Interventions to Reduce Fall Risk for Patients with Cognitive or Emotional Impairments
Some patients have cognitive or emotional impairments, such as impaired memory, impulsivity, or confusion. These impairments may contribute to lack of insight into how to reduce their risk of falling, making other risk factors (e.g. mobility impairments or toileting needs) even more challenging. These impairments may be long-standing for the patient, or may be acute changes due to the patient’s current medical condition.
They may also stem from medication side effects or problems with nutrition or hydration. Interventions directed at cognitive or emotional impairments seek to either reduce or compensate for these impairments to the extent possible.
Interventions
A list of interventions that may be of benefit to these patients include:
| Potential Interventions | Rationale |
| Bed and/or chair alarm | Alert staff when patient attempts to leave the bed or chair unassisted. |
| Delirium prevention or mitigation | Reduce confusion due to delirium. |
| Handoff to communicate risk | Transfer important information about a patient’s fall risk to another staff member caring for that patient. |
| Medication review by pharmacy | Address medication side effects that may be contributing to a patient’s current cognitive or emotional state and/or treat the patient’s symptoms. |
| Patient/family education | Simplify communication to better match a patient’s cognitive or emotional status. |
| Patient placed close to nurses’ station | Staff is in closer proximity to monitor the patient. |
| Purposeful hourly rounding | Proactively address the patient’s needs to reduce the chance he/she will get up unassisted. |
| Sitter | Provide close monitoring of a patient to better address the patient’s needs and reduce the chance he/she will get up unassisted. |
| Supervised mobility and/or activities of daily living | Provide close monitoring and/or physical assistance as needed to reduce fall risk or assist a fall, should one occur. |
| Supervised toileting | Provide close monitoring and/or physical assistance as needed to reduce fall risk or assist a fall, should one occur. While there are competing tensions between patient privacy and safety when it comes to toileting, the bathroom is an important place for staff to provide supervision and assistance due to the difficulty patients may have with transferring and managing clothing, as well as multiple hard surfaces that can cause injury in the event of a fall. |
| Video monitoring | Alert staff when patient attempts to leave bed or chair unassisted. |
| Visible identification of risk | Use of signage, colored bracelets, and/or socks helps all staff visually identify if a patient is at risk for falls. |
Cognitive or Emotional Education
Print Resource
Strategies for Fall Risk Reduction in Geriatric Behavioral Health: The Strategies for Fall Risk Reduction in a Geriatric Behavioral Health Unit document, created by the UNMC CAPTURE Falls Team and Fillmore County Hospital, provides an example of one hospital’s approach to fall risk reduction in patients with cognitive impairments and/or mental illness.