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Scientific community talks fall prevention

September 14, 2011
by Kevin Kolus, Editor
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For all the strife that was the Summer of 2011-what with its shameful debt deal-or-default fervor, or that punctuating 11.1 percent Medicare reduction to SNFs-at least one good trend consistently trickled into the news: a renewed emphasis on fall prevention via scientific research.

One of the more popular studies, which was published online in the Journal of Gerontology: Medical Sciences, found nursing home residents experience a fivefold increased risk of falling within two days of new prescriptions for or increased doses of non-SSRI antidepressants. These include bupropion or venlafaxine, researchers wrote, and their findings suggest that nursing home staff should closely monitor residents following such prescription changes to prevent potential falls.

Then in July emerged one of the bolder statements we've seen: Patient falls in hospital settings should not be considered preventable. That was the conclusion of a literature review published in the Journal of the American Academy of Orthopaedic Surgeons.

“We found no proof that falls in hospitals are, in fact, preventable,” said Terry A. Clyburn, MD, of The University of Texas Medical School at Houston and co-author of the review. “And if not, they should not be categorized as a preventable occurrence and the [financial] burden shouldn't be borne by hospitals.” The government has classified patient falls as “never events,” the costs of which must be absorbed by the hospital if the fall could have been prevented by following evidence-based guidelines.

But there's no evidence on the efficacy of evidence-based guidelines in preventing hospital falls, Clyburn argued, with the typically short length of stay and propensity for patients to be affected by anesthesia or pain meds being primary factors. Which, of course, factored into his next conclusion: Fall prevention programs in long-term care facilities or managed home care settings, which focus on strength training, balance and functional performance, and are delivered in an environment where the length of stay can extend past 30 days, are much more effective.

This leads to another literature review, published online in the Journal of the American Medical Directors Association, which may prove to be deflating for some eldercare professionals. Two researchers from IPC The Hospitalist Company reviewed randomized controlled trials on fall prevention programs for older adults conducted between 2000 to 2009, finding them to be effective in only a 9 percent overall reduction of fall rates.

But a 9 percent reduction is not necessarily a negative or surprising finding. The researchers even acknowledged that defining the most effective interventions for a frail older adult population is far and away from happening. It's an evolving part of healthcare, and as such providers can only follow recommendations, which the researchers expressed as:

“(1) identify an individual's risk factors for falls; (2) determine predisposing and precipitating factors if the patient has a history of falls, and intervene accordingly; (3) provide intervention programs and management focusing on lower-extremity balance and strengthening; (4) consider psychological factors such as fear of falling and self-imposed restriction of activity; and (5) classify injuries when they do occur based on the International Classification of Diseases (10th revision, classification system).”1

And don't forget, the American Geriatrics Society and British Geriatrics Society updated last year the “Clinical Practice Guideline for Prevention of Falls in Older Persons,” the first of such updates since 2001. An extensive section on preventing falls in long-term care facilities is included and covers multicomponent interventions, exercise and vitamin supplementation. A summary of these changes is available at

 

REFERENCES

  1. Choi M, Hector M. Effectiveness of Intervention Programs In Preventing Falls: A Systematic Review of Recent 10 Years and Meta-Analysis.Journal of the American Medical Directors Association,June 2011. Available at: http://www.sciencedirect.com/science/article/pii/S1525861011001691

Long-Term Living 2011 September;60(9):56

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