Preventing Falls in Long Term Care Setting - Essay Example

? Preventing Falls in Long Term Care Settings Preventing Falls in Long Term Care Settings The ageing process is characterized by a number of physical and psychological changes that determine the health outcomes of a patient in the long term care setting. Among these changes, the incidence of falls composes a major public health problem due to the physical vulnerability of the elderly population (Ray et al., 2005). Inquiries into the best practices for preventing falls in the long term care setting are, thus, justified and potentially solving a major problem. This study explores the prevalence and significance of falls in the long term care setting before discussing five nursing interventions that can be instituted to manage the problem. This is followed by an appraisal of the anticipated outcomes after implementation of the five strategies. The study draws from Registered Nurses’ Association of Ontario (RNAO) Best Practice Guideline (BPG) and a number of peer reviewed scholarly articles. The Prevalence and Significance of falls in the Long Term Care Setting According to McCarthy, Adedokun and Fairchild (2011) present statistics that capture the seriousness of falls in the long term care setting. A nursing home containing 100 beds reports between 100 and 200 falls among the residents annually. Elderly patients in the long term care setting are three times as likely to experience falls in comparison to their community-dwelling counterparts. The scholars’ report further state that falls are the leading cause of fatal and non-fatal injuries to individuals over the age of 65. RNAO (2005) reports 84.8% of all hospital injury admissions of individuals above the age of 65 are the result of falling. One in ten of emergency room visits among the elderly arises due to serious falls, while the incidences increase proportionately to age. Ferris (2008) attributes the disparity between long term care residents and community dwellers to the likelihood of having more comorbidities and advanced levels of diseases such as dementia. The significance of falls in the long term care setting is further underpinned by the contribution of falls to morbidity and mortality, decline in functional disposition and depression among other impacts on the elderly. Another perspective of the issue shows that a good number of falls may go unreported, which limits the capacity of data seekers to correctly capture the contribution of falls to elderly residents’ morbidity and mortality. Falls potentially cause more serious impacts and implications than the grim statistics presented. Thus, falls in the long term care setting are an issue of great significance in case the outcomes of long term care settings are to improve. Nursing Interventions to Prevent Falls in the Long Term Care Setting The seriousness of the issue of falls among residents of long term care homes makes it necessary to institute evidence-based and informed prevention strategies. The Registered Nurses’ Association of Ontario (RNAO) Best Practice Guideline (BPG) provides evidence-based strategies to prevent falls and thus will be the focus of this study. The first prevention strategy entails sensitizing the residents on the importance of vitamin D supplementation among other dietary, lifestyle and treatment choices for osteoporosis (RNAO, 2005). There exists sufficient evidence showing that decline in bone density among the elderly is directly associated to increased risk of falls. Elderly patients may have higher risks of vitamin D deficiency due to limited exposure to sunlight and skin changes associated with ageing. Bischoff-Ferrari et al. (2009) support RNAO’s position through their study indicating that vitamin D supplementation significantly reduces patient’s risks of falling. Their meta-analytic evidence indicates a reduction of 22% in falls among patients in the healthcare setting. The second prevention strategy involves assessing and modifying the long term care setting environment as a component of fall prevention strategies. RNAO (2005) argues that environmental assessment leads to identifying the environmental risk factors behind falling and their removal. Some of the modifications that can be instituted include changing chair and bed heights, proper use of walking aids, grab bars in the setting and adequate lighting provision all of which have been shown to significantly reduce the incidence of falls among elderly patients. Further, improvements on the accessibility of nursing alert systems effectively reduce falls (Ferris, 2008). Thirdly, nurses and fellow healthcare personnel should undertake periodic medical review/assessment on elderly patients to prevent falls in the long term care setting. Long term care patients usually use treatment regimes that potentially increase their risk of falls. These include psychotropic medications such as SSRIs and anti-depressants which have been shown to contribute to falls. Further, the dosage has been established to positively correlate with the risk of falling among patients in the long term care setting. Periodic reviews should mark patients using such drugs or those using more than five medications at one time as highly likely to experience falls. Another strategy put forth as best practice by RNAO (2005) involves implementing a multi-factorial targeted fall prevention program in the long term care setting, mediated by nurses as part of multi-disciplinary teams. Neyens et al. (2011) supports the benefits gained in reduction of falls through implementing multi-factorial intervention programs. The components of such programs include environmental modifications, mobility aids, staff education, exercise regimes, review of medication and post-fall problem solving. Lastly, nurses should be educated exhaustively on the prevention of falls and fall injuries since they play important patient-carer roles in the long term care setting. Such education should be incorporated into nursing curricula and on-job training through innovative training strategies such as reflective practice and case studies. Some of the topics that should be covered include the promotion of safe mobility among the elderly, fall risk assessment and the use of multi-disciplinary strategies to prevent falls. Importantly, nurses should be educated on alternative strategies of preventing falls rather than the traditional restraining or restriction (RNAO, 2005). Appraisal and Outcome Determinants of the Intervention Methods Proposed Upon critical evaluation, the proposed fall prevention strategies are the result of the highest level of evidence; meta-analytic studies and systematic reviews of randomized control studies (RNAO, 2005). Such studies review numerous peer-reviewed primary research efforts into the issue of preventing falls among the elderly. Hence, the interventions are informed by tried and tested strategies through the best research efforts, which places them at the core of RANO Best Practice Guidelines. The first strategy- sensitizing patients on the benefits of vitamin D supplementation- empowers the patient through providing them with important information. Thus, the likelihood of efficacy is heightened since such practice is patient-centered. Environmental assessment and modification removes risks and places aids in the environment; hence, the direct benefits of such a method are not in question. The multi-factorial approach entails many proven methods combining synergistically to bring better outcomes against falls. Lastly, all these methods would not work without properly training the nurses to implement them. One of the most important determinants of positive patient outcomes is the nurse-patient relationship. As placebo-controlled trials in many studies show, the relationship between nurses and patients may be in itself therapeutic, complementing the efforts made in solving problems such as falls in the long term care setting. The importance of this relationship is further underpinned in the long term care setting where agitation and difficulty in patients prevent desirable outcomes. Conclusion The statistics available on falls among elderly patients in long term care homes highlight the significance of the problem. Suggested interventions drawn from RNAO and relevant literature include supplementation with vitamin D, assessing and modifying the environment, periodic review of medicine regimes, implementing multi-factorial interventions and educating nurses and nurse students on the problem. The proposed interventions rely on the best available evidence and thus their efficacy is assured. Further, the nurse-patient relationship is a crucial determinant of patient outcomes from implementation of such strategies. References Bischoff-Ferrari, H. A. et al. (2009). Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomized controlled trials. BMJ, 339(b3692): 1-11. Ferris, M. (2008). Fall prevention in long-term care: Practical advice to improve care. Topics in Advanced Practice Nursing Journal, 8(3): 1-4. McCarthy, R, Adedokun, C. W., & Fairchild, R. M. (2011). Preventing falls in the elderly long term care facilities. RN Journal of Nursing, http://www.rnjournal.com/journal_of_nursing/preventing_falls_in_the_elderly_long_term_care_facilities.htm Neyens, J. C. et al. (2011). Effectiveness and implementation aspects of interventions for preventing falls in elderly people in long-term care facilities: a systematic review of RCTs. Journal of American Medical Directors Association, 12(6): 410-425. Ray, W. A. et al. (2005). Prevention of fall-related injuries in long-term care a randomized controlled trial of staff education. Archive of Internal Medicine, 165, 2293-2298. RNAO (2005). Prevention of falls and fall injuries in the older adult. Nursing Best Practice Guidelines. Retrieved 15 February 2012 from http://www.rnao.org/Storage/12/617_BPG_Falls_rev05.pdf Read More