Seniors, Personal Independence, and Fractures from Falls

South Carolina Nursing Home Injury

A new study has released some surprising facts about seniors, their mobility, and the likelihood of fractures, especially hip fractures. It turns out that those who have greater mobility in nursing homes are more likely to suffer fractures, while those still at home who have less mobility are the ones most vulnerable to fractures.

These facts may seem at odds with each other. Why should a person in a nursing home who is active be more vulnerable to falls and broken bones? You might be surprised at the reasons.

Some Statistics About Falls

The Centers for Disease Control and Prevention (CDC) have reported that, every year, millions of those aged 65 and older suffer falls. Of all seniors, more than one in four of them fall every year, but not quite half of them actually tell their doctor. (Seniors who fall at home are often afraid they will be hospitalized or institutionalized against their will if they reveal a history of falls.) But the sad fact is, if a senior falls once, they are twice as likely to fall again.

Some facts about falls among seniors:

  • Approximately 2.8 million seniors are treated for fall injuries in U.S. ERs every year.
  • Around 800,000 seniors are hospitalized each year because of a fall injury. Generally this is for a hip fracture (around 300,000 seniors) or a head injury.
  • The usual reason for traumatic brain injuries (TBI) among seniors is falls.
  • Over 95 percent of hip fractures are caused by falls.
  • One out of five falls among seniors result in either a head injury or at least one broken bone.

Mobility and Fall/Fracture Risk

Released in the August, 2017, issue of the Journals of Gerontology Series A, the study examined the likelihood of falls and their circumstances among seniors. It also reviewed an assessment model called “Fracture Risk Assessment in Long-term Care (FRAiL)” for how well it can predict the risk of falls. The study’s findings arise from nearly two years’ worth of data among 419,668 nursing home residents, of whom 14,553 suffered from hip fractures. The ages of residents ranged from 65 to 113, with the average age being 84. After two years, around 3.5 percent had endured a hip fracture.

Interestingly enough, those with more mobility—the ability to walk independently—in nursing homes had a 32 percent greater chance of suffering from a fall that resulted in a hip fracture than those who did not get about independently. That’s because those who could walk independently were often medically frail, suffering from dementia and/or diabetes, and prone to wander, increasing chances of injury. Sometimes the chance of falls increased because of the medications common among nursing home residents, such as sedatives and antidepressants, which can cause dizziness and disorientation.

However, nursing home residents who needed intensive, personal assistance to move were less likely to fall and experience a fracture because they had immediate help at hand that short-circuited the fall.

The study confirmed that those still living at home who have less mobility are more likely to fall.

There are good reasons for seniors to fear hip fractures. The study found that approximately 36 percent of those in nursing homes who suffer hip fractures will die within 6 months. Immobility increases the chances of life-threatening medical situations such as blood clots. Of those who survive the fracture and were mobile before the fracture, 17.3 percent become completely disabled. Once disabled, those with hip fractures endure infections, pressure sores (bed sores), and a general decline in function and quality of life.

Almost 10 percent of all U.S. hip fractures occur in nursing homes.

The FRAiL Study

The study also discovered characteristics that can significantly predict hip fractures in nursing home residents. Some of the most common factors are:

  • Female
  • Older
  • Able to walk independently
  • Independent with regard to common activities of daily living
  • Having impaired cognition (dementia or other mental impairment)
  • Easily distracted
  • Prone to wandering
  • A history of previous falls.

The study’s lead author, Dr. Sarah Berry of Boston’s Institute for Aging Research at Harvard Medical School, noted in a released statement, “The FRAiL model is the first clinical tool that could be used to discriminate residents at high risk for fracture and standardize fracture prevention efforts in the nursing home.”

When a loved one suffers a broken bone in a nursing home, it always bears looking into. Sometimes the reason can involve negligence or even physical abuse such as an assault. Why a loved one ended up with a broken bone needs to be the focus of a thorough investigation.