Falls in nursing homes are a common health problem in the older adult population, which is largely caused by such risk factors as age, balance impairment, taking sedative drugs, and neurological disorders. In the US, 28.7% of elderly patients fall annually, resulting in 7 million injuries (Dellinger, 2017). This health problem prioritizes the need for preventing falls and avoiding adverse health outcomes in patients, and nurses play a vital role as the key care providers. This paper aims to explore the primary, secondary, and tertiary levels of fall prevention among older adult patients of nursing homes, relating them to Healthy People 2020 objectives.
Description of a Scholarly Article Encompassing a Primary Level of Prevention
The primary prevention measures imply the stoppage of the disease or trauma onset before it occurs in a patient. The preparation of medical personnel (Registered Nurses (RNs), Licensed Professional Nurses (LPNs), and Certified Nurse Assistants (CNAs)) for the prevention of falls requires timely education to promote behavioral change. In their turn, nurses are expected to train their patients on proper exercising and safety measures in hospital settings.
The systematic review by Lee, Pritchard, McDermott and Haines (2014) that synthesized data from five databases and used a meta-analysis method found that fall prevention education allows reducing incidents by increasing overall awareness. The articles with multifactorial fall prevention programs and those with patient education as an intervention were included (Lee et al., 2014). The nurses, who updated their knowledge and skills, should use multimedia materials to closely interact with the patients of nursing homes, thus ensuring that they understand the key provisions that are vital for their health.
Description of a Scholarly Article Encompassing a Secondary Level of Prevention
The concept of secondary level prevention is directed towards early diagnosis identification based on routine screening and systemic checks. At the same time, this level emphasizes the need for prompt treatment to avoid further complications and more severe health problems. With regard to falls, nurse practitioners should have the skills to recognize fall symptoms and risk factors (McKenzie et al., 2017).
For example, Álvarez Barbosa et al. (2016) revealed that the risk of falls is associated with the quality of life, limb muscle performance, and functional status. The authors conducted the qualitative research based on the use of the timed up and go (TUG) test, Kistler force platform, Barthel index, and EuroQol‐5 dimension. Two groups, intervention, and control were organized to compare the results of introducing the identified intervention to test their stability indicators.
The outcomes of the study are representative of the fact that the intervention group showed better scores during stability tests and functional assessment. It is recommended by Álvarez Barbosa et al. (2016) to use the mentioned factors in early recognition of risk points and their elimination. In order to follow these directions, it is important for the medical staff to be aware of assessing patients’ life quality and limb muscle performance. Moreover, it should be emphasized that special attention should be paid to the residents of nursing homes with a cognitive impairment since they are more likely to lose balance and fall.
Description of a Scholarly Article Encompassing a Tertiary Level of Prevention
In terms of the tertiary level of prevention, rehabilitation after the illness or injury is regarded as the key goal. In particular, nurses need to be educated to assist elderly patients who received a certain disability or impairment so that they can recover in the most effective way. For instance, the medical staff should found the strategies to work towards rehabilitation via proper exercises or medication intake. Vlaeyen et al. (2015) claim that the evidence-based treatment and management programs are useful for recurrent fallers since their study found the 21% reduction in falls among the residents of nursing homes.
One of such programs is discussed by Palvanen et al. (2014) in the course of the randomized controlled trial that focused on high-risk patients. Speaking of the intervention, it should be identified that the Chaos falls clinics that are located in Finland recruited 1314 patients aged 70 and more to divide them into the control and intervention groups. The multifactorial Chaos Clinic Falls Prevention Program included medical reviews, strength and balance training, proper nutrition, and adjustments within a one-year follow-up.
The results of the described study show that the Chaos Program is effective in elderly patients with a high risk of falls, reducing the number of injuries by 30% (Palvanen et al., 2014). The rate of falls and associated trauma was decreased due to the appropriate implementation of a set of interventions, which were controlled by nurses. This study makes it clear that staff should be educated on the prevention of recurrent falls, and it is possible via the use of the given program as one of the evidence-based options.
How do the Findings Relate with Healthy People 2020 Objectives?
The overall goal that was determined by the Healthy People 2020 initiative for older adults is to enhance the health, quality of life, and functioning of this population. Specifically to falls, it is stated that they are the leading cause of injuries among the elderly: 1out of 3 patients fall annually (“Older adults”, n.d.). This statistic is consistent with the findings of the articles that are discussed earlier regarding the primary, secondary, and tertiary levels of prevention. Relating the first article to the goals of the mentioned resource, one should stress that both of them go in line with the Center for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, & Injuries (STEADI) educational materials that can be used by care providers to improve their knowledge on fall prevention.
In case a fall occurred, there is a need to employ an evidence-based program for early symptom recognition and proper treatment, as prescribed by Healthy People 2020 and the secondary prevention article. The latter also enlarges the given goal by emphasizing the necessity of monitoring their quality of life along with their functioning level. Furthermore, the National Institute on Aging (NIA) and the Patient-Centered Outcomes Research Institute (PCORI) verify evidence-based interventions and call nurses “falls care managers” (“Older adults”, n.d., para. 10). It is also noted in the tertiary prevention article that recurrent falls require a focus on stability training, nutrition, and so on. These considerations are also concordant with DNP essentials I (Scientific Underpinnings for Practice) and VII (Clinical Prevention).
This paper researched three levels of prevention in nursing with regard to a fall health problem in the older adult population in nursing homes. It was determined that each of the levels is reflected in the academic literature and supported by the Healthy People 2020 initiative. The primary level implies early identification of risks and their timely elimination. Within secondary prevention, nurses are expected to immediately react to falls to minimize health-related complications. Ultimately, the third level prioritizes patient training by nurses to achieve behavioral change and avoid falls in the future.
Álvarez Barbosa, F., del Pozo‐Cruz, B., del Pozo‐Cruz, J., Alfonso‐Rosa, R. M., Sanudo Corrales, B., & Rogers, M. E. (2016). Factors associated with the risk of falls of nursing home residents aged 80 or older. Rehabilitation Nursing, 41(1), 16-25.
Dellinger, A. (2017). Older adult falls: Effective approaches to prevention. Current Trauma Reports, 3(2), 118-123.
Lee, D. C. A., Pritchard, E., McDermott, F., & Haines, T. P. (2014). Falls prevention education for older adults during and after hospitalization: A systematic review and meta-analysis. Health Education Journal, 73(5), 530-544.
McKenzie, G., Lasater, K., Delander, G. E., Neal, M. B., Morgove, M., & Eckstrom, E. (2017). Falls prevention education: Interprofessional training to enhance collaborative practice. Gerontology & Geriatrics Education, 38(2), 232-243.
Older adults. (n.d.). Web.
Palvanen, M., Kannus, P., Piirtola, M., Niemi, S., Parkkari, J., & Järvinen, M. (2014). Effectiveness of the Chaos Falls Clinic in preventing falls and injuries of home-dwelling older adults: A randomized controlled trial. Injury, 45(1), 265-271.
Vlaeyen, E., Coussement, J., Leysens, G., Van der Elst, E., Delbaere, K., Cambier, D.,… Dejaeger, E. (2015). Characteristics and effectiveness of fall prevention programs in nursing homes: A systematic review and meta‐analysis of randomized controlled trials. Journal of the American Geriatrics Society, 63(2), 211-221.