Falls in a Hospital or a Care Home
Posted on 9th January 2021 at 11:38
As a person ages, they become more at risk of falls. And the older a person is, the more likely they are to suffer severe injury from a fall. Around 1/3 of the older population living in the community fall every year1 and this increases to 50% when a person reaches 80 years or older. There are also 240,000 reports of falls in hospital annually2.
Fall in a Hospital or Care Home
These falls are often preventable and reducing these incidents is extremely important. Falls can cause or contribute to health problems; they can have an impact on mental health and wellbeing and reduce the independence and confidence of an older person.
Falls are the top reason why an older person is taken to hospital and can lead to an inpatient stay. This costs the NHS approximately £435 million yearly.
Why are we at risk of falls as we get older?
There are many reasons why our risk increases as we age. Here are just a few: -
Lower limb muscle weakness
Balance/gait disturbances (these can be caused by conditions such as diabetes or Parkinson’s)
Medication – some medications can cause low blood pressure or visual disturbances
Being aged 65 or over
Having a fear of falling – this can lead to falls as a person becomes preoccupied with fear
Postural hypotension – this is where the blood pressure drops when a person stands up
Arthritis in legs
Cognitive impairment such as delirium or dementia
If a person has four or more of the above risk factors, they have an 80% chance of falling.
Preventing falls in a hospital or a care home
Patients who are a hospital inpatient or a care home resident should be risk assessed for falls before or at the point of admission.
Healthcare professionals usually use the Falls Risk Assessment Tool (FRAT) to help identify at risk patients aged 65 and over. Although some hospitals and care homes do have their own version.
The assessment will look at issues such as: -
whether the person has had any falls in the last year
if they are on four or more medications (known as polypharmacy)
if they are taking psychotropic drugs
their vision and how bad or good their eyesight is
whether they have sensation in their lower limbs
their strength (particularly their lower limbs), balance and reaction time (can they quickly steady themselves before they fall?)
If they are deemed at risk of a fall, then measures can be taken to reduce the chance a patient will fall. Hospitals or care homes can implement simple steps to keep patients safe from falling such as: -
Keep guardrails up on beds to stop patients from falling out of bed.
Ensuring the patient has access to a bell so that they can call the nurse rather than attempt to get out of bed alone.
If the patient is delirious, position their bed next to the nurses’ bay so that they can be observed and kept safe.
Assisted toileting – using commodes or assisting the patient to the toilet – maintaining the patient’s dignity and respect as much as possible.
Keeping the bedside or patient’s room well lit.
Immediately mopping up spillages.
Having the patient wear non-slip grip socks or secure fitting slippers when walking around – no flip flops or loose slippers!
Ensuring the patient has their glasses available if they need these and that they are wearing the correct prescription.
Mobility aids are available if the patient needs a stick or Zimmer frame to walk.
Making sure the bedside or the patient’s room is clutter free and there are no shoes/wires/bags on the floor.
A medication review by the hospital pharmacist can look at reducing how much medication a patient takes (polypharmacy) or reducing side effects that may contribute to falls.
Taking care of the patient’s feet – trimming toenails regularly and referral to a chiropodist if they have any foot problems.
Regular strength and balance training can improve a patient’s strength and reduce their risk of falls. If they are in hospital they can shown these by a physiotherapist. If they are in the community there are community groups that run events on keeping fit in older age and how to reduce falls at home. A person can even take up dancing or walking – anything to keep fit and improve muscle strength.
The NHS also state that taking part in regular tai chi sessions can reduce the risk of falls. Tai chi is a Chinese martial art that places emphasis on movement, balance and co-ordination.
Once a patient is discharged, you can request a ‘home hazard assessment’. A health professional will visit the patient at home and identify potential hazards in the home. They can discuss ways of reducing or removing these hazards. They may also recommend a falls alarm so that if an older person falls, they can quickly summon help if needed.
What are the complications of a fall?
Osteoporosis is a condition affecting the bones. As we age our bone mineral density decreases and our bones become easier to break. It can increase the risk of fractures and is more common in women. Around 50% of post-menopausal women will suffer an osteoporotic fracture at some point in their lifetime.
Hip Fracture and Avascular Necrosis
A fall can cause a fragility fracture such as a fractured neck of femur. This is at the top of your thigh where it connects to the hip. The blood supply to the femoral head runs up the neck and thus avascular necrosis is a risk in displaced fractures.
Avascular necrosis may be defined as death of bone tissue secondary to loss of the blood supply. This leads to bone destruction and loss of joint function. It is a serious condition and joint replacement may be necessary.
A fall could cause a rib fracture. These are painful but not usually serious. However, they can cause a complication known as a pneumothorax (a collapsed lung) and can result in chest pain and difficulty breathing. Another complication of rib fractures is something called flail chest. This is s a life-threatening medical condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall.
If an older person has fallen and is left undiscovered lying on the floor for hours, or even overnight, they can develop rhabdomyolysis. It is the breakdown of damaged skeletal muscle. Muscle breakdown causes the release of myoglobin into the bloodstream. Myoglobin is the protein that stores oxygen in your muscles. If you have too much myoglobin in your blood, it can cause kidney damage.
If a patient has injured their chest or is sore and bruised, they may have difficulty taking deep breaths or coughing. This can cause bacteria to accumulate in the lungs and lead to pneumonia. Alternatively, they may suffer a hospital-acquired pneumonia. Pneumonia strictly speaking describes any inflammatory condition affecting the alveoli of the lungs, but in most patients this is secondary to a bacterial infection. It causes chest pain, cough, fever, difficulty breathing and sputum. Pneumonia can be life-threatening in people with an already weakened immune system.
Loss of confidence/Depression
It should not be underestimated the impact a fall or falls can have on an older person. They may feel frightened to walk around or leave their house. They may feel guilty that they have fallen and feel as though they are a burden. It can make them feel depressed because they can’t partake in their usual hobbies or visit friends and family. If they are seriously injured recovery can often be long and exhausting, particularly if rehabilitation such as physiotherapy is needed or social care involvement. They may not be able to go back to their house and instead be moved into sheltered accommodation or a residential home. It can often be a confusing and challenging time for an older person and their wellbeing and mental health should be a priority.
Have you or your relative suffered a fall in hospital or in a care home?
We can discuss with you, in confidence, the circumstances of the accident and advise if you can make a claim for compensation on a ‘no win, no fee’ basis. We can also discuss whether you or your relative need further assistance such as physiotherapy or counselling. We have access to a panel of medical experts who can assist as part of your claim.
More often than not, if you do bring a claim against the NHS the incident is investigated, and safeguards are put in place to stop this happening to another patient. Falls are a serious issue and we understand the devastating impact it can have.
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