Care indicators - Falls

Falls

Definition

A fall incident is ‘an unexpected event in which the participant comes to rest on the ground, floor or a lower level’, irrespective of whether an injury occurs (Kellogg International Work Group 1987). Fall incidents are often experienced by the elderly and form an important geriatric problem (Schoon et al 2008, Verhaar et al 2007, WHO 2007). Most fall incidents occur among the growing group of the elderly, and the incidence of falls increases with age. Due to a potentially poor outcome with far-reaching consequences, falling is a major problem among the elderly. Moreover, fall incidents affect quality of life (CBO 2002). Healthcare professionals too regard falls as a troublesome and complex problem that is correspondingly hard to tackle. In fact this is an overly pessimistic assumption, because with sufficient knowledge and appropriate diagnostics the problem of falls can be dealt with quite effectively, and preventative action and treatment can be achieved through primary, secondary and tertiary fall prevention (CBO 2002, Gillespie et al 2004, Neyens 2007, Neyens et al 2009, Waaijer and Neyens 2009). Falls also form a significant societal problem (NHS NICE 2004). The healthcare costs associated with falls and fall-related injuries are related strongly and directly to the frequency of falls and the seriousness of injuries. This is a factor serving to increase the workload in the care sector.

Apart from the high incidence of falls, the incidence of fall-related injuries is also worrying. Fall injuries are divided into the categories of light, moderate and serious (Halfens et al 2007-2014). Light injuries are injuries that do not require medical consultation, such as a bruise or an abrasion. Moderate injuries are injuries that require medical consultation, such as a wound being glued or stitched. Serious wounds are wounds that require medical consultation and sometimes even admission to hospital, such as a hip fracture or certain head traumas. So we see that fall incidents can have considerable physical consequences. There may also be psychological and social effects of falls, such as the fear of falling, loss of self-confidence, depression and greater dependence on care, as well as the avoidance of (participation in) activities in order to avoid falling (Halfens et al 2007-2014). Both can lead to social isolation. Finally, fall incidents also have economic consequences (e.g. higher costs, admission to a residential care facility) (WHO 2007).

On 1 January 2015 some 3 million Dutch citizens were aged 65 or above, and the total number of elderly persons is expected to increase to 4.6 million by 2040. This means that the number of fall incidents in this group will increase substantially in the coming decades (Government of the Netherlands 2015).

Fall incidents are experienced by around 30% of elderly persons aged 65 or above who live independently, by half of elderly persons aged over 80 and by about 65% of elderly persons with dementia (Neyens 2007). Actually these figures are probably much higher: many fall incidents without injury are not reported, mostly because of a fear of being admitted to a residential care home. In these homes, 30 to 70% of the clients fall at least once a year and 15 to 40% of these suffer a fall more frequently than once a year. Here too, the risk increases for clients with cognitive disorders.

Elderly persons are still insufficiently aware that falling is a problem, and that fall incidents can be prevented. Ideas such as ‘I have got too old’, ‘there is nothing more to be done’ or ‘falls won’t happen to me’ often prevent elderly persons from doing something to reduce their risk of falling. So it is essential for professional care providers to help the elderly become aware that falls occur often and can have unpleasant consequences, but above all that prevention needs to be begun early (Gillespie et al 2004, Neyens 2007, Waaijer and Neyens 2009). After all, the older one becomes, the higher the chance of falling. On the other hand, the younger one is when one begins prevention, the lower the chance of fall incidents in later life. And this points to an important task for professional care providers in their field of work!

Every year around 3,200 persons aged 65+ suffer a fall in care homes and around 1,700 clients suffer a fall in nursing homes, requiring subsequent treatment in a casualty department. In nursing homes the number of fall incidents per bed is lowest in somatic wards and highest in psychogeriatric wards. This translates to almost two fall incidents per bed in nursing homes, with 1.3 % of these leading to a fracture (Dijcks et al 2005).

The consequences of a fall incident cost an average of 3,400 euros in direct medical costs per case – and this figure seems sure to increase in the coming years. So it is not only a cause for concern among politicians and policymakers, but also for care providers, due to the increasing workload occurring at the same time as an expected shrinkage on the labour market. Hence there is good reason to tackle this care problem carefully through primary, secondary and tertiary fall prevention. After all, many fall incidents can be prevented. The point of departure is that falling needs to be regarded as a problem by the client, the family and the professionals. Falls should not be dismissed as something that simply happens when one gets older. An appropriate plan for prevention and treatment generally involves a multifunctional approach, where possible implemented on a multidisciplinary basis.

Measurement of fall incidence

The LPZ measurement devotes attention to falls. We measure the fall incidence for two periods: the last 12 months and the last 30 days within the institution. Attention is given to the consequences of falls and to prevention of falls. The results of the measurement can explain the incidence rate and lets an institution see where policy improvements can be made or have already been achieved. By measuring the fall indicator annually, care organizations can evaluate and monitor their interventions and thus tackle the problem of falls within the institution with sufficient continuity (Halfens et al 2007-2014).

Incidence of falls 2007 – 2014
Incidence of falls 2007 – 2014 (Halfens et al., 2014)

References

  • CBO, Kwaliteitsinstituut voor de Gezondheidszorg. Osteoporose Tweede Herziene Richtlijn. Alphen a/d Rijn: van Zuiden Communications BV, 2002. (www.cbo.nl
  • Dijcks BPJ, Neyens JCL, Schols JMGA, van Haastregt JCM, Crebolder HFJM, de Witte LP. Valincidenten in verpleeghuizen: gemiddeld bijna 2 per bed per jaar met bij 1,3% een fractuur als gevolg. Ned Tijdschr Geneeskd 2005; 149: 1043-7.
  • Gillespie LD,Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH Interventions for preventing falls in elderly people. The Cochrane Library, Issue 2, 2004.
  • Halfens RJG, Meijers JMM, Neyens JCL, Offermans MPW. Rapportage resultaten Landelijke Prevalentiemeting Zorgproblemen 2007: Maastricht: Universiteit Maastricht, ISBN 978-90-806663-8-2.
  • Halfens RJG, Meijers JMM, Neyens JCL, Offermans MPW. Rapportage resultaten Landelijke Prevalentiemeting Zorgproblemen 2008: Maastricht: Universiteit Maastricht, ISBN 978-90-806663-9-9.
  • Halfens RJG, Meijers JMM, Neyens JCL, Schols JMGA. Rapportage resultaten Rapportage resultaten Landelijke Prevalentiemeting Zorgproblemen 2009: Maastricht: Universiteit Maastricht, ISBN 978-90-806663-9-9.
  • Halfens RJG, Meijers JMM, Du Moulin MFMT, van Nie NC, Neyens JCL, Schols JMGA. Rapportage resultaten Landelijke Prevalentiemeting Zorgproblemen 2010: Maastricht: Universiteit Maastricht, ISBN 978-94-90411-02-2.
  • Halfens RJG, Meesterberends E, Meijers JMM, Du Moulin MFMT, van Nie NC, Neyens JCL, Schols JMGA. Rapportage resultaten Landelijke Prevalentiemeting Zorgproblemen 2011: Maastricht: Maastricht University, ISBN 978-94-90411-00-8.
  • Halfens RJG, Meijers JMM, Meesterberends E, van Nie NC, Neyens JCL, Rondas AALM, Schols JMGA. Rapportage resultaten Landelijke Prevalentiemeting Zorgproblemen 2012: Maastricht: Maastricht University, ISBN 978-94-90411-03-9.
  • Halfens RJG, van Nie NC, Meijers JMM, Meesterberends E, Neyens JCL, Rondas AALM, Rijcken S, Wolters S en Schols JMGA (2013) Landelijke Prevalentiemeting Zorgproblemen Rapportage resultaten 2013. Universiteit Maastricht ISBN 978-94-90411-04-6
  • Halfens RJG, JMM Meijers, E Meesterberends, JCL Neyens, AALM Rondas, S Rijcken, S Wolters en JMGA Schols (2014). Rapportage Resultaten Landelijke Prevalentiemeting Zorgproblemen 2014. Maastricht: Maastricht University, oktober 2014.
  • Kellogg International Work Group on the prevention of falls by the elderly. The prevention of falls in later life. Dan Med Bull 1987; 34: 1-24.
  • Neyens JCL, Dijcks BPJ, Haastregt JCM van, Witte LP de, Heuvel WJA van den, Crebolder HFJM, Schols JMGA. The development of a multidisciplinary fall risk evaluation tool for demented nursing home patients in the Netherlands. BMC Public Health 2006;6:74.
  • Neyens JCL. Fall prevention in psychogeriatric nursing home residents. PhD Dissertation. Maastricht: Maastricht University, 2007.
  • Neyens JCL, Dijcks BPJ, Twisk J, Schols J, Haastregt JCM van, Heuvel WJA van den, Witte LP de. A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomized controlled trial (RCT). Age and Ageing 2009; 38: 194-9.
  • NHS National Institute for Clinical Excellence (NICE). Clinical practice guideline for the assessment and prevention of falls in older people. November 2004; clinical guideline 21.
  • Rijksoverheid (2015, 23 november). Ouderenzorg. Geraadpleegd van www.rijksoverheid.nl/onderwerpen/ouderenzorg.
  • Schoon Y, Neyens J, Boonen S. De gevallen patiënt. In: Olde Rikkert et al. (red). Probleem-georiënteerd denken in de geriatrie. Een praktijkboek voor de opleiding en de kliniek. Utrecht, De Tijdstroom, 2008; 57-74.
  • Verhaar H, Neyens J, Emmelot-Vonk M. (Neiging tot) vallen en mobiliteits-stoornissen. In: P. Janssen et al. (red). Het geriatrie formularium. Een praktische leidraad. Bohn Stafleu van Loghum, 2de herziene editie, 2007.
  • Waaijer J, Neyens JCL. Preventie van vallen, dat doen we met zijn allen.
  • WHO (2007) Global Report on Fall Prevention in older Age. World Health Organization 2007, Switzerland

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