Thursday, February 20, 2020

Intervention Series: Mom is Falling - what you can do


Ninety percent of the more than 352,000 hip fractures in the U.S. each year are the result of a fall. The remaining 10 percent of the hip fractures occur spontaneously due to low bone density or osteoporosis. Spontaneous fractures can then precipitate the fall. Women have two to three times as many hip fractures as men, and white post menopausal women have a 1 in 7 chance of a hip fracture during their lifetime.  The hip fracture rate increases at age 50, doubling every five to six years. More than one-third of adults ages 65 years and older fall each year.

Alternatives for Falls Intervention:

Physical Measures:  Using a recliner or rocking chairs, seating adaptations such as wedge cushion, lowering bed or removing of bedframe to put mattress on the floor, commode/urinal at bedside, assistive devices such as quad canes and walkers, review of current medications that may destabilize gait and balance (benzodiazapines), call bell within reach, monitor blood sugar and oxygen levels, check for presence of infections (URI or UTI), consider medications for pain relief, anti-tippers for wheelchairs, self -releasing Velcro lap belt, fall mats at bedside, orthostatic BP & P monitoring, place in high visibility areas. Discuss with physician discontinuing or decreasing doses of medications associated with cognition changes, hypnotic or sedative effects (sleeping medications), bradycardia, hypotensive episodes, or sensory changes.
Environmental Measures: anti-rollback device to wheelchair, remove wheelchair foot supports when not in transport, remove visual barriers, cleat pathways, remove clutter that can fall and pose a hazard (magazines are very slippery on the floor), brakes on beds, bed in low position, repositioning for comfort, personal items within reach, assess seating, brake extenders for wheelchair, walker/cane tips in good condition, room closer to nurses station, assess sidrail use, bed/chair tabs alarms, pressure sensor alarm, reminder signs, non-skid strips on floor, remove wheels from overbed tables, consider motion detection night lights to illuminate pathway to bathroom, non-skid socks while in bed, properly fitting footwear and non-skid shoes, clothing that does not interfere or restrict movement, toileting schedule, room monitor, storage pocket for walker/wheelchair.
Psychosocial Measures: Active listening, behavioural strategies, sensory stimulation, increased surveillance, mental health evaluation.
Activity Measures: Structured daily routines, physical exercises, evening exercises, buddy system to monitor, PO/OT screening, music therapy, restorative ambulation, frequent toileting post-opioid pain medication and constipation relief measures.

The Morse Fall Scale (MFS) is a rapid and simple method of assessing a patient’s likelihood of falling. A large majority of nurses (82.9%) rate the scale as “quick and easy to use,” and 54% estimated that it took less than 3 minutes to rate a patient. It consists of six variables that are quick and easy to score, and it has been shown to have predictive validity and interrater reliability. The MFS is used widely in acute care settings, both in the hospital and long term care inpatient settings. Conduct your own falls assessment: http://networkofcare.org/library/Morse%20Fall%20Scale.pdf

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