The objectives of the study were to determine the incidence of falls, the prevalence of fear of falling and fall risk factors and consequences in adults with rheumatoid arthritis (RA). 559 community dwelling adults with RA, aged 18 to 88 years (mean age 62; 69% female) participated in this prospective cohort study. Patients were recruited from four outpatient clinics in the Northwest of England and followed for 1 year after clinical assessment, using monthly falls calendars and telephone calls. Outcome measures included fall occurrence, reason for fall, type and severity of injuries, fractures, fall location, lie-times, use of health services and functional ability. Risk factors for falls included lower limb muscle strength, postural stability, number of swollen and tender joints, functional status, history of falling, fear of falling, pain, fatigue and medication. Data on demographics, vision, co-morbidities, history of surgery, fractures, and joint replacements were also recorded.535 participants followed for one year had a total of 598 falls. 36.4% participants (95% CI 32% to 41%) reported falling with an incidence rate of 1313/1000 person-years at risk or 1.11 falls per person. Over one third of the falls were reportedly caused by hips, knees or ankle joints giving way. Over half of all the falls resulted in moderate injuries, including head injuries (n=27) and fractures (n=26). Univariate logistic regression showed that falls risk was independent of age and gender. A history of falls in the previous one year was a strong medical fall predictor with an odds ratio (OR) for a single fall=3.3 and for multiple falls OR=4.3. Fear of falling was an important self-reported psychological predictor, with the risk increasing by 10% with each point above 7 (up to 28) in the Short FES-I score. The inability to complete the Four Test Balance Scale due to poor balance was a strong postural fall predictor (OR 2.3). The most significant functional predictor of falls was the functional Health Assessment Questionnaire score, and each additional point attained in the score (1-4) nearly doubled the risk of further falls. Multivariate logistic regression revealed that when taken in combination with other factors, a history of multiple falls in the previous one year was the most significant predictive risk factor (OR=5.3) and overall the model accounted for 71% of variation. The most significant modifiable risk factors were swollen and tender lower limb joints (hip, knee and ankle) (OR=1.7), psychotropic medication (OR=1.8) and increasing fatigue (OR=1.13) with this model accounting for 68% of variation. Adults of all ages with RA are at high risk of falls and fall-related injuries, fractures and head injuries. In clinical practice, high risk falls patients with RA can be identified by asking whether patients have fallen in the past year. The management of swollen and tender lower limb joints, fatigue and consideration of psychotropic medicines may be the most effective strategy to reduce falls in this group of patients. Fear of falling, pain, lower limb strength and poor balance are other useful clinical indicators that may be modified to prevent falls.

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.