Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2018 Fall Reduction Among the Geriatric Population in Assisted Living Facilities Marylyn A. Hagerty Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Nursing Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral study by Marylyn Hagerty has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Rosaline Olade, Committee Chairperson, Nursing Faculty Dr. Tracy Wright, Committee Member, Nursing Faculty Dr. Amelia Nichols, University Reviewer, Nursing Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2018 Abstract Fall Reduction Among the Geriatric Population in Assisted Living Facilities by Marylyn A. Hagerty MSN, University of Phoenix, 2011 BSN, University of Phoenix, 2009 AS, Long Beach City College, 1975 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2018 Abstract Incidents of falls among the elderly increase with age. About $31 million is spent annually in the United States on medical costs related to fall injuries in the elderly. This project evaluated the outcomes of a fall reduction program implemented in an assisted living facility (ALF). The Stop Elderly Accidents, Death & Injury program developed by the Centers for Disease Control and Prevention was implemented by the ALF for 60 days prior to the outcome evaluation project. The program included a convenience sample of 62 residents and involved medication evaluation, exercises, assistive devices, environmental risk reduction, and evaluation of blood pressure. Bandura’s theory on self- efficacy was applied in guiding the implementation process. The practice-focused question compared the fall rate among the ALF’s elderly residents during the 30-day period following implementation of the program, and the previous 12months. The fall rates were analyzed with descriptive statistics. Results showed the preintervention fall rate was 6.6 falls per month, while at the end of the 30-day postimplementation period, that rate was reduced by 39.4% to 4 falls per month. The conclusion of this outcome- evaluation project is that falls among the elderly in the ALF can be reduced with evidence-based programs. The recommendation is that ALFs should have fall reduction programs, thereby avoiding unnecessary complications of falls among elderly residents. Implications for nursing practice include improved understanding of falls as a safety issue for ALF residents and the need for nurse practitioners to take a more active role as advocates for fall prevention programs in ALFs. The positive societal change produced is improved safety and reduction in fall injuries among the elderly in assisted living facilities. Fall Reduction Among the Geriatric Population in Assisted Living Facilities by Marylyn A. Hagerty MSN, University of Phoenix, 2011 BSN, University of Phoenix, 2009 AS, Long Beach City College, 1975 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2018 Table of Contents List of Tables ..................................................................................................................... iv List of Figures ......................................................................................................................v Section 1: Nature of the Project ...........................................................................................1 Introduction ....................................................................................................................1 Problem Statement .........................................................................................................2 Purpose Statement ..........................................................................................................4 Nature of the Doctoral Project .......................................................................................6 Summary ......................................................................................................................11 Section 2: Background and Context ..................................................................................12 Introduction ..................................................................................................................12 Literature review ..........................................................................................................12 Relevance to Nursing Practice .....................................................................................15 Local Background and Context ...................................................................................19 Role of the DNP Student..............................................................................................22 Role of the Project Team .............................................................................................23 Summary ......................................................................................................................23 Section 3: Collection and Analysis of Evidence ................................................................25 Introduction ..................................................................................................................25 Practice-Focused Questions .........................................................................................26 Sources of Evidence .....................................................................................................26 Timeline for the Implementation and Collection of Data ............................................32 Participants, Procedures, and Protections ....................................................................35 i Analysis and Synthesis ................................................................................................37 Summary ......................................................................................................................38 Section 4: Findings and Recommendations .......................................................................40 Introduction ..................................................................................................................40 Findings and Implications ............................................................................................41 Implications..................................................................................................................52 Recommendations ........................................................................................................53 Contributions of Doctoral Project Team ......................................................................55 Strength and Limitations of the Project .......................................................................56 Recommendations for Future Projects .........................................................................59 Summary ......................................................................................................................59 Section 5: Dissemination Plan ...........................................................................................60 Analysis of Self ............................................................................................................61 Summary ......................................................................................................................63 References ..........................................................................................................................64 Appendix A: Patient Risk Factors, Baseline Data .............................................................71 Appendix B: 30 Days Post-Implementation Patient Data..................................................72 Appendix C: Stay Independent ..........................................................................................73 Appendix D: Medications Linked to Falls .........................................................................74 Appendix E: TUG Gait-Agility Test..................................................................................75 Appendix F: Screening for Orthostatic BP ........................................................................76 Appendix G: Patient Data—Modified Fall Risk Assessment ............................................77 Appendix H: Algorithm for Fall Risk Screening, Assessment, and Intervention ..............78 ii Appendix I: Self-Efficacy for Exercise (SEE) Scale and Questions .................................79 Self-efficacy For Exercise (SEE) Questions ................................................................79 Appendix J: Fall Incident Report .......................................................................................80 iii List of Tables Table 1. Resident Rating of Fall Risk ..............................................................................