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Chepyala P, Stead TS, Mangal RK, Ganti L. Prevalence of Craniofacial Injuries in the Elderly Population. J Craniofac Surg 2024:00001665-990000000-01309. [PMID: 38299824 DOI: 10.1097/scs.0000000000009974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION Recognizing and understanding risk factors for craniofacial injury in the elderly is of paramount importance in prevention. This research aims to investigate the prevalence of craniofacial injuries in connection with extrinsic preventable factors, particularly identifying common household products that pose the greatest risk for such injuries. MATERIALS AND METHODS This study was done with the utilization of the 2013 to 2022 National Electronic Injury Surveillance System (NEISS). Data gathered included patient age, injury type, cause of injury, and year of incidence. "Elderly" was defined as an individual of 65 years of age or older. RESULTS There was a total of 9,703,688 estimated national cases of elderly craniofacial injury from 2013 to 2022. In all, 5,888,112 (60.68%) of these occurred in females. In descending order, the 5 most common items responsible for craniofacial injury in the elderly are floors/flooring Materials (3,741,706, 30.92%), beds/bed frames (1,250,396, 10.33%), stairs/steps (907,92, 7.50%), chairs (546,697, 4.52%), and tables (453,989, 3.75%). These top 5 account for roughly 57% of all cases. The 5 most common presenting diagnoses were internal injury (2,957,095, 40.21%), lacerations (1,435,926, 19.53%), ABR (1,191,008, 16.20%), fracture (568,842, 7.74%), and hematoma (355,871, 4.84%). CONCLUSIONS Out of the roughly 10 million cases of craniofacial injury in the last decade, ~three-fifths have happened to women. The majority of injuries occur in a home setting. The overwhelming majority of cases were related to the product code 1807-floors or flooring materials, and the largest diagnosis was internal injury by a wide margin. Evidently, there is a large population of elderly patients who suffer from craniofacial injuries related to objects and items that permeate within their living residences. The elimination of excess elderly craniofacial injury can be achieved by reducing fall risk factors in the immediate vicinity of the elderly.
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Affiliation(s)
- Pranav Chepyala
- Department of Emergency Medicine, University of Central Florida, Orlando, FL
| | - Thor S Stead
- Division of Plastic Surgery, Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Rohan K Mangal
- Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL
| | - Latha Ganti
- Department of Emergency Medicine, University of Central Florida, Orlando, FL
- Division of Plastic Surgery, Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
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Orts-Cortés MI, Cabañero-Martínez MJ, Meseguer-Liza C, Arredondo-González CP, de la Cuesta-Benjumea C, Abad-Corpa E. Effectiveness of nursing interventions in the prevention of falls in older adults in the community and in health care settings: A systematic review and meta-analysis of RCT. ENFERMERIA CLINICA (ENGLISH EDITION) 2024; 34:4-13. [PMID: 38185371 DOI: 10.1016/j.enfcle.2024.01.001] [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: 03/26/2023] [Accepted: 08/09/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To estimate the effectiveness of fall prevention programs in people aged 65 years and older involving nursing professionals. METHODS We included available full-text randomized clinical trials on nurse-led prevention of falls in the community in people over 65 years of age and reporting the incidence of such falls. An extensive search was performed in 14 databases covering the period 2016-2018 for publications in English, French, Portuguese and Spanish. The quality of the papers was assessed independently and blindly by reviewers working in pairs using the risk of bias dominios of the Cochrane Collaboration. The hazard ratio was used as a measure of the effect size of the incidence of falls. A random-effects model was assumed for statistical analyses. The influence of moderator variables of the studies on the effect sizes was performed using ANOVAs and its 95% CI for each moderator category. RESULTS A total of 31 randomized clinical trials were selected with 25,551 participants. The most frequent type of intervention was education (57.1%), followed by multifactorial models (37.1%). The probability of falling was significantly reduced by 13% in the intervention groups compared to the control groups (RR+=0.87). Multifactorial (RR+=0.89) and education-based (RR=+0.84) interventions significantly reduced the probability of falls by 11% and 16%, respectively. CONCLUSIONS Discarding publication bias prevention programs carried out by nurses produce a significant 10% reduction in falls. Education-based and multifactorial interventions are the most effective when conducted by nurses.
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Affiliation(s)
- María Isabel Orts-Cortés
- Department of Nursing, University of Alicante, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Nursing and Healthcare Research Unit (Investén-ISCIII), CIBER of Frailty and Healthy Aging (CIBERFES) Instituto de Salud Carlos III, Madrid, Spain
| | - María José Cabañero-Martínez
- Department of Nursing, University of Alicante, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Cristóbal Meseguer-Liza
- Adjunct Professor of Nursing, University of Murcia, Nurse Murcia Health Service, Murcia, Spain
| | | | | | - Eva Abad-Corpa
- University of Murcia, Nurse, Murcia Health Service, IMIB-Arrixaca. Murcia, Nursing and Healthcare Research Unit (Investén-ISCIII), CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
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Kim EJ, Bustos VP, Lee BT. Sources of Facial Injury Across Age Groups: A Nationwide Overview Using the National Electronic Injury Surveillance System Database. J Craniofac Surg 2023; 34:1927-1930. [PMID: 37582255 DOI: 10.1097/scs.0000000000009582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/04/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Facial trauma comprises a significant portion of injuries that occur each year in the United States, with injuries ranging from lacerations to complex facial fractures. This study aims to provide a broad epidemiologic overview of facial trauma in the United States to direct preventative safety measures. METHODS A cross-sectional study was conducted utilizing the National Electronic Injury Surveillance System database to identify the weighted national incidence of facial injuries from 2017 to 2021. Descriptive and inferential statistical analysis was used to compare the demographics of patients, the settings where the injury occurred, and the products resulting in the injury. RESULTS A total of 8,465,538 out of 64,312,132 weighted encounters involved facial injuries. Less than 10 years was the highest-represented age group (36.8%). The most frequent disposition was treated and released (91.1%), with increasing age associated with higher rates of hospitalization (odds ratio: 1.04, P < 0.001). Cases predominantly occurred at home (49.0%), and the most common type of injury was laceration (36.5%). At-home injuries increased with age, comprising 39.2% of facial injuries for 21 to 40 years, 52.0% for 41 to 64 years, and 58.0% for older than 65 years. Building structures (21.4%) were the most prevalent source of injury, composed predominantly of floors (58.3%) and ceilings and walls (10.4%). CONCLUSIONS There is an understated burden of at-home facial injuries across all age groups, beyond the pediatric and geriatric population. Fall prevention and home environmental hazards education could benefit all ages, reducing the incidence of facial trauma.
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Affiliation(s)
- Erin J Kim
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Wiedenmann T, Held S, Rappelt L, Grauduszus M, Spickermann S, Donath L. Exercise based reduction of falls in communitydwelling older adults: a network meta-analysis. Eur Rev Aging Phys Act 2023; 20:1. [PMID: 36707758 PMCID: PMC9883964 DOI: 10.1186/s11556-023-00311-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/16/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Traditional meta-analyses with pairwise direct comparison revealed that a variety of exercise-based training interventions can prevent falls in community-dwelling older adults. This network meta-analysis adds value by comparing and ranking different exercise training strategies based on their effects on fall risk reductions determined by analysis of direct and indirect comparisons. METHODS The studies included in this network meta-analysis were identified through a comprehensive search in five biomedical databases (PubMed, SportDiscus, CINAHL, Web of Science and EMBASE). We included (randomized) controlled trials (RCTs) that compared the occurance of fall events in older adults who received different interventional treatments. RESULTS Seventy six comparisons from 66 RCTs with 47.420 (61% male / 39% female) participants aged 77 ± 4 (68 - 88) years were included in this network meta-analysis. The network model revealed low heterogeneity (I2 = 28.0, 95%CI 1.0 to 47.7%) and inconsistency (Q between designs = 15.1, p = 0.37). Postural control training was found to be most effective in preventing falls (Postural Control Training: (home): Risk Ratio (RR) = 0.66, 95%-CI [0.49; 0.88], P-score = 0.97;Postural Control Training: RR = 0.82, 95%-CI [0.75; 0.91], P-score = 0.82). Combined and multifactorial interventions also display a robust but smaller effect (RR = 0.88-0.93, P-score = 0.65-0.47). CONCLUSION Physical activity that includes balance training presents itself to be the most effective. Multifactorial approaches are well investigated but could be slightly less effective than isolated postural control training.
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Affiliation(s)
- Tim Wiedenmann
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
| | - Steffen Held
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
| | - Ludwig Rappelt
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
| | - Martin Grauduszus
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
| | - Sofie Spickermann
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
| | - Lars Donath
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
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Collins CE, Schultz K, Mathew P, Chandra A, Nguyen B, Chen T, Renshaw S, Rose KM, Santry HP. A personalized approach empowering successful aging: Patient perspective on fall prevention education. PM R 2021; 14:786-792. [PMID: 34181824 DOI: 10.1002/pmrj.12663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 04/28/2021] [Accepted: 06/07/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Falls are the leading cause of fatal injury, and the most common cause of nonfatal trauma, among older adults. However, patient perspectives on preferences for obtaining fall education are not well reported. OBJECTIVE To identify components of successful fall prevention education. DESIGN Prospective qualitative study. SETTING Tertiary care center; institutional. PARTICIPANTS Adults aged 65 years or older with a history of falls who received services from inpatient trauma or outpatient geriatric services. INTERVENTIONS One-hour face-to-face semistructured interview. MAIN OUTCOME MEASURE Semistructured interviews sought to determine participants' history of fall education and perceived strengths and weaknesses of various formats of fall education. RESULTS Nearly all participants (9/10) indicated they had not received fall prevention education of any kind. Many participants (6/10) reported that, despite not receiving any formal education about falls, they had either given or received information about falls from other older adults in their communities. Participants indicated that framing fall education as a part of healthy aging would be more desirable and mentioned involving participants' families as part of the education. The majority of participants (7/10) suggested fall education be delivered through in-person discussion with providers, and most (9/10) indicated this would provide a personalized approach with opportunity for questions. Participants specified fall education should consist of both environmental modifications (5/10) and awareness of one's surroundings (4/10). CONCLUSIONS Despite histories of falls, nearly all participants reported they had not received formal fall education. However, many indicated they received fall information informally through their communities. Participants agreed successful fall prevention education would be delivered in an empowering way by a trusted member of the care team.
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Affiliation(s)
- Courtney E Collins
- Department of Surgery, Ohio State University, Columbus, Ohio, USA.,Center for Surgical Health Assessment, Research & Policy, Ohio State University, Columbus, Ohio, USA
| | - Kurt Schultz
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Pawan Mathew
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Arnav Chandra
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bryan Nguyen
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Tiffany Chen
- Department of Family Medicine, Sutter Health, Sacramento, California, USA
| | - Savannah Renshaw
- Department of Surgery, Ohio State University, Columbus, Ohio, USA.,Center for Surgical Health Assessment, Research & Policy, Ohio State University, Columbus, Ohio, USA
| | - Karen M Rose
- College of Nursing, Ohio State University, Columbus, Ohio, USA.,Center for Healthy Aging, Self-Management and Complex Care, Ohio State University, Columbus, Ohio, USA
| | - Heena P Santry
- Department of Surgery, Ohio State University, Columbus, Ohio, USA.,Center for Surgical Health Assessment, Research & Policy, Ohio State University, Columbus, Ohio, USA
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Di Lorito C, Long A, Byrne A, Harwood RH, Gladman JRF, Schneider S, Logan P, Bosco A, van der Wardt V. Exercise interventions for older adults: A systematic review of meta-analyses. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:29-47. [PMID: 32525097 PMCID: PMC7858023 DOI: 10.1016/j.jshs.2020.06.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/24/2020] [Accepted: 04/26/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND The evidence concerning which physical exercise characteristics are most effective for older adults is fragmented. We aimed to characterize the extent of this diversity and inconsistency and identify future directions for research by undertaking a systematic review of meta-analyses of exercise interventions in older adults. METHODS We searched the Cochrane Database of Systematic Reviews, PsycInfo, MEDLINE, Embase, CINAHL, AMED, SPORTDiscus, and Web of Science for articles that met the following criteria: (1) meta-analyses that synthesized measures of improvement (e.g., effect sizes) on any outcome identified in studies of exercise interventions; (2) participants in the studies meta-analyzed were adults aged 65+ or had a mean age of 70+; (3) meta-analyses that included studies of any type of exercise, including its duration, frequency, intensity, and mode of delivery; (4) interventions that included multiple components (e.g., exercise and cognitive stimulation), with effect sizes that were computed separately for the exercise component; and (5) meta-analyses that were published in any year or language. The characteristics of the reviews, of the interventions, and of the parameters improved through exercise were reported through narrative synthesis. Identification of the interventions linked to the largest improvements was carried out by identifying the highest values for improvement recorded across the reviews. The study included 56 meta-analyses that were heterogeneous in relation to population, sample size, settings, outcomes, and intervention characteristics. RESULTS The largest effect sizes for improvement were found for resistance training, meditative movement interventions, and exercise-based active videogames. CONCLUSION The review identified important gaps in research, including a lack of studies investigating the benefits of group interventions, the characteristics of professionals delivering the interventions associated with better outcomes, and the impact of motivational strategies and of significant others (e.g., carers) on intervention delivery and outcomes.
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Affiliation(s)
- Claudio Di Lorito
- Division of Rehabilitation, Ageing, and Wellbeing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK.
| | - Annabelle Long
- Division of Rehabilitation, Ageing, and Wellbeing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Adrian Byrne
- Division of Rehabilitation, Ageing, and Wellbeing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Rowan H Harwood
- Division of Health Sciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - John R F Gladman
- Division of Rehabilitation, Ageing, and Wellbeing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Stefan Schneider
- Institute of Movement and Neurosciences, German Sport University, Cologne 50933, Germany
| | - Pip Logan
- Division of Rehabilitation, Ageing, and Wellbeing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Alessandro Bosco
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Veronika van der Wardt
- Center for Methodology and Health Research, Department of General Medicine, Preventive and Rehabilitative Medicine, Philipps-Universität Marburg, Marburg 35032, Germany
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Kim M, Chang M, Nam E, Kim SG, Cho SI, Ryu DH, Kam S, Choi BY, Kim MJ. Fall characteristics among elderly populations in urban and rural areas in Korea. Medicine (Baltimore) 2020; 99:e23106. [PMID: 33181676 PMCID: PMC7668504 DOI: 10.1097/md.0000000000023106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Falling is one of the leading causes of injury among elderly populations. As the population over 65 years old increases, medical costs due to falling will also increase. Urban and rural areas have different fall characteristics, and research into these differences is lacking.A survey was conducted on 2012 people over 60 years old between September 1, 2015, to October 12, 2015. Guro-gu (Seoul), Yeongdeungpo-gu (Seoul), and Jung-gu (Daegu) were classified as urban areas and included 1205 of the study participants. Dalseong-gun (Daegu) and Yangpyeong-gun (Gyeonggi-do) were categorized as rural areas and included 807 participants. The survey included questions about fall history, cause, season and time of recent falls, and external conditions associated with recent falls, like floor or ground materials and shoe types.Rural respondents were older than urban respondents (P < .001) but did not differ significantly in gender proportion (P = .082). Fall history over the past year was not different between the 2 regions (P = .693), but lifetime fall history was greater among rural respondents (P < .001). Only 5.1% of all respondents had undergone fall-prevention education. A slippery floor was the most common cause of falls in both regions, but there was a significant difference in pattern of fall causes (P < .001). Falls were more frequent in the summer, spring, and the afternoon in urban areas, and in the summer, autumn, and the morning in rural areas. Cement and asphalt were the most common ground materials at the time of falls in both regions, but rural respondents had higher fall rates when walking on soil and when wearing slippers.A fall-prevention program that reflects the characteristics and differences of falls in urban and rural areas should be developed and used to effectively prevent falling among elderly people.
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Affiliation(s)
- Myeongkyu Kim
- Department of Rehabilitation Medicine, Hanyang University, College of Medicine
| | - Misoo Chang
- Research Coordinating Center, Konkuk University Medical Center
| | - Eunwoo Nam
- Section of Pharmacoepidemiology, Hanyang University Hospital for Rheumatic Disease
| | - Seul Gi Kim
- Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul
| | - Sung-il Cho
- Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul
| | - Dong Hee Ryu
- Department of Preventive Medicine, Daegu Catholic University School of Medicine
| | - Sin Kam
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu
| | - Bo Youl Choi
- Department of Preventive Medicine, Hanyang University, College of Medicine, Seoul, Republic of Korea
| | - Mi Jung Kim
- Department of Rehabilitation Medicine, Hanyang University, College of Medicine
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Gait parameters and characteristics associated with increased risk of falls in people with dementia: a systematic review. Int Psychogeriatr 2019; 31:1287-1303. [PMID: 30520404 DOI: 10.1017/s1041610218001783] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND People with dementia fall twice as often and have more serious fall-related injuries than healthy older adults. While gait impairment as a generic term is understood as a fall risk factor in this population, a clear elaboration of the specific components of gait that are associated with falls risk is needed for knowledge translation to clinical practice and the development of fall prevention strategies for people with dementia. OBJECTIVE To review gait parameters and characteristics associated with falls in people with dementia. METHODS Electronic databases CINAHL, EMBASE, MedLine, PsycINFO, and PubMed were searched (from inception to April 2017) to identify prospective cohort studies evaluating the association between gait and falls in people with dementia. RESULTS Increased double support time variability, use of mobility aids, walking outdoors, higher scores on the Unified Parkinson's Disease Rating Scale, and lower average walking bouts were associated with elevated risk of any fall. Increased double support time and step length variability were associated with recurrent falls. The reviewed articles do not support using the Performance Oriented Mobility Assessment and the Timed Up-and-Go tests to predict any fall in this population. There is limited research on the use of dual-task gait assessments for predicting falls in people with dementia. CONCLUSION This systematic review shows the specific spatiotemporal gait parameters and features that are associated with falls in people with dementia. Future research is recommended to focus on developing specialized treatment methods for these specific gait impairments in this patient population.
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Park WC, Kim M, Kim S, Yoo J, Kim BS, Chon J, Jeong SJ, Won CW. Introduction of Fall Risk Assessment (FRA) System and Cross-Sectional Validation Among Community-Dwelling Older Adults. Ann Rehabil Med 2019; 43:87-95. [PMID: 30852875 PMCID: PMC6409653 DOI: 10.5535/arm.2019.43.1.87] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/07/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To predict the risk of falls, Fall Risk Assessment (FRA) system has been newly developed to measure multi-systemic balance control among community-dwelling older adults. The aim of this study was to examine the association between FRA and fall-related physical performance tests. METHODS A total of 289 community-dwelling adults aged 65 years and older participated in this cross-sectional study. All participants underwent FRA test and physical performance tests such as Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), and Timed Up and Go Test (TUG). RESULTS Participants who were younger, male, highly educated, living with family members, having high body mass index, having high appendicular lean mass index, and having no irritative lower urinary tract syndrome were more likely to have higher FRA scores. SPPB (β=1.012), BBS (β=0.481), and TUG (β=-0.831) were significantly associated with FRA score after adjusting for the variables (all p<0.001). CONCLUSION FRA composite score was closely correlated with SPPB, BBS, and TUG, suggesting that FRA is a promising candidate as a screening tool to predict falls among community-dwelling elderly people.
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Affiliation(s)
- Woo-Chul Park
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Miji Kim
- Department of Biomedical Science and Technology, Graduate School of Kyung Hee University, Seoul, Korea
- East-West Medical Research Institute, Kyung Hee University Medical Center, Seoul, Korea
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Jinho Yoo
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Byung Sung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Jinmann Chon
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Medical Center, Seoul, Korea
| | - Su Jin Jeong
- Statistics Support Department, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
| | - Chang Won Won
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Korea
- Elderly Frailty Research Center, Kyung Hee University Medical Center, Seoul, Korea
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Walters K, Frost R, Kharicha K, Avgerinou C, Gardner B, Ricciardi F, Hunter R, Liljas A, Manthorpe J, Drennan V, Wood J, Goodman C, Jovicic A, Iliffe S. Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT. Health Technol Assess 2018; 21:1-128. [PMID: 29214975 DOI: 10.3310/hta21730] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. OBJECTIVES (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). DESIGN Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. INTERVENTION DEVELOPMENT Two systematic reviews (including systematic searches of 14 databases and registries, 1990-2016 and 1980-2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65-94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the 'HomeHealth' intervention in collaboration with older people and multidisciplinary stakeholders. 'HomeHealth' comprised 3-6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. FEASIBILITY RCT Single-blind RCT, individually randomised to 'HomeHealth' or treatment as usual (TAU). SETTING Community settings in London and Hertfordshire, UK. PARTICIPANTS A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. MAIN OUTCOME MEASURES Feasibility - recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. RESULTS We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire -3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. CONCLUSIONS Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. FUTURE WORK A large, definitive RCT of the HomeHealth service is warranted. STUDY REGISTRATION This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Rachael Frost
- Department of Primary Care and Population Health, University College London, London, UK
| | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, London, UK
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Federico Ricciardi
- Department of Statistical Science, University College London, London, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ann Liljas
- Department of Primary Care and Population Health, University College London, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Vari Drennan
- Centre for Health and Social Care Research, Kingston University and St George's, University of London, London, UK
| | - John Wood
- Department of Primary Care and Population Health, University College London, London, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Ana Jovicic
- Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
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11
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Cheng P, Tan L, Ning P, Li L, Gao Y, Wu Y, Schwebel DC, Chu H, Yin H, Hu G. Comparative Effectiveness of Published Interventions for Elderly Fall Prevention: A Systematic Review and Network Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018. [PMID: 29534531 PMCID: PMC5877043 DOI: 10.3390/ijerph15030498] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Falls are a major threat to older adults worldwide. Although various effective interventions have been developed, their comparative effectiveness remains unreported. Methods: A systematic review and network meta-analysis was conducted to determine the most effective interventions to prevent falls in community-dwelling adults aged 60 and over. Combined odds ratio (OR) and 95% credible interval (95% CrI) were calculated. Results: A total of 49 trials involving 27,740 participants and 9271 fallers were included. Compared to usual care, multifactorial interventions (MFI) demonstrated the greatest efficacy (OR: 0.64, 95% CrI: 0.53 to 0.77) followed by interventions combining education and exercise (EDU + EXC) (OR: 0.65, 95% CrI: 0.38 to 1.00) and interventions combining exercise and hazard assessment and modification (EXC + HAM) (OR: 0.66, 95% CrI: 0.40 to 1.04). The effect of medical care performed the worst (OR: 1.02, 95% CrI: 0.78 to 1.34). Model fit was good, inconsistency was low, and publication bias was considered absent. The overall quality of included trials was high. The pooled odds ratios and ranking probabilities remained relatively stable across all sensitivity analyses. Conclusions: MFI and exercise appear to be effective to reduce falls among older adults, and should be considered first as service delivery options. Further investigation is necessary to verify effectiveness and suitableness of the strategies to at-risk populations.
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Affiliation(s)
- Peixia Cheng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China.
| | - Liheng Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China.
| | - Peishan Ning
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China.
| | - Li Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China.
| | - Yuyan Gao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China.
| | - Yue Wu
- Department of Environmental and Occupational Health, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China.
| | - David C Schwebel
- Department of Psychology, University of Alabama, Birmingham, AL 35294, USA.
| | - Haitao Chu
- Division of Biostatistics, The University of Minnesota, Minneapolis, MN 55455, USA.
| | - Huaiqiong Yin
- Central South University Library, 172 Tongzipo Rd., Changsha 410013, China.
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China.
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12
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Bolton LB, Donaldson NE, Rutledge DN, Bennett C, Brown DS. The Impact of Nursing Interventions. Med Care Res Rev 2016; 64:123S-43S. [PMID: 17406015 DOI: 10.1177/1077558707299248] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this article is to present findings from a review of published systematic/integrative reviews and meta-analyses on nursing interventions and patient outcomes in acute care settings. A literature search was conducted for the period 1999-2005, producing 4,000 systematic/integrative reviews and 500 meta-analyses covering seven topics selected by the authors: elder care, caregivers, developmental care of neonates and infants, symptom management, pressure ulcer prevention/treatment, incontinence, and staffing. The association between nursing care interventions/processes and patient outcomes in acute care settings was found to be limited in the articles reviewed. The strongest evidence was for the use of patient risk-assessment tools and interventions implemented by nurses to prevent patient harm. We observed significant variation in methods to measure the effect of independent variables (nursing interventions) on patient outcomes. Results indicate the need for more research measuring the effect of specific nursing interventions that may impact acute care patient outcomes.
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13
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Evidence for Occupational Therapy Interventions: Effectiveness Research Indexed in the OTseeker Database. Br J Occup Ther 2016. [DOI: 10.1177/030802260707001003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to determine the overall quantity and quality of randomised controlled trials and the quantity of systematic reviews relevant to occupational therapy practice. The content of OTseeker ( www.otseeker.com ) was surveyed in June 2006. There were 3401 randomised controlled trials and 939 systematic reviews in OTseeker (total = 4340), published mostly in non-occupational therapy journals. The diagnostic areas of stroke (n = 458) and back or neck conditions/injuries (n = 391), and the intervention categories of exercise (n = 1262) and consumer education (n = 1098), were the most frequently listed. Although the quantity of evidence available about the effectiveness of occupational therapy interventions is rapidly increasing, some areas require greater research effort. Occupational therapists also need to search more broadly than occupational therapy journals for research to support clinical decision making.
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Amacher AE, Nast I, Zindel B, Schmid L, Krafft V, Niedermann K. Experiences of general practitioners, home care nurses, physiotherapists and seniors involved in a multidisciplinary home-based fall prevention programme: a mixed method study. BMC Health Serv Res 2016; 16:469. [PMID: 27595748 PMCID: PMC5011799 DOI: 10.1186/s12913-016-1719-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 08/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The feasibility of effective fall prevention programmes (FPPs) for use in daily clinical practice needs to be assessed in the specific healthcare settings. The aim of this study was to explore the perceived benefits and barriers of an evidence-based, home-based pilot FPP among the involved seniors, general practitioners (GPs), home care nurses (HCNs) and physiotherapists (PTs), in order to develop tailored implementation strategies. METHODS The study was a mixed method study using an 'exploratory sequential design'. In the initial qualitative sequence, semi-structured interviews were performed with four participants from each group and analysed using a deductive content analysis. In the successive quantitative sequence, target group specific postal surveys were conducted with all participants. The triangulation of both steps allowed merging the in-depth experiences from the interviews with the general findings from the survey. RESULTS In this evaluation study participated 17 seniors (mean age 79.7 (SD +/-6.2) years). 40 GPs, 12 HCNs and four PTs. All were satisfied with the organization and processes of the FPP. The main benefit, perceived by each target group, was the usefulness of the FPP in detecting risk of falling at the senior's home. A low number of recruiting GPs and HCNs, divergent opinions of the health professionals towards the aim of the FPP as well as no perceived need for changes by the seniors were the most important barriers to the participation of (more) seniors. CONCLUSIONS Multidisciplinary home-based fall prevention is a useful approach to detect the risk of falling in seniors. The barriers identified need to be resolved through tailored strategies to facilitate the successful nationwide implementation of this pilot FPP.
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Affiliation(s)
- Astrid E Amacher
- Zurich University of Applied Sciences, Institute of Physiotherapy, Technikumstr. 71, Winterthur, 8401, Switzerland
| | - Irina Nast
- Zurich University of Applied Sciences, Institute of Physiotherapy, Technikumstr. 71, Winterthur, 8401, Switzerland
| | - Barbara Zindel
- Swiss League Against Rheumatism, Josefstr. 92, Zurich, 8005, Switzerland
| | - Lukas Schmid
- Department of Rheumatology, Central Hospital of Lucerne, 6000, Lucerne 16, Switzerland
| | - Valérie Krafft
- Swiss League Against Rheumatism, Josefstr. 92, Zurich, 8005, Switzerland
| | - Karin Niedermann
- Zurich University of Applied Sciences, Institute of Physiotherapy, Technikumstr. 71, Winterthur, 8401, Switzerland.
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15
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García-Flores FI, Rivera-Cisneros AE, Sánchez-González JM, Guardado-Mendoza R, Torres-Gutiérrez JL. [Correlation between gait speed and muscular strength with balance for reducing falls among elderly]. CIR CIR 2016; 84:392-7. [PMID: 26945638 DOI: 10.1016/j.circir.2015.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 11/09/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Evidence of the benefit on propioceptive neuromuscular facilitation for reducing falls in older people does not exist. OBJECTIVE The aim of this study is to evaluate the effects of propioceptive facilitation over falls and biomechanical variables, in comparison to standard treatment and control groups. MATERIALS AND METHODS Series cases comparative for the 24 participants were recruited and randomnly assigned to 3 groups. Group 1, propioceptive neuromuscular facilitation, group 2, standard treatment, and 3 control. Falls and biomechanic variables were measured before and after. Chi(2) was used for falls and multiple regression for biomechanical variables, RESULTS Participants had similar falls in previous year. Women had higher falls in a relation 7:1 women-men. After intervention, there was no difference between 3 groups. A correlation exista between muscular strength and gait speed with one foot position time r(2) = 0.67, p = 0.02. CONCLUSIONS Improving 1kilogram-force of muscular strength of pelvic limb and 0.1meter/second in gait speed, balance (unipodal position time) increases balance by 11.3%. After 3 months of intervention group 2 got 7.9kg-force and 0.26m/s of profit, while group 1 had 4.1kg-force and 0.15m/s and control group 2.4kg-force and 0.1m/s.
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Affiliation(s)
| | | | | | - Rodolfo Guardado-Mendoza
- Departamento de Medicina y Nutrición, Campus León, Universidad de Guanajuato, Guanajuato, México
| | - Jorge Luis Torres-Gutiérrez
- Hospital Regional, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, León, Guanajuato, México
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16
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Bae J, Cho SI. [Effects of community-based comprehensive fall prevention program on muscle strength, postural balance and fall efficacy in elderly people]. J Korean Acad Nurs 2015; 44:697-707. [PMID: 25608547 DOI: 10.4040/jkan.2014.44.6.697] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purposes of this study was to develop a comprehensive community-based fall prevention program and to test the effects of the program on the muscle strength, postural balance and fall efficacy for elderly people. METHODS The design of this study was a nonequivalent control group pretest-posttest design. There were 28 participants in the experimental group and 29 in the control group. The program consisted of balance exercises, elastic resistance exercises and prevention education. The program was provided five times a week for 8 weeks and each session lasted 90 minutes. Data were analyzed using χ²-test, independent t-test and paired t-test using the SPSS program. RESULTS Muscle strength of the lower extremities, postural balance and fall efficacy scores significantly improved in the experimental group compared to the control group. CONCLUSION These results suggest that this program can improve lower extremity muscle strength, postural balance and fall efficacy in elders. Therefore, this program is recommended for use in fall prevention programs for elders living in the community.
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Affiliation(s)
- Jeongyee Bae
- Department of Nursing, Inje University; International Safe Community Research Center of Busan Metropolitan; Institute for Health Science Research, Busan, Korea.
| | - Seong Il Cho
- Department of Rehabilitation Science, Graduate School, Inje University; International Safe Community Research Center of Busan Metropolitan, Busan, Korea
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Liu J, Lockhart TE. Trunk angular kinematics during slip-induced backward falls and activities of daily living. J Biomech Eng 2014; 136:101005. [PMID: 25033029 PMCID: PMC4127473 DOI: 10.1115/1.4028033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 06/29/2014] [Accepted: 07/18/2014] [Indexed: 11/08/2022]
Abstract
Prior to developing any specific fall detection algorithm, it is critical to distinguish the unique motion features associated with fall accidents. The current study aimed to investigate the upper trunk angular kinematics during slip-induced backward falls and activities of daily living (ADLs). Ten healthy older adults (age = 75 ± 6 yr (mean ± SD)) were involved in a laboratory study. Sagittal trunk angular kinematics were measured using optical motion analysis system during normal walking, slip-induced backward falls, lying down, bending over, and various types of sitting down (SN). Trunk angular phase-plane plots were generated to reveal the motion features of falls. It was found that backward falls were characterized by a simultaneous occurrence of a slight trunk extension and an extremely high trunk extension velocity (peak average = 139.7 deg/s), as compared to ADLs (peak average = 84.1 deg/s). It was concluded that the trunk extension angular kinematics of falls were clearly distinguishable from those of ADLs from the perspective of angular phase-plane plot. Such motion features can be utilized in future studies to develop a new prior-to-impact fall detection algorithm.
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Affiliation(s)
- Jian Liu
- Division of Applied Science and Technology,Marshall University,One John Marshall Drive, CB 212,Huntington, WV 25755e-mail:
| | - Thurmon E. Lockhart
- Grado Department of Industrial andSystems Engineering,Virginia Tech,Blacksburg, VA 24061-0002
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18
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Guo JL, Tsai YY, Liao JY, Tu HM, Huang CM. Interventions to reduce the number of falls among older adults with/without cognitive impairment: an exploratory meta-analysis. Int J Geriatr Psychiatry 2014; 29:661-9. [PMID: 24318959 DOI: 10.1002/gps.4056] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 10/29/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This exploratory meta-analysis aimed to examine and compare the effective interventions to prevent falls among institutionalized/non-institutionalized older adults without cognitive impairment with interventions to prevent falls for older adults with cognitive impairment. DESIGN A database search identified 111 trials published between January 1992 and August 2012 that evaluated fall-prevention interventions among institutionalized/non-institutionalized older adults with and without cognitive impairment as measured by valid cognition scales. RESULTS Exercise alone intervention was similar effective on reducing the numbers of falls among older adults without cognitive impairment regardless of setting (non-institutionalized: OR = 0.783, 95% confidence interval (CI) = 0.656-0.936; p = 0.007 institutionalized: OR = 0.799, 95% CI = 0.646-0.988, p = 0.038). Vitamin D/calcium supplementation had a positive effect on the reduction of numbers of falls among non-institutionalized older adults without cognitive impairment (OR = 0.789, 95% CI = 0.631-0.985, p = 0.036), as did home visits and environment modification (OR = 0.751, 95% CI = 0.565-0.998, p = 0.048). Exercise alone, exercise-related multiple interventions, and multifactorial interventions were associated with positive outcomes among both institutionalized and non-institutionalized older adults with cognitive impairment, but studies are limited. CONCLUSIONS Single exercise interventions can significantly reduce numbers of falls among older adults with and without cognitive impairment in institutional or non-institutional settings. Vitamin D and calcium supplementation, home visits, and environment modification can reduce the risk of falls among older adults in non-institutional settings. Exercise-related multiple interventions and multifactorial interventions may only be effective for preventing falls in older adults with cognitive impairment.
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Affiliation(s)
- Jong-Long Guo
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
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19
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Johnson M, Kelly L, Siric K, Tran DT, Overs B. Improving falls risk screening and prevention using an e-learning approach. J Nurs Manag 2014; 23:910-9. [PMID: 24848141 DOI: 10.1111/jonm.12234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/30/2022]
Abstract
AIM This study investigated the impact of an e-learning education programme for nurses on falls risk screening, falls prevention and post-falls management. BACKGROUND Falls injury within older inpatients is a major patient safety concern. METHOD Using a pre-post design, observation of the patient and environment and patient health care record audits, were conducted following the introduction of a falls e-learning education programme. RESULTS Audits of patient health care records (using the Falls Chart Audit Tool), together with observation of practice for 119 (pre) and 99 (post) patients, were undertaken. Initial risk screening was conducted using the Modified Ontario Stratify Scale for most patients (95%). Interventions such as a falls risk flag in the records/on beds, supervision when the patient is mobilising or in the bathroom, area clear of hazards, use of chair/bed alarms, and referral to allied health staff were significantly improved. CONCLUSIONS Initial risk screening of patients and improvements in preventive interventions were demonstrated. IMPLICATIONS FOR NURSING MANAGEMENT This falls e-learning programme represents a cost-effective method of increasing falls mitigation strategies within large organisations. The Falls Chart Audit Tool provides a valuable monitoring tool for managers. Falls risk screening when the patient's condition changes, requires vigilance by managers or reminders within clinical information systems.
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Affiliation(s)
- Maree Johnson
- School of Nursing and Midwifery, University of Western Sydney, Liverpool, NSW, Australia.,Centre for Applied Nursing Research, South Western Sydney Local Health District, University of Western Sydney (Affiliated with the Ingham Institute, Liverpool NSW), Liverpool, NSW, Australia
| | - Linda Kelly
- Centre for Education and Workforce Development, Rozelle, NSW, Australia
| | - Katica Siric
- Concord Repatriation General Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Duong Thuy Tran
- Centre for Health Research, School of Medicine, University of Western Sydney, Penrith, NSW, Australia
| | - Bronwyn Overs
- Mental Health Centre (Level 1), Faculty of Medicine, School of Psychiatry, Liverpool Hospital, Infant Child Adolescent Mental Health Service (ICAMHS) Research, University of New South Wales, Liverpool, NSW, Australia
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20
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Grundstrom AC, Guse CE, Layde PM. Risk factors for falls and fall-related injuries in adults 85 years of age and older. Arch Gerontol Geriatr 2012; 54:421-8. [PMID: 21862143 PMCID: PMC3236252 DOI: 10.1016/j.archger.2011.06.008] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 06/06/2011] [Accepted: 06/07/2011] [Indexed: 11/27/2022]
Abstract
Falls are a leading cause of morbidity and mortality in older adults. No previous studies on risk factors for falls have focused on adults 85 years and older, the most rapidly growing segment of adults. We examined demographic, health, and behavioral risk factors for falls and fall-related injuries in adults 65 years and older, with a particular focus on adults 85 years and older. We analyzed self-reported information from the Behavioral Risk Factor Surveillance System (BRFSS) for 2008. Data was available for 120,923 people aged 65 or older and 12,684 people aged 85 or older. Of those aged 85 or older, 21.3% reported at least one fall in the past 3 months and 7.2% reported at least one fall related injury requiring medical care or limiting activity for a day or longer. Below average general health, male sex, perceived insufficient sleep, health problems requiring assistive devices, alcohol consumption, increasing body mass index and history of stroke were all independently associated with a greater risk of falls or fall related injuries. The greater risk of falling in those 85 years and older appeared to be due to the deterioration of overall health status with age; among those with excellent overall health status, there was no greater risk of falling in adults 85 years and older compared to those 65-84 years of age. Our results suggest that those with risk factors for falls and fall-related injuries may be appropriate targets for evidence-based fall prevention programs.
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Affiliation(s)
| | - Clare E. Guse
- Injury Research Center, Medical College of Wisconsin, Milwaukee, WI
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Peter M. Layde
- Injury Research Center, Medical College of Wisconsin, Milwaukee, WI
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
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21
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Kim HD, Je HD, Jeong JH, Cho, KH. Tai Chi and Its Effects on Dynamic Postural Control in the Initiation of Gait by Older People. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hyeong-Dong Kim
- Department of Physical Therapy, College of Health Science, Korea University
| | - Hyun Dong Je
- Department of Pharmacology, College of Pharmacy, Catholic University of Daegu
| | - Ji Hoon Jeong
- Department of Pharmacology, College of Medicine, Chung-Ang University
| | - Kwang-ho Cho,
- Department of Radiological Science, Baekseok Culture University
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Effectiveness of intervention programs in preventing falls: a systematic review of recent 10 years and meta-analysis. J Am Med Dir Assoc 2011; 13:188.e13-21. [PMID: 21680249 DOI: 10.1016/j.jamda.2011.04.022] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 04/22/2011] [Accepted: 04/26/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the reported effectiveness of fall-prevention programs for older adults by reviewing randomized controlled trials from 2000 to 2009. DESIGN Systematic review and meta-analysis of randomized controlled trials. DATA SOURCES A systematic literature search of articles was conducted using 5 electronic databases (Medline, PubMed, PsycINFO, CINAHL, and RefWorks), including articles describing interventions designed to prevent falls, in English with full text availability, from 2000 through 2009. REVIEW METHODS Of a potential 227 studies, we identified 17 randomized controlled trials with a duration of intervention of at least 5 months of follow-up. Inclusion and exclusion criteria were used to assess the methodological qualities of the studies. We excluded unidentified study design, quasi-experimental studies, and/or studies that were nonspecific regarding inclusion criteria. DATA EXTRACTION Primary outcome measures were number of falls and fall rate. Methodological quality assessment included internal and external validity, reporting, and power. Data were extracted independently by 2 investigators and analyzed using a random-effects model. We analyzed the effectiveness of these fall intervention programs using their risk ratios (RR) in 2 single-intervention versus 15 multifactorial intervention trials, 3 nursing homes versus 14 community randomized controlled trials, and 8 Model 1 (initial intervention with subsequent follow up) versus 9 Model II (ongoing intervention throughout the follow-up) studies. RESULTS The combined RR for the number of falls among 17 studies was 0.855 (z = -2.168; p = .030; 95% CI = 0.742-0.985; Q = 196.204, df = 16, P = .000, I(2) = 91.845), demonstrating that fall-prevention programs across the studies were effective by reducing fall rates by 14%, but with substantial heterogeneity. Subgroup analysis indicated that there was a significant fall reduction of 14% in multifactorial intervention (RR = 0.856, z = -2.039, P = .041) with no variation between multifactorial and single-intervention groups (Q = 0.002, P = .961), 55% in the nursing home setting (RR = 0.453, z = -9.366, P = .000) with significant variation between nursing home and community groups (Q = 62.788, P = .000), and no significant effect was gained by dividing studies into either in Model I or II. Sensitivity analysis found homogeneity (Q = 18.582, df = 12, P = .099, I(2) = 35.423) across studies with a 9% overall fall reduction (RR = 0.906, 95% CI = 0.853-0.963, z = -3.179, P = .001), including a fall-reduction rate of 10% in multifactorial intervention (RR = 0.904, z = -3.036, P = .002), 9% in community (RR = 0.909, z = -3.179, P = .001), and 12% in Model I (RR = 0.876, z = -3.534, P = .000) with no variations among all the groups. Meta regression suggested that the model fit explained 68.6% of the relevant variance. CONCLUSIONS The meta-sensitivity analysis indicates that randomized controlled trials of fall-prevention programs conducted within the past 10 years (2000-2009) are effective in overall reduction of fall rates of 9% with a reduction of fall rates of 10% in multifactorial interventions, 9% in community settings, and 12% in Model I interventions (initial intervention efforts and then subsequent follow-up).
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Chapman J, Bachand D, Hyrkäs K. Testing the sensitivity, specificity and feasibility of four falls risk assessment tools in a clinical setting. J Nurs Manag 2011; 19:133-42. [PMID: 21223413 DOI: 10.1111/j.1365-2834.2010.01218.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This paper reports on a study undertaken to test the sensitivity, specificity and feasibility of four fall risk assessment tools. BACKGROUND Falls risk assessment tools have been developed based on literature and findings from empirical studies, but the instruments often lack further testing in the clinical setting. METHOD Four falls risk assessment tools were tested simultaneously in this study. The data was collected in May-June 2006. All assessment tools were completed on a total of 1546 patients. Descriptive statistics were used for data analysis. RESULTS The use of the instruments was moderately consistent among registered nurses, but the education provided did not entirely eliminate problems with accuracy. The sensitivity of the instruments was 57.1-100% and specificity was 24.9-69.3%. CONCLUSION The sensitivity and specificity of the instruments are important factors to consider when choosing an instrument. However, the strategies to educate staff and to intervene appropriately are equally important for an organization undertaking a proactive stance in mitigating the risk of falls. IMPLICATIONS FOR NURSING MANAGEMENT It is important for managers to test instruments in their own organizations and specific populations. It is also critical to carefully assess that the chosen instrument is easy and accurate in use.
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Affiliation(s)
- Joanne Chapman
- Center of Nursing Research and Quality Outcomes, Maine Medical Center, Portland, Maine, USA.
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24
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Factors Associated With Falls During Hospitalization in an Older Adult Population. Res Theory Nurs Pract 2011; 25:127-48. [DOI: 10.1891/1541-6577.25.2.127] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Falls of hospitalized older adults are of concern for patients, family members, third-party payers, and caregivers. Falls are the most common safety incident among hospitalized patients with fall rates from 2.9–13 per 1,000 patient days. Little effectiveness research has been conducted on nursing interventions and other variables associated with falls of older adults during hospitalization. Purpose: The purpose of this exploratory outcomes effectiveness study was to examine variables associated with falls during hospitalization of older adults. Method: An effectiveness research model composed of patient characteristics, clinical conditions, nursing unit characteristics, medical, pharmacy, and nursing interventions was tested using generalized estimating equations (GEE) analysis. The sample consisted of 10,187 hospitalizations of 7,851 patients, aged 60 or older, admitted for acute care services over a 4-year period. Those included in the sample either had received the Nursing Interventions Classification (NIC) intervention of Fall Prevention (defined as “instituting special precautions with patient at risk for injury from falling” [Dochterman & Bulechek, 2004, p. 363]) or were at risk for falling as defined by a fall risk assessment scale. Data were obtained retrospectively from 9 clinical and administrative data repositories from 1 tertiary care hospital. Discussion: Variables that were positively associated with falls, after controlling for other variables in the model, included several medical and nursing treatments; several types of medications including antidepressants, benzodiazepines, antipsychotic, and psychotropic agents; and several types of nursing treatments including restraints and neurologic monitoring (at low use rates of <2 times a day). Variables inversely associated with falls included registered nurse (RN) skill mix, pressure ulcer care, pain management, and tube care. Conclusions: The study demonstrates the importance of conducting interdisciplinary effectiveness research that includes nursing care. Most of the variables associated with falls were interventions (medical, pharmacy, and nursing). Dose of nursing treatments and RN skill mix were also associated with falls.
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Abstract
SummaryAppropriate social and medical interventions may help maintain independence in older people. Determinants of functional decline, disability and reduced independence are recognized and specific interventions target the treatment of clinical conditions, multiple health problems and geriatric conditions, prevention of falls and fractures, and maintenance of physical and cognitive function and social engagement.Preventive strategies to identify and treat diverse unmet needs of older people have been researched extensively. We reviewed systematically recent randomized controlled trials evaluating these ‘complex’ interventions and incorporated the findings of 21 studies into an established meta-analysis that included 108,838 people in 110 trials. There was an overall benefit of complex interventions in helping older people to live at home, explained by reduced nursing home admissions rather than death rates. Hospital admissions and falls were also reduced in intervention groups. Benefits were largely restricted to earlier studies, perhaps reflecting general improvements in health and social care for older people. The wealth of high-quality trial evidence endorses the value of preventive strategies to help maintain independence in older people.
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Allet L, Armand S, de Bie RA, Golay A, Monnin D, Aminian K, Staal JB, de Bruin ED. The gait and balance of patients with diabetes can be improved: a randomised controlled trial. Diabetologia 2010; 53:458-66. [PMID: 19921145 PMCID: PMC2815802 DOI: 10.1007/s00125-009-1592-4] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Accepted: 10/06/2009] [Indexed: 11/04/2022]
Abstract
AIMS/HYPOTHESIS Gait characteristics and balance are altered in diabetic patients. Little is known about possible treatment strategies. This study evaluates the effect of a specific training programme on gait and balance of diabetic patients. METHODS This was a randomised controlled trial (n=71) with an intervention (n=35) and control group (n=36). The intervention consisted of physiotherapeutic group training including gait and balance exercises with function-orientated strengthening (twice weekly over 12 weeks). Controls received no treatment. Individuals were allocated to the groups in a central office. Gait, balance, fear of falls, muscle strength and joint mobility were measured at baseline, after intervention and at 6-month follow-up. RESULTS The trial is closed to recruitment and follow-up. After training, the intervention group increased habitual walking speed by 0.149 m/s (p<0.001) compared with the control group. Patients in the intervention group also significantly improved their balance (time to walk over a beam, balance index recorded on Biodex balance system), their performance-oriented mobility, their degree of concern about falling, their hip and ankle plantar flexor strength, and their hip flexion mobility compared with the control group. After 6 months, all these variables remained significant except for the Biodex sway index and ankle plantar flexor strength. Two patients developed pain in their Achilles tendon: the progression for two related exercises was slowed down. CONCLUSIONS/INTERPRETATION Specific training can improve gait speed, balance, muscle strength and joint mobility in diabetic patients. Further studies are needed to explore the influence of these improvements on the number of reported falls, patients' physical activity levels and quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT00637546 FUNDING This work was supported by the Swiss National Foundation (SNF): PBSKP-123446/1/
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Affiliation(s)
- L Allet
- Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, the Netherlands.
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Abstract
OBJECTIVE Obtain the views of nurses and assistants as to why patients in acute care hospitals fall. BACKGROUND Despite a large quantitative evidence base for guiding fall risk assessment and not needing highly technical, scarce, or expensive equipment to prevent falls, falls are serious problems in hospitals. METHODS Basic content analysis methods were used to interpret descriptive data from 4 focus groups with nurses (n = 23) and 4 with assistants (n = 19). A 2-person consensus approach was used for analysis. RESULTS Positive and negative components of 6 concepts-patient report, information access, signage, environment, teamwork, and involving patient/family-formed 2 core categories: knowledge/ communication and capability/actions that are facilitators or barriers, respectively, to preventing falls. CONCLUSION Two conditions are required to reduce patient falls. A patient care plan including current and accurate fall risk status with associated tailored and feasible interventions needs to be easily and immediately accessible to all stakeholders (entire healthcare team, patients, and family). Second, stakeholders must use that information plus their own knowledge and skills and patient and hospital resources to carry out the plan.
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Zecevic AA, Salmoni AW, Lewko JH, Vandervoort AA, Speechley M. Utilization of the Seniors Falls Investigation Methodology to identify system-wide causes of falls in community-dwelling seniors. THE GERONTOLOGIST 2009; 49:685-96. [PMID: 19525208 DOI: 10.1093/geront/gnp059] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE As a highly heterogeneous group, seniors live in complex environments influenced by multiple physical and social structures that affect their safety. Until now, the major approach to falls research has been person centered. However, in industrial settings, the individuals involved in an accident are seen as the inheritors of system defects. The objective of the present study was to investigate safety deficiencies that contributed to falls in community-dwelling seniors using a systems approach. DESIGN AND METHODS The investigations were conducted using the Seniors Falls Investigation Methodology (SFIM), an adapted version of a method used to examine transportation accidents, such as airplane crashes. Fifteen seniors, who experienced a fall or near fall, participated in multiple case studies. A cross-case synthesis was used to summarize findings and identify common patterns of causes and safety deficiencies. RESULTS Falls and near falls are a result of latent unsafe conditions, and unsafe acts and decisions combined in a diverse set of circumstances. If not identified and removed, these unsafe conditions can cause falls for other seniors. IMPLICATIONS This study provided compelling evidence that causes of falling are systemic and develop over time. It demonstrated that the systems approach is needed to expand the focus from the individual to multilayered organizational and supervisory causes. The SFIM demonstrated capability to identify causes of falls that will allow better prevention and management programs, hence advancing seniors' safety. SFIM shows great potential for implementation in organized settings, such as hospitals and long-term care homes.
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Affiliation(s)
- Aleksandra A Zecevic
- School of Health Studies, Faculty of Health Sciences, The University of Western Ontario, London, Canada.
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Neyens JCL, Dijcks BPJ, Twisk J, Schols JMGA, van Haastregt JCM, van den Heuvel WJA, de Witte LP. A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomised controlled trial (RCT). Age Ageing 2009; 38:194-9. [PMID: 19221130 DOI: 10.1093/ageing/afn297] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE to evaluate the effectiveness of a multifactorial intervention on incidence of falls in psychogeriatric nursing home patients. DESIGN cluster-randomised controlled 12-month trial. SETTING psychogeriatric wards in 12 nursing homes in The Netherlands. PARTICIPANTS psychogeriatric nursing home patients (n = 518). INTERVENTION a general medical assessment and an additional specific fall risk evaluation tool, applied by a multidisciplinary fall prevention team, resulting in general and individual fall prevention activities. MEASUREMENTS falls. RESULTS there were 355 falls in 169.5 patient-years (2.09 falls per patient per year) in the intervention group and 422 falls in 166.3 patient-years (2.54 falls per patient per year) in the control group. Intention-to-treat analysis with adjustment for ward-related and patient-related parameters, and intra-cluster correlation, showed that the intervention group had a significantly lower mean fall incidence rate than the control group (rate ratio = 0.64, 95% CI = 0.43-0.96, P = 0.029). Subgroup analyses showed that fall risk declined further as patients participated longer in the intervention programme. CONCLUSION the introduction of a structured multifactorial intervention to prevent falls in psychogeriatric nursing home patients significantly reduces the number of falls. This reduction is substantial and of high clinical relevance.
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Affiliation(s)
- Jacques C L Neyens
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht 6200MD, The Netherlands. j.neyens@zw
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Kim HD. Effects of Tai Chi Exercise on the Center of Pressure Trace during Obstacle Crossing in Older Adults who are at a Risk of Falling. J Phys Ther Sci 2009. [DOI: 10.1589/jpts.21.49] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hyeong-Dong Kim
- Catholic University of Daegu, College of Health Science, Department of Physical Therapy
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Kato M, Izumi K, Shirai S, Kondo K, Kanda M, Watanabe I, Ishii K, Saito R. Development of a fall prevention program for elderly Japanese people. Nurs Health Sci 2008; 10:281-90. [DOI: 10.1111/j.1442-2018.2008.00404.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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High Efficacy for Hip Protectors in the Prevention of Hip Fractures Among Elderly People With Dementia. J Am Med Dir Assoc 2008; 9:313-8. [DOI: 10.1016/j.jamda.2007.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 10/22/2007] [Accepted: 10/31/2007] [Indexed: 11/18/2022]
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Dukyoo Jung, Juhee Lee, Lee SM. A Meta-Analysis of Fear of Falling Treatment Programs for the Elderly. West J Nurs Res 2008; 31:6-16. [DOI: 10.1177/0193945908320466] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examines the effectiveness of interventions for decreasing the fear of falling by synthesizing the results of individual studies of fear of falling prevention. The mean weighted effect sizes (MWES) of six studies are computed. The overall MWES is .21 ( N = 957; 95% CI .068—.362). Results indicate that interventions are effective in reducing the fear of falling or increasing fall efficacy. The MWES is .249, .024, and .418 for the combined intervention, exercise intervention only, and hip protector groups, respectively. The MWES of the 3 months or less group was .000, and the 4-months group was .240. The MWES is .022, .228, and .418 for the facility-based, community-based, and home-based intervention groups, respectively. Overall, interventions were effective in decreasing fear of falling and increasing fall efficacy. Results suggest that the best outcome is obtained after 4 months, indicating that interventions need some time to obtain their effects.
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Schott N, Kurz AK. Stürze bei älteren Erwachsenen: Risikofaktoren – Assessment – Prävention. ZEITSCHRIFT FUR SPORTPSYCHOLOGIE 2008. [DOI: 10.1026/1612-5010.15.2.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Zusammenfassung. Stürze gehören zu den häufigsten und komplexesten geriatrischen Syndromen. Sie tragen nicht nur zu einem beträchtlichen Anteil zur erhöhten Krankheits- und Sterberate bei, sondern auch zu funktionalen Einbußen, der Angst erneut zu stürzen sowie der frühzeitigen Einweisung in das Pflegeheim. Es lassen sich zahlreiche Ursachen und Risikofaktoren für Stürze benennen, die die Diagnose, Behandlung und Prävention zu einer schwierigen Herausforderung werden lassen. In den letzten Jahren wurde seitens der Forschung als auch der Gesundheitsversorgung das Augenmerk verstärkt auf die Identifikation effektiver Interventionen zur Vermeidung von Stürzen bzw. sturzbedingten Verletzungen bei älteren Erwachsenen gelegt. So gibt es eine ganze Anzahl randomisierter, kontrollierter Studien und systematische Reviews, die der Frage nach der günstigsten Kombination von Interventionen zur Sturzprävention nachgehen. In diesem Beitrag wird ein kurzer Überblick über die Epidemiologie von Stürzen, deren Hauptursachen und Risikofaktoren, Assessmentverfahren sowie verschiedene Interventionstypen gegeben. Abschließend werden Ergebnisse zur Effektivität eben dieser Intervention vorgestellt.
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Beswick AD, Rees K, Dieppe P, Ayis S, Gooberman-Hill R, Horwood J, Ebrahim S. Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet 2008; 371:725-35. [PMID: 18313501 PMCID: PMC2262920 DOI: 10.1016/s0140-6736(08)60342-6] [Citation(s) in RCA: 491] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In old age, reduction in physical function leads to loss of independence, the need for hospital and long-term nursing-home care, and premature death. We did a systematic review to assess the effectiveness of community-based complex interventions in preservation of physical function and independence in elderly people. METHODS We searched systematically for randomised controlled trials assessing community-based multifactorial interventions in elderly people (mean age at least 65 years) living at home with at least 6 months of follow-up. Outcomes studied were living at home, death, nursing-home and hospital admissions, falls, and physical function. We did a meta-analysis of the extracted data. FINDINGS We identified 89 trials including 97 984 people. Interventions reduced the risk of not living at home (relative risk [RR] 0.95, 95% CI 0.93-0.97). Interventions reduced nursing-home admissions (0.87, 0.83-0.90), but not death (1.00, 0.97-1.02). Risk of hospital admissions (0.94, 0.91-0.97) and falls (0.90, 0.86-0.95) were reduced, and physical function (standardised mean difference -0.08, -0.11 to -0.06) was better in the intervention groups than in other groups. Benefit for any specific type or intensity of intervention was not noted. In populations with increased death rates, interventions were associated with reduced nursing-home admission. Benefit in trials was particularly evident in studies started before 1993. INTERPRETATION Complex interventions can help elderly people to live safely and independently, and could be tailored to meet individuals' needs and preferences.
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Affiliation(s)
- Andrew D Beswick
- Department of Social Medicine, University of Bristol, Bristol, UK.
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Gates S, Fisher JD, Cooke MW, Carter YH, Lamb SE. Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis. BMJ 2008; 336:130-3. [PMID: 18089892 PMCID: PMC2206297 DOI: 10.1136/bmj.39412.525243.be] [Citation(s) in RCA: 302] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of multifactorial assessment and intervention programmes to prevent falls and injuries among older adults recruited to trials in primary care, community, or emergency care settings. DESIGN Systematic review of randomised and quasi-randomised controlled trials, and meta-analysis. DATA SOURCES Six electronic databases (Medline, Embase, CENTRAL, CINAHL, PsycINFO, Social Science Citation Index) to 22 March 2007, reference lists of included studies, and previous reviews. REVIEW METHODS Eligible studies were randomised or quasi-randomised trials that evaluated interventions to prevent falls that were based in emergency departments, primary care, or the community that assessed multiple risk factors for falling and provided or arranged for treatments to address these risk factors. DATA EXTRACTION Outcomes were number of fallers, fall related injuries, fall rate, death, admission to hospital, contacts with health services, move to institutional care, physical activity, and quality of life. Methodological quality assessment included allocation concealment, blinding, losses and exclusions, intention to treat analysis, and reliability of outcome measurement. RESULTS 19 studies, of variable methodological quality, were included. The combined risk ratio for the number of fallers during follow-up among 18 trials was 0.91 (95% confidence interval 0.82 to 1.02) and for fall related injuries (eight trials) was 0.90 (0.68 to 1.20). No differences were found in admissions to hospital, emergency department attendance, death, or move to institutional care. Subgroup analyses found no evidence of different effects between interventions in different locations, populations selected for high risk of falls or unselected, and multidisciplinary teams including a doctor, but interventions that actively provide treatments may be more effective than those that provide only knowledge and referral. CONCLUSIONS Evidence that multifactorial fall prevention programmes in primary care, community, or emergency care settings are effective in reducing the number of fallers or fall related injuries is limited. Data were insufficient to assess fall and injury rates.
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Affiliation(s)
- S Gates
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL.
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Factors influencing discharge location after hospitalization resulting from a traumatic fall among older persons. ACTA ACUST UNITED AC 2008; 63:902-7. [PMID: 18090024 DOI: 10.1097/01.ta.0000240110.14909.71] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify significant demographic, clinical, and nonclinical factors among elderly persons influencing the discharge location after hospitalization resulting from a traumatic fall. METHODS Population-based case-only study with use of data from the 2003 National Trauma Data Bank. The study analysis included 47,234 subjects admitted to 1 of 405 hospitals in the United States between 1989 and 2003, and aged between 65 and 89 years. Demographic characteristics, clinical factors, and discharge location were obtained from the database. RESULTS Eighty-three percent were discharged to home, 7% to a nursing home, and 10% to a rehabilitation facility. Female patients and white patients were more likely discharged to a nursing home or a rehabilitation facility than to home. Compared with commercial insurance, a patients who had Medicare was more likely discharged to a nursing home (odds ratio = 20.9; 95% confidence interval: 18.2-23.9) or a rehabilitation facility (odds ratio = 5.39; 95% confidence interval: 4.86-5.96) than to home. A patient who was injured in the face or neck, thorax, or abdomen was less likely discharged to a nursing home or a rehabilitation facility than to home when compared with a patient injured in an upper and lower extremity. A patient with an injury to the spine was more likely discharged to a rehabilitation facility than to home when compared with a patient injured in any other body region. CONCLUSION Gender, race, payment type, body region injured, Injury Severity Score, physiologically based Emergency Department Revised Trauma Score, and need for intensive care unit care were significant predictors of discharge location. Understanding and addressing the factors found in this study can improve the discharge planning process and posttreatment management.
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MacCulloch PA, Gardner T, Bonner A. Comprehensive fall prevention programs across settings: a review of the literature. Geriatr Nurs 2007; 28:306-11. [PMID: 17923287 DOI: 10.1016/j.gerinurse.2007.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Revised: 01/25/2007] [Indexed: 01/07/2023]
Abstract
The prevention and management of falls across health care and community settings continues to be one of the greatest challenges in geriatric nursing. This article reviews the literature on fall prevention and management and provides information on national programs and resources, as well as public policy related to falls in the elderly.
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Affiliation(s)
- Patricia A MacCulloch
- Department of Orthopedics, University of Massachusetts Memorial Hospital, Worcester, Massachusetts, USA
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Reducing Fall Risk for Frail Older Home-Care Clients Using a Multifactorial and Interdisciplinary Team Approach. J Patient Saf 2007. [DOI: 10.1097/pts.0b013e3181427930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Carole L Cooper
- Children's Hospital Central California, Madera, CA 93638, USA.
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Freedman VA, Hodgson N, Lynn J, Spillman BC, Waidmann T, Wilkinson AM, Wolf DA. Promoting declines in the prevalence of late-life disability: comparisons of three potentially high-impact interventions. Milbank Q 2006; 84:493-520. [PMID: 16953808 PMCID: PMC2690252 DOI: 10.1111/j.1468-0009.2006.00456.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Although the prevalence of late-life disability has been declining, how best to promote further reductions remains unclear. This article develops and then demonstrates an approach for comparing the effects of interventions on the prevalence of late-life disability. We review evidence for three potentially high-impact strategies: physical activity, depression screening and treatment, and fall prevention. Because of the large population at risk for falling, the demonstrated efficacy of multi-component interventions in preventing falls, and the strong links between falls and disability, we conclude that, in the short run, multi-component fall-prevention efforts would likely have a higher impact than either physical activity or depression screening and treatment. However, longer-term comparisons cannot be made based on the current literature and may differ from short-run conclusions, since increases in longevity may temper the influences of these interventions on prevalence. Additional research is needed to evaluate longer-term outcomes of interventions, including effects on length and quality of life.
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Affiliation(s)
- Vicki A Freedman
- University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08903, USA.
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Jeske L, Kolmer V, Muth M, Cerns S, Moldenhaur S, Hook ML. Partnering with patients and families in designing visual cues to prevent falls in hospitalized elders. J Nurs Care Qual 2006; 21:236-41. [PMID: 16816604 DOI: 10.1097/00001786-200607000-00008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Prevention of falls in hospitalized elderly is critical to avoid injury and maintain independence. As part of a comprehensive program, nursing staff in a medical telemetry unit partnered with patients and their families to design and implement an educational poster to prevent falls. Ongoing patient/family feedback was used to modify the poster until it was appealing and effective for patients. The effort resulted in a marked decrease in falls on the unit over the pilot period.
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Affiliation(s)
- Lee Jeske
- St. Luke's Medical Center, Aurora Health Care, Milwaukee, Wis, USA.
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Neyens JCL, Dijcks BPJ, van Haastregt JCM, de Witte LP, van den Heuvel WJA, Crebolder HFJM, Schols JMGA. The development of a multidisciplinary fall risk evaluation tool for demented nursing home patients in the Netherlands. BMC Public Health 2006; 6:74. [PMID: 16551348 PMCID: PMC1479328 DOI: 10.1186/1471-2458-6-74] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 03/21/2006] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Demented nursing home patients are at high risk for falls. Falls and associated injuries can have a considerable influence on the autonomy and quality of life of patients. The prevention of falls among demented patients is therefore an important issue. In order to intervene in an efficient way in this group of patients, it is important to systematically evaluate the fall risk profile of each individual patient so that for each patient tailor-made preventive measures can be taken. Therefore, the objective of the present study is to develop a feasible and evidence based multidisciplinary fall risk evaluation tool to be used for tailoring preventive interventions to the needs of individual demented patients. METHODS To develop this multidisciplinary fall risk evaluation tool we have chosen to combine scientific evidence on the one hand and experts' opinions on the other hand. Firstly, relevant risk factors for falling in elderly persons were gathered from the literature. Secondly, a group of Dutch experts in the field of falls and fall prevention in the elderly were consulted to judge the suitability of these risk factors for use in a multidisciplinary fall risk evaluation tool for demented nursing home patients. Thirdly, in order to generate a compact list of the most relevant risk factors for falling in demented elderly, all risk factors had to fulfill a set of criteria indicating their relevance for this specific target population. Lastly the final list of risk factors resulting from the above mentioned procedure was presented to the expert group. The members were also asked to give their opinion about the practical use of the tool. RESULTS The multidisciplinary fall risk evaluation tool we developed includes the following items: previous falls, use of medication, locomotor functions, and (correct) choice and use of assistive and protective devices. The tool is developed for the multidisciplinary teams of the nursing homes. CONCLUSION This evidence and practice based multidisciplinary fall risk evaluation tool targets the preventive interventions aimed to prevent falls and their negative consequences in demented nursing home patients.
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Affiliation(s)
- Jacques CL Neyens
- Nursing Home de Riethorst, P.O. Box 35, 4931 AA Geertruidenberg, The Netherlands
- iRv, Institute for Rehabilitation Research, P.O. Box 192, 6430 AD Hoensbroek, The Netherlands
| | - Béatrice PJ Dijcks
- iRv, Institute for Rehabilitation Research, P.O. Box 192, 6430 AD Hoensbroek, The Netherlands
| | - Jolanda CM van Haastregt
- Department of Health Care Studies, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Vivre, Polvertorenstraat 4, 6211 LX Maastricht, The Netherlands
| | - Luc P de Witte
- iRv, Institute for Rehabilitation Research, P.O. Box 192, 6430 AD Hoensbroek, The Netherlands
| | - Wim JA van den Heuvel
- iRv, Institute for Rehabilitation Research, P.O. Box 192, 6430 AD Hoensbroek, The Netherlands
- Department of General Practice, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Harry FJM Crebolder
- Department of General Practice, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jos MGA Schols
- Vivre, Polvertorenstraat 4, 6211 LX Maastricht, The Netherlands
- Department of General Practice, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Faculty of Social and Behavioural Sciences, Department Tranzo, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
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Volkert W, Hassan A, Hassan MA, Smock VL, Connor JP, McFee B, Ferguson SK, Burke TJ. Effectiveness of Monochromatic Infrared Photo Energy and Physical Therapy for Peripheral Neuropathy: Changes in Sensation, Pain, and Balance–A Preliminary, Multi-Center Study. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2006. [DOI: 10.1080/j148v24n02_01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Injuries resulting from falls in elderly people are a major public-health concern, representing one of the main causes of longstanding pain, functional impairment, disability, and death in this population. The problem is going to worsen, since the rates of such injuries seem to be rising in many areas, as is the number of elderly people in both the developed and developing world. Many methods and programmes to prevent such injuries already exist, including regular exercise, vitamin D and calcium supplementation, withdrawal of psychotropic medication, cataract surgery, professional environment hazard assessment and modification, hip protectors, and multifactorial preventive programmes for simultaneous assessment and reduction of many of the predisposing and situational risk factors. To receive broader-scale effectiveness, these programmes will need systematic implementation. Care must be taken, however, to rigorously select the right actions for those people most likely to benefit, such as vitamin D and calcium supplementation and hip protectors for elderly people living in institutions.
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Affiliation(s)
- Pekka Kannus
- Accident & Trauma Research Centre, UKK Institute for Health Promotion Research, Tampere, Finland.
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Hass CJ, Gregor RJ, Waddell DE, Oliver A, Smith DW, Fleming RP, Wolf SL. The influence of Tai Chi training on the center of pressure trajectory during gait initiation in older adults11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2004; 85:1593-8. [PMID: 15468016 DOI: 10.1016/j.apmr.2004.01.020] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine if a program of intense Tai Chi exercise that has been shown to reduce the risk of falling in older adults improves postural control by altering the center of pressure (COP) trajectory during gait initiation. DESIGN Before-after trial. SETTING Biomechanics research laboratory. PARTICIPANTS Twenty-eight older adults transitioning to frailty who participated in either a 48-week intervention of intense Tai Chi training or a wellness education (WE) program. INTERVENTIONS Eight Tai Chi forms emphasizing trunk rotation, weight shifting, coordination, and narrowing of lower-extremity stance were taught twice weekly. WE program participants met once a week and received lectures focused on health. Main outcome measures The COP was recorded during gait initiation both before and after the 48-week intervention by using a forceplate sampling at 300 Hz. The COP trajectory was divided into 3 periods (S1, S2, S3) by identifying 2 landmark events. Displacement and average velocity of the COP trace in the anteroposterior (x) and mediolateral (y) directions, as well as smoothness, were calculated. RESULTS Tai Chi training increased the posterior displacement of the COP during S1 and improved the smoothness of the COP during S2. CONCLUSIONS Tai Chi improved the mechanism by which forward momentum is generated and improved coordination during gait initiation, suggesting improvements in postural control.
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Affiliation(s)
- Chris J Hass
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30332, USA.
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Sherrington C, Lord SR, Finch CF. Physical activity interventions to prevent falls among older people: update of the evidence. J Sci Med Sport 2004; 7:43-51. [PMID: 15214601 DOI: 10.1016/s1440-2440(04)80277-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Injuries resulting from falls are a significant public health issue, particularly for older people. This review provides an update of the evidence on the effects of various physical activity (PA) or exercise intervention strategies for the prevention of unintentional falls among older people. Six systematic reviews, and three randomised controlled trials not incorporated in previous reviews, were located with a literature search. There is clear evidence that a targeted supervised home exercise program of strength and balance exercise and walking practice, prescribed by a trained health professional, can prevent falls among older community dwellers. There is also an indication that untargeted group exercise (ie, not individually prescribed) can prevent falls among community dwellers, particularly if it involves Tai Chi or other exercises which challenge balance. There is some indication that individual prescription of PA is more important in frailer groups. Further investigation is required to establish the effects of PA in residential aged care, and the relative effects of different types of PA in different populations. In addition, multidisciplinary, multifactorial. health/environmental risk factor screening/intervention programs have been found to be effective in preventing falls. For many individuals with physical risk factors for falls (eg, impaired strength, balance or functional ability), PA alone is likely to reduce the risk of falls. For those with additional risk factors (eg, visual impairments, psychoactive medication use), other interventions may also be required.
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Affiliation(s)
- C Sherrington
- Prince of Wales Medical Research Institute, The University of New South Wales, Australia
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Hip Protector Compliance: A 13-Month Study on Factors and Cost in a Long-Term Care Facility. J Am Med Dir Assoc 2003. [DOI: 10.1016/s1525-8610(04)70367-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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