April 2009 Article Review - Urinary incontinence and behavioral symptoms as risk factors for injurious falls

Rein Tideiksaar, PhD
Fall Prevent, LLC

Abstract
Hasegawa J, Kuzuya M, Iguchi A. (2009) Urinary incontinence and behavioral symptoms are independent risk factors for recurrent and injurious falls, respectively, among residents in long-term care facilities. Arch Gerontology and Geriatrics. Mar 16. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/19297035

Numerous risk factors of falls, including urinary incontinence and behavioral symptoms have been identified among elderly people in long-term care settings. However, it remains uncertain whether incontinence or behavioral symptoms are associated with recurrent falls and injurious falls. The purpose of this research was to examine the association between various types of falls and urinary incontinence or behavioral symptoms among the residents of long-term care facilities. The participants were 1082 older people (327 men and 755 women) who were admitted to facilities between 1 April 2003 and 31 March 2004. Fall experience, urinary incontinence, and behavioral symptoms were followed for up to 6 months or until death or discharge. The functional status, comorbidity, and prescribed medications were determined at the baseline. Analysis revealed that urinary incontinence and behavioral symptoms were independent risk factors of falls during the follow-up period. However, urinary incontinence was a risk factor for recurrent falls but not for injurious falls. In contrast, behavioral symptoms were an independent risk factor for injurious but not for recurrent falls. The results suggested that treatment or management of urinary incontinence and behavioral symptoms should be considered to prevent falls in long-term care settings.

Dr. Rein Comments:
Urinary incontinence and behavioral symptoms are common conditions among nursing home residents and are associated with increased fall risk. Once incontinence and/or behavioral symptoms are identified through risk assessment, the interdisciplinary assessments of both conditions provide guidance for targeting interventions aimed at reducing risk. Following the implementation of interventions, it’s important to monitor the effects of management and treatment interventions and redesign strategies that are not effective. Last, it’s been my clinical experience that both incontinence and behavioral symptoms are associated with activities of daily living impairments, and thus can represent an early marker of frailty or onset of fall risk.

See: Safety Tip: Management of Bladder Dysfunction and Fall Risk

April Q&A: When are bed side rails a safety device and when are they a restraint?

Q: When are bed side rails a safety device and when are they a restraint? -- Betty Holman, RN

A: The number or type of side rails (i.e., use of four half rails, three-quarter rails, or full-length rails) does not determine whether side rails are safety devices or restraints. It is the patient’s activity in relationship to side rails that is the determining factor. Side rails are a restraint if they restrict or impede a patient’s independent transfers from bed. Also, side rails can increase the risk of falls and injury. Many patients, especially those individuals who are cognitively impaired, tend to go over or around side rails when exiting the bed. On the other hand, simply removing side rails without addressing the patients underlying problems can be equally dangerous. This can result in increased falls (even injurious falls). To maintain patient safety, a half-side rail to assist or enable patients with bed positioning or balance stability during bed transfers can be used. Keeping bed heights low to the floor or using low platform beds helps to guard against injurious falls. In addition, some recommend the use of fall alarms to alert staff when mobility-impaired patients are exiting their bed.

I hope that this information has been helpful. Thank you for the question.

Dr. Rein Tideiksaar