Fall Risk Assessment Tool Research Articles

Abstract TP329: Patient Transfer Check Off Decreases Fall Rate on Stroke Unit

Background and Issues: Protecting stroke patients from falls and injury is fundamental to providing exceptional care. An increased risk for falls has been recognized among persons with diagnoses of stroke and other neurological disorders. Our Stroke Unit’s comprehensive fall prevention program, while helpful, did not adequately identify stroke patients who would fall. While instituting video monitoring of patients at high risk for falls provided a 20% reduction in fall rate, stroke patients evaluated at low and moderate risk continued to fall. Purpose: The purpose of our practice change was to determine if implementing high risk measures on all patients admitted to a stroke unit until demonstration of five safe transfers would decrease the number of patient falls. Methods: Utilizing a shared responsibility model, our Stroke Unit engaged all staff members in the falls prevention program. Each patient was evaluated using the current falls risk assessment tool. If the patient was scored high risk, full falls prevention measures were maintained. For patients scoring low to moderate risk, a safe patient transfer check off procedure was implemented. Each patient was monitored five times to ensure independent demonstration of all aspects of transfer without support. Upon five safe transfers, the patient’s bed alarm could be shut off and general fall preventative measures maintained. Unit secretaries checked the bed alarm system twice a day to monitor proper activation of alarms. A report was created representing the retrieved information for the charge nurse. The charge nurse followed up with nurses whose patient alarms were not on and ensured proper activation. Results: Since implementation of the safe patient transfer check off, we have seen an additional 33% reduction in fall rate compared to our post-implementation of video monitoring rate (3.48/1000 patient days compared to 5.20/1000 patient days). There were zero falls for patients who were successfully checked off on safe transfers. Conclusion: Implementing a safe transfer check off for mild to moderate fall risk patients on a Stroke Unit may be a successful strategy to prevent falls and fall related injuries. Engaging all staff members in the program increased awareness of the importance of falls prevention.

Pediatric falls: Effect of prevention measures and characteristics of pediatric wards

This study aimed to identify the effect of fall prevention measures and characteristics of wards on the rate of pediatric falls. Data on study variables were collected using a cross-sectional design and questionnaires of 603 randomized general hospitals in Japan. Among the hospitals that were contacted, 252 (41.8%) returned their questionnaires. The questionnaires included the annual number of falls, whether fall prevention measures were implemented, and characteristics of the wards. Data were analyzed from questionnaires from 162 of the hospitals, which included those that answered the number of falls. The pediatric fall rate was 1.36/1000 patient-days. Facilities were more likely to have a lower fall rate if they had a longer "length of stay" (P < 0.001), "shared information in high-risk patients and monitored them carefully" (P < 0.001), had higher totals for the "number of study sessions for novice nurses" (P = 0.01),and "used a pamphlet to educate patients and caregivers regarding appropriate use of side rails" (P < 0.001). Facilities that had a "playroom" (P < 0.001), higher "novice nurse-to-nurse ratio" (P < 0.001), and those at which "caregivers were necessary for hospitalization" (P = 0.04) were more likely to have a higher fall rate. The results of the present study suggest that education of parents and novice nurses on fall prevention is the most effective method of reducing pediatric falls. It is important to implement intensive fall prevention for high-risk patients and develop valid pediatric fall risk assessment tools.

Risk Assessment Tool for the Prediction of fall

An effective tool for the prediction of fall risk among the patients admitted in wards requires high sensitivity with specificity, good predictive value and easy to use in the clinical practice. Objective of the study is to develop fall risk assessment tool. Study was done on patients admitted at MMIMS&R Hospital, Mullana, Ambala and Methodological approach was used. From related review of literature, experts' guidance and investigators' personal experience, a list of risk factors were identified and compared with standardized risk assessment scales i.e. Morse Fall Scale & Fall Risk Assessment & Screening Tool i.e FRAST. Content validity was ascertained by expert's opinion & was found to be 0.94. The range of rating score was 12 to 48, with the assumption that higher the scores, the greater the risk of falls. At a cut-off point of ≥ 18, the best balance between the sensitivity and specificity was achieved, i.e. sensitivity was 26.42%, specificity 85.71%, predictive value positive 26 % and predictive value negative 74%. Cronbach's alpha and item item Correlation were used to measure the internal consistency of the tool, Coefficient alpha was 0.75, statistically significant at 0.001 levels. Item-item correlations were moderate (between 0.30 to 0.70) among most of the items. In order to estimate equivalence Inter-rater reliability method was used & percentage of agreement between raters was 84%. Concurrent validity of fall risk assessment tool was checked by calculating Pearson correlation in between the fall risk assessment tool and Morse Fall Scale & was found to be 0.70.

Comparison of the Reliability and Validity of Fall Risk Assessment Tools in Patients with Acute Neurological Disorders

Purpose: The aim of the study was to identify the most appropriate fall-risk assessment tool for neurological patients in an acute care setting. Methods: This descriptive study compared the reliability and validity of three fall-risk assessment tools (Morse Fall Scale, MFS; St Thomas's Risk Assessment Tool in Falling Elderly Inpatients, STRATIFY; Hendrich II Fall Risk Model, HFRM II). We assessed patients who were admitted to the Department of Neurology, Neurosurgery, and Rehabilitation at Asan Medical Center between July 1 and October 31, 2011, using a constructive questionnaire including general and clinical characteristics, and each item from the three tools. We analyzed inter-rater reliability with the kappa value, and the sensitivity, specificity, predictive value, and the area under the curve (AUC) of the three tools. Results: The analysis included 1,026 patients, and 32 falls occurred during this study. Inter-rater reliability was above 80% in all three tools. and the sensitivity was 50.0% (MFS), 84.4% (STRATIFY), and 59.4% (HFRM II). The AUC of the STRATIFY was 82.8. However, when the cutoff point was regulated as not 50 but 40 points, the AUC of the MFS was higher at 83.7. Conclusion: These results suggest that the STRATIFY may be the best tool for predicting falls for acute neurological patients.

Development and Implementation of the Memorial Emergency Department Fall Risk Assessment Tool

The purpose of this study was to determine the validity and reliability of an evidence-based, emergency department (ED) fall risk assessment tool as a sensitive predictor for falls in the ED population. The overarching goal of the project was to improve patient safety and eliminate patient falls resulting in serious injury in the ED. An ED-specific tool was designed on the basis of the risk factors consistently identified in the literature: prior fall history, impaired mobility, altered mental status, altered elimination, and the use of sedative medication. The Memorial ED Fall Risk Assessment Tool was validated in two EDs (North campus and Central campus) located within a large urban health care system in Colorado Springs, Colorado. The two EDs have a combined 140,000 annual patient visits. The Memorial ED Fall Risk Assessment Tool appears to be a valid tool for this two-ED hospital system.

Risk Factors for Pediatric Inpatient Falls

The purpose of this study was to identify risk factors for pediatric inpatients falls. The study was a matched case-control design. The participants were 279 patients under the age of 6 who were admitted between January 1, 2004 and December 31, 2009. Through chart reviews, 93 pediatric patients who fell and 186 ones who did not fall were paired by gender, age, diagnosis, and length of stay. Five experts evaluated the 38 fall risk factors selected by the researchers. In a general hospital, pediatric patients with secondary diagnosis, tests that need the patient to be moved, intravenous lines, hyperactivity, anxiolytics, sedatives and hypnotics, and general anesthetics showed significance for falls on adjusted-odds ratios. Conditional logistic regression analysis was performed to elucidate the factors that influence pediatric inpatient falls. The probability of falls increased with hyperactivity and general weakness. Patients who didn't have tests that required them to be moved and intravenous line had a higher risk of falls. These findings provide information that is relevant in developing fall risk assessment tools and prevention programs for pediatric inpatient falls.

Le cadute pediatriche in ospedale: una indagine italiana

Falls can be considered as the most relevant accident for frequency and severity among in-hospital paediatric accidents (0-18 years). There is still a lack of a common framework in defining and categorizing paediatric falls across European and Italian paediatric centres. The aim of this survey was to explore key aspects of paediatric in-hospital falls in a number of Italian paediatric facilities. In 2010, a questionnaire was sent to 15 paediatric centres selected through convenience sampling. Fourteen questionnaires (93.3%) were returned, six centres (42.9%) define clearly the term "fall", while 8 (57.1%) declare to track falls frequency; three (21.4%) trace the consequences of falls. Four centres (28.6%) track the impact of falls on care plans. Usually information on falls and on children are collected (10 centres, 71.4%) and reporting procedures are frequently in place (10, 71.4%); whereas, fall management procedures (5 centres, 35.7%) are rarely in place. Five centres (35.7%) use a paediatric fall risk assessment tool (devised by the centre itself, and not validated); none of the implemented prevention measures for high-risk patients evaluate effectiveness. Data show a lack or no consistency of paediatric fall-related practices in Italian paediatric facilities, this phenomenon its impact on care plans and healthcare costs is therefore difficult to evaluate, as well as making a comparison between facilities. Collaboration among major paediatric centres should be encouraged in order to establish a common framework and share approaches.

Determination of the reference value and systematic bias of the functional reach test in Japanese elderly people by meta-analysis

Background/PurposeThe functional reach test (FRT), which was developed as a clinical balance assessment tool, has been widely used as a fall risk assessment tool in elderly people. The aim of the present study was to investigate the reference value and the presence of systematic bias in the FRT using the methodology of meta-analysis in community-dwelling elderly people. MethodsRelevant research articles were sought from electronic databases: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Igakucyuouzasshi. The search was conducted from January 1990 to August 2011, and the terms “functional reach” and “elderly” were used in combination in the search. The searches were limited to peer-reviewed research articles involving Japanese elderly people with good functioning, aged 60 years and older. Weighted means were calculated for the reference value of FRT by a fixed effect model and a random effect model. Furthermore, weighted least squares regression was performed to determine the presence of systematic bias in the reference value of FRT. ResultsA total of 19 articles fulfilled the inclusion criteria, including 4274 participants whose mean age ranged from 69.0 to 81.4 years. The reference value of FRT was 29.44 cm (95% confidence interval: 27.60–31.27 cm) using the random-effect model, since the reference value using the fixed-effect model was found to have significant heterogeneity. Furthermore, multivariate weighted least squares regression was performed, and sex, age, height, and measurement method (one-arm or two-arm reach) were all independently associated with the FRT value (multiple R2 = 0.295, χ2 = 76.6, p < 0.001). ConclusionsSince participants' characteristics (sex, age, and height) and measurement method are probably related to systematic error in the FRT, judgment of physical function in elderly people using only the reference value determined in this study may have limitations.

Falls Risk Assessment Begins With Hello

Identifying older adults at risk for falls is a challenge all home healthcare agencies (HHAs) face. The process of assessing for falls risk begins with the initial home visit. One HHA affiliated with an academic medical center describes its experience in development and use of a Falls Risk Assessment (FRA) tool over a 10-year period. The FRA tool has been modified since initial development to clarify elements of the tool based on research and to reflect changes in the Outcome and Assessment Information Set (OASIS) document. The primary purpose of this article is to share a validated falls risk assessment tool to facilitate identification of fall-related risk factors in the homebound population. A secondary purpose is to share lessons learned by the HHA during the 10 years using the FRA.

A Validation Study of the Missouri Alliance for Home Care Fall Risk Assessment Tool

A retrospective review ( n = 2,247) was conducted from July 1st to October 1st 2010 to determine validity of the Missouri Alliance for Home Care Fall Risk Assessment Tool (MAHC-10). Fall risk was identified by a MAHC-10 score ≥ 4. Two sample t test, chi-square, logistic regression, and ROC curve analyses were performed. Fallers (6.35 ± 1.7, n = 195) and nonfallers (5.70 ± 1.9, n = 2,052) had significantly different ( p = .011) MAHC-10 scores. The MAHC-10 cutoff score of 4 demonstrated 96.9% sensitivity and 13.3% specificity; however, ROC curve analyses revealed a cutoff score of 6 maximized combined sensitivity and specificity. The MAHC-10 is valid for fall risk screening in the home health setting; however, a cutoff score of 6 may more accurately predict fall risk.

Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review protocol

The purpose of this article is to present the research protocol of a systematic review about fall risk assessment tools in acute hospitalized patients. Various risk assessment tools for falls have been developed, but with uncertainties derived from validation in heterogeneous environments and variations in their sensitivity, specificity and predictive validity. Systematic review and meta-analysis. Two independent reviewers will extract data in a blinded process. Quality of studies will be assessed using various standardized instruments. A meta-analysis will be performed if applicable. For all studies, sensitivity, specificity, positive and negative predictive values, together with the positive and negative likelihood ratios and Youden index will be calculated. The diagnostic odds ratio of the studies and the hierarchical summary Relative Operating Characteristic curve and bivariate model will be applied. Calculations will be made from random effects models. Forest-plot diagrams for sensitivity and specificity and likelihood ratios, in addition to Cochrane's Q test and the I(2) statistic, will be calculated. Funding of the review was confirmed in December 2010. The results of this review will help to clarify some uncertainties provoked by earlier research findings and enable informed choice of a validated, reproducible instrument for assessing the risk of falls by hospital patients, so that preventive action may be taken to minimize this risk.

Diagnostic Accuracy of Fall Risk Assessment Tools in People With Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy affects nearly half of individuals with diabetes and leads to increased fall risk. Evidence addressing fall risk assessment for these individuals is lacking. The purpose of this study was to identify which of 4 functional mobility fall risk assessment tools best discriminates, in people with diabetic peripheral neuropathy, between recurrent "fallers" and those who are not recurrent fallers. A cross-sectional study was conducted. The study was conducted in a medical research university setting. The participants were a convenience sample of 36 individuals between 40 and 65 years of age with diabetic peripheral neuropathy. Fall history was assessed retrospectively and was the criterion standard. Fall risk was assessed using the Functional Reach Test, the Timed "Up & Go" Test, the Berg Balance Scale, and the Dynamic Gait Index. Sensitivity, specificity, positive and negative likelihood ratios, and overall diagnostic accuracy were calculated for each fall risk assessment tool. Receiver operating characteristic curves were used to estimate modified cutoff scores for each fall risk assessment tool; indexes then were recalculated. Ten of the 36 participants were classified as recurrent fallers. When traditional cutoff scores were used, the Dynamic Gait Index and Functional Reach Test demonstrated the highest sensitivity at only 30%; the Dynamic Gait Index also demonstrated the highest overall diagnostic accuracy. When modified cutoff scores were used, all tools demonstrated improved sensitivity (80% or 90%). Overall diagnostic accuracy improved for all tests except the Functional Reach Test; the Timed "Up & Go" Test demonstrated the highest diagnostic accuracy at 88.9%. The small sample size and retrospective fall history assessment were limitations of the study. Modified cutoff scores improved diagnostic accuracy for 3 of 4 fall risk assessment tools when testing people with diabetic peripheral neuropathy.

In‐hospital paediatric accidents: an integrative review of the literature

Paediatric hospitals can be perceived by children, parents, health professionals as 'safe' places, but accidents do occur. To review publications relating to in-hospital paediatric accidents and highlight the state-of-the-science concerning this issue especially in relation to falls, and the evolution of research addressing this issue. Integrative review of papers published before March 2011 on accidents and falls occurred in hospitalized children. Electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature and Cochrane Library databases) and further hand searching through references were searched. The inclusion criteria were articles involving observational, quasi-experimental or experimental studies in English or Italian. Exclusion criteria were articles addressing the outcomes of falls caused by suspect violence on children. Thirteen studies in English were included. Of the 13 studies conducted between 1963 and 2010, 10 had been conducted in the last 5 years; 10 in the USA. The studies were divided into two categories: contextualization and prevention of the 'accident' or 'fall' phenomenon (10 studies), and fall risk assessment (three studies). The most frequent type of design was observational explorative/descriptive. Several areas of investigation were explored (hazardous environment, children's characteristics correlated to accidents/falls, characteristics of the accidents/falls and their outcomes, paediatric fall risk factors and risk assessment tools, fall risk prevention programmes, parents' perceptions of accident/fall risks, etc.). No comparable methods were used to investigate the contextualization and prevention of the 'accident' and 'fall' phenomena; proposed fall risk assessment tools were not evaluated for their reliability and validity. Consensus would be needed around the approach to accidents in terms of: the definition of 'accident' and 'fall'; 'fall-related injury' and respective classifications; the frequency and rate calculation methods; the tools used to assess the risk of falls; and evidence-based practice aimed at preventing them.

The effectiveness of a multidisciplinary QI activity for accidental fall prevention: staff compliance is critical.

BackgroundAccidental falls among inpatients are a substantial cause of hospital injury. A number of successful experimental studies on fall prevention have shown the importance and efficacy of multifactorial intervention, though success rates vary. However, the importance of staff compliance with these effective, but often time-consuming, multifactorial interventions has not been fully investigated in a routine clinical setting. The purpose of this observational study was to describe the effectiveness of a multidisciplinary quality improvement (QI) activity for accidental fall prevention, with particular focus on staff compliance in a non-experimental clinical setting.MethodsThis observational study was conducted from July 2004 through December 2010 at St. Luke’s International Hospital in Tokyo, Japan. The QI activity for in-patient falls prevention consisted of: 1) the fall risk assessment tool, 2) an intervention protocol to prevent in-patient falls, 3) specific environmental safety interventions, 4) staff education, and 5) multidisciplinary healthcare staff compliance monitoring and feedback mechanisms.ResultsThe overall fall rate was 2.13 falls per 1000 patient days (350/164331) in 2004 versus 1.53 falls per 1000 patient days (263/172325) in 2010, representing a significant decrease (p = 0.039). In the first 6 months, compliance with use of the falling risk assessment tool at admission was 91.5% in 2007 (3998/4368), increasing to 97.6% in 2010 (10564/10828). The staff compliance rate of implementing an appropriate intervention plan was 85.9% in 2007, increasing to 95.3% in 2010.ConclusionIn our study we observed a substantial decrease in patient fall rates and an increase of staff compliance with a newly implemented falls prevention program. A systematized QI approach that closely involves, encourages, and educates healthcare staff at multiple levels is effective.

Predictive Validity and Cut-Off Scores in Four Diagnostic Tests for Falls – A Study in Frail Older People at Home

ABSTRACTNo study has investigated the predictive validity and cut-off scores in diagnostic tests for falls used in in-home assessment in frail older people. The objective was to investigate the predictive validity for falls in the Downton Fall Risk Index (DFRI), Timed Up and Go (TUG) and Romberg test (RT) used in in-home assessment of frail older people (65+ years). Data on the diagnostic tests were collected at baseline (N = 153) and fall frequency were collected at six- and twelve-month follow-ups. The optimal cut-offs were 3 p in DFRI and 12 s in TUG. However, the validity indexes were generally low and only 40–50% were correctly classified. The RT showed low sensitivity. To increase the predictive validity for falls in this context, the use of DFRI and/or TUG as a part of a comprehensive fall-risk assessment tool, should be investigated in future studies.

Beyond the ‘tick and flick’: facilitating best practice falls prevention through an action research approach

To examine residential aged care facility staff views on using falls risk assessment tools and the implications for developing falls prevention practices in the context of an action research project. Falls risk assessments play an important role in care planning by identifying and monitoring aged care facility residents most at risk of falls. Yet while such assessments are recommended in falls prevention best practice guidelines, there is little published research that examines staff procedures and views related to conducting falls risk assessments. Falls risk assessments were undertaken in the context of an action research project. Twelve staff members from two residential aged care facilities (RACFs) in Tasmania formed a single Falls Action Research Group, which met 22 times over a year, providing the study's qualitative data. During this time, key group members assessed 178 residents using a new falls risk assessment tool (FROP-Resi). According to group members, facilities evolved from a 'tick-and-flick' approach to falls risk assessment to a more individualised, face-to-face assessment process. Group members perceived the process to be more meaningful and enjoyable for staff involved in the assessment process resulting in higher quality of assessments and leading to improved levels of falls awareness among staff, residents and family caregivers. An action research process is useful for facilitating a new approach to falls risk assessments, engaging aged care facility staff with falls prevention and prompting improvements in falls prevention practices. RACFs need to provide opportunities for staff to meet regularly to discuss practice, identify issues and take action. By doing so, staff can engage meaningfully with best practice activities such as optimising falls risk assessment processes.

Comparison of two fall risk assessment tools (FRATs) targeting falls prevention in sub-acute care

FRATs are designed to identify both persons at high risk of falls and to allow for cost-effective targeting of fall prevention strategies. This study compares two FRATs (BHS FRAT and TNH-STRATIFY) for accuracy of predicting falls and targeting of fall prevention strategies in a sub-acute hospital. Comparisons of retrospective audit data over two periods (use of the BHS-FRAT; post TNH-STRATIFY implementation) were used in the evaluation (n=362). Inter-rater reliability of the TNH-STRATIFY was evaluated from independent assessment by two nurses for 30 sub-acute patients and using intraclass correlation coefficient (ICC2,1). Event rate (ER) and standard measures of predictive accuracy were calculated for both FRATs. The proportions of patients with documented fall prevention strategies addressing identified fall risk factors were compared between audit phases. The TNH-STRATIFY had high inter-rater reliability (ICC2,1=0.96). The BHS-FRAT and TNH-STRATIFY demonstrated poor predictive accuracy using recommended high risk cut-off scores, with low specificityER (0.07 and 0.13 respectively) and very low Youden IndexER (0.04 and 0.07 respectively), although these measures improved using modified cut-off scores. Positive and negative predictive values were moderate for the BHS-FRAT (0.51, 0.64) and TNH-STRATIFY (0.52, 0.61). The falls rate and proportion of recurrent fallers did not change between audit phases. Implementation rates for prevention strategies for key risk factors were higher following implementation of the TNH-STRATIFY. The results indicated that the TNH-STRATIFY, combined with associated nursing care plan falls documentation, improved the targeting of prevention strategies for key risk factors such as cognitive impairment, incontinence and mobility impairment.

Effectiveness of interventions for the assessment and prevention of falls in adult psychiatric patients: A systematic review.

Patient fall is among the top five sentinel events in hospitals due to the resultant functional loss and injury sustained. Precise fall risk assessment and prevention strategies are important components of a fall prevention program. Due to psychiatric conditions and medications, these patients may require a different fall management program compared to other patient populations. The objective of this review was to identify the best available evidence for the effectiveness of nursing fall risk assessment tools, interventions to reduce incidence of falls, and common risk factors of adult psychiatric patients who fall. Adults (19 to 64 years) diagnosed with mental illnessEvaluation of nursing fall risk assessment tools in adult psychiatric settings, and interventions, which minimised fall risk or fall rates.Number of patient falls during hospitalisation was the main outcome.Primary quantitative studies published in English language. The literature search sought published studies, and was limited to English language reports. There were no date restrictions applied to the search. Electronic databases searched included:CINAHLPubMedCochrane Central Register of Controlled TrialsPsycINFOScienceDirectScopusWeb of ScienceWiley-InterScienceProQuestMedNar METHODOLOGICAL QUALITY: Studies retrieved were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI-SUMARI). Data including specific details about the methods, settings, purposes, populations, interventions, and outcomes significant to the review's objectives were extracted by two independent reviewers using standardised data extraction tools from JBI-SUMARI. Eleven studies were included in this review: three before-and-after studies, four descriptive studies, two case control studies and two cohort studies. Evidence with regards to the effectiveness of fall risk assessment tools and prevention strategies was inconclusive. Certain risk factors which were more frequently associated with falls included diagnoses of depression, bipolar disorder, and dementia / Alzheimer's disease, altered mental status, physiological symptoms, past history of falls, mobility and gait problems, concurrent medical conditions, polypharmacy, and taking of certain medications such as sedatives, antidepressants and mood stabilisers, particularly lithium. Evidence on the effectiveness of fall risk assessment tools and prevention strategies in psychiatric setting was inconclusive due to a paucity of studies. However, certain risk factors were found to be more commonly associated with falls in adult psychiatric patients (Level III Evidence).Constant observation of the side effects of medications, particularly orthostatic hypotension, and review of patients' medical profile by doctors or pharmacists may be helpful in preventing falls in psychiatric patients. Findings on common risk factors can better aid healthcare professionals in identifying psychiatric patients who are at risk for falls.More research is needed on the evaluation of fall risk assessment tools and fall prevention strategies, specifically for the adult psychiatric patients. More prospective and better quality studies examining fall risk factors in psychiatric patients are needed.

A Qualitative Review of Balance and Strength Performance in Healthy Older Adults: Impact for Testing and Training

A continuously greying society is confronted with specific age-related health problems (e.g., increased fall incidence/injury rate) that threaten both the quality of life of fall-prone individuals as well as the long-term sustainability of the public health care system due to high treatment costs of fall-related injuries (e.g., femoral neck fracture). Thus, intense research efforts are needed from interdisciplinary fields (e.g., geriatrics, neurology, and exercise science) to (a) elucidate neuromuscular fall-risk factors, (b) develop and apply adequate fall-risk assessment tools that can be administered in clinical practice, and (c) develop and design effective intervention programs that have the potential to counteract a large number of fall-risk factors by ultimately reducing the number of falls in the healthy elderly. This paper makes an effort to present the above-raised research topics in order to provide clinicians, therapists, and practitioners with the current state-of-the-art information.

Breaking the Fall

: The Helping Hands program is a nurse-directed falls prevention program designed to support a hospital-wide culture of safety and reduce harm from falls. : Patient falls and the associated morbidity and mortality represent a significant risk for patients and healthcare facilities. Age-adjusted fatalities from falls increased significantly from 1993 to 2003. By 2020, the annual cost of injuries from falls is expected to exceed $40 billion. : Components of the Helping Hands falls prevention program worked synergistically to support the development of a culture of safety at Robert Wood Johnson University Hospital. The program consisted of nursing assessment of fall risk with the Johns Hopkins Fall Risk Assessment Tool; reviews of fall risk and intervention efficacy; creation of communication mechanisms, reporting processes, and change champion roles; engagement of patients and families in falls prevention; increased public awareness of fall risk through signage; nursing interventions; and utilization of nursing performance improvement analysts. : Over 3 years, 65% (N = 7,900) of more than 12,000 patients assessed were at risk of falling. Most falls caused no or little harm, and at 3 years of follow-up, total falls decreased by 16.6 %, and severe falls accounted for 0.009 % (n = 2) of all falls. : The data offer a hopeful perspective on the role of nursing engagement in developing a hospital-wide culture of safety and protecting patients from permanent harm caused by fall events.