Taking a tumble is usually a minor mishap for the young -- but in older adults, including those hospitalized for other conditions, falls are insidious events that can set off a series of health consequences, from broken bones to bedsores and blood clots.

“A patient who has been admitted into the hospital is already at a vulnerable state,” says Kim Bailey, injury prevention coordinator at Duke University Hospital. “If you add a falls-related injury into the mix, the results can be catastrophic. And the older you get, the more serious falls become; some people never regain their mobility.”

At Duke and other institutions nationwide, there’s a growing movement to protect patients from falls, which can be surprisingly severe. In North Carolina, falls are the most common cause of fatal injuries in those age 65 and up.

According to the CDC, this age group is hospitalized for falls-related injuries at five times the rate of injuries from other causes. The cost impact of falls is estimated to reach $54.9 billion by 2020.

The Evidence Team

“There are many risk factors that contribute to falls: advanced age, history of falls in the previous 12 months, incontinence, medications, cognitive impairment, or limited mobility,” says Susan Avent, RN, MSN.

Avent, associate chief nursing officer for quality at Duke University Health System, chairs the Duke University Hospital Falls Advisory Board, which meets monthly to address risk factors and monitor falls data.

“We look at all of the factors leading up to a fall,” says Avent. “How did it happen? When did it happen? We work to identify the causes so that we can create a safer environment.”

All of the data is compiled in the health system’s Safety Reporting System, a Web-based application available to Duke’s clinical staff. The falls team looks for trends and determines an action plan to target emergent issues.

In 2007, the first iteration of the board instituted evidence-based revisions to Duke University Hospital’s falls policy and plan of care, and implemented patient safety checks (at two-hour intervals) and a revised falls assessment tool (to be used at every nursing shift).

More recently, the board has stressed a wider circle of involvement beyond just nurses -- including all hospital employees and patients themselves -- in falls awareness and prevention. Patients and families at Duke are encouraged to be mindful of their environment; falls alert posters have been placed throughout the hospital’s patient rooms and bathrooms, with details specific to adult and pediatric units.

North Carolina’s Safety Net

“Falls in the hospital setting is just a piece of the puzzle,” says Bailey. “We want to prevent them from happening in the first place, and the home is actually where the majority of falls occur.”

While the 65-and-up group does carry the highest risk, Bailey says, “There’s a false perception that only older people fall or only kids are prone to falls. But it can happen to someone who has a physical condition affecting strength, someone taking balance-altering medications, or just tripping over pets or rugs.”

Bailey serves as one of Duke’s liaisons to the North Carolina Falls Prevention Coalition, a statewide network of hospitals, emergency medical services, public health groups, and even housing specialists promoting multidisciplinary strategies to prevent falls and falls-related injuries, such as risk assessment, behavior intervention, and community education.

“For older people, trying not to point fingers is important. We can tell them about falls, but we also provide practical information and resources to prevent falls,” she says. “Simple adjustments can make a real difference in patient safety.”