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Mascarenhas M, Hill KD, Barker A, Burton E. Validity of the Falls Risk for Older People in the Community (FROP-Com) tool to predict falls and fall injuries for older people presenting to the emergency department after falling. Eur J Ageing 2019; 16:377-386. [PMID: 31543730 DOI: 10.1007/s10433-018-0496-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aims of this study were to (1) externally validate the accuracy of the Falls Risk for Older People in the Community (FROP-Com) falls risk assessment tool in predicting falls and (2) undertake initial validation of the accuracy of the FROP-Com to predict injurious falls (requiring medical attention) in people aged ≥ 60 years presenting to emergency departments (EDs) after falling. Two hundred and thirteen participants (mean age = 72.4 years; 59.2% women) were recruited (control group of a randomised controlled trial). A FROP-Com assessment was completed at a home visit within 2 weeks of ED discharge. Data on falls and injurious falls requiring medical attention were collected via monthly falls calendars for the next 12 months. Predictive accuracy was evaluated using sensitivity and specificity of a high-risk FROP-Com classification (score ≥ 19) in predicting a fall and injurious falls requiring medical attention. Fifty per cent of participants fell, with 60.4% of falls requiring medical attention. Thirty-two per cent were classified as high, 49% as moderate and 19% low falls risk. Low sensitivity was achieved for the FROP-Com high-risk classification for predicting falls (43.4%) and injurious falls (34.4%), although specificity was high (79.4% and 78.6%, respectively). Despite the FROP-Com's low predictive accuracy, the high fall rate and high falls risk of the sample suggest that older people who fall, present to ED and are discharged home are at high risk of future falls. In high-falls-risk populations such as in this study, the FROP-Com is not a valid tool for classifying risk of falls or injurious falls. Its potential value may instead be in identifying risk factors for falling to direct tailoring of falls prevention interventions to reduce future falls.
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Affiliation(s)
- Marlon Mascarenhas
- 1School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6485 Australia
| | - Keith D Hill
- 1School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6485 Australia
| | - Anna Barker
- 2Department of Epidemiology and Preventative Medicine, The Alfred Centre, Monash University, Melbourne, VIC 3004 Australia
| | - Elissa Burton
- 1School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6485 Australia
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Muray M, Bélanger CH, Razmak J. Fall prevention strategy in an emergency department. Int J Health Care Qual Assur 2018; 31:2-9. [PMID: 29504842 DOI: 10.1108/ijhcqa-09-2016-0122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to document the need for implementing a fall prevention strategy in an emergency department (ED). The paper also spells out the research process that led to approving an assessment tool for use in hospital outpatient services. Design/methodology/approach The fall risk assessment tool was based on the Morse Fall Scale. Gender mix and age above 65 and 80 years were assessed on six risk assessment variables using χ2 analyses. A logistic regression analysis and model were used to test predictor strength and relationships among variables. Findings In total, 5,371 (56.5 percent) geriatric outpatients were deemed to be at fall risk during the study. Women have a higher falls incidence in young and old age categories. Being on medications for patients above 80 years exposed both genders to equal fall risks. Regression analysis explained 73-98 percent of the variance in the six-variable tool. Originality/value Canadian quality and safe healthcare accreditation standards require that hospital staff develop and adhere to fall prevention policies. Anticipated physiological falls can be prevented by healthcare interventions, particularly with older people known to bear higher risk factors. An aging population is increasing healthcare volumes and medical challenges. Precautionary measures for patients with a vulnerable cognitive and physical status are essential for quality care.
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Affiliation(s)
| | | | - Jamil Razmak
- College of Business Administration, Al-ain University of Science and Technology, Abu Dhabi, United Arab Emirates
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Trevisan C, Di Gregorio P, Debiasi E, Pedrotti M, La Guardia M, Manzato E, Sergi G, March A. Decision tree for ward admissions of older patients at the emergency department after a fall. Geriatr Gerontol Int 2018; 18:1388-1392. [PMID: 30088330 DOI: 10.1111/ggi.13497] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 05/09/2018] [Accepted: 07/02/2018] [Indexed: 11/28/2022]
Abstract
AIM Falls are a prevalent issue for the older population, and for the healthcare system in terms of emergency department (ED) access and hospitalizations. There is still a lack of knowledge and guidelines, however, regarding the need to hospitalize older patients accessing the ED after a fall. In the present study, we aimed to analyze the factors and the decisional process that led to older patients accessing the ED after a fall being admitted to hospital or discharged. METHODS The study sample included 2144 older people who accessed the ED after a fall. For each patient, we obtained information on the nature of the fall and the related injuries, previous falls, dementia and ongoing medical therapies. As the outcome variable, we considered the indication for ward admission after the ED visit. RESULTS Of the 2144 individuals who accessed the ED after a fall, 38% had at least one fracture, and 40.1% were admitted to a ward. The decision tree obtained using the chi-squared automatic interaction detection algorithm showed that the indication for ward admission could be accurately predicted (risk estimate 0.205) by just five factors, namely: presence and severity of fall-related injuries, reportedly suspicious fall dynamics, use of anticoagulants, polypharmacy, and dementia. CONCLUSIONS The need for ward admission in older patients who access the ED after a fall seems to be determined not only by the severity of fall-related injuries, but also by the fall dynamics and the individual's clinical complexity. Geriatr Gerontol Int 2018; 18: 1388-1392.
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Affiliation(s)
- Caterina Trevisan
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | | | - Eugenio Debiasi
- Emergency Department, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Martina Pedrotti
- Department of Geriatrics, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Mario La Guardia
- Emergency Department, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Enzo Manzato
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy.,National Research Council, Institute of Neuroscience, Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | - Albert March
- Department of Geriatrics, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
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Abdalla A, Adhaduk M, Haddad RA, Alnimer Y, Ríos-Bedoya CF, Bachuwa G. Does acute care for the elderly (ACE) unit decrease the incidence of falls? Geriatr Nurs 2017; 39:292-295. [PMID: 29137820 DOI: 10.1016/j.gerinurse.2017.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/10/2017] [Accepted: 10/16/2017] [Indexed: 11/25/2022]
Abstract
To determine whether acute care for the elderly (ACE) units decrease the incidence of patient falls compared to general medical and surgical (GMS) units, a non-concurrent prospective study included individuals aged 65 and older admitted to ACE or GMS units over a 2-year span was done. There were 7069 admissions corresponded to 28,401 patient-days. A total of 149 falls were reported for an overall incidence rate (IR) of 5.2 falls per 1000 patient-days, 95% CI, 4.4/1000-6.1/1000 patient-days. The falls IR ratio for patients in ACE unit compared to those in non-ACE units after adjusting for age, sex, prescribed psychotropics and hypnotics, and Morse Fall Score was 0.27/1000 patient-days; 95% CI, 0.13-0.54; p < 0.001. So, an estimated 73% reduction in patient falls between ACE unit and non-ACE units. Hospitals may consider investing in ACE units to decrease the risk of falls and the associated medical and financial costs.
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Affiliation(s)
- Ahmed Abdalla
- Internal Medicine Residency Program, Hurley Medical Center, Michigan State University, 1 Hurley Plaza, Flint, MI 48503, USA.
| | - Mehul Adhaduk
- Internal Medicine Residency Program, Hurley Medical Center, Michigan State University, 1 Hurley Plaza, Flint, MI 48503, USA
| | - Raad A Haddad
- Internal Medicine Residency Program, Hurley Medical Center, Michigan State University, 1 Hurley Plaza, Flint, MI 48503, USA
| | - Yanal Alnimer
- Internal Medicine Residency Program, Hurley Medical Center, Michigan State University, 1 Hurley Plaza, Flint, MI 48503, USA
| | - Carlos F Ríos-Bedoya
- Internal Medicine Residency Program, Hurley Medical Center, Michigan State University, 1 Hurley Plaza, Flint, MI 48503, USA
| | - Ghassan Bachuwa
- Internal Medicine Residency Program, Hurley Medical Center, Michigan State University, 1 Hurley Plaza, Flint, MI 48503, USA
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Pain, not structural impairments may explain activity limitations in people with gluteal tendinopathy or hip osteoarthritis: A cross sectional study. Gait Posture 2017; 52:237-243. [PMID: 27951482 DOI: 10.1016/j.gaitpost.2016.12.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 02/02/2023]
Abstract
QUESTION What are the functional differences between people with greater trochanteric pain syndrome (GT), hip osteoarthritis (OA) or an asymptomatic population as measured by walking, Time Up and Go, single leg standing and strength? DESIGN Cross sectional study with blinded measurers. PARTICIPANTS 38 participants with GT, 20 with end stage hip OA and 21 asymptomatic healthy control (AS) participants. All participants were women. OUTCOME MEASURES Pain (numeric rating scale), Walking speed (m/s), cadence (steps/min) and step length (m) measured via the 10m walk test and the Timed Up and Go; balance via single leg stance (s) duration; and hip abduction, adduction, medial and lateral rotation strength, standardized to body mass (BM) via the body mass average index (BMavg), measured via a wall mounted dynamometer. RESULTS The two symptomatic groups reported similar pain levels (p=0.226), more pain then the AS group (p<0.000). Compared to the AS participants, participants with GT or hip OA demonstrated lower walking speed (10mwt and TUG, p<0.001), lower cadence and shorter duration single leg stance on the affected leg (p<0.05). Participants with GT or hip OA also demonstrated bilaterally weaker hip abduction than the AS group (p≤0.005). Compared to AS and GT participants, participants with hip OA demonstrated adduction weakness on the affected side (p=0.008 and p=0.002 respectively). CONCLUSION There is a significant level of dysfunction and impairments associated with GT and hip OA. As activity limitations do not appear to be differentiated by structural impairments, we suggest that pain, rather than the underlying pathology may be the driving impairment that leads to walking and single leg standing dysfunction.
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Pre-Procedural Patient Education Reduces Fall Risk in an Outpatient Endoscopy Suite. Gastroenterol Nurs 2015; 40:216-221. [PMID: 26458266 DOI: 10.1097/sga.0000000000000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this article was to determine whether scripted pre-procedural fall risk patient education and nurses' intention to assist patients after receiving sedation improves receptiveness of nursing assistance during recovery and decreases fall risk in an outpatient endoscopy suite. We prospectively identified high fall risk patients using the following criteria: (1) use of an assistive device, (2) fallen two or more times within the last year, (3) sustained an injury in a fall within a year, (4) age greater than 85 years, or (5) nursing judgment of high fall risk. Using a scripted dialogue, nurses educated high-risk patients of their fall risk and the nurses' intent to assist them to and in the bathroom. Documentation of patient education, script use, and assistance was monitored. Over 24 weeks, 892 endoscopy patients were identified as high fall risk; 790 (88.5%) accepted post-procedural assistance. Documentation of assistance significantly increased from 33% to 100%. Patients receiving education and postprocedural assistance increased from 27.9% to 100% at week 24. No patient falls occurred 12 months following implementation among patients identified as high fall risk. Scripted pre-procedural fall risk education increases patient awareness and receptiveness to assistance and can lead to decreased fall rates.
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Finch CF, Stephan K, Shee AW, Hill K, Haines TP, Clemson L, Day L. Identifying clusters of falls-related hospital admissions to inform population targets for prioritising falls prevention programmes. Inj Prev 2015; 21:254-9. [PMID: 25618735 PMCID: PMC4518748 DOI: 10.1136/injuryprev-2014-041351] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 01/07/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND There has been limited research investigating the relationship between injurious falls and hospital resource use. The aims of this study were to identify clusters of community-dwelling older people in the general population who are at increased risk of being admitted to hospital following a fall and how those clusters differed in their use of hospital resources. METHODS Analysis of routinely collected hospital admissions data relating to 45 374 fall-related admissions in Victorian community-dwelling older adults aged ≥65 years that occurred during 2008/2009 to 2010/2011. Fall-related admission episodes were identified based on being admitted from a private residence to hospital with a principal diagnosis of injury (International Classification of Diseases (ICD)-10-AM codes S00 to T75) and having a first external cause of a fall (ICD-10-AM codes W00 to W19). A cluster analysis was performed to identify homogeneous groups using demographic details of patients and information on the presence of comorbidities. Hospital length of stay (LOS) was compared across clusters using competing risks regression. RESULTS Clusters based on area of residence, demographic factors (age, gender, marital status, country of birth) and the presence of comorbidities were identified. Clusters representing hospitalised fallers with comorbidities were associated with longer LOS compared with other cluster groups. Clusters delineated by demographic factors were also associated with increased LOS. CONCLUSIONS All patients with comorbidity, and older women without comorbidities, stay in hospital longer following a fall and hence consume a disproportionate share of hospital resources. These findings have important implications for the targeting of falls prevention interventions for community-dwelling older people.
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Affiliation(s)
- Caroline F Finch
- Australian Centre for Research into Injury In Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
| | - Karen Stephan
- Monash Injury Research Institute (MIRI), Monash University, Clayton, Victoria, Australia
| | - Anna Wong Shee
- Australian Centre for Research into Injury In Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
| | - Keith Hill
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Terry P Haines
- Allied Health Research Unit, Monash Health, Monash University, Clayton, Victoria, Australia
| | - Lindy Clemson
- Ageing, Work & Health Research Unit, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Lesley Day
- Monash Injury Research Institute (MIRI), Monash University, Clayton, Victoria, Australia
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