Review Paper: Nursing Care for Preventing Elderly Falls - Analysis

This review paper evaluates the existing literature and nurses' knowledge regarding nursing care interventions for preventing accidental falls in elderly people. It highlights falls as a significant cause of morbidity and mortality, often leading to hospitalization and long-term care. The paper emphasizes the importance of fall prevention due to the impact on elderly individuals' autonomy and independence. It reviews relevant studies, including intervention studies and documentary analyses, and discusses the significance of nurses' roles in fall prevention. The review explores the context of falls, including physiological and environmental factors. The methodology involves an integrative assessment approach, including inclusion and exclusion criteria, data synthesis, and a timeframe from 2010 to 2019. The review's outcome underscores the significance of health education for nurses in fall prevention, the importance of risk factor investigation, and the need for developing action research across various care settings. The review aims to provide insight into practical strategies for preventing falls and improving the quality of life for the elderly population.

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Aim
The aim of this review paper is to evaluate the literature evidence available and the knowledge of
nurses for the nursing care interventions for prevention of accidental falls in elderly people.
Introduction
The serious and major cause of morbidity and death among the elderly people is the accidental
falls. Paralleled to other problems or diseases, accidental falls are linked to larger disability and
more chances of hospitalization and admittance to long-term care centers. The experience of
accidental fall by the elderly people is considered as a very important public health problem,
because of the frequency, problems and expenses on the healthcare system (Guarino et al., 2017).
Objective
The occasions related to the accidental falls results in the restriction of autonomy and
independence of the elderly people as they directly faced with the incidence of fractures. With
the progress of growing age, the elderly groups are at more danger of death and severe injury
when they experience falls. If old age people experience hospitalization due to accidental fall
then that indicates seriousness and severity of the problem. They would require intensive
thorough care when they are hospitalized. There are certain cases where elderly people are
treated in the emergency services or in family healthcare program. It exposes that the problem
was misjudged in the measurements as it negatively impacts on the quality of life of those
people. The complete assessment of the issue reveals that organizing and executing the treatment
to avoid falls in the elderly are important to successfully diminish injury and death rates from
falls among the elderly people. Due to the lack of study on the increasing elderly population and

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the impact of falls on the life of the elderly people, their family members and on the society led
to the interest to develop the present research review (Guarino et al., 2017).
Rationale
From a long time, millions of injury related visits done by the elderly people were made to the
emergency wards. Falls were the major cause of external injury responsible for 24% of these
visits. Emergency department visits due to the accidental falls are most common seen in the
children till age 5 years and adults above 65 years of age. Compared with children, elderly
people who fall are more likely to be hospitalized and more likely to face death scenario. Trauma
is another cause after falls which are responsible for 70% of accidental deaths in elderly persons.
Elderly people who survive a fall are faced with greater injury which can be long term non-
recoverable injury. Most falls do not result do not result finally to death or any physical injury.
There are some falls which put a deep psychological impact such fear of falling, or fear of doing
any activities. Fear of future falls and later institutionalization often adds to dependency and
increased immobility, accompanied by functional deficits and increased likelihood of
deterioration.
Significance
The serious and major cause of morbidity and death among the elderly people is the accidental
falls. Compared to other problems or diseases, accidental falls are linked to larger disability and
more chances of hospitalization and admittance to long-term care centers. According to the
World Health Organization, falls, and the injuries they cause, are major public health problems
not only because falls lead to around 20-30% of mild to severe injuries, but also because more
than 50% of hospitalizations from fall are among people aged 65 years and older. The occasions

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related to the accidental falls results in the restriction of autonomy and independence of the
elderly people as they directly faced with the incidence of fractures. With the progress of
growing age, the elderly groups are at more danger of death and severe injury when they
experience falls (Guarino et al., 2017).
This research review is significant as it evaluates the important role of nurses in the prevention of
falls. It is important to recognize the risk of fall to the elder patient, treat the elder patients who
have fallen, and apply appropriate falls prevention strategies (Guarino et al., 2017).
Context of the setting
The Victorian Quality Council defines the concept of fall as accidentally falling on the ground,
floor other any other surface, with the exception of a deliberate shift of place in furnishings,
walls or other items. This concept implies that in many respects a collapse can happen, including
someone falling, tripping over, lowering to the floor, giving way to their feet, or instantly and
unintentionally losing their equilibrium. Patients may not see those events in the same manner,
but, will often relate to their failure of equilibrium or stumbling as a' fall.' There are numerous
explanations why a person may collapse as a result of an accident. These may involve factors
related to health, such as:
 Balance issues and dizziness
 Muscle weakness and stiff joints
 Poor eyesight
 Hypotension
 Low sensation in the leg and feet
 Low reflex action
 Difficulty in focussing
 Dementia
 Adverse reaction of medicines

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There are some surrounding variables that should also be taken into account. Because of some of
the physiological considerations mentioned, domestic work becomes harder, the house becomes
a danger. Wet surfaces, unattended clothes, dull visibility, trying to achieve high or low for
objects, and running up or down the staircase to use the bathroom in the evening are all prevalent
triggers of falling (Hughes, 2018).
Literature review
Types of studies
This research review included the research papers, systematic reviews, and dissertations that
analyzed different strategies to reduce or prevent the accidental falls in elderly people.
Types of participants
This systematic review included those studies which included elderly patients, their fall
hospitalization report, different approaches, and communities.
Study papers
In 2010, two researchers Gray and Miceli conducted an intervention study where they tried to
determine the application of Fall Index Card (FIC) in between a community of retirees for
reducing the incidence of fall. The outcome of this intervention study was FIC proved to be an
effective intervention (Gray et al., 2010).
Another intervention study was conducted in the same year 2010 by Szczerbinsk. This study
wanted to evaluate the effectiveness of the multi-factorial interventions in reducing the fall in
elderly living people. This study conducted the intervention procedure on three nursing homes A,

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B and C. It was seen that nursing homes A and B had significant reduction in the risks of fall
while C did not had any much significant change (Szczerbińska, Żak & Ziomkiewicz, 2010).
In Brasil, a researcher named Freitas (2011) conducted a documentary study where he analyzed
the medical records of eighteen elderly patients. Based on the study he proposed a nursing action
to prevent fall in the elderly was drafted. Although the use of hip protectors and vitamin D
supplements increased significantly, there was no distinction in the number of falls. There was
also no important distinction between the pre-intervention period and the action phase in the
number of collapse (Freitas et al., 2011).
Project design and method
Assessment of methodological approach
The integrative assessment approach was chosen to achieve the desired objective. This technique
enables distinct methodological approaches to include theoretical and empirical literature and
research. The mentioned actions were taken for its implementation: identifying the key issue;
determination of inclusion and exclusion criteria for the research review; the data to be
elaborated from the papers included in the review comprised of specific details about the
interventions, study participants, and study methods; assessing the study approaches comprised
in the research sample; finalizing the outcomes and submission of the examination.
Inclusion criteria
Primary studies that were focused on the nursing interventions to reduce or prevent the falls in
the elderly people were included for the systematic review.

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Data synthesis
The final synthesis was carried out in a descriptive way, with regard to objectives, results and
conclusions obtained from each one of the studies. These data were grouped by similarity and
organized into thematic categories. Finally, in the last step, a document with the complete
description of the steps was created.
Proposed timeframe
The research review has been based on the reference lists which consist of the identified reports
and articles. Studies which have been published in English were selected and the time frame was
from 2010 to 2019 as there are not many researches on the topic of the systematic review. This
time frame was also chosen as to present the most current evidences as there have been
numerous modifications in the administration practice.
Outcome
The outcome of this research review shows that health education is very significant approach to
help the nursing specialists in preventing the incidence of falls in elderly people. The necessity of
continuing the education and sharing knowledge to the professionals to train them in carrying
their duties successfully and help the older people with proper education regarding their
condition. The research review gives emphasis on the investigation of risk factors as strategy for
averting falls in the elderly people. The evaluation is focused on developing action research to
avoid older people from falling into distinct work situations, such as during the Family Health
Approach System, clinics, and long-term care organizations.

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REFERENCES
Hughes, Z. (2018). Falls Prevention. Ausmed. Retrieved from
https://www.ausmed.com/cpd/articles/preventing-falls
Guarino de Moura Sá, G., Gomes da Silva Júnior, L., Rocha Bezerra, M., Mesquita de Carvalho,
K., Ribeiro dos Santos, A., & Teixeira Nunes, B. et al. (2017). Nursing care for the prevention of
falls in the elderly: an integrative review. International Archives Of Medicine, 10(122), 1-14.
doi: 10.3823/2392
Freitas, R. D., Santos, S. S. C., Hammerschmidt, K. S. D. A., Silva, M. E. D., & Pelzer, M. T.
(2011). Nursing care for the prevention of falls in elderly people: proposal for action. Revista
Brasileira de Enfermagem, 64(3), 478-485.
Gray-Miceli, D., Ratcliffe, S. J., & Johnson, J. (2010). Use of a comprehensive postfall
assessment tool to prevent falls.
Szczerbińska, K., Żak, M., & Ziomkiewicz, A. (2010). Role of method of implementing multi-
factorial falls prevention in nursing homes for elderly persons. The EUNESE project. Aging
clinical and experimental research, 22(3), 261-269.
de Moura Sá, G. G., da Silva Júnior, L. G., Bezerra, M. A. R., de Carvalho, K. M., dos Santos,
A. M. R., Nunes, B. M. V. T., ... & da Rocha, S. S. (2017). Nursing care for the prevention of
falls in the elderly: an integrative review. International Archives of Medicine, 10.