Best practice: Fall risk reduction

Falling is an ever-present concern and challenge for nursing homes, and falls at home is often the reason why family members decide to move their loved one to a nursing facility. Too often, however, staff and residents’ fear of falling can lead to a vicious cycle:

  • An ambulatory resident falls and gets hurt.
  • The resident recovers physically, but may now be afraid to walk for fear of falling.
  • The staff also fear that the resident will fall again, so they continually tell the resident to “sit down so you don’t fall,” reinforcing the resident’s fear.
  • The resident then sits more and walks less (if at all), and consequently becomes weak (which is just one of the many negative effects of immobility).
  • One day, the resident tries to walk or transfer without assistance (common among people with dementia who forget they need help) and falls because he/she is now so weak.

…And the cycle begins again.

How do we break this cycle?

Tricks of the trade:

  1. Review with staff why people with cognitive decline (who may not be able to communicate their needs verbally) want to get up and walk on their own. Are they bored? Do they hurt from sitting for a long period of time? Do they need to use the bathroom? Do they forget they need help to walk?
  2. A supervised 5-minute walk could be enough to satisfy their need to move for a while, and may help decrease negative behaviors later on due to boredom or discomfort.
  3. Instead of saying, “Sit down, you might fall!”, try to get in the habit of saying something like, “I see you want to walk. Please wait and someone will help you very soon.” …then take the individual for a short walk/ a quick stand up for a moment or two / a hug and a dance…..
  4. Perform fun “sit to stand” exercises throughout the day with residents….put on some music, have them grab the rails along the hallway and do 5 minutes of sit to stands with them!
  5. Spread the love and encourage physical function…..ask the resident, “Could you stand up and give me a hug?” –The reward back is a big hug from you!

Engaging residents with apathy

A person who is withdrawn or apathetic is someone who is socially withdrawn and is experiencing a loss of interest and motivation. Behaviors that reflect being withdrawn or apathetic might include:

  • sitting alone in one’s room
  • avoiding contact with others
  • making limited eye contact with others.

It’s important to note that these behaviors are not often considered problematic because they don’t call attention to themselves like screaming does. They can, however, lead to rapid loss of cognitive and physical function.

How to approach the person who is withdrawn or apathetic:
  • Try to engage the person in creative activities.
  • Give instructions slowly and break tasks down into manageable portions for the person.
  • Remain positive and calm with the person.
  • Encourage the person to do what they can for themselves and provide praise often.
  • Avoid excess stimulation such as large crowds or loud noises.

Things to try:

  • Sensory stimulation may be helpful. Some ways to do this might include playing music, looking through visually stimulating thing such as pictures from old calendars or holiday cards, and touching or holding a stuffed animal.
  • Involving the person in cooking or baking activities can help stimulate the sense of smell and be a good time to talk and reminisce with the person as their memory allows.
  • Consider the persons’ preferences. For example, if the person is fond of animals, bring in a therapy dog as a way to spark interest and movement (reaching, petting).
  • A visit from young children can be a wonderful, heartwarming way to engage a withdrawn older adult.
  • For many, a short walk or simply sitting outdoors for a short period of time can offer valuable sensory stimulation.
  • Try to engage the person in a 1:1 or small group social activity.  Try to individualize social contact, which can include casual conversations or “small talk.” Adapt the conversation based on how advanced the person’s dementia is. For someone with very advance dementia try to focus mostly on questions involving “here and now” discussion such as comments about music playing, food being served or the weather. For an individual with mild to moderate dementia, small talk can be facilitated by asking the person simple questions, such as: “did you ever play football in school?” or “have you always lived in Wisconsin?”
  • Talk to family members to learn more about the person’s history and use this information to plan activities. For example, a painter could help make posters for events; a policeman could “walk the beat”; a homemaker could help knead dough, dust or sweep the floors.
  • Another simple strategy for facilitating social contact is to share information about your life or plans for the day and ask the person with dementia for their input about things you share using straightforward questions.

Environmental influence on resident behavior

As promised, here is the first of the “Weekly Tidbits” we’ll be sending every Sunday to provide ideas and motivation to you and your staff as you work to address behavioral and psychological symptoms of dementia (BPSD) with your residents. If you’d like additional members of your staff to receive the tidbits, please email Erin Vigne (vigne1@verizon.net), and she will add their email addresses to our list. Please feel free to forward these tidbits to staff, print and post on bulletin boards, or even publish in your facility’s newsletter or on your Facebook page!

This week, we’d like you to think about the environment in your facility and how it may influence behavior and/or encourage or discourage physical activity among your residents. Remember, if we can help residents stay engaged in pleasant ways, then they may be less likely to become anxious, depressed or agitated. They may also feel better if moving a bit more with less pain and generalized achiness.

Look around your common areas. Are there cues that would prompt a staff member to lead residents in physical activity, or do you just see a television? When family members are visiting, do they always sit in the resident’s room and talk, or are they encouraged by staff to take their loved ones for a walk outside where there are benches to rest? Does your activity director have custody of all the fun items that could encourage movement?

Start with common areas, where many residents spend the majority of their day. Consider placing a basket there with foam swim noodles (when cut in half, they are great for resistance exercise!), small weights or elastic bands, and movement scarves to throw and catch. Having these items out in the open can prompt nursing assistants and other staff to start some spontaneous exercise with residents when they are bored or need distraction. Is there a way to play music in common areas? Turn off those TV’s for a while each day and get staff and residents to dance! Staff can bring in their iPods or phones to plug in to speakers and take turns playing their favorite dance tunes.

Next, are your halls dull? Look at your main corridors. Residents use corridors for walking to a destination, exercise, and social interaction. Are there places to rest if it is a long hall? Is the hall cluttered with items that could cause a trip, or limit access to the handrails? Are there pleasant things to look at during a walk? Consider changing artwork periodically and adding art created by residents. Or choose a new theme each month and hang posters down the hall that correlate with the theme. The hall can then become a destination itself, and family members may be more likely to take their loved ones for a stroll. You could host a contest to see who can decorate the best resident door around a certain theme (summer, holidays, sports, etc). Involve staff and family members too, and offer prizes.

We look forward to discussing your ideas at our next meeting. Have a great week!