Tuesday, November 6, 2007

This presentation is part of : Interventions to Care for the Older Adult
Falls and Fall-Related Injuries in Elderly Nursing Home Residents: Exploring the Person and Environment
Elizabeth E. Hill, PhD, RN1, Ann L. Gruber-Baldini, PhD2, Eileen T. Doll, BS, RN3, Kathleen A. Griffith, PhD, CRNP1, Benita Jeanne Walton-Moss, DNS1, and Jennifer A. Wenzel, PhD, RN, CCM1. (1) School of Nursing, Johns Hopkins University, Baltimore, MD, USA, (2) Dept. of Epidemiology & Preventive Medicine, Division of Gerontology, University of Maryland, Baltimore, School of Medicine, Baltimore, MD, USA, (3) Nursing, FutureCare Health and Management Corp, Pasadena, MD, USA
Learning Objective #1: 1. Describe person factors, environmental circumstances, and high-fall risk activities of nursing home residents experiencing falls and fall-related injuries.
Learning Objective #2: 2. Evaluate fall and fall-related injury prevention interventions for at risk elderly nursing residents.

Background: Approximately 750,000 nursing home (NH) residents fall annually, with resultant injuries ranging from minor to major, including death. Circumstances surrounding fall events, particularly environmental ones, are not well documented. Environmental fall prevention interventions, designed without scientific basis, have shown minimal effectiveness. The purpose of this study, guided by Lawton's Ecological Model of Aging, was to explore person and environmental circumstances surrounding fall events and their interaction (e.g. high fall-risk activities). Methods: Six months of incident report and Minimum Data Set 2.0 data were analyzed for a group of 597 fallers of a nine-facility Maryland NH corporation. Content analysis of open-ended fall event descriptions was used to generate lists of person and environmental factors and high fall-risk activities, which were assigned to a group of 1,297 fall events. Results: Residents were on average 82 years old, more than half were female, had moderate-severe cognitive impairment and urinary incontinence. Analyses of 1,297 falls revealed loss of balance (5%) the most commonly reported person factor and wheelchairs (23%) the most common environmental factor. In 5% of events, residents attempted to perform activities unassisted. High fall-risk activities included: transferring (6%) and standing (7%). Slipping from beds, wheelchairs, and other surfaces occurred in 18% of events. Falls resulted in 3% major injuries and 20% minor injuries. With injurious falls, balance and wheelchairs were most commonly reported. High fall-risk activities included standing (7%) and walking (8%). Conclusions: Discussion of findings will emphasize the importance of assessments and interventions for the person and environment of elderly NH residents. Large numbers of falls involving wheelchairs highlight the importance of modifying environmental risk factors, often under nursing’s control. Comprehensive, resident-specific interventions for modifying risk factors and performance of high fall-risk activities are critical for fall and fall-related injury prevention. Funded by STTI and ANF 2004-2005 grant.