Fall prevention in the elderly
About 9000 adults fracture a hip bone in Norway every year. Read on to find out how Remi Andersen MD from Ullernhjemmet Nursing Home in Oslo uses Somnofy as a tool to prevent falls before they occur.
Everyone falls repeatedly as a child — yes, to learn how to walk you have to fall down and rise again. The goal was to find the exact threshold between your body being in balance and being out of balance. Because the actual question is: can your body be in balance when walking? The answer is actually no. While walking, you are actually falling — what stops you from falling to the ground is your body’s ability to move your legs forward and correct the fall. If you don’t, well, then you are standing still.
This same pattern repeated itself when you learned ice-skating or skiing; falling for moving forward, down and up again before the technique was perfected. And up again…
The point is: You need to practice to master gravity. What you train is what you get good at.
Falls in the elderly
We often read about elderly who fall. The truth is rather that most people fall a couple of times a year. The consequences are much bigger, the older one gets — and this is largely due to a marked reduction of leg mass which can no longer support the same impacts.
Falls of the elderly bring high personal cost and suffering, but are also extremely expensive for society. The report «Cost of hip fractures in the elderly» (NOR: «Kostnader ved hoftebrudd hos eldre» [1]) from 2014 has calculated the average cost of hip fractures in home-dwelling elderly over 70 years old i the region of Southern Trondelag to be about $40,000 per case. If the fall led to a permanent nursing home residency, this cost increased to over $100,000 per year per case.
The risk of hip fracture increases with age
About 9000 adults fracture their hip bone in Norway every year. In other words, every hour of every day one person fractures their hip. Seven out of ten hip fractures happen to women. The risk of fracturing the hip bone increases rapidly from age 70 [1].
Falls make elderly feel unsafe and reduce quality of life
Older adults that have experienced a fall are often afraid of falling again. This quickly becomes a vicious cycle with reduced physical activity, isolation, lost independence and increased care needs. Preventing falls is therefore of utmost importance.
Fall prevention
Risk of falling can be assessed with different scoring tools. The following items are typically included and weighted: previous falls, reduced eye-sight, dementia/confusion, unrest/tendency for wandering, frequent toilet visits, ability to transfer from the bed and chair, walking abilities, medication (multiple) but especially sleeping pills prescriptions. The surrounding areas can also help to prevent falls. You should make sure there is sufficient lighting, sliding-proof floor covers, remove thresholds/corners/loose carpets and make sure the resident wears appropriate shoes.
Small actions — big changes
As I wrote in the introduction, you get good at what you practice.
Residents in elderly homes often fall transitioning from the bed to a standing position and during toilet visits in their own room at night. During the day, these situations only occur infrequently. But with personnel making sure the resident practices these transitions 5 times instead of once when they get up from their chair or the bed there is a 400% increase of exercising these situations each day. As written above: you get good at what you practice.
Can health technology reduce the number of falls?
Dementia is a prevalent diagnosis among nursing home residents and the group of elderly receiving care in their own homes. A big challenge in this population is the difficulty of retaining information given to them — not only when the topic is fall risk reduction. The wheeled walker is often left behind when residents go to the toilet or visit the common areas. They may not remember about their own frailty or forget calling help using buttons or ring cords in their room.
Dementia patients might switch around day and night rhythms and leave their bed at night. It is not an easy task for limited night resources to catch this happening and prevent a fall before it is too late.
Through sleep measurement of selected residents at our nursing home using Somnofy, we registered certain individuals to get out of bed 6-10 times during a night without the personnel being aware of this fact. This kind of risk assessment is very valuable to decide on actions required to prevent falling in the private rooms of the residents and reduce nightly wandering.
Elderly lady with dementia
The example below shows an elderly lady affected by advanced dementia. During the day, she is unstable and only mobilized using her walker, which she sometimes forgets to take with her.
This article is translated by Lukas Krondorf
Hypnogram
Picture 2 shows her sleep pattern on July 16th. The resident has voiced some pain during the day and she is exhibiting a reduced level of activity. At the same time, we can see through the Somnofy analysis, that she gets up and out of her bed nine times in the course of the night. She therefore shows a clear risk of falling.
What was done and how did it go?
Picture 3 shows her sleep on August 17th — which is one month later. The resident is more active during the day — and correspondingly not leaving her bed at night. She was provided with a higher dose of painkillers. This often produces a triple effect: less pain during the day allows more physical activity during the day, less pain at night improves sleep, as does the increased activity level.
Doctor Remi Andersen (Ullernhjemmet Nursing Home Oslo)Paradoxically, our goal shall always be to get our residents to fall — asleep — every night! This is likely the most important measure to prevent falls!
Remi is a medical doctor educated from Oslo University (1999). He has been an elite cross-country skier and has worked with professional athletes and the elderly for 20 years. He is currently employed as a lead nursing home doctor. In addition, he is working as the MD for the junior-, recruit-, and para national team of Norway in cross-country skiing and as a consultant for VitalThings.