The Role of the US Trauma Centers in Older Adult Fall Prevention: A National Survey

Introduction Approximately 27.5% of adults 65 and older fall each year, over 3 million are treated in an emergency department, and 32 000 die. The American College of Surgeons and its Committee on Trauma (ACSCOT) have urged trauma centers (TCs) to screen for fall risk, but information on the role of TC in this opportunity for prevention is largely unknown. Methods A 29-item survey was developed by an ACSCOT Injury Prevention and Control Committee, Older Adult Falls workgroup, and emailed to 1000 trauma directors of the National Trauma Data Bank using Qualtrics. US TCs were surveyed regarding fall prevention, screening, intervention, and hospital discharge practices. Data collected and analyzed included respondent’s role, location, population density, state designation or American College of Surgeons (ACS) level, if teaching facility, and patient population. Results Of the 266 (27%) respondents, 71% of TCs include fall prevention as part of their mission, but only 16% of TCs use fall risk screening tools. There was no significant difference between geographic location or ACS level. The number of prevention resources (F = 31.58, P < .0001) followed by the presence of a formal screening tool (F = 21.47, P < .0001) best predicted the presence of a fall prevention program. Conclusion Older adult falls remain a major injury risk and injury prevention opportunity. The majority of TCs surveyed include prevention of older adult falls as part of their mission, but few incorporate the components of a fall prevention program. Development of best practices and requiring TCs to screen and offer interventions may prevent falls.

Preventing Falls in Long-Term Care Using Patient-Centered Fall Interventions

Practice Problem: The practice problem identified within the Community Living Center included continuous falls, despite using current fall prevention strategies and provider-driven interventions. Baseline data reflected a fall rate of 4.2 in the long-term care areas despite improving the fall prevention program. PICOT: The PICOT question that guided this project was: In older adult residents (P), what is the effect of a standing operating procedure (SOP) using patient-centered interventions (I) compared to physician-driven fall interventions (C) on decreasing falls and falls with injuries (O) within one month (T)? Evidence: In twelve high-quality articles that fit the eligibility criteria and contained EBP literature, the overwhelming evidence revealed that an SOP encompassing patient-centered fall interventions could decrease LTC falls and falls within injury rates. Outcome: Observations reflected the nursing staff utilized the SOP and patient-centered fall interventions in practice; however, fall rates on both LTC #1 and LTC #2 increased from baseline, but the falls with injury rates remained zero. Patient satisfaction measured a weighted mean score of 4.7 of 5 points, representing satisfaction with the patient-centered interventions and nurses as a whole. Conclusion: The EBP project did not result in an overall reduction in the fall rates; however, falls with injury rates remained at zero. Furthermore, the patient's overall satisfaction with the nurses and patient-centered fall prevention program was favorable. It is essential to note that due to COVID-19 related events, the project halted after 30 days, and the results might have been different if implemented 90 days as initially projected.

Causes, Consequences, and Fall Prevention Preferences for Adults in Mid-Life

Date Presented 04/20/21 Most research studying fall experiences and fall prevention program preferences focuses on older adults, overlooking the falls that occur in midlife. This pilot study gathered preliminary data on fall experiences, consequences, and fall prevention preferences of adults in midlife. Almost all participants experienced functional consequences from their fall and had interest in learning about fall prevention, suggesting that fall prevention programs could be beneficial for middle-aged adults. Primary Author and Speaker: Meredith H. Lee Additional Authors and Speakers: Rachel Reed Contributing Authors: Samantha Grant, Jodi Thomas, and Roy St. Laurent

The Stroll Safe Outdoor Fall Prevention Program: Feasibility and Future Directions

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Using a quasi-experimental design, the feasibility of the Stroll Safe outdoor fall prevention program was examined. Process, scientific, management, and resource assessments were conducted. Results reveal that the program is feasible to implement among active, community-dwelling older adults. Further study using an efficacy trial is warranted. This study helps to build the body of knowledge in outdoor fall prevention, an area of research and practice that is critical to productive aging. Primary Author and Speaker: Tracy Chippendale

Analysis of risk factors of falls and audit of fall prevention program in the multidisciplinary hospital

Aim. To explore the organization of the activities of nurses in the prevention of falls and injuries of patients in the multidisciplinary hospital for compliance with the requirements of the quality management system. Materials and methods. Retrospective analysis of 1600 medical records of patients admitted to the surgical and therapeutic department of the multidisciplinary hospital, assessment of the risk of falls using the Morse scale, interviews of medical personnel, audit of the hospital using quality management system approaches. Results. Most of the patients in the hospital, despite of the profile, have a low and medium risk of falls, regardless of age, but due to the underlying disorders and concomitant diseases, as well as restrictions imposed by the disease, the presence of falls in the anamnesis. To assess the risk of falls in a medical organization for adult patients, it is advisable to use the Morse Fall Scale (MFS) in dynamics with fixation in the medical documentation in accordance with the adopted regulations. We have confirmed 70% compliance of the fall prevention program in the multidisciplinary hospital with the practical guidelines of Roszdravnadzor for the safety of medical care. Conclusions. In the context of limited resources, a differentiated approach to the prevention of falls in the medical organization will contribute to the decrease and absence of injuries.

Development and Effect of a Fall Prevention Program Based on King’s Theory of Goal Attainment in Long-Term Care Hospitals: An Experimental Study

A fall prevention program based on King’s goal attainment theory was developed to verify its effect on those in long-term care hospitals. The experiment was conducted at K Long-Term Care Hospital in S city for eight weeks. The study employed 57 elderly patients and 58 nurses. The program comprised an individual training conducted in a ward and hospital room for 20–30 min and a group training held in a conference room for 60 min. Significance levels were analyzed at p < 0.05 via frequency analysis, descriptive statistics, independent sample t-test, χ2-test, Mann–Whitney’s U test, Wilcoxon code rank test, and Cronbach’s α, and the clinical trial number was KCT0005908. In the patient intervention group, fall prevention behavior and knowledge increased, and the fear of falling decreased. Fall prevention behavior and knowledge increased in the nurse intervention group. Patient and nurse interaction satisfaction also increased. In contrast, the number of falls and nurses’ burden did not decrease. The fall prevention program was verified via the interaction of personal, interpersonal, and social systems. Thus, the patient’s fear of falling was reduced. Moreover, the program was effective for the fall knowledge, interaction satisfaction, and fall prevention behavior of both the patient and nurse.

A Systematic Review and Meta-Analysis of Fall Prevention Programs for Pediatric Inpatients

Falls account for a high proportion of the safety accidents experienced by hospitalized children. This study aims to analyze the contents and effects of fall prevention programs for pediatric inpatients to develop more adaptable fall prevention programs. A literature search was performed using PubMed (including Medline), Science Direct, CINAHL, Embase, and Cochrane. We included articles published from the inception of each of the databases up to 31 March 2019. A total of 1725 results were reviewed according to the inclusion and exclusion criteria, and nine studies were selected. Data were analyzed using descriptive statistics and the Comprehensive Meta-Analysis program. Four of the nine studies divided their participants into a high-risk fall group and a low-or medium-risk fall group, and all studies used a high-risk sign/sticker as a common protocol guideline for its high-risk fall group. The odds ratio of 0.95 (95% Cl 0.550–1.640) for the fall prevention program in seven studies was not statistically significant. To develop a standardized fall prevention program in the future, randomized control trial studies that can objectively measure the fall rate reduction effect of the integrated fall prevention program need to be expanded.

A Digital Health Fall Prevention Program for Older Adults: Feasibility Study (Preprint)

BACKGROUND About 1 in 3 adults aged 65 and older falls annually. Exercise interventions are effective in reducing the fall risk and fall rate among older adults. In 2020, startup company Age Bold Inc. disseminated the Bold Fall Prevention Program, aiming to reduce falls among older adults through a remotely delivered, digital exercise program. OBJECTIVE We conducted a feasibility study to assess the delivery of the Bold Fall Prevention Program remotely and evaluate the program's impact on 2 primary outcomes—annualized fall rate and weekly minutes of physical activity (PA)—over 6 months of follow-up. METHODS Older adults at high risk of falling were screened and recruited for the feasibility study via nationwide digital advertising strategies. Self-reported outcomes were collected via surveys administered at the time of enrollment and after 3 and 6 months. Responses were used to calculate changes in the annualized fall rate and minutes of PA per week. RESULTS The remote delivery of a progressive digital fall prevention program and associated research study, including remote recruitment, enrollment, and data collection, was deemed feasible. Participants successfully engaged at home with on-demand video exercise classes, self-assessments, and online surveys. We enrolled 65 participants, of whom 48 (74%) were women, and the average participant age was 72.6 years. Of the 65 participants, 54 (83%) took at least 1 exercise class, 40 (62%) responded to at least 1 follow-up survey at either 3 or 6 months, 20 (31%) responded to both follow-up surveys, and 25 (39%) were lost to follow-up. Among all participants who completed at least 1 follow-up survey, weekly minutes of PA increased by 182% (ratio change=2.82, 95% CI 1.26-6.37, n=35) from baseline and annualized falls per year decreased by 46% (incidence rate ratio [IRR]=0.54, 95% CI 0.32-0.90, n=40). Among only 6-month survey responders (n=31, 48%), weekly minutes of PA increased by 206% (ratio change=3.06, 95% CI 1.43-6.55) from baseline to 6 months (n=30, 46%) and the annualized fall rate decreased by 28% (IRR=0.72, 95% CI 0.42-1.23) from baseline to 6 months. CONCLUSIONS The Bold Fall Prevention Program provides a feasible strategy to increase PA and reduce the burden of falls among older adults.