Elderly Falls: Risk Factors and Intervention

Introduction

Aging is an inevitable process and the most sensitive era of life. It is the process of massive progressive changes in biological and sociology aspects of life. Examples of such progressive changes include reduced auditory and visual perception causing aging related balance disorders, chronic complications, and loss of body organs coordination. In addition, elderly bones are often less dense and more brittle making them prone to breaking easily.

These progressive elderly changes make the elderly people experience a broad range of problems including accidents at home and hospital areas. However, falling risks amongst the elderly are high with an increase in number of risk factors. For this reason, this research paper aims at highlighting the risk factors associated with elderly falls. Thereafter, the paper will explore the intervention strategies used to minimize home based and hospital related elderly falls.

Risk Factors for Elderly Falls

There are various risk factors associated with elderly falls. The factors are broadly categorized into two: host related factors and environmental factors. Host related factors include age, chronic illness, foot problems, decreased audiovisual perceptions, and postural instability. In addition, use of certain medications such as benzodiazepines, antipsychotics, and sedatives whose side effects include dizziness or vertigo may result to falls. Environmental factors may include poor lightning, slippery floors, inadequate ventilations, and poor structured stairs i.e. those lacking mounted grab bars, high location of bells or resting bed etc (Erkal, 2010).

Elderly Falls Prevention Strategies Implementation

Research estimates that one third of the elderly patients experiences a fall once in their lifetime. Falls related injuries are the leading public health issue amongst the elderly people in the US. Center for Disease Control and Prevention (CDC) reports indicate falls as the major cause of elderly non-fatal injuries, hospitalization for trauma and increased mortality. Besides the physical injuries on the patients, falls make their relatives experience psychological and financial burdens. These deleterious effects of falls amongst the elderly are preventable. This has triggered attention from advocates of patient safety such as the Joint Commission International (JCI), National Patient Safety Agency (NPSA) and British Geriatric Society (ABGS) (Ang, Zubaidah & Wong, 2011).

Previously, prevention of elderly falls in hospitals was enhanced through restraints. Restraints can be categorized into two: physical and chemical restraints. Physical restraints include use of bed rails and belts on beds and chairs. Chemical restraints involve the use of antipsychotic drugs and sedatives, which minimize movement. Research has demonstrated that use of physical and chemical restraints to prevent elderly falls lead to more harm than any good.

For example, research indicated that patients under physical and chemical restrictions suffered nosocomial infections, their muscle weakened, experienced physical reconditioning, suffered mental disorders and showed aggressive behaviors which increased the risk of injury and fall mortality further. Despite these observations being made, use of restraints is still used rampantly in public hospitals as an elderly fall prevention strategy (Fixsen et al., 2011).

Several elderly falls prevention strategies have been established. These include the targeted multiple interventions and evidence based fall interventions strategies. These intervention strategies are instituted according to a patient’s identified fall risk. A systematic review investigation of 22 studies reveals that multiple interventions are effective in reducing fall rate and risk of falling. The evidence based fall prevention strategy interventions involve programs of various practices tailored to current risk factors such as host related and environmental hazards reduction. These interventions include lowering of hospital beds, use of hip protectors to reduce fall related hip fractures and medicating the patients with vitamin D to enhance their muscle strengths (Ang, Zubaidah & Wong, 2011; Fixsen et al., 2011).

In addition, hospitals are encouraged to increase competency development. This can be done through training, coaching, and performance assessments. Competency development is important in any effective fall prevention program. Training and coaching helps the staff practitioner in practicing the activities that are abreast with the recent activities. Performance assessment establishes important feedback to the practitioner and his/her coach regarding skills in order to identify the strong and those that need improvements. In addition, the multiple interventions include changing an organization’s set up.

Research identifies that nearly all public health organizations have inadequate specialized personnel related to the multiple interventions. The new roles and functions need to be acquired and enhanced in all health facilities. Most of the legislative goals in public human services are not realized due to poor infrastructure implementation. The infrastructure implementation include financial or information technology. This causes constraint in achieving the desired outcome through expertise in supporting multiple intervention strategies (Fixsen et al., 2011).

Conclusion

Evidently, using of chemical and physical restraints to prevent elderly falls does not reduce falls and the related injuries. This calls for establishment of new policies to replace the use of restraints. However, the new multiple intervention strategies face several challenges including lack of competency development at public hospitals, lack of skilled implementation and support of the new policies at organizational levels. Therefore, to create a sustainable change in prevention of elderly falls, the ongoing multiple intervention strategies campaign must be supported and integrated in public and community health clinics.

References

Ang, E., Zubaidah, S., & Wong, H. B. (2011). Evaluating the use of a targeted, multiple intervention strategy in reducing patient falls in an acute care hospital: a randomized controlled trial. Journal of Advanced Nursing, 5(1), 1984-92.

Erkal, S. (2010). Home safety, safe behaviors of elderly people and fall accidents at home. Educational Gerontology, 36(1), 1051-64.

Fixsen et al. (2011). When evidence is not enough: the challenge of implementing fall prevention strategies. Journal of Safety Research, 42(1), 419-422.

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