Elderly Falls and Nursing

QSEN Clinical Integration Paper

Introduction: Elderly Falls and Nursing

Elderly Falls and Nursing: The link between the two underscores the pivotal role of nursing professionals in the prevention and management of falls among older adults. Healthcare professionals are often concerned about falls, especially in long-term and sub-acute care institutions where residents are frequently older and have many comorbidities. Patient falls not only cause injuries but also have an effect on their quality of life and might raise medical expenses. According to the Institute of Medicine’s Quality and Safety Education for Nurses (IOM/QSEN), safety is a crucial competency for nurses, and preventing falls is a crucial component of patient safety.

 Falls with major injuries continue to occur in many clinical settings despite the implementation of fall prevention protocols and safety measures, necessitating additional research and intervention. In this paper, we’ll look at the issue of patient falls in long-term and subacute care institutions, analyze fall prevention tactics now in use, and suggest fresh treatments to improve patient safety and stop falls.

 For nurse practitioners, the issue of patient falls in long-term and sub-acute care settings is very important since it directly relates to the IOM/QSEN nursing competency of safety.

Enhancing Patient Safety Through Nurse Practitioner Proficiency

Patient falls can severely impact patient outcomes since they can cause physical pain, emotional suffering, and higher healthcare expenses. To avoid falls and increase patient safety, nurse practitioners must have the information, abilities, and attitude necessary. Taking up the issue of patient falls in long-term and sub-acute care institutions allows nurse practitioners to show their proficiency in safety while still giving their patients the high-quality care they require.

For many reasons, it is crucial to research and examine the problem of patient falls in long-term and sub-acute care institutions. First, falls are a concern that affects many older persons, especially those who are fragile and have several chronic diseases, both of which are prevalent in long-term care facilities. Falls can hurt patients and their families in the long run by causing physical pain, mental distress, and poor quality of life. Second, it is crucial to develop measures to avoid falls and improve patient safety because they can result in higher healthcare expenditures, longer hospital stays, and significant legal liability.

 Third, dealing with the issue of falls is consistent with the IOM/QSEN competency of safety, which is essential for nurse practitioners and other healthcare professionals. Last but not least, researching and examining the problem of patient falls may reveal fresh, cutting-edge approaches to increasing patient safety and reducing falls, therefore enhancing patient outcomes and raising the standard of care in long-term and subacute care institutions.

 Literature Review: Elderly Falls and Nursing

According to the research, falls in long-term and sub-acute care facilities are a major worry for healthcare professionals, especially elderly people who have several comorbid conditions and are frail. There are many risk factors, such as polypharmacy, cognitive dysfunction, a history of falls, and mobility issues. Falls can have serious repercussions, including bodily harm, psychological discomfort, and higher healthcare expenditures.

 A multidisciplinary strategy is necessary to avoid falls in healthcare settings, with nurses playing a crucial part in fall management and prevention. Two assessment and screening instruments, the Morse Fall Scale and the Hendrich II Fall Risk Model, identifies patients at risk of falling. Programs for healthcare professionals’ education and training, the use of assistive technology, fall prevention procedures, and safety precautions are all examples of fall prevention interventions. Demonstrations have shown that collaborative treatment, involving doctors, nurses, physical therapists, occupational therapists, and pharmacists, is useful in reducing falls in older persons.

The literature presents evidence-based methods for enhancing patient safety and providing high-quality care, emphasizing the significance of fall prevention in long-term and subacute care institutions. Nurse practitioners and other healthcare professionals can use this knowledge to design and implement fall prevention programs that enhance patient outcomes and improve safety in healthcare facilities.

(I) Patient Falls in Long-term and Sub-acute Care Facilities

Epidemiology and Risk Factors for Elderly Falls and Nursing

Understanding the epidemiology and risk factors for falls is essential for effective fall prevention and management in long-term and sub-acute care institutions, where falls are a serious problem for older persons. According to studies, among those 65 and older, falls are the main reason for injury-related hospital admissions and fatalities.

Several risk factors increase the risk of falls in older individuals. These include advanced age, being a woman, cognitive impairment, fall history, gait and balance issues, visual impairments, using psychoactive medicines, urine incontinence, polypharmacy, and long-term medical illnesses like diabetes and arthritis. The presence of numerous risk factors significantly increases the likelihood of falls and injuries from falls.

As the likelihood of falls rises with age, advanced age is one of the major risk factors for falls. According to studies, people 85 and older have a four times higher risk of falling than people 65 to 74. Women experience more falls than men do, which is another example of gender disparities. Another risk factor for falls is cognitive impairment, such as dementia, which can affect a person’s judgment, focus, and balance. Additionally, older persons who have already fallen are 50% more likely to fall in the future than older adults who have never fallen.

Another risk factor for falls is polypharmacy, or taking numerous medications, as this can raise the possibility of negative drug reactions, drug interactions, and cognitive impairment. Chronic medical disorders that impact movement and balance, such as diabetes and arthritis, can further raise the risk of falling. In long-term and sub-acute care facilities, identifying and addressing these risk factors through thorough evaluations and tailored care plans can help avoid falls and enhance patient safety.

 Consequences of Falls in Healthcare Settings

In healthcare settings, falls can have serious physical, psychological, and financial repercussions for older patients. Falls can result in physical harm, such as fractures, head damage, and bruises. Hospitalizations, drawn-out healing periods, and loss of independence are possible outcomes of these injuries. Falls may occasionally result in fatalities or lasting disabilities. As patients need more medical interventions, such as imaging tests, drugs, and rehabilitation services, falls in healthcare settings can also result in higher healthcare expenses.

Falls can also have psychological repercussions, such as lower quality of life and a fear of falling. After a fall, older adults may become afraid of falling again, which can limit their mobility and cause them to withdraw from society. Additionally, this dread may cause a reduction in physical activity, which may lead to a drop in physical ability and general health. Falls can also result in melancholy, worry, and a helpless feeling. Falls can also have financial repercussions in healthcare settings since they can increase medical expenses and legal liabilities. Healthcare facilities may face lawsuits from patients who have fallen and suffered injuries, potentially leading to reduced payment rates from insurers and governments.

To reduce the physical, psychological, and monetary effects of falls in healthcare settings, preventing falls is essential. Reduce the risk of falls and increase patient safety by putting fall prevention techniques in place, such as thorough evaluations, tailored care plans, and environmental changes. Additionally, ensuring the successful adoption and maintenance of fall prevention techniques over time requires healthcare worker education and training programs.

Challenges in Preventing Falls in Long-Term and Sub-Acute Care Facilities

It might be difficult to prevent falls in long-term and sub-acute care facilities due to many variables. Elderly persons with several chronic illnesses, cognitive decline, and functional limitations are frequently patients in long-term and sub-acute care facilities. It may be more difficult to adopt fall prevention techniques for these individuals because of their health status, which may put them at a higher risk for falls. The physical surroundings of long-term and subacute care facilities can facilitate falls. Elements such as poor illumination, slick surfaces, and poorly designed furniture can increase the likelihood of falls.

The implementation and maintenance of fall prevention programs may be challenging for facilities due to staffing shortages and high turnover rates. The ability of the staff to properly prevent falls may also be lacking. Effective fall prevention techniques may be difficult to execute because certain staff members and patients may be reluctant to changes in care procedures or environmental alterations. Collaboration and communication between healthcare professionals, patients, and families are essential for effective fall prevention. Occasionally, falls may result from a breakdown in communication or a lack of teamwork.

Addressing these issues requires a multimodal strategy that includes thorough fall risk assessments, tailored care plans, environmental adjustments, staff education and training, and continuous monitoring and evaluation. Incorporating families and patients into fall prevention initiatives can also take into consideration patients’ wants and preferences. Healthcare institutions can enhance patient safety and lower the risk of falls by addressing these issues. 

Existing Fall Prevention Protocols and Safety Measures

Long-term and sub-acute care institutions have created and implemented numerous fall prevention protocols and safety measures. To identify a patient’s fall risk, a thorough fall risk assessment looks at their medical history, physical capabilities, prescription use, and environmental factors. This evaluation aids healthcare professionals in creating tailored care plans that take into account the patient’s particular needs and hazards. Healthcare professionals can create tailored care plans that include particular measures to avoid falls based on the findings of the fall risk assessment.

These interventions could consist of devices like mobility aids, hip guards, and bed alarms. Altering the physical surroundings of the care facility can lead to a reduction in falls. For instance, adding handrails to corridors, enhancing lighting, and getting rid of trip hazards can all help lower the risk of falls. Educating and training employees on fall prevention techniques and best practices can efficiently facilitate the implementation of these steps. Additionally, staff members need to be taught to spot and react to changes in a patient’s condition that can raise their risk of falling.

Fall risk can be decreased by educating patients and their families about fall prevention techniques. Information about exercise regimens, medication administration, and environmental changes may be covered in this education (Up to Date). To guarantee that patients stay safe and have their requirements fulfilled, fall prevention protocols and safety measures must be regularly monitored and evaluated. Regular fall risk assessments, tracking of falls and near-misses, and analysis of the efficiency of treatments may all be a part of this review.

(II) Elderly Falls and Nursing Practice and Care for Fall Prevention

 Assessment and Screening Tools for Identifying Patients at Risk of Falls

 Tools for assessment and screening are crucial for identifying people who are at risk of falling as they age. One of the most popular tools for detecting patients who are at risk of falling is the Hendrich II Fall Risk Model. Eight risk indicators are listed in the tool, including disorientation, lightheadedness, and decreased mobility (WHO, 2021). The patient’s fall risk level is determined by adding the scores given to each risk factor. In terms of forecasting falls in older persons, the instrument is valid and trustworthy.

The Morse Fall Scale, which covers six risk indicators such as a history of falls, altered gait, and the presence of specific medications, is another frequently used tool. Each risk factor is given a score by the tool, and the patient’s overall fall risk is determined by the sum of those scores. To anticipate falls in older persons, the Morse Fall Scale has also been demonstrated to be valid and trustworthy.

Healthcare professionals may also utilize a comprehensive geriatric assessment (CGA) to check older persons’ general health and functional condition, which may help detect fall risk factors, in addition to these particular fall risk assessment methods. The CGA has been proven to be successful in detecting older persons who are at risk for falling. It comprises a thorough evaluation of numerous areas, including physical function, cognitive function, and social support.

Multidisciplinary Approaches to Fall Prevention and Patient Safety

 Elderly patient safety and effective fall prevention depend on multidisciplinary strategies. Multiple risk factors, including the surroundings, medication usage, and physical impairments, must be identified and addressed as part of fall prevention treatments (Patient Safety). Healthcare professionals, patients, and their families must work together on this.

Nursing personnel, physical therapists, occupational therapists, pharmacists, and doctors may all contribute to a multidisciplinary team approach to fall prevention. Fall prevention methods that can be implemented by nursing personnel include bed and chair alarms, bed railings, and routine patient checks. To increase strength and balance, physical therapists and occupational therapists can create personalized training programs for patients after evaluating their mobility and functional abilities. To reduce the risk of side effects, such as disorientation and dizziness, which can increase the risk of falling, pharmacists can review prescription regimens and modify dosages.

By recognizing and treating underlying medical disorders including osteoporosis, Parkinson’s disease, and cardiovascular disease that increase fall risk, doctors can also play a significant part in fall prevention. Additionally, they can inform patients and their families about fall prevention techniques and make necessary referrals to other healthcare professionals.

 Role of Nursing Staff and Nurse Practitioners in Fall Prevention and Management

 In long-term and sub-acute care institutions, nursing personnel and nurse practitioners (NPs) are crucial to fall management and prevention. Nursing professionals frequently detect patients at risk of falling and begin fall prevention treatments as frontline healthcare providers. By completing thorough assessments, creating care plans, and coordinating treatment with other healthcare providers, NPs can offer additional support.

Using a variety of screening techniques, nursing staff can determine a patient’s fall risk and then implement fall prevention measures like bed and chair alarms, routine patient checks, and environmental adjustments. To reduce the danger of falls, they can also keep an eye on the patient’s movement and help with daily tasks like showering and using the restroom (Patient Safety). Nurses can also educate patients and their families on fall prevention measures and the value of reporting falls or near-misses as soon as possible.

By completing thorough evaluations of patients’ medical histories, physical capabilities, and medication use, nurse practitioners can play a leading role in fall prevention. They can work with other healthcare professionals to coordinate care and create tailored care plans that address various fall risk factors. Nursing staff and other healthcare professionals can benefit from NPs’ knowledge of fall prevention techniques and the best ways to care for patients who have fallen.

 Education and Training Programs for Elderly Falls and Nursing Providers

 To improve fall prevention procedures in long-term and sub-acute care institutions, healthcare providers must participate in education and training programs. In addition to promoting best practices in fall prevention and management, these programs can improve the knowledge, abilities, and attitudes of nursing staff, NPs, and other healthcare professionals. Studies have indicated that education and training initiatives can enhance healthcare professionals’ capacity to recognize patients at risk for falls, evaluate fall risk factors, and put fall prevention measures into practice. These initiatives can help raise healthcare professionals’ awareness of the value of interdisciplinary cooperation and communication in preventing falls.

Programs for education and training can be given in a variety of media, such as online modules, live workshops, and simulations. These programs may cover tools for assessing fall risk, interventions that are supported by evidence in preventing falls, medication management techniques, and environmental changes. Education and training initiatives can enhance healthcare workers’ job satisfaction and morale in addition to patient results. Organizations may increase staff retention and foster a patient safety culture by giving healthcare personnel the knowledge and skills they need to offer high-quality care.

 Using Technology and Assistive Equipment to Prevent Elderly Falls for Nursing

 To prevent falls in older individuals, the use of technology and assistive gadgets has shown promise. Wearable sensors, video monitoring systems, and motion detectors are just a few of the gadgets and technologies that have been created to assist in detecting and preventing falls. According to one study, older persons can have their gait and balance alterations, which are fall predictors, detected using wearable sensors. Another study showed that the use of video monitoring systems can enhance the development of fall prevention treatments by assisting in the identification of environmental risks that contribute to falls.

Assistive equipment including raised toilet seats, grab bars, and walking aids have been demonstrated to be useful in lowering the risk of falling in addition to technology-based solutions. These gadgets can increase mobility and balance, help with transfers and other mobility-related tasks, and lessen the danger of environmental risks. There are obstacles to their use, notwithstanding the potential advantages of technology and assistive technologies in fall prevention. For long-term and sub-acute care institutions, for instance, the cost of various technology and devices may be a barrier. Additionally, discomfort or stigmatization may make some patients reluctant to use assistive technology.

Case Example: Elderly Falls and Nursing

 An elderly patient of a long-term care home with a history of falls and dementia is one case example that highlights the issue associated with the designated IOM/QSEN safety competency of falls. This resident broke his hip after falling in the restroom during the night despite the fall protection measures in place. As the on-call nurse practitioner, I evaluated the resident right away and made arrangements for her transport to the hospital for additional assessment and care. Further research revealed that the bathroom’s inadequate lighting and the floor’s unevenness may have contributed to the fall.

I reviewed the facility’s fall prevention procedures after this incident and identified areas for improvement with the nursing staff. We made adjustments like improving bathroom illumination, adding handrails in strategic places, and checking that seniors were utilizing the proper assistive devices, such as walkers or canes. I learned from this experience the value of continual evaluation and enhancement of fall prevention procedures as well as the requirement for a multidisciplinary strategy to address falls in older persons with complicated medical requirements. It emphasizes how crucial it is for medical personnel, nursing staff, and facility managers to work together to promote patient safety and prevent falls.

 Conclusion

 According to the literature evaluation, a multidisciplinary strategy that incorporates continual assessment and monitoring, staff education and training, and the use of technology and assistive devices is the best practice for fall prevention in older individuals in long-term and sub-acute care facilities. Modifying the surroundings, reviewing prescription drugs, and designing exercise regimens that are specific to each patient’s needs should all be important components of fall prevention strategies.

References

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