head injury from a fall can be very serious, especially if an older adult is on specific medications. If your loved one hits their head from a fall, be sure to notify their doctor immediately. 


For the elderly, an injury from a fall could mean longer hospitalization than younger adults. They might also experience anxiety about future falls after the first time, which could restrict their movement and affect their quality of life.


Many falls do not result in severe injuries, but they can still have a negative effect. After one fall, one might become more apprehensive of exercise, which could decrease muscle strength and mass and increase the risk of another fall.

How does a nursing diagnosis work for the risk of falls?


When assessing someone’s risk of falls, it is vital to consider a variety of factors about the individual and their environment. For example, if they have a history of previous falls, or if they live in an environment that makes it more likely that they can slip or stumble on objects, etc.


The assessment methods must have been approved by research or by associations like NANDA, as we mentioned above. 


We should also note that a falls risk assessment shouldn’t be a one-time event. The tests should be done periodically, ss your loved one’s health conditions change, or at a specific date every year. Your medical provider will be able to recommend how often you should do a test based on your family members' current cognitive and physical conditions.


Here are some of the factors that the nurse or the medical professional will take into consideration when conducting the assessment.


History of falls - The nurse will ask about your loved one’s history of previous falls, if any. Someone who has suffered a fall in the past 6 months is more likely to fall again.


Cognitive status - Impaired brain function can contribute to an increased risk of falls. The assessment will take into account cognitive impairments, if any. They may check reaction times to see if quick reflexes can protect against a fall.


Age-related musculoskeletal changes - Older adults who have weaker muscles and bones due to aging and lack of adequate exercise are at a higher risk of falling. The nurse may test strength, balance, as well as check for any gait, altered depth perception, etc.


Impaired vision and hearing - If one has impaired vision and hearing, it might limit their ability to identify dangers in the environment, increasing the risk of falls. 


Proper usage of mobility assistance devices - The nurse may check that your loved one is using their mobility devices correctly. Whether it's a cane, walker, or wheelchair, improper use can lead to an increased risk of injury.


Underlying medical conditions - Certain diseases can cause complications such as dizziness, improper blood circulation, weakness, brain fog, all of which could increase one’s risk of falling. 


Medications - If your loved one is currently on any medications, be sure to make a complete list before the assessment. Specific drugs can affect balance, blood circulation, and more, which could impact risk levels.


Improper clothing - Clothing, like pants or shoes that don’t fit correctly, can also cause issues with movement and increase the risk of falling.


Environmental factors - The risk of falls can be higher in unfamiliar environments. If your loved one has moved to a new home or an assisted living facility, and the living space isn’t set up correctly, there can be an additional risk of an accident. Also, inadequate lighting, too much clutter, and wet surfaces should be avoided.

The Morse Falls Test


The Morse Falls Test (MFS) is another standardized test often used by nurses and practitioners. The MFS might be conducted if your family member is admitted to a nursing home or living facility, or if there is a change of status in their health.


The MFS assigns scores based on different criteria, like the previous history of falling, the use of mobility devices, the presence of gait or balance issues, and cognitive impairments.


The total score will determine whether one needs any intervention to prevent the risk of falling and to what degree.

What precautions should you take with a patient that is a fall risk?


In this section, we’ll list some of the potential nursing interventions that could lower the risk of falling. 


These measures are applicable only if one is living in a nursing home or a long term care facility. If your family member is living at home, we’ll discuss steps to prevent falling later in the article.


Also, these are some examples of what the care facility might implement to lower the chances of a fall. Your medical provider will recommend specific measures based on your family member’s individual needs.


Wristbands - Wristbands, or other signs that a patient is at risk of falling, can alert care providers around the facility and draw extra attention to prevent a falling incident.


Proximity to nurses - For patients who are at a higher risk of falling, it is best to place them in rooms closer to the nurses’ stations. In the event they need assistance, they’re more likely to get quick help if they are closer to the nurses.


Mindful items placement - When setting up the room, identify objects that are used frequently, and place them in close to the patient. This would prevent too much unnecessary movement by the patient without assistance and lower their risk of falling.


Lower beds - Keeping the bed as low as possible means that the patient has to apply less effort to get in and out of bed. It also means a smaller range of motion. These factors could make movement more comfortable and lower the risk of injury.


Rails on the bed - Rails on the bed can prevent falling off the bed. But at least one of the rails, preferably the one at the bottom of the bed should be left down to let the patient quickly get out of bed if needed.


Adequate lighting - If there’s sufficient lighting in the room, one is less likely to trip over or bump into objects. Make sure the light switch is easily accessible from the bed so that the senior person can use it if he or she has to get up at night. 


Proper footwear - The nursing facility might provide shoes with a better grip, so it doesn’t slip on the floor. It should also fit well for comfortable and secure walking. 


Familiarize room layout - If the patient has cognitive impairments, and if they are moving into a new facility, extra care should be given to make sure that they become familiar with the environment.

Other methods to evaluate the risk of falls for seniors


Falls can happen to anyone at any age. But since the elderly are at a higher risk of severe injuries, it is a good idea to evaluate their risk levels periodically.


But how do you know if your parent or loved one is at a higher risk of falling?


The first thing to look out for is changes in their movement or attitude. Are they walking slower than they used to? Do you see them struggling a bit when getting up from a chair or the bed? Are they more reluctant to go out than usual?


If you notice significant changes in their behavior, then you should talk to them about if something is bothering them.


But beyond your general impression, you should consider your family member’s overall fitness levels.


Fitness and the risk of falls


The higher the overall fitness level, the lower the risk of falls. Not only is the risk of falling lower, but so is the chance of severe injuries and complications.


If you know that your older family member has been working out for a long time, it is more likely that they have a better balance due to a stronger core, which would reduce their risk of falling. They most likely also have stronger bones, which means they’ll be better able to withstand the impact and avoid severe injury.


Another thing to consider is their diet. If they’ve been eating a diet rich in vegetables, fruits, lean proteins, then they’re also more likely to have healthier bones. 


But it’s never too late, and we’ll talk more about how to lower the risk of injuries from a fall later in the article.


But first, let’s take a look at how you can measure your family member’s fitness level when it comes to the risk of falling.


The elderly mobility scale (EMS) and the risk of falling


The elderly mobility scale (EMS) is a standardized test used by health professionals, like physiotherapists, to assess the level of mobility in older adults. 


The EMS test involves going through the different activities measuring the time and difficulty level for each task.


Here are the different mobility tests used to calculate the EMS score.


  • If one needs help to go from a lying position to a sitting position
  • If one needs help to go from a sitting position to a lying position
  • How much time and/or assistance is required to go from sitting to standing
  • The ability to stand with or without support
  • The presence of gait (balance issues) during walking
  • Timed walk for 6 meters
  • Functional reach (ability to reach something while standing in place)


When the test is done, you will get a total score, and it would provide you with an assessment of the overall mobility level. You can use this score to make further necessary decisions.


The EMS score will range between 0 and 20, 20 being the best possible score.


A higher score means that your family member has good strength and balance, and is not at a significant risk of falling and getting injured.


A lower score means that they might need to improve their fitness, or maybe even hire a home caregiver.


For more details, including specific recommended action steps based on score, be sure to check out our in-depth guide on the elderly mobility scale (EMS)


Who is at a higher risk of injury from falling?


We mentioned some of the risk factors in the nursing assessment section above, like history of falls, vision problems, cognitive impairments, and others. 


But your loved one might be living at home, without any significant difficulties that make it seem likely that they’re at a higher risk of falling.


But if your family member is 65+ years old, there are other risk factors to keep in mind that could also increase their chances of injury from a fall.


Lower body weakness


According to a study published in the Annals of Rehabilitation Medicine, there’s evidence to suggest a link between decreased lower body strength and an increased risk of falling in the elderly. 


We lose muscle strength and mass naturally as we age, and it can contribute to decreased balance. According to the study, the “standing up from a chair” test (also included in the EMS test) is an excellent way to measure lower body strength in older adults.



Vitamin D deficiency


Vitamin D is essential for good health for many reasons. But the deficiency in vitamin D can also increase one’s risk of falling.


Deficiency in vitamin D can contribute to impaired muscle function because vitamin D plays a role in distributing dietary calcium to the muscle. Calcium is necessary for muscle contraction. 


So, inadequate vitamin D potentially means weakened muscles, which can contribute to injuries from falling, as well as other factors. 


Calcium and vitamin D also helps maintain healthy bones, and deficiency can lead to bone health issues like osteoporosis, as well as a higher risk of rheumatoid arthritis. 


In an overview of available studies published in the Journal of NeuroEngineering and Rehabilitation, the authors concluded that vitamin D supplementation should be a part of fall prevention strategies for older adults.


If possible, you should also encourage your elderly family member to get sunlight daily to get vitamin D from the sun.


Bone health conditions


It’s not only vitamin D deficiency that can cause bone health issues. Osteoporosis can have a variety of other causes, like genetics, hormonal factors, low dietary calcium intake, among others.


Regardless of the reasons for osteoporosis, it can increase the risk of injury, both from falling, as well as other factors. 


According to a Finnish study, improving bone mass and structure is an essential element of preventing severe injuries from falls in the elderly. They also recommend improving lance, strength, mobility, and overall fitness.


Gait disorders


A gait is someone’s pattern of walking. Walking is something most of us don’t pay much attention to. But there’s a lot of coordination happening between the muscles to move us forward in a rhythm.


When someone has abnormalities in their pattern of walking, they have a gait disorder. The cause can be a wide variety of factors, including arthritis, cognitive conditions, inner ear conditions affecting balance, or even ill-fitting shoes.


Older adults are typically at a higher risk of gait issues due to weakened muscles, and loss in coordination. Unfortunately, a gait disorder can also increase their risk of falling. 


Keep an eye out for any changes in the pace or pattern of your family member’s walking. If you identify noticeable changes, notify their care provider as soon as possible. 


What can you do to help patients lower their fall risk?


Most older adults suffer falls due to a combination of risk factors. It is vital that their medical providers periodically assess their risk of falling so that they can take precautions on time.


Let’s take a look at some of the things your family member can do to maintain overall health, lower their risk of falling, and improve quality of life.


Strength training 


As we’ve discussed, one of the primary risk factors of falling in older adults is weakened muscles and bones. The best way to improve bone health, as well as increase muscle mass and strength is through resistance training.


But for older adults, injury from exercise is always a concern, especially if they haven’t been working out till now.


To get started, it might be best to make an appointment with a physical therapist who can recommend safe exercises. Or, you can hire a personal trainer, but make sure he or she has experience training older adults.


You can also check with your local senior center to see if they offer exercise classes geared for the elderly. 


Yoga 


Yoga has a variety of benefits for the elderly, like reducing stress, improving cardiovascular health, and more.


When it comes to preventing falls, yoga can be of great benefit as well. 


Yoga improves core strength, which means that your loved one will be less likely to fall in case of bumping into another person or object. Yoga also improves balance and mobility, which can help (or prevent) with any gait disorders. 


Find a yoga studio in your area, and check with them to make sure they have classes that are suitable for seniors, especially if this is the first time doing yoga.


A combination of a strength training routine and yoga is ideal for lowering the risk of falls because it will increase strength and muscle mass, as well as balance and mobility. 


Eat a nutritious diet


A diet rich in calcium, vitamin K, magnesium, and other nutrients will promote healthy bones, muscle function, as well as restful sleep.


To ensure a nutritious diet, help your loved one cut back on junk food consumption, and increase healthy foods like fruits, and a wide variety of vegetables. Help them get leafy greens like spinach, cruciferous vegetables like broccoli and kale, roots like beets and carrots, or anything else they prefer.


For calcium, your family member can consume dairy, or take a supplement, depending on what their doctor recommends. 


Sleep well


Adequate restful sleep will prevent weakness and fatigue during the day, which can be risk factors for falls.


If your loved one follows the recommendations of exercise and proper nutrition, they will likely find it easy to fall asleep.


The other aspect of good sleep is to reduce stress. They can try to go on walks, spend time with loved ones, get a pet, or try mindfulness practices like meditation, to reduce stress.


What should you do after a patient falls?


If your elderly family member suffers a fall, do not assume that no injury has occurred, even if one isn’t apparent.


Take them to a medical facility as soon as possible so they can run a quick assessment to rule out any complications from a fall.


If your loved one lives by themselves, make sure they have access to a device so that, in case of a fall, they can either notify you, their caregiver, or their doctor.

What precautions should you take with a patient that is a fall risk?


If the nursing assessment test finds that your family member is at risk of falling, the first thing you should do is to adjust their environment in a way that makes falling less likely.


Your provider will recommend specific steps, as some of the ones we mentioned here in this article (better lighting, well-fitting shoes, familiar environment, etc.)


You can consider hiring a home care provider to help your loved one with tasks of daily living such as grooming, cleaning, meal prep, shopping, and more. 


Having someone around will also provide an extra layer of security and further lower the risk of a fall.


If you live in New York, the state Medicaid program allows you to hire friends and family members as caregivers through a program called CDPAP. For more information, including eligibility requirements and how to apply, check out our CDPAP page.


Final thoughts on the risk of falling for the elderly


As we age, it is natural that our muscles and bones get weaker. Unfortunately, it also means that we are at a higher risk of injuries, either due to falling or from other factors.


Falling can have severe consequences for the elderly. It can lead to prolonged hospitalizations, decreased mobility, and a lower quality of life.


But the good news is that you can take steps to prevent and lower the risk of your loved one suffering a fall-related injury.


If they are above the age of 65, or if you notice significant changes in their movement, schedule an assessment for the risk of falling with your family medical provider. 


If it turns out that the risk of falling is high, your provider will recommend interventions to prevent a fall. Otherwise, help them follow some of the steps recommended in this article to stay fit and healthy like exercising, eating a nutritious diet, and sleeping well.


And if your loved one needs home care to ensure their safety from falling, and you live in NY, be sure to check out CDPAP to see if you can hire a friend or family member as a caregiver.

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