Fall Prevention Strategies for Older Adults Nursing

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Table of Contents

Abstract
Purpose
Literature Review
Methods
Significance to Nursing and Conclusion
References

Abstract

Falls are common threats to the health and wellbeing of older adults, aged 60 years and above. Currently, at least one in every three older adults suffers from a fall incident every year. Considering the consequences of falls in terms of injuries and increased direct medical costs, it is important to prevent falls beforehand to minimize suffering and unnecessary hospital visits.

The article, Factors Associated with falls during Hospitalization in an Adult Population explores the major risk factors, both medical and non-medical, that contribute to the occurrence of falls among older adults.

More specifically, the article presents the findings of a recent study, which shows that various variables including patient characteristics, clinical conditions, nursing unit characteristics, and nursing interventions contribute to the occurrence of falls among older adults. Summaries and critical analyses of these research findings as well as their significance to current nursing practice are provided in the subsequent sections of this paper.

Fall-related injuries are common among the elderly population. Currently, one out of three older adults aged 65 years and above encounters a fall incident that results into moderate-to-severe injuries (Centers for Disease Control and Prevention [CDC], 2013). Moreover, falls contribute to an increase in emergency room visits and hospitalizations among older adults.

Furthermore, the direct health care costs arising from fall injuries among older adults are very high (CDC, 2013). This shows that there is the need to address falls among older adults to prevent unnecessary injuries and minimize the direct medical costs associated with such events.

Different studies have addressed the issue of fall prevention, and current strategies include medical, pharmacy, and nursing interventions. In the article, Factors Associated with falls during Hospitalization in an Adult Population the authors examined the key variables and nursing interventions that might cause falls in study involving older adults (Titler, Shever, Kanak, Picone, & Qin, 2011).

The authors determined the contribution of several variables including patient characteristics, clinical conditions, and the characteristics of nursing units as well as medical, pharmacy, and nursing interventions to the occurrence of falls among a sample of older adults (Titler et al., 2011).

The abovementioned study is very important to nursing practice as it sought to generate evidence on the causes of falls among hospitalized adults and the strategies for preventing them. This evidence is significant to nurses in their quest to inform Evidence-Based Practice (EBP) in their current practice. The subsequent sections of this paper will highlight the findings of the above-mentioned study with the aim of determining the purpose and significance of the study to professional nursing practice.

Purpose

The purpose of the afore-mentioned study was to determine the major variables underlying the occurrence of falls among hospitalized older adults (Titler et al., 2011). More specifically, the authors wanted to address the lack of sufficient effectiveness studies on specific interventions that could contribute to falls among hospitalized adults.

According to Titler et al. (2011), the specific research question [for their study] was; What patient characteristics, clinical conditions, nursing unit characteristics, medical, pharmacy, and nursing interventions are associated with falls during hospitalization of older adults? (p. 129).

Accordingly, both the purpose and research question are clearly stated in the research article, and they all related to a gap in the current literature. However, the authors did not define the specific variables that they wanted to measure; hence, it is difficult to determine why the authors settled on the chosen variables instead of others.

On the other hand, the authors developed a clear theoretical framework that offered sufficient background to the study. The authors used an effectiveness model to connect various variables to specific patient outcomes.

As a result, the theoretical framework identified the specific independent variables, intervening variables, and dependent variables and their relationships. The only problem with the theoretical framework presented in the study is that it is not based on sufficient literature studies; hence, it may not find sufficient support in the current nursing practice.

Literature Review

Titler et al. (2011) provided a good background to their study by reviewing various primary and secondary sources. The authors noted that the issue of falls among hospitalized adults was a matter of concern for different stakeholders including family members, patients, and health insurance companies. Moreover, the authors observed that fall injuries were becoming more prevalent among the adult population, and that they were causing anxiety and loss of confidence besides increasing medical costs.

Additionally, based on a review of previous studies, the authors found out that the major risk factors, which contributed to the occurrence of falls among older adults, included mobility limitations, the use of some varieties of medications, and cognitive impairment among others (Titler et al., 2011).

On the other hand, Titler et al. (2011) discovered that most of the studies they had reviewed focused on the development of risk factors and preventive interventions or guidelines. As a result, few studies had explored the relationship between specific interventions and patient outcomes. Accordingly, Titler and colleagues designed their study around the afore-mentioned background information and the existing gap in literature.

As a result, the studies reviewed are quite relevant to the current study as well as the theoretical framework, and they are predominantly primary sources. Nonetheless, the literature review seems to be one-sided since the authors did not attempt to analyze the strengths and weaknesses of specific studies to demonstrate their value to their research project.

Methods

Design

In order to achieve the above-mentioned research purpose, Titler and colleagues used a quantitative research design, and more specifically, an exploratory outcomes effectiveness research design. This research design falls under the first S or Studies in the pyramid of evidence because it is a quantitative study in nature (Schmidt & Brown, 2011).

The importance and appropriateness of this design to the current study is that it enabled the researchers to determine the effectiveness of various nursing interventions associated with falls among older adults. Effectiveness studies tend to evaluate the efficacy of a given intervention in a population that may not have been part of other efficacy studies such as randomized controlled trials (RCTs).

This implies that the evidence level of effectiveness studies is almost similar to that of RCTs because both study designs tend to perform complementary purposes (Ho, Peterson, & Masoudi, 2008). Nonetheless, an outcomes effectiveness research design can be problematic because it is susceptible to the Hawthorne effect, meaning that some participants may change their behavior in the presence of the researchers; hence, the findings may be unreliable (Ho et al., 2008).

Population and Sample

The sample used in the study comprised at least 10,187 hospitalizations involving about 7,851 older adults, aged 60 years and above (Titler et al., 2011). All the participants came from a single tertiary care hospital whereby they were receiving acute care services, and the researchers studied them over a period of four years. Moreover, the sample included individuals who had undertaken the Nursing Interventions Classification (NIC) and those who were at an increased risk for fall injuries (Titler et al., 2011).

Generally, the sample was sufficient and large enough to guarantee the researchers ability to gather enough empirical data to answer the research question. However, due to the need for patient consent before commencing a study of this magnitude, the researchers may have considered selecting only the willing patients, and this could be a major cause of selection bias. Nonetheless, the authors did not address issues of selection and any problems they encountered.

Reliability and Validity

The authors did not address issues of reliability and validity in their study. However, since the study used a large retrospective sample, it is possible that the study findings are highly reliable. On the other hand, it is obvious that the issue of confounding is a major threat to internal validity in this study (Schmidt & Brown, 2011). Moreover, the authors may have achieved ecological validity by using a large sample, but this sample is also problematic because it came from a single institution; hence, there is low generalizability.

Lastly, the authors used generalized estimating equations (GEE) statistical analyses to determine the relationships between different variables. While this analytical approach was sufficient in establishing the associations between independent and dependent variables, it was not appropriate in terms of addressing the problem of confounding (Ho et al., 2011).

Results and Discussion

The study findings reported in the article provide compelling evidence, which practicing nurses can use to inform clinical practice. The research analyses indicate that many variables and nursing interventions contribute to patient falls among older adults. For example, the authors discovered that the co-morbidity of depression was significantly associated with falls among hospitalized older adults (Titler et al., 2011). This implies that depression is a major risk factor in the occurrence of patient falls among hospitalized older adults.

Furthermore, the study findings show that registered nurse (RN) skill mix is a major nursing unit characteristic that has a significant relationship with patient falls. More specifically, the higher the number of RNs who are attending to the same group of hospitalized older adults, the less the number of patient falls among that group (Titler et al., 2011).

On the other hand, the authors discovered that certain medical treatments had a significant relationship with patient falls. For instance, patients who received CT scans of the head or those who had therapeutic radiology were at an increased risk for falling. Furthermore, the study findings showed that the more the number of medical treatments, the higher the rate of falls among older adults (Titler et al., 2011). Moreover, the use of some medications had a significant relationship with patient falling among hospitalized older adults.

Generally, the research article presents various pieces of evidence in a clear and succinct manner. Besides, the article presents both significant and non-significant findings; hence, it allows readers to explore all aspects of the study. The above-mentioned findings are very important to current nursing practice because they provide sufficient evidence to inform EBP in relation to fall prevention.

Strengths and Weaknesses

The study presented in the article is unique in that it is among a limited number of studies that have established statistically significant associations between specific nursing interventions and patient falls among older adults. As a result, this study is very important to current nursing practice because it forms a good foundation for the use of Evidence-Based Practice (EBP) in current practice.

Moreover, it highlights the complexity of the issues underlying fall prevention; hence, it may enable nurses to understand the risk factors underlying patient falls in order to develop effective prevention strategies. Nonetheless, the study findings are limited to the extent that the study sample included patients from a single health care institution. This means that the research findings may not generalize to entire populations or those populations that are beyond the study site (Titler et al., 2011).

Significance to Nursing and Conclusion

Overall, the research article presents a very important study that explores the relationship between different medical and nursing interventions, which have a significant relationship with falls among older adults. The study findings support the authors theoretical framework, which sought to connect various medical and nursing interventions with patient falls. More specifically, the study findings show that both the number and type of medical and nursing interventions are very important toward the development of patient falls.

This type of evidence is imperative to current nursing practice because it may go a long way to inform Evidence-Based Practice (EBP) in relation to the prevention of falls among older adults. Furthermore, the evidence presented in the study will help patients as well as other healthcare professionals to understand the major risk factors that cause falls among older adults in order to take preventive measures beforehand.

Nonetheless, there is need for further research to determine the contribution of patient characteristics and behaviors to the occurrence of falls as this may be important toward enabling patients to change personal attributes that may cause falls during their hospitalization.

References

Centers for Disease Control and Prevention. (2013). Falls among older adults: An overview. Atlanta, GA: U.S. Government Printing Office.

Ho, M. P., Peterson, P. N., & Masoudi, F. A. (2008). Key issues in outcomes research: Evaluating evidence is there a rigid hierarchy? Circulation, 118, 1675-1684.

Schmidt, N. A., & Brown, J. M. (2011). Evidence-based practice for nurses: Appraisal and application of research. New York, NY: Jones & Bartlett Publishers.

Titler, M. G., Shever, L. L., Kanak, M. F., Picone, D. M., & Qin, R. (2011). Factors associated with falls during hospitalization in an older adult population. Research and Theory for Nursing Practice: An International Journal, 25(2), 127-152.

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