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Abstract
OBJECTIVE The purpose of this study was to evaluate the psychometric properties of the Baptist Health High Risk Falls Assessment (BHHRFA). BACKGROUND The cost of falls and the potential for increased patient morbidity and mortality necessitate the development of a psychometrically sound assessment. METHODS Based on pilot data, a multisite study was conducted. Assessments were collected on 21 medical-surgical units, 1 rehabilitation unit, 1 psychiatric unit, and 3 critical care units (N = 241599). Sensitivity, specificity, and diagnostic odds ratios (DORs) were calculated. Clinical usefulness in terms of assessment performance time was addressed. RESULTS Psychometric properties were within a desirable range for each site, critical care patients, and all participants (sensitivity, 0.64-1.00; specificity, 0.50-0.70; and DOR, 4.73-7.0). Although sensitivity at 1 site was high (0.84), specificity was low (0.37). CONCLUSIONS Results suggest that the BHHRFA is clinically useful for adult inpatients across acute care settings.
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203
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Severo IM, Almeida MDA, Kuchenbecker R, Vieira DFVB, Weschenfelder ME, Pinto LRC, Klein C, Siqueira APDO, Panato BP. Risk factors for falls in hospitalized adult patients: an integrative review. Rev Esc Enferm USP 2014; 48:540-54. [DOI: 10.1590/s0080-623420140000300021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 03/29/2014] [Indexed: 11/22/2022] Open
Abstract
Objective: Identifying risk factors for the occurrence of falls in hospitalized adult patients. Method: Integrative review carried out in the databases of LILACS, SciELO, MEDLINE and Web of Science, including articles published between 1989 and 2012. Results: Seventy-one articles were included in the final sample. Risk factors for falls presented in this review were related to patients (intrinsic), the hospital setting and the working process of health professionals, especially in nursing (extrinsic). Conclusion: The systematic screening of risk factors for falls was identified as a contributing factor to the reduction of this injury, helping the non-occurrence of this event that, despite being preventable, can have serious consequences including death.
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204
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Johnson M, Kelly L, Siric K, Tran DT, Overs B. Improving falls risk screening and prevention using an e-learning approach. J Nurs Manag 2014; 23:910-9. [PMID: 24848141 DOI: 10.1111/jonm.12234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/30/2022]
Abstract
AIM This study investigated the impact of an e-learning education programme for nurses on falls risk screening, falls prevention and post-falls management. BACKGROUND Falls injury within older inpatients is a major patient safety concern. METHOD Using a pre-post design, observation of the patient and environment and patient health care record audits, were conducted following the introduction of a falls e-learning education programme. RESULTS Audits of patient health care records (using the Falls Chart Audit Tool), together with observation of practice for 119 (pre) and 99 (post) patients, were undertaken. Initial risk screening was conducted using the Modified Ontario Stratify Scale for most patients (95%). Interventions such as a falls risk flag in the records/on beds, supervision when the patient is mobilising or in the bathroom, area clear of hazards, use of chair/bed alarms, and referral to allied health staff were significantly improved. CONCLUSIONS Initial risk screening of patients and improvements in preventive interventions were demonstrated. IMPLICATIONS FOR NURSING MANAGEMENT This falls e-learning programme represents a cost-effective method of increasing falls mitigation strategies within large organisations. The Falls Chart Audit Tool provides a valuable monitoring tool for managers. Falls risk screening when the patient's condition changes, requires vigilance by managers or reminders within clinical information systems.
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Affiliation(s)
- Maree Johnson
- School of Nursing and Midwifery, University of Western Sydney, Liverpool, NSW, Australia.,Centre for Applied Nursing Research, South Western Sydney Local Health District, University of Western Sydney (Affiliated with the Ingham Institute, Liverpool NSW), Liverpool, NSW, Australia
| | - Linda Kelly
- Centre for Education and Workforce Development, Rozelle, NSW, Australia
| | - Katica Siric
- Concord Repatriation General Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Duong Thuy Tran
- Centre for Health Research, School of Medicine, University of Western Sydney, Penrith, NSW, Australia
| | - Bronwyn Overs
- Mental Health Centre (Level 1), Faculty of Medicine, School of Psychiatry, Liverpool Hospital, Infant Child Adolescent Mental Health Service (ICAMHS) Research, University of New South Wales, Liverpool, NSW, Australia
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205
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Toyabe SI. Development of a risk assessment tool to predict fall-related severe injuries occurring in a hospital. Glob J Health Sci 2014; 6:70-80. [PMID: 25168984 PMCID: PMC4825464 DOI: 10.5539/gjhs.v6n5p70] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 04/02/2014] [Indexed: 11/12/2022] Open
Abstract
Inpatient falls are the most common adverse events that occur in a hospital, and about 3 to 10% of falls result in serious injuries such as bone fractures and intracranial haemorrhages. We previously reported that bone fractures and intracranial haemorrhages were two major fall-related injuries and that risk assessment score for osteoporotic bone fracture was significantly associated not only with bone fractures after falls but also with intracranial haemorrhage after falls. Based on the results, we tried to establish a risk assessment tool for predicting fall-related severe injuries in a hospital. Possible risk factors related to fall-related serious injuries were extracted from data on inpatients that were admitted to a tertiary-care university hospital by using multivariate Cox' s regression analysis and multiple logistic regression analysis. We found that fall risk score and fracture risk score were the two significant factors, and we constructed models to predict fall-related severe injuries incorporating these factors. When the prediction model was applied to another independent dataset, the constructed model could detect patients with fall-related severe injuries efficiently. The new assessment system could identify patients prone to severe injuries after falls in a reproducible fashion.
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206
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Tzeng HM, Yin CY. i Engaging as an innovative approach to engage patients in their own fall prevention care. Patient Prefer Adherence 2014; 8:693-700. [PMID: 24868148 PMCID: PMC4027936 DOI: 10.2147/ppa.s62746] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Decreasing patient fall injuries during hospitalization continues to be a challenge at the bedside. Empowering patients to become active participants in their own fall prevention care could be a solution. In a previous study, elderly patients recently discharged from a United States hospital expressed a need for nurses to give and repeat directives about fall prevention; when the nurse left a brochure on the topic, but did not provide any (or limited) verbal explanations about the content or the importance of the information, the patient felt that the information was insufficient. To address patients' needs, we developed "i Engaging", a Web-based software application for use at the bedside. i Engaging is an innovative approach that is used to engage patients in their own fall prevention care during hospital stays. The application was designed based on the assumption that patients are the best and most critical sources of information about their health status. i Engaging has not yet been tested in clinical trials.
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Affiliation(s)
- Huey-Ming Tzeng
- College of Nursing, Washington State University, Spokane, WA, USA
| | - Chang-Yi Yin
- Department of History, Chinese Culture University, Taipei, Taiwan
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207
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Van Hanegem E, Enkelaar L, Smulders E, Weerdesteyn V. Obstacle course training can improve mobility and prevent falls in people with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:485-492. [PMID: 23600491 DOI: 10.1111/jir.12045] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Persons with intellectual disabilities (ID) constitute a special-needs population at high risk of falling. This is the first study to evaluate whether obstacle course training can improve mobility and prevent falls in this population. METHODS The intervention was implemented as part of an institution-wide health care improvement plan aimed at reducing falls at a residential facility for people with ID. It comprised an annual screening of each resident for his or her individual fall risk. Subsequently, the group of ambulatory persons with a moderate to high fall risk (n = 39) were offered 10-session obstacle course training to improve their balance and gait abilities. Mobility was assessed pre-intervention, mid-term and post-intervention with the Performance Oriented Mobility Assessment (POMA), the Timed Up and Go (TUG) and the 10-meter walking test. The number of falls was compared between the year before and after intervention. RESULTS The number of falls decreased by 82% (P < 0.001). POMA scores significantly improved from pre-intervention to mid-term (mean difference ± SD, 1.8 ± 2.9, P = 0.001), from mid-term to post-intervention (2.0 ± 2.9, P < 0.001), and from pre-intervention to post-intervention (3.8 ± 4.3, P < 0.001). Participants completed the 10-meter walking test faster at the post-intervention compared with the pre-intervention assessment (difference ± SD, 2.1 ± 5.1 s, P = 0.022). TUG scores did not improve significantly. CONCLUSIONS The present study provides preliminary evidence for the effectiveness of obstacle course training in improving mobility and preventing falls in people with ID. As falls are a significant health concern in this population, further research is advocated to provide conclusive evidence for the suggested beneficial effects of exercise interventions.
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Affiliation(s)
- E Van Hanegem
- Valley View Centre Long Term Care Residential Facility for People with Intellectual Disabilities, Moose Jaw, Saskatchewan, Canada
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208
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Milos V, Bondesson Å, Magnusson M, Jakobsson U, Westerlund T, Midlöv P. Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care. BMC Geriatr 2014; 14:40. [PMID: 24674152 PMCID: PMC3986685 DOI: 10.1186/1471-2318-14-40] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 03/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are the most common cause of injuries and hospital admissions in the elderly. The Swedish National Board of Health and Welfare has created a list of drugs considered to increase the fall risk (FRIDs) and drugs that might cause/worsen orthostatism (ODs). This cross-sectional study was aimed to assess FRIDs and their correlation with falls in a sample of 369 community-dwelling and nursing home patients aged ≥75 years and who were using a multi-dose drug dispensing system. METHODS Data were collected from the patients' electronic medication lists. Retrospective data on reported falls during the previous three months and severe falls during the previous 12 months were collected. Primary outcome measures were incidence of falls as well as numbers of FRIDs and ODs in fallers and non-fallers. RESULTS The studied sample had a high incidence of both reported falls (29%) and severe falls (17%). Patients were dispensed a mean of 2.2 (SD 1.5) FRIDs and 2.0 (SD 1.6) ODs. Fallers used on average more FRIDs. Severe falls were more common in nursing homes patients. More women than men experienced severe falls. There were positive associations between number of FRIDs and the total number of drugs (p < 0.01), severe falls (p < 0.01) and female sex (p = 0.03). There were also associations between number of ODs and both total number of drugs (p < 0.01) and being community dwelling (p = 0.02). No association was found between number of ODs and severe falls. Antidepressants and anxiolytics were the most frequently dispensed FRIDs. CONCLUSIONS Fallers had a higher number of FRIDs. Numbers of FRIDs and ODs were correlated with the total number of drugs dispensed. Interventions to reduce falls in the elderly by focusing on reducing the total number of drugs and withdrawal of psychotropic medications might improve the quality and safety of drug treatment in primary care.
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Affiliation(s)
- Veronica Milos
- Center for Primary Health Care Research, Institution of Clinical Sciences, Lund University, Lund, Sweden.
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209
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Healthcare providers' knowledge of disordered sleep, sleep assessment tools, and nonpharmacological sleep interventions for persons living with dementia: a national survey. SLEEP DISORDERS 2014; 2014:286274. [PMID: 24851185 PMCID: PMC3977107 DOI: 10.1155/2014/286274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 02/12/2014] [Indexed: 12/11/2022]
Abstract
A large proportion of persons with dementia will also experience disordered sleep. Disordered sleep in dementia is a common reason for institutionalization and affects cognition, fall risk, agitation, self-care ability, and overall health and quality of life. This report presents findings of a survey of healthcare providers' awareness of sleep issues, assessment practices, and nonpharmacological sleep interventions for persons with dementia. There were 1846 participants, with the majority being from nursing and rehabilitation. One-third worked in long-term care settings and one-third in acute care. Few reported working in the community. Findings revealed that participants understated the incidence of sleep deficiencies in persons with dementia and generally lacked awareness of the relationship between disordered sleep and dementia. Their knowledge of sleep assessment tools was limited to caregiver reports, self-reports, and sleep diaries, with few using standardized tools or other assessment methods. The relationship between disordered sleep and comorbid conditions was not well understood. The three most common nonpharmacological sleep interventions participants identified using were a regular bedtime routine, increased daytime activity, and restricted caffeine. Awareness of other evidence-based interventions was low. These findings will guide evidence-informed research to develop and test more targeted and contextualized sleep and dementia knowledge translation strategies.
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210
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Demontiero O, Gunawardene P, Duque G. Postoperative prevention of falls in older adults with fragility fractures. Clin Geriatr Med 2014; 30:333-47. [PMID: 24721372 DOI: 10.1016/j.cger.2014.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The postoperative period after correction of a fragility fracture is usually associated with functional deconditioning. This deconditioning is caused by multiple factors associated with a higher risk of falls during the immediate postoperative period and after discharge. Identification of risk and appropriate fall prevention interventions in these patients are pivotal. In this article, an overview is presented of the strategies to identify falls risk in postoperative patients after suffering a fragility fracture. Evidence is presented favoring targeted multicomponent intervention for falls prevention rather than a single intervention in fractured older patients at high risk of new falls and fractures.
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Affiliation(s)
- Oddom Demontiero
- Department of Geriatric Medicine, Nepean Hospital, PO Box 63, Penrith, New South Wales 2750, Australia; Ageing Bone Research Program, Sydney Medical School Nepean, The University of Sydney, Penrith, New South Wales, Australia
| | - Piumali Gunawardene
- Department of Geriatric Medicine, Nepean Hospital, PO Box 63, Penrith, New South Wales 2750, Australia; Ageing Bone Research Program, Sydney Medical School Nepean, The University of Sydney, Penrith, New South Wales, Australia
| | - Gustavo Duque
- Department of Geriatric Medicine, Nepean Hospital, PO Box 63, Penrith, New South Wales 2750, Australia; Ageing Bone Research Program, Sydney Medical School Nepean, The University of Sydney, Penrith, New South Wales, Australia; Division of Geriatric Medicine, Sydney Medical School Nepean, The University of Sydney, PO Box 63, Penrith, New South Wales 2750, Australia.
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211
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Lee J, Geller AI, Strasser DC. Analytical review: focus on fall screening assessments. PM R 2014; 5:609-21. [PMID: 23880047 DOI: 10.1016/j.pmrj.2013.04.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 03/30/2013] [Accepted: 04/02/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Falls and their associated injuries profoundly impact health outcomes, functional independence, and health care expenses, particularly for the ever-increasing elderly population. This systematic search and review assessed the current evidence for the role of fall screening assessments. OBJECTIVE To review the current evidence for fall risk screening assessments in community-dwelling (outpatient), inpatient medical and surgical wards, inpatient rehabilitation centers, and postrehabilitation outpatient settings. DATA SOURCES MEDLINE and Embase (January 1980 to December 2012). STUDY SELECTION Prospective validation studies of acute medical or surgical inpatients, acute rehabilitation inpatients, outpatients who completed acute inpatient rehabilitation, or community-dwelling elderly. DATA EXTRACTION Sensitivity, specificity, positive predictive value, negative predictive value, receiver operating characteristics with area under the curve. RESULTS We summarized key findings from 6 literature reviews. We then identified 31 articles: 12 studies in community setting, 13 in the acute medical inpatient or surgical inpatient setting, and 6 studies in the rehabilitation setting. Twenty-two studies not previously reviewed were included, and 9 studies previously reviewed were considered relevant and were included to allow comparison with data from the studies not previously reviewed. CONCLUSION We recommend consideration of 7 assessment tools to be used in conjunction with overall clinical evaluation to assess falls risk: the Timed Up and Go Test with a cutoff of >12.34 seconds and Functional Gait Assessment among community-dwelling elderly; St Thomas Risk Assessment Tool in medical inpatients <65 years old and surgical inpatients; Hendrich fall risk model II in medical inpatients; 10-Minute Walk Test in patients in poststroke rehabilitation; and Berg Balance Scale or the Step Test in patients in poststroke rehabilitation who had fallen during their inpatient stay.
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Affiliation(s)
- Jacob Lee
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
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212
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Costa-Dias MJ, Oliveira AS, Martins T, Araújo F, Santos AS, Moreira CN, José H. Medication fall risk in old hospitalized patients: a retrospective study. NURSE EDUCATION TODAY 2014; 34:171-176. [PMID: 23769987 DOI: 10.1016/j.nedt.2013.05.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 04/08/2013] [Accepted: 05/15/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND While the causes of falls in old hospitalized patients are multifactorial, medication has been considered as one of the most significant factors. Given the large impact that this phenomenon has on the lives of the elderly and organizations, it is important to explore such phenomenon in greater depth. OBJECTIVE The objective of this study was to explore the association between medication and falls and the recurrent falls (n≥2), and identify medication related risk for fall in hospitalized patients, in a large acute hospital. DESIGN Retrospective and quantitative study from June 2008 to December 2010. SETTING The study was conducted in a private hospital for acute patients in Lisbon, Portugal. PARTICIPANTS The study included a sample of 214 episodes of fall event notifications which occurred in 193 patients. METHODS The current study was conducted through the "face to face consensus" technique which emerged the treatment groups to investigate. Regarding the data analysis we used Student's t test, ANOVA and Odds Ratio. In the violation of the premises for the use of parametric statistics we used the Kruskal-Wallis test. To assess the fall risk, and the medication-related fall risk, we used the Morse Fall Risk Scale, and the Medication Fall Risk Score. RESULTS Patients who received drugs from the therapy group of "Central Nervous System", are 10 times more likely to have fall risk (OR 9. 90, 95% CI 1.6-60.63). Association was found between falls (OR 6.09, 95% CI 1.30-28.54) and its recurrence (OR 3.32, 95% CI 1.61-6.85), among patients receiving haloperidol and receiving tramadol for recurrent falls (OR 3.10, 95% CI 1.59-6.07). In 34% of the patients the medication fall risk score was 6 or higher. CONCLUSIONS This current study allowed identifying medication-related risk factors for falls, that nurses should consider when prescribing interventions to prevent falls and its recurrence, when patients are admitted to acute care hospitals.
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Affiliation(s)
| | | | | | | | - Ana Sofia Santos
- Unit of Continuing and Palliative Care, Hospital da Luz, S.A., Lisbon, Portugal
| | | | - Helena José
- Catholic University of Portugal, Lisbon, Portugal; European Academy of Nursing Science, United Kingdom.
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213
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Brown CJ, Miltner RS. Hospital Falls. PATIENT SAFETY 2014. [DOI: 10.1007/978-1-4614-7419-7_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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214
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Lawson SN, Zaluski N, Petrie A, Arnold C, Basran J, Dal Bello-Haas V. Validation of the Saskatoon Falls Prevention Consortium's Falls Screening and Referral Algorithm. Physiother Can 2014; 65:31-9. [PMID: 24381379 DOI: 10.3138/ptc.2011-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the concurrent validity of the Saskatoon Falls Prevention Consortium's Falls Screening and Referral Algorithm (FSRA). METHOD A total of 29 older adults (mean age 77.7 [SD 4.0] y) residing in an independent-living senior's complex who met inclusion criteria completed a demographic questionnaire and the components of the FSRA and Berg Balance Scale (BBS). The FSRA consists of the Elderly Fall Screening Test (EFST) and the Multi-factor Falls Questionnaire (MFQ); it is designed to categorize individuals into low, moderate, or high fall-risk categories to determine appropriate management pathways. A predictive model for probability of fall risk, based on previous research, was used to determine concurrent validity of the FSRI. RESULTS The FSRA placed 79% of participants into the low-risk category, whereas the predictive model found the probability of fall risk to range from 0.04 to 0.74, with a mean of 0.35 (SD 0.25). No statistically significant correlation was found between the FSRA and the predictive model for probability of fall risk (Spearman's ρ=0.35, p=0.06). CONCLUSION The FSRA lacks concurrent validity relative to to a previously established model of fall risk and appears to over-categorize individuals into the low-risk group. Further research on the FSRA as an adequate tool to screen community-dwelling older adults for fall risk is recommended.
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Affiliation(s)
| | | | | | - Cathy Arnold
- School of Physical Therapy, University of Saskatchewan
| | - Jenny Basran
- Geriatric Evaluation and Management Program, Saskatoon City Hospital, Saskatoon, Sask
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Hamilton, Ont
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215
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Van Gaal BG, Schoonhoven L, Mintjes-de Groot JA, Defloor T, Habets H, Voss A, van Achterberg T, Koopmans RT. Concurrent Incidence of Adverse Events in Hospitals and Nursing Homes. J Nurs Scholarsh 2013; 46:187-98. [DOI: 10.1111/jnu.12063] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Betsie G.I. Van Gaal
- Senior researcher, Scientific Institute for Quality of Healthcare; Radboud university medical center; Nijmegen the Netherlands
| | - Lisette Schoonhoven
- Senior Research Fellow Nursing Science, Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, the Netherlands and Faculty of Health Sciences; University of Southampton; Southampton UK
| | - Joke A.J. Mintjes-de Groot
- Emeritus Professor Critical Care, Faculty of Health and Social Studies; HAN University of Applied Sciences; Nijmegen the Netherlands
| | - Tom Defloor
- Was Professor of Nursing Science, Department of Public Health, Faculty of Medicine and Health Science; Ghent University; Gent Belgium
| | - Herbert Habets
- Geriatric Clinical Nurse Specialist, Orbis Medical Centre, Sittard-Geleen, Senior Lecturer; Zuyd University of Applied Sciences; Heerlen The Netherlands
| | - Andreas Voss
- Professor of Clinical Microbiology and Infection Control, Department of Medical Microbiology, Radboud university medical center, Nijmegen, the Netherlands and Consultant Clinical Microbiologist; Canisius-Wilhelmina Hospital; Nijmegen the Netherlands
| | - Theo van Achterberg
- Professor of Nursing Science, Scientific Institute for Quality of Healthcare, Radboud university medical center; Nijmegen, the Netherlands and Center for Health Services and Nursing Research; KU Leuven Leuven Belgium
| | - Raymond T.C.M. Koopmans
- Professor of Elderly Care Medicine, Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health; Radboud university medical center; Nijmegen the Netherlands
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216
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Haines T, O'Brien L, McDermott F, Markham D, Mitchell D, Watterson D, Skinner E. A novel research design can aid disinvestment from existing health technologies with uncertain effectiveness, cost-effectiveness, and/or safety. J Clin Epidemiol 2013; 67:144-51. [PMID: 24275500 DOI: 10.1016/j.jclinepi.2013.08.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 08/07/2013] [Accepted: 08/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Disinvestment is critical for ensuring the long-term sustainability of health-care services. Key barriers to disinvestment are heterogeneity between research and clinical settings, absence of evidence of effectiveness of some health technologies, and exposure of patients and organizations to risks and poor outcomes. We aimed to develop a feasible research design that can evaluate disinvestment in health technologies of uncertain effectiveness or cost-effectiveness. STUDY DESIGN AND SETTING This article (1) establishes the need for disinvestment methodologies, (2) identifies the ethical concerns and feasibility constraints of conventional research designs for this issue, (3) describes the planning, implementation, and analytical framework for a novel disinvestment-specific study design, and (4) describes potential limitations in application of this design. RESULTS The stepped-wedge, roll-in cluster randomized controlled trial can facilitate the disinvestment process, whereas generating evidence to determine whether the decision to disinvest was sound in the clinical environment. A noninferiority research paradigm may be applied to this methodology to demonstrate that the removal of a health technology does not adversely affect outcomes. CONCLUSION This research design can be applied across multiple fields and will assist determination of whether specific health technologies are clinically effective, cost-effective, and safe.
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Affiliation(s)
- Terry Haines
- Allied Health Research Unit, Monash Health, Kingston Centre, Kingston Rd, Cheltenham, Victoria 3192, Australia; Physiotherapy Department, Southern Physiotherapy Clinical School, Monash University, Peninsula Campus, McMahon's Rd, Frankston, Victoria 3199, Australia.
| | - Lisa O'Brien
- Department of Occupational Therapy, Monash University, Peninsula Campus, McMahon's Rd, Frankston, Victoria 3199, Australia; Department of Occupational Therapy, The Alfred, 55 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Fiona McDermott
- Department of Social Work, Faculty of Medicine Nursing and Health Sciences, Monash University and Southern Health, PO Box 197, Caulfield East, Victoria 3156, Australia; Social Work Department, Monash Medical Centre, Clayton Rd, Clayton, Victoria 3168, Australia
| | - Donna Markham
- Monash Health, Monash Medical Centre, Clayton Rd, Clayton, Victoria 3168, Australia
| | - Deb Mitchell
- Monash Health, Monash Medical Centre, c/Site Management, 246 Clayton Rd, Clayton, Victoria 3168, Australia
| | - Dina Watterson
- Department of Occupational Therapy, Caulfield Hospital, Alfred Health, 60 Kooyong Rd, Caulfield, Victoria 3162, Australia
| | - Elizabeth Skinner
- Physiotherapy Department, Sunshine Hospital, Western Health, Furlong Rd, St Albans, Victoria 3021, Australia
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217
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Tsur A, Eluz D, Itah D, Segal Z, Shakeer N, Galin A. Clinical profile of fallers with femoral neck fractures. PM R 2013; 6:390-4. [PMID: 24252491 DOI: 10.1016/j.pmrj.2013.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 10/25/2013] [Accepted: 10/29/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the most common characteristics of elderly people who fell and fractured their femoral neck and who were admitted to our rehabilitation setting after surgery by an orthopedic surgeon. SETTING A rehabilitation department in a general regional hospital. PARTICIPANTS A cohort of 100 patients, 37 men and 63 women, hospitalized for rehabilitation after surgery for a fracture in the femoral neck. METHODS All the patients were interviewed by a physician from the rehabilitation department about the circumstances of their fall injuries, examined by an ophthalmologist for ocular problems, and evaluated by an occupational therapist for cognitive function. Data about background diseases were retrieved from the patients' medical records. MAIN OUTCOME MEASUREMENTS Age of the patients, place and time of the fall, the circumstances of the fall event, the footwear used at the time of the fall, ophthalmic problems, cognitive disorders, eyeglasses use, walking aids use, medication used that may affect the central nervous system, and the presence of diseases that may influence patients' equilibrium. RESULTS The mean age of the patients was 78 years, with a mean weight of 69 kg. Seventy-eight percent had 1-5 diseases that could influence their balance during weight bearing; 67% had an ophthalmic disease. For 70% of the patients, the cause of the fall appeared to be intrinsic (personal). Seventy-two percent wore socks or slippers, or were barefoot at the time of the fall. Sixty-four percent of the patients who used a walking aid did not use it during the fall event. Seventy-one percent of falls occurred indoors and 29% outdoors. Fifty-five percent of the patients were with another person when they fell. Fifty-one percent were taking tranquilizers or medications for sleep disorders. Sixty-eight percent fell during the daylight hours, between 6 AM and 6 PM. Of the patients who wore eyeglasses, 77.6% were not wearing them when they fell. Seventy percent had a short-term memory disorder, 57% had a concentration disorder, and 49% had an orientation disorder. CONCLUSIONS Characteristics common to patients who fell and fractured their femoral neck included age older than 78 years, cognitive impairment, nonuse of eyeglasses that were prescribed, and inappropriate footwear.
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Affiliation(s)
- Atzmon Tsur
- Department of Rehabilitation, Western Galilee Hospital, POB 21, Nahariya 22100, Israel (Affiliated to the Faculty of Medicine in the Galilee, Bar-Ilan University, Israel)(∗).
| | - Dana Eluz
- Occupational Therapy Institute, Western Galilee Hospital, Nahariya, Israel (Affiliated to the Faculty of Medicine in the Galilee, Bar-Ilan University, Israel)(†)
| | - Dorit Itah
- Occupational Therapy Institute, Western Galilee Hospital, Nahariya, Israel (Affiliated to the Faculty of Medicine in the Galilee, Bar-Ilan University, Israel)(‡)
| | - Zvi Segal
- Department of Ophthalmology, Western Galilee Hospital, Nahariya, Israel (Affiliated to the Faculty of Medicine in the Galilee, Bar-Ilan University, Israel)(§)
| | - Nael Shakeer
- Department of Rehabilitation, Western Galilee Hospital, Nahariya, Israel (Affiliated to the Faculty of Medicine in the Galilee, Bar-Ilan University, Israel)(‖)
| | - Arkady Galin
- Department of Rehabilitation, Western Galilee Hospital, Nahariya, Israel (Affiliated to the Faculty of Medicine in the Galilee, Bar-Ilan University, Israel)(¶)
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Ebeling PR, Daly RM, Kerr DA, Kimlin MG. Building healthy bones throughout life: an evidence‐informed strategy to prevent osteoporosis in Australia. Med J Aust 2013. [DOI: 10.5694/mjao12.11363] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Peter R Ebeling
- NorthWest Academic Centre, University of Melbourne, and Western Health, Melbourne, VIC
| | - Robin M Daly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, VIC
| | - Deborah A Kerr
- Curtin Health Innovation Research Institute and School of Public Health, Curtin University, Perth, WA
| | - Michael G Kimlin
- Faculty of Health, Queensland University of Technology, Brisbane, QLD
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Cumbler EU, Simpson JR, Rosenthal LD, Likosky DJ. Inpatient falls: defining the problem and identifying possible solutions. Part I: an evidence-based review. Neurohospitalist 2013; 3:135-43. [PMID: 24167647 DOI: 10.1177/1941874412470665] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In this 2 part series, analysis of the risk stratification tools that are available, definition for the scope of the problem, and potential solutions through a review of the literature are presented. A systematic review was used to identify articles for risk stratification and interventions. Three risk stratification systems are discussed, St Thomas's Risk Assessment Tool in Falling Elderly Inpatients, Morse Fall Scale, and the Hendrich Fall Risk Model. Of these scoring systems, the Hendrich Fall Risk Model is the easiest to use and score. Predominantly, multifactorial interventions are used to prevent patient falls. Education and rehabilitation are common themes in studies with statistically significant results. The second article presents a guide to implementing a quality improvement project around hospital falls. A 10-step approach to Plan-Do-Study-Act (PDSA) cycles is described. Specific examples of problems and analysis are easily applicable to any institution. Furthermore, the sustainability of interventions and targeting new areas for improvement is discussed. Although specific to falls in the hospitalized patient, the goal is to present a stepwise approach which is broadly applicable to other areas requiring quality improvement.
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Affiliation(s)
- Ethan U Cumbler
- Department of Internal Medicine, University of Colorado, Denver, CO, USA
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Nassar N, Helou N, Madi C. Predicting falls using two instruments (the Hendrich Fall Risk Model and the Morse Fall Scale) in an acute care setting in Lebanon. J Clin Nurs 2013; 23:1620-9. [PMID: 24124974 DOI: 10.1111/jocn.12278] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To assess the predictive value of two instruments (the Morse Fall Scale (MFS) and the Heindrich II Fall Risk Model (HFRM)] in a Middle Eastern country (Lebanon) and to evaluate the factors that are related to falls. DESIGN A prospective observational cross-sectional design was used. BACKGROUND Falls and fall-related injuries in the acute care settings contribute a substantial health and economic burden on patients and organisations. Preventing falls is a priority for most healthcare organisations. While the risk of falling cannot be eliminated, it can be significantly reduced through accurate assessment of patients' risk of falling. METHODS Data from 1815 inpatients at the American University of Beirut Medical Center (AUBMC) in Lebanon were evaluated using two instruments to predict falls: the MFS and the HFRM. RESULTS The incidence of falls was 2·7% in one year. The results indicate that while the instruments were significantly correlated, the HFRM was more sensitive in predicting falls than the MFS. The internal consistency of both scales was moderate, but inter-rater reliability was high. Patients using antiepileptic drugs and assistance devises had higher odds of falling. CONCLUSIONS Although both instruments were easy to use in a Middle Eastern country, the HFRM rather than the MFS is recommended for inpatients in an acute care setting as it had higher sensitivity and specificity. RELEVANCE TO CLINICAL PRACTICE It is recommended that while the HFRM had adequate sensitivity, it is not seamless, and as such, nurses should not rely entirely on it. Rather, nurses should use their expert clinical judgement, their ethical obligations and cultural considerations to implement a safer environment of care for the patient.
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Affiliation(s)
- Nada Nassar
- Nursing Services Department, American University of Beirut Medical Center, Beirut, Lebanon
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Sung YH, Cho MS, Kwon IG, Jung YY, Song MR, Kim K, Won S. Evaluation of falls by inpatients in an acute care hospital in Korea using the Morse Fall Scale. Int J Nurs Pract 2013; 20:510-7. [DOI: 10.1111/ijn.12192] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yung Hee Sung
- Graduate School of Clinical Nursing Science; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Myung Sook Cho
- Graduate School of Clinical Nursing Science; Sungkyunkwan University School of Medicine; Seoul Korea
| | - In Gak Kwon
- Graduate School of Clinical Nursing Science; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Yoen Yi Jung
- Research Institute of Clinical Nursing Science; Samsung Medical Center; Seoul Korea
| | - Mi Ra Song
- Nursing Professional Development; Samsung Medical Center; Seoul Korea
| | - Kyunghee Kim
- College of Nursing; Chung-Ang University; Seoul Korea
| | - Sungho Won
- Department of Applied Statistics; The Research Center for Data Science; Chung-Ang University; Seoul Korea
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Laureani A, Brady M, Antony J. Applications of Lean Six Sigma in an Irish hospital. Leadersh Health Serv (Bradf Engl) 2013. [DOI: 10.1108/lhs-01-2012-0002] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Khusainov R, Azzi D, Achumba IE, Bersch SD. Real-time human ambulation, activity, and physiological monitoring: taxonomy of issues, techniques, applications, challenges and limitations. SENSORS (BASEL, SWITZERLAND) 2013; 13:12852-902. [PMID: 24072027 PMCID: PMC3859040 DOI: 10.3390/s131012852] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/02/2013] [Accepted: 09/10/2013] [Indexed: 01/06/2023]
Abstract
Automated methods of real-time, unobtrusive, human ambulation, activity, and wellness monitoring and data analysis using various algorithmic techniques have been subjects of intense research. The general aim is to devise effective means of addressing the demands of assisted living, rehabilitation, and clinical observation and assessment through sensor-based monitoring. The research studies have resulted in a large amount of literature. This paper presents a holistic articulation of the research studies and offers comprehensive insights along four main axes: distribution of existing studies; monitoring device framework and sensor types; data collection, processing and analysis; and applications, limitations and challenges. The aim is to present a systematic and most complete study of literature in the area in order to identify research gaps and prioritize future research directions.
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Affiliation(s)
- Rinat Khusainov
- School of Engineering, Faculty of Technology, University of Portsmouth, Anglesea Building, Anglesea Road, Portsmouth PO1 3DJ, UK; E-Mails: (R.K.); (D.A.); (S.D.B.)
| | - Djamel Azzi
- School of Engineering, Faculty of Technology, University of Portsmouth, Anglesea Building, Anglesea Road, Portsmouth PO1 3DJ, UK; E-Mails: (R.K.); (D.A.); (S.D.B.)
| | - Ifeyinwa E. Achumba
- School of Engineering, Faculty of Technology, University of Portsmouth, Anglesea Building, Anglesea Road, Portsmouth PO1 3DJ, UK; E-Mails: (R.K.); (D.A.); (S.D.B.)
| | - Sebastian D. Bersch
- School of Engineering, Faculty of Technology, University of Portsmouth, Anglesea Building, Anglesea Road, Portsmouth PO1 3DJ, UK; E-Mails: (R.K.); (D.A.); (S.D.B.)
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Baek S, Piao J, Jin Y, Lee SM. Validity of the Morse Fall Scale implemented in an electronic medical record system. J Clin Nurs 2013; 23:2434-40. [PMID: 24112535 DOI: 10.1111/jocn.12359] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the validity of the Morse Fall Scale by analysing the electronic medical records on fall risk during different phases of hospitalisation. BACKGROUND Regular monitoring on fall risk with a reliable and valid assessment tool is a key element in the fall prevention. In Korea, the Morse Fall Scale is currently being used in numerous medical institutions, yet it has not been comprehensively evaluated whether it is suitable and valid. DESIGN The study design was a retrospective case-control study. METHODS The participants included 151 fallers and 694 nonfallers. Data were extracted from a university hospital implementing Morse Fall Scale in the electronic medical records between October 2010 and June 2011. The nonfallers were selected by the stratified random sampling method among the patients who were in the hospital during the same period as the fallers. The Morse Fall Scale scores during three different time periods of hospital stay were used for analysis: the initial assessment score upon admission, the last and the maximum scores recorded from admission to the fall or discharge. RESULTS With the maximum Morse Fall Scale score and the best cut-off point of 51, validity indicators showed the highest performance: 0·72 for sensitivity, 0·91 for specificity, 0·63 for positive predictive value, 0·94 for negative predictive value, 0·63 for Youden Index and 0·77 for the area under the receiver operating characteristic curve. CONCLUSION The Morse Fall Scale showed relatively high predictive performance for the Korean population. RELEVANCE TO CLINICAL PRACTICE The study results recommend practice change in fall prevention. As the validity was highest when the patient was first classified into the high-risk group based on the Morse Fall Scale cut-off score 51, patients classified as high risk should be placed under special nursing interventions until the day of their discharge, regardless of change in the patient state.
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Affiliation(s)
- Seonhyeon Baek
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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225
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Características de eventos adversos evitáveis em hospitais do Rio de Janeiro. Rev Assoc Med Bras (1992) 2013; 59:421-8. [DOI: 10.1016/j.ramb.2013.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/26/2013] [Accepted: 03/23/2013] [Indexed: 11/19/2022] Open
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Abstract
BACKGROUND Injurious fall is a serious hospital-acquired condition. Screening tools for injurious falls in hospitalized patients have received limited evaluation. OBJECTIVE To compare operating characteristics of a succinct screening tool for injurious falls, the University of Pittsburgh Medical Center (UPMC) screening tool (based on mobility, fall history, and nursing judgment), with the ABCS injurious fall screening tool (based on Age, Bone, Coagulation, and recent Surgery). DESIGN Case control study. METHODS Hospitalized patients with injurious falls were identified from the UPMC adverse events database for 2007-2008 (N = 43). Controls (n = 86) matched for age, location, and period of fall event were selected from the hospital's administrative database. Tools were evaluated independently by 2 screeners using electronic charts. Interrater agreement, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and c-statistics for the screening tools were calculated. RESULTS Case and control groups were similar in age, sex, and race. Interrater agreement was 71% for ABCS and 72% for UPMC screens. ABCS and UPMC screens had sensitivity of 60.5% (95% CI, 52.0%-68.9%) and 62.8% (95% CI, 54.5%-71.1%), specificity of 41.9% (95% CI, 33.4%-50.4%) and 58.1% (95% CI 49.6%-66.7%), and c-statistics of 51.2% and 59.3%, respectively. With a 33% prevalence of injurious fall, the PPV was 34.2%, and NPV was 67.9% for ABCS, and the PPV was 42.9%, and NPV was 75.8% for UPMC. Operating characteristics were not statistically significantly different, although the UPMC screen was 8% more accurate in predicting injurious falls and had a lower false-positive rate (44.2% versus 65.1%). CONCLUSIONS Compared with the ABCS screen, the UPMC screen is a simple, practical tool. Prospective studies are needed to establish the UPMC tool's predictive value in hospital practices with lower rates of injurious falls. In general, better screening tools for injurious falls should be developed to meet quality standards.
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227
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Howcroft J, Kofman J, Lemaire ED. Review of fall risk assessment in geriatric populations using inertial sensors. J Neuroeng Rehabil 2013; 10:91. [PMID: 23927446 PMCID: PMC3751184 DOI: 10.1186/1743-0003-10-91] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 07/02/2013] [Indexed: 12/22/2022] Open
Abstract
Background Falls are a prevalent issue in the geriatric population and can result in damaging physical and psychological consequences. Fall risk assessment can provide information to enable appropriate interventions for those at risk of falling. Wearable inertial-sensor-based systems can provide quantitative measures indicative of fall risk in the geriatric population. Methods Forty studies that used inertial sensors to evaluate geriatric fall risk were reviewed and pertinent methodological features were extracted; including, sensor placement, derived parameters used to assess fall risk, fall risk classification method, and fall risk classification model outcomes. Results Inertial sensors were placed only on the lower back in the majority of papers (65%). One hundred and thirty distinct variables were assessed, which were categorized as position and angle (7.7%), angular velocity (11.5%), linear acceleration (20%), spatial (3.8%), temporal (23.1%), energy (3.8%), frequency (15.4%), and other (14.6%). Fallers were classified using retrospective fall history (30%), prospective fall occurrence (15%), and clinical assessment (32.5%), with 22.5% using a combination of retrospective fall occurrence and clinical assessments. Half of the studies derived models for fall risk prediction, which reached high levels of accuracy (62-100%), specificity (35-100%), and sensitivity (55-99%). Conclusions Inertial sensors are promising sensors for fall risk assessment. Future studies should identify fallers using prospective techniques and focus on determining the most promising sensor sites, in conjunction with determination of optimally predictive variables. Further research should also attempt to link predictive variables to specific fall risk factors and investigate disease populations that are at high risk of falls.
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Affiliation(s)
- Jennifer Howcroft
- Department of Systems Design Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada.
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Menéndez MD, Alonso J, Miñana JC, Arche JM, Díaz JM, Vazquez F. Characteristics and associated factors in patient falls, and effectiveness of the lower height of beds for the prevention of bed falls in an acute geriatric hospital. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2013; 28:277-84. [PMID: 23684046 DOI: 10.1016/j.cali.2013.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 12/17/2012] [Accepted: 01/22/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Whereas several studies about patient falls have provided data for long-term healthcare institutions, less information is available for acute care centres. The objective was to analyze the characteristics of the patient falls and associated factors, and the effectiveness of the lower beds' height to reduce the frequency and the harms of the patient falls in an acute geriatric hospital. METHODS A descriptive and retrospective study using a mandatory safety incident report, the IHI Global Trigger Tool, and the claims related to patient falls between 2007 and 2011 in a 200-bed university-associated geriatric hospital. RESULTS The falls rate was 5.4 falls per 1000 patient days (1.3% of falls led to fractures) and there was exitus in 6 patients (0.6%). Nearly half of the falls ocurred during the night shift (42.4%). By wards, falls were more frequent in acute geriatric wards (42.9%). A 7.5% of patients had a fall before admission. 3 (0.2%) claims due to possible clinical negligence were found. A reduction (28.3%) of bed falls with the lower height of the bed and a 1.88 times less falls with harm (RR 0.53; CI 95% 0.83-0.34) (p=0.006) was observed. CONCLUSION The prevention of patient falls is an important task in geriatric units with a potential reduction of harms and costs, some measures such as the lower height of the bed showed a significant reduction of the falls.
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Affiliation(s)
- M D Menéndez
- Servicio de Calidad del Área 4, Hospital Monte Naranco, Oviedo, Spain
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Gietzelt M, Spehr J, Ehmen Y, Wegel S, Feldwieser F, Meis M, Marschollek M, Wolf KH, Steinhagen-Thiessen E, Gövercin M. GAL@Home: a feasibility study of sensor-based in-home fall detection. Z Gerontol Geriatr 2013. [PMID: 23184297 DOI: 10.1007/s00391-012-0400-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND A considerable proportion of falls occur within the domestic environment. Sensor-based identification of falls in seniors' homes could help them to remain autonomous and self-sufficient in their own homes. The objective of this study was to evaluate fall detection systems within the home environment using optical and accelerometric sensor systems. METHODS Portable triaxial accelerometers and optical sensors were used to detect falls in subjects with known problems of mobility and a recent fall history. RESULTS Three subjects were investigated with the system. Overall nine falls occurred during the study period. Four falls were recorded by the accelerometric system and one fall by the optical system. Subjects with increased risk of falling as measured with mobility and fall risk assessments tend to fall more frequently. CONCLUSION The study shows that there is a considerably large difference between fall-detector evaluation studies in domestic environments and in laboratory trials.
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Affiliation(s)
- M Gietzelt
- University of Braunschweig-Institute of Technology and Hannover Medical School, Mühlenpfordtstr. 23, 38106, Braunschweig, Germany.
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Aranda-Gallardo M, Morales-Asencio JM, Canca-Sanchez JC, Barrero-Sojo S, Perez-Jimenez C, Morales-Fernandez A, de Luna-Rodriguez ME, Moya-Suarez AB, Mora-Banderas AM. Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review and meta-analysis. BMC Health Serv Res 2013; 13:122. [PMID: 23547708 PMCID: PMC3637640 DOI: 10.1186/1472-6963-13-122] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 03/14/2013] [Indexed: 11/10/2022] Open
Abstract
Background Falls are a serious problem for hospitalized patients, reducing the duration and quality of life. It is estimated that over 84% of all adverse events in hospitalized patients are related to falls. Some fall risk assessment tools have been developed and tested in environments other than those for which they were developed with serious validity discrepancies. The aim of this review is to determine the accuracy of instruments for detecting fall risk and predicting falls in acute hospitalized patients. Methods Systematic review and meta-analysis. Main databases, related websites and grey literature were searched. Two blinded reviewers evaluated title and abstracts of the selected articles and, if they met inclusion criteria, methodological quality was assessed in a new blinded process. Meta-analyses of diagnostic ORs (DOR) and likelihood (LH) coefficients were performed with the random effects method. Forest plots were calculated for sensitivity and specificity, DOR and LH. Additionally, summary ROC (SROC) curves were calculated for every analysis. Results Fourteen studies were selected for the review. The meta-analysis was performed with the Morse (MFS), STRATIFY and Hendrich II Fall Risk Model scales. The STRATIFY tool provided greater diagnostic validity, with a DOR value of 7.64 (4.86 - 12.00). A meta-regression was performed to assess the effect of average patient age over 65 years and the performance or otherwise of risk reassessments during the patient’s stay. The reassessment showed a significant reduction in the DOR on the MFS (rDOR 0.75, 95% CI: 0.64 - 0.89, p = 0.017). Conclusions The STRATIFY scale was found to be the best tool for assessing the risk of falls by hospitalized acutely-ill adults. However, the behaviour of these instruments varies considerably depending on the population and the environment, and so their operation should be tested prior to implementation. Further studies are needed to investigate the effect of the reassessment of these instruments with respect to hospitalized adult patients, and to consider the real compliance by healthcare personnel with procedures related to patient safety, and in particular concerning the prevention of falls.
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Milisen K, Coussement J, Arnout H, Vanlerberghe V, De Paepe L, Schoevaerdts D, Lambert M, Van Den Noortgate N, Delbaere K, Boonen S, Dejaeger E. Feasibility of implementing a practice guideline for fall prevention on geriatric wards: A multicentre study. Int J Nurs Stud 2013; 50:495-507. [DOI: 10.1016/j.ijnurstu.2012.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 09/18/2012] [Accepted: 09/30/2012] [Indexed: 11/16/2022]
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Signorovitch JE, Macaulay D, Diener M, Yan Y, Wu EQ, Gruenberger JB, Frier BM. Hypoglycaemia and accident risk in people with type 2 diabetes mellitus treated with non-insulin antidiabetes drugs. Diabetes Obes Metab 2013; 15:335-41. [PMID: 23121373 PMCID: PMC3593162 DOI: 10.1111/dom.12031] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 09/25/2012] [Accepted: 10/24/2012] [Indexed: 12/11/2022]
Abstract
AIMS To assess associations between hypoglycaemia and risk of accidents resulting in hospital visits among people with type 2 diabetes receiving antidiabetes drugs without insulin. METHODS People with type 2 diabetes who were not treated with insulin were identified from a US-based employer claims database (1998-2010). Following initiation of an antidiabetes drug, the occurrence of accidents resulting in hospital visits was compared between people with, and without, claims for hypoglycaemia using multivariable Cox proportional hazard models adjusted for demographics, comorbidities, prior treatments and prior medical service use. Additional analyses were stratified by age 65 years or older. RESULTS A total of N = 5582 people with claims for hypoglycaemia and N = 27,910 with no such claims were included. Accidents resulting in hospital visits occurred in 5.5 and 2.8% of people with, and without, hypoglycaemia, respectively. After adjusting for baseline characteristics, hypoglycaemia was associated with significantly increased hazards for any accident [hazard ratio (HR) 1.39, 95% CI 1.21-1.59, p < 0.001], accidental falls (HR 1.36, 95% CI 1.13-1.65, p < 0.001) and motor vehicle accidents (HR 1.82, 95% CI 1.18-2.80, p = 0.007). In age-stratified analyses, hypoglycaemia was associated with greater hazards of driving-related accidents in people younger than age 65 and falls in people aged 65 or older. CONCLUSIONS In people with type 2 diabetes receiving antidiabetes drugs without insulin, hypoglycaemia was associated with a significantly higher risk of accidents resulting in hospital visits, including accidents related to driving and falls.
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Affiliation(s)
- J E Signorovitch
- Health Economics and Outcomes Research, Analysis Group, Inc., Boston, MA 02199, USA.
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Stenhagen M, Nordell E, Elmståhl S. Falls in elderly people: a multifactorial analysis of risk markers using data from the Swedish general population study 'Good ageing in Skåne'. Aging Clin Exp Res 2013; 25:59-67. [PMID: 23740634 DOI: 10.1007/s40520-013-0015-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 02/21/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to describe the prevalence of falls in a general older population, especially among the most elderly, and the risk markers associated with falls. METHODS This is a cross-sectional study in which 38 fall risk markers were analysed in non-, occasional- and frequent-fallers. The population was 2,865 individuals (aged 60-93), randomly selected from the general population register. The risk of falling was calculated as age-adjusted odds ratios. The relation between the number of risk markers for an individual and falls was also analysed. RESULTS About one in ten reported falling during the past 6 months, 35% of which were over 90 years old. Twenty-one risk markers were significantly related to falls confirming falling as a multifactorial problem. These included a variety of diseases, symptoms, medical and physical functions, life-style factors and the taking of certain drugs. The five risk markers with the highest odds ratio in frequent fallers were 'tendency to fall' (37.9), 'low walking speed' (12.8), consumption of 'neuroleptics' (10.9), 'impaired mobility' (10.0) and 'dementia' (5.4). Subjects with more than four and seven risk markers showed a 9- respectively 28-fold increase in the risk of falling, especially among frequent fallers and those aged over 90 years. CONCLUSION Falls are common in the elderly population and the risk is multifactorial. The results imply that there is an overrepresentation of fallers in a distinct subgroup of the very elderly and those with multiple risk markers. The self-perceived clinical sign 'tendency to fall' seems highly sensitive as indicator of individuals at risk. Several risk markers may be treatable. Fall risk seems to increase in a non-linear, almost exponential way with increasing number of risk markers.
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234
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Mansfield A, Inness EL, Wong JS, Fraser JE, McIlroy WE. Is Impaired Control of Reactive Stepping Related to Falls During Inpatient Stroke Rehabilitation? Neurorehabil Neural Repair 2013; 27:526-33. [DOI: 10.1177/1545968313478486] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Individuals with stroke fall more often than age-matched controls. Although many focus on the multifactorial nature of falls, the fundamental problem is likely the ability for an individual to generate reactions to recover from a loss of balance. Stepping reactions to recover balance are particularly important to balance recovery, and individuals with stroke have difficulty executing these responses to prevent a fall following a loss of balance. Objective. The purpose of this study is to determine if characteristics of balance recovery steps are related to falls during inpatient stroke rehabilitation. Methods. We conducted a retrospective review of individuals with stroke attending inpatient rehabilitation (n = 136). Details of falls experienced during inpatient rehabilitation were obtained from incident reports, nursing notes, and patient interviews. Stepping reactions were evoked using a “release-from-lean” postural perturbation. Poisson regression was used to determine characteristics of stepping reactions that were related to increased fall frequency relative to length of stay. Results. In all, 20 individuals experienced 29 falls during inpatient rehabilitation. The characteristics of stepping reactions significantly related to increased fall rates were increased frequency of external assistance to prevent a fall to the floor, increased frequency of no-step responses, increased frequency of step responses with inadequate foot clearance, and delayed time to initiate stepping responses. Conclusions. Impaired control of balance recovery steps is related to increased fall rates during inpatient stroke rehabilitation. This study informs the specific features of stepping reactions that can be targeted with physiotherapy intervention during inpatient rehabilitation to improve dynamic stability control and potentially prevent falls.
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Affiliation(s)
- Avril Mansfield
- Toronto Rehabilitation Institute–UHN, Toronto, ON, Canada
- Heart and Stroke Foundation Centre for Stroke Recovery, ON, Canada
| | - Elizabeth L. Inness
- Toronto Rehabilitation Institute–UHN, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | | | - Julia E. Fraser
- Toronto Rehabilitation Institute–UHN, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - William E. McIlroy
- Toronto Rehabilitation Institute–UHN, Toronto, ON, Canada
- Heart and Stroke Foundation Centre for Stroke Recovery, ON, Canada
- University of Toronto, Toronto, ON, Canada
- University of Waterloo, Waterloo, ON, Canada
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235
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Duffy A. The assessment and management of falls in residential care settings. ACTA ACUST UNITED AC 2013; 22:259-63. [DOI: 10.12968/bjon.2013.22.5.259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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236
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Neumann L, Hoffmann VS, Golgert S, Hasford J, Von Renteln-Kruse W. In-hospital fall-risk screening in 4,735 geriatric patients from the LUCAS project. J Nutr Health Aging 2013; 17:264-9. [PMID: 23459980 DOI: 10.1007/s12603-012-0390-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES In-hospital falls in older patients are frequent, but the identification of patients at risk of falling is challenging. Aim of this study was to improve the identification of high-risk patients. Therefore, a simplified screening-tool was developed, validated, and compared to the STRATIFY predictive accuracy. DESIGN Retrospective analysis of 4,735 patients; evaluation of predictive accuracy of STRATIFY and its single risk factors, as well as age, gender and psychotropic medication; splitting the dataset into a learning and a validation sample for modelling fall-risk screening and independent, temporal validation. SETTING Geriatric clinic at an academic teaching hospital in Hamburg, Germany. PARTICIPANTS 4,735 hospitalised patients ≥65 years. MEASUREMENTS Sensitivity, specificity, positive and negative predictive value, Odds Ratios, Youden-Index and the rates of falls and fallers were calculated. RESULTS There were 10.7% fallers, and the fall rate was 7.9/1,000 hospital days. In the learning sample, mental alteration (OR 2.9), fall history (OR 2.1), and insecure mobility (Barthel-Index items 'transfer' + 'walking' score = 5, 10 or 15) (OR 2.3) had the most strongest association to falls. The LUCAS Fall-Risk Screening uses these risk factors, and patients with ≥2 risk factors contributed to the high-risk group (30.9%). In the validation sample, STRATIFY SENS was 56.8, SPEC 59.6, PPV 13.5 and NPV 92.6 vs. LUCAS Fall-Risk Screening was SENS 46.0, SPEC 71.1, PPV 14.9 and NPV 92.3. CONCLUSIONS Both the STRATIFY and the LUCAS Fall-Risk Screening showed comparable results in defining a high-risk group. Impaired mobility and cognitive status were closely associated to falls. The results do underscore the importance of functional status as essential fall-risk factor in older hospitalised patients.
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Affiliation(s)
- L Neumann
- Albertinen-Haus Geriatrics Centre, University of Hamburg, Hamburg, Germany
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237
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Capone LJ, Albert NM, Bena JF, Tang AS. Predictors of a fall event in hospitalized patients with cancer. Oncol Nurs Forum 2013; 39:E407-15. [PMID: 22940520 DOI: 10.1188/12.onf.e407-e415] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To determine predictors of fall events in hospitalized patients with cancer and develop a scoring system to predict fall events. DESIGN Retrospective medical record review. SETTING A 1,200-bed tertiary care hospital in northeastern Ohio. SAMPLE 145 patients with cancer who did not have a fall event were randomly selected from all oncology admissions from February 2006-January 2007 and compared to 143 hospitalized patients with cancer who had a fall event during the same period. METHODS Multivariable logistic regression models predicting falls were fit. Risk score analysis was completed using bootstrap samples to evaluate discrimination between patients who did or did not fall and agreement between predicted and actual fall status. A nomogram of risk scores was created. MAIN RESEARCH VARIABLES Fall episodes during hospitalization and patient characteristics that predict falls. FINDINGS While patients were hospitalized for cancer care, their predictors of a fall episode were low pain level, abnormal gait, cancer type, presence of metastasis, antidepressant and antipsychotic medication use, and blood product use (all p < 0.02); risk model c-statistic was 0.89. CONCLUSIONS For hospitalized patients with cancer, predictors reflecting greater fall episode risk can be assessed easily by nursing staff and acted on when the risk is sufficiently high. IMPLICATIONS FOR NURSING Understanding specific risk factors of falls in an adult oncology population may lead to interventions that reduce fall risk.
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Affiliation(s)
- Luann J Capone
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Ohio, USA.
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238
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Launay C, De Decker L, Annweiler C, Kabeshova A, Fantino B, Beauchet O. Association of depressive symptoms with recurrent falls: a cross-sectional elderly population based study and a systematic review. J Nutr Health Aging 2013; 17:152-7. [PMID: 23364494 DOI: 10.1007/s12603-012-0370-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Screening of depressive symptoms is recommended in recurrent fallers. Compared to the 30-item and 15-item Geriatric Depression Scales (GDS), the 4-item GDS is easier to administer and quicker to perform. The association between abnormal 4-item GDS score and recurrent falls has not yet been examined. In addition, while depressive symptoms-related gait instability is well known, the association with recurrent falls has been few studied. OBJECTIVE 1) To examine the association between abnormal 4-item GDS score and recurrent falls in community-dwelling older adults using original data from health examination centers (HEC) of French health insurance of Lyon, and 2) to perform a systematic review of studies that examined the association of depressive symptoms with recurrent falls among older adults. METHODS Firstly, based on a cross-sectional design, 2,594 community-dwellers (mean age 72.1±5.4years; 49.8% women) were recruited in HEC of Lyon, France. The 4-item GDS score (abnormal if score≥1) and recurrent falls (i.e., 2 or more falls in the past year) were used as main outcomes. Secondly, a systematic English and French Medline literature search was conducted on May 28, 2012 with no limit of date using the following Medical Subject Heading (MeSH) terms "Aged OR aged, 80 and over", "Accidental falls", "Depressive disorder" and "Reccurence". The search also included the reference lists of the retrieved articles. RESULTS A total of 19.0% (n=494) participants were recurrent fallers in the cross-sectional study. Abnormal 4-item GDS score was more prevalent among recurrent fallers compared to non-recurrent fallers (44.7% versus 25.0%, with P<0.001), and was significantly associated with recurrent falls (Odd ratio (OR)=1.82 with P<0.001 for full model; OR=1.86 with P<0.001 for stepwise backward model). In addition to the current study, the systematic review found only four other studies on this topic, three of them examining the association of depressive symptoms with recurrent falls using 30-item or 15-item GDS. All studies showed a significant association of depressive symptoms with recurrent falls. CONCLUSIONS The current cross-sectional study shows an association between abnormal 4-item GDS score and recurrent falls. This association of depressive symptoms with recurrent falls was confirmed by the systematic review. Based on these results, we suggest that recurrent falls risk assessment should involve a systematic screening of depressive symptoms using the 4-item GDS.
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Affiliation(s)
- C Launay
- Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, Angers, France
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Schoene D, Wu SMS, Mikolaizak AS, Menant JC, Smith ST, Delbaere K, Lord SR. Discriminative Ability and Predictive Validity of the Timed Up and Go Test in Identifying Older People Who Fall: Systematic Review and Meta-Analysis. J Am Geriatr Soc 2013; 61:202-8. [DOI: 10.1111/jgs.12106] [Citation(s) in RCA: 262] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Daniel Schoene
- Falls and Balance Research Group; Neuroscience Research Australia; Sydney New South Wales Australia
- School of Public Health and Community Medicine, University of New South Wales; Sydney New South Wales Australia
| | - Sandy M.-S. Wu
- Prince of Wales Medical School; University of New South Wales; Sydney New South Wales Australia
| | - A. Stefanie Mikolaizak
- Falls and Balance Research Group; Neuroscience Research Australia; Sydney New South Wales Australia
- School of Public Health and Community Medicine, University of New South Wales; Sydney New South Wales Australia
| | - Jasmine C. Menant
- Falls and Balance Research Group; Neuroscience Research Australia; Sydney New South Wales Australia
- School of Public Health and Community Medicine, University of New South Wales; Sydney New South Wales Australia
| | - Stuart T. Smith
- Falls and Balance Research Group; Neuroscience Research Australia; Sydney New South Wales Australia
- School of Public Health and Community Medicine, University of New South Wales; Sydney New South Wales Australia
| | - Kim Delbaere
- Falls and Balance Research Group; Neuroscience Research Australia; Sydney New South Wales Australia
- School of Public Health and Community Medicine, University of New South Wales; Sydney New South Wales Australia
| | - Stephen R. Lord
- Falls and Balance Research Group; Neuroscience Research Australia; Sydney New South Wales Australia
- School of Public Health and Community Medicine, University of New South Wales; Sydney New South Wales Australia
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240
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Fujita Y, Fujita M, Fujiwara C. Pediatric falls: Effect of prevention measures and characteristics of pediatric wards. Jpn J Nurs Sci 2013; 10:223-31. [DOI: 10.1111/jjns.12004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 10/26/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Yuichi Fujita
- Department of Nursing, School of Nursing; Hyogo University of Health Sciences; Kobe
| | - Mayuko Fujita
- Kobe College Junior and Senior High School; Nishinomiya Hyogo
| | - Chieko Fujiwara
- Course of Health Science, Graduate School of Medicine; Osaka University; Suita Osaka Japan
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241
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Kim SR, Yoo SH, Shin YS, Jeon JY, Kim JY, Kang SJ, Choi HS, Lee HL, An YH. Comparison of the Reliability and Validity of Fall Risk Assessment Tools in Patients with Acute Neurological Disorders. ACTA ACUST UNITED AC 2013. [DOI: 10.7475/kjan.2013.25.1.24] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sung Reul Kim
- College of Nursing, Chonbuk National University, Cheonju, Korea
| | - Sung-Hee Yoo
- College of Nursing, Chonnam National University, Gwangju, Korea
| | - Young Sun Shin
- Department of Nursing, Changwon National University, Changwon, Korea
| | - Ji Yoon Jeon
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Jun Yoo Kim
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Su Jung Kang
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Hea Sook Choi
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Hea Lim Lee
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Young Hee An
- Department of Nursing, Asan Medical Center, Seoul, Korea
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242
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Affiliation(s)
| | - Smi Choi-Kwon
- College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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243
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Affiliation(s)
- Myung Sook Cho
- Graduate School of Clinical Nursing Science, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Ra Song
- Nursing Professional Development, Samsung Medical Center, Seoul, Korea
| | - Sun Kyung Cha
- Department of Nursing Science, Sun Moon University, Asan, Korea
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González Ramírez A, Calvo Aguirre JJ, Lekuona Ancizar P, González Oliveras JL, Marcellán Benavente T, Ruiz de Gordoa Armendia A, Salvá Casanovas A, Alcalde Tirado P, González Alonso T, Padilla Clemente R, Clerencia Sierra M, Ubis Diez E. [Falls in nursing homes and institutions: update by the Osteoporosis, Falls and Fractures Working Group of the Spanish Society of Geriatrics and Gerontology (GCOF-SEGG)]. Rev Esp Geriatr Gerontol 2012; 48:30-8. [PMID: 23218786 DOI: 10.1016/j.regg.2011.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 09/20/2011] [Indexed: 10/26/2022]
Abstract
The Workshop on Osteoporosis, Falls and Fractures (GCOF) of The Spanish Geriatrics and Gerontology Society (SEGG) formed a committee in order to review the state of the art on the detection, risk factors and assessment tools for falls, and intervention protocols when falls occurs in nursing homes, long-term hospitals or medium-stay units. The different patient profiles are described in order to make a comprehensive approach to this heterogeneous topic and population, offering a risk classification and specific advice according to these categories.
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Affiliation(s)
- Alfonso González Ramírez
- Facultativo especialista en Geriatría, Servicio de Geriatría, Hospital General de Ciudad Real, Ciudad Real, España.
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245
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Wong Shee A, Phillips B, Hill K. Comparison of two fall risk assessment tools (FRATs) targeting falls prevention in sub-acute care. Arch Gerontol Geriatr 2012; 55:653-9. [DOI: 10.1016/j.archger.2012.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 05/04/2012] [Accepted: 05/07/2012] [Indexed: 11/26/2022]
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246
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Aranda-Gallardo M, Morales Asencio JM, Canca-Sanchez JC, Mora-Banderas AM, Moya-Suarez AB. Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review protocol. J Adv Nurs 2012; 69:185-93. [DOI: 10.1111/j.1365-2648.2012.06104.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2012] [Indexed: 11/28/2022]
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247
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Billington J, Fahey T, Galvin R. Diagnostic accuracy of the STRATIFY clinical prediction rule for falls: a systematic review and meta-analysis. BMC FAMILY PRACTICE 2012; 13:76. [PMID: 22870921 PMCID: PMC3460792 DOI: 10.1186/1471-2296-13-76] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 07/04/2012] [Indexed: 01/15/2023]
Abstract
Background The STRATIFY score is a clinical prediction rule (CPR) derived to assist clinicians to identify patients at risk of falling. The purpose of this systematic review and meta-analysis is to determine the overall diagnostic accuracy of the STRATIFY rule across a variety of clinical settings. Methods A literature search was performed to identify all studies that validated the STRATIFY rule. The methodological quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. A STRATIFY score of ≥2 points was used to identify individuals at higher risk of falling. All included studies were combined using a bivariate random effects model to generate pooled sensitivity and specificity of STRATIFY at ≥2 points. Heterogeneity was assessed using the variance of logit transformed sensitivity and specificity. Results Seventeen studies were included in our meta-analysis, incorporating 11,378 patients. At a score ≥2 points, the STRATIFY rule is more useful at ruling out falls in those classified as low risk, with a greater pooled sensitivity estimate (0.67, 95% CI 0.52–0.80) than specificity (0.57, 95% CI 0.45 – 0.69). The sensitivity analysis which examined the performance of the rule in different settings and subgroups also showed broadly comparable results, indicating that the STRATIFY rule performs in a similar manner across a variety of different ‘at risk’ patient groups in different clinical settings. Conclusion This systematic review shows that the diagnostic accuracy of the STRATIFY rule is limited and should not be used in isolation for identifying individuals at high risk of falls in clinical practice.
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Affiliation(s)
- Jennifer Billington
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Republic of Ireland
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248
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Baadh AS, Zikria JF, Rivoli S, Graham RE, Javit D, Ansell JE. Indications for Inferior Vena Cava Filter Placement: Do Physicians Comply with Guidelines? J Vasc Interv Radiol 2012; 23:989-95. [DOI: 10.1016/j.jvir.2012.04.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 04/09/2012] [Accepted: 04/12/2012] [Indexed: 10/28/2022] Open
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da Costa BR, Rutjes AWS, Mendy A, Freund-Heritage R, Vieira ER. Can falls risk prediction tools correctly identify fall-prone elderly rehabilitation inpatients? A systematic review and meta-analysis. PLoS One 2012; 7:e41061. [PMID: 22815914 PMCID: PMC3398864 DOI: 10.1371/journal.pone.0041061] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 06/16/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Falls of elderly people may cause permanent disability or death. Particularly susceptible are elderly patients in rehabilitation hospitals. We systematically reviewed the literature to identify falls prediction tools available for assessing elderly inpatients in rehabilitation hospitals. METHODS AND FINDINGS We searched six electronic databases using comprehensive search strategies developed for each database. Estimates of sensitivity and specificity were plotted in ROC space graphs and pooled across studies. Our search identified three studies which assessed the prediction properties of falls prediction tools in a total of 754 elderly inpatients in rehabilitation hospitals. Only the STRATIFY tool was assessed in all three studies; the other identified tools (PJC-FRAT and DOWNTON) were assessed by a single study. For a STRATIFY cut-score of two, pooled sensitivity was 73% (95%CI 63 to 81%) and pooled specificity was 42% (95%CI 34 to 51%). An indirect comparison of the tools across studies indicated that the DOWNTON tool has the highest sensitivity (92%), while the PJC-FRAT offers the best balance between sensitivity and specificity (73% and 75%, respectively). All studies presented major methodological limitations. CONCLUSIONS We did not identify any tool which had an optimal balance between sensitivity and specificity, or which were clearly better than a simple clinical judgment of risk of falling. The limited number of identified studies with major methodological limitations impairs sound conclusions on the usefulness of falls risk prediction tools in geriatric rehabilitation hospitals.
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Affiliation(s)
- Bruno Roza da Costa
- Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anne Wilhelmina Saskia Rutjes
- Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Angelico Mendy
- Department of Epidemiology and Biostatistics, Robert Stempel School of Public Health, Florida International University, Miami, Florida, United States of America
| | | | - Edgar Ramos Vieira
- Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
- Department of Physical Therapy, Florida International University, Miami, Florida, United States of America
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250
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Yeung DY, Kwok SY, Chung A. Institutional peer support mediates the impact of physical declines on depressive symptoms of nursing home residents. J Adv Nurs 2012; 69:875-85. [DOI: 10.1111/j.1365-2648.2012.06076.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Dannii Y. Yeung
- Department of Applied Social Studies; City University of Hong Kong; Kowloon; Hong Kong
| | - Sylvia Y.C. Kwok
- Department of Applied Social Studies; City University of Hong Kong; Kowloon; Hong Kong
| | - Annie Chung
- Social Service Department; The Yuen Yuen Institute; Hong Kong
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