Senior Fall Prevention At Home: A Case Study

Strategies for preventing falls among elderly people include ensuring that the environment is free from clutters, and it has adequate light. Encourage elderly to participate in activities and ROM to strengthen and preserve their muscles. Provide assistive devices to that resident who needs it such as cane, walker, wheel chairs etc. Review and address medications with increase fall risks. Ensure that those residents with poor vision are screened and are wearing their glasses.

Falls among any individual can cause significant trauma, often leading to an increase in mortality. According to the Centers for Disease Control and Prevention (2012), one in every three adults over the age of 65 falls each year. Long-term care facilities account for many of these falls, with an average of 1.5 falls occurring per nursing home bed annually (Vu, Weintraub, & Rubenstein, 2004). In 2001, the American Geriatric Society, British Geriatric Society, and the American Academy of Orthopaedic Surgeons Panel on Falls Prevention published specific guidelines to prevent falls in long-term

Provide mandatory, up-to-date education related fall prevention. Every single one in this facility can have the adequate capacities to prevent falls and offer education to patients, family members and caregivers regarding skills and knowledge of fall prevention. Develop policies in multifaceted and tailored strategies with evidence-based practice (Breimier, Halfens, & Lohrmann, 2015). Have more awareness and "need for individualizing the care plan and communicating the plan to those working with the patient becomes evident when implementing a fall reduction program" (Ambutas, Lamb, & Quigley, 2017, p 179). In addition, maintain consistency or accuracy in risk identification and action planning, as well as obtain patient and caregiver’s commitment to adhere to the safety plan on the daily basis (Silva, & Hain, 2017). Everyone is in the same page and conduct measures effectively and efficiently. Evaluate and assess the implementation of strategies monthly. Change and correct properly and timely to reach the aim of zero falls.

The Prevention and Public Health Fund’s Fall Prevention Program aims to implement programs that have been proven to reduce the incidence of falls in older adults and adults with disabilities. It also promotes the importance of fall prevention strategies and provides education on the risk of falls and how to prevent them (U.S Department of Health

The Center for Disease Control and Prevention (2016) informs us that “health care providers play a major role in fall prevention.” The care of our elders is entrust to all employees, every team member is value and fall prevention is not a concern of only the nursing staff. Therefore, as we embarked on this quality improvement endeavor our entire interdisciplinary team (IDT) met and brainstormed to develop a preventative plan to ensure safety. The fall policy was revised from the standard event reporting guidelines to to a more detailed and specific protocol. This protocol was in addition to the normal assessment, vital signs, mandate paperwork, and the procedures of notify the physician and the responsible party. The new ground rules laid out step by step guidelines. All staff members was informed about our concern with the increase rate of falls, the goal to reduce this number and the role they play in achieving this goal. “Every health care provider should be proactive in evaluating he risk of falls in their elderly patients” (Schimke & Schimke, 2014, p. 228). Therefore, a rallying of the troops is always necessary to assure we are all on board and moving in the same direction. Also, meetings of this nature reduces resistance from the direct caregivers. As well as, provides supports to the supervisors as they enforce and oversee the changes in our procedures. According to Osuji et al,

Falls are considered a leading cause of mortality and injury among older adults and majority of the falls occurs while hospitalized. One would think being in the hospital would be one of the safest places for older adults as far as fall prevention is concern due to the fact that hospitals provide staffing around the clock for patients but more and more falls have been occurring in the hospital especially in the older adult population. Fall is an unintended descent to the ground. It raises public and family care liability; it also decreases patient’s functioning because it causes pain and suffering, and increases medical costs (Saverino et al, 2015). The Center for Disease Control

Elimination of patient falls is not an easy task otherwise they would have been eliminated by now. Patient falls unfortunately continue to be a challenge and occur within the hospital and nursing home settings at alarming and sometimes deadly rates. The Center for Disease Control estimates that 1,800 older adults living in nursing homes die each year from fall-related injuries. Survivors frequently sustain injuries resulting in permanent disability and reduced quality of life. Annually, a typical nursing home with 100 beds reports 100 to 200 falls and many falls go unreported (CDC, 2015). Falls occur more often in nursing homes because patients are generally weaker, have more chronic illnesses, have difficulty ambulating, memory issues,

My target population for this project was geared towards the elderly group. "About 40% of this age group living at home will fall at least once each year, and about 1 in 40 of them will be hospitalized. Of those admitted to the hospital after a fall, only about half will be alive a year later."(Rubenstein, 2006) This group although not the highest incidence of falls but rather the highest susceptibility to injury from falls.

The paper will discuss falls prevention in the older adult over the age of 55 and new and alternative interventions for fall prevention compared to current practice. The desired outcome of the paper is to provide information for fall prevention and, therefore, decrease the occurrence of falls. First, in order to understand the importance falls have within the clinical setting, statistics showing the mortality, morbidity and financial impact should be understood. The occurrence of falls within the acute care setting is a growing problem among the elderly. The evidence shows that one in three people aged 65 or older will sustain a fall and that only half will report the fall to a caregiver (CDC, 2014). The number increases to one in two when the patient reaches the age of 80. The Center for Disease Control (CDC) defines a fall when a person unintentionally comes to rest on the ground or another lower level. Falls are not an inevitable part of aging, however, aging does influence such things as reduced mobility, comorbidities, and cognitive impairment which contribute to fall risk. Falls are one of the leading causes of injuries in the acute care setting. The injuries sustained from falls leads to increased hospital stay time and a chance for further injuries which may harm the patient (CDC, 2014). According to the CDC in 2013, 2.5 million people suffered a fall, of these falls 734,000 were hospitalized. The falls also resulted in 22,900 people dying from fall

“RNAO Falls Prevention CPG” has been developed and frequently reviewed by a panel of nurses and other health professions with expertise and interest in falls and falls related injuries in the older population (Brouwers, et al., 2010, P.18; RNAO, 2011, P.13 ). In addition, it introduces some general principles indicating the authors’ intention of considering the views and preferences of the target population: “The client’s perspective, individual desires and needs are central to the application of the guideline; The over-arching principle that guides the intervention choices is the principle of maintaining the highest quality of life possible while striving for a safe environment and practices. Risk taking, autonomy, and self-determination are supported, respected, and considered in the plan of interventions; Individuals, their significant other(s) and the care team engage in assessment and interventions through a collaborative process” (RNAO, 2011, P.8

Falls amongst elderly adults are a major societal problem leading to fall-related injuries and disabilities. Falls impact aging in place, bring high healthcare costs, as well as isolation and disengagement due to the fear of falling. A sociopolitical influence that may have impacted Dr. Chippendale’s work is the Centers for Disease Control and Prevention. The Centers for Disease Control and Prevention (CDC) has an intervention program that promotes healthy aging by addressing falls and fall prevention in the neighborhood context. The goal of this program is to partner with other organizations that share the same interest in reducing fall-related injuries amongst the elderly population (Centers for Disease Control and Prevention, 2004). This

Method: The study question investigated was; what impact will individualized fall-prevention education, supported by training and feedback for staff reduce have on the number of falls during hospital stays? The study was a pragmatic study of patients admitted to one of 8 rehabilitation units in general hospitals that were over sixty years old, with a projected hospital stay of at least three days, and had basic cognitive functioning. 3,606 patients admitted were admitted to the eight units during the study period, with 1,983 in the control group and 1623 in the intervention group. The pragmatic nature of the study is a strength given the nature of the intervention. However, the investigators do not explain the logic of limiting the study to patients over age 60, with a length of stay of at least three days, and this restricts the extrapolation of the results to these groups.

It is essential to track the falls and develop strategies to prevent them in the future. This tracking and reinforcement are good quality indicators. The nursing staff continues to develop strategies to prevent falls in the center and in the client’s homes. According to the meta-analysis study done by Stubbs, Brefka and Denkiner, there is consistent evidence that exercise and individually tailored multifactorial interventions are effective in reducing falls by 83% in older adults living in the community (2015). In our center we offer physical therapy, occupational therapy, daily exercise classes, transportation to doctor appointments, medication management and provide reminders to use their assistive devices.

In the absence of evidence to support a population-based approach to prevention and the imperative to deliver cost-effective and efficient services, health care providers need risk assessment tools that reliably identify at-risk populations and guide intervention by highlighting remediable risk factors for falls and fall-related injuries. Such tools typically consist of a rating or scoring system designed to reflect the cumulative effect of known risk factors for the purpose of identifying those at greatest risk for sustaining a fall or fall-related injury [*]. Historically, fall risk tools have focused on institutional settings with little attention to tools tested in community settings. Of the reviews that do include community dwelling seniors, tools are typically limited to the assessment of balance with little consideration of other risk factors [*].

Through this information it is clearly see that older people, ages 65+ are at highest risk of falling when in the home environment. This is profoundly due to the individuals being more active with less support. Activities include cook, cleaning, dressing and cleansing self which all vital to maintain balanced ‘Activities of living’.