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Gutiérrez-Valencia M, Leache L, Saiz LC. [Review of the validity of fall risk assessment scales in hospitalised patients]. Rev Esp Geriatr Gerontol 2022; 57:186-194. [PMID: 35589476 DOI: 10.1016/j.regg.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 02/23/2022] [Accepted: 03/16/2022] [Indexed: 06/15/2023]
Abstract
Falls in the hospital setting are a major health problem due to their high prevalence and their physical, functional, psychological or economic consequences. Since 1990s, different fall risk assessment scales have been developed to detect high-risk patients, which are also applied in the hospital setting. The aim of this review is to analyse the validity of different scales for assessing fall risk in adults in the hospital setting, especially in elderly patients. Following a literature search in April 2021, 36 primary studies were found that analysed the validity of the Downton, Morse, HendrichII, Stratify and Tinetti scales. Meta-analyses of sensitivity and specificity showed a high heterogeneity that does not allow recommending a specific tool that can be considered as standard in acute inpatients.
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Affiliation(s)
- Marta Gutiérrez-Valencia
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, España.
| | - Leire Leache
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Pamplona, España
| | - Luis Carlos Saiz
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, España
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Imaginário C, Martins T, Araújo F, Rocha M, Machado P. Risk Factors Associated with Falls among Nursing Home Residents: A Case-Control Study. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2021. [DOI: 10.1159/000520491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: To identify factors predictive of falls and enable appropriate management of fall risk it is necessary to understand the behaviour and health conditions of older adults living in nursing homes. Objective: This study had two main objectives. The first was to find significant predictors for falls in older adults living in nursing homes. The second main goal was to build a predictive model to find the best predictors for falls. Methods: Out of 56 nursing homes with the same legal statute, 25 agreed to participate. The sample was randomly selected and only the independent or slight/moderately dependent participants were included in the study (n = 325). Results: There was a mean of 1.47 ± 0.99 falls (range from 1 to 7) per resident in nursing homes. By using the t test and odds ratio analysis, ten factors related to falls were identified. Through the binary logistic regression, a model was tested identifying four robust predictors: static balance, resorting to emergency services, polypharmacy, and an independent self-care profile. Conclusions: The present study replicated the main results of contemporary research on the risk factors of falls. More importantly, it suggests that the self-care profile model should be taken into account in future studies and early interventions. It is crucial to implement preventive measures consistent with safer environments and to establish an individual plan for integrated activities according to older adults’ health needs.
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Tago M, Katsuki NE, Oda Y, Nakatani E, Sugioka T, Yamashita SI. New predictive models for falls among inpatients using public ADL scale in Japan: A retrospective observational study of 7,858 patients in acute care setting. PLoS One 2020; 15:e0236130. [PMID: 32673366 PMCID: PMC7365416 DOI: 10.1371/journal.pone.0236130] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/29/2020] [Indexed: 11/23/2022] Open
Abstract
AIM Most predictive models for falls developed previously were awkward to use because of their complexity. We developed and validated a new easier-to-use predictive model for falls of adult inpatients using easily accessible information including the public ADL scale in Japan. METHODS We retrospectively analyzed data from Japanese adult inpatients in an acute care hospital from 2012 to 2015. Two-thirds of cases were randomly extracted to the test set and one-third to the validation set. Data including age, sex, activity of daily living (ADL), public scales in Japan of ADL "bedriddenness rank," and cognitive function in daily living, hypnotic medications, previous falls, and emergency admission were derived from hospital records. Falls during hospitalization were identified from incident reports. Two predictive models were created by multivariate analysis, each of which was assessed by area under the curve (AUC) from the validation set. RESULTS A total of 7,858 adult participants were available. The AUC of model 1, using 13 factors-age, sex (male), emergency admission, use of ambulance, referral letter, admission to Neurosurgery, admission to Internal Medicine, use of hypnotic medication, permanent damage by stroke, history of falls, visual impairment, independence of eating, and bedriddenness rank-with low mutual collinearity and showing significant relationship by multivariate logistic regression analysis, was 0.789 in the validation set. The AUC of parsimonious model 2, using age and seven factors-sex (male), emergency admission, admission to Neurosurgery, use of hypnotic medication, history of falls, independence of eating, and bedriddenness rank-showing statistical significance by multivariate analysis in model 1, was 0.787 in the validation set. CONCLUSIONS We proposed new predictive models for inpatients' fall using the public ADL scales in Japan, which had a higher degree of usability because of their use of simpler and fewer (8 or 13) predictors, especially parsimonious model 2.
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Affiliation(s)
- Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Naoko E. Katsuki
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Yoshimasa Oda
- Department of General Medicine, Saga University Hospital, Saga, Japan
- Department of General Medicine, Yuai-Kai Foundation and Oda Hospital, Saga, Japan
| | - Eiji Nakatani
- Division of Statistical Analysis, Research Support Center, Shizuoka General Hospital, Shizuoka, Japan
- Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe, Hyogo, Japan
| | - Takashi Sugioka
- Community Medical Support Institute, Faculty of Medicine, Saga University, Saga, Japan
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Abstract
Falls and injurious falls are a major safety concern for patient care in acute care hospitals. Inpatient falls and injurious falls can cause extra financial burden to patients, families, and healthcare facilities. This article provides clinical implications and recommendations for adult inpatient fall and injurious fall prevention through a brief review of factors associated with falls and injurious falls and current fall prevention practices in acute care hospitals.
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Ruggieri M, Palmisano B, Fratocchi G, Santilli V, Mollica R, Berardi A, Galeoto G. Validated Fall Risk Assessment Tools for Use with Older Adults: A Systematic Review. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2019. [DOI: 10.1080/02703181.2018.1520381] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Biagio Palmisano
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giancarlo Fratocchi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Valter Santilli
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberta Mollica
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Galeoto
- Department of Public Health, Sapienza University of Rome, Rome, Italy
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Wang H, Zhang Q, So HY, Kwok A, Wong ZSY. Temporal prediction of in-hospital falls using tensor factorisation. ACTA ACUST UNITED AC 2018; 4:75-83. [PMID: 29670759 PMCID: PMC5890633 DOI: 10.1136/bmjinnov-2017-000221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/06/2017] [Accepted: 02/21/2018] [Indexed: 11/28/2022]
Abstract
In-hospital fall incidence is a critical indicator of healthcare outcome. Predictive models for fall incidents could facilitate optimal resource planning and allocation for healthcare providers. In this paper, we proposed a tensor factorisation-based framework to capture the latent features for fall incidents prediction over time. Experiments with real-world data from local hospitals in Hong Kong demonstrated that the proposed method could predict the fall incidents reasonably well (with an area under the curve score around 0.9). As compared with the baseline time series models, the proposed tensor based models were able to successfully identify high-risk locations without records of fall incidents during the past few months.
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Affiliation(s)
- Haolin Wang
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, China.,Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon, Hong Kong, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Qingpeng Zhang
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon, Hong Kong, China.,Shenzhen Research Institute, City University of Hong Kong, Shenzhen, Guangdong, China
| | - Hing-Yu So
- New Territories East Cluster (NTEC), Quality and Safety Division Prince of Wales Hospital, New Territories, Hong Kong, China
| | - Angela Kwok
- New Territories East Cluster (NTEC), Quality and Safety Division Prince of Wales Hospital, New Territories, Hong Kong, China
| | - Zoie Shui-Yee Wong
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
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7
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Chari SR, Varghese P, Bell RAR, Smith K, Haines TP. Understanding and managing the risk of "head impact" from in-hospital falls: A cross-sectional analysis of data from 166 public hospitals. J Healthc Risk Manag 2017; 37:40-47. [PMID: 28719088 DOI: 10.1002/jhrm.21281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Falls are a leading cause of preventable harm in the hospitalized elderly, and head impacts (HIs) can be a precursor to serious injury. The aim of this study was to examine if the risk of fall-related HI can be explained by incident characteristics. METHODS All reported falls across public hospital facilities in the state of Queensland, Australia, over a 2-year period were analyzed using univariate and multiple logistic regression. RESULTS In all, 650 instances of HI were reported across 24 218 falls. Falls due to fainting were associated with elevated HI odds (odds ratio [OR] = 2.00, 95% confidence interval [CI] = 1.30, 3.08). Similarly, falls while walking (OR = 1.48, 95% CI = 1.20, 1.81) and falls during certain time periods, namely, from 11:00 pm to midnight (OR = 1.79, 95% CI = 1.24, 2.59) and between 5:00 am and 6:00 am (OR = 1.50, 95% CI = 1.01, 2.22) were linked to increased HI odds. Falls among males were associated with lowered odds of HI (adjusted odds ratio [AOR] = 0.78, 95% CI = 0.64, 0.74). CONCLUSIONS Results confirm links between characteristics of inpatient falls and the likelihood of HI, and these data can assist risk managers to better target fall prevention strategies. Assisted mobility in high-risk patients and improved environmental lighting are advanced as foci for future research.
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Affiliation(s)
- Satyan R Chari
- Royal Brisbane and Women' s Hospital, Herston, Queensland, Australia
| | - Paul Varghese
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Rebecca A R Bell
- Royal Brisbane and Women' s Hospital, Herston, Queensland, Australia
| | - Kate Smith
- Queensland FallsInjury Prevention Collaborative
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Homer ML, Palmer NP, Fox KP, Armstrong J, Mandl KD. Predicting Falls in People Aged 65 Years and Older from Insurance Claims. Am J Med 2017; 130:744.e17-744.e23. [PMID: 28111165 PMCID: PMC5441951 DOI: 10.1016/j.amjmed.2017.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 12/30/2016] [Accepted: 01/02/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Accidental falls among people aged 65 years and older caused approximately 2,700,000 injuries, 27,000 deaths, and cost more than 34 billion dollars in the US annually in recent years. Here, we derive and validate a predictive model for falls based on a retrospective cohort of those 65 years and older. METHODS Insurance claims from a 1-year observational period were used to predict a fall-related claim in the following 2 years. The predictive model takes into account a person's age, sex, prescriptions, and diagnoses. Through random assignment, half of the people had their claims used to derive the model, while the remaining people had their claims used to validate the model. RESULTS Of 120,881 individuals with Aetna health insurance coverage, 12,431 (10.3%) members fell. During validation, people were risk stratified across 20 levels, where those in the highest risk stratum had 10.5 times the risk as those in the lowest stratum (33.1% vs 3.1%). CONCLUSIONS Using only insurance claims, individuals in this large cohort at high risk of falls could be readily identified up to 2 years in advance. Although external validation is needed, the findings support the use of the model to better target interventions.
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Affiliation(s)
- Mark L Homer
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Mass; Department of Biomedical Informatics, Harvard Medical School, Boston, Mass
| | - Nathan P Palmer
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Mass; Department of Biomedical Informatics, Harvard Medical School, Boston, Mass
| | | | | | - Kenneth D Mandl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Mass; Department of Biomedical Informatics, Harvard Medical School, Boston, Mass.
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Jacobi L, Petzold T, Hanel A, Albrecht M, Eberlein-Gonska M, Schmitt J. [Epidemiology and prediction of the risk of falling in patients in acute care settings: Analysis of routine data from a university hospital]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 120:9-15. [PMID: 28284369 DOI: 10.1016/j.zefq.2016.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/15/2016] [Accepted: 12/19/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Falls are a relevant issue of inpatient treatment. Epidemiological analysis concerning incidence, risk factors for falls and the quality of risk assessments are missing. METHODS In a routine data-based cross-sectional study all patients hospitalized in the University Hospital Dresden, Germany, during 2012 and 2013 were analyzed according to fall incidence and risk factors (items of Dresden fall risk assessment [Dresden-FRA], age, sex, severity of disease, and length of stay. Fall risk and associated risk factors were determined using descriptive methods and logistic regression models. In addition, the quality of the fall risk assessment was evaluated. RESULTS The risk of falling during the observation period was 1.6 %. Differences exist between the medical disciplines (risk of falling 0.1 % to 9.8 %). The fall rate was 2.9/1,000 days of treatment. Higher age, longer inpatient stay, and a higher level of disease severity were significant predictors of falls. Less serious consequences of falls were more frequently documented (84 %) than consequences of falls requiring treatment (16 %). All nine items of the Dresden-FRA were significant risk factors. The sensitivity and specificity of the Dresden-FRA were 69.9 % and 71.4 %, respectively. CONCLUSION Patients at an older age and with more severe disease have a higher risk of falling. The validated assessment of the individual risk of falling is an important tool of medical quality management and risk management. The present study can help to raise awareness about the quality of risk assessments, to further improve fall risk assessment, and to increase patient safety in acute care.
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Affiliation(s)
- Lena Jacobi
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität, Dresden, Deutschland.
| | - Thomas Petzold
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität, Dresden, Deutschland; Zentralbereich Qualitäts- und Medizinisches Risikomanagement, Universitätsklinikum Carl Gustav Carus an der Technischen Universität, Dresden, Deutschland
| | - Andreas Hanel
- Zentralbereich Qualitäts- und Medizinisches Risikomanagement, Universitätsklinikum Carl Gustav Carus an der Technischen Universität, Dresden, Deutschland
| | - Michael Albrecht
- Medizinischer Vorstand, Universitätsklinikum Carl Gustav Carus an der Technischen Universität, Dresden, Deutschland
| | - Maria Eberlein-Gonska
- Zentralbereich Qualitäts- und Medizinisches Risikomanagement, Universitätsklinikum Carl Gustav Carus an der Technischen Universität, Dresden, Deutschland
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität, Dresden, Deutschland
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10
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Hou WH, Kang CM, Ho MH, Kuo JMC, Chen HL, Chang WY. Evaluation of an inpatient fall risk screening tool to identify the most critical fall risk factors in inpatients. J Clin Nurs 2016; 26:698-706. [PMID: 27533486 DOI: 10.1111/jocn.13510] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients. BACKGROUND Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high-risk inpatients. DESIGN Secondary data analysis. METHODS A subset of inpatient data for the period from June 2011-June 2014 was extracted from the nursing information system and adverse event reporting system of an 818-bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis. RESULTS During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut-off point of ≥3) had a low sensitivity level (60%), satisfactory specificity (87%), a positive predictive value of 2·0% and a negative predictive value of 99%. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8%; specificity, 78%). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut-off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards. CONCLUSIONS The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions. RELEVANCE TO CLINICAL PRACTICE This study highlights the needs for redefining the cut-off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely monitored by nurses to prevent falling during hospitalisations.
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Affiliation(s)
- Wen-Hsuan Hou
- College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chun-Mei Kang
- Nursing Department, Cathay General Hospital, Taipei, Taiwan.,School of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Mu-Hsing Ho
- College of Nursing, Taipei Medical University, Taipei, Taiwan
| | | | | | - Wen-Yin Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Saverino A, Waller D, Rantell K, Parry R, Moriarty A, Playford ED. The Role of Cognitive Factors in Predicting Balance and Fall Risk in a Neuro-Rehabilitation Setting. PLoS One 2016; 11:e0153469. [PMID: 27115880 PMCID: PMC4846032 DOI: 10.1371/journal.pone.0153469] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 03/30/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction There is a consistent body of evidence supporting the role of cognitive functions, particularly executive function, in the elderly and in neurological conditions which become more frequent with ageing. The aim of our study was to assess the role of different domains of cognitive functions to predict balance and fall risk in a sample of adults with various neurological conditions in a rehabilitation setting. Methods This was a prospective, cohort study conducted in a single centre in the UK. 114 participants consecutively admitted to a Neuro-Rehabilitation Unit were prospectively assessed for fall accidents. Baseline assessment included a measure of balance (Berg Balance Scale) and a battery of standard cognitive tests measuring executive function, speed of information processing, verbal and visual memory, visual perception and intellectual function. The outcomes of interest were the risk of becoming a faller, balance and fall rate. Results Two tests of executive function were significantly associated with fall risk, the Stroop Colour Word Test (IRR 1.01, 95% CI 1.00–1.03) and the number of errors on part B of the Trail Making Test (IRR 1.23, 95% CI 1.03–1.49). Composite scores of executive function, speed of information processing and visual memory domains resulted in 2 to 3 times increased likelihood of having better balance (OR 2.74 95% CI 1.08 to 6.94, OR 2.72 95% CI 1.16 to 6.36 and OR 2.44 95% CI 1.11 to 5.35 respectively). Conclusions Our results show that specific subcomponents of executive functions are able to predict fall risk, while a more global cognitive dysfunction is associated with poorer balance.
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Affiliation(s)
- A. Saverino
- Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom
- Institute of Rehabilitation, Fondazione Salvatore Maugeri, Genova, Italy
- Wolfson Neurorehabilitation Centre, St Georges Hospital, London, United Kingdom
| | - D. Waller
- Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - K. Rantell
- Research Support Centre, Joint UCL/UCLH/Royal Free Hospital, London, United Kingdom
- Institute of Neurology, University College London, London, United Kingdom
| | - R. Parry
- Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - A. Moriarty
- Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - E. D. Playford
- Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom
- Institute of Neurology, University College London, London, United Kingdom
- * E-mail:
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12
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Callis N. Falls prevention: Identification of predictive fall risk factors. Appl Nurs Res 2016; 29:53-8. [DOI: 10.1016/j.apnr.2015.05.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 04/17/2015] [Accepted: 05/09/2015] [Indexed: 10/23/2022]
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von Renteln-Kruse W, Neumann L, Klugmann B, Liebetrau A, Golgert S, Dapp U, Frilling B. Geriatric patients with cognitive impairment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:103-12. [PMID: 25780869 DOI: 10.3238/arztebl.2015.0103] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hospitals are now faced with increasing numbers of cognitively impaired patients aged 80 and older who are at increased risk of treatment complications. This study concerns the outcomes when such patients are treated in a specialized ward for cognitive geriatric medicine. METHODS Observation of a cohort of 2084 patients from 2009 to 2014, supplemented by a sample of 380 patients from the hospital cohort of the Longitudinal Urban Cohort Ageing Study (LUCAS) for the years 2010 and 2011. RESULTS Geriatric inpatients with cognitive impairment tend to be multimorbid. Half of the patients studied (1031 of 2084 patients) were admitted to the hospital on an emergency basis. Complications arising on the ward that necessitated transfer elsewhere arose in 2.6% (51 of 2084 patients). Moreover, analysis of the sample of 380 patients from the LUCAS cohort revealed that the treatments they underwent during hospitalization were associated with an improvement of their functional state: their mean overall score on the Barthel index rose from 39.8 ± 24.3 (median, 35) on admission to 52.7 ± 27.0 (median, 55) on discharge. The percentage of patients being treated with 5 or more drugs fell from 98.2% (373/380) on admission to 79.3% (314/362) on discharge. The percentage receiving potentially inappropriate medications (PIM), as defined by the PRISCUS list, fell from 45% to 13.3%, while the percentage of drug orders and prescriptions involving PIM fell from 7.8 % (327/4181) to 2.0% (53/2600). 70% of the patients were discharged to the same living situation where they had been before admission. CONCLUSION In this study, structured geriatric treatment in a cohort of older acutely ill patients with cognitive impairment was associated with improvement of functions that are relevant to everyday life, as well as with a reduction of polypharmacy. Controlled studies are needed to confirm the observed benefit.
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Affiliation(s)
- Wolfgang von Renteln-Kruse
- Albertinen-Haus, Geriatrics Centre, Scientific Department at the University of Hamburg, Hamburg, Germany, Albertinen-Haus, Geriatrics Centre, Scientific Department at the University of Hamburg, Research Department, Hamburg Germany, Albertinen-Hospital, Department of Medical Controlling, Hamburg, Germany
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Hoffmann VS, Neumann L, Golgert S, von Renteln-Kruse W. Pro-Active Fall-Risk Management is Mandatory to Sustain in Hospital-Fall Prevention in Older Patients--Validation of the LUCAS Fall-Risk Screening in 2,337 Patients. J Nutr Health Aging 2015; 19:1012-8. [PMID: 26624213 DOI: 10.1007/s12603-015-0662-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Prevention of in-hospital falls contributes to improvement of patient safety. However, the identification of high-risk patients remains a challenge despite knowledge of fall-risk factors. Hence, objective was to prospectively validate the performance of the LUCAS (Longitudinal Urban Cohort Ageing Study) fall-risk screening, based on routine data (fall history, mobility, mental status) and applied by nurses. DESIGN Observational study comparing two groups of patients who underwent different fall-risk screenings; the LUCAS screening (2010 - 2011) and the STRATIFY (St. Thomas's Risk Assessment Tool In Falling Elderly Inpatients) (2004 - 2006). SETTING Urban teaching hospital. PARTICIPANTS Consecutively hospitalized patients (≥ 65 years old) were screened on admission; LUCAS n = 2,337, STRATIFY n = 4,735. MEASUREMENTS The proportions of fallers were compared between the STRATIFY and the LUCAS time periods. The number of fallers expected was compared to that observed in the LUCAS time period. Standardized fall-incidence recording included case-note checks for unreported falls. Plausibility checks of fall-risk factors and logistic regression analysis for variable fall-risk factors were performed. RESULTS The proportions of fallers during the two time periods were LUCAS n = 291/2,337 (12.5%) vs. STRATIFY n = 508/4,735 (10.7%). After adjustment for risk-factor prevalence, the proportion of fallers expected was 14.5% (334/2,337), the proportion observed was 12.5% (291/2,337) (p = 0.038). CONCLUSIONS In-hospital fall prevention including systematic use of the LUCAS fall-risk screening reduced the proportion of fallers compared to that expected from the patients' fall-risk profile. Raw proportions of fallers are not suitable to evaluate fall prevention in hospital because of variable prevalence of patients' fall-risk factors over time. Continuous communication, education and training is needed to sustain in-hospital falls prevention.
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Affiliation(s)
- V S Hoffmann
- Lilli Neumann, Albertinen-Haus, Geriatrics Centre, Scientific Department at the University of Hamburg, Sellhopsweg 18-22, D-22459 Hamburg, Germany, Tel.: ++49-40-5581-1692; Fax: ++49-40-5581-1874; E-Mail:
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Park H, Satoh H, Miki A, Urushihara H, Sawada Y. Medications associated with falls in older people: systematic review of publications from a recent 5-year period. Eur J Clin Pharmacol 2015; 71:1429-40. [PMID: 26407688 DOI: 10.1007/s00228-015-1955-3] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 09/18/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE Falls are an important public health problem in older people. Medication use is considered a risk factor for falls. This study systematically reviewed recent studies to determine the medications that might be associated with the risk of falling in older people. METHODS We conducted a systematic review of prospective and retrospective studies identified through the MEDLINE and CINAHL databases that quantitatively assessed the contribution of medications to falls risk in participants ≥60 years old published in English between May 2008 and April 2013. RESULTS The search identified 1,895 articles; 36 articles met the inclusion criteria. Of the 19 studies that investigated the effect of polypharmacy on the risk of falling, six studies reported that the risk of falling increased with polypharmacy. Data on the use of antihypertensive medications including calcium channel blockers, beta-blockers, and angiotensin system blocking medications were collected in 14 studies, with mixed results. Twenty-nine studies reported an association between the risk of falls and psychotropic medications including sedatives and hypnotics, antidepressants, and benzodiazepines. CONCLUSIONS The use of sedatives and hypnotics and antidepressants including tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin norepinephrine reuptake inhibitors appears to be related with an increased risk of falls. It is not clear if the use of antihypertensive medications is associated with the risk of falls in older people.
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Affiliation(s)
- Hyerim Park
- Endowed Laboratory of Drug Lifetime Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroki Satoh
- Endowed Laboratory of Drug Lifetime Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Akiko Miki
- Endowed Laboratory of Drug Lifetime Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hisashi Urushihara
- Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, 1-5-30 Shiba-koen, Minato-ku, Tokyo, 105-8512, Japan
| | - Yasufumi Sawada
- Endowed Laboratory of Drug Lifetime Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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Zhao YL, Kim H. Older Adult Inpatient Falls in Acute Care Hospitals: Intrinsic, Extrinsic, and Environmental Factors. J Gerontol Nurs 2015; 41:29-43; quiz 44-5. [PMID: 26126026 DOI: 10.3928/00989134-20150616-05] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/20/2015] [Indexed: 11/20/2022]
Abstract
The current integrative literature review of 23 studies aimed to identify multidimensional risk factors of falls among older adult patients in acute care hospitals. The incidence rate of fall-related injuries ranged from 6.8% to 72.1%. Advanced age was a major intrinsic risk factor, whereas being a patient in a geriatric unit was a significant extrinsic factor for inpatient falls and fall-related injuries based on statistical significance obtained from quantitative data analyses. Other critical risk factors were: (a) cognitive impairment; (b) impaired mobility; (c) prolonged length of hospital stay; and (d) fall history. Environmental/situational factors, such as patient ambulation and fall locations, also contributed to inpatient falls. In clinical practice, nurses need to know who are the most vulnerable patients in the hospital and develop comprehensive interventions to decrease intrinsic, extrinsic, and environmental risk factors. Prospective mixed-methods studies are needed to examine psychosocial factors and consequences of falls.
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Yoo JW, Kim SJ, Geng Y, Shin HP, Nakagawa S. Quality and innovations for caring hospitalized older persons in the unites States. Aging Dis 2014; 5:41-51. [PMID: 24490116 PMCID: PMC3901613 DOI: 10.14366/ad.2014.050041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/09/2013] [Accepted: 10/14/2013] [Indexed: 01/22/2023] Open
Abstract
Older persons are occasionally acutely ill and their hospitalizations frequently end up with complications and adverse outcomes. Medicare from U.S. federal government's payment resource for older persons is facing financial strain. Medicare highlights both cost-saving and high quality of care while older persons are hospitalized. Several health policy changes were initiated to achieve Medicare's goals. In response to Medicare's health policy changes, U.S. hospital environments have been changed and these resulted in hospital quality measurements' improvement. American seniors are facing the challenges during and around their hospital care. Several innovative measures are suggested to overcome these challenges.
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Affiliation(s)
- Ji Won Yoo
- Center for Senior Health and Longevity, Aurora Health Care, Milwaukee, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Sun Jung Kim
- Department of Public Health, College of Medicine, Yonsei University Seoul, Korea
- Institute of Health Services Research, College of Medicine, Yonsei University Seoul, Korea
| | - Yan Geng
- Center for Senior Health and Longevity, Aurora Health Care, Milwaukee, WI, USA
| | - Hyun Phil Shin
- Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Shunichi Nakagawa
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY. USA
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18
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Neumann L, Hoffmann V, Klugmann B, Golgert S, Hasford J, von Renteln-Kruse W. In-hospital falls and potentially inappropriate medication (PIM). Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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von Renteln-Kruse W, Neumann L, Krause T, Golgert S, Frilling B. When Older In-Hospital Patients Fall-Insights from the Lucas In-Hospital Fall Database. J Am Geriatr Soc 2013; 61:161-3. [DOI: 10.1111/jgs.12048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lilli Neumann
- Albertinen-Haus, Geriatrics Centre; University of Hamburg; Hamburg Germany
| | - Tom Krause
- Albertinen-Haus, Geriatrics Centre; University of Hamburg; Hamburg Germany
| | - Stefan Golgert
- Albertinen-Haus, Geriatrics Centre; University of Hamburg; Hamburg Germany
| | - Birgit Frilling
- Albertinen-Haus, Geriatrics Centre; University of Hamburg; Hamburg Germany
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