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Guidance on Urinary Symptoms and Fall Risks - DEMO

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The spectacle of a nursing home resident their losing balance and falling is a common everyday occurrence. About 50% of residents fall each year. Although most residents are not injured when they fall, the more falls an individual has, the greater the chance of injury, such as a hip fracture, head injury or spinal cord trauma. While anyone can fall, there are certain health conditions that place residents at high risk of falling. For instance, residents who have impaired gait and/or balance are at greater risk.

Another important condition placing residents at fall risk is the loss of bladder control, a condition that affects anywhere from 30-50% of residents. Residents who experience urinary symptoms (such as urgency, frequency, nocturia, or unexpected loss of urine), are three times more likely to fall than residents without symptoms or those having good bladder control. In fact, experiencing urinary symptoms is one of the strongest predictors of falls in nursing home residents. More importantly, the risk of falling increases with the worsening of symptoms; the risk increases by 11 % with moderate symptoms and by 33% with severe symptoms.

Falling Circumstances

About half of all falls occurring in nursing homes are related to bladder dysfunction or elimination (i.e., defined as a fall that occurs during an activity related to elimination, such as ambulating to or from the bathroom or bedside commode, reaching for toilet tissue, exiting a soiled bed, etc.). The circumstances of elimination-related falls are as follows:

  • About 20% of falls occur between the resident’s bed and bathroom. Most falls occur in the evening or at night while individuals are moving to or from the bathroom.
  • The most common activity performed at the time of the fall is walking and losing balance; residents in many situations hurry to the toilet to avoid wetting themselves.
  • In about 10% of falls, loss of urine leads to slips on wet bedroom or bathroom floor surfaces.
  • In several instances, a nurse or nurse assistant helping the resident to the toilet or bedside commode is present at the time of the fall.
  • Sudden loss of urine can lead to episodes of dizziness, such as micturition syncope (fainting shortly after or during urination).
  • Occurrences of urine loss may be temporary; often the result of acute illness, such as urinary tract infection that can cause confusion, hypotension, etc. and increased fall risk as a consequence.
  • Medications used to treat incontinence (e.g., anticholinergics or alpha-blockers) can cause postural hypotension (i.e., low blood pressure when changing position such as getting up from bed to a standing position).
  • Nocturia (i.e., waking at night to void) can result in poor sleep, which is associated with drowsiness and increased fall risk.
  • Urinary symptoms most strongly associated with falling are urgency, difficulty initiating urination and nocturia.
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