Clinical Practice in Long-Term CareFall Prevention and Injury Protection for Nursing Home Residents
Section snippets
Objectives
The objectives of this literature review were the following:
- (1)
to examine the selection and specificity of fall prevention and injury protection interventions described in the literature since 1990;
- (2)
to evaluate the strength of evidence for interventions that both prevent falls and protect residents from fall-related injury; and,
- (3)
to provide clinical and policy guidance to integrate specific interventions into practice.
Vu et al4 completed a differential effect analysis of multifaceted intervention
Method
Eligible studies were limited to multifactorial intervention studies conducted in long-term care settings since 1990, and in English. All articles were reviewed by 2 research geriatricians, 2 research nurse scientists, 1 policy analyst, and 1 health science specialist. To build on prior analyses,5 this review differed from other systematic reviews in that we used 2 rating scales for our analysis: The Agency for Healthcare Research and Quality (AHRQ)6 Types of Research: Evidence Hierarchy (Table
Definition of Terms
Fall Prevention is the multifaceted approach that has been tested in nursing homes to modify intrinsic and extrinsic fall risk factors such as modifying medications to reduce fall risk. In contrast, Injury Protection includes interventions (such as hip protectors, floor mats, low beds, and elimination of sharp edges) to mitigate physical injury, such as fracture, hemorrhage, and head trauma, when a fall occurs. We focused on physical injury because of the potential for loss of function and loss
Results
Article sources included databases (ie, Journals@Ovid, PsycINFO, Ovid MEDLINE(R), HAPI, Your Journals@Ovid, HealthSTAR, and Google Scholar) and hand searching of references from clinical guidelines and literature reviews. Separate searches were also conducted to locate publications for economic consequences of nursing home falls and injuries and in dissertation abstracts to capture relevant new research. Using key words (fall prevention and injurious falls or loss of life, and nursing home and
Discussion
Based on this detailed review of the multifaceted interventions, the interventions clearly vary in specificity, dose, intensity, and duration. Several studies show a beneficial effect of the program on fall and/or injury prevention, whereas several others do not. It seems apparent that no one study provides a definitive multifactorial model to guide clinical practice programs in nursing homes. Studies that included reducing serious injuries in nursing home residents focused on fractures,
Summary and Recommendations
Our approach to this review builds on and is supported by the recommendations of Cusimano et al5 who evaluated 5 rigorous trials of multifaceted programs. They recommended more well-designed research to assess the effectiveness of intervention on reducing injuries, quality of life, cost-effectiveness, and sustainability.
Thus, we propose testing a model that is a population-based approach and includes both fall prevention and injury protection, which could potentially mobilize changes on a large
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2012, InjuryCitation Excerpt :The findings of this study signify that fall mortality rate is on the rise in the older U.S. population. Despite significant amounts of research conducted on the burden of falls2,19,20 and evidence on numerous effective public health initiatives,20–25 the progress made so far is evidently not adequate, as reported in this study. There is a steady rise in fall mortality rate with increasing age, and the oldest group had the highest risk.
Disclaimer: This material is based on work supported by the Office of Research and Development, Department of Veterans Affairs, Health Services Research and Development award #IIR –03–003–1 and the Patient Safety Center of Inquiry, James A. Haley VAMC. The views expressed in this article are those of the authors and do not necessarily represent the views of the Veterans Healthcare Administration or Department of Veterans Affairs.