There were about 1.2 million people (as of July 2022) residing in more than 15,000 certified nursing homes, according to the U.S. Centers for Medicare & Medicaid Services (CMS) data.1 The Agency for Healthcare Research and Quality (AHRQ) estimates that about half of nursing home residents fall annually, and that “1 in 3 will fall two or more times in a year.”2

The World Health Organization’s Global Report on Falls Prevention in Older Age states that about “28-35% of people aged of 65 and over fall each year increasing to 32-42% for those over 70 years of age.”3  For older adults, the consequences of falls can range from simple skin lacerations to devastating injuries that can lead to loss of their independence and even death. One out of five falls cause serious injury, such as broken bones or a head injury, according to the Centers for Disease Control and Prevention (CDC).4 Consequently, many studies have been conducted to better understand falls and find ways to reduce the risk for falls and their outcomes.

In one such study, Lu Shao and colleagues performed a meta-analysis of nearly 20 studies that assessed fall incidence and risk factors in nursing home residents from 10 countries.5 They found the combined frequency of falls in these nursing homes was as high as 43% and determined that “assessment of balance and mobility, disease status, and medication use should be key factors” in the nursing home fall risk assessment. They also observed that “environmental and institutional factors require further exploration.” The team noted that the occurrence of falls at facilities dropped over time with upgraded fall safeguards combined with the establishment of “effective fall prevention programs”. These programs implemented new strategies such as exercises to help residents improve strength/balance and wearable devices to stabilize gait.

Because falls present a significant hazard for older adults, healthcare staff at nursing facilities initially assess fall risk at admission and follow up quarterly, or as needed, to identify and implement interventions for modifiable risk factors, such as low activity levels and physical environmental hazards. Effective interventions could include residents participating in more physical activity, the use of hip protectors, medication adjustment, and environmental changes.6

It is worth noting that data about falls are an important element in the CMS Five-Star Quality Rating System, which assists consumers, families, and caregivers who are comparing nursing home facilities.7 The Minimum Data Set (MDS) and Medicare claims data “measures address a broad range of function and health status indicators” of their residents, including “percentage of long-stay residents experiencing one or more falls with major injury.”8 Therefore, minimizing the number of nursing facility residents that experience falls will positively impact a nursing facility’s Five-Star Quality Rating. As a result, many guidelines and programs exist to help nursing facilities reduce, and hopefully prevent, fall incidence for residents within their care.

One helpful resource is the CDC Injury Center’s “Stopping Elderly Accidents, Deaths, and Injuries” (STEADI) program created for “healthcare providers who treat older adults who are at risk of falling, or may have fallen in the past.”9 The program features three key components: screen, assess, and intervene. It also enacts the American and British Geriatrics Societies’ Clinical Practice Guideline for fall prevention. According to the CDC, the combination of these elements can have a considerable impact on decreasing falls, achieving better health outcomes, and lowering healthcare expenditures. This website has all the necessary materials to launch the program including educational brochures, clinical tools, functional assessments, and more.

It is said that “an ounce of prevention is worth a pound of cure.” This old adage rings especially true concerning falls in older adults. As the world’s population grows even older, the value of fall education, simple interventions, and awareness should not be underestimated.