Capezuti E. Minimizing the use of restrictive devices in dementia patients at risk for falling. Nursing Clinics of North America. 2004;39(3):625-647.

The accumulating empirical evidence demonstrates that restrictive devices can be removed without negative consequences. Most importantly, use of nonrestrictive measures has been correlated with positive patient outcomes and represents care that is dignified and safe for confused elders. Most of these nonrestrictive approaches promote mobility and functional recovery; however, testing of individual interventions is needed to further the science. As the research regarding restrictive devices has been translated into professional guidelines and regulatory standards, the prevalence of usage has declined dramatically. New institutional models of care discouraging routine use of restrictive devices also will foster innovative solutions to clinical problems associated with dementia.

Capezuti E, Talerico KA, Cochran I, Becker H, Strumpf N, Evans L. Individualized interventions to prevent bed-related falls and reduce siderail use. Journal of Gerontological Nursing. 1999;25(11):26-34.

Five categories of problems that often result in siderail use: memory disorder, impaired mobility, injury risk, nocturia/incontinence, and sleep disturbance. As nursing homes work toward meeting the Health Care Financing Administration's mandate to examine siderail use, administrators and staff need to implement interventions that support safety and individualize care for residents. While no one intervention represents a singular solution to siderail use, a range of interventions, tailored to individual needs, exist. This article describes the process of selecting individualized interventions to reduce bed-related falls.

Capezuti E, Talerico KA, Strumpf N, Evans L. Individualized assessment and intervention in bilateral siderail use. Geriatric Nursing. 1998;19(6):322-330.

The use of bilateral siderails, similar to physical restraints, can be safely reduced by a comprehensive assessment process. This article presents an individualized assessment for evaluating siderail use to guide nurses in managing resident characteristics for falling out of bed and intervening for high-risk residents. The individualized assessment is consistent with federal resident assessment instrument requirements and includes risk factors specific to falls from bed.

ECRI
Plymouth Meeting, Pennsylvania: ECRI; 2006

The comprehensive guide and accompanying CD-ROM provide interventions and tools for reducing falls in health care settings, including how to establish a falls prevention program, developing policies and procedures, understanding falls risk assessments and prevention requirements of the Joint Commission on Accreditation of Healthcare Organizations, and more. [The full-text guide is available for free in PDF format, or the CD-ROM and companion guide may be ordered via the ECRI website.]

Stein J, Viramontes BE, Kerrigan DC. Fall-related injuries in anticoagulated stroke patients during inpatient rehabilitation. Archives of Physical Medicine and Rehabilitation. 1995 Sep;76(9):840-843.

This article looks at the frequency and severity of fall-related injuries in anticoagulated patients undergoing rehabilitation after stroke to nonanticoagulated stroke patients undergoing rehabilitation.

Bond AJ, Molnar FJ, Li M, Mackey M, Man-Son-Hing M. The risk of hemorrhagic complications in hospital in-patients who fall while receiving antithrombotic therapy. Thrombosis Journal. 2005 Jan;3(1):1.

This study compares the rates of fall-related hemorrhagic injury in hospital in-patients who are taking and not taking antithrombotic therapy. In this study, compared with persons taking no antithrombotic therapy, those taking warfarin had lower rates of fall-related hemorrhagic injuries. The absolute rate of the development of fall-related intracranial hemorrhagic injury such as subdural hematomas was low, even in persons taking warfarin.

Cappuzzo KA. Anticoagulation in elderly patients who fall frequently: a therapeutic dilemma. The Consultant Pharmacist. 2005 Jul;20(7):601-605.

Falls can lead to serious injuries in anticoagulated individuals, including intracranial hemorrhages. This article discusses the relationship between anticoagulation, falling, and the risks of hemorrhagic events. It also discusses opinions on when to restart anticoagulation following resolution of the subdural hematoma.

Velozo CA, Peterson EW. Developing meaningful Fear of Falling Measures for community dwelling elderly. American Journal of Physical Medicine and Rehabilitation. 2001 Sep;80(9):662-673.

This study demonstrates how a Rasch analytic approach can be used to create Fear of Falling Measures that remain connected to the meaningful descriptions provided by the instrument items. Analysis of responses from community dwelling elderly revealed that the two middle rating scale categories (a little worried and moderately worried) were not being used in the expected fashion. After modification of the rating scale, Rasch analysis showed that the three items causing the least worry (get dressed, get on/off toilet, and get in/out of bed) were statistically erratic.

McCarter-Bayer A, Bayer F, Hall K. Preventing falls in acute care: An innovative approach. Journal of Gerontological Nursing. 2005 Mar;31(3):25-33.

This article describes a fall prevention program instituted in an acute care setting in southern Arizona that has produced encouraging results. Addresses individualizing interventions through a continuous clinical feedback loop, which provides patient care areas with relevant information about their patients who fell and recommendations for improving fall prevention.

Shaw FE, Bond J, Richardson DA, et al. Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: Randomised controlled trial. British Medical Journal. 2003 Jan;326(7380):73.

This article describes the effectiveness of multifactorial intervention after a fall in older patients with cognitive impairment and dementia attending the accident and emergency department. The authors conclude that multifactorial intervention was not effective in preventing falls in these patients.