Welcome to the latest key papers and publications focussing mainly on Falls and Falls Prevention in the nursing profession.
The British Journal of Nursing, Nursing Times, British Journal of Healthcare Assistants, Journal of Perioperative Practice and the British Journal of Midwifery are all either available in print within the library or online via your OpenAthens username and password.
Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.
Abstract: Aims: To explore the nature of interactions that enable older inpatients with cognitive impairments to engage with hospital staff on falls prevention.
Design: Ethnographic study.
Methods: Ethnographic observations on orthopaedic and older person wards in English hospitals (251.25 h) and semi-structured qualitative interviews with 50 staff, 28 patients and three carers. Findings were analysed using a framework approach.
Results: Interactions were often informal and personalised. Staff qualities that supported engagement in falls prevention included the ability to empathise and negotiate, taking patient perspectives into account. Although registered nurses had limited time for this, families/carers and other staff, including engagement workers, did so and passed information to nurses.
Conclusions: Some older inpatients with cognitive impairments engaged with staff on falls prevention. Engagement enabled them to express their needs and collaborate, to an extent, on falls prevention activities. To support this, we recommend wider adoption in hospitals of engagement workers and developing the relational skills that underpin engagement in training programmes for patient-facing staff.
Implications for Profession and Patient Care: Interactions that support cognitively impaired inpatients to engage in falls prevention can involve not only nurses, but also families/carers and non-nursing staff, with potential to reduce pressures on busy nurses and improve patient safety.
Source: McVey, L. Journal of Clinical Nursing, May 2024; 33(5): 1884-1895
Abstract: Background: Falls in hospitalised patients remain an ongoing challenge for healthcare systems internationally. Limited research exists on the perspectives of older people on falls risk, cause and care.
Objectives: This study explored the experiences of patients and their families after a fall in a healthcare facility.
Methods: Semi-structured interviews were conducted with patients and families to explore the experience of having a fall. Data were analysed thematically.
Results: The themes that emerged from the 14 interviews included the following: explanations; physical environment; communication; experiences of care; perceptions of risk; ageism; feelings towards the fall; and independence and dignity.
Conclusions: This research emphasises the diversity in older people's experiences after experiencing a fall. Falls prevention should be incorporated as one part of healthy, dignified ageing.
Implications for practice: Falls prevention and management strategies should be multifactorial, including enhanced communication with the patient and their families. When engaging in education and awareness, falls prevention should be positioned as one component of independent and dignified healthy ageing.
Source: Kerr, L. International Journal of Older People Nursing, Nov 2023; 18(6): e12578
Abstract: Introduction: Inpatients need to recognize their fall risk accurately and objectively. Nurses need to assess how patients perceive their fall risk and identify the factors that influence patients' fall risk perception.
Purpose: This study aims to explore the congruency between nurses' fall risk assessment and patients' perception of fall risk and identify factors related to the non-congruency of fall risk.
Designs: A descriptive and cross-sectional design was used. The study enrolled 386 patients who were admitted to an acute care hospital. Six nurses assessed the participants' fall risk. Congruency was classified using the Morse Fall Scale for nurses and the Fall Risk Perception Questionnaire for patients.
Findings: The nurses' fall risk assessments and patients' fall risk perceptions were congruent in 57% of the participants. Underestimation of the patient's risk of falling was associated with gender (women), long hospitalization period, department (orthopedics), low fall efficacy, and history of falls before hospitalization. Overestimation of fall risk was associated with age group, gender (men), department, and a high health literacy score. In the multiple logistic regression, the factors related to the underestimation of fall risk were hospitalization period and department, and the factors related to the overestimation of fall risk were health literacy and department.
Conclusions: Nurses should consider the patient's perception of fall risk and incorporate it into fall prevention interventions.
Clinical Relevance: Nurses need to evaluate whether patients perceive the risk of falling consistently. For patients who underestimate or overestimate their fall risk, it may be helpful to consider clinical and fall-related characteristics together when evaluating their perception of fall risk.
Source: Choi, J. Journal of Nursing Scholarship, Feb 2024; Online ahead of print
Abstract: Background: While many falls are preventable, they remain a leading cause of injury and death in older adults. Primary care clinics largely rely on screening questionnaires to identify people at risk of falls. Limitations of standard fall risk screening questionnaires include suboptimal accuracy, missing data, and non-standard formats, which hinder early identification of risk and prevention of fall injury. We used machine learning methods to develop and evaluate electronic health record (EHR)-based tools to identify older adults at risk of fall-related injuries in a primary care population and compared this approach to standard fall screening questionnaires.
Methods: Using patient-level clinical data from an integrated healthcare system consisting of 16-member institutions, we conducted a case–control study to develop and evaluate prediction models for fall-related injuries in older adults. Questionnaire-derived prediction with three questions from a commonly used fall risk screening tool was evaluated. We then developed four temporal machine learning models using routinely available longitudinal EHR data to predict the future risk of fall injury. We also developed a fall injury-prevention clinical decision support (CDS) implementation prototype to link preventative interventions to patient-specific fall injury risk factors.
Results: Questionnaire-based risk screening achieved area under the receiver operating characteristic curve (AUC) up to 0.59 with 23% to 33% similarity for each pair of three fall injury screening questions. EHR-based machine learning risk screening showed significantly improved performance (best AUROC = 0.76), with similar prediction performance between 6-month and one-year prediction models.
Conclusions: The current method of questionnaire-based fall risk screening of older adults is suboptimal with redundant items, inadequate precision, and no linkage to prevention. A machine learning fall injury prediction method can accurately predict risk with superior sensitivity while freeing up clinical time for initiating personalized fall prevention interventions. The developed algorithm and data science pipeline can impact routine primary care fall prevention practice.
Source: Song, W. Journal of the American Geriatrics Society, Apr 2024; 72(4): 1145-1154
Abstract: Objectives: To develop an instrument to facilitate the risk assessment of falls in older outpatients.
Design: A quantitative methodological study using the cross-sectional data.
Methods: This study enrolled 1988 older participants who underwent comprehensive geriatric assessment (CGA) in an outpatient clinic from May 2020 to November 2022. The history of any falls (≥1 falls in a year) and recurrent falls (≥2 falls in a year) were investigated. Potential risk factors of falls were selected by stepwise logistic regression, and a screening tool was constructed based on nomogram. The tool performance was compared with two reference tools (Fried Frailty Phenotype; CGA with 10 items, CGA-10) by using receiver operating curves, sensitivity (Sen), specificity (Spe), and area under the curve (AUC).
Results: Age, unintentional weight loss, depression measured by the Patient Health Questionnaire-2, muscle strength measured by the five times sit-to-stand test, and stand balance measured by semi- and full-tandem standing were the most important risk factors for falls. A fall risk screening tool was constructed with the six measurements (FRST-6). FRST-6 showed the best AUC (Sen, Spe) of 0.75 (Sen = 0.72, Spe = 0.69) for recurrent falls and 0.65 (Sen = 0.74, Spe = 0.48) for any falls. FRST-6 was comparable to CGA-10 and outperformed FFP in performance.
Conclusions: Age, depression, weight loss, gait, and balance were important risk factors of falls. The FRST-6 tool based on these factors showed acceptable performance in risk stratification.
Impact: Performing a multifactorial assessment in primary care clinics is urgent for falls prevention. The FRST-6 provides a simple and practical way for falls risk screening. With this tool, healthcare professionals can efficiently identify patients at risk of falling and make appropriate recommendations in resource-limited settings.
Source: Wu, W. Journal of Advanced Nursing, Feb 2024; Online ahead of print
Expanding the Health Belief Model for exploring inpatient fall risk perceptions: A methodology paper
Abstract: Aims: Inpatient falls among older adults are a relentless problem, and extant inpatient fall prevention research and interventions lack the older adults' perspectives and experiences of their own fall risk in the hospital. Theory-guided research is essential in nursing, and the purpose of this paper was to describe the process of developing a theoretical framework for a phenomenological nursing study exploring older adults' lived experiences of being at risk for falling in the hospital.
Method: Based on philosophical nursing underpinnings, the Health Belief Model (HBM) was selected as the theoretical model. The limitations of the model led to expansion of the model with established concepts associated with accidental falls among older adults.
Results: The HBM was selected as the guiding model due to its ability to capture a broad range of perceptions of a health threat. The HBM was expanded with the concepts of embarrassment, independence, fear of falling, dignity and positivity effect. The addition of these concepts made the theoretical framework more applicable to age-related developmental behaviours of older adult and more applicable to nursing research.
Conclusion: The Expanded HBM theoretical framework may guide future nursing research to develop fall prevention interventions to decrease fall rates among hospitalized older adults.
Source: Dolan, H. Journal of Advanced Nursing, Dec 2023; Online ahead of print
Abstract: Aims: To examine how perceived balance problems are associated with self-reported falls in the past month after controlling for known correlates of falls among older adults.
Background: Approximately 30% of adults age 65 and older fall each year. Most accidental falls are preventable, and older adults' engagement in fall prevention is imperative. Limited research suggest that older adults do not use the term ‘fall risk’ to describe their risk for falls. Instead, they commonly use the term ‘balance problems’. Yet, commonly used fall risk assessment tools in both primary and acute care do not assess older adults' perceived balance.
Design and Method: The Health Belief Model and the concept of perceived susceptibility served as the theoretical framework. A retrospective, cross-sectional secondary analysis using data from the National Health and Aging Trends Study from year 2015 was conducted. The outcome variable was self-reported falls in the last month.
Results: A subsample of independently living participants (N = 7499) was selected, and 10.3% of the sample reported a fall. Multiple logistic regression analysis revealed that the odds of reporting a fall in the past month was 3.4 times (p < .001) greater for participants who self-reported having a balance problem compared to those who did not. In contrast, fear of falling and perceived memory problems were not uniquely associated with falls. Using a mobility device, reporting pain, poor self-rated health status, depression and anxiety scores were also associated with falling.
Conclusion and Implications: Older adults' perceived balance problem is strongly associated with their fall risk. Perceived balance may be important to discuss with older adults to increase identification of fall risk. Older adults' perceived balance should be included in nursing fall risk assessments and fall prevention interventions. A focus on balance may increase older adults' engagement in fall prevention.
Source: Dolan, H. Journal of Clinical Nursing, Jan 2024; Online ahead of print
Abstract: Background: There is growing recognition of the importance of sex and gender differences within falls literature, but the characterization of such literature is uncertain. The aim of this scoping review was to (1) map the nature and extent of falls literature examining sex or gender differences among older adults, and (2) identify gaps and opportunities for further research and practice.
Methods: We used a scoping review methodology. Eligible studies included participants with a mean age of ≥60 years and study aims specifying falls and either sex or gender concepts. MEDLINE, Embase, CINAHL, Ageline, and Psychinfo databases were searched from inception to March 2, 2022. Records were screened and charted by six independent reviewers. Descriptive and narrative reports were generated.
Results: A total of 15,266 records were screened and 74 studies were included. Most studies reported on sex and gender differences in fall risk factors (n = 52, 70%), incidence/prevalence (n = 26, 35%), fall consequences (n = 22, 30%), and fall characteristics (n = 15, 20%). The majority of studies (n = 70, 95%) found significant sex or gender differences in relation to falls, with 39 (53%) identifying significant sex differences and 31 (42%) identifying significant gender differences. However, only three (4%) studies defined sex or gender concepts and only nine (12%) studies used sex or gender terms appropriately. Fifty-six (76%) studies had more female participants than males. Four (5%) were intervention studies. Studies did not report falls in line with guidelines nor use common fall definitions.
Conclusion: Sex and gender differences are commonly reported in falls literature. It is critical for future research to use sex and gender terms appropriately and include similar sample sizes across all genders and sexes. In addition, there is a need to examine more gender-diverse populations and to develop interventions to prevent falls that address sex and gender differences among older adults.
Source: Sebastiani, C. Journal of the American Geriatrics Society, Mar 2024; 72(3): 903-915
Abstract: Background: Emergency department (ED) presentations after a ground-level fall (GLF) are common. Falls were suggested to be another possible presenting feature of a myocardial infarction (MI), as unrecognized MIs are common in older adults. Elevated high-sensitivity cardiac troponin (hs-cTn) concentrations could help determine the etiology of a GLF in ED. We investigated the prevalence of both MI and elevated high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI), as well as the diagnostic accuracy of hs-cTnT and hs-cTnI regarding MI, and their prognostic value in older ED patients presenting after a GLF.
Methods: This was a prospective, international, multicenter, cohort study with a follow-up of up to 1 year. Patients aged 65 years or older presenting to the ED after a GLF were prospectively enrolled. Two outcome assessors independently reviewed all discharge records to ascertain final gold standard diagnoses. Hs-cTnT and hs-cTnI levels were determined from thawed samples for every patient.
Results: In total, 558 patients were included. Median (IQR) age was 83 (77–89) years, and 67.7% were female. Elevated hs-cTnT levels were found in 384 (68.8%) patients, and elevated hs-cTnI levels in 86 (15.4%) patients. Three patients (0.5%) were ascertained the gold standard diagnosis MI. Within 30 days, 18 (3.2%) patients had died. Nonsurvivors had higher hs-cTnT and hs-cTnI levels compared with survivors (hs-cTnT 40 [23–85] ng/L in nonsurvivors and 20 [13–33] ng/L in survivors; hs-cTnI 25 [14–54] ng/L in nonsurvivors and 8 [4–16] ng/L in survivors; p < 0.001 for both).
Conclusions: A majority of patients (n = 364, 68.8%) presenting to the ED after a fall had elevated hs-cTnT levels and 86 (15.4%) elevated hs-cTnI levels. However, the incidence of MI in these patients was low (n = 3, 0.5%). Our data do not support the opinion that falls may be a common presenting feature of MI. We discourage routine troponin testing in this population. However, hs-cTnT and hs-cTnI were both found to have prognostic properties for mortality prediction up to 1 year.
Source: Espejo, T. Academic Emergency Medicine, Mar 2024; Online ahead of print
Abstract: Background: Opioids are recommended for pain management in patients being cared for and transported by emergency medical services, but no specific guidelines exist for older adults with fall-related injury. Prior research suggests prehospital opioid administration can effectively manage pain in older adults, but less is known about safety in this population. We compared short-term safety outcomes, including delirium, disposition, and length of stay, among older adults with fall-related injury according to whether they received prehospital opioid analgesia.
Methods: We linked Medicare claims data with prehospital patient care reports for older adults (≥65) with fall-related injury in Illinois between January 1, 2014 and December 31, 2015. We used weighted regression models (logistic, multinomial logistic, and Poisson) to assess the association between prehospital opioid analgesia and incidence of inpatient delirium, hospital disposition, and length of stay.
Results: Of 28,150 included older adults, 3% received prehospital opioids. Patients receiving prehospital opioids (vs. no prehospital opioids) were less likely to be discharged home from the emergency department (adjusted probability = 0.30 [95% CI: 0.25, 0.34] vs. 0.47 [95% CI: 0.46, 0.48]), more likely to be discharged to a non-home setting after an inpatient admission (adjusted probability = 0.43 [95% CI: 0.39, 0.48] vs. 0.30 [95% CI: 0.30, 0.31]), had inpatient length of stay 0.4 days shorter (p < 0.001) and ICU length of stay 0.7 days shorter (p = 0.045). Incidence of delirium did not vary between treatment and control groups.
Conclusions: Few older adults receive opioid analgesia in the prehospital setting. Prehospital opioid analgesia may be associated with hospital disposition and length of stay for older adults with fall-related injury. However, our findings do not provide evidence of an association with inpatient delirium. These findings should be considered when developing guidelines for prehospital pain management specific to the older adult population.
Source: Jarman, Molly P. Journal of the American Geriatrics Society, Feb 2024; Online ahead of print
Abstract: Falls among older people with chronic kidney disease are of concern. Professor Helen Hurst and colleagues explore assessments of falls and propose the need to consider potentially helpful interventions.
Source: Hurst, Helen. Journal of Kidney Care, May 2023; 8(3): 108-154
Abstract: Falls are the second leading cause of unintentional injury deaths worldwide and are a major health issue for older people. This article is the first in a series and aims to provide an overview of falls in the community and hospital setting, as well as the importance of holistic care. The series aims to educate readers on why older people are at risk of falling and what can be done to reduce the risk factors and enable people to remain healthy and well.
Source: Nazarko, L. British Journal of Healthcare Assistants, Jul 2022; 16(7): 334-338
Abstract: In adults, falls become more common as age increases (Blain et al, 2016). Falls and fear of falling can affect the older person's quality of life. If we are to reduce the risk of falls and improve quality of life, we need to understand why falls occur and what can be done to reduce the risk of falls and improve quality of life. Falls occur because of interactions between the person, the environment and the quality of care the person receives. This article, the second in a series, examines the risk factors relating to the ageing process and how to reduce the impact of these changes.
Source: Nazarko, L. British Journal of Healthcare Assistants, Sep 2022; 16(9): 412-420
Abstract: The world's population is ageing and as people age, they are more likely to develop one or more long-term conditions. These conditions can increase the risk of falls and ill-health. This article explores how long-term conditions can affect the risk of falls.
Source: Nazarko, L. British Journal of Healthcare Assistants, Oct 2022; 16(10): 444-452
Abstract: Older people and people who have long-term conditions have an increased risk of falls. One of the factors that can increase the risk of falls is medication. This article, the fourth in a series, examines how medication can affect fall risk and how medication review can reduce the risk of falls.
Source: Nazarko, L. British Journal of Healthcare Assistants, Nov 2022; 16(11): 516-525
Abstract: Falls occur because of factors relating to the individual, the environment and the care and support available. As people age, the risk of falls increases. That risk is further increased when a person is unwell and when the person moves to a new ...
Source: Nazarko, L. British Journal of Healthcare Assistants, Feb 2023; 17(2): 58-94
Abstract: Falls are the second leading cause of unintentional injury deaths worldwide and are a major health issue for older people (World Health Organization, 2021). Older people are more vulnerable to injury when they fall; over 5000 older people die as a result ...
Source: Nazarko, L. British Journal of Healthcare Assistants, Apr 2023; 17(4): 142-148
Abstract: In one large UK hospital trust, data from the electronic incident reporting system were studied to determine the number of falls within one division taking place while patients were under enhanced supervision. This supervision was commonly carried out by ...
Source: Roberts, M. British Journal of Nursing, Jun 2023; 32(11): 508-513
Abstract: Falls are the second leading cause of unintentional injury deaths worldwide and are a major health issue for older people. One of the factors that can increase the risk of falls is medication. This article examines how medication can affect fall risk and ...
Source: Nazarko, L. British Journal of Community Nursing, Nov 2023; 28(11): 534-540
Abstract: Commentary on: Pope J, Truesdale M, Brown M. Risk factors for falls among adults with intellectual disabilities: A narrative review. J Appl Res Intellect Disabil. 2021; 34: 274–285. 10.1111/jar.12805Falls are a serious and common problem for people with ...
Source: Doherty, Alison J. British Journal of Community Nursing, May 2023; 28(5): 238-242
Abstract: UK healthtech company Cera Care (ceracare.co.uk) has launched an artificial intelligence (AI) discovery that predicts with 83% accuracy people falling at home a week before it happens. Cera is rolling out AI that is set to improve social care and prevent hospitalisations.
Source: Sollof, J. Digital Health, Aug 2023; Online
