"I HATE FALLING" and "NO STUMBLES" mnemonics to aid in patients at risk for falls
Falls are often the result of a complex interplay of factors, including physical, environmental, and medical conditions. Understanding these causes is crucial in preventing falls among individuals, especially the elderly, as they can lead to injuries and other health-related issues.
"I HATE FALLING", Causes of Falls in Elderly Patients
Inflammation of joints (or joint deformity): Inflammation in the joints or joint deformities can lead to pain and reduced range of motion, making it difficult for elderly individuals to move comfortably. This discomfort and limited mobility increase the risk of tripping or stumbling.
Hypotension (orthostatic blood pressure changes): Orthostatic hypotension, where blood pressure drops when transitioning from lying to standing, can result in dizziness or lightheadedness. This sudden drop in blood pressure can cause a loss of balance and lead to falls.
Auditory and visual abnormalities: Impaired vision and hearing can make it challenging to perceive environmental hazards or obstacles. This sensory deficit reduces an individual's ability to detect and react to potential fall risks.
Tremor (Parkinson's disease or other cause): Tremors, such as those seen in Parkinson's disease, can cause involuntary shaking, making it difficult for an individual to maintain stability and balance.
Equilibrium (balance) problem: An issue with the body's balance system, such as problems with the inner ear or neurological conditions, can result in an increased risk of losing balance and falling.
Foot problems: Foot issues, like pain, deformities, or improper footwear, can affect an individual's ability to walk steadily and may cause trips or slips.
Arrhythmia, heart block, or valvular disease: Heart conditions can lead to episodes of dizziness or fainting, which can result in sudden falls.
Leg-length discrepancy: A difference in leg length can lead to an uneven gait and balance problems, making it more likely for someone to trip and fall.
Lack of conditioning (generalized weakness): Muscle weakness and poor physical conditioning reduce an individual's ability to support their body and maintain balance. This weakness increases the risk of falling.
Illness: Acute or chronic illnesses can lead to weakness, fatigue, or disorientation, all of which contribute to an elevated risk of falls in elderly patients.
Nutrition (poor; weight loss): Poor nutrition and weight loss can result in muscle wasting and frailty, making it more difficult for individuals to maintain their balance and strength, increasing their fall risk.
Gait disturbance: An abnormal gait pattern, caused by factors like neurological conditions or musculoskeletal issues, can lead to an unsteady and irregular walking pattern, increasing the likelihood of falling.
"NO STUMBLES": An Aid to Help Prevent Falls
Normalcy: Assess what is normal for the individual. Any behavior changes should be considered, whether they indicate infection, environmental factors, or delirium.
Osteoporosis: Consider bone health. If someone has osteoporosis, the consequences of a fall can be more severe.
Shoes and Slippers: Are the footwear choices fit for their intended purpose? Shoes and slippers should be comfortable, well-fitting, and provide adequate support with backs.
Toilet: Do they know its location and can they access it? Is the patient experiencing urgency or frequency of urination or bowel problems?
Urine: Are there any signs or risks of urinary tract infection or dehydration?
Medication, Medical Condition, and Mobility: Check for medications that may increase the risk of falls, including analgesics, sedatives, antihypertensives, and diabetic medications. Ensure that walking aids are within reach and suitable for their intended purpose.
Beds and Bells: Make sure that the call bell is within reach. Lower the bed to its lowest position with at least one bottom side rail down.
Lighting: Provide adequate lighting.
Eyesight, Exercise, and Environment: Ensure that the individual is wearing the correct and clean glasses. Encourage balance and strength exercises. Remove all clutter from the floor.
Support and Supervision: Consider using sensor alarms when necessary and provide supervision as needed.