Fall Prevention in Dementia Population in Aged Care Facilities - Management Assignment Help

Assignment Task

Title- Fall prevention in dementia population in aged care facilities

1. Introduction The issue of fall is a serious health related concern when it comes to older population. This will have a strong negative effect on the overall standard of life of the person affected from the same. fall can also lead to complicated fractures and even traumatic brain injuries (Allali et al., 2017). This not only add to the medical cost of the treatment, but also impacts in the physical and emotional well-being of the person. However, there are multiple reasons for fall in elderlies, this condition is based on multifactorial presentation ((Iaboni et al., 2017). Fall can be linked to the patient and even the environment. Both of these factors play a risk factor, especially when the person is suffering from any other medical impairment (Allali, et al., 2017). Some other issues that conclude to falling, include advancing age, cognitive impairments, reduced lower limb strength and multiple comorbidities as well (Groot et al., 2016).

Impact of dementia
Dementia on the other hand is syndrome which is chronic and progressive in nature. The condition is mainly observed to manifest in advancing age and has a progressively deteriorating impact on the overall well-being of the patients. It is also marked with patient having severe deterioration in cognitive function, which hinders with their ability to make a sound decision. Apart from cognition, dementia is observed to have a negative impact on the memory of the person, their pattern of thinking, their mental orientation, and their learning as well as generally judgment capacity (Goren et al., 2016). The process of ageing is inevitable and is marked with multiple physical as well as mental impairments. This condition also has a direct impact on the overall behavioural pattern of the patient. It can be a challenging condition for both patients and their family members as the patient suffers from lack of emotional control as well as social control. The prevalence of condition of dementia is on higher rate in elderly population as compared to the younger age group. Thus, collective impairments of dementia and advancing age can bring about an increased distress for the patients and their family members (Cheng, 2017). In most cases of advanced dementia, the person is required to be admitted to a care facility for further treatment and management. This is required in many cases as dementia is marked by variety of other diseases and injuries related to the condition. This can be bifurcated into primary and secondary impacts of the dementia. Primary impacts might include, fear, depression, despair and even grief for some patients. Whereas secondary impact includes long-term effects on the person (Goren et al., 2016).. This can be inclusive of manifestation of other medical comorbidities, such as stroke, Alzheimer’s and risk of fall in older patients.

Incidence of fall in dementia
Residents falling is one of the main consequences for people suffering from dementia. This is mainly due to various contributing risk factors. Patients suffering from dementia have a higher chance to develop depression. Therefore, they might lose track of time and place. They might not be able to recognize the similar setting and can get confused quite easily. With dementia comes potential memory loss for the patient. Thus, they might not be able to relate well within their close niche as well. This confusion might cause them to trip and fall, if they do not recall the place that well (Lach et al., 2017). There are other physiological limitations that comes along with dementia. This is generally observed in hampered vison, lowered blood pressure, restricted mobility, abrupt cognition and balance and many other deficits. These impairments can add to the risk of the patient falling and possibly injuring themselves, as they might lack the judgment to comprehend the situation. Patients suffering from dementia are also being managed with multiple medications, which makes them drowsy and include side effects to the patient. Due to prolonged use of these medications, the patient might trip and fall due to unconscious state of being (Tsuda, 2017). Therefore, it can be considered that the gravity of fall is higher in patients with dementia due to advanced age and physiological limitations caused by the disease (Tsuda, 2017).
Role of education in prevention of fall in dementia

Multidisciplinary approach should be used for fall prevention, which is required to fabricate and promote a secure environment for the patients. There might be evidence pointing out towards lack of education amongst healthcare workers on the impact of fall on patients and preventive measures, that can be followed to lower these incidences (Chu, 2017). Educational measures can be of various types. It can be either in the form of educational pamphlet, or in the form of educational session used for imparting awareness to the care delivery staff in residential care settings. There is a dire need of the same as residential care settings might not be well-equipped as dementia requires comprehensive care with trained staff and specialised tools that can ensure person- centred dementia care to manage cases of fall on emergency basis (Fernando et al., 2017). This can also be ensured with the help of weekly staff meetings to discuss potential changes required in the working of the system to make it more efficient and capable. This is also to be evaluated from the point of view of poly-risk factors, thus, ensuring multi-modal approach. These educational strategies should also be based on inclusion of family members of the patients in the process of decision-making and promoting awareness to improve the overall quality of life. This has to be kept in due considerations for negative impact of dementia on emotional, physical and mental well-being of the patients (Fernando et al., 2017). Thus, preventive educational strategies should be drafted encompassing all of these attributes. The following research proposal will help in defining the role of educational strategies for healthcare workers in residential care settings, to help prevent the incidences of fall in patients suffering from dementia.

2. Research Question/ PICOT questionCan incidences of fall for patients with dementia, be prevented with effective education promoting strategies for healthcare workers in residential care settings?
P- Healthcare workers in residential homes for dementia patients.
I- Training and education of healthcare workers using in-person educational training.
C- Comparison of results between healthcare workers receiving educational intervention and healthcare workers not receiving the same.
O- Improved patient’s outcomes with reduced incidences of fall.
T- Qualitative study

3. Background and justification
The issue of fall and its related injuries have been an ongoing motion in recent times. It is safe to say that older population is much more vulnerable to these incidences than their younger counterparts. Healthcare workers lack the approach to tackle such patients, which will help in reducing the incidences of fall and its related complications in patients suffering from dementia (Groot et al., 2016).
Study conducted by Clancy et al. in 2016 reflected on the issue of attentiveness of nursing staff towards older patients who ate more prone to fall. This study was based in a residential care setting. The study also helped in highlighting the issue of safety promotion strategies in place to reduce the negative impact of fall on patients. The study was based on interview method which was carried out in the nursing staff working in the residential care setting. Total number of 14 interviews were conducted. Findings indicated that the nursing staff only had a generalised understanding of safety measures and protocol in residential care setting for fall prevention (Clancy& Mahler, 2016). The Main target for the staff was prevention and protection, rather than it being the patient’s well-being and safety promotion (Zhang et al. ,2019). Study highlighted the issue of complexity of care provision for older patients. It also focused those preventive measures in place are not enough to reduce the chances of fall in patients (Groot et al., 2016). Study clearly indicated the role of education intervention in the care setting to help the staff members have a better understanding of holistic care provision for the patients. Study also laid emphasis on use of scientific knowledge to improve the current methods and strategies in place (Allali et al.,2017).
Another study conducted by Isbel et al. in 2016 highlighted the views of primary care providers on how to proceed for rehabilitating elderly that suffer from dementia and having hip fracture. Studies have shown that patients who have mild-to-moderate dementia, hip movement can be useful in improving functional capacity of the patients. However, the process of rehabilitation follows a strict pattern of procedure steps which are to be ensured for each patient. However, the healthcare specifications might alter from one patient to another. Therefore, alteration in rehabilitation regimen is also to be followed. The study highlighted that instead of using a multi-directional approach and taking consent from other healthcare providers, staff directly aligned in patient should be able to take decision for the patients (Isbel et al., 2016). The study also reflected on the limitation of staff member’s perception regarding the benefit of rehabilitation for people with dementia. As the evidential information overall suggest a stronger positive inference of inclusion of rehabilitation for such patients, the same should be followed without any questions asked. This should only be done to assist and ameliorate the current standard of living of patient by improving healthcare outcomes. The study concluded the need of integrated teaching programs in place to not only marginalise these educational gaps, but also to narrow down the myths and disbelief rooting in the system. This will also be beneficial for the staff members in increasing their respective capacities for treating patients in a more methodical and systemic manner.

Study conducted by Phelan et al. in 2016, focused on inclusion of evidence-based prevention in primary care environment for aged patients having a continuous history of falling. The study commenced by collecting the modifiable factors which are mainly responsible for falls in patients. Inclusion criteria was based on 65 and older patients, who had repeated incidents of fall over the past few months. Overall risk assessment for these patients was carried out, to ensure best possible intervention method in place. Two independent risk factors which were identified included non-adherence to medication and lack of home safety in the care setting for these patients. The study highlighted on focusing upon preventive measures in place to help with profound risk assessment for potential harm (Phelan et al., 2016). It also focused on surfacing the patients who are more vulnerable than others and are prone to have more negative impact from these falls. The study also suggested this risk of fall in older patients, to be considered as matter of public health. As the risk of fall was noted to be quite higher for older patients in the study, effective educational efforts on fall prevention can also be helpful in to marginalise the underlying risk and reducing the number of reported incidences.

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