Does delirium prevention reduce risk of in‐patient falls among older adults? A systematic review and trial sequential meta‐analysis

He, Steven; Rolls, Kaye; Stott, Katrina; Shekhar, Rozina; Vueti, Vaulina; Flowers, Kelli; Moseley, Margaret; Shepherd, Bernadette; Mayahi-Neysi, Mandana; Chasle, Briony; Warner, Bradley; Chróinín, Danielle Ní; Frost, Steven A.

doi:10.1111/ajag.13051

Cited by 5 publications

(2 citation statements)

References 41 publications

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“…A recent systematic review and meta-analysis by He et al . [ 83 ] found that evidence-based delirium management strategies have the potential to reduce the risk of falls in older patients.…”

Section: Discussionmentioning

confidence: 99%

Hospital falls clinical practice guidelines: a global analysis and systematic review

McKercher,

Peiris,

Hill

et al. 2024

Age and Ageing

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Background Hospital falls continue to be a persistent global issue with serious harmful consequences for patients and health services. Many clinical practice guidelines now exist for hospital falls, and there is a need to appraise recommendations. Method A systematic review and critical appraisal of the global literature was conducted, compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Web of Science, Embase, CINAHL, MEDLINE, Epistemonikos, Infobase of Clinical Practice Guidelines, Cochrane CENTRAL and PEDro databases were searched from 1 January 1993 to 1 February 2024. The quality of guidelines was assessed by two independent reviewers using Appraisal of Guidelines for Research and Evaluation Global Rating Scale and Appraisal of Guidelines of Research and Evaluation Recommendation Excellence (AGREE-REX). Certainty of findings was rated using Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research. Data were analysed using thematic synthesis. Results 2404 records were screened, 77 assessed for eligibility, and 20 hospital falls guidelines were included. Ten had high AGREE-REX quality scores. Key analytic themes were as follows: (i) there was mixed support for falls risk screening at hospital admission, but scored screening tools were no longer recommended; (ii) comprehensive falls assessment was recommended for older or frail patients; (iii) single and multifactorial falls interventions were consistently recommended; (iv) a large gap existed in patient engagement in guideline development and implementation; (v) barriers to implementation included ambiguities in how staff and patient falls education should be conducted, how delirium and dementia are managed to prevent falls, and documentation of hospital falls. Conclusion Evidence-based hospital falls guidelines are now available, yet systematic implementation across the hospital sector is more limited. There is a need to ensure an integrated and consistent approach to evidence-based falls prevention for a diverse range of hospital patients.

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Section: Discussionmentioning

confidence: 99%

Hospital falls clinical practice guidelines: a global analysis and systematic review

McKercher,

Peiris,

Hill

et al. 2024

Age and Ageing

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“…20 • Counterbalance: Potential for improved delirium prevention to reduce other hospital complications such as falls. 44 • Provision of patient-centred information and support is part of the Delirium Standard (QS 3). • Counterbalance: Qualitative evidence from diverse settings is consistent that patients and family carers want and appreciate information about delirium from clinicians.…”

Section: Research Staffmentioning

confidence: 99%

Driving quality in delirium care through a patient-centered monitoring system in palliative care: Protocol for the two-staged exploratory sequential mixed methods MODEL-PC study

van Oosterom,

Agar,

Walpole

et al. 2024

Delirium Communications

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Introduction Delirium is a serious acute neurocognitive condition that is common in palliative care units and yet under-addressed. To improve delirium care in this setting, we will develop and pilot a monitoring system that integrates the Delirium Clinical Care Standard, Palliative Care Outcomes Collaboration (PCOC) methods, and perspectives of patients, carers and staff. Methods This paper reports the protocol for a two-stage, exploratory, sequential mixed-methods implementation study. Stage 1 data collection includes Delirium Standard-aligned process mapping and clinical audits, and Critical Incident Technique interviews with patients, carers and staff with a recent experience of delirium. We will present integrated stage 1 findings to stakeholders then collaboratively develop a delirium monitoring system that aligns with the Delirium Standard and PCOC methods. In stage 2, we will pilot the new system and repeat stage 1 data collection and analyses, adding PCOC and adverse event measures. Implementation principles and strategies such as audit and feedback and education will be applied. We developed simplified participants information sheets and consent forms for interview and process mapping participants, who will provide written informed consent; and waiver of consent to collect clinical audit, PCOC and adverse event data from patients’ medical records is approved. At study end, we will report implementation, effectiveness and safety outcomes, including systemic utility of the delirium monitoring system for wider testing and use to meet the Delirium Standard in palliative care units. Quantitative data analyses will include descriptive and inferential statistics and qualitative analyses will incorporate thematic content analysis aligned to the Critical Incident Technique. Mixed methods data integration will be at the end of each stage. Discussion This protocol paper describes the mixed methods, systems integration, and innovative measures and study processes of the MODEL-PC study. We also share data collection tools and a simplified information sheet and consent form for patients.

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Inpatients' experiences of falls: A qualitative meta‐synthesis

Jarden,

Cherry,

Sparham

et al. 2024

Journal of Advanced Nursing

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ObjectivesIdentify and synthesize published qualitative research reporting inpatient experiences of a fall to determine novel insights and understandings of this longstanding complex problem.Research DesignQualitative meta‐synthesis.MethodsOnline databases were searched to systematically identify published research reporting inpatient experiences of a fall. The included studies were inductively analysed and interpreted then reported as a meta‐synthesis.Data SourcesDatabases Ovid MEDLINE, Embase, Ovid Emcare, CINAHL Complete, Scopus and ProQuest Dissertations and Theses Global were searched on 3rd August, 2023.ResultsFrom 10 included publications, four new themes of inpatients' experiences of a fall were constructed. Themes one, two and three related to antecedents of patient falls, and theme four related to consequences. Theme one, ‘My foot didn't come with me: Physiological and anatomical changes’, encompassed patients' experiences of medical conditions, medication, and anatomical changes. These aspects contributed to alterations in balance and strength, and misconceptions of capability in activities of daily (inpatient) living. Theme two, ‘I was in a hurry: Help‐seeking’, encompassed patients' experiences striving for independence while balancing power and control, minimizing their own needs over care of others', and unavailability of support. Theme three, ‘I couldn't find the call light: Environment and equipment’, encompassed patients' experiences of not being able to reach or use equipment, and environment changes. Theme four, ‘It was my fault too: Blame and confidence’, encompassed patients' expressions of blame after their fall, blame directed at both themselves and/or others, and impacts on confidence and fear in mobilizing.ConclusionsInpatient falls are embedded in a complexity of individual, relational, and environmental factors, yet there are potential ways forward both informed and led by the patient's voice. Strength‐based approaches to address the tenuous balance between independence and support may be one opportunity to explore as a next step in complementing the existing multifaceted interventions.Impact Inpatient falls are a complex and costly health safety and quality problem. Despite global initiatives in the prevention of inpatient falls, they remain intractable. This meta‐synthesis provides an in‐depth exploration of extant qualitative data on patients' experiences of falls in hospitals. Four themes were constructed expressing the inpatients' experiences: physiological and anatomical changes, help‐seeking, environment and equipment, and blame and confidence. Novel considerations for future investigation are offered, drawing from self‐determination theory and positive psychological interventions. Implications for Patient CareThis meta‐synthesis elicits new considerations for future interventions based on people's experiences of their fall in hospital, offering healthcare professionals novel directions in fall prevention.Reporting MethodThe review was reported according to the Enhancing transparency in reporting the synthesis of qualitative research statement (ENTREQ; Tong et al., 2012).Patient or Public ContributionNo Patient or Public Contribution.RegistrationPROSPERO CRD42023445279.

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Does delirium prevention reduce risk of in‐patient falls among older adults? A systematic review and trial sequential meta‐analysis

Cited by 5 publications

References 41 publications

Hospital falls clinical practice guidelines: a global analysis and systematic review

Hospital falls clinical practice guidelines: a global analysis and systematic review

Driving quality in delirium care through a patient-centered monitoring system in palliative care: Protocol for the two-staged exploratory sequential mixed methods MODEL-PC study

Inpatients' experiences of falls: A qualitative meta‐synthesis

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