While management depends on the underlying etiology of the fall, some generally acceptable practices are effective:
- Maintain a safe physical environment. Making sure spills are cleaned up quickly and walkways are kept free of obstruction is as important as maintaining adequate lighting in all areas where older adults will walk;
- Avoid use of restraints. Though restraints are often employed to prevent falls, they have not proved effective in medical trials. It has been demonstrated that their use increases the injury associated with falls, and several restraint-reduction projects have demonstrated that restraints can be removed without a significant increase in falls or injuries;
- Deal with medication side effects. The side effects of CNS altering drugs, and drugs affecting postural blood pressure, balance, and gait should be expected and addressed. Polypharmacy should be minimized;
- Watch patients closely. High risk patients should be positioned by the nursing station so that their visibility to the staff is maximized; and
- Promote mobility. There has been considerable research demonstrating the positive effect of exercise on reducing fall risk among community-residing older adults. While no study to date has addressed the impact of exercise in the hospital-based community, improved balance, mobility, and flexibility have been documented in nursing home residents receiving aggressive physical therapy. TH
Dr. Landis is a frequent contributor to The Hospitalist.
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