Falls and Dementia in Nursing Homes

Serious Injuries and Death from fall among Elderly residents with dementia living in nursing homes.

Introduction

Injuries from falls are a serious problem for elderly people in nursing homes (NH) that can cause permanent debilitation or even death. The problem is especially severe with the elderly who are mentally impaired and who unable to assess their surroundings (Ref_). The prevalence
of falls among older adults living with dementia is two to three times higher than among those who are cognitively intact (Kehinde et al.

, 2012). Injuries from falls are the main cause of accidental death in the elderly and is also responsible for much long-term pain, loss of function, and disability (Pi, Hu, Zhang, Peng, & Nie, 2015). Fall trauma is the fifth leading cause of death in people 65 years of age and older, and falls are responsible for 70% of accidental deaths in people age 75 or older (Chiara et al, 2013). Although previous studies relevant to this subject abound (need studies and references) there is no tangible solution to this complex issue.

Injuries from fall in older people are a major public health concern in terms of morbidity, mortality, health, and social services costs (Chiara et al., 2013). These problems dramatically affect not only patients but also their loved ones, both emotionally and financially.

Injury from falls among the elderly is an international issue and a public health problem that brings substantial economic and quality-of-life burdens to individuals and society (Zhou, Chen, & Zhu, 2014). Injury from falls among elderly people in the NH is one of the serious
problems that need to be reduced or eliminated.

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However, the fundamental elements are to understand why some of the protocols in place such as coloring rooms, removing clutter from rooms, scheduled toileting, closely monitoring them( As such the need to find concrete
solutions still exists.

The risk of injuries from falls could be associated with drugs that inhibit proper functioning of the central nervous system such as cough preparations, nonsteroidal anti- inflammatory drugs, anti-Alzheimer’s agents, antiplatelet agents, calcium antagonists, diuretics, a-blockers, digoxin, hypoglycemic drugs, neurotoxic chemotherapeutic agents, nasal preparations, and antiglaucoma ophthalmic preparations (Zhou, Chen, & Zhu, 2014). However, the use of computerized and alert systems for medication may reduce some of the risks (Zhou,
Chen, & Zhu, 2014). In addition environmental factors such as wet floors and objects not properly placed, and physiologic changes due to age and debilitation could contribute to risk of injuries associated with falls (Quigley, P. 2015).

Some studies point to the use of preventive measures such exercise reduce injuries elderly with dementia from falls (Taylor, Delbaere, Close & Lord, 2012). while others point to staff experience and attitudes (Livingston, Pitfield, Morris, Manela, Lewis-Holmes, and
Jacobs, 2011). Staff experience require education and implementation of programs Since serious injuries and death from falls have continued to increase in the frail dementia population, current efforts appear limited and as such further research is needed. The purpose of this research therefore is to determine if a relationship exists between serious injuries from fall in frail elderly and dementia.

Research Questions

1. What is the relationship between serious injuries from falls in elderly patients and dementia?
2. How does fall injuries affect the health outcomes of the elderly with dementia?
3. How does safety education affect the rate of falls in the elderly with dementia?

Methods: Search and Strategy

The search strategy for this study took into account research on both qualitative and quantitative methodologies as well as the review of the literature. The search was limited to peer- reviewed items in English language only. The literature search started with a scan of some
databases such as CINAHL, Science Direct, Google Scholar, ProQuest, and EBScOhost without date limitation. This general scanning was to see the history of the topic and research questions. After the initial scanning, the author then limited the years from 2009-2016. This timeline was to focus on a new understanding of the topic as well as the research questions.

Starting with CINAHL with full text, the author used terms such as dementia, frail, frailty, falls, nursing home, injuries, disability, death and falls, elderly. This search resulted in a large number of articles (40). From this initial search, further search was done using associated
themes and key words. As such a search of ProQuest yielded (15 items), Science Direct (10 items) EBScOhost (12 items), and Google Scholar netted 8 articles. An ancestry search was done with a prior selected study, resulting in three items. The Boolean operator used included dementia AND falls, Elderly+ falls, Elderly AND injuries, fall AND serious injuries AND death.

Searches were done starting in September with the last date of November 2, 2016.

Study Selection

An initial screening with databases used titles and abstracts; the author selected articles from 2009-2016 that had keywords such as falls, injuries, and dementia. Abstracts that had an introduction, references, results, and findings with the key terms were selected. This included
keywords such as frail, elderly, falls and serious injuries, frail, frailty and/or plus fall injuries and death. This search resulted in a total of 17 articles. Articles with key terms published before 2009 were used as a reference to gauge previous research. However, materials prior to 2009 were excluded as dated items.

Full text papers were read thoroughly. Each was read at least two times to make sure the author’s criteria were used. Papers with a detailed introduction, methodology, results, and data aligned with research questions and topic were chosen. In addition, key terms for the study were also used for inclusion and exclusion as well as clarity of tables and graphs. Sixteen items in total were selected. (See Matrix attached).

Data Extraction

Articles with data on research related to the topic were included. Materials that showed a clear relationship between data and its applicability to the study were also included. Research articles with evidence of metadata or data from other studies that could be used for comparison
were chosen. To organize this information, a matrix was used to record themes, aim of the study, study design, setting, sample size and sample size calculation techniques, results, study implications, and limitations. The matrix will make it easy to compare and contrast each item and will enable the author to assess them further.

The risk of bias-quality appraisal and key words for the study and use of peer-review materials as a guide to the conduct of the study. In addition, being aware of bias will enable the author to review articles thoroughly for bias.

References

1. Chiara, M., Gianluigi, G., Pasquale, A., Alessandro, M., Alice, M., Gabriele, N.,… Andrea, U.(2013).
2. Unexplained falls are frequent in patients with fall-related injury admitted to orthopedic wards: The UFO study (unexplained falls in older patients). Current Gerontology and Geriatrics Research, 1-6. doi:10.1155/2013/92860
3. Kehinde, J. O., Amella, E. J., Pepper, G. A., Mueller, M., Kelechi, T. J., & Edlund, B. J. (2012).
4. Structure- and process-related fall risks for older adults living with dementia in nursinghomes. Journal of Clinical Nursing, 23(23-24), 3600-3602. doi: 10.1111/j.1365-2702.2012. 04319.xOlsen, C. F, Telenius, E. W., Engedal, K., & Bergland, A. (2015).
5. Increased self-efficacy: The experience of high-intensity exercise of nursing home residents with dementia – a qualitative study. BMC Health Services Research, 15(1). doi: 10.1186/s12913-015-1041-7