Characteristics of the Fall-Prone Patient

The Gerontologist (Impact Factor: 3.21). 09/1987; 27(4). DOI: 10.1093/geront/27.4.516
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Interviews, observational data, and quantitative data on physical condition were collected on 100 hospitalized patients at the time of a fall and compared with data from 100 randomly selected patients who had not fallen. Those who had fallen were more likely to have had a previous fall, presence of a secondary diagnosis, intravenous therapy, impaired gait, used walking aids, and have a poor mental status. Correctly classified by these variables were 80.5% of the patients. Examination of the falls and the false negative group revealed three types of patient falls: physiological anticipated, physiological unanticipated, and accidental falls. Appropriate preventive strategies for each type of fall are suggested.

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    • "Falls are a leading cause of injury and concern among older people. Among individuals living at home it has been estimated that: around 30% of them aged over 65 years and 50% of them aged over 80 years fall each year; 20%–30% of these falls result in individuals having reduced mobility and independence; around 10% of falls lead to serious injury and about 5% to fractures; around 20% of frequent fallers followed up at one year are either in hospital, in long term care or have died (O'Loughlin et al., 1993; Rawsky, 1998; Tinetti et al., 1998; Cryer and Patel, 2001; Tinetti, 2003; Todd and Skelton, 2004; Morse et al., 1987). "
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    ABSTRACT: Background This study investigated two initiatives for preventing falls in Cheshire: public events to raise population awareness about falls and ways of preventing falls, a programme of falls assessments and falls prevention classes.Aim The study aimed to support service development by generating local learning about: the falls risk status of older people attending the public events and their use of services for preventing falls, the efficiency and effectiveness of the falls programme.Methods A local adaptation of an instrument used in similar research was administered to assess the falls risk status of older people attending the public events. This instrument captures data about the age, sex, gait, sensory deficit, falls history, current medication, medical history, mobility and living situation of respondents. Attendees were also asked about their current use of falls services. To evaluate the falls programme data were collected about the characteristics and referral sources of service users and, for users of the falls prevention classes: their mobility and balance on joining and completing the classes; their fear of falling and confidence linked to falls at the start of the classes and six months later; the number of falls they experienced in the six months before starting and after completing the classes.Findings Of the 453 attendees screened, 64.3% were at medium risk of falling or above and 34.3% had suffered previous falls. None were accessing falls prevention services. During its first year, 324 individuals were referred to the falls programme. Overall, among those individuals who provided data for analysis, there was a statistically significant improvement in the ‘clinical’ outcomes assessed and a statistically significant reduction in the occurrence of falls. The majority of respondents indicated that they achieved an improved confidence linked to falls and a reduced fear of falling.Conclusions Studies of this type can provide a valuable contribution to local learning but the characteristics of the research collaborations developed can affect study designs and the quality of the information generated. Improved contracting arrangements between service commissioners and providers may provide an opportunity to increase the rigour of local developmental studies.
    Primary Health Care Research & Development 06/2010; 11(03):222 - 232. DOI:10.1017/S1463423610000046
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    • "tances of falls that occurred in patients in the false negative group , we identified two addi - tional types of fall : the accidental fall ( true accidents , slips and trips in those who are rated at not risk of falling ) , and the unanticipated physio - logical fall ( falls due to a seizure or fainting in patients who also scored not at risk ) ( Morse et al . , 1987 ) . Recalculating the ability of the scale to discriminate after making these corrections , the sensitivity and specificity of the scale increases to 84% sensitivity . But the importance of recog - nizing the three types of fall is that the scale will never identify 100% of falls in a hospital , and staff should always try to determine "
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    ABSTRACT: Most fall intervention programs consist of 2 components: fall risk prediction instruments to identify the patient who is likely to fall, and fall intervention strategies to prevent the patient from falling or to protect the patient from injury should a fall occur. While critical to the effectiveness of a fall intervention program, many of the fall risk prediction instruments have been criticized for their failure to accurately identify the fall-prone patient. In this article, in the context of the validity assessments conducted on the Morse Fall Scale, the research conducted in the past 2 decades on fall risk assessment is critiqued. Some fall prediction research is based upon invalid assumptions and/or errors in design, both in the development of risk scales and in the evaluation of these instruments. Many of these instruments have been constructed with inappropriate reliance on face validity, have been evaluated inadequately, or have been tested in the clinical setting using an invalid design. Finally, improper use of fall scales in the clinical area may increase the risk of injury to the patient. The author concludes that much nursing research on patient falls does not contribute to improved patient safety.
    The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières 07/2006; 38(2):73-88.
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    • "The rate of patient falls at the patient care unit level is usually measured using voluntary reports fi-om staff. Kustaborder and Rigner (1983), Morse, Tylko, and Dixon (1987), and Tutuarini, de Hann, and Limburg (1993) found no relationship between patient fall rates and the number of nurses or the patient to nurse ratios. Fall rates declined with restructuring that reduced staff mix RNs (from 80%-60%) (Grillo-Peck & Risner, 1995) and with the introduction of differentiated practice (Malloch, Milton, & Jobes, 1990). "
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    ABSTRACT: The most visible threats to patient safety associated with nursing care occur on hospital inpatient units. Patient safety research is a new phenomenon, but it builds on the knowledge provided by quality-of-care research done previously. The purpose of this chapter is to describe the current state of the science in the area of nurse staffing and patient safety. The results of research studies published since the last round of reviews (1996-2005) are described by level of analysis, measures of nurse staffing and patient outcomes. Although research linking nurse staffing to the quality of patient care has increased markedly since 1996, the results of recent research projects do not yet provide a thorough and consistent foundation for producing solutions to the crisis in hospital nursing care. The inconsistencies are largely due to differing units of analysis (hospital, patient, care unit), variability in measures of nurse staffing, the variety of quality indicators chosen, the difficulty finding accurate measures of these indicators, and the difficulty creating risk-adjustment strategies for the indicators most sensitive to nursing care. Nursing administration and policy most urgently need research conducted with standardized data collected at the patient care unit level.
    Annual review of nursing research 02/2006; 24:103-25.
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