REDUCE FALL RISK + PROMOTE HEALTHY AGING
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Four Steps to Help Prevent Falls After Hospital Discharge

Person in wheelchair being discharged from hospital

Falls are one of the most common reasons for 30-day readmissions.  A recent study provided insight to inform the development of transitional fall prevention programs that could support older adults in successfully transitioning home and reducing their risk of a fall post-discharge. In the study, nine older adults identified as a fall risk during their hospitalization who were recently discharged home were interviewed about their perceptions of fall risk and prevention, as well as their knowledge and opinion of materials from the Centers for Disease Control and Prevention (CDC) Stopping Elderly Accidents, Deaths & Injuries Initiative (STEADI).

The qualitative analysis resulted in the identification of five themes:

Sedentary behaviors and limited functioning Many participants perceived themselves to be relatively sedentary, e.g. primarily watching TV and using personal electronic devices. They also indicated their caregivers aided with their activities of daily living (ADL) and instrumental activities of daily living (IADL).
Prioritization of social involvement Participants reported prioritizing engagement in numerous social and community activities. They also described limitations (e.g., limited physical functioning) that contribute to their sedentary behaviors or require them to rely on caregivers.
Low perceived fall risk and attribution of risk to external factors Most participants perceived they were at low risk for falling in their home/community despite the fact many mentioned they had previously fallen. Participants attributed those falls to treatment-related factors (e.g., medication side effects); environmental hazards (e.g., uneven pavement); or because of their comorbidities. Participants did not perceive these external factors were related to their own underlying health or behavior.
Avoidance and caution as fall prevention Participants reported using avoidance and caution as first-line fall prevention strategies. However, research indicates these strategies lead to functional decline, social isolation, and decreased independence, which can ultimately result in a greater fall risk (Hadjistavropoulos, Delbaere, & Fitzgerald, 2011).
Limited falls prevention information provided during transition from hospital to home Participants did not recall receiving falls education at discharge, but they perceived the CDC STEADI brochures to be useful and helpful, particularly Stay Independent and Check for Safety.

Clinical Practice Implications

  • Utilize available resources to engage and educate older adults and their caregivers in fall prevention strategies post-discharge, such as the CDC STEADI materials
  • Recommend fall prevention strategies that promote “what matters” to the older adult, which typically includes maintaining their autonomy, independence, social interaction, and well-being
  • Integrate effective practices from other transitional care programs that address chronic conditions
  • Connect the older adults to community-based fall prevention programs and resources during discharge planning

Connection to Hendrich II Fall Risk Model

By utilizing the Hendrich II Fall Risk Model, significant insight is gathered on older adults which can impact their health and well-being beyond their hospital stay.  Opportunities exist to integrate this information into the older adults’ continuum care plan and discharge planning process, thus supporting their smooth transition to home or alternate post-acute setting.

References:

Hadjistavropoulos, T., Delbaere, K., Fitzgerald, T.D., 2011. Reconceptualizing the role of fear of falling and balance confidence in fall risk. Journal of Aging and Health, 23, 3-23. doi: 10.1177/0898264310378039

Shuman C., Montie M., Hoffman G., Powers K., Doettl S., Anderson C., Titler M., 2019. Older Adults’ Perceptions of Their Fall Risk and Prevention Strategies After Transitioning from Hospital to Home. J Gerontol Nurs. 45(1) 23-30. doi: 10.3928/00989134-20190102-04

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