Fall Prevention Among Elderly Patients - Literature review Example

Table of Contents Table of Contents 1.0 Introduction 2 2.0 Review of the Literature 2 2 Sherrod and Good (2006) 2 2.2 Cheek, Nikpour and Nowling (2005) 3 2.3 Poe et al. (2005) 4 2.4 Semin-Goossens, van der Helm and Bossuyt (2003) 5 2.5 Dochterman et al. (2005) 6 2.6 McFarlane-Kolb (2004) 7 2.7 Hsu et al. (2004) 8 2.8 Hays (2004) 9 3.0 Conclusion 10 4.0 References 11 1.0 Introduction Falls are threatening events for an elderly person, and sometimes are fatal. Falls and their sequela are among the most common cause of death in older persons. Until recently, falls were considered a normal occurrence in the aging process. Recent research findings have changed that perception to some extent. As a major health problem, falls among elderly persons are becoming a concern of great significance because they happen quite frequently resulting in serious injuries and greater health care costs. Nursing staff can be instrumental in helping to improve the quality of care among this age group by using risk factors as guides in intervention and management. The studies reviewed in the below emphasise the aforementioned and suggest strategies for fall-risk assessment and fall prevention. 2.0 Review of the Literature 2.1 Sherrod and Good (2006) The authors propose the adoption of a data-driven, evidence-based approach for fall-prevention among elderly inpatients. The study, which includes neither subjects nor a data collection and analysis approach is, nevertheless, an extremely informative nursing guide on fall prevention. As Sherrod and Good (2006) write, the primary problem confronting nurses in elderly patient settings is falls, especially those which result in fractures. Apart from the healthcare/treatment costs which are subsequently incurred, within the parameters of elderly patients, falls are immediately linked to morbidity rates. The implication here is, as Sherrod and Good (2006) emphasise, is that fall prevention among elderly patients must be defined as the primary nursing responsibility. It is within the context of the stated that the authors identify fall prevention strategies as their research purpose. As noted in the preceding, Sherrod and Good (2006) adopt an evidence-based approach. There exists a wealth of data on fall risk factors and prevention strategies among elderly inpatients and this data, if properly and thoroughly analysed has the potential to yield important information regarding the efficacy and effectiveness of the variant fall prevention strategies and techniques. Rather than proposed a specific technique, Sherrod and Good (2006) contend that it is imperative that each setting develop its own. Certainly, nurses must be well-trained in the general causal factors and the relevant prevention strategies but, more importantly, each setting/environment has its own set of risk factors. These must be identified through a review of the relevant data and prevention strategies designed in direct correlation to those risk factors. While the reviewed research offers a potentially useful generic framework for fall prevention, the study is ultimately limited by both its generality and the absence of identifiable and concrete data. 2.2 Cheek, Nikpour and Nowling (2005) The purpose of this study emanates from within the framework of a well-defined problem: ever-increasing fall rates among an ever-aging population as which substantially increase healthcare costs for the elderly. Although subjects are not included in the study, this does not detract from its overall value since Cheek, Nikpour and Nowling (2005) undertake a comprehensive review of the literature on elderly patient fall risk-factors for the purpose of identifying the most prominent ones. As the data results indicate, falls are generally caused by failing eyesight, decreased limber control, ever weakening muscles and susceptibility to vertigo. The extent to which the stated contribute to falls can be significantly reduced through medication and exercise programs, not to mention rendering a house elderly-friendly through, for example, the removal of rugs as which can trip an elderly patient. Proceeding from the above stated, Cheek, Nikpour and Nowling (2005) propose a set of in-house nursing practices as which would minimise the risk of falls. These include a thorough review of the house to ensure that it is elderly-friendly, including the removal of objects which can increase fall risk rates, the timely administration of prescribed medication, the implementation of an exercise regime as would offset the deterioration of muscular strength and the continued monitoring of the elderly patient’s movements as a strategy for the proactive prevention of falls. In essence, Cheek, Nikpour and Nowling (2005) present nursing professionals with a set of practical guidelines for the reduction of the risk of falling to which the elderly patients in their care confront. 2.3 Poe et al. (2005) Poe et al. (2005) outline the health risks posed to elderly patients as a consequence of falling, asserting that the resultant problems emphasise the imperatives of designing and instituting fall prevention programs for elderly patients in long-term healthcare settings. Proceeding from the premise that nursing professionals have an integral role to play in fall prevention, the purpose of the study is the creation of an evidence-based tool for fall prevention/reduction of fall risk. The researchers adopt an evidence-based approach which necessitated the collection, analysis and review of primary and secondary data. Primary data was collected through the researchers’ long term observation of falls among elderly hospital inpatients and secondary data from a Joint Commission on Accreditation of Healthcare Organizations’ study. The data covered a ten year period and was specifically focused on the factors leading to sentinel-related falls. The mentioned data sets were subsequently analysed for determination of fall-specific risk factors. Through the adoption of the evidence-based approach, briefly outlined in the preceding paragraph, Poe et al. (2005) uncover a set of factors and symptoms which identify particular patients as `at-risk.’ Following that, the researchers propose a set of fall prevention technologies for each set of risk-factors for determination of a perfect fit between specific fall-risk factors and fall-prevention techniques and technologies. Proceeding from the above stated, Poe et al. (2005) propose that nurses utilise their fall risk assessment tool for determination of the extent and nature of the fall risk their elderly patients are exposed to and the subsequent adoption of the fall-prevention strategy which most effectively addresses the risk-set in question. While Poe et al. (2005) clearly present all of their study’s purpose, research design, data collection, data analysis, results and conclusions, they do not explain their subject selection or subject criteria processes. Instead, readers are left to assume that a convenience sampling approach was adopted. 2.4 Semin-Goossens, van der Helm and Bossuyt (2003) The purpose of the study was the determination of whether or not a specific evidence-based nursing guideline for fall prevention among elderly patients in a hospital setting had the potential to reduce falls by 30%. The guideline in question had been designed in 1993 but had never been implemented. The researchers, however, upon the critical assessment of that guideline, had hypothesised that it could significantly reduce falls among elderly patients. Accordingly, focusing on two wards in a large urban hospital, the researchers implemented the guidelines using the Grol 5-step implementation model. Pre-implementation data was collected and upon its analysis, indicated an average of 13 falls per 1000 patients per year in the neurology ward and 11 in the internal medicine ward. Post implementation data indicated reduction, although insignificant. The researchers conclude that the findings do not establish the failure of the prevention program per se but that nurses are not committed to it, leading to their argument for greater nurse awareness of fall assessment and fall prevention and intervention strategies vis-à-vis elderly patients. 2.5 Dochterman et al. (2005) The purpose of the study was the determination of the effect of nursing intervention on the prevention, or reduction, of falling among aged patients in a hospital setting. In other words, the study, which commenced on July 1st, 1998 and which was concluded on June 30th, 2002, sought to question whether or not nursing intervention reduced the risk of falling among three groups of aged, high risk patients. These are heart patient, the hip fracture and fall prevention group of patients. The last is particularly interesting insofar as it refers to inpatients whom, upon admission, were identified as highly vulnerable to falling. Data on the three groups of patients was collected through the hospital electronic database system and referenced 1,435 heart patients, 567 hip fracture patients and close to 12,000 fall prevention patients. The study of each of these three groups indicated that heart patients were susceptible to falling as an outcome of medication, hip fracture patients because of obvious limber and movement difficulties and fall prevention patients as a result of a myriad of factors, with the most prevalent one being loss of musculature. Focusing on a sample of 304 patients from all three groups, nurses were directed to engage in fall prevention intervention. It is important to note here that the nurses in question were given a solid grounding in a variety of intervention strategies and directed to which intervention program was most suitable for each of the fall causes. Fall prevention intervention successfully reduced fall incidence rates by approximately one-third. The mentioned study, as may have been deduced from the preceding review, presents readers with a thorough overview of its methodological approach and the process by which study findings were validated. This, needless to say, solidifies the value of this study. That value, or importance, immediately emanates from the fact that it establishes the extent to which nursing intervention can positively impact a significant reduction in falling incidence rates among older, at-risk, patients. 2.6 McFarlane-Kolb (2004) The study had two purposes. The first was the evaluation of the Morse Falls Scale, falls risk assessment tool and, the second was the extent to which the said tool has contributed, or failed to, fall prevention among elderly surgical patients. The study setting was a 600 bed regional, teaching and research hospital whose database indicated that it had a high elderly surgical patient fall incident rate, amounting to 280 patients in a one-year period. At the time of the study, and despite the mentioned fall incident rate, the hospital did not have a fall risk assessment tool or fall prevention program in place. McFarlane-Kolb (2004) focused her study on a 30-bed vascular surgical ward over a three month period, collecting data from a quasi-random sample of 100 patients (admitted to the ward and beds in question). Prior to ward admission, the researcher administered the Morse Falls Scale for risk assessment purposes, following which she targeted the identified at-risk patients with fall prevention programs. The conclusion established that not only was the Morse Falls Scale a highly versatile, easily adaptable risk assessment tool but that it facilitated the accurate identification of the at-risk patients, allowing for the implementation of suitable fall prevention programs, resulting in the significant reduction of falls. As may be determined from this particular study, the consequences of falling among frail and elderly, surgical patients is extremely high. There is, therefore, no justification for hospitals’ failures to implement fall risk assessment tools and prevention strategies, especially when they have proven the extent to which they can significantly contribute to the reduction of the said risk. 2.7 Hsu et al. (2004) The researchers, all of whom are practitioner nurses, conducted a multiple step experimental model. Focusing on ageing patients in a medical centre in Taiwan, they first studied falling prevalence rates and isolated the causal factors, as explained by the patients themselves. These factors were contrasted against those outlined in professional academic literature and were found to coincide. Falling was found to be an outcome of limber and muscular weakness, failing eyesight and occasional bouts of passing vertigo. Following from that, the authors studied falling incidence rates in the medical centre itself and its causal factors. Again, the causal factors were found to be similar. Falling rates, however, while unacceptably high for a medical centre were lower then in the home setting. Following from that the authors implemented a falls prevention guideline and tutored both patients and their caretakers, if any, on the ways and means of fall prevention. Emphasis was placed on the time of the administration of sedatives, if prescribed, and on exercises as which would strengthen muscles and maximise the capacity of patients to walk steadily. The authors report that the aforementioned resulted in the decrease of falling by 20.4%. Even though this study contributes to our understanding of the primary causes of falling among hospital patients, it is difficult to generalize its findings for two reasons. In the first place, even though the authors defined their methodological approach as quasi-experimental, thy did not explain their data collection or data analysis methods. In the second place, the authors did not provide an explanation of their data validation process or, indeed, if any was used. Consequently, even though this study is useful insofar as it supports a large body of literature regarding the causes of falling among older patients, its findings vis-à-vis fall prevention strategies cannot be generalized or implemented due to the stated shortcomings. 2.8 Hays (2004) Hays (2004) founds his study on the premise that falls among the elderly population will happen and even though fall prevention strategies can reduce the risk of falls, it is necessary to implement techniques as which would minimize the consequences of falls. The purpose of the study, therefore, is the presentation of a strategy for the minimization of the consequences of falls, and not fall prevention. Reviewing the data on elderly females who have experienced falls and have fractured their hips as a direct result, Hays (2004) maintains that the pre-fall medical records clearly indicated that there was an inordinately high risk of hip fracture should a fall occur. The implication here is that if the fall itself could not have been prevented, its consequences could have been. It is, thus, that the researcher proposes that elderly-patient healthcare providers, specifically nurses, subject their elderly patients to medical tests as would assess the risk of fractures and, in instances where both risk of falling and risk of fractures are identified, to arrange for the fitting of their patients with hip protection devices (Hays, 2004). The validity of the proposed recommendation emanate from the author’s reference to empirical data which indicates a significant reduction of fall-induced hip fractures following the use of hip protection devices. 3.0 Conclusion The literature reviewed in the above, and which focuses on fall prevention among elderly patients, has highlighted the role of nursing staff in fall-risk assessment, fall prevention and the reduction of the consequences of falls to the elderly. The general consensus is that existent tools and strategies can significantly reduce the risk and the consequences of falling among the elderly, with it being incumbent upon nursing professionals to deploy these tools and strategies. 4.0 References Dochterman, J. et al. (2005) `Describing use of nursing interventions for three groups of patients.’ Journal of Nursing Scholarship, 37(1), 57-66. Cheek, P., Nikpour, L., Nowlin, H. D. (2005) `Aging well with smart technology.’ Nursing Administration Quarterly, 29(4), 329-338. Hayes, N. (2004) `Hip protectors: interpreting the evidence and addressing practicalities.’ Nursing Older People, 16(3), 15-20. Hsu, S. (2004) `Fall Risk Factors Assessment Tool: Enhancing Effectiveness in Falls Screening.’ Journal of Nursing Research, 12(3), 169-178. McFarlane-Kolb, H. (2004) `Falls risk assessment, multitargeted interventions and the impact on hospital falls.’ International Journal of Nursing Practice, 10(5), 199-206. Poe, S. S. et al. (2005) `An evidence-based approach to fall risk assessment, prevention, and management.’ Journal of Nursing Care Quality, 20(2), 107-116. Semin-Goossens, A., van der Helm, J. M.J. and Bossuyt, P. M.M. (2003) `A failed model-based attempt to implement an evidence-based nursing guideline for fall prevention.’ Journal of Nursing Care Quality, 18(3), 217-226. Sherrod, M.M. and Good, J.A. (2006) `Crack the code of patient falls.’ Nursing Management, 37(8), 25-29. Read More