Falling short on fall prevention

Hospital wristband showing Fall RiskCaregivers are not being given the resources needed to prevent falls for their care recipient, according to new research from Geoffrey Hoffman, Ph.D., MPH, a University of Michigan School of Nursing (UMSN) assistant professor, and a team of UMSN researchers. 

“Falls are a trifecta in terms of reasons why they need an increased focus,” explained Hoffman. “They are highly prevalent, cause a lot of damage, including death, and they are preventable. However, fall prevention is being left out of the discharge planning conversation and that needs to change.”

Hoffman and his U-M colleagues interviewed informal caregivers of older patients about the fall-related information they and the patient received leading up to and during the patient's discharge from the hospital, their perceptions of post-discharge fall risks and knowledge about fall prevention strategies.

“The transitional period from hospital to home is important given the high risk of falling following discharge and what we found is that even if the care recipient was classified as a fall risk in the hospital, they didn’t get much information about preventing falls at home,” said Hoffman. “This included a lack of conversation with their clinicians as well as not receiving widely available educational materials.”

The researchers found many of the caregivers and patients underestimated the risk of falls following a hospitalization. Conversely, some caregivers were overly cautious and restrictive of the recipient’s movements, meaning the lower perceived risk for falling may result from overly restricted mobility.

“It comes from good intentions,” Hoffman explained. “However, if the caregiver encourages too much sedentary behavior, that can cause more problems for long-term functioning and independence. We recommend that, during discharge, clinicians increase their engagement with older adults and their caregivers on recommending activities that help with post-discharge functional recovery and promote independence in the long-term, rather than discourage activity.”

Hoffman says despite the strong arguments for increased fall prevention education, there’s often a financial barrier around preventive strategies.

“Medicare doesn’t generally pay for fall prevention,” he said. “If someone is at risk for diabetes, they can receive a screening or be treated for that but a fall isn’t technically treatable until it happens.”

However, Hoffman says reducing falls, especially those that cause a readmission to the hospital, does come with financial benefits.

“Readmissions to hospitals are very costly under the federal policy of punishing hospitals with excess readmission,” said Hoffman. “Our focus is on what is best for the patient but it’s important to note that hospitals can save money if they reduce readmissions by investing in transitional fall prevention programs. There is a cost-effectiveness argument for doing the right thing.”