ABSTRACT
Although approximately 50% of nursing home residents fall annually, the surrounding circumstances remain inadequately understood. This study explored nursing staff perspectives of person, environment, and interactive circumstances surrounding nursing home falls. Focus groups were conducted at two nursing homes in the mid-Atlantic region with the highest and lowest fall rates among corporate facilities. Two focus groups were conducted per facility: one with licensed nurses and one with geriatric nursing assistants. Thematic and content analysis revealed three themes and 11 categories. Three categories under the Person theme were Change in Residents' Health Status, Decline in Residents' Abilities, and Residents' Behaviors and Personality Characteristics. There were five Nursing Home Environment categories: Design Safety, Limited Space, Obstacles, Equipment Misuse and Malfunction, and Staff and Organization of Care. Three Interactions Leading to Falls categories were identified: Reasons for Falls, Time of Falls, and High-Risk Activities. Findings highlight interactions between person and environment factors as significant contributors to resident falls.
Subject(s)
Accidental Falls/statistics & numerical data , Attitude of Health Personnel , Health Facility Environment/organization & administration , Nursing Assistants/psychology , Nursing Homes/organization & administration , Nursing Staff/psychology , Accidental Falls/prevention & control , Aged , Environment Design , Female , Focus Groups , Geriatric Assessment , Health Status , Humans , Interior Design and Furnishings , Male , Mid-Atlantic Region/epidemiology , Middle Aged , Nursing Assessment , Nursing Assistants/organization & administration , Nursing Methodology Research , Nursing Staff/organization & administration , Risk Assessment , Risk Factors , Time FactorsABSTRACT
The assisted living housing option for older adults with limitations in activities of daily living presents a problem with medication administration. The purpose of this project was to expand the functions of the unlicensed caregivers in Group Senior Assisted Housing (GSAH) in Maryland. The caregivers and the GSAH providers or managers completed a 16-hour medication administration training program. Additionally, an oversight program using a delegating registered nurse (DRN) was established. The DRN verified the learning of the unlicensed caregivers, delegated medication administration (not including injections), and monitored this new care practice. Completion rate of the training program was 89% (N = 176). A high school education was significant in being successful. The oversight by the DRN was positively received by the caregivers, and it was clear that this was an essential part of the program. The project led to the first statewide regulations related to medication administration in assisted living.
Subject(s)
Assisted Living Facilities , Inservice Training/methods , Medication Systems/organization & administration , Nursing Assistants/education , Aged , Aged, 80 and over , Curriculum , Female , Health Plan Implementation , Humans , Male , MarylandABSTRACT
BACKGROUND: Although fall prevention studies for the elderly have been reported, there is a paucity of work summarizing the effectiveness of these interventions. OBJECTIVES: The research question that guided this study was: 'What are the effects of fall prevention programs on the proportion of falls in the elderly?" METHOD: Meta-analysis was employed to summarize findings of intervention studies of fall prevention in the elderly involving a comparison group and a quantifiable outcome. Studies were reviewed by two of the authors with the eligibility criteria in mind. Studies were then coded and an inter-rater reliability check was performed. RESULTS: The overall mean weighted effect size for the 12 studies included in the meta-analysis was .0779 (Z = 5.03, p < .001). For fall prevention intervention types, exercise alone had a mean weighted effect size of .0220 (Z = .5303, p > .5), exercise and risk modification had a mean weighted effect size of .0687 (Z = 3.41, p < .001), and comprehensive risk assessment intervention studies had an effect size of .1231 (Z = 3.97, p < .001). The mean weighted effect size size for community-based studies was .0972 (Z = 5.37, p < .001) and for institution-based studies was .0237 (Z = .7822, p = .22). Time to outcome measure analyses revealed that the mean weighted effect size for studies measuring proportion of falls at 12 months was .0905 (Z = 5.43, p < .001), and those measuring at four months or less was -.0972 (Z = -.005, p > .50). CONCLUSIONS: The results of this meta-analysis indicate that there was a 4% decrease in the rate of falls for individuals who were in the treatment groups receiving various fall prevention interventions. Additional intervention studies need to be conducted in the elderly population with a goal of preventing falls.
