Why Do Seniors Fall in Nursing Homes?

A sign that reads 'why do seniors fall in nursing homes?'.

According to the Agency for Health Care Administration, there are 691 licensed nursing homes in Florida, representing approximately 84,448 beds.   Often, residents will fall resulting in catastrophic or life-ending injuries.  So how does this happen?

In nursing homes, common occurrences such as falling out of bed or a chair, losing your footing on a slick surface, or other slips, trips, and falls can have profound consequences. For the senior population residing in nursing homes, a fall may have severe implications. Among nursing home residents, falls that lead to fractured bones are frequent and distressing.  For seniors, such injuries often initiate a sequence of escalating health issues and can ultimately result in death if protective measures are not taken. [i]

Falls: The Startling Numbers

The National Institute on Aging reports that more than one in four people aged 65 years or older fall each year. [ii] In fact, more than one out of four “older people” falls each year, but less than half tell their doctors.[iii] Falling just once doubles the chances of falling again, and these are not just tumbles—the consequences frequently involve serious injuries like head traumas or hip fractures.

Even more alarmingly, the National Center for Injury Prevention and Control reports that unintentional falls are the #1 leading cause of nonfatal injury ER visits across all age groups. [iv]

The Center for Disease Control and Prevention provides additional alarming statistics, including: [v]

  • One out of five falls causes a serious injury such as broken bones or a head injury.
  • Each year, 3 million older people are treated in emergency departments for fall injuries.
  • Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.
  • Each year at least 300,000 older people are hospitalized for hip fractures. More than 95% of hip fractures are caused by falling; usually by falling sideways.
  • Falls are the most common cause of traumatic brain injuries (TBI)

Common Causes of Falls

Certain factors and health conditions, such as Dementia, recent surgeries, medications, prior injuries, or over-confidence in mobility increase fall risks. Dementia has been linked to an increased risk of falls. Several studies have shown that people living with dementia or cognitive impairment have a 2- to 8 times higher risk of falls compared with those with normal cognition.[vi] After developing dementia, older adults experience more cognitive and functional decline, can develop activity disturbances (such as wandering), take on a more sedentary lifestyle, and feel more loss, denial, anger, and apathy. Such changes may have an impact on physical and mental health and could influence the subsequent occurrence of falls.

Here are some of the more common causes of these falls:

  • Medication Side Effects: Medication to manage pain or health conditions is essential, but some medications can lead to side effects such as dizziness or disorientation, compromising balance and increasing the risk of falls.
  • Physical and Muscular Weakness: nursing home residents may face periods of inactivity, resulting in muscle atrophy and general physical weakness, making it harder to maintain their balance or move confidently.
  • Impact of Anesthesia: After surgery, anesthesia can linger in a patient’s system long after they wake up, causing issues with coordination and cognitive functions, and contributing to a higher likelihood of falls.
  • Pain-Induced Movement Alterations: Pain can alter the way people move, affecting gait and posture, which can destabilize an individual and lead to potential falls.
  • Cognitive Changes: For some, especially the elderly or those with existing cognitive issues, certain medications can induce or exacerbate delirium or confusion, increasing the fall risk.
  • New Assistive Devices: As a result of prior injuries or recent surgery, patients may need to use crutches or walkers. Unfamiliarity with these devices can lead to improper use and falls if not adequately guided.
  • Psychological Factors: Anxiety about falling or fear of pain upon movement can lead patients to hesitate or become overly cautious, ironically making falls more likely.

A Look at Long-Term Care Facilities: Beyond Beds and Meals

The term “long-term care facility” spans a diverse array of residential options, from nursing homes and assisted living facilities to adult family-care homes. More than just a place to live, these facilities are tasked by the Legislature with upholding the dignity and independence of all residents.[vii] This includes safeguarding the rights to civil and religious liberties, private communication, and personal decision-making. Residents also have the right to be informed about their medical conditions and treatments and to refuse them if they choose. These rights, protected under Florida law, are fundamental, ensuring that facilities are not just housing but homes where our elderly can thrive with autonomy and respect.

The Silent Epidemic: Falls in Nursing Homes

A fall can result in a lifetime of anxiety and trauma. Millions of individuals aged 65 and older fall each year, with such events leading to a cascade of health issues—from fractures to long-term disability, and even death.[viii]

Falls not only endanger physical health but also symbolize a wider systemic issue— nursing homes average hundreds of falls yearly, many unreported, masking the true extent of the problem.[ix] It’s a silent crisis where a single misstep or an unaccounted-for obstacle could lead to catastrophic outcomes. Falls often go unreported, leaving seniors in nursing homes to suffer in silence with their relatives uninformed and unable to help.

How to Prevent Falls

Thankfully, falls are not an inevitable facet of aging. Strategic modifications to the environment and fall risk assessments can significantly mitigate fall risks.[x]

The Morse Fall Risk Assessment is a tool used to identify factors that could lead to a fall, allowing healthcare providers to craft care plans that mitigate these risks.[xi] In addition to such assessments, adjusting the physical environment of the care facility is crucial. [xii] This can range from ensuring bed alarms or call lights are within reach to keeping hospital beds in a low position near the floor and hallways equipped with sturdy handrails. Additional recommendations include but are not limited to:

  • teaching residents how to use the safety resources and ensuring that they understand how they work
  • keeping residents’ possessions within safe reach
  • ensuring that brakes on hospital beds and wheelchairs are in the “locked” position when stationary
  • Keeping nonslip, comfortable, well-fitting footwear on the resident
  • Using night lights or supplemental lighting to avoid trips or slips due to lack of visibility
  • Keeping floor surfaces clean and dry
  • Keeping patient care areas uncluttered
  • Following safe patient handling practices

Always report falls to a healthcare provider, as it can indicate underlying issues in need of attention. Report the fall even if they did not feel pain when they fell! Reports can alert medical providers to new medical problems or issues with medications that can be corrected. They may suggest physical therapy, a walking aid, or other steps to help prevent future falls.

Your Rights and Remedies: The Role of Effective Advocacy

If a fall occurs and you suspect neglect or other types of abuse in a nursing home or related facility, seeking legal assistance is critical. The dedicated nursing home abuse attorneys at Lipinski Law[xiii] understand how urgent and profound these situations are. We stand ready to provide the support and advocacy necessary to protect our most vulnerable citizens.

As we entrust the care of our elderly to long-term facilities, it is imperative to remain informed of their rights and the standards set by Florida law. Vigilance in preventing falls and advocating for the well-being of residents isn’t just a responsibility—it’s a shared mission to ensure the safety and dignity of every individual in long-term care.

Understanding the Risks and Rights in Florida’s Long-Term Care Facilities

Florida Statutes Chapter 400 (governing nursing homes) and Chapter 429 (governing Assisted Living Facilities) are crucial safeguards for those who require long-term care. This chapter of the Florida Statutes provides the foundation for health, care, and treatment standards in various facilities[xiv]—including long-term care facilities, nursing homes, and intermediate care facilities—to ensure our family members receive the safety and respect they deserve. Contact Lipinski Law today for more information.

[i] National Institute on Aging, Falls and Fractures in Older Adults: Causes and Prevention, https://www.nia.nih.gov/health/falls-and-falls-prevention/falls-and-fractures-older-adults-causes-and-prevention#steps

[ii] National Institute on Aging, Falls and Falls Prevention, https://www.nia.nih.gov/health/falls-and-falls-prevention

[iii] Centers for Disease Control and Prevention, Older Adult Fall Prevention, https://www.cdc.gov/falls/facts.html

[iv] Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed March 27, 2024.

[v] Centers for Disease Control and Prevention, Older Adult Fall Prevention, https://www.cdc.gov/falls/facts.html

[vi] Zhang L, Wang J, Dove A, Yang W, Qi X, Xu W. Injurious falls before, during and after dementia diagnosis: a population-based study. Age Ageing. Dec. 2022 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9799250/#:~:text=Meanwhile%2C%20dementia%20has%20also%20been,cognition%20%5B10%2C%2011%5D.

[vii] The Florida Statutes, 400.0061 Legislative findings and intent; long-term care facilities. http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0400/Sections/0400.0061.html

[viii] Centers for Disease Control and Prevention, Older Adult Fall Prevention, https://www.cdc.gov/falls/facts.html

[ix] Nursing Home Abuse Center, Nursing Home Falls, https://www.nursinghomeabusecenter.com/nursing-home-injuries/falls-fractures/

[xii] Agency for Healthcare Research and Quality, Preventing Falls in Hospitals: Which Fall Prevention Practices Do You Want to Use? https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/practices.html#3-2

[xiii] Lipinski Law practice areas: Nursing Home Abuse https://lipinskilaw.com/nursing-home-abuse/

[xiv] The Florida Statutes, Chapter 400, Nursing Homes and Related Health Care Facilities http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0400/0400ContentsIndex.html

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