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Kiyoshi-Teo H, De Lima B, Dieckmann NF, Vincenzo JL, Eckstrom E. Impact of Documented Fall-Risk, Self-Reported Health and Confidence to Prevent Falls on Concern About Falling Among Community-Dwelling Older Adults: Secondary Analysis of a Randomized Clinical Trial. Clin Interv Aging 2024; 19:1273-1280. [PMID: 39011313 PMCID: PMC11249068 DOI: 10.2147/cia.s453789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/27/2024] [Indexed: 07/17/2024] Open
Abstract
Purpose Individuals identified as high fall risk are expected to have high concern about falling. However, perception and individual factors that influence concern about falling have yet to be thoroughly studied. We aimed to understand factors that influence concern about falling among older adults with increased risk for falling. Patients and Methods This was a secondary analysis of a clinical trial among community-dwelling older adults (age ≥65 years old) at high risk for falls (n = 178). Descriptive and regression analyses were used. We analyzed the relationship between participants' baseline concern about falling - categorized into three groups: low (7-8), moderate (9-13), and high (≥14) - and factors that may impact their concern. Exploratory factors included age, sex, self-reported health status and confidence to address fall risks, fall risk scores, and physical performance measures. Results Among these individuals, 15.2% reported low concern about falling. On average, individuals in higher concern about falling groups had higher fall risk scores (low [5.7], moderate [6.4], and high [8.0]; p < 0.001). Our regression model showed that the odds of being in a higher concern group increased by 21% for every one unit increase in fall risk score and increased by 67% for every one unit increase toward poorer health rating. Conversely, for every one unit increase in self-reported confidence, the odds of being in a higher concern group decreased by 27.5%. Conclusion Knowledge of older adults' fall risk, health status, and concerns about falling can be used to assist in the personalization of fall prevention interventions for a more holistic approach.
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Affiliation(s)
- Hiroko Kiyoshi-Teo
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Bryanna De Lima
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer L Vincenzo
- Department of Physical Therapy, Center for Implementation Research, University of Arkansas for Medical Sciences, Fayetteville, AR, USA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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Eckstrom E, Vincenzo JL, Casey CM, Gray S, Cosley K, Caulley J, Parulekar M, Rasheed A, Sanon M, Demiris G, Zimbroff R, De Lima B, Phelan E. American Geriatrics Society response to the World Falls Guidelines. J Am Geriatr Soc 2024; 72:1669-1686. [PMID: 38131656 PMCID: PMC11187658 DOI: 10.1111/jgs.18734] [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: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
Falls are a major cause of preventable death, injury, and reduced independence in adults aged 65 years and older. The American Geriatrics Society and British Geriatrics Society (AGS/BGS) published a guideline in 2001, revised in 2011, addressing common risk factors for falls and providing recommendations to reduce fall risk in community-dwelling older adults. In 2022, the World Falls Guidelines (WFG) Task Force created updated, globally oriented fall prevention risk stratification, assessment, management, and interventions for older adults. Our objective was to briefly summarize the new WFG, compare them to the AGS/BGS guideline, and offer suggestions for implementation in the United States. We reviewed 11 of the 12 WFG topics related to community-dwelling older adults and agree with several additions to the prior AGS/BGS guideline, including assessment and intervention for hearing impairment and concern for falling, assessment and individualized exercises for older adults with cognitive impairment, and performing a standardized assessment such as STOPPFall before prescribing a medication that could potentially increase fall risk. Notable areas of difference include: (1) AGS continues to recommend screening all patients aged 65+ annually for falls, rather than just those with a history of falls or through opportunistic case finding; (2) AGS recommends continued use of the Timed Up and Go as a gait assessment, rather than relying on gait speed; and (3) AGS recommends clinical judgment on whether or not to check an ECG for those at risk for falling. Our review and translation of the WFG for a US audience offers guidance for healthcare and other providers and teams to reduce fall risk in older adults.
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Affiliation(s)
- Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Jennifer L. Vincenzo
- Lewis E. Epley Jr. Department of Physical Therapy, College of Health Professions, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA
| | - Colleen M. Casey
- Senior Health Program, Providence Health & Services, Portland, Oregon, USA
| | - Shelly Gray
- Department of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Kristina Cosley
- Rehab Therapies, University of Washington, Seattle, Washington, USA
| | - Jamie Caulley
- Providence Northeast Rehabilitation, Providence Health & Services, Portland, Oregon, USA
| | - Manisha Parulekar
- Hackensack Meridian School of Medicine, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Anita Rasheed
- Department of Internal Medicine, The University of Arizona College of Medicine – Phoenix, Phoenix, Arizona, USA
- Department of Internal Medicine, Banner-University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Martine Sanon
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - George Demiris
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robbie Zimbroff
- Division of Geriatrics, University of California, San Francisco, California, USA
| | - Bryanna De Lima
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Elizabeth Phelan
- School of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, USA
- School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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Alsaqer H, Rababah JA, Al-Hammouri MM, Barbarawi MM, Suliman M. The Effect of the Stopping Elderly Accidents, Deaths, and Injuries Program on Falls Prevention in Neurosurgical Patients. J Neurosci Nurs 2024; 56:92-98. [PMID: 38598842 DOI: 10.1097/jnn.0000000000000753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
ABSTRACT BACKGROUND: Despite the negative consequences of falls among neurosurgery patients in acute care settings, there is a lack of high-quality evidence for successful fall prevention programs. This study was conducted to evaluate the effectiveness of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) program on falling prevention compared with routine falling protocol in neurosurgical patients in Jordan. METHODS: A prospective quasi-experimental design was used in this study. The sample comprised 70 neurosurgical patients from a major university-affiliated hospital in Jordan. The study sample was assigned into a control group (35 patients) and an intervention group (35 patients). A demographics questionnaire, and different fall risk screening tools and tests were used in this study as recommended by the STEADI program. RESULTS: Multivariate analysis of variance results showed a significant effect ( P = .001) of the STEADI program on the linear combination of outcome measures. Independent samples t tests further confirmed the program's effectiveness, with statistically significant mean differences in most outcome measures between the intervention and control groups post intervention. After implementing the study intervention, participants in the intervention group had a statistically significant lower risk for falls. CONCLUSION: The findings indicate potential effectiveness in improving neurosurgery patients' outcomes and reducing the risk of falls. Implementing the study recommendations can enhance patient safety and promote evidence-based fall prevention interventions in neurosurgery patients.
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Hark LA, Wang Y, Gorroochurn P, Simon PR, Maruri SC, Henriquez DR, Diamond DF, Horowitz JD, Park L, Wang Q, Auran JD, Carrion J, Friedman DS, Liebmann JL, Cioffi GA, Harizman N. Manhattan Vision Screening and Follow-up Study (NYC-SIGHT): a nested cross-sectional assessment of falls risk within a cluster randomised trial. Br J Ophthalmol 2024:bjo-2022-323052. [PMID: 38609163 DOI: 10.1136/bjo-2022-323052] [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: 12/09/2022] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND To investigate the feasibility of using the Stopping Elderly Accidents, Deaths and Injuries (STEADI) Falls Risk Tool Kit during community-based eye health screenings to assess falls risk of participants enrolled in the Manhattan Vision Screening and Follow-Up Study (NYC-SIGHT). METHODS Cross-sectional analysis of data from a 5-year prospective, cluster-randomised clinical trial conducted in affordable housing developments in New York City in adults age 40 years and older. Prescreening questions determined whether participants were at risk of falling. STEADI tests classified participants at low, moderate or high risk of falling. Multivariate logistic regression determined odds of falls risk of all enrolled participants. RESULTS 708 participants completed the eye health screening; 351 (49.6%) performed STEADI tests; mean age: 71.0 years (SD±11.3); 72.1% female; 53.6% Black, non-Hispanic, 37.6% Hispanic/Latino. Level of falls risk: 32 (9.1%) low, 188 (53.6%) moderate and 131 (37.3%) high. Individuals age >80 (OR 5.921, 95% CI (2.383 to 14.708), p=0.000), had blurry vision (OR 1.978, 95% CI (1.186 to 3.300), p=0.009), high blood pressure (OR 2.131, 95% CI (1.252 to 3.628), p=0.005), arthritis (OR 2.29876, 95% CI (1.362 to 3.875), p=0.002) or foot problems (OR 5.239, 95% CI (2.947 to 9.314), p=0.000) had significantly higher odds of falling, emergency department visits or hospitalisation due to falling. CONCLUSION This study detected a significant amount of falls risk in an underserved population. The STEADI Falls Risk screening questions were easy for eye care providers to ask, were highly predictive of falls risk and may be adequate for referral to occupational health and/or physical therapy.
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Affiliation(s)
- Lisa A Hark
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Yujia Wang
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Prakash Gorroochurn
- Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Phyllis R Simon
- Occupational Therapy, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Daniel F Diamond
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Jason D Horowitz
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Lisa Park
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Qing Wang
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - James D Auran
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | | | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Jeffrey L Liebmann
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - George A Cioffi
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Noga Harizman
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
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Coleman A. Reducing falls among residents of retirement homes: A DNP project. Nurse Pract 2024; 49:39-47. [PMID: 38530379 DOI: 10.1097/01.npr.0000000000000161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
ABSTRACT Falls among older adults (OAs) living in retirement homes (RHs) in Canada are a major public health concern due to high morbidity and mortality as well as significant healthcare expenditures. This quality improvement (QI) initiative, conducted for the author's Doctor of Nursing Practice (DNP) project, aimed to decrease fall rates and ED transfers related to falls among OAs in six RHs across the Greater Toronto Area in Ontario, Canada through a multipart intervention with two primary goals. First, the project aimed to facilitate RH NPs' implementation of a comprehensive fall risk assessment and fall prevention strategy in their practice by incorporating the Stopping Elderly Accidents, Deaths & Injuries (STEADI) toolkit into their armamentarium. Second, it sought to enhance the knowledge of the RHs' registered practical nurses (RPNs), personal support workers (PSWs), and unregulated care providers (UCPs) in assessing fall risk and incorporating fall prevention strategies in their daily practice. By improving NP, RPN, PSW, and UCP knowledge and increasing (by 20%) RPN, PSW, and UCP use of fall prevention strategies, this QI initiative successfully reduced fall rates in the RHs by 40.4%, with no falls requiring transfer to the ED, in the postintervention period. The results of this project highlight the need for an interdisciplinary approach to fall risk reduction in RHs that includes implementation of multifactorial intervention strategies as well as effective organizational policies and procedures for maximum impact.
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Affiliation(s)
- Alanna Coleman
- Alanna Coleman is an adjunct assistant professor with the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, Ohio
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Lafontant K, Blount A, Suarez JRM, Fukuda DH, Stout JR, Trahan EM, Lighthall NR, Park JH, Xie R, Thiamwong L. Comparing Sensitivity, Specificity, and Accuracy of Fall Risk Assessments in Community-Dwelling Older Adults. Clin Interv Aging 2024; 19:581-588. [PMID: 38562971 PMCID: PMC10982579 DOI: 10.2147/cia.s453966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose The US Centers for Disease Control and Prevention (CDC) has implemented the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. This initiative provides an algorithm for fall risk screening. However, the algorithm has the potential to overcategorize individuals as high risk for falling upon initial screening, which may burden clinicians with the task of recategorizing individuals after follow-up testing. Therefore, this study aimed to compare the accuracy, sensitivity, and specificity of fall risk appraisal between the STEADI, Short Fall-Efficacy Scale International (FES-I), and portable balance system (BTrackS) assessments in community-dwelling older adults. Patients and Methods This cross-sectional analysis included 122 community-dwelling older adults, comprising 94 women and 28 men. Center-of-pressure postural sway was assessed using the BTrackS, fear of falling was assessed using the Short FES-I questionnaire, and all participants completed the STEADI checklist. Each assessment categorized participants as either high or low fall risk and fall risk appraisal was compared between groups using McNemar tests. Results The STEADI checklist (high risk: n = 62; low risk: n = 60) significantly differed in fall risk appraisal compared to the BTrackS (high risk: n = 44; low risk: n = 78; p = 0.014) and the Short FES-I (high risk: n = 42; low risk: n = 80; p = 0.002). Compared to the BTrackS, the STEADI checklist had a specificity of 62.8%, sensitivity of 70.5%, and accuracy of 65.6%. Compared to the Short FES-I, the STEADI checklist had a specificity of 67.5%, sensitivity of 81.0%, and accuracy of 72.1%. Conclusion The STEADI checklist appears to overcategorize individuals as high fall risk more frequently than direct assessments of postural sway and fear of falling. Further research is needed to examine potential improvements in accuracy when combining the STEADI checklist with direct assessments of postural sway and/or fear of falling.
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Affiliation(s)
- Kworweinski Lafontant
- Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Amber Blount
- College of Nursing, University of Central Florida, Orlando, FL, USA
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Jethro Raphael M Suarez
- College of Nursing, University of Central Florida, Orlando, FL, USA
- Mechanical and Aerospace Engineering Department, University of Central Florida, Orlando, FL, USA
| | - David H Fukuda
- Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - Jeffrey R Stout
- Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - Evette M Trahan
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | | | - Joon-Hyuk Park
- Mechanical and Aerospace Engineering Department, University of Central Florida, Orlando, FL, USA
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - Rui Xie
- College of Nursing, University of Central Florida, Orlando, FL, USA
- Department of Statistics and Data Science, University of Central Florida, Orlando, FL, USA
| | - Ladda Thiamwong
- College of Nursing, University of Central Florida, Orlando, FL, USA
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, USA
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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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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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Liang HW, Ameri R, Band S, Chen HS, Ho SY, Zaidan B, Chang KC, Chang A. Fall risk classification with posturographic parameters in community-dwelling older adults: a machine learning and explainable artificial intelligence approach. J Neuroeng Rehabil 2024; 21:15. [PMID: 38287415 PMCID: PMC10826018 DOI: 10.1186/s12984-024-01310-3] [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: 10/15/2023] [Accepted: 01/24/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Computerized posturography obtained in standing conditions has been applied to classify fall risk for older adults or disease groups. Combining machine learning (ML) approaches is superior to traditional regression analysis for its ability to handle complex data regarding its characteristics of being high-dimensional, non-linear, and highly correlated. The study goal was to use ML algorithms to classify fall risks in community-dwelling older adults with the aid of an explainable artificial intelligence (XAI) approach to increase interpretability. METHODS A total of 215 participants were included for analysis. The input information included personal metrics and posturographic parameters obtained from a tracker-based posturography of four standing postures. Two classification criteria were used: with a previous history of falls and the timed-up-and-go (TUG) test. We used three meta-heuristic methods for feature selection to handle the large numbers of parameters and improve efficacy, and the SHapley Additive exPlanations (SHAP) method was used to display the weights of the selected features on the model. RESULTS The results showed that posturographic parameters could classify the participants with TUG scores higher or lower than 10 s but were less effective in classifying fall risk according to previous fall history. Feature selections improved the accuracy with the TUG as the classification label, and the Slime Mould Algorithm had the best performance (accuracy: 0.72 to 0.77, area under the curve: 0.80 to 0.90). In contrast, feature selection did not improve the model performance significantly with the previous fall history as a classification label. The SHAP values also helped to display the importance of different features in the model. CONCLUSION Posturographic parameters in standing can be used to classify fall risks with high accuracy based on the TUG scores in community-dwelling older adults. Using feature selection improves the model's performance. The results highlight the potential utility of ML algorithms and XAI to provide guidance for developing more robust and accurate fall classification models. Trial registration Not applicable.
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Affiliation(s)
- Huey-Wen Liang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, ROC
| | - Rasoul Ameri
- Department of Information Management, National Yunlin University of Science and Technology, Douliu, Taiwan, ROC
| | - Shahab Band
- International Graduate School of Artificial Intelligence, National Yunlin University of Science and Technology, Douliu, Taiwan, ROC.
- Future Technology Research Center, National Yunlin University of Science and Technology, Douliu, Taiwan, ROC.
| | - Hsin-Shui Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Yulin Branch, Douliu, Taiwan, ROC.
| | - Sung-Yu Ho
- Department of Information Management, National Yunlin University of Science and Technology, Douliu, Taiwan, ROC
| | - Bilal Zaidan
- International Graduate School of Artificial Intelligence, National Yunlin University of Science and Technology, Douliu, Taiwan, ROC
- SP Jain School of Global Management, Sydney, Australia
| | - Kai-Chieh Chang
- Department of Neurology, National Taiwan University Hospital Yulin Branch, Douliu, Taiwan, ROC
| | - Arthur Chang
- Department of Information Management, National Yunlin University of Science and Technology, Douliu, Taiwan, ROC
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Lewis SR, McGarrigle L, Pritchard MW, Bosco A, Yang Y, Gluchowski A, Sremanakova J, Boulton ER, Gittins M, Spinks A, Rapp K, MacIntyre DE, McClure RJ, Todd C. Population-based interventions for preventing falls and fall-related injuries in older people. Cochrane Database Syst Rev 2024; 1:CD013789. [PMID: 38180112 PMCID: PMC10767771 DOI: 10.1002/14651858.cd013789.pub2] [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] [Indexed: 01/06/2024]
Abstract
BACKGROUND Around one-third of older adults aged 65 years or older who live in the community fall each year. Interventions to prevent falls can be designed to target the whole community, rather than selected individuals. These population-level interventions may be facilitated by different healthcare, social care, and community-level agencies. They aim to tackle the determinants that lead to risk of falling in older people, and include components such as community-wide polices for vitamin D supplementation for older adults, reducing fall hazards in the community or people's homes, or providing public health information or implementation of public health programmes that reduce fall risk (e.g. low-cost or free gym membership for older adults to encourage increased physical activity). OBJECTIVES To review and synthesise the current evidence on the effects of population-based interventions for preventing falls and fall-related injuries in older people. We defined population-based interventions as community-wide initiatives to change the underlying societal, cultural, or environmental conditions increasing the risk of falling. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers in December 2020, and conducted a top-up search of CENTRAL, MEDLINE, and Embase in January 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster RCTs, trials with stepped-wedge designs, and controlled non-randomised studies evaluating population-level interventions for preventing falls and fall-related injuries in adults ≥ 60 years of age. Population-based interventions target entire communities. We excluded studies only targeting people at high risk of falling or with specific comorbidities, or residents living in institutionalised settings. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane, and used GRADE to assess the certainty of the evidence. We prioritised seven outcomes: rate of falls, number of fallers, number of people experiencing one or more fall-related injuries, number of people experiencing one or more fall-related fracture, number of people requiring hospital admission for one or more falls, adverse events, and economic analysis of interventions. Other outcomes of interest were: number of people experiencing one or more falls requiring medical attention, health-related quality of life, fall-related mortality, and concerns about falling. MAIN RESULTS We included nine studies: two cluster RCTs and seven non-randomised trials (of which five were controlled before-and-after studies (CBAs), and two were controlled interrupted time series (CITS)). The numbers of older adults in intervention and control regions ranged from 1200 to 137,000 older residents in seven studies. The other two studies reported only total population size rather than numbers of older adults (67,300 and 172,500 residents). Most studies used hospital record systems to collect outcome data, but three only used questionnaire data in a random sample of residents; one study used both methods of data collection. The studies lasted between 14 months and eight years. We used Prevention of Falls Network Europe (ProFaNE) taxonomy to classify the types of interventions. All studies evaluated multicomponent falls prevention interventions. One study (n = 4542) also included a medication and nutrition intervention. We did not pool data owing to lack of consistency in study designs. Medication or nutrition Older people in the intervention area were offered free-of-charge daily supplements of calcium carbonate and vitamin D3. Although female residents exposed to this falls prevention programme had fewer fall-related hospital admissions (with no evidence of a difference for male residents) compared to a control area, we were unsure of this finding because the certainty of evidence was very low. This cluster RCT included high and unclear risks of bias in several domains, and we could not determine levels of imprecision in the effect estimate reported by study authors. Because this evidence is of very low certainty, we have not included quantitative results here. This study reported none of our other review outcomes. Multicomponent interventions Types of interventions included components of exercise, environment modification (home; community; public spaces), staff training, and knowledge and education. Studies included some or all of these components in their programme design. The effectiveness of multicomponent falls prevention interventions for all reported outcomes is uncertain. The two cluster RCTs included high or unclear risk of bias, and we had no reasons to upgrade the certainty of evidence from the non-randomised trial designs (which started as low-certainty evidence). We also noted possible imprecision in some effect estimates and inconsistent findings between studies. Given the very low-certainty evidence for all outcomes, we have not reported quantitative findings here. One cluster RCT reported lower rates of falls in the intervention area than the control area, with fewer people in the intervention area having one or more falls and fall-related injuries, but with little or no difference in the number of people having one or more fall-related fractures. In another cluster RCT (a multi-arm study), study authors reported no evidence of a difference in the number of female or male residents with falls leading to hospital admission after either a multicomponent intervention ("environmental and health programme") or a combination of this programme and the calcium and vitamin D3 programme (above). One CBA reported no difference in rate of falls between intervention and control group areas, and another CBA reported no difference in rate of falls inside or outside the home. Two CBAs found no evidence of a difference in the number of fallers, and another CBA found no evidence of a difference in fall-related injuries. One CITS found no evidence of a difference in the number of people having one or more fall-related fractures. No studies reported adverse events. AUTHORS' CONCLUSIONS Given the very low-certainty evidence, we are unsure whether population-based multicomponent or nutrition and medication interventions are effective at reducing falls and fall-related injuries in older adults. Methodologically robust cluster RCTs with sufficiently large communities and numbers of clusters are needed. Establishing a rate of sampling for population-based studies would help in determining the size of communities to include. Interventions should be described in detail to allow investigation of effectiveness of individual components of multicomponent interventions; using the ProFaNE taxonomy for this would improve consistency between studies.
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Affiliation(s)
- Sharon R Lewis
- Bone and Joint Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Lisa McGarrigle
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Michael W Pritchard
- Bone and Joint Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alessandro Bosco
- NIHR Applied Research Collaboration Greater Manchester, School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Yang Yang
- NIHR Applied Research Collaboration Greater Manchester, School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Ashley Gluchowski
- NIHR Applied Research Collaboration Greater Manchester, School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
- School of Health & Society, University of Salford, Salford, UK
| | - Jana Sremanakova
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Elisabeth R Boulton
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Matthew Gittins
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Anneliese Spinks
- School of Population Health, University of Queensland, Queensland, Australia
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | | | - Chris Todd
- NIHR Applied Research Collaboration Greater Manchester, School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, and Manchester University NHS Foundation Trust, Manchester, UK
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Duc M, Mittaz Hager AG, Zemp D, Roulet G, Bridel A, Hilfiker R. Current practices of physiotherapists in Switzerland regarding fall risk-assessment for community-dwelling older adults: A national cross-sectional survey. F1000Res 2023; 11:513. [PMID: 38131051 PMCID: PMC10733665 DOI: 10.12688/f1000research.73636.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Background Falls can strongly impact older people's quality of life, health, and lifestyle. Multifactorial assessment can determine an individual's risk of falling as the first step for fall prevention intervention. Physiotherapists have an essential role to play in assessing fall risk by older adults living in the community. In the absence of published data on this topic in Switzerland, this study investigated the current practices of physiotherapists to determine whether those are in line with recommendations. Methods An anonymous cross-sectional survey was undertaken among physiotherapists practising in Switzerland between the 21st of November and the 31st of December 2020. A priori and exploratory hypotheses were tested. Responses to open-ended questions were grouped into themes for analysis. Results A total of 938 questionnaires from all three language regions of Switzerland was analysed. Participants worked in different settings, with a higher representation of private practice self-employees (56%). Standardised fall risk assessments or instruments were used by 580 (62%) participants, while 235 (25%) preferred subjective assessment of fall risk only. Differences in fall risk assessment were observed according to the workplace setting (adjusted OR 1.93, 95% CI 1.37 to 2.7) and education level (trend test, p<0.001). The standardised assessments most frequently employed were the Berg Balance Scale (58%), the Timed-Up-and-Go (57%) and the Tinetti Balance Assessment tool (47%). Risk factors for falls were frequently queried, particularly history of falls (88%), home hazards (84%), and functional ability (81%). Technical resources (40%), knowledge (30%), and time (22%) were common barriers to implement a systematic fall risk assessment. Conclusions This study provides an overview of the current practices of physiotherapists in Switzerland in fall risk assessment. There is still room to optimise the standardisation and systematisation of this assessment to implement a best practice strategy and prevent avoidable falls.
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Affiliation(s)
- Morgane Duc
- Department of Health Professions, Bern University of Applied Sciences, Bern, Bern, 3008, Switzerland
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Leukerbad, Valais, 3954, Switzerland
| | - Anne-Gabrielle Mittaz Hager
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Leukerbad, Valais, 3954, Switzerland
| | - Damiano Zemp
- Geriatric Service, Ospedale Regionale di Mendrisio (EOC), Mendrisio, Ticino, 6850, Switzerland
| | - Guillaume Roulet
- Service of Geriatrics and Geriatric Rehabilitation, Lausanne University Hospital (CHUV), Lausanne, Vaud, 1011, Switzerland
| | - Alice Bridel
- Department of Health Professions, Bern University of Applied Sciences, Bern, Bern, 3008, Switzerland
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Leukerbad, Valais, 3954, Switzerland
| | - Roger Hilfiker
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Leukerbad, Valais, 3954, Switzerland
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Moran R. Patient-stimulated fall prevention screening in primary care: analysis of provider coding changes. BMC PRIMARY CARE 2023; 24:186. [PMID: 37710193 PMCID: PMC10503052 DOI: 10.1186/s12875-023-02154-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) has developed an evidenced based clinical screening tool, Stopping Elderly Accidents, Deaths & Injuries (STEADI) but penetration into routine clinical practice has been slow. To increase screening for falls and fall risk in an internal medicine primary care practice, a patient-centered screening program was integrated into a busy academic clinic. METHODS Over a three month period, Patients were invited to self-screen via a large poster in the waiting room, and complete a STEADI Staying Independent questionnaire, and discuss findings with their healthcare provider. Fall Prevention Booklets were made readily available in clinic exam rooms. Questionnaires and fall prevention booklets, were uniquely numbered, and Epic Slicer-Dicer reports were utilized to evaluate falls screening-related ICD-10 codes determined a priori. Generalized linear modeling calculated difference-in-difference compared with other clinics without this program for rates of coding for fall-related diagnosis codes. RESULTS In three months, 255 questionnaires were taken; only 5 (2%) were returned for later review. 110 booklets were disseminated from clinic exam rooms. The absolute difference-in-difference in ICD-10 coding was 0.7% compared to other clinics in the same practice, and year before. Generalized linear modeling showed a 4.7% increased impact in screening-related ICD-10 codes, which was statistically significant (P = < .0001) without reported disruption to clinical workflows. CONCLUSION There are indicators that patient-centered selective screening at a busy academic practice may have resulted in an increase in falls-related ICD-10 coding. Clinical integration of this program was well received.
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Affiliation(s)
- Ryan Moran
- San Diego Department of Medicine, Department of Family Medicine, University of California, 8899 University Center Lane, St 4000, La Jolla, CA, 92037, USA.
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13
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Ortmann N, Haddad YK, Beck L. Special Report from the CDC: Provider knowledge and practices around driving safety and fall prevention screening and recommendations for their older adult patients, DocStyles 2019. JOURNAL OF SAFETY RESEARCH 2023; 86:401-408. [PMID: 37718068 PMCID: PMC11323765 DOI: 10.1016/j.jsr.2023.06.011] [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: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Falls and motor-vehicle crashes (MVCs) are leading causes of unintentional injury deaths among older adults (65+) in the United States. Injury prevention resources exist to help healthcare providers reduce fall and MVC risk among older adult patients. However, awareness of these resources among healthcare providers is unclear. METHODS Questions were included in the 2019 DocStyles survey that assessed healthcare provider awareness of three injury prevention resources: (1) the American Geriatrics Society's (AGS's) Clinician's Guide to Assessing and Counseling Older Drivers, (2) the Clinical Assessment of Driving Related Skills (CADReS), and (3) the Centers for Disease Control and Prevention's (CDC) Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. We also explored the circumstances and current practices for counseling older adult patients on fall prevention and driving safety. RESULTS Only 20% of providers reported awareness of any of the injury prevention resources. Providers were more likely to report either screening for fall risk or unsafe driving when an older adult presented with a fall concern (74.5%) or driving concern or recent crash (85.1%), compared to annual screening for fall risk (67.7%) or driving safety (47.7%). More providers reported discussing the increased fall or MVC risk associated with patient medications, referring patient for driving fitness evaluations, or discussing alternative transportation options with the patient after adverse events or patient-initiated concerns compared to routine annual discussions. CONCLUSION Healthcare gaps persist in the screening and assessment of older adult risk factors for falls and unsafe driving. Limited provider awareness of clinical resources related to preventing older adult falls and unsafe driving may be contributing to these healthcare gaps. PRACTICAL APPLICATIONS Improving healthcare provider awareness of these resources could help them identify older adults at risk of a fall or MVC and promote injury prevention efforts in their clinical practices.
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Affiliation(s)
- Neil Ortmann
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA; Cherokee Nation Operational Solutions, Atlanta, GA, USA.
| | - Yara K Haddad
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laurie Beck
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Kakara R, Bergen G, Burns E, Stevens M. Nonfatal and Fatal Falls Among Adults Aged ≥65 Years - United States, 2020-2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:938-943. [PMID: 37651272 DOI: 10.15585/mmwr.mm7235a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
In the United States, unintentional falls are the leading cause of injury and injury death among adults aged ≥65 years (older adults). Patterns of nonfatal and fatal falls differ by sex and state. To describe this variation, data from the 2020 Behavioral Risk Factor Surveillance System and 2021 National Vital Statistics System were used to ascertain the percentage of older adults who reported falling during the previous year and unintentional fall-related death rates among older adults. Measures were stratified by demographic characteristics, U.S. Census Bureau region, and state. In 2020, 14 million (27.6%) older adults reported falling during the previous year. The percentage of women who reported falling (28.9%) was higher than that among men (26.1%). The percentage of older adults who reported falling ranged from 19.9% (Illinois) to 38.0% (Alaska). In 2021, 38,742 (78.0 per 100,000 population) older adults died as the result of unintentional falls. The unintentional fall-related death rate was higher among men (91.4 per 100,000) than among women (68.3). The fall-related death rate among older adults ranged from 30.7 per 100,000 (Alabama) to 176.5 (Wisconsin). CDC's Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative recommends that health care providers screen and assess older adults for fall risk and intervene using effective preventive strategies.
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Affiliation(s)
- Ramakrishna Kakara
- Division of Injury Prevention, National Center for Injury Prevention and Control, CDC
| | - Gwen Bergen
- Division of Injury Prevention, National Center for Injury Prevention and Control, CDC
| | - Elizabeth Burns
- Division of Injury Prevention, National Center for Injury Prevention and Control, CDC
| | - Mark Stevens
- Division of Injury Prevention, National Center for Injury Prevention and Control, CDC
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Quinlan S, Ryer S. Implementing a Fall Prevention Initiative in Nurse-Facilitated Annual Wellness Visits: A Quality Improvement Project. J Nurs Care Qual 2023; 38:243-250. [PMID: 36657141 DOI: 10.1097/ncq.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Falls are the leading cause of injury-related death and disability in community-dwelling older adults. LOCAL PROBLEM Evidence-based fall prevention activities in primary care, including nurse-facilitated wellness visits, have been limited. Barriers including patient engagement and adherence exist. METHOD A quality improvement project integrating components of the Centers for Disease Control and Prevention's Stopping Elder Accidents, Deaths & Injury (STEADI) was introduced by registered nurses during older adult annual wellness visits. INTERVENTION Nurses assessed risk and implemented patient-centered fall prevention plans including follow-up. RESULTS A total of 522 patients were screened, with 21% (n = 111) having increased fall risk. Of these, 78% (n = 87) engaged in home safety, gait, strength, and balance assessments and the majority (n = 83; 95%) participated in fall prevention plans of care. At 2-week follow-up, patients' self-reported adherence was 74% for gait/strength/balance and 67% for home safety. CONCLUSION An expanded primary care team model shows promise for promoting fall prevention behaviors.
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Johnston YA, Reome-Nedlik C, Parker EM, Bergen G, Wentworth L, Bauer M. Preventing Falls Among Older Adults in Primary Care: A Mixed Methods Process Evaluation Using the RE-AIM Framework. THE GERONTOLOGIST 2023; 63:511-522. [PMID: 35917287 PMCID: PMC10258889 DOI: 10.1093/geront/gnac111] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Falls are a leading cause of injuries and injury deaths for older adults. The Centers for Disease Control and Prevention's Stopping Elderly Accidents Deaths and Injuries (STEADI) initiative, a multifactorial approach to fall prevention, was adapted for implementation within the primary care setting of a health system in upstate New York. The purpose of this article is to: (a) report process evaluation results for this implementation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and (b) examine the utility of RE-AIM for assessing barriers and facilitators. RESEARCH DESIGN AND METHODS This evaluation used mixed methods. Qualitative evaluation involved semistructured interviews with key stakeholders and intercept interviews with health care providers and clinic staff. Quantitative methods utilized surveys with clinic staff. Process evaluation tools were developed based on the AIM dimensions of the RE-AIM framework. The study was conducted over a 2-month period, approximately 18 months postimplementation, and complements previously published results of the program's reach and effectiveness. RESULTS Primary barriers by RE-AIM construct included competing organizational priorities (Adoption), competing patient care demands (Implementation), and staff turnover (Maintenance). Primary facilitators included having a physician champion (Adoption), preparing and training staff (Implementation), and communicating about STEADI and recognizing accomplishments (Maintenance). DISCUSSION AND IMPLICATIONS Results revealed a high degree of concordance between qualitative and quantitative analyses. The framework supported assessments of various stakeholders, multiple organizational levels, and the sequence of practice change activities. Mixed methods yielded rich data to inform future implementations of STEADI-based fall prevention.
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Affiliation(s)
- Yvonne A. Johnston
- Division of Public Health, Decker College of Nursing and Health Sciences, Binghamton University, Binghamton, New York, USA
| | | | - Erin M. Parker
- US Public Health Service, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gwen Bergen
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Leah Wentworth
- National Alliance on Mental Illness (NAMI), Arlington, Virginia, USA
| | - Michael Bauer
- New York State Department of Health, Bureau of Occupational Health and Injury Prevention, Albany, New York, USA
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Lach HW, Berg-Weger M, Washington S, Malmstrom TK, Morley JE. Falls across Health Care Settings: Findings from a Geriatric Screening Program. J Appl Gerontol 2023; 42:67-75. [PMID: 36121797 DOI: 10.1177/07334648221124912] [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: 12/14/2022] Open
Abstract
Falls are a major public health problem for older adults, resulting in injuries and mortality. Screening is recommended to identify the multifactorial fall risks that can be addressed with interventions to prevent future falls. This study examined the utility of using the Rapid Geriatric Assessment (RGA) tool to identify fall risks across multiple settings. RGA data was collected at primary care sites, hospitals, long-term care settings, and community events (n = 8686, 65% female, mean age 77.6). Multinomial logistic regression was used to determine predictors of falls using the RGA. The FRAIL, SARC-F, Rapid Cognitive Screen and SNAQ measures all significantly predicted history of falls. The RGA provides a brief screening that can be used in any setting by multiple providers to identify fall risk.
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Affiliation(s)
- Helen W Lach
- Trudy Busch Valentine School of Nursing40272 Saint Louis University, Saint Louis, MO, USA
| | - Marla Berg-Weger
- School of Social Work, 40272Saint Louis University, Saint Louis, MO, USA
| | - Selena Washington
- Doisy College of Health Sciences, of Occupational Science and Occupational Therapy, 40272Saint Louis University, Saint Louis, MO, USA
| | | | - John E Morley
- School of Medicine, 40272Saint Louis University, Saint Louis, MO, USA
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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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Shropshire M, Hovey S, Dyck MJ, Johnson B, Yoder K, Denton S. Accidental Fall Death in McLean County: Examining Variables in Community-Dwelling Older Adults. J Gerontol Nurs 2022; 48:26-32. [PMID: 35648581 DOI: 10.3928/00989134-20220506-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Fall risk assessment is a complex phenomenon involving several risk factors, including an individual's balance and mobility status, chronic health conditions, visual impairment, hearing deficits, environmental hazards (e.g., loose rugs, clutter), and being homebound or semi-homebound. Comprehensive fall risk assessment is the cornerstone of fall prevention in older adults throughout the community. The current study was based on secondary data and sought to examine variables associated with death due to accidental fall in a rural, midwestern county in Illinois, and to heighten awareness for consistent screening and risk assessment in older adults residing in the community. Results illustrated that among community-dwelling older adults with accidental falls, blunt injury or subdural hematoma had significantly fewer days until death than a fracture. [Journal of Gerontological Nursing, 48(6), 26-32.].
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The Predictive Validity and Clinical Application of Stopping Elderly Accidents, Deaths & Injuries (STEADI) for Fall Risk Screening. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2022; 4:e220008. [PMID: 36315107 PMCID: PMC9615094 DOI: 10.20900/agmr20220008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fall prevention is critical for older adults. Stopping Elderly Accidents, Deaths, and Injuries (STEADI) is a fall prevention initiative, promoted by the Center for Disease Control (CDC). The purpose of this review aims to discuss the predictive validity, improve the predictive validity of STEADI, and apply STEADI in clinical settings.
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Monteiro YCM, Vieira MADS, Vitorino PVDO, Queiroz SJD, Policena GM, Souza ACSE. Trend of fall-related mortality among the elderly. Rev Esc Enferm USP 2021; 55:e20200069. [PMID: 34643638 DOI: 10.1590/1980-220x-reeusp-2020-0069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/23/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the temporal trend of fall-related mortality in elderly in Brazil from 2008 to 2016. METHOD Study of time series of rates of fall-related mortality according to CID-10 from 2008 to 2016. Data from the Mortality Information System on death registers of people ≥ 60 living in Brazil were used. The specific rates of fall-related mortality among the elderly were calculated through the ratio between the number of deaths and the elderly population of that year and region. The populational information was obtained from the 2000 and 2010 censuses. The variation rate and temporal trend were obtained through linear regression (p < 0.05). RESULTS The fall-related deaths among the elderly aged ≥ 60 amounted to 72,234 (31.2%). Falls from the same level were the most frequent (53.8%) and death rates in all ages ranged from 29.7 to 44.7 per 100,000 elders. Fall-related deaths increased with age. CONCLUSION There was a growing trend of fall-related deaths among elderly in all age groups, an event which is avoidable through the adoption of preventive measures. The high rates and growing trend of fall-related deaths, as well as the aging of the Brazilian population, suggest that public policies for protecting the elderly must be prioritized.
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Affiliation(s)
| | | | | | - Silvio José de Queiroz
- Pontifícia Universidade Católica de Goiás, Escola de Ciências Sociais e da Saúde, Goiânia, GO, Brazil
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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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Orthopaedic Injuries Associated With Cell Phone Use Resulting in Emergency Department Visits: A 20-Year Analysis. J Am Acad Orthop Surg 2021; 29:571-579. [PMID: 32947349 DOI: 10.5435/jaaos-d-20-00639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/23/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Cell phones are an integral part of daily life but are distractors that can contribute to injury. The present study uses a large national emergency department (ED) database to evaluate the frequency, anatomic location, and type of injuries associated with cell phone use. We hypothesize that orthopaedic injuries related to cell phone use have increased over time and affect certain body parts and age groups more than others. METHODS The 1999 to 2018 Nation Electronic Injury Surveillance System was queried for cell phone-related injuries leading to ED visits (injuries to the head or face or involving a landline were excluded). Demographics, type of orthopaedic injury, and body part injured were tabulated, and injuries were then classified over time as direct mechanical or cell phone use-associated, as well as related to texting compared with talking. RESULTS A weighted national total of 44,599 injuries met inclusion criteria. A marked increase was noted in the incidence of cell phone use-associated injuries over the time (2,900%). Injuries occurred in persons with mean ± standard deviation age of 36.6 ± 19.9 years old, predominantly in women (60.6%), at home (32.8%) or on the street (22.4%), and while walking (31.6%) or driving (18.16%). The distribution of orthopaedic injuries was defined and occurred most frequently in the neck, lower torso/hip, and ankle. The most common types of injuries were sprain/strain (56.8%) and fracture (32.6%). The proportion of fracture injury types was significantly greater in adults aged greater than 65 (P < 0.001). The proportion of injuries related to texting on a cell phone was greatest in the 13- to 29-year-old age group and declined as age increased. DISCUSSION Orthopaedic injures related to cell phone use resulting in ED visits have markedly increased over time. The distribution and characteristics of such injuries can be used in targeted public health education and policy development.
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Kannoth S, Mielenz TJ, Eby DW, Molnar LJ, Jia H, Li G, Strogatz D. Adapted Stopping Elderly Accidents, Deaths, and Injuries Questions for Falls Risk Screening: Predictive Ability in Older Drivers. Am J Prev Med 2021; 61:105-114. [PMID: 34020849 PMCID: PMC9945655 DOI: 10.1016/j.amepre.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Fall fatality rates among U.S. older adults increased 30% from 2007 to 2016. In response, the Centers for Disease Control and Prevention developed the Stopping Elderly Accidents, Deaths, and Injuries algorithm for fall risk screening, assessment, and intervention. The current Stopping Elderly Accidents, Deaths, and Injuries algorithm with 2 levels (at risk and not at risk) was adapted to an existing cohort of older adult drivers. METHODS A U.S. multisite prospective cohort (N=2,990) of drivers (aged 65-79 years), from 2015 to 2017, was used for these analyses completed in January 2020-October 2020. To measure the adapted Stopping Elderly Accidents, Deaths, and Injuries key questions for fall risk screening performance in predicting future falls, adjusted logistic regression determined the area of the receiver operating characteristic curve. An adjusted mixed logistic regression modeled the association between the adapted Stopping Elderly Accidents, Deaths, and Injuries key questions and future falls. RESULTS The adapted Stopping Elderly Accidents, Deaths, and Injuries key questions yielded an area under the curve of 0.65 in determining any fall over 2 years. The adjusted mixed logistic regression model suggests that those at risk for falls at baseline were associated with 2.37 times higher odds of any fall (95% CI=2.00, 2.80) and 3.60 times higher odds of multiple falls (95% CI=2.88, 4.51) over 2 years. CONCLUSIONS The adapted Stopping Elderly Accidents, Deaths, and Injuries key questions for fall risk screening yielded fair predictive ability for falls over 2 years and were strongly associated with future falls for older adult drivers. The adapted Stopping Elderly Accidents, Deaths, and Injuries key questions can be applied to existing data in nonclinical settings to strengthen fall screening and prevention at a population level.
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Affiliation(s)
- Sneha Kannoth
- Center for Injury Science and Prevention, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Thelma J Mielenz
- Center for Injury Science and Prevention, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
| | - David W Eby
- Behavioral Sciences Group, University of Michigan Transportation Research Institute, Ann Arbor, Michigan
| | - Lisa J Molnar
- Behavioral Sciences Group, University of Michigan Transportation Research Institute, Ann Arbor, Michigan
| | - Haomiao Jia
- Office of Scholarship & Research Development, Columbia University Irving Medical Center, Columbia University School of Nursing New York, New York; Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Guohua Li
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York; Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - David Strogatz
- Center for Rural Community Health, The Bassett Research Institute, Bassett Healthcare Network, Cooperstown, New York
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On the Move clinic: A fall prevention nurse practitioner-driven model of care. Geriatr Nurs 2021; 42:850-854. [PMID: 34090230 DOI: 10.1016/j.gerinurse.2021.03.019] [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: 10/31/2020] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/22/2022]
Abstract
Falls in older adults are common and interventions to reduce associated morbidity and mortality remain difficult to implement. This quality improvement project evaluated On the Move, a new clinic designed to provide tailored recommendations to reduce falls risk, based on an adaptation of CDC's STEADI: a falls risk screening, assessment and intervention guide. 89 participants were referred by primary care and emergency services. A nurse practitioner assessed modifiable physical, behavioral and environmental risk factors and utilized motivational interviewing and education to guide participants in developing an intervention plan. A physical therapist assessed gait/balance, the need for ongoing PT services and provided brief counseling. Participants received a 6-week phone call and 12-week follow up visit. Measurements, including 30-second chair stands, Timed Up and Go, 4-Item Dynamic Gait Index, and Activities-Specific Balance Confidence Scale all showed significant improvement. Participants made behavioral changes to reduce risk, and plans to continue exercise.
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Predicting Falls Among Community-Dwelling Older Adults: A Demonstration of Applied Machine Learning. Comput Inform Nurs 2021; 39:273-280. [PMID: 33208628 DOI: 10.1097/cin.0000000000000688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Data science skills are increasingly needed by informatics nurses and nurse scientists, but techniques such as machine learning can be daunting for those with clinical, rather than computer science or technical, backgrounds. With the increasing quantity of publicly available population-level datasets, identification of factors that predict clinical outcomes is possible using machine learning algorithms. This study demonstrates how to apply a machine learning approach to nursing-relevant questions, specifically an approach to predict falls among community-dwelling older adults, based on data from the 2014 Behavioral Risk Factor Surveillance System. A random forest algorithm, a common approach to machine learning, was compared to a logistic regression model. Explanations of how to interpret the models and their associated performance characteristics are included to serve as a tutorial to readers. Machine learning methods constitute an increasingly important approach for nursing as population-level data are increasingly being made available to the public.
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Newgard CD, Lin A, Caughey AB, Eckstrom E, Bulger EM, Staudenmayer K, Maughan B, Malveau S, Griffiths D, McConnell KJ. The Cost of a Fall Among Older Adults Requiring Emergency Services. J Am Geriatr Soc 2020; 69:389-398. [PMID: 33047305 DOI: 10.1111/jgs.16863] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/10/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVE The cost of a fall among older adults requiring emergency services is unclear, especially beyond the acute care period. We evaluated medical expenditures (costs) to 1 year among community-dwelling older adults who fell and required ambulance transport, including acute versus post-acute periods, the primary drivers of cost, and comparison to baseline expenditures. DESIGN Retrospective cohort analysis. SETTING Forty-four emergency medical services agencies transporting to 51 emergency department in seven northwest counties from January 1, 2011, to December 31, 2011, with follow-up through December 31, 2012. PARTICIPANTS We included 2,494 community-dwelling adults, 65 years and older, transported by ambulance after a fall with continuous fee-for-service Medicare coverage. MEASUREMENTS The primary outcome was total Medicare expenditures to 1 year (2019 U.S. dollars), with separation by acute versus post-acute periods and by cost category. We included 48 variables in a standardized risk-adjustment model to generate adjusted cost estimates. RESULTS The median age was 83 years, with 74% female, and 41.9% requiring admission during the index visit. The median total cost of a fall to 1 year was $26,143 (interquartile range (IQR) = $9,634-$68,086), including acute care median $1,957 (IQR = $1,298-$12,924) and post-acute median $20,560 (IQR = $5,673-$58,074). Baseline costs for the previous year were median $8,642 (IQR = $479-$10,948). Costs increased across all categories except outpatient, with the largest increase for inpatient costs (baseline median $0 vs postfall median $9,477). In multivariable analysis, the following were associated with higher costs: high baseline costs, older age, comorbidities, extremity fractures (lower extremity, pelvis, and humerus), noninjury diagnoses, and surgical interventions. Compared with baseline, costs increased for 74.6% of patients, with a median increase of $12,682 (IQR = -$185 to $51,189). CONCLUSION Older adults who fall and require emergency services have increased healthcare expenditures compared with baseline, particularly during the post-acute period. Comorbidities, noninjury medical conditions, fracture type, and surgical interventions were independently associated with increased costs.
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Affiliation(s)
- Craig D Newgard
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Oregon, Portland, USA
| | - Amber Lin
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Oregon, Portland, USA
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Oregon, Portland, USA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Oregon, Portland, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Kristan Staudenmayer
- Department of Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Brandon Maughan
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Oregon, Portland, USA
| | - Susan Malveau
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Oregon, Portland, USA
| | - Denise Griffiths
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Oregon, Portland, USA
| | - K John McConnell
- Department of Emergency Medicine, Center for Health Systems Effectiveness, Oregon Health & Science University, Oregon, Portland, USA
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Juckett LA, Bunger AC, Jarrott SE, Dabelko-Schoeny HI, Krok-Schoen J, Poling RM, Mion LC, Tucker S. Determinants of Fall Prevention Guideline Implementation in the Home- and Community-Based Service Setting. THE GERONTOLOGIST 2020; 61:942-953. [DOI: 10.1093/geront/gnaa133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Objectives
Home- and community-based service (HCBS) recipients often possess multiple fall risk factors, suggesting that the implementation of evidence-based fall prevention guidelines may be appropriate for the HCBS setting. The purpose of this exploratory study was to examine the determinants of fall prevention guideline implementation and the potential strategies that can support implementation in HCBS organizations.
Research Design and Methods
Semistructured interview and focus group data were collected from 26 HCBS professionals representing the home-delivered meals, personal care, and wellness programs. Qualitative codes were mapped to the Consolidated Framework for Implementation Research by means of directed content analysis. The Consolidated Criteria for Reporting Qualitative research checklist was used to report the findings of this study.
Results
We identified 7 major determinants of guideline implementation: recipient needs and resources, cosmopolitanism, external policy and incentives, networks and communication, compatibility, available resources, and knowledge/beliefs. Strategies to support guideline implementation included the involvement of recipient and caregiver feedback, building fall prevention networks, and conducting educational meetings for HCBS staff.
Discussion and Implications
Falls and fall-related injuries will continue to plague the older adult community unless innovative approaches to fall prevention are developed and adopted. The implementation of fall prevention guidelines in the HCBS setting can help mitigate fall risk among a highly vulnerable older adult population and may be facilitated through the application of multifaceted implementation strategies.
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Affiliation(s)
- Lisa A Juckett
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | | | | | | | - Jessica Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - Rachael M Poling
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | | | - Sharon Tucker
- College of Nursing, The Ohio State University, Columbus
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Mielenz TJ, Kannoth S, Jia H, Pullyblank K, Sorensen J, Estabrooks P, Stevens JA, Strogatz D. Evaluating a Two-Level vs. Three-Level Fall Risk Screening Algorithm for Predicting Falls Among Older Adults. Front Public Health 2020; 8:373. [PMID: 32903603 PMCID: PMC7438745 DOI: 10.3389/fpubh.2020.00373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives: Falls account for the highest proportion of preventable injury among older adults. Thus, the United States' Centers for Disease Control and Prevention (CDC) developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) algorithm to screen for fall risk. We referred to our STEADI algorithm adaptation as “Quick-STEADI” and compared the predictive abilities of the three-level (low, moderate, and high risk) and two-level (at-risk and not at-risk) Quick-STEADI algorithms. We additionally assessed the qualitative implementation of the Quick-STEADI algorithm in clinical settings. Research Design and Methods: We followed a prospective cohort (N = 200) of adults (65+ years) in the Bassett Healthcare Network (Cooperstown, NY) for 6 months in 2019. We conducted a generalized linear mixed model, adjusting for sociodemographic variables, to determine how baseline fall risk predicted subsequent daily falls. We plotted receiver operating characteristic (ROC) curves and measured the area under the curve (AUC) to determine the predictive ability of the Quick-STEADI algorithm. We identified a participant sample (N = 8) to gauge the experience of the screening process and a screener sample (N = 3) to evaluate the screening implementation. Results: For the three-level Quick-STEADI algorithm, participants at low and moderate risk for falls had a reduced likelihood of daily falls compared to those at high risk (−1.09, p = 0.04; −0.99, p = 0.04). For the two-level Quick-STEADI algorithm, participants not at risk for falls were not associated with a reduced likelihood of daily falls compared to those at risk (−0.89, p = 0.13). The discriminatory ability of the three-level and two-level Quick-STEADI algorithm demonstrated similar predictability of daily falls, based on AUC (0.653; 0.6570). Furthermore, participants and screeners found the Quick-STEADI algorithm to be efficient and viable. Discussion and Implications: The Quick-STEADI is a suitable, alternative fall risk screening algorithm. Qualitative assessments of the Quick-STEADI algorithm demonstrated feasibility in integrating a falls screening program in a clinical setting. Future research should address the validation and the implementation of the Quick-STEADI algorithm in community health settings to determine if falls screening and prevention can be streamlined in these settings. This may increase engagement in fall prevention programs and decrease overall fall risk among older adults.
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Affiliation(s)
- Thelma J Mielenz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Sneha Kannoth
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Kristin Pullyblank
- Bassett Research Institute, Center for Rural Community Health, Cooperstown, NY, United States
| | - Julie Sorensen
- The Northeast Center for Occupational Health and Safety in Agriculture, Forestry, and Fishing, Cooperstown, NY, United States
| | - Paul Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Judy A Stevens
- University of North Carolina Injury Prevention Research Center (UNC IPRC), Carrboro, NC, United States
| | - David Strogatz
- Bassett Research Institute, Center for Rural Community Health, Cooperstown, NY, United States
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Casey CM, Caulley J, Phelan EA. The Intersection of Falls and Dementia in Primary Care: Evaluation and Management Considerations. Med Clin North Am 2020; 104:791-806. [PMID: 32773046 DOI: 10.1016/j.mcna.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A large body of research has addressed the assessment and management of fall risk among community-dwelling older adults. Persons with dementia are at higher risk for falls and fall-related injuries, yet less is known about effective strategies for reducing falls and injuries among those with dementia. Falls and dementia are regularly considered to be discrete conditions and are often managed separately. Increasing evidence shows that these conditions frequently co-occur, and one may precede the other. This article explores the relationship between falls and dementia, including the importance of rehabilitation strategies for reducing fall risk in these individuals.
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Affiliation(s)
- Colleen M Casey
- Senior Health Program, Providence Health & Services, 4400 NE Halsey, Fifth Floor, Portland, OR 97213, USA.
| | - Jamie Caulley
- Senior Health Program, Providence Health & Services, 4400 NE Halsey, Fifth Floor, Portland, OR 97213, USA
| | - Elizabeth A Phelan
- Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Harborview Medical Center, 325 9th Avenue, Box 359755, Seattle, WA 98104-2499, USA
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Paul SS, Li Q, Harvey L, Carroll T, Priddis A, Tiedemann A, Clemson L, Lord SR, Close JCT, Sherrington C. Scale-up of the Stepping On fall prevention program amongst older adults in NSW: Program reach and fall-related health service use. Health Promot J Austr 2020; 32 Suppl 2:391-398. [PMID: 32860442 DOI: 10.1002/hpja.413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/24/2020] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED We describe the reach of the scale-up of Stepping On, a fall prevention program targeting community-dwellers aged ≥65 years in NSW, along with fall-related ambulance service use and fall-related hospitalisations after scale-up. METHODS Data on program provision were received from Local Health Districts. Routinely collected fall-related ambulance usage and hospital admissions in NSW residents aged ≥65 years between 2009 and 2015 were compared within Statistical Local Areas prior to and following the implementation of Stepping On using multilevel models. RESULTS Between 2009 and 2014 the program was delivered in 1077 sites to 10 096 older adults. Rates of fall-related ambulance use and hospital admissions per 100-person-years were 1-2 in people aged 66-74, 4-5 in people aged 75-84 and 12-13 in people aged ≥85. These rates increased over time (P < .001). The interaction between time and program delivery was not significant for fall-related ambulance use or hospital admissions. The time-related increase in fall-related ambulance usage in people aged 75-84 years may have been moderated by the Stepping On program (rate ratio 0.97, 95% CI 0.93-1.00, P = .045). CONCLUSIONS There was no indication of a reduced rate of fall-related ambulance use or hospital admissions across the entire sample. Ambulance call-outs for falls in people aged 75-84 years may have reduced following program participation. SO WHAT?: Program scale-ups need to reach a large proportion of the target population with a focus on those groups contributing most to fall-related health service utilisation. Linking individual participants' health data as part of large-scale evaluations may provide better insights into program outcomes.
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Affiliation(s)
- Serene S Paul
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Qiang Li
- The George Institute for Global Health, UNSW, Camperdown, Australia
| | - Lara Harvey
- Neuroscience Research Australia, Randwick, Australia.,School of Public Health and Community Medicine, UNSW, Sydney, Australia
| | | | | | - Anne Tiedemann
- Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Lindy Clemson
- Sydney School of Health Sciences, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | | | - Jacqueline C T Close
- Neuroscience Research Australia, Randwick, Australia.,Prince of Wales Clinical School, UNSW, Sydney, Australia
| | - Cathie Sherrington
- Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, Australia
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A Qualitative Study of Nursing Students' Experiences in Fall Prevention for Older Home Care Clients. J Aging Res 2020; 2020:7652623. [PMID: 32676211 PMCID: PMC7338978 DOI: 10.1155/2020/7652623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/20/2020] [Accepted: 06/03/2020] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to describe the experiences of nursing students in fall prevention during clinical practice in the context of older home care clients. This was a qualitative focus group study of nursing students (n = 9) who had completed clinical practice in older clients' home care. The data were analysed using inductive content analysis. The nursing students described their experiences regarding falls and fall prevention in older clients' home care from two perspectives: evaluation of falls at older people's homes and fall prevention during home visits. Systematic evaluation of falls was based on physical examination and is the basis of fall prevention. However, evaluation of nutrition and adverse drug effects seemed to be ignored. In addition, fall prevention during home visits included concrete fall prevention in authentic client situations, confidential relationships with older clients, and evidence-based knowledge. From the perspective of fall prevention, there was a lack of comprehensive evaluation and understanding of the meaning of psychological factors, such as fear of falling. In order to be able to prevent falls in the older client population, students need more guidance regarding a comprehensive approach based on evaluation of falls. In addition, there is a need for continuous collaboration between education and home care services to develop educational approaches that interlink knowledge and skills in fall prevention.
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Urban K, Wright PB, Hester AL, Curran G, Rojo M, Tsai PF. Evaluation of an Education Strategy versus Usual Care to Implement the STEADI Algorithm in Primary Care Clinics in an Academic Medical Center. Clin Interv Aging 2020; 15:1059-1066. [PMID: 32753856 PMCID: PMC7345972 DOI: 10.2147/cia.s256416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background Although falls are the leading cause of morbidity and mortality in the US in the older adult population, there is little information regarding implementation of evidence-based fall prevention guidelines within primary care settings. The objective of this study was to address this gap in the literature by determining the effectiveness of the use of education and written materials as implementation strategies. Methods Using a prospective, mixed methods, controlled before-and-after study design, we studied the effect of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) education and written materials on knowledge and intention to use in primary care clinics as well as test the screening, assessment, and intervention behaviors. This manuscript details the quantitative findings of the study, using STEADI Knowledge Test, Continuing Professional Development (CPD) Reaction Questionnaire, and EMR Reports. We compared data between the study arms (usual implementation versus education implementation) using descriptive statistics, paired t-tests, and factorial ANOVAs. Results In total, data from 29 primary care staff, including physicians, APRNs, RNs, and medical assistants, were analyzed. Although we found a statistically significant difference within the education arm between immediate pretests and posttests/surveys mean scores, there was no statistically significant difference between the study arms' knowledge, intent to use STEADI, or use behaviors. The pre/immediate post education mean knowledge score increased by 1.19 (p= 0.02) and the pre/immediate post education intent to use mean increased by 0.64 (p 0.01). There was no statistically significant change between the study arms over time. Conclusion Educational strategies, particularly written materials and an online module, did not increase the long-term use of the STEADI toolkit. Implementation research is needed to identify the strategies that are most effective for promoting the adoption of STEADI in primary care.
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Affiliation(s)
- Kelly Urban
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Patricia B Wright
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Amy L Hester
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,HD Nursing, Bauxite, Arkansas, USA
| | - Geoffrey Curran
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Martha Rojo
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Pao-Feng Tsai
- School of Nursing, Auburn University, Auburn, Alabama, USA
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Haddad YK, Shakya I, Moreland BL, Kakara R, Bergen G. Injury Diagnosis and Affected Body Part for Nonfatal Fall-Related Injuries in Community-Dwelling Older Adults Treated in Emergency Departments. J Aging Health 2020; 32:1433-1442. [PMID: 32515622 DOI: 10.1177/0898264320932045] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To estimate frequency and type of older adult fall-related injuries treated in emergency departments (EDs). Methods: We used the 2015 National Electronic Injury Surveillance System: All Injury Program. Patient data were abstracted from the narratives describing the circumstance of injury. Data for community-dwelling older adults (n = 34,336) were analyzed to explore differences in injury diagnosis by demographic characteristics, location of fall, and disposition. Results: 70% of head-related injuries were internal injuries, suggestive of a traumatic brain injury. Most hip injuries were fractures or dislocations (73.3%). Women had higher percentages of fractures/dislocations but lower percentages of internal injuries than men. About a third of fall-related ED visits required hospitalization or transfer. Discussion: Falls in older adults result in array of injuries and pose a burden on the healthcare system. Understanding how fall injuries vary by different characteristics can help inform targeted prevention strategies.
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Affiliation(s)
| | - Iju Shakya
- 1242Centers for Disease Control and Prevention, USA
| | | | | | - Gwen Bergen
- 1242Centers for Disease Control and Prevention, USA
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Hughes KM, Witry MJ, Doucette WR, Veach SR, McDonough RP. Use of a fall risk evaluation in a community-based pharmacy. J Am Pharm Assoc (2003) 2020; 60:S91-S96. [DOI: 10.1016/j.japh.2020.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 11/29/2022]
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Blalock SJ, Ferreri SP, Renfro CP, Robinson JM, Farley JF, Ray N, Busby-Whitehead J. Impact of STEADI-Rx: A Community Pharmacy-Based Fall Prevention Intervention. J Am Geriatr Soc 2020; 68:1778-1786. [PMID: 32315461 DOI: 10.1111/jgs.16459] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/06/2020] [Accepted: 03/13/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the effects of a community pharmacy-based fall prevention intervention (STEADI-Rx) on the risk of falling and use of medications associated with an increased risk of falling. DESIGN Randomized controlled trial. SETTING A total of 65 community pharmacies in North Carolina (NC). PARTICIPANTS Adults (age ≥65 years) using either four or more chronic medications or one or more medications associated with an increased risk of falling (n = 10,565). INTERVENTION Pharmacy staff screened patients for fall risk using questions from the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) algorithm. Patients who screened positive were eligible to receive a pharmacist-conducted medication review, with recommendations sent to patients' healthcare providers following the review. MEASUREMENTS At intervention pharmacies, pharmacy staff used standardized forms to record participant responses to screening questions and information concerning the medication reviews. For participants with continuous Medicare Part D/NC Medicaid coverage (n = 3,212), the Drug Burden Index (DBI) was used to assess exposure to high-risk medications, and insurance claims records for emergency department visits and hospitalizations were used to assess falls. RESULTS Among intervention group participants (n = 4,719), 73% (n = 3,437) were screened for fall risk. Among those who screened positive (n = 1,901), 72% (n = 1,373) received a medication review; and 27% (n = 521) had at least one medication-related recommendation communicated to their healthcare provider(s) following the review. A total of 716 specific medication recommendations were made. DBI scores decreased from the pre- to postintervention period in both the control and the intervention group. However, the amount of change over time did not differ between these two groups (P = .66). Risk of falling did not change between the pre- to postintervention period or differ between groups (P = .58). CONCLUSION We successfully implemented STEADI-Rx in the community pharmacy setting. However, we found no differences in fall risk or the use of medications associated with increased risk of falling between the intervention and control groups. J Am Geriatr Soc 68:1778-1786, 2020.
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Affiliation(s)
- Susan J Blalock
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stefanie P Ferreri
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chelsea P Renfro
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA
| | - Jessica M Robinson
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joel F Farley
- Department of Pharmaceutical Care & Health Systems, University of Minnesota College of Pharmacy, Minneapolis, Minnesota, USA
| | - Neepa Ray
- University of North Carolina, Eshelman School of Pharmacy, Center for Medication Optimization Through Practice and Policy, Chapel Hill, North Carolina, USA
| | - Jan Busby-Whitehead
- Division of Geriatric Medicine and Center of Aging and Health, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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McConville A, Hooven K. Factors influencing the implementation of falls prevention practice in primary care. J Am Assoc Nurse Pract 2020; 33:108-116. [PMID: 32251034 DOI: 10.1097/jxx.0000000000000360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient falls in the primary care setting are a complex problem and are detrimental to the independence and quality of life of older adults. OBJECTIVES The purpose of this integrative review is to identify what factors influence the implementation of fall prevention practice in the primary care setting. This review explores qualitative and quantitative research published between 2004 and 2018 on barriers to fall prevention management in primary care. DATA SOURCES The authors conducted a systematic search of the evidence and identified 18 articles which met the inclusion criteria. CONCLUSIONS Five themes were identified that described barriers in fall risk management in the primary care setting. These included provider beliefs and practice, lack of provider knowledge, time constraints, patient engagement, and financial issues. IMPLICATIONS FOR PRACTICE The lack of screening and assessment regarding fall risk identification demonstrates a gap in the management of older adults in primary care. Using the evidence- and theory-based Stopping Elderly Accidents, Deaths, and Injuries toolkit and algorithm is an effective method to assist practitioners with fall assessment and preventative measures.
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Affiliation(s)
| | - Katie Hooven
- Department of Nursing, The College of New Jersey, Ewing, New Jersey
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Goldberg EM, Marks SJ, Ilegbusi A, Resnik L, Strauss DH, Merchant RC. GAPcare: The Geriatric Acute and Post-Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data. J Am Geriatr Soc 2020; 68:198-206. [PMID: 31621901 PMCID: PMC7001768 DOI: 10.1111/jgs.16210] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/25/2019] [Accepted: 09/07/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We aimed to describe a new multidisciplinary team fall prevention intervention for older adults who seek care in the emergency department (ED) after having a fall, assess its feasibility and acceptability, and review lessons learned during its initiation. DESIGN Single-blind randomized controlled pilot study. SETTING Two urban academic EDs PARTICIPANTS: Adults 65 years old or older (n = 110) who presented to the ED within 7 days of a fall. INTERVENTION Participants were randomized to a usual care (UC) and an intervention (INT) arm. Participants in the INT arm received a brief medication therapy management session delivered by a pharmacist and a fall risk assessment and plan by a physical therapist (PT). INT participants received referrals to outpatient services (eg, home safety evaluation, outpatient PT). MEASUREMENTS We used participant, caregiver, and clinician surveys, as well as electronic health record review, to assess the feasibility and acceptability of the intervention. RESULTS Of the 110 participants, the median participant age was 81 years old, 67% were female, 94% were white, and 16.3% had cognitive impairment. Of the 55 in the INT arm, all but one participant received the pharmacy consult (98.2%); the PT consult was delivered to 83.6%. Median consult time was 20 minutes for pharmacy and 20 minutes for PT. ED length of stay was not increased in the INT arm: UC 5.25 hours vs INT 5.0 hours (P < .94). After receiving the Geriatric Acute and Post-acute Fall Prevention Intervention (GAPcare), 100% of participants and 97.6% of clinicians recommended the pharmacy consult, and 95% of participants and 95.8% of clinicians recommended the PT consult. CONCLUSION These findings support the feasibility and acceptability of the GAPcare model in the ED. A future larger randomized controlled trial is planned to determine whether GAPcare can reduce recurrent falls and healthcare visits in older adults. J Am Geriatr Soc 68:198-206, 2019.
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Affiliation(s)
- Elizabeth M Goldberg
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Health Services, Practice and Policy, Brown University School of Public Health, Providence, Rhode Island
| | - Sarah J Marks
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Aderonke Ilegbusi
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Linda Resnik
- Department of Health Services, Practice and Policy, Brown University School of Public Health, Providence, Rhode Island
- Providence VA Medical Center, Providence, Rhode Island
| | - Daniel H Strauss
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
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Conley RB, Adib G, Adler RA, Åkesson KE, Alexander IM, Amenta KC, Blank RD, Brox WT, Carmody EE, Chapman-Novakofski K, Clarke BL, Cody KM, Cooper C, Crandall CJ, Dirschl DR, Eagen TJ, Elderkin AL, Fujita M, Greenspan SL, Halbout P, Hochberg MC, Javaid M, Jeray KJ, Kearns AE, King T, Koinis TF, Koontz JS, Kužma M, Lindsey C, Lorentzon M, Lyritis GP, Michaud LB, Miciano A, Morin SN, Mujahid N, Napoli N, Olenginski TP, Puzas JE, Rizou S, Rosen CJ, Saag K, Thompson E, Tosi LL, Tracer H, Khosla S, Kiel DP. Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition. J Bone Miner Res 2020; 35:36-52. [PMID: 31538675 DOI: 10.1002/jbmr.3877] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/08/2019] [Accepted: 09/11/2019] [Indexed: 12/13/2022]
Abstract
Osteoporosis-related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first-line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive but may be beneficial for selected patients at high risk. Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the early post-fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease). © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
| | | | | | | | - Ivy M Alexander
- UConn School of Nursing, University of Connecticut, Storrs, CT, USA
| | - Kelly C Amenta
- Department of Physician Assistant Studies, Mercyhurst University, Erie, PA, USA
| | - Robert D Blank
- Department of Endocrinology, Metabolism and Clinical Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA.,Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | | | - Emily E Carmody
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Bart L Clarke
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Douglas R Dirschl
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine, Chicago, IL, USA
| | | | - Ann L Elderkin
- American Society for Bone and Mineral Research, Washington, DC, USA
| | - Masaki Fujita
- Science Department, International Osteoporosis Foundation, Nyon, Switzerland
| | - Susan L Greenspan
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Marc C Hochberg
- Division of Rheumatology, University of Maryland School of Medicine and VA Maryland Health Care System, Baltimore, MD, USA
| | - Muhammad Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, USA
| | - Kyle J Jeray
- Prisma Health - Upstate (formerly Greenville Health System), Greenville, SC, USA
| | - Ann E Kearns
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Toby King
- US Bone and Joint Initiative, Rosemont, IL, USA
| | | | - Jennifer Scott Koontz
- Orthopedics & Sports Medicine, Newton Medical Center, Newton, KS, USA.,Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, KS, USA
| | - Martin Kužma
- 5th Department of Internal Medicine, University Hospital, Comenius University, Bratislava, Slovakia
| | - Carleen Lindsey
- Bones, Backs and Balance, LLC, Bristol Physical Therapy, LLC, Bristol, CT, USA
| | - Mattias Lorentzon
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.,Department of Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.,Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | - Nadia Mujahid
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Nicola Napoli
- Department of Nutrition and Metabolic Disorders, Campus Bio-Medico University of Rome, Rome, Italy.,Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | | | - J Edward Puzas
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Clifford J Rosen
- Tufts University School of Medicine, Boston, MA, USA.,Maine Medical Center Research Institute, Portland, ME, USA
| | - Kenneth Saag
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Laura L Tosi
- Department of Orthopaedic Surgery and Sports Medicine, Children's National Hospital, Washington, DC, USA
| | - Howard Tracer
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Sundeep Khosla
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Douglas P Kiel
- Harvard Medical School, Musculoskeletal Research Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
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Susilowati IH, Nugraha S, Sabarinah S, Hasiholan BP, Pengpid S, Peltzer K. Comparison of Fall Risk Assessment Tools for Older Indonesian Adults in the Elderly Home and the Community. THE INDONESIAN JOURNAL OF OCCUPATIONAL SAFETY AND HEALTH 2019. [DOI: 10.20473/ijosh.v8i3.2019.241-248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: One of the causes of disability among elderly is falling. The ability to predict the risk of falls among this group is important so that the appropriate treatment can be provided to reduce the risk. The objective of this study was to compare the Stopping Elderly Accidents, Deaths, & Injuries (STEADI) Initiative from the Centers for Disease Control and Prevention (CDC) and The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) from the Johns Hopkins University. Methods: This study used the STEADI tool, JHFRAT, Activities-Specific Balance Confidence Scale (ABC), and The Geriatric Depression Scale (GDS). The study areas were in community and elderly home in both public and private sectors and the samples were 427 after cleaning. Results: The results for the STEADI and JHFRAT tools were similar where the respondents at highest risk of falling among women (STEADI: 49%; JHFRAT: 3.4%), in Bandung area (63.5%; 5.4%), in private homes (63.3%; 4.4%), non-schools (54.6%; 6.2%), aged 80 or older (64.8%; 6.7%) and not working (48.9%;3.3%). The regression analysis indicated that there was a significant relationship between the risk factors for falls in the elderly determined by the JHFRAT and STEADI tools: namely, region, type of home, age, disease history, total GDS and ABC averages. Conclusion: Despite the similarity in the risk factors obtained through these assessments, there was a significant difference between the results for the STEADI tool and the JHFRAT. The test strength was 43%. However, STEADI is more sensitive to detect fall risk smong elderly than JHFRATKeywords: Activities-Specific Balance Confidence scale, elderly, fall risk,The Johns Hopkins Fall Risk Assessment Tool, the Stopping Elderly Accidents, Deaths, & Injuries
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Abstract
PURPOSE OF REVIEW The aims of this review are to summarize current performance for osteoporosis quality measures used by Centers for Medicare and Medicaid (CMS) for pay-for-performance programs and to describe recent quality improvement strategies around these measures. RECENT FINDINGS Healthcare Effectiveness Data and Information (HEDIS) quality measures for the managed care population indicate gradual improvement in osteoporosis screening, osteoporosis identification and treatment following fragility fracture, and documentation of fall risk assessment and plan of care between 2006 and 2016. However, population-based studies suggest achievement for these process measures is lower where reporting is not mandated. Performance gaps remain, particularly for post-fracture care. Elderly patients with increased comorbidity are especially vulnerable to fractures, yet underperformance is documented in this population. Gender and racial disparities also exist. As has been shown for other areas of health care, education alone has a limited role as a quality improvement intervention. Multifactorial and systems-based interventions seem to be most successful in leading to measurable change for osteoporosis care and fall prevention. Despite increasing recognition of evidence-based quality measures for osteoporosis and incentives to improve upon performance for these measures, persistent gaps in care exist that will require further investigation into sustainable and value-adding quality improvement interventions.
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Affiliation(s)
- S French
- Division of Rheumatology, Department of Medicine, University of California, 4150 Clement St, Rm 111R, San Francisco, CA, 94121, USA
| | - S Choden
- Division of Rheumatology, Department of Medicine, University of California, 4150 Clement St, Rm 111R, San Francisco, CA, 94121, USA
| | - Gabriela Schmajuk
- Division of Rheumatology, Department of Medicine, University of California, 4150 Clement St, Rm 111R, San Francisco, CA, 94121, USA.
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
- Rheumatology Section, Medical Service, San Francisco VA Hospital, San Francisco, CA, USA.
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Bergen G, Stevens MR, Kakara R, Burns ER. Understanding Modifiable and Unmodifiable Older Adult Fall Risk Factors to Create Effective Prevention Strategies. Am J Lifestyle Med 2019; 15:580-589. [PMID: 34916876 DOI: 10.1177/1559827619880529] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 11/17/2022] Open
Abstract
Each year, more than 1 in 4 older adults in the United States report a fall and 1 in 10 a fall injury. Using nationally representative data from the 2016 US Behavioral Risk Factor Surveillance System, we evaluated demographic, geographic, functional, and health characteristics associated with falls and fall injuries among adults aged 65 years and older. Analyses included descriptive statistics and multivariable logistic regression to produce crude and adjusted percentages by characteristic. Characteristics most strongly associated with increased fall risk in order of adjusted percentage were depression, difficulty doing errands alone, and difficulty dressing or bathing. Characteristics most strongly associated with fall injury risk in order of adjusted percentage were depression, difficulty dressing or bathing, and being a member of an unmarried couple. The diverse health and functional characteristics associated with increased falls and fall injuries confirm the importance of screening and assessing older adult patients to determine their individual unique risk factors. Health care providers can use tools and resources from the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative to screen their older adult patients for fall risk, assess at-risk patients' modifiable risk factors, and intervene to reduce risk by prescribing evidence-based interventions.
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Affiliation(s)
- Gwen Bergen
- Division of Unintentional Injury (GB, RK, ERB).,Division of Analysis, Research and Practice Integration (MRS).,National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; and Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee (RK)
| | - Mark R Stevens
- Division of Unintentional Injury (GB, RK, ERB).,Division of Analysis, Research and Practice Integration (MRS).,National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; and Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee (RK)
| | - Ramakrishna Kakara
- Division of Unintentional Injury (GB, RK, ERB).,Division of Analysis, Research and Practice Integration (MRS).,National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; and Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee (RK)
| | - Elizabeth R Burns
- Division of Unintentional Injury (GB, RK, ERB).,Division of Analysis, Research and Practice Integration (MRS).,National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; and Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee (RK)
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Lee R, Moreland B. Aging without injury in the United States requires action today. JOURNAL OF SAFETY RESEARCH 2019; 70:272-274. [PMID: 31848005 PMCID: PMC7001090 DOI: 10.1016/j.jsr.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/02/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION In 2017, unintentional injuries were the seventh leading cause of death among older adults (age ≥ 65), resulting in over 55,000 deaths. Falls accounted for more than half of these deaths. Given that older adults are the fastest growing age group in the United States, we can anticipate that injuries will become an even greater health concern in the near future. METHODS Aging without injury is possible. There are evidence-based strategies that can reduce falls. However, older adults may not realize that falls can be prevented or they may be afraid to admit their fear of falling or difficulty with walking as these issues may signal their inability to live independently. RESULTS In this commentary, we will highlight what the Centers for Disease Control and Prevention is doing to prevent older adult falls. We also highlight the importance of broadening older adults' awareness about falls to successfully empower them to begin contemplating and preparing to adopt fall prevention strategies that can help them age in place. CONCLUSIONS Older adult falls are common and can result in severe injury and death but they can be prevented. Broadening older adults' awareness about falls can empower them to take the actions necessary to reduce their fall risk. Practical applications: Increasing awareness about falls can help older adults, healthcare providers, and local and state health departments take steps to reduce fall risk.
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Affiliation(s)
- Robin Lee
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 4770 Buford Highway, Atlanta, GA 30341, United States.
| | - Briana Moreland
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 4770 Buford Highway, Atlanta, GA 30341, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, United States
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