Change Project Using a Fall Prevention Action Program to Decrease Falls on a Behavioral Health Unit

Practice Problem: Fall rates are increasing in the behavioral health units of the East Texas hospital. Due to the worldwide COVID-19 pandemic, the units are short-staffed, which further supports the urgent need for a targeted intervention to reduce fall risk. PICOT: The PICOT question that guided this project was: “In adult behavioral health patients (P), what is the effect of the Edmonson Psychiatric Fall Risk Assessment Tool (I), compared with previous use of the Morse Fall Risk tool (C), on the fall rate (O), in 8 weeks (T)?” Evidence: Falls are the most reported incidents in acute care hospitals and falls of behavioral health patients are more challenging to mitigate than those of other patients. Evidence suggested that the Edmonson Psychiatric Fall Risk Assessment Tool aided in identifying and mitigating fall risks by tailoring care plans to individual patients. Intervention: The Edmonson Psychiatric Fall Risk Assessment Tool was completed on every patient over the age of 18 years, which was admitted, discharged, falling, or had a change in condition, while on the psychiatric unit. The risk assessment was used to determine the risks and other factors that contribute to the patient falling. Once the contributors were identified, the data was used to put interventions into place and revise each individualized care plan to decrease falls. Outcome: The intended outcome was to identify patients that were at substantial risk for falls using the EPFRAT tool, mitigate some of their risks, and therefore decrease falls. Conclusion: Continued emphasis on the fall risks of behavioral health patients will be paramount in the management and success of the continued improvement in patient outcomes.

Challenge or Opportunity? Impacts of Falls among Older Adults Living with Dementia on their Care Partners

Previous studies suggest that falls among community-dwelling older adults living with dementia (OLWD) harm the health and wellbeing of their family/friend care partners. However, little is known about the process through which falls impact care partners. We conducted a grounded theory analysis using 59 semi-structured interviews with care partners of OLWD who were recently hospitalized and had a history of falls. We identified several areas of care partners’ functioning that were affected by falls in positive and negative ways: everyday life, health management for OLWD, and interactions with healthcare providers. Both the fall events and fall risks had negative consequences of reducing care partners' self-care activities and work productivity. Other adverse consequences of fall risks were (1) care partners’ fatigue and conflicts with OLWD due to the intense requirement of daily monitoring, and (2) hesitance to ask healthcare providers for assistance because clinicians frequently did not teach care partners how to address fall risks and might recommend institutionalization. However, OLWD's fall events became a transition point for some care partners to seek support and gain more information and skills about managing OLWD’s health conditions, which might reduce care partners’ burden in the long term. Because OLWD’s falls may have negative and positive consequences for care partners, both problem-solving and strength-based fall management approaches are needed. These strategies focus on developing and sustaining care partners’ self-care, developing collaborative relationships with OLWD, enhancing successful capacity for OLWD’s health management, and cultivating partnerships with healthcare providers.

Medications and Falls Experiences among Older People

Purpose: This study aimed to identify the status of drug use and analyze the effects of drug use on falls among older people.Methods: The data were collected from 285 community-dwelling older persons through interviewing with questionnaires and checking participants’ medication prescriptions and the drugs using the Korea Pharmaceutical Information Center’s (KPIC) website. The medications were classified into anatomical and therapeutic divisions based on the medications’ ingredients provided by the KPIC. x2 test, ANOVA, t-test, and logistic regressions were applied to analyze the data.Results: The finding showed that 81.4% of the older adults were taking medications. Older people taking antihyperlipidemic drugs were at 1.79 times higher risk for experiencing a fall (95% CI=1.01~3.16, p=.046), and hypnotic sedative and sleeping pills increased their fall risks 11.06 times (95% CI=1.27~96.07, p=.029) compared to those not taking the medications. Nonsteroidal antiinflammatory agents showed a 2.74 odds ratio (95% CI=1.23~5.73, p=.013) and narcotic analgesics increased the fall experience risk 8.56 times (95% CI=1.02~71.88, p=.048). Those with chronic diseases experienced falls 3.04 times more than those without chronic diseases.Conclusion: The study findings showed medications might be one of the important influencing factors on fall risks among older adults. Raising awareness of fall risks associated with medicines through health education and medication reviews by health professionals should be considered a strategy for preventing older adults' falls.

Oncology clinic nurses’ attitudes and perceptions regarding implementation of routine fall assessment and fall risk screening: A survey study

Falls in older adults with cancer are often under-recognized and under-reported. The objective of this study was to explore oncology clinic nurses’ willingness and perceived barriers to implement routine falls assessment and falls screening in their practice. Nurses working in outpatient oncology clinics were invited to complete an online survey. Data were analyzed using descriptive statistics and sorted into thematic categories. The majority of respondents indicated willingness to routinely ask older patients about falls (85.7%) and screen for fall risks (73.5%). The main reasons for unwillingness included: belief that patients report falls on their own, lack of time, and lack of support staff. Findings from this study show many oncology nurses believe in the importance of routine fall assessment and screening and are willing to implement them routinely, although falls are not routinely asked about or assessed. Future work should explore strategies to address barriers nurses face given the implications of falls amongst this vulnerable population.

Hybrid Early Warning System for Rock-Fall Risks Reduction

Rock-fall is a natural threat resulting in many annual economic costs and human casualties. Constructive measures including detection or prediction of rock-fall and warning road users at the appropriate time are required to prevent or reduce the risk. This article presents a hybrid early warning system (HEWS) to reduce the rock-fall risks. In this system, the computer vision model is used to detect and track falling rocks, and the logistic regression model is used to predict the rock-fall occurrence. In addition, the hybrid risk reduction model is used to classify the hazard levels and delivers early warning action. In order to determine the system’s performance, this study adopted parameters, namely overall prediction performance measures, based on a confusion matrix and reliability. The results show that the overall system accuracy was 97.9%, and the reliability was 0.98. In addition, a system can reduce the risk probability from (6.39 × 10−3) to (1.13 × 10−8). The result indicates that this system is accurate, reliable, and robust; this confirms the purpose of the HEWS to reduce rock-fall risk.

Identification of Fall Risks by Nurses in Hospitalized Adult Patients

The aim of this study was to provide a nurses' comparison of fall risks in hospitalized adults according to gender, age and clinic, and to identify significant risk factors associated with the specific levels of the risk of falling. The respondent group consisted of patients hospitalized in selected hospital wards. Morse Fall Scale was used to map the data. We tested the statistical significance of differences among categories by using the chí2 test, Mann-Whitney U test and Kruskal-Wallis test. The average risk score of falling in a group of 688 patients was at a high level 47.87 ± 26.4. In the group of 430 elderly patients, we found significantly higher average values than in the group of 258 patients younger than 65 years (p = < 0.00001).Patients hospitalized in the geriatric ward had the highest average Morse Fall Scale values (55.3 ± 26.11). The results of our study confirmed the risk of falling in selected groups of patients.

A Safe Mobilisation Program to Improve Functional Mobility and Reduce Fall Risks in Cognitively Impaired Older Adults with Higher Level Gait Disorders: A Pilot Study

<b><i>Background:</i></b> The association between gait and cognition, and their combined impact on postural stability may underlie the increased fall risk in older adults with dementia. However, there are few interventions to improve functional mobility and reduce fall risks in people with cognitive impairment. <b><i>Objectives:</i></b> This study aims to investigate the feasibility and acceptability of a Safe Mobilisation Program for cognitively impaired older adults with higher level gait disorders. It also explores the potential effectiveness of the program on mobility and fall risks. <b><i>Methods:</i></b> Fifteen community-dwelling older adults participated in a 3-week pre-post intervention study. They were trained to take steady steps in transfers and mobilization using errorless learning and spaced retrieval teaching techniques. <b><i>Results:</i></b> The intervention program was feasible, all the participants completed the program and were able to mobilize safely. The program was acceptable and participants reported an increase in safety awareness, improvement in confidence while transferring and mobilising, and better quality of life. There was a trend of improvement in Falls Efficacy Scale-international (FES-I), 360° turn and Tinetti Performance Oriented Mobility Assessment (POMA), which may indicate improvement in balance and mobility. <b><i>Conclusion:</i></b> The Safe Mobilisation Program was feasible and acceptable in older adults with cognitive impairment and gait disorders and warrants further evaluation.

An analysis of the risk factors for falls, recurrent falls, and fall-related injuries among the elderly in senior Chinese apartments: a cross-sectional study

Objective Falls, recurrent falls, and fall-related injuries among the elderly are severe problems that seriously threaten the quality of life and health in old age. However, there are few studies on fall risks among the elderly living in senior apartments in China. Our study aims to investigate the factors and differences in falls, recurrent falls, and fall-related injuries among these elderly residents, providing a reference for screening those with high fall risks. Method Face-to-face structured interviews were conducted on 331 older adults over 65 years of age living in four senior apartments. We performed comparative analyses on the results of fall events with two separate criteria (falls vs. no falls; number of falls ≤ 1 and without injury vs. fall-related injuries or number of falls ≥ 2). Several significant variables were involved in a logistic model for regression analysis. Results Falls, recurrent falls, and fall-related injuries among the elderly in senior apartments were independently associated with gender (female), urinary incontinence/frequency, and conscious unsteady gait. Furthermore, fall risks increased with age and the number of risk factors. The AUC, sensitivity, and specificity of the fall risk prediction model were 0.749, 82.4%, and 57.1%, respectively. Conclusions Falls among the elderly in senior apartments are affected by several factors. Female elderly with urinary incontinence/frequency and conscious unsteady gait should be prioritized for fall prevention interventions.