Falls in nursing homes: challenges from a nursing perspective

Falls are very common among older people. Previous literature has reported a mean fall rate of 1.7 falls per person-year (range, 0.6–3.6) for those who live in nursing homes (Rubenstein et al, 1994) and a rate of 0.65 (range, 0.3–1.6) for those living in the community (Rubenstein, 2006). A more recent study of 70,000 falls in Bavarian nursing homes has reported a similar fall rate (1.6 per person-year), with the rate being higher among men (Rapp et al, 2012). The higher fall rate among older people in nursing homes compared to the rest of the community is expected, and falls are a major reason for admission into nursing homes. One non-injurious fall carries a 3.1 times relative risk of admission into a nursing home, while a fall accompanied by serious injuries is associated with a 10.2 times higher relative risk (Tinetti and Williams, 1997). Even though the majority of falls in nursing homes do not result in serious injury, 10–25% result in hospital admission and/or fractures (Vu et al, 2004). With such a high prevalence, falls, unsurprisingly, result in 81.5% of external (defined as premature, usually injury related and potentially preventable) causes of deaths among nursing home residents (Ibrahim et al, 2017).