Falls in elderly people: is the risk suitably assessed?

The effect of high nursing surveillance on hospital cost

PURPOSE

The purpose of this study was to determine the cost of one nursing treatment, surveillance, for older, hospitalized adults at risk for falling.

DESIGN

An observational study using information from data repositories at one Midwestern tertiary hospital. The inclusion criteria included patients age>60 years, admitted to the hospital between July 1, 1998 and June 31, 2002, at risk for falls or received the nursing treatment of fall prevention.

METHODS

Data came from clinical and administrative data repositories that included Nursing Interventions Classification (NIC). The nursing treatment of interest was surveillance and total hospital cost associated with surveillance was the dependent variable. Propensity-score analysis and generalized estimating equations (GEE) were used as methods to analyze the data. Independent variables related to patient characteristics, clinical conditions, nurse staffing, medical treatments, pharmaceutical treatments, and other nursing treatments were controlled for statistically.

FINDINGS

The total median cost per hospitalization was $9,274 for this sample. The median cost was different (p=0.050) for patients who received high versus low surveillance. High surveillance delivery cost $191 more per hospitalization than did low surveillance delivery.

CONCLUSION

Propensity scores were applied to determine the cost of surveillance among hospitalized adults at risk for falls in this observational study. The findings show the effect of high surveillance delivery on total hospital cost compared to low surveillance delivery and provides an example of a useful method of determining cost of nursing care rather than including it in the room rate. More studies are needed to determine the effects of nursing treatments on cost and other patient outcomes in order for nurses to provide cost-effective care. Propensity scores were a useful method for determining the effect of nursing surveillance on hospital cost in this observational study.

CLINICAL RELEVANCE

The results of this study along with possible clinical benefits would indicate that frequent nursing surveillance is important and might support the need for additional nursing staff to deliver frequent surveillance.

Health visitor risk assessment for preventing falls in elderly people

This study was undertaken to look at the feasibility of a health visitor risk assessment for falls at the time of the routine health check for people aged 75 years and above. A total of 162 people were eligible for inclusion in the study. The standard over-75 assessment check was carried out either in the GP surgery or the person's home. A questionnaire was developed to obtain additional information not collected in the routine health check. The results identified two key risk areas: a history of polypharmacy and living in sheltered housing. There were no differences for a range of physical, emotional and environmental factors between people who had fallen and those who had not. A larger study is required to look at the identification of risk factors for falling at the routine over-75 health check, and appropriate referrals that can be put into place to deal with any problems uncovered. Education of health professionals on the risk factors of falls is also required.

Home‐Screen: A Short Scale to Measure Fall Risk in the Home

Community nurses are often the health professionals with whom older Australians living at home have most contact. The home environment has been identified to have a number of hazards associated with falls in older people. The Home-screen scale was specifically designed as a nurse-administered instrument to identify environmental and behavioral risks that alert nurses to the need for action to reduce fall risks in the home. A 14-item scale was administered to 1,165 older people receiving community nursing services. Psychometric investigation confirmed a 10-item scale with construct validity and internal consistency (alpha = 0.86, n = 989), explaining 60% of the construct of home safety (safe home environment and safe home behaviors). In addition, differences in mean scores were found in clients able and unable to transfer independently (t = 4.5 [df = 323.1] p < 0.001 [Group 1: M = 82.14, SD = 15.56; Group 2: M = 75.54, SD = 20.83, n = 989]). Similarly, an association existed between clients with low scores on the Home-screen scale and the perceived need for home modification. A score of 74 on this scale has been identified as a critical point for potential client injury. The use of this scale, both as an initial screening instrument and as a monitoring tool for community nurses working with older people, is recommended.

A falls risk-assessment tool in an elderly care environment

Falls are a major cause of morbidity and mortality among older people. In an inpatient setting it has been suggested that the introduction of risk-assessment tools may be an important way of managing the issue. The study reported in this article was carried out in two stages. First, fall incidents were identified retrospectively using 'falls incident forms' and nursing notes, and the characteristics and management of patients who had fallen were compared with those who had not fallen. A risk-assessment tool and care plan were developed and evaluated prospectively. By analysing the data in stage one it was found that falls incidence reporting was poor and patients who had fallen had more evidence of previous falls than those who had not fallen. In stage two staff found the risk-assessment tool and care plan easy to complete; however, there was little documentation about whether any appropriate interventions, specific to the individuals' risk score, were carried out. Appropriate interventions identified on the risk-assessment tool were put into place inconsistently. As a result of this work the hospital has set up a multidisciplinary group to look at falls management.