Identifying Risk Factors for Elder Falls in Geriatric Rehabilitation in Israel

Anosognosia for Hemiplegia and Falls After Stroke: A Prospective Correlational Study

PURPOSE

The aim of this study was to explore the association between the presence and severity of anosognosia for hemiplegia (AHP) and falls in stroke survivors.

DESIGN

A prospective, correlational research design was utilized.

METHODS

Primary instrumentation included demographic information and the Visual-Analogue Test for Anosognosia for motor impairment (VATA-m). Correlational and regression analyses were performed between a priori variables.

RESULTS

There was no statistically significant relationship found between AHP and falls. An incidental finding included that clinicians erroneously charted that their patients were aware of their physical limitations 100% of the time, which indicates that there is discord between clinicians and patients regarding physical limitations.

CONCLUSIONS

Though no statistically significant relationship was found between AHP and falls, the incidental finding of dissonance between the patient and the clinician has important clinical implications.

RELEVANCE

The relationship between AHP and stroke rehabilitation outcomes is still not understood, and incorporating part of the VATA-m into patient assessment could improve clinician understanding of patient awareness.

Characteristics of those who fall during orthopedic hospitalization - A retrospective case-control study

BACKGROUND

The causes of falls are heterogeneous and represent an interaction between patient and environmental factors. This study aimed to explore the characteristics of patients who fell in an in-patient orthopedic department and explore possible reasons for their falls.

METHODS

A retrospective case-control study of adults in an orthopedic in-patient setting at a major hospital, who sustained a fall. Sociodemographic and medical characteristics of randomly sampled patients who fell (cases, n = 128) and their controls (n = 128) were compared.

RESULTS

Fallers were younger, had less comorbidities, took less medications, and had a shorter length of stay than non-fallers. Moreover, fallers' reasons for hospitalization were not necessarily associated with limited mobility. Fall events occurred most frequently from the patient's bed, in the bathroom and during night shifts.

CONCLUSIONS

Our study portrays atypical fallers; that is, patients who had no obvious risk factors for falls and, thus, were not expected to fall. It appears that reduction in falls among high-risk patients may artificially create a population of atypical fallers. The patients may overestimate their abilities and avoid asking for assistance. Our findings suggest that emphasizing the importance of asking for assistance among both low-risk and high-risk patients as well as male and female patients should be an integral part of patient education in orthopedic departments.

Comparison of two fall-risk assessment tools used in a long-term care facility

PURPOSE

The purpose of this paper is to compare the ability of the Morse Fall Scale (MFS) and Farmer's fall-risk assessment tool (FFAT) to identify correlations between risk factors and falls among older adult long-term care (LTC) facility residents.

DESIGN/METHODOLOGY/APPROACH

This was a correlational retrospective study. 200 medical records of older adults hospitalized in a LTC facility in central Israel, from January 2017 to January 2018, were examined.

FINDINGS

Of all the residents, 75% and 99.5% of the residents were identified as having a high fall risk according to the MFS and FFAT, respectively. Only 12.5% of residents actually fell. MFS score was weakly correlated with actual falls (odds ratio = 1.035). It was also found that all fallers fell during their first week at the facility.

RESEARCH LIMITATIONS/IMPLICATIONS

Future research should explore the ability of the tools to capture changes in the fall risk by repeat assessments, as this has not been examined in the present study.

PRACTICAL IMPLICATIONS

The MFS and FFAT tool may have little value in assessing fall risk in older adult LTC facility residents. Therefore, nurses should perform a clinical evaluation of each individual patient. In addition, nurses should place a particular emphasis on fall risk and prevention during the first week following admission.

ORIGINALITY/VALUE

The findings of the present study raise doubts regarding the utility of the common practice of assessing fall risk in older adult LTC facility residents using the tools MFS and the FFAT, thus emphasizing the need to adopt a different approach.

The Perceptions and Rehabilitation Experience of Older People After Falling in the Hospital

PURPOSE

Falls are a major cause of disability and mortality due to injury. To reduce fall rates and improve health outcomes, it is important to design services based on patient experience and engagement. This study aimed to explore the experiences of older patients who fell during their hospital stay.

DESIGN

Five patients from two rehabilitation wards in the United Kingdom participated in this qualitative study.

METHODS

Semistructured interviews, incident reports, and medical records provided information about each fall. Thematic, discourse, and descriptive analysis were used to analyze data.

FINDINGS

The data demonstrated how a fall impacted patients' experience of rehabilitation and resulted in changes to mobility, self-confidence, management of falls risk, avoidance of daily activities, and increased assistance from others.

CONCLUSIONS

Falling in hospital can influence patients' ability to reach their potential of an optimal level of functioning.

CLINICAL RELEVANCE

There is a need to place an equal and mutual understanding on the physical, psychological, and social impact of falling to reduce falls and improve functional outcomes.