November 17, 2003

Study hopes to minimize falls in nursing homes

By Tia Webster

As many as 75 percent of nursing home residents fall annually, twice the rate of seniors living in the community. And now, a federal agency is supporting an Emory study on how best to minimize the problem.

The collaborative effort of the Emory Center on Health Outcomes and Quality and the Emory Center for Health in Aging have been jointly funded by the Agency for Healthcare Research and Quality (AHRQ) for $375,775. Beginning in January 2004, the two-year project will build on the Falls Management Program (FMP),
a previous AHRQ-funded effort that developed fall-related education strategies and standardized electronic reporting forms. The goal of the new project is to rapidly disseminate the FMP tools and products into a real-world setting.

Co-investigators for the project are Kimberly Rask, director of the Center on Health Outcomes and Quality and associate professor of health policy and management in the Rollins School of Public Health; and Joseph Ouslander, director of the Center for Health in Aging and head of geriatric medicine and gerontology in the School of Medicine.

“The existing data collection tools for nursing homes don’t accurately capture fall risk factors for the residents,” Rask said. “Even when a resident-assessment plan is developed, the existing tools don’t provide specific enough guidance to help staff develop individualized care plans that can reduce fall risks. Many falls can be prevented if appropriate protocols are followed.”

The Emory team will build on the FMP work by using its improvement tools in 26 Georgia nursing homes. The selected community-based nursing homes are owned and operated by Ethica Health & Retirement Communities, a Georgia nonprofit company and member of the Southeastern Consortium for Long Term Care Quality.

“We will be streamlining the previously developed educational materials and quality-improvement tools in such a way that they can be incorporated into standard practices at the participating nursing homes,” Rask said. “If successful, the project could result in widespread dissemination of these tools to improve the management of falls in nursing homes.”

According to the CDC’s National Center for Injury Prevention and Control, a typical 100-bed nursing home reports 100–200 falls each year, but many others go unreported.

“Risk factors for falls are well known and can be attributed to mobility disorders, incontinence, coexisting medical diseases or medication side effects,” Ouslander said. “Falls among residents are also a major cause of morbidity, health care expenditure and legal liability in nursing home facilities. Reducing falls will have a significant impact on quality of life as well as health care costs.”

Rask said many promising research findings are never translated into actual improvements in clinical care because the research model is too labor- or expertise-intensive to be adopted widely. With the new project, she said, fall and injury rates will decline over the course of the project, although there may be an initial increase in rates because of the improved reporting of falls.

“If we are successful,” Rask said, “we will have created a model program that can be rapidly and easily implemented in community nursing homes across the country, making a real impact on reducing the rates of preventable falls."