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Introduction
Due to the increase in life expectancy, the number of people at risk of falls is increasing worldwide. According to statistics, 28-38% of older people had at least one fall, and by 2030, 49 million falls will cause 12 million injuries in the United States (Ott, 2018). Firstly, falls are a serious threat to patients’ life and health, as they can be fatal. Second, trauma treatment is costly, especially given the magnitude of the problem. This paper aims to summarize and discuss two quantitative studies about education and prevention of falls in the older population and answer the PICOT question, whether the prevention strategy based on education or intervention is more effective.
First Study: Measuring Impact of Education
In her research “The impact of implementing a fall prevention educational session for community-dwelling physical therapy patients,” Ott (2018) conducted a study with twenty patients who visited the clinic for falls. The scientist provided patients with two comprehensive educational sessions and measured the falls and attitudes towards falls among patients. Patients lived in their own homes, with family or alone. Educational programs were designed to enable patients to change their home environment and make it safer. Questionnaires were used before and after testing to determine the knowledge about the risk of falls, the number of participants using fall prevention techniques, and the number of falls within 60 days after two training sessions.
The study included patients from South Georgia at risk of falls. The first session was provided for patients, family members, or caregivers. Educational information was presented in a PowerPoint presentation, which explained the definition of falls, the prevalence of falls, complications of falls, the location of falls, diseases associated with a high risk of falls, risk factors with an emphasis on factors important to the participants, and prevention of falls through intervention. After watching the presentation, participants were given an information booklet that was a visual reminder of risk factors, information about community resources, a home safety list, information on preventing falls, and myths associated with falls. The first session lasted 90 minutes; before ending the therapy, patients underwent a second educational session, and the FRAQ post-test was performed. The second session considered the identified risks of falls individually for the participants and techniques to prevent falls. 30 and 60 days after the second training session, the patients were interviewed by telephone.
As a result, 8 out of 20 patients received training and follow-up testing. The scientist recorded an increased awareness of the risks of falls and preventive measures and a decrease in the number of falls – 60 days after therapy, there was one fall. Interestingly, since the questionnaires included open-ended responses, patients were able to share their views. Two participants believed that they would fall in the next six months; five believed that they would fall in the early hours on the way to the bathroom or kitchen. Participants identified home intervention strategies to prevent falls, such as removing rugs and clutter.
Six people commented on the effectiveness of this modification, five participants said they were interested in change, and four participants made lifestyle changes by implementing strategies. Two more participants needed assistance with the modification – installing a porch rail and shower rail. All participants stated that they would be able to do the balance exercises, and four continued to do the exercises after discharge. Two participants were unable to do the exercises for health reasons, and six people underwent vision tests. Most did not buy new walking shoes, did not discuss fall-risk medications, and did not have difficulty showering or dressing.
Before starting the project, four people who went to the clinic died from falls in 2 years. Therefore, this pilot study could serve as a benchmark for introducing fall education into medical practice to increase patient awareness and reduce falls. The research also shows that patient education increased awareness and preventive measures at home while reducing falls. Educating patients and families is essential in medical practice, as most falls are predictable and preventable. Education about the risk of falls aims at introducing preventive measures by patients, their families, or medical personnel who care for patients at home. This study is completely ethical and does not disseminate the personal data of participants.
Second Study: Measuring Impact of STEADI Intervention Initiative
Another study by Johnston et al. (2019) studied the implementation of the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative in primary care. This initiative is a multifactorial approach that includes screening for risk of falls, assessing risk factors, and prescribing interventions. The study involved 12,346 adults over 65 who visited one of the outpatient clinics between 2012 and 2015. The study aimed to determine the relationship between having a Fall Plan of Care (FPOC) and the risk of falls. The results showed that patients with FPOC were 0.6 less likely to be hospitalized for a fall. The study also demonstrated the effectiveness of implementing the STEADI strategy in reducing the number of hospitalizations associated with falls.
The STEADI initiative includes screening people at risk of falls, assessing modifiable risk factors such as medications, functional ability, visual acuity, orthostatic blood pressure, podiatry examination, and home hazard assessments. The initiative also includes interventions to reduce the risk of falls using various proven programs – strength and balance programs, medication, occupational therapy, and glasses for vision correction. Therefore, the study demonstrates the effectiveness of the implementation of the STEADI initiative in outpatient practice. Healthcare providers should integrate elements of the initiative into workflows, change the traditional form of EHR to apply STEADI and enter related data, and have training in using the initiative.
According to scientists, today, STEADI is working in 18 medical institutions. And the initiative’s multifactorial fall prevention measures resulted in a 24% reduction in falls (Johnston et al., 2019). Patients at risk with FPOC were 40% less likely to be hospitalized for falls. FPOC was defined as having an EHR referral for a physical therapy program, a prescription for an assistive device, providing a risk brochure or home safety list, and risk of falling explained by a nurse to a patient.
The initiative can be used in medical practice to prevent and reduce the number of falls. Widespread implementation of STEADI could reduce the risk of hospitalization by 40% among patients at risk of falls. This study is ethical and does not violate patients’ rights. It aims to improve the practice of treating patients over 65 and ensure their health and safety. According to the study results, education, both for patients and their families, and interventions contribute equally to reducing fall risk.
Thus, two quantitative studies were analyzed in the context of the PICOT question. It is clear that educating patients and their families about the risks of falls and preventive measures, as well as implementing these measures, such as checking patients’ visual acuity or helping them to set up their home environment, is of great importance in reducing the risk of hospitalization and the number of falls. The widespread application of the discussed strategies in medical practice will minimize the number of falls among older patients.
References
Johnston, Y. A., Bergen, G., Bauer, M., Parker, E. M., Wentworth, L., McFadden, M., & Garnett, M. (2019). Implementation of the stopping elderly accidents, deaths, and injuries initiative in primary care: an outcome evaluation. The Gerontologist, 59(6), 1182-1191.
Ott, L. D. (2018). The impact of implementing a fall prevention educational session for community‐dwelling physical therapy patients. Nursing Open, 5(4), 567-574.
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