Question

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Safety of the hospital environment in terms of preventing falls on the part of the elderly: a descriptive study

Several factors inherent to the aging process may cause a progressive loss of ability on the part of the elderly in adapting to their environment, especially in terms of changing location, such as in a hospital. Thus, the evaluation of the environment of the patient is essential to develop strategies to help prevent falls.

Thinking about safe areas in which the elderly spend the majority of their time is a major challenge. A closer look is necessary since the environment can be a facilitator or a barrier to the physical performance of these individuals(1). In this sense, the hospital environment needs to be safe, foster rapid adaptation, provide security, functionality, and comfort, and compensate for the limitations imposed by the aging process(2).

The term "patient safety" is widely used, but rarely defined clearly. In its most elementary form, it can be defined as "...the act of avoiding, preventing and improving adverse outcomes or injuries arising in the hospital care process"(3:32).

Ordinance No. 2095 of 2013(4) approved the Basic Protocols for Patient Safety, and among these, there is the "Protocol for the Prevention of Falls" whose purpose is "...to reduce the occurrence of falls of patients in care facilities". In particular, this relates to hospitalized patients, during the entire period of their hospitalization. According to the protocol, "...all patients should have their risk of falling assessed" the outcome of the assessment must be recorded in medical records and preventive measures that are appropriate to each patient should be prescribed and implemented(5:1).

The hospital environment is a strange world to the elderly and can lead to stressful experiences, albeit that human illness alone is an event that generates anxiety and insecurity(6).

The physical environment and its structure, the furniture arrangement, and the ways in which material is used have an important role to play in the occurrence of falls on the part of the elderly, accounting for approximately 30% to 50% of these events(7). The falls suffered by hospitalized patients is one of the most important occurrences in terms of breaches in safety, and are often responsible for an increased hospitalization time and a worse recovery(8).

In Brazil, an investigation into falls on the part of the hospitalized elderly in Belo Horizonte showed that, in 1000 beds, approximately 3% to 13% of individuals fall on a daily basis(9). Another study conducted in nine wards of the Clinical Hospital of Porto Alegre, showed 58 specific events of falls from beds. The data revealed that most accidents occurred with regard to elderly patients (57%), male (50.9%), at night (56.60%) and in the clinical hospitalization sector (58%)(10).

The fall is a multifactorial event of great complexity and, when associated with an environment and a context of care, it raises the need for an investigation and for continuing education on the key risk factors, the incidence, the consequences, and specific preventive measures(11). Given the above, the objective of this study is to evaluate the safety of the individual and collective physical environment in terms of the prevention of falls on the part of the hospitalized elderly.

Answer 1

Answer: Due to Aging process, many of the incapabilities occurs which causes a progressive loss of ability to work normally on the part of the elderly patients. They become incapable to adapt their environment, especially in terms of changing location, such as in a hospital. Thus, the evaluation of the environment of the patient is essential to develop strategies to help prevent falls. To minimize the incident of fall the hospital environment needs to be safe, foster rapid adaptation, provide security, functionality, and comfort, and compensate for the limitations imposed by the aging process.

The physical environment and its structure, the furniture arrangement, and the ways in which material is used have an important role to play in the occurrence of falls on the part of the elderly, accounting for approximately 30% to 50% of this event. In the survey in Brazil it has been found that falls on the part of the hospitalized elderly in Belo Horizonte showed that, in 1000 beds, approximately 3% to 13% of individuals fall on a daily basis. The data revealed that most accidents occurred with regard to elderly patients (57%), male (50.9%), at night (56.60%) and in the clinical hospitalization sector (58%)(10).