Nurse Intervention May Reduce Fear of Falling in Post–Hip Fracture Older Adults

Falls are common among elderly persons. In fact, the Centers for Disease Control and Prevention report that falls are the leading cause of both fatal and nonfatal injuries in this age group. Most hip fractures, for instance, occur as a result of falling.

In an attempt to determine whether a nurse-led care package would improve hip fracture outcomes, including fear of falling (FoF), among older adults, researchers from the Bone Health Unit at St. James’s Hospital in Dublin led by Niamh Maher conducted a randomized, controlled trial involving 226 patients.

Results of the study were presented as a poster presentation at the recent World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases in Milan, Italy (March 26–29, 2015).

The nurse-led care package included early access to a bone health clinic at 3 months post-fracture and a multidisciplinary approach to falls risk and bone health, according to the poster.

Participants, who were divided into an intervention group (IG) and a control group (CG), included individuals who sustained a hip fracture and reported to the study site between 2008 and 2010. The authors measured FoF by the Falls Efficacy Scale-International and by comparing participants in the IG with those in the CG at 15 months.

At 3 months post-fracture, severe FoF and moderate FoF were reported by 50% and 27% of IG participants, respectively. At 15 months post-fracture, however, rates of severe FoF and moderate FoF decreased to 17% and 27%, respectively (P=.025). Furthermore, the researchers reported that significantly more CG participants experienced FoF than IG participants at 15 months (P=.002).

The authors also reported that FoF was linked to increased age (P=.001), female sex (P=.047), decreased mobility (P=.005), reduced amended Barthel Index score (P=.001), increased anxiety (P=.001), and increased depression (P=.001). In addition, FoF correlated with a decreased self-care ability in each of the following domains of the Nottingham Extended Activities of Daily Living Scale: in the kitchen (P=.025), domestic tasks (P=.028), and leisure activities (P=.025).

“FoF is common after a hip fracture and is detrimental to rehabilitation outcomes, resulting in reduced mobility, increased dependency, institutionali[z]ation, and increased mortality,” the authors concluded. “The intervention group had less FoF than controls at 15 months, indicating that a nurse-led care package for hip fracture patients can improve FoF.”

This research was funded in part by the Health Research Board, headquartered in Dublin, Ireland.

References:
Centers for Disease Control and Prevention. Falls among older adults: An overview. https://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html. Accessed May 5, 2015.