Falls in the Elderly in Long-Term Care

Introduction

The problem of fall-related injuries is common among the elderly. People who live at home or in a long-term care setting and are not able to care for themselves often encounter the issue of moving independently. Thus, they may fall while trying to perform some daily tasks. The lack of awareness about this issue is usually coupled with one’s reduced physical strength and agility, which results in them being unable to coordinate their movements.

The occurrence rate for this problem can be measured. For example, to assess the scope of such a problem as falls in the elderly, one can define the type of fall and estimate the number of falls per person for people who did not undergo any type of intervention (Spath, 2013). Then, the same rate of falls can be determined for individuals who went through an intervention process. This data can help establish the success or failure of intervention and prove that it does or does not work.

The issue of falling is very serious for older individuals, as it can lead to a number of traumatizing and lasting outcomes. For instance, one’s fall may cause long-term pain, fractures, psychological distress, and even prolonged hospitalization. Moreover, some people may be forced to leave their homes and placed under professional care. For some persons, the lack of personal freedom and remoteness from their homes may negatively affect their mental stability.

Therefore, this problem has to be addressed in order to lower the rate of falls and prevent some related injuries. It is necessary to find a working intervention process and implement it in practice. The problem of falling among the elderly in long-term care is critical and requires intervention as it may lead to serious and long-lasting physical and mental harm.

Literature Review

The topic of falls for elderly patients is discussed in a variety of scholarly works. Many authors not only describe the scope of the problem but also evaluate different types of interventions and test their effectiveness. In the analysis of the issue, authors note the significance of the effect that falls have on the elderly. For instance, Siegrist et al. (2016) state that frequent and infrequent falling can result in higher rates of mortality among older patients.

Such problems as institutionalization and complete loss of self-sufficiency are also often linked to falling. The authors note that falls can be caused by many factors that are directly and indirectly linked to the patient’s health and environment. It is undeniable that some age-related changes and correlated diseases affect the way people move. Nevertheless, other factors may play their role as well. The authors outline exercising as the best way to reduce falls.

Ungar et al. (2013) establish that changes in sight, hearing, and locomotor functions of the body are the main reasons for falling. However, these initial factors are also followed by various conditions of neurologic, musculoskeletal, cardiovascular, and other systems. Thus, the reasons for falling are complicated and should be addressed by multiple interventions. The authors conclude that appropriate medication, regular exercise, and modification of the surrounding environment can help older individuals to reduce the risk of falling.

The article by Karlsson, Magnusson, von Schewelov and Rosengren (2013) also reviews some approaches to fall prevention. The authors outline the same outcomes to the issue and highlight the increasing cost of treatment that usually occurs after the patient falls. This article, however, divides all possible risks into two types – modifiable and non-modifiable where the former can be improved with an intervention while the latter cannot be changed significantly.

For example, the environment of the person can be made safer to avoid falling. On the other hand, such conditions as cardiovascular disease should be treated separately from fall prevention. The authors distinguish seven different types of intervention, including exercise, vitamin D supplements, drug treatment, surgery, home modifications, and specific footwear. The seventh category is multifaceted intervention, which combines multiple approaches to create a more personalized plan. The authors conclude that an exercise program that targets various groups of muscles is the most effective type of fall prevention. Environmental alteration can also make one’s surroundings safer.

The effect of falls and the importance of exercise in their prevention are also discussed in the article by Granacher, Gollhofer, Hortobágyi, Kressig, and Muehlbauer (2013), where they link the trunk muscle strength to one’s ability to keep balance and avoid falling. The authors suggest that the stability of core muscles significantly impacts the daily activities of people and may prevent or reduce falling. The proposed exercises promote mobility and improve balance. The conclusion states that trunk stabilization and balance significantly improve one’s overall health and reduce the rate of falls.

The same conclusions can be found in the study by El-Khoury, Cassou, Charles, and Dargent-Molina (2013), who attempt to determine the success rate of exercising for fall prevention. The article provides some measurable data about the number and severity of falls and their outcomes and their change after the implementation of the prevention technique. El-Khoury et al. (2013) state that exercise is extremely successful in lowering the rates of falling as they are reduced by almost a half in all presented trials. Thus, it is possible to assume that specific exercise programs that are designed for older individuals can prevent falls and mitigate the physical outcomes of falling as well.

Quality Improvement Process

The majority of the articles discussed above highlight exercising as the best improvement process that can help older patients to lower the rate of falls. The benefits of exercise are found to be the most visible and useful for individuals with various musculoskeletal and cardiovascular problems. Moreover, many scholars describe the overall improvement of patients’ health, which can be reached by organized and regulated physical activity.

It is also interesting to note that exercising is cost-beneficial to both patients and medical establishments. According to Carande-Kulis, Stevens, Florence, Beattie, and Arias (2015), various programs that promote some type of physical activity give healthcare organizations the ability to avoid using expensive equipment and medication, while patients usually are able to save their money as well. Thus, the implementation of an exercise program in long-term care has many advantages.

Long-term settings allow patients and their care providers to create a system for exercising, which can be easily monitored and measured. One of the tools suggested by scholars for its ability to include the opinions of the elderly is the Fall Efficacy Scale, which can assess patients’ fear of falling (Siegrist et al., 2016). This tool can help medical professionals to evaluate various concerns of their patients and see whether exercising makes them more confident in their abilities.

Furthermore, such tools as Romberg’s Test and Timed-Up-and-Go Test can help caregivers to evaluate the effects of physical training (Siegrist et al., 2016). The final result of this improvement can be measured by counting the number of falls before and after the program’s implementation.

References

Carande-Kulis, V., Stevens, J. A., Florence, C. S., Beattie, B. L., & Arias, I. (2015). A cost–benefit analysis of three older adult fall prevention interventions. Journal of Safety Research, 52, 65-70.

El-Khoury, F., Cassou, B., Charles, M. A., & Dargent-Molina, P. (2013). The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: Systematic review and meta-analysis of randomised controlled trials. BMJ, 347(f6234), 1-13.

Granacher, U., Gollhofer, A., Hortobágyi, T., Kressig, R. W., & Muehlbauer, T. (2013). The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: A systematic review. Sports Medicine, 43(7), 627-641.

Karlsson, M. K., Magnusson, H., von Schewelov, T., & Rosengren, B. E. (2013). Prevention of falls in the elderly — A review. Osteoporosis International, 24(3), 747-762.

Siegrist, M., Freiberger, E., Geilhof, B., Salb, J., Hentschke, C., Landendoerfer, P.,… Blank, W. A. (2016). Fall prevention in a primary care setting: The effects of a targeted complex exercise intervention in a cluster randomized trial. Deutsches Ärzteblatt International, 113(21), 365-372.

Spath, P. (2013). Introduction to healthcare quality management (2nd ed.). Chicago, IL: Health Administration Press.

Ungar, A., Rafanelli, M., Iacomelli, I., Brunetti, M. A., Ceccofiglio, A., Tesi, F., & Marchionni, N. (2013). Fall prevention in the elderly. Clinical Cases in Mineral and Bone Metabolism, 10(2), 91-95.