Deanna Gray-Miceli

Psychometric Properties of the Post-Fall Index:

Evaluation and prevention of falls begin with a thorough understanding of their occurrence. Post-fall assessment (PFA) tools should be available to sufficiently guide nursing staff in identification of all possible causes. Absence of empirically tested PFA tools led to the development of the Post-Fall Index (PFI). Developed and validated in three phases, a 76-item PFI was first tested for content validity by national experts. Next, it was tested for feasibility with registered nurses practicing in nursing homes. Last, it was piloted with a sample of 30 falls by older residents of a skilled nursing unit in a continuing care retirement community. Review of data from these 30 falls provided the item analysis. Reflective of evidenced-based guidelines, a 30-item PFI emerged, containing essential items causing falls. Although lengthier than incident reports, its comprehensiveness was deemed of higher value. Large absolute agreement of items (70%-100%) indicates good interrater reliability. The PFI is valid, reliable, and feasible and has clinical utility for the secondary prevention of falls.

Use of a Postfall Assessment Tool to Prevent Falls

Nursing research in fall prevention should not only identify etiologic risk factors to fall but seek to identify underlying causes, whenever possible. Few studies have investigated the use of a comprehensive postfall assessment tool (PFAT) by nurses as an intervention for the prevention of recurrent falls, especially one that prompts nurses to consider all potential causes through a categorization scheme. This study tested use of a comprehensive PFAT as an intervention, prospectively, facility-wide for 1 year by registered nurses using a pretest—posttest design. A 29.4% reduction in the fall rate (z = 3.89, p < .001), 27.6% decline in total falls experienced by all fallers (p < .001), and a 34.0% decline for recurrent fallers (p = .025) from preintervention to intervention year was observed when trained nurses categorized falls according to perceived causes. These declines are likely due to consistent and rigorous use by trained nursing staff, prompting their critical examination of each fall.

Improving the quality of geriatric nursing care: Enduring outcomes from the Geriatric Nursing Education Consortium

The nations aging demography, few nursing faculty with gerontological nursing expertise, and insufficient geriatric content in nursing programs have created a national imperative to increase the supply of nurses qualified to provide care for older adults. Geriatric Nursing Education Consortium (GNEC), a collaborative program of the John A. Hartford Foundation, the American Association of Colleges of Nursing, and the New York University (NYU) Nursing Hartford Institute for Geriatric Nursing, was initiated to provide faculty with the necessary skills, knowledge, and competency to implement sustainable curricular innovations in care of older adults. This article describes the background, step-by-step process approach to the development of GNEC evidence-based curricular materials, and the dissemination of these materials through 6-, 2-, and a half-day national Faculty Development Institutes (FDIs). Eight hundred eight faculty, representing 418 schools of nursing, attended. A total of 479 individuals responded to an evaluation conducted by Baruch College that showed faculty feasibility to incorporate GNEC content into courses, confidence in teaching and incorporating content, and overall high rating of the GNEC materials. The impact of GNEC is discussed along with effects on faculty participants over 2 years. Administrative- and faculty-level recommendations to sustain and expand GNEC are highlighted.

Clinical Risk Factors for Orthostatic Hypotension: Results Among Elderly Fallers in Long-Term Care.

Background Patients at greatest risk for fall-related injuries are older adults with orthostatic hypotension (OH), a condition which drops blood pressure. This study sought to determine salient demographic and patient-level factors increasing risk for OH among a sample of elderly fallers. Methods Data analysis for this retrospective study sought to assess the relationship between various demographic and clinical risk factors and the likelihood of OH. Because fallers could experience multiple falls, generalized estimating equations were used to account for patient-level correlations. Results One hundred seventeen falls occurred in 47 patients, who were primarily female with a mean age of 90.7 years. Falls resulted in 18 cases of OH. Orthostatic hypotension cases were less likely to have a gait in a steady line (5.6% vs 55.6%, P = 0.001). Patients with decreased muscular coordination were almost 5 times more likely to experience OH than those with no coordination problems (odds ratio = 4.86, P = 0.02). Patients with gait in a steady line were less likely to experience OH after a fall (OR = 0.06, P = 0.006). Conclusions Orthostatic hypotension is potentially modifiable once detected. Evidenced-based protocol for assessment and management of OH among patients with gait and balance impairment is presented.

Ambulatory assisted living fallers at greatest risk for head injury

27 OBJECTIVES: To determine the relationship between head injuries sustained during each fall 28 with various known high risk health and demographic factors predictive of falls. 29 DESIGN: Prospective cohort study conducted over 1 year 30 SETTING: Assisted living and skilled nursing units of a Continuing Care Retirement 31 Community located in the northeastern United States. 32 PARTICIPANTS: Sixty nine OAs who fell. 33 MEASUREMENTS: Age, gender, diagnosis, high risk medication, functional, cognitive, 34 ambulation/elimination status, mode of locomotion, fall related symptoms and the position of the 35 fall, were analyzed using General Estimating Equations among elderly fallers with and without 36 head injury. 37 RESULTS: A total of 173 falls (average of 2.9 times) were observed for 62 patients who had 38 complete injury data. Injuries were recorded in 40.5% of falls, with 41.4% being head injuries. 39 Head injuries were more likely to be hematomas than lacerations (66.7% vs. 14.7%) and among 40 assisted living residents (p=0.04). Head injured patients were more likely to be walking at the 41 time of the fall (69% vs. 36.1%) and less likely to have bowel incontinence (3.5% vs. 28.5%; 42 p=0.04). None of the high risk diagnosis or medications associated with falls risk increased risk 43 for head injury. 44 CONCLUSION: Those at greatest risk for head injury were ambulatory assisted living 45 residents. None of the known clinical conditions predictive of risk to fall were predictive of head 46 injury. For head injury prevention to be successful we need a closer examination of resident’s 47 mobility, shoe-wear, health behavior with respect to ability to use assistive devices, and floor 48 Elderly fallers at greatest risk for head injury surface landing area. Future health policy implications include measures to ensure standard of 49 care practices for head injured patients are in place. 50 51

Advanced Practice Nurse-Led Statewide Collaborative to Reduce Falls in Hospitals.

Thirty-eight hospitals participated in falls prevention team training, followed by coaching and mentoring over 3 months to develop unit-based initiatives to reduce falls. Initiatives centered on fall risk assessment, rounding, or postfall assessment. Paired t test of the pre-/postintervention fall rates of 23 of the hospitals revealed reduced fall rates (P < .01). The estimated mean decrease was 1.7 falls per 1000 patient days (95% confidence limits of 0.7-2.7).

Nursing Home Registered Nurses' and Licensed Practical Nurses' Knowledge of Causes of Falls.

Reducing falls in nursing homes requires a knowledgeable nursing workforce. To test knowledge, 8 validated vignettes representing multifactorial fall causes were administered to 47 nurses from 3 nursing homes. Although licensed practical nurses scored higher than registered nurses in individual categories of falls, when we computed the average score of all 8 categories between groups of registered nurses and licensed practical nurses, registered nurses scored higher (F = 4.106; P < .05) in identifying 8 causal reasons for older adults to fall.