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Ragione B, Rothburd L, Drucker T, Eckardt S, Eckardt PA. Screening for Risk of Fall-Related Inpatient Trauma in a US Acute Care Setting. Cureus 2024; 16:e63199. [PMID: 38933346 PMCID: PMC11203275 DOI: 10.7759/cureus.63199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Falls during hospitalization are a leading cause of preventable trauma-related injuries. Factors associated with fall risk include an unfamiliar environment, changes in health status, and efficacy based on the home environment. Assessing fall efficacy with an individualized prevention plan can decrease falls. The primary aim of this study was to estimate the effect of implementing a fall efficacy screening and intervention on reducing patient falls. Methods The study utilized a quasi-experimental, cross-sectional design with a convenience sample of patients admitted to an in-patient adult medical unit within a community hospital over a twelve-month period. Sampling times included pre-implementation, immediately post-implementation, and a second post-implementation phase. The intervention consisted of an admission fall efficacy screening tool and an individualized educational initiative. Statistical analysis included descriptive statistics of central tendency and dispersion, along with inferential statistics using independent sample t-tests, chi-square tests, correlations, and binary logistic regression. Results Among the study participants (n=2,074), the total sample had an average age of 67.7 (+/- 17.4) years and had mean scores of 13.3 (6.9) on the Short Falls Efficacy Scale-International and 51.8 (20.3) on the Morse Fall Scale. Fifty-two percent of the study population were female; 16.2% of the patients were diagnosed with cerebrovascular accident (CVA) or CVA-like symptoms. Fall rates decreased with a rate of change of -4.15% after efficacy screening and intervention. Males demonstrated higher efficacy in avoiding falls compared to females (t(828) = 3.369, p <0.001). Patients with a CVA diagnosis demonstrated higher efficacy scores compared to non-CVA patients (t(2071) = -3.348, p <0.001). FES risk groups (OR of 5.632, 95% CI (2.171-7.892)) and age over 65 (OR 1.21, 95% CI (1.006-1.442)) were significant predictors of a fall when patients with a primary CVA diagnosis were omitted from the sample (p= 0.022 and 0.046 respectively). Conclusion The findings suggest that efficacy screening may be associated with decreased falls for acute care non-CVA inpatient populations over 65 years of age. Further research into the predictive utility of fall efficacy screening in acute care CVA and non-CVA hospitalized patient populations aged 65 years and above is recommended.
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Affiliation(s)
- Barbara Ragione
- Nursing Quality Improvement, Good Samaritan University Hospital, West Islip, USA
| | | | | | - Sarah Eckardt
- Process Improvement, Northwell Health, Huntington, USA
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Sung P, Rowland P. Impact of sensory reweighting strategies on postural control using the sensory organization test in older adults with and without fall risks. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2075. [PMID: 38430540 DOI: 10.1002/pri.2075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 03/04/2024]
Abstract
BACKGROUND The Sensory Organization Test (SOT), an integral part of computerized dynamic posturography, plays a crucial role in evaluating postural stability under various altered sensory conditions. Despite its importance, there have been noted inconsistencies in the results pertaining to equilibrium and sensory system evaluations. This study aimed to compare four sensory analysis scores and equilibrium indices between older adults with and without fall risks. METHODS The study included 34 participants identified as being at risk of falls and 42 control subjects. To categorize individuals between the two groups, we performed area under the receiver operating characteristic curve analyses. This classification was based on scores from the Modified Falls Efficacy Scale (MFES) and the composite scores obtained from the SOT. In addition, we used the Tampa Scale for Kinesiophobia (TSK) as well as the level of disability. RESULTS The fall risk group demonstrated significantly higher TSK scores (39.39 ± 15.24 for control group vs. 54.65 ± 10.70 for fall risk group; t = -5.09, p = 0.001). The groups demonstrated a significant interaction on the equilibrium index (F = 4.59, p = 0.03), which was lower in the fall risk group in Condition 6 with a moving surface and surround and eyes open (t = 2.29, p = 0.01). The fall risk group demonstrated a higher somatosensory score (t = -1.73, p = 0.04). CONCLUSIONS The fall risk group had a lower equilibrium index score in Condition six of the SOT, which was useful for identifying deficits in vestibular function to integrate sensory information under challenging conditions for postural adaptation. This strategy suggested that the fall risk group could compensate for their risk of falls by utilizing more effective somatosensory reweighting strategies compared with the control group.
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Affiliation(s)
- Paul Sung
- Department of Physical Therapy, Indiana Wesleyan University, Marion, Indiana, USA
| | - Phyllis Rowland
- Department of Physical Therapy, Indiana Wesleyan University, Marion, Indiana, USA
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McNamara CS, Toner A, Murray L. Preventing falls in older people on mental health inpatient wards: a quality improvement project. Nurs Older People 2023; 35:18-23. [PMID: 36514871 DOI: 10.7748/nop.2022.e1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 12/15/2022]
Abstract
Older people on mental health inpatient wards are at high risk of falls due to a combination of physiological, pathophysiological and pharmacological factors. Falls prevention should therefore be a priority for nursing staff caring for this patient group. This article describes a quality improvement project conducted on four older adult mental health inpatient wards in Scotland. The project aimed to reduce the number of falls, increase staff's adherence to person-centred falls prevention care planning, and ensure every fall would prompt a post-fall review. Nursing staff participated in a falls prevention training session and registered nurses received, in addition, one-to-one coaching sessions on person-centred care planning. Despite the challenges faced by mental healthcare professionals at the time of the project, staff responded positively and there was a decrease in the number of falls, including falls resulting in harm.
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Affiliation(s)
| | - Alison Toner
- Ayrshire Central Hospital, NHS Ayrshire & Arran, Irvine, Scotland
| | - Lynne Murray
- elderly mental health inpatients, Ayrshire Central Hospital, NHS Ayrshire & Arran, Irvine, Scotland
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Oren G, Jolkovsky S, Tal S. Falls in oldest-old adults hospitalized in acute geriatric ward. Eur Geriatr Med 2022; 13:859-866. [PMID: 35776410 DOI: 10.1007/s41999-022-00660-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/09/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE The study aims to identify risk factors for falling among acutely ill older patients, hospitalized in acute geriatric ward. METHODS A retrospective study of 260 cases of patients who had fallen and 439 controls was conducted in a geriatric ward. We retrieved from the electronic hospital records data including patient demographics, medical diagnoses, and laboratory results, and drugs taken prior to the fall were reviewed. In addition, data on functional and cognitive status were recorded. Admission Morse Falls Scale for every patient was also retrieved. RESULTS The following on-admission diagnoses were associated with a higher incidence of falls during hospitalization: hypertension (84% vs. 38%), congestive heart failure (CHF), 74% vs 16%, dementia (36% vs. 5%), and delirium (36% vs 5%). A higher percentage of fallers compared to controls consumed beta blockers (69% vs. 53%), benzodiazepines (46% vs. 32%), antidepressants (33% vs. 23%), oral diabetes drugs (20% vs. 11%) and opiates (8% vs. 4%). On-admission Morse Falls Scale score was found to be higher in the patients who fell (59 vs.53). The strongest predictors of falling during hospitalization were CHF, hypertension, dementia, delirium, assisted mobility and dependence. CONCLUSION A systematic screening of risk factors for falls and identification of them might contribute to reducing the risk associated with falls during hospitalization.
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Affiliation(s)
- Gal Oren
- Acute Geriatrics Department at Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, 1, Derech Pasternak, st., Rehovot, Israel
| | - Svetlana Jolkovsky
- Geriatrics Department, Hartzfeld Hospital, Kaplan Medical Center, Gedera, Affiliated with the Hebrew University of Jerusalem, Rehovot, Israel
| | - Sari Tal
- Acute Geriatrics Department at Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, 1, Derech Pasternak, st., Rehovot, Israel. .,Geriatrics Department, Hartzfeld Hospital, Kaplan Medical Center, Gedera, Affiliated with the Hebrew University of Jerusalem, Rehovot, Israel.
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Adult Inpatients’ Perceptions of Their Fall Risk: A Scoping Review. Healthcare (Basel) 2022; 10:healthcare10060995. [PMID: 35742046 PMCID: PMC9222288 DOI: 10.3390/healthcare10060995] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Abstract
Patient falls in hospitals continue to be a global concern due to the poor health outcomes and costs that can occur. A large number of falls in hospitals are unwitnessed and mostly occur due to patient behaviours and not seeking assistance. Understanding these patient behaviours may help to direct fall prevention strategies, with evidence suggesting the need to integrate patients’ perspectives into fall management. The aim of this scoping review was to explore the extent of the literature about patients’ perceptions and experiences of their fall risk in hospital and/or of falling in hospital. This review was conducted using a five-stage methodological framework recommended by Arksey and O’Malley. A total of nine databases were searched using key search terms such as “fall*”, “perception” and “hospital.” International peer-reviewed and grey literature were searched between the years 2011 and 2021. A total of 41 articles, ranging in study design, met the inclusion criteria. After reporting on the article demographics and fall perception constructs and measures, the qualitative and quantitative findings were organised into five domains: Fall Risk Perception Measures, Patients’ Perceptions of Fall Risk, Patients’ Perceptions of Falling in Hospital, Patients’ Fear of Falling and Barriers to Fall Prevention in Hospital. Approximately two-thirds of study participants did not accurately identify their fall risk compared to that defined by a health professional. This demonstrates the importance of partnering with patients and obtaining their insights on their perceived fall risk, as this may help to inform fall management and care. This review identified further areas for research that may help to inform fall prevention in a hospital setting, including the need for further research into fall risk perception measures.
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Adams RB, Dudley JT, Struessel TS. Physical therapy to address fall risk in an individual with neurofibromatosis. Physiother Theory Pract 2021; 38:1823-1831. [PMID: 33497265 DOI: 10.1080/09593985.2021.1875523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: While physical therapy may help improve function and quality of life in patients with neurofibromatosis (NF), a standard of care remains to be established. This case report describes the physical therapy management of an individual with NF who was at high fall risk.Case Description: A 61-year-old male with NF and multiple comorbidities was determined to be at high fall risk by the Dynamic Gait Index, Berg Balance Scale, and Modified Falls Efficacy Scale. Deficits included coordination and strength which limited his ability to ascend and descend stairs or walk on uneven terrain. This reduced his independence at home and in his rural community. Interventions incorporated components of hip and trunk coordination, and addressed balance, strength, and functional mobility.Outcomes: The patient scored above the cutoff for high fall risk on all outcome assessments.Discussion: This case report describes physical therapy management to reduce fall risk for an individual with NF. Due to the limited research on NF, the treatment plan was developed using evidence-based practice for fall-risk reduction in other neurological disorders.
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Affiliation(s)
- Robert B Adams
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Justin T Dudley
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Cascade Sports Injury Prevention & Physical Therapy, Lakewood, CO, USA
| | - Tamara S Struessel
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Mascret N, Delbes L, Voron A, Temprado JJ, Montagne G. Acceptance of a Virtual Reality Headset Designed for Fall Prevention in Older Adults: Questionnaire Study. J Med Internet Res 2020; 22:e20691. [PMID: 33315019 PMCID: PMC7769685 DOI: 10.2196/20691] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/17/2020] [Accepted: 10/28/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Falls are a common phenomenon among people aged 65 and older and affect older adults' health, quality of life, and autonomy. Technology-based intervention programs are designed to prevent the occurrence of falls and their effectiveness often surpasses that of more conventional programs. However, to be effective, these programs must first be accepted by seniors. OBJECTIVE Based on the technology acceptance model, this study aimed to examine the acceptance among older adults before a first use of a virtual reality headset (VRH) used in an intervention program designed to prevent falls. METHODS A sample of 271 French older adults (mean age 73.69 years, SD 6.37 years) voluntarily and anonymously filled out a questionnaire containing the focal constructs (perceived usefulness, perceived enjoyment, perceived ease of use, intention to use, fall-related self-efficacy, and self-avoidance goals) adapted to the VRH, which was designed to prevent falls. RESULTS The results of the structural equation modeling analysis showed that intention to use the VRH was positively predicted by perceived usefulness, perceived enjoyment, and perceived ease of use. Perceived usefulness of the VRH was also negatively predicted by fall-related self-efficacy (ie, the perceived level of confidence of an individual when performing daily activities without falling) and positively predicted by self-avoidance goals (ie, participating in a physical activity to avoid physical regression). CONCLUSIONS A better understanding of the initial acceptance among older adults of this VRH is the first step to involving older adults in intervention programs designed to prevent falls using this kind of device.
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Affiliation(s)
| | - Lisa Delbes
- Aix Marseille Univ, CNRS, ISM, Marseille, France
| | - Amélie Voron
- Aix Marseille Univ, CNRS, ISM, Marseille, France
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Ifrach J, Basu R, Joshi DS, Flanders TM, Ozturk AK, Malhotra NR, Pessoa R, Kallan MJ, Maloney E, Welch WC, Ali ZS. Efficacy of an Enhanced Recovery After Surgery (ERAS) Pathway in Elderly Patients Undergoing Spine and Peripheral Nerve Surgery. Clin Neurol Neurosurg 2020; 197:106115. [DOI: 10.1016/j.clineuro.2020.106115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/25/2020] [Accepted: 07/25/2020] [Indexed: 01/22/2023]
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Ariza-Vega P, Shu H, Amarasekera R, Y. Edwards N, Filipski M, Langford D, Madden K, C. Ashe M. Older adults’ activity on a geriatric hospital unit: A behavioral mapping study. AIMS MEDICAL SCIENCE 2019. [DOI: 10.3934/medsci.2019.1.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Perrot A, Castanier C, Maillot P, Zitari H. French validation of the modified-falls efficacy scale (M-FES Fr). Arch Gerontol Geriatr 2018; 78:233-239. [PMID: 30025268 DOI: 10.1016/j.archger.2018.07.001] [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: 11/23/2017] [Revised: 07/02/2018] [Accepted: 07/02/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Among the tools assessing fall related self-efficacy, the Modified-Falls Efficacy Scale (M-FES) seems to be a comprehensive and sensitive scale. However, no validated French version exists to this day. OBJECTIVE This study aims to translate the M-FES and validate this French translation (M-FES Fr). METHOD The validation steps used to translate and validate the M-FES Fr were i) forward - backward translation, ii) examination of the internal structure and reliability, iii) evaluation of the convergent validity. In this study, 310 French-speaking older adults (56 geriatric patients and 254 community-dwelling older adults) completed the M-FES Fr. Among the community-dwelling older adults, 67 fallers and 70 non-fallers were also asked to complete questionnaires related to variables such as health, fear of falling, and physical activity levels. RESULTS A two-factor solution (indoor vs outdoor activities) was suggested, which accounted for 68.1% of the total variance. Reliability estimates for both factors were good (Cronbach α > 0.94, ICC > .93). Significant differences between geriatric patients and community-dwelling older adults and between fallers and non-fallers were highlighted. Furthermore, the M-FES Fr scores were significantly linked to various risk factors for falling. CONCLUSION The M-FES Fr has psychometric properties which are similar to those found in the original version, including reliability and validity. This questionnaire will enable French-speaking researchers and health professionals to work with the same concepts as those used in other languages. Notably, the M-FES Fr could be used in the development and evaluation of intervention strategies in the prevention of falls.
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Affiliation(s)
- Alexandra Perrot
- CIAMS, Univ. Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France; CIAMS, Université d'Orléans, 45067, Orléans, France.
| | - Carole Castanier
- CIAMS, Univ. Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France; CIAMS, Université d'Orléans, 45067, Orléans, France.
| | | | - Haifa Zitari
- hôpital de jour gérontologique de Richaud, Versailles, France.
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Kothari D, Struyvenberg MR, Perillo MC, Ezaz G, Freedman SD, Sheth SG. Extra-pancreatic complications, especially hemodialysis predict mortality and length of stay, in ICU patients admitted with acute pancreatitis. Gastroenterol Rep (Oxf) 2018; 6:202-209. [PMID: 30151205 PMCID: PMC6101622 DOI: 10.1093/gastro/goy005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/26/2017] [Accepted: 01/04/2018] [Indexed: 01/03/2023] Open
Abstract
Background and aims Patients in the intensive care unit (ICU) with acute pancreatitis (AP) are at risk for extra-pancreatic complications given their severe illness and prolonged length of stay. We sought to determine the rate of extra-pancreatic complications and its effect on length of stay (LOS) and mortality in ICU patients with AP. Methods We performed a retrospective cohort study of ICU patients admitted to a tertiary-care center with a diagnosis of AP. A total of 287 ICU patients had a discharge diagnosis of AP, of which 163 met inclusion criteria. We calculated incidence rates of extra-pancreatic complications and performed a univariate and multi-variable analysis to determine predictors of LOS and mortality. Results There were a total of 158 extra-pancreatic complications (0.97 extra-pancreatic complications per patient). Ninety-five patients had at least one extra-pancreatic complication, whereas 68 patients had no extra-pancreatic complications. Patients with extra-pancreatic complications had a significantly longer LOS (14.7 vs 8.8 days, p < 0.01) when controlling for local pancreatic complications. Patients with non-infectious extra-pancreatic complications had a higher rate of mortality (24.0% vs 16.2%, p = 0.04). Patients requiring dialysis was an independent predictor for LOS and mortality (incidence risk ratio [IRR] 1.73, 95% confidence interval [CI]: 1.263–2.378 and IRR 1.50, 95% CI 1.623–6.843, p < 0.01) on multi-variable analysis. Coronary events were also a predictor for mortality (p = 0.05). Other extra-pancreatic complications were not significant. Conclusions Extra-pancreatic complications occur frequently in ICU patients with AP and impact LOS. Patients with non-infectious extra-pancreatic complications have a higher mortality rate. After controlling for local pancreatic complications, patients requiring dialysis remained an independent predictor for LOS and mortality.
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Affiliation(s)
- Darshan Kothari
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Maarten R Struyvenberg
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Michael C Perillo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Ghideon Ezaz
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Steven D Freedman
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Sunil G Sheth
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
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12
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Pua YH, Ong PH, Clark RA, Matcher DB, Lim ECW. Falls efficacy, postural balance, and risk for falls in older adults with falls-related emergency department visits: prospective cohort study. BMC Geriatr 2017; 17:291. [PMID: 29268720 PMCID: PMC5740922 DOI: 10.1186/s12877-017-0682-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 12/07/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Risk for falls in older adults has been associated with falls efficacy (self-perceived confidence in performing daily physical activities) and postural balance, but available evidence is limited and mixed. We examined the interaction between falls efficacy and postural balance and its association with future falls. We also investigated the association between falls efficacy and gait decline. METHODS Falls efficacy, measured by the Modified Falls Efficacy Scale (MFES), and standing postural balance, measured using computerized posturography on a balance board, were obtained from 247 older adults with a falls-related emergency department visit. Six-month prospective fall rate and habitual gait speed at 6 months post baseline assessment were also measured. RESULTS In multivariable proportional odds analyses adjusted for potential confounders, falls efficacy modified the association between postural balance and fall risk (interaction P = 0.014): increasing falls efficacy accentuated the increased fall risk related to poor postural balance. Low baseline falls efficacy was strongly predictive of worse gait speed (0.11 m/s [0.06 to 0.16] slower gait speed per IQR decrease in MFES; P < 0.001). CONCLUSION Older adults with high falls efficacy but poor postural balance were at greater risk for falls than those with low falls efficacy; however, low baseline falls efficacy was strongly associated with worse gait function at follow-up. Further research into these subgroups of older adults is warranted. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01713543 .
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Affiliation(s)
- Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Peck-Hoon Ong
- Department of Physiotherapy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Ross Allan Clark
- Research Health Institute, University of the Sunshine Coast, Sunshine Coast, Australia
| | - David B Matcher
- Health Services & Systems Research Program, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Edwin Choon-Wyn Lim
- Department of Physiotherapy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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Gettens S, Fulbrook P, Jessup M, Low Choy N. The patients' perspective of sustaining a fall in hospital: A qualitative study. J Clin Nurs 2017; 27:743-752. [PMID: 28926152 DOI: 10.1111/jocn.14075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 01/03/2023]
Abstract
AIMS AND OBJECTIVES To understand the patient's perspective of falling in hospital. BACKGROUND A fall in hospital can affect a patient physically and psychologically, increasing their hospital length of stay and potentially putting them at risk of further complications. Despite a wealth of literature on falls that focuses on risk assessment, preventive interventions and cost, very little research has focused on the experience of the patient that has fallen, particularly within the acute hospital setting. DESIGN A qualitative phenomenological design was used to investigate the experience of falling in hospital. METHODS Twelve hospital inpatients that had recently fallen were interviewed while in hospital using unstructured interviews. The methodology was guided by Van Manen's approach to data collection and analysis. FINDINGS Three key themes emerged from the analysis: Feeling safe, Realising the risk and Recovering independence and identity. These themes describe a continuum whereby falling was not initially a concern to participants, who trusted staff to keep them safe, and tended to not seek assistance. As participants began to appreciate the reality of their falls risk, they felt disempowered by their loss of independence but were more receptive to receiving assistance. Finally, as participants recovered, their desire to regain independence increased. They wanted others to perceive them as physically competent, rather than as a frail older person, meaning they were more willing to take risks with mobility. CONCLUSION The participants' perspective of falling describes a continuum of responses with participants positioned at different psychosocial standpoints: from initial denial of their risk of falling to realisation of the importance of their fall and acceptance of its repercussions. RELEVANCE TO CLINICAL PRACTICE By understanding the patient's perspective of falling, nurses and other health professionals conducting risk assessment can tailor their discussions and interventions to the patient's perceptions and needs.
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Affiliation(s)
- Stephanie Gettens
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Banyo, QLD, Australia
| | - Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Banyo, QLD, Australia
| | - Melanie Jessup
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Banyo, QLD, Australia
| | - Nancy Low Choy
- Department of Physiotherapy, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Physiotherapy, Australian Catholic University, Banyo, QLD, Australia
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Reliability of an Installed Chair Exit Alarm System for Fall Prevention: A Double-Blind Randomized Controlled Trial. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2017. [DOI: 10.1097/jat.0000000000000067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Longitudinal Evaluation of Johns Hopkins Fall Risk Assessment Tool and Nurses' Experience. J Nurs Care Qual 2017; 32:242-251. [DOI: 10.1097/ncq.0000000000000235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Morello RT, Barker AL, Watts JJ, Haines T, Zavarsek SS, Hill KD, Brand C, Sherrington C, Wolfe R, Bohensky MA, Stoelwinder JU. The extra resource burden of in-hospital falls: a cost of falls study. Med J Aust 2016; 203:367. [PMID: 26510807 DOI: 10.5694/mja15.00296] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 09/07/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To quantify the additional hospital length of stay (LOS) and costs associated with in-hospital falls and fall injuries in acute hospitals in Australia. DESIGN, SETTING AND PARTICIPANTS A multisite prospective cohort study conducted during 2011-2013 in the control wards of a falls prevention trial (6-PACK). The trial included all admissions to 12 acute medical and surgical wards of six Australian hospitals. In-hospital falls data were collected from medical record reviews, daily verbal reports by ward nurse unit managers, and hospital incident reporting and administrative databases. Clinical costing data were linked for three of the six participating hospitals to calculate patient-level costs. OUTCOME MEASURES Hospital LOS and costs associated with in-hospital falls and fall injuries for each patient admission. RESULTS We found that 966 of a total of 27 026 hospital admissions (3.6%) involved at least one fall, and 313 (1.2%) at least one fall injury, a total of 1330 falls and 418 fall injuries. After adjustment for age, sex, cognitive impairment, admission type, comorbidity and clustering by hospital, patients who had an in-hospital fall had a mean increase in LOS of 8 days (95% CI, 5.8-10.4; P < 0.001) compared with non-fallers, and incurred mean additional hospital costs of $6669 (95% CI, $3888-$9450; P < 0.001). Patients with a fall-related injury had a mean increase in LOS of 4 days (95% CI, 1.8-6.6; P = 0.001) compared with those who fell without injury, and there was also a tendency to additional hospital costs (mean, $4727; 95% CI, -$568 to $10 022; P = 0.080). CONCLUSION Patients who experience an in-hospital fall have significantly longer hospital stays and higher costs. Programs need to target the prevention of all falls, not just the reduction of fall-related injuries.
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Wong JS, Brooks D, Mansfield A. Do Falls Experienced During Inpatient Stroke Rehabilitation Affect Length of Stay, Functional Status, and Discharge Destination? Arch Phys Med Rehabil 2015; 97:561-566. [PMID: 26711169 DOI: 10.1016/j.apmr.2015.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/01/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare length of stay, functional status, and discharge destination between individuals who fell during inpatient stroke rehabilitation and those who did not fall. DESIGN Retrospective cohort study. SETTING Rehabilitation hospital. PARTICIPANTS Individuals who fell during inpatient stroke rehabilitation (n=106; fallers group; mean age, 67.8±12.9y; mean time poststroke, 26.4±28.3d) were matched to individuals who did not fall (n=106; nonfallers group; mean age, 67.3±13.6y; mean time poststroke, 21.9±28.8d) on age and functional status (N=212). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Total length of stay, FIM assessed at discharge, and discharge destination. RESULTS The mean length of stay for fallers was 11 days longer than nonfallers (P=.0017). Nonfallers and fallers did not differ on discharge total FIM scores (P=.19), and both groups were discharged home after inpatient rehabilitation (nonfallers: 77%; fallers: 74%; P=.52). CONCLUSIONS This study suggests that falls experienced during inpatient stroke rehabilitation may have contributed to a longer length of stay; however, falls did not affect discharge functional status or discharge destination.
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Affiliation(s)
- Jennifer S Wong
- Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
| | - Dina Brooks
- Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; West Park Healthcare Centre, Toronto, ON, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada
| | - Avril Mansfield
- Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada; Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
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Salehi L, Shokrvash B, Jamshidi E, Montazeri A. Physical activity in Iranian older adults who experienced fall during the past 12 months. BMC Geriatr 2014; 14:115. [PMID: 25361641 PMCID: PMC4226854 DOI: 10.1186/1471-2318-14-115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 10/24/2014] [Indexed: 11/16/2022] Open
Abstract
Background Physical activity may have several benefits for elderly people. However, the risk of falling might prevent this population from showing interest in physical activity. This research was aimed to explore facilitators and barriers to physical activity in older persons who have experienced at least one fall in the past 12 months. Methods This cross sectional study was conducted in 2010-2011, in Tehran, Iran. Using a multistage sampling method a group of elderly people entered into the study. A multi-section questionnaire was used to collect data on demographic information, physical activity level, and different determinants that might influence physical activity. Several statistical tests including linear regression were used to analyze the data. Results In all, 180 old people from 40 elderly centers (49 men and 131 women) took part in the study. The mean age of participants was 65.9 ± 6.1 years. The result indicated that most participants experienced two or more falls during the last year (54.5%). Those who had more falls significantly scored lower on the Physical Activity Scale for Elderly (p < 0.0001). ‘Keeping in touch with friends’ was the most important advantage cited by participants for performing physical activity. The results obtained from linear regression analysis showed that ‘perceived benefits’ was the only significant factor that associated with physical activity (β = 1.03, p < 0.001). Conclusion The findings suggest that perceived benefits could facilitate physical activity among elderly regardless of number of falls, self-reported health and daily living activities. However, we observed inverse association between number of falls and physical activity. Indeed the findings suggest that we should reinforce benefits exist when designing programs to increase physical activity among elderly population.
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Affiliation(s)
| | | | - Ensiyeh Jamshidi
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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