Falls in Healthcare
Falls Among Older Adults
Falls can occur in hospital settings or at home. When they occur, they predispose the individual to the risk of injury, injury-related disability and morbidity, and injury-related deaths. Higher risks are seen among older adults and patients with medical, surgical, and mental health comorbidities. Falls are preventable health concerns. However, recent statistics show that fall rates have been increasing nationally despite interventions. This paper aims to describe the at-risk populations, epidemiology, and management of falls among older adults.
The target population for this clinical health problem was older adults. Usually, older adults are those aged above 65 years. However, this paper includes a target population of adults aged 55 years and above to include various vulnerabilities. Vulnerabilities in adults aged above 55 years occur due to a decline in cognitive capacity, deteriorating physical health status due to the normal aging process, and declining social networks.
A decline in cognitive capacity is common among older adults and worsens with age. Dementing illnesses such as Alzheimer’s and neurodegenerative diseases such as Parkinson’s are feared conditions that can complicate the vulnerability of this target population to falls.
Adults aged 55 years and above begin to undergo the normal aging process. In the process, they lose some bio-physiological and psychological functions due to this aging. Physiologically, the risk of degenerative diseases such as osteoporosis and osteoarthritis increases. In women, the process of osteoporosis is worse because of menopause. In menopause, there is insufficient estrogen to sustain bone formation; thus, bone resorption exceeds bone-forming processes.
Frailty is a health concern that has been described among older adults. In the frailty state, the individual is vulnerable to poor homeostatic resolution. According to McCance & Huether (2018), frailty is the most problematic expression of population aging. Falls often result in frailty among adults because of the loss of respiratory, cardiovascular, hemopoietic, and nutritional reserves that characterize older adults (McCance & Huether, 2018). Older adults progressively lose proprioception due to frailty.
Financially, older adults are generally poorer because their diminished capacity to work leads to dependence on savings or pensions for sustenance. Self-care also diminishes with aging. Therefore, the selected target population has multiple vulnerabilities that make them appropriate for the study of the health concern. However, falls are not a health concern specific and are limited to people aged 55 years and above. Other populations can also sustain falls and related injuries.
Statistics and Data
The population of older adults is increasing in the United States. According to Guirguis-Blake et al. (2018), adults aged 65 years and above formed the fastest-growing population segment in the US. By 2012, there were about 43 million older adults in the US. The U.S. Census Bureau projected that this number could double to about 84 million by 2050 (Guirguis-Blake et al., 2018).
The population of adults aged above 85 years is increasing as well. With this increase comes the need to establish a preventive mechanism to reduce the prevalence and incidence of falls among this at-risk population. Adults aged between 55 and 65 years were included in this population, including females who are postmenopausal because they have severe outcomes such as fractures when they incur falls.
Background of the Falls
A fall is an event leading to an individual coming to contact with a lower level or ground from a standing or higher level position. Falls, the musculoskeletal system, and aging cannot be discussed independently. The normal aging that starts in the sixth and seventh decade of life is associated with various physiologic musculoskeletal outcomes that increase the risk of falls.
The bones, muscles, and joints accord the body the necessary support that facilitates stability and prevents falls. Coordination and balance are neurological factors that play important roles in the interplay between fall prevention, proprioception, and support. With aging, there is a loss of these functions.
According to McCance & Huether (2018), the rate of deterioration musculoskeletal and neurological is not the same for all populations. Certain epidemiologic factors play an important part in the skewness of the risk of falls among adults aged 55 years and older. Vaishya & Vaish (2020) classified leading to falls among adults as extrinsic, intrinsic, and situational factors. These coincide with the elements of the epidemiological triad or epidemiological triangle.
The epidemiological triangle is most commonly used to explain infectious or communicable diseases in epidemiology. Hoover, these concepts can be borrowed to explain the epidemiology of falls among adults aged 55 years and older. The epidemiological triangle consists of the host, agent, and environmental factors at the corners of the triangle and time factors at the center of the triangle.
Host factors represent the intrinsic factors that lead to falls in adults aged 55 years and above. These are the commonest causes of falls among older adults. Diseases that affect coordination, proprioception, muscle function, joint function, and bone density can cause falls.
According to Vaishya and Vaish (2020), these diseases include but are not limited to Parkinson’s disease, osteoarthritis of the knee, vertebra, and hip, osteoporosis, muscle atrophy, and presbycusis. Diseases affecting vision can cause falls. For example, severe cataracts, retinopathy, macular degeneration, and glaucoma lead to poor vision and diminished visual acuity that can lead to falls in combination with environmental factors.
Cardiovascular conditions associated with hypotension and hypo-perfusion can cause confusion and loss of balance. In older adults, heart failure is a risk factor for falls. Most medication used for some conditions among adults can cause sedation and hypotension, thus the risk of falls. These medications include but are not limited to sedative-hypnotics and cardiovascular medications.
The living conditions of the individual contribute immensely to their risk of falls. These conditions include but are not limited to lighting, floor, organization, and the presence of obstacles. Obstacles such as hedges, furniture, cables, broken curbs, and steps can cause falls in the house and hospital.
Poor lighting leads to poor vision, and the risk of falls increases in combination with reduced vision. Poor lighting, in this case, includes both dim lighting and excessively bright lighting of the residence. Floor conditions that can cause falls are slippery floors, loose carpets, wet floors, and loose objects on the floor.
Situational factors in falls’ causation are equivalent to agent factors in the epidemiological triangle. Situational factors are not universal to every older adult’s falls but specific to their living situations. For example, rushing to answer phone calls, multitasking leads to distractions, failure to watch steps in the staircase, walking while talking, rushing to the washrooms, and noise distractions.
Situational factors accelerate every fall incidence; identifying these factors is essential in patient-centered management. Other factors such as living alone, depression, loneliness, and low physical and cognitive functional abilities can be situational and intrinsic simultaneously. Figure 1 below demonstrates the epidemiological triangle shown in fall risk factors and causes.
Demonstration of the epidemiological triangle shown in fall risk factors and causes
Descriptive Epidemiology of Falls
Trends and Incidence Data: Fall among older adults contribute to significant morbidity and mortality in the United States and worldwide. Hoffman et al. (2022) studied fall injuries using data from 2016 and 2019. This study included expenditure in the treatment of fall-related injuries as well as examining the prevalence and incidence rate of falls among older adults.
In their cross-sectional study, Hoffman et al. (2022) found about 120 million national claims involving falls and fall-related injuries. An incidence rate was 1.5% annual growth in reported falls per year. According to the World Health Organization (WHO) fact sheet on falls and related outcomes in 2021, falls come second to road traffic accidents as the leading cause of death from unintentional injury (World Health Organization, 2021).
Annually, about 600,000 people die worldwide from falls, and the majority of the mortalities are reported in low- and middle-income countries (LMICs). Adults 60 years and over suffer most falls worldwide.
Vaishya & Vaish (2020) studied falls as they relate specifically to older adults. Their review study found that the epidemiology of falls among older adults is becoming an epidemic. According to (Vaishya & Vaish, 2020), about one-third of the older adult population experiences at least one incident of fall every year. This incidence rises to about 50% in octogenarians and nonagenarians. Therefore, the incidence of falls increases with age from the sixth decade of life.
Costs and Quality of Life: Falls negatively impact the quality of life of the victims. They increase the years of life lived with disability and years of life lost among fall victims. A study by James et al. (2020) reported that age-specific values for these parameters increase substantially. The burden falls on the population’s health and the health system. The health system and individuals spend substantial amounts of money to treat fall-related injuries.
According to Guirguis-Blake et al. (2018), the US healthcare system in 2015 spent about 600 million dollars and 32 billion in direct care for fatal fall-related injuries and nonfatal fall-related injuries, respectively. Hospitalizations due to falls incur more costs than other admissions. Every admission due to fall-related injuries could cost up to 10000 US dollars, according to (Guirguis-Blake et al., 2018).
James et al. (2020) also noted that, even though the mortality rates and disability-adjusted life years improved before 2017 worldwide, the figures were still higher and significantly reflected the need for further interventions to improve the health of older adults and preserve life.
Descriptive Statistics: The epidemiological data of falls among the specific population were significantly higher. Falls are more common among older adults who are females than their male counterparts. This has been explained by the bio-physiological differences between these two sexes. Males have testosterone, and their musculoskeletal health deteriorates slower than in women (McCance & Huether, 2018).
Women 55 years of age and older are primarily postmenopausal and have minimal estrogen to sustain their bone health; thus in the absence of hormone replacement therapy may develop osteoporosis, a major cause of fall-related futures due to poor bone health.
However, males have a higher risk of experiencing fatal falls and incurring severe fall relayed injuries than females (Guirguis-Blake et al., 2018). Hoffman et al. (2022) found that falls affected more whites and non-Hispanics than blacks and Hispanics. The outcomes of falls are severe with advanced ages of older adults due to diminished capacity for self-healing and increased dependencies among the aged.
Costs of care related to falls
|Cost per fall (2010)||$1,596||$10,913|
|Costs per fall-related hospitalization||$10,052||$42,840|
|Average cost per person who fell (2010)||$2,044||$25,955|
Note: A table comparing minimum and maximum expenditures on care for fall-related costs in the United States in 2010, according to reports by Guirguis-Blake et al. (2018)
Signs and Symptoms of Falls
There are no specific symptoms before falls happen. However, certain symptoms highly suggest the risk of falls among older adults. Syncope, vertigo, confusion, staggering gait, lightheadedness, and palpitations can be signs and symptoms of an impending fall. For abrupt sudden falls resulting from the aforementioned environmental factors, there are no warning signs or symptoms.
The usual fight and flight mechanisms set in just before the fall. There can be resultant telltale signs that can be used to assess falls in susceptible individuals. After the occurrence of a fall, an individual may develop bruises and lacerations on the contact part of the body. Feared signs of fall include but are not limited to signs of traumatic brain injury such as concussion, obtundation, and signs of internal bleeding such as confusion, syncope, and shock.
Falls can lead to rhabdomyolysis in some cases. Muscle damage and breakdown can cause acute kidney injury leading to failure if not picked up early. Older adults who experience falls can lose consciousness and remain on the site of the fall, especially if they live alone. Sometimes if they remain conscious, they cannot be strong enough to call for help. Therefore, serious injuries and death can occur due to the above-mentioned complications. Pressure sores and dehydration are some of the intermediate complications in the events that the fall victim survives.
Diagnosis, Screening, and Prevention
Falls are a health risk of concern rather than a disease condition. Diagnostic tests for falls are done to discover complications that may cause disability or death if not treated in time. Imaging studies such as play x-ray radiographs and computed tomography (CT) scans are usually helpful in the emergency room when patients are suspected of having fallen and sustained injuries or complications.
Screening for complications such as fractures and head injury using these imaging studies helps in early intervention to prevent severe complications. Thorough history-taking and physical examination remain essential in diagnosis and screening for fall-related complications. Vital signs and signs of fall-related trauma are part of the routine building of health history for patients at risk of falls, such as older adults.
Risk assessment tools assist in objective screening for falls and fall risks and preventive management of falls. A commonly used screening approach in primary care assesses fall history, unsteadiness, and anxiety to screen for the risk of falls in older adults. Other risk assessment tools include the Timed Up and Go (TUG), Performance Oriented Mobility Assessment (POMA), Short Physical Performance Battery, Gait speed, and 30-Second Chair Stand (Ha et al., 2021). These are screening tools that can be performed in the office and involve either history taking or physical examination.
The CDC Stopping Elderly Accidents, Deaths, and Injuries (STEADI) toolkit designed guidelines for screening and preventing falls among older adults. This tool was designed by the National Center for Injury Prevention and Control to be used by healthcare providers. Among other resources, this toolkit contains assessment for gait and balance, brochures for patient education, training materials, and flowcharts for patient evaluation.
Regarding falls among older adults, the United States Preventive Services Task Force (USPSTF) provided grade C recommendations for healthcare providers to perform an in-depth multifactorial assessment of community-indwelling patients 65 years and older. Grade B recommendations by the USPSTF required that healthcare providers offer preventive methods for falls among older adults, including vitamin D supplementations, physical therapy, and exercise.
Other preventive strategies involve using safety devices, monitoring medication lists for medication errors, treatment of risks such as osteoporosis, and using hip protectors to reduce the impact of falls (Vaishya & Vaish, 2020). Reviewing the living conditions of every patient is important to reduce the effect of situational factors.
Management Challenges and Potential Solutions
Evidence-based management of falls among older adults incorporates a multidisciplinary approach. However, adherence to preventive and management interventions is the main challenge (Santhagunam et al., 2021). Health literacy, self-efficacy, and self-care deficits are some of the causes of poor adherence to management interventions. A potential solution to this challenge is to target priority factors for falls. This will also promote patient-centered care.
Patient education and utilization of community resources can improve patient literacy and self-care to enhance adherence. Polypharmacy, sarcopenia, and cognitive decline contribute to the challenges in the management of falls. Multicomponent interventions and multidisciplinary approaches are potential solutions that can address these management challenges (Giovannini et al., 2022). These interventions require nursing care coordination and collaboration.
Falls among older adults occur when an individual position with vertical orientation changes and the individual unintentionally comes into contact with the ground. The target population in this paper was older adults, usually 65 years and older. However, adults aged 55 years and older were also included due to shared risks between these age groups.
The causation of falls can be explained using the epidemiological triangle with situational, extrinsic, and intrinsic factors as agent, environmental, and host, respectively. The incidence of falls keeps rising in the US and worldwide, with recent reports stating annual incident rates of 1.5% among older adults. Women and whites experience more falls and fall-related injuries.
Falls have no specific symptoms before they occur. However, risks can be evaluated through the use of risk assessment tools. Preventive management focuses on risk factor control. However, challenges in adherence to intervention still exist. Therefore, patient education and multidisciplinary and multicomponent approaches are the recommendable potential solution to achieving successful patient outcomes.
Giovannini, S., Brau, F., Galluzzo, V., Santagada, D. A., Loreti, C., Biscotti, L., Laudisio, A., Zuccalà, G., & Bernabei, R. (2022). Falls among older adults: Screening, identification, rehabilitation, and management. Applied Sciences (Basel, Switzerland), 12(15), 7934. https://doi.org/10.3390/app12157934
Guirguis-Blake, J. M., Michael, Y. L., Perdue, L. A., Coppola, E. L., Beil, T. L., & Thompson, J. H. (2018). Interventions to Prevent Falls in Community-Dwelling Older Adults: A Systematic Review for the U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/books/NBK525704/
Ha, V.-A. T., Nguyen, T. N., Nguyen, T. X., Nguyen, H. T. T., Nguyen, T. T. H., Nguyen, A. T., Pham, T., & Vu, H. T. T. (2021). Prevalence and factors associated with falls among older outpatients. International Journal of Environmental Research and Public Health, 18(8), 4041. https://doi.org/10.3390/ijerph18084041
Hoffman, G., Franco, N., Perloff, J., Lynn, J., Okoye, S., & Min, L. (2022). Incidence of and county variation in fall injuries in US residents aged 65 years or older, 2016-2019. JAMA Network Open, 5(2), e2148007. https://doi.org/10.1001/jamanetworkopen.2021.48007
James, S. L., Lucchesi, L. R., Bisignano, C., Castle, C. D., Dingels, Z. V., Fox, J. T., Hamilton, E. B., Henry, N. J., Krohn, K. J., Liu, Z., McCracken, D., Nixon, M. R., Roberts, N. L. S., Sylte, D. O., Adsuar, J. C., Arora, A., Briggs, A. M., Collado-Mateo, D., Cooper, C., … Murray, C. J. L. (2020). The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017. Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention, 26(Supp 1), i3–i11. https://doi.org/10.1136/injuryprev-2019-043286
McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby.
Santhagunam, S. N., Li, E. P. H., Buschert, K., & Davis, J. C. (2021). A theoretical framework to improve adherence among older adults to recommendations received at a falls prevention clinic: A narrative review. Applied Nursing Research: ANR, 62(151493), 151493. https://doi.org/10.1016/j.apnr.2021.151493
Vaishya, R., & Vaish, A. (2020). Falls in older adults are serious. Indian Journal of Orthopaedics, 54(1), 69–74. https://doi.org/10.1007/s43465-019-00037-x
World Health Organization. (2021, April 26). Falls. Who.int. https://www.who.int/news-room/fact-sheets/detail/falls
Population Health & Health Issue Identification Paper & Presentation Instructions
Purpose: The purpose of this assignment is to provide students with the opportunity to integrate knowledge and skills learned throughout this course. Students will choose a health concern or disease process affecting their chosen population and investigate the condition using epidemiological and population health principles.
Requirements: The assigned paper should be organized into the following sections:
- Introduction paragraph with a clear presentation of the problem and significance within your identified population.
- Target Population: Target population is clearly identified. Population characteristics and vulnerabilities are identified and expanded upon. Statistics and data are clearly related to the target group and demonstrate a clear understanding of their meaning and implications.
- Background of the chosen health concern or disease process including definition, description with application of the epidemiological triangle (include a figure with the epi triangle applied to the problem), risk factors, signs and symptoms, and current incidence and/or prevalence/surveillance statistics – including local, state, national and world. Additional epidemiological concepts should be addressed, including morbidity and mortality, history of disease, prognosis and risk.
- Conduct a descriptive epidemiology analysis of the disease including who is more frequently affected and characteristics of the population that might help in creating a prevention plan. Include costs (both financial and social) associated with the disease or problem. Provide general analysis for the health concern/disease process AND analysis for your target population.
- Diagnosis, Screening and Prevention: Review how the disease/health concern is diagnosed, current national standards for screening or prevention. Include any current national guidelines for conducting the screening and diagnosis including which patients should be screened.
- Management Challenges and Potential Solutions: Provide a brief overview of how the epidemiological disease is currently addressed/managed and challenges encountered in your target population and in your nursing practice. Provide ideas for potential actions you could implement to improve management of the problem. The interventions should be documented in the literature (i.e. review peer reviewed studies on your topic).
- Conclusion with a clear brief synopsis of key points and recommendations
Each student will create at fifteen (15) minute video presentation of their project on YouTube (or other video platform) and submit it to the Discussion Board. The presentation portion of this assignment will count for 10% of your overall grade. Peer evaluation is an important component of the DNP program. As a leader in healthcare, DNP graduates must become comfortable with team and project evaluation, which includes both positive feedback and areas needing improvement. Students will have one week to watch their peers’ presentations, evaluate, and comment on what was done well, and areas for improvement. Students will be divided into groups and only responsible for watching the presentations in their group.
Preparing the Paper:
- Page length: Maximum 10 pages, excluding title page and references/appendices
- APA format 7th edition
- Include references and citations
- No direct quotes!
- Include at least one table to present information somewhere in the paper
Rubric: Population Health & Health Issue Identification Paper
|STUDENT NAME:||Points||FACULTY COMMENTS|
|Clear presentation of the problem and significance within your identified population.|
|Target Population & Population Health Need (30%)||30|
|Target population is clearly identified. Population characteristics and vulnerabilities are identified and expanded upon. Statistics and data are clearly related to the target group and demonstrate a clear understanding of their meaning and implications. Clear and logical connections are drawn between the population and their characteristics/vulnerabilities and is supported with evidence.|
|Background of Health Concern/Disease||20|
|Background of the chosen health concern or disease process including definition, description with application of the epidemiological triangle (include a figure with the epi triangle applied to the problem), risk factors, signs and symptoms, and current incidence and/or prevalence/surveillance statistics – including local, state, national and world. Additional epidemiological concepts should be addressed, including morbidity and mortality, history of disease, prognosis and risk.
|Descriptive Epidemiology Analysis||15|
|Conduct a descriptive epidemiology analysis of the disease including who is more frequently affected and characteristics of the population that might help in creating a prevention plan. Include costs (both financial and social) associated with the disease or problem. Provide general analysis for the health concern/disease process AND analysis for your target population.|
|Diagnosis, Screening & Prevention||10|
|Review how the disease/health concern is diagnosed, current national standards for screening or prevention. Include any current national guidelines for conducting the screening and diagnosis including which patients should be screened.|
|Management Challenges and Potential Solutions||5|
|Provide a brief overview of how the epidemiological disease is currently addressed/managed and challenges encountered in your target population and in your nursing practice. Provide ideas for potential actions you could implement to improve management of the problem. The interventions should be documented in the literature (i.e. review peer reviewed studies on your topic).|
|6. Conclusion (5%)||5|
|Provide a clear and brief synopsis and recommendations|
|7. Organization and Style/References (10%)||10|
|APA (see APA Manual, 7th ed.) format must be used for citations and references. Appropriate substantiation is provided. Sufficient references are used to meet the requirements of the assignment. Correct spelling, grammar and punctuation are used.|
|Rubric: Population Health & Health Issue Presentation|
|Presentation (10% of course grade)|
|Presentation is narrated appropriately; able to see both student and slide presentation; student is professionally dressed; stays within 10-minute time limit (15-minute maximum).||60|
|Student is professionally dressed with professional background and no distractions during the presentation.||20|
|Student watched and peer rated presentations of classmates in assigned group.||20|