Tuesday, 21 August 2012

Bariatric Patient Falls: What You Need to Know

Over 33% of adults aged 65 and older fall each year in the United States. In the hospital, 20% of senior patients experience falls every year. These falls are most often caused by risk factors like medication use, confusion, or weakness, but there is a new risk factor that can increase the likelihood of patient falls: obesity.

A recent study published by the Journal of the American Geriatrics Society found that bariatric patients over the age of 65 are 12-50% more likely to suffer a fall than normal weight patients. In the same study, it was discovered that the risk of falling increases with a patient’s weight. Patients with a BMI that exceed 40 were found to have the highest risk of experiencing a fall in the hospital.

Why Do Bariatric Patients Fall?

Though common risk factors including medication and cognitive awareness do contribute to bariatric patient falls, there is a unique set of fall risk factors associated with obesity:
  1. Low levels of physical activity
  2. Pain
  3. Vitamin D deficiency
  4. Chronic illness
  5. Fear of falling
  6. Depression
  7. History of falls

Muscle weakness and balance can be caused by a number of attributes common in bariatric patients, including low levels of physical activity, pain, vitamin D deficiency, and chronic illness. A patient’s fall risk is increased when a patient experiences mobility issues, which can lead to stumbling when walking, or lead to trips or falls when exiting or entering the hospital bed. 

Often, a bariatric patient may fear falling because of self-esteem issues and social stigma. This fear of falling may lead to even further decreased physical activity and more mobility issues, which actually amplifies the patient’s likelihood of falling. 

Depression, which is more common in bariatric patients, can also contribute to a bariatric patient’s risk of falling because of increased medication use that can lead to confusion and muscle weakness.  
Bariatric patients are 66% more likely than the average patient to have experienced a previous fall. Patients with a fall history are already 3 times more likely to experience another fall, and obesity can further increase this likelihood. Complications from falls such as trauma and injury, and the fear of falling can also increase fall risk.

How to Prevent Bariatric Patient Falls

Implementing fall risk assessments is the foundation of any fall prevention strategy. Though variables such as history of falling and ambulatory aids are addressed in these assessments, explicitly listing obesity as a fall risk predictor could limit the occurrence of bariatric patient falls. Having a BMI over 30 can increase a patient’s risk of falling, hospitals should immediately introduce strategies like hospital bed positioning and non-skid footwear for bariatric patients as a prevention measure.

One of the most common causes of patient falls is entering and exiting the hospital bed. Low mobility patients can benefit from using an adjustable low hospital bed that can reach an appropriate height to touch the floor with their feet. This makes getting in and out of bed less difficult for patients and can allow nurses to use bariatric lifts at the side of the bed for safer patient transfers. Low hospital bed features like built-in scales can also limit the need to transfer patients, which reduces the occurrence of patient falls.

Frequent monitoring of bariatric patients can also reduce the risk of falls. Using a bed-exit alarm and hourly rounding can further decrease a patient’s risk of falling. Bariatric patients often need assistance toileting, and frequent monitoring can reduce the likelihood of unassisted exits from bed and limits falls from the bed.

Bariatric patients with low mobility can become restless over time. Restlessness can cause agitation and lead to patients attempting to exit the hospital bed without staff assistance, which can lead to falls. A solution for restlessness for fall risk bariatric patients is supervised mobilization. Though patients are at a risk of stumbling when walking, supervised walks can reduce unassisted bed exits which lead to falls, and improve quality of life for bariatric patients, which can positively affect self-esteem.

As patient falls continue to be a concern for health care facilities, routinely identifying new fall risks such as obesity can help staff provide the proper support and strategies to improve the patient experience and reduce falls. Strategies such as using a low hospital bed, frequent monitoring and toileting, and mobilization are universal fall prevention strategies that can be extended to all bariatric patients to reduce fall rates and increase patient safety.

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CHG Hospital Beds specializes in low hospital beds that are designed to prevent patient falls and related injuries within acute care environments. We are focused on patient and nurse safety and deliver innovative solutions to meet the needs of our customers.

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