Falls Prevention in Nursing Homes for the Elderly Literature Review
Elderlies or individuals who belong to the geriatric population can be prone to a lot of illnesses and diseases. This is mainly because of the consequences of degeneration. As a person grows old, most body systems’ functions deteriorate. Examples would be degradations in the functions of the immune system to combat diseases and infection, and the muscular and skeletal system to prevent falls. In this paper, the author conducts a brief but thorough literature review on measures how falls can be prevented in nursing homes for elderly people.
Nurses play an important role in patient care and disease prevention. They are the front liner employees in a skill nursing home facility setting; they are the ones that interact directly with the patients, a larger percentage of which are elderly people. In a study published in the International Journal of Older People Nursing, the researchers examined the different views of registered and enrolled nurses on the use of a rather radical approach in fall prevention (among the elderlies) in a skilled nursing facility in Stockholm. In the said study, the researchers examined the nurses’ view on using shielding and caging. What is important to note is that both procedures involve the use of physical restraints to significantly limit the patients’ freedom of movement. The results of the said study confirmed that the use of shielding or caging would not have any negative implications on the patient’s safety or the patients and their respective family members’ perception on quality service as long as the nurses have sufficient knowledge on which pathologically related conditions would require the use of shielding and or caging in an effort to prevent falls—something that can lead to further injuries. Some of the examples exhibited in the study were the use of wheelchairs with safety belts, bed rails, and protective straps .
One of the major causes of falls, apart from the non-modifiable ones, is the lack of awareness, training, and knowledge of the nurses taking care of high fall risk patients—such as the elderlies. Falls can significantly contribute to the worsening of the patients’ condition.
In the case of the elderlies, they can lead to fractures and soft tissue injuries, depending on the manner how the patient fell. Other direct factors that could lead to higher risks of falls include muscle weakness, improper gait, confusion and the effects of certain medications . According to a study published in Age Ageing Oxford Journals, ‘considerable evidence now documents that the most effective and cost-effective fall reduction programs have involved systemic fall assessment and targeted interventions, exercise programs, and environmental inspection and hazard reduction programs” .
This is opposed to what the initial study that was reviewed suggested about the use of shielding and caging. The advantage of this second approach on fall prevention is that it addresses most, if not all, risk factors that contribute to the occurrence of falls. It is therefore a more holistic and more effective approach, at least theoretically.
The use of a systemic fall assessment and prevention strategy similar to what Rubenstein (2006) suggested is not exactly new. It has been discussed and examined in other studies about elderly fall prevention; a good example would be a study published in the Cochrane Database of Systematic Reviews. In it, the researchers conducted a total of 111 trials involving 55,303 participants who became a part of a program that incorporated multiple component group exercises and home based exercises (Gillespie, Robertson, Gillespie, Lamb, Gates, & Cumming, 2009).
If Rubenstein’s (2009) suggestions and theories about the systemic assessment and fall prevention strategies are correct, then on paper, what Gillespie, Robertson, Gillespie, Lamb, Gates, & Cumming (2009) conducted and tested should yield positive results as well.
Unsurprisingly, the patients in the intervention group indeed exhibited better fall prevention outcomes. It is worth noting that this study, as opposed to the first two studies, focused on the effectiveness of the proposed fall prevention strategy on elderlies living in the community and not in skilled nursing home settings.
Another interesting study that made use of this holistic approach in fall prevention among elderlies was this one published in the British Medical Journal in 2008. What the researchers in the said study used and examined was a multifactorial assessment and targeted intervention for preventing falls. Their target population was also the elderlies.
This means that the fall prevention strategies that they used were directed at the problems causing the increase in fall risk. The results of the said study showed that multifactorial fall prevention programs in primary care, community, and emergency care settings can prove to be effective measures in reducing the number of fallers and sufferers of fall related injuries . This means that at some point, findings of studies that focused on the use of this strategy on elderly fall prevention in a community setting may also be used to improve fall prevention outcomes in nursing homes and other skilled nursing facilities.
Conclusions
Bibliography
Fonad, E., Burnard, P., & Emami, A. 2008. Shielding or Caging? Healthcare Staffs' Views on Fall Risk and Protection in Stockholm. International Journal Older People Nursing, 46-54.
Gates, S., Fisher, J., Cooke, M., Carter, Y., & Lamb, S. 2008. Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis. British Medical Journal, 130.
Gillespie, L., Robertson, C., Gillespie, W., Lamb, S., Gates, S., & Cumming, R. 2009. Interventions for Preventing Falls for Older People Living in the Community. The Cochrane Database of Systematic Reviews, 01-16.
Rubenstein, L. 2006. Falls in Older People: Epidemilogy, Risk Factors and Strategies for Prevention. Age Ageing Oxford Journals, 37-41.
