1
|
Chieffe DJ, Zuniga SA, Marmor S, Adams ME. Nationwide Utilization of Computerized Dynamic Posturography in an Era of Deimplementation. Otolaryngol Head Neck Surg 2023; 169:1090-1093. [PMID: 36994931 PMCID: PMC10782839 DOI: 10.1002/ohn.333] [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: 12/09/2022] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/31/2023]
Abstract
Computerized dynamic posturography (CDP) provides multisensory assessment of balance. Consensus is lacking regarding CDP utility and coverage determinations vary. To inform best practices and policy, this cross-sectional study quantifies provider use of CDP among Medicare beneficiaries over time (2012-2017), by geographic region (hospital referral region [HRR]), and specialty. We observed 195,267 beneficiaries underwent 212,847 CDP tests totaling $15,780,001 in payments. Number of CDPs billed per 100,000 beneficiaries varied 534-fold across HRRs. Over 6 years, CDP use grew by 84% despite stagnant reimbursement. More utilization was attributable to primary care clinicians than specialties focused on care for dizziness and balance disorders. The observed growth and variation illustrate the potential for policy and provider preferences to drive unexpected practice patterns and underscore the need to engage a broad network of providers to develop optimal guidelines for use. CDP may offer a use case for deimplementation of low-value diagnostic services.
Collapse
Affiliation(s)
- Douglas J. Chieffe
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Steven A. Zuniga
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Schelomo Marmor
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Surgery, Center for Quality Outcomes and Discovery (C-QODE), University of Minnesota, Minnesota, Minneapolis, USA
| | - Meredith E. Adams
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
2
|
Lathouwers E, Dillen A, Díaz MA, Tassignon B, Verschueren J, Verté D, De Witte N, De Pauw K. Characterizing fall risk factors in Belgian older adults through machine learning: a data-driven approach. BMC Public Health 2022; 22:2210. [PMID: 36443808 PMCID: PMC9707258 DOI: 10.1186/s12889-022-14694-5] [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: 05/25/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Falls are a major problem associated with ageing. Yet, fall-risk classification models identifying older adults at risk are lacking. Current screening tools show limited predictive validity to differentiate between a low- and high-risk of falling. OBJECTIVE This study aims at identifying risk factors associated with higher risk of falling by means of a quality-of-life questionnaire incorporating biological, behavioural, environmental and socio-economic factors. These insights can aid the development of a fall-risk classification algorithm identifying community-dwelling older adults at risk of falling. METHODS The questionnaire was developed by the Belgian Ageing Studies research group of the Vrije Universiteit Brussel and administered to 82,580 older adults for a detailed analysis of risk factors linked to the fall incidence data. Based on previously known risk factors, 139 questions were selected from the questionnaire to include in this study. Included questions were encoded, missing values were dropped, and multicollinearity was assessed. A random forest classifier that learns to predict falls was trained to investigate the importance of each individual feature. RESULTS Twenty-four questions were included in the classification-model. Based on the output of the model all factors were associated with the risk of falling of which two were biological risk factors, eight behavioural, 11 socioeconomic and three environmental risk factors. Each of these variables contributed between 4.5 and 6.5% to explaining the risk of falling. CONCLUSION The present study identified 24 fall risk factors using machine learning techniques to identify older adults at high risk of falling. Maintaining a mental, physical and socially active lifestyle, reducing vulnerability and feeling satisfied with the living situation contributes to reducing the risk of falling. Further research is warranted to establish an easy-to-use screening tool to be applied in daily practice.
Collapse
Affiliation(s)
- Elke Lathouwers
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium.,Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Arnau Dillen
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium.,Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - María Alejandra Díaz
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium.,Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Bruno Tassignon
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Jo Verschueren
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Dominique Verté
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium.,Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Nico De Witte
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium.,Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.,Gerontology and Frailty in Ageing (FRIA) research department, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium. .,Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium.
| |
Collapse
|
3
|
Barbier J. [Select and combine tools to assess the risk of an elderly person falling]. SOINS. GERONTOLOGIE 2022; 27:37-45. [PMID: 35926972 DOI: 10.1016/j.sger.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Falls are a major problem in the elderly population. It is important to be able to effectively estimate the risk in order to implement appropriate actions. The large number of existing tools and the sometimes divergent or contradictory data make clinical assessment of this risk difficult. A review of the literature helps to determine the most relevant methods.
Collapse
Affiliation(s)
- Jules Barbier
- Université de Paris-Saclay, site Ambroise-Paré, Assistance publique-Hôpitaux de Paris, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
| |
Collapse
|
4
|
Fontenot J. Utilizing Assessment Tools in Decreasing Fall Risk Among Community-Dwelling Adults: A Quality Improvement Project. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211034773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although there are standardized fall risk assessment tools in home care clinical practice, there are no standardized tools to reduce fall risk. This quality improvement project aims to test the adaptability of the Fall TIPS (Tailoring Interventions for Patient Safety) tool among the community-dwelling adult population by measuring the impact of the tool’s implementation on client fall risk. Participants included n = 54 clients enrolled in home care and n = 14 members of the clinical team. This project used a quantitative method with a quasi-experimental pre-and post-intervention design. The quality improvement project implemented the Fall TIPS tool, and fall risk was measured using the Morse Fall Risk Assessment (MFRA). The Fall TIPS tool was provided to participants by visiting staff, and interventions were selected based on the participant’s assessment. Participants’ fall risk was scored during in-person home visits, and the results were recorded in the electronic health record. A dependent 2-tailed t-test measured the variance of means between the pre-and-post groups. The pre-intervention MFRA score mean was 63.43 ± 22.52; p = .000 and the mean score in the post-intervention group was 58.15 ± 22.49; p = .000. The mean difference between the pre-and post-groups was 5.28. Implementing the Fall TIPS toolkit in the home care clinical setting reduced fall risk post-intervention and offered tools for future evaluation in home care settings.
Collapse
Affiliation(s)
- Justin Fontenot
- Grand Canyon University, Phoenix, AZ, USA
- University of Louisiana at Lafayette, Lafayette, LA, USA
| |
Collapse
|
5
|
Guerreiro C, Botelho M, Fernández-Martínez E, Marreiros A, Pais S. Determining the Profile of People with Fall Risk in Community-Living Older People in Algarve Region: A Cross-Sectional, Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042249. [PMID: 35206432 PMCID: PMC8871874 DOI: 10.3390/ijerph19042249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022]
Abstract
One in three people aged 65 years or older falls every year. Injuries associated with this event among the older population are a major cause of pain, disability, loss of functional autonomy and institutionalization. This study aimed to assess mobility and fall risk (FR) in community-living older people and to determine reliable and independent measures (health, social, environmental and risk factors) that can predict the mobility loss and FR. In total, 192 participants were included, with a mean age of 77.93 ± 8.38. FR was assessed by EASY-Care (EC) Standard 2010, the Tinetti Test and the Modified Falls Efficacy Scale (MFES). An exploratory analysis was conducted using the divisive non-hierarchical cluster method, aiming to identify a differentiator and homogeneous group of subjects (optimal group of variables) and to verify if that group shows differences in fall risk. Individually, the health, social, environmental and risk factor categories were not found to be an optimal group; they do not predict FR. The most significant predictor variables were a mix of the different categories, namely, the presence of pain, osteoarthritis (OA), and female gender. The finding of a profile that allows health professionals to be able to quickly identify people at FR will enable a reduction in injuries and fractures resulting from falls and, consequently, the associated costs.
Collapse
Affiliation(s)
- Carla Guerreiro
- Algarve Biomedical Center Research Institute (ABCRI), University of Algarve, 8005-139 Faro, Portugal; (C.G.); (M.B.); (A.M.); (S.P.)
| | - Marta Botelho
- Algarve Biomedical Center Research Institute (ABCRI), University of Algarve, 8005-139 Faro, Portugal; (C.G.); (M.B.); (A.M.); (S.P.)
| | - Elia Fernández-Martínez
- Department of Nursing, University of Huelva, 21004 Huelva, Spain
- Department of Nursing, University of Sevilla, 41009 Sevilla, Spain
- Correspondence:
| | - Ana Marreiros
- Algarve Biomedical Center Research Institute (ABCRI), University of Algarve, 8005-139 Faro, Portugal; (C.G.); (M.B.); (A.M.); (S.P.)
- Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal
| | - Sandra Pais
- Algarve Biomedical Center Research Institute (ABCRI), University of Algarve, 8005-139 Faro, Portugal; (C.G.); (M.B.); (A.M.); (S.P.)
- Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal
- Comprehensive Health Research Center (CHRC), 1150-082 Lisboa, Portugal
| |
Collapse
|
6
|
Baker N, Grimmer K, Gordon S. Balance provocation tests identify near falls in healthy community adults aged 40-75 years; an observational study. Physiother Theory Pract 2021; 38:3072-3081. [PMID: 34637669 DOI: 10.1080/09593985.2021.1983909] [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: 10/20/2022]
Abstract
BACKGROUND Near falls, such as stumbles or slips without falling to the ground, are more common than falls and often lead to a fall. PURPOSE The objective of this study was to investigate which balance tests differentiate near fallers from fallers and non-fallers. METHODS This cross-sectional, observational study assessed balance in healthy community dwelling adults aged 40-75 years. Participants reported falls and near falls in the previous 6 months. Balance testing was completed in the local community for static (i.e. feet together and single-leg stance) and dynamic balance (i.e. tandem walk, Functional Movement Screen hurdle step and lunge). Between-group comparative analysis of pass-fail for each balance test was undertaken. RESULTS Of 627 participants, there were 99 fallers (15.8%), 121 near fallers (19.3%) and 407 non-fallers (64.9%). Near fallers were twice as likely as non-fallers to fail single-leg stance eyes (OR 2.7, 95% CI 1.5-4.9), five tandem steps (OR 2.5, 95% CI 1.5-5.7), hurdle step (OR 2.9, 95% CI 1.4-5.8), and lunge (OR 2.5. 95% CI 1.5-4.1). The predictive capacity differentiates near fallers with a sensitivity of 73.3%. DISCUSSION A new battery of tests assessing static and dynamic balance identifies near fallers in seemingly healthy, community dwelling middle- and young-older-aged adults.
Collapse
Affiliation(s)
- Nicky Baker
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Karen Grimmer
- Division of Physiotherapy, Faculty of Medicine and Health Science, Stellenbosch University, Stellenbosch, South Africa
| | - Sue Gordon
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| |
Collapse
|
7
|
Menezes M, Meziat-Filho NAM, Lemos T, Ferreira AS. 'Believe the positive' aggregation of fall risk assessment methods reduces the detection of risk of falling in older adults. Arch Gerontol Geriatr 2020; 91:104228. [PMID: 32827945 DOI: 10.1016/j.archger.2020.104228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Screening programs for fall prevention in older adults may include several assessment methods. This study investigated the validity of aggregating fall risk assessment methods for stratifying the risk of falling in older adults. METHODS This secondary data analysis included 52 community-dwelling residents aged [median (interquartile range)] 74 (69-80) years. Fall occurrences were registered prospectively for six months, with 9 (17%) participants reporting at least one fall during follow-up. The fall risk assessment included the Berg Balance Scale (BBS); polypharmacy (POLY); Falls Risk Assessment Score (FRAS); Fall Risk Assessment Tool (FRAT-up); Falls Efficacy Scale (FES); and posturography with the Wii Balance Board (WBB). Aggregation of methods' results was performed according to the risk classification ('high risk' or 'low risk') assigned by their respective cut-off values under the 'believe the positive' (BP) strategy. RESULTS Aggregating 1 (POLY), 2 (+BBS), 3 (+FES), 4 (+FRAT-up), 5 (+FRAS), and 6 (+BBS) methods resulted in a monotonic decrease of several validity indices including (index [95% confidence interval]) diagnostic odds ratio (10.82 [2.38-54.28] to 0.59 [0.12-2.09]) and accuracy (0.67 [0.54-0.78] to 0.20 [0.11-0.31]). CONCLUSIONS Aggregating fall risk assessment methods-BBS, POLY, FRAS, FRAT-up, FES, WBB-under the BP strategy does not increase the validity of stratification of the risk of falling in older adults.
Collapse
Affiliation(s)
- Michele Menezes
- Postgraduate Program in Rehabilitation Sciences, Augusto Motta University Center, Brazil
| | | | - Thiago Lemos
- Postgraduate Program in Rehabilitation Sciences, Augusto Motta University Center, Brazil
| | - Arthur Sá Ferreira
- Postgraduate Program in Rehabilitation Sciences, Augusto Motta University Center, Brazil.
| |
Collapse
|
8
|
Villumsen M, Grarup B, Christensen SWMP, Palsson TS, Hirata RP. "Study protocol for the ≥65 years NOrthern jutland Cohort of Fall risk Assessment with Objective measurements (the NOCfao study)". BMC Geriatr 2020; 20:198. [PMID: 32513121 PMCID: PMC7278063 DOI: 10.1186/s12877-020-01535-6] [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: 07/06/2019] [Accepted: 03/25/2020] [Indexed: 01/06/2023] Open
Abstract
Background Accidental falls are common among community-dwellers, probably due to the level of physical activity and impaired postural stability. Today, fall risk prediction tools’ discriminative validity are only moderate. In order to increase the accuracy, multiple variables such as highly validated objective field measurements of physical activity and impaired postural stability should be adressed in order to predict falls. The main aim of this paper is to describe the ≥65 years NOrthern jutland Cohort of Fall risk Assessment with Objective measurements (NOCfao) investigating the association between physical activity and impaired postural stability and the risk of fall episodes among community-dwelling older adults. Methods The study consists of a baseline session where the participants are asked to respond to three questionnaires, perform physical tests (i.e., measuring strength in the upper and lower extremities, balance, and walking speed), participate in an assessment of pain sensitivity, and to wear an ankle mounted pedometer for measuring physical activity for 5 days. Subsequently, the fall incidences and the circumstances surrounding the falls during the previous 1 to 2 months will be recorded throughout a one-year follow-up period. Discussion This study will add to the present-day understanding of the association between physical activity and impaired postural stability and the risk of fall episodes among community-dwelling older adults. These data will provide valid and reliable information on the relationship between these variables and their significance for community-dwelling older adults. Trial registration ClinicalTrials.gov identifier: NCT2995317. Registered December 13th, 2016.
Collapse
Affiliation(s)
- Morten Villumsen
- Department of Elderly and Health, Section of Training and Activity, Aalborg Municipality, Aalborg, Denmark.,Department of Health Science and Technology, Aalborg University (AAU), Aalborg, Denmark
| | - Bo Grarup
- Department of Physiotherapy, University College of Northern Denmark (UCN), Selma Lagerløfs Vej 2, 9220, Aalborg East, Denmark.
| | - Steffan Wittrup Mc Phee Christensen
- Department of Health Science and Technology, Aalborg University (AAU), Aalborg, Denmark.,Department of Physiotherapy, University College of Northern Denmark (UCN), Selma Lagerløfs Vej 2, 9220, Aalborg East, Denmark
| | | | - Rogerio Pessoto Hirata
- Performance and Technology, Department of Health Science and Technology Aalborg University, Niels Jernes Vej 12, 9220, Aalborg East, Denmark
| |
Collapse
|