Current research on falls prevention: what are the influences and consequences of falls?

November provided abundant information about falls and falls reduction. Following is an overview of some recent publications on the prevalence, correlates, and consequences of falls. These articles look at person-centered factors such as balance confidence, falls history, and individuals’ perspectives on falls, and provide broader perspectives on the prevalence of falls and their societal impact. In addition, recent efficacy research on falls prevention programs is also presented.

The occurrence of falls is influenced by many contextual and individual factors. In the community, in hospital settings, and in palliative care, falls are one of the major contributors to injuries, death, health care costs, and reduced mobility. A recent Dutch survey on the prevalence and consequences of falls showed that falls represent 21% of total injury-related health care costs in the Netherlands. A recent American study published in Gerontologist suggested another effect of falls—they seem to predict residential adjustments such as relocation, adopting personal care, or making modifications to one’s home. Injurious falls in particular seem to predict the use of home health care services and use of new equipment. The authors suggested that a use of appropriate residential adjustments can proactively prevent falls via education and interventions.

Falls negatively impact general quality of life in hospice settings, even for individuals with higher rates of cognitive and physical functioning. Researchers and service providers have struggled to implement effective falls reduction programs with hospice patients and the “oldest old,” so a recent study was devised to develop better ways to predict falls in this population. Several factors increased an individual’s likelihood of falling, including greater fears of losing independence, avoidance of or uneasiness about asking for help, and, perhaps counterintuitively, a higher degree of physical functioning. Patients who are dependent on “ambulatory aids” such as walkers are less likely to experience a fall. The researchers found that their model of falls prediction accurately predicted falls in 78% of the participants in the study, which is higher than other falls prediction scales.

Other recent articles offer person-centered approaches to the study of falls. As a recent nursing article shows, a person-centered approach can also be used to improve communication and direct care. In this study, patients who had fallen were asked about their perspective on what caused falls and how they might be prevented. The authors advocated that nurses communicate more specifically and frequently to their patients that they are there to ensure safety in mobility as well as in getting medical treatment.

Another means of support indicated by recent research is in the area of balance confidence. A review of balance confidence interventions for community-dwelling older adults found that balance confidence is not only useful for preventing falls, but also in avoiding unnecessary activity restrictions. Behavioral group activities such as group exercise like tai chi is one intervention shown in the literature to improve balance confidence. Among interventions that involved multiple components (e.g., a combination of educational and social techniques or a combination of exercise and education programs), seven of the nine that were successful in improving balance confidence included exercise as a main component.

These articles provide more than just quantitative evidence on the impact of falls. Taken as a whole, they suggest that many risk factors of falls involve attitudes such as resistance to asking for help and concerns about losing independence. In the U.S., there is still a stigma attached to asking for help and a related resistance to take on assistance either from other people or from ambulatory aids. It seems as though encouraging individuals to remain active and to embrace support that will make activities easier and safer might lead to a society less endangered by falls. Whittling away at the stigma of asking for help, or maybe by adapting more inclusive standards of what it means for an individual to be independent, might contribute to this.

Articles cited:

Büla CJ, Monod S, Hoskovec C, Rochat S. (2010). “Interventions Aiming at Balance Confidence Improvement in Older Adults: An Updated Review.” Gerontology 56(7)

Carroll DL, Dykes PC, Hurley AC.(2010). “Patients’ perspectives of falling while in an acute care hospital and suggestions for prevention.” Applied Nursing Research 23(4):238-41

Hartholt KA, van Beeck EF, Polinder S, van der Velde N, van Lieshout EM, Panneman MJ, van der Cammen TJ, Patka P. (2010) “Societal Consequences of Falls in the Older Population: Injuries, Healthcare Costs, and Long-Term Reduced Quality of Life.” Journal of Trauma 69(5)

Leland N, Porell F, Murphy SL. (2010). Does Fall History Influence Residential Adjustments? Gerontologist

Schonwetter RS, Kim S, Kirby J, Martin B, Henderson I. (2010)  Etiology of Falls among Cognitively Intact Hospice Patients. Journal of Palliative Medicine.

Mather LifeWays Institute on Aging SAFE-TI Falls Reduction Program

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