The impact of fall risk assessment on nurse fears,patient falls,and functional ability in long-term care

Purpose: The purpose of this study was to determine whether providing fall risk information to long-term care (LTC) nurses affects restraint use, activities of daily living (ADL), falls, and nurse fears about patient falls. Methods: One-hundred and fifty LTC residents were randomized to a fall risk assessment intervention or care-as-usual group. Hypotheses were tested using analyses of variance and path analyses. Results: Restraint use was associated with lower ADL scores. In the intervention group, there ceased to be significant relationships between nurse fears about falls and patient falls (after controlling for actual patient risk; post-intervention, nurse fears about falls were based on realistic appraisals), and between fears and restraints (i.e. unjustified nurse fears became less likely to lead to unjustified restraint use). No group differences in falls were identified. Conclusion: Despite a lack of group differences in falls, results show initial promise in potentially impacting resident care. Increasing intervention intensity may lead to fall reductions in future research.

• Implications for Rehabilitation

• Given the high prevalence rates of falls in LTC and associated injuries, prevention programs are important.

• Nurse fears about patient falls may impact upon restraint use which, when excessive, can interfere with the patient’s ability to perform ADL. Excessive restraint use, due to unjustified nurse fears, could also lead to falls.

• Providing accurate, concise information to nursing staff about patient fall risk may aid in reducing the association between unjustified nurse fears and the resulting restraint use that can have potential negative consequences.

     

Is Fear of Falling Associated With Decline in Global Cognitive Functioning in Older Adults: Findings From the Irish Longitudinal Study on Ageing

Background

Fear of falling (FoF) is present in 20% to 85% of older adults and may be an early marker of decline in global cognitive functioning (GCF). We tested the hypothesis that FoF is associated with lower levels of GCF (cross-sectional) and greater decline in GCF (prospective) in adults aged 50 and older.

Description of an advanced practice nursing consultative model to reduce restrictive siderail use in nursing homes

Researchers have demonstrated that the use of physical restraints in nursing homes can be reduced, particularly where advanced practice nurses (APNs) are utilized. We examined the link between APN practice, siderail reduction, and the costs of siderail alternatives in 273 residents in four Philadelphia nursing homes. The majority of participants were cognitively and physically impaired with multiple co-morbidities. APNs recommended a total of 1,275 siderail-alternative interventions aimed at reducing fall risk. The median cost of siderail alternatives to prevent falls per resident was $135. Residents with a fall history experienced a significantly higher cost of recommendation compared to non-fallers. Findings suggest that an APN consultation model can effectively be implemented through comprehensive, individualized assessment without incurring substantial costs to the nursing home.     

“I think I could have designed it better,but I didn’t think that it was my place”: a critical review of home modification practices from the perspectives of health and of design

Abstract

Purpose: The research presented demonstrates the disharmony between end user goals and their consideration in service outcomes within ageing-in-place and asks “what can design offer health” within this domain.

Methods: Data was collected using semi-structured interviews with various stakeholders within the context of ageing in place. All data are thematically analysed through a theoretical lens of control theory.

Results: The results demonstrate a contrast between purported patient-centred care models, and a human-centred design model. This contrast in cultures causes a disconnect between the health practitioners and the end users, with a lack of clarity about the end user's intended engagement within the modification of their environment. Consequently, the goals of older adults are inadequately represented as typical home modification design processes often fail to support the reflection of goals in practice, in turn, restricting client engagement and control. Reviewing occupational therapy practices through the critical lens of control has highlighted opportunities for service improvements.

Conclusion: The consideration of co-design methodologies within home modification design is a way to reinforce client engagement and provide better pathways for older adults to remain in control and raise acceptability of modification through a better-informed decision-making process.

• Implications for Rehabilitation

• The following points detail the implications of this research upon the rehabilitation practice and theory:

• Compliance with recommendations is deeply connected to a person’s intrinsic sense of control within the clinical decision-making process.

• Co-design practices between practitioners and clients provide and novel pathway to achieve truly person-centred care and create better service experiences and clinical outcomes.

• The human-centred design methodology is highly applicable within clinical practice and provides an opportunity for clinicians to see and learn about their patients through a holistic lens centred around goals and motivations rather than physical impairments.

• The scoping of health literacy should be inclusive of all service artefacts and touchpoints that a client may encounter throughout the entire duration of experience, this includes design artefacts such as architectural drawings and other home modification designs.

     

Falls risk assessment, multitargeted interventions and the impact on hospital falls

There is an urgent need for inquiry to validate existing scales in the accurate assessment of falls risk. Moreover, where fall prevention projects have targeted specific risk factors of falling, such as cognitive impairment, few have measured the impact of their intervention on fall outcomes. A comparative design compared and described differences in falls data within and between two study cohorts before and after a multitargeted intervention was introduced. A cut-off score of > or = 50 using the Morse Scale was a good baseline indicator for accurate identification of fall risk and outcomes verify that the modified Morse Falls Scale, in combination with other risk factors, more accurately profiled fall risk among this population. Fall incidence among the intervention cohort did not increase significantly despite a rise in the number of hospital admissions and a significantly higher reported fall risk potential.     

STEADI跌倒风险自评量表在社区老年人中的应用研究

目的应用STEADI跌倒风险自评量表筛查社区老年人跌倒风险,并了解其对老年人远期跌倒的预测效能。方法采用多阶段整群随机抽样,选取重庆市社区老年人1 168人,运用汉化版STEADI跌倒风险自评量表筛查其跌倒风险。6个月后电话随访老年人跌倒发生情况。结果 321人(27.5%)自评有跌倒风险。6个月后有效电话随访825人,64人发生跌倒,跌倒发生率为7.8%(64/825),跌伤率为71.9%(46/64)。汉化版预测6个月后社区老年人发生跌倒的灵敏度为45.3%,特异性为75.4%,AUC为0.604,约登指数为0.208。71.6%的老年人认为跌倒风险自我评估对其有意义,69.9%的老年人评估后实施了预防跌倒的相关措施。结论大多数老年人认可跌倒风险自评的意义并采取相关措施预防跌倒,但汉化版预测社区老年人6个月后发生跌倒的效能欠佳,建议结合步态、力量和平衡的评估结果来预测老年人跌倒风险。