Preventing falls can be within your power

Three keys to preventing falls in senior living environments are staff members' awareness of challenges facing residents, a belief that they can help address some of those issues, and their taking action based on that belief, says Lynn Beattie, vice president of injury prevention at the National Council on Aging.

“Everyone has a role to play and a contribution to make in fall prevention, as long as they have some education,” she says. “Within their sphere of influence, they can make a difference.”

Vision is a major risk factor associated with falls, says Beattie, who leads the national Falls Free Initiative and is involved with many projects related to falls prevention.

“As we age…you have less light entering the eye, and so it’s harder to see in darkened areas, it’s harder to see contrasting edges, it’s harder to see slips and spills, it’s harder to see the brick or sidewalk that might be sticking up. So just by aging alone, an increased risk [exists] around vision,” she says. “And vision is part of your balance system. It’s also is how you interact with the environment, which may be unsafe. So it’s all integrated.”

If a resident falls, he or she should be examined so that any related health needs can be addressed, Beattie says. Ongoing assessments—including a fall risk assessment—and subsequent monitoring may prevent falls from occurring in the first place, she adds. And preventing falls in the first place can reduce costs in the healthcare system, according to Jeff Todd, JD, chief operating officer of Prevent Blindness America.

$20 BILLION IN COSTS

The organization issued a report, “The Cost of Vision Problems: The Economic Burden of Vision Loss and Eye Disorders in the United States,” in June. According to the research, which was conducted by the University of Chicago, annual nursing home costs related to vision impairment or blindness in those aged at least 65 years totaled about $16.8 billion; these costs are borne by the government, private insurers and individuals. Vision loss-related skilled nursing facility care, calculated separately from nursing home care, was estimated as $3.4 billion.

“So we’re talking close to $20 billion that relates to long-term care of folks who are visually impaired or blind,” Todd says. “Certainly this emphasizes the…importance of prevention and why we need to detect the problems early that can not only reduce the costs involved in long-term care but also increase quality of life and independent living for people who are able to get their vision issues diagnosed early and treated before they lose significant vision.”

Todd says that falls figure prominently in the cost estimates. “We know that repeated falls are a significant predictor of nursing home admission,” he adds. “As people age and we see falls increase, there’s a direct correlation between the number of people who are going into long-term care. There’s also a pretty strong correlation to the role that vision plays in that.”

About one-fourth of people with vision impairment who are aged more than 85 years had reported a fall in the past three months, Todd says. The Los Angeles Latino Eye Study, he adds, “showed that those individuals with impaired central vision, through macular degeneration and other conditions, are almost three times higher to experience falls with injuries than those with no visual impairment. And those with peripheral vision problems such as glaucoma are almost one and a half times at greater risk for falls with injury.”

11 MORE TIPS

Senior living communities can take several additional steps to prevent vision-related falls in their facilities and reduce costs locally and generally within the healthcare system, according to Todd and Beattie:

• Establish a culture where employees feel empowered to take action to help prevent falls within the scope of their positions. The custodial staff, for instance, can address spills in a timely manner, and everyone can ensure that equipment and supplies that might pose tripping hazards are stowed in their proper places, out of the way.
• Design rooms, hallways and other areas with a natural, obstacle-free flow and features—such as grab bars in bathrooms and other areas—to assist residents with movement.
• Minimize the rearrangement of furniture and other movable objects.
• Clearly delineate potentially challenging areas—steps, for instance—with contrasting edges and lighting.
• Encourage routine eye care.
• Facilitate easy access to eyeglasses for residents who wear them—and make sure they wear them. See that the glasses don’t get wrapped up in bedding or some other aspect of the living quarters, and make sure the lenses are clean. If possible, mark the glasses with some kind of identification so they can be returned to the owner if misplaced.
• For residents who wear eyeglasses, encourage the use of single-vision lenses to avoid depth perception issues related to progressive lenses meant to accommodate distance, intermediate and near vision.
• Urge residents to avoid adaptive eyeglass lenses that darken or lighten automatically depending on the strength of indoor or outdoor lighting. The delay in color change may present a danger to seniors already experiencing vision difficulties.
• Help residents take their medications as prescribed, and look for any vision-related side effects linked to any drug or nonadherence to prescribed therapy.
• Offer programs for residents with low vision.
• Coordinate care across work shifts via electronic clinical decision support tools or other means so that all personnel are aware of the occurrence and status of any vision-related issues in residents. Medical records—paper or electronic—also can assist healthcare professionals when multiple people are caring for those with multiple chronic illnesses, as often is the case with seniors.

Much of the advice comes down to person-centered care delivery, which is the overarching goal of any senior living community, Beattie says.

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Lois Bowers

Lois A. Bowers was senior editor of I Advance Senior Care / Long-Term Living from 2013-2015.