Other causes, which can also be easily addressed within subacute facilities, "include wet floors, poor lighting, incorrect bed height, and improperly fitted or maintained wheelchairs" (Falls in nursing homes, 2010, CDC). These types of environmental hazards are estimated to cause 16% to 27% of falls for patients. Even seemingly unavoidable problems such as medications that interfere with coordination can be mitigated by flagging the individual as taking such a drug, and notifying staff that additional care of the patient is required. In the instances of patients with dementia, or those who cannot care for themselves enough to learn to improve their balance skills to mitigate the risk of falls, measures other than educational endeavors should be undertaken. "Grab bars, adding raised toilet seats, lowering bed heights, and installing handrails in the hallways," as well as "providing patients with hip pads that may prevent a hip fracture if a fall occurs" and "using devices such as alarms that go off when patients try to get out of bed or move without help" are helpful in these instances (Falls in nursing homes, 2010, CDC). The Haines (et al. 2010) study merely identified a general fall mitigation program, including both exercise and environmental changes, but to most effectively treat patient needs, engaging in some 'triage' efforts will enable the staff to more appropriately structure a fall prevention program.

A 2003 multifactor review of contributing factors to falls amongst the elderly yielded the surprising finding that, along with such expected fall-mitigation efforts as a pharmacist's review of medications, "Vitamin D supplementation may help reduce falls in elderly nursing home residents" (Barclay 2003). While Vitamin D has been linked to a lower risk of osteoporosis, because of its bone-building attributes (along with calcium, zinc, and magnesium), falls in general were reduced amongst patients that received Vitamin D supplementation, according to the results of a systematic review reported online January 20 in the Cochrane Database of Systematic Reviews (Barclay 2003).

In my own experience on a subacute unit, I have experienced the frustrations of dealing with patients who are often not cooperative with measures taken to prevent...

Some incapacitated patients insist upon moving about without recommended walking devices. When possible, empowering patients through balance education before they become unable to assist themselves seems ideal. When this is not possible, staff must receive training in how to deal with assisting patients and monitoring patients who are at high risk for a fall. Incorporating pharmacists into the treatment plan, when patients are taking medications that interfere with their judgment and balance, also seems warranted, and the findings about supplementing patient treatments with Vitamin D seems promising. The best method of fall prevention at a subacute facility is likely to create an individualized plan for every patient, taking into consideration his or her personal physical challenges, stressors, and psychological issues.