Glen Xiong​Over the last year, senior care providers have faced many new challenges and opportunities. While advances in robotics, artificial intelligence, and other technologies are helping provide better care for seniors, new research by the National Center for Assisted Living found that more than half of senior care providers say their overall workforce situation has worsened since January 2022. In fact, the same survey found that 63 percent of assisted living communities are experiencing staffing shortages, and a staggering 98 percent have asked staff to work overtime or extra shifts due to the staffing shortages.

Without the right support, these issues leave providers with less oversight, which makes it difficult to maintain the same quality of care. For assisted living communities, that unfortunately means more falls are likely to occur.

According to the Centers for Disease Control and Prevention, a person falls every second, and for those living with dementia—who often need to be cared for in assisted living communities—that number doubles. Falls are truly happening all the time, and they're a source of significant concern for care providers. Even more distressing, older adults with dementia are often unable to describe how they fell, making post-fall response and prevention challenging for caregivers and distressing for family members. I know because as a doctor I've seen this firsthand. However, I have also learned that falls don't have to be inevitable. Here are five ways care providers can reduce the fall risk in their communities.

1.     Keep an eye on medications that increase fall risk.

One of the first steps caregivers should take to protect residents from falls is understanding their medications. That's because some pain medications—particularly narcotic medications—can cause problems with coordination, making someone more prone to falling. Similarly, psychotropic medications can also increase the risk of falls—especially antipsychotics. Anyone that is taking these kinds of medications, or is caring for someone taking them, should be aware of this heightened fall risk and make changes to their environment accordingly.

2.     Stay consistent with staffing.

As I mentioned earlier, providers across the US are struggling with staffing, which is likely to increase fall risk at assisted living communities. That's because for people living in a senior care community, staffing patterns can be a source of disruption or one of calmness and stability.

When we think of staffing disruptions, it could be anything from shift changes to staff members missing their rounds and disrupting a patient's usual routine. This can leave a patient feeling confused, neglected, or uncomfortable, which are emotional triggers that can easily instigate anxiety, increased movement, and ultimately, falls.

This is why our current staffing shortages are such a critical issue for assisted living communities; without the right staff, quality of care decreases.

3.     Watch out for sleep disruptions.

When a person's sleep cycle is disrupted, they have a greater risk of falling. In an assisted living community, it's important for caregivers to ask questions like, “What can we do to manage or fix sleep disruptions?" For instance, something as simple as monitoring the thermostat could prevent someone from waking up and falling on their way to get that extra blanket. Additionally, ensuring that a person is not sleeping excessively during the day and is engaged in meaningful activities will ensure better sleep at night. 

4.     Be aware of the time of day, week, and year.

Keeping in mind the time of day, week, and year can help prevent falls, because we know some falls happen more often at certain times.

For instance, “sundowning" is a term we use to characterize the increased confusion or agitation that some aging people experience in the late afternoon or early evening. This can sometimes lead to more anxious and aggressive behavior, including shouting, cursing, and running around. This is a time for extreme risk of falling, and caregivers need to plan accordingly.

Based on data during the pandemic, most falls happen on Saturday. In fact, the least falls happen on Sunday and then they trend up during the week. We think this happens because of a few factors, including staffing patterns, family visits (with more happening on the weekend), and spiritual engagement (decreasing the number of falls on Sunday).

Falls occur more often during the spring and summer than during colder months. Some believe cold weather reduces fall risk because residents have slower mobility and might be more stiff. Others believe it's because the colder weather makes people less active as they stay bundled up, reducing their fall risk. Whatever the case, care champions should be aware of how these changes impact fall risk.

5.     Understand patients to understand the cause of cognitive disorientation.

Anyone with cognitive impairments is at greater risk of falls. Part of the reason for this is because cognitive disorientation often leads to agitation and to difficulties with balance as people get anxious, putting them at greater risk of falling.

Caregivers can help prevent falls in their patients by getting to know them. Something as simple as knowing their hobbies, family background, and personal history can help caregivers understand what's behind their cognitive disorientation—and thus, help mitigate fall risk because of it.

For example, I once took care of a mail delivery person with dementia, which meant he was used to large amounts of walking as part of his vocation before he started living in the care facility. With that in mind, he needed to be given plenty of space and time to walk the facility—just as he had walked his mail route—so that his energy was appropriately expended during the day. Then, he would naturally sleep better at night.

Similarly, it is important to avoid sedating medication during the day that would cause a person to sleep during the day but pace at night. “Agitation" often occurs if this person is not given ample opportunity for physical activity.

Between fall risks, staffing shortages, and an aging population that's constantly getting bigger, assisted living communities certainly have plenty to worry about. Falls, however, don't have to feel like an unsolvable problem for senior care providers—not when the right steps are taken to help prevent them.

Glen Xiong, MD, is chief medical officer at SafelyYou. He is certified by the American Medical Directors Association in Post-Acute and Long-term Care Medicine (2006, 2016). He provides clinical care at the UC Davis Medical Center and in skilled nursing and assisted living facilities.​