The Impact of Patient Assessments on nurse Fears, Patient Falls, and Functional Ability in Seniors with Dementia
Fitzgerald, Theresa Gloria
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Falls are a highly prevalent problem and a leading cause of pain among older adults (Hawk, Hyland, Rupert, Colonvega, & Hall, 2006; Proctor & Hirdes, 2001). For some individuals, actual or potential pain and falls lead to the development of fear of pain and fear of falling. It has been suggested that fears regarding pain and falling increase the likelihood of experiencing a subsequent fall and related pain (Brummel-Smith, 1989). Fear-avoidance models of pain and falls suggest that individuals who are afraid of pain and falling are more likely to engage in avoidance behaviours, which may result in deconditioning. This deconditioning, in turn, may result in increased risk for experiencing pain and falls (e.g., Vlaeyen & Linton, 2000). Support has been found for a direct relationship between fear of falling and falls, suggesting that fear has a negative effect on postural control (Carpenter, 2006). Hadjistavropoulos and colleagues (2004) proposed a modified fear-avoidance model for seniors with dementia in which caregiver fears and worries about their care-recipient experiencing falls and pain are thought to be linked to activity restrictions among care-recipients. Previous research with seniors in long-term care facilities (LTC) has led to support for the extension of the model to caregivers (Dever Fitzgerald, Hadjistavropoulos, & MacNab, 2009). This study extended previous research by examining fall risk in a subset of LTC residents based on a physiotherapy and a cognitive battery and actual fall rate. Seniors with dementia from 26 LTC facilities were randomized to control (care as usual) and experimental (fall risk assessment) groups. For the experimental group, all nursing staff were given residentspecific feedback regarding each care recipient's level of fall risk based on the assessment. Nurses’ fears about patient falls, as well as falls and restraint use were tracked for the four month periods that preceded and followed the assessment. Prior to the assessment, nurses’ fears about patient falls were found to be related to restraint use in both groups. Given that previous research has established that nurses' fears about patient falls are not always related to physical risk for falls (Dever Fitzgerald et al., 2009), such nurse fears may be excessive and therefore lead to unnecessary restraint use. Post-assessment, no relationship was found between nurses’ fears about patient falls and restraint use in the experimental group, suggesting that nurses may be basing their decisions to restrain residents on more objective criteria rather than their fear. Not surprisingly, restraint use was associated with decreased ability to perform activities of daily living (ADLs). Fall rates did not differ between the two groups. Implications and directions for future research are discussed.