Why do hospitalized older adults take risks that may lead to falls?

Abstract

Background The behaviour of hospitalized older adults can contribute to falls, a common adverse event during and after hospitalization.Objective To understand why older adults take risks that may lead to falls in the hospital setting and in the transition period following discharge home. Design Qualitative research.Setting and participants Hospital patients from inpatient medical and rehabilitation wards (n = 16), their informal caregivers (n = 8), and health professionals (n = 33) recruited from Southern Health hospital facilities, Victoria, Australia.Main variables studied Perceived motivations for, and factors contributing to risk taking that may lead to falls.Main outcome measures Semi-structured, in depth interviews and focus groups were used to generate qualitative data. Interviews were conducted both 2 weeks post-hospitalization and 3 months post-hospitalization.Results Risk taking was classified as; (i) enforced (ii) voluntary and informed and (iii) voluntary and mal informed. Five key factors that influence risk taking behaviour were (i) risk compensation ability of the older adult, (ii) willingness to ask for help, (iii) older adult desire to test their physical boundaries, (iv) communication failure between and within older adults, informal care givers and health professionals and (v) delayed provision of help. Discussion and ConclusionTension exists between taking risks as a part of rehabilitation and the effect it has on likelihood of falling. Health professionals and caregivers played a central role in mitigating unnecessary risk taking, though some older adults appear more likely to take risks than others by virtue of their attitudes.

The impact of patient age and comorbidities on the occurrence of “never events” in cerebrovascular surgery: an analysis of the Nationwide Inpatient Sample

“…Prior studies have demonstrated an increased risk of falls in hospitalized stroke patients 21,25,34,43,48 and in individuals admitted to Neuroscience and Neurosurgery services. 21,25,34,36,40,43,48 The high proportion of UTIs probably reflects intraoperative use of urinary catheters secondary to procedural length and inherent need for osmotic diuresis. A recent study by Titsworth et al suggests that comprehensive UTI prevention efforts along with continuous quality improvement programs can significantly reduce the duration of urinary catheterization and the rate of catheterassociated UTIs in a neurological ICU.…”

‘It promoted a positive culture around falls prevention’: staff response to a patient education programme—a qualitative evaluation

“…Previous studies, including an analysis of a large US national data set of over 165 000 falls, have demonstrated that over 85% of falls are not witnessed;2 therefore, patients need to be aware of how to initiate activities safely on the ward, when not in the immediate presence of assisting staff. Other researchers have also stated that if hospital falls prevention is to be effective, it is vital that patients are considered part of the team,25 26 33 34 and that the falls prevention plan should be communicated directly to the patient and their family 2734 The staff perspectives concurred with the educators' perspectives about how the programme worked.…”

“…This perspective was also taken by the patients and the educators, suggesting that the education facilitated useful communication between staff and patient and was critical to patients engaging in safe behaviours such as ringing the bell 2223 Other qualitative studies have also identified that patients may feel reluctant to ring the bell to seek help, and that staff think that it is important to emphasise to patients that they should feel confident to ring the bell for assistance 2528 34 One staff member felt that nurses' instructions were sufficient and that the patient education programme was not required.…”

“…Additionally, patients and educators perceived that staff communication and response to the programme formed a potential barrier to patients engaging in falls prevention strategies 2223 Previous qualitative work has explored staff perceptions about the falls prevention education they provide for patients 25–28. However, no previous study has investigated how staff respond when patients on their ward have been provided with the Safe Recovery programme, which encourages them to initiate falls prevention strategies, rather than be solely directed by staff.…”

Conceptual definitions of indicators for the nursing outcome "Knowledge: Fall Prevention"

“…The situations pointed out in the literature in which patients need to request personal assistance are those activities in which, due to the reduction of their abilities, they are no longer able to perform alone, such as getting out of bed and/or going to the bathroom (12,26) . Conceptual definition: the patient describes his or her knowledge about when to ask for help to perform activities that is not able to perform alone due to physical limitation.…”