Mr Grams, what are the classic causes of falls?
Grams: 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?
Grams: 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 25 cm, as is customary in the industry, but to 15 cm. This is because the fall speed from a height of 25 cm is almost 30% higher than from a height of 15 cm, 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?
Grams: 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?
Grams: 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 15 cm 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.
In what other aspects do low beds support the care process?
Grams: The floorline 15|80 can be raised to 80 cm and lowered to 15 cm. It gives the caregiver a better opportunity to act immediately with residents who are at risk of falling, but also relieves physical strain through back-friendly, kinaesthetic work at an ideal care height. At the end of the day, low beds must have comprehensive standard equipment that allows the caregiver more time for personal attention towards the residents. These include, for example, an integrated bed and side rail extension for quick adjustment to different body sizes, large double castors for easy manoeuvring and a wide range of adjustment options for optimal lying comfort.
How are low beds to be evaluated from the resident's point of view?
Grams: The nursing care bed is a central aid in elderly care. Older people in particular like to sleep during the day after lunch or use their bed as a place of retreat. So it contributes massively to the quality of life. Anxious residents lie more securely because they can feel the floor and thus know that the fall height is low. This gives an enormous sense of security. By losing their fears, residents experience more self-determination and a significant psychological relief. The reduction of falls and the consequences of falls improves the resident's well-being and makes it easier for caregivers to focus more on the social aspects of care.
The new German Care TÜV Reform stipulates how important it is to prevent the consequences of falls. Therefore, low beds have a very high value in nursing care.
Qualified Nurse
Care consultant according to §7a SGB XI, Case Manager (DGCC)
Senior consultant for nursing processes and technology at Hermann Bock GmbH
1 Source: Konnopka A, Jerusel, N, König, HH (2009). The Health and Economic Consequences of Osteopenia and Osteoporosis Attributable Hip Fractures in Germany –Estimation for 2002 and Projection until 2050 (in press).
2 Source Dr. George Zaphir (2014). Study: Lowest Heights of Floor Level Beds: Fall Velocity and Impact Force Analysis and Resulting Injuries.