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The Impact and Prevention of Chemical Restraints on Falls in Nursing Facilities

Falls occur very frequently within nursing homes and usually result in bone fractures, broken hips, or head injuries. These injuries often require hospitalization and can be prevented with proper attention and supervision, along with a decrease of environmental hazards within nursing homes that contribute to the problem. The Centers for Disease Control and Prevention (CDC) documented that a typical nursing home with 100 beds would report as many as 100 to 200 falls in a year, and many falls still go unreported. Falls can greatly affect a nursing home resident’s happiness and self-assurance, as the resulting disability, functional decline and reduced quality of life can cause depression, social isolation, and feelings of helplessness.

A risk factor study on falls among older residents in nursing homes was recently conducted by the Journal of the American Medical Directors Association (JAMDA). It differed from most risk factor studies, which usually focus on a smaller scope of cognitive or physical performance, in that the study was a more comprehensive examination of the various medical, psychological, and physiological factors that could affect the fall risk for older patients who suffer from cognitive impairments while residing in residential care. The main objective of the study attempted to better understand potential fall risk factors and their causes while providing possible methods that could help lower the chances of a falling accident. Data was collected in three to four interview sessions with participants from seven different South London care homes, and any additional information was obtained from care staff interviews and medical records.

The study results showed that there was a definite correlation between the patients who fell more often and the amounts of medication administered. The researchers were concerned with the possibility that medications affecting the central nervous system had a large impact on fall risk through a direct affect on balance control. Fallers were more likely to be taking psychotropic medications, which are often used to treat mental disorder symptoms such as depression, dementia, bipolar disorder, and other anxiety disorders. These medications include sedative hypnotics, antipsychotics, and antidepressants, which are commonly overused by understaffed nursing homes as a tool to subdue the more difficult patients that require larger amounts of attention. The medication essentially becomes what is known as a chemical restraint, the negative aspects of which greatly outweigh any positive aspect that could be determined. The simultaneous usage of too many drugs on a patient, known as polypharmacy, can actually aggravate dementia further, and even double the risk of death in dementia patients. Despite this evidence, some nursing homes still persist in using antipsychotics as a chemical restraint on their patients.

The study also found that older people diagnosed with dementia and cognitive impairment often have either double or triple the annual fall incidence in comparison with their peers who were considered to be cognitively-intact. Because patients with dementia often require more care and supervision, understaffed facilities are usually unable to monitor these residents closely enough to prevent falls from occurring. Instead, they are often chemically restrained, by psychotropic medications, which increases the risk of falls, as discussed above.

Based on these findings, the researchers were able to identify four significant, independent predictors of falls: poor attention and orientation, anxiety, antidepressant use, and increased postural sway with eyes closed. The fact that researchers were able to identify four predictors of a falling scenario shows that nursing homes are more than capable of reducing the amount of falls that happen every year. Because falls can usually be avoided provided that proper care and supervision is given by the caretakers of the nursing homes, understaffing plays a large role within a facility’s means to prevent a fall from occurring. A nursing facility is required under California law to provide a minimum of 3.2 nursing hours per patient per day, but older patients often need more time and care than the bare minimum requires. For this reason, the law also requires that nursing homes provide sufficient staff to fully tend to the needs of its patients, even if this requires a staffing level higher than 3.2 nursing hours per patient per day.

The study highlighted potential interventions that nursing homes should put into practice in order to lower fall risks for residents, such as medication review, exercises that improve balance ability, and the employment of better strategies in order to understand and manage wandering behaviors, agitation, and poor attention. Researchers also emphasized that, more than anything else, the reduction and minimization of psychotropic medication usage plays an important role in reducing fall risk among nursing home residents.

If you believe that your loved one might have suffered a fall or injury that could have been prevented by adequate nursing home staff, or that they might currently be at risk for injury within a facility, please contact us today at the Law Offices of Ben Yeroushalmi. Our specialization in nursing home neglect disputes has provided us with a thorough amount of experience in handling cases concerning falling that could be prevented. Allow us to help protect your loved one’s rights to an adequately staffed environment safe from the fear of a preventable fall.