Avoiding Patient Falls: A Literature Review

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Avoiding Patient Falls: A Literature Review

Consequences and Implications of Falls

Falls are a major public health issue and the leading cause of unintentional or accidental injury or hospitalization. Patient falls in hospitals are associated with readmissions, longer length of hospital stay, and poor healthcare outcomes (Slade et al., 2017). Similarly, falls in an oncology has been associated with increased length of stay (Vonnes & Wolf, 2017). Falls cause about 420,000 deaths around the world per year. Besides, it is responsible for approximately 17 million disability-adjusted life-years per years.  On the other hand, falls are the leading causes of hip fractures, bruises, and head injuries (Slade et al., 2017). Similarly, advanced aged oncology patient are at an increased risk of fall injuries due to thrombocytopenia and coagulopathy (Vonnes & Wolf, 2017). Falls in older adults may result in longstanding functional impairment, pain, premature nursing home admission, disability, mortality, and increased length of stay in hospitals (King et al., 2016).

Falls increase the cost of healthcare. In 2013, gross expenditure in the U.S. due to patient falls was more than $34 billion (Toren & Lipschuetz, 2017). In 2014, fall-associated injuries in the U.S. accounted for about $31 billion in terms of annual Medicare costs. The average cost per fall in people aged over 65 years is $1,049 in Australia and $3611 in Finland. Patient falls cost the U.K. more than £2 billion per annum (Slade et al., 2017). Toren and Lipschuetz (2017) state that the economic cost of falls is between $12,000 and $23,000 per patient who has fallen and sustained an injury; whereas the average cost of hospitalization for falls per patient is $6,669. Apart from impact on patients and the hospital, patient falls tend to lead to increased guilt, stress, self-doubt about quality of care, and concern for liability among nurses. Nurses experience pressure from the hospital to reduce falls to avoid Centers for Medicare and Medicaid Services (King et al., 2016).

Contributing Factors

            Fall prevention depends on accurate risk prevention and knowledge of reversible fall risk factors. Patient factors are the major risk factors for falls. Advanced age is a major risk factor for falls. Adults aged over 65 years experience greater risk of falls compared to the younger population. It is even more pronounced in people aged over 65 years and having chronic conditions such as dementia and Parkinson’s disease (Slade et al., 2017). Over the past three decades, the rise in the number of patient falls has been attributed to significant increase in the aging population (King et al., 2016). Functional decline, particularly due to motor and/or cognitive deficits, may increase the risk of falls (Vonnes & Wolf, 2017). Other patient factors that can increase the risk of falls include delirium, gait instability, visual impairment, urinary incontinence, multi-morbidity, and cognitive impairment (Slade et al., 2017). There is evidence that communication disability is a significant risk factor for falls. Stroke patients represent higher incidence and prevalence of patients with communication disability. Several other health issues that may affect communication ability include Parkinson’s disease and dementia. In addition, degenerative diseases such as Parkinson’s disease, motor neuron disease, and multiple sclerosis may lead to impairment of speech motor control (Hemsley et al., 2019).

            Other factors such as history of previous falls and use of psychotropic medications may also increase the risk of falls in hospitalized patients. Use of medications such as antihypertensives, anticonvulsants, and tranquillizers are also known falls risk factors (Slade et al., 2017). In oncology settings, falls among older adults may be due to response to opiates, anxiolytics, and chemotherapy protocols (Vonnes & Wolf, 2017). In addition, environmental conditions may increase the risk of falls. Carpet flooring and the nature of the floor are important determinants to be taken into consideration (Slade et al., 2017).  Watson, Salmoni, and Zecevic (2018) add that organizational factors such as reduced supervision, poor hospital policies, and transfer of patients without assistance are some of the reasons that increase the risk of falls.

Current Interventions and Prevention Measures

In nursing and residential care facilities, the efficacy of exercise in prevention of falls has not been established but vitamin D supplementation has been proven as an effective measure for reducing the risk of falls (Slade et al., 2017). Nursing interventions that have been described include continuous monitoring of patients for conditional changes and having consistent contact with patients (King et al., 2016). Older adults should be assessed for the risk of falls (Howland et al., 2018). Currently, hospitals use rigid risk assessment scales that are based on patient’s medical condition, mental status, mobility, history of falls, toileting, and medication therapy to identify particular patients at risk of falls (Toren & Lipschuetz, 2017). The proposed study will identify the risk factors of falls among specific patient population; patients with psychiatric and mental health issues.

            Multifactorial interventions for reducing risk of falling include strength training, aerobic exercises, consumer and staff education, medication management, environmental modifications, and provision of effective assistive-devices. Individual interventions such as provision of low-lying beds, bed-side alarms, and hourly nursing rounding are some of the other identified strategies (Slade et al., 2017). Education of hospitalized patients about the risks and implications of falls increases may help reduce the risk of falls (Heng et al., 2019). Toren and Lipschuetz (2017) recommend that patients should be involved in assessment of risk of falls so as to develop person-centered intervention measures. Other strategies for reducing the risk of falls among hospitalized patients include staff and patient education about best practices and risk factors, diagnosis and treatment of medical issues; patient exercise; enhanced surrounding environment; and using information technological tools such as alarms, monitors, and feedback systems (Khalifa, 2019). Patients need to be familiarized with the hospital environment since unfamiliar surroundings contribute to an increased risk of falls (Comer, 2016). On the other hand, education of hospital staff is considered as the first step for preventing patient falls (Dykes et al., 2018).

A major gap in current literature is lack of effective strategies for preventing falls among the elderly population (65 years and over) with mental health issues. The rationale for investigating fall-prevention strategies for this population is that the risk of falls grows if one has chronic conditions such as dementia and Parkinson’s disease. Exercise has been established as an effective strategy for reducing the risk of falls in geriatric rehabilitation centers and sub-acute hospitals (Slade et al., 2017).  In fact, communication disability, which is often associated with psychiatric or patients with mental health issues, are actively excluded from research on causal factors of falls (Hemsley et al., 2019).