Research: Falls Prevention In Nursing Homes: Still A Challenge?
The aim of this research was to evaluate current falls prevention measures in care homes and make recommendations to improve practice. The role and experiences of nursing home staff in preventing falls were explored as they are responsible for translating these measures into practice. The objectives of the study were
- To collect data on falls policies and procedures at each care home in accordance with the NICE guidelines.
- To explore the role and experiences of staff in preventing falls using an in-depth interview on a 1:1 basis at each nursing home.
- To undertake qualitative data analysis to understand key themes and to undertake qualitative data analysis using Excel.
- To make recommendations to care homes based on findings on falls prevention.
BACKGROUND
‘A fall is an unintentional or unexpected loss of balance resulting in coming to rest on the floor, the ground or an object below knee level’ (NICE 2013). There has been a lot of research on falls prevention, however despite the vast knowledge on falls prevention in older people, falls are still a global challenge. It has been projected that falls amongst this age group will increase with the growing ageing population if effective measures are not put in place (Noonan, Sleet and Stevens, 2011).
In England about one in three people over 65 fall at least once every year (Treml et al., 2011). However, these statistics are underrepresented the actual number by almost 75% as many falls are unreported (Age UK, 2012).
Falls result in serious injuries such as head injuries or fractures (Deandrea et al., 2013), pain, disability, reduced quality of life, fear of falling, depression and social isolation (Tian et al., 2013).
Falls cost the NHS and social care an estimated £6m per day or £2.3bn per year (NICE, 2015). This figure however only represents the cost associated with hip fractures and does not include costs associated with falls that do not result in hip fracture but that may still require treatment or care (NICE, 2015).
METHOD
This was a multicentre mixed method study. To meet the objectives of the study, a triangulation study design was used to obtain different but complementary data on falls prevention in care homes. The study utilised maximum variation sampling which involves selecting cases with a wide variation of knowledge (Polit and Beck 2014). To obtain rich data on falls prevention in care homes, staff with different knowledge, experience, and roles in falls prevention were interviewed. The participants in the study were managers, staff nurses and healthcare assistants.
RESULTS
The results showed that the care homes had the policies and procedures in place, although they were not standard and not comprehensive. Participants reported that the policies and procedures were applicable to the nursing home environment, but they were not always practical to implement. There is a gap between knowledge and practice mainly due to inadequate staffing levels, and the complexity of falls.
RECOMMENDATION
Nursing home managers should ensure NICE guidelines and quality standards are incorporated within care home the policies and procedures on falls prevention. They should also ensure that care staff are trained in falls prevention to facilitate the transition of knowledge into practice. Nurses should ensure that the falls risk assessments are comprehensive and that multifactorial interventions are put in place to minimise the risk of falling. There should be multidisciplinary collaboration in falls prevention. Fall-risk management is a piece of a larger puzzle and putting together the pieces of the puzzle requires a comprehensive strategy (Clancy et al., 2015)