Fallolyckor är ett stort patientsäkerhets- och samhällsekonomiskt problem. I Sverigedrabbas varje år cirka 18 000 personer av höftfraktur som leder till lidande för patientenoch stora kostnader för samhället. Syftet med litteraturöversikten var att beskrivautfallet av att använda höftskydd som prevention. Studien genomfördes som en litteraturöversikt där tolv vetenskapliga artiklar utgjorde underlaget för resultatet.Resultatet som redovisas i tre kategorier är: effekter av höftskydd, följsamhet till att bära höftskydd och upplevelser av höftskydd. Risken för höftfraktur minskas vid fall om höftskydd används. Följsamheten till att använda höftskydd minskar över tid. Resultatetvisar även att både personal och patienter är överens om att en stor anledning till varförinte höftskydd används är att de anses vara obekväma. Sjuksköterskor bör genomutbildning få en ökad medvetenhet om höftskyddens effekt för att därmed kunna minskaantalet höftfrakturer. Forskning inom området för att öka följsamheten och görahöftskydden bekvämare är önskvärt för att kunna minska antalet höftfrakturer, ochdärigenom reducera lidandet och minska stora samhällskostnader för vård ochrehabilitering som en höftfraktur medför. / Falls is a major patient safety and socio- economic concern. In Sweden approximately 18 000 persons every year suffer a hip fracture which causes the person major suffering and cost forthe society. The aim of this literature study was to describe the outcome of using hipprotectors as prevention. A literature overview was carried out were twelve scientific articleswere the basis of the result. The result is presented in three categories: effect of hip protectors, compliance to the use of hip protectors and the experiences of hip protectors. The risk of contacting a hip fracture is reducing if the fall occurs when using hip protectors. Compliance to the use of hip protector decreases over time. The result showed that patient and staff both agreed that a large reason for not using hip protectors is that they are uncomfortable. Through education nurses need to increase their awareness about the effect of hip protectors and thereby decrease the amount of hip fractures. Further research to increase compliance and to make the hip protector more comfortable would be desirable to reduce the amount of hip fractures. This will not only reduce suffering for those who contract a hip fracture but also reduce society´s major cost for the care and rehabilitation of a hip fracture.

<p>Bakgrund: Fall är vanligt och kan leda till höftfrakturer och ett tidigare behov av särskiltboende. Ett hälsofrämjande och sjukdomsförebyggande perspektiv ska vara en självklar deli all vård och behandling. Syfte: Syftet med studien var att beskriva hur sjuksköterskor kanförebygga och minska risken för fallskador hos äldre på särskilt boende. Metod: Arbetetvar en litteraturstudie på tidigare forskningsmaterial. Resultat: Den viktigaste åtgärden äratt få fram vilka äldre som tillhör riskgruppen. Detta innebär att det är viktigt attuppmärksamma äldre med kognitiva försämringar, tidigare fall, urininkontinens,nedstämdhet, lågt BMI och äldre med behov av hjälp i sin ADL. Andra åtgärder är blandannat att ha regelbundna läkemedelsgenomgångar, att skapa förutsättningar för äldrepersoner att bära höftskydd, att informera och handleda omvårdnadspersonalen, attinformera de äldre och deras anhöriga om risker och åtgärder. Slutsats: Ytterligareforskning behövs vad det gäller sjuksköterskans omvårdnadsåtgärder för att förebygga ochminska fallskador på särskilt boende för att nå ett tillförlitligt resultat inom dettaämnesområde. Förbättrade bedömningar och åtgärder, mer stöd och förståelse från cheferskulle kunna ge tydligare rutiner, minskade kostnader för samhället och inte minst minskadet lidande som det kan innebära för äldre med fallskador.</p> / <p>Background: Falls are common and can lead to hip fractures and earlier need ofinstitutionalization. A health promoting and preventive perspective is an important concernin public health. Aim: The aim of the study was to examine how the nurse can prevent andreduce the risk of fall injures at older people living in residential care. Method: This workwas a literature study on earlier research materials. Results: The most important measureis to identify older people with risk factors for falls. This means that it is important toattentive older people with cognitive impairment, history of falls, urinary incontinence,depressed mood, low BMI and older persons with needs of help in daily physical activities.Other measures are for example to have regular medicine reviews, to create conditions forthe older to carry hip protections, to inform and teach the care employers, to inform theolder and his relative about risks and measures. Conclusion: Further research is neededregarding nurses care measures to prevent and decrease fall injuries in residential care inorder to reach a good result within the subject. Improved assessment and measures, moresupport and understanding of the managers would give more clear routines, the costs forsociety would decrease and most important it would decrease the suffering that fall injuriescauses elderly residents.</p>

This study assessed falls efficacy and confidence-related changes among participants attending the a Matters of Balance/Volunteer Lay Leader (AMOB/VLL) falls prevention program for older adults, based on their residential location. Data were examined from 431 older Texans enrolled in AMOB/VLL during a two-year period, and assessed at baseline and post-intervention. Results indicate that participants significantly increased falls efficacy, reduced activity interference due to their health, and decreased the number of days limited from usual activity. Regression models show that participants, despite entering the program with lower reported health status, reported greater rates of positive change for falls efficacy and health interference compared with their baseline pre-intervention counterparts. Overall program attendance and attendance at major sessions showed the greatest influence. Findings contribute to the understanding of cognitive restructuring and strengthening variations with falls prevention program outcomes.

Falls among hospitalized elderly patients are a safety concern for health care organizations and the patients they serve, but falls can be prevented through the team effort of nurses and other health care professions to promote safety within the organization. The project site was experiencing an increase in the number of patients falls and identified the need for staff education related to assessment and intervention to prevent patient falls in the elderly population. Thus, the practice-focused question for this project was whether an educational program on evidence-based fall prevention strategies using the American Medical Directors Association clinical guidelines would improve staff nurse ability to assess fall risk and apply intervention strategies for elderly patients in an acute care setting compared to standard practice. Lewin's change theory was used as the theoretical foundation for this project. A total of 29 cardiac unit staff nurses who participated in the educational program were provided information on recognizing risk factors for falls, conducting an accurate fall risk assessment using the Morse Fall Scale, and developing individualized care plan for managing fall risk. The Agency for Healthcare Research and Quality 2E Fall Knowledge Test was used in a pre- and posttest design to assess the efficacy of the educational program. The results showed a statistically significant increase (p < 0.001) in staff members' knowledge in recognizing, assessing, and managing falls. This project can improve nurse's knowledge with evidence-based recommendations in practice, which promotes positive social change through improved staff competency that may result in decreased patient falls and adverse patient outcomes.

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Yes / Inpatient falls are the most common safety incident reported by hospitals worldwide. Traditionally, responses have been guided by categorising patients' levels of fall risk, but multifactorial approaches are now recommended. These target individual, modifiable fall risk factors, requiring clear communication between multidisciplinary team members. Spoken communication is an important channel, but little is known about its form in this context. We aim to address this by exploring spoken communication between hospital staff about fall prevention and how this supports multifactorial fall prevention practice. Data were collected through semistructured qualitative interviews with 50 staff and ethnographic observations of fall prevention practices (251.25 hours) on orthopaedic and older person wards in four English hospitals. Findings were analysed using a framework approach. We observed staff engaging in 'multifactorial talk' to address patients' modifiable risk factors, especially during multidisciplinary meetings which were patient focused rather than risk type focused. Such communication coexisted with 'categorisation talk', which focused on patients' levels of fall risk and allocating nursing supervision to 'high risk' patients. Staff negotiated tensions between these different approaches through frequent 'hybrid talk', where, as well as categorising risks, they also discussed how to modify them. To support hospitals in implementing multifactorial, multidisciplinary fall prevention, we recommend: (1) focusing on patients' individual risk factors and actions to address them (a 'why?' rather than a 'who' approach); (2) where not possible to avoid 'high risk' categorisations, employing 'hybrid' communication which emphasises actions to modify individual risk factors, as well as risk level; (3) challenging assumptions about generic interventions to identify what individual patients need; and (4) timing meetings to enable staff from different disciplines to participate. / This research was funded by the National Institute for Health and Care Research Health Services and Delivery Research Programme (project number HSDR NIHR129488).

Introduction: Falls are the leading cause of death due to injury among the elderly. Every 24 minutes an older adult dies from a fall related injury. Studies using 3 different methods were performed at a large urban, academic medical center in the US. Aim #1: Understand the advantages and disadvantages of QI methodologies (Lean and Six Sigma) and HFE when applied to fall prevention in the acute care setting: o Evaluate the contribution of QI and HFE to fall prevention with a focus on reducing falls with serious injury. o Use studies with different methodologies (Lean, Six Sigma) to develop and implement an intervention with the goal of decreasing total falls and falls with injury. o Compare methodologies (Lean, Six Sigma and HFE) to understand their benefits and limitations. Aim #2: Develop recommendations for fall prevention: o Investigate interventions and assess success of fall prevention. o Develop an understanding of interventions that prevent falls resulting in injury. Methodology and Results: Study #1 (Method = Lean, Intervention = Standard Work): Study #1 used Lean techniques such as standard work to improve fall risk assessment and intervention selection. Total falls decreased by 22%. At first glance this appears successful but a deeper evaluation of the serious injuries revealed more improvement is needed. There were still 15 falls with serious injuries that occurred among the three oncology divisions. These rare but serious injuries result in a longer hospital stay and increased cost of treatment that is not reimbursed. Due to a climate of increasing financial pressure further reduction of serious injury was desired. Study #2 (Method = Six Sigma, Intervention = Patient Partnering: Study #2 used Six Sigma tools to investigate root causes of falls. An intervention called Patient Partnering was developed to encourage patients to call for help and participate in preventing their own falls. There were no falls with serious injury for over 14 consecutive months. However, the intervention was difficult to sustain due to resistance from nurses and patients. Falls with injuries resumed as the intervention ceased. Study #3 (Method = Qualitative HFE, Intervention = Patient Interview): Study #3 was a qualitative study based on Human Factors principles to understand patient s perception of fall risk. It was found that patients did not think they would fall and felt particularly safe and protected while in hospital. They found it difficult to get around with IV tubes and crowed spaces. They wanted information and assistance when they need it, in the format they prefer (customized for each individual patient). Impact on society: Falls prevention interventions need to be designed for all the stakeholders (patients and staff). Patients think nurses will keep them safe and are willing to participate with fall prevention if they feel it is tailored to their needs. Until all perspectives are taken into account it is unlikely that there will be sustained and embedded improvements. Key message: Falls with injury are rare events with complex root causes that require agile solutions with constant revision to align with rapidly changing conditions and interactions. Reducing injury will take a balance between safe environment, organization, processes, tasks and behaviors from staff and patients.

Increasing levels of physical activity in older adults and fall prevention are key concerns of current UK health policy. Regular physical activity has many positive benefits for older adults, for example in fall prevention. However, sedentary behaviour among older adults is common. Forty per cent of over 50s in the UK report less physical activity than is considered necessary to maintain good health. Sedentary behaviour is even more common in South Asian older people in the UK. The aim of this research was to investigate the attitudes and beliefs that drive or hinder uptake and adherence of physical activity, in general and in relation to fall prevention, among 60-70 year old Caucasian and South Asian community dwellers. An ethnographic method was chosen as the research approach as it provided the framework for facilitating the incorporation of multiple voices. Two main geographical areas were chosen to conduct the study and included eight sites of study. Data collection used multiple methods (participant observation, focus groups and semi-structured interviews). In total 60 hours of participant observation, 15 focus group discussions (n = 87; mean age = 65.74 years) and 40 semi-structured interviews (mean age = 64.83 yrs) were conducted. Data analysis and classification followed a framework approach, comparing and contrasting themes within and across groups. Findings demonstrate that older people do not recognise falls as a risk and are not motivated to perform physical activity on a regular basis purely to help prevent falls. Social support and social benefits of physical activity appear to be key motivators to initiating and maintaining physical activity. Enjoyment, increased self-confidence and developing social networks seem to be important motivators in terms of adherence. Health, although a good motivator for the initiation of physical activity, appears to be a secondary motivator in terms of adherence. Barriers to physical activity include perceived and actual poor physical health, lack of social support, specificity of physical activity messages by health professionals as well as lack of motivation, low mood, fear of harm and domestic and carer issues. These findings suggest that older adults should be assessed individually, to address physical symptoms and possible low mood, and not according to age. The importance of exercise, even in the presence of physical illness needs to be explained. There is a need to promote confidence in older people’s ability to perform an activity, as this appears to be essential in continuing with exercise. Activities that take a ‘one size fits all’ approach, serve as a de-motivating force. Variety in exercise and physical activity is important to maintain motivation in the long-term.

The United States is a rapidly aging nation. Older adults have higher rates of falls than any other age group. One in four older adults fall each year. Many of these falls are associated with sedentary lifestyles and decreased muscular strength effecting balance and gait performance. Physical activity (exercise) can reduce the risk of falls among older adults, yet adherence remains low. Exergames can increase adherence to interventions that promote health and physical activity. Social engagement can increase self-efficacy and motivation to exercise. By design, the Bingocize® health promotion mobile application (app) increases social engagement, while providing a multi-factorial fall prevention intervention. The purpose of this investigation was to evaluate the efficacy of the app to improve gait in community-dwelling older adults (N=38; mean age 72.42 years +12.58). Participants were clustered and randomly assigned to (a) experimental (n=20; using app with bingo game, health education and exercise) or (b) control (n=18; using app with bingo game, health education without exercise) condition. Each group completed a tenweek intervention that consisted of two- 45-60 minute sessions per week. Pre and post gait analysis, at self-selected (SS) and fast-walking speeds, measured using the GAITRite® Electronic Walkway (GWS). Gait analysis included parameters of velocity, cadence, step time, step length and width, and single and double support time. A mixedmodel ANOVA (p < .05) was used for statistical analysis. There were no main effects observed. Significant interactions (group x time) were observed at fast speed and SS speed compared to the control group. Significant interactions were observed at fast speed included velocity (λ = .886, F (1, 36) = 4.61, p = .039, 𝜼𝒑 𝟐 = .114); and step length (λ = .864, F (1, 36) = 5.64, p = .023, 𝜼𝒑 𝟐 = .136); and were observed at SS speed for single support time (λ = .887, F (1, 36) = 4.59, p = .039, 𝜼𝒑 𝟐 = .113). Post hoc analyses using paired and independent samples t-tests were conducted on gait variables with observed significant interactions. The independent samples t-test for Single Support Time (SS) post was significant (t (36) = 2.454, p = .019, two-tailed). None of the remaining post hoc analyses were significant. There was a meaningful detectable change (MDC) in mean velocity (>5 cm/s) over time, for both SS and fast walking speeds, within the experimental condition. MDC in gait speed ranges from 5 cm/s (small) to 10 cm/s (large). As for clinical significance, this should be considered a small, yet meaningful detectable change. It is the conclusion of the investigators, that the app, with the exercise intervention, can effectively produce a meaningful change in gait speed (5 cm/s), which has the potential for reducing the risk of falls in older adults. This investigation was funded by The Retirement Research Foundation.