Current approaches to postfall assessment in nursing homes

Falls in nursing homes occur among a large percentage of residents. Their onset necessitates a postfall assessment (PFA) be performed by clinical staff to determine likely etiology. The absence of an empirically validated comprehensive postfall assessment tool has led to considerable variability in the types of PFAs performed. The purpose of this study was to examine the types of PFA tools available, their content, and to compare this with national recommendations for fall assessment in geriatric practice.

A convenience sample of 379 long-term care facilities, with a cumulative census of over 40,000 residents, in New Jersey were solicited to return to the Director of Long-Term Care Surveys at the NJ Department of Health and Senior Services a copy of any PFA tools used in practice.

A review of the types of assessment tools used in each of the responding facilities were tabulated and coded as belonging to one of five categories: (1) fall-risk assessment short form, (2) fall-risk assessment long form, (3) fall prevention protocols such as fall programs and postfall assessment forms, (4) incident reports, and (5) other. A subset of 20 facilities used a specific PFA. This content was further analyzed and compared with national and professional recommendations for PFA that included five domains: (1) history of the fall, (2) environmental issues, (3) physical examination, (4) functional assessment, and (5) laboratory and other diagnostics.

Of 379 facilities solicited, 149 responded (40%) to reveal a wide array of tools used for the purpose of PFA. These included: risk assessment tools, fall prevention programs, policies and procedures for fall management, and incident reports. Overall, most facilities used fall-risk assessment tools in place of PFA (63.7%; n=95). Many of the nationally recommended guidelines for PFA were not included in the tools included in this sample, with the exception of environmental questions that were evident in all PFAs surveyed (100%). Other fall circumstances related to time, mobility, and footwear were included less often (70% n=14) as were use of diuretics (55%;=11), mental status and ambulation ability (45%; n=9) of the falling older adult.

Despite recommendations in the geriatric literature, comprehensive postfall assessment tools were unavailable for use by nursing home staff. When a PFA was performed, there was no consistency among facilities sampled. Data collected was minimal and unlikely to reveal the full range of possible underlying etiologies. Improved, validated PFA tools are needed to aid clinical staff in evaluating older adults who have fallen.