Prevention of fall of the Elderly in the Hospital Setting

Description, Significance, and Current Practice

Description. Falls in the hospitals setting constitute the most prevalent type of accident within a hospital setting. According to the World Health Organization, falls are the second most common cause of accident-related deaths after road traffic accidents. Falls account for 646,000, deaths every year in the world. The inpatient hospital falls most commonly occur among individuals aged above 65 years. Falls in a hospital setting within the age of above 65 years are more common among the males than females. Falls result in brain injury, most commonly traumatic brain injury fractures such as of hipbones and soft tissue injury and bleeding (Barker, 2014). The occurrence of falls leads to fear and worry of subsequent falls, leading to reduced physical activity. Reduced physical activity reduces the strength of bones and muscles, further increasing the probability of sustained falls in the future. A patient who sustains falls is treated for bone fractures, brain hematoma or general bleeding. Besides, fall cause further healthcare complications, including cognitive functioning impairment such as the loss of memory and motor functions (Centers for Disease Control and Prevention, 2015).

Significance. In the year 2015, the cost of managing falls was estimated at $50 billion of the healthcare expenditure. Out of the total number of falls in the world, approximately 37 million cases require medical attention. Additionally, 17 million of cases of falls constitute disability assisted lost years lost. In the United States of America, about 30% of the population aged 65 years and above sustain falls annually, constituting about 9,000, annually. According to CDC, 3 million people in the USA are treated in the emergency departments for injuries resulting from falls in hospitals.

Further, the CDC states that approximately 800,000 injuries resulting from falls require hospitalization. The prevalence of falls among the population aged above 65 years of age has been increasing annually. CDC predicts that by the year 2030, falls will account for seven deaths every hour in the USA (Florence, Bergen, Atherly, Burns, Stevens, & Drake, 2018).   

Current Practice. Currently, there are several practices to prevent falls inpatient setting. The practice guidelines provided by the Rees-Jones Trauma Center injury flow sheets are used for the screening patient for the risk of falls. The criteria are used as a guideline to assess the risk of a patient sustaining a fall. Assessing the nature and outcome of previous falls assists in predicting the risk and outcome of future falls. Healthcare practice concerning falls among the elderly also involves the assessment of the need for vitamin D supplementation that aids in strengthening the bones. Physical exercise is also an essential management component of falls. Physical exercises increase muscle strength and improve gait. Reviewing medication that contributes to falls is a useful practice (Ayton, O’Brien, Treml, Soh, Morello, & Barker, 2017).

The Impact of the Problem. Falls among the elderly have an impact on healthcare institutions and patients significantly. Healthcare providers have to modify building structures to prevent falls. One of the ways to prevent falls is through the construction of support bars in places such as bathrooms and rails on staircases. Additionally, healthcare providers have had to spend more resources on the management of injuries resulting from falls among the elderly. Falls among the elderly reduce the individual self-care and thus reduced capacity to maintain health behavior pattern.

Picot Table

Population (P)The focus population in this topic consists of patients aged 65 years and above. Increase in age has been associated with increased vulnerability to falls in the hospital setting due to impaired cognitive, sensory and memory functioning and lack of physical activities and bone and muscle weakness.
Intervention (I)Patient education and discussion of falls with the patient. The patient can accurately report medication side effects such as dizziness. Education of elderly patients on risks of falls with an increase in age informs on the need for the patient’s participation in prevention and adherence measures against falls among the group of patients.
Comparison(C)The comparison is made between the current prevention measures and patient education, and discussion with the patient.
Outcomes (O)Increase in the rate of patients’ participation and reporting of previous falls, medication side effects and other symptoms of fall.
Timeline (T)The timeline will be six months

PICOT Question. Is patient education on falls more effective than the current falls prevention measures among patients aged 65 years and above in six months? 

Matrix Articles 

AuthorsJournal NameYear of PublicationResearch DesignSample SizeOutcome Variables MeasuredLevel Results/ Author’s suggested Conclusions
AytonBrien, Treml, Soh, Morello,BarkerAustralian Journal of Aging2018Secondary analysis96The environment in the prevention of falls challenges elderly patients.  IElderly patients require direct supervision and assistance to prevent falls
Avanecean D1CallisteContreras1Lim 1Fitzpatrick A,2.JBI Database System Rev Implement Reports2017Review of secondary data100Patient-focused interventions resulted in reduced rates of fallsIIIPatient-tailored intervention in preventing falls should be implemented.
McEwanBakerArmstrongBanerjee 3.International Journal Of emergency medicine2018Cross-sectional study design27Increase in the rate of patients’ participation and reporting of previous falls, medication side effects and other symptoms of fallIIThe patient can accurately report medication side effects such as dizziness.
StenhagenEkströmNordellElmståhl Clinical Interventions in aging2014Longitudinal study design1,540Falls were associated with a reduction in ADLs. IManagement of falls among elderly patients should include a focus on ADLs.
Sato SKakamu T,Hidaka T,Geriatric and Gerontology2018Longitudinal study design242Psychological and behavioral impairments are associated with risk of falls among the elderly increases. IBehavioral and psychological impairments should be used as an indicator in predicting the risk of falls.

Research Strategy

Key Words. The keywords used in search of the articles are; falls, Inpatient, Elderly patients, preventive measures, education, and awareness.

The Number and Types of Articles

In order to choose four articles, I reviewed a total of ten articles. Out of the four articles, two were non-research evidence articles while the other two were research evidence articles.  Two of the articles were qualitative while the other two were quantitative research articles. Two articles were random controlled trials, and the other two were recommendations of expert committees.

The article by Bergen, Stevens, Burns (2018) is one of the non-research articles describing the current statistics on falls among the elderly. The article describes the current practices on preventing falls. The article utilizes recommendation from The National Council on Aging and the CDC. The article is level VII of evidence.

The article by Wendy Barker (2018) is the other non-research article. The article describes additional preventative measures against falls among the elderly in the hospital setting. The article describes physical exercises, cognitive and behavioral training as preventive measures against falls among the elderly. The article is level VII evidence that contains recommendations by various researchers on ways to prevent falls among the elderly.

The article written by Lipardo and Tsang (2018) is one of the research evidence articles. The article is level II evidence which reports on the results of randomized control trial on the rehabilitative approaches applied as preventative measures against falls.

Lastly, the article by Bjerk, Brovold, Skelton, and Bergland (2017), is also level II evidence. The article compares the effectiveness of aerobic exercises and home-based exercises in preventing falls among the elderly.

The Number and Types of ArticlesNon-Evidence Articles. The article by Bergen, Stevens, Burns (2018), identifies the current statistics in the USA on falls among the elderly. The article identifies the current practice on prevention of falls including physical activities, vitamin D supplementation, and medication adjustments. The article provides international and national guidelines on the prevention of falls applied in the USA and elsewhere in the world, for example, guidelines American and British Geriatrics Societies (AGS/BGS) Clinical Practice Guidelines.

Additionally, the article provides the economic burden of falls among elderly patients within hospital settings.  The article discusses the prevention of falls among the elderly through quality improvement assessments. The article notes the lack of discussion between healthcare professionals and the patient on the prevention of falls among the elderly. What the article reports on the economic costs of managing falls among elderly patients.

The article by Wendy Barker (2018) identifies the real update on the guidelines including physical exercise for the elderly patients, nutritional supplementation and assessment of risks for future falls and the patients’ education concerning the risk of falls. The article describes multifactorial interventions, including cognitive training, and nutritional measures appropriate for the prevention of falls among the elderly. Further, the author list participation in prevention of falls programs as another means towards addressing the problem of falls among the elderly. Gait and balance strengthening are additional interventional approaches that the author of the article identifies as appropriate means towards prevention of falls affecting the elderly. 

 Research Evidence Articles. The article by Lipardo and Tsang (2018) investigates the effectiveness of a combination of physical activities and cognitive training as ways of preventing falls among elderly patients. The background of the study identifies that there is a significant amount of data on the impact of physical activities training on the level of prevention against falls among the elderly. Further, the background information presents evidence from previous studies about the availability of evidence on the effectiveness of cognitive training. However, there is lack of evidence on the impact of combined cognitive training and physical exercises as a means of preventing falls among the elderly. 

The study methodology describes the process of data collection that involves the formation of three groups; one for physical activities and another for cognitive training and the third research group comprising of patients where both physical activities and cognitive training were both applied. The outcomes of the interventions were measured regarding cognitive functioning, physiological and psychological outcomes. The study concludes that the impact of combined interventions through physical activities and leads to reduced rates of falls among the elderly. 

The article by Bjerk, Brovold, Skelton, and Bergland (2017) is a research-based article describing the research on the impacts of the falls prevention program. The background describes that assessing the effectiveness of a falls prevention programs consisting of a single individual’s approaches. However, the introduction part of the article appreciates the lack of sufficient evidence on the effectiveness of the multifactorial approach to preventing of falls among the elderly. The study presented in this article has a sample size of 150 patient, aged 67 years and above and who have the history of falls in the last 12 months. The study consists of a control group that receives conventional interventions. The intervention is performed for three months and a follow-up exercise for six months. Baseline data were collected on gait, the speed of walking, walking habits and activities of daily living. The same parameters were measured at three months and six months of interventions. 

In all of the practices, both the research evidence articles and non-research evidence articles, patient education is not researched as much as other interventional approaches. Additionally, patient education, as compared to the other conventional prevention programs of falls among elderly patients. Therefore, based on the data provided in the above-described articles, there is a need to compare the effectiveness of patient education on prevention of falls in comparison to the other traditional method of preventing and managing falls. 

Recommended Practice Change

The evidence provided indicates that patient education is one of the effective ways to prevent falls among the elderly. According to McEwan, Baker, Armstrong, Banerjee (2018), patient education facilitates patient centered preventative measures against falls. Ayton Brien, Treml, Soh, Morello, Barker (2018), explain that patient education increases patients independence among the elderly. StenhagenEkströmNordellElmståhl (2014), patient education on the importance of physical exercises increase participation of the patient in activities of daily living. 

Therefore, assessing the difference between the home environment and the hospital environment helps determine the risk of falls. Additionally, the ability of patients to adjust to the new hospital environment should form the basis for assessing the risk of falls during admissions. 

Implementing recommendations

Stakeholders. One of the key stakeholders is the patient who has sustained falls or at risk of sustaining falls in a hospital setting. Patients provide data on the history of falls, physical, behavioral or cognitive impairments. The history of falls, impairments in behavioral, physical and cognitive functioning increase the risk of falls within the hospital. The assessment of these risks requires data provided by the patient during the initial contact. Nurses and other healthcare workers are key stakeholders in implementing the recommendations put forward. The healthcare personnel carries out recommendations on assessment to determine the risks of falls and carry out preventive measures such as physical exercises, vitamin D supplementation, and medication modification. One of the highly recommended measures is patient education. Nurses and healthcare professionals are vital to carrying out patient education on the risks of falls and preventive measures against falls within the hospital setting.  Healthcare policy makers and leaders are vital stakeholders about the policies required to develop policies that align with the needs of elderly patients. Implementation of preventive measures against falls requires additional resources. Therefore, government, the policymakers, and healthcare revenue sources need to be involved in determining and assessing the cost-effectiveness of the new preventive measures against falls among the elderly.

Possible Barriers. Resistance to the introduction of newly effective preventive measures against falls among the elderly. Some of the healthcare professionals may be resistant to the change in management approach. Elderly patients who experience falls also diagnosed with cognitive disorders such as dementia. Obtaining data and information from such groups of patient with memory loss may be problematic. 

Strategies to Overcome Barriers. Education of healthcare workers on the importance of new approaches to prevent falls among the patients reduces resistance to chance (Avanecean, Calliste, Contreras, Lim, & Fitzpatrick, 2017). Secondly, cognitive impairments should be managed through psychological and psychiatric interventions. Cognitive deficits contribute to falls among the elderly, and therefore psychological interventions are necessary (SatoKakamuHidaka, 2018).

Indicator to Measure Outcome. The reduction in the number of elderly patients’ falls is an appropriate indicator to assess the effectiveness of recommended preventive measures. Measuring the number of falls within a given period informs the impact and comparison with data before the implementation of preventive measures. 

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