The intent and mission of the healthcare industry is to heal and care for the sick and injured. Good intentions can be helpful, but if the proper guidelines and protocols are not in place in nursing homes, hospitals and other long term care facilities, certain dangers and risks may infringe on the healthcare team in achieving its goal of healing the patient. Accidental falss is one of the biggest problems in the healthcare industry and especially among elderly patients. The purpose of this paper is to highlight and discuss this public health problem. This essay will first provide a synthesis of available literature on the subject and summarize factors that contribute to this problem. Next, this essay will analyze this evidence and highlight prevention efforts that can be utilized to minimize the risks to this problem. Before concluding, this paper will provide a best approach solution to this problem based on strategic interventions found in the literature. This paper will eventually conclude that accidents and falls can be prevented when the right leadership and protocols are put into place within long-term care facilities.
Synthesis
Accidents and injuries from falls appears to be a serious problem that needs to be addressed in many long care facilities. According to PS Net (2019), between 700 thousand and 1 million hospitalized patients fall each year and half of the 1.6 million nursing home residents will fall sometime during their stay. These accidents can cause serious injuries and hamper the caring efforts for the nurses responsible for these patients. Death, bone breaks and concussions are likely results of these accidents which appear to require specific interventions to reduce these injuries.
Accidental falls and injuries are a common problem in many long term facilities. Falls impact the elderly most of all due to the circumstances they face during this stage of life. Older people are simply more vulnerable to falls. According to Cameron et al (2018) elderly patients who are physically weaker may be at higher risk for falls. Also, elderly patients who may have cognitive impairments also significantly contribute to this problem. This research also designated certain drugs such as benzodiazepines, SSRI’s, neuroleptics, sedatives, and anti-hypertensive drugs as contributing factors to the increased risk of falls. This suggests that elderly people are more likely to experience falls if they are already in a weakened condition.
It appears that brain function is the driving force behind falls in most cases where elderly people are involved. According to Montero-Odasso & Speechley (2018), the factor of cognitive impairment appears to be the most serious contributor to this problem. Those with low attention spans and executive cognitive function were found to have issues with balancing, walking gait and instability. Those on medications were more at risk for suffering falls as well showing again how this combination of increased cognitive impairment will lead to dangerous situations where falls are likely to happen and further impair the patient. This also points towards the idea that patients with conditions such as dementia are also at a higher risk for falls and need to be cared for in a more effective manner to prevent these falls.
Falls themselves are dangerous for several reasons. According to Ozturk et al (2017), nearly 10% of all falls by the elderly lead to major injuries, and almost all falls lead to some form of reduced functionality. This reduced functionality increases the risk of more falls and a vicious circle is created where an elderly person is much more likely to hurt themselves after an initial accident. This research suggested that the risk of mortality from the fall itself is quite low, the reduced functionality and minor injuries that do occur significantly increase mortality rates. It appears that falls are a silent killer in an indirect manner.
Another factor that contributes to this problem is the costs that are associated with these falls in long term care facilities. According to Florence et al (2018), falls are quite expensive in terms of medical costs. Their research study found that Medicare paid nearly $30 billion and Medicaid spend nearly $9 billion with private player paying over $12 billion in 2015 for treatments due to non-fatal flaws. Additionally, fatal falls increased medical costs by $754 million. This suggests that much money is being wasted due to a lack of control over this problem. It appears that the environmental factors of long term facilities are grossly under-prepared to handle the problems associated with elderly accidents and falls.
Another factor that impacts this problem is that it is difficult to convince elderly people that they are at a higher risk for these accidents to happen. According to the research conducted by Collins et al (2020), even though elderly people understood that falls can be dangerous, they were unlikely to take any precautions against them occurring. They concluded that elderly people had a natural bias where they were overconfident about their ability to overcome these risk factors. It appears that human nature does not allow people to admit their own weaknesses and that overconfident elderly patients are unaware of the risks they are taking by not adhering to precautions needed to minimize the likelihood of a fall.
Analysis
Since there are many possible factors that can contribute to how and why a patient may have an accident and fall there are no crystal clear solutions on the prevention of these incidents. It appears that there are strong combination of environmental and personal factors that may contribute to any given scenario where a fall is likely. Fall prevention programs can be used to mitigate these problems. According to the research of Tricco et al (2017) where 54 studies were reviewed regarding the best types of fall prevention programs, several features stood out as helpful strategies to combat this problem. They suggested that their review of the data pointed towards elderly people staying healthy through exercise and improved vision practices. Another useful strategy that was helpful in the prevention of falls was to create an awareness and assessment program for health care workers who serve high risk patients for falls. By keeping an elderly’ person’s body strong and able, falls were less likely to happen. While this solution sounds simple, it appears challenging for many nurses to force their patients to exercise and many times an elderly patient will be incapable of doing much exercise due to cognitive and other physical limitations.
Teamwork appears to be a helpful strategy in minimizing the fall rates in long term care facilities. According to Morris & O’Riordan (2017) a coordinated multidisciplinary clinical team that focuses on this specific issue can reduce the occurrence of falls. These teams must be able to identify the underlying risk factors associated with each patient requiring better and more accurate assessment tools that may exist in many long term care facilities. The finding from this research revealed that when these teams and proper interventions that follow are implemented falls can be decreased by 20-30%. This approach may be more resource intensive and requires more effort by the medical team. It is important that the leadership within any organization where falls may occur is on board with this style of intervention. Safety and awareness of this problem needs to be a constant practice within these organization in order for this strategic approach to be optimal and work for the patients who are at the highest risk.
Since every healthcare organization is different with different requirements, patients and circumstances, accident and fall prevention programs need to be specifically designed to fit the operational capabilities of that organization. According to Cunha et al (2019), teams created to prevent falls in long term facilities should reflect five basic principles. These include:
– A feasible team structure.
– Strong communication plans.
– Involved leadership
– Consistent monitoring
– Mutually supportive attitudes
While these qualities and characteristics are general, they provide a useful guideline to create an intervention that can limit the problems of falls.
Conclusions
The cognitive functioning of elderly people seem to present the greatest risk factor in the cause of accidental falls. Whether a patient has poor vision, a poor memory, dementia or a simple lack of awareness due to the aging process, it seems necessary and mandatory to identify those who lack the most cognitive ability because they are most likely to fall. Therefore, placing the responsibility to maintain a physical exercise program to improve their bodies does not seem to be an optimal strategy for this group of people who need more monitoring and guidance than younger and more responsible patients. Prevention programs should be created with the 5 principles highlighted from Cunha et al (2019). This is a holistic team based effort that hones in on the problem of identifying those who are most at risk This approach understands the nature of the problem and intervenes in a manner that seems the most logical and reasonable. Cognitive impairment not only causes more falls, but also prevents a patient from performing self care and maintenance to avoid becoming a high risk for falling. Healthcare teams must take it upon themselves in a more proactive manner to help solve this problem.
References
Cameron, E. J., Bowles, S. K., Marshall, E. G., & Andrew, M. K. (2018). Falls and long-term care: a report from the care by design observational cohort study. BMC family practice, 19(1), 1-7.
Collins, C. E., Chandra, A., Nguyen, B., Schultz, K., Mathew, P., Chen, T., … & Santry, H. P. (2020). The rose-colored glasses of geriatric fall patients: inconsistencies between knowledge of risk factors for and actual causes of falls. Gerontology and geriatric medicine, 6, 2333721420967884.
Cunha, L. F. C. D., Baixinho, C. L., & Henriques, M. A. (2019). Preventing falls in hospitalized elderly: design and validation of a team intervention. Revista da Escola de Enfermagem da USP, 53.
Florence, C. S., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatrics Society, 66(4), 693-698.
Montero‐Odasso, M., & Speechley, M. (2018). Falls in cognitively impaired older adults: implications for risk assessment and prevention. Journal of the american geriatrics society, 66(2), 367-375.
Morris, R., & O’Riordan, S. (2017). Prevention of falls in hospital. Clinical Medicine, 17(4), 360.
Ozturk, T. C., Ak, R., Akoglu, E. U., Onur, O., Eroglu, S., & Saritemur, M. (2017). Factors associated with multiple falls among elderly patients admitted to emergency department. International Journal of Gerontology, 11(2), 85-89.
PS Net (2019). Falls. Accessed from https://psnet.ahrq.gov/primer/falls#:~:text=Epidemiologic %20studies%20have%20found%20that,very%20high%20risk%20of%20falls.
Tricco, A. C., Thomas, S. M., Veroniki, A. A., Hamid, J. S., Cogo, E., Strifler, L., … & Straus, S. E. (2017). Comparisons of interventions for preventing falls in older adults: a systematic review and meta-analysis. Jama, 318(17), 1687-1699.
