Measures to Prevent Falls in Elderly Demented Patients

Introduction

Individuals with dementia are at a greater risk of falling and sustaining serious injuries. The issue of falls is even greater in the elderly with dementia because of issues like impaired judgment and impaired sensory perception that come with the disease (Meyer et al., 2020). Each year, more than 3 million older people are treated because of falls, and about 300,000 are hospitalized (Centers for Disease Control and Prevention (CDC), 2023). Because of problems like prolonged hospitalization and increased costs associated with falls among the elderly, it is important to implement evidence-based interventions to alleviate the problem.

The purpose of this paper is to demonstrate the challenge of falls among the elderly with dementia, ways that can be used to mitigate the challenge, and the evaluation strategies of the interventions within a given timeline. The goal of the project is to reduce the number of falls in elderly demented patients using evidence-based strategies. The key parts that will be addressed in this paper include the goal statement, project objectives, evidence from literature, methodology, required resources, formative evaluation, summative evaluation, and timeline for completing the project.

Goal statement

The goal of this project is to reduce the incidence of falls among elderly individuals with dementia by implementing evidence-based interventions. The focus area is on enhancing the safety and well-being of this vulnerable population to minimize the risk of fall-related injuries and improve their quality of life. The specific areas of target will include mobility and coordination, sensory perceptions, judgment, and communication of the elderly needs. This project will focus on individuals aged 65 years and older diagnosed with dementia. The reason for choosing this population is because they are prone to falls and data indicates that one in three adults aged over 65 years will experience at least one fall in a year (Meyer et al., 2020). This project should be able to lead to the creation of a safer environment for elderly patients with dementia and reduce emergency department visits for this group.

Project objectives

1. Analyze organizational insights regarding the issue of falls in the facility.
2. Design a training program for providers to reduce the number of falls among patients using the Agency for Healthcare Research and Quality (AHRQ) tool kit.
3. Recommend a falls prevention strategy that be used to reduce the fall rate in the organization.

Evidence-based review of the literature for project justification

Falls and dementia often co-exist in elderly people leading to unwanted injuries. Falls can lead to fractures and other injuries which in turn causes functional dependence and premature death. Data shows that approximately 28 to 35% of elderly patients experience one or more falls per year (Zhang et al., 2022). The incidence rate of falls increases with age and those with comorbid conditions like dementia are affected even more. Studies have been conducted to establish the risk factors that increase falls among elderly patients with dementia. In support of this discussion, it is observed that cognitive impairment, attention deficits, and the use of medications are the main reasons that lead to falls (Baniasadi, 2023). Other studies indicate that falls can be related to female sex, heavy drinking, physically active elderly people, and the presence of cardiometabolic diseases (Meyer et al., 2020). This evidence suggests that there is a need for targeted fall prevention strategies for individuals with dementia, especially soon after diagnosis.

Using Electronic Health Records (EHR) for Better Nursing Education

Many falls do not cause injuries, but those who are unfortunate suffer a great deal of loses. Among the elderly, falls can cause broken bones, hip fractures, and head injuries that turn out to be costly (Meyer et al., 2020). In 2015, the cost of falls totaled more than $50 billion showing how costly it is to manage falls (CDC, 2023). Clinical practice guidelines have been developed to help in designing strategies for fall prevention among the elderly. All guidelines recommend multifactorial risk assessment using various tools and interventions for those identified to be at risk (Montero-Odasso et al., 2021). Apart from these, it is recommended to use exercise strategies and minimize the use of psychoactive medications. For those who are hospitalized, interventions like the use of walking aids, nonslip wear, and frequent comfort rounds are recommended. Recent approaches like the use of multidisciplinary teams have also demonstrated promising results in minimizing falls among the elderly (Vaishya & Vaish, 2020). Addressing the issue of falls should involve passing safety in homes and hospitals alongside causative factors that can be prevented.

Methodology

This project will be conducted by focusing on the key objectives to ensure a strategy to prevent falls is selected. The people who will be involved in the project include registered nurses, demented patients, physical therapists, and physicians. The interventions will be initiated within the first month of the project and ongoing evaluations will be conducted throughout. The project will be implemented in a hospital setting and it will focus on patients with dementia. The initial step will involve analyzing organizational insight into the issue of falls in the facility. Upon gaining insight into the fall rates in the organization, the second step will involve training providers on fall prevention using the Agency for Healthcare Research and Quality (AHRQ) tool kit.  This training will provide valuable information on overcoming the challenges associated with developing, implementing, and sustaining a fall prevention program. Based on the information from the literature review and the AHRQ tool kit, the last step will involve recommending a strategy that can be adopted across the facility to reduce fall rates.

Lewin’s change management theory will be used to guide the implementation of a new strategy to reduce falls in the facility. This theory describes change management in three steps including unfreezing, changing, and refreezing (Amina et al., 2022). The unfreezing stage involves acknowledging the need for change and preparing for the same. The changing stage involves implementing the desired changes, often through communication, training, and support (Amina et al., 2022). In the refreezing stage, the new changes will be solidified and integrated into the system to ensure they become the new norm. This theory will be used to guide this project and ensure all the objectives are met.

Resources

The human resources that will be required for this project will include geriatric nurses, nurses specialized in dementia care, physical therapists, and occupational therapists. These individuals will be required because of their expertise in dementia care and for educational purposes concerning the newly proposed interventions. Physical equipment will include educational materials like printed manuals, facility modifications, especially in inpatient rooms like lighting, and medical equipment for dementia patients like safety alarms and walkers. Technical resources will include an audio-visual display for educational purposes and a secure database computer system to collect, store, and analyze the collected data from the project.

Formative evaluation

Formative evaluation involves the collection of data and feedback during the development of a project. The formative evaluation plan for this project will involve gathering weekly feedback from providers and patients regarding the progress of the plan. Observations will also be made to monitor the number of falls occurring and to guide any required changes. The initial evaluations will be done weekly followed by another evaluation after one month to identify any challenges. The results from the evaluation will be utilized in real-time to modify interventions and conduct further education to providers if required.

Summative evaluation

A summative evaluation will be conducted at the end of the project to assess the overall effectiveness of implemented interventions and achieved outcomes. This evaluation will happen at the end of the project timeline and it will involve analyzing reported fall rates. The fall rates will then be compared with previous reports to ascertain the effectiveness of the project. A short questionnaire will be administered to assess the overall effectiveness of the new interventions and satisfaction levels among staff and patients. The evaluation results will be used to recommend practice changes in the institution regarding falls prevention among patients with dementia. Best practices and lessons learned from the project will be used to inform future initiatives and interventions in the institution.

Timeline

|——————|———————|———————|———————|——————-

|   Days 1-10    |    Days 11-30      |   Days 31-60      |  Days 61-70       |Days 71-77       |

|——————|———————|———————|———————|——————-

| Project Launch|  Implementation | Monitoring       | Summative        |  Final              | &Training    | & Formative     | Evaluation        |Evaluation                                                              |                              Evaluation

|——————|———————|———————|———————|——————-

 This project is expected to be completed within 77 days. The first ten days will be used to launch the project by identifying the goals, objectives, and methodology. The next step will involve a literature review to identify evidence-based strategies to address the issue of falls among dementia patients. This stage will also deal with the identification of stakeholders, seeking approval of the project, and assembly of required resources. A formative evaluation of these steps will be conducted weekly and after one month progress will be assessed. The next step will involve monitoring the project and conducting a summative evaluation. The last days of the project will be used to compile results and communicate findings to the stakeholders. 

References

Amina, A., Kassem, A., & Sleem, W. (2022). Applying Lewin’s Change Management theory to improve patient’s discharge plan. Mansoura Nursing Journal, 9(2), 335-348. https://doi.org/10.21608/mnj.2022.295591

Baniasadi, T. (2023). Risk factors associated with falls in older adults with dementia and alzheimer’s diseases among older adults in the united states. MedRxiv, 2023-01. https://doi.org/10.1101/2023.01.10.23284411

Centers for Disease Control and Prevention. (2023). Older adult fall prevention: Facts about falls. https://www.cdc.gov/falls/facts.html

Meyer, C., Hill, K. D., Hill, S., & Dow, B. (2020). Falls prevention for people with dementia: A knowledge translation intervention. Dementia, 19(7), 2267-2293. https://doi.org/10.1177/1471301218819651

Montero-Odasso, M. M., Kamkar, N., Pieruccini-Faria, F., Osman, A., Sarquis-Adamson, Y., Close, J., … & Kobusingye, O. (2021). Evaluation of clinical practice guidelines on fall prevention and management for older adults: A systematic review. JAMA Network Open, 4(12), e2138911-e2138911. https://doi.org/10.1001%2Fjamanetworkopen.2021.38911

Vaishya, R., & Vaish, A. (2020). Falls in older adults are serious. Indian Journal of Orthopaedics, 54(1), 69–74. https://doi.org/10.1007/s43465-019-00037-x

Zhang, L., Wang, J., Dove, A., Yang, W., Qi, X., & Xu, W. (2022). Injurious falls before, during and after dementia diagnosis: A population-based study. Age and Ageing, 51(12), afac299. https://doi.org/10.1093/ageing/afac299