Falls and fall risk among nursing home residents

Aim and objectives. The aim of this study was to identify risk factors for falls in older people living in nursing homes. Background. Impaired cognitive function and a poor sense of orientation could lead to an increase in falls among those with impaired freedom of movement. Many accidents occur while an older person is walking or being moved. Method. The study was carried out over four years (2000–2003) and 21 nursing home units in five municipal homes for older people in Stockholm, Sweden, participated. A questionnaire was sent to staff nurses, including questions on fall risk assessments, falls, fractures, medication and freedom‐restricting measures, such as wheelchairs with belts and bed rails. The data were aggregated and not patient‐bound. The study covered 2343 reported incidents. Results. There was a significant correlation between falls and fractures (r = 0·365, p = 0·004), fall risk and use of wheelchairs (r = 0·406, p = 0·001, safety belts (r = 0·403, p = 0·001 and bed rails (r = 0·446, p = 0·000) and between the occurrence of fractures and the use of sleeping pills with benzodiazepines (r = 0·352, p = 0·005). Associations were also found between fall risk and the use of anti‐depressants (r = 0·412, p = 0·001). Conclusion. In clinical practice, patient safety is very important. Preventative measures should focus on risk factors associated with individuals, including their environment. Wheelchairs with safety belts and bed rails did not eliminate falls but our results support the hypothesis that they might be protective when used selectively with less anti‐depressants and sleeping pills, especially benzodiazepines.     

The Use of Physical Restraints in Elder Care in Relation to Fall Risk

Physical restraints are a frequently used but disputed method to prevent falls. The aim of the present study was to investigate how the use of restraints in institutional elder care relates to previous falls and to the estimated fall risk of the individual patient. A total of 1 142 patients, mean age 82 years, were included in the study. A questionnaire, the Multi-Dimensional Dementia Assessment Scale (MDDAS), was used to measure motor function, vision, hearing, ADL performance, behavioral symptoms, psychiatric symptoms, cognitive impairment and use of medication. Questions concerning the use of physical restraints and known previous falls were added to the instrument. Based on data from the questionnaire (MDDAS), a score on the Downton Fall Risk Index was calculated for each patient. All in all, 248 (22%) of the patients had been subject to restraints and for 155 of them (14%) such measures had been taken to prevent falls. Only weak connections were found between the restraining of patients to prevent falls and the prevalence of known previous falls during hospital stay (? = 0.05), and estimated fall risk (? = 0.07). The results indicate that the use of physical restraints is poorly connected with the estimated fall risk. Therefore, this study may point to a possible overuse of these measures.     

太极拳锻炼对防止老年人跌倒作用机制的研究

[目的]研究太极拳锻炼防止老年人跌倒的作用机制。[方法]社区中53名老年人被随机分配到太极拳组和对照组，太极拳组进行为期10周的简化24式太极拳的培训和锻炼，对照组依原常规生活；干预前后对老年人进行功能评估（包括单腿支撑时间、10m往返步行时间、直体前屈和反应能力）。[结果]太极拳组老年人单腿支撑时间、增强直体前屈和反应能力较对照组增加（P〈0．05），对10m往返步行时间无显著影响（P〉0．05）。[结论]太极拳锻炼能够增强老年人平衡能力、反应能力，改善身体柔韧性，从而达到防止老年人跌倒的目的。     

老年住院患者跌倒护理研究进展

在我国,跌倒位于医院护理不良事件前3 位,也是65 岁以上老年人首位伤害死因。本文从跌倒危险因素及特征、护理评估、护理干预措施等方面进行综述,旨在探索老年住院患者跌倒危险因素,进一步提高护理干预手段。     

苏州市城市社区老年人跌倒的流行现状及其危险因素分析

目的了解苏州市城市社区老年人跌倒的流行现状,探索老年人跌倒的危险因素。方法2018年4月—5月对苏州市姑苏区5家社区内≥60岁的具有本地户籍的老年人进行跌倒流行情况的调查。结果过去一年中共有195名老年人发生过238人次的跌倒,跌倒年发生率为9.79%,其中男性跌倒年发生率为8.04%,女性跌倒年发生率为10.84%。而且年龄越大,老年人跌倒发生率越高,90岁以上老年人跌倒发生率高达28.60%。多因素Logistic回归分析结果显示年龄、身体状况不适为苏州市姑苏区社区老年人跌倒的危险因素,运动为老年跌倒的保护因素。结论本次调查结果显示,苏州市城市社区老年人跌倒发生率9.79%,今后我们应针对本辖区老年人跌倒的发生因素开展干预工作,减少老年人跌倒的发生。     

老年人跌倒的评估与干预策略研究进展

跌倒是老年人群中常见的严重公共卫生事件。跌倒的预防和干预是老年康复医学研究的重要课题之一。本文回顾近年来老年人跌倒的相关文献,对跌倒的概念、流行病学调查、危险因素分析与评估以及多学科多因素干预策略进行综述,并就该领域未来研究方向提出建议。     

Physical Restraints in Geriatric Care

The aim of the present study was to investigate the use of physical restraints in institutional elder care and staff knowledge about and attitudes toward the use of these restraints. Poor knowledge and negative attitudes toward the use of restraints were found among staff. Significant differences between various staff categories were found concerning knowledge about the use of restraints; nurse aids had the lowest and physicians the highest scores on the knowledge test. Nurse aids demonstrated the least negative attitudes (were most prone to use restraints) and physicians the most negative. Furthermore, there was a significant relation between attitudes and knowledge, i.e. staff with poor knowledge also demonstrated the least negative attitudes toward the use of restraints. Despite these negative attitudes among staff, we found a large proportion of restrained patients in the institutions investigated. Twenty-nine percent of the patients at the investigated clinics were physically restrained. The most common reason given was that restraints were used to prevent falls. No documentation of the observed use of restraints was found in any of the restrained patients' hospital records.     

The use of physical restraints as a safety measure in the care of older people in four rehabilitation wards: findings from an exploratory study.

We investigated the prevalence and type of physical restraint used with older persons on four rehabilitation wards in Northern Ireland. A longitudinal observational approach was used. One hundred and two patients were observed on four occasions over a three-day period. Most of the patients (68%) were subjected to some form of physical restraint, side-rails being the most commonly observed method. Those who were restrained were dependent on nursing care to meet their needs and received more drugs than those whose mobility was not restricted. No association was found between restraint use and nursing staffing levels, nor was there any association with the incidence of falls. Nurses rationalised their use of restraint as being linked to wandering and patient protection in cases of confusional type behaviours. An association was found between stroke and the maintenance of positional support through the use of restraints (side-rails and screw-on tabletops). Approximately, one-third of those restrained had this noted in their care plans, with concomitant evidence of patient/family involvement in the restraining decision.     

Incidence and risk factors of hospital falls on long-term care wards in Japan

Rationale, aims and objective Falls among hospitalized patients are an important patient safety issue. In particular, the incidence of falls and risk of related injuries among the elderly are particularly high. Because the epidemiology of falls is not well scrutinized in Japanese long‐term care wards, we evaluated the incidence and risk factors of falls in this setting. Methods A prospective cohort study was conducted on long‐term care wards with 160 beds in a general hospital in Japan. All patients admitted to the wards over 25 months were enrolled and followed until discharge. The baseline characteristics and incidences of falls were measured. Results We enrolled 2973 patients with a mean age of 74 years, and median length of stay was 36 days. During the study period, 657 falls occurred in 411 (14%) patients. The incidence of falls was 3.8 per 1000 patient‐days, and by 15 and 30 days after admission to the ward, 7.3% and 11.4% of patients, respectively, had fallen. Independent risk factors related to falls during hospitalization were advanced age [≥70 years, hazard ratio (HR) 1.5, 95% confidence interval (CI) 1.2–2.0], history of falls (HR 1.2, 95% CI 1.0–1.5), frequent urination (HR 1.4, 95% CI 1.0–1.8) and requirement for toileting assistance (HR 1.4, 95% CI 1.1–1.8). Among patients who fell during the study period, 23% sustained an injury. Conclusions Many patients on long‐term care wards in Japan were elderly and experienced falls during their hospital stay, with consequent injuries. Taking into account the risk factors identified, we need to devise effective strategies to prevent falls and related injuries.     

Nurses' feelings and thoughts about using physical restraints on hospitalized older patients

Aim. To explore nurses’ feelings and thoughts about physically restraining older hospitalized patients. Background. The use of physical restraints is still highly prevalent in hospitals; furthermore, older patients are most likely to be so restrained. Studies in acute care settings have focused mainly on nurses’ knowledge, attitudes, or practice concerning physical restraints, on physical restraint reduction programmes, on nurses’ perceptions about the use of physical restraints, or on elderly patients’ experiences with physical restraints. To the best of our knowledge no studies have been conducted on hospital nurses’ feelings and thoughts about the use of physical restraints in Taiwan. Design and methods. A qualitative approach was used to understand this phenomenon. Semi‐structured interviews were carried out, from August 2002 to March 2003, with 12 nurses working in three hospitals. The interviews were audiotaped and transcribed verbatim; content analysis was used to analyse the data. Results. Nurses reported a variety of emotional responses regarding the use of physical restraints, including sadness, guilt, conflicts, retribution, absence of feelings, security, and pity for the restrained older people. Rationalization, sharing with colleagues, and compensating behaviours were ways that nurses used to manage their negative feelings. Conclusions. Most nurses had negative feelings towards the use of physical restraints. Among these nurses there was a struggle between patients’ autonomy and the practice of care. However, other nurses said they had ‘no feelings’ or ‘feeling of security’ while using physical restraints. Relevance to clinical practice. The findings of this study may contribute to filling the gaps in nursing knowledge, to improving protocols for physical restraint use in hospitals, and may also assist nurse managers to create a supportive practice environment. It is recommended that in‐service training programmes should cover misconceptions regarding physical restraint use, ethical issues and how to cope with feelings while using physical restraints.     

Interventions for preventing and reducing the use of physical restraints in long‐term geriatric care – a Cochrane review

Aims and objectives. To evaluate the effectiveness of interventions to prevent and reduce the use of physical restraints in older people requiring long‐term nursing care. Background. Physical restraints are commonly used in geriatric long‐term care. However, they are associated with adverse outcomes. Therefore, freedom from physical restraints should be the aim of high‐quality nursing care. Design. Systematic review of randomised controlled trials. Methods. This review followed the methods of the Cochrane Handbook of systematic reviews of interventions. The systematic search (September 2009) covered the Cochrane Dementia and Cognitive Improvement Group’s Specialized Register, MEDLINE, EMBASE, CINAHL, PsycINFO and LILACS. Results. Six cluster‐randomised controlled trials met the inclusion criteria. All studies investigated educational approaches targeting nursing staff. In addition, two studies offered consultation, two guidance and one support and free access to technical aids. Five studies examined nursing home residents and one study residents in group dwelling units. No studies in community settings were included. Overall, the methodological quality of studies was low. Their results were inconsistent. One study with good methodological quality in the nursing home setting documented an increase in physical restraints use in both groups, while the other four studies with lower quality found reduced use of physical restraints in the intervention group. The single study in group dwelling units found no change in physical restraints use in the intervention group but a significant increase in the control group. Conclusions. There is insufficient evidence supporting the effectiveness of educational interventions targeting nursing staff for preventing or reducing the use of physical restraints in geriatric long‐term care. Relevance to clinical practice. Our findings indicate that educational programmes targeting nursing staff might not be effective in reducing the use of physical restraints in geriatric long‐term care. It remains unclear which components should be included in educational programmes aiming to reduce physical restraints.     

某社区老年人抑郁状况及影响因素分析与对策

目的了解社区老年人抑郁的发生情况并探讨其影响因素，以提出相应对策。方法采用方便抽样方法，应用老年抑郁量表及自制调查表对武汉市某社区9个卫生服务站的117位老年人进行问卷调查。以抑郁与否作为应变量，以一般资料的各项目为自变量进行多元回归分析。结果本组对象中，27．4％老年人存在不同程度的抑郁症状；单因素分析结果表明，不同年龄、婚姻状况、文化程度、经济状况、有无社会保障、有无慢性病的老年人抑郁发生率差异有统计学意义（P〈0．05）；多元回归分析显示：经济状况和慢性病是抑郁发生的两大影响因素。结论抑郁症状是老年人常见的心理健康问题，受经济状况和有无慢性病的影响，应加强社区精神卫生服务，提供相应护理措施。     

Physical and chemical restraints in acute care: their potential impact on the rehabilitation of older people

Agitation is a major problem for older people and is present in over half of the hospitalizations for people > 65 years of age. In a previous study by the authors, results indicated that nursing actions often did not meet best-practice standards in the care of older, agitated patients. This paper builds on these results by reviewing the literature pertaining to the use of restraints and contributes to the body of knowledge surrounding the impact of the acute-care experience on rehabilitation outcomes. Successful rehabilitation relies on the improvement of functional health outcomes and, for this to happen, physical and emotional well-being are important. The sequelae of restraint use in acute care have the potential to alter peoples' ability to participate fully in a rehabilitation programme, thereby placing their future placement at risk. This paper explores the outcomes of restraint use in the acute-care setting and presents the argument that their effects are likely to be detrimental to rehabilitation outcomes.     

Impact of a psychotropic medication and physical restraint review process on adults with mental retardation,psychiatric diagnoses,and challenging behaviors

We examined the impact of a medication and physical restraint review process at an intermediate care facility for persons with mental retardation (ICF/MR) in Hawaii. The process was established in 1987 to review, approve, and monitor client programs that utilize medication, physical restraints, and time-out rooms to manage challenging behaviors, with a primary goal of establishing minimum effective use of restraints. Five variables were examined: (a) sample demographics; (b) psychotropic medication; (c) medication side effects; (d) physical restraints/time out; and (e) targeted behaviors. The study sample consisted of all current and former residents of the facility who participated in the review process and for whom an initial report and a follow-up report were available for examination (N=80). Results indicated a decrease in (a) the number of psychotropic medications prescribed, (b) reported medication side effects, and (c) frequency and duration of use of physical restraints/time out. There was an increase in the number of subjects for whom targeted challenging behaviors and behavioral counts were documented. In all behavioral categories except for physically aggressive behaviors, there was a decrease in the maximum number of incidents. In all behavioral categories, there was a decrease in the average number of incidents.     

惯性测量单元在老年人跌倒风险评估中的应用进展

跌倒是老年人群中常见且后果严重的公共卫生事件,跌倒风险评估是跌倒预防和干预的重要手段。国外研究者将惯性测量单元引入老年人运动/平衡功能测量和跌倒风险的评估。研究提示,它比常用的跌倒评估工具具有优势,可应用于医院、社区和养老机构等。惯性测量单元可能是测量步态变异性的良好方法,步态变异性与跌倒风险相关性很高。     

Handbook for Practice Learning in Social Care and Social Work

The specialist knowledge and skills of health and social care practitioners working with older people are often unacknowledged. This paper examines an important aspect of specialist knowledge, the understandings of ageing and old age that underpin practice in a society where negative assumptions about old age and older people are widespread. These understandings were explored through analysis of data from 30 interviews with health and social care practitioners working with older people at risk of falling. The interviews centred on a case vignette and the analysis presented here focuses on respondents' perceptions of the scenario and of the reluctance of its subject, a 79-year-old woman, to seek help after a fall. The findings suggest that practitioners' understandings of older people are grounded in practice and personal experience, with little evidence of the use of theoretical or research-based knowledge of ageing and old age. This suggests that the potential for formal knowledge of ageing to support reflective and empowering practice with older people has yet to be fully exploited. The paper concludes with a discussion of the relevance to interprofessional practice of gerontological theory and research and suggestions for further research.