With our aging population pressure is mounting on health services to provide the best possible care for more and more frail individuals. As resources are stretched more risks are taken to discharge patients as soon as possible, with as little support as required. This is absolutely the right thing to do and there is a huge amount of evidence to show why this is the case. Hospital is dangerous for frail individuals, take #endPJparalysis as a high profile example highlighting the risk of deconditioning.
One of the concerns which physiotherapists have when discharging a frail patient home from hospital is whether they are going to fall. We know that falls increase during the post-discharge period. Compared to the average annual fall rate of 30% in the general older community, 40% of older adults recently discharged from hospital fall at least once in the 6-month period following discharge and 54% of these falls result in a serious injury.
As Naseri et al report, many systematic reviews have taken place in the past and demonstrated the effectiveness of falls prevention interventions in the community. However these reviews did not evaluate interventions aimed at reducing falls risk in the post-discharge period. Naseri et al primary objective of their systematic review was to evaluate just that.
Their search used a respected systematic review strategy and they specifically looked at interventions provided to patients over 60 who were discharged from hospital to the community. To be included within the review the intervention MUST have been commenced in hospital or within 1 month of discharge.
The results of this systematic review suggest that:
- Home hazard modifications alone has a limited evidence that they reduce falls post-discharge. If services were tailored, individualised and were evaluated specifically for the post-discharge period results may be different.
- A home hazard modification may be beneficial for people with recurrent falls history.
- Falls prevention exercise programmes are beneficial for older people generally however during the post-discharge period they may be detrimental. If they contain exercises which provide a moderate to high challenge on balance falls increase. This is likely because this population is deconditioned as a result of their admission and acute illness. These programmes are usually unsupervised and have limited 1:1 contact time. To correct this more supervision, tapered intensity and duration is advised. Build up slowly!
- Vitamin D & calcium supplements alone do not reduce falls risk however are advised to protect against reduced bone mineral density.
- Nutrition supplementation for malnourished elderly was effective at reducing the risk of falls post-discharge.
- Services which target specific elements of frailty are likely to have a positive effect on falls risk and fall outcomes.
If you’d like to lean more about the falls risk factors discussed in this post then check out the content on Physiopedia:
- Motor impairments
- Sensory impairments
- Cognitive impairments
- Orthostatic hypotension
- Polypharmacy
- Environmental hazards