Evaluating Fall Prevention Strategies

This assignment involves a comprehensive analysis of different fall prevention strategies. The provided references include articles on vitamin D and calcium supplementation, exercise programs, and individualized patient and staff education. Additionally, guidelines for older adults living in long-term facilities are discussed. The goal is to evaluate the effectiveness of these approaches in reducing falls and injuries among older populations.

Relevance of clinical issue
Falls in people aged 65 years and over are very common and may result to physical harm
(NSW Health 2011). The incidence of falls increases with age (Kenny et al. 2012).
Approximately one third of adults aged 65 and over fall every year and after the age of 80,
this proportion rises to a half (Saccomano & Ferrara 2015). A fall is an unexpected event in
which a person comes to rest on the ground, floor or lower level without known loss of
consciousness (Kenny et al. 2012). Falls in elderly are a major health concern but are
preventable in most of the cases. Complications of falls includes physical harm, such as
fractures, traumatic head injury and also negative psychological and functional impacts, such
as loss of confidence in undertaking daily activities and inappropriate activity restriction
(NSW Health 2011). Falls are associated with an increased length of stay in a hospital,
increased in healthcare costs and lawsuits against hospitals (Choi et al. 2011).
Literature review
There are various factors that contribute to increase risk in falls of patients in a hospital
setting. The risk factors for falls include intrinsic and extrinsic factors, and a complex
interaction of such factors. Some of these are physical issues which involves visual
impairment, weakness of lower extremities, balance disorders, postural hypotension;
environmental factors and mental or cognition factors (Saccomano & Ferrara 2015).
Assessment
Falls risk assessment tool are used to identify patients who are at a greater risk of fall. It is
used to identify falls’ risk factors. According to Stenvall et al. (2007), the use of
comprehensive geriatric assessments and treatment of falls risk factors and post-operative
complications can successfully prevent inpatient falls and injuries, even in patients with
dementia. Some of the assessment tools used in the study were Mini Mental State
Examination (MMSE), Organic Brain Syndrome Scale (Obs scale), and Geriatric Depression
Scale (GDS-15). The activities of daily living of the patients were also assessed. After the
falls assessment risk, the team formulated and implemented a plan based on the patient’s
data, to prevent new falls and its complications. A multifactorial interventional program was
developed to address the issues identified which then decreased the incidence of falls of the
elderly patients in this study. (Stenvall et al. 2007) This study proves that the effectiveness of
a fall prevention programme greatly relies on comprehensive assessments by the health
care workers.
Risks assessment is essential in developing and increasing patient’s awareness may reduce
risk of falling in a hospital setting. People with a history of fall should be assessed to identify
and address future risk and individualised intervention (Short 2006).

Education and information giving
A study by Hill et al. (2015) showed that individualised education to patients decreased falls
and injurious fall incidents in a rehabilitation ward. The hospital’s falls incident data has
significantly decreased in number after the patient education sessions. Either presented with
other complementary programmes or as a single intervention, providing fall-prevention
education to patients resulted to reduce number of fall incidence. Information about patient’s
personal risk factors, fall epidemiology and falls-prevention strategies were included in the
health teaching. Educators also helped each patient identify their risk factors, set their
personal goals and develop their own fall-prevention strategies. Health care staff were
supported through trainings and provided with feedbacks from the patients. (Hill et al. 2015)
Environment
Another factor that greatly affects the risk for fall of elderly patients is the environment. In a
study conducted by Barry et al. (2001), there was a significant decrease in percentage of
falls after implementing a fall prevention programme. This programme mainly focused on the
environment in a hospital setting. In the first year, there was a decrease of 21% fall incidents
and 49.3% lesser after two years of the programme. An occupational therapist helped the
team identify environmental hazards in the unit. As a result, hand rails were installed along
the corridors, grab rails and arm rests in the bathrooms. Environmental hazards were
modified. Obstructive furniture in the busy area were removed, poor lighting and loose
carpets were repaired or changed. Commode chairs without wheels were purchased and
emergency patient call buzzers were checked and repaired. Special rubber tiling was fitted in
an outdoor patio where patients spent most of their time. For the patients, visual aids such
as glasses and mobility aids e.g. walkers and sticks were provided. Replacement of
unsuitable footwear and provision of special footwear was also implemented. After the falls
risks assessment for each patient, the team categorised the patients as low, medium or high
risk of falling. Those identified as high risk were encouraged to wear hip protector pads.
(Barry et al. 2001)
Exercise
Not only awareness and education important in preventing falls in a hospital setting, but we
also need to know how to enhance the mobility of the elderly patients. One of the identified
risk factors for falls among elderly is their functional disability due to ageing. It is also known
that exercise may be effective in preventing, delaying or reversing the frailty process among
elderly. In a study by Faber et al. (2006), it was found that functional walking and in balance
exercise programmes were effective in reducing the falls risk among pre-frail elderly. The
two main domains that the researchers focused on were balance and functional strength of

the participants. The exercises adopted in this study “were tailored to the functional needs of
the participants, maintaining a moderate intensity that focuses on long-term sustainability
and enjoyment” (Faber et al. 2016, p. 888). Functional walking exercises consisted of
standing up from the chair, heel and toe stands, stepping on and over an obstacle, reaching
and stepping forward and sideward, staircase walking, single-limb standing and tandem foot
standing. Meanwhile, in balance exercises was mainly based from the principles of Tai Chi.
As a result, the exercise group also showed increase in mobility and physical performance
score. The authors recommended that exercise programmes be included in falls-prevention
intervention for non-frail and pre-frail elderly. (Faber et al. 2006)
Medication
Elderly patients with higher vitamin D levels have been identified to have increased muscle
strength and lower number of falls. The findings of a paper by Bischoff et al. (2003) indicate
that vitamin D and calcium supplementation reduced the number of falls per patient by 49%,
improved musculoskeletal function, increased vitamin D status and decreased parathyroid
hormone secretion and bone resorption within 3 months of treatment in elderly women with
vitamin D deficiency. (Bischoff et al. 2003) The possibility of developing adverse reactions
and overdosing are the potential issues in this study. However, only two participants
reported increased constipation but they did not withdraw from the study. None of the
subjects developed hypercalcaemia or any other reaction from the vitamin D and calcium
supplements. In addition, the authors argued that this programme is less expensive and has
a short period of treatment, three months, compared to other multifactorial interventions
(Bischoff et al. 2003).
One can conclude that falls among elderly admitted to hospital setting is quite common. Risk
factors for falls such as physical, mental, emotional, social, cognitive, and financial could be
identified through a comprehensive and thorough risk assessment. There are sufficient
numbers of interventions that can prevent falls. These programmes should be tailored,
specific and patient centred to be able to maximise their purpose. By effectively addressing
the various risk factors for falling, the incidence of falls in the hospital setting will definitely
decrease.
Application to nursing practice
It is known that there is a lack of awareness about falls risk across all health care sectors. A
study by Tzeng & Yin (2013) revealed that hospital nursing staff’s perceptions about the
most frequently adopted and most effective interventions were mostly inconsistent. These

inconsistencies are due to staff not being able to recognise the importance of some fall
prevention interventions and the patient’s risk factors (Tzeng & Yin 2013).
Since the risks for falls are multifactorial, a complete and thorough assessment should be
done by the nurses. People who have suffered a fall, or report current falls, even without
obvious injury, should routinely be tested to for their gait, balance, and muscle weakness
(Mclnnes 2005). Many falls are preventable through the proper implementation of these fall-
prevention programmes. The use of targeted multiple interventions in hospitals were
effective in reducing the incidence of falls compared to the usual care given to patients in a
hospital (Tzeng & Yin 2013). Efforts to reduce falls and injury need to involve a wide range
of individuals and agencies across health and social care (Barker 2014). Registered nurses
should collaborate with the interdisciplinary team to determine the best plan of care to
prevent falls for every patient.
A summary of the studies will help health care professionals most especially nurses about
fall prevention in hospital facilities. Providing education sessions to staff working facility will
help them gain more knowledge about the nature of the prevention programmes (McInnes
2005). Nursing unit managers must evaluate the effectiveness of the fall-prevention
interventions and the staff’ feedbacks in their wards on a regular basis (Tzeng & Yin 2013).
Falls prevention is vital in formulating framework and guidelines. The guidelines will provide
recommendations on the care given by health professionals who have a direct contact with
elderly patients with falls risks (McInnes 2005). By using these guidelines, nurses will be
able to identify the falls risk within the first stage of assessment, give priority to the identified
risk factors and address them accordingly (Jung et al. 2014). Trainings and education about
these fall-prevention programmes should be provided to the staff.
Since the risks for falls are related to numerous factors, the use of multifactorial fall-
prevention programme is necessary. In the literature review, all of the interventions were
found to be effective in preventing falls. As a nurse, these interventions should be utilised
according to the patient’s assessment data and physical and mental capabilities. (Moore et
al. 2010)

Reference List:
Ang, E., Mordiffi, S. & Wong, H. 2011, ‘Evaluating the use of a targeted multiple intervention
strategy in reducing patients falls in an acute care hospital: A randomised controlled
trial’, Journal of Advanced Nursing, vol. 67, no. 9, pp. 1984-1992.
Barker, W. 2014, ‘Assessment and prevention of falls in older people’, Nursing Older People,
vol. 26, no. 6, pp. 18-24.
Barry, E. 2015, ‘Preventing accidental falls among older people in long stay units’, The Irish
Medical Journal, vol. 108, no. 9.
Bischoff, H., Stahelin, H., Dick, W. Akos, R., Knecht, M., Salis, C., Nebiker, M., Theiler, R.,
Pfeifer, M., Begerow, B, Lew, R. & Conzelmann M, 2003, ‘Effects of vitamin D and
calcium supplementation on fall: A randomised controlled trial’, American Society for
Bone and Mineral Research, vol. 18, no. 2, pp. 343-351.
Choi, Y., Lawler., Boenecke, C., Ponatoski, E. & Zimring, C., 2011, ‘Developing a multi
systemic fall prevention model, incorporating the physical environment, the care
process and technology: a systematic review’, Journal of Advanced Nursing, vol. 67,
no. 12, pp. 2501-2524.
Faber, M., Bosscher, R. Paw, M., Wieringen, P. 2006, ‘Effects of exercise programs on falls
And mobility in frail and pre-fail older adults: A multicentre randomised controlled
trial’, Archives of physical medicine and rehabilitation, vol. 87, pp. 885-896.
Hill, A., McPhail, S., Waldron, N., Beer, C., Ingram, K., Flicker, L., Bulsara, M. & Haines, T.
2015, ‘Fall rates in hospital rehabilitation units after individualised patient and staff
education programmes: A pragmatic, stepped-wedge, cluster-randomised controlled
trial,’ Lancet, vol. 385, pp. 2592-2599.
Jung, D., Shin, S. & Kim H. 2014, ‘A fall prevention guideline for older adults living in long
term facilities’, International Council of Nurses, vol. 61, no. 4, pp. 525-533.
Kenny, R., Ortuno, R. & Cogan, L. 2012, ‘Falls’, Medicine, vol. 41, no. 3, pp. 155-159.
McInnes, L., Gibbons, E. & Chandler-Oatts, J. 2005, ‘Clinical practice guideline for the
assessment and prevention of falls in older people’, Worldviews on Evidence-Based
Nursing, vol. 2, no. 1, pp. 33-36.
Moore, M., Williams, B., Ragsdale, S., LoGerfo, J., Goss, R., Schreuder, A. & Phelan, E.
2010, ‘Translating a multifactorial fall prevention intervention into practice: A
controlled evaluation of a fall prevention clinic’, Journal of American Geriatrics
Society, vol. 58, no. 2, pp.357-363.
NSW Health, 2011, Falls- prevention of falls and harm from falls among older people: 2011
2015, viewed 01 November 2015,
http://www0.health.nsw.gov.au/policies/pd/2011/pdf/pd2011_029.pdf>.
Saccomano, S. & Ferrara, L. 2015, ‘Fall prevention in older adults’, The Nurse Practitioner,

vol. 40, no. 6, pp. 40-47.
Short, R. 2006, ‘Falls’, Nursing older people, vol. 18, no. 10, pp.16-18.
Stenvall, M., Olofsson, B., Lundstrom, M., Englund, U., Borssen, B., Svensson, O., Nyberg,
L. & Gustafson, ‘A multidisciplinary, multifactorial intervention program reduces
postoperative falls and injuries after femoral neck fracture’, Osteoporosis Int, vol. 18,
pp. 167-175.
Tzeng, H. & Yin, C. 2013, ‘Most and least helpful aspects of fall prevention education to
prevent injurious falls: A qualitative study on nurses’ perspectives’, Journal of Clinical
Nursing, vol. 23, pp. 2676-2680.