Evidence-Based Research Capstone: Problem and Recommendation
Falls and falls-associated injuries represent one of the major adverse events that affect the elderly as they increase morbidity and mortality. Mostly, falls affect individuals who are sixty-five years old and above. These individuals are more vulnerable to falls as compared to those who are younger. Falls result in both physical and emotional consequences that contribute to the deterioration of the individual’s health and are also associated with a huge financial burden. Such impact reinforces the need for evidence-based strategies to reduce the occurrence of falls. One strategy that has been found to be effective in reducing the incidence of falls among the elderly is the implementation of multidisciplinary teams to asses for risk and make appropriate recommendations. This paper, therefore, describes the problem of falls among the elderly and identifies a multidisciplinary fall risk assessment and intervention program as a best practice recommendation to address the problem before a summary is provided.
Identification of Problem
Falls represent a significantly damaging adverse event that affects the geriatric community. The World Health Organization (2012) defines a fall as an event in which an individual inadvertently comes to rest on the floor or on the ground. The elderly are deemed more vulnerable to falls. Falls or fall-linked injuries are the chief complaints among the geriatric population seeking care in healthcare facilities more so the emergency departments. According to World Health Organization (2012), falls represent the second leading cause of unintentional deaths and this may be due to direct contact or injuries sustained. The fatal or non-fatal falls they experience not only decreases their quality of life but also increases their risk of developing other health problems. These falls may also occur in the hospital settings where Bennett et al. (2014) noted that about 2-7 falls per 1000 days are experienced by patients with injuries reported in about 30-40%.
Falls experienced by the elderly have different features and this is dependent on the time of occurrence and how they occur (Nyman et al., 2013). Falls may occur at home, in the open, at the workplace, in the hospital and other settings. The elderly are at an increased risk of experiencing falls because they are perceived to be physically weak and some are perceived to be confused. Although such negative perceptions should not be used, there is no denying that the older adults may have poor health which increase the risk of falling (Waldron et al. 2011). According to a study by Nyman et al. (2013), most falls occur in presence of bystanders, when crossing roads, as well as in familiar places and therefore it is important to understand all these factors if one is to prevent them effectively. Nyman et al. (2013) added that the elderly who experience falls sustain minor or moderate injuries and may feel anxious and embarrassed. All these experiences may increase the risk of falling in the future.
The main problem regarding falls in the elderly is that the current measures have not realized absolute success. These measures include promoting a culture of safety and implementation of walking rounds among others. With an increasingly aging population, older adults are likely to visit emergency departments with falls or to treat fall-related injuries. A lot of healthcare resources including finances and staff such as nurses are therefore being utilized to care for those who have experienced falls rather than other more pressing health concerns. This burden to the healthcare sector reinforces a need for this preventable adverse event to be addressed once and for all. Therefore, since falls are detrimental and damaging, it is critical to ensure that there are measures taken to implement best practices aimed at reducing and/or preventing the high incidence and prevalence of falls among the at-risk individuals
Identification of Recommendation
In today’s healthcare setting, evidence-based practice is considered the best since it allows for the integration of a clinician’s expertise, patient values, and preferences with evidence derived from research (Melnyk & Fineout-Overholt, 2011). Considering the functional impairment and the emotional and financial burden associated with falls, it is necessary to implement evidence-based fall prevention programs customized to reduce the fall risk in the vulnerable frail older adults. Some of the best practices have sought to promote a culture of safety and this has led to the reduction of the incidence of falls. However, there is still a lot that needs to be done.
While promoting safety is critical, it is equally important to implement more effective best practices. One of these strategies is the adoption of multidisciplinary team approaches. The recommended solution to the problem of ineffective fall prevention in the elderly is the implementation of a multidisciplinary fall risk assessment and intervention program. This proposed solution is based on literature review which found studies advocating for multidisciplinary fall prevention strategies due to their effectiveness. According to Carpenter et al. (2014), Waldron et al. (2011) and Spice et al. (2008), the multidisciplinary approach allows for the effective fall risk assessment and also makes it possible for clinicians to make recommendations or referrals that can help reduce the risk of falling. The multidisciplinary team may be composed of professionals including nurses, doctors, nurse safety managers, health information managers, physicians, occupational and physical therapists (Ohde et al., 2012). These individuals must collaborate to ensure that they achieve a common goal which is to reduce or prevent the incidence of falls and promote the individual’s quality of life.
The multidisciplinary team will be tasked with coming up with a fall risk assessment tool that will help them identify the at-risk individuals and subsequently make an appropriate recommendation based on the results of the assessment. The team will, therefore, be able to collaboratively determine the most effective intervention for a given individual to ensure that they do not experience falls in the future (Huded et al., 2015). For instance, in studies conducted by Ohde et al. (2012) and Huded et al. (2015), the multidisciplinary team effectively rated the risk of falling of each individual based on the assessment findings and accordingly came up with an appropriate intervention that included making referrals for instance to physical therapists. The at-risk individuals and their families were also provided with written educational materials and an intervention plan that included interventions such as the installation of handrails, and use of motion sensors. In Ohde et al. (2012), the multidisciplinary approach resulted in a reduction of falls by 0.6 falls per 1000 patient days.
As such, there is enough evidence supporting that if a multidisciplinary fall risk assessment and intervention programs are well implemented, they can successfully prevent or reduce the incidence of falls among the elderly. The argument is that this approach helps to successfully identify those at a heightened risk of falls and after identifying them, develop appropriate interventions that will ensure that the at-risk individual does not experience falls. Importantly, since a multidisciplinary team is involved, this means that the older adult is provided with holistic care to address the many fall risk factors.
Summary
There is a high number of older adults who experience falls and the consequence is functional impairment, emotional burden, and a huge financial cost. When patients visit a healthcare facility, this presents an opportunity to ensure that those at risk of falls are identified and the appropriate care and preventive measures taken. For this reason, the recommended solution to address the ineffectiveness of current measures is the implementation of a multidisciplinary fall risk assessment and intervention program. As such, there is a need for a practice change in the ED and nursing department to ensure that there is a fall prevention protocol that allows for the creation of multidisciplinary teams tasked with assessing the elderly and providing holistic care to the at-risk individuals to ensure that they do not experience falls in the future. It is important to note that there have been studies that have supported the effectiveness of this approach. It is anticipated that this practice change will provide the most effective avenue for clinicians to enhance the quality of life of the elderly by helping them avoid death, fall-related injuries or complications that may compromise their health status.
References
Bennett, P.N., Ockerby, C., Willcocks, K., & Chalmers, C. (2014). Measuring hospital falls prevention safety climate. Contemporary Nurse: A Journal for the Australian Nursing Profession, 47(1-2): 27-35
Carpenter, C., Avidan, M., Wildes, T., Stark, S., Fowler, S., & Lo, A. (2014). Predicting Geriatric Falls Following an Episode of Emergency Department Care: A Systematic Review. Acad Emerg Med, 21(10), 1069-1082.
Huded, J., Dresden, S., Gravenor, S., Rowe, T., & Lindquist, L. (2015). Screening for Fall Risks in the Emergency Department: A Novel Nursing-Driven Program. Western Journal Of Emergency Medicine, 16(7), 1043-1046.
Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice (2nd ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins
Nyman, S., Ballinger, C., Phillips, J., & Newton, R. (2013). Characteristics of outdoor falls among older people: a qualitative study. BMC Geriatr, 13(1), 125.
Ohde, S., Terai, M., Oizumi, A., Takahashi, O., Deshpande, G. A., Takekata, M., … & Fukui, T. (2012). The effectiveness of a multidisciplinary QI activity for accidental fall prevention: Staff compliance is critical. BMC health services research, 12(1), 197.
Spice, C., Morotti, W., George, S., Dent, T., Rose, J., Harris, S., & Gordon, C. (2008). The Winchester falls project: a randomised controlled trial of secondary prevention of falls in older people. Age And Ageing, 38(1), 33-40.
Waldron, N., Dey, I., Nagree, Y., Xiao, J., & Flicker, L. (2011). A multi-faceted intervention to implement guideline care and improve quality of care for older people who present to the emergency department with falls. BMC Geriatr, 11(1), 6.
WHO. (2012). Falls. World Health Organization.