Why it gets harder to prevent falls when older people leave hospital

Chiara Naseri is a physiotherapist and is currently completing her PhD at Western Australia’s Curtin University School of Physiotherapy and Exercise Science. She has recently published a review in Age and Ageing entitled “Reducing falls in older adults recently discharged from hospital: A systematic review and meta-analysis.”

The paper reveals the complexity of the discharge process for older people and that more support is required than is currently widely recognised. Her team found that falls prevention strategies, known to reduce falls for older people in general, were not as effective for older people following hospital discharge.

Evidence has shown 30% of the population of older people who live in the community fall at least once per year, 10% of these falls result in a serious injury. Whereas 40% of the population of older people who have recently been discharged home from hospital fall within 6 months of discharge, most of these falls occur in the first month and 54% result in a serious injury, particularly hip fractures.

The shift from hospital to home is a sensitive transition time. Hospital stays are an adverse event, during which older people have faced prolonged bed-rest, changes in medications, diet and daily routine.  Their progressive deterioration doesn’t necessarily stop once they reach home, especially as they may still be medically unwell and recovering from their hospital stay.  So, when older people reach home they may be physically deconditioned and dependent on others while they attempt to recover their normal function.

While new programs can take hospital care into the home setting and potentially allow people to recover in their own home, there is a concurrent need to work on what type of program can reduce the adverse events that may occur when people are discharged so rapidly in today’s health environment. This transition from hospital to home is a large area of focus at present in health research, as we know that unplanned re-admissions after a hospital stay may indicate that not all problems have been addressed prior to discharge.

We know from previous research that older people are willing to accept education around the time of discharge and falls prevention education that is tailored to their individual falls risk factors, could improve their engagement in falls prevention strategies following hospital discharge.  Falls prevention education can also explain to older people in real terms, that falls risks can manifest in real life once they return home from hospital.

So far, our investigations have revealed that falls prevention interventions delivered to the population of older people recently discharged from hospital may need to be individually tailored, with regular supervision over an extended period to increase their safety and compliance. We are investigating what the ideal form of patient education in this population could be and what barriers may prevent older people from making that successful transition from hospital to home such that they can return to their usual life.

Read the Age and Ageing paper: Reducing falls in older adults recently discharged from hospital: A systematic review and meta-analysis.