Increasing Awareness of the Factors Producing Falls: The Mini Falls Assessment

Abstract

Falls represent one of the most common harmful occurrences in nursing homes, and injurious falls account for approximately 60% of all liability cases filed against nursing homes.1,2 Persons in nursing homes fall three times more frequently than persons living in the community. There are approximately 1.7 (0.6e3.6) falls per nursing home bed per year.3 Falls are the major cause of hip fractures, head trauma, lacerations, other fractures, and soft tissue injuries. As we age, falls are inevitable; therefore, our goals are to decrease the number of falls and prevent injuries where possible. Among nursing home residents, rates of hip fracture can be as high as 6.2% in women and 4.9% in men.4 The cost of falls in the United States is estimated to be $40 billion by 2020.5 Although single intervention programs have minor effects on falls, the Cochrane review has found that multifactorial interventions successfully reduce falls.6,7 Despite this, certified nursing aides believe that falls are not preventable.8 Numerous physiological changes occur with aging that increase the propensity for falls. The development of frailty,9e20 weight loss,21e24 and sarcopenia,25e32 which are all common in the nursing home, leads to the increased propensity for falls. Physiological changes increasing the likelihood of falls include decreased muscle strength, altered length and height of steps, increased dual foot contact time, a broader walking base, and slowed walking speed. Both very slow ( 1.3 m/s) walking speeds are associated with increased falls.33 A decline in vestibular function (30% loss of hair cells and nerve fibers), decreased nerve conduction owing to axonal atrophy, and alterations in joint function result in a decline in propioception. This leads to increased body sway. Older persons tend to develop backward disequilibrium or retropulsion, which leads to their tendency to fall backwards or to the side. This appears to be associated with increased subcortical vascular lesions.34 The decline in executive function with aging leads to the “stops talking while walking” syndrome or problems with dual tasking. Changes in vision (decline in visual acuity, cataracts, and age-related macular degeneration)35,36 and wearing bifocals37 are also associated with falls. Most falls are caused by tripping, as the ability to see and negotiate obstacles in time, and the ability to