Falls in Older Hospital Inpatients (Research Paper Sample)

Research Title: Falls in Older Hospital Inpatients and the effect of Cognitive Impairment: A Secondary analysis of Prevalence Studies.
Name:
Institution:
Abstract
This study aims to investigate the fall rates among older inpatients suffering from cognitive impairment and those without these impairments. Falls among older patients with cognitive impairments are common despite the lack of studies on these falls. This study aims to fulfill this research gap by investigating the causes and occurrence of falls among older patients. This study also investigates the relationship between fall rates and other factors such as age, gender and cognitive damages among other factors. In addition, this research also investigated the relationship between fall rates and care dependency and urinary problems among older patients. The lack of adequate research studies on fall rates among older patients is a concern among health care professionals. With the occurrence of bed falls among older patients on the rise, research studies on this problem are necessaryADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1188/10.ONF.S1.7-16", "ISBN" : "1538-0688\\n0190-535X", "ISSN" : "0190-535X", "PMID" : "20797938", "abstract" : "To describe approaches to pain assessment in cognitively intact and cognitively impaired older adults with cancer.", "author" : [ { "dropping-particle" : "", "family" : "Curtiss", "given" : "Carol P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Oncology nursing forum", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "7-16", "title" : "Challenges in pain assessment in cognitively intact and cognitively impaired older adults with cancer.", "type" : "article-journal", "volume" : "37 Suppl" }, "uris" : [ "/documents/?uuid=a2fbad97-9903-418b-8179-85488c7b4a2d" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(Curtiss, 2010)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(Curtiss, 2010). In this regard, this research offers recommendations on the best strategies of reducing fall rates among older patients suffering and those not suffering from cognitive injuries. The findings of this research will profoundly help in reducing fall rates among older patients.
Literature Review
Current literature indicates presence of numerous risk factors for falls among patients suffering from cognitive injuries such as dementiaADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1447-0594.2008.00506.x", "ISSN" : "1447-0594", "PMID" : "19260978", "abstract" : "BACKGROUND: Confusion and cognitive impairment, are risk factors for falls in hospital. Evidence for reducing falls in cognitively-impaired patients is limited and to date no intervention has consistently been shown to reduce falls in this group of patients. We explored characteristics associated with falls in cognitively-impaired patients in a rehabilitation setting. METHODS: In a prospective observational study, 825 consecutive patients were studied. Patient characteristics were assessed on admission. Factors predisposing to falls in cognitively-impaired patients were identified. RESULTS: Cognitively-impaired patients were more likely to be fallers or recurrent fallers and more likely to sustain an injury than cognitively intact patients. They had a higher incidence of nursing home discharges and a significantly higher mortality. Logistic regression analysis showed that an unsafe gait (P < 0.001; 95% confidence interval, 0.13-0.57) was the only independent risk factor for falls in this group of patients. There was a cumulative higher risk of falling associated with an unsafe gait demonstrable throughout the patients' stay. CONCLUSION: Unsafe gait was the only significant independent risk factor for falls among cognitively-impaired patients in a rehabilitation environment. Interventions that improve gait patterns or that enhance safety for patients with abnormal gait are required if fall reduction in this group of patients is to be achieved.", "author" : [ { "dropping-particle" : "", "family" : "Vassallo", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mallela", "given" : "Santhosh Kumar", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Williams", "given" : "Andrew", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kwan", "given" : "Joseph", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Allen", "given" : "Steve", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sharma", "given" : "Jagdish C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Geriatrics & gerontology international", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "41-46", "title" : "Fall risk factors in elderly patients with cognitive impairment on rehabilitation wards.", "type" : "article-journal", "volume" : "9" }, "uris" : [ "/documents/?uuid=861f6197-d900-4c27-9230-9e7ffc967b69" ] } ], "mendeley" : { "previouslyFormattedCitation" : "(Vassallo et al., 2009)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(Vassallo et al., 2009). A patient with a history of falls is likely to experience highfall rates in the future. Medical personnel, therefore, use patients’ history to identify patients with the most risks of falls. Fall history is a useful screening method of identifying fall risks among individuals with cognitive impairments such as dementia. It is also vital to use informants to identify the fall risks among older patients. The risk factors for patients who are cognitively intact include old age and female gender. However, there is a little evidence to indicate whether these factors also affect patients with cognitive impairments. Most research studies on falls have conflicting evidence regarding the relationship between falls and age. Some studies indicate that male gender is a risk factor among patients with cognitive impairments. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/ebn.6.4.114", "ISBN" : "13676539", "ISSN" : "1367-6539", "PMID" : "14577396", "abstract" : "Objective: To determine the effectiveness of multifactorial intervention after a fall in older patients with cognitive impairment and dementia attending the accident and emergency department. Design: Randomised controlled trial. Participants: 274 cognitively impaired older people (aged 65 or over) presenting to the accident and emergency department after a fall: 130 were randomised to assessment and intervention and 144 were randomised to assessment followed by conventional care (control group). Setting: Two accident and emergency departments, Newcastle upon Tyne. Main outcome measures: Primary outcome was number of participants who fell in year after intervention. Secondary outcomes were number of falls (corrected for diary returns), time to first fall, injury rates, fall related attendances at accident and emergency department, fall related hospital admissions, and mortality. Results: Intention to treat analysis showed no significant difference between intervention and control groups in proportion of patients who fell during 1 year's follow up (74% (96/130) and 80% (115/144), relative risk ratio 0.92, 95% confidence interval 0.81 to 1.05). No significant differences were found between groups for secondary outcome measures. Conclusions: Multifactorial intervention was not effective in preventing falls in older people with cognitive impairment and dementia presenting to the accident and emergency department after a fall. What is already known on this topic Multifactorial intervention prevents falls in cognitively normal older people living in the community and in those who present to the accident and emergency department after a fallFall prevention strategies have not been tested by controlled trials in patients with cognitive impairment and dementia who fallWhat this study adds No benefit was shown from multifactorial assessment and intervention after a fall in patients with cognitive impairment and dementia presenting to the accident and emergency departmentThe intervention was less effective in these patients than in cognitively normal older people", "author" : [ { "dropping-particle" : "", "family" : "Birks", "given" : "Yvonne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Evidence-based nursing", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2003" ] ] }, "page" : "114-115", "title" : "A multifactorial intervention after a fall did not prevent falls in elderly patients with cognitive impairment and dementia.", "type" : "article-journal", "volume" : "6" }, "uris" : [ "/documents/?uuid=3518cd87-2763-446b-9f8c-5ecc6411f306" ] } ], "mendeley" : { "manualFormatting" : "Birks (2003)", "previouslyFormattedCitation" : "(Birks, 2003)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }Birks (2003) explains that short-term studies indicate that female patients with Alzheimer disease and male patients with dementia suffered multiple falls than patients with other cognitive impairments. Other studies set in nursing homes found out that falling rates were more prevalent among men patients than females.
Medical factors also contribute to the risks of falls. For instance, patients suffering from Lewy body dementia ha...