Beechwood Falls Prevention

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A Team Approach in Dementia Care
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• Strategies for Reducing Falls
• Among Residents with Dementia
• In Long Term Care Facilities
• Introduction

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• Rate of falls in long term care facilities
• is 3x greater than people over 65 living in the
• community
• Residents with Dementia present a
• greater challenge
• Falls have serious consequences

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• Program Goal
• Help facilities develop
• effective approaches for reducing falls
• Program Developers
• Nurses
• Certified Nursing Assistants
• Therapists
• Social Workers
• Administrators

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Interactive DVDSections specific to your role
in the facilityMay be used in a group or
individuallyQuizzes and case studies to review
topic
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Dementia affects more than 60 of all nursing
home residents Specialized dementia units
provide care to residents in more advanced stages
of dementia Residents with mild to moderate
dementia may live in any area of a nursing home
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Staff working on a dementia unit generally
receives more specific training for caring for
their residents. Staff working in other areas
may be given some education regarding dementia
but not necessarily detailed information.
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This section presents basic information about the
changes in the brain. The effects of those
changes on a persons ability to function Our
goal is to help you better understand residents
with dementia to reduce their risk for falls.
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Everyone in a facility has an important role in
fall prevention. All employees, volunteers and
visitors can have an impact on reducing the risk
of falls BE ALERT and TAKE ACTION
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What Dementia meansA group of symptoms that
result from a disease or conditionAlzheimers
is an example of a disease that causes symptoms
of dementia.Stroke is an example of a condition
that causes symptoms of dementia.
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• Most common symptoms of Dementia
• loss of memory
• loss of thinking skills
• loss of language skills
• decrease perception

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• When the brain is affected by injury or disease,
• neurons die and areas of the brain atrophy.
• Early stages of Alzheimer's Disease
• short term memory loss
• confusion about familiar places
• takes longer to accomplish familiar tasks
• trouble handling money
• poor judgment
• mood and personality changes

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Advanced Alzheimers disorientation to place,
date and time decreased communication using
wrong words or repeating themselves loss of
self care abilities incontinence difficulty
walking Symptoms will change over time
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• When judgment, memory and thinking
• processes are affected by loss of brain
• tissue, a persons ability to function in their
• environment is reduced and risk for fall
• Increased.
• It is important to understanding how
• symptoms of dementia can cause changes
• in physical functioning, decrease the ability
• to recognize limitations and express needs.

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Introduction to Strategies for Reducing Falls
Falls cause stress for everyone. Injuries may
lead to loss of function or may be life
threatening. Fall prevention begins with
awareness and understanding of fall risk
factors. Everyone has an important role in fall
prevention.
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Goals of Fall Prevention Assess risk
factors Analyze circumstances after a
fall Correct problems and minimize risk on a
daily basis
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Intrinsic Risk Factors-related to residents
health status Gait instability Lower limb
weakness Balance problems Urinary incontinence
or frequency The effects of certain drugs,
particularly sedatives and hypnotics visual
impairment dizziness
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Residents with Dementia may also
exhibit Disorientation Anxiety and
agitation Impaired judgment and decision
making Impaired perception Impaired
communication Failure to recognize limitations
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Extrinsic Risk Factors-related to physical
environment Poor lighting Wet or shiny
floors Physical obstacles Walkers/wheelchairs R
estraints Inappropriate footwear or clothing
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Organizational Risk Factors-any other extrinsic
factors not related to health status or
environment Staff Training
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Most effective strategies for managing falls in
long term care facilities involves everyone who
works at the facility and also includes support
from families.
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Guiding Principles to Fall Management Recogniti
on that a comprehensive team approach to fall
assessment and management is an integral part
of the care process. Commitment to a
facility-wide approach That includes every
employee and volunteer as well as family
members. A goal to create an environment that
is safe, with sufficient staff to adequately
monitor and assist residents as needed, while
allowing as much individual freedom and
autonomy as possible for residents, based on
their capabilities.
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Guiding Principles to Fall Management contd A
systematic approach, involving an
Interdisciplinary Falls Management Team, for
collecting and analyzing data on falls and
conducting thorough assessments of each incident
to identify and address risk factors. Knowing
that each resident has unique capabilities and
intrinsic risk factors, so fall prevention
strategies must be individualized. Recognition
that the intrinsic risk factors for each resident
will change over time as their physical and
mental health status changes, and individualized
care plans and fall-prevention strategies must
be modified to accommodate these changes.
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Although restraints can increase falls, some can
give freedom and mobility.
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Risk Assessment and Problem Solving
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This module will Review elements of fall
management program Review risk assessment for
intrinsic and extrinsic factors Describe
procedures for post fall assessment Offer
ideas for reducing risk with emphasis on
dementia Practice exercises
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A formal assessment of fall risk should be
completed Prior to or at time of
admission At re-admission from hospital A
residents health status changes
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Conditions affecting fall risk generally included
in a Fall Risk Assessment A history of
falls Mental status Cardiovascular and
pulmonary systems Neuromuscular
system Orthopedic conditions Vision Pain Phys
ical functioning Medications Difficulties with
communication and other factors
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• Fall risk assessments are used to identify fall
  risk factors and assist to develop care plan
  approaches to prevent falls
• Every member of the care team-including
  family-should be aware and understand risk
  factors that are specific to a resident

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All staff members-direct care AND indirect care
including volunteers- have an important rolein
looking for fall risks and Take ActionReport
changes (mental or physical) in residents Move
or report environmental hazardsInteract with and
engage residents
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• Role of Therapy
• in Fall Prevention

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Goal of intervention and care plan approachesis
to minimize risk of fall while maintaining
functional mobility and ADL skillsRisk factors
predict likelihood of fallTherapists role is to
identify actions thatchallenge balance to
recommend interventions and train staff
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Standardized testing may be limitedVestibular
system may be tested by observing Body
sway Presence of nystagmus Observation of gait
for loss of balance with head turningModify
Functional Reach test to reach for objectat a
preset distanceObserve, observe, observe
functional mobility and ADLs Observe in
different setting and at different times of day
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Additional training for direct care staff for
communication or task segmentationList
specific directions or commandsin care plan
approaches Emphasize importance of consistency
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• Following a fall
• Review circumstances
• Determine root cause
• Be objective and identify details
• Encourage creativity and think imaginatively

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Post Fall Review Circumstances of a fall are
reviewed immediately after a fall when details
of the fall are easier to remember. The Post
Fall tool is used to help determine root cause
of a fall and possible care plan approaches to
prevent another fall.
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• Problem Solving
• to Reduce Risk of Falls

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The best ideas or solutions to reduce the risk of
a fall are the ones created based on the unique
mix of intrinsic and extrinsic risk factors for a
specific resident in a particular situation and
organizational factors.
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Root Cause AnalysisAsk at least 5 Why
questionswhen reviewing the circumstances that
may have contributed to a fall.Answers will
help to find solutions to prevent another
similar fall.
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Residents with dementia are more apt to fall
when they are not engaged inan activity, are
unattended or whenthey wander.Risk reduction
strategies focus onways to provide engaging
activitiesfor residents and increase interaction.
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Suggestions for active engagement Memory
Boxes Sing Alongs Movies Music Balls Quiet
area
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Suggestions contd Tai Chi Hand
Massages Repetition Reading with resident Talk
about families Know the residents like and
dislikes
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Environmental Changes Lighting Gait or unit
entryway Decoration/Pictures Non-skid
surfaces No overhead paging Simple
carpeting Staff education and awareness
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• Enlist the help of all staff (direct and indirect
  care)
• volunteers and families to brainstorm creative
  ways to reduce the risk of falls.