Fall Risk Management Research Articles

Fall Risk Management by Nurses in the Inpatient Wards of Aceh Government Regional General Hospital, Indonesia

A patient fall is an incident that commonly occurs with or without injury. Not only does it potentially cause injury, but these incidents can also prolong the length of stay and increase the treatment cost. Nurses play an essential role in assessing and preventing the risk of falls in patients through appropriate education and preventive measures by Standard Operating Procedures (SOP). Effective implementation of SOPs can reduce the frequency and impact of fall incidents and improve the safety and quality of patient care. This case study aimed to expound on fall risk management in the Aceh Government Regional General Hospital wards. A quantitative case study type with a cross-sectional study was designed. The sample consisted of 28 nurses, and the data collection tool used an observation sheet to examine the implementation of fall risk management following the hospital SOP. Data analysis used descriptive statistical tests; the data was then presented as a frequency distribution table. The results show that 67.9% of nurses implemented fall risk management, and 32.1% did not implement it. It was essential to increase nurses’ compliance with the SOP for managing fall risk by monitoring and evaluating periodically and in stages by the first-line manager in the Aceh Government Regional General Hospital wards. It is also recommended that nurses routinely assess the risk of falling in patients, educate patients and their families about it, and participate in ongoing training to improve patient safety in hospitals to achieve better quality healthcare.

Reliability and validity of balance tests for community-dwelling older adults with musculoskeletal ambulation disability symptom complex

IntroductionPhysical performance-based tests are useful indices for identifying and managing fall risk in community-dwelling older adults. However, measurement errors in these tests have not been examined. This study aimed to clarify the reliability and validity of balance tests in community-dwelling older adults with musculoskeletal ambulation disability symptom complex. MethodsThis cross-sectional study used a test-retest design and included 52 participants from three medical facilities. The participants reported demographic and medical information using a questionnaire. Primary outcomes were the timed up-and-go test, five-times sit-to-stand test, one-leg standing test, and functional reach test results. ResultsSignificant correlations were found between each balance test and fear of falling and between the four balance tests. Each balance test demonstrated discriminant validity with intraclass correlation coefficients (1,1) ≥0.81. The minimal detectable change was 1.4 s, 1.6 s, 3.3 s, and 4.0 cm for the timed up-and-go test, five-time sit-to-stand test, one-leg standing test, and functional reach test, respectively. ConclusionChanges exceeding the minimal detectable change95 in balance tests can be used to judge improvement or decline in physical function, which may inform clinical decision-making. The minimal detectable change95 of balance tests should be used when implementing or modifying fall prevention programs.

Evidence-based physiotherapy interventions: evaluation of current practice in a palliative care service

Maintaining independence and quality of life are significant issues for patients with a life-limiting illness and physiotherapists play an essential role in the palliative care multidisciplinary team in maintaining, restoring, and improving physical function and quality of life (QOL). This study aims to describe current physiotherapy interventions utilized in a palliative care service and compare it to the evidence base of physiotherapy interventions in palliative care. An audit was conducted of all inpatient and community palliative care patients referred for physiotherapy review and intervention, over a 4-week period. A literature search was conducted and the level of evidence for individual physiotherapy interventions was assessed. The audit identified 35 patients referred to the Physiotherapist for the assessment and management of mobility, falls risk management and prevention, lymphoedema management and assessment of functional decline. The most frequently performed physiotherapy assessments and interventions were for mobility and transfer (94.3%), falls prevention and management (74.3%), reconditioning and strengthening (57.1%), and exercise prescription (48.6%). Physiotherapy in the palliative care setting is becoming more accepted to help benefit the function and QOL of patients with advanced progressive diseases. This audit highlights the importance of these interventions in assisting patients to manage their symptoms and function at home.

Care Partners' Engagement in Preventing Falls for Community-Dwelling Older People With Dementia.

Little is known about how to prevent falls in community-dwelling older people with dementia. Although their care partners adopt various behaviors to prevent their falls, it is unclear if these behaviors reduce falls for those with different levels of fall risk. Linking the 2015 and 2016 National Health and Aging Trends Study and the 2015 National Study of Caregiving (NSOC), we identified 390 community-dwelling older people with dementia with 607 care partners. We selected 26 NSOC items representing fall risk management (FRM) behaviors. We examined the prevalence and dimensionality of these behaviors and investigated associations between care partners' behaviors in 2015 (T1) and older people's falls in 2016 (T2) stratified by their fall incidence at T1, adjusting for covariates. Five domains of FRM were identified: mobility and safety assistance, medical service coordination, health management, social service coordination, and accommodation. For those who did not fall at T1, mobility and safety assistance and social service coordination were each associated with an increased risk of falling at T2 (adjusted incidence rate ratio [aIRR] = 1.39, 95% confidence interval [CI] = 1.06-1.83, p = .019, aIRR = 1.25, 95% CI = 1.01-1.55, p = .043). For those who had fallen at T1, social service coordination was associated with a decreased risk of falling at T2 (aIRR = 0.83, 95% CI = 0.73-0.94, p = .004). The different impacts of dementia care partners' FRM behaviors emphasize the need to address specific behaviors when involving care partners in preventing falls for older people with dementia at varying levels of fall risk.

Construction of clinical nursing pathway for falls risk management in elderly cardiovascular disease patients.

Construction of clinical nursing pathway for falls risk management in elderly cardiovascular disease patients.

Preventing falls in multiple sclerosis: a qualitative study on user requirements for a self-management programme

Purpose To explore perspectives of ambulatory and non-ambulatory people with MS (PwMS) and health care professionals (HCPs) on falls and falls management to gain a deeper understanding of how a self-management programme can be designed to fit the needs of end users. Materials and methods Twelve PwMS and seven HCPs participated in three four-hour workshops based on Design Thinking. Collected data were field notes and digital post-it notes gathered at the workshops. Data were analyzed using qualitative content analysis with an inductive approach. Results Two main categories, “Managing the complexity of fall-risk behaviour” and “Embracing diversity to establish group engagement”, comprising a total of seven categories were constructed from the analysis. The first main category reflects the challenges PwMS face in managing fall risk in their daily lives, and the support needed to address these challenges. The second main category highlights how engaging in peer learning activities can fulfil individual needs and improve learning outcomes for PwMS. Conclusion A self-management fall prevention programme that is relevant to PwMS regardless of ambulation level should include the development of self-tailored behavioural strategies to prevent falls along with interactive learning activities with other PwMS.

Reframing Fall Prevention and Risk Management as a Chronic Condition Through the Lens of the Expanded Chronic Care Model: Will Integrating Clinical Care and Public Health Improve Outcomes?

Falls are a leading cause of morbidity and mortality among adults aged 65 years and older (older adults) and are increasingly recognized as a chronic condition. Yet, fall-related care is infrequently provided in a chronic care context despite fall-related death rates increasing by 41% between 2012 and 2021. One of the many challenges to addressing falls is the absence of fall-focused chronic disease management programs, which improve outcomes of other chronic conditions, like diabetes. Policies, information systems, and clinical-community connections help form the backbone of chronic disease management programs, yet these elements are often missing in fall prevention. Reframing fall prevention through the Expanded Chronic Care Model (ECCM) guided by implementation science to simultaneously support the uptake of evidence-based practices could help improve the care of older adults at risk for falling. The ECCM includes seven components: (1) self-management/develop personal skills, (2) decision support, (3) delivery system design/re-orient health services, (4) information systems, (5) build healthy public policy, (6) create supportive environments, and (7) strengthen community action. Applying the ECCM to falls-related care by integrating health care delivery system changes, community resources, and public policies to support patient-centered engagement for self-management offers the potential to prevent falls more effectively among older adults.

Developing an Ontology Representing Fall Risk Management Domain Knowledge

Ontologies serve as comprehensive frameworks for organizing domain-specific knowledge, offering significant benefits for managing clinical data. This study presents the development of the Fall Risk Management Ontology (FRMO), designed to enhance clinical text mining, facilitate integration and interoperability between disparate data sources, and streamline clinical data analysis. By representing major entities within the fall risk management domain, the FRMO supports the unification of clinical language and decision-making processes, ultimately contributing to the prevention of falls among older adults. We used Ontology Web Language (OWL) to build the FRMO in Protégé. Of the seven steps of the Stanford approach, six steps were utilized in the development of the FRMO: (1) defining the domain and scope of the ontology, (2) reusing existing ontologies when possible, (3) enumerating ontology terms, (4) specifying the classes and their hierarchy, (5) defining the properties of the classes, and (6) defining the facets of the properties. We evaluated the FRMO using four main criteria: consistency, completeness, accuracy, and clarity. The developed ontology comprises 890 classes arranged in a hierarchical structure, including six top-level classes with a total of 43 object properties and 28 data properties. FRMO is the first comprehensively described semantic ontology for fall risk management. Healthcare providers can use the ontology as the basis of clinical decision technology for managing falls among older adults.

Assessment and Management of Fall Risk in the Inpatient Ward of the Aceh Government Hospital: Case Study

One of the goals of patient safety is to prevent patient falls. Patient falls are an incident in hospitals that result in injury and even death of patients and are the second most common adverse event in health services after medication errors. Nurses can prevent falls by implementing fall prevention guidelines such as closely monitoring patients at high risk of falling and involving the patient's family to avoid falls. Nurses have a role in assessing and managing falls in patients by providing education to patients and taking fall prevention measures based on applicable Standard Operating Procedures. This case study aims to determine the assessment and management of fall risk in the Aceh Government Hospital inpatient ward. The sampling technique used total sampling with a total of 23 nurses. Data was collected in September 2023 after obtaining institutional permission and filling out informed consent to become a research respondent. The data collection tool uses an observation sheet to assess and manage fall risk, developed based on Standard Operational Procedures. Data analysis uses descriptive statistical tests. This case study shows that 78.2% of nurses did not carry out fall risk assessments, and 74.00% did not manage fall risks. As direct superiors of nurses, first-line managers can carry out supervision, guidance, and regular discussions to assess and manage fall risk. Hospital Patient Safety Committees must provide ongoing training regarding patient safety goals to improve patient safety.

The effect of complex cognitive context on the dynamic stability during gait initiation in older women.

Changes in cognitive control are considered potential factors affecting voluntary motor movements during gait initiation (GI). Simulating environments with higher cognitive resource demands have an effect on the stability of GI task performance, which is of significant importance for assessing fall risk in the older adults and devising fall risk management measures in multiple environments. This study aims to reveal the influence of complex cognitive competitive environment with increased cognitive demands on the dynamic stability during GI in the older women. Twenty-three older females and twenty-three younger females performed walking tests under three conditions: voluntary initiation (SI), visual light reaction time task (LRT), and cognitive interference + visual light reaction time task (C + LRT). Eight cameras (Qualisys, Sweden, model: Oqus 600) and three force plates (Kistler, Switzerland, model: 9287C) are used to obtain kinematic and kinetic data. To recorde the trajectory of center of pressure (CoP) and the position of the foot placement, and compute the anterior-posterior (A-P) and medio-lateral (M-L) dynamic stability at the onset and end moments of the single-leg support by means of center of mass (CoM) and gait spatiotemporal parameters. Older women responded to the effect of complex environments involving cognitive competition on body stability by prolonging the lateral displacement time of the CoP during the anticipatory postural adjustments (APAs) phase, reducing step length and velocity, and increasing step width and foot inclination angle. Complex initiation environments lead to competition for cognitive resources in the brain, resulting in decreased stability of GI motor control in older adults. The higher the complexity of the cognitive resource demands environment, the lower the stability of GI in older adults, and the greater the effect on their M-L stability at the onset of stepping.

Design and Implementation of an Inpatient Fall Risk Management Information System.

Falls had been identified as one of the nursing-sensitive indicators for nursing care in hospitals. With technological progress, health information systems make it possible for health care professionals to manage patient care better. However, there is a dearth of research on health information systems used to manage inpatient falls. This study aimed to design and implement a novel hospital-based fall risk management information system (FRMIS) to prevent inpatient falls and improve nursing quality. This implementation was conducted at a large academic medical center in central China. We established a nurse-led multidisciplinary fall prevention team in January 2016. The hospital's fall risk management problems were summarized by interviewing fall-related stakeholders, observing fall prevention workflow and post-fall care process, and investigating patients' satisfaction. The FRMIS was developed using an iterative design process, involving collaboration among health care professionals, software developers, and system architects. We used process indicators and outcome indicators to evaluate the implementation effect. The FRMIS includes a fall risk assessment platform, a fall risk warning platform, a fall preventive strategies platform, fall incident reporting, and a tracking improvement platform. Since the implementation of the FRMIS, the inpatient fall rate was significantly lower than that before implementation (P<.05). In addition, the percentage of major fall-related injuries was significantly lower than that before implementation. The implementation rate of fall-related process indicators and the reporting rate of high risk of falls were significantly different before and after system implementation (P<.05). The FRMIS provides support to nursing staff in preventing falls among hospitalized patients while facilitating process control for nursing managers.

A SYSTEMATIC REVIEW OF CARE PARTNERS’ PERCEPTIONS OF FALL RISK AMONG OLDER PEOPLE WITH DEMENTIA

Abstract Community-dwelling older people with dementia (cd-OPWD) experience a high risk of falling. Care partners have varied levels of involvement in fall risk management for cd-OPWD. However, little is known about what factors may shape their involvement. Understanding care partners’ perceptions of fall risk, associated factors, and impacts will be critical for service providers to effectively engage care partners in fall risk management for cd-OPWD. Utilizing the Common Sense Model of Illness Perceptions, we conducted a literature search among 6 research databases and identified 23 articles using predefined inclusion/exclusion criteria. Our study found that care partners’ perceptions of cd-OPWD’s fall risk comprised beliefs about fall risk management behaviors/programs (i.e., mobility aides, exercise, home modification, fall detector system), their understanding of indicators, causes, consequences, timeline, and controllability of cd-OPWD’s fall risk, and emotional reactions. These perceptions were influenced by care partners’ previous experiences with falls, cd-OPWD’s declining health and functions, experienced care burden, relationships with cd-OPWD, and interactions with healthcare providers. Care partners’ beliefs about fall risk management behaviors/programs and their understanding of indicators, causes, consequences, and timeline of falls are often associated with their adoption of fall risk management behaviors. Their emotional responses to cd-OPWD’s fall risk are associated with increased care burden. These findings point to a need for solution-oriented fall prevention interventions to increase care partners’ perceived benefits of fall risk management behaviors/programs and their knowledge about cd-OPWD’s falls. Future interventions should also try to mitigate the negative impact of care partners’ emotional responses to cd-OPWD’s fall risk.

CARE PARTNERS’ ENGAGEMENT IN PREVENTING FALLS FOR COMMUNITY-DWELLING OLDER PEOPLE WITH DEMENTIA

Abstract Care partners adopt various behaviors to manage fall risk for community-dwelling older people with dementia (cd-OPWD). It is unknown if these behaviors reduce falls for cd-OPWD at different levels of fall risk. We linked the data from the 2015 and 2016 National Health and Aging Trends Study (NHATS) and the 2015 National Study of Caregiving (NSOC) (cd-OPWD n=365, 89% aged 75+) to explore this question. The outcome was no fall, one fall, and multiple falls in 2016. We used the same variable in 2015 to indicate fall risk at baseline. We identified 28 items from NSOC to represent dementia care partners’ fall risk management (FRM) behaviors based on existing literature and expert review. Using exploratory factor analysis, we identified five categories of FRM behaviors: mobility and safety assistance, health management, accommodations, medical services coordination, and social services coordination. We performed multinomial logistic regression to investigate associations between care partners’ FRM behaviors in 2015 and cd-OPWD’ falls in 2016 stratified by cd-OPWD’s history of falls in 2015, adjusting for selected covariates. For cd-OPWD who had no fall in 2015, mobility and safety assistance was associated with a higher risk of having one fall in 2016; for those who had one fall in 2015, medical services coordination was associated with a lower risk of multiple falls; for those who had multiple falls in 2015, social services coordination was associated with a lower risk of multiple falls. Future research may target care partners’ different FRM behaviors based on cd-OPWD’s history of falls.

Feasibility of Implementing Patient-Reported and Physical Performance Measures to Identify and Manage Fall Risk in Older Adults Within a Secondary Fracture Clinic.

The purpose of this study was to assess the feasibility of implementing both electronic and in-person assessments to assess falls risk in an older adult secondary fracture clinic. Electronic data capture feasibility was defined as the proportion of patients that completed the electronic questionnaires prior to their clinic visit. In-clinic feasibility was defined in two ways: (1) the proportion of patients that consented to participate at their clinic visit; (2) time to complete testing. Patients were contacted electronically through their health system portal for electronic consent. Patients were invited to complete consent, the STopping Elderly Accidents, Deaths, and Injuries (STEADI) falls risk assessment tool, and the visual analog scale (VAS) for pain. The Short Physical Performance Battery (SPPB) was performed at the clinic visit. A total of 310 patients were contacted electronically. No patients (0%) provided consent through their health portal. Of the 310 patients, 200 (65%) consented in person (Ineligible: 67 [21%]; Declined: 43 [14%]), resulting in an 82% response rate. In-person data collection took a median of 38.48 (Range: 12.34-54.30) minutes to complete. It was not feasible to contact and collect older adult patient data electronically prior to clinic; but, was feasible to obtain these patient-reported outcomes and physical performance data in person.

Clinical pharmacist-led assessment and management of anticholinergic burden and fall risk in geriatric patients

BackgroundThe aim of this study was to examine the risk of fall with the surrogate outcome of the Aachen Falls Prevention Scale and to assess the clinical pharmacist interventions in order to minimize anticholinergic drug burden and associated risk of fall according to a fall risk assessment scale in the older adults.MethodsPatients who admitted to the geriatric outpatient clinic of a university hospital and taking at least one anticholinergic drug were evaluated both retrospectively and prospectively as groups of different patients by the clinical pharmacist. Patients’ anticholinergic burden was assessed using the Anticholinergic Cognitive Burden Scale. For fall risk assessment, the Aachen Falls Prevention Scale was also administered to each patient whose anticholinergic burden was determined in the prospective phase of the study.ResultsA total of 601 patients were included. Risk of falls increased 2.50 times in patients with high anticholinergic burden (OR (95% CI) = 2.503 (1.071–5.852); p = 0.034), and the existing history of falls increased the risk of high anticholinergic burden 2.02 times (OR (95%CI) = 2.026 (1.059–3.876); p = 0.033). In addition, each unit increase in the fall scale score in the prospective phase increased the risk of high anticholinergic burden by 22% (p = 0.028). Anticholinergic burden was significantly reduced as a result of interventions by the clinical pharmacist in the prospective phase (p = 0.010).ConclusionOur study revealed that incorporating a clinical pharmacist in the handling of geriatric patients aids in the detection, reduction, and prevention of anticholinergic adverse effects.

Using depth sensors for a fall risk prediction system for socially vulnerable older adults with cognitive impairment

AbstractFalls and fall‐related injuries are significant public health issues for adults 65 years of age and older. Over a third of older adults (OA) fall each year and 10‐20% of falls result in serious injuries such as fractures and head trauma. Cognitive impairment is a leading risk factor for falls in OA. Over 60% of OA with MCI fall annually – two to three times the rate of those without cognitive impairment. OA living in low‐resource neighborhoods with poor housing conditions have twice the risk of falling. We have developed a technology‐based intervention called Sense4Safety that facilitates fall risk management and fall risk reduction for older adults (OA) with cognitive impairment living in low‐resource communities. Specifically, the intervention is designed to to 1) identify escalating risk for falls real‐time through in‐home passive sensor monitoring using depth sensors; 2) employ machine learning to inform individualized alerts for fall risk; and 3) link OA with a nurse tele‐coach who guides them in implementing evidence‐based individualized plans to reduce fall‐risk. The nurse coach is accessible via video‐conferencing or phone to discuss fall prevention and risk reduction strategies with the OA and their trusted other depending on the patterns identified in sensor‐detected changes in functional mobility and gait. The measurable primary outcomes include number of fall and near‐fall events, number of fall‐related hospitalizations, functional mobility, self‐reports of fear of falling and perceived independence. We have conducted an initial feasibility study of the intervention with 10 older adults in low income housing settings for a period of 3 months. The Sense4Safety intervention has the potential to become a feasible and cost‐effective approach to increase safety and quality of life for community dwelling low income OA with cognitive impairment and prevent or reduce falls. Currently, in most cases fall risk is addressed only after an adverse event has occurred or cognitive decline has progressed significantly. This intervention changes that paradigm to maximize safety and promote aging in place.

Development of a statistical analysis software for determining effectiveness of a comprehensive fall risk management protocol

IntroductionAs the leading cause of fatal injuries in geriatric populations, falls are a serious health concern with a predicted rate of seven fall-related deaths per hour by 2030. The Timed...

Recurrent Neural Network Methods for Extracting Dynamic Balance Variables during Gait from a Single Inertial Measurement Unit.

Monitoring dynamic balance during gait is critical for fall prevention in the elderly. The current study aimed to develop recurrent neural network models for extracting balance variables from a single inertial measurement unit (IMU) placed on the sacrum during walking. Thirteen healthy young and thirteen healthy older adults wore the IMU during walking and the ground truth of the inclination angles (IA) of the center of pressure to the center of mass vector and their rates of changes (RCIA) were measured simultaneously. The IA, RCIA, and IMU data were used to train four models (uni-LSTM, bi-LSTM, uni-GRU, and bi-GRU), with 10% of the data reserved to evaluate the model errors in terms of the root-mean-squared errors (RMSEs) and percentage relative RMSEs (rRMSEs). Independent t-tests were used for between-group comparisons. The sensitivity, specificity, and Pearson's r for the effect sizes between the model-predicted data and experimental ground truth were also obtained. The bi-GRU with the weighted MSE model was found to have the highest prediction accuracy, computational efficiency, and the best ability in identifying statistical between-group differences when compared with the ground truth, which would be the best choice for the prolonged real-life monitoring of gait balance for fall risk management in the elderly.

Fall risk management in interventional prenatal diagnosis perioperative pregnant women based on tracking methodology and failure mode and effect analysis application.

The aim was to explore the effectiveness of a tracing methodology combined with failure mode and effect analysis (FMEA) for managing falls in pregnant women during the perioperative period of interventional prenatal diagnosis. Using the tracing methodology, the process was evaluated and analyzed using FMEA after reviewing data, on-site interview, case tracking and on-site inspection, and improvement measures were proposed for the existing risk factors, and the fall-related quality indicators, satisfaction with fall-related health education, and risk priority number were compared before and after implementation. Effectiveness analysis for interventional prenatal diagnosis of perioperative maternal falls risk management resulted in a significant decrease in risk priority number (P < .01), a significant increase in the rate of correct fall risk identification and assessment, correct handover rate of pregnant women at risk of falls, correct intervention rate of pregnant women at high risk of falls, and effective coverage of falls-related health education (P < .01), a significant increase in satisfaction with falls-related health education (P < .001), and the incidence of falls among pregnant women decreased from 0.12% to 0%. The use of tracking methodology combined with FMEA can reduce the risk of perioperative maternal falls in interventional prenatal diagnosis and improve the safety of maternal visits.

Nurses' perspectives on inpatient falls in a large academic hospital in South Africa.

Falls risk assessment tools, including the Morse Falls Scale, have been used for years, and yet falls remain key adverse events in hospitals. Nurses are key role players in falls prevention and can champion patient safety. The aim of the study was to explore ward nurses' attitudes, knowledge and practices regarding the use of falls risk assessment tools, institutional falls policy and falls prevention. A survey design was used. All permanent ward nurses were eligible to participate, and a convenience sample was used. Nurses endorsed the Morse Falls Scale, recommended by institutional policy, as effective in reducing falls and indicated that incident reporting measured progress on monitoring fall events. Falls prevention training was scanty; however, nurses were keen for further education of falls. Effective falls risk management needs to extend beyond promulgating policy and actively address nursing and patient education.Contribution: This study adds to the sparse literature regarding nursing practice and falls prevention in a developing country. Recommendations for change have been made.