Mr Grams, what are the classic causes of falls?
There are many reasons. On the one hand, the risk of falling and the number of falls increase with age. This is due to the fact that cognitive abilities decline as a result of the ageing process. Over the years, vision is impaired and muscle performance decreases. In addition, bone density decreases with age, which increases the risk of bone fractures.
On the other hand, neurological diseases in particular lead to an increased risk of falls. For example, Parkinson’s disease affects a resident’s gait. Frequent consequences of a stroke include a disturbed sense of balance and reduced muscle strength. Dementia patients with orientation difficulties and perception disorders are also acutely at risk of falling.
Likewise, there is a possibility that medical treatment methods may lead to falls and severe consequences. Blood thinners promote haematomas. Antidepressants can cause agitation and hallucinations after the level of their effect has decreased.
Physical causes can therefore massively increase the risk of falling. Which factors in the living environment increase the risk of falling?
Extrinsic fall hazards play a major role especially in the ambulant care settings. Here, the living environment should be checked for tripping hazards; steps, carpets, cables, insufficient lighting or loose footwear often lead to falls. In residential care, nursing care homes are equipped barrier-free so that environment-related causes are minimised as much as possible.
As you can see, the list of causes and risks is long and serious. After all, about two-thirds of people who suffer a femoral neck fracture as a result of a fall become dependent on assistance with everyday living activities.1
What can caregivers do to minimise the consequences of falls?
Care professionals have a great responsibility for their residents and are also aware of this. That is why nursing staff adjust the care planning according to the resident’s clinical profiles and the degree of care required. The prevention of falls and their consequences is always a major topic and is discussed with the German MDK (German Medical Service of Health Insurance).
Preventing the consequences of falls already begins with providing slippers for the nightly trip to the toilet. To protect the resident, corridors in nursing care homes are equipped with grab rails. Aids such as hip protectors, walkers or wheelchairs help to reduce the risk of falls. In order to offer residents effective fall prevention in the bedroom as well, we at Hermann Bock have opened our own low bed category with the floorline. With the floorline 15|80, we lower the lowest height of care beds by 40%. This means that we are not going down to 25cm, as is customary in the industry, but to 15cm. This is because the fall speed from a height of 25cm is almost 30% higher than from a height of 15cm, and the impact force is as much as 67% higher.2 This means that falls can be mitigated to a much greater degree. At the same time, we are pursuing the approach of reducing measures that deprive patients of their freedom. If the bed is then connected to a bed exit system, caregivers can react extremely early when residents fall.
You have already mentioned it: measures that deprive freedom are a frequently discussed topic in care. How do you assess the use of side rails to prevent the consequences of falls?
In order to protect the resident, when I was a nurse, deprivation of freedom measures were carried out much more frequently than today. Nowadays, there are far more aids available to prevent the consequences of falls, which means that in many cases there is no need for these restrictive measures. In addition, the German local court only rarely enforces a measure involving deprivation of freedom. Therefore, we say that side rails on the head end are completely sufficient. They offer protection and cover >50% of the lying surface. Of course, there are also residents who are physically fit but feel the need for side rails because they simply feel safer with them.
In my view, however, the way forward is to use fewer side rails, as low beds provide sufficient safety.
For whom is such a low bed suitable?
Low beds are especially suitable for people with an acute risk of falling. Therefore, also for people suffering from dementia who, due to their disturbed day and night rhythm and triggered fears, leave the bed in a hasty manner. The low position of 15cm is documented by the nursing staff in care planning and used as a counter measure to the consequences of falls. During the night, the resident has the possibility to move the bed to its perfect exit position at any time, for example to go to the toilet. Caregivers can use low beds alternatively for preventative care, making the floorline 15/80 a long-term and safe investment with a wide range of uses.