Falls are caused by many factors in older patients. Medications have been shown to be a risk factor for falls, and studies have shown that patients taking more than five total medications may have a two-fold increased risk of impaired balance. A more recent model suggests only medications with sedating and anticholinergic properties contribute significantly to physical impairment. The authors of this paper helped to develop a multidisciplinary clinic to evaluate the risk of falls in at-risk patients. We present the case of a woman on multiple medications that increased her risk of falling. Of note, this patient was taking a total of 14 prescription medications, seven of which were considered sedating. Based on a comprehensive medication evaluation, six specific changes were recommended to improve this patient's medication regimen and reduce her risk of falling.

Bakgrund: Fallolyckor bland äldre är vanligt. År 2019 var drygt 5% av vårdskadorna på sjukhus fallolyckor. Fallolyckor får konsekvenser för samhället i form av stora kostnader, men även för den äldre i form av bland annat social isolation. Idag finns många fallpreventiva åtgärder och riskbedömningsinstrument och det är sjuksköterskans ansvar att bedriva säker vård och förhindra fallolyckor som skapar ett vårdlidande hos patienterna. Syfte: Att undersöka faktorer som orsakar fallolyckor bland äldre patienter på sjukhus. Metod: Metoden som användes var en allmän litteraturöversikt av vetenskapliga artiklar med både kvalitativ och kvantitativ ansats som tagits fram genom systematisk artikelsökning i flera databaser.Resultat: Tre huvudkategorier identifierades: inre faktorer, yttre faktorer och mänskliga faktorer. Inre faktorer som orsakar fall är sjukdomar och läkemedel. Yttre faktorer är miljöfaktorer, eller tid, rum och aktivitet där de flesta fall sker nattetid vid förflyttning till badrummet eller i samband vid toalettbesök. Mänskliga faktorer är faktorer orsakat av patient och anhörig, eller på grund av brister i sjuksköterskans omvårdnad i form av brister i riskbedömning, åtgärder och information. Konklusion: Orsaken till fall hos äldre patienter är ofta multifaktoriella men det vanligaste är fall nattetid på väg till toaletten. Den mänskliga faktorn är en stor bidragande faktor till fall. / Background: Fall accidents among older persons are common. In 2019, just over 5% of health care injuries in hospitals were fall accidents. Fall accidents have consequences for the society such as large costs, but also for the older patients who become socially isolated. Today, there are many fall prevention interventions and risk assessment instruments. It is the nurse’s responsibility to provide safe care and to prevent falls that cause patients to suffer. Aim: To investigate factors that cause fall accidents among elderly inpatients.Method: The method used was a general literature review of articles with both a qualitative and quantitative approach, which was found through a systematic article search in several databases.Findings: Three main categories were identified: internal factors, external factors and human factors. Internal factors that cause falls are diagnoses and drug treatments. External factors are environmental factors, or time, space and activity where most falls occur at night when transferring to the bathroom or in near connection to toilet visits. Human factors are factors caused by the patients and relatives, or due to lacks in the nurse's care such as risk assessment, measures and information.Conclusion: Cause of falls in older patients is often multifactorial, but the most common fall is falling at night on the way to the toilet. The human factor is a major contributing factor to falls.

Despite the availability of many fall prevention measures, many patients fall in U.S. hospitals each year. Experts view patient fall rates as the measure that can be most affected by a nurse-led, evidence-based intervention. The purpose of this quality improvement project was to implement and evaluate the impact of patient engagement strategies on patient compliance to fall prevention education and the reduction of falls. The quality improvement framework used for this project was the Iowa Model. Interventions for this project included patient engagement strategies including the teach-back (TB) method and video-based fall prevention education paired with the project site's existing fall prevention program. A prospective quantitative design was used to answer the practice-focused question of whether the implementation of a falls protocol incorporating patient engagement strategies improves patient compliance with the fall prevention plan of care and reduces patient falls. A total of 58 patients were included in this project, conducted from July to October 2017. The results showed a 75% reduction in the fall rate compared to the same three month period in 2016. This finding suggests that reinforcement of oral and written instruction through video education follow-up and the use of the TB method to assess patient understanding are effective measures to reduce patient falls and increase patient compliance to the fall prevention plan of care. These patient engagement strategies can be replicated by nurses in similar acute care settings. Adoption of such evidence-based changes in nursing practice may improve patient safety and decrease harm in hospital settings as implications for positive social change.

Fall risk among older adult is a worldwide public health problem. As the older adult population is continuing to increase, addressing this issue is critical. Several fall risk assessment tools have been designed to help predict various risk factors. Among these assessment tools is the Hendrich II Fall Risk Model (HIIFRM). This tool uses evidence-based risk factors including mental status, sex, functional status, and whether the patient is taking antileptics and/or benzodiazepines. The purpose of this paper is to validate the HFRM, explore additional variables that increase the likelihood of falling including both past falls and the number of prescription medications a patient is taking. Our findings validate the HFRM; with each additional point on the HFRM score, holding all other explanatory variables constant, the odds of having multiple previous fall-related admissions increased by 38.3% (P < 0.001). The strongest predictor of future falls was previous falls. With confounders held constant, each additional previous fall predicted a 3.9-fold increase in the odds of experiencing a future fall (p < 0.001; 95% CI of OR: 3.131 to 4.961). When looking at prescription medications, for each additional increase in prescription medications, we observe a 11.8% increase in the number of falls experienced during the tracking period (p<0.001; 95% CI of IRR: 1.084 to 1.170). Although a validated tool, our research indicates additional variables that could further enhance its effectiveness.

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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.

Problem: The Centers for Disease Control and Prevention indicates that falls are the “leading cause of injury death and the most common cause of nonfatal injuries and hospital admission for trauma among people ages 65 and older.”1 Falls can have significant economic consequences to the individual and payer sources. To address these consequences, telerehabilitation was hypothesized to be a suitable supplement for fall screening efforts. Several sources concluded that support for synchronous telerehab was underdeveloped in the literature. Purpose: The purpose of this study was to explore the acceptability, feasibility, reliability, and validity of telehealth-delivered fall screening among community-dwelling older adults. Procedures: This investigation implemented an experimental, quantitative, cross-sectional design employing both pretest-posttest control group and quasi-experimental static group comparisons using non-probability sampling. This study assembled a panel of experts to provide content validation for a survey tool developed to quantify an older adult’s behavioral intension to use and attitudes towards a telerehabilitation delivery system. Seven fall screening tools were investigated for agreement among remote and face-to-face raters, and for comparison with the face-to-face reference standard (Mini-BEST). Results: All three null hypotheses were rejected. Results indicate that a telerehabilitation delivery system is a reliable and valid method of screening and determining fall risk in community-dwelling older adults. This study produced a content validated, internally consistent survey instrument designed to determine attitudes and beliefs about telerehabilitation. An experimental design was able to demonstrate a positive significant change in 4 of 7 survey constructs among the intervention group after exposure to telerehabilitation as compared to post-test controls. Overall, no significant difference was calculated between face-to-face or telerehab raters, and both environments produced equivalency with scoring, fall risk classification, and ability to discern fallers from non-fallers. Results from the telerehab STEADI fall risk conclusions were calculated to be concurrently valid with the face-to-face reference standard screening tool, the Mini-BEST. Conclusions: This investigation expanded the array of remote healthcare delivery options for clinicians and clients. Further investigation in residential and community settings are recommended.

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Purpose/Hypothesis: Falls in the older adult population are the leading cause of fatal and non-fatal injuries in America. Polypharmacy, the use of multiple medications, has been identified as a major risk factor for falls in older adults. A variety of medication screens exist that identify adverse effects of medications which can directly impact fall risk; however, current screening measures have limitations. The Quantitative Drug Index (QDI) is a new, clinically anchored index to quantify all potential adverse effects associated with drug-mediated fall risk. The purpose of this study was to validate the QDI as a fall risk screening tool. Number of Subjects: 138 adults were recruited from local senior centers and screened. Inclusion criteria: community-dwelling, age 60 to 89 years, and currently prescribed at least one medication. Exclusion criteria: progressive neurological disorders, unstable medical conditions, cognitive impairment, severe depression or anxiety, severe lower extremity impairment that would impact mobility, and severe vision impairment. Materials and Methods: Mobility and balance outcome measures related to fall risk included: 30-second chair stand test, 10-meter walk test, Timed Up and Go (TUG) and Dynamic Gait Index (DGI). Self-report measures of fall risk included fall history, Fall Risk Questionnaire (FRQ) and Activity-specific Balance Confidence scale (ABC). The QDI was derived from each participant's medications. Participants were classified as either fallers or nonfallers based on self-report history of falls within the past year. Nonparametric Spearman’s Rho correlations were used to determine relationships between faller status and measures of fall risk. A receiver operating characteristic (ROC) curve analysis determined cutoff scores for outcome measures related to faller status. Results: A fair to moderate relationship between the QDI and several physical performance and self-report measures was identified: FRQ (r=0.363), ABC (r=-0.401), DGI (r=-0.360). However, little to no relationship was found between faller status and QDI score (r=0.221). The ROC analysis determined the area under the curve for QDI was 0.63 with a cutoff score of 2.5 yielding sensitivity of 78% and specificity of 47%. Conclusions: The development of the QDI was an interdisciplinary effort between pharmacists and physical therapists to screen for fall risk in older individuals. The QDI offers a better way to quantify the adverse effects of drugs on mobility compared with simple drug counts. The QDI alone does not identify individuals at fall risk; however, the QDI is significantly correlated to several measures of fall risk, including FRQ, ABC, and DGI. The ROC Curve Analysis identified a cutoff score for fall risk for the QDI which was found to have similar sensitivity and specificity to the TUG. Clinical Relevance: The QDI could be incorporated into electronic medical records to identify patients who may be at fall risk and would be appropriate for further balance and mobility evaluation.