Tailoring a Comprehensive Bundled Intervention for ED Fall Prevention

IntroductionFalls in the emergency department pose an important challenge for patient safety. Multifactorial fall prevention bundles have been associated with a reduction in patient falls in the inpatient setting. The purpose of this project was to tailor and implement a comprehensive fall prevention bundle in our emergency department.MethodsFall bundle components for this intervention were selected on the basis of a review of fall prevention research and included fall risk assessment, safe ambulation, safe toileting, staff communication, early warning, and patient education. The fall risk assessment was tailored to the emergency department through an appraisal of select inpatient fall risk assessments, literature search for ED-specific fall risk factors, and a site-specific chart review, after which pertinent fall risk factors were integrated into a modified screening. Fall prevention materials that were both practical and applicable to the emergency department and facilitated patient safety along each bundle domain were selected for implementation at our site.ResultsThe tailored fall prevention bundle was championed by the interdisciplinary ED Fall Prevention Team and implemented over the course of 5 months in 1 emergency department. Education on fall prevention equipment was delivered in a peer-to-peer format, and an online module was designed to guide staff through the new fall risk assessment. The fall prevention bundle was adopted into clinical practice after staff education was completed, and the fall risk screening was merged into the electronic medical record.DiscussionED fall prevention requires a comprehensive bundled approach, which includes a fall risk screening and multifactorial interventions that are tailored to the ED setting. Successful implementation relies on the involvement of front-line staff from the design through the delivery of the bundled fall prevention measures. Continued inquiry and innovation in ED fall prevention will help provide a safer health care environment and improve patient outcomes.     

How older adults and their informal carers prevent falls: An integrative review of the literature

Falls in older persons are prevalent and costly for the individual and the health system. Falls prevention guidelines have been developed from best evidence to minimise falls in older persons.AimTo synthesise the literature on falls prevention strategies used by community dwelling older persons and/or their informal carers and to compare the commonly adopted strategies with those recommended by falls prevention guidelines.Data sourcesHealth sciences databases for full text articles published in English plus reference list searching of included articles.Review methodAn integrative review approach. Studies were included if they identified fall prevention management strategies used by community dwelling older adults and/or their informal carers. Quality appraisal was undertaken using appropriate Joanna Briggs Institute critical appraisal tools. Information relevant to the aim of the review were extracted and coded into categories then inductively sorted into sub-themes and themes.ResultsOf the seventeen studies included in the review, eleven identified older adults’ falls prevention strategies, two investigated fall prevention strategies used by carers, and four explored perspectives of older persons together with their carers, representing the perspectives of an estimated 501 older persons and 102 carers. Strategies used by older adults arose because of self-awareness about their changing physical ability, and advice and support mainly from family or friends. Carer fall prevention strategy was predominantly around protection of the older adult from falling by discouraging independence.ConclusionsThe fall self-management strategies adopted by older adults and their carers to prevent falls, in the main, do not align with international best practice fall prevention guidelines.     

Disparity between perceived and physiological risks of falling among older patients in an acute care hospital

BackgroundFalls are the most frequent adverse events among hospitalised older adults. Previous studies highlighted that older adults might not understand the risk factors associated with falls and may have an altered perception of their actual risk.AimTo describe differences between perceived and actual physiological risk of falling among older adults and to explore factors associated with the differences.Methods: A prospective cohort study was done. Older adults (age 65 years and above) were interviewed one-to-one at bedside. Morse Fall Scale (MFS) and other risk factors for falls were used to identify the patients’ physiological fall risks. Patients’ perceived risk of falls were assessed using the Falls Efficacy Scale-International (FES-I).ResultsThree hundred patients were recruited. Patients’ mean age was 75.3 (SD = ± 6.2). Majority were males (51.7%), lived with others (91.7%), and had received primary school education (35.3%). Based on the MFS, most patients had moderate fall risk (59.7%). Using the FES-I, more than half the patients (59%) interviewed had high concerns about falling. About one-third of the patients’ (31.3%) perceived risk matched with their physiological fall risk (Risk-Aware). Half of the patients’ perceived risks was higher than their physiological fall risk (50.7%) (Risk-Anxious), while the remaining patients’ perceived risks was reported to be lower than their physiological fall risk (18%) (Risk-Taker).ConclusionOlder patients are poor at recognizing their fall risks. Both patients’ perceived and actual fall risks should be evaluated in the inpatient setting in order to inform individualized fall prevention education and strategies.     

Identification of Fall Risk Factors in Older Adult Emergency Department Patients

Objectives: Falls represent an increasingly frequent source of injury among older adults. Identification of fall risk factors in geriatric patients may permit the effective utilization of scarce preventative resources. The objective of this study was to identify independent risk factors associated with an increased 6‐month fall risk in community‐dwelling older adults discharged from the emergency department (ED). Methods: This was a prospective observational study with a convenience sampling of noninstitutionalized elders presenting to an urban teaching hospital ED who did not require hospital admission. Interviews were conducted to determine the presence of fall risk factors previously described in non‐ED populations. Subjects were followed monthly for 6 months through postcard or telephone contact to identify subsequent falls. Univariate and Cox regression analysis were used to determine the association of risk factors with 6‐month fall incidence. Results: A total of 263 patients completed the survey, and 161 (61%) completed the entire 6 months of follow‐up. Among the 263 enrolled, 39% reported a fall in the preceding year, including 15% with more than one fall and 22% with injurious falls. Among those completing the 6 months of follow‐up, 14% reported at least one fall. Cox regression analysis identified four factors associated with falls during the 6‐month follow‐up: nonhealing foot sores (hazard ratio [HR] = 3.71, 95% confidence interval [CI] = 1.73 to 7.95), a prior fall history (HR = 2.62, 95% CI = 1.32 to 5.18), inability to cut one’s own toenails (HR = 2.04, 95% CI = 1.04 to 4.01), and self‐reported depression (HR = 1.72, 95% CI = 0.83 to 3.55). Conclusions: Falls, recurrent falls, and injurious falls in community‐dwelling elder ED patients being evaluated for non–fall‐related complaints occur at least as frequently as in previously described outpatient cohorts. Nonhealing foot sores, self‐reported depression, not clipping one’s own toenails, and previous falls are all associated with falls after ED discharge.     

Mitigating fall risk: A community fall reduction program

One fourth of all American’s over 65 years of age fall each year. Falls are a common and often devastating event that can pose a serious health risk for older adults. Healthcare providers are often unable to spend the time required to assist older adults with fall risk issues. Without a team approach to fall prevention the system remains focused on fragmented levels of health promotion and risk prevention. The specific aim of this project was to engage older adults from the community in a fall risk assessment program, using the Stopping Elderly Accidents, Deaths & Injuries (STEADI) program, and provide feedback on individual participants’ risks that participants could share with their primary care physician. Older adults who attended the risk screening were taking medications that are known to increase falls. They mentioned that their health care providers do not screen for falls and appreciated a community based screening.     

Older hospital inpatients’ fall risk factors,perceptions, and daily activities to prevent falling

PurposeTo identify associations among patient fall risk factors, perceptions, and daily activities to improve patient engagement with fall prevention among hospitalized older adults.BackgroundThe risk of falling increases for older patients but few researchers have reported patient-centered measures on this topic.MethodsSurveys and chart reviews of inpatients aged ≥ 65 with Morse Falls Scale scores of ≥ 45. Measurements included validated tools and the modified Fall Behavioral Scale-Inpatient (FaB-I).ResultsA fall within 3 months before hospitalization was associated with an increased level of importance to preventing falls and higher FaB-I score (more fall prevention behaviors) but decreased level of confidence related to preventing falls (p < 0.05). Perception measures (concern: r = 0.52; patient activation: r = 0.46) were positively associated with FaB-I (p < 0.001).ConclusionsAddressing patient-centered measures such as perceptions of and daily activities for fall prevention could add value to existing fall prevention programs.     

Falls risk screening tools intended to reduce fall risk among independent community-dwelling older adults: A systematic review

Aims

The aim of this study is to evaluate an evidence-based fall risk screening tool to predict the risk of falls suitable for independent community-dwelling older adults guided by the World Health Organization's International Classification of Functioning, Disability and Health (WHO-ICF) components, and to examine the reliability and validity of the fall risk screening tool to predict fall risks, and to examine the feasibility of tools among independent community-dwelling older adults.

Methods

A systematic literature search guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed using the EBSCOHost® platform, ScienceDirect, Scopus and Google Scholar between July and August 2021. Studies from January 2010 to January 2021 were eligible for review. Nine articles were eligible and included in this systematic review. The risk of bias assessment used the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. The WHO-ICF helped to guide the categorization of fall risk factors.

Results

Seven screening tools adequately predicted fall risk among community-dwelling older adults. Six screening tools covered most of the components of the WHO-ICF, and three screening tools omitted the environmental factors. The modified 18-item Stay Independent Brochure demonstrated most of the predictive values in predicting fall risk. All tools are brief and easy to use in community or outpatient settings.

Conclusion

The review explores the literature evaluating fall risk screening tools for nurses and other healthcare providers to assess fall risk among independent community-dwelling older adults. A fall risk screening tool consisting of risk factors alone might be able to predict fall risk. However, further refinements and validations of the tools before use are recommended.     

Efectividad de los ejercicios de equilibrio entre los adultos mayores en Depok,Indonesia

ObjectiveFalls are a serious problem for older adults. Balance impairment is one of the most significant reasons why adults fall from a standing position. This study aims to investigate the effect of an eight-week postural balance exercise intended to reduce the risk of falls among older adults in a community in Depok City, Indonesia.MethodThis quasi-experimental study employed a pre- and post-test design using a control group. The study involved an intervention group of 30 respondents and a control group of a further 30 respondents. The sample was selected using multistage random sampling. The data were analyzed using a t-test.ResultsThe balance exercise significantly affected the respondents’ postural balance and reduced their risk of falling. There were significant differences between the two groups (intervention group and control group) in postural balance (p < 0.001) and the risk of suffering a fall (p = 0.023).ConclusiónBalance exercises can be utilized as one of the preventive efforts to maintain postural balance and reduce the risk of falls among older adults. Future studies may consider the variation of age to more accurately determine the effectiveness of this balance exercise.     

Are triage questions sufficient to assign fall risk precautions in the ED?

Objectives

The American College of Emergency Physicians Geriatric Emergency Department (ED) Guidelines and the Center for Disease Control recommend that older adults be assessed for risk of falls. The standard ED assessment is a verbal query of fall risk factors, which may be inadequate. We hypothesized that the addition of a functional balance test endorsed by the Center for Disease Control Stop Elderly Accidents, Deaths, and Injuries Falls Prevention Guidelines, the 4-Stage Balance Test (4SBT), would improve the detection of patients at risk for falls.

Fall prevention program for community-dwelling older adults and their caregivers

Falls are the leading cause of injury and death among community-dwelling older adults. Many of these falls are a result of environmental and internal risk factors. The authors developed a fall prevention program consisting of a self-administered checklist and an audio-visual presentation on ways to reduce or prevent falls for community-dwelling older adults and their caregivers.     

Characteristics of falls and recurrent falls in residents of an aging in place community: A case-control study

BackgroundFalls and fall-related injuries remain an ongoing and serious health problem in older adults. Many clinical and environmental factors have been implicated in falls and recurrent falls, including sleep disturbances, sensory deficits, balance problems, incontinence, comorbid conditions, and certain categories of medications. We undertook this study to determine if there was an association between these factors and falls or recurrent falls in older adult residents of an aging in place community.MethodsOur retrospective case-control study compared residents who did and did not fall in an aging in place community, as well as those who experienced recurrent versus single falls in a single year.ResultsA total of 50 residents met the criteria for inclusion in this study, with 30 participants (60%) having experienced one or more falls during the observation period. Of the 30 participants who fell, 21 (70%) experienced more than one fall in a single year. Variables associated with falls included marital status and bowel incontinence; variables associated with recurrent falls included self-reported sleep difficulty, balance with sitting to standing and surface-to-surface transfer, use of a walker, and use of antidepressant medications.DiscussionOur study supports the existing nursing research that falls, and recurrent falls are the result of multiple, interrelated factors. Further research is needed into preventative measures for both falls and recurrent falls, particularly in the context of aging in place.     

The Falls Risk Awareness Questionnaire: development and validation for use with older adults

Falling is a significant cause of disability and death among older adults, and assessing awareness of risk factors is the first step to developing falls intervention programs. Older adults who had fallen in the past were more aware of risk factors for falls, and may be receptive to fall risk information following a fall. This may be an opportune time for health care professionals to provide education on risks for falls to prevent further injury. The Falls Risk Awareness Questionnaire (FRAQ) was validated in a range of patients and practice settings, and after further testing, the FRAQ may play an important role in identifying specific differences in the knowledge of risk factors.     

Assessing risk of falling in older adults

Falls by older people present serious problems in every society. The purpose of this study was to investigate the role of a checklist in estimation and reduction of the risk for falls for older adults in Taiwan. Following literature review, a purposive sample was used in a cross-sectional design to assess risk factors using a checklist. Older adults (N = 103) were recruited from three sheltered housing projects (elderly apartments in Taipei County); 52 individuals had fallen within the past year. A set of significant risk factors was identified, including physiological, psychological, environmental, and social dimensions. Members of the fall group had shorter Functional Reach and took more time to complete the Get-up and Go test than the control group. Some illnesses and drugs were associated with an increased risk of fall.     

Outdoor Fall Experiences: An Exploratory Study of Urban and Suburban Dwelling Older Adults

Abstract

Aims: Outdoor falls can result in significant challenges to the health and well-being of older adults. Therefore, factors associated with outdoor fall risk warrant attention in research and clinical practice. The purpose of this exploratory study was to compare the outdoor fall experiences of urban and suburban residents with an eye towards considerations for prevention practices. Methods: A convenience sample of community dwelling older adults was recruited. Qualitative analysis of open-ended responses from a survey was used to explore and compare and contrast the outdoor fall experiences of suburban and urban dwellers. Results: Both similarities and differences in the causes and locations of outdoor falls were identified. Conclusions: Preliminary results from this exploratory study suggest differences between the outdoor falls of urban and suburban dwelling older adults. A larger scale study to confirm the findings is warranted given the implications for planning community-based occupational therapy-led outdoor fall prevention programs.     

Exercise for Fall Risk Reduction in Community-Dwelling Older Adults: A Systematic Review

Purpose:

To evaluate the influence of exercise on falls and fall risk reduction in community-dwelling older adults and to present an updated synthesis of outcome measures for the assessment of fall risk in community-dwelling older adults.

Method:

A systematic review was performed, considering English-language articles published from 2000 to 2006 and accessible through MEDLINE, CINAHL, PEDro, EMBASE, and/or AMED. Included were randomized controlled clinical trials (RCTs) that used an exercise or physical activity intervention and involved participants over age 50. Screening and methodological quality for internal validity were conducted by two independent reviewers.

Results:

The search retrieved 156 abstracts; 22 articles met the internal validity criteria. Both individualized and group exercise programmes were found to be effective in reducing falls and fall risk. The optimal type, frequency, and dose of exercise to achieve a positive effect have not been determined. A variety of outcome measures have been used to measure fall risk, especially for balance.

Conclusions:

Falls and fall risk can be reduced with exercise interventions in the community-dwelling elderly, although the most effective exercise variables are unknown. Future studies in populations with comorbidities known to increase fall risk will help determine optimal, condition-specific fall-prevention programmes. Poor balance is a key risk factor for falls; therefore, the best measure of this variable should be selected when evaluating patients at risk of falling.