Patient Falling and Nursing Precautionary Measures

Precautionary Measures for Patient Falling In Nursing

Whats is Fall,Risk Factors for Falling,Most Common Cause of Falling,Most Common Personal Risk Factor,Evidence Based Screening of Fall,Interventions or Precautionary Measures to Reduce Falling.

Whats is Fall

    A fall is an unintentional slip, trip, or drop from an upright position resulting in the person landing on the ground or furniture. In older adults, a fall often leads to fear of falling that may contribute to restriction of daily activities or requests for assistance in performing these activities (Howland et al., 1998). 

    The inactivity contributes to deconditioning and disability that place an older adult at an even greater risk for falls. Injury, disability, and death are serious consequences of falls, making this a critical issue for older adults.

Risk Factors for Falling

    Falls are multifactorial in nature and represent the interplay between personal and environmental factors whose pattern of interrelationships varies among individuals and settings. Often falls occur because of a mismatch between these factors. 

    Although being female and over 65 years of age consistently have been found to be risk factors for falls across all settings (community, long-term care, and acute care), these are not sensitive enough for identifying those at greatest risk because all older adults would be considered at risk for a fall. 

    Moreover, these demographic characteristics are not amenable to intervention and provide no direction for interventions to reduce the risk for falls. 

    Although certain diseases and medications have been found to be risk factors, consistency in findings across studies and settings have not been found, and these factors may be of little use in clinical practice to identify those at greatest risk for a fall (Lord, Sherrington, & Menz, 2001) and provide little direction for intervention except for changes to pharmacologic treatments. 

    Although fear of falling has been found to be a risk factor for falls (Harada et al., 1995), this fear may be attributable to poor balance, gait, and muscle strength ( Kressig et al., 2001) that also have been related to falls and are more amenable to intervention than demographic characteristics.

Most Common Cause of Falling

    Much of the early epidemiological and clinical research on falls focused on environmental factors, while more recent research focuses on personal risk factors. Inconsistencies of findings related to environmental factors among studies and settings abound. 

    Clinical and research interventions targeted to environmental factors were designed to educate older adults about how to eliminate these risks. These environmental interventions and education of older adults were marginally successful at best. 

    In some studies, community dwelling older adults often were reluctant to make the recommended environmental changes and were more interested in interventions to reduce the risks related to personal factors. 

    In contrast, clinicians and architects used the clinical and research information to design health care facilities and have begun to examine the effects of environmental factors, such as carpeting, on personal factors (Dickinson, Shroyer, & Elias, 2002).

Most Common Personal Risk Factor

    Balance, gait, and muscle strength emerged from more recent research as significant risk factors for falls. The Physiologic Profile Assessment (PPA) consists of physiologic factors associated with balance control (vision, muscle strength, postural sway, reaction time, and peripheral sensation) (Lord, Menz, & Tiedemann, 2003). 

    Using the Internet, the results of the PPA can be compared to a normative sample. Many screening tools contain similar information and have strong sensitivity and specificity in predicting falls (Perell et al., 2001). Consensus regarding the assessment of risk and determination of risk profiles is needed before clinically useful screening tools appropriate for various settings are widely used.

Evidence Based Screening of Fall 

    In 1991, the American Geriatrics Society and the American Academy of Orthopedic Surgeons Panel on Falls Panel (2001) put forth an evidence based tiered approach to screening. 

    The initial screen includes the Get Up and Go test that had good specificity and sensitivity (Perell et al., 2001; Shumway-Cook, Brauer , & Woollacott, 2000) and assesses the older adult for instability or inability in getting up from a chair without using their arms, walking a known distance, and sitting down. 

    If the Get Up and Go ( Podsi adlo & Richardson, 1991) is abnormal, the panel recommends a comprehensive assessment that includes medical history, medications, evaluation of balance, gait, vision, and cardiovascular and neurological status. 

    Other measures with good sensitivity and specificity were the Elderly Fall Screening Test ( Cwikel , Fried, Biderman , & Galinsky, 1998), and the STRATIFY (Oliver, Britton, Seed, Martin, & Hopper, 1997).

Interventions or Precautionary Measures to Reduce Falling 

    Risk factors for falls are multifactorial, and interventions also must be multidimensional. Interventions must target the deficits of the older person that place them at risk for a fall and compensate for nonmodifiable factors. Consideration of the capabilities of the older adult and the setting are essential in selecting interventions. 

    Comprehensive descriptions for interventions can be found in Falls in Older People: Risk Factors and Strategies for Prevention (Lord et al., 2001) and Falls in Older People: Prevention and Management ( Tideiksaar , 2002).

    The American Geriatric Society Panel on Falls Prevention (2001) recommended guidelines for interventions. Reducing medications, exercise, and treatment of disease were most effective in community-based interventions. Reducing environmental hazards in the home, comprehensive assessment of fall risk, and education were not effective. 

    Exercise, aerobics and muscle strengthening, was the most effective single intervention. The concurrent management of visual impairment and reduction of environmental hazards increased the effects above those attributed to exercise alone (Day et al., 2002). 

    The panel found that staff education, reduction of medications, and comprehensive assessment significantly reduced falls in long-term care facilities. The panel found no significant multifactorial interventions for the hospital setting where shortened hospital stays preclude some interventions (eg, exercise). 

    Environmental interventions, medication management, and treatment of disease or injury may be the most effective in the hospital setting. No matter the setting, the acceptability of the intervention to the older adult and their ability to use the intervention are significant factors in adherence. 

    Strategies to increase acceptability and adherence, particularly for exercise interventions, have achieved limited success. The most potent strategies are engaging older adults in the selection of relevant interventions and assisting them to remove barriers and to increase support for using the intervention.