“Prevent residents from falling” is one of the National Patient Safety Goals for long-term care centers. Client falls in long-term care centers, hospitals, or homes are very common and can cause serious injury and death. Older adults have the highest risk of falling. Each year, three million older people are treated in emergency departments for fall injuries, and over 800,000 are hospitalized because of a head injury or hip fracture resulting from a fall. Many older adults who fall, even if they’re not injured, become afraid of falling. This fear may cause them to limit their everyday activities. When a person is less active, they become weaker, which further increases their chances of falling.^[1]

Many conditions increase an individual’s risk for falls, including the following^[2]:

• Lower body weakness
• Vitamin D deficiency
• Difficulties with walking and balance
• Medications, such as tranquilizers, sedatives, antihypertensives, or antidepressants
• Vision problems
• Foot pain or poor footwear
• Environmental hazards, such as throw rugs or clutter that can cause tripping

Most falls are caused by a combination of risk factors. The more risk factors a person has, the greater their chances of falling. Many risk factors can be changed or modified to help prevent falls.^[3] The best way to prevent falls is to follow these guidelines:

• Keep residents as strong and mobile as possible
• Utilize the interventions described in the “Assisting With Sensory Deficits” section of this chapter to address any sensory impairments
• Use proper transfer techniques as outlined in Chapter 8.4
• Report any weakness, confusion, or change in condition
• Encourage fluid and nutritional intake to prevent dizziness and promote strength

Residents are assessed for their potential fall risk by the nursing staff or therapists when they are admitted to a facility, at regular intervals during their stay, and any time there is a change in their condition or when certain medications are ordered. Nursing assistants do not perform this assessment but should be aware of factors that can increase fall risk.