Falls in Medical Care: Types & Prevention - Research Paper

Introduction

Understanding patients' falls is crucial due to its commonality in the medical field. According to Morse (2008), a fall is when an individual comes to rest on the ground resulting in an injury and occurs in either of the categories which includes accidental falls, unanticipated falls, and anticipated falls. The Agency for Healthcare Research and Quality (AHRQ) defines it further as unintended descent of a patient to the floor or another low level which can result in bleeding, lacerations, or fractures, thus triggering increased healthcare utilization. As a result, patient's falls may result in mortalities and morbidities such as decreased quality of life, increased hospital financial burdens, and extended hospitalizations (Bates, Pruess, Souney, & Platt, 1995). However, some falls do not cause physical harm to the patient, although they may cause psychological distress and loss of confidence. Therefore, it is crucial to better understand accidental falls, unanticipated falls, and anticipated falls and its impact on healthcare.

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Anticipated Physiological Falls

The overwhelming majority of falls that occur in hospital settings belong to this category. The patients in this category usually have increased risk of falls and are typically identifiable before their occurrences taking place. Most of the patients in this category usually have persistent toileting needs, high-risk medications that could cause dizziness, mental impairments, or abnormal gaits. These patients customarily require to be closely monitored together with making attempts to addressing risk factors that could increase the chances of the patient falling.

Unanticipated Physiological Falls

Unlike in anticipated types of falls, unanticipated falls are a type of falls occasioned by an event whose timing cannot not be premeditated, for instances, occurrences of syncope episodes, heart attack, extreme hypoglycemia, stroke or seizures. Such patients often require to have proper post-fall care integrated with injury preventative measures in cases of recurrences.

Accidental Falls

Accidental falls are the types of falls that occur in low-risk patients as a result of environmental hazards or equipment failure. The environmental hazards could trigger a patient to slip or tip over. This type of fall is distinct from the other types of falls in that a patient cannot be established as being at risk of falling before their fall. Increased age of the patient has been recognized as one of the main contributing factors of accidental falls in acute care facilities.

What are Patients Found Doing in Hospital Settings when They Fall?

There is scant information on what patients have been found doing when they fall, which could be because a patients are unable to explain what happened or falls are not in most of cases witnessed when they occur. Oliver, Healey, & Haines (2010), asserts that, most of patients most of falls are normally found near their chairs or hospital beds, because most of patients who are mobile have reduced chances of falling. An analysis NHS Litigation Authority data on patient falls that led to litigations litigation cases from acute hospitals showed that 24 % of the cases occurred while the patient was in motion, 23% were falls from the hospital bed, 20% were from unclear places, 14% were from either a commode or a toilet, 11% were from trolleys, 5% from chairs and 3% took place in bathrooms (Hempel, et al., 2013)

The Size of the Challenge

According to National Institute for Health and Clinical Excellence (2013), hospital statistics and research findings have markedly demonstrated that patients in the hospitals have an increased risk of falling in the hospital than in the community. NICE also states that older people are more vulnerable to falls, and people with over the age of 65 years occupy over two-thirds of hospital beds. According to the CDC (2017), one out every four elderly individuals fall each year, and only about half of these inform their doctors. This is because a considerable number of falls do not cause physical injuries. CDC has also reported that out of every five cases of falls, one result in injuries such as head injuries or broken bones. Injuries such as broken bones in ankles, wrists, and hip fractures can tamper with an individual's everyday activities. Although there are some cases where people do not usually get injured after falling, this can spark feelings of falling in them which may lead to a person becoming less active, which ultimately makes them weaker thereby increasing the chances of falling again.

The rates of falling according to CDC have been increasing at a rate of about 30%, and it is expected that if the trend is going to continue at this rate, then there will about seven falls per hour in the year 2030. These estimates about incidences of falls were determined through the analysis of incidences of falls and subsequent premature deaths recorded from the year 2007 to 2016. The report by CDC showed that there are at about three million older people treated at the emergency departments for injuries caused by falls, out of which over eight hundred thousand are hospitalized. Out of the nearly eight hundred thousand fall cases, there are at least 300,000 cases of hip fractures among older people, and that emanates from falls during hospital stays. Over 95% of these hip fractures were found to result from falling sideways. The findings from the CDC also showed that falls were the most common cause of traumatic brain injuries. Patients who have ever fallen at least once also have double chances of falling again in future (CDC, 2013; Oliver, Daly, Martin, & McMurdo, 2004).

When a patient undergoes through surgical operations, they often need medications for sedation, relieving pain, or as anesthesia. Some of these are known to confer side effects to the patients that increases their risks of falling. There are several medical conditions that increase the chances of falling. Delirium, for instance, which is an altered state of mind is likely to increase risks of falling in medical wards. Patients who have dementia have double chances of falling than people without memory difficulties. This implies that a patient who has had an incident of fall or who has a medical condition that increases the risks of a falling should be closely monitored to prevent other falls.

Should the rates of falls increase as predicted by the CDC, this implies that the cost of medical cost is likely to even go higher than the $50 billion established to have been spent in the year 2015. Owing to the fact that the aging population in the US and many other parts of the world is rising rapidly, the costs associated with treating injuries resulting from falls are expected to increase.

Global Incidences of Patient Falls

Globally, the incidences and the prevalence of falls vary based on the population studied. In developed countries injuries from falls have been listed as the fifth cause of mortalities in older people, after cardiovascular diseases, stroke, cancers and pulmonary diseases (American Geriatrics Society, Geriatrics Society & American Academy of Orthopaedic Surgeons Panel on Falls Prevention, 2001). According to Tinetti (2003), injuries from falls account for about 10% of emergency visits and 6% of inpatient admissions in hospitals. In the US, the rates of falls are estimated to range from 3.3 to 11.5 falls in every 1,000 patient days (Bouldin et al., 2012). In 2004, Australian Hospitals, about 17% of the fall incidences, occurred among the elderly. In 2007, nearly one million patients had fallen in hospitals, while almost three hundred thousand events were reported in Wales and England in the years 2008 and 2009 (Thomson, 2007). In 2009, over three hundred thousand hospitalizations occurred in Brazil as a result of falls and which accounted for about 40% of the total admissions that were triggered by external causes (Siqueira et al., 2011). The Brazilian hospitalization rates for falls were found to be about 27.6%, a figure that coincided with the data that was collected and analyzed from the Southern region and which was 26.9% (Siqueira et al.).

Studies on patient falls have mostly been conducted in developed countries. There is little literature, if any, about the risk factors for the patient, falls in seniors in most of developing countries, especially in African and Asian countries. In South Africa, a survey determined that there was a prevalence rate of 26.4% for falls and 11% recurrent rates during baseline study and about 22% for patient falls and about 7% recurrent during the follow-up study (Kalula, Ferreira, Swingler, & Badri, 2016). Some of the risk factors determined by the determined from the analysis of the two prospective studies were: ethnicity, history of falls, and dizziness. Poor cognitive scores were established to be one of the risk factors of falls. In India, according to Chacko, Thangaraj, & Muhammad (2017), 26% of elderly patients were found to have had at least one fall. Dsouza, Rajashekar, Dsouza & Kumar (2014), found that falls was one of the barriers to aging in India as the prevalence of falls among seniors to range from 14% to 53%.

Global incidences of falls indicate that falls is a public health problem that does not only happen in high-income countries but also in developing countries. There are numerous research gaps in developing countries about falls in hospital settings as literature searches did not any studies carried out in Sub-Saharan countries. There is a dire need to have research studies conducted in developing countries as well as having collaborative efforts of researchers, health systems, policy makers, and healthcare professionals to foster active aging and mitigating falls.

Epidemiology of Patient Falls in Hospital Settings

Falls is one of the significant issues of public health concern. According to WHO (2018), there are about 646, 000 fatal falls occur annually, making falls to be the second leading cause of unintentional or accidental injury after road traffic injuries. According to (WHO) it is estimated that in the US about 20-30% of the older generation who fall sustain moderate to severe injuries like head trauma, bruises or hip fractures

In particular, patient falls within hospital settings are estimated to cause about seventy percent of inpatient accidents to the patients during their stay at medical facilities (Krauss et al., 2007). Even though falls in a nursing home and community settings have comparatively been well studied (Tinetti, Speechley, & Ginter, 1988; Mustard & Mayer, 1997), there is little literature about the epidemiology of patient falls in hospital settings. Recent research findings show that about 35 to 20 % of patients admitted to hospitals falls at least falls once during their hospital stay (Clyburn & Heydemann, 2011). According to findings of a study conducted by Anderson, Postler, and Dam (2016), over eighty percent of falls in hospital settings were found to have occurred in within inpatient settings, despite over seventy percent of the followers having had prevention protocol put in place before their fall.

Research findings from preceding studies, identified and categorized the risk factors into two main categories, namely: extrinsic and intrinsic factors. Intrinsic factors are comprised of the factors that have a physiologic origin, while the extrinsic consist of risk factors that precipitate from either environmental or other forms of hazards (Hughes, 2008). Most studies have focused more on psychiatric patients and patients seeking orthopedic services. Other studies have focused on falls that occur in bathrooms and patient rooms (Hitcho, et al., 2004; Krauss, et...