Falls are the most common cause of head injuries and research has shown that elderly patients older than 65 years old have about a 27% chance of falling in any given year. Most falls in this population tend to be ground-level falls which would otherwise be benign in younger people. However, advancing age often leads to progressive brain atrophy, leaving more room for increased bleeding for the subdural hematoma within the cranial cavity, thus increasing the risk of a negative outcome. 

When this happens, the onset of symptoms may be delayed resulting in a delay of treatment which contributes to the higher morbidity and mortality in the elderly. Add to that, the incidence of chronic dementia can also delay the presentation of symptoms, making it more challenging to identify and treat in a timely manner. As if we aren’t already facing a challenging situation, think about this, about 10% of patients with head trauma are on anticoagulation therapy, a medication that decreases clotting time, often leading to more significant brain bleeds.  

Now that I have your attention, when was the last time you reviewed your fall log and discussed outcomes at your QAPI committee meeting? Remember, it may only take one fall to change a resident’s life forever. What is your protocol for neuro checks? Are your licensed staff trained to perform them? Does your documentation support “best practice” for neuro checks or are your staff cutting corners? Honestly, the only way to know is to check. Perform some audits, review documentation, talk to staff members on the unit, review your current policy and if you find things are not as expected, develop a PIP through QAPI and address areas of deficient practice. You may not be able to prevent that next fall, however with training and policies based on best practice, we will be better equipped to assess and respond timely and more effectively. As always, check out the HealthCap Resource and Education Center for resources! Stay well and stay tuned! 

For more information:

• HealthCap – Head Precautions – Neurological Assessment Policy and Procedure
• HealthCap – Identification of Neurological Deficits Policy and Procedure
• HealthCap – Management of Neurological and Mental Manifestations Associated with COVID-19