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Dabkowski E, Missen K, Duncan J, Cooper S. Falls risk perception measures in hospital: a COSMIN systematic review. J Patient Rep Outcomes 2023; 7:58. [PMID: 37358752 DOI: 10.1186/s41687-023-00603-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/04/2023] [Indexed: 06/27/2023] Open
Abstract
Falls prevention in hospital continues to be a research priority because of the poor health outcomes and financial burdens that can arise. Recently updated World Guidelines for Falls Prevention and Management strongly recommend evaluating patients' concerns about falling as part of a multifactorial assessment. The aim of this systematic review was to evaluate the quality of falls risk perception measures for adults in a hospital setting. This review was conducted using the Consensus-based Standards for the selection of health Measurement Instruments guidelines and provides a comprehensive summary of these instruments, including psychometric properties, feasibility and clinical recommendations for their use. The review followed a prospectively registered protocol, in which a total of ten databases were searched between the years 2002 and 2022. Studies were included if the instruments measured falls risk perception and/or other psychological falls constructs, if they were conducted in a hospital setting and if the target population contained hospital inpatients. A total of 18 studies met the inclusion criteria, encompassing 20 falls risk perception measures. These falls risk perception instruments were grouped into five falls-related constructs: Balance Confidence, Falls Efficacy/Concern, Fear of Falling, Self-Awareness and Behaviour/Intention. Two of the patient reported outcome measures (PROMs) received Class A recommendations (Falls Risk Perception Questionnaire and the Spinal Cord Injury-Falls Concern Scale); however, this rating is only applicable for the populations/context described in the studies. Thirteen PROMs received Class B recommendations, solidifying the need for further validation studies of these PROMs.
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Affiliation(s)
- Elissa Dabkowski
- Institute of Health and Wellbeing, Federation University Australia, Northways Road, Churchill, VIC, 3842, Australia.
| | - Karen Missen
- Institute of Health and Wellbeing, Federation University Australia, Northways Road, Churchill, VIC, 3842, Australia
| | - Jhodie Duncan
- Research Unit, Latrobe Regional Hospital, Traralgon West, VIC, Australia
| | - Simon Cooper
- Health Innovation and Transformation Centre, Federation University Australia, Berwick, VIC, Australia
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Adult Inpatients’ Perceptions of Their Fall Risk: A Scoping Review. Healthcare (Basel) 2022; 10:healthcare10060995. [PMID: 35742046 PMCID: PMC9222288 DOI: 10.3390/healthcare10060995] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Abstract
Patient falls in hospitals continue to be a global concern due to the poor health outcomes and costs that can occur. A large number of falls in hospitals are unwitnessed and mostly occur due to patient behaviours and not seeking assistance. Understanding these patient behaviours may help to direct fall prevention strategies, with evidence suggesting the need to integrate patients’ perspectives into fall management. The aim of this scoping review was to explore the extent of the literature about patients’ perceptions and experiences of their fall risk in hospital and/or of falling in hospital. This review was conducted using a five-stage methodological framework recommended by Arksey and O’Malley. A total of nine databases were searched using key search terms such as “fall*”, “perception” and “hospital.” International peer-reviewed and grey literature were searched between the years 2011 and 2021. A total of 41 articles, ranging in study design, met the inclusion criteria. After reporting on the article demographics and fall perception constructs and measures, the qualitative and quantitative findings were organised into five domains: Fall Risk Perception Measures, Patients’ Perceptions of Fall Risk, Patients’ Perceptions of Falling in Hospital, Patients’ Fear of Falling and Barriers to Fall Prevention in Hospital. Approximately two-thirds of study participants did not accurately identify their fall risk compared to that defined by a health professional. This demonstrates the importance of partnering with patients and obtaining their insights on their perceived fall risk, as this may help to inform fall management and care. This review identified further areas for research that may help to inform fall prevention in a hospital setting, including the need for further research into fall risk perception measures.
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Kalkers K, Schols JMGA, van Zwet EW, Roos RAC. Dysphagia, Fear of Choking and Preventive Measures in Patients with Huntington's Disease: The Perspectives of Patients and Caregivers in Long-Term Care. J Nutr Health Aging 2022; 26:332-338. [PMID: 35450988 DOI: 10.1007/s12603-022-1743-6] [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: 11/26/2022]
Abstract
OBJECTIVES To explore the prevalence of dysphagia and fear of choking in patients with Huntington's disease (HD) as well as preventive measures, both those applied and those not included in managing dysphagia. Also, to investigate related problems encountered by their formal and informal caregivers. DESIGN A multi-center observational cross-sectional study. SETTING AND PARTICIPANTS 158 HD patients, recruited from six Dutch nursing homes specialized in HD, and their formal and informal caregivers. MEASUREMENTS Patients were assessed by means of questionnaires enquiring about dysphagia, fear of choking and measures to manage dysphagia. Also, questionnaires were administered about awareness of dysphagia symptoms, cognition and anxiety. Because we expected individuals with greater care dependency to have a higher severity of dysphagia, we distinguished between a care-independent and a care-dependent group of HD patients. RESULTS In the total group, 90.5% of HD patients had one or more dysphagia symptoms. The prevalence of FoC in HD patients and the formal and informal caregivers' fears about choking in HD patients was 45.7%, 19.0% and 59.5%, respectively, for care-independent patients and 58.7%, 50.1% and 77.5% for care-dependent patients. The score on the Huntington's Disease Dysphagia Scale was a predictor for fear of FoC in care-independent patients. Speech-language therapy, supervision during eating and drinking and adaptation of food and drink consistency were the most frequently applied measures to manage dysphagia, a combination was used in most HD patients. CONCLUSIONS In HD patients, the prevalence of dysphagia is high and fear of choking is common among both patients and caregivers. A more severe degree of dysphagia is a predictor of FoC in care-independent HD patients. A combination of measures was used to manage dysphagia in most HD patients.
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Affiliation(s)
- K Kalkers
- K. Kalkers, MSc, Mijzo, Department of Psychology, Kloosterweg 1, 4941EG, Raamsdonksveer, The Netherlands. Tel- +31653198462, E-mail
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Kalkers K, Schols JMGA, van Zwet EW, Roos RAC. Falls, Fear of Falling, and Preventive Measures in Huntington's Disease: The Perspectives of Individuals with Huntington's Disease and Caregivers in Long-Term Care. J Huntingtons Dis 2021; 10:493-503. [PMID: 34719503 DOI: 10.3233/jhd-210493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Falls are common in Huntington's disease (HD), which can have serious consequences and may therefore lead to fear of falling (FoF). There is little knowledge about falls or FoF in individuals with HD or about formal and informal caregivers' fear about falls in individuals with HD. OBJECTIVE To explore prevalence of falls, FoF and fall preventive measures both those applied and those not included in managing falls in individuals with HD and their formal and informal caregivers, and to identify the relationship between FoF and, anxiety, awareness and cognitive functioning respectively. METHODS In a multi-center observational cross-sectional study, care-independent and -dependent individuals with HD and their formal and informal caregivers were recruited from six Dutch nursing homes specialized in HD. The participants were assessed by means of questionnaires enquiring about falls, FoF, awareness of fall risk, cognition, anxiety and fall preventive measures. RESULTS For all included 158 individuals with HD, the fall prevalence over the last 30 days was 28.8%. The prevalence of FoF in individuals with HD, formal caregivers and informal caregivers was 47.6%, 25.6%, and 63.5%, respectively, for care-independent individuals with HD and 46.9%, 26.3%, and 62.0%, respectively, for care-dependent individuals with HD. Anticipatory awareness of fall risks and gender are predictors of FoF in care-independent individuals with HD, though not in the care-dependent group. A combination of fall preventive measures is used in most individuals with HD. CONCLUSION Fall prevalence is high and FoF is common in individuals with HD and their caregivers. Gender and anticipatory awareness are risk factors for FoF. In addition to the use of individual multifactorial fall prevention strategies, it is important to support both formal and informal caregivers in coping with falls.
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Affiliation(s)
- Kristel Kalkers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Mijzo, Raamsdonksveer, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Erik W van Zwet
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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Ruggieri M, Palmisano B, Fratocchi G, Santilli V, Mollica R, Berardi A, Galeoto G. Validated Fall Risk Assessment Tools for Use with Older Adults: A Systematic Review. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2019. [DOI: 10.1080/02703181.2018.1520381] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Biagio Palmisano
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giancarlo Fratocchi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Valter Santilli
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberta Mollica
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Galeoto
- Department of Public Health, Sapienza University of Rome, Rome, Italy
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Mihaljcic T, Haines TP, Ponsford JL, Stolwyk RJ. Investigating the relationship between reduced self-awareness of falls risk, rehabilitation engagement and falls in older adults. Arch Gerontol Geriatr 2016; 69:38-44. [PMID: 27886565 DOI: 10.1016/j.archger.2016.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/24/2016] [Accepted: 11/05/2016] [Indexed: 10/20/2022]
Abstract
The present study aimed to investigate whether self-awareness of falls risk is associated with rehabilitation engagement, motivation for rehabilitation, and number of falls after hospital discharge. The sample comprised 91 older adults (Mage=77.97, SD=8.04) undergoing inpatient rehabilitation. The Self-Awareness of Falls Risk Measure (SAFRM) was used to measure different aspects of self-awareness. The treating physiotherapist and occupational therapist rated the patient's engagement in rehabilitation and the patient reported his/her motivation for treatment. Falls information was collected from the patient and significant other once a month for three months following hospital discharge. Significant correlations were found between physiotherapist-rated engagement and intellectual (rs=-0.22, p<0.05) and anticipatory awareness (rs=-0.24, p<0.05). Occupational therapist-rated engagement and patient-reported motivation for rehabilitation was correlated with emergent awareness (rs=-0.38 and -0.31, p<0.05, respectively) and overall self-awareness (rs=-0.31 and -0.26, p<0.05, respectively). Regression analyses indicated that overall self-awareness provided a unique contribution to occupational therapist-rated engagement when controlling for age, gender, cognition and functional ability. Falls were reported by 29.9% of participants, however, self-awareness did not differ significantly between fallers and non-fallers. The findings suggest that self-awareness of falls risk is associated with rehabilitation engagement and motivation. Therefore, improving patient self-awareness of falls risk may increase engagement in therapy leading to better patient outcomes.
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Affiliation(s)
- Tijana Mihaljcic
- School of Psychological Sciences, Monash University, Wellington Road, Clayton, VIC 3800, Australia
| | - Terry P Haines
- Department of Physiotherapy, Monash University, McMahons Road, Frankston, VIC 3199, Australia; Allied Health Research Unit, Monash Health, Warrigal Road, Cheltenham, VIC 3192, Australia
| | - Jennie L Ponsford
- School of Psychological Sciences, Monash University, Wellington Road, Clayton, VIC 3800, Australia; Monash-Epworth Rehabilitation Research Centre, Suite 1.7, 173 Lennox Street, VIC 3121, Australia
| | - Renerus J Stolwyk
- School of Psychological Sciences, Monash University, Wellington Road, Clayton, VIC 3800, Australia.
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Gooden JR, Ponsford JL, Charlton JL, Ross PE, Marshall S, Gagnon S, Bédard M, Stolwyk RJ. The development and initial validation of a new tool to measure self-awareness of driving ability after brain injury. Aust Occup Ther J 2016; 64:33-40. [DOI: 10.1111/1440-1630.12306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 01/09/2023]
Affiliation(s)
- James R. Gooden
- School of Psychological Sciences; Monash University; Clayton Victoria Australia
- Monash Epworth Rehabilitation Research Centre; Clayton Victoria Australia
- Monash Institute of Cognitive and Clinical Neurosciences; Monash University; Clayton Victoria Australia
| | - Jennie L. Ponsford
- School of Psychological Sciences; Monash University; Clayton Victoria Australia
- Monash Epworth Rehabilitation Research Centre; Clayton Victoria Australia
- Monash Institute of Cognitive and Clinical Neurosciences; Monash University; Clayton Victoria Australia
| | - Judith L. Charlton
- Monash University Accident Research Centre; Monash University; Clayton Victoria Australia
| | | | - Shawn Marshall
- Department of Medicine; University of Ottawa; Ottawa Ontario Canada
| | - Sylvain Gagnon
- School of Psychology; University of Ottawa; Ottawa Ontario Canada
| | - Michel Bédard
- Centre for Research and Safe Driving; Lakehead University; Thunder Bay Ontario Canada
| | - Renerus J. Stolwyk
- School of Psychological Sciences; Monash University; Clayton Victoria Australia
- Monash Epworth Rehabilitation Research Centre; Clayton Victoria Australia
- Monash Institute of Cognitive and Clinical Neurosciences; Monash University; Clayton Victoria Australia
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Development and Evaluation of an Online Fall-Risk Questionnaire for Nonfrail Community-Dwelling Elderly Persons: A Pilot Study. Curr Gerontol Geriatr Res 2016; 2016:1520932. [PMID: 27247571 PMCID: PMC4877464 DOI: 10.1155/2016/1520932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/22/2016] [Accepted: 04/13/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction. Falls are frequent in older adults and may have serious consequences but awareness of fall-risk is often low. A questionnaire might raise awareness of fall-risk; therefore we set out to construct and test such a questionnaire. Methods. Fall-risk factors and their odds ratios were extracted from meta-analyses and a questionnaire was devised to cover these risk factors. A formula to estimate the probability of future falls was set up using the extracted odds ratios. The understandability of the questionnaire and discrimination and calibration of the prediction formula were tested in a cohort study with a six-month follow-up. Community-dwelling persons over 60 years were recruited by an e-mail snowball-sampling method. Results and Discussion. We included 134 persons. Response rates for the monthly fall-related follow-up varied between the months and ranged from low 38% to high 90%. The proportion of present risk factors was low. Twenty-five participants reported falls. Discrimination was moderate (AUC: 0.67, 95% CI 0.54 to 0.81). The understandability, with the exception of five questions, was good. The wording of the questions needs to be improved and measures to increase the monthly response rates are needed before test-retest reliability and final predictive value can be assessed.
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Mihaljcic T, Haines TP, Ponsford JL, Stolwyk RJ. Self-Awareness of Falls Risk Among Elderly Patients: Characterizing Awareness Deficits and Exploring Associated Factors. Arch Phys Med Rehabil 2015; 96:2145-52. [DOI: 10.1016/j.apmr.2015.08.414] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/27/2015] [Accepted: 08/12/2015] [Indexed: 11/24/2022]
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