Technology and Building Design: Initiatives to Reduce Inpatient Falls among the Elderly

Abstract

This paper offers a narrative exploration of interventions for inpatient falls among the elderly with respect to the design of technology (equipment and furniture) and buildings. Most of the contributory risk factors for inpatient falls among the elderly were identified in the 1950s, but incident and injury rates remain relatively unchanged in the 2000s. Interventions have predominantly focused on staff and organizational changes, for example monitoring (observation) and communication, possibly in response to increased patient privacy (isolation) in single rooms. The clinical response has been to modify the patient by means of medication review, continence management, and impact protectors. This paper considers whether technology and building design have helped or hindered the newly admitted frail and/or confused elderly patient at risk of falling, assuming the provision of good nursing and medical practice (e.g., observation, treatment, and care).

Design Research and the Globalization of Healthcare Environments

“…• Accessible design Newton & Bright, 2009 Aggression in ERs Howroyd, 2012 Ambulance design Matthews, 2011 Behavioral health environments Daykin, Byrne, Soteriou, & O'Conner, 2010;Chrysikou, 2012 Business case Ruddock, 2007 Environments for autism Brand, 2010;McAllister & Maguire, 2011;Shabha & Gaines, 2012;Gaudion & McGinley, 2013 Facilities for seniors Alves, Thompson, Zuin, Milington, & Aspinall, 2009;Lindquist, Barnes, Torrington, & Parker, 2013Falls Hignett & Richardson, 1995Hignett, Masud, & Jansen, 2005;Hignett & Masud, 2006;Hignett, 2010;Hignett & Lu, 2010;Hignett et al, 2013 Healing architecture Lawson, 2010 Healthy community environments Hung, 2009;Thompson, Millington, Roe, Zuin, & Alves, 2009;Thompson, Alves, Aspinall, Roe, & Zuin, 2011 Health facility POE Forbes, 2013a;Young, 2013 Healthcare workers' well-being and performance Rechel, Buchan, & McKee, 2009;Rechel, Wright, Edwards, Dowdeswell, & McKee, 2009 Infection control Gardner, Court, Brocklebank, Downham, & Weightman, 1973;Jeanes, Rao, Osman, & Merrick, 2005;Healthcare Commission, 2006;Noise Bentley, Murphy, & Dudley, 1977 Palliative care Brereton et al, 2012;Rowlands & Noble, 2008;Stevenson, Humphris, & Howells, 2008 Perceptions of hospitals Douglas & Douglas, 2005;…”

How Feasible Was a Bed-Height Alert System?

“…Fall-related injuries are among the most common and expensive hospital-acquired health conditions of adult inpatients (Simmons, 2010). Keeping patient beds in a low position, providing low-low beds to patients at greatest risk of falls, bed alarms, and implementing wider mattresses for patient beds are a few of potential bed-related interventions to reduce patient falls from their beds (Anderson, Boshier, & Hanna, 2012; Fragala, Perry, & Fragala, 2012; Haines, Bell, & Varghese, 2010; Hignett, 2010). Anderson et al (2012) found that limited clinical trials have been conducted on testing the effectiveness of bed-related interventions.…”

“…Bed height has been identified as one of the extrinsic contributory factors of falls in adult inpatient care settings (Hignett, 2010). A study conducted by Tzeng (2010) shows that in adult acute inpatient care settings, 51.4% of all inpatient fall incidents and 56% of injurious falls are associated with an activity related to the bed (e.g., transfers to and from bed).…”

Nursing Unit Design, Nursing Staff Communication Networks, and Patient Falls: Are They Related?

“…The results of numerous studies have suggested that visibility (observability) of patients from nursing work areas, such as nurses’ stations and medication preparation areas, is important in improving safety outcomes such as patient falls ( Hadi & Zimring, 2016 ; Hignett, 2010 ; Lopez, Gerling, Carey, & Kanak, 2010 ; Taylor & Hignett, 2016 ). Long corridors with greater space between rooms or between the two ends of the hall reduce visibility, and therefore the nursing staff’s ability to surveil their patients ( Hadi & Zimring, 2016 ).…”