Management and Prevention of Fall Risk: A Literature Review

The World Health Organization (WHO) defines the term fall as the consequence of any event that hurls an individual to the ground against their will. Accidents are the sixth leading cause of death in people over 65 years of age, and falls are the leading cause of accidental death, especially in older adults, whether preventable or not. Falls are a global problem. Every year, approximately 600,000 falls worldwide result in death, making them a leading cause of traumatic death (World Health Organization, 2018). Falls account for 38% of adverse hospital events, and approximately 30% of in-hos pital falls result in injury, with approximately 4% to 6% resulting in serious injuries, such as fractures, subdural hematoma, bleeding, and death. In addition to the physical consequences, falls also have psychological and social consequences. Fear of falling, the most common psychological consequence, leads to a reduction in physical and social activities (Lavedan et al., 2018). Falls prevention education (FPE) is one strategy to reduce falls (Kamei et al., 2015; Ott, 2018). Providing FPE also improves positive healthcare outcomes in older people (Chaudhry, 2020; Chidume, 2021), as they become more independent in their perceived quality of life to perform daily activities and live in a safer environment (Minnier et al., 2019). Al though falls can occur throughout life, people aged 65 and over are at the highest risk of falling in hospital. The resulting consequences of a fall can significantly impact a person’s overall quality of life or more likely lead to a life-threatening event (Australian Commission on Safety and Quality in Health Care [ACSQHC] 2018b). Falls occur in hospital and community settings and are a major concern in nursing. Although falls can occur at any time throughout a person’s lifespan, risks vary based on age, gender, and other factors. Some risk factors are intrinsic (e.g., visual impairment and mobility) and others are extrinsic (e.g., medications; Xu et al., 2017). Falls are a well-known quality indicator sensitive to nursing care and a patient care outcome reported in the National Nursing Quality Indicators Database (Madaris, 2023). Although the risk of falling is often associated with older adults (Appeadu & Bordoni, 2023; World Health Organization, 2021a), women during pregnancy, labor, and the postpartum period may also be at increased risk. Postural stability decreases as pregnancy progresses (El- Shamy et al., 2016; Opala- Berdzik et al., 2015; Shingala et al., 2019) and remains impaired during the postpartum period (Opala-Berdzik et al., 2015), placing women at high risk for falls. After childbirth, women have different risk factors for falls compared to other patients, such as postpartum haemorrhage and no food intake after birth for more than 6 hours (Xu et al., 2017).

Nurses can focus on identifying patients at particular risk of falling, and population stratification for this purpose is possible using assessment tools to quantify risk. For example, the Morse Fall Scale is a classic tool used to assess fall risk in the general patient population (Morse et al., 1989).

The research was conducted using the research question that I posed as the starting point of my research: Which prevention interventions on patients reduce the risk of falling?

I conducted the research using the PIO methodology which allowed me to identify the keywords and subsequently the articles related to the chosen topic:

• P (Population and Problem): The skills of the healthcare professional

• THE (Intervention): strategies harvest in act from the professional

• (Outcomes or themes): Reduction of fall episodes during hospital stay

Their research of the articles and was conduct on Bank Data PubMed, Where I have used the following keywords: Nurse- fall Risk- prevention by combining and/or including them together through the use of Boolean operators AND OR, obtaining results that contain the related terms at the same time or both.

MeSH (Medical Subject) terms. Headings).

The strings of research with the results obtained and the criteria adopted I am the following:

Motion Sensors

Most falls occur in patient rooms, accounting for more than half of all falls. Other common locations include the hallway outside the room and the bathroom inside the room.

The installation of bells and alarms in hospitalized patient rooms alerts caregivers to the need for movement of patients who require assistance. However, the use of this patient-activated light or bell alarm system is questionable in preventing falls, especially when the patient doesn’t communicate movement due to health problems; therefore, changes in position and the initiation of walking aren’t detected by the nurse in time before the fall occurs.

The use of motion sensors with alarms has been studied as predictive devices for hospital-level falls. These are offered to caregivers as devices installed on beds and chairs (pressure sensors), or less frequently attached to patients (portable accelerometers-gyroscopes), with the ability to predict falls in hospitalized patients. Is there an impact on falls among adult patients receiving preventive care with sensor-based devices placed on hospital-use or portable items during hospitalization?

The primary objective was to conduct a systematic review of the available scientific literature exploring the impact of the use of sensor-based devices to prevent falls in adults and older adults in hospital settings. Furthermore, this study describes the technical development aspects of the sensors and the implementation characteristics identified in each of the studies.

The study by Olga et al. included randomized controlled trials (RCTs) in which hospitalized patients were assigned to wearable sensors (portable or attached to the bed, chair, or other items) diagnosed with any medical or surgical condition. The intervention under consideration was defined as the use of sensors that tracked changes in movement during hospitalization (such as from lying to sitting; from sitting to standing and walking), monitored throughout the patient’s hospitalization, and implemented with the goal of preventing patient falls.

Of the four studies found, three used sensors fixed to the bed, bedside chair, or chair in the room. Only one study evaluated the impact of sensors (accelerometers) attached to the patient’s body (thigh with Velcro). The sensors attached to the bed or bedside chair were pressure sensors that produced an alarm when the patient stood up and broke contact with the sensor.

The sensors identified in the studies included in this meta-analysis failed to predict falls in real time. Because the sensors, which are placed on beds or chairs, are static and activated by patients’ hand pressure on the devices, they do not provide a reliable and predictive alert if the patient moves away from the sensor. On the other hand, once the alarm stops, it can be interpreted as if an atrisk patient has stopped moving, thus potentially causing a mobility- related fall. If the sensors are not adequately programmed to identify changes in broad-spectrum movement, possibly before atrisk patients stand, they are unable to capture true and false positives, thus reducing their predictive power (positive or negative).

This study highlights the increase in falls in hospitalized older adults using motion sensors placed on the bed or chair in their rooms.

Physical Activity as Fall Prevention

Physical inactivity and deficits in functional ability (e.g., reduced lower limb muscle strength and impaired balance) have been identified as independent contributors to falls and fall-related injuries (e.g., head injuries and hip fractures) among older adults. Although they are critical risk factors for older adults, they are modifiable and preventable through exercise. Physical training is widely recognized as an appropriate intervention strategy for improving functional performance in older adults by reducing these risk factors and consequently minimizing the risk of falling. Furthermore, reducing physical inactivity has been shown to have positive economic impacts at the national, societal, and individual levels. Cognitive decline also occurs during normal aging, which is considered a significant factor in increasing functional dependence and decreasing activities of daily living among older adults. Consequently, the WHO recommends that older adults over 65 adopt an active lifestyle that includes a minimum of 150 minutes of moderate- intensity physical activity per week, in addition to engaging in fall prevention exercises. This moderate amount of physical activity has been shown to reduce risk factors associated with falls by up to 50%, reducing functional limitation in older people and ultimately reducing the risk of falls.

The included studies involved 4,330 participants, of whom 4,121 participated at the end of the studies and were analysed for outcome measures. The mean age of participants ranged from 66.4 to 82.4 years, and all were older adults living in the community. The interventions were conducted primarily in gyms, exercise studios, community facilities, combined gyms, home-based settings, and laboratories.

A variety of training equipment was used: resistance training machines, recumbent trainer, stationary seated cycle ergometer, treadmill, stair climber, recumbent bike, weighted equipment such as cuff and vest weights, resistance bands/tubing, free weights, body weights, balls, steps, chairs, equipment used for balance training such as non-slip tiles, balance foams, soft wedge mat, soft pads, non-inverted BOSU® balls, BOSU® balls, balance cushions, balance beams, semi-circular blocks, Posturomed , wobble boards, and inflatable discs.

The duration of exercise interventions ranged from 15 minutes to 90 minutes per session, the frequency of interventions ranged from once per day to five times per week, and the duration of exercise programs ranged from 1 week to 2 years.

Although poor muscle strength is an established risk factor for falls, strength training has been found to have no significant effect on falls when a person has sufficient strength to avoid falling. Furthermore, strength training as a single intervention has shown no evidence of being effective in preventing falls. However, strength training is likely to offer long-term fall prevention and other health benefits for older adults. To be effective, strength training should provide a certain amount of resistance in an exercise, and a maximum of 10–15 repetitions should be completed before reaching muscle fatigue. Similarly to strength training, balance training as a single intervention has shown no evidence of being effective in reducing the rate and risk of falls, yet including balance training in exercise programs appeared to be a crucial factor in reducing falls. Furthermore, it is recommended that exercises provide a moderate or high balance challenge to prevent falls. Thus, this explained that different exercise programs that included balance training were equally effective in reducing falls.

Therefore, practicing regular physical activity is essential for reducing and preventing chronic diseases, maintaining a healthy musculoskeletal system and balance, and reducing the risk of falls.

In conclusion, our review included numerous RCTs of physical exercise interventions, including strengthening and balance interventions, on physical function and the risk of falls in community- dwelling older adults. This review confirms previous findings that exercise improves the components of functional ability, namely, strength, balance, and lower limb mobility. Furthermore, exercise reduces falls and minimizes their serious consequences.

None.

No conflict of interest.

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