Falls Prevention

Falls Prevention

According to the Center for Disease Control and Prevention (2016), at least one in every four senior persons falls each year and only about half of these persons inform their doctors about the predicaments. As compared to other demographics, the elderly have a higher likelihood of falling. This paper explores the impacts of falls on the elderly and how this problem can be addressed using evidence-based practice guidelines.

Impacts of fall on the Elderly

Falls have serious ramifications on the elderly. According to Phelan, Aerts, Dowler, Eckstrom, and Casey (2016), falls expose people aged 65 years old and older to the risk of injury, decreased mobility, nursing home placement, loss of independence, hospitalization, and early death. For instance, falls may result in older persons being admitted to emergency rooms. On this note, three million older persons are admitted to emergency departments every year after suffering fall-related injuries (Center for Disease Control and Prevention, 2016). At the same time, falls can result in older persons becoming inactive. Inactivity may increase the likelihood of older persons falling in the future or suffering anxiety.

Evidence-Based Practice (EBP) Guidelines that Can Be Used in Primary Care Settings

One of the EBP guidelines that can be used in primary care settings is Orlando’s Nursing Process Discipline. The tool requires that the nurses assess the patient’s behavior. This assessment should inform them about the decision to take regarding how to prevent patients from suffering from negative outcomes as far as prevention of falls is concerned (Wilkerson, 2017). However, the tool only focuses on the interaction between the practitioners and the patients while ignoring the latter’s families. The other guideline is the Iowa Model of Evidence-Based Practice. The first step under this guideline is the recognition of the knowledge-focused trigger followed by the determination of whether or not the identified problem is a priority of the unit, organization, or department (Wilkerson, 2017). The next step involves the identification of the team that will implement the identified program.  The other guideline that can be applied in the primary care settings in falls prevention is STEADI which denotes Stopping Elderly Accidents, Deaths and Injuries developed by the Center for Disease Control and Prevention (Dellinger, 2017). The guideline focuses on the screening of falls risk, the assessment of modifiable risk factors specific to the patient, and intervening with the help of clinical strategies. Also, the American Geriatrics Society has developed a guideline for preventing falls among older persons (Moncada & Mire, 2017). The guideline focuses on evaluating the patient’s gait, strength, and balance. Also, it focuses on conducting a multi-factorial assessment and offering individualized fall interventions.

Literature Review

In their study, Phelan et al. (2016) explored the extent to which physicians use a multifactorial approach in assessing and managing modifiable risk factors when offering care to older patients who have fallen in the past. The study revealed that geriatric specialists have a higher likelihood of using a structured note template in assessing and managing modifiable risk factors during the provision of care to older persons with a history of falls in comparison to general practitioners (Phelan et al. 2016). At the same time, this study revealed that medications comprise an independent factor as far as falls are concerned (Phelan et al., 2016). As a result, there is a need for special attention to be directed to medications given to older patients as far as fall prevention and public health education programs in primary care practice is concerned. Lach, Harrison, and Phongphanngam (2016) explored the literature that exists on falls and falls prevention among older adults suffering from early-stage dementia. The study revealed that multifactorial interventions and exercises have some capacity to decrease falls among older patients. Wilkerson (2017) conducted a study in which she evaluated the effects of the implementation of a multifactorial fall prevention protocol in an orthopedic/neurosurgical unit. The protocol was implemented through guidance from the Orlando’s Nursing Process Discipline and the Iowa Model of Evidence-based Practice protocols. The participants were educated on how to use the multifactorial falls prevention protocol. Data analysis revealed that the implementation of the multifactorial protocol had positive results in increased utilization of falls risk interventions in the areas of nursing documentation, bed or chair arms, and patient wristbands. This study underscores the significance of the use of multifactorial approach to the prevention of falls, such as toileting, patient education, and post-fall reviews (Wilkerson, 2017). As such, a literature review has shown that a combination of several interventions should be adopted in preventing falls among older patients in primary care settings.  Dellinger (2017) explores the efficacy of evidence-based strategies in fall prevention. These strategies include multifactorial intervention, medications, strengths and balance programs, vitamin D supplements, foot and footwear, and cataract surgery. Although these strategies are effective in the prevention of falls among the elderly, primary care providers encounter several problems when implementing them in their practice. These challenges include the logistics of the setting, time and reimbursements, and patient compliance (Dellinger, 2017). These challenges must be addressed if the implementation of the EBP guideline in primary care settings is to be effective.

Policies Regarding Fall Preventions

Various states have different policies on fall prevention. States such as Connecticut, Florida, Massachusetts, Hawaii, and Minnesota have policies that guide efforts aimed at reducing the prevalence of falls among the elderly (National Conference of State Legislatures, 2018). However, most of these policies focus on community-based interventions. However, Maine has a policy that promotes research aimed at helping in the implementation and evaluation of fall prevention programs in primary care settings (National Conference of State Legislatures, 2018). Also, the policy focuses on educating healthcare providers on ways of preventing falls in their practices. Family nurse practitioners can benefit from the education programs offered under different pieces of legislation. Also, family nurse practitioners should refer their patients to community-based fall prevention programs made available through various state laws.

In conclusion, falls are among the most prevalent problem as far as the elderly patients are concerned. Falls have physical and emotional consequences on elderly patients in addition to affecting their quality of life. Several guidelines have been developed to address this problem in primary care settings. Most of these guidelines prioritize multifactorial fall prevention initiatives. However, there is a need for federal policies that mandate the provision of fall prevention services in all healthcare settings.

References

Center for Disease Control and Prevention. (2016). Older adult falls. Retrieved from https://www.cdc.gov/homeandrecreationalsafety/falls/index.html

Dellinger, A. (2017). Older adult falls: effective approaches to prevention. Current Trauma Reports, 3(2), 118-123.

Lach, H. W., Harrison, B. E., & Phongphanngam, S. (2016). Falls and fall prevention in older adults with early-stage dementia: an integrative review. Research in Gerontological Nursing, 10(3), 139-148.

Moncada, L. & Mire, G. (2017). Preventing fall in older persons. American Family Physician, 96(4): 240-247.

National Conference of State Legislatures. (2018). Elderly falls prevention legislation and statues. Retrieved from https://www.ncsl.org/research/health/elderly-falls-prevention-legislation-and-statutes.aspx

Phelan, E. A., Aerts, S., Dowler, D., Eckstrom, E., & Casey, C. M. (2016). Adoption of evidence-based fall prevention practices in primary care for older adults with a history of falls. Frontiers in Public Health, 4, 190.

Wilkerson, L. (2017). Implementation of a Multifactorial Fall Prevention Protocol. Evidence-Based Practice Project Reports, 111.