AALNA Section Reducing falls in assisted living using a comprehensive stepwise approach & clinical model for assessment of older residents who fall Deanna Gray-Miceli, PhD, GNP-BC, FGSA, FAANP, FAAN * Florida Atlantic University, Christine E. Lynn College of Nursing and Faculty Fellow, Institute for Sensing and Embedded Network Systems Engineering (I-SENSE), 777 Glades Road, Office 321, Boca Raton, FL 33431, USA Falls are a widespread public health problem affecting all older adults including the current 2.1 million residents who have moved into the assisted living-long term care community. The Centers for Disease Control estimates there were 29 million falls which caused 7 million injuries in 2014. 1 They further note the fall rate is twice as large for our nation’s most vulnerable population of residents of long-term care communities as the rate of falls which occurs for older adults living in the community. 2 Older adult residents in U.S. long-term care community experience an average of 2.6 falls per person per year. The rate of fall reoccurrence in this practice setting is high, according to the CDC with between 50 to 75% of patients experiencing a repeat fall. 3 Why is it important to identify older resident’s symptoms associated with falls? While there are many factors associated with fall risk, 4 there are also many symptoms and concerns older adult resident’s voice, if given the opportunity which occur at the time of their fall. Through a comprehensive post fall assessment, many stories unfold which capture the resident’s symptoms, concerns and thoughts. It is im- portant to note while our science has elucidated the multifactorial reasons to fall among older adults, without treatment of symp- toms producing falls, falls will continue to reoccur for similar reasons. In our previous work of elucidating older adults symptoms and con- cerns at the time of their fall, use of a comprehensive post fall assessment tool by nurses within 24 hours of the fall among a sample of 77 older adults with 207 falls revealed older adults experience antecedent symptoms of dizziness (2.6%), loss of balance (44.6%), instability with walking or balance (62.8%) or the need to urinate (9.8%), among other symptoms. Identification of antecedent symptoms is important as many symptoms are modifiable when addressed in the resident’s plan of care. Identification of resident symptoms and concerns also inform the nurse of the fall type, such as a fall due to an acute medical reasons such as dizziness due to drops in blood pressure with stand- ing (postural hypotension) or an inner ear infection. In prior work, Morse (2008) 5 has identified modifiable factors association with falls as anticipated physiological falls. Within the long term care com- munity, 7 types of falls have been identified by nurses using a comprehensive post fall assessment, these include: falls due to acute or chronic medical reasons, falls due to medications, falls due to poor safety awareness by residents, falls due to environmental factors, falls due to poor judgment by residents and/or falls due to behavioral factors. 6 How is the post fall assessment different than fall risk analysis? The post fall assessment and fall risk assessment are both rec- ommended by national professional societies to prevent falls. 7 However, it is the post fall assessment which frames the provid- er’s assessment of older adults understanding and awareness of their fall event based on a structured, stepwise approach. 8 Therefore, one strategy to reduce recurrent falls among older adults is to provide every resident with an opportunity to discuss openly the details of their fall event with their nurse provider. When a nursing situa- tion is created between the nurse care provider and the resident to better understand the resident concerns and symptoms associ- ated with falls- it evolves to a mutual understanding of shared information so that the nurse provider can re-create the fall event in their mind. Post fall assessment tools can aide to elicit this un- derstanding and are far more comprehensive than use of incident report forms or fall risk analysis tools which center on provider iden- tification of impairments of the resident’s vision, cognition, gait or {AALNA section for the October 2018 issue of GN} * dgraymiceli@health.fau.edu. 0197-4572/$ — see front matter https://doi.org/10.1016/j.gerinurse.2018.09.006 Geriatric Nursing 39 (2018) 610–611 Contents lists available at ScienceDirect Geriatric Nursing journal homepage: www.gnjournal.com