Falls and Hip Fractures in Independent and Assisted Living
FALLS AND HIP FRACTURES OCCUR EVERYWHERE
While most of the published research on falls and hip fractures comes from the nursing home community (see other pages in this section), most falls occur in the course of daily living throughout the community, just from walking around or getting out of a chair or bed.
This should not be surprising. If anything, the risks factors associated with falls are multiplied in less-controlled environments – uneven or slippery surfaces, unseen obstacles, poor lighting, etc. And of course, the contributing individual factors – unsteadiness due to age-related frailty or injury, or because of illness or medications that interfere with balance or gait – bear no allegiance to any particular geography.
Indeed, we are all often just a single degree of separation away from someone who suffered a hip fracture. “She (he) was doing just fine before the hip fracture, but everything went downhill from there” is the all-too-common everyday refrain. Most commonly a parent, elderly relative, friend or just acquaintance. What drives this widespread awareness is not necessarily knowledge of the fall or its contributing factors, nor even any knowledge about the nature of the hip fracture. Rather, it is the frequently life-altering nature of the injury.
The key challenge to reducing the incidence of hip fractures is insufficient recognition of the risk and sluggish or incomplete adoption of preventive measures. While nursing homes have naturally and understandably been at the forefront of fall prevention, and now increasingly fracture prevention, adoption of such preventative practices has been slow elsewhere.
HIP FRACTURE PREVENTION SHOULD ALSO OCCUR EVERYWHERE
It took years of vehicle crash data and huge legal settlements for vehicle seatbelts to come into widespread use and not just when engaging in overtly dangerous driving. Change of behavior on a broad scale requires not only continuous beating of the drums of risk but also, unfortunately, prominent examples of the devastating consequences of failure to take adequate precautions.
With a better educated population, the ubiquity of information via the internet and increasing life spans, the stage is set for more people in the general – in particular 40- and 50-somethings – to engage more aggressively in promoting the implementation of fall and fracture prevention measures by their parent(s) or other elderly relatives. With more and more people entering the at-risk population, the emphasis on retaining independence and delaying or avoiding the need to move into an assisted living facility or nursing home is driving more and more people to encourage or deploy better fall and fracture prevention practices in their parents’ or relative’s own home.
And as stated elsewhere in this website, hip protectors represent simple, relatively inexpensive risk management tools that make all the difference in preserving independence of daily living – for the at-risk person as well as those on whom they might have to depend for post-fracture care.
ASSISTED LIVING FACILITIES
Most of what we have written in the Nursing Home sections on this website applies just as well to Assisted Living facilities. Qualitatively, the risks to both residents and facility operators are essentially the same. As the population of those living in assisted living facilities continues to grow however, quantitatively the risks are growing.
If anything, the medico-legal liability risks to facilities may be compounded by families being potentially less expecting of a hip fracture occurring in an assisted living facility. Risk managers are increasingly becoming aware of this, especially as more and more consolidation of various senior living models occurs. And in the private sector, enhanced risk management is also becoming an increasingly important marketing strategy – all for good reason.
