Abstract
Falls and their potential injuries are a significant concern to nurses in every setting where they interact with older adults. Approximately one third of older people living in the community fall each year, and rates for those in long-term care settings are even higher (Stevens, Baldwin, Ballesteros, Noonan, & Sleet, 2010). Furthermore, falls in acute settings prolong hospitalizations for older patients and often lead to additional complications, such as institutionalization. The physical and psychological sequelae of falls reduce the quality and quantity of life for our older patients worldwide (World Health Organization [WHO], 2007). As described by an early nurse researcher in this field, falls result from “a combination of circumstances in which the demands of the task exceed the combined resources of the individual and environmental support,” which speaks to the multifactorial nature of falls (Hogue, 1991, p. 96). The holistic approach used by nurses is well suited to addressing this significant health concern.
Nurses are the largest group of health care providers, and recommendations in the landmark “Future of Nursing” report (Institute of Medicine, 2010) call for nurses to lead change in health care and develop models of nursing care to address critical problems. As such, nurses should be on the forefront of addressing the issue of falls in older adults. However, when the National Council on Aging pulled together health care organizations to develop a national coalition to address falls a few years ago, only one nursing organization participated (http://www.healthyagingprograms.org/content.asp?sectionid=113). Much of the early research on falls was conducted by physicians or public health researchers, even when nurses were part of the intervention. Early nursing studies tended to include small samples or were reports of quality improvement projects at individual institutions.
I am pleased to report that a brief review of recent literature on falls included more nurse researchers who are now making an impact in this field of study. The articles in this special issue of Clinical Nursing Research highlight just some of the current work of nurse researchers to address falls in older adults. They span a variety of settings, from home to hospital to nursing home, and a variety of topics from risk identification to injuries and measurement of fear of falling. They show a growing understanding of the ways that nurses can interact with older adults and their environments to help reduce falls and their impact.
Still nurses need to pull together to address this significant problem. Recent reports indicate an increasing number and rate of hospitalizations for falls in the United States (Hartholt, Stevens, Polinder, van der Cammen, & Parka, 2011) in spite of all the work to date. Few would suggest that we have made significant progress in changing practice around management and prevention of falls. A prudent approach may be to put together an agenda for research on falls in older adults from the nursing perspective, an approach recently used by public health professionals (Stevens et al., 2010). We have evidence for a variety of interventions (Gillespie et al., 2009) and recent guidelines for addressing falls in older people (Drootin, 2011). However, at the forefront of this effort should be plans for translational research to explore how to practically incorporate fall prevention strategies and interventions into busy clinical settings.
Translational studies help identify how to apply findings from research into practice from development of interventions to testing of outcomes in the real world (Grady, 2010). Partnering with the many nurse managers and clinicians practicing in hospitals, nursing homes, and the community, researchers can explore the barriers and facilitators to addressing fall in practice, and identify and evaluate new approaches. Nurses have the numbers, but need to take the opportunity to step up and get involved in translating research findings. This may be the unique contribution that nursing can provide in the area of falls research that will affect the lives of the older people we serve.