Exercise programs that promote balance and strength training, and risk assessment tools, such as STEADI, are two common strategies adopted by assisted living facilities in the United States to prevent falls.
1. Exercise Programs
- According to the Special Committee on Aging of the United States Senate, a meta-analysis of “exercise interventions to prevent falls in older adults found that programs that included balance training and a higher dose (higher intensity and longer duration) of exercise were most effective at reducing falls.”
- A review of 21 controlled trials concluded that programs that combined exercise with other initiatives (such as education) reduced the number of falls and the number of participants who fell. In contrast, programs that only used a single type of exercise decreased the number of falls, but not the number of participants that fell.
- Exercises involving balance (e.g., Tai Chi), strength training, or using mechanical devices to improve gait, balance, and function are the most effective. Meanwhile, exercises that “included a walking component increased risk of falls for this at-risk group of frail older adults.”
- The Otago exercise program is a “strengthening, balance, and walking program designed to decrease falls.” A study conducted in two assisted living facilities (ALF) in Florida discovered that it reduces the number of falls from 1.4 to 0.5 fall per person per year.
- In 2010, Heritage Woods Supportive Living facility in Bolingbrook conducted an experiment with the Otago program, recruiting 23 residents with a history of falling. Participants of the study experienced “54% fewer falls and fall-related hospital visits” compared to the control group.
- Belmont Village in California partnered with The Institute for Rehabilitation and Research (TIRR) Memorial Hermann to create a fall-prevention program based on the Otago exercise program. The six-week program is available to all low-risk residents, and groups are divided as “low, moderate, or high risk of falling.”
- Five Star Senior Living has the “Strength Training and Fall Prevention” program.
2. Fall Risk Assessment Tools
- Fall risk assessment tools can help ALF reduce falls by identifying at-risk residents, developing effective interventions, and mitigating the risk of injuries. It is a well-known strategy with many tools available, such as The Johns Hopkins Fall Risk Assessment Tool (JHFRAT).
- For example, 81% of ALFs in Oregon use fall risk assessment tools as a standard practice (60%) or on a case-by-case basis (21%). ALFs typically do not disclose the assessment tools they use, and studies available about the strategy maintain the name of the facility confidential.
- One assessment tool with proven effectiveness is the Stopping Elderly Accidents, Deaths & Injuries (STEADI), designed by the CDC. It offers educational tools and assessment forms to help providers identify modifiable risk factors, classify patients according to risk, and develop effective interventions.
- A study examined the outcomes of implementing the program in an ALF located in urban southern California. Part of the program was to educate the staff and residents about “fall reduction techniques; managing medications; teaching exercises to enhance functional mobility, strength, and balance; and monitoring and managing postural hypotension.”
- The staff was trained in the use of assessment forms and tools, with training videos provided by the STEADI program. Weekly meetings with the nursing team and administrative staff were conducted to discuss progress and outcomes.
- Three steps were necessary to reduce the rate of falls: screen, review, and recommend. Patients were screened for history, risk factors, medication, and modifiable risk factors. The nursing staff “reviewed, assessed, and documented the medications being taken by participants with special attention to medications that can put elderly patients at risk for falls” using the SAFE medication review tool.
- The ALF classified residents as low (47%), moderate (26%) or high risk (27%) based on STEADI. The assessments showed that 61% of the residents were on medications that put them at risk of falling, 58% had medical conditions that increased their chances of falling, 22% had high TUG scores, and 12% had “documented episodes of orthostatic hypotension.”
- The staff adopted a variety of direct interventions to reduce the number of falls based on the assessments, such as changing or reducing medications, exercise interventions, physical or occupational therapy, and remodeling the room of patients at high-risk (e.g., double-tape on rugs, moving furniture.)
- The program resulted in a fall rate reduction of 39.4% “30 days after the ALF fall reduction program was in place for 60 days in the facility.” STEADI also helped the staff better locate riskier areas, which improved the facility’s safety practice.
3. Multifactorial Interventions
- Multifactorial interventions target multiple risk factors that are identified by the initial fall risk assessment. Research has shown that risk factors for senior citizens differ according to their health and social circumstances (i.e., where they live). The different components of multifactorial interventions in ALFs are discussed below.
- Assistive devices and protective equipment are important for senior citizens residing in ALFs who suffer from gait and balance problems. Special footwear and hip protectors often prevent or minimize falls among senior citizens. Research has shown that 35% of all fall-related hospitalizations in Canada are a result of hip fractures.
- Research has shown that exercise programs and physical training may reduce falls among senior citizens. However, proper assessment of the individual’s capacity and suitability for exercising should be done before introducing physical exercises.
- For senior citizens with mobility problems and a high risk of falling, environmental modifications can often lead to a reduction in falls. Research has shown that low stiffness flooring can decrease the impact of falls by at least 50% without leading to an impairment in balance.
- A review of the medication practices by senior citizens and the removal of inappropriate medications can lead to a decrease in falls in ALFs. Research has shown that removal and modifications of medications that alter mood (psychotropics) significantly decrease the incidence of falling.
- Since older citizens have lower muscle strength and often suffer from dehydration, they need good nutrition and sufficient protein. Research has shown that seniors living in ALFs mostly suffer from Vitamin D deficiency. Hence, Vitamin D supplementation should be given to seniors living in ALFs who are at high risk of falling.
- The William Osler Health System in Ontario adopted a multifactorial intervention strategy. This strategy focused on a comprehensive falls risk assessment, re-assessment, universal and high-risk interventions, documentation, evaluation, and further monitoring. Along with process mapping exercises, the institute also documented the transitions of patient flow and team movements. Within 4 months, the fall rate dropped from 11 per 1,000 patient days to 2 per 1,000 patient days.
- Using a multi-disciplinary approach, the Cypress Health Region in Saskatchewan was able to reduce falls among senior citizens in ALFs and long-term care centers. The Western Senior Citizens Home in Leader, Saskatchewan, was able to achieve a 0% fall injury rate for a period of 11 months using this approach.