April No Falls: An International Campaign Stacks Up
April No Falls is an international campaign aiming to reduce falls and the harm caused by falls. Moving beyond awareness raising, the April No Falls campaign provides the latest information on falls prevention strategies and education. Falls are a significant and growing public health issue, with deaths related to falls doubling in the last two decades. Falls within hospitals are common and can often make a great difference to successful outcome in hospital. A fall can make the difference in the patient’s ability to return home or needing to move into supported accommodation or aged care.
During April No Falls month in 2021, I attended three online conferences presenting evidence for falls prevention across the lifespan:
- World Health Organisation Step Safely: Strategies for preventing and managing falls across the life-course (27th April 2021),
- New South Wales Fall Prevention and Healthy Ageing Network Annual Webinar (30th April 2021), and
- Monash Partners Falls prevention in hospital settings (23rd April 2021).
People with stroke are at high risk of falls in hospital and the vast majority (almost 90%) have a communication disability – which includes aphasia (language difficulty after stroke), dysarthria (slurred speech), apraxia of speech (poorly co-ordinated speech) and cognitive communication difficulties. In this blog post I am going to discuss my take home messages from the three falls conferences in relation to the falls of people with communication disability following stroke.
Step Safely: Strategies for preventing and managing falls across the life course
The World Health Organisation (WHO) report on the impact of falls prevention and management was launched this year, WHO’s first technical package addressing falls. The package is designed to support practitioners, policy makers, managers, researchers and advocates in falls prevention and prevent and manage fall-related injuries in relation to three key populations at risk of falls: children and adolescents; workers in high-risk occupations; and older people. Step Safely describes how falls are preventable and provides evidence-based recommendations for falls prevention including at the policy level.
Whilst not specific to people with communication disability following stroke in hospital, the WHO’s launch of a package highlights the growing public health issue of falls and provides a platform to push falls prevention and management higher up planning, policy, and research agenda.
Falls Screening
Evidence suggests that falls screening and falls risk assessment tools are not effective tools to identify a patient who is at risk of a fall. Health services spend an estimated $590 million attempting to prevent falls in hospitals with falls assessment and screens making up 12% and 8% respectively. I recently conducted a review of Australian hospital policy and procedure documents relating to falls and found that communication disability is not specifically captured as a risk factor for a fall in hospital and when it is included, it is typically included into categories relating to cognition.
Falls screening and risk assessment tools typically provide insight into the individual risk factors for a fall (e.g., balance impairment, confusion) but they do little to assess and mitigate the other contributing factors to falls in hospital. The unfamiliar hospital environment, medications, equipment (e.g. unfamiliar walking aids), organisational policies and documentation, as well as other people (staff and visitors) may all be contributing factors to falls, but appear to be overlooked when using risk screening and assessment tools.
Providing education to patients on how to prevent falls in hospital has the most robust evidence in terms of effectiveness. Education assists patients to weigh up the risks of particular actions and develop a plan to prevent falling such as using the call bell to seek help before walking. However, patients with communication disability often find participating in education to be difficult or impossible unless the education has been adapted to suit their individual communication needs, and communication barriers removed. Empowering patients to prevent falls should be a clinical priority and part of a multifactorial approach to falls prevention, as failure to communicate effectively with patients may contribute to their falls.
Communication disability following stroke has a range of functional implications for day to day care and safety of the patient. Patients with a severe communication disability may have trouble using the call bell to get attention, communicating their basic needs such as the need for the toilet, following instructions and participating in falls prevention education. These difficulties may lead to an increase in risk taking behaviour such as attempts to walk to the toilet alone and thus increase the risk of falling.
Currently there is little knowledge of the circumstances and outcomes of falls in patients with communication disability following stroke. This means that we don’t know the most common location, time of day and factors that contribute to the fall including the hospital environment. When combined with information about the patient’s own risk factors, including their communication disability, this information may identify ways to reduce their risk of falls. My PhD includes a focus on this, and by April No Falls next year I will be quite a few more steps further along the path of understanding the circumstances surrounding the falls of patients with communication disability and able to contribute further to their prevention and improved communicatively accessible falls-prevention education for patients with communication disability in hospital.
References
Haines, T., Lee, D., O’Connell, B., McDermott, F., Hoffman, T. (2015). Health Expectations, 18(2), 233-249.
Haines, T. (2021, April 23). A new approach to changing practice and finding out whether our falls prevention strategies are effective [Conference presentation]. Monash Partners Falls prevention in hospital settings, Online.
Hill, A., Francis-Coad, J., Haines, T., Waldron, N., Etherton-Beer C., Flicker, L., Ingram, K., McPhail, S. (2016). ‘My independent streak may get in the way’: how older adults respond to falls prevention education in hospital. BMJ Open, 6, e012363.
Hill, AM. (2021, April 30). Translating Fall prevention Evidence into Practice [Conference presentation]. NSW Fall Prevention and Healthy Ageing Network Annual Webinar, Online.
https://fallsnetwork.neura.edu.au/event/network-virtual-forum-2021/
Mitchell, D., Raymond, M., Jellet, J., Webbs-St Mart, M., Boyd, L., Botti, M., Steen, K., Hutchinson, A., Redley, B.,Haines, T. (2018). Where are the falls prevention resources allocated by hospitals and what do they cost? A cross sectional survey using semi structured interviews of key informants at six Australian health services. International Journal of Nursing Studies, 86, 52-59.
Morris, M. (2021, April 23). Latest research in health service falls prevention [Conference presentation]. Monash Partners Falls prevention in hospital settings, Online.
World Health Organisation. (2021). Step Safely: strategies for preventing and managing falls across the life-course. Retrieved from https://www.who.int/publications/i/item/978924002191-4
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