The Agency for Healthcare Research and Quality (AHRQ) partners with the Evidence-
Based Practice Center’s Program to contribute to the efforts of various organizations to improve
the quality of healthcare in the United States (Agency for Healthcare Research and Quality,
2010). The program awards contracts to public and private organizations who strive to improve
health care delivery in the US by providing literature on diverse health topics (Agency for
Healthcare Research and Quality, 2010). The literature that is provided is then compiled into
evidence based practice reports that are used for coverage decisions, quality measures,
educational materials and tools, clinical practice guidelines, and research agendas (Agency for
Healthcare Research and Quality, 2010). The specific EPC report that was examined was
“Interventions to Prevent Falls in Older Adults” that was published by Annals of Internal
Medicine on December 21, 2010.
The evidence based practice report focused on assessing the benefits and consequences of
interventions for reducing falls to improve health outcomes in older adults. In 2003, the CDC
stated that falls were the leading cause of injury deaths among adults 65 years of age and older
(CDC, 2003). With this age population, there is an increased risk of injury, specifically hip
fractures, from falling due to comorbidities and pre-existing conditions (Fuller, 2000). More than
90% of hip fractures are a result of falls in those 70 years of age or over (Fuller, 2000). The
increased number of falls in this population results in more hospitalizations than any other injury
(Agency for Healthcare Research and Quality, 2010). The factors that increase the risk of fall in
the elderly include an increase in age, cognitive and functional decline, medication use, and
sensory deficits (Fuller, 2000). Typically, when individuals fall, the treatment is directed at any
possible injuries, but also the underlying cause of the fall such declining physical function or
medications (Fuller, 2000). This report, however, focuses on the interventions used to prevent the
number of falls in the elderly. The interventions that were examined include treatment of
nutritional risks and visual deficits, hip protectors, home hazard modifications, exercise and
physical therapy, assessment and management of various issues, and clinical education (Agency
for Healthcare Research and Quality, 2010).
The findings of the different studies included evidence of multiple fall interventions that
reduced falls in older adults. However, there was not enough evidence to suggest that there were
any harm or consequences to the interventions. In its entirety, the study included 47 trials of
interventions with around 23,980 participants (Agency for Healthcare Research and Quality,
2010). The falls were measured by the number of fallers rather than fall rate, time to first fall,
and number of frequent fallers (Agency for Healthcare Research and Quality, 2010). The
findings included trials involving multifactorial assessment and management, single clinical
treatment, clinical education, physical activity, and home hazard modification. When examining
multifactorial assessment and management, risk assessments were completed screening for fall
risk individuals based on vision, gait, mobility, strength, medication review, cognitive
impairment, and orthostatic hypotension (Agency for Healthcare Research and Quality, 2010).
However, there was not enough conclusive evidence to support a decrease in falls due to
challenges such as lack of patient compliance and lack of knowledge and skills, but did show
there was not serious harm from falling (Agency of Healthcare Research and Quality, 2010). The
next intervention that was examined was single clinical treatment. Single clinical treatment
included vitamin D supplementation, vision correction, medication withdrawal, and protein
supplementation. The study showed that vitamin D supplements didn’t affect fall related injuries,
but did reduce the risk of falling (Agency of Healthcare Research and Quality, 2010). Vision
correction was not found to have any correlation with a reduction in falls or injuries related to
falling (Agency of Healthcare Research and Quality, 2010). Regarding medication withdrawal
and protein supplementation, there was no evidence supporting a reduction in falls (Agency of
Healthcare Research and Quality, 2010). Clinical education alone was not found to reduce the
risk of falling in the elderly and could not be correlated to falls resulting in injury (Agency of
Healthcare Research and Quality, 2010). Lastly, there was limited evidence to suggest that
physical activity and home hazard modification reduced the risk for falling (Agency of
Healthcare Research and Quality, 2010). During this study, there were limitations that affected
the quality and quantity of the data. For example, only 28 out of the 47 studies included any
health outcomes, an important component of the study (Agency of Healthcare Research and
Quality, 2010).
To better address the issue of falling in the elderly population, it’s recommended to focus
more on identifying modifiable risk factors for falling (Agency of Healthcare Research and
Quality, 2010). By identifying these modifiable factors, healthcare providers can decrease the
number of falls and the number of injuries related to falls. In an acute care setting, it is easy to
assess people at high risk for falling by using the Morse Fall Risk Score. However, in the
community setting, it is difficult to truly assess who is at risk for falling, therefore impeding
interventions for decreasing the number of falls. Overall, the study showed that more research
needs to be conducted to identify the at-risk population for falls and once this group is identified,
more research should be conducted on the interventions to prevent falling. As healthcare
providers, it is our duty to keep our patients and communities safe and to improve healthcare
outcomes. As the bible states in John 15:12, “This is my commandment, that you love one
another as I have loved you” (John 15:12, New Revised Standard Version). It is our duty as
nurses and healthcare providers to care for others how we would want to be treated. We must
keep each other safe and healthy as we would want to remain.
References
Agency for Healthcare Research and Quality. (2020, December). EPC evidence-based reports.
https://www.ahrq.gov/research/findings/evidence-based-reports/index.html
Centers for Disease Control and Prevention (CDC) (2006). Fatalities and injuries from falls
among older adults--United States, 1993-2003 and 2001-2005. MMWR.
Morbidity and mortality weekly report, 55(45), 1221–1224.
Fuller G. F. (2000). Falls in the elderly. American family physician, 61(7), 2159–2174.
New Revised Standard Version Bible. (1989). The Division of Christian Education of the
National Council of the Churches of Christ in the United States of America
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