Preventing Falls in Older Adults in Aged Care Settings: Evidence-Based Strategies

Falls in aged care settings are a major issue related to patient safety. Exercise programs alone are insufficient to prevent falls in older adults. A multi-component approach that includes exercise, safety devices, medication monitoring, vitamin D supplementation, and reviewing living conditions is necessary. Healthcare workers should implement exercise programs to prevent falls and improve patient safety in older adults.

Best practice recommendations for
prevention falls in older adults in an
aged care settingBackground
• The aged care setting refers to a health system that offers a plethora of
healthcare options to older adults, with the aim of meeting their different care
needs. Hence, the primary objective of healthcare workers present in aged care
settings is to improve the wellbeing and health of all older adults, while
providing them a safe environment (1).
• Patient safety has been identified as the cornerstone of superior quality health
care. Most of the work that defines patient safety and related practices that
avert harm have focus on undesirable consequences of care, such as,
morbidity and mortality. Nurses play a critical role in the coordination and
surveillance of the care services, in order to eliminate chances of adverse
health outcomes (2).
• While in most hospitals, patient safety is considered as a central priority, there
is a lack of collaborative work between teams in other aged care settings.
Presence of an experienced and strong healthcare team works towards
reducing the rates of infection, thereby imposing a check on mistakes that
violate the safety of the patients. This is usually achieved with the help of
effective communication between the hospital staff, families, and the service
users.
• Falls in aged care setting is one major issue related to patient safety that has
gained tremendous attention in the past decades. Falls in the healthcare
setting has been identified as a noteworthy cause of mortality and morbidity,
besides being categorised as a central type of preventable or avoidable
injuries. While the reason for falls in aged care setting is multifactorial, this
requires delivery of care in association with a multidisciplinary approach (3).
Hence, the key aim of workers in aged care setting is focused on preventing
future falls among the aged patients and treating all forms of injuries that occur
due to such circumstances. While 30-50% of fall related incidents in aged care
settings threaten the patient safety and lead to bruises, lacerations, and
abrasions, some of them even prove fatal and lead to fracture of the bones or
intracranial injuries (4). Hence, the primary aim is to conduct an extensive
search of article on fall prevention strategies that are effective in aged care
settings.
Search strategy and critical appraisal
A PICO framework was adopted for the formulation of the research question.
The research question is as follows;
Are fall prevention exercise effective in reducing fall related injuries and
providing patient safety in aged care settings?
The different components of the PICO question are given below:
P Older adults in aged care settings
I Fall prevention exercise
C Usual care
O Reduced fall related injuries
Two electronic databases namely PubMed and CINAHL were used for searching
the relevant literature with the use of specific key terms namely, ‘fall’,
‘injuries’, ‘elderly’, ‘older adults’, ‘prevention’, ‘exercise’, and ‘management’.
English published articles from 2013 till date were retrieved, followed by
assessment of their title and abstracts (5). This was followed by appraisal of
the articles with the use of the CASP critical appraisal tool.
Summary of evidence
The outcomes presented in the poster show a constructive
consequence of exercise on detrimental falls in aged people,
including the minor falls as well as those that need immediate
medical attention. These results should deliver useful
supplementary proof for healthcare workers to encourage
contribution in exercise based fall deterrence programmes, and
additional reasoning for decision makers to afford funding.
Recommendations
All healthcare workers present in aged care setting should
implement exercise programs to prevent falls and violation of
patient safety in older people.
Evidence bottom line statement
Exercise programs alone are insufficient to enhance safety of
older adults who are susceptible to falls. There must be other
provisions for safety devices, medication monitoring, vitamin D
supplementation, and reviewing the living conditions.
Limitations
It is clear that heterogeneity exists between the different aged care settings
and the fall prevention exercises that are implemented in them, across the
globe. Although the articles solely focused on fall prevention exercises to
improve patient safety, the interventions selected were moderately diverse in
terms of the intensity, duration, frequency, and delivery of the exercises
Implementation to practice
Barriers Strategies
Falls normalised by older
people
Enforcing a community based
fall prevention programme and
active health promotion
Denial in accepting fall
related advice
Care coordination to make them
learn about the impacts of the
hazard and potential
advantages of the intervention
Lack of fall education Delivery of comprehensive fall
education material, pamphlets,
posters, booklets or videos
Source- (12)
Source- (14)
Source- (13)

Literature Matrix
Author/
Date
Research
Question/ Aim
Population Study Design Findings Conclusions and
Implications for Practice
Level of
Evidence12
Limitations
El-Khoury F,
Cassou B,
Charles MA,
Dargent-Molina P
(2013)
Determine the
effectiveness of
fall prevention
program
17 trials that
comprise of 4305
participants
Systematic
review and
meta-analyses
Exercise
programmes were
found effective in
preventing injuries
that occur due to
falls among older
adults
Such programmes were also
able to decrease the rates of
falls that calls for the need of
medical care and should be
implemented in practice
Level I (11) Heterogeneity in the
data
Granacher U,
Gollhofer A,
Hortobágyi T,
Kressig RW,
Muehlbauer T.
(2013)
To report
possible link
between
TMS/trunk
muscle balance
and composition,
falls, and
functional
performance in
old adults
20 studies Systematic
review
Small-to-moderate
correlations were
observed between
balance and
TMS/trunk muscle
composition, falls,
and functional
performance
Core strength based training
and PET might be used in the
form of an adjunct or
alternative to conventional
balance or resistance training
for old adults.
Level I (11) PEDro quality score did
not match the
prearranged cut-
off score of ≥6.
Gianoudis J,
Bailey CA,
Ebeling PR,
Nowson CA,
Sanders KM, Hill
K, Daly RM.
(2014)
To assess the
efficiency and
feasibility of
multimodal
exercise
program that
encompassed
high‐velocity
(HV)‐PRT,
behavioural
change
program., and
osteoporosis
education on
functional
muscle
performance,
strength and
bone density in
older adults
162 older adults
with 67 ± 6 years
mean age
Randomised
Controlled Trial
Osteo‐cise program
helped in
significant gain in
BMD of lumbar
spine and femoral
neck, muscle
power, and
dynamic balance
Osteo‐cise: Strong Bones for
Life community‐based,
exercise program acted as an
important strategy for
enhancing several functional
and musculoskeletal
performance among older
adults, who have been found
at a risk of fall and low BMD
Level II (11) The findings were not
translated into any
decrease in the rates of
falls
Cadore EL,
Rodríguez-Mañas
L, Sinclair A,
Izquierdo M.
(2013)
Recommend
training policies
that progress the
functional
capacity in older
adults
20 studies Systematic
review
Most studies
showed an
improvement in
strength outcome,
gait speed, physical
performance and
balance, and
reduction in fall
rates
Multi-component exercise is
the best intervention for fall
reduction
Level I (11) Absence of significant
changes in strength
and functional
outcomes
Tousignant M,
Corriveau H, Roy
PM, Desrosiers J,
Dubuc N, Hébert
R. (2013)
To compare the
efficiency of Tai
Chi aerobics
versus
traditional
physical therapy
on fall severity
and incidence
152 frail older
adults
Randomised
controlled trial
Tai Chi showed
greater effect on
fall prevention, in
comparison to
physical therapy
Administered Tai Chi exercises
as component of
rehabilitation program are
better effective to traditional
physical therapy based
exercise for reducing falls in
the elderly.
Level II (11) Information bias was a
major limitation

References
1) Brownie S, Nancarrow S. Effects of person-centered care on residents and staff in aged-care facilities: a systematic review. Clinical interventions in
Aging. 2013;8:1.
2) Kitson A, Marshall A, Bassett K, Zeitz K. What are the core elements of patient‐centred care? A narrative review and synthesis of the literature from
health policy, medicine and nursing. Journal of advanced nursing. 2013 Jan;69(1):4-15.
3) Robinovitch SN, Feldman F, Yang Y, Schonnop R, Leung PM, Sarraf T, Sims-Gould J, Loughin M. Video capture of the circumstances of falls in elderly
people residing in long-term care: an observational study. The Lancet. 2013 Jan 5;381(9860):47-54.
4) Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas. 2013 May 1;75(1):51-61.
5) McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline statement.
Journal of clinical epidemiology. 2016 Jul 1;75:40-6.
6) El-Khoury F, Cassou B, Charles MA, Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling
older adults: systematic review and meta-analysis of randomised controlled trials. BMj. 2013 Oct 29;347:f6234.
7) Granacher U, Gollhofer A, Hortobágyi T, Kressig RW, Muehlbauer T. The importance of trunk muscle strength for balance, functional performance, and
fall prevention in seniors: a systematic review. Sports medicine. 2013 Jul 1;43(7):627-41.
8) Gianoudis J, Bailey CA, Ebeling PR, Nowson CA, Sanders KM, Hill K, Daly RM. Effects of a targeted multimodal exercise program incorporating high‐
speed power training on falls and fracture risk factors in older adults: a community‐based randomized controlled trial. Journal of bone and mineral
research. 2014 Jan;29(1):182-91.
9) Cadore EL, Rodríguez-Mañas L, Sinclair A, Izquierdo M. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically
frail older adults: a systematic review. Rejuvenation research. 2013 Apr 1;16(2):105-14.
10)Tousignant M, Corriveau H, Roy PM, Desrosiers J, Dubuc N, Hébert R. Efficacy of supervised Tai Chi exercises versus conventional physical therapy
exercises in fall prevention for frail older adults: a randomized controlled trial. Disability and rehabilitation. 2013 Aug 1;35(17):1429-35.
11)NHMRC. Additional levels of evidence and grades for recommendations for developers of guidelines [document on the Internet]: National Health and
Medical Research Council; 2009 [cited 2018 October 11]. Available from: https://
www.mja.com.au/sites/default/files/NHMRC.levels.of.evidence.2008-09.pdf
12)Shehan T. Don’t take the fall – preventing falls in the elderly – part 1 [document on the Internet]: Medication Advisors; 2013 [cited 2018 October
12]. Available from: http://www.medicationadvisors.com/dont-take-the-fall-preventing-falls-in-the-elderly-part-1/
13)Gethealthyclarkcounty.org. Fall prevention [document on the Internet]: Get Healthy Clark County; 2018 [cited 2018 October 12]. Available from:
https://gethealthyclarkcounty.org/be-safe/senior-fall-prevention/
14)National Council for Aging Care. Preventing falls in older adults [document on the Internet]: Aging.Com; 2018 [cited 2018 October 12]. Available
from: http://www.aging.com/preventing-falls-in-older-adults/