Why patients in specialist palliative care in-patient settings are at high risk of falls and falls-related harm: A realist synthesis. (December 2022)

• Record Type: Journal Article
• Authors: Louise Forrow, Helen; Lhussier, Monique; Scott, Jason; Atkinson, Joanne
• Is Part Of: Palliative medicine. Volume 36:Number 10(2022)
• Page Start: 1469
• Page End: 1482
• Publication Date: 2022-12
• Subjects: Fall -- palliative care -- hospice -- risk; Pain -- Treatment -- Periodicals; Cancer -- Palliative treatment -- Periodicals; Palliative Care -- Periodicals; Palliatieve behandeling; 616.029
• DOI: 10.1177/02692163221127808
• Languages: English
• ISSNs: 0269-2163

Abstract

Background: Falls are the third highest reported safety incident in Specialist Palliative Care in-patient settings and yet specific risk factors connected with falling and associated outcomes in this setting are poorly understood. Aim: To understand the key individualised risk factors leading to falls in specialist in-patient palliative care settings and understand the implications and outcomes for the patients who fall. Design: A realist synthesis of the literature, reported following the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) standards. Data sources: An iterative literature search was conducted across three recognised health collections as well as grey literature from policy, practice and other relevant areas. Results: Falls taking place within in-patient specialist palliative care settings can cause significant harm to patients. The risk factors for these patients are multifaceted and often interlinked with underpinning complex realist mechanisms including a history of falls, the age of the person, impact of complex medications, improving functional status and the presence of delirium. Conclusion: In-patients in specialist palliative care settings are at risk of falling and this is multifactorial with complex reasoning mechanisms underpinning the identified risks. There is a significant impact of a fall in this cohort of patients with many sustaining serious harm, delayed discharge and both physical and psychological impacts.