Fall Prevention in Long-Term Care Facilities

In this article, Jung, Shin, and Kim (2014) argue that falls are the most common health challenges affecting patients aged 65 years and above, which often results in significant injuries. In this regard, the researchers have developed a guideline to take into consideration all the risk factors and interventions associated with falls for the purpose of preventing such incidents in long-term care facilities. The authors anchored their study on a methodological approach guided by the Scottish Intercollegiate Guideline Network used in creating evidence-based approaches that included various steps. Firstly, the research procedure included the creation of a target population and latitude of the guidelines. Secondly, a systematic review of the literature and critical analysis was conducted to assess the data available on fall preventions among elderly patients above the age of 65 years. Thirdly, the researchers assigned different grades to rank and differentiate the diverse levels of evidence obtained from various articles identified by the study. Fourthly, the researchers developed an algorithm and drafting of fall prevention intervention procedures. Fifthly, the researcher employed 20 experts with experience in fall prevention who developed a questionnaire taking into consideration the feasibility, appropriateness, and effectiveness of every evidence-based intervention (Jung, Shin, & Kim, 2014). The findings were used to identify the best alternatives to be used in the guidelines. Finally, the guideline and recommendations of the grades of evidence were determined by the group of experts. The observations of the study imply that the evidence-based fall prevention regulations are comprised of a three-step evaluation process, as well as a three-phase intervention procedure. However, the study has a limitation due to its overdependence on clinical experts and evidence from the literature. In conclusion, the authors espouse that the established guideline can be utilized by nurses to evaluate which patients have a higher risk of succumbing to fall incidents so that relevant preventive interventions can be formulated.

Relevance and Implication

The guidelines developed for fall prevention in this article are vital because they are work oriented, and specific to LTC care facilities. They take into account the existing guidelines and opinions of all LTC experts including nurses. The guideline also takes into account customized and individualized interventions through the use of evidence-based approaches that nurses can use to categorize populations that at risk of falling. Research has demonstrated that effective fall prevention interventions can only be attained when patients with a high-risk predisposition are identified and customized prevention interventions formulated to mitigate the consequences of the predisposing factors (Jung, Shin, & Kim, 2014).
Moreover, the guidelines recently published with regard to fall prevention from the American Geriatrics Society as well as the British Geriatrics Society also have similar recommendations. They argue that risk factors need to be evaluated before commensurate prevention intervention measures can be formulated. In addition, they also propose a three-stage process of conducting assessments. The first two steps are used in the identification of high-risk populations, which is later followed by a comprehensive evaluation that identifies specific challenges inherent to particular patients, which has facilitated the development of precise interventions (Jung, Shin, & Kim, 2014). This form of guidelines are specifically apt taking into consideration that falls are often caused by a myriad of factors that are correlated.
According to the assessment conducted by the team of experts, the feasibility, effectiveness, and appropriateness of the comprehensive evaluation of predisposing factors to falls are observed to be high. This is an indication that in clinical settings nurses are well informed of the significance of comprehensive fall evaluation and the need for such assessments to be highly feasible. Nonetheless, experts have noted that even though interventions that encourage physical activities and engaging in exercises among elderly patients in LTC facilities are presumed to be appropriate, the viability of such interventions is relatively low (Jung, Shin, & Kim, 2014).
An explanation offered for this variance is that nurses in these facilities are often understaffed, which makes it challenging for them to allocate adequate time required to manage each adult patient during physical exercises that assist them in preventing falls. Another explanation offered is that nurses usually lack the prerequisite knowledge to determine the most appropriate individualized exercises that can help elderly patients to avoid falls. In this regard, educational and on the job training programs are required to assist nurses in determining the best exercises that can help patients strengthen their muscles, enhance their balance, as well as develop endurance and gait. Even though previous surveys have observed a correlation between increased endurance and patient falls, a gap in knowledge still exists with regard to the evidence obtained. The assumption is that the perceptions of nurses are that the impacts of stronger endurance physical exercise regimes have a minimal effect on the minimization of falls among elderly patients (Jung, Shin, & Kim, 2014).

Limitation

The guideline proposed in this study is anchored on a literature review and input from clinical experts. In this respect, there is the need for more research geared at testing the feasibility of the proposed guidelines in long-term care facilities that cater to elderly patients above the age of 65 years (Jung, Shin, & Kim, 2014). Therefore, future studies should explore whether the use of the proposed guidelines have an impact on the reduction of patient falls.

Reference

Jung, D., Shin, S., & Kim, H. (2014). A fall prevention guideline for older adults living in long‐term care facilities. International Nursing Review, 61(4), 525-533.