Fall Prevention Interventions Research Articles

Fall Assessment and Monitoring in People With Multiple Sclerosis: A Practical Evidence-Based Review for Clinicians.

Falls occur in more than half of all people with multiple sclerosis (MS) but tend to be underdiagnosed and underreported in clinical encounters. This narrative review aims to summarize evidence-based approaches for evaluating fall risk and proven treatment strategies to reduce falling in people with MS to improve care for people with MS and to enhance interprofessional care coordination between treating neurologic and physical therapy (PT) teams. Screening not just for falls but for near-falls as well because fear of falling can improve fall assessment and identify patients who may benefit from fall prevention interventions. A number of barriers, including time constraints during visits and the fallacy that falling is inevitable in MS, can limit clinician awareness about patient falls and delay timely referral to PT. Consultation with physical therapists for individualized fall prevention treatment can reduce risk of falling. Interventional studies have also shown that PT-guided exercise programs improve balance confidence in people with MS. However, people with MS are often under-referred to PT by treating clinicians. A clinical approach is provided to summarize practical, accessible, evidence-based, low-burden measurements and interventions likely to improve ascertainment of patients at risk of falling and optimize timely PT referral and treatment.

164 Association between medications and increased fall risk among older adults: implications for medication management and fall prevention interventions

Abstract Background Falls among older adults are a significant public health concern, and certain medications have been identified as potential risk factors. The National integrated care programme for older people is prioritising services to be developed for older people in the areas of frailty, dementia and falls. Methods Information on recurrent falls, polypharmacy, and the number of falls experienced by each patient was collected retrospectively via chart review. Logistic regression analysis was performed to assess the association between STOPPfall medication use and the risk of falling, with odds ratios and p-values reported. Results Data was available on 48 patients (median age 79, range 65–92) of a total of 73 patients seen. The gender distribution was 62.5% female. Among the patients included, 31 experienced recurrent falls, and polypharmacy was observed in 35 patients. The distribution of falls in the previous year was as follows: 8 patients had three or more falls, 5 patients had two falls, 18 patients had one fall, and 14 patients did not experience any falls. Logistic regression analysis revealed that the use of antihypertensive medications was associated with an increased risk of falling, with an odds ratio of 3.85 (CI =1.08–13.75, p = 0.037). There was no statistically significant association between falls and other STOPPfall medication. Conclusion In this study, antihypertensive medications were found to be significantly associated with an increased risk of falling among older adults. These findings emphasise the importance of considering medication-related factors when assessing fall risk in this population. Further research is warranted to determine whether appropriate medication management strategies can mitigate fall risk. Effective fall prevention interventions should incorporate comprehensive medication reviews, particularly for patients on antihypertensive therapy, to optimise patient safety and reduce the burden of falls in older adults.

93 Reduce falls rates in care homes by replacing falls risk screening with a Multifactorial Falls Risk Assessment Tool

Abstract Background Following a review (Nov 2022) of 203 residents across four locations, it was noted that falls risk screening tools were used to identify falls risk status. This resulted in a proportion of residents identified as low (5%) and medium risk (28%). New falls prevention guidelines incorporating care homes, recommend against falls risk screening (Montero-Odassa et al, 2022). The guidelines recommend that all residents in care homes should be considered at high risk of falls and use of a Multifactorial Falls Risk Assessment Tool (MFRAT) is preferable in falls prevention. Our aim is a reduction in falls rate by discontinuing the use of falls risk screening tools and implementing a MFRAT. Embed this change within a new standardised falls policy and deliver staff education sessions to support this change. Methods Stakeholder engagement and development of a falls committee with seven representatives across each location including nursing, management, quality and patient safety advisor and falls coordinator was undertaken. Communication strategy of weekly online meetings developed a standardised falls policy, tailored MFRAT and audit tool to monitor compliance. Reported falls were cross referenced with our national incident management system. Falls rate calculation across each location was used to measure the impact of change. Results Results demonstrated a 29% reduction in falls rate for the first quarter of 2023, compared to 2022. 100% compliance with policy implementation across all locations, with 68% of staff trained through education sessions face to face and online. Conclusion Implementing a MFRAT, aligned with new world guidelines, supported by staff education, and associated falls prevention interventions provides a reduction in fall rates in care home residents. The process of falls rate calculation across locations provides ease of evaluation.

Age Is Not Just a Number: The Intersection of Age, Orthopedic Injuries, and Worsening Outcomes Following Low-Energy Falls.

The purpose of this study is to stratify the age at which older adults are most likely to sustain injuries and major complications resulting from low-energy falls so that fall prevention strategies may be targeted to more susceptible age groups. A consecutive series of 12 709 patients older than 55 years enrolled in an orthopedic trauma registry from October 2014 to April 2021 were reviewed for demographic factors, hospital quality measures, and outcomes. Patients were grouped by age brackets in 5-year intervals. Comparative analyses were conducted across age groups with an additional post hoc analysis comparing the 75- to 79-year-old cohort with others. All statistical analyses were conducted utilizing a Bonferroni-adjusted alpha. Of the 12 709 patients, 9924 patients (78%) sustained a low-energy fall. The mean age of the cohort was 75.3 (range: 55-106) years and the median number of complications per person was 1.0 (range: 0-7). The proportion of females increased across each age group. The mean Charlson Comorbidity Index increased across each age group, except in the cohort of 90+ years of age. There was a varied distribution of fractures among age groups with the incidence of hip fractures most prominently increasing with age. Complication rates varied significantly between all age groups. Between the ages of 70 to 74 years and 80 to 84 years, there was a 2-fold increase in complication rate, and between the ages of 70 to 74 years and 75 to 79 years, there was a near 2×/1.5×/1.4× increase in inpatient, 30-day, and 1-year mortality rate, respectively. When controlling for confounding demographic variables between age groups, the rates of complications and mortality still differed. Fall prevention interventions, while applicable to all older adult patients, could improve outcomes by offering additional resources particularly for individuals between 70 and 80 years of age. These additional resources can help minimize excessive hospitalizations, prolonged lengths of stay, and the detrimental complications that frequently coincide with falls. Although hip fractures are the most common fracture as patients get older, other fractures still occur with frequency, and fall prevention strategies should account for prevention of these injuries as well.

O.4.1-1 Impact of a pre-pandemic, tele-exercise, fall-prevention intervention on outcomes in older adults

Abstract Purpose This pre-pandemic study used an alternative delivery mode to provide an evidence-based, fall-prevention exercise intervention to older adults. We delivered Tai Ji Quan: Moving for Better Balance® (TJQMBB) via tele-exercise and determined its impact on self-reported and performance-based outcomes in older adults. Methods Five community sites (3 urban, 2 rural) held 6, 1-hour, synchronous TJQMBB classes, over the internet, twice weekly for 16 weeks (32 hours). Baseline and 16-week self-reported data included fear of falling (Falls Efficacy Scale), depression (Geriatric Depression Scale-Short), physical and mental health-related quality of life (HRQOL) (SF-12 PCS and MCS), and total minutes of physical activity per week. Performance-based outcomes included a 5-Meter Walk Test (gait speed), the Timed Up-and-Go Test (mobility), the 4-Square Step Test (balance), and the 5-Times Sit-to-Stand Test (leg strength). Height and weight were used to calculate body mass index (BMI). Paired t-tests and Friedman 2-Way ANOVA tests examined changes in outcomes between baseline and 16 weeks. Results Sixty-three (79.7%) of 79 people were eligible, of which 52 (82.5%) enrolled. Participants were a mean ± SD age of 68.5 ± 7.7 years old, primarily white (96.2%), and female (80.8%). There were no significant improvements in fear of falling (X2r =3.8, p = 0.15), depression (X2r =0.19, p = 0.91), physical (X2r =1.2, p = 0.56) or mental (X2r =0.31, p = 0.86) HRQOL, or physical activity (X2r =3.7, p = 0.16). Gait speed (meters/second) significantly improved from baseline (1.1 ± 0.2) to 16 weeks (1.2 ± 0.2) (p = 0.02). Balance, leg strength, and BMI also improved significantly (balance [seconds]: baseline 10.9 ± 2.4, 16 weeks 10.2 ± 2.5, p = 0.045; strength [seconds]: baseline 14.7 ± 5.7, 16 weeks 12.4 ± 2.9, p = 0.01; BMI [kg/m2]: baseline 30.8 ± 6.3, 16 weeks 30.2 ± 5.6, p < 0.01). There were no changes in mobility (p = 0.16). Conclusions This tele-TJQMBB intervention improved physical function (gait speed, balance, leg strength) and BMI in older adults. Tele-TJQMBB provided an alternative delivery mode that could help overcome the barrier of identifying experienced instructors in rural areas, and could expand TJQMBB’s reach into the older adult population. Future comparative effectiveness studies could establish if outcomes are equivalent between in-person and tele-exercise delivery modes.

O.4.1-10 The FITT guidelines for multicomponent fall prevention programmes for community-dwelling older adults

Abstract Purpose The most commonly proposed intervention for fall prevention in community-dwelling older adults is a multicomponent exercise programme. This is a structured form of exercise that improves muscle performance, balance, proprioception, coordination, mobility, and gait. It usually includes balance and functional exercises versus control. Although it has been suggested that exercise programmes for fall prevention should be performed three or more times per week, no precise guidelines for frequency (F), intensity (I), T(time), and T(type) of a multicomponent exercise programme have been proposed. It has already been pointed out that frequency, type, and time of a multicomponent exercise programme do not explain the effects of balance exercises in older adults. The aim of this systematic review was to evaluate the reporting of FITT guidelines for a multicomponent exercise programme for fall prevention in community-dwelling older adults, with a focus on intensity. Methods Systematic reviews of randomised control trials comparing the effectiveness of structured, multicomponent fall prevention programmes in community-dwelling older adults were included. Studies that focused on a specific condition, such as stroke, were excluded. We included only studies that compared fall rates before and after the multicomponent programme. PubMed, PEDro, EMBASE, Scopus were searched until January 2023. Results Preliminary results showed that FITT guidelines for multicomponent exercise were not consistently reported across studies. In particular, exercise intensity was often not reported. Without a valid and reliable measure of exercise intensity, the dose-response relationship for a multicomponent exercise programme should be further investigated. Conclusions Limitations of this systematic review include variability in the design of multicomponent interventions and incomplete reporting of FITT in reported studies. Support/Funding Source The study is founded from Next Generation EU Recovery and Resilience Facility and resources from National institute of public health Slovenia.

Lower extremity joint power and work during recovery following trip-induced perturbations

BackgroundSuccessful recovery following a perturbation during walking depends on a quick well-coordinated response from the body. As such, lower limb joint power and work provide critical information characterizing the success of the recovery after a perturbation. Therefore, this study aimed to investigate lower-limb joint power and the relative contribution of each joint to the total leg work during the recovery following a trip-induced perturbation. MethodsTwenty-four young male volunteers walked at 1.1 m/s for 2 min, followed by two unexpected perturbations induced by rapidly decelerating the right belt of the split-belt treadmill. Joint moments and powers were calculated using an inverse dynamic approach. Joint work was found as the integral of joint power with respect to time. Statistical parametric mapping (SPM) and paired-sample t-tests were used to compare joint power and work between recovery and unperturbed steps. ResultsCompared to normal walking, recovery from the trip required a significant increase in both positive (+27 %, p < 0.05) and negative(+28 %,p < 0.05) leg work. During unperturbed walking, the ankle was the key contributor to both positive (ankle=50 %, hip=34 %, and knee=15 %) and negative (ankle=62 %, knee=32 %, and hip=6 %) leg work. During recovery, the knee eccentric work significantly increased (+83 %,p < 0.05) making it the main contributor to the negative leg work (knee=46 %, ankle=45 %, and hip=9 %). The hip positive work also increased during recovery (+62.7 %, p < 0.05), while ankle and the knee positive work remained unchanged. SignificanceThese findings highlight the importance of eccentric work of the knee, and concentric work of the hip joint during recovery from trip-induced perturbations. The additional mechanical demand of producing and absorbing more power during recovery is primarily imposed on the knee and hip, rather than the ankle. This new insight into the specific functions of lower-limb joints during recovery from trip-induced perturbations has important implications for the design of targeted fall prevention interventions.

Prevention of Falls in Parkinson's Disease: Guidelines and Gaps.

People living with Parkinson's disease (PD) have a high risk for falls. To examine gaps in falls prevention targeting people with PD as part of the Task Force on Global Guidelines for Falls in Older Adults. A Delphi consensus process was used to identify specific recommendations for falls in PD. The current narrative review was conducted as educational background with a view to identifying gaps in fall prevention. A recent Cochrane review recommended exercises and structured physical activities for PD; however, the types of exercises and activities to recommend and PD subgroups likely to benefit require further consideration. Freezing of gait, reduced gait speed, and a prior history of falls are risk factors for falls in PD and should be incorporated in assessments to identify fall risk and target interventions. Multimodal and multi-domain fall prevention interventions may be beneficial. With advanced or complex PD, balance and strength training should be administered under supervision. Medications, particularly cholinesterase inhibitors, show promise for falls prevention. Identifying how to engage people with PD, their families, and health professionals in falls education and implementation remains a challenge. Barriers to the prevention of falls occur at individual, environmental, policy, and health system levels. Effective mitigation of fall risk requires specific targeting and strategies to reduce this debilitating and common problem in PD. While exercise is recommended, the types and modalities of exercise and how to combine them as interventions for different PD subgroups (cognitive impairment, freezing, advanced disease) need further study.

Feasibility, effectiveness and acceptability of two perturbation-based treadmill training protocols to improve reactive balance in fall-prone older adults (FEATURE): protocol for a pilot randomised controlled trial

IntroductionPerturbation-based balance training (PBT) targets the mechanism of falls (eg, slipping, tripping) to specifically train the recovery actions needed to avoid a fall. This task-specific training has shown great promise...

Potential Factors Associated with Healthcare Utilization for Balance Problems in Community-Dwelling Adults within the United States: A Narrative Review.

Falls are the leading cause of mortality and chronic disability in elderly adults. There are effective fall prevention interventions available. But only a fraction of the individuals with balance/dizziness problems are seeking timely help from the healthcare system. Current literature confirms the underutilization of healthcare services for the management of balance problems in adults, especially older adults. This review article explores factors associated with healthcare utilization as guided by the Andersen Healthcare Utilization Model, a framework frequently used to explore the factors leading to the use of health services. Age, sex, race/ethnicity, BMI, and comorbidities have been identified as some of the potential predisposing factors; socioeconomic status, health insurance, and access to primary care are the enabling and disabling factors; and severity of balance problem, perceived illness, and its impact on daily activities are the factors affecting need for care associated with healthcare utilization for balance or dizziness problems. Knowledge about these barriers can help direct efforts towards improved screening of vulnerable individuals, better access to care, and education regarding effective fall prevention interventions for those who are at risk for underutilization. This can aid in timely identification and management of balance problems, thereby reducing the incidence of falls.

Nursing interventions for fall prevention in hospitalized aged people: an integrative review

Objective: to identify nursing interventions for fall prevention in hospitalized aged people. Methods: integrative review developed on the Web of Science, MEDLINE/PubMed, SCOPUS, CINAHL and LILACS databases using the PICo strategy with controlled descriptors and their combinations using the Boolean operators AND and OR. Studies addressing interventions to prevent falls in aged people in the hospital setting were included, without geographical or language limitation, from 2004 with the creation of The World Alliance for Patient Safety. Three reviewers worked on the citations, using EndNote basic and Rayyan, reaching a final sample of 20 studies. Results: 202 nursing interventions were identified for fall prevention in hospitalized aged people, categorized into six domains of the Nursing Interventions Classification (Physiological: basic; Physiological: complex; Behavioral; Safety; Family; Health Systems). Conclusion: nursing interventions were identified for the prevention of falls in hospitalized aged people, which provides subsidies for the construction of care protocols and improvements in care. Contributions to practice: the results allow nurses to prevent the occurrence of falls, putting into practice consistent scientific findings from the planning of actions to the execution and reassessment of results with the team.

‘Maintaining balance in life’—exploring older adults’ long-term engagement in self-managed digital fall prevention exercise

BackgroundAccidental falls are one of the greatest threats to older adults’ health and well-being. The risk of falling can be significantly reduced with strength and balance interventions. However, there needs to be further knowledge into how older adults can be supported to achieve a maintained exercise behaviour. Therefore, the aim of this study was to explore factors that enabled older adults to maintain their exercise during a 1-year self-managed digital fall prevention exercise intervention.MethodsThis study used a grounded theory methodology. Semi-structured individual interviews were conducted by phone or conference call. Eighteen community-dwelling older adults aged 70 years or more participated. The participants had a self-reported exercise dose of 60 min or more per week during the last three months of participation in a 12-months intervention of self-managed digital fall prevention exercise, the Safe Step randomized controlled trial. Open, axial, and selective coding, along with constant comparative analysis, was used to analyze the data.ResultsThe analysis resulted in a theoretical model. We found that the fall prevention exercise habits of adults were developed through three stages: Acting against threats to one’s own identity, Coordinating strategies to establish a routine, and Forming habits through cues and evaluation. The main category of Maintaining balance in life encases the participants transition through the three stages and reflects balance in both physical aspects and in between activities in daily life. The process of maintaining balance in life and desire to do so were mediated both by intrinsic person-dependent factors and the Safe Step application acting as an external mediator.ConclusionThis study identified three stages of how older adults developed self-managed fall prevention exercise habits, supported by a digital application. The generated theoretical model can inform future interventions aiming to support long-term engagement in digitally supported and self-managed fall prevention interventions.

Interventions to reduce falls in community-dwelling adults with intellectual disability: a systematic review.

People with intellectual disability have a high risk of falls and falls-related injuries. Although people with intellectual disability are at increased risk of falls, there is a need to better understand the efficacy of interventions that can help reduce falls and address risk factors in this population. This systematic review aimed to evaluate the type, nature and effectiveness of interventions undertaken to reduce falls with community-dwelling adults with intellectual disability and the quality of this evidence. Four electronic databases were searched: Ovid MEDLINE, PsycINFO, CINAHL Plus and the Cochrane Library. Studies were included if they involved people aged 18years or over, at least 50% of study participants had intellectual disability, participants were community-dwelling, and the study evaluated any interventions aiming to reduce falls. Study quality was assessed using the National Institutes of Health study quality assessment tools. Reporting of the review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seven studies were eligible for review, with a total of 286 participants and mean age of 50.4years. As only one randomised trial was identified, a narrative synthesis of results was undertaken. Five studies evaluated exercise interventions, one evaluated a falls clinic programme, and one evaluated stretch fabric splinting garments. Methodological quality varied (two studies rated as good, four as fair, and one as poor). Exercise interventions varied in terms of exercise type and dosage, frequency and intensity, and most did not align with recommendations for successful falls prevention exercise interventions reported for older people. While the majority of studies reported reduced falls, they differed in methods of reporting falls, and most did not utilise statistical analyses to evaluate outcomes. This review identified a small number of falls prevention intervention studies for people with intellectual disability. Although several studies reported improvements in fall outcomes, ability to draw conclusions about intervention effectiveness is limited by small sample sizes and few studies. Further large-scale research is required to implement and evaluate falls prevention interventions specifically for adults with intellectual disability.

Current Cut Points of Three Falls Risk Assessment Tools Are Inferior to Calculated Cut Points in Geriatric Evaluation and Management Units

Background: Falls risk assessment tools are used in hospital inpatient settings to identify patients at increased risk of falls to guide and target interventions for fall prevention. In 2022, Western Health, Melbourne, Australia, introduced a new falls risk assessment tool, the Western Health St. Thomas’ Risk Assessment Tool (WH-STRATIFY), which adapted The Northern Hospital’s risk tool (TNH-STRATIFY) by adding non-English speaking background and falls-risk medication domains to reflect patient demographics. WH-STRATIFY replaced Peninsula Health Risk Screening Tool (PH-FRAT) previously in use at Western Health. This study compared the predictive accuracy of the three falls risk assessment tools in an older inpatient high-risk population. Aims: To determine the predictive accuracy of three falls risk assessment tools (PH-FRAT, TNH-STRATIFY, and WH-STRATIFY) on admission to Geriatric Evaluation Management (GEM) units (subacute inpatient wards where the most frail and older patients rehabilitate under a multi-disciplinary team). Method: A retrospective observational study was conducted on four GEM units. Data was collected on 54 consecutive patients who fell during admission and 62 randomly sampled patients who did not fall between December 2020 and June 2021. Participants were scored against three falls risk assessment tools. The event rate Youden (Youden IndexER) indices were calculated and compared using default and optimal cut points to determine which tool was most accurate for predicting falls. Results: Overall, all tools had low predictive accuracy for falls. Using default cut points to compare falls assessment tools, TNH-STRATIFY had the highest predictive accuracy (Youden IndexER = 0.20, 95% confidence interval CI = 0.07, 0.34). The PH-FRAT (Youden IndexER = 0.01 and 95% CI = −0.04, 0.05) and WH-STRATIFY (Youden IndexER = 0.00 and 95% CI = −0.04, 0.03) were statistically equivalent and not predictive of falls compared to TNH-STRATIFY. When calculated optimal cut points were applied, predictive accuracy improved for PH-FRAT (Cut point 17, Youden IndexER = 0.14 and 95% CI = 0.01, 0.29) and WH-STRATIFY (Cut point 7, Youden IndexER = 0.18 and 95% CI = 0.00, 0.35). Conclusions: TNH-STRATIFY had the highest predictive accuracy for falls. The predictive accuracy of WH-STRATIFY improved and was significant when the calculated optimal cut point was applied. The optimal cut points of falls risk assessment tools should be determined and validated in different clinical settings to optimise local predictive accuracy, enabling targeted fall risk mitigation strategies and resource allocation.

A Process Evaluation of a Fall Prevention Intervention Using the RE-AIM Framework.

Home hazard removal programs are effective in reducing falls among older adults, but delivery in the United States is limited. We completed a process evaluation of the Home Hazard Removal Program (HARP), an intervention delivered by occupational therapists. Using the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), we examined outcomes using descriptive statistics and frequency distribution. We examined differences between covariates using Pearson correlation coefficients and two-sample t tests. 79.1% of eligible older adults participated (reach); they experienced a 38% reduction in fall rates (effectiveness). Ninety percent of recommended strategies were completed (adoption), 99% of intervention elements were delivered (implementation), and 91% of strategies were still used at 12 months (maintenance). Participants received an average of 258.6 minutes of occupational therapy. An average of US$765.83 was spent per participant to deliver the intervention. HARP has good reach, effectiveness, adherence, implementation, and maintenance and is a low-cost intervention.

Online Fall Risk Management Program for People With Multiple Sclerosis Who Use Wheelchairs or Scooters: A Pilot Study With Promising Findings

Abstract Date Presented 04/22/2023 A preintervention–postintervention study to evaluate iROLL-O, an online fall prevention intervention for people with multiple sclerosis who use a wheelchair or scooter, is described. Findings advance evidence-based fall prevention practice. Primary Author and Speaker: Toni Van Denend Additional Authors and Speakers: Amy McArthur Contributing Authors: Elizabeth Walker Peterson, Deborah Backus, Jacob Sosnoff, Libak Abou, Arman Sandhu, Laura Rice

Novel interventions significantly reduce falls with fractures: A meta-analysis and systematic review

IntroductionWorldwide, falls lead to possible complications such as prolonged hospitalization, prolonged bed rest, pressure injuries, fractures and mortality. AimsThe study aimed to evaluate the effectiveness of novel fall prevention strategies that utilized technology in preventing falls. MethodsThe meta–analysis and systematic review was guided by the Cochrane guidelines for systematic reviews of interventions. The authors searched databases for specified keywords. ResultsA total of 22 studies were included. Interventions included multi-modal fall prevention interventions, camera surveillance, motion sensors and bed/chair exit alarms. Video monitoring was equivocal in reducing fall rates. Exit alarms statistically significantly reduce falls between groups but not within groups. The interventions were not statistically significant in reducing falls with minor injuries but they were statistically significant in reducing falls with serious injuries including fractures. ConclusionA comprehensive fall prevention care plan, rather than one specific intervention, is necessary to prevent falls effectively.

Nurses' experiences of using falls alarms in subacute care: A qualitative study.

Bed and chair alarms have been included in many multifaceted falls prevention interventions. None of the randomised trials of falls alarms as sole interventions have showed significant effect on falls or falls with injury. Further, use of bed and chair alarms did not change patients' fear of falling, length of hospital stay, functional status, discharge destination or health related quality of life. The aim of this study was to explore nurses' experiences of using bed and chair alarms. A qualitative descriptive study using semi-structured interviews with a purposive sample of 12 nurses was conducted on a 32-bed Geriatric Evaluation and Management ward in Melbourne, Australia. Participants were interviewed between 27 January and 12 March 2021.Transcribed audio-recordings of interviews were analysed using inductive thematic analysis. NVIVO 12.6 was used to manage the study data. Three major themes and four subthemes were constructed from the data: i) negative impacts of falls alarms (subthemes: noisy technology, imperfect technology), ii) juggling the safety-risk conflict, and iii) negotiating falls alarm use (subthemes: nurse decision making and falls alarm overuse). Nurses' experience of using falls alarms was predominantly negative and there was tension between falls alarms having limited impact on patient safety and risks associated with their use. Nurses described a need to support nurse decision making related to falls alarms use in practice and policy, and a desire to be empowered to manage falls risk in other ways.

Exploring variation in implementation of multifactorial falls risk assessment and tailored interventions: a realist review

BackgroundFalls are the most common safety incident reported by acute hospitals. In England national guidance recommends delivery of a multifactorial falls risk assessment (MFRA) and interventions tailored to address individual falls risk factors. However, there is variation in how these practices are implemented. This study aimed to explore the variation by examining what supports or constrains delivery of MFRAs and tailored interventions in acute hospitals.MethodsA realist review of literature was conducted with searches completed in three stages: (1) to construct hypotheses in the form of Context, Mechanism, Outcome configurations (CMOc) about how MFRAs and interventions are delivered, (2) to scope the breadth and depth of evidence available in Embase to test the CMOcs, and (3) following prioritisation of CMOcs, to refine search strategies for use in multiple databases. Citations were managed in EndNote; titles, abstracts, and full texts were screened, with 10% independently screened by two reviewers.ResultsTwo CMOcs were prioritised for testing labelled: Facilitation via MFRA tools, and Patient Participation in interventions. Analysis indicated that MFRA tools can prompt action, but the number and type of falls risk factors included in tools differ across organisations leading to variation in practice. Furthermore, the extent to which tools work as prompts is influenced by complex ward conditions such as changes in patient condition, bed swaps, and availability of falls prevention interventions. Patient participation in falls prevention interventions is more likely where patient directed messaging takes individual circumstances into account, e.g., not wanting to disturb nurses by using the call bell. However, interactions that elicit individual circumstances can be resource intensive and patients with cognitive impairment may not be able to participate despite appropriately directed messaging.ConclusionsOrganisations should consider how tools can be developed in ways that better support consistent and comprehensive identification of patients’ individual falls risk factors and the complex ward conditions that can disrupt how tools work as facilitators. Ward staff should be supported to deliver patient directed messaging that is informed by their individual circumstances to encourage participation in falls prevention interventions, where appropriate.Trial registrationPROSPERO: CRD42020184458.

The direct and mediating effects of cognitive impairment on the occurrence of falls: a cohort study based on community-dwelling old adults.

Cognitive impairment has been reported to be associated with falls in older adults. However, the complex relationship among falls, cognitive impairment and its associated factors, which could be targeted with specific interventions, remains to be elucidated. This study aimed to examine the direct effects of cognitive impairment on falls, to identify the factors associated with cognitive impairment and to explore the mediation role of cognitive impairment in the association of fall with cognition related factors. This 1-year follow-up cohort study enrolled old adults aged 60 years or over. Information about demographic and anthropometric characteristics, fall outcomes, function and nutritional status were collected through face-to-face interview. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA). Multivariable regression analyses were used to test the association between cognitive impairment and falls and to identify the factors related to cognitive impairment. Additionally, we conduct causal mediation analyses to estimate the mediation effects of cognitive impairment in the pathways of fall occurrence. Of the 569 participants included in this study, 366 (64.32%) had cognitive impairment, 96 (16.87%) had fall history in the past 1 year, 81 (14.24%) experienced fall and 47 (8.26%) received treatment because of falling during the 1-year follow-up. The association between cognitive impairment and 1-year fall risk was confirmed after adjusting for multiple covariates [odds ratio (OR):2.03, 95% confidence interval (CI): 1.13-3.80]. IADL disability, depression and low grip strength were associated with a higher prevalence of cognitive impairment. While overweight, higher education and higher income level were found to be related to a lower risk of cognitive impairment. Among these associated factors, cognitive impairment mediated the positive association of falling with IADL ability and depression, and a negative relationship with education and income level. Our study not only confirmed the direct influence of cognitive impairment on fall risk in older adults, but also suggested a mediating role that cognitive impairment played in the pathways of fall occurrence. Our finding could help develop more specific interventions for fall prevention.