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Reason for selecting the policy

Discuss about the Clinical Cases in Mineral and Bone Metabolism.

A fall can be defined as the unintentional and sudden, change in the position causing a person to land in the lower level, on the ground or on an object, due to the sudden onset of paralysis, epileptic seizure, or by an external force. Most of the falls has been found to be occurring due to some predisposing and precipitating factor in the environment where the person is living. It has been found that one half to two thirds of falls occur in the patient home. This paper would demonstrate the policy of “Falls - Prevention of Falls and Harm from Falls among Older People: 2011-2015”.Provide an in-depth knowledge regarding the rationale for choosing this policy supported by literature and a succinct summary of the policy document. The report would proceed by the formulation of the identified issue in the policy, the stakeholders involved, setting out of the objectives and the goals followed by identification of the parameters like the resources, timeframes and the priorities. The paper would end with a final recommendation for covering the gaps of this policy.

The health policy involves the provision, screening, assessment and management of the fall risk factors among the elderly person. It is presented to the NSW health services after an incidence of fall, and notifies people at high risk of falls. Minimizing the risks of falls occurring in the NSW health facilities require implementation of the best practice in the management of the fall risks. NSW involves in up taking these programs, responding to information and the service needs of the targeted population, identification of the opportunities for promoting the best practice in the fall prevention within the external organizations and external providers of the aged health care. The action area of the policy is to provide, or arrange for the screening, management and assessment of the risk factors among the older people coming to the NSW health services after a fall (NSW government health policy statement, 2011). the initiatives taken under this section mainly focuses on the dissemination of the best practice guidelines against fall prevention across the community based services, the outpatient and the in-patient services, the state government residential aged care services.

Another strategy related to this is the provision of education to the ambulance staffs about the ACSQHC recommendation guidelines regarding the best practice for fall prevention. Other strategies involved the issuing of a policy directives, adopting fall prevention initiatives such as the NSW health and patient safety programs, LHDs for supporting the collection of data regarding the fall prevention services provided (NSW government health policy statement, 2011). Developing standardized key fall prevention strategies for the aged care emergency teams and the chronic care provider network. The second action area of the policy refers to the minimization of the risks of falls within the NSW health care facilities. This can be done by the adoption of proper risk assessment tools for the adult patients admitted to the acute care facilities. Another initiatives includes seeking of advice from the fall prevention experts at the time of the development of the guidelines. Other reason in this policy involves services for the special group in the population. Identification of the opportunities for promoting best practice in terms of fall prevention. An important point of this policy is that apart from the adoption of risk assessment, this policy also supported the healthy, active ageing by continuing the support for the healthy life styles and the effective management of chronic diseases.

Policy analysis

Injuries due to fall are very common among the older people. It is the major cause of pain and discomfort, loss of independence, disability, premature death. In Australia it has been found that 1 in every 3 adults fall every year.

Older people are subjected to slips and falls. This is a serious problem with a potential impact on the health and the health care costs (Moyer, 2012). In spite of the several measures taken, the size and the procedure for the prevention of falls and subsequent mortality and morbidity in the old age due to falls are still to be addressed. Incidence of the fall hip fractures are “38.0, 135.8 and 501.9” per 100 person years among the males. Incidence of the fall hip fractures are “67.3, 214.7 and 564.6” per 100 person years among the female age group 60-69, 70-79 and 80 + respectively. In each year approximately 27,000 people were admitted to the hospital causing almost 400 deaths each year (NSW government health policy statement, 2011). Furthermore the age standardized hospitalizations among the older people had been found to be increasing for more than 10 years.  The substantial health care cost for slips and the falls have also been found to be increasing drastically. Prolonged hospital stays and rehabilitation has been long and expensive and recent fall has been considered as one of the leading cause of premature admission in the hospital.

Nine areas are defined in this policy (NSW government health policy statement, 2011):-

  1. Provision of “screening, assessment and management” of the fall risk factors among the older people.
  2. Minimizing the risk of falls and injuries in the NSW health care facilities, by the implementation of the recommendations.
  3. Implementing best practice in the management of falls.
  4. Conduction of exercise regimen for the aged people.
  5. Support healthy and active life style by adoption of proper nutrition regimen.
  6. Provision of proper education to the patient and the carers for fall prevention.
  7. Provision of services to special groups in need, such as the culturally and linguistically diverse group, people having low income status or with disability.
  8. Identification of opportunities for promoting best practices in fall prevention in the external organization.
  9. Dissemination of the research regarding the fall prevention strategies.

In spite of the policy take for mitigating the risks of fall among the older adults, gaps are still left in the strategy taken. It has been proven by the studies that even after he implementation of the policy, older people who have been discharged from the hospital settings are at risk of functional decline, adverse events, infections, medication complications, unplanned readmission to the hospitals, falls during the post discharged period (Chase et al., 2013). However the older people in the community do not view the fall prevention strategy to be equally relevant that can be explained by the low adherence by the older community older adults to the fall prevention strategies (NSW government health policy statement, 2011). Hence this can provide rationale to the fact that the strategies taken for educating the patients about the fall prevention strategies have not been successful.

The policy did not provide any information about the cost estimation regarding the implementation of the initiatives (Moyer, 2012). Other program gaps in the fall prevention strategies for the older adults involves the recommendations for the use of restraints in case of the older adults. Fall prevention committees should be careful about the any long term and the short term goals to transition any kind of restraint out of the structure of the community wall and culture (Chase et al., 2013). Fall prevention strategies often overlook the importance of the environmental factors throughout the living spaces of the residences. Uneven floors, rugs in the bathrooms and crowded living rooms with big furniture and can lead to falls in the older adults (Inouye et al., 2013). The policy did not emphasize on the environmental fall risk assessment performed in the resident rooms or the living areas. Another limitation of this policy is that it did not emphasize on the work force of the clinical settings. It has been found that the low workforce in a clinical setting is directly proportional to the occurrence of the adverse events (Hempel et al., 2014). The policy also did not provide a detailed explanation of any health monitoring technologies such as provision of the sensors and monitors. It has been found that that discreetly place data can be useful in providing information to the staff members regarding the unusual gait changes, increased heart rate and increased early symptoms of illness that can lead to fall (Cameron et al., 2012). One of the gap that has been identified is that the policy did not identify any community based health groups that would assist in providing care to the fall prone elderly in need (Hempel et al., 2014).. Social workers have to collaborate with the health care team in identifying the people who are unable to approach any clinical settings and remoteness. It is evident from the policy that social marketing would be done for the dissemination of the research. But how many of the older adults are under the umbrella of social networking is questionable (Hempel et al., 2014).

The policy analysis is vital for the social workers at every levels of practice.  Several authors organize the policy analysis into frame works that are used to judge the policy. One of the framework for the policy analysts consists of a policy cycle  including- formulation of the problem, developing objectives and the goals, identifying decision parameters, looking for the alternatives, proposing a remedy and the options.

There are two aims for the policy - One is to decrease the occurrence and the severity of the falls and another is to minimize the social, psychosocial and economic impact of falls in older population and their families (Boehm et al., 2014).. The goals for the policy has been appropriate in its sense. Falls can cause significant harm to the older people and hence shall be prevented at its earliest level. It has been found that falls in the older adults brings about psychosocial burden to the older people and hence any policy that should be made should include the mental stats of both the formal and the informal caregivers (Moyer, 2012). Hence one of the objective for the policy is relevant to its context. Other goals such as multifactorial interventions that includes assessments of the fall risk, the exercise programs are appropriate for the policy.   It has been found in a number of trials and systematic reviews that exercise has been found to decrease   the chance of falling in the older adults (El-Khoury et al. 2013).  An individualized exercise regimen is important for improving the balance deficiencies in the older adults (Boehm et al., 2014). The policy has emphasized on the staff education but has not emphasized on the means of education. The policy has also discussed about addressing the needs of culturally diverse population groups but did not emphasize on the way they has to be educated or how the guidelines can be disseminated (Moyer, 2012). The policy have emphasized on the reduction of the face to face delivery by providing telephone based support, but the validity of providing a telephone based support to the linguistically diverse cultural group is questionable as it is difficult to conduct an exercise regimen or fall risk screening. Furthermore communication with individuals from different culture can be challenging hence the telephone based support might not be much useful. Furthermore the development of the materials can be

There are several parameters that guides the credibility of the policies and makes them acceptable. It is this parameters that decides whether this policy has to be implemented or not. The parameters helps the analysts to decide how much time and attention should be given to a problem. The clear cut identification of the parameters help them to identify the issue and the time that a problem deserves.

The resources that have been used for this policy included written fall prevention control materials, printed resources, training and the resources for assisting the health professionals in communicating key messages to the elderly people. The policy did not provide much information regarding the budget that would be required for implementing this practice. It has only been mentioned that the Clinical excellence program would get the funding from the NSW department of health for the supporting the local health districts through program (Robertson & Gillespie, 2013).  

If policies are the outcome of the choices that the entities make to achieve their goals. The legislation and the budgetary process is the important factor of a policy implementation. It is important to understand how the system operates at various levels, as not all the policies comes in to effect through the law making process. The budget is one of the important policy document in any government and it shows how the government allocates the resources among the various needs. The policy did not provide an insight to how the budget would be distributed in this program. Furthermore politics is another parameter that decides what has to be done, what, when and how. It is government officials that has to decide on the funding and for that they should be provided with a clear estimation of the spending which is absent in this report (Miake-Lye et al., 2013). Another factor is the time frame. Furthermore the policy did not clearly mention the time frame required for carrying out the interventions. Timeliness is an important parameter for the success of a policy as the advice should be timely and forward looking. A policy without a stipulated time frame can lose proper directives and may take several time for the implementation which can lead to the failure of this project. A proper time line helps in the accomplishment of the goals quickly. The priorities highlighted in the policy are relevant as the policy not only focuses on preventing falls in the clinical setting but also in residential care settings.

One of the priorities that has been identified in the policy is the adoption of certain exercise programs such as the balance restraining and the muscle straining exercises such as Tai Chi group exercises (Li et al., 2014). Some of the interventions that has been focused on are commendable and are important facts to be considered while the making up of the fall prevention strategies such as the withdrawal of the psychotropic medications that can lead to seizures. Another priority of this policy involves the social engagement for the older people in the interventions by providing personal invitation s for the participating in the community based program (Li et al., 2014).

The policy contains several factors that can be implemented successfully for preventing falls, but most of the interventions have been mentioned for a clinical settings. The policy could inform very less about the prevention strategies that could be used at home and about the nutritional assessment that could have been made for the adults. According to El-Khoury et al. (2013), falls have been found to be related with functional disability and decline, and it has been found that in many cases the nutritional status of the person who has suffered from fall is limited. Hence apart from the risk assessment, nutritional assessment should also be done. Interventions involves supplementation of calcium and vitamin D in food regimen (Bischoff-Ferrari et al., 2016).

The involvement of the stakeholders is an important aspect of this policy. The stakeholders has been rightly identified in the policy, that is the Australian, hospitals, the residential aged health care facility, health districts, the elderly people, the families and the health care professionals.

Conclusion

In conclusion it can be said that the policy analysis reveals the gaps and the problems in the broader sense, including the legislation. The rationale behind the fall prevention policy has been found to be quite relevant but the success of this policy is questionable as there are certain gaps in the policies that has to be addressed (Sherrington et al., 2012). The main focus of the project is to arrange for a screening, fall assessment and its management in the older adults. It involved the application of the risk assessment techniques, supporting program for the older people and their family caregivers and provision of exercises regimen for the vulnerable group. The policy also provided information about the continuing support for the vulnerable group belonging culturally diverse background (Lukaszyk, et al., 2016). The NSW fall prevention policy for the older adults was expected to reduce the leading cause of mortality among the older adults. The cost burden of falls in NSW is as high as $558.5 million. This policy would probably help in reducing the cost burden by reducing the number of hospital admissions due to all. Proper exercise regimen proposed in the policy would effect in strengthening of the bones and restoring balance in the older adults. The risk assessment would definitely help in identifying the individuals that are at a greater risks of falls. And there was an urgent need of such a policy to be implemented.

An important recommendation for this policy would be to emphasize more on staff education. It will help create awareness of the issue, its importance, and preventive measures.  Provision of latest technologies is suggested for providing training and education to the staff.  It will also help educate the families regarding the prevention of falls and home remedies to avoid the fall. The rationale is most of the falls are avoidable by using simple strategies. Falls are also common due to the carelessness of the formal or the informal caregivers. Education and policy will ensure adherence to fall prevention protocol (Robertson & Gillespie, 2013). Furthermore, anthemion should be focused more towards the diverse cultural groups to minimize the language barriers in addressing fall related concerns.  It is suggested to obtain the exact data regarding the number of sentinel events occurring due to fall. This would help to assign the focus groups required for providing the fall prevention activities. To evaluate the outcome of the policy it is suggested to conduct surveys involving the patients and other stakeholders (Spoelstra et al., 2012). Questionnaire may be used to investigate the use of healthy and the ageing services mainly targeting the aboriginal people for giving the feedback and the staff. It will help make modification to existing policies. It is recommended to develop multiple fall prevention programs to address this issue among the diverse groups. Online health care service databases must be regularly updated and used to spread the awareness on recent evidence of fall prevention for nurses (Lukaszyk et al., 2016). Another key recommendation is to include strategies that are culturally acceptable and appealing for the older aboriginal people. It can be achieved by recruitment of indigenous health care professionals, and culturally competent nurses as they can better understand the needs of the Indigenous population (Chase et al., 2012).

References

Althaus, C., Bridgman, P., & Davis, G. (2007). The Australian policy handbook (pp. xii-268). Sydney: Allen & Unwin.

Bischoff-Ferrari, H. A., Dawson-Hughes, B., Willett, W. C., Staehelin, H. B., Bazemore, M. G., Zee, R. Y., & Wong, J. B. (2014). Effect of vitamin D on falls: a meta-analysis. Jama, 291(16), 1999-2006.

Boehm, J., Franklin, R. C., & King, J. C. (2014). Falls in rural and remote community dwelling older adults: a review of the literature. Australian journal of rural health, 22(4), 146-155.

Buse, K., Mays, N., & Walt, G. (2012). Making health policy. McGraw-Hill Education (UK).

Cameron, I. D., Gillespie, L. D., Robertson, M. C., Murray, G. R., Hill, K. D., Cumming, R. G., & Kerse, N. (2012). Interventions for preventing falls in older people in care facilities and hospitals. The Cochrane Library.

Chang, J. T., Morton, S. C., Rubenstein, L. Z., Mojica, W. A., Maglione, M., Suttorp, M. J., ... & Shekelle, P. G. (2004). Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. Bmj, 328(7441), 680.

Chase, C. A., Mann, K., Wasek, S., & Arbesman, M. (2012). Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults. American Journal of Occupational Therapy, 66(3), 284-291.

Chien, M.-H., & Guo, H.-R. (2014). Nutritional Status and Falls in Community-Dwelling Older People: A Longitudinal Study of a Population-Based Random Sample. PLoS ONE, 9(3), e91044. https://doi.org/10.1371/journal.pone.0091044

El-Khoury, F., Cassou, B., Charles, M. A., & Dargent-Molina, P. (2013). The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMj, 347, f6234.

Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., ... & Ganz, D. A. (2013). Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society, 61(4), 483-494.

Inouye, S. K., Studenski, S., Tinetti, M. E., & Kuchel, G. A. (2007). Geriatric syndromes: clinical, research and policy implications of a core geriatric concept. Journal of the American Geriatrics Society, 55(5), 780.

Li, F., Harmer, P., Fisher, K. J., McAuley, E., Chaumeton, N., Eckstrom, E., & Wilson, N. L. (2005). Tai Chi and fall reductions in older adults: a randomized controlled trial. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 60(2), 187-194.

Lukaszyk, C., Harvey, L., Sherrington, C., Keay, L., Tiedemann, A., Coombes, J., ... & Ivers, R. (2016). Risk factors, incidence, consequences and prevention strategies for falls and fall?injury within older indigenous populations: a systematic review. Australian and New Zealand journal of public health, 40(6), 564-568.

Miake-Lye, I. M., Hempel, S., Ganz, D. A., & Shekelle, P. G. (2013). Inpatient fall prevention programs as a patient safety strategy: a systematic review. Annals of internal medicine, 158(5_Part_2), 390-396.

Miake-Lye, I. M., Hempel, S., Ganz, D. A., & Shekelle, P. G. (2013). Inpatient fall prevention programs as a patient safety strategy: a systematic review. Annals of internal medicine, 158(5_Part_2), 390-396.

Moyer, V. A. (2012). Prevention of falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement. Annals of internal medicine, 157(3), 197-204.

NSW government health policy statement (2011).Falls - Prevention of Falls and Harm from fall among Older People: 2011-2015. Access date: 6.6.2018. Retrieved from: https://www1.health.nsw.gov.au/pds/ArchivePDSDocuments/PD2011_029.pdf

Robertson, M. C., & Gillespie, L. D. (2013). Fall prevention in community-dwelling older adults. Jama, 309(13), 1406-1407.

Sherrington, C., Tiedemann, A., Fairhall, N., Close, J. C., & Lord, S. R. (2011). Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. New South Wales public health bulletin, 22(4), 78-83.

Spoelstra, S. L., Given, B. A., & Given, C. W. (2012). Fall prevention in hospitals: an integrative review. Clinical nursing research, 21(1), 92-112.

Ungar, A., Rafanelli, M., Iacomelli, I., Brunetti, M. A., Ceccofiglio, A., Tesi, F., & Marchionni, N. (2013). Fall prevention in the elderly. Clinical Cases in mineral and bone metabolism, 10(2), 91.

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