“We've done everything but she keeps falling.”
“But his balance is terrible and he might fall.”
“With her medications, her chance of falling is sky high.”
It is true that medications, vision, strength, and balance are, of course, some of the reasons residents fall, but these are not the only causative factors. The focus has been on physical factors for years and years. Residents, particularly those with cognitive loss, continue to fall while the social aspects of the life of the resident with cognitive loss are ignored.
This scenario will continue unless and until the social aspects of a person's life are seen as an additional causative factor in falls. Accepting the fact that falls are the result of a motivated behavior must take a position of priority in any assessment process. If people didn't move, they wouldn't fall regardless of their meds, their vision, or their ambulation abilities.
In spite of healthcare professionals' desire to help-and in the face of the focus on patient safety-residents still wish to prove they can still “do it themselves,” while the current approaches to falls mitigation attempt to stop them from doing so. Devices such as alarms, siderails, physical restraints, mats, and defined perimeter mattresses have been developed to stop the resident rather than assist him or her to meet personal goals.
It's about motivation
Assessing why residents are moving and then assisting them to meet their needs must be the goal. Use of root cause analysis skills is vital, realizing the vast majority of falls occur in residents with cognitive loss.
Motivation to move is often as simple as the resident is cold or needs to see what is causing that noise in the hall. Residents may move because they want to get that favorite family picture off of the dresser or they just want to talk with another person. In many cases the motivation to move is as basic as wanting to combat boredom.
These motives for moving are considered normal in a person without cognitive loss. However, they are often not recognized in the person with cognitive loss; devices such as alarms are designed to stop residents from meeting their need. Thwarting the resident's motivation results not only in an agitated person but in a fall.
Family contributions become vital when learning who the resident is as a person. They can assist by sharing personal history about the resident such as sleep patterns, drive for independence, sense of responsibility, the need to be in control, and his or her level of impatience in the past. Families know what their loved ones enjoyed talking about and what they enjoyed seeing, smelling, tasting, touching, and hearing. This information, along with knowledge of the resident's previous favorite chair and where he or she slept are facts families can share. Encourage the family to bring in personal items, such as that favorite chair and bed or couch from home. Familiar objects increase resident comfort and feelings of security.
Assist families in sharing their knowledge about their loved one. This is the one area where the family makes a difference. Too often families feel they can't help because they can't fix their loved one's physical issues. But families do have the power to address the social issues. Even if they haven't been geographically close to their loved one in the recent past, the long-term personal history they can provide is vital and desperately needed by the staff.
Meeting needs = Meeting success
Implementing social interventions is supportable, makes the resident happier, reduces the potential for falls, and leads to staff feelings of success. It provides a “win-win-win-win” situation.
Interventions that consider who the resident is as a social being not only work, they help families understand that their loved ones are being treated as individuals. Individualized interventions are also supportable when talking with surveyors, lawyers, and the general community. Personalized social interventions create a calm, contented person who is assisted in meeting his or her mobility goal.
Interventions also fit very well in light of the current focus on person-centered care and the resident-preferences focus of the MDS 3.0. Knowing who the resident is as a social being and then using that information when providing care is not only rewarding for residents and staff, but it meets the commitment expected from facilities to put the person into the care picture.
Diana F. Waugh, BSN, RN, is owner of Waugh Consulting in Toledo, Ohio. For more information, call (419) 351-7654 or e-mail
firstname.lastname@example.org. Long-Term Living 2010 November;59(11):16