Nursing care related to fall prevention among hospitalized elderly people: an integrative review

Sena, Adnairdes Cabral de; Alvarez, Angela Maria; Nunes, Simony Fabíola Lopes; Costa, Nadia Pinheiro da

doi:10.1590/0034-7167-2020-0904

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 74 (Suppl 2) • 2021 • https://doi.org/10.1590/0034-7167-2020-0904 copy

Nursing care related to fall prevention among hospitalized elderly people: an integrative review

Atención de enfermería relacionada con la prevención del riesgo de caídas en ancianos hospitalizados: una revisión integradora

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to identify scientific productions on nursing care related to fall risk prevention among hospitalized elderly people.

Methods:

an integrative literature review from 2015 to 2019 in the PubMed/MEDLINE, Scopus, Web of Science, LILACS, BDENF, SciELO and CINAHL databases, in Portuguese, English and Spanish. The keywords were elderly, hospitalization, accidents due to falls, nursing care.

Results:

thirty-three publications were analyzed. The synthesis of the studies resulted in the categories: Clinical nursing assessments to prevent falls among hospitalized elderly people; Fall risk factors for elderly people; Fall risk prevention strategies for elderly people.

Final considerations:

it was found that the scientific knowledge produced on nursing care related to fall risk prevention for hospitalized elderly people evidences the clinical assessment, risk factors and strategies such as nursing care, contributing to foster self-care behavior and promotion security for elderly people.

Descriptors:
Aged; Hospitalization; Accidental Falls; Nursing Care; Review

Authors year/ country	Design	Objective	Main results	Thematic content
Royset et al. 2019⁽¹⁰10 Royset B, Talseth-Palmer BA, Lydersen S, Farup PG. Effects of a fall prevention program in elderly: a pragmatic observational study in two orthopedic departments. Clin Interv Aging. 2019;14:145-54. https://doi.org/10.2147/CIA.S191832 https://doi.org/10.2147/CIA.S191832... ⁾ Norway	Quantitative study n= 3,143	To assess the effects of fall prevention program on reducing its rate on patient safety culture.	The fall prevention program showed no significant effect on the rate of falls.	Fall risk factors.
Fridman 2019⁽¹¹11 Fridman V. Redesigning a fall prevention program in acute care: building on evidence. Clin Geriatr Med. 2019;35(2):265-71. https://doi.org/10.1016/j.cger.2019.01.006 https://doi.org/10.1016/j.cger.2019.01.0... ⁾ United States of America	Qualitative study	To decrease falls and promote patient safety, health and comfort.	Current practices should be redesigned to ensure that fall prevention and acute care initiatives are consistent and transformational.	Clinical assessment and fall prevention.
Yamashita et al. 2019⁽¹²12 Yamashita T, Yamashita K, Rinoie C, Takase Y, Sato M, Yamada K, et al. Improvements in lower-limb muscle strength and foot pressure distribution with foot care in frail elderly adults: a randomized controlled trial from Japan. BMC Geriatr. 2019;19(83):2-9. https://doi.org/10.1186/s12877-019-1097-z https://doi.org/10.1186/s12877-019-1097-... ⁾ Japan	Quantitative study n=180	To investigate changes in the strength of the feet, knees and the distribution of pressure in the feet.	Care for feet and toenails can improve lower limbs muscle strength, decrease fall risk and distribute foot pressure.	Fall risk factors.
Bolton 2019⁽¹³13 Bolton L. Preventing fall injury. Wounds[Internet]. 2019 [cited 2020 Jul 27];31(10):269-71. Available from: https://pubmed.ncbi.nlm.nih.gov/31730506/ from: https://pubmed.ncbi.nlm.nih.gov/31... ⁾ United States of America	Quantitative study n= 401	To determine the cost-effectiveness of a hospital fall prevention program.	At least 4% of cognitively intact patients fell into the ward under the normal conditions of care.	Fall risk factors.
Toye et al 2019⁽¹⁴14 Toye C, Slatyer S, Kitchen S, Ingram K, Bronson M, Edwards D, et al. Bed moves, ward environment, staff perspectives and falls for older people with high falls risk in an acute hospital: a mixed methods study. Clin Interv Aging. 2019;14:2223-37. https://doi.org/10.2147/CIA.S211424 https://doi.org/10.2147/CIA.S211424... ⁾ Australia	Quantitative and qualitative study n=486	To investigate the association between multiple movements and bed falls during hospitalization of elderly patients.	Patients with high fall risk admitted to the hospital are at increased risk of fall.	Fall risk factors.
Souza et al. 2019⁽¹⁵15 Souza AB, Maestri RN, Röhsig V, Lorenzini E, Alves BM, Oliveira D, et al. In-hospital falls in a large hospital in the south of Brazil: a 6-year retrospective study. Appl Nurs Res. 2019;48:81-7. https://doi.org/10.1016/j.apnr.2019.05.017 https://doi.org/10.1016/j.apnr.2019.05.0... ⁾ Brazil	Quantitative study n=1,071	To describe in-hospital falls reported in a large hospital in southern Brazil.	Fall prevention strategies focus on patients hospitalized patients in hospitalization units aged 60 years or older, assessed as high risk for falls.	Fall prevention strategies.
Ferreira et al. 2019⁽¹⁶16 Ferreira TCB, Santana RF, Carmo TGS, Souza MV, Souza, LSM. Instrumentos para avaliação do uso de grades laterais do leito: segurança ou contenção? Nurs [Internet]. 2019 [cited 2020 Jul 29];22(254):3052-9. Available from: http://www.revistanursing.com.br/revistas/254/pg35.pdf http://www.revistanursing.com.br/revista... ⁾ Brazil	Integrative review	To identify the instruments for evaluating the use of siderails in hospitalized patients.	Four articles using the same instrument, Assessment of Siderail Use, were selected, with a detailed approach to the assessment of patients regarding the use of siderails, discussing alternative interventions for the use of siderails that should be adapted to individual needs.	Fall prevention strategies.
Cunha et al. 2019⁽¹⁷17 Cunha LFC, Baixinho CL, Henriques MA. Preventing falls in hospitalized elderly: design and validation of a team intervention. Rev Esc Enferm USP. 2019;53:e3479. https://doi.org/10.1590/S1980-220X2018031803479 https://doi.org/10.1590/S1980-220X201803... ⁾ Portugal	Quantitative-qualitative study n=18	To design and validate a team intervention.	It allowed to validate the intervention of the team by panel of experts, so that the teams can manage the fall risk in hospitalized elderly patients.	Fall risk factors.
Wong and Pang 2019⁽¹⁸18 Wong MMC, Pang PF. Factors associated with falls in psychogeriatric inpatients and comparison of two fall risk assessment tools. East Asian Arch Psychiatry [Internet]. 2019 [cited 2020 Jul 29];29(1):10-4. Available from: https://easap.asia/abstracts/v29n1/1901_V29N1_p10a.html https://easap.asia/abstracts/v29n1/1901_... ⁾ China	Quantitative study n=123	To investigate factors associated with falls in psychogeriatric patients.	Patients with dementia and women had higher fall risk.	Fall prevention strategies.
Dolan and Taylor-Piliae 2019⁽¹⁹19 Dolan H, Taylor-Piliae R. Selecting a theoretical framework to guide a research study of older adults' perceptions and experiences of falling in the hospital. Appl Nurs Res. 2019;47:38-40. https://doi.org/10.1016/j.apnr.2019.04.004 https://doi.org/10.1016/j.apnr.2019.04.0... ⁾ United States of America	Theoretical reflection study	To describe the process of selecting a theoretical framework.	The Health Belief Model was selected as the theoretical framework.	Fall risk factors.
Falcão et al. 2019⁽²⁰20 Falcão RMM, Costa KNFM, Fernandes MGM, Pontes MLF, Vasconcelos JMB, Oliveira JS. Risk of falls in hospitalized elderly people. Rev Gaúcha Enferm. 2019;40(N.Esp.):1-8. 22. https://doi.org/10.1590/1983-1447.2019.20180266 https://doi.org/10.1590/1983-1447.2019.2... ⁾ Brazil	Quantitative study n= 284	To assess fall risk in hospitalized elderly people.	The use of specific tools in fall prevention allows the improvement of the quality of care based on scientific evidence.	Clinical assessment and fall prevention.
LeLaurin and Shorr 2019⁽²¹21 LeLaurin JH, Shorr R. Preventing falls in hospitalized patients: state of the science. Clin Geriatr Med. 2019; 35(2):273-283. https://doi.org/10.1016/j.cger.2019.01.007 https://doi.org/10.1016/j.cger.2019.01.0... ⁾ United States of America	Literature review	To analyze the drawings of common studies and the evidence of various hospital interventions of fall prevention.	There is an urgent need for well-designed research on the theme of hospital fall prevention.	Clinical assessment and fall prevention.
Chan et al. 2019⁽²²22 Chan EY, Hong MLI, Tan MYHG, Chua WL. Older patient´s participation in physical activity during hospitalization: a qualitative study of ward nurses´ perceptions in an Asian context. Geriatr Nurs. 2019;40(1):91-8. https://doi.org/10.1016/j.gerinurse.2018.07.002 https://doi.org/10.1016/j.gerinurse.2018... ⁾ Singapore	Qualitative study n=30	To explore the perceptions of nurses about their participation in the physical activity of elderly patients.	Culturally appropriate strategies at the organizational and individual levels are necessary to reinvigorate nurses and optimize participation in physical activity.	Fall risk factors.
Kiyoshi-Teo et al. 2019⁽²³23 Kiyoshi-Teo H, Northrup-Snyder K, Cohen DJ, Dieckmann N, Stoyles S, Winters-Stone K, et al. Older hospital inpatients' fall risk factors, perceptions, and daily activities to prevent falling. Geriatr Nurs. 2019;40(3):290-5. https://doi.org/10.1016/j.gerinurse.2018.11.005 https://doi.org/10.1016/j.gerinurse.2018... ⁾ United States of America	Documentary research	To identify associations between risk factors, perceptions and daily activities of patients.	Address measures, include validated tools, and modified fall behavioral scale in a patient-centered way, such as daily perceptions and activities. These actions prevent patients from falls.	Fall prevention strategies.
Grealish et al. 2019⁽²⁴24 Grealish L, Chaboyer W, Darch J, Real B, Phelan M, Soltau D, et al. Caring the person with cognitive impairment in hospital: qualitative analysis of nursing personnel reflections on fall events. Clin Nurs. 2019;28(7-8):1346-53. https://doi.org/10.1111/jocn.14724 https://doi.org/10.1111/jocn.14724... ⁾ Australia	Qualitative study n=17	To explore reflections of nurses and nursing assistants about the care of elderly patients with cognitive impairment who suffered a fall.	Participants knew the policy and techniques available to prevent falls, but their implementation was challenging due to the complexity of care required by elderly people with cognitive impairment.	Clinical assessment and fall prevention.
Smith et al. 2018⁽²⁵25 Smith T, Clark A, Dodd E, Khoo ME, Heneker S, Cross J, et al. Feasibility study suggests no impact from protected engagement time on adverse events in mental health wards for older adults. Int J Ment Health Nurs. 2018;27(2):756-764. https://doi.org/10.1111/inm.12362 https://doi.org/10.1111/inm.12362... ⁾ Australia	Quantitative study n=653	To determine whether patients' time in care resulted in lower adverse events and incidents when compared to patients admitted to mental health wards of elderly people.	The characteristics of the reported adverse events appeared similar and there seems to be no substantial difference between the wards that entered the study.	Fall prevention strategies.
Shyu et al. 2018⁽²⁶26 Shyu ML, Huang HC, Wu MJ, Chang HJ. Development and validation of the self-awareness of falls in elderly scale among elderly inpatients. Clin Nurs Res. 2018;27(1):105-20. https://doi.org/10.1177/1054773817714663 https://doi.org/10.1177/1054773817714663... ⁾ China	Quantitative study n=600	To develop the Self-Awareness scale of Falls in the Elderly (SAFE) and test its reliability.	Combining the SAFE scale with other fall assessment tools can help the care team effectively assess the self-awareness of fall risk.	Fall prevention strategies.
Oliveira et al. 2018⁽²⁷27 Chaves BJP, Oliveira JS, Rodrigues MMP, Falcão RMM, Souza SVO, Carvalho EAS, et al. Fatores extrínsecos para risco de quedas de idosos hospitalizados. Rev Enferm UFPE. 2018;12(7):1835-40. https://doi.org/10.5205/1981-8963-v12i7a231271p1835-1840-2018 https://doi.org/10.5205/1981-8963-v12i7a... ⁾ Brazil	Quantitative study n= 424	To identify extrinsic factors favorable to the occurrence of falls of hospitalized elderly patients.	Knowing the profile of elderly people and extrinsic factors will enable health professionals to identify the risks and provide safe care.	Fall risk factors.
Oliveira et al. 2017⁽²⁸28 Oliveira DU, Ercole FF, Melo LS, Matos SS, Campos CC, Fonseca EAM. Avaliação de quedas em idosos hospitalizados. Rev Enferm UFPE. 2017;11(suple):4589-97. https://doi.org/10.5205/reuol.11138-99362-1-SM.1111sup201707 https://doi.org/10.5205/reuol.11138-9936... ⁾ Brazil	Quantitative study n=96	To assess the occurrence of fall in hospitalized patients who presented high risk for the event.	Falls are directly linked to patient safety indicators, and a multidisciplinary and interdisciplinary approach is necessary.	Clinical assessment and fall prevention.
Victor et al. 2017⁽²⁹29 Victor MAG, Luzia MF, Severo IM, Almeida MA, Goes MGO, Lucena AF. Quedas em pacientes cirúrgicos: subsídios para o cuidado de enfermagem seguro. Rev Enferm UFPE. 2017;11(Supl.10):4027-35. https://doi.org/10.5205/reuol.10712-95194-3-SM.1110sup201704 https://doi.org/10.5205/reuol.10712-9519... ⁾ Brazil	Quantitative study n=70	To describe the adverse fall event in patients hospitalized in surgical units.	Nurses should be aware of risk factors to intervene and prevent events.	Fall risk factors.
Durán et al. 2017⁽³⁰30 Durán ER, Camarero GFR, Martínez-Esparza EH. Incidencia y características de las caídas en un hospital de cuidados intermedios de Barcelona. Gerokomos [Internet]. 2017[cited 2020 Jul 29];28(2):78-82. Available from: http://scielo.isciii.es/pdf/geroko/v28n2/1134-928X-geroko-28-02-78.pdf http://scielo.isciii.es/pdf/geroko/v28n2... ⁾ Spain	Descriptive, observational and retrospective study n=99	To determine the incidence and characteristics of falls in elderly hospitalized.	Nursing interventions in the HSPV were oriented towards strengthening fall prevention in patients with cardiovascular pathology and in polymedicated patients.	Clinical assessment and fall prevention.
Kobayashi et al. 2017⁽³¹31 Kobayashi K, Ando K, Inagaki Y, Suzuki Y, Nagao Y, Ishiguro N, et al. Measures and effects on prevention of fall: the role of a fall working group at a university hospital. Nagoya J Med. Sci. 2017;79:497-504. https://doi.org/10.18999/nagjms.79.4.497 https://doi.org/10.18999/nagjms.79.4.497... ⁾ Japan	Quantitative study n=212,617	To examine fall prevention due to fall work group intervention established in hospital.	The decrease in patients at risk of grade 3 did not decrease, but increased; on the other hand, the decrease in grade 1 and 2 patients decreased, suggesting that better information sharing is needed for patients with high fall risk.	Clinical assessment and fall prevention.
Esparza-Bohórquez et al. 2017⁽³²32 Esparza-Bohórquez M, Granados-Oliveros LM, Serrano-Sanmiguel E, Peñaloza-Jaimes S. Prevención de caídas y lesiones derivadas en adultos mayores hospitalizados: experiencia de cuidado de enfermería de la aplicación de una guía de buenas prácticas en la Fundación Oftalmológica de Santander. MedUnab. 2017;20(2):174-81. https://doi.org/10.29375/01237047.3246 https://doi.org/10.29375/01237047.3246... ⁾ Colombia	Quantitative study N=2,387	To reduce falls in the old people in hospitalization services.	The implementation of evidence-based nursing guides generates a positive effect on the quality of care, obtaining results that affect the health and well-being of patients.	Clinical assessment and fall prevention.
Hill et al. 2016⁽³³33 Hill AM, Nicholas W, Francis-Coad J, Haines T, Etherton-Beer C, Flicker L, et al. 'It Promoted a Positive Culture Around Falls Prevention': staff response to a patient education programme-a qualitative evaluation. BMJ Open. 2016;6(12):1-7. https://doi.org/10.1136/bmjopen-2016-013414 https://doi.org/10.1136/bmjopen-2016-013... ⁾ Australia	Qualitative study n=30	To understand how the team responded to individualized education for fall prevention of patients.	Providing individualized education to elderly patients with good levels of cognition can empower the team.	Clinical assessment and fall prevention.
Mazur et al. 2016⁽³⁴34 Mazur K, Wilczyński K, Szewieczek J. Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors. Clin Interv Aging. 2016;14(11):1253-61. https://doi.org/10.2147/CIA.S115755 https://doi.org/10.2147/CIA.S115755... ⁾ Poland	Quantitative study n=788	To assess the factors associated with falls in geriatric patients after the implementation of the fall prevention program.	Delirium, history of falls and advanced age seem to be the main risk factors for geriatric falls.	Clinical assessment and fall prevention.
Meuleners et al. 2016⁽³⁵35 Meuleners LB, Fraser ML, Bulsara MK, Chow K, Jonathon QN. Risk factors for recurrent injurious falls that require hospitalization for older adults with. dementia: a population based study. BMC Neurol. 2016;16(1):1-8. https://doi.org/10.1186/s12883-016-0711-3 https://doi.org/10.1186/s12883-016-0711-... ⁾ Australia	Quantitative study n=32,519	To identify risk factors for recurrent harmful falls that require hospitalization in adults over 60 years of age with dementia.	Screening those with dementia for the history of harmful falls could help identify those with higher fall risk.	Fall risk factors.
Oliveira et al. 2016⁽³⁶36 Oliveira DM, Hammerschmidt KSA, Schoeller SD, Girondi JBR, Bertoncello KCG, Paula Jr NF. Instrumento de avaliação de quedas em idosos hospitalizados (IAQI HOSPITALAR): enfermeiro analisando vulnerabilidade e mobilidade. Rev Enferm UFPE. 2016;10(11):4065-74. https://doi.org/10.5205/1981-8963-v10i11a11491p4065-4074-2016 https://doi.org/10.5205/1981-8963-v10i11... ⁾ Brazil	Qualitative study	To develop an instrument to assess the vulnerability of hospitalized elderly people in relation to falls.	The instrument for assessing falls in hospitalized elderly people is additional in the work process.	Clinical assessment and fall prevention.
Latt et al. 2016⁽³⁷37 Latt MD, Loh KF, Ge L, Hepworth A. The validity of three fall risk screening tools in an acute geriatric inpatient population. Australas J Ageing. 2016;35(3):167-73. https://doi.org/10.1111/ajag.12256 https://doi.org/10.1111/ajag.12256... ⁾ Australia	Quantitative study n=217	To examine the validity of Ontario Modified STRATIFY (OM).	Screening tools have limited accuracy in identifying patients with high fall risk.	Clinical assessment and fall prevention.
Said et al. 2016⁽³⁸38 Said CM, Batchelor F, Shaw K, Blennerhassett J. Preparing patients at high risk of falls for discharge home after rehabilitation: do we meet the guidelines? Geriatr Gerontol Int. 2016;16(5):570-6. https://doi.org/10.1111/ggi.12511 https://doi.org/10.1111/ggi.12511... ⁾ Australia	Quantitative study n= 121	To determine whether patients hospitalized in rehabilitation with high fall risk receive adequate assessment, management and care.	There was little evidence that people with high fall risk received systematic assessment of fall risk during rehabilitation.	Clinical assessment and fall prevention.
Fernandes et al. 2015⁽³⁹39 Fernandes APNL, Araújo AKC, Botarelli FR, Araújo JMN, Ferreira Jr MA, Vitor AL. Risco de quedas e a saúde do homem: desafios do cuidado na internação hospitalar. Rev Enferm UFPE[Internet]. 2015[cited 2020 Jul 23];9(10):9541-9. Available from: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/10899 https://periodicos.ufpe.br/revistas/revi... ⁾ Brazil	Quantitative study n=59	To characterize the fall risk in elderly men hospitalized in a hospital environment.	Risk factors for fall related to clinical, physiological, environmental, cognitive and drug conditions were identified.	Fall risk factors.
Vass et al. 2015⁽⁴⁰40 Vass C, Edwards C, Smith A, Sahota O, Drummond A. What do patients wear on their feet? A service evaluation of footwear in elderly patients. Int J Ther Rehabil. 2015;22(5):21-28. https://doi.org/10.12968/ijtr.2015.22.5.225. https://doi.org/10.12968/ijtr.2015.22.5.... ⁾ England	Qualitative study n= 675	Assessment of the service to examine and describe the style and quality of footwear used by elderly patients in the hospital.	It was found that 46% of hospitalized elderly people use slippers and 60% of the shoes have moderate to excessive wear, not promoting stability or ideal gait for elderly people.	Fall risk factors.
Abreu et al. 2015⁽⁴¹41 Abreu HCA, Reiners AAO, Azevedo RCS, Silva AMC, Abreu DROM, Oliveira AD. Incidência e fatores preditores de quedas de idosos hospitalizados. Rev Saúde Pública. 2015;49(37):1-9. https://doi.org/10.1590/S0034-8910.2015049005549 https://doi.org/10.1590/S0034-8910.20150... ⁾ Brazil	Quantitative study n=221	To estimate the incidence and predictors associated with falls in elderly patients.	Predictors such as educational level, polypharmacy, visual impairment, gait and balance impairment, urinary incontinence and use of laxatives and antipsychotics predispose to fall.	Fall risk factors.
Hill et al. 2015⁽⁴²42 Hill AM, McPhail SM, Francis-Coad J, Waldron N, Etherton-Beer C, Flicker L, et al. Educators perspectives about how older hospital patients can engage in a falls prevention education programme: a qualitative process evaluation. BMJ Open. 2015;5:1-8. https://doi.org/10.1136/bmjopen-2015-009780 https://doi.org/10.1136/bmjopen-2015-009... ⁾ Australia	Qualitative study n=10	To explore educators' perspectives of providing education.	Individualized fall prevention education effectively provides patients who receive the ability and motivation to develop and undertake behavioral strategies that reduce their falls.	Fall risk factors.

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[1] Corresponding author: Adnairdes Cabral de Sena adnairdes-13@hotmail.com