← Chapter 12
Medical-Surgical Nursing II · Chapter 12

Falls, Frailty and the Hazards of the Bed

About one in four adults aged 65 and older falls each year, and falls are the leading cause of injury-related death in that age group — but hospitalisation is itself the hazard. Move six screening scores past the exact numbers that change your plan, put the eight actions after a fall into the order that protects a hip and a head, and then dose bed rest like the drug it is.
Timed Up and Go14 seconds
Rise from a chair, walk 3 metres, turn, return and sit.
Standing systolic (supine 138)112 mmHg
Standing diastolic (supine 76)64 mmHg
Supine 5 minutes, then repeat at 1 and 3 minutes of standing — record symptoms as well as numbers.
Braden Scale total17 of 6–23
Post-void residual240 mL
Mini-Cog2 of 5
Three-word recall plus a clock draw.
Geriatric Depression Scale (15-item)6 of 15
You find your anticoagulated 81-year-old on the floor beside the bed. She says she is fine and wants to get up. Click the actions in order.
The rule that governs all of it. Assess before you move the patient. The fall you investigate is the second one you prevent.
Days of bed rest5 days
An older adult loses roughly 1 to 3 percent of muscle strength for every day of immobility, and the losses accelerate under acute illness.
Body weight62 kg
Clinical state
Mobility plan on the care plan today
Mobility is not the physiotherapist’s job alone. It is nursing care, and it belongs on the plan every shift.
0Thresholds crossedMove the dials and watch each plan change.
Prevention on the unit is unglamorous and effectiveRound hourly using the four P’s — pain, potty, position, possessions — because most falls happen on the way to the bathroom. Bed low and locked; call light, phone, water, glasses and walking aid in reach; non-skid footwear; a night light and a clear path; a raised toilet seat; scheduled toileting rather than waiting for urgency. Review the list for anything sedating, hypotensive or anticholinergic. Ensure vitamin D repletion and refer to physiotherapy for strength and balance training, which has the best evidence of any single intervention. Bed and chair alarms have not been shown to reduce falls and are no substitute for a person.
And restraints are not the answerPhysical restraints do not prevent falls — they change the mechanics of the fall for the worse. Restrained patients fall from a higher position with less ability to protect themselves, and they develop agitation, incontinence, pressure injury, deconditioning and prolonged delirium. Restraint requires a provider order, is time-limited, needs documented failed alternatives, and demands ongoing monitoring of circulation, skin, toileting, hydration and range of motion.
0/8After the fallClick the next correct action on the left.
Why order matters hereShe says she is fine. That is not information — pain perception is reduced, a hip fracture can be missed, and an anticoagulated head strike may be silent for hours to weeks. Everything in this sequence exists to stop you doing the natural, kind, wrong thing first.
5–15%Strength lost to the bedMove the days dial.
The dose–response
Protein is the counter-dose
And watch the waterThe older adult has both a reduced thirst drive and a reduced ability to concentrate urine. Weight is the most reliable monitor — a change of 1 kg equals roughly 1 L of fluid. Look for orthostatic hypotension, a dry axilla, longitudinal tongue furrows, urine output below 0.5 mL/kg/hr () and a BUN-to-creatinine ratio above 20:1. Skin turgor is unreliable in aged skin; if you use it, test over the sternum or forehead rather than the back of the hand. Offer fluids proactively on a schedule, because a patient who is not thirsty will not ask.