With the population aging and about 1.4 million Americans already in
nursing homes, programs focused on fall prevention should
concentrate more on averting these injuries that can cause
considerable pain and disability, the research team writes in JAMA
Otolaryngology - Head and Neck Surgery.
“Families move their loved ones into facilities to keep them safe.
Since this can already be a difficult process, we feel an obligation
to identify preventable injuries in our continuing efforts to
improve patient safety,” Dr. Peter Svider, one of the study authors,
said by email.
Face injuries can be particularly serious for elderly people because
they can affect vital functions like speech, swallowing, sight, and
even breathing, said Svider, a researcher at Wayne State University
School of Medicine in Detroit, Michigan.
To estimate the number and causes of face injuries in elderly
nursing home residents, the research team analyzed nationwide data
from emergency departments.
Between 2011 and 2015, they found that 109,795 people over age 60
and living in nursing homes required emergency room care for face
injuries. Half of the patients were over age 84 and 65 percent were
For each incident, the study team noted where on the face patients
were hurt and how they sustained the injury.
The most common wounds were deep cuts or skin tears, which made up
over 44 percent of all injuries. A similar proportion of patients
experienced other soft-tissue injuries, including bruises on the
skin or in deep tissues and the tearing off of patches of skin
including eyelids or ears.
Bone fractures accounted for nearly 13 percent of injuries. More
than two thirds of these breaks were to the nose, and the next most
common fracture site was the eye socket.
The injuries were most often the result of falling and hitting
structures like the floor, countertops, doors or cabinets,
representing 57 percent of injuries.
Getting in and out of bed was the second most common source of
injury, accounting for 23 percent.
“Falls are a tremendous source of disability in older adults,” said
Hilaire Thompson, a professor at the University of Washington School
of Nursing in Seattle.
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“Older trauma patients are more likely to experience a longer
hospital stay, increased number of complications, higher costs of
care and a higher likelihood of dying for any specific injury than
younger adults,” Thompson, who was not involved in the study, said
“Facial injuries are underappreciated,” Thompson added, “as they may
accompany other sometimes more severe injuries and are therefore
Thompson said patients can reduce their risk of falling by doing
exercise or physical therapy and getting their vision checked, while
nursing homes can pay greater attention to fall risks during their
“We encourage families moving their loved ones into a skilled
nursing facility to inquire about the level of supervision provided,
particularly with regards to transfer to and from bed as well as
assistance using the bathroom,” Svider said.
(This version of the story adds dropped word JAMA in paragraph 2)
SOURCE: bit.ly/2n8c8jI JAMA Otolaryngology – Head and Neck Surgery,
online March 16, 2017.
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