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in-hospital falls

Complications: - fear of falling - injury - increased length of stay - hip fracture - in hospital hip fracture with greater risk of institutionalization & death vs hip fracture in the community [22,23] Management: - a fall risk assessment should incorporate intrinsic & extrinsic factors [1] - multicomponent nonpharmacological interventions are effective in reducing incidence of delirium & preventing falls in the elderly [8] - multicomponent nonpharmacologic measures to prevent delirium reduce in hospital falls & injuries from falls [1] - measures include reorientation, early mobilization, therapeutic activities, clinical hydration, nutrition, sleep hygiene, & hearing & vision adaptations [1] - care planning by nursing staff may reduce risk of falls - a fall prevention toolkit that produced bed posters composed of brief text with an accompanying icon, patient education handouts, & plans of care communicating patient-specific alerts to key stakeholders may reduce falls risk - education alone insufficient to reduce in-hospital falls in the elderly - no significant effect on falls-related injuries [4] - nurse-led fall-prevention intervention involving both patient & family throughout hospitalization associated with lower risk for falls & fall-related injuries - 15% reduction in risk for falls; 34% reduction in risk for injurious fall [14] - considerations - patients often with intravenous infusions - cognitively impaired patients not likely to use call button - fall prevention should not promote immobility [11] - scheduled toileting reduces risk of in-hospital falls [1,5] - bed alarms signal too late - patient is on floor or away from bed - night lights may be useful, but clinical efficacy in unproven [1] - physical therapy - the most effective evidence-based strategy for reducing in hospital falls in the elderly [19] - assisted ambulation around the hospital >= 3 times daily [21] - helpful but not likely to be translated into reduced in-hospital fall risk (unless hospitalization is prolonged) - Hospital Elder Life Program (HELP) reduces frailty at hospital discharge - Fall TIPS (Tailoring Interventions for Patient Safety) program effective in preventing inpatient falls through formal risk assessment & tailored patient care plans [13] - Fall TIPS poster, a colorful laminated poster designed to engage & involve patients in their own fall prevention may reduce in-hospital falls [24] - little evidence to support a other particular interventions - non-slip socks* - wrist bands &/or room markers to identify patients at risk - in-hospital exercise programs - sitters to prevent falls in high-risk patients [12] - education of nursing staff [1] - restraints may increase risk of falls - patient education reduces risk of falls in cognitively intact elderly (RR= 0.6-0.65); NNT=20 [6] * smart socks reduce in hospital falls among patients at risk of falls [18]

General

falls in the elderly

References

  1. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  2. Cameron ID, Gillespie LD, Robertson MC et al Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev. 2012 Dec 12;12:CD005465. PMID: 23235623
  3. Coussement J, De Paepe L, Schwendimann R, Interventions for preventing falls in acute- and chronic-care hospitals: a systematic review and meta-analysis. J Am Geriatr Soc. 2008 Jan;56(1):29-36. PMID: 18031484
  4. Dykes PC, Carroll DL, Hurley A Fall prevention in acute care hospitals: a randomized trial. JAMA. 2010 Nov 3;304(17):1912-8. PMID: 21045097
  5. Oliver D et al, Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. BMJ. 2007 Jan 13;334(7584):82. Epub 2006 Dec 8. Review. PMID: 17158580
  6. Hill A-M et al. Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: A pragmatic, stepped-wedge, cluster-randomised controlled trial. Lancet 2015 Apr 9 PMID: 25865864
  7. Chen CC, Chen CN, Lai IR, et al. Effects of a modified Hospital Elder Life Program on frailty in individuals undergoing major elective abdominal surgery. J Am Geriatr Soc. 2014;62:261-268 PMID: 24437990
  8. Hshieh TT, Yue J, Oh E et al. Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis. JAMA Intern Med. 2015;175(4):512-520 PMID: 25643002
  9. Hill AM, Hill K, Brauer S et al Evaluation of the effect of patient education on rates of falls in older hospital patients: description of a randomised controlled trial. BMC Geriatr. 2009 Apr 24;9:14. PMID: 19393046 Free PMC Article
  10. Miake-Lye IM, Hempel S, Ganz DA, Shekelle PG. Inpatient fall prevention programs as a patient safety strategy: a systematic review. Ann Intern Med. 2013 Mar 5;158(5 Pt 2):390-6. Review. PMID: 23460095
  11. Bailey M Overzealous in preventing falls, hospitals are producing an 'epidemic of immobility' in elderly patients. Washington Post. Oct 13, 2019 https://www.washingtonpost.com/health/overzealous-in-preventing-falls-hospitals-are-producing-an-epidemic-of-immobility-in-elderly-patients/2019/10/11/d1894374-d8ab-11e9-a688-303693fb4b0b_story.html
  12. Greeley AM, Tanner EP, Mak S, et al. Sitters as a patient safety strategy to reduce hospital falls: A systematic review. Ann Intern Med 2020 Feb 4; PMID: 32016286 https://annals.org/aim/article-abstract/2760490/sitters-patient-safety-strategy-reduce-hospital-falls-systematic-review - Schubert CC. The challenge of reducing patient falls in hospitals. Ann Intern Med 2020 Feb 4; PMID: 32016370 https://annals.org/aim/article-abstract/2760491/challenge-reducing-patient-falls-hospitals
  13. Christiansen TL, Lipsitz SR, Scanlan M. Patient activation related to fall prevention: A multisite study. Jt Comm J Qual Patient Saf. 2020. Feb 19. PMID: 31948814 https://psnet.ahrq.gov/issue/patient-activation-related-fall-prevention-multisite-study
  14. Dykes PC, Burns Z, Adelman J et al Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries. A Nonrandomized Controlled Trial. JAMA Netw Open. 2020;3(11):e2025889. Nov 17 PMID: 33201236 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773051 - Fall T.I.P.S. Tailorin Interventions for Patients Safety. A Patient-Centered Fall-Prevention Toolkit. https://www.falltips.org/fall-tips-collaborative/
  15. Cameron ID, Dyer SM, Panagoda CE, et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev. 2018 Sep 7;9(9):CD005465. PMID: 30191554 PMCID: PMC6148705 Free PMC article https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005465.pub4/full
  16. Hshieh TT, Yue J, Oh E et al. Effectiveness of multi-component non-pharmacologic delirium interventions: a meta-analysis. JAMA Intern Med. 2015;175(4):512-520 PMID: 25643002 PMCID: PMC4388802 Free PMC article https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2107611
  17. Hill AM, McPhail SM, Waldron N et al. Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial. Lancet. 2015;385:2592-2599 PMID: 25865864 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61945-0/fulltext
  18. Moore T, Kline D, Palettas M, et al. Fall prevention with the Smart Socks System reduces hospital fall rates. J Nurs Care Qual. 2022;Epub Aug 19. PMID: 35984693 https://psnet.ahrq.gov/issue/fall-prevention-smart-socks-system-reduces-hospital-fall-rates
  19. Growdon ME, Shorr RI, Inouye SK. The Tension Between Promoting Mobility and Preventing Falls in the Hospital. JAMA Intern Med. 2017 Jun 1;177(6):759-760 ]PMID: 28437517 PMCID: PMC5500203 Free PMC article
  20. Morris ME, Webster K, Jones C et al Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age Ageing. 2022 May 1;51(5):afac077. PMID: 35524748 PMCID: PMC9078046 Free PMC article
  21. NEJM Knowledge+ - Hastings SN, Choate AL, Mahanna EP et al Early Mobility in the Hospital: Lessons Learned from the STRIDE Program. Geriatrics (Basel). 2018 Dec;3(4):61. PMID: 30775370 PMCID: PMC6371091 Free PMC article.
  22. Murray GR, Cameron ID, Cumming RG. The consequences of falls in acute and subacute hospitals in Australia that cause proximal femoral fractures. J Am Geriatr Soc. 2007 Apr;55(4):577-82. PMID: 17397437
  23. Zapatero A, Barba R, Canora J et al Hip fracture in hospitalized medical patients. BMC Musculoskelet Disord. 2013 Jan 8;14:15. PMID: 23298165 PMCID: PMC3561229 Free PMC article.
  24. Cooper AS ROI for a Fall Prevention Intervention: Invest a Little, Save a Lot. Nurs Adm Q. 2024 Jul-Sep;48(3):248-252 PMID: 38848487