ABSTRACT of different risk assessment methods, the main


The purpose of
this extract is to analyse the factors which may contribute to patients falling
in nursing homes. A research into the rehabilitation in the environment in
which they are living in is helping them to have a better quality of life after
sickness and if previous or current medical conditions may be a cause of
elderly patients falling. Finally, researching if new nursing home technology
is aiding the staff in their work of keeping patients safe. Risk assessments
help the staff and nurses in the homes to evaluate whether the patient is low,
medium or high falls assessment risk.  Producing a risk assessment form and locating
different risk assessments from nursing homes in the local area.

We Will Write a Custom Essay Specifically
For You For Only $13.90/page!

order now


INDEPENDENCE. These are the top priorities for older people living in Irish
nursing homes.” (Hennessey, 2017)

Over the past few
years nursing homes have become a norm in the aging population in Ireland. Many
people feel it is the only option for the elderly. In some cases, patients may
think they are going for rest bite but never get to see their homes again.
Although it may be hard for these patients it can sometimes be the best option
for their safety and wellbeing. New advances in medical technology have made
these places even safer with different tools to aid the care staff and nurses
on helping patients receive the best standard of care to meet the Health
Service Executive (HSE) guidelines.



The literature
review aims to provide an overview of different risk assessment methods, the
main causes of falls in elderly people and the different technologies which are
implemented to prevent falls within the nursing home care environments.



A literature
review was undertaken by searching different databases such as Limerick
Institute of Technology library both in house and online, PubMed and google
scholar. Relative articles in English, were obtained by using term such as
“falls risk assessment for the elderly in nursing care environments” and “falls
prevention strategies for the elderly in nursing care homes”. Different risk
assessment methods were obtained from a local nursing home. These ranged from
smoking risk assessments to falls risk. Most of the articles obtained were
relevant and are discussed in more detail throughout the following extract.



 “A patient presenting with a fall resulting in
a fracture receives both a falls risk assessment and a fracture risk assessment.” ((HSE), 2008)

“A nursing
home is a place for people who don’t need to be in a hospital but who require
more assistance or treatment than is available at home.” (Homes, 2015)  Majority of elderly people end up in nursing homes
because they may no longer need general hospital care, but still need nursing
and medical care. Others may be unable to look after themselves at home or can
no longer be looked after by their immediate family or may not even have
families around them to take the responsibility of their sometimes full time
care. “Ireland’s population is ageing. Today 11% are aged 65
years or over (468,000). Within the next 25 years this will increase to 18% (to
over one million people). The risk of falling increases with age. One in three
older people fall every year and two-thirds of them fall again within six months.
Older people are most likely to suffer serious injuries, disability,
psychological consequences and death following a fall.” ((HSE), 2008). “Figures made
available at the annual conference of the Irish Society of Chartered
Physiotherapists (ISCP) also revealed that 7,000 people over the age of 65 are
admitted to hospital for the treatment of fall-related injuries each year. This
costed an estimated €402 million” (Condon, 2010). Some of these falls
are due to age, impaired mobility, history of falls, balance issue or gait,
medication and many more problems in elderly people which in some cases may be
more severe.

What is a falls risk assessment?

Throughout an
elderly person’s life their mobility becomes much more impaired as their mobility
and overall health decreases. As their journey beings through both hospital and
post hospital care systems many implementations are put in place to prevent any
serious falls which may cause a patient to become bed bound. These are called falls
risk assessment tools which are used in the best interest of the patients,
healthcare staff and their families.

“Falls in the
elderly are often a symptom of acute medical problems in combination with
underlying risks such as medications, postural hypotension and lower extremity weakness.
Identifying those at risk allows targeted assessment and intervention such as a
review of medications and environmental modifications.” (Papioannon, 2004)

“Risk screening
tools estimate a person’s likelihood of falling. They consider a variety of
clinical factors or domains associated with falling that are relevant to the target
population and the setting such as balance and mobility, functional status, continence,
cognitive status, history of falls, medications. These tools have a scoring
mechanism that can predict the individual’s level of risk at low, medium or
high risk of falling.” (V Welch, 2016). Preventing falls
from happening is a major priority within the health system in many countries.
Risk assessment is an essential part of the risk management process. Assessing
a patient’s risk assessment provides an insight to the type equipment and
prevention strategies needed to prevent as little accidents as possible.
Although, there may be actions implemented to prevent these incidents happening
the patient’s medical conditions and the environment in which surrounds them
can sometimes take effect. “Many methods and programmes to prevent such
injuries already exist, including regular exercise, vitamin D and calcium
supplementation, withdrawal of psychotropic medication, cataract surgery,
professional environment hazard assessment and modification, hip protectors,
and multifactorial preventive programmes for simultaneous assessment and
reduction of many of the predisposing and situational risk factors.” (Prof Pekka
Kannus, 2005).
While some patients may be in their right mind within the nursing homes others
may be suffering from Alzheimer’s disease, Dementia, Parkinson’s disease,
chronic pulmonary disease, cancer among other illnesses. For the likes of
patients with these diseases and illnesses the environment in which they are
living in at home may not be safe enough or well-equipped enough for the
person/persons to live alone at home any longer. In these cases, they may end
up in nursing homes as a safer option made by the persons family or by the
person themselves.

A common tool used
to assess falls risk is Falls Risk Assessment Score for the Elderly (F.R.A.S.E)
made by Cannard 1996.

Rehabilitation in the environment

“Rehabilitation is
a key concept in the government’s plans to modernise the NHS. Its aim is to
restore a person’s autonomy, although there are sometimes barriers to making
effective rehabilitation a reality, some of which are explored here, along with
ways of helping teams in nursing homes to undertake more effective
rehabilitation.” (Clay, 2001).

When the patient
enters the nursing home they are cared for any pervious illness in which they
will avail of services such as, physiotherapy, rehabilitation, risk assessments,
regular exercise etc. these services help patients to improve their ability to
walk, keep their balance and help to improve their overall physical and mental health.
“Physiotherapy programmes that improve balance and strength are the key
element in preventing and rehabilitating falls and thus ensuring large
healthcare cost savings. Unfortunately, we know that that when people stop
exercise they will return to their base-line mobility and balance within four
weeks. The bottom line here is that the risk of fall increases significantly
once people stop exercising,” (Shumway-Cook,

“Physical therapy
is treatment that focuses on improving a person’s function, whether it’s
related to bones, joints, muscles or nerves. Typically, a person’s function has
been impaired in some manner because of an injury, wear and tear, or as part of
the aging process. When treating geriatric patients, physical therapists most
often treat functional problems such as pain, balance issues, poor endurance,
trouble walking and poor muscle strength. They also provide patients with
therapeutic programs to retain strength. Occupational therapy is treatment that
focuses on helping a person achieve independence in his or her day-to-day life.
Within the geriatric population, occupational therapists typically focus on a
person’s bathing, dressing, and grooming abilities. Occupational therapists are
trained to identify problems in these areas and make recommendations for
improvement. At times, equipment recommendations are made including rolling
walkers, tub benches, commodes and adaptive eating utensils.” (Jacobs, 2017)

Age related changes that contribute to the increase of
falls and its severity of injury

Medical conditions
and age related changes can be a huge factor for risk assessments being
produced, these can be in different forms and each has a specific purpose for
each medical condition/ illness. (See Appendices). As the focus of this is on
elderly people the main medical conditions for the elderly people are the focus,
these include;

Parkinson’s disease- “Parkinson’s disease (PD) is a neurodegenerative
disorder that affects predominately dopamine-producing (“dopaminergic”) neurons
in a specific area of the brain called substantia nigra.” (Elkouzi, 2017). “As your
Parkinson’s progresses, your posture can change – you may become more stooped
and your muscles may become more rigid. Having muscles that are less flexible can
increase your risk of falling. It’s more difficult for your body to move and
for you to protect yourself if you lose your balance.” (Parkinsons.org.uk, 2013). “Falling and loss
of balance are common problems for people living with Parkinson’s. These
problems develop over time as the condition progresses. For some people falling
may be a daily occurrence and may even occur several times in one day.” (Austrailia, 2015)

Alzheimer’s/Dementia- “Alzheimer’s is the most common form of dementia, a
general term for memory loss and other cognitive abilities serious enough to
interfere with daily life. Alzheimer’s disease accounts for 60 to 80 percent of
dementia cases.” (Association, 2017). “Dementia is an
independent risk factor for falling. Although most falls do not result in
injury, the fact that residents with dementia fall more often than their
counterparts without dementia leaves them with a higher overall risk of
sustaining injurious falls over time. Nursing home residents with dementia
should be considered important candidates for fall-prevention and
fall-injury-prevention strategies.” (Carol van Doorn, 2003)


Arthritis affects
majority of elderly people throughout their lives and can be a huge risk factor
in falling as patient’s mobility is reduced immensely and usually results in
the patients needing walking aids, such as walking stick and frames. In some
cases, if physical therapy begins soon after the diagnosis the speed in which
the disease develops can be slowed. Arthritis is a disease which causes
inflammation of the joints, there are over 100 forms of Arthritis for most
sufferers it can be extremely painful and can impact on their daily lives.

Cardiovascular System

Over the years,
the elasticity of the heart muscles degenerates causing a reduction in the
contractility of the heart, resulting in a reduction in stroke volume and
cardiac reaction.

Central Nervous System

Responses from the
brain to the central nervous system become slower due to an increase in space
surrounding the brain. This causes the messages taking longer to reach certain
parts of the body which can bring an increase in falls. Dural veins can become
fragile and inelastic, causing an increased risk of subdural haematomes.

Musculoskeletal System

Elderly people’s
bones become more fragile due to a weakened inner matrix in the bones. This can
lead to a tendency for osteoporosis to develop. This can be caused due to the
lack of physical activity, which can reduce bone strength and result in serious

Integumentary System

The skin becomes
thinner and more fragile due to the loss of the protective subcutaneous layer
of fat being lost. This results in the skin tearing quicker and more severe.
These severe tears can result in an increased risk of wound infection, which
hinders the immune systems response to antibodies.

Respiratory System

The muscle
strength in the chest becomes decreased and leads to breath becoming short and
rapid. This can result in an increased risk of chest problems including
kyphosis. There is also an increased risk of falls due to problems in the
respiratory system causing immobility following falls. (Jones D, 2011)



Nursing home technology and prevention

techniques are becoming more and more important in these environments as
technology is on the rise. Many different initiatives have become available to
prevent these falls happening.  

“Methods of preventing
falls in the elderly have improved greatly over the years, and technology and
fall management strategies in hospitals and nursing homes have all contributed
to improve care of patients, residents and family members at risk of a fall. One
of the main improvements in technology has been to give carers and nurses
“advanced warning” when there is a risk of a fall. This is commonly
when a person at risk of falling leaves their bed or chair. The latest bed
sensor mats and chair sensors are able to alert the carer or nursing staff or
indeed warn the person themselves to stay where they are until assistance
arrives.” (Technologies, 2015)

Bed Sensors – a sensor mat is placed under the bed occupant or
under the mattress. Sensors located within the mat identify when the occupant
is about to leave the bed and alerts the carer. The nurse or carer can be
notified in a number of ways including an audible alarm, a radio pager or by
connecting to a nurse call system.

Chair Sensors – as with the bed sensor only the mat is placed below
the chair occupant and are also use-able in wheel chairs.

PIR Sensors – a sensor is placed in a particular location, often
at exit points of a room or building. When the sensor beam is broken the carer
or nurse is notified as described under bed sensor.

sensors can be connected to a range of monitors including a friendly voice
reminder – e.g. “stay in bed John, I’m on my way” and can be
programmed to only send an alert when someone does not return to their bed
within a pre-determined time. This feature is particularly helpful for anyone
who regularly visits the bathroom during the night.” (Technologies, 2015)

Bed exit alarms

“Bed alarm systems
are built to detect a person making attempt to get out of bed thereby making it
easy for the caregiver to monitor them closely and prevent unguided movements that
could lead to falls. Major identified requirements for an optimized bed-exit alarm
system were usability, wide range usage, low costs, hygiene factors,
integration into nursing beds and nurse call systems and an adequate
alarm/false alarm ratio with early alarm trigger functionality.” (Ademola, 2014)