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Wingood M, Kiyoshi-Teo H, Scott AJ, Caulley JM, Wilson BS, Council SK, Vincenzo JL. Demographic Comparisons of Self-Reported Fall Risk Factors Among Older Adults Attending Outpatient Rehabilitation. Clin Interv Aging 2024; 19:1287-1300. [PMID: 39050519 PMCID: PMC11268720 DOI: 10.2147/cia.s456894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose Identify the prevalence and prevalence differences of fall risk factors by sex, clinic rurality, and race/ethnicity among older adults (≥65 years old) receiving outpatient rehabilitation. Patients and Methods Our secondary analysis used Electronic Health Record data of 108,751 older adults attending outpatient rehabilitation (2018-2022) within a large health system across 7 states and completed the Stay Independent Questionnaire. The mean age was 73.3 (±6.36), 58.1% were female, 84.3% were non-Hispanic White, and 88.8% attended an urban clinic. Fall risks were identified via the Centers for Disease Control and Prevention's Stay Independent Questionnaire. Results Older adults had a high prevalence of fall risks (44.3%), including history of falls (34.9%). The most prevalent fall-risk factors were impaired strength, gait, and balance. Compared to males, females had a higher prevalence of reporting a fall (4.3%), a fall with injury (9.9%), worrying about falling 9.1%), rushing to the toilet (8.5%), trouble stepping onto a curb (8.4%), taking medicine for sleep or mood (6.0%), feeling sad or depressed (5.3%), and feeling unsteady (4.6%). Males reported a higher prevalence of losing feeling in feet (9.4%), ≥1 fall in the past year (8.1%), and using hands to stand up (4.4%). Compared to White older adults, Native American/Alaska Natives had the highest prevalence of fall history (43.8%), Hispanics had the highest prevalence of falls with injury (56.1%), and Hispanics and Blacks had a higher prevalence of reporting 11/12 Stay Independent Questionnaire risk factors. Conclusion Older adults receiving outpatient rehabilitation have a high prevalence of fall risks, including falls and difficulties with strength, balance, or gait. Findings indicate that rehabilitation providers should perform screenings for these impairments, including incontinence and medication among females, loss of feeling in the feet among males, and all Stay Independent Questionnaire -related fall risk factors among Native American/Alaska Natives, Hispanics, and Blacks.
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Affiliation(s)
- Mariana Wingood
- Department of Implementation Science, Department of Internal Medicine/Section of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Hiroko Kiyoshi-Teo
- School of Nursing, Oregon Health and Science University, Portland, OR, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Jamie M Caulley
- Rehabilitation Services, Providence St. Joseph Health, Portland, OR, USA
| | - Brian S Wilson
- Rehabilitation Services, Providence St. Joseph Health, Portland, OR, USA
| | - Sarah K Council
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Jennifer L Vincenzo
- Department of Physical Therapy, College of Health Professions, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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Phelan EA, Williamson BD, Balderson BH, Cook AJ, Piccorelli AV, Fujii MM, Nakata KG, Graham VF, Theis MK, Turner JP, Tannenbaum C, Gray SL. Reducing Central Nervous System-Active Medications to Prevent Falls and Injuries Among Older Adults: A Cluster Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2424234. [PMID: 39052289 PMCID: PMC11273227 DOI: 10.1001/jamanetworkopen.2024.24234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/23/2024] [Indexed: 07/27/2024] Open
Abstract
Importance High-risk medications that contribute to adverse health outcomes are frequently prescribed to older adults. Deprescribing interventions reduce their use, but studies are often not designed to examine effects on patient-relevant health outcomes. Objective To test the effect of a health system-embedded deprescribing intervention targeting older adults and their primary care clinicians for reducing the use of central nervous system-active drugs and preventing medically treated falls. Design, Setting, and Participants In this cluster randomized, parallel-group, clinical trial, 18 primary care practices from an integrated health care delivery system in Washington state were recruited from April 1, 2021, to June 16, 2022, to participate, along with their eligible patients. Randomization occurred at the clinic level. Patients were community-dwelling adults aged 60 years or older, prescribed at least 1 medication from any of 5 targeted medication classes (opioids, sedative-hypnotics, skeletal muscle relaxants, tricyclic antidepressants, and first-generation antihistamines) for at least 3 consecutive months. Intervention Patient education and clinician decision support. Control arm participants received usual care. Main Outcomes and Measures The primary outcome was medically treated falls. Secondary outcomes included medication discontinuation, sustained medication discontinuation, and dose reduction of any and each target medication. Serious adverse drug withdrawal events involving opioids or sedative-hypnotics were the main safety outcome. Analyses were conducted using intent-to-treat analysis. Results Among 2367 patient participants (mean [SD] age, 70.6 [7.6] years; 1488 women [63%]), the adjusted cumulative incidence rate of a first medically treated fall at 18 months was 0.33 (95% CI, 0.29-0.37) in the intervention group and 0.30 (95% CI, 0.27-0.34) in the usual care group (estimated adjusted hazard ratio, 1.11 (95% CI, 0.94-1.31) (P = .11). There were significant differences favoring the intervention group in discontinuation, sustained discontinuation, and dose reduction of tricyclic antidepressants at 6 months (discontinuation adjusted rate: intervention group, 0.23 [95% CI, 0.18-0.28] vs usual care group, 0.13 [95% CI, 0.09-0.17]; adjusted relative risk, 1.79 [95% CI, 1.29-2.50]; P = .001) and secondary time points (9, 12, and 15 months). Conclusions and Relevance In this randomized clinical trial of a health system-embedded deprescribing intervention targeting community-dwelling older adults prescribed central nervous system-active medications and their primary care clinicians, the intervention was no more effective than usual care in reducing medically treated falls. For health systems that attend to deprescribing as part of routine clinical practice, additional interventions may confer modest benefits on prescribing without a measurable effect on clinical outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT05689554.
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Affiliation(s)
- Elizabeth A. Phelan
- Department of Medicine, Division of Gerontology and Geriatric Medicine, School of Medicine, University of Washington, Seattle
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle
| | - Brian D. Williamson
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
- Department of Biostatistics, University of Washington, Seattle
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Benjamin H. Balderson
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Andrea J. Cook
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
- Department of Biostatistics, University of Washington, Seattle
| | - Annalisa V. Piccorelli
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Monica M. Fujii
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Kanichi G. Nakata
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Vina F. Graham
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Mary Kay Theis
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Justin P. Turner
- Center for Medication Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Cara Tannenbaum
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Shelly L. Gray
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle
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Juckett LA, Nikahd M, Hyer JM, Klaus JN, Rowe ML, Bunck LE, Hariharan G. Preliminary evaluation of home-delivered meals for reducing frailty in older adults at risk for mal-nutrition. J Nutr Health Aging 2024; 28:100283. [PMID: 38865738 DOI: 10.1016/j.jnha.2024.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/30/2024] [Accepted: 05/26/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE To examine the potential benefit of home-delivered meals for reducing frailty levels among community-dwelling older adults at risk for malnutrition. DESIGN A retrospective, single-group observational approach. SETTING One large home-delivered meal agency in the Midwest United States. PARTICIPANTS 1090 community-dwelling older adults who received home-delivered meal services, funded through the Older Americans Act, between June 2020 and December 2021. MEASUREMENT Frailty status was measured by the Home Care Frailty Scale (HCFS) which was routinely administered by agency staff to home-delivered meal clients as part of a quality improvement project. The HCFS was administered at the start of meal services, 3-months after meals began, and 6-months after meals began. RESULTS At baseline, 55.4% of clients were found to be at high risk for malnutrition. While there was a significant and consistent decline in HCFS throughout the follow-up period for both high and low nutritional risk groups, the reduction in frailty from baseline to 6-months was greater for the high nutritional risk group (Δ = -1.9; 95% CI: [-2.7, -1.1]; p < 0.001) compared to those with low nutritional risk (Δ = -1.5; 95% CI: [-2.3, -0.7]; p < 0.001). Compared to those who lived alone, clients who lived with other individuals presented with higher levels of frailty at baseline and 3-month follow-up for both low and high malnutrition risk groups. CONCLUSION Home-delivered meal clients are commonly at risk for both frailty and malnutrition. Home-delivered meal programs, which are intended to reduce malnutrition among older adults, may serve as a promising solution for reducing frailty in the vulnerable aging population.
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Affiliation(s)
- Lisa A Juckett
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43210-2205, United States.
| | - Melica Nikahd
- Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - J Madison Hyer
- Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | | | | | | | - Govind Hariharan
- Coles College of Business, Kennesaw State University, Kennesaw, GA, United States
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Xue L, Napoleone JM, Winger ME, Boudreau RM, Cauley JA, Donohue JM, Newman AB, Waters TM, Strotmeyer ES. Medicare Fee-For-Service Spending for Fall Injury and Nonfall Events: The Health, Aging, and Body Composition Study. Innov Aging 2024; 8:igae051. [PMID: 38939652 PMCID: PMC11208929 DOI: 10.1093/geroni/igae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Indexed: 06/29/2024] Open
Abstract
Background and Objectives Fall injuries are prevalent in older adults, yet whether higher spending occurs after nonfracture (NFFI) and fracture is unknown. We examined whether incident fall injuries, including NFFI and fractures, were associated with higher Medicare spending in 12 months after incident events in older adults. Research Design and Methods The Health, Aging, and Body Composition Study included 1 595 community-dwelling adults (53% women, 37% Black; 76.7 ± 2.9 years) with linked Medicare Fee-For-Service (FFS) claims at 2000/01 exam. Incident outpatient and inpatient fall injuries (N = 448) from 2000/01 exam to December 31, 2008 were identified using the first claim with a nonfracture injury diagnosis code with a fall E-code, or a fracture diagnosis code with/without an E-code. Up to 3 participants without fall injuries (N = 1 147) were matched on nonfall events to 448 participants in the fall injury month. We calculated the change in monthly FFS spending in 12 months before versus after index events in both groups. Generalized linear regression with centered outcomes and gamma distributions examined the association of prepost expenditure changes with fall injuries (including NFFI and fractures) adjusting for related covariates. Results Monthly spending increased after versus before fall injuries (USD$2 261 vs $981), nonfracture (N = 105; USD$2 083 vs $1 277), and fracture (N = 343; USD$2 315 vs $890) injuries (all p < .0001). However, after adjusting for covariates in final models, fall injuries were not significantly associated with larger increases in spending/month versus nonfall events (differential increase: USD$399.58 [95% CI: -USD$44.95 to $844.11]). Fracture prepost change in monthly spending was similar versus NFFI (differential increase: USD$471.93 [95% CI: -USD$21.17 to $965.02]). Discussion and Implications Although substantial increases occurred after injuries, with fracture and NFFI increasing similarly, changes in monthly spending after fall injury were not different compared to nonfall events. Our results contribute to the understanding of subsequent spending after fall injury that may inform further research on fall injury-related health care spending.
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Affiliation(s)
- Lingshu Xue
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Mary E Winger
- Department of Health Economics, UPMC Insurance Services Division, Pittsburgh, Pennsylvania, USA
| | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julie M Donohue
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Teresa M Waters
- Institute for Public and Preventive Health, Augusta University, Augusta, Georgia, USA
| | - Elsa S Strotmeyer
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Vincenzo JL, Bergen G, Casey CM, Eckstrom E. Reframing Fall Prevention and Risk Management as a Chronic Condition Through the Lens of the Expanded Chronic Care Model: Will Integrating Clinical Care and Public Health Improve Outcomes? THE GERONTOLOGIST 2024; 64:gnae035. [PMID: 38666718 PMCID: PMC11149378 DOI: 10.1093/geront/gnae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Indexed: 06/05/2024] Open
Abstract
Falls are a leading cause of morbidity and mortality among adults aged 65 years and older (older adults) and are increasingly recognized as a chronic condition. Yet, fall-related care is infrequently provided in a chronic care context despite fall-related death rates increasing by 41% between 2012 and 2021. One of the many challenges to addressing falls is the absence of fall-focused chronic disease management programs, which improve outcomes of other chronic conditions, like diabetes. Policies, information systems, and clinical-community connections help form the backbone of chronic disease management programs, yet these elements are often missing in fall prevention. Reframing fall prevention through the Expanded Chronic Care Model (ECCM) guided by implementation science to simultaneously support the uptake of evidence-based practices could help improve the care of older adults at risk for falling. The ECCM includes seven components: (1) self-management/develop personal skills, (2) decision support, (3) delivery system design/re-orient health services, (4) information systems, (5) build healthy public policy, (6) create supportive environments, and (7) strengthen community action. Applying the ECCM to falls-related care by integrating health care delivery system changes, community resources, and public policies to support patient-centered engagement for self-management offers the potential to prevent falls more effectively among older adults.
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Affiliation(s)
- Jennifer L Vincenzo
- Department of Physical Therapy and Center for Implementation Research, Fayetteville, Arkansas, USA
| | - Gwen Bergen
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Colleen M Casey
- Department of Internal Medicine, Providence Senior Health, Portland, Oregon, USA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Honda H, Ashizawa R, Take K, Hirase T, Arizono S, Yoshimoto Y. Effect of chronic pain on the occurrence of falls in older adults with disabilities: a prospective cohort study. Physiother Theory Pract 2024; 40:1206-1214. [PMID: 36335438 DOI: 10.1080/09593985.2022.2141597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The relationship between chronic pain and the occurrence of falls in healthy older adults has been clarified in previous studies, but its relationship in older adults with disabilities has not. OBJECTIVE This study aimed to determine whether chronic pain is related to the occurrence of falls in older adults with disabilities. METHODS The participants were 101 older adults above 65 years old who used long-term care insurance services in Japan. Of these, 30 were fallers and 71 were non-fallers. Chronic pain, defined as pain lasting more than three months, was assessed using questionnaires, and the falls' occurrence was followed up for six months using a fall calendar. Logistic regression analysis was used to analyze the data, with falls as the dependent variable, chronic pain as the independent variable, and age, sex, body mass index, number of drugs, sleep disorders, and depression as covariates. RESULTS After adjusting for covariates, chronic pain significantly influenced the occurrence of falls (odds ratio: 3.168, 95% confidence interval: 1.057-9.495, p = .04). CONCLUSION Chronic pain was related to the occurrence of falls in older adults with disabilities. There is a need to focus on chronic pain presence in falls' prevention among older adults with disabilities.
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Affiliation(s)
- Hiroya Honda
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Shizuoka, Japan
| | - Ryota Ashizawa
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Shizuoka, Japan
| | - Koki Take
- Visiting Nurse Station Sumiyoshi-daini, Shizuoka, Japan
| | - Tatsuya Hirase
- Division of Physical Therapy Science, Graduate Course of Health and Social Work, Kanagawa University of Human Services, Yokosuka-shi, Japan
| | - Shinichi Arizono
- School of Rehabilitation Science, Seirei Christopher University, Shizuoka, Japan
| | - Yoshinobu Yoshimoto
- School of Rehabilitation Science, Seirei Christopher University, Shizuoka, Japan
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Sokołowska B, Świderski W, Smolis-Bąk E, Sokołowska E, Sadura-Sieklucka T. A machine learning approach to evaluate the impact of virtual balance/cognitive training on fall risk in older women. Front Comput Neurosci 2024; 18:1390208. [PMID: 38808222 PMCID: PMC11130377 DOI: 10.3389/fncom.2024.1390208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/02/2024] [Indexed: 05/30/2024] Open
Abstract
Introduction Novel technologies based on virtual reality (VR) are creating attractive virtual environments with high ecological value, used both in basic/clinical neuroscience and modern medical practice. The study aimed to evaluate the effects of VR-based training in an elderly population. Materials and methods The study included 36 women over the age of 60, who were randomly divided into two groups subjected to balance-strength and balance-cognitive training. The research applied both conventional clinical tests, such as (a) the Timed Up and Go test, (b) the five-times sit-to-stand test, and (c) the posturographic exam with the Romberg test with eyes open and closed. Training in both groups was conducted for 10 sessions and embraced exercises on a bicycle ergometer and exercises using non-immersive VR created by the ActivLife platform. Machine learning methods with a k-nearest neighbors classifier, which are very effective and popular, were proposed to statistically evaluate the differences in training effects in the two groups. Results and conclusion The study showed that training using VR brought beneficial improvement in clinical tests and changes in the pattern of posturographic trajectories were observed. An important finding of the research was a statistically significant reduction in the risk of falls in the study population. The use of virtual environments in exercise/training has great potential in promoting healthy aging and preventing balance loss and falls among seniors.
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Affiliation(s)
- Beata Sokołowska
- Bioinformatics Laboratory, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Wiktor Świderski
- Department of Geriatrics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Edyta Smolis-Bąk
- Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, Warsaw, Poland
| | - Ewa Sokołowska
- Department of Developmental Psychology, Faculty of Social Sciences, Institute of Psychology, The John Paul II Catholic University of Lublin, Lublin, Poland
| | - Teresa Sadura-Sieklucka
- Department of Geriatrics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
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García MC, Rossen LM, Matthews K, Guy G, Trivers KF, Thomas CC, Schieb L, Iademarco MF. Preventable Premature Deaths from the Five Leading Causes of Death in Nonmetropolitan and Metropolitan Counties, United States, 2010-2022. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2024; 73:1-11. [PMID: 38687830 PMCID: PMC11065459 DOI: 10.15585/mmwr.ss7302a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Problem/Condition A 2019 report quantified the higher percentage of potentially excess (preventable) deaths in U.S. nonmetropolitan areas compared with metropolitan areas during 2010-2017. In that report, CDC compared national, regional, and state estimates of preventable premature deaths from the five leading causes of death in nonmetropolitan and metropolitan counties during 2010-2017. This report provides estimates of preventable premature deaths for additional years (2010-2022). Period Covered 2010-2022. Description of System Mortality data for U.S. residents from the National Vital Statistics System were used to calculate preventable premature deaths from the five leading causes of death among persons aged <80 years. CDC's National Center for Health Statistics urban-rural classification scheme for counties was used to categorize the deaths according to the urban-rural county classification level of the decedent's county of residence (1: large central metropolitan [most urban], 2: large fringe metropolitan, 3: medium metropolitan, 4: small metropolitan, 5: micropolitan, and 6: noncore [most rural]). Preventable premature deaths were defined as deaths among persons aged <80 years that exceeded the number expected if the death rates for each cause in all states were equivalent to those in the benchmark states (i.e., the three states with the lowest rates). Preventable premature deaths were calculated separately for the six urban-rural county categories nationally, the 10 U.S. Department of Health and Human Services public health regions, and the 50 states and the District of Columbia. Results During 2010-2022, the percentage of preventable premature deaths among persons aged <80 years in the United States increased for unintentional injury (e.g., unintentional poisoning including drug overdose, unintentional motor vehicle traffic crash, unintentional drowning, and unintentional fall) and stroke, decreased for cancer and chronic lower respiratory disease (CLRD), and remained stable for heart disease. The percentages of preventable premature deaths from the five leading causes of death were higher in rural counties in all years during 2010-2022. When assessed by the six urban-rural county classifications, percentages of preventable premature deaths in the most rural counties (noncore) were consistently higher than in the most urban counties (large central metropolitan and fringe metropolitan) for the five leading causes of death during the study period.During 2010-2022, preventable premature deaths from heart disease increased most in noncore (+9.5%) and micropolitan counties (+9.1%) and decreased most in large central metropolitan counties (-10.2%). Preventable premature deaths from cancer decreased in all county categories, with the largest decreases in large central metropolitan and large fringe metropolitan counties (-100.0%; benchmark achieved in both county categories in 2019). In all county categories, preventable premature deaths from unintentional injury increased, with the largest increases occurring in large central metropolitan (+147.5%) and large fringe metropolitan (+97.5%) counties. Preventable premature deaths from CLRD decreased most in large central metropolitan counties where the benchmark was achieved in 2019 and increased slightly in noncore counties (+0.8%). In all county categories, preventable premature deaths from stroke decreased from 2010 to 2013, remained constant from 2013 to 2019, and then increased in 2020 at the start of the COVID-19 pandemic. Percentages of preventable premature deaths varied across states by urban-rural county classification during 2010-2022. Interpretation During 2010-2022, nonmetropolitan counties had higher percentages of preventable premature deaths from the five leading causes of death than did metropolitan counties nationwide, across public health regions, and in most states. The gap between the most rural and most urban counties for preventable premature deaths increased during 2010-2022 for four causes of death (cancer, heart disease, CLRD, and stroke) and decreased for unintentional injury. Urban and suburban counties (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan) experienced increases in preventable premature deaths from unintentional injury during 2010-2022, leading to a narrower gap between the already high (approximately 69% in 2022) percentage of preventable premature deaths in noncore and micropolitan counties. Sharp increases in preventable premature deaths from unintentional injury, heart disease, and stroke were observed in 2020, whereas preventable premature deaths from CLRD and cancer continued to decline. CLRD deaths decreased during 2017-2020 but increased in 2022. An increase in the percentage of preventable premature deaths for multiple leading causes of death was observed in 2020 and was likely associated with COVID-19-related conditions that contributed to increased mortality from heart disease and stroke. Public Health Action Routine tracking of preventable premature deaths based on urban-rural county classification might enable public health departments to identify and monitor geographic disparities in health outcomes. These disparities might be related to different levels of access to health care, social determinants of health, and other risk factors. Identifying areas with a high prevalence of potentially preventable mortality might be informative for interventions.
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Konstantinidis C, Psoma O, Kotsias C, Panagiotopoulos V, Plakoutsis S, Tsiampas D, Vardakas D, Giotis D. Vitamin D Deficiency in Patients With Low-Energy Hip Fractures in Accordance With the Mediterranean Paradox. Cureus 2024; 16:e57583. [PMID: 38707155 PMCID: PMC11069122 DOI: 10.7759/cureus.57583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Vitamin D deficiency (VDD) is considered one of the leading causes of poor bone quality. It may also be related to severe muscular weakness, especially in the elderly, which leads to frequent falls. Thus, VDD might be associated with fragility fractures of the hip, wrist, and spine in this age category. In this cross-sectional study, our goal was to present vitamin D levels in an elderly Mediterranean population with hip fractures and to assess whether its levels are related to the incidence or prevention of such injuries. Methods Between January and December 2021, 140 patients aged 65 years or older were hospitalized in our department with a fracture involving the hip joint. Serum calcium and vitamin D level control was performed upon admission, as well as recording whether anti-osteoporosis medication had been prescribed. Only patients with low-energy fractures were included, whereas oncologic patients and those with high-energy trauma were excluded. Results Thirty-eight men and 102 women, with a mean age of 83.12 and 84.88 years, respectively, participated in our study. Intertrochanteric fractures were the most common injuries (50.72%). Low vitamin D levels (<30 ng/mL) were observed in 132 patients (94.28%). A bone density scan during the last year had been conducted by only seven patients (5%), whereas in 136 patients (97.14%), no anti-osteoporotic medication was given. Conclusion There is an excessive percentage of aged patients with hip fractures in Greece, demonstrating a significant vitamin D insufficiency despite the high annual frequency of sunny days in this Mediterranean region. Presumably, most of these patients neither perform the routine bone density scan nor do they take any kind of preventive pharmaceutical treatment, which might reveal devaluation of osteoporosis from this age group due to contingent comorbidities.
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Affiliation(s)
| | - Ourania Psoma
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, GRC
| | - Christos Kotsias
- Orthopaedic Department, General Hospital of Ioannina "G. Hatzikosta", Ioannina, GRC
| | | | - Sotiris Plakoutsis
- Orthopaedic Department, General Hospital of Ioannina "G. Hatzikosta", Ioannina, GRC
| | - Dimitrios Tsiampas
- Orthopaedic Department, General Hospital of Ioannina "G. Hatzikosta", Ioannina, GRC
| | - Dimitrios Vardakas
- Orthopaedic Department, General Hospital of Ioannina "G. Hatzikosta", Ioannina, GRC
| | - Dimitrios Giotis
- Orthopaedic Department, General Hospital of Ioannina "G. Hatzikosta", Ioannina, GRC
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10
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Camp K, Murphy S, Pate B. Integrating Fall Prevention Strategies into EMS Services to Reduce Falls and Associated Healthcare Costs for Older Adults. Clin Interv Aging 2024; 19:561-569. [PMID: 38533419 PMCID: PMC10964786 DOI: 10.2147/cia.s453961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
Purpose The purpose of this study is to detail the implementation of fall prevention initiatives through emergency medical services (EMS) and associated outcomes. Methods Paramedics with MedStar Mobile Healthcare utilized the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention model to screen and direct intervention through 9-1-1 emergency response, High Utilization Group (HUG), and 30-day Hospital Readmission Avoidance (HRA) programs. Outcomes from 9-1-1 calls measured the number of older adults screened for falls and identified risk factors. The HUG and HRA programs measured change in quality of life with EuroQol-5D, referral service utilization, falls, emergent healthcare utilization, and hospital readmission data. Analysis included costs associated with reduced healthcare usage. Results Emergency paramedics provided fall risk screening for 50.5% (n=45,090) of adults aged 65 and older and 59.3% were at risk of falls, with 48.1% taking medications known to increase the risk of falls. Services provided through the HUG and HRA programs, along with additional needed referral services, resulted in a 37.2% reduction in fall-related 9-1-1 calls and a 29.5% increase in overall health status related to quality of life. Analysis of the HUG program revealed potential savings of over $1 million with a per-patient enrolled savings of $19,053. The HRA program demonstrated a 16.4% hospital readmission rate, in comparison to a regional average of 30.2%, and a cost-savings of $4.95 million or $15,618 per enrolled patient. Conclusion Implementation of the STEADI model into EMS services provides an effective and cost-saving model for addressing fall prevention for older adults, provides meaningful and impactful improvement for older adults, and could serve as a model for other EMS programs.
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Affiliation(s)
- Kathlene Camp
- Department of Internal Medicine and Geriatrics, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Sara Murphy
- Department of Internal Medicine and Geriatrics, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Brandon Pate
- Mobile Integrated Healthcare, MedStar Mobile Healthcare, Fort Worth, TX, USA
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11
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Francisco L, Duarte J, Albuquerque C, Albuquerque D, Pires IM, Coelho PJ. Mobile Data Gathering and Preliminary Analysis for the Functional Reach Test. SENSORS (BASEL, SWITZERLAND) 2024; 24:1301. [PMID: 38400459 PMCID: PMC10892343 DOI: 10.3390/s24041301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
The functional reach test (FRT) is a clinical tool used to evaluate dynamic balance and fall risk in older adults and those with certain neurological diseases. It provides crucial information for developing rehabilitation programs to improve balance and reduce fall risk. This paper aims to describe a new tool to gather and analyze the data from inertial sensors to allow automation and increased reliability in the future by removing practitioner bias and facilitating the FRT procedure. A new tool for gathering and analyzing data from inertial sensors has been developed to remove practitioner bias and streamline the FRT procedure. The study involved 54 senior citizens using smartphones with sensors to execute FRT. The methods included using a mobile app to gather data, using sensor-fusion algorithms like the Madgwick algorithm to estimate orientation, and attempting to estimate location by twice integrating accelerometer data. However, accurate position estimation was difficult, highlighting the need for more research and development. The study highlights the benefits and drawbacks of automated balance assessment testing with mobile device sensors, highlighting the potential of technology to enhance conventional health evaluations.
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Affiliation(s)
- Luís Francisco
- Electrotechnical Department, Polytechnic University of Leiria, 2411-901 Leiria, Portugal
| | - João Duarte
- Electrotechnical Department, Polytechnic University of Leiria, 2411-901 Leiria, Portugal
| | - Carlos Albuquerque
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal;
- Higher School of Health, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
- Child Studies Research Center (CIEC), University of Minho, 4710-057 Braga, Portugal
| | - Daniel Albuquerque
- Instituto de Telecomunicações, Escola Superior de Tecnologia e Gestão de Águeda, Universidade de Aveiro, 3750-127 Águeda, Portugal; (D.A.); (I.M.P.)
| | - Ivan Miguel Pires
- Instituto de Telecomunicações, Escola Superior de Tecnologia e Gestão de Águeda, Universidade de Aveiro, 3750-127 Águeda, Portugal; (D.A.); (I.M.P.)
| | - Paulo Jorge Coelho
- Electrotechnical Department, Polytechnic University of Leiria, 2411-901 Leiria, Portugal
- Institute for Systems Engineering and Computers at Coimbra (INESC Coimbra), 3030-290 Coimbra, Portugal
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12
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Reider L, Falvey JR, Okoye SM, Wolff JL, Levy JF. Cost of U.S emergency department and inpatient visits for fall injuries in older adults. Injury 2024; 55:111199. [PMID: 38006782 DOI: 10.1016/j.injury.2023.111199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Falls are a leading cause of injury and hospital readmissions in older adults. Understanding the distribution of acute treatment costs across inpatient and emergency department settings is critical for informed investment and evaluation of fall prevention efforts. METHODS This study used the 2016-2018 National Inpatient Sample and National Emergency Department Sample. Annual treatment cost of fall injury among adults 65 years and older was estimated from charges, applying cost-to-charge and professional fee ratios. Weighted multivariable generalized linear models were used to separately estimate cost for inpatient and emergency department (ED) setting by injury type and individual demographic and health characteristics after adjusting for payer and hospital level characteristics. RESULTS Older adults incurred an estimated 922,428 inpatient and 2.3 million ED visits annually due to falls with combined annual costs of $19.8 billion. Over half of inpatient visits for fall injury were for fracture. Notably, 23% of inpatient visits were for fractures other than hip fracture and 14% of inpatient visits were for multiple fractures with costs totaling $3.4 billion and $2.5 billion, respectively. Annual ED costs were driven by superficial injury totaling $1.5 billion. Cost of ED visits were higher for adults 85 years and older (adjusted cost ratio (aCR): 1.11, 95% Confidence Interval (CI)I: 1.11-1.12) and those with dementia (aCR: 1.14, 95% CI: 1.13-1.15). Higher inpatient and ED visit cost was also associated with high-energy falls and discharge to post-acute care. CONCLUSION The study found that more than 3 million older adults in the United States seek hospital care for fall injuries annually, a major concern given increasing capacity strain on hospitals and EDs. The $20 billion in annual acute treatment costs attributed to fall injury indicate an urgent need to implement evidence-based fall prevention interventions and underscores the importance of newly launched ED-based fall prevention efforts and investments in geriatric emergency departments.
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Affiliation(s)
- Lisa Reider
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy, and Management, 624N. Broadway, Baltimore MD 21205, United States.
| | - Jason R Falvey
- Department of Physical Therapy and Rehabilitation Science, Department of Epidemiology and Public Health, University of Maryland School of Medicine, United States
| | - Safiyyah M Okoye
- Department of Graduate Nursing, Drexel University College of Nursing and Health Professions, United States; Department of Health Management and Policy, Drexel University Dornsife School of Public Health Philadelphia, PA, United States
| | - Jennifer L Wolff
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy, and Management, 624N. Broadway, Baltimore MD 21205, United States
| | - Joseph F Levy
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy, and Management, 624N. Broadway, Baltimore MD 21205, United States
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13
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Kishita R, Miyaguchi H, Ohura T, Arihisa K, Matsushita W, Ishizuki C. Fall risk prediction ability in rehabilitation professionals: structural equation modeling using time pressure test data for Kiken-Yochi Training. PeerJ 2024; 12:e16724. [PMID: 38188148 PMCID: PMC10771090 DOI: 10.7717/peerj.16724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Background Falls occur frequently during rehabilitation for people with disabilities. Fall risk prediction ability (FRPA) is necessary to prevent falls and provide safe, high-quality programs. In Japan, Kiken Yochi Training (KYT) has been introduced to provide training to improve this ability. Time Pressure-KYT (TP-KYT) is an FRPA measurement specific to fall risks faced by rehabilitation professionals. However, it is unclear which FRPA factors are measured by the TP-KYT; as this score reflects clinical experience, a model can be hypothesized where differences between rehabilitation professionals (licensed) and students (not licensed) can be measured by this tool. Aims To identify the FRPA factors included in the TP-KYT and verify the FRPA factor model based the participants' license status. Methods A total of 402 participants, with 184 rehabilitation professionals (physical and occupational therapists) working in 12 medical facilities and three nursing homes, and 218 rehabilitation students (physical and occupational therapy students) from two schools participated in this study. Participant characteristics (age, gender, job role, and years of experience and education) and TP-KYT scores were collected. The 24 TP-KYT items were qualitatively analyzed using an inductive approach based on content, and FRPA factors were extracted. Next, the correction score (acquisition score/full score: 0-1) was calculated for each extracted factor, and an observation variable for the job role (rehabilitation professional = 1, rehabilitation student = 0) was set. To verify the FRPA factors associated with having or not having a rehabilitation professional license, FRPA as a latent variable and the correction score of factors as an observed variable were set, and structural equation modeling was performed by drawing a path from the job role to FRPA. Results The results of the qualitative analysis aggregated patient ability (PA), physical environment (PE), and human environment (HE) as factors. The standardized coefficients of the model for participants with or without a rehabilitation professional license and FRPA were 0.85 (p < 0.001) for FRPA from job role, 0.58 for PA, 0.64 for PE, and 0.46 for HE from FRPA to each factor (p < 0.001). The model showed a good fit, with root mean square error of approximation < 0.001, goodness of fit index (GFI) = 0.998, and adjusted GFI = 0.990. Conclusion Of the three factors, PA and PE were common components of clinical practice guidelines for fall risk assessment, while HE was a distinctive component. The model's goodness of fit, which comprised three FRPA factors based on whether participants did or did not have rehabilitation professional licenses, was good. The system suggested that rehabilitation professionals had a higher FRPA than students, comprising three factors. To provide safe and high-quality rehabilitation for patients, professional training to increase FRPA should incorporate the three factors into program content.
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Affiliation(s)
- Ryohei Kishita
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
- Department of Occupational Therapy, Faculty of Health Sciences, Osaka University of Human Sciences, Settsu, Osaka, Japan
| | - Hideki Miyaguchi
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Tomoko Ohura
- Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Katsuhiko Arihisa
- Division of Occupational Therapy, Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Kashiwara, Osaka, Japan
| | - Wataru Matsushita
- Department of Occupational Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Okawa, Fukuoka, Japan
| | - Chinami Ishizuki
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
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14
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Sotoudeh GR, Mohammadi R, Mosallanezhad Z, Viitasara E, Soares JJF. A population study on factors associated with unintentional falls among Iranian older adults. BMC Geriatr 2023; 23:860. [PMID: 38102576 PMCID: PMC10724897 DOI: 10.1186/s12877-023-04571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Falls among older adults are a significant cause of disability, injury, and death worldwide. The high incidence of falls in older adults, combined with the increased susceptibility to injury of the older adult population, leads to severe global health issues. Further studies are needed to comprehensively evaluate the typical personal and environmental risk factors of falls in the Iranian elderly population. Future preventive strategies and intervention programs will be based on these findings. The study determined the risk factors associated with unintentional falls among a representative sample of older adults living in Tehran, the capital city of Iran. METHODS The study design was cross-sectional. The target population was men/women aged 65 years and over from the general population living in 22 different districts of Tehran who were selected by stratified random sampling. The researchers gathered the data using validated questionnaires and observations. The informed consent was obtained from all participants before starting the interview. Multivariate logistic regression analysis examined the association between falls occurring during the past 12 months with demographics/ socioeconomics and fall-related predictor factors. RESULTS The risk of falls was higher in women (47.0%) and those aged ≥ 75 years (44.1%). Older adults who were married had their fall risk reduced by 36.4% compared with other types of marital status. Older adults who were illiterate (48.1%), housewives (47.0%), and always had concerns about living expenses (53.9%) tended significantly to have a higher risk of falls. Moreover, participants who live with their family were less likely to fall than those who live alone (36.5% vs. 40.4%). Persons with safe homes were less likely to experience falls than persons with unsafe homes (30.9% vs. 41.4%). The logistic regression analysis showed that the female gender, being worried about living expenses, home safety, functional behavior, and function factors, were independently associated with the risk of falls during the past 12 months. CONCLUSIONS Our findings revealed that a wide range of intrinsic and extrinsic risk factors contributed to injurious falls; based on the literature, some are preventable. The present data may be helpful as a starting point and guide future efforts for health providers and policymakers to allocate additional resources and develop proper falls prevention or intervention programs at the community level.
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Affiliation(s)
- Gholam Reza Sotoudeh
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden.
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Mohammadi
- Division for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Zahra Mosallanezhad
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Eija Viitasara
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Joaquim J F Soares
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden
- Faculdade de Ciências Sociais e Tecnologia da Universidade Europeia, Universidade Europeia, Lisboa, Portugal
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15
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Vergouwen M, Tarcea A, Van Essen D, Sayre EC, White NJ. FROST 2.0: Factors Predicting Orthopaedic Trauma Volumes - A Validation Study. Injury 2023; 54:111111. [PMID: 37839917 DOI: 10.1016/j.injury.2023.111111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
The anecdotal relationship between weather, season, and orthopaedic trauma volumes is understood by patients and healthcare providers: when the winter ground is icy, people fall. Previous research established that winter and summer months as well as ice and snow were significant predictors of orthopaedic trauma and surges in volumes. The current study validates the previously established predictive model in one Canadian city; the original methods were repeated using a new, yet geographically similar dataset. The effect of month and ice were consistent, which suggests the proposed model has sufficient external validity to guide resource allocation and primary prevention strategies.
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Affiliation(s)
- Martina Vergouwen
- Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4 Calgary, AB Canada.
| | - Adina Tarcea
- Section of Orthopaedics, Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4 Calgary, AB Canada
| | - Darren Van Essen
- Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4 Calgary, AB Canada
| | - Eric C Sayre
- Arthritis Research Canada, 5591 Number 3 Rd, V6X 2C7 Richmond, BC Canada
| | - Neil J White
- Section of Orthopaedics, Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4 Calgary, AB Canada
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Shankar KN, Li A. Older Adult Falls in Emergency Medicine, 2023 Update. Clin Geriatr Med 2023; 39:503-518. [PMID: 37798062 DOI: 10.1016/j.cger.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Of 4 older adults, 1 will fall each year in the United States. Based on 2020 data from the Centers of Disease Control, about 36 million older adults fall each year, resulting in 32,000 deaths. Emergency departments see about 3 million older adults for fall-related injuries with falls having the ability to cause serious injury such as catastrophic head injuries and hip fractures. One-third of older fall patients discharged from the ED experience one of these outcomes at 3 months.
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Affiliation(s)
- Kalpana N Shankar
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA 02115, USA.
| | - Angel Li
- Department of Emergency Medicine, The Ohio State University, 376 West 10th Avenue, Columbus, OH 43210, USA
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17
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Moreland BL, Legha JK, Thomas KE, Burns ER. Hip Fracture-Related Emergency Department Visits, Hospitalizations and Deaths by Mechanism of Injury among Adults Aged 65 and Older, United States 2019. J Aging Health 2023; 35:345-355. [PMID: 36210739 PMCID: PMC10083185 DOI: 10.1177/08982643221132450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Describe rates of hip fracture-related emergency department (ED) visits, hospitalizations, and deaths among older adults (aged ≥65 years) in the United States. METHODS Data from the 2019 Healthcare Cost and Utilization Project and National Vital Statistics System were used to calculate rates of hip fracture-related ED visits, hospitalizations, and deaths among older adults by select characteristics and mechanism of injury. RESULTS In 2019, there were 318,797 ED visits, 290,130 hospitalizations, and 7731 deaths related to hip fractures among older adults. About 88% of ED visits and hospitalizations and approximately 83% of deaths related to hip fractures were caused by falls. Rates were highest among older adults living in rural areas and among those aged ≥85 years. DISCUSSION Most hip fractures among older adults are fall-related. Healthcare providers can prevent falls among their older patients by screening for fall risk, assessing modifiable risk factors, and offering evidence-based interventions.
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Affiliation(s)
| | | | - Karen E. Thomas
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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18
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DelMastro HM, Simaitis LB, Gromisch ES, Gomes K, Ruiz JA. Establishment of regression-based normative isometric strength values for major lower limb muscle groups in persons with multiple sclerosis. Mult Scler Relat Disord 2023; 75:104772. [PMID: 37247487 DOI: 10.1016/j.msard.2023.104772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/20/2023] [Accepted: 05/22/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Limb weakness is a major impairment that affects mobility in persons with multiple sclerosis (PwMS). Specifically, lower limb (LL) weakness can greatly affect gait and balance, while increasing fall risk and decreasing quality of life. Numerous studies have compared LL strength of PwMS to healthy controls, however none have objectively measured strength in all major LL joints (hip, knee, and ankle) in a large number of PwMS. Additionally, while discrete normative values exist for knee extensors in PwMS, there has yet to be regression-based normative isometric strength values for all major LL muscle groups. Therefore, this study aimed to develop gender-specific regression-based normative prediction equations, with 95% confidence intervals, for maximal isometric peak torque of major LL muscles in PwMS. A secondary aim was to characterize the prevalence of LL weakness in PwMS, defined as ≥ 2 SD below values reported for healthy individuals. METHODS A convenience sample of 175 (women: n = 135) PwMS participated in a prospective, cross-sectional study where isometric peak torque of hip flexors, extensors, and abductors, knee flexors and extensors, and ankle plantarflexors and dorsiflexors were measured using the Biodex System 4 Pro-Dynamometer®. Demographics (age, height, and weight) and disease characteristics (disease duration and disability) were collected. Performances were separated for each muscle group into strongest limb and weakest limb. For each gender, regression-based equations were generated for the LL muscle groups by limb with age, height, weight, disability, and disease duration as the covariates. Descriptive statistics were used to examine the frequency of LL weakness by gender and disability level. For comparison purposes, age-stratified (<30, 30-39, 40-49, 50-59, 60-69, >70 years) and disability-stratified (mild, moderate, and severe ambulant) discrete peak torque values were also generated for each gender. RESULTS Regression-based normative data are presented for men and women, accounting for age, height, weight, disability, and disease duration. Men were significantly stronger (P < 0.001) than women for all LL, with the men's models accounting for a greater percent of muscle strength variation than women's models for all muscle groups, except for hip extension. Disability was inversely related to strength in all of the models. LL weakness was prevalent in hip flexion (m: 47.5%; w: 63.0%) and extension (m: 92.5%; w: 88.1%), knee extension (m: 30.0%; w: 33.3%) and flexion (m: 25.0%; w: 34.8%), and ankle plantarflexion (m: 15.0%; w: 10.4%) and dorsiflexion (m: 100.0%; w: 96.3%). PwMS with mild disability had a high prevalence of ankle dorsiflexion (94.9-100.0%) and hip extension (81.4-90.0%) weakness. CONCLUSIONS This study is the first to provide regression-based normative data of bilateral strength in all major LL muscle groups and clinically useful prevalence data on the occurrence of weakness in these muscles. Of note, PwMS had a high prevalence of ankle dorsiflexion and hip extension weakness even when they were only mildly disabled. These findings can help guide the direction of future interventions and treatments to improve muscle function in PwMS.
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Affiliation(s)
- Heather M DelMastro
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, United States; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States.
| | - Laura B Simaitis
- Department of Physical Therapy, School of Health Sciences at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States
| | - Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, United States; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States; Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States; Department of Neurology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, United States
| | - Kayla Gomes
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, United States; Rehabilitation Medicine, Department of Veterans Affairs, 555 Willard Avenue, Newington, CT, 06111 United States
| | - Jennifer A Ruiz
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, United States; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States; Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States
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McBride C, Story S, Cason J. Development and Validation of the Protocol for Administering Telehealth Home (PATH) Assessments. Int J Telerehabil 2023; 15:e6545. [PMID: 38046548 PMCID: PMC10687956 DOI: 10.5195/ijt.2023.6545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Home safety assessments and subsequent modifications can prevent hospitalization, institutionalization, and death among older adults. Telehealth has been shown to be an effective means to administer home safety assessments. However, a structured approach to synchronous telehealth home assessments has not been examined. This study involved development and validation of a structured telehealth home assessment protocol. The Protocol for Administering Telehealth Home (PATH) assessment was developed based on literature review, clinical experience with in-person and telehealth home assessments, and interviews with content experts. Six older adults participated in the validation phase of the protocol using a quasi-experimental, mixed-methods, one-group research design. The validation process resulted in modifications to the protocol to enhance its utility in practice. The PATH protocol provides a valid, structured approach to conducting synchronous telehealth home assessments and can be used by occupational therapists to administer home assessments for older adults desiring to age in place.
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Affiliation(s)
- Cicily McBride
- Spalding University, Auerbach School of Occupational Therapy, Louisville, Kentucky, USA
| | - Sara Story
- Valparaiso University, College of Nursing and Health Professions, Valparaiso, Indiana, USA
| | - Jana Cason
- Spalding University, Auerbach School of Occupational Therapy, Louisville, Kentucky, USA
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20
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Mele F, Leonardelli M, Duma S, Angeletti C, Cazzato G, Lupo C, Gorini E, Pomara C, Dell'Erba A, Marrone M. Requests for Compensation in Cases Involving Patients' Falls in Healthcare Settings: A Retrospective Analysis. Healthcare (Basel) 2023; 11:healthcare11091290. [PMID: 37174832 PMCID: PMC10178431 DOI: 10.3390/healthcare11091290] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/24/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Falls are the most frequent adverse events recorded in healthcare facilities. By employing a multifaceted strategy to ensure prevention interventions that are specific to the patient type and environmental risk management, risk factor evaluation may help to reduce falls in the hospital setting. Patient falls are one of the main causes of lawsuits against hospitals, which has led to the development of validated instruments that are beneficial in treating the patient after the incident and effective in minimizing the frequency of falls. The aim of our study is to evaluate compensation claims asserting healthcare culpability in situations where a patient fell in a hospital setting. The collected data relate to judgments issued in Italy until December 2022 regarding 30 episodes of falls that occurred between 2003 and 2018. Our research revealed that approximately 50% of Italian healthcare organizations lose the case in court when a patient falls in a hospital setting and dies or is injured. In half of these cases, the failure of the medical staff to use protective equipment against falls is what led to the court's acceptance of the compensation claim. In order to improve the quality of healthcare services, fall prevention techniques must continue to be implemented.
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Affiliation(s)
- Federica Mele
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Mirko Leonardelli
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Stefano Duma
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Carlo Angeletti
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gerardo Cazzato
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), School of Medicine, University of Bari "Aldo Moro", 70100 Bari, Italy
| | - Carmelo Lupo
- Innovation Department, Diapath S.p.A., Via Savoldini n. 71, 24057 Martinengo, Italy
| | - Ettore Gorini
- Department of Economics and Finance, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Cristoforo Pomara
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, 95121 Catania, Italy
| | - Alessandro Dell'Erba
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Maricla Marrone
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
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Elrod CS, Pappa ST, Heyn PC, Wong RA. Using an academic-community partnership model to deliver evidence-based falls prevention programs in a metropolitan setting: A community case study. Front Public Health 2023; 11:1073520. [PMID: 37064710 PMCID: PMC10097908 DOI: 10.3389/fpubh.2023.1073520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
BackgroundPrevention is an effective approach for mitigating the negative health outcomes associated with falls in older adults. The Administration for Community Living (ACL) has sponsored the implementation of evidence-based falls prevention programs (EBFPPs) across the United States through cooperative agreement grants to decrease the health and economic burden of falls. Marymount University received two of these grants to deliver three EBFPPs into the northern Virginia region. This community case study describes the development of a collaboration between a university and community-based organizations to adopt and implement multiple evidence-based programming in an area where none previously existed.MethodsThrough an academic-community partnership, EBFPPs were introduced to and implemented by senior-focused organizations. Target adopters were senior and community centers, multi-purpose senior services organizations, recreational organizations, and residential facilities serving older adults. The three EBFPPs were (1) Stay Active and Independent for Life (SAIL), (2) a Matter of Balance (MOB) and (3) Otago Exercise Program (OEP). Key interdependent project elements included: (1) fostering ongoing community organization collaboration, (2) introducing programs in the community, (3) growing and sustaining delivery sites, (4) preparing trained program leaders, and (5) building community demand for the programs.ResultsFrom August 2016–June 2022, 5,857 older adults participated in one of the three EBFPPs. SAIL classes were offered at 33 sites and MOB workshops at 31 with over 70% of them occurring at community or senior centers. OEP was offered at 4 sites. Factors that influenced the implementation of these programs included having: key advocates at host organizations, programs embedded into site workflows, sufficient capacity and workforce, engaged invested partners, and flexibility in working with a complex set of agencies and systems with different administrative structures.ConclusionBy connecting academic faculty with various community members from multiple sectors, new initiatives can be successfully implemented. Results from this ACL-funded project indicate that using an academic-community partnership model to build relationships and capacity for ongoing delivery of health promotion programming for older adults is feasible and effective in delivering EBFPPs. In addition, academic-community partnerships can develop a strong network of invested partners to foster continued support of fall prevention activities.
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Camp K, Hartos J, Atanda A. Use of Clinical Practice Guidelines and Quality Metrics to Assess Primary Care Management of Osteoporosis. Gerontol Geriatr Med 2023; 9:23337214231202152. [PMID: 37786542 PMCID: PMC10541736 DOI: 10.1177/23337214231202152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 08/23/2023] [Accepted: 09/01/2023] [Indexed: 10/04/2023] Open
Abstract
Background: Clinical practice guidelines and quality measures provide recommendations for physicians addressing osteoporosis management. This study explored the alignment of osteoporosis clinical practice in a primary care geriatric clinic with recommended guidelines. Methods: This retrospective chart review included 388 patients 65 or older from a primary care geriatric clinic diagnosed with osteopenia or osteoporosis, with or without a fragility fracture. Data included history of falls and use of DXA scans, FRAX® fracture risk assessment tool, osteoporosis medication, and fall risk mitigation plans. Results: For age-related primary fracture prevention, 68% of women and 87% of men had documented DXA scans, and 45% of patients diagnosed with osteoporosis and 42% determined at high risk were prescribed osteoporosis medication. For secondary fracture prevention, 72% of women aged 67 to 85 had DXA scans and 21% were prescribed osteoporosis medication. Only 10% of patients with a history of falls had documented fall risk management plans. Conclusion: Although showing higher rates of primary and secondary prevention outcomes than did research results from general primary care, gaps were identified for high fracture risk patients and fall risk management documentation. Medical record review may not provide sufficient data to capture factors influencing decision-making for fracture prevention.
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Affiliation(s)
- Kathlene Camp
- University of North Texas Health Science Center, Fort Worth, USA
| | | | - Adenike Atanda
- University of North Texas Health Science Center, Fort Worth, USA
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Peterson AB, Zhou H, Thomas KE. Disparities in traumatic brain injury-related deaths-United States, 2020. JOURNAL OF SAFETY RESEARCH 2022; 83:419-426. [PMID: 36481035 PMCID: PMC9795830 DOI: 10.1016/j.jsr.2022.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/06/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Traumatic brain injury (TBI) affects how the brain functions and remains a prominent cause of death in the United States. Although preventable, anyone can experience a TBI and epidemiological research suggests some groups have worse health outcomes following the injury. METHODS We analyzed 2020 multiple-cause-of-death data from the National Vital Statistics System to describe TBI mortality by geography, sociodemographic characteristics, mechanism of injury (MOI), and injury intent. Deaths were included if they listed an injury International Classification of Diseases, Tenth Revision (ICD-10) underlying cause of death code and a TBI-related ICD-10 code in one of the multiple-cause-of-death fields. RESULTS During 2020, 64,362 TBI-related deaths occurred and age-adjusted rates, per 100,000 population, were highest among persons residing in the South (20.2). Older adults (≥75) displayed the highest number and rate of TBI-related deaths compared with other age groups and unintentional falls and suicide were the leading external causes among this older age group. The age-adjusted rate of TBI-related deaths in males was more than three times the rate of females (28.3 versus 8.4, respectively); further, males displayed higher numbers and age-adjusted rates compared with females for all the principal MOIs that contributed to a TBI-related death. American Indian or Alaska Native, Non-Hispanic (AI/AN) persons had the highest age-adjusted rate (29.0) of TBI-related deaths when compared with other racial and ethnic groups. Suicide was the leading external cause of injury contributing to a TBI-related death among AI/AN persons. PRACTICAL APPLICATION Prevention efforts targeting older adult falls and suicide are warranted to reduce disparities in TBI mortality among older adults and AI/AN persons. Effective strategies are described in CDC's Stopping Elderly Accidents, Deaths, & Injuries (STEADI) initiative to reduce older adult falls and CDC's Preventing Suicide: A Technical Package of Policy, Programs, and Practices for the best available evidence in suicide prevention.
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Affiliation(s)
- Alexis B Peterson
- Applied Sciences Branch, Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, United States.
| | - Hong Zhou
- Data Analytics Branch, Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, United States
| | - Karen E Thomas
- Data Analytics Branch, Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, United States
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Hirata R, Tago M, Katsuki NE, Oda Y, Tokushima M, Tokushima Y, Hirakawa Y, Yamashita S, Aihara H, Fujiwara M, Yamashita SI. History of Falls and Bedriddenness Ranks are Useful Predictive Factors for in-Hospital Falls: A Single-Center Retrospective Observational Study Using the Saga Fall Risk Model. Int J Gen Med 2022; 15:8121-8131. [PMID: 36389017 PMCID: PMC9657273 DOI: 10.2147/ijgm.s385168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/21/2022] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION In our former study, we had validated the previously developed predictive model for in-hospital falls (Saga fall risk model) using eight simple factors (age, sex, emergency admission, department of admission, use of hypnotic medications, history of falls, independence of eating, and Bedriddenness ranks [BRs]), proving its high reliability. We found that only admission to the neurosurgery department, history of falls, and BRs had significant relationships with falls. In the present study, we aimed to clarify whether each of these three items had a significant relationship with falls in a different group of patients. METHODS This was a single-center based, retrospective study in an acute care hospital in a rural city of Japan. We enrolled all inpatients aged 20 years or older admitted from April 2015 to March 2018. We randomly selected patients to fulfill the required sample size. We performed multivariable logistic regression analysis using forced entry on the association between falls and each of the eight items in the Saga fall risk model 2. RESULTS A total of 2932 patients were randomly selected, of whom 95 (3.2%) fell. The median age was 79 years, and 49.9% were men. Multivariable analysis showed that female sex (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.39-0.93, p = 0.022), having a history of falls (OR 1.9, 95% CI 1.16-2.99, p = 0.010), requiring help with eating (OR 1.9, 95% CI 1.12-3.35, p = 0.019), BR of A (OR 6.6, 95% CI 2.82-15.30, p < 0.001), BR of B (OR 7.5, 95% CI 2.95-19.06, p < 0.001), and BR of C (OR 4.1, 95% CI 1.53-11.04, p = 0.005) were significantly associated with falls. CONCLUSION History of falls and BRs were independently associated with in-hospital falls.
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Affiliation(s)
- Risa Hirata
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - 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, Yuai-Kai Foundation and Oda Hospital, Saga, Japan
| | - Midori Tokushima
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | | | - Yuka Hirakawa
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Shun Yamashita
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Hidetoshi Aihara
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Motoshi Fujiwara
- Department of General Medicine, Saga University Hospital, Saga, Japan
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Crawley MR, Chapman AJ, Koestner A, Pounders S, Krech L, Lypka M, Fisk C, Iskander G. Fall Risk Identification Throughout the Continuum of Care for Elderly Trauma Patients: An Injury Prevention Initiative. Injury 2022; 53:3715-3722. [PMID: 36075779 DOI: 10.1016/j.injury.2022.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 08/06/2022] [Accepted: 08/29/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Falls are the second leading cause of trauma-related deaths worldwide. Identifying fall risk patients and initiating interventions reduces injuries and mortality, particularly in the elderly. The primary aim of this retrospective study was to identify missed opportunities for fall risk identification and intervention for geriatric trauma patients. PATIENTS AND METHODS In this retrospective observational cohort study, the trauma registry was queried to identify geriatric patients admitted for a fall over 36 months. The electronic medical record (EMR) was reviewed to evaluate patients' fall risk in the 12 months prior to the index fall admission. The EMR was also queried for repeat falls within 12 months after discharge, and to determine if fall prevention education was provided at discharge. RESULTS 597 patients met inclusion criteria; 68.3% were female. 64.7% were at risk for falling in the year before admission. 2% had documented fall prevention education at discharge. 32% of patients fell again within a year of discharge and 19.4% were readmitted for a repeat fall. Patients at high risk for falls (on the Hester-Davis scale) were significantly more likely to be readmitted (p = 0.005) and expire within six months (p = 0.033) than moderate risk patients. Mortality at 12 months post-admission for all patients was 19.4%. CONCLUSION This large study demonstrated that geriatric trauma patients admitted for a fall were already at risk for falling in the 12 months prior to admission. This is a novel finding that presents a substantial prevention opportunity for healthcare systems. Education and implementation of proven techniques to prevent falls as soon as at-risk patients are identified has the potential to change the course for a patient who may not only fall, but also fall again. This proactive approach could significantly impact the fall epidemic in our elderly population.
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Affiliation(s)
- Meaghan R Crawley
- Spectrum Health Butterworth Hospital, Trauma Services, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Alistair J Chapman
- Spectrum Health Butterworth Hospital, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA; Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Amy Koestner
- Spectrum Health Butterworth Hospital, Trauma Services, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Steffen Pounders
- Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Laura Krech
- Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA.
| | - Matthew Lypka
- Spectrum Health Office of Research and Education, Biostatistics Core, 15 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Chelsea Fisk
- Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Gaby Iskander
- Spectrum Health Butterworth Hospital, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
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de Clercq H, Naudé A, Bornman J. Development and Utility of an International Classification of Functioning, Disability and Health Code Set for Younger-Old Adults With Fall Risk: Implications for Audiologists. Am J Audiol 2022; 31:1116-1132. [DOI: 10.1044/2022_aja-21-00269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose:
Falling is a multifactorial condition that can cause severe injury and even death in older adults. Early identification of fall risk factors, as the first step of preventive health care, can assist in reducing the negative and often debilitating effects of falls in older adults. By using the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to develop an ICF code set to identify fall risk factors in older adults, health care practitioners could obtain health information in a multidimensional way.
Method:
This study describes the final phase of a comprehensive, three-phase, mixed-methods sequential study. For this third phase, a pre–post group design that focused on the audiologist's perceptions of the clinical utility of a newly developed ICF code set was employed. The questionnaire that was used for this purpose consisted of two distinct sections: clinical application and clinical utility (viz., appropriateness, accessibility, practicability, acceptability, and professional utility). Thirty practicing audiologists participated in the study. Data were analyzed for each of the two sections of the questionnaire.
Results:
Results related to clinical application indicated that regardless of the audiologists' experience in routine fall risk assessment or fall risk factor identification, the use of the developed ICF code set increased their ability to correctly identify relevant clinical aspects. Results related to clinical utility showed high scores across all five measure components, with the highest clinical utility component being acceptability, closely followed by appropriateness and professional utility, and the lowest being accessibility.
Conclusion:
Several clinical implications have emerged from this study, including the usefulness of the ICF code set to identify and document fall risk factors in older adults, the code set's ability to guide audiologists to determine individualized assessment needs either by themselves or by other health care disciplines, and that the code set could be used by audiologists regardless of their experience in vestibular assessments.
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Affiliation(s)
- Hendrika de Clercq
- Centre for Augmentative and Alternative Communication, Faculty of Humanities, University of Pretoria, South Africa
| | - Alida Naudé
- Centre for Augmentative and Alternative Communication, Faculty of Humanities, University of Pretoria, South Africa
| | - Juan Bornman
- Centre for Augmentative and Alternative Communication, Faculty of Humanities, University of Pretoria, South Africa
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Lin RL, Frazier HN, Anderson KL, Case SL, Ghoweri AO, Thibault O. Sensitivity of the S1 neuronal calcium network to insulin and Bay-K 8644 in vivo: Relationship to gait, motivation, and aging processes. Aging Cell 2022; 21:e13661. [PMID: 35717599 PMCID: PMC9282843 DOI: 10.1111/acel.13661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/10/2022] [Accepted: 06/05/2022] [Indexed: 01/25/2023] Open
Abstract
Neuronal hippocampal Ca2+ dysregulation is a critical component of cognitive decline in brain aging and Alzheimer's disease and is suggested to impact communication and excitability through the activation of a larger after hyperpolarization. However, few studies have tested for the presence of Ca2+ dysregulation in vivo, how it manifests, and whether it impacts network function across hundreds of neurons. Here, we tested for neuronal Ca2+ network dysregulation in vivo in the primary somatosensory cortex (S1) of anesthetized young and aged male Fisher 344 rats using single‐cell resolution techniques. Because S1 is involved in sensory discrimination and proprioception, we tested for alterations in ambulatory performance in the aged animal and investigated two potential pathways underlying these central aging‐ and Ca2+‐dependent changes. Compared to young, aged animals displayed increased overall activity and connectivity of the network as well as decreased ambulatory speed. In aged animals, intranasal insulin (INI) increased network synchronicity and ambulatory speed. Importantly, in young animals, delivery of the L‐type voltage‐gated Ca2+ channel modifier Bay‐K 8644 altered network properties, replicating some of the changes seen in the older animal. These results suggest that hippocampal Ca2+ dysregulation may be generalizable to other areas, such as S1, and might engage modalities that are associated with locomotor stability and motivation to ambulate. Further, given the safety profile of INI in the clinic and the evidence presented here showing that this central dysregulation is sensitive to insulin, we suggest that these processes can be targeted to potentially increase motivation and coordination while also reducing fall frequency with age.
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Affiliation(s)
- Ruei-Lung Lin
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Hilaree N Frazier
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Katie L Anderson
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Sami L Case
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Adam O Ghoweri
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Olivier Thibault
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA
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Wingood M, Peterson E, Neville C, Vincenzo JL. Feet/Footwear-Related Fall Risk Screening Tool for Older Adults: Development and Content Validation. Front Public Health 2022; 9:807019. [PMID: 35186877 PMCID: PMC8847373 DOI: 10.3389/fpubh.2021.807019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose Screening for feet- and footwear-related influences on fall risk is an important component of multifactorial fall risk screenings, yet few evidence-based tools are available for this purpose. We developed the Screening Tool for Feet/Footwear-Related Influences on Fall Risk to support interprofessional health care providers in their efforts to screen for feet/footwear-related influences on fall risk among community-dwelling older adults identified at risk for falling. Materials and Methods The study consisted of two phases. During Phase 1, results of a systematic review of lower-limb factors associated with balance and falls informed tool development. The tool's initial draft was evaluated by an external group of nine interprofessional content experts. After incorporating changes recommended by Phase 1 participants, Phase 2 was initiated. During Phase 2, eight new interprofessional experts (19.3 average years of experience) completed the three rounds of a modified Delphi study. Results Phase 1 experts recommended modifying eight items and rated the tool's clarity, appeal and clinical feasibility as 81.2/100, 79.1/100, and 76.1/100, respectively. Phase 2 participants suggested combining items with similar recommended actions, adding a question about orthoses, and increasing the specificity of nine items. The refinements resulted in a 20-item screening tool. Each item was approved by the Phase 2 participants with > 80% agreement after two rounds of consensus voting, reflecting the tool's high face and content validity. Conclusion The new screening tool has high face and content validity and supports identification of feet- and footwear-related influences on fall risk among community-dwelling older adults. The tool can be used by interprofessional healthcare providers completing a multifactorial fall risk screening on community-dwelling adults identified as being at risk for falling.
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Affiliation(s)
- Mariana Wingood
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, United States
| | - Elizabeth Peterson
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Christopher Neville
- Department of Physical Therapy Education, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Jennifer L Vincenzo
- Department of Physical Therapy, University of Arkansas for Medical Sciences, Fayetteville, AR, United States
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Waltzman D, Haarbauer-Krupa J, Womack LS. Traumatic Brain Injury in Older Adults-A Public Health Perspective. JAMA Neurol 2022; 79:437-438. [PMID: 35285868 DOI: 10.1001/jamaneurol.2022.0114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Dana Waltzman
- Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Juliet Haarbauer-Krupa
- Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lindsay S Womack
- Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.,Public Health Service, Rockville, Maryland
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Honda H, Ashizawa R, Kiriyama K, Take K, Hirase T, Arizono S, Yoshimoto Y. Chronic pain in the frail elderly mediates sleep disorders and influences falls. Arch Gerontol Geriatr 2022; 99:104582. [DOI: 10.1016/j.archger.2021.104582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/04/2021] [Accepted: 11/13/2021] [Indexed: 11/29/2022]
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Automatic and Efficient Fall Risk Assessment Based on Machine Learning. SENSORS 2022; 22:s22041557. [PMID: 35214471 PMCID: PMC8875808 DOI: 10.3390/s22041557] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 01/04/2023]
Abstract
Automating fall risk assessment, in an efficient, non-invasive manner, specifically in the elderly population, serves as an efficient means for implementing wide screening of individuals for fall risk and determining their need for participation in fall prevention programs. We present an automated and efficient system for fall risk assessment based on a multi-depth camera human motion tracking system, which captures patients performing the well-known and validated Berg Balance Scale (BBS). Trained machine learning classifiers predict the patient’s 14 scores of the BBS by extracting spatio-temporal features from the captured human motion records. Additionally, we used machine learning tools to develop fall risk predictors that enable reducing the number of BBS tasks required to assess fall risk, from 14 to 4–6 tasks, without compromising the quality and accuracy of the BBS assessment. The reduced battery, termed Efficient-BBS (E-BBS), can be performed by physiotherapists in a traditional setting or deployed using our automated system, allowing an efficient and effective BBS evaluation. We report on a pilot study, run in a major hospital, including accuracy and statistical evaluations. We show the accuracy and confidence levels of the E-BBS, as well as the average number of BBS tasks required to reach the accuracy thresholds. The trained E-BBS system was shown to reduce the number of tasks in the BBS test by approximately 50% while maintaining 97% accuracy. The presented approach enables a wide screening of individuals for fall risk in a manner that does not require significant time or resources from the medical community. Furthermore, the technology and machine learning algorithms can be implemented on other batteries of medical tests and evaluations.
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Vincenzo JL, Patton SK, Lefler LL, McElfish PA, Wei J, Curran GM. Older Adults' Perceptions and Recommendations Regarding a Falls Prevention Self-Management Plan Template Based on the Health Belief Model: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041938. [PMID: 35206125 PMCID: PMC8871905 DOI: 10.3390/ijerph19041938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 12/10/2022]
Abstract
Falls are the leading cause of fatal and non-fatal injuries among older adults. Self-management plans have been used in different contexts to promote healthy behaviors, but older adults’ perceptions of a falls prevention self-management plan template have not been investigated. Using mixed methods, we investigated older adults’ perceptions and recommendations of a falls prevention self-management plan template aligned with the Health Belief Model. Four focus groups (n = 27, average age 78 years) were conducted using semi-structured interview guides. Participants also ranked the written plan on paper with respect to each item by the level of importance, where item 1 was the most important, and 10 was the least important. Focus groups were transcribed and analyzed. Descriptive statistics were calculated for item rankings. Older adults felt that the plan would raise awareness and help them to engage in falls prevention behaviors. Participants recommended adding graphics and using red to highlight the risk of falling. Participants opined that ranking the items by level of importance was challenging because they felt all items were important. ‘What might happen to me if I fall’ was ranked as the most important item (average 2.6), while ‘How will I monitor progress’ was the least important (average = 6.6). Considering that older adults need support to engage in falls prevention, future research should investigate the impact of implementing an individually tailored falls prevention self-management plan on older adults’ engagement in falls prevention behaviors and outcomes of falls and injuries.
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Affiliation(s)
- Jennifer L. Vincenzo
- Department of Physical Therapy, College of Health Professions, University of Arkansas for Medical Sciences, Fayetteville, AR 72703, USA
- Correspondence:
| | - Susan K. Patton
- Department of Nursing, College of Education and Health Professions, University of Arkansas, Fayetteville, AR 72703, USA;
| | - Leanne L. Lefler
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Pearl A. McElfish
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Fayetteville, AR 72703, USA;
| | - Jeanne Wei
- Department of Geriatrics, Reynolds Institute on Aging, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Geoffrey M. Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
- Central Arkansas Veterans Healthcare System, North Little Rock, AR 72114, USA
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Designing and Implementing a Zero Harm Falls Prevention Program. J Nurs Care Qual 2022; 37:199-205. [DOI: 10.1097/ncq.0000000000000617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Physical Therapists and Physical Therapist Assistants' Knowledge and Use of the STEADI for Falls Risk Screening of Older Adults in Physical Therapy Practice in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031354. [PMID: 35162377 PMCID: PMC8834951 DOI: 10.3390/ijerph19031354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/11/2022] [Accepted: 01/23/2022] [Indexed: 12/17/2022]
Abstract
Fall-risk screening and prevention is within the scope of physical-therapy practice. Prior research indicates United States-based physical therapists (PTs) and physical-therapist assistants (PTAs) use the Centers for Disease Control and Prevention’s STEADI (Stopping Elderly Accidents, Deaths, and Injuries) toolkit for community-based fall-risk screenings of older adults. However, clinically based fall-risk screenings and knowledge and use of the STEADI by PTs and PTAs is unknown. We conducted a cross-sectional survey distributed to a convenience sample of PTs and PTAs in the United States through email blasts and social media. PTs and PTAs (N = 425) who responded to the survey and worked in clinical settings with older adults were included. Eighty-nine percent of respondents reported conducting clinical fall-risk screening. Approximately 51% were ‘familiar’ to ‘very familiar’ with the STEADI, and 21.7% of the overall sample were not familiar at all. Only 26.1% utilize the STEADI for clinical fall-risk screening. Of the respondents who were ‘very familiar’ with the STEADI (n = 132, 31.1%), 84.1% (n = 111) reported using the STEADI in clinical practice. Seventy-six percent of respondents who use the STEADI implemented it by choice even though the majority (52.1%, n = 63) did not have it embedded in their documentation/workflow. Some PTs/PTAs can and do manage falls using the STEADI, but there is a gap in knowledge and use of the STEADI for falls management among PTs and PTAs in the United States. Further research is needed to identify the tools PTs use for multifactorial-fall screening and management and the impact of PTs’ use of the STEADI on patient outcomes.
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Brullo J, Rushton S, Brickner C, Madden-Baer R, Peng T. Using Root Cause Analysis to Inform a Falls Practice Change in the Home Care Setting. Home Healthc Now 2022; 40:40-48. [PMID: 34994719 DOI: 10.1097/nhh.0000000000001036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Falls are a significant health problem in community-dwelling older adults, resulting in injuries, deaths, and increased healthcare costs. Falls were a quality concern for a Northeastern home care agency and this project aimed to evaluate the falls prevention process for older adults receiving home care services by determining potential root causes of falls and to identify a practice change. This quality improvement project used a root cause analysis methodology with a retrospective matched case-control design. Records of patients with falls were assessed for falls prevention process fidelity and compared with patients without a fall matched on the Missouri Alliance for Home Care-10 (MAHC-10) assessment, examining plan of care accuracy and patient fall risk factors. Findings indicated fidelity concerns in the fall prevention process, with gaps in care planning aligned with identified risk factors. Interventions to mitigate identified MAHC-10 risk factors on care plans were present less than 50% of the time for four of the six factors. Polypharmacy (7.46%) and pain affecting function (9.21%) were most frequently unaddressed risk factors in the care plan. Recommendations included implementation of a falls prevention pathway, including standardized falls risk assessment, universal falls precautions in the care plan with tailored interventions based on risk factors, and referral initiation when necessary.
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Hunter EG, Rhodus E. Interventions Within the Scope of Occupational Therapy to Address Preventable Adverse Events in Inpatient and Home Health Postacute Care Settings: A Systematic Review. Am J Occup Ther 2022; 76:23140. [PMID: 34990510 DOI: 10.5014/ajot.2022.047589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Practitioners need to be familiar with, and involved in, managing quality-related adverse events in postacute care. OBJECTIVE To determine interventions within the scope of occupational therapy that address preventable adverse events in adult postacute inpatient and home health settings. DATA SOURCES Articles published from January 1995 through 2019 identified through searches of MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases. Study Selection and Data Collection: Articles were collected, evaluated, and analyzed by two independent reviewers. They were assessed and synthesized with a goal of informing clinical practice. FINDINGS Twenty-four articles were included in the review. Of the 10 Centers for Medicare & Medicaid Services preventable adverse events, 6 were addressed: diabetes management (n = 2), dysphagia (n = 5), infection control (n = 1), pressure ulcers (n = 6), falls (n = 5), and discharge management (n = 5). There was strong strength of evidence that exercise programs should, when appropriate, be implemented in both inpatient and home health settings to decrease the risk of falls. There was moderate strength of evidence that practitioners could consider implementing a facility wide evidence-based pressure ulcer program; providing multidisciplinary rehabilitation and swallow strengthening exercises for dysphagia; implementing a multidisciplinary, multicomponent falls program; and using a manualized depression intervention in home health to decrease hospital readmission. CONCLUSIONS AND RELEVANCE The review highlights the importance of preventable adverse events and of occupational therapy practitioners acknowledging and managing these events to enhance health outcomes and to control health care costs. What This Article Adds: Many interventions typically performed by occupational therapy practitioners address preventable adverse events. The review highlights the importance of practitioners being aware of this category of impairment or injury.
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Affiliation(s)
- Elizabeth G Hunter
- Elizabeth G. Hunter, PhD, OTR/L, is Assistant Professor, Graduate Center for Gerontology, College of Public Health, University of Kentucky, Lexington;
| | - Elizabeth Rhodus
- Elizabeth Rhodus, PhD, OTR, is Postdoctoral Fellow, Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington
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Kalim RA, Cunningham CJ, Ryder SA, McMahon NM. Deprescribing Medications that Increase the Risk of Falls in Older People: Exploring Doctors' Perspectives Using the Theoretical Domains Framework (TDF). Drugs Aging 2022; 39:935-947. [PMID: 36409404 PMCID: PMC9676799 DOI: 10.1007/s40266-022-00985-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Falls can lead to hospitalisation and death in older people. Polypharmacy is a major risk factor, and deprescribing fall-risk increasing drugs (FRIDs) is one of several possible important preventive measures. The objective of this study was to explore the factors that influence doctors when deprescribing FRIDs in a hospital setting. METHOD Semi-structured interviews were conducted with consultant geriatricians and hospital doctors experienced in dealing with patients aged 65 years or older, at a large academic teaching hospital (~ 1000 beds), Dublin, Ireland. The interviews were directed by an interview guide and audio recorded and transcribed verbatim, with subsequent thematic analysis in NVivo 12 software. RESULTS A total of 18 participants were interviewed. Barriers to deprescribing included: insufficient time, incomplete patient records, changing medications initiated by other specialists and difficulties following up patients after discharge. Facilitators included: enhanced documentation through electronic patient records, the support of other healthcare professionals such as clinical pharmacists, and patients' engagement, which is considered essential for the success of the deprescribing process's outcome. CONCLUSION Deprescribing FRIDs in older adults in the hospital setting is challenging. Implementation of the process in practice requires combined effort from stakeholders to tackle everyday work environment challenges. Future studies are required examining the clinical effect of the suggested interventions and exploring patients' involvement in deprescribing decisions.
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Affiliation(s)
- Reham A Kalim
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Conal J Cunningham
- St James's Hospital, James's Street, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sheila A Ryder
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.
| | - Niamh M McMahon
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
- St James's Hospital, James's Street, Dublin, Ireland
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Vincenzo JL, Patton SK, Lefler LL, McElfish PA, Wei J, Curran G. A qualitative study of older adults' facilitators, barriers, and cues to action to engage in falls prevention using health belief model constructs. Arch Gerontol Geriatr 2022; 99:104610. [PMID: 34954649 PMCID: PMC9344858 DOI: 10.1016/j.archger.2021.104610] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/15/2021] [Accepted: 12/12/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Falls are the leading cause of fatal and nonfatal injuries among older adults. Decreasing falls is highly dependent on engagement in fall prevention activities. The Health Belief Model (HBM) theoretical framework was used to explore older adults' perceptions about falls prevention. RESEARCH DESIGN AND METHODS An informed grounded theory approach was applied. Four focus groups were conducted using semi-structured interview guides based on the HBM with 27 community-dwelling older adults (average age = 78 years). Deductive content analysis was used to apply constructs of the HBM to the data and explain the findings. RESULTS Potential reasons for not engaging in falls prevention included lack of self-perceived severity, susceptibility, and self-efficacy with a subtheme of lack of information about falls prevention from medical providers. Potential facilitators included older adults' knowledge and current engagement in falls prevention and socializing while engaging in falls prevention. Participants recommended cues to action to improve engagement in falls prevention from family, friends, physicians, pharmacists, and insurance companies; and using various modes to deliver cues to action, including print, audiovisual, online, and reminders. DISCUSSION AND IMPLICATIONS In this study, the HBM was used to understand older adults' potential barriers, facilitators, and cues to action to support engagement in falls prevention. Engagement in fall prevention behaviors could be improved by addressing barriers such as lack of knowledge, and lack of self-perceived severity and susceptibility to falls. Reinforcing the benefits of fall prevention, and promoting cues to action to engage in falls prevention may also support engagement.
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Affiliation(s)
- Jennifer L. Vincenzo
- University of Arkansas for Medical Sciences, Department of Physical Therapy, College of Health Professions
| | - Susan Kane Patton
- University of Arkansas, Department of Nursing, College of Education and Health Professions, United States.
| | | | - Pearl A. McElfish
- University of Arkansas for Medical Sciences, Office of Community Health and Research
| | - Jeanne Wei
- University of Arkansas for Medical Sciences, Department of Geriatrics, College of Medicine, Reynolds Institute on Aging, United States.
| | - Geoffrey Curran
- University of Arkansas for Medical Sciences, Departments of Pharmacy Practice and Psychiatry, Central Arkansas Veterans Healthcare System
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White ND. Mitigating Medication-Related Fall Risk Through Pharmacist-Prescriber Collaboration. Am J Lifestyle Med 2021; 15:602-604. [PMID: 34916879 DOI: 10.1177/15598276211035361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Medications are known to increase the risk for fall in older adults, and pharmacists can contribute to fall risk prevention through medication therapy management services. STEADI-Rx is an initiative developed to facilitate fall risk reduction through pharmacist-prescriber collaboration. Key components of the STEADI-Rx algorithm are described as well as evidence supporting its integration in practice.
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Sarmiento K, Kennedy J, Daugherty J, Peterson AB, Evans ME, Haberling DL, Billie H. Traumatic Brain Injury-Related Emergency Department Visits Among American Indian and Alaska Native Persons-National Patient Information Reporting System, 2005-2014. J Head Trauma Rehabil 2021; 35:E441-E449. [PMID: 32472829 PMCID: PMC7483258 DOI: 10.1097/htr.0000000000000570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The American Indian/Alaska Native (AI/AN) population has a disproportionately high rate of traumatic brain injuries (TBIs). However, there is little known about incidence and common mechanisms of injury among AI/AN persons who seek care in an Indian Health Service (IHS) or tribally managed facility. METHODS Using the IHS National Patient Information Reporting System, we assessed the incidence of TBI-related emergency department visits among AI/AN children and adults seen in IHS or tribally managed facilities over a 10-year period (2005-2014). RESULTS There were 44 918 TBI-related emergency department visits during the study period. Males and persons aged 18 to 34 years and 75 years and older had the highest rates of TBI-related emergency department visits. Unintentional falls and assaults contributed to the highest number and proportion of TBI-related emergency department visits. The number and age-adjusted rate of emergency department visits for TBI were highest among persons living in the Southwest and Northern Plains when compared with other IHS regions. CONCLUSION Thousands of AI/AN children and adults are seen each year in emergency departments for TBI and the numbers increased over the 10-year period examined. Evidence-based interventions to prevent TBI-related emergency department visits, such as programs to reduce the risk for older adult falls and assault, are warranted.
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Affiliation(s)
- Kelly Sarmiento
- Divisions of Injury Prevention (Ms Sarmiento and Drs Daugherty and Peterson) and Overdose Prevention (Dr Evans), National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (Mss Kennedy and Haberling); and Indian Health Service, Office of Environmental Health and Engineering, Division of Environmental Health Services, Injury Prevention Program, Washington, District of Columbia (Ms Billie)
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Pai DR, Hosseini HM, Rosito SR. Determining the relative risk of hospitalisation and surgery of fall injury patients. Health Syst (Basingstoke) 2021; 11:288-302. [DOI: 10.1080/20476965.2021.1966323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Dinesh R. Pai
- Project and Supply Chain Management, Penn State Harrisburg, School of Business Administration, Middletown, PA, USA
| | - Hengameh M. Hosseini
- University of Scranton, Heath administration and Human Resources instead of Penn state school of public affairs,
| | - Stephen R. Rosito
- Health Administration, Penn State Harrisburg, School of Public Affairs, Middletown, PA, USA
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Stark S, Keglovits M, Somerville E, Hu YL, Barker A, Sykora D, Yan Y. Home Hazard Removal to Reduce Falls Among Community-Dwelling Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2122044. [PMID: 34463746 PMCID: PMC8408671 DOI: 10.1001/jamanetworkopen.2021.22044] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Falls are the leading preventable cause of morbidity, mortality, and premature institutionalization for community-dwelling older adults. OBJECTIVE To test the effectiveness of a behavioral intervention on fall risk among older adults receiving services from an Area Agency on Aging. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial examined a home hazard removal intervention in the community using a race- and sex-stratified randomization design. Older adults receiving services from the Area Agency on Aging in urban St Louis, Missouri, were assigned to a home hazard removal intervention delivered over 2 weeks with a 6-month booster or usual care control. Eligible participants were adults aged 65 years or older who did not have dementia, were at high risk for falling, and resided in the community. Enrollment occurred from January 2015 to September 2016; 12-month follow-up occurred from February 2016 to October 2017. Data were analyzed from February 2019 to July 2021. INTERVENTIONS The intervention was a home hazard removal program delivered by an occupational therapist in the home that included a comprehensive clinical assessment and a tailored hazard removal plan. Usual care control consisted of annual assessments and community referral. MAIN OUTCOMES AND MEASURES The primary outcome was the hazard of a fall over 12 months. Prespecified secondary outcomes included the rate of falls over 12 months, daily activity performance, falls self-efficacy, and self-reported quality of life. RESULTS A total of 310 participants (mean [SD] age, 75 [7.4] years; 229 [74%] women; 161 Black participants [52%]) were randomized, with 155 participants assigned to the intervention and 155 participants assigned to usual care. Retention was 127 participants (82%) in the intervention group and 126 participants (81%) in the control group. There was no difference for our primary outcome of fall hazard (hazard ratio, 0.90; 95% CI, 0.66-1.27). There was a 38% reduction in the rate of falling in the intervention group compared with the control group (relative risk, 0.62; 95% CI, 0.40-0.95; P = .03). At 12 months, the rate of falls per person-year was 1.5 (95% CI, 1.32-1.75) in the intervention group and 2.3 (95% CI, 2.08-2.60) in the control group. There was no difference in daily activity performance (adjusted difference, -0.20; 95% CI, -0.95 to 0.55; P = .60), falls self-efficacy (adjusted difference, -0.12; 95% CI, -1.25 to 1.01; P = .84), or quality of life (adjusted difference, 0.84; 95% CI, -0.95 to 2.64; P = .35). CONCLUSIONS AND RELEVANCE This randomized clinical trial found that a brief home hazard removal program did not reduce the hazard of falls among community-dwelling older adults at high risk for falling. The intervention was effective in achieving a reduced rate of falls, a prespecified secondary outcome. This effectiveness study has the potential for delivery through the national aging services network. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02392013.
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Affiliation(s)
- Susan Stark
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Marian Keglovits
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Emily Somerville
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Yi-Ling Hu
- Institute of Gerontology, Wayne State University, Detroit, Michigan
| | - Abigail Barker
- Brown School of Social Work, Washington University in St Louis, St Louis, Missouri
| | - Dave Sykora
- St Louis Area Agency on Aging, St Louis, Missouri
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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Chen K, Dandapani H, Guthrie KM, Goldberg E. Can Older Adult Emergency Department Patients Successfully Use the Apple Watch to Monitor Health? RHODE ISLAND MEDICAL JOURNAL (2013) 2021; 104:49-54. [PMID: 34323880 PMCID: PMC8519485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To determine usability of the Apple Watch in older adult emergency department (ED) patients after a fall. METHODS We recruited older adults who fell and visited two urban EDs. They participated in an Apple Watch orientation and interviews on their experiences using the watch to complete varied tasks for 30 days. Interviews were recorded, transcribed, coded, and analyzed using framework analyses. RESULTS Eight participants (mean age 77.6 years) enrolled from November 2019 to March 2020. Participants reported being able to apply and charge the watch but struggled with navigating screens, monitoring charging status, and responding with de novo text messages. Many cited difficulties with advanced tasks, such as the study's app-based movement and memory activities. Experience with smartphones and caregiver assistance enhanced users' ability to complete tasks. CONCLUSIONS Older adults successfully performed basic Apple Watch functions. Family and community members may be necessary to assist with complex tasks.
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Affiliation(s)
- Kevin Chen
- Warren Alpert Medical School of Brown University, Providence, R
| | | | - Kate M Guthrie
- Brown University, School of Public Health; Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI
| | - Elizabeth Goldberg
- Brown University, School of Public Health; Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, RI
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Antcliff S, Welvaert M, Witchalls J, Wallwork SB, Waddington G. Assessing Proprioception in an Older Population: Reliability of a Protocol Based on Active Movement Extent Discrimination. Percept Mot Skills 2021; 128:2075-2096. [PMID: 34210231 DOI: 10.1177/00315125211029906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Proprioceptive ability - the sense of where body parts are located in space - is one of many factors thought to affect falls risk among the elderly. Active movement extent discrimination is an approach to measuring proprioception that is administered in an ecologically valid testing environment to better reflect the exercise of proprioceptive skills in daily life. The Active Movement Extent Discrimination Apparatus (AMEDA) was developed to objectively measure this proprioceptive discrimination. However, the current absolute identification testing protocol is cognitively demanding, and it yields results that are insufficiently reliable to assess performance at the individual level. The objectives of this pilot study were to test the reliability and feasibility of a proposed new AMEDA testing protocol and to explore how performance related to cognitive ability and any perceived dysfunction in the foot or ankle. We tested 42 participants (aged 19 - 94 years) three times on the ankle AMEDA using a newly developed protocol that asked participants to report whether a given angle of ankle inversion was shallower or deeper than the immediately preceding inversion. Participants also completed the Stroop test, as a measure of cognitive ability, and two validated questionnaires for identifying foot or ankle dysfunction (the Cumberland Ankle Instability Tool and the Foot and Ankle Ability Measure). The proportion of correct responses for the AMEDA test showed the expected sigmoid shape of the psychometric function as signal strength increased. The intraclass correlation coefficient measured over the three tests was 0.65 (95% confidence interval: 0.49 - 0.78), suggesting moderate reliability. We found a positive and statistically significant correlation between AMEDA performance and Stroop results but no relationship between the AMEDA score and questionnaire-measured foot or ankle dysfunction. This study confirmed that the alternative testing protocol was simple to administer and easily understood by participants.
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Affiliation(s)
- Susan Antcliff
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | - Marijke Welvaert
- Statistical Consulting Unit, 2219Australian National University, Australian National University, Canberra, Australia
| | - Jeremy Witchalls
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | - Sarah B Wallwork
- IImpact in Health, 1067University of South Australia, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Gordon Waddington
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
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Vincenzo JL, Hergott C, Schrodt L, Perera S, Tripken J, Shubert TE, Brach JS. Physical Therapists as Partners for Community Fall Risk Screenings and Referrals to Community Programs. Front Public Health 2021; 9:672366. [PMID: 34249840 PMCID: PMC8267879 DOI: 10.3389/fpubh.2021.672366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/04/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives: Physical therapists (PTs) are integral team members in fall prevention in clinical settings; however, few studies have investigated PTs' engagement in pro-bono community-based falls prevention. Therefore, we aimed to describe the characteristics of PTs and physical therapist assistants (PTAs) in the United States who conduct community-based fall screenings, the reach of screenings, their knowledge and utilization of the Centers for Disease Control and Prevention's fall-risk screening toolkit (STEADI, Stopping Elderly Accidents, Deaths, and Injuries), and therapists' knowledge and referrals to evidence-based programs (EBPs) and community resources. Methods: A cross-sectional survey distributed to a convenience sample of PTs/PTAs in the United States through news-blasts, and social media. Results: Four hundred and forty-four therapists who worked with older adults completed the survey. Approximately 40% of the respondents (n = 180) conduct screenings, most frequently annually. People who screen tend to be PTs with >20 years of experience, work in outpatient/wellness or academia, and be involved in the least amount of direct patient care. The majority (n = 344, 77.5%) of survey respondents were somewhat to very familiar with the STEADI, and ~84% (n = 114) of respondents who were very familiar with the STEADI (n = 136) use the toolkit to conduct community-based, pro-bono fall risk screenings. Twenty-six percent (n = 14) out of the 53 PTAs who responded to the survey conduct falls screenings in the community. Of the PTs/PTAs who conduct community-based fall screenings (n = 180), ~ 75% (n = 136) are aware of and refer older adults to EBPs. Over half also refer to Silver Sneakers and/or senior centers. Discussion: PTs and PTAs are key partners in evidence-based multifactorial fall prevention in the community. Data helps inform community organizations that most PTs who engage in community-based fall risk screening utilize the STEADI toolkit and refer to community-based programs. Community organizations seeking PT partners to engage in fall risk screenings and promote referrals to local resources or EBPs will likely have the most success collaborating with local physical therapy education programs or physical therapy clinic managers.
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Affiliation(s)
- Jennifer L Vincenzo
- Department of Physical Therapy, University of Arkansas for Medical Sciences, Fayetteville, AR, United States
| | - Colleen Hergott
- Department of Physical Therapy, Augusta University, Augusta, GA, United States
| | - Lori Schrodt
- Department of Physical Therapy, Western Carolina University, Cullowhee, NC, United States
| | - Subashan Perera
- Department of Physical Therapy, University of Pittsburg, Pittsburg, PA, United States
| | - Jennifer Tripken
- Center for Healthy Aging, National Council on Aging, Washington, DC, United States
| | - Tiffany E Shubert
- University of North Carolina Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, United States
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburg, Pittsburg, PA, United States
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Juckett LA, Bunger AC, Bunck L, Balog EJ. Evaluating the Implementation of Fall Risk Management Practices within Home-delivered Meal Organizations. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2021; 64:372-387. [PMID: 33627048 DOI: 10.1080/01634372.2021.1894521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 06/12/2023]
Abstract
Falls remain a major public health issue, particularly for frail older adults, such as those who receive home-delivered meals (HDMs). Social workers who assess the needs of HDM clients and routinely monitor their care are uniquely positioned to address fall prevention; however, the degree to which HDM social workers currently manage fall risk is unknown. To close this knowledge gap, we conducted a retrospective chart review and evaluated HDM social workers' current practices relative to identifying clients at risk for falling and the client characteristics associated with social workers' perceptions of fall risk. A total of 230 client charts were included in our analysis. Thirty-eight percent of HDM clients were determined to be at risk of falling. Advanced age, activity limitations, and specific health conditions (e.g., diabetes mellitus) were associated with social workers' fall risk concerns. However, over 80% of our sample presented with well-established fall risk factors (e.g., mobility impairment) suggesting that HDM social workers might be under-identifying fall-risks. Though HDM social workers are well positioned to play a critical role in fall risk management, systematic efforts are needed to optimize social workers' capacity for effectively identifying HDM clients at risk for falling.
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Affiliation(s)
- Lisa A Juckett
- The Ohio State University, School of Health and Rehabilitation Sciences, Columbus, Ohio, USA
| | - Alicia C Bunger
- The Ohio State University, College of Social Work, Columbus, Ohio, USA
| | | | - Emily J Balog
- Thomas Jefferson University, Jefferson College of Rehabilitation Sciences, Philadelphia, Pennsylvania, USA
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Abstract
BACKGROUND Falls remain the leading cause of injury-related death for 65 years and older. Matter of Balance is a well-documented community-based program designed to reduce participants' fear of falling. However, Matter of Balance classes' effect on physical measures remains less well studied. OBJECTIVE The objective of this study was to evaluate the effects of the Matter of Balance program on balance, strength, and fall risk. METHODS This is a single-group pretest-posttest evaluation of balance and strength in community participants enrolled in 8-week Matter of Balance classes. Physical therapist assessments of the Functional Reach Test and five times sit-to-stand test at week 1 and week 8 were compared. RESULTS A total of 33 class participants were studied. The average improvement in the Functional Reach Test was M = 1.33 (SD = 1.6) inches and the five times sit-to-stand test was M = -3.24 (SD = 3.42) seconds; p < .05. CONCLUSIONS Matter of Balance classes resulted in improvement in both balance and strength. This study's findings support Matter of Balance classes' efficacy as a community-based program that can reduce a participant's physical risk for falls.
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Affiliation(s)
- Rebecca L Geyer
- Zanesville-Muskingum County Health Department, Zanesville, Ohio (Ms Geyer); and Genesis HealthCare System, Zanesville, Ohio (Dr Thompson). Ms Geyer is now with Pennsylvania Trauma Systems Foundation, Camp Hill, Pennsylvania
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48
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Gross K, King AN, Steadman E. Impact of a Pharmacy-Led Fall Prevention Program for Institutionalized Older People. Sr Care Pharm 2021; 36:217-222. [PMID: 33766194 DOI: 10.4140/tcp.n.2021.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the impact of pharmacy interventions on recurrence of falls in older people. DESIGN Prospective case-crossover study. SETTING LECOM Health Nursing and Rehabilitation (LNR) and Senior Living Center (SLC) and Millcreek Community Hospital older adult behavioral health and inpatient rehabilitation units (IRU). PARTICIPANTS Twenty and 15 residents of the SLC and LNR, respectively, and 5 and 2 patients of the older adult behavioral health unit and IRU, respectively, experienced a fall during the 8-week study period. INTERVENTIONS Medication reviews were conducted by a pharmacist assessing for fall risk-increasing drugs (FRIDs). Adverse effects, drug interactions, and nonpharmacologic causes were evaluated, and recommendations were made to reduce future fall risk. MAIN OUTCOME MEASURES Recommendation acceptance rate, FRID use, and incidence of recurrent falls. RESULTS Eighty percent of fall risk-reduction recommendations were accepted and implemented by the medical team. The mean number of potential FRIDs prescribed per participant was reduced from 3.71 to 3.38. There was a 12.4% reduction in recurrent falls after pharmacy intervention (P = 0.0336; odds ratio [95% confidence interval] = 1.783 [1.045-3.112]). CONCLUSION Pharmacist interventions for older people who experience a fall were associated with a high acceptance rate by health care providers, a reduction in FRID use, and decreased rate of recurrent falls.
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Affiliation(s)
- Kylee Gross
- 1Lake Erie College of Osteopathic Medicine (LECOM), Health, Erie, Pennsylvania
| | - Ashley N King
- 1Lake Erie College of Osteopathic Medicine (LECOM), Health, Erie, Pennsylvania
| | - Elizabeth Steadman
- 1Lake Erie College of Osteopathic Medicine (LECOM), Health, Erie, Pennsylvania
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Karlsson L, Doe K, Gerry M, Moore B, Wingood M, Renfro M, Gell N. Outcomes of a Physical Therapist-Led, Statewide, Community-Based Fall Risk Screening. J Geriatr Phys Ther 2021; 43:185-193. [PMID: 30883528 DOI: 10.1519/jpt.0000000000000228] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE Falls are the leading cause of morbidity and mortality among US older adults and result in considerable medical and social consequences. Community-based screenings are a type of intervention that provides accessible fall risk screening and education at no cost to the participants. However, little is known about whether or how participants change behavior after screening events. Therefore, the purpose of this study was to quantify and characterize participant risk-reducing behaviors after community-based fall risk screenings. METHODS Participants were recruited during 22 community-based fall risk screening events in 2017 led by physical therapists. The screenings were conducted using a modified version of the Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths, and Injuries (CDC STEADI) toolkit. Screenings included risk reduction education via group format and individual recommendations tailored to fall risk classification based on the screening outcomes. For the study, questionnaires were used at baseline to collect demographics and screening results and at 1-month and 5-month follow-up to assess risk reduction behavior change. Descriptive statistics characterized behavior change and assessed outcome differences by baseline fall risk level. Logistic regression analyses examined factors impacting behavior change after screening. RESULTS AND DISCUSSION At baseline, 123 participants enrolled and 104 (84.6%) responded at 1- and 5-month follow-up. By 1 month, 50.0% of participants had adopted at least 1 fall risk-reducing behavior, which increased to 64.9% by 5 months. Moderate or high fall risk was significantly associated with adopting a new behavior change by 5 months compared with those with low fall risk (P = .04). The odds of adopting a fall risk reduction strategy by 5 months increased with higher education (odds ratio: 2.5, 95% confidence interval: 1.0-6.0) and moderate/high fall risk (odds ratio: 3.0, 95% confidence interval: 1.3-7.2) in a logistic regression model adjusted by age and sex. CONCLUSIONS Screening and education using the STEADI toolkit during community-based screenings result in short- and long-term behavior change to reduce fall risk among older adults, particularly those with moderate to high fall risk. Further research is needed to identify barriers and incentives among participants who do not make fall-related behavioral changes after screening.
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Affiliation(s)
- Lee Karlsson
- Department of Rehabilitation and Movement Science, The University of Vermont, Burlington
| | - Kelsey Doe
- Department of Rehabilitation and Movement Science, The University of Vermont, Burlington
| | - Meghan Gerry
- Department of Rehabilitation and Movement Science, The University of Vermont, Burlington
| | - Brooke Moore
- Department of Rehabilitation and Movement Science, The University of Vermont, Burlington
| | - Mariana Wingood
- College of Nursing and Health Sciences, The University of Vermont, Burlington
| | - Mindy Renfro
- School of Physical Therapy, Touro University Nevada, Henderson
| | - Nancy Gell
- Department of Rehabilitation and Movement Science, The University of Vermont, Burlington
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50
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Lozano-Ortega G, Schermer CR, Walker DR, Szabo SM, Rogula B, Deighton AM, Gooch KL, Campbell NL. Fall/Fracture-Related Healthcare Costs and Their Association with Cumulative Anticholinergic Burden in People with Overactive Bladder. PHARMACOECONOMICS - OPEN 2021; 5:45-55. [PMID: 32291728 PMCID: PMC7895881 DOI: 10.1007/s41669-020-00215-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Falls/fractures are major causes of morbidity and mortality among older adults and the resulting health consequences generate a substantial economic burden. Risk factors are numerous and include overactive bladder (OAB) and anticholinergic use. OBJECTIVES We aimed to estimate the impact of falls/fractures on all-cause healthcare resource utilization and costs, according to levels of cumulative anticholinergic burden, among individuals with OAB. METHODS Among a US cohort of adults with OAB (identified based on medical claims for OAB or OAB-specific medications), the frequency of resource utilization (outpatients visits, medication use, and hospitalizations) was examined according to level of anticholinergic burden. Anticholinergic burden was assessed cumulatively using a published measure, and categorized as no, low, medium, or high. Resource utilization prior to and after a fall/fracture was compared. Generalized linear models were used to examine overall and incremental changes in healthcare resource utilization and costs by fall/fracture status, and annual costs were predicted according to age, sex, fall/fracture status, and level of anticholinergic burden. RESULTS The mean age of the OAB cohort (n = 154,432) was 56 years, 68% were female, and baseline mean anticholinergic burden was 266.7 (i.e. a medium level of burden); a fall/fracture was experienced by 9.9% of the cohort. All estimates of resource utilization were higher among those with higher levels of anticholinergic burden, regardless of fall/fracture status, and higher for all levels of anticholinergic burden after a fall/fracture. Among those with a fall/fracture, the highest predicted annual costs were observed among those aged 66-75 years with high anticholinergic burden (US$22,408 for males, US$22,752 for females). CONCLUSIONS Falls/fractures were associated with higher costs, which increased with increasing anticholinergic burden.
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Affiliation(s)
- Greta Lozano-Ortega
- Broadstreet Health Economics and Outcomes Research, 203-343 Railway St, Vancouver, BC, V6A 1A4, Canada
| | - Carol R Schermer
- Medical Affairs, Americas, Astellas Pharmaceutical Global Development Inc., Northbrook, IL, USA
| | - David R Walker
- Medical Affairs, Americas, Astellas Pharmaceutical Global Development Inc., Northbrook, IL, USA
| | - Shelagh M Szabo
- Broadstreet Health Economics and Outcomes Research, 203-343 Railway St, Vancouver, BC, V6A 1A4, Canada.
| | - Basia Rogula
- Broadstreet Health Economics and Outcomes Research, 203-343 Railway St, Vancouver, BC, V6A 1A4, Canada
| | - Alison M Deighton
- Broadstreet Health Economics and Outcomes Research, 203-343 Railway St, Vancouver, BC, V6A 1A4, Canada
| | - Katherine L Gooch
- Medical Affairs, Americas, Astellas Pharmaceutical Global Development Inc., Northbrook, IL, USA
| | - Noll L Campbell
- College of Pharmacy, Purdue University, West Lafayette, IN, USA
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