Selective restraints and reduced medication could reduce nursing home falls says 4-year study

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Public release date: 14-Jan-2008

http://www.eurekalert.org/pub_releases/2008-01/bpl-sra011408.php

Contact: Annette Whibley

wizard.media@...

Blackwell Publishing Ltd.

Selective restraints and reduced medication could reduce nursing home

falls says 4-year study

Selectively restraining elderly residents and giving them fewer sleeping

pills could significantly reduce falls, according to a survey of 21

nursing home units published in the January issue of Journal of Clinical

Nursing.

The four-year study, led by the Karolinska Institutet, Sweden, analysed

2,343 reported falls and fractures in five municipal homes to find out

how they related to fall risk assessments and the use of safety belts,

wheelchairs and sleeping pills.

Researchers analysed incidents affecting 743 males and 1,908 females

ranging from 40 to 105 years of age, with an average age of 72. All had

been diagnosed with a physical illness or dementia and some suffered

from both.

The researchers found that people using certain drugs were much more

likely to experience a fall. Sleeping pills and anti-depressants made

people 1.4 times more likely to fall, neuroleptics (antipsychotic drugs)

made them 1.9 times more likely and sleeping pills with benzodiazepines

(sedatives) made them 2.9 times more likely.

“In Sweden the use of medication has increased during the past ten

years” explains lead author Edit Fonad RN MNSc from the Department of

Neurobiology at the Institutet.

“Nine per cent of the population are aged 75 years or more, yet this

group accounts for a quarter of the medication prescribed in the

country. On average, this age group consumes six to 10 different types

of medication.”

People who were in wheelchairs, or who had been assessed as a fall risk,

were much less likely to fall. The fall risk was assessed as 0.7, with

1.0 being the normal average. Bed rails reduced this risk even further

to 0.5 and the risk when belts were used was negligible at 0.09.

“Patients are often restrained for reasons that remain unclear and more

often as a matter of routine rather than a reaction to a specific

situation” says Edit Fonad. “These actions are often justified by

concerns for patient safety or behaviour control.”

However, the authors point out that in using restraints healthcare

professionals should take into account the need to maintain the

patients’ independence if possible and the fact that restraints can

themselves cause injuries.

“It is impossible to prevent every single fall and we cannot rule out

the fact that freedom-restricting measures will continue to be used in

the care of older people” concludes Edit Fonad.

“Our results suggests that freedom-restricting actions cannot eliminate

falls totally, but they might be protective when used selectively with

fewer sedatives, especially benzodiazepines.”

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* Falls and fall risk among nursing home residents. Fonad et al.

Journal of Clinical Nursing. 17, 126-134. January 2008.

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