Phase V .Apa Seven

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Falls in The Long-Term Care Settings

Nayaris Reyes

Florida National University

June 12, 2021

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Brief Literature Review

The elderly in the long-term care facilities are typically predisposed to falling and might

fall for various reasons. Some predisposing factors might be related to unsteady balance and gait,

poor vision, weak muscles, dementia, and medications. In addition, various medical conditions,

including stroke, low blood pressure, brain disorders, and poorly managed epilepsy, might increase

older people's risk for falls (Golmakani et al., 2014). Therefore, several studies have been

conducted to evaluate the efficacy of multi-factorial interventions on the occurrence of falls in

long-term care settings, including psycho-geriatric nursing home patients. Based on the clinical

study, it was concluded that various multi-factorial interventions used in preventing falls such as a

general medical assessment emphasizing falls, specific fall risk evaluation devices, assessing

medication intake, fall history, and mobility, using protective and assistive aids play a significant

role in reducing the incidence of falls among the elderly (Ungar et al., 2013). Accordingly, it was

evident that fall prevention, usually geared towards psycho-geriatric patients in a long-term care

facility, is possible and efficient in minimizing falls among older people.

Other researchers carried out a study in developing a fall prevention program for the aged

patients in long-term care entities, especially those at risk of falling, by increasing caregiving

expertise or skills and motivating staff members. From the analysis, exercise programs

encompassing warm-up, muscle reinforcement, especially in the lower extremities, and

proprioceptive neuromuscular expedition are used in increasing motivation and caregiving skills

(Donath et al., 2016). Another research conducted to evaluate the statistics of falls among the

elderly found out that falls are the leading cause of injury-interrelated visits to emergency facilities

in the U.S. They are also the primary etiology of accidental deaths in persons aged 60 and above.

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From the analysis, falls might be markers of diminishing function and poor health and are

significantly attributable to morbidity.

To assess the risk factors related with falls among the older people in the long-term care

facilities, it was realized that more than 25% of facility-dwelling older individuals and 60% of

nursing home residents fall yearly (Pfortmueller et al., 2014). Various risk factors linked to their

falls are medication use, increasing age, sensory deficits, and cognitive impairment. Studies depict

that older persons who have fallen must undergo a thorough clinical evaluation (within the

facilities) to analyze the preventive strategies further. This will aid in determining and treating the

underlying cause of their falls, return them to baseline function, and minimize the likelihood of

recurrent falls (Karlsson et al., 2013). Such measures have a significant effect on the mortality and

morbidity of falls.

Methodology and Design

General Overview

The research paper tries to analyze the issue of falls among the elderly in the long-term care

setting. This section will encompass justification of the research methods, data collection

procedures, and research design. Research methods are the strategies, techniques, and procedures

utilized in data collection and evidence to analyze the collected information. The ideal research

methods for this research topic will be quantitative and qualitative. The two research techniques

will follow under a mixed research method and precisely assist in finding a solution to the existing

problems. Mixed methods use qualitative and quantitative methods in the same study and mainly

used in clinical settings. Quantitative research techniques in the nursing profession are fundamental

since they utilize accurate approaches to collect and analyze measurable data (Kim et al., 2015).

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This is a precise technique because it is a number-based technique that gives accurate results

critical factors in the medical field outcomes. Besides, qualitative techniques deal with the lived

experiences of different patients and nursing professionals. The research on chronic infections such

as falls gives the healthcare professionals a sound understanding of the lived experiences of the

elderly patients.

Research Design

Consequently, the research design will act as the guiding framework for the fundamental

research. The study will use mixed methods (quantitative and qualitative) since it will address the

research issue more inclusively than qualitative or quantitative methods alone. Quantitative

research is attributable to a positivist stance and assumes that reality might be measured and

observed objectively. It will be the best technique due to its procedures of minimizing falls among

older people. Thus, it will be the dominant paradigm in health issue research. Moreover, qualitative

research majorly comes from an interpretive framework and assumes multiple realities are framed

by individual perceptions, meaning, and context. This will be suitable for the issue under research.

Therefore, there is a need to ensure high-quality qualitative research to generate sturdy theory

which applies to the contexts outside the area under research.

Data Collection Procedures

The quantitative research will employ clinical trials or observational studies to generate

relevant data for patients experiencing falls. Thus, there will be surveys where questionnaires will

be issued to the patients and collected after filling them. The questionnaires will comprise close-

ended questions entailing putting responses into groups and multiple lists where the patients will

choose from. The structured questions are suitable for this clinical issue because they are cheap,

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swift, and practical tools for attaining a comparatively large amount of pertinent data from

samples. The qualitative research methods will incorporate semi-structured interviews, participant

observation, and focus group discussion (Singh, & Okeke, 2016). For the semi-structured

interviews, the researcher will allow the patients to share their daily experiences within the scope

of the clinical issue and determine the ideal prevention measures. The researcher will also visit the

care settings and homes of the older adults and assess the comfortability and safety of their living

environment. Calling them in groups to hold discussions will also be appropriate since they will

state their risk factors for falls and suggest the best measures to prevent its occurrence.

Data Sampling

Sampling entails techniques in which researchers infer information regarding a given

population based on findings from a subsection of the whole populace (Karlsson et al., 2013). The

ideal sampling method to investigate falls among older persons in long-term care institutions

includes a randomized controlled trial (RCT). These are the gold standards to establish the efficacy

of various interventions. In clinical and long-term care facilities, RCTs are the best techniques in

studying the safety and effectiveness of new interventions for preventing falls among older

patients. This is because they are used in answering patient-interrelated issues. In trials with

randomized and controlled design, the impacts of the clinical interventions will be compared with

those of control treatment, and the participants will be randomly assigned to the selected groups.

Randomized controlled trials of fall prevention strategies targeting the elderly population in the

long-term care settings with various elements including reach, timeliness, and adherence to the

program must be reported consistently.

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Necessary Tools

There are vital tools used in the research and fall risk assessment, such as Falls Risk for

Older People (Long-term-care setting) and RESPOND intervention (a telephone-related falls

prevention program for older persons. The RESPOND intervention must encompass various

evidence-based modules linked to falls risk factors, including better bones, better strength and

balance, better sleep, and better eyesight. Every RESPOND must have an associated pamphlet that

should have positively framed clinical messages concerning the recommended preventions,

including how exercise might help one feel revitalized and relaxed. The RESPOND physician must

make subsequent telephone coaching calls through the use of motivational interviewing strategies.

Notably, good timing, intended dosage, and conveyance style must be pre-determined in the

randomized control trial protocol. Using Falls Risk for Older People will be possible to evaluate

patients for fall risk and motivate them to adopt recommended evidence-based prevention

approaches. Such approaches might assist patients in reducing their likelihood of falling and

experiencing injuries, death, and functional decline.

Algorithms or Flow Maps Created.

To determine preventive strategies for reducing falls among the elderly in a long-term care

facility, a decision tree analysis might be used in developing a prediction algorithm for the

frequency of occurrence of falls. The long-care patients will be assessed using a Resident

Assessment Instrument-Home Care (RAI-HC) model. The validity of the fall algorithm might be

tested and verified among long-term care patients in the designated settings. Such algorithms must

incorporate assistive tools, age, unsteady gait, pain, cognition, and incontinence to various

categories from low to high risk. The algorithms would only be used in long-term care settings

using the RAI-HC system. There is a need to determine how the percentage of falls would behave

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following an upsurge in the risk class. Logistic regression analysis must be utilized to derive odds

ratios to assess the algorithm's validity in various samples. Fall algorithms might provide a typical

assessment model to facilitate the allocation of assistive resources, improve the efficacy of the

healthcare system and minimize costs (Panneman et al., 2021). This is because falls are a prevalent

cause of death and injuries among the elderly in long-term care facilities and are extremely

expensive in healthcare institutions.

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References

Donath, L., van Dieën, J., & Faude, O. (2016). Exercise-based fall prevention in the elderly: what

about agility?. Sports medicine, 46(2), 143-149.

Golmakani, E., Usefi, M. R., Tabatabaeichehr, M., Moayyed, L., & Mortazavi, H. (2014). Fall in

elderly: A literature review. Journal of North Khorasan University of Medical

Sciences, 5(5), 1159-1163.

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.

Kim, E. J., Arai, H., Chan, P., Chen, L. K., Hill, K. D., Kong, B., ... & Won, C. W. (2015).

Strategies on fall prevention for older people living in the community: a report from a

round-table meeting in IAGG 2013. Journal of Clinical Gerontology and Geriatrics, 6(2),

39-44.

Panneman, M. J., Sterke, S. C., Eilering, M. J., Blatter, B. M., Polinder, S., & Van Beeck, E. F.

(2021). Costs and benefits of multifactorial fall prevention in nursing homes in the

Netherlands. Experimental gerontology, 143, 111173.

Pfortmueller, C. A., Lindner, G., & Exadaktylos, A. K. (2014). Reducing fall risk in the elderly:

risk factors and fall prevention, a systematic review. Minerva Med, 105(4), 275-81.

Singh, I., & Okeke, J. (2016). Reducing inpatient falls in a 100% single room elderly care

environment: Evaluation of the impact of a systematic nurse training program on falls risk

assessment (FRA). BMJ Quality Improvement Reports, 5(1).

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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.