Fall Prevention Strategy - Term Paper Example

Student Name: Tutor: Title: Fall Prevention strategy Course: Executive Summary An introductory paragraph Falls in elderly people are a leading concern with respect to mortality, institutionalization, disability, and socioeconomic burden. During the last decade, evidence of falls prevention has expanded and various guidelines are now available. Regardless of this, there is still a national tendency of raising falls that lead to escalating healthcare expenses. Improving results needs addressing evidence gaps of practice for people and a system wide approach. An overview of the injury issue In Australia, injury is considered the foremost causes of morbidity, permanent disability and mortality. Falls’ prevention is of main significance since falls cause significant morbidity, mortality and suffering for elderly people as well as their families, and bring about social expenses as a result of nursing home and hospital admissions. Description of the intervention An intervention falls prevention strategy that is multidisciplinary can be effective in reducing of falls among the elderly in Australia. Exercise and physiotherapy, home education program, withdrawal of medicine, and vitamin D administration are some of the intervention comprising the proposed intervention strategy that is multidisciplinary. Individual interventions have their own limitations. Evaluation methods Quality assurance of the multidisciplinary strategy will be demonstrated through reduction of falls and hazard factors. The process will be evaluated through implementation and compliance to the intervention. The impact of the strategy will be evaluated in the expected outcomes. Expected outcomes Expected outcomes are measured through mortality and morbidity rates. The rate of falls among the elderly is expected to reduce following the implementation of a multidisciplinary intervention strategy. Increase community awareness will lead to reduction of hazards leading to falls. Table of Contents Executive Summary 2 Table of Contents 4 Introduction/Background 4 Epidemiology of the Injury Issue 5 Current Interventions and Limitations 6 Goals and Objectives using Smart Principles 8 Rationale using Bradshaw’s 4 different types of needs 9 Proposed Intervention 9 Reference 14 Introduction/Background Falls are considered a leading cause of harm to elderly people and injuries related to falls impose a considerable burden on the systems of health care as well as aged care (ACSQHC, 2009). On the other hand, research has shown there can be prevention of a lot of falls. Effective falls prevention action call for activity in a broad range of community- based, population-focused, and health care settings initiatives. With age, comes an increase in falls, with considerable harm that lead to high utilization of health and socioeconomic burden. Elderly people who have cognitive impairment are also frequently at greater risk of falling (Muir et al, 2012). With this in mind, this paper seeks to highlight various injury issues in relation elderly falls and how to come up with suitable prevention strategies of falls as a specific issue in injury. Epidemiology of the Injury Issue With regards to falls, which is one of the leading causes of injury among the elderly, in 2008-09, nearly 70 percent of hospitalized falls were recorded to have taken place in either an aged care facility or at home (Thomas et al, 2010). A lot of falls in homes were recorded to have happened in unspecified areas in the home, even though outdoor regions of the home, the bedroom and the bathroom were also frequent occurrence places reported for hospitalized falls (Watson et al, 2010). Miller (2009) contends that older adults constitute a large and increasing fraction of the population. As one grows older he or she is progressively more at risk of falling and subsequent injuries. A fall can be the initial sign of an illness that is undetected. Arenson et al (2009 explain that falls’ prevention is of significance since falls cause severe morbidity, mortality and suffering for elderly people as well as their families, and bring about social expenses as a result of nursing home and hospital admissions. Falls are considered to be the most frequently reported incident of patient-safety in settings of mental health for older people with nearly 36,000 falls reported in such settings (Watson et al, 2010). Falling risk is exacerbated by problems of health, like impaired mental status as a result of depression, anxiety, mania, and dementia (Arenson et al, 2009). Additionally, mental health conditions’ treatment, for instance, with electroconvulsive therapy and psychotropic medication also raise the risk of falling. Falls affect mental and physical function, rehabilitation, can raise hospital stay duration and the possibility of discharge to care settings that are long-term (Thomas et al, 2010). Costs of health care linked to falls are rising globally, with falls in elderly people with conditions of mental health linked to higher expenses compared to the older people population in general (Watson et al, 2010). Current Interventions and Limitations There is evidence to demonstrate that some interventions prove to be effective as compared to others tailored to individual risk profiles in residential, community and care settings. Quigley et al (2010) are of the view that exercise is an integral part of a multifactorial intervention when used persistently and for 10 weeks or longer periods. Engaging in moderate physical activity is important to good health and independence maintenance. The relation between decreased falls and exercise in aged people in the community is well-established. Disability can be decreased through exercises that are well-designed among this population (Thomas et al, 2010). Some systematic reviews as well as some more recent studies have illustrated that exercises that are well-designed can decrease falls among elderly people that live in the community (Sherrington et al, 2011). As a single strategy of intervention, exercise is demonstrated to be the most effective and it is individually tailored balance retraining and muscle strength under the guidance of a trained health professional (Miller, 2009). Group exercise programs are been known to be less effective as compared to individually prescribed exercises except a group program using the Tai Chi intervention. Exercise improves mobility, balance as well as reaction time. It boosts bone mineral density in individuals aged 70 and above and postmenopausal women (Deandrea et al, 2010). Exercise as a strategy has limitations because little is known concerning the cost effectiveness of exercise programs in elderly people and further research is needed to establish the optimal type, frequency, intensity, and duration of the programs (Chase et al, 2012). Education has also been involved as an intervention strategy. An education program targeting to increase awareness of risks that come with falling can possess beneficial effects. Peer-delivered education can enhance more participation, and has been demonstrated to increase falls-prevention awareness (Thomas, Mackintosh & Halbert, 2010). Participants gain a more pro-active approach to ways of preventing recurrent falls. Education is crucial for building the required capacity for effective fall prevention practice and policy (Michael et al, 2010). Education has to be provided to those at risk of falling, to those who offer social and health services to those at risk and people in charge of designing and constructing public spaces and housing utilized by older persons. Education can work well as a part of a larger strategy for falls prevention (Henley& Harrison, 2009). Education will require more input and involvement of a larger lot of stakeholders hence making it slow, time consuming and expensive. Education has to be integrated with other interventions to be effective (Chase et al, 2012). Supplementation of vitamin D for the elderly people with deficiency is another simple and effective strategy of fracture and fall prevention, with benefits of fracture persisting with age increase. Supplementation of vitamin D can decrease falls by 17 percent and greater cholecalciferol dosage decrease the risk of hip fracture by 30 percent (Miller, 2009). For monthly, weekly, or daily regimes seem to be effective, although high administration of the dose need to be avoided. A level of vitamin D greater than nmol/L is needed for fracture and falls’ prevention with the advantage of additional uncertain calcium supplementation. People that require anti-osteoporosis treatment need to be given supplement of calcium and vitamin D when there is inadequate dietary intake (Chase et al, 2012). However, the use Vitamin D can be associated with adverse effects like hypercalcaemia. There are no economic evaluations integrated in the randomized controlled trials of vitamin D with regard to falls prevention (Quigley et al, 2010). Goals and Objectives using Smart Principles When setting the goals and objectives for designing strategies in falls prevention, it is imperative to apply the SMART principles as a guideline to establish whether the goals are met or not (Michael et al, 2010). The strategy will be multidisciplinary in order to be comprehensive and ensure that elements overlooked by one intervention are covered. It can be applied in number of settings in the society. The strategy will be evaluated after a period of time like every six month to ensure at is attaining its goal, hence its measurability. The other objective is reducing falls among the elderly by at least 10% within a year, and this is attainable. The other objective is to decrease the number of falls that are presented to the hospital by 10% in individuals aged 65 to 75 years who independently live in the community by December 2015 (Quigley et al, 2010). A multidisciplinary strategy incorporates a wider scope and it can lead to significant reduction in falls. Within a period of one year the falls among elderly out have to be reduced and hence there is a timeline of achieving the set goals using the strategy. The risk of falling has to be reduced significantly. Rationale using Bradshaw’s 4 different types of needs The limitations in the current interventions call for development and implementation of a strategy that will compressively lead to preventions of falls among the elderly in Australia. The cost of falls among elderly is enormous calling for a comprehensive prevention strategy (Henley& Harrison, 2009). Recognition of the need is important to development of strategy. No single intervention can resolve falls among elderly in Australia and it is important to research on the specific needs within communities. During home visits, assessment of risk factors for falling need to be identified and applicable measures applied such as putting up hand rails (Henley& Harrison, 2009). There are different needs for every individual in reference to a particular setting such as in hospitals and in aged care facilities. However, a number of falls may still occur regardless of application of a single intervention hence the need of a comprehensive strategy. In such instances, there is still need to vigilantly monitor, review plan of care as well as actions’ implementation to reduce the risk of injury (Watson & Mitchell, 2010). The community feels the heavy burden of spending and high mortality rates as a result of falls among the elderly. These falls can be prevented through a multidisciplinary strategy. The implemented strategy has to try to cover up the limitation of single interventions. Proposed Intervention The intervention strategy that best be applied in falls prevention is a multidisciplinary intervention. Multidisciplinary falls prevention strategy can be effective whereas single intervention strategy work best in high-risk populations. A multidisciplinary intervention strategy is suitable since it will involve a combination of interventions that address the shortcomings of the other intervention (Michael et al, 2010). No one intervention is totally effective. Education, exercise and physical therapy and use of Vitamin D supplement together with other interventions like home safety program can be integrated into a multidisciplinary strategy for falls preventions (Watson & Mitchell, 2010) The intervention strategy will use the 4E’s of Education, Enforcement, Environment and Engineering. It will be important to raise awareness through education. The physical environments have to be altered to avoid the chances of triggering falls. The structure and nature of the physical environment can essentially influence the likelihood of a person suffering a fall (Thomas, Mackintosh & Halbert, 2010). It is important to improve assessment of the individual and the environmental factors contributing to the likelihood of falls. Gradual withdrawal of medication has been noted to result in a huge reduction in falls although is challenging to maintain elderly people without psychoactive medications one there is a prescription (Henley& Harrison, 2009). Medicine withdrawal is part and Vitamin D administration is part of engineering. Home safety programs are also important. Systematic reviews demonstrate that assessment as well as modification can lead to reduction of falls in elderly people at high risk (Sherrington et al, 2011). Home safety assessment as well as modification using an experienced occupational therapist reduces falls among subgroup of older people. The review of identified hazards like poor lighting and slippery floor, and unsafe behavior such as wearing shoes that are loose or leaving clutter in high traffic areas. Behavioral change is important to this intervention (Miller, 2009). This can be part of enforcement of the multidisciplinary strategy for falls prevention. Raising physical activity can be helpful in programs of falls prevention. Activities which improve balance, coordination, and strength can decrease the falling risk (Michael et al, 2010). Even though programs of fall prevention have centered on various techniques to improve balance, flexibility, mobility, coordination, and strength, Tai Chi is possibly the most commonly studied kind of exercise (Arenson et al (2009). Michael et al (2010), state that physical therapy and exercise interventions for older adults in community-dwelling settings can be specifically effective in higher risk participants for falls with regards to fall risk. Otago exercise program is an individually tailored home exercise program comprising lower limb muscle strengthening, balance retraining, and walking components (Bloch et al, 2011). A trained nurse or an experienced physiotherapist has to be involved. This should enable health care professional to consider the interventions of falls prevention that they presently recommend and thereby question the proof for or against their effectiveness (Miller, 2009). Capacity building is part of engineering and it is important for achieving sustainability of the strategy and achieving all the desired objectives. Capacity building of activity and exercise strategy will be achieved through training of nurses and relevant health care personnel to equip them with adequate knowledge about Tai Chi exercises and other forms of exercises targeting to prevent cases of falls among the elderly in Australia (Bloch et al, 2011). More personnel have to be trained to offer the exercise to the elderly with the increasing balance and muscle strengthening. Equity will be achieved through ensuring the equal number of men and women are trained on the strategy in order to attend to potential victims from all genders among the elderly (Chase et al, 2012). The participation of the public in the strategy implementation is very crucial because they are directly involved. The lifestyles and behavior of the community influence safety. Social responsibility will be improved through creating awareness or sensitizing the public about risk factors of falls among the elderly and the importance of the intervention strategy. Social responsibility is important for this strategy because the community has to be fully involved in improving care of its elderly since they have to be integrated in the society (ACSQHC, 2009). The cost of health care is a burden to many families and this strategy will be crucial to also to them in cutting down health care spending and mortality as a result of preventable falls among the elderly. Social marketing will be employed to disseminate information with regard to physical activity and exercise as a strategy of prevention of falls in the elderly Australians (Gray & Heinsch, 2009). The increase use of the Internet makes many families to be interconnected on social media like Facebook, twitter, yahoo and Google hangouts. These social media platforms provide avenues of sharing and dissemination of information about the strategy proposed (Bloch et al, 2011). Networking through social marketing will ensure the wide use of the strategy as an intervention measure for falls preventions among the elderly Australians. Evaluation in relation to goals and objectives In evaluation, there is a hierarchy that relates to it. The first level of the intervention process is evaluated as an exercise of quality assurance, although it is important to accurately define the intervention so that precise attribution can be established. Process measures will include compliance level with recommendations of intervention and program’s community awareness (Henley& Harrison, 2009). When compliance is poor, the results will also be poor. Secondly, the intervention’s impact is evaluated whereby what transformations are made within the environment that can explain changes in health status. Like process measures, these measures seem to be both quantitative and qualitative. When the complications related to falls are reduced, the health status of the elderly person will be improved (Thomas, Mackintosh & Halbert, 2010). The falls among the elderly will go done as the public become aware of this strategy. Finally, there is evaluation of health outcomes that are quantitative, such as changes in target injury frequency within the community. For example, osteopathy, massage, and physio visits, GP visits, and Emergency Department attendances (Gray & Heinsch, 2009). When the visits at the ED are reduced, it will be an indicator that the level of fallers has reduced. Expected Outcomes The strategy is can easily be implemented so many people will be willing to participate since it is only therapist for exercise that are needed. The falls among the elderly is expected to reduce by 10% within a period of one year (Watson & Mitchell, 2010). Many people can be involved in the program and it will require the government and other health practitioners little investment using this strategy. Stability will be enhanced and falls among the elderly will be reduced using the least cost as compared to other strategies that appear complicated and costly (Henley & Harrison, 2009). There will be improved strength guard and reduced falling risk in the elderly. Weight bearing capacities will be enhanced. Discussion/Conclusion This paper has discussed various issues in falls among the elderly in Australia. Elderly people who have cognitive impairment are also frequently at greater risk of falling with some effective preventive measures for falls as discussed above, falls among the elderly can be decreased to a greater extent. One of the strategies discussed in prevention of injury is multifaceted approach that addresses the issue as a whole through collaborative measures. This involves corporation of every stakeholder so that the desired health outcome can be achieved through effective interventions. The proposed intervention is multidisciplinary strategy that incorporates several interventions like exercise and physical activity, vitamin D administration, withdrawal of medicine, and home education programs. The essence of capacity building and social marketing cannot be overlooked in the implementation of the strategy. Reference Arenson, C., Busby-Whitehead, J., Reichel, W. & Brummel-Smith, K. (2009). Reichel's Care of the Elderly: Clinical Aspects of Aging. Cambridge: Cambridge University Press. Australian Commission on Safety and Quality in Healthcare (ACSQHC). (2009). Preventing falls and harm from falls in older people: best practice guidelines for Australian community care. 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Conflicting trends in fall-related injury hospitalizations among older people: variations by injury type. Osteoporosis International, 22(10):2623-31. doi: 10.1007/s00198-010-1511-z Read More