Causative Factors Of Falls In Aged Care: Comparison Of Staff Strategies And Governing Body Recommendations

Aim is to find out the causative factor of falls in aged care and then compare the strategies followed by the staff to the strategies recommended by the governing body.

The main objectives of this project are given as below.

To identify the core contributing factors of the falls in an aged care facilities.
To assess knowledge and attitudeof staff towards the falls prevention.
To identify staffs perception towards the resident falls.
To determine staffs strategiesfor falls prevention.
Please include problems that aged care is having recently with references. Literature should be in simple sentences that can be easily understandable don’t try to make long sentences with unnecessary items.  Causative Factors Of Falls In Aged Care Example Paper

Objectives Of The Project
Australians today are found to be enjoying a longer life expectancy than previous few generations. However, this is been disrupted by patient falls in the context of an increased patient burden in aged care facilities. Almost one in three older Australians suffer a fall every year, and these falls have severe complications as a result, including disability and eventual death (Twigg et al. 2016). Falls are one of the significant causes of harm in a care setting and imply that prevention of falls and eliminating the harmful impacts is pivotal for preventing negative outcomes. Falls in older patients is a major concern in terms of instituonalisation, socioeconomic burden, mortality (Ungar et al. 2013). A rich pool of studies and evaluations have indicated that the problem of patient falls in aged care facilities have not been addressed adequately in the modern day healthcare systems and much is to be done in at the earliest in order to change this situation (Coppedge, Conner and Se 2016).

The project hence proposed would aim to find out the causative factors of falls in aged care and then put forward a comparison between the strategies followed by the health care staff in the health care setting and the strategies recommended by the governing body.

The objectives of the project are multi-faceted and encompass all the crucial factors pertaining to fall prevention in aged care facility. The objectives of the proposed project are as follows-

To identify the primary factors contributing to patient falls in aged care facilities
To understand the level of knowledge and attitude of staffs towards fall prevention in the care setting
To assess perception of staffs towards patient falls
To determine the effectiveness of strategies used by staffs to prevent falls
The proposed project would be carried out in an aged care facility ABC in Western Australia with the approximate project fund of 1000$. The aged care facility strives to provide a comprehensive care approach to elderly through a combined care approach towards body and mind. The comprehensive care package is provided in form of support and help as per the requirements of the patients, comfortable environment and involvement of healthcare professionals for achieving better outcomes in a proactive manner. The project would, therefore, be beneficial for the aged care setting in bringing positive changes in the scenario of patient falls and the resulting negative outcomes in terms of social, health and economic burden.

The present proposal outlines the project with all relevant details put in place. The first section of the proposal aims to highlight the chosen problem and discuss the existing literature covering the significance of the problem, that is patient fall in aged care facility, the consequences, complications and social and economic burden of patient fall, the seriousness of the problem, the issues faced by aged care facilities in addressing the problem, why the change is required, and the possible solutions to the problems. The purpose of the literature review would be to indicate the gaps in limitations in existing literature and the constraints and inconsistencies prevailing within the literature. The next section of the proposal would outline the project details. This would highlight the scope of the project and the description of the project, the deliverbales, constraints of the project, stages of implementation, monitoring and evaluation, SWOT analysis of the project, resources needed, project plan and timeline and project costs. The following section would be on the project methodology and would describe the procedure to be used for the project. The proposal would end with a logical conclusion and provide the readers with a summary of the important points from the project.

Background And Significance Of Patient Falls In Aged Care
A patient fall is defined as the unplanned descent to the floor of any extension of the floor without or without any injury suffered by the patient in healthcare. All kinds of falls are included within this broader definition irrespective of whether they are caused due to physiological reasons or environmental reasons. The falls suffered by patients have a wide range of outcomes that might be drastic or less severe, depending on different factors. The falls might be injurious or non-injurious (Court-Brown et al. 2017). The most common physical injuries include pain, bruising, scratches and superficial wounds, haematoma, lacerations, intracranial bleeding and fractures (Shubert et al. 2013). Falls that do not lead to physical injury can possibly instil a sense of fear among the patients, resulting in self-imposed limitation of activity and decreased functional ability (Hempel et al. 2013). Falls occurring in hospitals is associated with increased length of stay at the hospital, utilisation of health resources as well as increased rates of discharge to a health care setting (Miake-Lye et al. 2013).

A study of hospitalisations in Australia due to falls in older patients indicated that the patient days for hospitalisation care had almost doubled from 0.7 million patient days in the time frame of 1999 to 2000 to approximately 1.4 million patient days in the time frame of 2010 to 2011. It was also found that one in every ten days spent in hospital by a patient with age 65 years and above in between the years 2010 and 2011 were attributable to a fall that is injurious in nature. The episodes of care had an average total length of stay estimated to 14.7 days. In Western Australia, falls were the reason for a total of 585,532 hospital bed-days between the year 2000 and 2008. The cost for the same was about $617.8 million, equating to $68.6 million per year. As the population ages with the passage of time, the demand for advanced and sufficient healthcare services increase. If projections are to be followed, fall-related injuries would cost the Western Australian health system about $174 million in the year 2021. The reason for the same are multi-faceted and include the absence of effective fall prevention strategies and lower costs for treatments. Falls are an indication of other underlying health complications faced by patients. Patients who suffer falls once during their stay at the health care settings are more likely to suffer falls again during their stay at the hospital (health.wa.gov.au 2017).

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Impact Of Patient Falls In Aged Care
Gu et al. (2016) defined falls as an event that is completely untoward in nature and is a common complication occurring in health care settings. Patient of older age, mostly 65 years and above, are at increasd risk of falls. Given the compromised and disabled nature of the patients who suffer falls, there is a marked increase in the utilisation of healthcare resources in all such settings. The root causes of falls can be attributed to chronic illness, orthostatic hypotension, urinary incontinence, medication, antidepressant, impaired daily activities of living, vision deficit, balance deficits and arthritis. The authors further highlight that mitigation of risks of falls in elder patients in healthcare settings is lacking the robust strategic support that can push the mitigation approach upwards. The main challenge faced by aged care settings in delivering effective mitigation strategies is proper communication between the patients and the healthcare professionals. Professionals are not found to be interacting at a desired level that can foster preventive strategies and the resulting outcomes. However, not much is known about why there is a lack of standard and appropriate operating procedures as the same are not found often to be implemented in healthcare settings, especially aged care settings. Hospital systems need to bring rapid improvements in the reduction of fall incidences, and rigorous assessments are needed in this contexts as a part of needs assessment (Ungar et al. 2013).

Lam et al. (2016) had studied recurrent falls to understand the severity of such falls in comparison to single falls. The aim of the study was to understand the relation between injury characteristics of the initial patient fall and the chances of recurrent falls injurious in nature in a chort of hospitalised patients. The study found that spine and head injuries have a significant relation with an enhanced risk of recurrent injurious falls leading to hospitalisation. The risk of recurrent falls that lead to hospitalisation increases significantly for patients whose age is above 40 years. Patients who are at risk of consecutive falls must receive rehabilitation that is tailored as per their respective injuries. The authors suggested that further research is utmost required for having a more in-depth understanding of the impact of the injury characteristics related with the first fall leading to anatomical damages.

Wilson et al. (2016) had pointed out that evidence-based (EB) fall prevention strategic interventions for mitigating the patient-specific fall risk factors re available in most of the aged care settings. However, these are not in use on a regular basis. A number of factors contribute to this situation, the most significant one being a lack of adequate staff to apply and monitor the practices on a daily basis. Some studies have highlighted the perception of nurses about the application and utilisation of evidence-based interventions for fall prevention and the strategies they use for promoting such practices. The researchers carried out a qualitative study revealed five significant themes; useful implementation strategies, before-study fall prevention practices, use of fall prevention interventions addressing patient-specific fall risk factors, the overall effect on approach to fall prevention, and the consecutive challenges.

Current Status Of Fall Prevention Strategies In Healthcare Systems
According to Tzeng and Yin (2015), injurious falls are found to be the most prevalent in-hospital adverse event that a patient suffers. Hospitalised patients are at greater risk of falling when compared to the general patient population. Patients are not engaged in fall prevention strategies, and as a result, the outcomes are negative. Engaging patients in hospital fall prevention strategies is a good approach to reduce falls and related injuries. For better engagement of patients, the nursing staff must have a proper understanding of the concept of patient centeredness which is to be applied to clinical practice. Clinicians have the responsibility of acting as enablers and not just experts taking care of medical aspects. A conceptual model is to be developed for conceptualising the knowledge gaps identified through research and improvements of quality improvement.

Loganathan et al. (2015) studied the barriers faced by different health care professionals while taking care of and preventing falls in older patients. The study was set in Malaysia and considered a qualitative study methodology with 20 health acre professionals (HCP). Two focus group discussions and interviews were conducted for the study. Four barriers were identified from the research in the domains of barriers of HCPs, perceived barriers for older patients, lack of support by caregivers and barriers of healthcare systems. The dearth of training and fall education given to HCPs emerged as the most prominent cause of falls suffered by patients in aged care settings. Lack of structured guidelines on fall prevention adds to the issue. Insufficient training is partly due to lack of resources and fundings and partly due to lack of leadership and unwillingness of professionals. As a result, professionals are not in the position to guide the patients about how falls can be prevented. The findings of the study however warrant further evidence-based reviews on the concerned topic that can uncover other similar factors influencing fall management.

Lea et al. (2016) highlight that fall prevention can be easily achieved if the issues pertaining to perceptions and experiences of professionals are taken into account. Understaffing is the most common hindrance in maintaining the required patient and care professional ratio in any setting. Due to a shortage of staff, it is not possible for professionals to allocate sufficient time for each patient. Staff mix is not appropriate at many instances, and therefore constant care is not delivered. Lack of leadership and knowledge of the professionals also form a barrier in preventing falls maximally. Staff burnout and overburden compel the professionals to miss out some of their duties and responsibilities. However, there is still a lack of adequate information about the exact factors that act as barriers in the path of implementation of fall prevention strategies. Further research needs to be qualitative in nature so that these can express the views and opinions of the care professionals.

Scope of the project
Challenges Faced By Aged Care Settings For Effective Fall Prevention
The scope of the project includes identifying the factors contributing to fall in the aged care facility. It also encompasses the strategies used by the staff to prevent falls in the facility followed by the comparison of the strategies to that recommended by the governing body. These data will be collected from the primary research using the focused group discussion method. Based on the primary data the perceptions, attitudes and knowledge of staff regarding the fall and fall prevention will be determined. The data pertaining to fall prevention strategies recommended by the governing body will be obtained from the secondary search. Based on this data the strategies used by the staff will be compared to identify the areas of improvement. These are the inclusions of the project. The project excludes the implementation of the project findings on a wider scale aged care facilities. The implementation of the corrective strategies may not be possible within the period of the project.

Deliverables
After the completion of the project, the core contributing factors of the fall in the aged cave facility will be known. The attitude and the perception of the staff members related to fall prevention in the target facility will be identified. Their attitude towards the incidents of falls in the facility will be interpreted. Accomplishing the project objectives will aid in determining the impact of the fall on different aspects of the aged care services. Once the research objectives are achieved using the primary data and the secondary data it will be easy to develop strategies to reduce falls in the facility. When comparing the fall prevention strategies in the facility to that recommended by the government, it will indicate the point of corrective action. Based on the data obtained pertaining to the strategies used for fall prevention the act of nonadherence to the regulations will be identified. It will increase the awareness among the staff and the administrators of the facility. Upon collecting the background data on falls, practice evidence from the regional, national and international perspectives can be implemented in the facility within 2 months (Büchele et al. 2014). Depending on the attitude of the staff regarding the falls in the facility new and effective policies will be developed that will prevent any negligence and carelessness exhibited by the staff. It will help introduce evidenced based options for fall prevention. Upon assessing the knowledge of the staff in regards to falls and fall prevention in general, the need of training and education program can be determined. The training of the staff can follow it. The training program of 3 months will help increase the knowledge of the importance of the older adult falls. The knowledge will assist them in taking corrective action and encourage actions to prevent falls and related injuries (Francis?Coad et al. 2015). It will be evident by the number of students attending the training or workshops.

Constraints
Literature Review And Discussion
The findings of the project may be limited due to the focus group where the small sample size may not be a good representation of the larger population. It might be difficult to steer and control the group discussions. There might be a loss of extra time in discussing extra points. While answering the moderator’s question, the participants may feel peer pressure. The responses related to subject may be hampered if the questions are not skilfully phrased (Merriam and Tisdell 2015). Further, limitation may be added to the project by lack of sufficient funding due to diversion of fund and stakeholder’s support. It may happen due to little attention given by the stakeholders to the recommendations of the project and may assume that such specific studies have been conducted. The nurses may not be comfortable with the focused group discussion out of the fear of negative implications on their profession. Due to time constraints and collection of secondary data being hectic all the relevant data may not be completely retrieved from the databases.

Implementation stage
The project will be implemented once the grant or fund is obtained and the consent from the concerned parties is observed. The next step is to eliminate the ethical issues. While collecting the secondary data it will be ensured that no relevant articles is excluded. Based on the knowledge gained it will be easy to interpret the narrations of the participants. Before conducting research, it will be ensured that all the instruments are ready for use. Prior to interview sufficient information on the ABC aged care facility will be gained. The indicators of risks will be identified and develop a preventive plan before hand. Such as modifying the questionnaire.

Monitoring and evaluation
To ensure the reliability and validity of the project proposal it will be monitored and evaluated Berdonés et al. (2014). It will include-

Collection of the consent form from the concerned aged care facility and the type of the residents present
Regulate the meetings with the mangers and the coordinator in the aged care facility
Ensuring that the participants are aware of the project objectives
The questionnaires are designed and framed skilfully by the moderators to ensure reliability and validity
Monitor Equal division of focused group
When talking with the aged patients communication will be made in low and clear voice
Project delivery permit from the local council and the Australian aged care agency
Recruit trained staff as project team member
Maintain log book and enter each step of the research for representation to the stakeholders
Manual and computer records at different stages of project
Recruitment of the trained professional and educator for critical appraisal of the secondary data and safeguard of the data
Setting realistic goals , identification and revising strategies
Keep records of project evaluation form
Collation of the data from primary and secondary source
Ensure collection of sufficient data on flaks and staff attitudes on fall prevention
Allocation of more money from health and social welfare and other public services
Project SWOT analysis (Strengths, Weaknesses, Opportunities and Threats)
SWOT analysis is performed to assess the feasibility of the project and the expected outcomes. It will assist in identifying the benefits and impeding factors of the project. The strength of the project, its weaknesses, opportunities and perceived threat are presented in the matrix below. Causative Factors Of Falls In Aged Care Example Paper

Strengths

Weaknesses

· The project will reduce medication errors

· The initiative is not capital intensive

· It will improve quality on aged care

· The project will enhance quality management skills

· The Project will improve client satisfaction

· Human resources will be required

· The project will take time to implement

· The initiative may not be unanimously accepted

Opportunities

Threats

· Applicable in home-based aged care

· The project can outsource relevant equipment

· It can also be applied across health sector

· The initiative is sustainable

· Non-compliance among some aged care facilities

· Limited resources that limit implementation

· High initial costs of implementation

Resource required
The resources required for conducting the project is data collected from the secondary search, and the primary data. It includes consent from the participants and the aged care facility, respondents instruments such as computer, typewriter, papers, video or audio recorder and printer. Academic resources include open access to library and other databases, data analysis software, online sources. Money for travelling and other expenses. Other personnel required are statistician, moderator for questionnaire and research guide (professor). Funding from the governing body is required to conduct the research and consent from the ethical committee.

Action plan and timeline
Project Details
The total time that will be required for completing the project is 4 months.

Selection of topic of Research and Justification

Construction of literature

Selection of appropriate methods

Data collection

Data analysis and representation

Reviewing the outcomes

Conclusions and recommendations

Submitting draft of the project

Printing and final submission

Project costs
The required fund for the project is $1000 and & 500 for expenses (paper works, phone bill, travelling). The fund for the project will be collected from the “Australian aged care quality agency”. It is the accreditation body for residential aged care homes. The Aged Care Act approves the funded aged care provided by the agency (Radford et al. 2015). Since the project will ensure quality services in future, which is also the goal of the agency; the funding will be provided along with required support.

Methodology
The project adopts the qualitative descriptive study and main mode of the data collection is primary research studies. This research method is justified because it will help in comprehensive summarisation of specific events experienced by the target individuals in everyday terms (Silverman 2016). Moreover, it is the least theoretical method among all the designs available. This research design is appropriate considering the research objectives as the qualitative descriptive methodology tend to draw from naturalistic inquiry. It purports a commitment to study the chosen subject in the natural state and in the context of the research arena. Further, it eliminates the need of commitment to any one theoretical view of the target phenomenon (Merriam and Tisdell 2015).

Data collection

In order to implement the project both the primary and the secondary data is needed. The secondary data refers to the data obtained from the books, journals, websites and relevant databases and will be used as supporting material. For this project, the primary data will be collected using the focused group interview as an instrument.

While conducting the focused group interview 20 participants are recruited randomly who are then divided into two focused groups to discuss the desired topic. The interview process will be conducted using open-ended questionnaire as data collection instrument. The interview process for each group will consist of 1 hour (Silverman 2016). The participants will consist of the staff members, nurses and health care professionals of the ABC aged care in Australia. The participants also include aged care patients with different illnesses such as dementia, immobilised patients, and patients using assistive devices such as walker. Nurses both at senior and mid level are included. The staff members include manager and coordinator. The interview will be conducted after taking consent from the participants and the facility coordinator. The interview will be conducted in the facility during daytime and includes both male and female participants aged above 40 years (Appendix).

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Project Methodology
In order to collect the primary data five databases will be used which are Medline, CINAHL PLUS, PubMed, ESCBO and Google Scholar. The relevant articles for this project will be retrieved from the period 2008-2017. The key words for searching the data includes aged care facility, falls, falls in elderly, causes of falls, falls in Australian aged care, fall prevention, fall prevention strategies, falls prevention in residential home and in aged care, and urinary continence and falls. Initially the abstracts of the articles will be screened to determine the relevancy of the information. It is followed by screening the full text of the articles. Articles that not align with the research objectives are excluded. The selected relevant articles are then analysed thoroughly to obtain the information that will help in accomplishing the project objectives. Articles of different research methodology such as randomised control trials, cohort study, longitudinal study, case control studies, cross sectional studies are considered while searching the articles.

The inclusion criteria for the articles search includes English as the published language, and date of publish within the range 2008-2017. The main inclusion criteria is the focus of the articles on falls in the aged care facilities, its causes, fall prevention, and the current isssues in aged care facility in Australia.

The exclusion criteria for this project are: exclusion of the articles published in language other than English. Articles published before the year 2008 are excluded from the research. Articles that do not contain the search terms are not included in the study. Other journal paper dealing with the fall prevention in hospitals, models of fall prevention, assistive devices and other fall prevention measures are excluded. Other articles dealt with falls in other countries will also be excluded (Moher et al. 2015).

The data analysis process includes recorded spoken language as the main source. It will help in capturing the non-verbal communication expressed by the participants, as it will add a valuable dimension to the analysis of the data. In case there are ethical, barrier related to use of the audio tape or video tape a reflective diary will be maintained. It will contain the refection of the interview and facilitate the moderator with the observational notes. It will be written immediately after the end of each interview (Silverman 2016).

Data analysis will use the continuum: raw data, descriptive statements and interpretation as discussed by Silverman (2016). The aim is to skilfully frame the questions to facilitate the discussion, obtain rich data, and complement the data with the observational notes and typing of the recorded information. It is followed by listening and reading the transcripts several times to immerse in details to synthesize the themes. It will be followed by the thematic framework which includes jotting of ideas and concepts arising from the text followed by descriptive statements and quotes added under appropriate thematic content . The next stage is the sorting of data using computer based approach and comparison of various themes. Since this process is hectic software such as QSR NUD*IST will be used as mentioned in the paper of Dyer and das Nair (2013) and is considered effective. Interpretation of the data includes deciphering the actual meaning of the words used , considering the context and out of context narrations, revisiting the frequency and extensiveness of comments , intensity of the comments, internal consistency, specificity of responses and big ideas (Moher et al. 2015). The data analysis of the secondary data includes critical appraisal of the selected relevant articles using the CASP tool (Critical Appraisal Skills Program tool). It is followed by the synthesis of the data (Nadelson and Nadelson 2014).

Conclusion And Summary
While conducting the project ethical considerations will be valued. The project will ensure the protection to patient rights, privacy and confidentiality of the data collected. The participants anonymity while responding, safety and security will be maintained. The researcher will comply with the Data Protection Act (Council 2016).

Stakeholders
The key stakeholders of the project are the aged care patients, staff members, nurses, and health care professionals, family members of the patients and the administrators of the aged care agencies in Australia. The health care professionals and the caregivers in the aged care are responsible for delivering high quality care and prevent falls and related injuries (Lovarini, Clemson, and Dean 2013). The family members are the indirect caregivers. The project will directly affect all the stakeholders and particularly decision makers of the patient, the research team conducting the project who are responsible for the delivering correct information through project and other community groups associated with the aged care agencies in Australia. The responsibility of the agencies is to maintain the safety of the older patients and the quality of care. It is their responsibility to comply with the national standards of care to continue receiving the government funds and achieve positive patient experiences (Büchele et al. 2014).

Beneficiaries
The initiative or action will directly affect the stakeholders. The older adults will be benefitted from the project as they will receive higher quality care and reduce falls and their vulnerability to falls. It will decrease the concern and worry among the family members. As the causes of the falls will be identified, it will help develop preventive strategies, which will be implemented in the aged care facility (Francis?Coad et al. 2015). As the project describes the strategies used by the nurses in preventing falls and compared to the governing standards, it will help the organisation and the governing body to understand how local staffing levels were having an impact on falls. The staff and the nurses will work in accordance with the national policies, as they will be aware of the consequences of the fall and importance of fall prevention. It will improve the quantity and quality of the incident reporting system in the aged care facility (Büchele et al. 2015). The aged care facilities will be benefitted as it will decrease the cost of patient fall and renew the efforts of the organisation in implementing the evidence based options (Hill et al. 2015). The project team will be benefitted with more funds and rewards for conducting similar projects if the results of the project lead to positive implications.

Conclusion

In conclusion, it can be stated that the proposed project would be a highly beneficial one in bringing into limelight the chief contributing factors towards patient falls in aged care facilities. The project would serve as a vehicle to understand the perception of viewpoints of the healthcare professionals. In addition, it would gather information on the barriers that act as a hindrance in delivering appropriate fall prevention strategic interventions.

The advantages of the proposed program are wide spread and multi-dimensional. Since there is a major paucity of research that has been successful in addressing sufficiently the issues faced while preventing falls and highlighting the factors causing patient falls, the proposed research would be a milestone in collecting valuable data for the same purpose. It is to be mentioned in this regard that an aged care setting can only achieve success in preventing falls when the exact reasons for falls are known. The project would aid in this context and provide the foundation base for collection of maximal data of high quality. The third advantage is in alignment with the objective of achieving better patient outcomes as patients would be getting increased satisfaction and comfort during their stay at the aged care facilities. The literature review has indicated that there is a need for studies that cover data collected from different approaches and epidemiological dimensions. The proposed project would be a helping aid in this matter.

It is recommended that policy reforms are brought about resting on the findings of the proposed research. Health care organisations and the government must consider the project report for considering bringing changes in the manner in which fall prevention in aged care facilities in addressed at present (Twibell et al. 2015). In the end, it is to be stated that a major transformation is to be brought about in health care system specifically related to patient falls after the dissemination of findings of the proposed project.

References

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Büchele, G., Becker, C., Cameron, I.D., König, H.H., Robinovitch, S. and Rapp, K., 2014. Predictors of serious consequences of falls in residential aged care: analysis of more than 70,000 falls from residents of Bavarian nursing homes. Journal of the American Medical Directors Association, 15(8), pp.559-563.

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Hill, A.M., McPhail, S.M., Waldron, N., Etherton-Beer, C., Ingram, K., Flicker, L., Bulsara, M. and Haines, T.P., 2015. Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial. The Lancet, 385(9987), pp.2592-2599.

Lam, C, Kang, J, Lin, H, Huang, H, Wu, C, and Chen, P 2016, ‘First Fall-Related Injuries Requiring Hospitalization Increase the Risk of Recurrent Injurious Falls: A Nationwide Cohort Study in Taiwan’, Plos One, 11, (2), p. e0149887. Available from: 10.1371/journal.pone.0149887.

Lea, E., Andrews, S., Haines, T., Nitz, J., Haralambous, B., Moore, K., Hill, K. and Robinson, A., 2016. Developing networks between residential aged care facilities as a result of engagement in a falls prevention project: an action research study. Contemporary nurse, 52(2-3), pp.163-175.

Loganathan, A., Ng, C.J., Tan, M.P. and Low, W.Y., 2015. Barriers faced by healthcare professionals when managing falls in older people in Kuala Lumpur, Malaysia: a qualitative study. BMJ open, 5(11), p.e008460. Available from:. https://dx.doi.org/10.1136/bmjopen-2015-008460.

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Miake-Lye, I.M., Hempel, S., Ganz, D.A. and Shekelle, P.G., 2013. Inpatient Fall Prevention Programs as a Patient Safety StrategyA Systematic Review. Annals of internal medicine, 158(5_Part_2), pp.390-396.

Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P. and Stewart, L.A., 2015. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews, 4(1), p.1.  Causative Factors Of Falls In Aged Care Example Paper