Falls and fall injuries in hospitals and other nursing facilities are the most regularly reported severe events among adults in inpatients settings. Improving the assessment and prevention interventions in clinical facilities is important as it can enhance the health of elder citizens and reduce the cost incurred in treating and managing injuries that are a result of the fall experience. Frameworks for the implementation of various prevention intervention strategies are discussed in the paper. The integration of the multidimensional fall risk assessment and modification, which are combined with the exercise interventions strategy, are some of the possible intervention programs that are outlined in the study. The purpose of the survey involved the evaluation of various intervention programs that aim at protecting the elders from falling. The qualitative research findings indicate that most of the falls and fall-related injuries are reducible and preventable via the implementation of an effective intervention strategy. The effectiveness of these methods is usually determined by their cost-effectiveness, sustainability, and feasibility.
Falls are complex but rather common geriatric syndrome that causes significant mortality, reduced functionality, morbidity and, in some instances, premature nursing home admissions. Falls are considered a difficult clinical challenge primarily because of multiple predisposing risks factors and precipitating causes, which pose a challenge in the diagnosis, prevention, and treatments. A fall may be an indicator of normal and age-related changes in gait, vision, and strength or may be an initial sign of acute health problems. Postural hypotension, infection, and cardiac arrhythmia are some of the critical problems that are associated with falls. Similarly, chronic diseases such as diabetes, dementia, neuropathy, and Parkinsonism sometimes become identifiable because of falls, especially when they have reached critical levels. Moreover, the majority of falls that are experienced by elderly people usually have interacting and multifactorial precipitating and predisposing causes such as a trip over an electric cord as a result of impaired vision and gait disorders. The purpose of this study is to evaluate various falls protection methods that can be put in place with the view to reducing falls injuries among hospitalized elderly people. In the process, the paper highlights the complex relationship between falls and various risk factors, precipitating events, and ultimately, underlying causes and prevention strategy.
Identifying efficient interventions with the potential to prevent or significantly reduce falls and falls-related injuries particularly among elderly members of the society form one of the major areas in geriatrics. The issue requires more research data and findings (Huang & Liang, 2005). For the past few years, several randomized prevention interventions have been implemented in numerous hospitals but with little conclusive information on the way forward. Evidentially, the available data prove insufficient when offering guidance in the geriatrics policy development. The need for more evidence on the efficacy based on the meta-analysis of data defined the selection of the topic and the direction that the research sought to take. The extensive literature on the falls prevention and clinical guidelines that are outlined in the paper indicate the challenging clinical issues, which are associated with the falls prevention among hospitalized elderly citizens. Moreover, the evaluation of the epidemiology of falls with a focus on risks factor and leading causes goes a long way in ensuring that the majority of the health care institutions and medical practitioners possess the necessary information on the available falls interventions tools and strategies (Burns, Stevens, & Lee, 2016). The review of the latest reports and evidence on the falls prevention and interventions strategies will also help in bridging existing gaps in determining the most effective approach to protecting hospitalized elders from falling.
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The goal of the study is to develop a comprehensive report on falls among elderly people with the view to increasing knowledge and awareness of the significance of dealing with people of advanced age with special care by taking an action, to prevent falls and fall-related injuries in all healthcare facilities all over the world. The paper will present a comprehensive summary of the available falls, and fall-related injuries research findings data, practice evidence, and research knowledge in order to outline both national and international perspectives. Relevant data from the World Health Organization (WHO) will also be incorporated. Appropriate conclusions drawn at the end of the research will be entirely based on the objective meta-analysis of previous qualitative and quantitative researches. Therefore, the purpose of this study is to evaluate available data on falls and fall-related injuries with the aim of developing a strategy that will be able to reduce or even entirely protect hospitalized elderly people from falling. The successful implementation of various falls prevention strategies will save the government spending and minimize other financial expenses that relatives of senior citizens incur when treating fall-related injuries (Burns, Stevens, & Lee, 2016). The effectiveness of a strategy will be determined based on its feasibility, suitability, cost-effectiveness, and ability to reduce the number of falls in every five elderly people within a year.
The actual definition of a fall in relation to elderly people remains open to debate. According to the most frequently used definition, a fall is an “unintentionally coming to a lower level or the ground and not as a result of the sustained violent blow, the onset of epileptic seizure or paralysis like in stroke, loss of consciousness and other similar causes” (Sherrington, 2011). The above explanation is exclusive of any overwhelming external disturbance with the potential to cause an elderly person to be knocked over, as well as other primary internal disturbances that are associated with causing such individuals to collapse other than fall. However, in some research, the definition is expanded to include falls that occur as a result of syncope and dizziness (Huang & Liang, 2005). In some research works that are evaluated in the paper, a fall is defined as a sudden, unplanned change in a position that results in a person landing on a lower level, floor, object, or ground due to a sudden onset of the epileptic seizure, paralysis, or some overwhelming external forces (Shi, 2014).
Falls and fall-related injuries remain a considerable common problem in elderly people. Available data indicate that people above 65 years old have the highest risk of falling with 30% of all individuals above that age falling at least once a year (Haines & Healey, 2011). Similarly, fifty percent of citizens above 80 years old fall at least once a year, while some experience repetitive falls depending on the topography of an area that they spend most of their time (Haines & Healey, 2011). As simple as it may sound, falling has numerous human costs, some of which include the pain, distress, loss of independence, loss of confidence, and mortality in some extreme cases (Burns, Stevens, & Lee, 2016). Moreover, falling affects family members and may bring to an end the career of those who fall and those who become caregivers as a result of severe fall injuries. It is estimated that NHS spend more than 2.3 billion Euros every year on dealing with issues that are related to falling (Burns, Stevens, & Lee, 2016). Therefore, falling is not just a mere accident as it may sound because it has a severe impact on the quality of life, as well as health and healthcare costs. These figures and realities explain the importance of the extension of the National Institute for Health and Care Excellence (NICE) assessment and clinical prevention guidelines and proactive implementation of the modified recommendations (Huang & Liang, 2005). In such a manner, the inculcation of clinical guidelines will reduce both human and financial costs that are associated with fall-related injuries.
According to the statistics from the Center for Disease Control and Prevention, one out of five elderly people’s falls leads to serious injuries such as head injury or bone fractures (Sherrington, 2011). The seriousness of sustained damages has seen more that 2.5 million people being treated in the emergency department for fall-related injuries every single year (Burns, Stevens, & Lee, 2016). Besides, over 0.7 million patients are hospitalized every year because of falls injuries, particularly because of the hip fracture or head injury (Shi, 2014). Available data also estimate that at least quarter a million of elderly people is hospitalized due to hip fractures that are sustained during fall experiences (Shi, 2014). Moreover, CDC statistics demonstrate that 95% of the total recorded hip fractures occur as a result of a fall injury, especially sideway falls (Haines & Healey, 2011). According to the same report, falls are the primary cause of traumatic brain injuries (TBI). Turning to the cost of treating of all medical issues that are associated with the falls experience with inflation adjustments; such events cause a direct expenditure of 34 billion dollars annually (Burns, Stevens, & Lee, 2016). The report released by CDC indicates that two-thirds of the total cost of health care services is obtained from various healthcare institutions both private and public.
Environmental hazards trigger some of recorded falls. These kinds of falls stand for from 25% to 45% of the total number of falls; it means that they are among the leading causes of senior citizens’ falls (Huang & Liang, 2005). However, the majority of the falls that are categorized as originating from environmental hazards are not caused by this issue alone as the majority of them occur as a result of the interaction of environmental risks and other risk factors such as accumulated susceptibility due to the advancement in age. For example, age-associated changes such as worsened muscle strength, posture control, and step height lower the ability of a person to poise especially after an unexpected trip or when bending or reaching out for something (Huang & Liang, 2005). However, this kind of falls is experienced more by elderly individuals in the community and not in the healthcare institutions primarily because certain steps have been taken in order to create a hazardous-free environment in hospitals. The other primary cause of falls is associated with the age-related body development (Huang & Liang, 2005). As a result, the healthier elderly population records fewer such falls as compared to a high-risk population.
Evidentially, it is difficult to isolate an independent cause of falls because most of them have a multifactorial origin. Consequently, the majority of investigators and researchers on the topic perform an epidemiological cause control with the view to identifying specific risk factors (Sherrington, 2011). In this case, a risk factor is considered a characteristic that is regularly found in persons that experience an advance event when compared to those who do not experience similar events. In spite of small differences in risks factors that are associated with the institutionalized environment and community setup, most of these risk factors largely overlap. In both environments, leg weakness, which is detectable through the muscle examination or functional testing, remains the primary potent risk factor (Sherrington, 2011). In addition to having a strong association with falls, the legs weakness is expectedly more common in older people as compared to the young population. The legs weakness stem from the loss of the healthy condition as a result of extended bed rest or prolonged time of limited physical exercises (Shi, 2014). The leg weakness can also be a result of chronic medical conditions such as stroke, heart failure, or pulmonary diseases. Gait and balance disorder is also a common risk factor among the older people that is directly associated with the first risk factor (Shi, 2014). Elderly people in nursing institutions are predominately affected by this risk factor as three-quarters of the population require the ambulation assistance or are completely unable to ambulate (Haines & Healey, 2011). Ambulatory devices that are used by older people have also been known to increase their chances of falling.
The visual impairment is another factor that increases the risk of falling by about 2.5 times, especially in older people (Haines & Healey, 2011). Some of the primary causes of the visual impairment include the macular degeneration, glaucoma, and cataracts; all these issues are associated with the advancement in age. Also, the functional impairment that is characterized by the inability to perform some of the personal daily activities, for example, bathing, doubles the risks of falling (Haines & Healey, 2011). In nursing homes, the functional impairment remains much higher as more than 96% of residents cannot have a bath without the assistance from a caregiver (Haines & Healey, 2011). 45% of the same population also requires some help with eating (Haines & Healey, 2011). Older people are likely to suffer depression, which increases the risk of falling, due to this harsh health conditions. Although the link between depression and falling is not direct, this state of the mind is associated with the reduced attention to the environment, which predisposes an individual to tripping (Huang & Liang, 2005). Psychotropic medications and cognitive impairment also increase the fall risk and are common among people above the age of 65 years.
Based on the nature of the research work and the research proposal, the data for the development of the study, appropriate results, and the eventual conclusion were electronically gathered from the available research works. Keywords related to the research topic were used in order to enable the search engine to return relevantly and up-to-date information.
This paper is a product of qualitative research as illustrated by its exploratory nature. Considering that the aim of the paper was not to generate data related to elderly people’s falls but to develop an understanding of different opinions, reasons, and motivations behind this topic, the study took a qualitative research design. By analyzing the findings of various qualitative researches, the study provided insights into the problem and developed a hypothesis that could be used in the future quantitative research works.
Different research findings that were used in the development of the research topic were randomly selected from online resources based on the level of relevance to the problem and their year of publication. Outdated publications were avoided.
All falls prevention strategies can be categorized into exercise programs, multidimensional fall risk assessment, risk reduction, institutional intervention, environmental assessment, and modification (Haines & Healey, 2011). Although the end goal of different approaches is the same, the implementation procedure and the fitness of each approach vary from one institution to another. Nevertheless, a well-trained medical professional should carry out an appropriate assessment of the risks based on the prevalence conditions in a hospital and develop prevention programs in line with the hospital core values. No single preventive intervention must be carried out across hospitals within the United States and around the globe due to the random variation in the effectiveness of various preventive intervention strategies when implemented in different environments. Instead, medical professional should be provided with the available data on falls preventive interventions and guided on how they can develop a comprehensive preventive intervention that would work best for the hospital and respective community that the health institution serves (Haines & Healey, 2011). This intervention programs should put into consideration measures that are to be taken with the view to preventing the reoccurrence of falls.
Based on various studies evaluated in the research, an exercise has potential to improve fall risk factors, such as gait impairment, poor balance, and muscle weakness (Sherrington, 2011). Consequently, hospitals and nursing institutions that are responsible for taking care of older people should ensure that patients do some physical exercise instead of remaining in the bed all the time. Grouped and individualized exercise programs will improve the health and reduce impairments among the hospital population. Because of the advanced age of target participants, a planned therapist should conduct exercise programs once or twice a week, and they should last for approximately one hour each (Sherrington, 2011). Depending on the capabilities of trainee, a training instructor can incorporate aerobics conditioning, balance exercises, and strength exercises. Some exercises may require an elderly person to stand on one foot, lift some light weights, or stretch elastic bands with both hands and legs. Other viable exercises include stairs climbing, walking, riding stationary bicycles, bending, and some other low-intensity physical activities (Huang & Liang, 2005). Tai Chi is one of the physical activities that have been reported to improve balance and significantly reduce the risk of falling among older people (Shi, 2014). Evidentially, hospitals that specialize in taking care of such individuals must be equipped with some of these tools and well-trained physical therapist if the costs of dealing with fall-related injuries are to be reduced.
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The assessment strategy mainly aims at identifying risk factors for the future falls and implementing viable interventions with the view to countering potential fall risks. The multidimensional fall risks assessment is either focused or comprehensive dependant on the population that is targeted by the intervention strategy (Haines & Healey, 2011). Older people, who have just experienced a fall or have multiple risk factors for the same, require a holistic approach. Meanwhile, a focused approach is ideal for elderly people with average fall hazards. Individuals with the higher fall risk need a thorough evaluation as it contains details of the medical problem of each person, as well as one’s fall history, mobility assessment, balance, gait, and vision examination, among other assessments, including the cardiovascular status and muscle strength (Haines & Healey, 2011). Usually, a comprehensive multidimensional risk assessment is conducted in clinical settings such as a hospital or nursing home. Outcomes of the assessment allow developing an effective therapy program that is to be implemented under the guidance of a trained therapist. This approach to the fall reduction has been successfully used in institutions with older people regardless of their cognitive impairment status. In addition, the intervention strategy works well with patients that have experienced one or numerous falls in the past (Sherrington, 2011). On the other hand, the focused multidimensional fall risk assessment aids in screening elderly members of the society in order to identify those individuals that need to be placed in a fall preventive intervention program (Haines & Healey, 2011). The approach involves rather simple tests if compared to the comprehensive assessment; however, it covers almost all risk factors.
Based on the available quantitative data, the environmental assessment and modification are elements of a strong falls prevention strategy. Primarily, this approach identifies and removes potential hazards from the environment of older people. Some hazardous issues in the hospital environment may include throw rugs, poor lighting, and other objects. In line, the modification involves lowering the beds height, installation of grab bars, and positioning toilet seats at an appropriate height (Sherrington, 2011). The observation of the functioning of an elderly person by a trained professional informs the modification and assessment strategy that is used in intervention programs. In most cases, institutional settings implement safety practices and policies that protect both the staff and patients. Also, regulators of healthcare institutions have enacted laws that govern the condition of hospitals in relation to the lighting, toilet seats, bathrooms, grab bars, bed height, furniture, and other general modification interventions (Sherrington, 2011). Nevertheless, the hospital management has freedom to modify some of the set standards if it will reduce the fall risk factor and keep particular patients more comfortable.
Multifactorial intervention as the name suggests combining multiple prevention strategies into a single coordinated intervention program. These interventions include elements of all other intervention programs. As a result, a program that is designed for a certain intervention is usually comprehensive and deal with most if not all the fall risk factors that were discussed in the literature review section (Huang & Liang, 2005). Such intervention programs also have regular training programs for the staff and patients. In some cases, alert cards with different colors code that indicate the patient’s risk levels are used in order to help both the patients and practitioners to identify and assist those at a higher risk quickly (Burns, Stevens, & Lee, 2016).
The objectives of the research were achieved as various fall risk intervention strategies were identified and analyzed. Moreover, appropriate conclusions were drawn from the available data. Also, research results responded to all study questions. For instance, health professionals have been designated as people that are primarily responsible for the assessment, reduction, and prevention of falls among elderly people in clinical settings. Similarly, the effectiveness of each of the identified preventive intervention strategies was evaluated based on the environment and predisposition risk condition of patients. A significant number of falls and falls injuries occurs as a result of multiple risk factors that are modifiable and preventable through the implementation of targeted falls interventions. The success of the intervention at a larger scale depends on its feasibility, sustainability, and cost-effectiveness. As hypothesized, exercise interventions and multidimensional fall risk assessment and modification are the most promising prevention intervention strategies. The incorporation of the two strategies into a comprehensive falls prevention programs has the potential to resolve certain challenges that are associated with this problem. Although the government does not have to micromanage healthcare institutions, it should offer general guidance concerning the development of such programs.
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