Introduction
The reduction of the risk of patient harm resulting from falls was always on the Joint Commission on Accreditation of Healthcare Organizations’ agenda (Cooper & Nolt, 2007). Following the National Patient Safety Goals, Cooper and Nolt (2007) define patient falls as “sudden unexpected descent from a standing, sitting or horizontal position, including slipping from a chair to the floor and an assisted fall (where an individual guides the falling individual to the floor), with or without injury to the patient” (p. 108).
The risk factors for falls include the old age, low body weight, medical comorbidities, musculoskeletal system disorders, cognitive disorders, gait and balance disorders, sensory impairments, use of diuretics, antidepressants, benzodiazepines, sedative-hypnotics, antihypertensive, antiseizure, and antiarrhythmic drugs (Karlsson, Vonschewelov, Karlsson, Cöster, & Rosengen, 2013). Specialists also distinguish a group of environmental hazards such as “rugs, slippery or uneven floors, poor lighting, electrical cords, chairs and armchairs without handrails, slippery surfaces, and unsuitable footwear” (Karlsson et al., 2013, p. 748).
It has been found that the educational training of medical staff for fall prevention, application of the nursing care plan, and use of the fall risk assessment tools allow for a significant reduction of the fall rate within a hospital population (Cooper & Nolt, 2007). Prevention of Falls in the Elderly Trial (PREFET) program developed several interventions that decreased the future fall risk by 70%. Briefly, those interventions presuppose patient fall risk assessment, communication to increase patient awareness, re-evaluation of drug therapy, and physical exercises (Cooper & Nolt, 2007; Ungar et al. 2013). The paper presents a fall prevention program that also employs these interventions.
Analysis
The developed fall prevention program Elderly Fall Prevention Care is to be implemented in The Rehabilitation Center at Hollywood Hills, Hollywood, Florida. The Rehabilitation Center at Hollywood Hills is a licensed nursing facility that provides mind-body and individualized care, considering all personal needs of each patient.
The Elderly Fall Prevention Care program includes five interventions that are aimed at the reduction of fall incidence in elderly nursing home residents:
- individual management, addressing patient-specific factors,
- reduction of environmental hazards,
- appropriate reduction of medication,
- individual education in behavior strategies,
- exercise programs improving strength, balance, and aerobic capacity” (Karlsson et al., 2013, p. 749).
The individual management component of the program considers various fall-related problems of patients and suggests an individual and structured approach to the evaluation of each patient’s risk factors for falls. The reduction of environmental hazards presupposes the arrangement of a favorable living environment without loose floor mats, extensive glare, and clutter. It is recommended to install grab bars and stair rails and improve lighting in a nursing facility if necessary.
Appropriate reduction of medication with dose adjustments or withdrawal is needed when a patient is administered to take antihypertensive, diuretics, and benzodiazepines (Ungar et al. 2013). Individual behavior strategies are developed on the basis of individual evaluation of a patient. Exercise programs that improve strength, balance, and aerobic capacity should be developed on the basis of the Tai Ji Quan program. Karlsson et al. (2013) report that the Tai Ji Quan program reduces “the number of falls by almost 50 %” (p. 750).
Although the Tai Ji Quan program is targeted at community-dwelling older adults, training services may be needed in assisted living facilities. The training is aimed to teach patients the key elements of the program and encourage independent exercising. Tai Ji Quan: Moving for better balance (2014) defines the key elements of the exercising program: “self-initiated and coordinated movement sway around the ankle and hip joints with control of the center of gravity, rotational weight shifting initiated by the trunk, and eye-head-hand coordination” (p. 2).
Items for implementation of the program include safe household appliances, construction, finishing, and home decoration materials (e.g. floor mats, bulbs, grab bars, stair rails), special footwear for nursing home residents, instructor DVD and other Tai Ji Quan program teaching materials, medical and training equipment for patients.
The cost of Elderly Fall Prevention Care program implementation is comprised of geriatrician salary amounting approximately $160,000 a year (Geriatrician salary in 33186, Florida, n.d., para 1), nursing facility maintenance expenses amounting approximately $60,000 a year (medications included) (Perley, 2016), and exercise trainers for patients amounting $3200 a year (four times a year exercising class with a professional trainer and further distribution of materials for independent exercising) (Tai Ji Quan: Moving for better balance, 2014).
Conclusion
Many falls result in “fractures and also soft tissue injuries, longstanding pain, functional impairment, reduced quality of life, and increased mortality” (Karlsson et al., 2013, p. 747). The goal of the Elderly Fall Prevention Care program implementation is the reduction of the rate of falls in elderly nursing home residents group by the patient fall risk evaluation, communication to increase patient awareness, re-evaluation of drug therapy, and the introduction of physical exercises. The outcome of the Elderly Fall Prevention Care program implementation is the improvement in the balance and mobility of elderly nursing home residents and the reduction of the fall incidence.
References
Cooper, C. L., & Nolt, J. D. (2007). Development of an evidence‐based pediatric fall prevention program. Journal of Nursing Care Quality, 22(2), 107–112.
Karlsson, M. K., Vonschewelov, T., Karlsson, C., Cöster, M., & Rosengen, B. E. (2013). Prevention of falls in the elderly: A review. Osteoporosis International, 24(1), 747–762.
Perley, R. (2016). Managing the long-term care facility: Practical approaches to providing quality care. Hoboken, NJ: Jossey-Bass.
Salary Genius. (n.d.). Geriatrician salary in 33186, Florida. Web.
Tai Ji Quan: Moving for better balance. (2014). Web.
Ungar, A., Rafanelli, M., Iacomelli, I., Brunetti, M. A., Ceccofiglio, A., Tesi, F., & Marchionni, N. (2013). Fall prevention in the elderly. Clin Cases Miner Bone Metab, 10(2), 91-5.