RNIB Care Homes Falls Prevention Project: A review of the Literature
Author Pam Turpin, Arup
With an increasing ageing demographic, a significant public health challenge is the incidence of falls. The frequency of falling increases with age and can have serious consequences for older people. 35 per cent of people aged 65 and over who live in the community fall each year, increasing to 45 per cent for those 80 years and older (DH:2009)
The prevention of falls is high on the government agenda. In the UK, falls are a major cause of disability and mortality. The risk of injury after a fall is higher in the older population because of reduced protective reflexes and greater bone fragility (Dhital: 2010). Every year, approximately 310,000 patients, the majority of whom are elderly, present at UK hospitals with fractures, of which around 80,000 people suffer an osteoporotic hip fracture due to falling (British Orthopaedic Association: 2007). The annual cost of treating osteoporotic fractures in the UK is £1.8 billion - an estimated £1.5 million per PCT (Age UK: 2010). Recurrent falls are associated with increased disability and are the leading cause of death resulting from injury in people aged 75 years and over (Scuffham et al: 2003). Age UK (2010) reported that an older person dies every five hours as a result of a fall.
Historically, falls were accepted as an unavoidable problem of advancing years and frailty. However, there is now a large-body of evidence based research that considers that such events can be predicted and prevented (Close: 2001; Becker et al: 2003; Chang et al: 2004; Oliver and Masud: 2004; Cox et al: 2008; DH: 2009; Cameron et al: 2010). Effective interventions are important and can result in significant benefits with regard to improving individual well-being.
Changes in visual components such as visual field, acuity contrast sensitivity and depth perception has been identified as a key risk factor in falling (Dhital et al: 2010).
This literature review was undertaken by Arup during November 2010 and was not restricted to care homes only but included general research on falls and older people.
The following databases were searched:
Keywords used included:
In addition, a number of journals were hand searched for appropriate information.
Studies that were published in English appeared in refereed journals and addressed the specific challenges around falls and/or falling in older people and people with sight loss were included.
The following were excluded: studies not reproduced in English, studies focusing only on younger people who had fallen or younger people with visual impairments.
2. The Care Home Population
This section examines the risk of falling in older people, particularly exploring reasons that might exacerbate the risk of falling in residents with visual impairments living in long term facilities. Current policy and best practice in falls management and prevention interventions are also discussed.
Falls are believed to be a contributing factor in 40 per cent of admissions to nursing homes (Close 2001). This population of older people is more likely to experience a fall than those living in the community. Approximately 60 per cent of people living in care homes experience recurrent falls each year (DH 2009). It has been estimated that up to 25 per cent of falls in institutions result in fracture, laceration or the need for hospital care (MacLean: 2007).
Serious sight loss can also be a contributory factor of an older person being admitted into a care home (NCHR&D Forum: 2006). Sensory difficulties have been noted as having negative impact on a resident’s quality of life (Cook: 2006) and can lead to depression, social isolation, loneliness, reduced mobility, as well as an increased risk of falling (Berry et al: 2004; Cattan et al: 2010).
2.1 Impact of falls in care homes
2.1.1 For residents
The consequences of a fall can be extensive. Besides physical injuries, falling can also have an effect on a person’s level of psychosocial functioning. For instance they could develop a fear of falling again or lose confidence in being able to move about safely resulting in increased dependence and loss of autonomy. Reduced mobility could lead to social isolation and depression. Oddy (2003) advised that a fall could induce an acute confusional state and with an existing diagnosis of dementia may cause the person to be viewed as ‘difficult’. For instance, they may be frightened of falling again and refuse to stand or walk. If they have cognitive impairment and are not able to communicate this fear; such apprehension could be shown in agitated behaviours leading to misunderstandings by staff. When care staff are busy or feeling stressed their patience might be stretched to breaking point (Stokes: 2003) which could lead to poor care practices.
2.1.2 For care home staff
Care homes are charged with ensuring the safety of their residents. Complaints and litigation may suggest a breach in the duty of care and could create negative publicity, family members may assume that a fall has occurred due to negligence by staff. Oliver (2007) advised that families may complain that “something should have been done”. In addition, Mitchell (2009) reported that as well as fear of recrimination, staff may experience feelings of guilt or distress, particularly if the fall resulted in an individual being injured.