Falls are the most frequently reported incidents among hospitalized patients in the United States with at least 4 falls per 1,000 patient days occurring annually. Falls are related to high rates of mortality and morbidity and high hospital costs. The purpose of this project was to evaluate a fall prevention quality initiative to reduce falls in an acute care facility by educating staff on an evidence-based fall prevention protocol. The project sought to explore whether implementation of an evidence-based fall prevention initiative in educating nurses would affect the nurses’ professional knowledge and the number of patient fall incidences in the cardiac care unit. The theoretical framework supporting this project was Neuman’s systems theory. The Iowa model was used to guide this evidence-based project. An educational session was implemented to increase nurses’ awareness of fall prevention practices. Two sets of data were collected: the pretest and posttest results, and the number of falls on the unit. A total of 21 unit nurses participated in the pretest; 18 (86.0%) completed the posttest. The mean score on the pretest was 81.62%; the mean score was 85.89% for the posttest with a mean difference of 4.27%. A paired sample t-test revealed no statistically significant differences in scores after education. This project has implications for social change by supporting patient safety, decreased hospital stays, and reduced health care expenses to patients and health care organizations.

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease comprising of respiratory-related and systemic effects, including impairments in balance. Balance impairments are especially problematic as they increase the risk of falling, potentially leading to negative outcomes such as hospitalization, disability, and death. The main objectives of this thesis were to 1. determine underlying balance impairments that distinguish between individuals with COPD with and without a history of falls and 2. explore facilitators and barriers of a home-based fall prevention program for people with COPD. The first study of this thesis was a secondary analysis of cross-sectional data that showed that the stability limits/verticality and postural responses subcomponents of the Balance Evaluation Systems Test (BESTest) distinguished between those with and without a fall history among 72 patients with moderate to severe COPD. The stability limits/verticality subcomponent also showed acceptable accuracy in identifying individuals with COPD at high risk of falls (cut-off score of 73.8%). In the second study, a qualitative analysis of interviews with 15 patients who completed a home-based fall prevention program, participants indicated that programs that are personalized and focus on providing support for older adults with COPD may help to improve adherence and reduce participants’ risk of falling. The findings from the two studies included in this thesis provide new knowledge for informing fall risk assessment and prevention for people with COPD. / Thesis / Master of Science (MSc)

Slips are a leading cause of injury among older adults. Specific slip recovery measures, including slip distance and peak slip speed, have been shown to increase significantly among fallers as compared to non-fallers. Often, slipping kinematics are measured using optoelectronic motion capture (OMC), requiring a laboratory setting and limiting data collection to experimentally-controlled conditions. Inertial measurement units (IMUs) show promise as a portable and wearable form of motion capture. This study had two objectives. First, we investigated whether foot and ankle IMU-derived slip recovery measures could be considered equivalent to the same OMC-derived measures. Second, we investigated if both participant-placed and researcher-placed IMU-derived slip recovery measures could be considered equivalent to the same OMC-derived measures. 30 older adults (ages 65-80) were exposed to a slip while wearing both IMUs and OMC markers. Slip distance and peak slip speed were measured by both systems and compared. Equivalence testing (α = 0.05) showed that IMUs placed on the foot and the ankle were equivalent to OMC in measuring these slip recovery measures. Furthermore, it was shown that researcher and participant-placed IMUs were equivalent (α = 0.05) to OMC in measuring these slip recovery measures. These results confirm that IMUs can be a viable substitute for OMC and have the potential to expand data capture to a real-world environment. / Master of Science / Falls are a major cause of injury among older adults. Slips are a large contributor to falls, so it is important to better understand how slips occur to develop more efficient fall-prevention programs. To understand slips, previous research often utilized optoelectronic motion capture (OMC) to measure slip recovery measures. However, OMC relies on multiple cameras, limiting slip measurement to a laboratory. As we want to understand slips in the real-world, we must use a different form of motion capture. Inertial measurement units (IMUs) are sensors that can afford real-world biomechanical measurement. In this thesis research, 30 older adults (ages 65-80) were exposed to one over-ground slip. Slip recovery measures are compared between OMC and IMUs placed on the foot and ankle. Furthermore, IMU placement is compared between researchers and participants. Equivalence testing showed that IMUs placed on the foot and the ankle were equivalent to OMC in measuring these slip recovery measures. Furthermore, it was shown that researcher and participant-placed IMUs were equivalent to OMC in measuring these slip recovery measures. These results confirm that IMUs can be a viable substitute for OMC and have the potential to expand data capture to a real-world environment.

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No description available.

Residents in nursing facilities are more prone to falls than those living in the community. Injuries resulting from falls impact residents, their families, and healthcare costs. The gap in nursing practice was the lack of a comprehensive fall-prevention program in a long-term care facility that had experienced high fall rates among residents. This project addressed whether an educational program using the American Medical Directors Association's clinical practice guideline and the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, & Injuries) toolkit for fall- prevention improved the self-efficacy of direct-care staff in preventing falls among residents in a long-term care facility. The practice-focused question focused on whether education on the use of an integrated multifactorial fall-prevention guideline would increase confidence of long-term care staff in reducing falls in long-term care residents. The evaluation used the 11-item Self-Efficacy for Preventing Falls-Nurse scale for 5 licensed nursing staff and the 8-item Self-Efficacy for Preventing Falls-Assistant scale for 21 nursing assistants. The positive change in self-efficacy scores of nurses and nursing assistants after the education program was greatest for face-to-face team communication regarding fall risk and individual resident prevention plans. The use of best-practice guidelines that improve fall risk-assessment and use of fall precautions to decrease the number of falls and falls with injury has the potential to bring about positive social change by improving the nursing care of nursing home residents, resulting in improved resident safety and quality of life.

BACKGROUND: Age-related deterioration in the nervous system results in the decline of motor and cognitive abilities, which both have been identified as contributing to fall risk in older adults. Dual-task gait, which involves walking while performing a secondary cognitive task, is a common way to assess the interactions between cognitive and motor function. Previous work has established associations between the cost of the cognitive load on gait parameters (e.g., velocity) and fall risk in older adults. However, to date, no study has explored the potential value of combining a direct measure of performance on the cognitive component of the dual-task with the gait measures in fall risk prediction modeling. RESEARCH QUESTIONS: Does including measures of performance on the cognitive task in dual-task walking with the gait velocity measures enhance the capacity to predict fall risk. Is this predictive capacity different in models employing dual-task gait velocity versus models including the cost of the cognitive load on gait velocity? METHODS: Thirty-two community-dwelling older adults (76 years ± 3.44) were classified as fallers (n = 17) and non-fallers (n = 15) based on self-report of having at least one fall in the past 12 months. They completed single-task and dual-task walking on a pressure-sensing electronic walkway system. A progressively enhanced series of logistic regression models were performed commencing with gait velocity during the dual-task (Loaded Gait Velocity, LGV) as the covariate in predicting fall risk. This model was subsequently augmented by adding a measure of cognitive performance covariate and then further augmented with the addition of the interaction variable between the LGV and the cognitive performance variables. This stepped series of modelling was then repeated with the dual-task cost gait velocity (DTCGV, difference in gait velocity between single and dual-task). RESULTS: With the addition of the cognitive measures (CM) and the interaction variables between the GV and CM variables, in both the LGV and DTC_GV models, the Nagelkerke’s R square increased as did the models’ respective sensitivity. Notably, the model including the LGV, CM and the interaction variables achieved 88.2% sensitivity, 80% specificity, with an overall classification accuracy of 84.4%. DISCUSSION: This study is the first to show that the ability to identify fallers and non-fallers is enhanced by using both gait and cognition measures as well as interaction variables between gait and cognition measures. Further, our findings suggest that the added value of the cognitive measures is best realized with LGV rather than DTCGV. It reasons that because DTC already encompasses the cost of the cognitive load on the motor performance (gait velocity), combining it with cognitive metrics does not enhance its predictive capacity. This work suggests there is clinical utility of including cognitive performance measures in fall risk modeling as well as it provides further evidence of the interplay between cognitive and motor function in fall risk. / Graduate

Falls are a major public health concern and contribute significantly to mortality and morbidity in the older adult population. Each year, approximately 3 million older adults are treated in emergency departments for fall-related injuries and at least 300,000 older people are hospitalized for hip fractures. The purpose of this project was to improve the participants' knowledge and highlight interventions to reduce the incidence of falls and injuries as a result of falls. The project was developed using the Stop Accidents, Deaths and Injuries (STEADI) toolkit, the Iowa model of evidence-based practice to promote quality of care, and the Lewin's change theory. The practice-focused question related to whether fall prevention would improve following the implementation of a staff education project using the STEADI toolkit. Twenty-six nurses were assessed to determine their knowledge deficits. Pretest and posttest data were analyzed, and as a result of the staff education initiative, the nurses' knowledge increased by 99.25%. Prior to the session, the facility had not participated in a fall-prevention initiative. This project offered a practical solution to the educational gaps identified at the practice setting. Adopting the STEADI toolkit at the practice setting is expected to improve patient safety, reduce falls with injuries and prevent fall-related deaths.

Background and Purpose: Falls are the leading cause of accidental death among older adults. Reducing falls risk is one of the major safety concerns for older persons. More than one-third of people 65 years and older will experience one or more falls per year and nearly half of the people over 80 years of age will fall at least once each year. A key initial step in reducing falls is identifying those persons at highest risk so that they can be assessed and prescribed appropriate interventions. Therefore, the purpose of this study was to examine the capacity of a number of field and laboratory tests to identify fallers in a sample of older independently-living, community-dwelling persons. Participants: 66 healthy, independently living older persons, ages 60 and older. Method: During three visits to the laboratory, participants performed various field and laboratory balance tests. Field tests included the Timed Up and Go Test (TUG), the One-Leg Stand Test (OLS), the Functional Reach Test (FR), and the Tinetti Performance Oriented Mobility Assessment (POMA). The laboratory tests included a center of pressure (COP) test with time-to-boundary (TTB) measurements on a force platform, and dynamic posturography using the Proprio 5000. Each participant was classified as a “faller” or “non-faller” based on whether he or she recalled experiencing a fall within the past year. Results: Receiver-operated characteristics (ROC) curve analyses (specificity and sensitivity throughout the measurement ranges) revealed the OLS and TUG field tests and selected Proprio 5000 and TTB variables had the best capacity to distinguish fallers from non-fallers. For both field and laboratory tests one-way ANOVA revealed between-group differences similar to those indicated by the ROC results. Discussion and Conclusion: Both selected field and laboratory tests could identify fallers (16 out of 66). In addition, the laboratory tests revealed balance decrements in specific planes of motion that provide information concerning directional falls risk and a offer a framework for the prescription of interventions to reduce that risk.

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. / 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.