Fall Risk Factors

Patient safety is one of the nation's most imperative health care issues. A 1999 article by the Institute of Medicine estimates that 44,000 to 98,000 people die in U.S. hospitals each year as the result of lack of in patient safety regulations. Inhibiting falls among patients and residents in acute and long term care healthcare settings requires a multifaceted method, and the recognition, evaluation and prevention of patient or resident falls are significant challenges for all who seek to provide a safe environment in any healthcare setting. Yearly, about 30% of the persons of 65 years and older falls at least once and 15% fall at least twice. Patient falls are some of the most common occurrences reported in hospitals and are a leading cause of death in people ages 65 or older. Falls often result in serious injuries, such as fractures. For that reason, the impediment of accidental falls is essential. The aim is to describe the design of a study that assesses the effectiveness of prevention and intervention strategies implemented to lessen multiple fall risk factors in independently living older persons with a high risk of falling.

For decades, hospitals and other health care organizations have integrated to understand the contributing causes of falls, to minimize their occurrence and resulting injuries or deaths. Today, organizations have begun reaching out to each other for collaboration on the best ways to prevent falls. Of those who fall, as many as half may suffer moderate to severe injuries that reduce mobility and independence, and increase the risk of premature death. The mortality and financial burdens attributed to patient falls in hospitals and other healthcare settings are among the most serious risk management issues facing the healthcare industry. For the patient and resident, consequences include, but are not limited to, fracture, soft tissue or head injury, fear of falling, anxiety, and depression

When making an attempt to analyze and implement intervention strategies to falls, we must first examine the factors that cause these incidents. It is generally accepted that patient falls are caused by multiple factors. Another popular classification scheme of falls is based on the assumption that they result from a complex interaction of intrinsic and/or extrinsic risk factors. Intrinsic risk factors for falls consist of changes that are part of normal aging in addition to acute or chronic conditions. Causes of these specific falls are impairments in balance, gait, muscle strength, visual acuity and cognition, chronic diseases and use of psychotropic medication. In addition to intrinsic, are the opposing extrinsic factors. Extrinsic risk factors for falls are part of the resident's environment and are most likely to be seen in areas such as the bedroom, bathroom, dining room and hallways. Environmental factors account for up to one-half of all falls among elders. The risk of environmental hazards contributing to falls is greatest in those individuals with poor ambulation and transfer abilities, which may result in a inequality between the individual's mobility potential and the design of the surrounding environment. For example, individuals with poor gait are at a greater risk of loss of balance and falling while walking on waxed or slippery floors than those individuals with usual gait.

Due to the fact that the rate of falling increases partly with increased number of pre-existing conditions and risk factor, fall risk assessment is a useful guideline for practitioners. One must also determine the underlying etiology of "why" a fall occurred with a comprehensive post-fall assessment. Fall risk screeners and post-fall assessment are two interrelated, but distinct approaches to fall evaluation, both recommended by national professional organizations.

With the numerous intrinsic and extrinsic factors leading to falls, it is probable to regard each factor and recognize constructive steps and safe interventions proven effective for preventing falls. Here are several interventions that can be employed in the best interest of the medical center:

* Inform and educate patients and /or family members regarding a plan of care to prevent falls.

* Observe environment for potentially unsafe conditions, such as loose carpeting and water on the floor. Notify appropriate department(s) of hazardous conditions.

* Consider peak effect for prescribed medications that affect level of consciousness, gait and elimination when planning patient care

* Instruct the patient to wear non-skid footwear, considering the type and condition of footwear such as ill-fitting shoes or incompatible soles

* Place assistive devices such as walkers and canes within a patient's or resident's reach.

Intervening falls can reduce the financial burdens attributed to patient falls in hospitals and other healthcare settings are among the most serious risk management issues facing the healthcare industry.

Fall risk assessments tools, which help to identify those patients at risk of falling, play a vital role in reducing the number of falls. The basis for this assessment is that if patients at high fall risk can be acknowledged, then proper interventions can be instituted to minimize this risk. Assessment tools may also assist in stratifying or targeting the urgency and types of interventions required, and play a role in raising staff awareness of the risk of patients/residents falling. A fall risk screener also promotes the ability of staff to use time and resources more competently, and allows the staff to identify specific risk factors and initiate more effective fall prevention strategies.

Preliminary fall risk assessments should be completed upon admittance to the hospital or care homes since patients are subject to a change of condition, fall