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.     

Perceptions of older people living in the community about their fear of falling

Purpose. A fear of falls is widespread amongst older Australians. It increases the risk of falls and can lead to restriction of activity. The aim of this study was to gain insight into the precursors of a fear of falls and the experiences associated with this fear.

Methods. Using a qualitative, phenomenological method, individual, semi-structured interviews were conducted with 9 community-based participants who reported moderate to high levels of fear of falling.

Results. Most participants did not fear falling until they had experienced a fall themselves. The fear of falls was described as a negative experience, often linked with incapacitation, fear of dependence and having to leave their home. Participants chose to avoid falls by ‘taking care’. Five themes emerged from data analysis: activity levels; view of the future; perceptions of fall experiences; fall avoidance; and development of fear of falls.

Conclusions. The results indicated that factors other than a fear of falling resulted in a restriction of activities for these participants; therefore, it cannot be assumed that a fear of falls alone results in reduction of activity. Fear of falls, in combination with other potential issues that could restrict activities, should be taken into account in the development of fall-prevention programs in order to ensure clients' needs are being met.     

Predictors for recurrent falls among the home-dwelling elderly

Objective - Scant attention has been paid to the risk factors for recurrent falls among the home-dwelling elderly, although there are remarkable age and sex differences according to whether or not the falls recur. in this report we describe and analyse the risk factors for recurrent falls by selected clinical variables and the history of falling during the previous year.

Design - A community-based prospective study covering two years.

Setting - All home-dwelling persons (N=1016) aged 70 years or older living in five municipalities in northern Finland.

Outcome measures - the risk factors of recurrent falling by selected clinical variables using cross-tabulations and multivariate analyses.

Results - Previous falls, peripheral neuropathy, use of psychotropic medication and slow walking speed were independent risk factors for recurrent falling. the risk of recurrent falling increased with an increasing number of previous falls.

Conclusions - Early preventive measures should be taken among the elderly persons who are prone to falling. in order to reduce the risk of recurrent falls among the elderly, the attending physician should take a critical view of the use of psychotropic medications, and attempts should be made to treat conditions underlying peripheral neuropathies and abnormal gait.     

风险管理在住院患者跌倒／坠床预防中的应用

目的：探讨风险管理预防患者跌倒／坠床事件发生的实践及效果。方法：2010年1-12月住院患者采用常规预防跌倒／坠床管理方法,2011年1-12月住院患者采用预防跌倒／坠床风险管理。比较预防跌倒／坠床风险管理实施前、后患者跌倒／坠床发生率。结果：预防跌倒／坠床风险管理前患者跌倒／坠床的发生率为0．88‰,实施后为0．45‰。结论：实施风险管理,可明显降低住院患者跌倒／坠床的发生率,提高护理质量,保障患者安全。     

Investigating Older Adults’ Expressed Needs Regarding Falls Prevention

Abstract

Aims: The purpose of this study was to explore perceptions regarding falls prevention programs for community-dwelling older adults offered in a specific geographic area. Method: The investigators conducted focus groups with 44 community-dwelling older adults in four locations. Focus group discussions were transcribed, coded, and analyzed by all investigators. Results: Themes included what people want, why people fall, what people do, impact of falls, and barriers to falls prevention participation. Older adults wanted falls prevention programs to include socialization among peers, various types of education, balance training, convenience in times and locations where falls prevention programs are offered, affordability, and independence and autonomy for decision-making. Participants believed they fell due to inattention and the aging process, and they made lifestyle changes and tried to recognize their own ability accordingly. Older adults believed the impact of falls on lifestyle was far-reaching and drastic. The main barrier to falls prevention participation was motivation, mitigated by other priorities. The Person-Environment-Occupation (PEO) Model provided a framework for considering occupational impact when addressing older adults’ concerns regarding falls. Conclusions: Occupational therapists can be key contributors to falls prevention programing by developing programs that focus on current perceptions and barriers in programing and the expressed wants and needs of community-dwelling older adults.     

Striving to prevent falls in an acute care setting — action to enhance quality

• ? Although most falls do not result in serious physical injury, they can contribute to a loss of confidence and mobility which can culminate in a significant reduction in quality of life. Furthermore, the potential to fall is often increased when an individual is institutionalized because of frailty or confusion.
• ? The purpose of the study was, therefore, to establish whether a structured intervention would assist in preventing falls in an acute setting.
• ? This pre-test/post-test study was carried out over a 12-month period. Interventions included risk assessment, an alert system, reinforcing preventive actions, staff education and ongoing audits and feedback. Initial analysis of the data and comparison of fall rates indicated a significant reduction in the rate of falls between the pre- and post-intervention phases, although subsequent statistical analysis did not identify any significant relationships.
• ? It must be noted that no controls existed for extraneous variables, although patient profiles varied minimally during the period of the study.
• ? Outcomes include: a reduction in fall numbers and rates, enhanced staff morale with ownership of the programme, provision of a learning experience for staff (on which to build), and the fostering of a professional approach to improving the quality of patient care.

     

住院患者发生排泄相关性跌倒情况调查分析及对策

目的探讨住院患者发生排泄相关性跌倒的情况和防范措施。方法回顾性分析和总结影响21例发生排泄相关性跌倒患者的情况。结果发生排泄相关性跌倒的患者有57.14%≥65岁,100.00%认知能力正常,61.90%生活完全能自理,57.14%行动自如,85.71%在跌倒前24h内用药,61.90%排泄型态改变,90.48%视力正常,80.95%跌倒后受伤1～2级,跌倒地点为卫生间有52.38%、床旁有33.33%。清晨6：00～8：00和夜晚20：00～22：00为发生跌倒的2个高峰期。结论增强护理人员安全意识,建立跌倒高危患者的评估制度,对患者进行健康教育和改善住院环境、设施对预防排泄相关性跌倒的发生具有积极的意义。     

Physical restraint reduction in the acute rehabilitation setting: a quality improvement study.

A prospective, continuous quality improvement study was implemented at a hospital on two rehabilitation units: stroke and brain injury. The purpose of the study was to decrease restraint use by 25% and to maintain fall rates no greater than 10% over baseline. A multi-component restraint reduction program was implemented that focused on administrative support, education, consultation, and feedback. Monthly restraint rates and fall rates were monitored and compared to the previous year's rates. Both units reduced restraint use. Importantly, this reduction was accomplished at the same time as a decline in fall rates.     

Delphi-Based Assessment of Fall-Related Risk Factors in Acute Rehabilitation Settings According to the International Classification of Functioning,Disability and Health

Objective

To apply the International Classification of Functioning, Disability and Health (ICF) model to fall prevention by developing an ICF core set for fall risks in acute rehabilitation settings.

Design

Fall risk factors were identified based on a systematic review of the literature and linked to ICF categories. A consensus process was conducted using a Delphi-based evaluation technique.

Setting

University-based hospital.

Participants

Multidisciplinary participants (N=20) from different institutions.

Interventions

Not applicable.

Main Outcome Measures

A 5-point Likert-type scale was used to weigh the importance of each risk category. The level of agreement for each consensus was assessed based on Spearman rho and semi-interquartile range indices. Categories with a mean score ≥4 in the third round of evaluation were included in this ICF core set.

Results

The core set comprised 34 fall risk categories that were distributed as follows: 18 categories on body functions, 2 on body structures, 8 on activities and participation, 4 on environmental factors, and 2 categories on personal factors.

Conclusions

An ICF core set for falls in acute rehabilitation settings was developed in this study. Further validation is required.     

老年病人蹲起动作诱发跌倒的相关性研究

目的探讨老年病人蹲起动作诱发跌倒的相关性。方法选取2013年7月~2014年7月我科住院的512例病人,随机分为观察组和对照组,每组256例。对照组接受常规护理。观察组在对照组的基础上接受健康教育与专业护理。比较两组防跌倒知识及蹲起技能的掌握率及跌倒发生率,同时对护理满意度和照顾者防跌倒意识进行调查。结果观察组防跌倒知识掌握率达99.6%,4例发生意外跌倒,占1.6%,无1例因蹲起动作诱发跌倒。对照组防跌倒知识掌握率67.2%,9例发生意外跌倒,占3.5%,其中5例因蹲起动作诱发跌倒,两组比较有显著性差异(P0.05)。观察组蹲起技能掌握率94.9%,对照组78.1%,两组比较有显著性差异(P0.05)。观察组护理满意度为96.1%,对照组85.5%,两组比较有显著性差异(P0.05)。观察组照顾者中对防跌倒意识的认识以及防跌倒的预防措施掌握情况明显优于对照组。结论老年病人蹲起动作极易诱发跌倒,为防止老年病人发生意外跌倒,在护理过程中应避免病人行蹲起动作,加强病人防跌倒知识的教育,同时加强对病人照顾者的培训及教育。     

Exploring and evaluating five paediatric falls assessment instruments and injury risk indicators: an ambispective study in a tertiary care setting

harvey k., kramlich d., chapman j., parker j. & blades e. (2010) Journal of Nursing Management 18 , 531–541
Exploring and evaluating five paediatric falls assessment instruments and injury risk indicators: an ambispective study in a tertiary care setting Aim To evaluate currently available paediatric falls assessments instruments and to build a predictive fall model while also evaluating injury risk as a predictor of fall likelihood within the paediatric inpatient population. Background There is lack of paediatric-specific fall assessment instruments and little information on the exploration of injury risk as related to falls in hospitalized children. Method An ambispective, matched case–control design conducted in a sample of 100 inpatient paediatric patients. Results Two out of five instruments performed well to classify children at risk of falls. Longer length of stay, bleeding cautions/blood disorders and temperament/behaviour issues were significant predictors of fall likelihood. Cognitive impairment or neurological disease was not related to an increased likelihood of fall or injury risk for this sample. Conclusions More research is required to institute and standardize paediatric fall and injury risk assessments for everyday use. The explicit approach of using predictive modelling is critical in creating a universal, baseline reference for the most reliable and valid measure of assessment in children. Implications for nursing management Findings of the present study increase awareness of nursing managers and leaders as to the necessity for fall and injury risk assessment as a safety and quality measure for inpatient paediatric populations.     

A study on the relationship between age and inpatient falls in Taiwan

Falls are the most frequently reported adverse hospital events. How to prevent inpatients from falling has become an important issue of patient safety in hospitals. The purpose of this study was to investigate the correlation between age and inpatient falls. A retrospective study design was used. This study, which extracted information from fall‐related incident reports, enrolled patients who had fallen during hospitalization in Taiwan. Of the 221 falls evaluated, 63.8% had occurred under companion care, 98.2% of patients had fallen once and most fall‐related injuries were minor (46.6%). Falls occurred most frequently when patients were going to the toilet, walking and being moved. There were significant correlations with age groups and fall‐related factors (P = 0.000; P < 0.05), the presence/absence of a companion (P = 0.022, P < 0.05), the situation of falls (P = 0.000; P < 0.05), and fall‐related injuries (P = 0.000, P < 0.05). Preventive interventions related to falls should vary for different age groups.     

Identification of Patients at Risk for Falls in an Inpatient Rehabilitation Program

Purpose

To determine if there is a more sensitive method to identify inpatient rehabilitation patients at high risk for falls rather than the Morse fall scale.

Method

Retrospective analysis of falls occurring during 6‐month period in 2009. Age and diagnosis were used to create comparison groups between patients who fell and those who did not. T‐tests were used to determine differences between the two groups in FIM scores and Morse fall scores.

Results

Patients who had stroke as a primary diagnosis were more likely to fall than other patients. Length of stay was greater for patients who fell (p = .008). The positive predictive value of the Morse fall scale for patients who fell was 57%, suggesting that it is not a sensitive predictor of falls in rehabilitation patients. Patients who fell had significantly lower FIM expression scores (p = .02).     

The costs of falls in the community to the North East Ambulance Service

Background

This study set out to quantify the immediate costs to the North East Ambulance Service (NEAS) of attending to fallers.

Methods

Data from the Newcastle, UK area were collated by NEAS to identify those aged over 65 who had fallen and required an assistance only call or were subsequently transported to an Accident and Emergency (A&E) department. The 2001 census data for the total population served by NEAS in Newcastle were obtained.

Results

The total population of Newcastle over the age of 65 was 41 338. Over 7 months NEAS attended to 1504 falls in Newcastle (at £115 per call out, this equates to £172 960). The faller was transported to A&E on 1339 occasions, while 165 falls required assistance only (11% of total) (36 falls requiring NEAS assistance per 1000 Newcastle population aged over 65 in 7 months). The total time on site for ambulance crews attending to fallers was 377.1 h (15.7 days in 7 months or 2.25 days per month). As the cost of emergency ambulance time is £123/h, the total cost was £46 383.30. Therefore, in Newcastle, attending to fallers in the community costs NEAS £376 018 per year (£145.83 per fall or £9.10 per person over the age of 65 per year).

Conclusion

NEAS attend to a significant number of older people who fall in the community. In Newcastle alone the cost of this service equates to over 2 days of emergency ambulance crew time per month. Studies are needed to determine whether responding to falls in the community differently would be cost effective.