Kelly A, Dowling M. Reducing the likelihood of falls in older people. Nursing Standard. 2004 Aug;18(49):33-40.

Falls are a serious health concern for older people and an important issue for nurses. The authors describe the important role that nurses, particularly those based in hospitals, have in developing fall prevention strategies, either individually or as part of an interdisciplinary team. They conclude that all prevention strategies have the potential to improve the quality of life for at-risk older patients and their families, as well as to provide economic benefits to society.

Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Interventions for preventing falls in elderly people. Cochrane Database of Systematic Reviews. 2003;(4):CD000340.

This study assessed the effects of interventions designed to reduce the incidence of falls in elderly people (living in the community, or in institutional or hospital care). The article describes the interventions to prevent falls that are available, but less is known about their effectiveness in preventing fall-related injuries. Costs per fall prevented have been established for four of the interventions and careful economic modelling in the context of the local health care system is important. Some potential interventions are of unknown effectiveness and further research is indicated.

Close JC, Hooper R, Glucksman E, Jackson SH, Swift CG. Predictors of falls in a high-risk population: Results from the prevention of falls in the elderly trial (PROFET). Emergency Medicine Journal. 2003 Sep;20(5):421-425.

This prevention of falls in the elderly (PROFET) study in the UK examined risk factors and used these to devise a practical approach to streamlining referrals from accident and emergency departments to specialist falls services. The study focused on a readily identifiable high-risk group of people presenting at a key interface between the primary and secondary health care sectors. Analysis of derived predictors offers a practical risk-based approach to streamlining referrals that is consistent with an attainable level of service commitment.

Tinetti ME, Williams CS. The effect of falls and fall injuries on functioning in community-dwelling older persons. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 1998 Mar;53(2):M112-119.

The authors conclude that falls and fall injuries appear to be independent determinants of functional decline in community-dwelling older persons. Falling is a health condition meeting all criteria for prevention: high frequency, evidence of preventability, and high burden of morbidity.

Stevenson B, Mills EM, Welin L, Beal KG. Falls risk factors in an acute-care setting: A retrospective study. The Canadian Journal of Nursing Research. 1998;30(1):97-111.

Research findings have been contradictory regarding risk factors for falls in the acute-care setting. Identification of factors that place individuals at risk of falling in this setting are a priority because falls result in high morbidity and mortality and thus increased health care costs. The purpose of this study was to extend knowledge beyond the known risk factors of age and medical diagnosis by comparing the characteristics of 301 adults who fell while hospitalized with a matched sample of adults who did not fall while hospitalized.

Tepp J, Voitk A. Hip fracture as a complication of hospitalization. International Journal of Health Care Quality Assurance Incorporating Leadership in Health Services. 1999;12(6-7):x-xiii.

This article assesses the possible contribution of hospitalization to hip fractures sustained in an acute care hospital and to determine the need for hospital care for these patients at the time of the fracture. The authors found that most fractures occur early during hospitalization; some patients seem to have no predisposing factors for falling and about one-half may not require hospitalization at the time, all implicating hospitalization as a causative factor.

Petrella RJ, Payne M, Myers A, Overend T, Chesworth B. Physical function and fear of falling after hip fracture rehabilitation in the elderly. American Journal of Physical Medicine and Rehabilitation. 2000 Mar;79(2):154-160.

This study looks at the relationship between physical function and fall-related self-efficacy in older patients with a hip fracture who are undergoing an intensive rehabilitation program. The findings may represent a discrepancy between attention of the rehabilitation program on functional outcomes and less emphasis on confidence building behaviors. Restrictions in function from a fear of falling may negate any gains made through rehabilitation, and this could limit the long-term success of these programs and patient outcomes after hip fracture.

Schwendimann R. Prevention of falls in acute hospital care: Review of the literature. Pflege. 2000 Jun;13(3):169-179.

This article examines 21 articles related to fall prevention in acute hospital settings. The prevention strategies are essentially based on risk assessment (guess of fall danger), intervention (preventive care measures), systematic reporting of the incidents of falls and their consequences. Introduction of the preventing programs and measures resulted in a considerable reduction of patient falls. The preventive measures focused on reducing the risks of falling in everyday clinical life by increasing attention and presence of the staff caring for patients.

McGarry LJ, Thompson D, Millham FH, et al. Outcomes and costs of acute treatment of traumatic brain injury. The Journal of Trauma. 2002;53(6):1152-1159.

Although there are nearly a quarter of a million hospitalizations for traumatic brain injury (TBI) in the United States each year, data on the outcomes and costs of TBI treatment in the acute care setting are limited. Using a large, geographically diverse, multihospital database, the authors examined inpatient records for persons aged 16 years or older who were hospitalized for TBI between January 1997 and June 1999.

Fakhry SM, Trask AL, Waller MA, Watts DD. Management of brain-injured patients by an evidence-based medicine protocol improves outcomes and decreases hospital charges. The Journal of Trauma. 2004;56(3):492-499.

Traumatic brain injury (TBI) is the leading cause of death from blunt trauma, with an estimated cost to society of over $40 billion annually. Evidence-based guidelines for TBI care have been widely discussed, but in-hospital treatment of these patients has been highly variable. The purpose of this study was to determine whether management of TBI patients according to a protocol based on the Brain Trauma Foundation (BTF) guidelines would reduce mortality, length of stay, charges, and disability.