Falls are the leading cause of injury deaths and hospital admissions among persons 65 years of age or older, according to the Centers for Disease Control (CDC). In 2003, falls sent 1.8 million older Americans to the emergency room. The total cost of falls accounts for 10% of healthcare spending in the United States. Perhaps the most shocking fact is that 30% to 40% of all falls can be prevented (National Center for Injury Prevention and Control [NCIPC], Coordinating Center for Environmental Health and Injury Prevention, Centers for Disease Control and Prevention, n.d.).

"There are groups all over the country that are working on fall prevention," says Shelley Ludwick, director of VNAA clinical programs. Ludwick is in the process of gathering the best resources for falls prevention and making them available to member VNAs through the VNAA Web site. She says good programs begin with a thorough patient assessment. This includes reviewing of medications, a vision screen, an orthopedic screen, and a search for physical hazards in the home and surrounding community. "These are all areas where VNAs can make a difference. VNAs that have developed such screening tools are seeing a decrease in falls and improvements in patients' rehospitalization rate," explains Ludwick.

Proper medication management also is an integral key to falls prevention. Medications that cause dizziness and confusion increase a patient's risk of falling (NCIPC et al.). Assessing dosage and schedules, screening for interactions, and considering alternatives without side effects all can lower that risk. Medication management is addressed in depth in VNAA's Curricula for Homecare Advances in Management and Practice (CHAMP). This multimodal learning program is aimed at helping frontline nurse managers institute evidence-based geriatric practice and continuous quality improvement in their agencies.

Many other factors go into creating a situation that leaves patients at risk of falling. Ludwick recently participated in a partner meeting entitled Prevention of Older Adult Falls hosted by the CDC's National Center for Injury Prevention and Control (NCIPC et al.). Attendees learned and discussed the expected topics: injury research, training and education for the public, community demonstration projects, medication management, and exercises for strengthening and balance. In addition, participants heard from a representative of the National Floor Safety Institute regarding the possibility of issuing walkway safety standards for manufacturers of floor coverings, cleaning products, and floor coatings.

Many homes have hazardous conditions not readily apparent to most patients. This is the reason why agencies send out a trained therapist to look for spots in need of handrails or better lighting. Something as simple as purchasing and correctly installing a nonslip bath mat can prevent a broken hip.

Another preventive measure is exercise because it improves a patient's strength and balance, thus preventing falls. One prevention consortium found that Tai Chi was especially effective and well received by patients. A physical therapist can design a balance therapy program built to fit a patient's individual needs.

Fall prevention services can save lives, prevent injury, and forestall functional decline for elderly patients. These programs also can provide a peace of mind that promotes healthy independence. Fall prevention techniques increase patient satisfaction, improve patient health outcomes, and create major savings in the healthcare system. It is no accident that so many VNAs are embracing these techniques.

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