This paper examines the problem of falls among elderly patients in subacute care settings, where fall rates can reach up to 47% in some units and result in significant physical and psychological harm. Drawing on multiple recent studies, the paper reviews the effectiveness of targeted fall-prevention programs, including structured exercise (eurhythmics), balance training using Wii Fit, environmental modifications, staff education, and Vitamin D supplementation. The paper also considers individualized approaches to fall prevention, differentiating between cognitively intact patients who can participate in balance education and those with dementia who require more passive protective measures. It concludes with a call for personalized, multifactor fall-prevention plans in subacute facilities.
The paper models effective evidence synthesis by introducing each intervention type with a specific study, summarizing its methodology and outcome, and then connecting findings across sources to build toward a practical recommendation. This technique — moving from evidence to implication — is central to evidence-based practice writing in health and nursing disciplines.
The paper opens by establishing the prevalence and cost of falls, then moves through a series of intervention types: structured programs, balance and movement training, technology-aided exercises, environmental risk reduction, protective devices for high-risk patients, and nutritional supplementation. It closes with a reflective section integrating the author's clinical experience with the research findings, culminating in a call for individualized care planning. The structure is cumulative, with each section adding a new dimension to the overall argument.
While falling can be dangerous for any individual regardless of their state of health, falls are particularly dangerous for seniors due to elderly patients' greater fragility. Having a serious fall is one of the greatest predictors of future degeneration and fragility for older patients. Although the common image of an elderly fall victim is someone who has "fallen and can't get up" and is lying alone at home, in subacute hospitals falls are reported to occur in between 13% and 32% of admitted patients. In stroke rehabilitation units, falls have been reported in up to 47% of patients. Up to 70% of falls result in injuries, and 1–10% of falls result in fractures as well as long-standing psychological effects for the elderly person (Haines et al., 2004).
Falls are costly for patients and their families in terms of psychological distress, and also for the subacute facility in terms of additional healthcare costs incurred when treating the patient.
One recent study, as reported in the British Medical Journal, found that a specific fall prevention program was extremely helpful in dramatically reducing fall rates. "Participants in the intervention group received a targeted falls prevention programme in addition to usual care. This programme consisted of a falls risk alert card with information brochure, an exercise programme, an education programme, and hip protectors" (Haines et al., 2004). The type of intervention depended upon the patient's specific complaint, level of cognitive impairment, and age. Regardless, all 310 patients who received intervention and care showed a significantly lower rate of falls than the 316 in the control group — a reduction of 30%.
Current research conducted by Dr. Andrea Trombetti of the University Hospitals and Faculty of Medicine of Geneva suggests that many types of educational programs can be helpful for the elderly in preventing falls. The important finding is that an interventional fall-prevention program of some kind is indeed undertaken.
A trial of 134 people with an average age of 75, identified as having notable unsteadiness and being at high risk for falls, received weekly hour-long eurhythmics sessions. Eurhythmics focuses on teaching movement in time to music, having patients "walk and turn around, stay in step with changing tempos, learn to shift their weight and balance, handle objects while walking, and make exaggerated upper-body movements while walking" (Rabin, 2010). Only 24 of the elderly patients in the experimental group experienced falls, versus 54 in the control group, suggesting that intervention of various kinds can have a demonstrable positive effect for the elderly. Despite the small number of participants in the study, the difference between the two groups is significant.
Balance is a skill that can quickly deteriorate with age if not reinforced. In another recent study comparing the balance of healthy elderly volunteers (average age 75) with undergraduates, the older individuals — despite being in good health and exercising an hour a day — fared poorly: "They thought they were in good shape and had good balance. It scared them a bit, frankly, to see how awful their balance really was" compared with younger test subjects (Reynolds, 2010).
After several sessions using a Wii Fit — the popular video exercise system — the older subjects showed significant improvement in their ability to engage in simple balance exercises, such as standing on one foot. After the intervention, the subjects tested eight years "younger" in balance than they had previously. Additionally, "a representative case study published last year found that an 89-year-old woman with a balance disorder and a history of falls significantly improved her scores on a series of balance tests after six sessions of Wii Bowling" (Reynolds, 2010).
Barclay, L. (2003). Vitamin D may reduce falls in elderly nursing home patients. Cochrane Database of Systematic Reviews. Retrieved through Medscape on December 29, 2010, from
Falls in nursing homes. (2010). Centers for Disease Control (CDC). Retrieved December 28, 2010, from
Haines, T. P., Bennell, K. L., Osborne, R. H., & Hill, K. D. (2004). Effectiveness of targeted falls prevention programme in subacute hospital setting: Randomized controlled trial. British Medical Journal, 328(7441), 676.
Houser, J. (2008). Nursing research: Reading, using, creating evidence. Jones & Bartlett.
Rabin, R. C. (2010, November 26). Eurhythmics aids elderly. The New York Times. Retrieved December 28, 2010, from http://www.nytimes.com/2010/11/30/health/research/30aging.html
Reynolds, G. (2010, December 1). Why Wii Fit is best for grandparents. The New York Times. Retrieved December 28, 2010, from http://well.blogs.nytimes.com/2010/12/01/phys-ed-why-wii-fit-is-best-for-grandparents/
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