Problem Statement

Discuss about the Research Proposal Aims to Design the Strategies.

This research proposal aims to design the strategies of “Fall prevention of the elderly in the geriatric wards”. In the elderly population, falls are a rising problem (Bird et al., 2013).  Age-related alterations and disease have an impact on elderly person’s ability of balancing. In the elderly populations falls are a public health as well as community problem and results in adverse physical, psychological and social consequences. According to the current literature, this problem is of concern in the developed as well as the developing countries. In Australia, it has been estimated that about a third of the elderly individual in the geriatric wards experience at least one fall (Haines et al., 2015).

Falls in the elderly individuals is the main cause of their poor health outcomes (Boehm et al., 2013). This project has been proposed to improve the quality of the services that are concerned with fall prevention of the elderly individuals in the geriatric wards. It affects the dimensions of quality in the way that aims to provide quality care to the elderly patients. This project is effective, safe person-centred, timely efficient and equitable and it aims to provide sufficient care to the elderly populations in an efficient manner.

This project will focus on the situation associated with falls and fall prevention in the elderly populations in the geriatric wards. The aims of this project are to explain and review the following:

• To reduce the epidemiology of falls in the elderly populations
• To enhance the quality of health services that will address the increasing incidents of fall prevention of the elderly individuals in the geriatric wards
• To develop Interventions and policies concerning fall prevention
• To explain and demonstrate the situation associated with falls and falls prevention in the elderly populations in the geriatric wards.

This project is relevant to the clinical practice in the way that it will provide the strategies that will address the prevalence of falls in the elderly individuals. As the elderly populations are facing this problem, this project will help them to apply the strategies that have been designed to deal with this issue. This project will help the nursing professionals to effectively employ the discussed measures and utilize them in the treatment and providing care to the elderly patients.

According to Cassell & Clapperton (2013), more than 35% of the individuals aged 65 or above in the geriatric wards fall every year. This risk of falling is increases with the age of the elderly individuals. The statistics of the geriatric wards of the hospitals in Australia show that one-third to one-half of the individuals over 65 years of age is more prone to falling in the hospitals (Tiedemann, Sherrington, & Lord, 2013).  Falls are more prevalent in older females. Data are now emerging from the developing world, which suggest that falls among the older individuals is a rising problem and important health concern for the public. The figures are increasing regarding the cases of fall in almost all the countries. About 85% of hip fractures are related with a fall. The majority of such falls is due to a standing height or less Sakamoto, K., Endo, N., Harada, A., (Sakada et al., 2013).

Aims of the Project

The most important cause of injury-related visits in the emergency departments in Australia and the primary cause of deaths due to accidents of individuals overt 65 years of age (Meyer et al., 2015). The rate of mortality due to falls increases significantly with the progression of age in both the sexes and as well in all the ethnic and racial groups. The elderly individuals who stay alive with a fall experience remarkable morbidity (Pritchard et al., 2014). The stays in hospital are more or less twice as long in older individuals who are admitted in the geriatric wards after a fall in comparison to the patients who are hospitalized for some other causes (Toye et al., 2016).  In comparison with the older individuals who do not fall, those who have an experience of fall have vast functional decline in their activities of daily life (ADLs), together with the physical as well as social activities. They are also at greater risk of ensuing institutionalization (Lee et al., 2015).

Falls and associated instability can be indicators of deprived health and the functions that are declining (Gelbard et al., 2014). In the elderly individuals, falls may be non-specific, which presents signs of several acute illnesses like myocardial infarction, urinary tract infection and pneumonia or in some of the cases; it may exhibit the sign of severe aggravation of a chronic disease (Gomez et al., 2013). Around one-third of the elderly individuals dwelling in communities and up to 65 percent of hospitalized elderly individuals fall every year. About one-half of them experience multiple episodes. In the year 1996, above 250, 00 older Australians suffered from fractured hips. More than 80 percent of the cases of hip fractures are linked with falls (Simpson et al., 2013). The elderly individuals who stay alive with a fall experience remarkable morbidity. The stays in hospital are more or less twice as long in older individuals who get admitted in the geriatric wards after a fall in comparison to the patients who are hospitalized for some other causes. Most of the fractures occur in individuals having more than 65 years of age (Mitchell et al., 2013).  

Source: (Pritchard et al., 2014)

Data are now emerging from the developing world, which put forward that falls among the elderly individuals is a rising problem and important health concern for the public, particularly the older populations. The numbers are increasing regarding the cases of fall in almost all the countries. The rate of mortality because of falls is increasing considerably with the progression of age in both the sexes as well in all the ethnic and racial groups. The elderly individuals who stay alive with a fall experience significant morbidity. The stays in hospital are more or less twice as long in older individuals who are admitted in the geriatric wards after a fall in comparison to the patients who are hospitalized for some other causes. Around one-third of the elderly individuals living in the communities and up to 65 percent of hospitalized elderly individuals fall every year. (Cassell & Clapperton, 2013).

Relevance of the project to clinical practice

Establishing measures are concerned with the measurement of quality (Church et al., 2012). The program is likely to be implemented successfully and it will be sustained when it will be compatible with the priorities of the hospital and for providing the best care to the elderly patients in the geriatric wards. After the implementation of the program, feedback will be taken from the elderly patients as well as the nurses to know the advantages or disadvantages of this program. The feedback of the nursing professionals as well as the elderly patients in the geriatric wards will let us know whether the program has been successful after its execution as well as implementation. As this problem is increasing on a daily basis, hence there is a need to develop some strategies or frameworks, which will address fall prevention of the elderly in the geriatric wards. If the elderly individual as well as the nurses will give a positive feedback then, it can be said that this project will help the nursing professionals to effectively employ the measures and utilize them in the treatment and providing care to the elderly patients.

This project will consist of unit team and implementation team for stating the plans in order to implement the best practices that are intended for preventing fall in the elderly in the geriatric wards. The team members will reach consensus with respect to the following questions:

• Which of the practices of fall prevention should be utilized?
• Which of the universal fall precautions should be applied in the geriatric wards?
• How the identified factors of risk should be used for the planning of fall prevention care?
• How should the nursing professionals review and manage the patients after a fall?
• How can the hospitals include these practices into the program of fall prevention?

A survey will be performed for collecting the data in which the participants will be elderly individuals and nursing professionals. They will be asked question like what is the most important cause of  falls, what are the challenges faced by the nursing professionals in providing treatment along with care to the elderly patients. This survey will help us in knowing what all strategies needs to be developed in order to provide appropriate treatment and care to the elderly patients in the geriatric ward.

• Standardized evaluation of the risk factors of fall
• Scheduled protocols, together with the universal fall precautions
• Interventions and planning of care that will deal with the identified factors of risk within the overall plan of care of the patients
• Post-fall procedures along with a root cause investigation and clinical review.

For implementing the plan, an appropriate improvement approach such as Plan-Do-Study-Act (PDSA) will be used. It is used for improving a process or carrying out a change. This approach involves a series of systematic steps in order to valuable learning and knowledge for the continual improvement of a process (Taylor et al., 2014).  This project will use this improvement approach. It will include the nursing professionals and the nurses, who will provide a feedback what the project has achieved until date and what it did not? The elderly patients in the geriatric ward of the hospitals will define the quality of the improvement regarding the quality improvement with respect to fall prevention. It will also identify the problem areas and will focus on further improvement in the quality of this project, which aims to address the issue of fall prevention of the elderly patients in the geriatric wards. 

Review of Literature

The practices will be tailored to the healthcare organization. Additionally, the unit level, all these components will be covered in a manner modified to the patient-types and the flow of care on each unit. The program is likely to be implemented successfully and it will be continued when it will be compatible with the priorities of the hospital and for providing the best care to the elderly patients. After the implementation of the program, feedback will be taken from the elderly patients as well as the nurses to know the advantages or disadvantages of this program. The feedback of the nursing professionals as well as the elderly patients in the geriatric wards will let us know whether the program has been successful after its execution as well as implementation. It affects the dimensions of quality in the way that aims to provide quality care to the elderly patients.

Attention is required for implementing the best practices. A number of issues relating to the prevention of falls in the geriatric wards of hospital will include:

• Providing education to the clinical and nonclinical staff- The nurses of the geriatric wards of the hospital will be educated regarding fall prevention, particularly in the night shifts, when there is a high possibility of falling of the elderly individuals. They will be trained for professional disciplines.
• The nurses will be instructed to communicate regarding the risk of fall of the elderly patients such as development of methods for the emergency department for communicating the factors of risk for falls of the elderly patients in the geriatric wards of the hospital. To improve the handoff tools between the night shifts and departments.
• The role of the nurses will be clearly defined so that the members of the unit team will be able of understanding if and how the role will change.
• The unit team members comprising of the staff members will provide direct care to the elderly patients in the geriatric wards on a daily basis by assessing fall risk, planning care for preventing falls and ascertaining that the care of the elderly patients is performed in an appropriate manner and is well documented.
• The unit team and implementation team will develop a process for constantly monitoring the alterations in the rate of falls and process of care for preventing falls in the elderly patients in the geriatric wards.
• Feedback will be taken from the staff, patients and clinicians. The unit team will compile questions as well as problems from the members of the staff for sending back to the implementation team.
• Additionally, the process of monitoring will comprise tracking the changes in the rate of falls and processes of care for preventing falls and the results will be communication to the implementation team and the staff.
• Regular meetings will be arranged for updating the progress and discussing the outcomes and policies on a regular basis. The support of the individuals will be needed in every step.
• The implementation team will continue to keep the managers and the higher authorities of the hospital informed on a regular basis regarding the fall prevention program in order to sustain the early support for improving the efforts.

This program anticipates that it will be successful after its execution and implementation. The feedback of the nursing professionals as well as the elderly patients in the geriatric wards will let us know whether the program has been successful after its execution as well as implementation. If the elderly individual as well as the nurses will give a positive feedback then, it can be said that this project has helped the nursing professionals to effectively employ the measures and have utilized them in the treatment and providing care to the elderly patients. The program will be made to improve more after knowing the feedback and it will work on the areas that need more improvement in the future.

References

Bird, M. L., Pittaway, J. K., Cuisick, I., Rattray, M., & Ahuja, K. D. (2013). Age-related changes in physical fall risk factors: Results from a 3 year follow-up of community dwelling older adults in Tasmania, Australia.International journal of environmental research and public health, 10(11), 5989-5997.

Boehm, J., Franklin, R. C., Newitt, R., McFarlane, K., Grant, T., & Kurkowski, B. (2013). Barriers and motivators to exercise for older adults: A focus on those living in rural and remote areas of Australia. Australian journal of rural health, 21(3), 141-149.

Cassell, E., & Clapperton, A. (2013). A decreasing trend in fall-related hip fracture incidence in Victoria, Australia. Osteoporosis international, 24(1), 99-109.

Church, J., Goodall, S., Norman, R., & Haas, M. (2012). The costâ€Âeffectiveness of falls prevention interventions for older communityâ€Âdwelling Australians. Australian and New Zealand journal of public health, 36(3), 241-248.

Current State

Gelbard, R., Inaba, K., Okoye, O. T., Morrell, M., Saadi, Z., Lam, L., … & Demetriades, D. (2014). Falls in the elderly: a modern look at an old problem.The American Journal of Surgery, 208(2), 249-253.

Gomez, F., Curcio, C. L., Suriyaarachchi, P., Demontiero, O., & Duque, G. (2013). Differing approaches to falls and fracture prevention between Australia and Colombia. Clinical interventions in aging, 8, 61.

Haas, R., & Haines, T. P. (2014). Twelve month follow up of a falls prevention program in older adults from diverse populations in Australia: A qualitative study. Archives of gerontology and geriatrics, 58(2), 283-292.

Haines, T. P., Williams, C. M., Hill, A. M., McPhail, S. M., Hill, D., Brauer, S. G., … & Etherton-Beer, C. (2015). Depressive symptoms and adverse outcomes from hospitalization in older adults: secondary outcomes of a trial of falls prevention education. Archives of gerontology and geriatrics, 60(1), 96-102.

Lee, H., Bein, K. J., Ivers, R., & Dinh, M. M. (2015). Changing patterns of injury associated with lowâ€Âenergy falls in the elderly: a 10â€Âyear analysis at an Australian Major Trauma Centre. ANZ journal of surgery, 85(4), 230-234.

Meyer, C., Hill, S., Dow, B., Synnot, A., & Hill, K. (2015). Translating falls prevention knowledge to community-dwelling older PLWD: a mixed-method systematic review. The Gerontologist, 55(4), 560-574.

Mitchell, R. J., Watson, W. L., Milat, A., Chung, A. Z., & Lord, S. (2013). Health and lifestyle risk factors for falls in a large population-based sample of older people in Australia. Journal of safety research, 45, 7-13.

Pritchard, E., Brown, T., Lalor, A., & Haines, T. (2014). The impact of falls prevention on participation in daily occupations of older adults following discharge: a systematic review and meta-analysis. Disability and rehabilitation, 36(10), 787-796.

Sakamoto, K., Endo, N., Harada, A., Sakada, T., Tsushita, K., Kita, K., … & Liu, M. (2013). Why not use your own body weight to prevent falls? A randomized, controlled trial of balance therapy to prevent falls and fractures for elderly people who can stand on one leg for≤ 15 s. Journal of orthopaedic science, 18(1), 110-120.

Simpson, P. M., Bendall, J. C., Patterson, J., Tiedemann, A., Middleton, P. M., & Close, J. C. (2013). Epidemiology of ambulance responses to older people who have fallen in New South Wales, Australia. Australasian journal on ageing, 32(3), 171-176.

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ quality & safety, 23(4), 290-298.

Tiedemann, A., Sherrington, C., & Lord, S. R. (2013). The role of exercise for fall prevention in older age. Motriz: Revista de Educação Física, 19(3), 541-547.

Toye, C., Kitchen, S., Hill, A., Edwards, D., Sin, M., & Maher, S. (2016). Piloting staff education in Australia to reduce falls in older hospital patients experiencing delirium. Nursing & Health Sciences.