* ECPN * January/February 2001

Injury Prevention/Liability
Wandering and Fall Prevention

In an increasingly litigious society, administrators in long-term care facilities must look to products and programs that enhance patient care and reduce risk. One very important risk management concern is liability from wandering and/or falling residents.

Fall Prevention

Falls are one of the leading problems facing the older person. One in three persons older than age 65 falls each year resulting in an estimated 250,000 hip fractures annually (Weber & Kehoe, 1996). Lange (1996) estimates 50 percent of all persons over age 80 will fall. Lange also found falls are listed as a reason for 40 percent of all nursing home admissions.

Many times injury from falls leads to permanent disability, limiting a person's active, independent life. Indirectly, the fear may also be damaging. It's estimated that 20 percent of the elderly who fear falling limit their activities of daily living. Making simple changes to lifestyle and environment can provide peace of mind and prevent the likelihood of falling.

The older population's risk of falling is related to three influences:

* The normal aging progress

* Pathology that increases with age

* Environmental conditions.

As people age, there are normal alterations in vision, gait, posture, hearing, and cognition, which may increase incidence of falls. For example, a person may not have the muscle strength or reflex reaction to avoid a fall after an unexpected trip, or impaired vision may interfere with a person's ability to avoid obstacles.

In addition, the elderly also have a higher incidence of chronic illness. Cardiovascular conditions, neurological impairments, psychological disorders, and metabolic disorders may directly influence a person's functional capabilities. Environmental factors, including a person's physical surroundings, and medications may put a person at risk for falling.

There are many products available that allow fall monitoring for residents in beds, chairs, or wheelchairs. These monitors provide a way to alert staff when a patient leaves a bed, chair or wheelchair. Staff is alerted when a monitored individual moves to get up. Manufacturers also can provide voiced monitors that allow a favorite caregiver or family member to record a reassuring message that help is on the way.

Wandering

Alzheimer's disease (AD) is the most common cause of dementia in older people. A dementia is a medical condition that disrupts the way the brain works. An estimated 4 million people in the United States suffer from AD. According to Robert Koester, a Virginia researcher who studies the habits of Alzheimer's patients, about 32,000 Alzheimer's patients wander from US homes or care facilities each year. If Alzheimer's patients aren't found within 24 hours, their survival rate drops to 46 percent.

AD begins slowly. At first, the only symptom may be mild forgetfulness. People with AD may have trouble remembering recent events, activities, or the names of familiar people or things. However, as the disease goes on, symptoms are more easily noticed and become serious enough to cause people with AD or their family members to seek medical help. People with AD may become anxious or aggressive, or wander away from home. Eventually, patients may need total care.

No treatment can stop AD. However, for some people in the early and middle stages of the disease, the drug tacrine (also known as THA or Cognex) may alleviate some cognitive symptoms. Also, some medicines may help control behavioral symptoms of AD such as sleeplessness, agitation, wandering, anxiety, and depression. Treating these symptoms often makes patients more comfortable and makes their care easier for caregivers.

Other provisions to decrease the risk of wandering include:

* Careful assessment of the patient and environment

* Environmental manipulation, such as electronic surveillance devices

* Programs and activities specifically geared to the cognitively-impaired individual

* Specific interactions and approaches to reduce or manage wandering behavior

* Behavioral consistency among all personnel toward wandering patients

* Full administrative support to forego use of restraints. ***