One of the major cause of injuries in a healthcare
settings is falls. Most falls are usually seen commonly among the elderlies
their causes can be because of their aging process, disease process, polypharmacy,
poor fall risk assessment and poor fall risk education. Falls can cause serious
injuries such as fractures and hematomas. If the impact of the fall is severe
or injured any of the vital organs, it can be fatal. Falls can be prevented
through various assessment through planning, implementation and evaluation.  Although different institutions have different
fall risk assessment, it is important to know that it is important to prioritize
the purpose of the assessment is to prevent falls and not “just another check
off” in the checklist. If the cause is because of shortage of manpower, the
fall risk assessment can assist the aid to increase the healthcare employment. By
understanding the meaning of falls, it means moving from a higher position to a
lower position in a rapid speed with no control. Thus, elderlies are more prone
to fall because of their gait and their level of understanding to comply with
fall risk prevention.

In a research article by Barbara E. H. (2017), an
eight week fall prevention program was provided by a nurse practitioner and team
of healthcare worker on elderlies living in two community centers. They met for
one hour twice a week to conduct a pretest and posttest as a design study. A
fall risk questionnaire (FRQ) with a total score of varying between 0 to 14 in
a 12-item score where score of 14 indicates a high fall risk. Up to 40
elderlies attended the program but only 20 among them had completed the pretest
and posttest. These elderlies are from various language, culture and literacy
level. Eighty-two percent were female with an average age of 78 (standard
deviation SD=2.25) and average years of education were 13.9 (SD=2.25). At
pretest, the fall risk score was reported low (FRQ mean =4.0, SD=1.5) and the
fall risk score in the posttest were reported even lower (FRQ mean 3.07,
SD=1.4). In this research article, I understand that pre-educating is important
so that the elderlies will be able to comply and to get positive feedback on
their level of understanding in fall prevention.

In another research by Wagner L.M., Scott V. and Mara
S. (2011) examine the types of fall risk assessment tools (FRAT) used in
nursing homes and to address the gap between the research literature and what
is done in the clinical practice. A sample size of 305 nursing homes to
complete a nursing home Facility Measures Survey. Out of 305 nursing homes, 137
responded which bearing 45% response rate. Among the 137, one-third (n=54) are
classified as “rural” facilities. 10 out of the 137 (n=19%) used the Morse Fall
Scale and 1 nursing home used the Performance –Oriented Mobility Assessment for
assessment of fall risk. All of the FRAT uses point system, with unpredictable
detail to estimate fall risk. There were discrepancies between the thresholds
used to identify fall risk. For an example, the Morse Fall Scale is commonly
use in most healthcare institution but one of the question ask is the use of
intravenous therapy. This question is useful and applicable in hospitals but less
than 2% of nursing home elderlies are on this therapy. These concluded that
although fall risk assessment is required to identify the accurate nature of
the risk, it can be used as a guide for healthcare staff to tailor fall risk
planning. FRAT is also needed to aid staff in better assess residents and
identifying those at higher risk. It also highlights that some tools are useful
but not applicable to all institution thus the results may not be accurate.

Although both articles Barbara E. H and Wagner et al
both discuss on the fall risk assessment, they did not discuss on the
preventions. Hanger H. C. (2017) compared the fall rates and injuries of falls
from Low-Impact Flooring (LIF) with a standard vinyl flooring. Four general
subacute wards for elderlies and one specialized stroke rehabilitation ward
from the Princess Margaret Hospital (PMH). Ward 2B in which the LIF were placed
is a 20-bedded general ward. Using the established normal quality incident
event reporting (QIER), over 31 month there were 323 falls reported in the
whole ward. Of these, 278 (86%) occurred in the bedrooms. Results has shown
that LIFs significantly reduce the percentage of falls by 35% and also it
reduces the severity of injuries sustaining from it. However, LIFs does
increase the resistance in rolling such as movable beds, floor-based hoist and
wheelchairs which may results the risk in staff injuries. It was concluded that
LIF can reduce injuries resulting from fall in hospitals without increasing the
risk of falling. It should be highly promoted for use in nursing home settings,
but further work on minimizing its rolling resistance before it can be adopted
in the hospitals.

In conclusion on all three articles, fall risk is
vital among the elderlies whether in a community based or in an institution such
as community based or hospitals. Pre-educating the elderly helps to prevent and
ensuring the elderly are aware of their safety. Healthcare worker can also
understand their understanding to improve on it. Fall risk assessment tools are
efficient to asses for their fall risk. However different institution should
always reassess their risk of falls and not just based on their previous institution
scores as it may be inaccurate.