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Falls in The Long-Term Care Settings
Nayaris Reyes
Florida National University
June 12, 2021
Brief Literature Review
The elderly in the long-term care facilities are typically
predisposed to falling and might fall for various reasons. Some
predisposing factors might be related to unsteady balance and
gait, poor vision, weak muscles, dementia, and medications. In
addition, various medical conditions, including stroke, low
blood pressure, brain disorders, and poorly managed epilepsy,
might increase older people's risk for falls (Golmakani et al.,
2014). Therefore, several studies have been conducted to
evaluate the efficacy of multi-factorial interventions on the
occurrence of falls in long-term care settings, including psycho-
geriatric nursing home patients. Based on the clinical study, it
was concluded that various multi-factorial interventions used in
preventing falls such as a general medical assessment

2. emphasizing falls, specific fall risk evaluation devices,
assessing medication intake, fall history, and mobility, using
protective and assistive aids play a significant role in reducing
the incidence of falls among the elderly (Ungar et al., 2013).
Accordingly, it was evident that fall prevention, usually geared
towards psycho-geriatric patients in a long-term care facility, is
possible and efficient in minimizing falls among older people.
Other researchers carried out a study in developing a fall
prevention program for the aged patients in long-term care
entities, especially those at risk of falling, by increasing
caregiving expertise or skills and motivating staff members.
From the analysis, exercise programs encompassing warm-up,
muscle reinforcement, especially in the lower extremities, and
proprioceptive neuromuscular expedition are used in increasing
motivation and caregiving skills (Donath et al., 2016). Another
research conducted to evaluate the statistics of fall s among the
elderly found out that falls are the leading cause of injury-
interrelated visits to emergency facilities in the U.S. They are
also the primary etiology of accidental deaths in persons aged
60 and above. From the analysis, falls might be markers of
diminishing function and poor health and are significantly
attributable to morbidity.
To assess the risk factors related with falls among the
older people in the long-term care facilities, it was realized that
more than 25% of facility-dwelling older individuals and 60%
of nursing home residents fall yearly (Pfortmueller et al., 2014).
Various risk factors linked to their falls are medication use,
increasing age, sensory deficits, and cognitive impairment.
Studies depict that older persons who have fallen must undergo
a thorough clinical evaluation (within the facilities) to analyze
the preventive strategies further. This will aid in determining
and treating the underlying cause of their falls, return them to
baseline function, and minimize the likelihood of recurrent falls
(Karlsson et al., 2013). Such measures have a significant effect
on the mortality and morbidity of falls.
Methodology and Design

3. General Overview
The research paper tries to analyze the issue of falls among
the elderly in the long-term care setting. This section will
encompass justification of the research methods, data collection
procedures, and research design. Research methods are the
strategies, techniques, and procedures utilized in data collection
and evidence to analyze the collected information. The ideal
research methods for this research topic will be quantitative and
qualitative. The two research techniques will follow under a
mixed research method and precisely assist in finding a solution
to the existing problems. Mixed methods use qualitative and
quantitative methods in the same study and mainly used in
clinical settings. Quantitative research techniques in the nursing
profession are fundamental since they utilize accurate
approaches to collect and analyze measurable data (Kim et al.,
2015). This is a precise technique because it is a number -based
technique that gives accurate results critical factors in the
medical field outcomes. Besides, qualitative techniques deal
with the lived experiences of different patients and nursing
professionals. The research on chronic infections such as falls
gives the healthcare professionals a sound understanding of the
lived experiences of the elderly patients.
Research Design
Consequently, the research design will act as the guiding
framework for the fundamental research. The study will use
mixed methods (quantitative and qualitative) since it will
address the research issue more inclusively than qualitative or
quantitative methods alone. Quantitative research is attributable
to a positivist stance and assumes that reality might be
measured and observed objectively. It will be the best technique
due to its procedures of minimizing falls among older people.
Thus, it will be the dominant paradigm in health issue research.
Moreover, qualitative research majorly comes from an
interpretive framework and assumes multiple realities are
framed by individual perceptions, meaning, and context. This
will be suitable for the issue under research. Therefore, there is

4. a need to ensure high-quality qualitative research to generate
sturdy theory which applies to the contexts outside the area
under research.
Data Collection Procedures
The quantitative research will employ clinical trials or
observational studies to generate relevant data for patients
experiencing falls. Thus, there will be surveys where
questionnaires will be issued to the patients and collected after
filling them. The questionnaires will comprise close-ended
questions entailing putting responses into groups and multiple
lists where the patients will choose from. The structured
questions are suitable for this clinical issue because they are
cheap, swift, and practical tools for attaining a comparatively
large amount of pertinent data from samples. The qualitative
research methods will incorporate semi-structured interviews,
participant observation, and focus group discussion (Singh, &
Okeke, 2016). For the semi-structured interviews, the researcher
will allow the patients to share their daily experiences within
the scope of the clinical issue and determine the ideal
prevention measures. The researcher will also visit the care
settings and homes of the older adults and assess the
comfortability and safety of their living environment. Calling
them in groups to hold discussions will also be appropriate
since they will state their risk factors for falls and suggest the
best measures to prevent its occurrence.
Data Sampling
Sampling entails techniques in which researchers infer
information regarding a given population based on findings
from a subsection of the whole populace (Karlsson et al., 2013).
The ideal sampling method to investigate falls among older
persons in long-term care institutions includes a randomized
controlled trial (RCT). These are the gold standards to establish
the efficacy of various interventions. In clinical and long-term
care facilities, RCTs are the best techniques in studying the
safety and effectiveness of new interventions for preventing
falls among older patients. This is because they are used in

5. answering patient-interrelated issues. In trials with randomized
and controlled design, the impacts of the clinical interventions
will be compared with those of control treatment, and the
participants will be randomly assigned to the selected groups.
Randomized controlled trials of fall prevention strategies
targeting the elderly population in the long-term care settings
with various elements including reach, timeliness, and
adherence to the program must be reported consistently.
Necessary Tools
There are vital tools used in the research and fall risk
assessment, such as Falls Risk for Older People (Long-term-
care setting) and RESPOND intervention (a telephone-related
falls prevention program for older persons. The RESPOND
intervention must encompass various evidence-based modules
linked to falls risk factors, including better bones, better
strength and balance, better sleep, and better eyesight. Every
RESPOND must have an associated pamphlet that should have
positively framed clinical messages concerning the
recommended preventions, including how exercise might help
one feel revitalized and relaxed. The RESPOND physician must
make subsequent telephone coaching calls through the use of
motivational interviewing strategies. Notably, good timing,
intended dosage, and conveyance style must be pre-determined
in the randomized control trial protocol. Using Falls Risk for
Older People will be possible to evaluate patients for fall risk
and motivate them to adopt recommended evidence-based
prevention approaches. Such approaches might assist patients in
reducing their likelihood of falling and experiencing injuries,
death, and functional decline.
Algorithms or Flow Maps Created.
To determine preventive strategies for reducing falls
among the elderly in a long-term care facility, a decision tree
analysis might be used in developing a prediction algorithm for
the frequency of occurrence of falls. The long-care patients will
be assessed using a Resident Assessment Instrument-Home Care

6. (RAI-HC) model. The validity of the fall algorithm might be
tested and verified among long-term care patients in the
designated settings. Such algorithms must incorporate assistive
tools, age, unsteady gait, pain, cognition, and incontinence to
various categories from low to high risk. The algorithms woul d
only be used in long-term care settings using the RAI-HC
system. There is a need to determine how the percentage of falls
would behave following an upsurge in the risk class. Logistic
regression analysis must be utilized to derive odds ratios to
assess the algorithm's validity in various samples. Fall
algorithms might provide a typical assessment model to
facilitate the allocation of assistive resources, improve the
efficacy of the healthcare system and minimize costs (Panneman
et al., 2021). This is because falls are a prevalent cause of death
and injuries among the elderly in long-term care facilities and
are extremely expensive in healthcare institutions.
References
Donath, L., van Dieën, J., & Faude, O. (2016). Exercise-based
fall prevention in the elderly: what about agility?. Sports
medicine, 46(2), 143-149.
Golmakani, E., Usefi, M. R., Tabatabaeichehr, M., Moayyed, L.,
& Mortazavi, H. (2014). Fall in elderly: A literature
review. Journal of North Khorasan University of Medical

7. Sciences, 5(5), 1159-1163.
Karlsson, M. K., Magnusson, H., von Schewelov, T., &
Rosengren, B. E. (2013). Prevention of falls in the elderly—a
review. Osteoporosis international, 24(3), 747-762.
Kim, E. J., Arai, H., Chan, P., Chen, L. K., Hill, K. D., Kong,
B., ... & Won, C. W. (2015). Strategies on fall prevention for
older people living in the community: a report from a round-
table meeting in IAGG 2013. Journal of Clinical Gerontology
and Geriatrics, 6(2), 39-44.
Panneman, M. J., Sterke, S. C., Eilering, M. J., Blatter, B. M.,
Polinder, S., & Van Beeck, E. F. (2021). Costs and benefits of
multifactorial fall prevention in nursing homes in the
Netherlands. Experimental gerontology, 143, 111173.
Pfortmueller, C. A., Lindner, G., & Exadaktylos, A. K. (2014).
Reducing fall risk in the elderly: risk factors and fall
prevention, a systematic review. Minerva Med, 105(4), 275-81.
Singh, I., & Okeke, J. (2016). Reducing inpatient falls in a
100% single room elderly care environment: Evaluation of the
impact of a systematic nurse training program on falls risk
assessment (FRA). BMJ Quality Improvement Reports, 5(1).
Ungar, A., Rafanelli, M., Iacomelli, I., Brunetti, M. A.,
Ceccofiglio, A., Tesi, F., & Marchionni, N. (2013). Fall
prevention in the elderly. Clinical Cases in mineral and bone
metabolism, 10(2), 91.
Research Paper-Planning
2
Research Paper-Planning

8. The issue of falls in the long-term care settings
The issue of falls in the long-term care settings
The issue of falls is a common event for elderly patients
who are living in acute care settings. This leads to the loss of
independence, injuries, and even death if proper intervention
and care are not taken. This, therefore, implies that the
preventive approaches are the major concern for elderly patients
and healthcare professionals. Reports reveal that about 700,000
to 1,000,000 fall-related cases are common within acute care
settings (Panneman, et al., 2021).
The United States Centers for Disease Control and
Prevention (CDC) reports that one in every four individuals of
age 65 years and above falls every year. This is more than 2.8
million injuries that are being treated within the emergency
departments every year. The reported annual rates of
hospitalization and deaths are 800, 000 and over 27, 000
respectively not forgetting the financial burden associated with
adult falls. The medical cost for the fall issue was anticipated to
rise to $ 67.7 billion by 2020 (Panneman, et al., 2021). Most of
the insurance firms are not reimbursing for these never events
hence causing more financial burden to the healthcare
organizations.
These burdens and the adverse impacts of fall rates require
urgent interventions from healthcare professionals in acute care

9. settings. The best practices must be put in place to help in the
successful management of the falls thus enhancing the overall
safety and the autonomy of the individuals in healthcare
facilities. The purposeful, as well as timely hourly rounding,
has been recommended to be an effective intervention that helps
in meeting the needs of the clients, reduction of the fall rates in
every department or units, improvement of the patients' safety,
and helping in the proactive approaches towards addressing the
falls issues before they occur (Brewer, Carley, Benham-
Hutchins, Effken, & Reminga, 2018).
Identification of the problem
Even though hourly rounding has proven to be one of the
effective approaches that help reduce the burden and other
adverse problems caused by the issue of patients, little attention
has been given to such practices. There is an increased lack of
accountability by the nurses when it comes to implementing
hourly rounding. This, therefore, implies that however much the
hourly rounding intervention or practice is made available, the
reluctance in its implementation would still lead to an increase
in the rates of falls.
The reluctance and lack of accountability among nurses in
the implementation of this intervention are also increased by the
healthcare organizations. Many healthcare facilities have not
yet designed a plan that can help in holding the staff
accountable in the performance of the hourly rounding
responsibilities. Consequently, the fall rates have continued to
rise thus resulting in preventable injuries and deaths (Brewer et
al., 2018). The majority of the nursing staff are not active in the
performance of the hourly rounding on the patients thus leaving
these patients at risk of injuries.
The report by the National Institute of Health and Clinical
Excellence, NICE of 2004 reveals that the positive outcomes in
the reduction of the fall rates were successful when the patient
was provided with the information and education on the
prevention of falls. This is linked to the fact that the majority of
the residents in the acute care settings are at higher risks of

10. experiencing fall-related episodes as a result of the extended
hospital stay, reduction in their function for example handling
of the activity of the daily living (ADLs), polypharmacy, and
the advancement in their ages (National Institute for Clinical
Excellence (NICE), 2004).
The increase in the rates of falls among elderly individuals
requires immediate implementation of purposeful hourly
rounding procedures to help in reducing the adverse impacts and
the medical costs associated with fall-associated injuries. It is
therefore important for the frontline healthcare providers
especially nurses to make sure that the present knowledge of the
hourly rounding intervention is applied in the daily practice to
help in the improvement and the attainment of the maximum and
safe patient care (Radecki et al., 2018).
The significance of the problem
The issue of falls in the acute care settings is amongst the
major hospital-associated diseases that affect the safety of the
patients and requires interventions. The Joint Commission for
Transforming Healthcare acknowledges that patient of any age
is at risk of fall especially when the psychological needs
changes as a result of the present medical conditions. Therefore,
these patients are exposed to severe injuries that lead to
extended days of hospital stays and the burden associated with
the healthcare costs (Al Danaf, et al., 2018). The effective
approaches to the prevention and reduction of patient falls
require the identification of the risk factors linked to the fall.
The identification of the risk factors is helpful in the
determination of whether the present condition of the patient is
having a potential risk for fall. It also helps in the formulation
of effective interventions for such risks to prevent future
occurrence.
One of the barriers that have been identified to be the
cause of the failure to implement the prevention practices is the
absence of consistency in the implementation of the proposed
standardized intervention or healthcare care approaches. The
effective approaches in addressing the barrier involve the

11. utilization of the hospital data associated with the medication
errors and performance of the survey to act as a guideline
towards addressing the issues and promote change within the
organization (National Institute for Clinical Excellence (NICE),
2004).
The intervention involving the use of the intentional-
rounding is considered to be a proactive approach that assists in
meeting the needs of the patients. It helps in ensuring that
nurses remain to make routine visits to the patients' rooms and
checking for specific tools within the patients' wards and
gathering more information concerning the self-care of the
patient continuously and consistently. Therefore, the
introduction of the hourly rounding ad educating nurses about
their protocols required in their implementation helps in
ensuring that there is a reduction in the fall rates among
patients. There is a need to have a plan of the intentional hourly
rounding procedure and incorporating the education approach to
the nurse staff on the prevention of falls to increase the
knowledge concerning the approaches towards prevention of the
falls (Singh & Okeke, 2016). The identification of the problem
helps in determining the need for the education of the nurses in
combating the issue of fall rates.
The identification of the fall problems helps in revealing
the existence of the unaccountability and inconsistency about
the prevention protocols and the documentation of the records
of the patient's falls. The practice of hourly rounding help in
ensuring that patients' safety is promoted through meeting the
ADLs requirements of the patients. For example, nurses will be
able to assists patients with the Ps i.e. potty, pain, position, and
possession. This is important in ensuring that all the established
preventive measures for the assessment of the patients for
example the use of the Morse Fall Risk Assessment Scale are
implemented within the facility.
References
Al Danaf, J., Chang, B. H., Shear, M., Johnson, K. M., Miller,

12. S., Nester, L., . . . Amy, W. W. (2018). Surfacing and
addressing hospitalized patients’ needs: Proactive nurse
rounding as a tool. Journal of nursing management, 26(5), 540-
547. https://doi.org/10.1111/jonm.12580
Brewer, B. B., Carley, K. M., Benham-Hutchins, M., Effken, J.
A., & Reminga, J. (2018). Nursing unit design, nursing staff
communication networks, and patient falls: Are they related?.
HERD: Health Environments Research & Design Journal, 11(4),
82-94. https://doi.org/10.1177/1937586718779223
National Institute for Clinical Excellence (NICE). (2004).
Clinical practice guideline for the assessment and prevention of
falls in older people. Royal College of Nursing.
http://www.nice.org.uk/nicemedia/pdf/ CG021fi4liguideUne.pdf
Panneman, M. J., Sterke, S. C., Eilering, M. J., Blatter, B. M.,
Polinder, S., & Van Beeck, E. F. (2021). Costs and benefits of
multifactorial fall prevention in nursing homes in the
Netherlands. Experimental gerontology, 143, 111173.
https://doi.org/10.1016/j.exger.2020.111173
Radecki, B., Reynolds, S., & Kara, A. (2018). Inpatient fall
prevention from the patient's perspective: a qualitative study.
Applied Nursing Research, 43, 114-119.
doi:https://doi.org/10.1016/j.apnr.2018.08.001
Singh, I., & Okeke, J. (2016). Reducing inpatient falls in a
100% single room elderly care environment: Evaluation of the
impact of a systematic nurse training program on falls risk
assessment (FRA). BMJ Quality Improvement Reports, 5(1).
doi:10.1136/bmjquality. u210921.w4741
Phase 3-Implementation (Due by WEEK 9)
Phase 3 of the research project is the implementation phase. The
implementation phase will be written state as we will not be
implementing the actual project. This phase focuses on
providing steps by steps instructions on how the program will
be implemented, a table describing the time frame of the
project, if any budget needs to be considering, and any
resources or statistically tools required. The length of this paper

13. should be around 5-6 pages.
Phase 1 y 2 attached
Phase 3 of the research project is the implementation phase.
*** If you have not documented IRB approval for your paper, it
should be done in this phase. (The IRB process is simulated for
this project).
The implementation phase will be written state as we will not be
implementing the actual project.
This phase focuses on providing steps by steps instructions on
how the program will be implemented, a table describing the
time frame of the project, if any budget needs to be considering,
and any resources or statistically tools required.
***When writing this area, the paper should be written in the
same manner as a recipe for a cake, this means write your paper
so that the next person following you can duplicate your
research word for word.
The length of this paper should be around 5-6 pages.
Please follow APA guidelines and ensure that all documents are
produced in Microsoft Word. I cannot accept any other
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Pay close attention to your similarity index of 10%.
Please note the grading rubric that is attached to this document.
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Good 6 Points
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Integration of Knowledge
12.5%
The paper demonstrates that the author understands and has

14. applied concepts learned in the course.
Concepts are integrated into the writer’s own insights.
The writer provides concluding remarks that show analysis and
synthesis of ideas
The paper demonstrates that the author, mostly, understands and
has applied concepts learned in the course.
Some conclusions, however, are not supported in the body of
the paper
The paper demonstrates that the author, to a certain extent,
understands and has applied concepts learned in the course
The paper does not demonstrate that the author has understood,
and applied concepts learned in the course.
Topic Focus
12.5%
The topic is focused narrowly enough for the scope of this
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A thesis statement provides direction for the paper, either by a
statement of a position or hypothesis
The topic is focused but lacks direction.
The paper is about a specific topic, but the writer has not
established a position.
The topic is too broad for the scope of this assignment.
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Depth of Discussion
12.5 %
In-depth discussion and elaboration in all sections of the paper.
In-depth discussion and elaboration in most sections of the
paper.
The writer has omitted content.
Quotations from others outweigh the writer’s own ideas
excessively.
Cursory discussion in all the sections of the paper or brief
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Cohesiveness
12.5%
Ties together information from all sources.

15. Paper flows from one issue to the next with no headings.
Author’s writing demonstrates an understanding of the
relationship among material obtained from all sources
Mostly, it ties together information from all sources.
Paper flows with only some disjointedness.
The author’s writing demonstrates an understanding of the
relationship among material obtained from all sources.
Sometimes ties together information from all sources.
Paper does not flow.
Disjointedness is apparent.
The author’s writing does not demonstrate an understanding of
the relationship among material obtained from all sources.
It does not tie together information.
Paper does not flow and appears to be created from disparate
issues.
Headings are necessary to link concepts.
Writing does not demonstrate understanding any relationship
Spelling and Grammar 12.5%
Minimal spelling and/or grammar mistakes
Some spelling and or grammar mistakes.
Noticeable spelling and grammar mistakes.
An unacceptable number of spelling and/or grammar mistakes
Sources
12.5%
Over 5 current sources, of which at least 3 are peer-review
journal articles or scholarly books.
Sources include both general background sources and
specialized sources.
Special-interest sources and popular literature and
acknowledged as such if they are cited.
All web sites utilized are authoritative.
5 current sources, of which at least 2 are peer-review journal
articles or scholarly books.
All web sites utilized are authoritative.
Fewer than 5 current sources or fewer than 2 of 5 are peer -
reviewed journal articles or scholarly books. All web sites

16. utilized are credible.
Fewer than 5 current sources or fewer than 2 of 5 are peer -
reviewed journal articles or scholarly books. Not all web sites
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Citations
12.5%
Cites all data obtained from other sources.
APA citation style is used in both text and bibliography
Cites most data obtained from other sources.
APA citation style is used in both text and bibliography.
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Citation style is inconsistent or incorrect.
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Research Paper Rubric