EFFECT OF FALL PREVENTION ON INCIDENCE OF FEMORAL FRACTURES: A COMMENTARY

Abstract

To the Editor: This letter presents this author's response to the article that investigated the effectiveness of a fall prevention program in terms of reducing the incidence of femoral fractures in residents of long-term care facilities.1“There is evidence that fall prevention interventions reduce falls, but there is little evidence to support a reduction in fracture.”1 The older adult population has constantly been physically and mentally challenged. A major concern today is how older adults will be able to remain in their homes and maintain their highest functional level. When staying at home is no longer possible for safety reasons, most of the older generation goes to assisted living facilities or nursing homes, but even under watchful eyes, accidents like falls still happen. The aim of the authors was to provide the public with information based on clinical research about the effectiveness of a program for fall-related injuries in nursing homes. Although the study did not find that the incidence of femoral fractures was significantly lower in long-term care facilities, this study can be critically analyzed when looking at its alternative benefits. It was found that, in general, fall-prevention programs lead to fewer falls by older adults and enhance their quality of life. We can then capitalize on this positive outcome to ensure that fall-related injuries such as femoral fractures can be avoided. Overall, the study promoted the concept of evidence-based practice in the area of fall prevention for institutionalized older adults. Several limitations can be considered in this study. In addition to the ones mentioned in the article, the lack of an occupational therapist's input during a fall prevention effort may have contributed to the limited success of the program. The article should have looked into the advantages of having an occupational therapist involved in the study. Furthermore, slips, trips, and stumbling from one level to another cause the majority of fall-related injuries in older adults.2 It is important that the environment be taken into consideration when formulating a fall intervention program. The study in review did not give much emphasis to environmental modifications. There was only a brief discussion of the use of a checklist for home hazard evaluation as part of a fall prevention strategy.1 It would have been beneficial for the outcome if home modifications had been pursued. In addition, staff education should not have been limited to nurses. Nursing assistants or aides should also be included because they typically spend more time with residents. Another limitation was that there was no close monitoring on the participation rate of the target population regarding the exercise program. Adherence to exercise can generate more-positive results. Participation in wellness exercises were linked to functional lifestyle tasks such as safe transfers, dressing, and the use of walking aids.3 The exercise component in a fall prevention program is important because it allows participants to improve strength and balance during activities of daily living. It is time to become serious about fall prevention. The existence of long-term care facilities nationwide introduced a new area where occupational therapists can practice. In occupational therapy, we always strive to help our clients maintain their life-long abilities. The incidence of falls in older adults gives us the opportunity to develop a solution to this ongoing concern. It is imperative that, because most falls happen during activities of daily living, the expertise of an occupational therapist should be sought to ensure a successful fall prevention program. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the author and has determined that the author has no financial or any other kind of personal conflicts with this paper. Author Contribution: The author is the sole contributor of this paper. Sponsor's Role: None.