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Falls: Prevention in nursing care facilities and the hospital setting

Sarah Berry, MD
Douglas P Kiel, MD, MPH
Section Editor
Kenneth E Schmader, MD
Deputy Editor
Daniel J Sullivan, MD, MPH


Falls occur commonly in older individuals and are a major health concern. Falls usually occur in older adults with multiple impairments in cognitive, sensory, and gait domains [1]. Falls are therefore very common among older adults who are cared for in institutional health care settings such as nursing homes, rehabilitation facilities, or acute hospitals.

Falls in institutional settings lead to functional decline, increased length of stay in acute care hospitals, and increased institutional liability. Much geriatric research has focused on strategies and interventions to prevent falling in the institutional environment.

This topic will address risk factors and prevention strategies for older patients in nursing homes and acute care facilities. A discussion of fall risks and prevention for community-dwelling older individuals is presented separately. (See "Falls in older persons: Risk factors and patient evaluation" and "Falls: Prevention in community-dwelling older persons".)


Compared with community dwellers, falls occur more commonly among patients in nursing home, rehabilitation, and acute hospital settings. Data vary regarding fall rates and number of patients who fall, and depend upon the particular patient population studied. Approximately 50 percent of individuals in the long-term care setting fall each year [2,3].

The average rate of falls in the nursing home is estimated to be 1.5 falls per nursing home bed annually (range: 0.2 to 3.5 falls per bed annually) [4]. In the rehabilitation setting, rates may be higher for certain groups of patients. For instance, in the acute rehabilitation setting, fall rates for stroke patients have been reported as 3.4 falls per bed annually [5]. Certain groups of hospitalized patients are particularly vulnerable to falls; for example, 5 percent of inpatients with a recent ischemic stroke will fall [6], and nearly 10 percent of older adults admitted to a geriatric psychiatric unit will fall [7]. Hospitalized patients with cancer are also at especially high fall risk [8].

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Literature review current through: Nov 2017. | This topic last updated: Nov 29, 2017.
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