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Gagnon ME, Talbot D, Tremblay F, Desforges K, Sirois C. Polypharmacy and risk of fractures in older adults: A systematic review. J Evid Based Med 2024; 17:145-171. [PMID: 38517979 DOI: 10.1111/jebm.12593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/28/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Fractures have serious health consequences in older adults. While some medications are individually associated with increased risk of falls and fractures, it is not clear if this holds true for the use of many medications (polypharmacy). We aimed to identify what is known about the association between polypharmacy and the risk of fractures in adults aged ≥65 and to examine the methods used to study this association. METHODS We conducted a systematic review with narrative synthesis of studies published up to October 2023 in PubMed, Embase, CINAHL, PsychINFO, Cochrane Library, Web of Science, and the grey literature. Two independent reviewers screened titles, abstracts, and full texts, then performed data extraction and quality assessment. RESULTS Among the 31 studies included, 11 different definitions of polypharmacy were used and were based on three medication counting methods (concurrent use 15/31, cumulative use over a period 6/31, daily average 3/31, and indeterminate 7/31). Overall, polypharmacy was frequent and associated with higher fracture risk. A dose-response relationship between increasing number of medications and increased risk of fractures was observed. However, only seven studies adjusted for major confounders (age, sex, and chronic disease). The quality of the studies ranged from poor to high. CONCLUSIONS Polypharmacy appears to be a relevant modifiable risk factor for fractures in older individuals that can easily be used to identify those at risk. The diversity of medication calculation methods and definitions of polypharmacy highlights the importance of a detailed methodology to understand and compare results.
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Affiliation(s)
- Marie-Eve Gagnon
- Faculty of Pharmacy, Université Laval, Québec, Québec, Canada
- Department of Health Sciences, Université du Québec à Rimouski (UQAR), Rimouski, Québec, Canada
- Centre de recherche du CHU de Québec - Université Laval, Québec, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, VITAM - Centre de recherche en sante durable, Québec, Québec, Canada
| | - Denis Talbot
- Centre de recherche du CHU de Québec - Université Laval, Québec, Québec, Canada
- Department of Social and Preventive Medicine, Université Laval, Québec, Québec, Canada
- Faculty of Medicine, Université Laval, Québec, Québec, Canada
| | | | - Katherine Desforges
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
- Department of Pharmacy, McGill University Health Centre, Montréal, Québec, Canada
| | - Caroline Sirois
- Faculty of Pharmacy, Université Laval, Québec, Québec, Canada
- Centre de recherche du CHU de Québec - Université Laval, Québec, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, VITAM - Centre de recherche en sante durable, Québec, Québec, Canada
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Reider L, Falvey JR, Okoye SM, Wolff JL, Levy JF. Cost of U.S emergency department and inpatient visits for fall injuries in older adults. Injury 2024; 55:111199. [PMID: 38006782 DOI: 10.1016/j.injury.2023.111199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Falls are a leading cause of injury and hospital readmissions in older adults. Understanding the distribution of acute treatment costs across inpatient and emergency department settings is critical for informed investment and evaluation of fall prevention efforts. METHODS This study used the 2016-2018 National Inpatient Sample and National Emergency Department Sample. Annual treatment cost of fall injury among adults 65 years and older was estimated from charges, applying cost-to-charge and professional fee ratios. Weighted multivariable generalized linear models were used to separately estimate cost for inpatient and emergency department (ED) setting by injury type and individual demographic and health characteristics after adjusting for payer and hospital level characteristics. RESULTS Older adults incurred an estimated 922,428 inpatient and 2.3 million ED visits annually due to falls with combined annual costs of $19.8 billion. Over half of inpatient visits for fall injury were for fracture. Notably, 23% of inpatient visits were for fractures other than hip fracture and 14% of inpatient visits were for multiple fractures with costs totaling $3.4 billion and $2.5 billion, respectively. Annual ED costs were driven by superficial injury totaling $1.5 billion. Cost of ED visits were higher for adults 85 years and older (adjusted cost ratio (aCR): 1.11, 95% Confidence Interval (CI)I: 1.11-1.12) and those with dementia (aCR: 1.14, 95% CI: 1.13-1.15). Higher inpatient and ED visit cost was also associated with high-energy falls and discharge to post-acute care. CONCLUSION The study found that more than 3 million older adults in the United States seek hospital care for fall injuries annually, a major concern given increasing capacity strain on hospitals and EDs. The $20 billion in annual acute treatment costs attributed to fall injury indicate an urgent need to implement evidence-based fall prevention interventions and underscores the importance of newly launched ED-based fall prevention efforts and investments in geriatric emergency departments.
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Affiliation(s)
- Lisa Reider
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy, and Management, 624N. Broadway, Baltimore MD 21205, United States.
| | - Jason R Falvey
- Department of Physical Therapy and Rehabilitation Science, Department of Epidemiology and Public Health, University of Maryland School of Medicine, United States
| | - Safiyyah M Okoye
- Department of Graduate Nursing, Drexel University College of Nursing and Health Professions, United States; Department of Health Management and Policy, Drexel University Dornsife School of Public Health Philadelphia, PA, United States
| | - Jennifer L Wolff
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy, and Management, 624N. Broadway, Baltimore MD 21205, United States
| | - Joseph F Levy
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy, and Management, 624N. Broadway, Baltimore MD 21205, United States
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Ganta A, Meltzer-Bruhn AT, Esper GW, Konda SR, Egol KA. Does a hip fracture mean we should we operate on a concomitant proximal humerus fracture? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3435-3441. [PMID: 37184596 DOI: 10.1007/s00590-023-03529-7] [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: 01/31/2023] [Accepted: 03/13/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Concomitant upper extremity and hip fractures present a challenge in postoperative mobilization in the geriatric population. Operative fixation of proximal humerus fractures allows for upper extremity weight bearing. This retrospective study compared outcomes between operative and non-operative proximal humerus fracture patients with concomitant hip fractures. METHODS A trauma database of 13,396 patients age > 55 years old was queried for concomitant hip and proximal humerus fracture patients between 2014-2021. Medical records were reviewed for demographics, hospital quality measures, Neer classification, morphine milligram equivalents (MME), and outcomes. All hip fractures were treated operatively. Patients were grouped based on operative vs. non-operative treatment of their proximal humerus fracture. Primary outcomes included comparing postoperative ambulatory status, pain, length of stay (LOS), intensive care unit (ICU) need, discharge disposition, and readmission rates. RESULTS Forty-eight patients (0.4%) met inclusion criteria. Twelve patients (25%) underwent operative treatment for their proximal humerus fracture and 36 (75%) received non-operative treatment. Patients with operative fixations were younger (p < 0.01), had more complex Neer classifications (p = 0.031), more likely to be community ambulators (p < 0.01), and required more inpatient MMEs (p < 0.01). There were no differences in LOS (p = 0.415), need for ICU (p = 0.718), discharge location (p = 0.497), 30-day readmission (p = 0.228), or 90-day readmission (p = 0.135) between cohorts. At 6 months postoperatively, among community or household ambulators, a higher percentage of operative patients returned to their baseline ambulatory functional status, however, this was not significant (70% vs. 52%, p = 0.342). There were three deaths in the non-operative cohort and no deaths in the operative cohort. CONCLUSION Patients with hip fractures and concomitant proximal humerus fractures treated operatively required more inpatient MMEs and trended toward maintaining baseline ambulatory function. There were no differences in inpatient LOS, ICU need, discharge location, or readmissions. Future larger, multicenter studies are needed to further delineate if operative repair of concomitant proximal humerus fractures provides a benefit in the geriatric population.
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Affiliation(s)
- Abhishek Ganta
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Ariana T Meltzer-Bruhn
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
| | - Garrett W Esper
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
| | - Sanjit R Konda
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Kenneth A Egol
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA.
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA.
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Falvey JR, Chen C, Johnson A, Ryan KA, Shardell M, Ren H, Reider L, Magaziner J. Associations of Days Spent at Home Before Hip Fracture With Postfracture Days at Home and 1-Year Mortality Among Medicare Beneficiaries Living With Alzheimer's Disease or Related Dementias. J Gerontol A Biol Sci Med Sci 2023; 78:2356-2362. [PMID: 37402643 PMCID: PMC10692421 DOI: 10.1093/gerona/glad158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Hip fracture is a disabling event experienced disproportionately by older adults with Alzheimer's disease or related dementias (ADRD). Claims information recorded prior to a hip fracture could provide valuable insights into recovery potential for these patients. Thus, our objective was to identify distinct trajectories of claims-based days at home (DAH) before a hip fracture among older adults with ADRD and evaluate associations with postfracture DAH and 1-year mortality. METHODS We conducted a cohort study of 16 576 Medicare beneficiaries living with ADRD who experienced hip fracture between 2010 and 2017. Growth mixture modeling was used to estimate trajectories of DAH assessed from 180 days prior to fracture until index fracture admission, and their joint associations with postfracture DAH trajectories and 1-year mortality. RESULTS Before a hip fracture, a model with 3 distinct latent DAH trajectories was the best fit. Trajectories were characterized based on their temporal patterns as Consistently High (n = 14 980, 90.3%), Low but Increasing (n = 809, 5.3%), or Low and Decreasing (n = 787, 4.7%). Membership in the Low and Decreasing prefracture DAH trajectory was associated with less favorable postfracture DAH trajectories, and a 65% higher 1-year mortality rate (hazard ratio 1.65, 95% confidence interval 1.45-1.87) as compared to those in the Consistently High trajectory. Similar albeit weaker associations with these outcomes were observed for hip fracture survivors in the Low but Improving prefracture DAH trajectory. CONCLUSIONS Distinct prefracture DAH trajectories among hip fracture survivors with ADRD are strongly linked to postfracture DAH and 1-year mortality, which could guide development of tailored interventions.
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Affiliation(s)
- Jason R Falvey
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Chixiang Chen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Abree Johnson
- Department of Practice, Sciences and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Kathleen A Ryan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michelle Shardell
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Haoyu Ren
- Department of Mathematics and Statistics, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Lisa Reider
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Development of a prosthetic fit and alignment assessment (ProFit) in persons with post-traumatic transtibial amputation. Prosthet Orthot Int 2023; 47:599-606. [PMID: 37052578 DOI: 10.1097/pxr.0000000000000237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 02/05/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND There are no standards for reliably measuring the quality of prosthetic fit and alignment which is important for evaluation and improvement of clinical care for patients with transtibial amputation. OBJECTIVES The purpose of this study was to develop an instrument to quantitatively assess prosthetic fit and alignment in patients with transtibial amputation. STUDY DESIGN Prospective cohort study. METHODS The fit and alignment assessment (ProFit) included 39 items for assessments of skin quality, stance and gait, and radiographic characteristics that could be feasibly captured in clinic using photographs, video, and radiographs. Data were collected on adults aged 18-60 years treated with transtibial amputation and followed up for 18 months at 1 of 27 US hospitals. One hundred thirteen assessments were conducted by 6 prosthetists using an online platform. Items demonstrating reliability and face validity were included in the ProFit score for subsequent validation testing. Validation measures included 18-month patient-reported function (Short Musculoskeletal Function Assessment ), tests of physical performance, patient-reported pain (Brief Pain Inventory ), satisfaction with prosthesis (Orthotics Prosthetics Users Survey), prosthesis use, and walking activity. RESULTS The ProFit score included 10 of 39 items that demonstrated high inter-rater reliability and face validity. A higher ProFit score correlated with worse function on all domains of the Short Musculoskeletal Function Assessment except arm and hand and with worse performance on the 4-Square Step Test, Shuttle Run, and Illinois Agility Test. ProFit scores did not correlate with the Brief Pain Inventory, Orthotics Prosthetics Users Survey, prosthesis use, or walking activity. CONCLUSIONS The ProFit score can be used by researchers and clinicians to measure the quality of socket fit and prosthetic alignment. Future prospective validation is necessary to verify the promising results observed in ProFit development and establish clinical utility.
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Dong W, Lisitano LSJ, Marchand LS, Reider LM, Haller JM. Weight-bearing Guidelines for Common Geriatric Upper and Lower Extremity Fractures. Curr Osteoporos Rep 2023; 21:698-709. [PMID: 37973761 DOI: 10.1007/s11914-023-00834-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review paper is to summarize current weight-bearing guidelines for common geriatric fractures, around weight-bearing joints, of the upper and lower extremities. RECENT FINDINGS There is an increasing amount of literature investigating the safety and efficacy of early weight-bearing in geriatric fractures, particularly of the lower extremity. Many recent studies, although limited, suggest that early weight-bearing may be safe for geriatric distal femur and ankle fractures. Given the limited data pertaining to early weight-bearing in geriatric fractures, it is difficult to establish concrete weight-bearing guidelines in this population. However, in the literature available, early weight-bearing appears to be safe and effective across most injuries. The degree and time to weight-bearing vary significantly based on fracture type and treatment method. Future studies investigating postoperative weight-bearing protocols should focus on the growing geriatric population and identify methods to address specific barriers to early weight-bearing in these patients such as cognitive impairment, dependence on caregivers, and variations in post-acute disposition.
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Affiliation(s)
- Willie Dong
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Leonard S J Lisitano
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Lucas S Marchand
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Lisa M Reider
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Justin M Haller
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
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Orces CH. Trends in emergency department visits for fall-related fractures in U.S. older adults, 2001- 2020. Inj Prev 2023; 29:528-531. [PMID: 37562943 DOI: 10.1136/ip-2023-044911] [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] [Indexed: 08/12/2023]
Abstract
The present study analysed data from the National Electronic Injury Surveillance System All Injury Programme to examine trends in emergency department visits (EDs) for fall-related fractures in adults aged 65 years or older between 2001 and 2020. Overall, the estimated number of ED's visits for fall-related fractures increased from 574 000 in 2001 to 9 84 000 in 2020. After adjusting for age, fall-related fracture rates increased annually by 1.1% (95% CI: 0.4%, 1.7%) in women and by 1.3% (95% CI: 0.4%, 2.2%) in men between 2001 and 2012. Moreover, a non-significant increase in fracture rates was seen in both sexes between 2012 and 2016. From 2016 onward, fracture rates decreased annually in women by -5.0% (95% CI: -7.9%, -2.0%) and did not significantly change in men. This downward trend was mostly attributed to a decrease in fall-related fractures of the arm/hand, lower trunk, and among subjects aged 75 years and older. Therefore, it appears that fall-related fracture rates have recently decreased in U.S. older women.
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Canal C, Kaserer A, Morax LS, Ziegenhain F, Pape HC, Neuhaus V. Does the type of anesthesia (regional vs. general) represent an independent predictor for in-hospital complications in operatively treated malleolar fractures? A retrospective analysis of 5262 patients. Eur J Trauma Emerg Surg 2023; 49:1587-1593. [PMID: 36790446 PMCID: PMC10229458 DOI: 10.1007/s00068-023-02235-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/27/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE The impact of the type of anesthesia (regional vs. general anesthesia) on in-hospital complications in ankle fractures has not been thoroughly studied yet. Identifying factors that place patients at risk for complications following ankle fractures may help reduce their occurrence. The primary goal of this study was (1) to describe the cohort of patients and (2) to evaluate independent risk factors for complications during hospitalization. METHODS We analyzed patients from 2005 to 2019 with an operatively treated isolated fracture of the medial or lateral malleolus using a prospective national quality measurement database. Patients were selected based on international classifications (ICD) and national procedural codes (CHOP). Uni- and multivariate analysis were applied. RESULTS In total, we analyzed 5262 patients who suffered a fracture of the malleolus; 3003 patients (57%) had regional and 2259 (43%) general anesthesia. Patients with regional anesthesia were significantly older (51 vs. 46 years), but healthier (23 vs. 28% comorbidities) than patients who received general anesthesia. The in-hospital complication rate was not significantly lower in regional anesthesia (2.2% vs 3.0%). The type of anesthesia was not an independent predictor for complications while controlling for confounders. CONCLUSION Type of anesthesia was not an independent predictor of complications; however, higher ASA class, age over 70 years, fracture of the medial versus lateral malleolus, longer preoperative stay, and duration of surgery were significant predictors of complications. Patient and procedure characteristics, as well as changes in medical care and epidemiological changes along with patient requests, influenced the choice of the type of anesthesia.
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Affiliation(s)
- Claudio Canal
- Klinik für Traumatologie, Universitätsspital Zürich (USZ), Universität Zürich (UZH), Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Alexander Kaserer
- Klinik für Anästhesie, Universitätsspital Zürich (USZ), Universität Zürich (UZH), Rämistrasse 100, 8091, Zurich, Switzerland
| | - Laurent Sébastien Morax
- Klinik für Anästhesie, Kantonsspital Luzern (LUKS), Spitalstrasse 16, 6000, Lucerne, Switzerland
| | - Franziska Ziegenhain
- Klinik für Traumatologie, Universitätsspital Zürich (USZ), Universität Zürich (UZH), Rämistrasse 100, 8091, Zurich, Switzerland
| | - Hans-Christoph Pape
- Klinik für Traumatologie, Universitätsspital Zürich (USZ), Universität Zürich (UZH), Rämistrasse 100, 8091, Zurich, Switzerland
| | - Valentin Neuhaus
- Klinik für Traumatologie, Universitätsspital Zürich (USZ), Universität Zürich (UZH), Rämistrasse 100, 8091, Zurich, Switzerland
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Crawley MR, Chapman AJ, Koestner A, Pounders S, Krech L, Lypka M, Fisk C, Iskander G. Fall Risk Identification Throughout the Continuum of Care for Elderly Trauma Patients: An Injury Prevention Initiative. Injury 2022; 53:3715-3722. [PMID: 36075779 DOI: 10.1016/j.injury.2022.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 08/06/2022] [Accepted: 08/29/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Falls are the second leading cause of trauma-related deaths worldwide. Identifying fall risk patients and initiating interventions reduces injuries and mortality, particularly in the elderly. The primary aim of this retrospective study was to identify missed opportunities for fall risk identification and intervention for geriatric trauma patients. PATIENTS AND METHODS In this retrospective observational cohort study, the trauma registry was queried to identify geriatric patients admitted for a fall over 36 months. The electronic medical record (EMR) was reviewed to evaluate patients' fall risk in the 12 months prior to the index fall admission. The EMR was also queried for repeat falls within 12 months after discharge, and to determine if fall prevention education was provided at discharge. RESULTS 597 patients met inclusion criteria; 68.3% were female. 64.7% were at risk for falling in the year before admission. 2% had documented fall prevention education at discharge. 32% of patients fell again within a year of discharge and 19.4% were readmitted for a repeat fall. Patients at high risk for falls (on the Hester-Davis scale) were significantly more likely to be readmitted (p = 0.005) and expire within six months (p = 0.033) than moderate risk patients. Mortality at 12 months post-admission for all patients was 19.4%. CONCLUSION This large study demonstrated that geriatric trauma patients admitted for a fall were already at risk for falling in the 12 months prior to admission. This is a novel finding that presents a substantial prevention opportunity for healthcare systems. Education and implementation of proven techniques to prevent falls as soon as at-risk patients are identified has the potential to change the course for a patient who may not only fall, but also fall again. This proactive approach could significantly impact the fall epidemic in our elderly population.
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Affiliation(s)
- Meaghan R Crawley
- Spectrum Health Butterworth Hospital, Trauma Services, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Alistair J Chapman
- Spectrum Health Butterworth Hospital, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA; Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Amy Koestner
- Spectrum Health Butterworth Hospital, Trauma Services, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Steffen Pounders
- Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Laura Krech
- Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA.
| | - Matthew Lypka
- Spectrum Health Office of Research and Education, Biostatistics Core, 15 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Chelsea Fisk
- Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Gaby Iskander
- Spectrum Health Butterworth Hospital, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
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