Falls prevention in older people is a significant issue that requires attention because of its impact on their health and wellbeing. An older adult is defined in this article as someone who is 65 years of age or older (Reis da Silva, 2023a,b; 2024a,b), although it has been debated whether to categorise this age as younger because it is the point at which ageing begins. The ageing population of the UK includes around 12 million individuals who are 65 years of age or older. Over 500 000 are 90 years of age or more, 1.6 million are 85 years of age or older, and 5.4 million are 75 years of age or older (Office for National Statistics, 2018).
The role of nursing in falls prevention is crucial in ensuring the safety and care of older adults (Dahlke et al, 2019; Montero-Odasso et al, 2021; 2022; Reis da Silva, 2023a). Falls among older adults present a pervasive and multifaceted public health challenge globally, impacting individuals, healthcare systems and society at large. This article aims to explore the definition and significance of falls prevention in older people, as well as provide an overview of the role of nursing in this area. It will discuss the prevalence of falls in older adults and the risk factors associated with them.
Falls represent a significant health concern among older adults, with a staggering prevalence worldwide. Individuals over 65 years are predicted to make up 16% of the population by 2050 (Xu et al, 2022; Reis da Silva, 2023a). Because 28–35% of people over 65 years have falls annually, falls are a serious public health concern. An increasing number of people will be at danger of falling as the population ages (Xu et al, 2022; Reis da Silva, 2023a). Physically falling has a negative impact on health in older adults, increasing the risk of disability and death (Xu et al, 2022; Reis da Silva, 2023a). Furthermore, the economic costs associated with falls are significant and are rising globally (Xu et al, 2022). Quality of life (QoL) and ageing trajectory are significantly impacted by the negative effects of falls, such as anxiety, depression and reduced mobility, which are also linked to falls that do not result in injuries (Xu et al, 2022; Reis da Silva, 2023a). Among this cohort, falls are the primary cause of fatal and non-fatal injuries, leading to hospitalisations, fractures, head traumas and significant declines in functional independence. These encompass multifactorial elements such as advancing age, chronic health conditions (eg osteoporosis, cardiovascular diseases), polypharmacy, impaired mobility, sensory deficits, environmental hazards and cognitive impairments. Understanding these risk factors is crucial in formulating targeted prevention strategies (Reis da Silva, 2023a; 2023b).
Nurses play an indispensable role in preventing falls across various healthcare settings (Reis da Silva, 2023a; 2023c). Using comprehensive assessment tools and multifaceted evaluations, nurses can identify individuals at risk and discern the complex interplay of intrinsic and extrinsic factors contributing to falls. This evaluation encompasses detailed medical histories, physical examinations, medication reviews, cognitive assessments and environmental analyses (Reis da Silva, 2023a). Armed with this holistic assessment, nurses design individualised care plans to address identified risk factors. Interventions include exercise regimens, balance training, medication management, and environmental modifications aimed at minimising risks and enhancing safety (Reis da Silva, 2023a). Nurses serve as educators, empowering older adults and caregivers with the knowledge, strategies and resources to mitigate the risks of falling (Reis da Silva, 2023c). Additionally, nurses advocate for safer healthcare environments, collaborate with interdisciplinary teams to rectify environmental hazards and actively participate in policy initiatives aimed at enhancing falls prevention strategies. Nurses' pivotal role in preventing falls cannot be overstated; in the ways mentioned they enhance patient safety and improve the QoL for older adults.
Definition and significance
This section explores the definition and significance of falls prevention in this population. Falls in older adults can lead to devastating physical and psychological consequences, such as fractures, loss of independence and fear of falling (Dahlke et al, 2019; Montero-Odasso et al, 2021; 2022; Reis da Silva, 2023a). There are multiple consequences of a fall, which divides them into two main categories: physical and psychological (Reis da Silva, 2023a) (Table 1). Implementing effective strategies to prevent falls is crucial. This section further examines the overall role of nursing in falls prevention, which includes collaboration with interdisciplinary healthcare teams, education and counselling for older adults and their families, as well as the implementation and evaluation of falls prevention strategies.
| Physical consequences | Psychological consequences |
|---|---|
| Immobility | Feelings of uselessness |
| Incontinence | Increased dependency |
| Cuts, bruises and soft tissue injuries | Emotional stress |
| Fractures and dislocations | Loss of control |
| Respiratory infections | Social isolation/withdrawal |
| Head injuries | Fear of further falls and loss of confidence |
| Dehydration | Low self-esteem |
| Pressure injuries | Embarrassment |
| Hypothermia | Anxiety/depression |
| Death | Carer and family stress |
Source: Care Inspectorate and NHS Scotland, 2016; Cooper, 2017; Reis da Silva, 2023a; 2024b; 2024c
The World Falls Guidelines (WFG) Task Force was established in response to talks held in 2019 among 14 worldwide experts regarding the necessity of updating falls prevention guidelines to take into account emerging data and issues in clinical practise (Montero-Odasso et al, 2021; 2022). The team also developed terminology around falls (Table 2).
| Term | Definition |
|---|---|
| Fall | An unforeseen incident where someone falls to the ground, a floor or a lower level |
| Recurrent | falls At least two falls were recorded in the preceding 12 months. |
| Unexplained fall | After completing a multifactorial falls risk assessment, if no obvious reason for the fall has been identified and it cannot be attributed to an aberration in gait or balance or a failure to adapt to an environmental hazard |
| Severe fall | Fall that causes injuries serious enough to warrant a clinical evaluation; leaves the victim laying on the ground unable to move for at least an hour; necessitates an emergency room visit; connected to unconsciousness |
| Fall related injury | An injury that happened after a fall. This covers any injury that requires medical attention after a fall, such as fractures, joint dislocations, head injuries, sprains or strains, bruising, swelling, lacerations or other significant injuries that require hospitalisation |
Sources: Montero-Odasso et al, 2021; 2022
By understanding the definition, significance and nurses' role in falls prevention, healthcare professionals can work towards ensuring the safety and wellbeing of older adults.
Nurses' role in falls prevention
Nurses are vital in identifying and assessing risk factors and collaborating with interdisciplinary healthcare teams to develop multifactorial interventions, such as exercise programmes, medication management, environmental modifications, and assistive devices and technology (Morilla-Herrera et al, 2016; Montero-Odasso et al, 2021; 2022; Reis da Silva, 2023a; Sherrington et al, 2020).
Nurses educate and counsel older adults and their families, raising awareness about preventing falls and promoting behavioural changes. They play a key role in implementing falls prevention strategies in healthcare settings, ensuring that guidelines are followed and resources are optimised. Furthermore, nurses contribute to the evaluation and monitoring of falls prevention programmes, continuously assessing their effectiveness and making appropriate adjustments as needed (Box 1) (Morilla-Herrera et al, 2016; Montero-Odasso et al, 2021; 2022; Reis da Silva, 2023a).
Community nursing interventions to prevent falls
Comprehensive assessments:
Personalised care plans:
There are, however, challenges and barriers to nurses preventing falls that need to be addressed. Ageism and stereotypes can affect the perception and priority given to falls prevention in older people. Limited awareness and knowledge among healthcare professionals can also hinder effective falls prevention strategies. Constrained resources and funding also pose obstacles to the development and implementation of comprehensive falls prevention programmes (Morilla-Herrera et al, 2016; Montero-Odasso et al, 2021; Reis da Silva, 2023a).
By addressing challenges and working collaboratively with other healthcare professionals, nurses contribute significantly to reducing the incidence and impact of falls in older adults (Ganz and Latham, 2020; Montero-Odasso et al, 2021; 2022; Reis da Silva, 2023a).
Epidemiology
The epidemiology of falls in older people is a significant concern because of its prevalence and associated risks. Various risk factors contribute to the high occurrence of falls in this population, including age-related declines in physical function, chronic conditions (Reis da Silva, 2024b,c), and medication use (Montero-Odasso et al, 2021; Montero-Odasso et al, 2022; Reis da Silva, 2023a). Understanding the epidemiology of falls is crucial for identifying and implementing effective preventive measures, such as educating the individual to maintain an active lifestyle, refering to a physiotherapy and occupational therapy team to customise fitness regimen and promote mobility, and verifying that the walking and mobility aids are sufficient (Reis da Silva, 2023a; 2023c).
The patterns and effects of indoor falls differ from those of outdoor falls. A sedentary lifestyle, more comorbidities, and a higher degree of disability have all been linked to indoor falls (Gazibara et al, 2017). On the other hand, people who lead active lives tend to fall outside more frequently, while they also tend to feel better about their general health than people who lead sedentary lives (Kelsey et al, 2012; Gazibara et al, 2017). Approximately 30% of elderly people worldwide fall at least once a year, and 15% fall twice or more (Peeters et al, 2007; Gazibara et al, 2017). A fall does not always mean that there is an underlying illness, but the effects of falls can put people at risk of negative outcomes. Most falls cause mild to moderate injuries, but 5–10% of elderly people experience hip fractures and wrist injuries that necessitate medical attention in a hospital (Gazibara et al, 2017; Montero-Odasso et al, 2021; 2022; Reis da Silva, 2023a). Falls can also lead to psychological problems including embarrassment and fear of falling again, which affect a person's lifestyle (Nyman et al, 2013; Care Inspectorate and NHS Scotland, 2016; Cooper, 2017; Gazibara et al, 2017; Reis da Silva, 2023a).
The fear of falling should not be underestimated when considering falls in the elderly population (Reis da Silva, 2023a). Among older adults, fear of falling is more common than fear of being robbed in the street or of financial or health issues (Rivasi et al, 2020). Fear of falling is defined as ‘a persistent feeling related to the risk of falling during one or more activities of daily living’ (Kumar et al, 2016; Rivasi et al, 2020; Sherrington et al, 2020; Reis da Silva, 2023a). Fear of falling leads to people avoiding situations, losing one's equilibrium, losing confidence and persistently being afraid of falling (Tinetti et al, 1994; Yardley and Smith, 2002; Gazibara et al, 2017; Montero-Odasso et al, 2021; 2022; Reis da Silva, 2023a). About 60–85% of older individuals who live in the community may experience fear of falling (Niino et al, 2000; Scheffer et al, 2008; Rivasi et al, 2020; Reis da Silva, 2023a), which is acknowledged by 50% of those who fall (Tinetti et al, 1988; 1994; Rivasi et al, 2020). Fear of falling appears to be more common in women and those who have fallen, and it appears to rise with age (Scheffer et al, 2008; Rivasi et al, 2020; Reis da Silva, 2023a). Yet research indicates that as many as 50–60% of those who are afraid have not yet fallen (Rivasi et al, 2020). Furthermore, a number of authors have suggested that an elderly person's fear of falling may be a predictor of future falls (Camargos et al, 2010; Helbostad et al, 2010; Ulus et al, 2012; Gazibara et al, 2017; Montero-Odasso et al, 2021; 2022; Reis da Silva, 2023a).
Prevalence
One in three older adults experiences a fall each year (Kabeshova et al, 2016; Jehu et al, 2021; Montero-Odasso et al, 2022; Reis da Silva, 2023a). Moreover, the prevalence of falls increases with age. Falls can result in serious injuries, such as fractures or head trauma, leading to functional decline, reduced QoL and increased healthcare costs (Jehu et al, 2021; Montero-Odasso et al, 2022; Reis da Silva, 2023a). By acknowledging the extent of the problem, nurses promote the wellbeing of older individuals (Reis da Silva, 2023a).
Risk factors associated with falls in older people
Various risk factors are associated with falls in older people. Jehu et al (2021) discussed that the risk factors could be divided in seven areas of: balance and mobility, environmental, psychological, medical, pharmacological, sensory and neuromuscular, and sociodemographic. More studies will be required to assess the impact of each risk factor after falls. It is conceivable that some of these risk factor domains have a higher risk of recurring falls than others (Lord et al, 2004; Jehu et al, 2021; Montero-Odasso et al, 2022; Reis da Silva, 2023a). It is also possible for extrinsic (eg living situation) and intrinsic (eg biological sex and body mass index [BMI]) factors to mitigate the risk of recurrent falls across each of these seven risk factor domains (Formiga et al, 2008; Jehu et al, 2021; Montero-Odasso et al, 2022). For example, females are more likely to experience repeated falls than males (Gale et al, 2016; Jehu et al, 2021). Low BMI is linked to an increased risk of falling and may be a sign of frailty (Ensrud et al, 2007; Jehu et al, 2021). Because they have less functional freedom, older persons who reside in nursing homes and long-term care institutions are more likely to fall than older adults who live in the community (Gill et al, 2013; Ganz and Latham, 2020; Jehu et al, 2021; Reis da Silva, 2023a; Reis da Silva, 2023b). It is critical to ascertain whether biological sex, BMI and living situation mitigate the attributable risk of repeated falls in order to pinpoint the most vulnerable demographic groups (Jehu et al, 2021).
Conclusion
In conclusion, falls prevention in older people is a critical aspect of healthcare that requires the close involvement of nursing professionals. Falls can lead to various negative outcomes, including physical injuries such as fractures, head trauma and soft tissue injuries (Jehu et al, 2021; Montero-Odasso et al, 2022; Reis da Silva, 2023a). These injuries can result in functional decline, decreased mobility and increased dependence on others for daily activities (Jehu et al, 2021; Montero-Odasso et al, 2022; Reis da Silva, 2023a). Falls also have psychological consequences, including fear of falling again, anxiety (Montero-Odasso et al, 2022; Reis da Silva, 2023a; 2024c). Both physical and psychological effects of falls lead to a reduced QoL. Falls also have economic consequences, as they often lead to hospital admissions, increased healthcare costs and prolonged rehabilitation (Montero-Odasso et al, 2022; Reis da Silva, 2023a). Given the detrimental effects of falls in older adults, nurses play a vital role in falls prevention by implementing strategies such as comprehensive assessments, individualised care plans and interdisciplinary collaboration. By focusing on falls prevention, nurses can help older adults maintain their independence, improve their overall wellbeing and reduce the burden on healthcare systems.