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Fall Prevention Guidelines for Patients in Wheelchairs or Patients with Delirium: A Review of Evidence-Based Guidelines

Last updated: July 19, 2019
Project Number: RC1159-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What are the evidence based guidelines to prevent falls for older adults requiring wheelchairs in institutionalized care?
  2. What are the evidence based guidelines to prevent falls for adult patients with delirium in institutionalized care?

Key Message

One evidence-based guideline was included in this review that addressed fall prevention in both patients in wheelchairs and patients with delirium. For patients in wheelchairs, multifactorial fall prevention interventions that include individualized gait, balance and functional coordination exercises are recommended (level II evidence). In addition, it is recommended that fall prevention for patients in wheelchairs include: supervised exercise; assessment of a patient’s ability to use their wheelchair (including transfers) and whether this mobility aid is appropriate for the patient; and ensuring the wheelchair is in good condition (clinical experience and expert consensus). For patients with delirium, it is recommended that multifactorial fall prevention interventions address individual fall risk factors for patients in long-term care facilities (level I evidence) and in acute care facilities (level II evidence). Based on clinical experience and expert consensus, the guideline also recommends: treating delirium as well as the reversible causes of delirium, assessing the presence of delirium in older adults after a fall, modifying regular fall prevention interventions to suit the individual patient’s situation, and avoiding the use of restraints unless all other options have been exhausted. Lastly, it is recommended that older adults with cognitive impairments be assessed for fall risk (expert opinion).