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Shishov N, Komisar V, Marigold DS, Blouin JS, Robinovitch SN. Interactions during falls with environmental objects: evidence from real-life falls in long-term care captured on video. BMC Geriatr 2024; 24:726. [PMID: 39223462 PMCID: PMC11368007 DOI: 10.1186/s12877-024-05306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Falls are the leading cause of injuries in older adults. Environmental objects (such as furniture, walls, and handrails) may act as hazards or facilitators to balance maintenance and safe landing. There is lack of objective evidence on how older adults interact with objects during falls. We addressed this gap by characterizing body part contacts with objects other than the floor during real-life falls in long-term care. METHODS We analyzed videos of 1759 falls experienced by 584 residents to characterize the prevalence of contacts with objects before, during, and after fall initiation. Using generalized estimating equations, we compared the prevalence of falls with versus without contact to objects after fall initiation. Using linear mixed models, we tested for differences across body parts in the probability of contacting objects after fall initiation. RESULTS In nearly one-third of falls, interactions with objects (e.g., trips over objects, loss of support with objects) or with other people (e.g., being pushed by another person) had a primary role in causing imbalance and initiating the fall. After fall initiation, participants contacted objects in 60% of falls, with intentional hand contacts to objects via reach-to-grasp or bracing being the most common type of interaction (Probability ± SE = 0.32 ± 0.01), followed by unintentional impacts to the torso (0.21 ± 0.01) and head (0.16 ± 0.01). Intentional hand contact to an object was more common during forward than backward falls (p < 0.001), while head and torso contacts to objects were more common during backward and sideways falls than forward falls (multiple p values ≤ 0.003). The hand most often contacted chairs, wheelchairs or couches, followed by tables or counters, walls, other people, walkers, and handrails. The head, torso, and shoulder most often contacted a wall. CONCLUSIONS Most falls in long-term care involved contacts with objects other than the ground, indicating that complex environments often accompany falls in long-term care. Higher probabilities of intentional hand contacts in forward falls, versus unintentional head and torso impacts in backward and sideways falls may reflect the influence of being able to visualize and adjust one's falling patterns to nearby objects.
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Affiliation(s)
- Nataliya Shishov
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
| | - Vicki Komisar
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Daniel S Marigold
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- Institute for Neuroscience and Neurotechnology, Simon Fraser University, Burnaby, BC, Canada
| | - Jean-Sébastien Blouin
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Institute for Computing, Information and Cognitive Systems, University of British Columbia, Vancouver, BC, Canada
| | - Stephen N Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
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Ma Z, He Z, Li Z, Gong R, Hui J, Weng W, Wu X, Yang C, Jiang J, Xie L, Feng J. Traumatic brain injury in elderly population: A global systematic review and meta-analysis of in-hospital mortality and risk factors among 2.22 million individuals. Ageing Res Rev 2024; 99:102376. [PMID: 38972601 DOI: 10.1016/j.arr.2024.102376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/05/2024] [Accepted: 06/05/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Traumatic brain injury (TBI) among elderly individuals poses a significant global health concern due to the increasing ageing population. METHODS We searched PubMed, Cochrane Library, and Embase from database inception to Feb 1, 2024. Studies performed in inpatient settings reporting in-hospital mortality of elderly people (≥60 years) with TBI and/or identifying risk factors predictive of such outcomes, were included. Data were extracted from published reports, in-hospital mortality as our main outcome was synthesized in the form of rates, and risk factors predicting in-hospital mortality was synthesized in the form of odds ratios. Subgroup analyses, meta-regression and dose-response meta-analysis were used in our analyses. FINDINGS We included 105 studies covering 2217,964 patients from 30 countries/regions. The overall in-hospital mortality of elderly patients with TBI was 16 % (95 % CI 15 %-17 %) from 70 studies. In-hospital mortality was 5 % (95 % CI, 3 %-7 %), 18 % (95 % CI, 12 %-24 %), 65 % (95 % CI, 59 %-70 %) for mild, moderate and severe subgroups from 10, 7, and 23 studies, respectively. A decrease in in-hospital mortality over years was observed in overall (1981-2022) and in severe (1986-2022) elderly patients with TBI. Older age 1.69 (95 % CI, 1.58-1.82, P < 0.001), male gender 1.34 (95 % CI, 1.25-1.42, P < 0.001), clinical conditions including traffic-related cause of injury 1.22 (95 % CI, 1.02-1.45, P = 0.029), GCS moderate (GCS 9-12 compared to GCS 13-15) 4.33 (95 % CI, 3.13-5.99, P < 0.001), GCS severe (GCS 3-8 compared to GCS 13-15) 23.09 (95 % CI, 13.80-38.63, P < 0.001), abnormal pupillary light reflex 3.22 (95 % CI, 2.09-4.96, P < 0.001), hypotension after injury 2.88 (95 % CI, 1.06-7.81, P = 0.038), polytrauma 2.31 (95 % CI, 2.03-2.62, P < 0.001), surgical intervention 2.21 (95 % CI, 1.22-4.01, P = 0.009), pre-injury health conditions including pre-injury comorbidity 1.52 (95 % CI, 1.24-1.86, P = 0.0020), and pre-injury anti-thrombotic therapy 1.51 (95 % CI, 1.23-1.84, P < 0.001) were related to higher in-hospital mortality in elderly patients with TBI. Subgroup analyses according to multiple types of anti-thrombotic drugs with at least two included studies showed that anticoagulant therapy 1.70 (95 % CI, 1.04-2.76, P = 0.032), Warfarin 2.26 (95 % CI, 2.05-2.51, P < 0.001), DOACs 1.99 (95 % CI, 1.43-2.76, P < 0.001) were related to elevated mortality. Dose-response meta-analysis of age found an odds ratio of 1.029 (95 % CI, 1.024-1.034, P < 0.001) for every 1-year increase in age on in-hospital mortality. CONCLUSIONS In the field of elderly patients with TBI, the overall in-hospital mortality and its temporal-spatial feature, the subgroup in-hospital mortalities according to injury severity, and dose-response meta-analysis of age were firstly comprehensively summarized. Substantial key risk factors, including the ones previously not elucidated, were identified. Our study is thus of help in underlining the importance of treating elderly TBI, providing useful information for healthcare providers, and initiating future management guidelines. This work underscores the necessity of integrating elderly TBI treatment and management into broader health strategies to address the challenges posed by the aging global population. REVIEW REGISTRATION PROSPERO CRD42022323231.
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Affiliation(s)
- Zixuan Ma
- Brain Injury Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Shanghai Institute of Head Trauma, Shanghai 200127, China
| | - Zhenghui He
- Brain Injury Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Shanghai Institute of Head Trauma, Shanghai 200127, China
| | - Zhifan Li
- Brain Injury Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Shanghai Institute of Head Trauma, Shanghai 200127, China
| | - Ru Gong
- Brain Injury Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jiyuan Hui
- Brain Injury Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Weiji Weng
- Shanghai Institute of Head Trauma, Shanghai 200127, China
| | - Xiang Wu
- Shanghai Institute of Head Trauma, Shanghai 200127, China
| | - Chun Yang
- Shanghai Institute of Head Trauma, Shanghai 200127, China
| | - Jiyao Jiang
- Brain Injury Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Shanghai Institute of Head Trauma, Shanghai 200127, China
| | - Li Xie
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Junfeng Feng
- Brain Injury Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Shanghai Institute of Head Trauma, Shanghai 200127, China.
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Banaszak‐Holl J, Morello R, Soh S, Cameron P, Brown M, Mitsch V, Moubarak R, Winkler D. Do young people with neurological conditions in residential aged care use hospitals differently than those in the community? Evidence from Victorian hospital data, 2014-2017. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5907-e5915. [PMID: 36111880 PMCID: PMC10087403 DOI: 10.1111/hsc.14022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 07/08/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
This study describes the duration and reasons for hospitalisation for three cohorts of younger adults with neurological conditions who either used residential aged care (RAC) or lived in the community. Hospitalisations as a clinical event indicate conditions for which younger people in RAC may need support as they move into community-based housing. Data describing 3 years of hospitalisations in Victorian public hospitals and emergency departments were used. The neurological conditions occurring among the three cohorts include (1) Cerebral Vascular Accident (CVA), (2) Traumatic Brain Injury (TBI) and (3) Multiple Sclerosis (MS). Frequency of hospitalisation, length of stay and leading causes of potentially preventable hospitalisations were examined. Two hundred and fifty-two (2.7%) of 9333 patients hospitalised for these neurological conditions subsequently used RAC. Hospitalisations were more frequent for those using RAC compared to those living in the community for cohorts with CVA and TBI (6.26 vs. 2.65 events per person-year for CVA and 4.34 vs. 1.88 for TBI) while hospitalisations were more frequent among those in the community compared to those using RAC for the cohort living with MS (3.62 vs. 5.35 per person-year). However, for all the cohorts, the average length of acute hospital stays was longer among RAC users than among those in the community (19.6 vs. 6.2 days for CVA, 15.5 vs. 4.5 for TBI and 12.2 vs. 7.0 for MS). Leading causes for hospitalisation were complex comorbidities and changes in health status (such as seizures, ulcers, dehydration and cellulitis). Efforts should be made to design supports and proactively manage health needs leading to these hospitalisations.
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Affiliation(s)
- Jane Banaszak‐Holl
- School of Population Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of Health Services Administration, School of Health ProfessionsUniversity of Alabama – BirminghamBirminghamAlabamaUSA
| | - Renata Morello
- School of Population Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Sze‐Ee Soh
- School of Population Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- School of Primary and Allied Health CareMonash UniversityMelbourneVictoriaAustralia
| | - Peter Cameron
- School of Population Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Mark Brown
- Summer FoundationMelbourneVictoriaAustralia
- Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Virginia Mitsch
- Resolution Consulting and TherapyAlburyNew South WalesAustralia
| | - Rosemary Moubarak
- South Western Sydney Local Health DistrictLiverpoolNew South WalesAustralia
| | - Dianne Winkler
- Summer FoundationMelbourneVictoriaAustralia
- Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
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Yeganeh L, Bugeja L, Berecki J, Laughlin A, Ibrahim J. Injury-Related Emergency Department Presentations Among Residential Aged Care Residents in Victoria, Australia. J Aging Health 2021; 34:206-212. [PMID: 34404259 DOI: 10.1177/08982643211039299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to quantify and describe the characteristics of emergency department (ED) injury presentations and subsequent hospital admissions among residents of residential aged-care facilities (RACFs) in Victoria, Australia between 2008 and 2018. METHODS This study comprised a single jurisdiction population-based study of consecutive injury-related ED presentations of RACFs residents using the Victorian Emergency Minimum Dataset (VEMD). RESULTS The rate of ED injury presentations per 100,000 population decreased by .8% per year over 10 years (P = .03); however, the rate per 100,000 RACF bed days increased by .6% per year (P = .05). The proportion of presentations subsequently admitted to hospital increased 4.0% per year (P<.0001). The majority of presentations were due to falls (82.5%), with fracture(s) being the most common injury type (34.0%). DISCUSSION The increased rate of ED visits and hospital admissions in RACFs residents highlights the need to design specialized emergency care services and/or provide better direct access to hospital care for this vulnerable population.
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Affiliation(s)
- Ladan Yeganeh
- Department of Forensic Medicine, 2541Monash University, Southbank, VIC, Australia.,22457Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - Lyndal Bugeja
- Department of Forensic Medicine, 2541Monash University, Southbank, VIC, Australia.,22457Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - Janneke Berecki
- 367274Monash University Accident Research Centre, Clayton, VIC, Australia
| | - Adrian Laughlin
- 367274Monash University Accident Research Centre, Clayton, VIC, Australia
| | - Joseph Ibrahim
- Department of Forensic Medicine, 2541Monash University, Southbank, VIC, Australia.,22457Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia
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Burns Z, Khasnabish S, Hurley AC, Lindros ME, Carroll DL, Kurian S, Alfieri L, Ryan V, Adelman J, Bogaisky M, Adkison L, Ping Yu S, Scanlan M, Herlihy L, Jackson E, Lipsitz SR, Christiansen T, Bates DW, Dykes PC. Classification of Injurious Fall Severity in Hospitalized Adults. J Gerontol A Biol Sci Med Sci 2021; 75:e138-e144. [PMID: 31907532 DOI: 10.1093/gerona/glaa004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many hospital systems in the United States report injurious inpatient falls using the National Database of Nursing Quality Indicators categories: None, Minor, Moderate, Major, and Death. The Major category is imprecise, including injuries ranging from a wrist fracture to potentially fatal subdural hematoma. The purpose of this project was to refine the Major injury classification to derive a valid and reliable categorization of the types and severities of Major inpatient fall-related injuries. METHODS Based on published literature and ranking of injurious fall incident reports (n = 85) from a large Academic Medical Center, we divided the National Database of Nursing Quality Indicators Major category into three subcategories: Major A-injuries that caused temporary functional impairment (eg, wrist fracture), major facial injury without internal injury (eg, nasal bone fracture), or disruption of a surgical wound; Major B-injuries that caused long-term functional impairment or had the potential risk of increased mortality (eg, multiple rib fractures); and Major C-injuries that had a well-established risk of mortality (eg, hip fracture). Based on the literature and expert opinion, our research team reached consensus on an administration manual to promote accurate classification of Major injuries into one of the three subcategories. RESULTS The team tested and validated each of the categories which resulted in excellent interrater reliability (kappa = .96). Of the Major injuries, the distribution of Major A, B, and C was 40.3%, 16.1%, and 43.6%, respectively. CONCLUSIONS These subcategories enhance the National Database of Nursing Quality Indicators categorization. Using the administration manual, trained personnel can classify injurious fall severity with excellent reliability.
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Affiliation(s)
- Zoe Burns
- Partners HealthCare System, Boston, Massachusetts
| | | | - Ann C Hurley
- Partners HealthCare System, Boston, Massachusetts
| | | | | | | | | | | | - Jason Adelman
- New York-Presbyterian/Columbia University Medical Center, New York
| | | | | | - Shao Ping Yu
- New York-Presbyterian/Columbia University Medical Center, New York
| | | | - Lisa Herlihy
- Partners HealthCare System, Boston, Massachusetts
| | - Emily Jackson
- New York-Presbyterian/Columbia University Medical Center, New York
| | - Stuart R Lipsitz
- Partners HealthCare System, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - David W Bates
- Partners HealthCare System, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Patricia C Dykes
- Partners HealthCare System, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
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6
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Fall-induced hospital-treated traumatic brain injuries among elderly Finns in 1970–2017. Arch Gerontol Geriatr 2020; 86:103958. [DOI: 10.1016/j.archger.2019.103958] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/26/2019] [Accepted: 09/21/2019] [Indexed: 01/15/2023]
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Gardner RC, Dams-O'Connor K, Morrissey MR, Manley GT. Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions. J Neurotrauma 2018; 35:889-906. [PMID: 29212411 PMCID: PMC5865621 DOI: 10.1089/neu.2017.5371] [Citation(s) in RCA: 244] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This review of the literature on traumatic brain injury (TBI) in older adults focuses on incident TBI sustained in older adulthood ("geriatric TBI") rather than on the separate, but related, topic of older adults with a history of earlier-life TBI. We describe the epidemiology of geriatric TBI, the impact of comorbidities and pre-injury function on TBI risk and outcomes, diagnostic testing, management issues, outcomes, and critical directions for future research. The highest incidence of TBI-related emergency department visits, hospitalizations, and deaths occur in older adults. Higher morbidity and mortality rates among older versus younger individuals with TBI may contribute to an assumption of futility about aggressive management of geriatric TBI. However, many older adults with TBI respond well to aggressive management and rehabilitation, suggesting that chronological age and TBI severity alone are inadequate prognostic markers. Yet there are few geriatric-specific TBI guidelines to assist with complex management decisions, and TBI prognostic models do not perform optimally in this population. Major barriers in management of geriatric TBI include under-representation of older adults in TBI research, lack of systematic measurement of pre-injury health that may be a better predictor of outcome and response to treatment than age and TBI severity alone, and lack of geriatric-specific TBI common data elements (CDEs). This review highlights the urgent need to develop more age-inclusive TBI research protocols, geriatric TBI CDEs, geriatric TBI prognostic models, and evidence-based geriatric TBI consensus management guidelines aimed at improving short- and long-term outcomes for the large and growing geriatric TBI population.
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Affiliation(s)
- Raquel C. Gardner
- Department of Neurology, University of California San Francisco, and San Francisco VA Medical Center, San Francisco, California
- University of California San Francisco Weill Institute for Neurosciences, San Francisco, California
| | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Molly Rose Morrissey
- Department of Neurosurgery, Brain and Spinal Injury Center, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Geoffrey T. Manley
- University of California San Francisco Weill Institute for Neurosciences, San Francisco, California
- Department of Neurosurgery, Brain and Spinal Injury Center, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California
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Schumacher R, Müri RM, Walder B. Integrated Health Care Management of Moderate to Severe TBI in Older Patients-A Narrative Review. Curr Neurol Neurosci Rep 2017; 17:92. [PMID: 28986740 DOI: 10.1007/s11910-017-0801-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Traumatic brain injuries are common, especially within the elderly population, which is typically defined as age 65 and older. This narrative review aims at summarizing and critically evaluating important aspects of their health care management in covering the entire pathway from prehospital care to rehabilitation and beyond. RECENT FINDINGS The number of older patients with traumatic brain injury (TBI) is increasing, and there seem to be differences in all aspects of care along their pathway when compared to younger patients. Despite a higher mortality and a generally less favorable outcome, the current literature shows that older TBI patients have the potential to make significant improvements over time. More research is needed to evaluate the most efficient and integrated clinical pathway from prehospital interventions to rehabilitation as well as the optimal treatment of older TBI patients. Most importantly, they should not be denied access to specific treatments and therapies only based on age.
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Affiliation(s)
- Rahel Schumacher
- Department of Neurology, University Neurorehabilitation, Inselspital, University Hospital Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
| | - René M Müri
- Department of Neurology, University Neurorehabilitation, Inselspital, University Hospital Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Bernhard Walder
- Division of Anaesthesiology, University Hospitals of Geneva, Geneva, Switzerland
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