Introduction
The purpose of the study is to address the causes that lead to hospital falls and fall-related injuries in elderly patients with mental illnesses. In this part of the paper, the demographic data about the sample size, the results of the study, and the discussion of the interviews will be presented.
Demographic Data
For this study, interviews with medical personnel were conducted to address the following questions: what are the intrinsic risk factors that influence the incidence of hospital falls and fall-related injuries? What are the extrinsic risk factors that influence the incidence of hospital falls and fall-related injuries? Which fall prevention processes could be implemented in these units to enhance the quality of care and minimize hospital-associated costs?
Twenty nursing professionals who work with elderly patients with mental illnesses agreed to participate in the interviews. Thirteen participants were female; seven participants were male. The majority of the nurses (fifteen individuals) have been working three or more than three years (3 to 4.5 years) with elderly patients. One nurse has been working with such patients for ten years. Four nurses have been working with these patients, two or less than two years (2-0.5 years). Participants of the study work at two different psychiatric clinics and provide similar services to elderly patients.
The majority of the patients have one of the following conditions: dementia, depression, post-traumatic stress disorder (PTSD), various anxiety disorders (e.g., social anxiety, panic attacks, generalized anxiety disorder), and others. According to the World Health Organization (2016), approximately 15% of older adults (>60) have mental disorders. Most of the patients are 60-65 years and older (>85).
The duration of the interviews conducted with medical personnel varied; most of the interviews took thirty-five or forty minutes to conduct. Two interviews were shorter than others due to the lack of time or a sudden emergency situation at the clinics. All interviews were conducted on-site (in the medical facility); hospital administration was contacted to attain approval prior to the interviews.
Interviews’ Results
The interviews supported the hypothesis discussed in the previous papers: falls and fall-related injuries are connected to the use of different drugs, including antipsychotics and antidepressants. Eighteen nurses confirmed that drugs used for treatment could negatively influence movements and cause balance problems. The participants also commented on the impact of weak sight and possible faints or fatigue on falls and fall-related injuries. Four participants agreed that weak sight could strongly influence the possibility of a fall in elderly adults. Ten participants pointed out that faint and fatigue are more likely to cause falls and fall-related injuries compared to weak sight. They also provided an explanation for this phenomenon, stating that antipsychotic drugs could adversely influence muscle strength, which eventually led to the increased frequency of falls and fall-related injuries. What is more, twelve participants stated that other diseases such as hypertension or osteoarthritis, combined with the use of drugs, could result in even more frequent falls.
Extrinsic reasons were also addressed in the interviews. The majority of the participants (eighteen nurses) agreed that unsafe hospital conditions were the main cause of falls and fall-related injuries. Poor construction of facilities and staircases, slippery floors, carpets, uneven paving, and even footwear were named as the main causes of falls. Five nurses stated that medical personnel inaccuracy contributed to the problem as well. According to the participants, exhaustion, fatigue, and the fast-paced working process often resulted in mistakes that led to fall-related injuries in patients. One should bear in mind that some of the participants possibly decided not to mention this problem, and it was difficult to estimate the real influence of medical personnel inaccuracy on falls and fall-related injuries. Two participants stated that they were injured when trying to catch falling patients. Poor illumination and lack of grab bars also caused falls, but not as frequently as other factors.
It should be noted that weather conditions also contributed to the increased rates of falls. All participants pointed out that slippery or icy pavements after rain or snow significantly increased the risk of falls. Here, poor illumination or lack of sunlight was also significant because, on cloudy days, patients with weak sight were more likely to fall. Although the medical personnel agreed they tried to help patients during their walks, it was not always possible due to their other responsibilities and workload. Other causes included accidental hits from or with other patients or distracting factors such as loud noises, calls, loud talks.
When the participants of the study were asked about possible strategies that could prevent falls and fall-related injuries, many (seventeen nurses) agreed that the shortage of medical workers was the main reason and needed to be addressed as soon as possible. Some of the nurses (eleven participants) also indicated that improving environmental conditions would be a positive influence. Three participants stated that as it was almost impossible to reduce the doses of medications due to the prescribed rules of treatment, it would be reasonable to provide a surveillance system in the hospital or give patients wearable fall-detectors. Furthermore, each participant agreed that slippery falls or lacking grab bars should not be ignored when treating any patients, including elderly ones.
Discussion
As it can be seen from the interviews, the major causes of falls and fall-related injuries are the following:
- Drug use (sedative antipsychotics and antidepressants)
- Mental conditions
- Environmental factors (slippery floors, lack of grab bars, poor illumination, etc.)
- Human error (medical personnel inaccuracy)
As it can be seen, the main factors that cause falls and injuries are drugs that patients are prescribed to take. This statement is supported by Oderda, Young, Asche, and Pepper (2012), who points out that both use of first and second-generation antidepressants and antipsychotics correlates with the risk of hip fracture in older adults. El-Bendary, Tan, Pivot, and Lam (2013) notice that these injuries lead to decreased mobility and inability to look after oneself. The relation between hip fracture and dementia is also supported by another study: the authors state that the mortality rates among such patients are greater (Scandol, Toson, & Close, 2012). Environmental factors as possible causes of falls and injuries are discussed by El-Bendary et al. (2012) and Quigley, Barnett, Bulat, and Friedman (2014), who suggest using floor mats to prevent injuries in elderly patients. Environmental factors that significantly worsen the mobility of patients need to be improved by hospital administration in order to reduce the rates of falls and fall-related mortality. Furthermore, human errors are accountable for multiple problems in healthcare, and falls are one of them. As it was already mentioned, the shortage of medical professionals, especially nurses, adversely affects patients and their well-being. Therefore, hospital administrations need to pay attention to the lack of nursing professionals if it has a negative impact on the injury frequency rates. This approach can minimize hospital-associated costs because the treatment of patients will be more efficient without additional injuries and injury-related infections or disorders. Furthermore, hospital facilities need to be reconstructed to ensure that patients can use grab bars, staircases, steps, rugs, and mats without being at risk of being injured.
Limitations and Recommendations for Future Research
The limitation of this study includes the small sample size, the members of which work at two hospitals with possibly similar approaches towards patients with mental disorders and fall-related injuries. Moreover, this study was not able to correct the bias linked to medical personnel’s unwillingness to discuss human errors as possible causes of falls and fall-related injuries. The study was also unable to gather specific data about mental illnesses and their correlation to fall rates (e.g., if patients with depression are more likely to fall than patients with PTSD). The dosage of medications was also not discussed in the interviews.
Due to the growing age of the population, this study can be used as a supporting study in future research about hospital falls and injuries, which will include larger sample size and address the specifics of each mental illness separately. The issue of hospital falls and injuries is underresearched. A larger prospective study is needed to address the problem on different levels, including community, urban, suburban, state, and national levels. The author of this study also believes that comparing data from American and European researchers would also be useful for future research. It is possible to assume that data about hospital falls, and fall-related injuries will vary depending on the city, country, climate, economic state, and other factors.
References
El-Bendary, N., Tan, Q., Pivot, F. C., & Lam, A. (2013). Fall detection and prevention for the elderly: A review of trends and challenges. International Journal on Smart Sensing and Intelligent Systems, 6(3), 1230-1266.
Oderda, L. H., Young, J. R., Asche, C. V., & Pepper, G. A. (2012). Psychotropic-related hip fractures: Meta-analysis of first-generation and second-generation antidepressant and antipsychotic drugs. Annals of Pharmacotherapy, 46(8), 917-928.
Quigley, P. A., Barnett, S. D., Bulat, T., & Friedman, Y. (2014). Reducing falls and fall-related injuries in mental health: A 1-year multihospital falls collaborative. Journal of Nursing Care Quality, 29(1), 51-59.
Scandol, J. P., Toson, B., & Close, J. C. (2013). Fall-related hip fracture hospitalisations and the prevalence of dementia within older people in New South Wales, Australia: An analysis of linked data. Injury, 44(6), 776-783.
World Health Organization. (2016). Mental health and older adults. Web.