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La Porta F, Lullini G, Caselli S, Valzania F, Mussi C, Tedeschi C, Pioli G, Bondavalli M, Bertolotti M, Banchelli F, D'Amico R, Vicini R, Puglisi S, Clerici PV, Chiari L. Efficacy of a multiple-component and multifactorial personalized fall prevention program in a mixed population of community-dwelling older adults with stroke, Parkinson's Disease, or frailty compared to usual care: The PRE.C.I.S.A. randomized controlled trial. Front Neurol 2022; 13:943918. [PMID: 36119666 PMCID: PMC9475118 DOI: 10.3389/fneur.2022.943918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Fall risk in the elderly is a major public health issue due to the injury-related consequences and the risk of associated long-term disability. However, delivering preventive interventions in usual clinical practice still represents a challenge. Aim To evaluate the efficacy of a multiple-component combined with a multifactorial personalized intervention in reducing fall rates in a mixed population of community-dwelling elderly compared to usual care. Design Randomized Controlled Trial (NCT03592420, clinicalTrials.gov). Setting Outpatients in two Italian centers. Population 403 community-dwelling elderly at moderate-to-high fall risk, including subjects with Parkinson's Disease and stroke. Methods After the randomization, the described interventions were administered to the intervention group (n = 203). The control group (n = 200) received usual care and recommendations to minimize fall risk factors. In addition, each participant received a fall diary, followed by 12 monthly phone calls. The primary endpoint was the total number of falls in each group over 12 months, while the secondary endpoints were other fall-related indicators recorded at one year. In addition, participants' functioning was assessed at baseline (T1) and 3-month (T3). Results 690 falls were reported at 12 months, 48.8% in the intervention and 51.2% in the control group, with 1.66 (± 3.5) and 1.77 (± 3.2) mean falls per subject, respectively. Subjects with ≥ 1 fall and ≥2 falls were, respectively, 236 (58.6%) and 148 (36.7%). No statistically significant differences were observed between groups regarding the number of falls, the falling probability, and the time to the first fall. According to the subgroup analysis, no significant differences were reported. However, a statistically significant difference was found for the Mini-BESTest (p = 0.004) and the Fullerton Advanced Balance Scale (p = 0.006) for the intervention group, with a small effect size (Cohen's d 0.26 and 0.32, respectively), at T1 and T3 evaluations. Conclusions The intervention was ineffective in reducing the number of falls, the falling probability, and the time to the first fall at 12 months in a mixed population of community-dwelling elderly. A significant improvement for two balance indicators was recorded in the intervention group. Future studies are needed to explore different effects of the proposed interventions to reduce falls and consequences.
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Affiliation(s)
- Fabio La Porta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giada Lullini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- *Correspondence: Giada Lullini
| | - Serena Caselli
- Rehabilitation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Franco Valzania
- Azienda Ospedaliera Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Chiara Mussi
- Rehabilitation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Claudio Tedeschi
- Azienda Ospedaliera Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Giulio Pioli
- Azienda Ospedaliera Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | - Marco Bertolotti
- Rehabilitation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Federico Banchelli
- Rehabilitation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Unit of Statistical and Methodological Support for Clinical Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto D'Amico
- Rehabilitation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Unit of Statistical and Methodological Support for Clinical Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Vicini
- Rehabilitation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Unit of Statistical and Methodological Support for Clinical Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Puglisi
- Rehabilitation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | | | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi” (DEI), University of Bologna, Bologna, Italy
- Health Sciences and Technologies Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
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Ferris H, Brent L, Sorensen J. Cost of hospitalisation for hip fracture-findings from the Irish hip fracture database. Osteoporos Int 2022; 33:1057-1065. [PMID: 35015086 PMCID: PMC8749353 DOI: 10.1007/s00198-021-06294-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022]
Abstract
UNLABELLED The authors utilised the Irish Hip Fracture Database (IHFD) to quantify the impact of hip fracture on the health service in terms of incidence, bed days and financial costs. The absolute number of hip fracture cases recorded by the IHFD has increased, as has the associated costs of hospitalisation. INTRODUCTION Hip fracture places a considerable clinical and financial burden on the healthcare system, with acute hospitalisation accounting for a substantial proportion of the costs incurred. This paper aimed to quantify the cost of hospitalisation for hip fracture in Ireland in terms of bed days and direct hospital costs. METHODS The authors analysed 23,494 cases in the Irish Hip Fracture Database (IHFD) from 2014 to 2020. Case numbers and length of stay were analysed annually. Hospital costs for hip fracture were described using the 2020 Activity-Based Funding Price List, which outlines the fees paid to public hospitals for inpatient activity. RESULTS For the time period 2014-2020, the total cost of hospitalisation for hip fracture was approximately €296 million, equating to approximately €11,700 per episode of care. The annual cost of hospitalisation increased from approximately €34 million in 2014 to €44 million in 2020. In 2020, the mean length of stay for hip fracture was 17 days accounting for > 62,600 acute hospital bed days. CONCLUSION The absolute number of hip fracture cases recorded by the IHFD has increased, as has the cost of hospitalisation. Given the current capacity issues and economic constraints, there is a growing need to prioritise time spent in the most expensive acute hospital setting to the immediate perioperative period and maximise the use of community services and early supportive discharge for the rehabilitation phase.
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Affiliation(s)
- H Ferris
- Department of Public Health, Health Service Executive-South, Cork, Ireland.
| | - L Brent
- National Office of Clinical Audit, Dublin, Ireland
| | - J Sorensen
- Healthcare Outcomes Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Golinelli D, Sanmarchi F, Capodici A, Gribaudo G, Altini M, Rosa S, Esposito F, Fantini MP, Lenzi J. Variations of the quality of care during the COVID-19 pandemic affected the mortality rate of non-COVID-19 patients with hip fracture. PLoS One 2022; 17:e0263944. [PMID: 35171967 PMCID: PMC8849602 DOI: 10.1371/journal.pone.0263944] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/30/2022] [Indexed: 02/07/2023] Open
Abstract
Introduction As COVID-19 roared through the world, governments worldwide enforced containment measures that affected various treatment pathways, including those for hip fractures (HFs). This study aimed to measure process and outcome indicators related to the quality of care provided to non-COVID-19 elderly patients affected by HF in Emilia-Romagna, a region of Italy severely hit by the pandemic. Methods We collected the hospital discharge records of all patients admitted to the hospitals of Emilia-Romagna with a diagnosis of HF from January to May in the years 2019 (pre-pandemic period) and 2020 (pandemic period). We analyzed surgery rate, surgery delays, length of hospital stay, timely rehabilitation, and 30-day mortality for each HF patient. We evaluated monthly data (2020 vs. 2019) with the chi-square and t-test, where appropriate. Logistic regression was used to investigate the differences in 30-day mortality. Results Our study included 5379 patients with HF. In April and May 2020, there was a significant increase in the proportion of HF patients that did not undergo timely surgery. In March 2020, we found a significant increase in mortality (OR = 2.22). Male sex (OR = 1.92), age ≥90 years (OR = 4.33), surgery after 48 hours (OR = 3.08) and not receiving surgery (OR = 6.19) were significantly associated with increased mortality. After adjusting for the aforementioned factors, patients hospitalized in March 2020 still suffered higher mortality (OR = 2.21). Conclusions There was a reduction in the overall quality of care provided to non-COVID-19 elderly patients affected by HF, whose mortality increased in March 2020. Patients’ characteristics and variations in processes of care partially explained this increase. Policymakers and professionals involved in the management of COVID-19 patients should be aware of the needs of patients with other health needs, which should be carefully investigated and included in future emergency preparedness and response plans.
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Affiliation(s)
- Davide Golinelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum–University of Bologna, Bologna, Italy
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum–University of Bologna, Bologna, Italy
- * E-mail:
| | - Angelo Capodici
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum–University of Bologna, Bologna, Italy
| | - Giorgia Gribaudo
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum–University of Bologna, Bologna, Italy
| | - Mattia Altini
- Healthcare Administration, AUSL Romagna, Ravenna, Italy
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum–University of Bologna, Bologna, Italy
| | - Francesco Esposito
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum–University of Bologna, Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum–University of Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum–University of Bologna, Bologna, Italy
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Drahota A, Felix LM, Raftery J, Keenan BE, Lachance CC, Mackey DC, Markham C, Laing AC. The SAFEST review: a mixed methods systematic review of shock-absorbing flooring for fall-related injury prevention. BMC Geriatr 2022; 22:32. [PMID: 34991466 PMCID: PMC8739972 DOI: 10.1186/s12877-021-02670-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Shock-absorbing flooring may minimise impact forces incurred from falls to reduce fall-related injuries; however, synthesized evidence is required to inform decision-making in hospitals and care homes. METHODS This is a Health Technology Assessment mixed methods systematic review of flooring interventions targeting older adults and staff in care settings. Our search incorporated the findings from a previous scoping review, MEDLINE, AgeLine, and Scopus (to September 2019) and other sources. Two independent reviewers selected, assessed, and extracted data from studies. We assessed risk of bias using Cochrane and Joanna Briggs Institute tools, undertook meta-analyses, and meta-aggregation. RESULTS 20 of 22 included studies assessed our outcomes (3 Randomised Controlled Trials (RCTs); 7 observational; 5 qualitative; 5 economic), on novel floors (N = 12), sports floors (N = 5), carpet (N = 5), and wooden sub-floors (N = 1). Quantitative data related to 11,857 patient falls (9 studies), and 163 staff injuries (1 study). One care home-based RCT found a novel underlay produced similar injurious falls rates (high-quality evidence) and falls rates (moderate-quality evidence) to a plywood underlay with vinyl overlay and concrete sub-floors. Very low-quality evidence suggested that shock-absorbing flooring may reduce injuries in hospitals (Rate Ratio 0.55, 95% CI 0.36 to 0.84, 2 studies; 27.1% vs. 42.4%; Risk Ratio (RR) = 0.64, 95% CI 0.44 to 0.93, 2 studies) and care homes (26.4% vs. 33.0%; RR 0.80, 95% CI 0.70 to 0.91, 3 studies), without increasing falls. Economic evidence indicated that if injuries are fewer and falls not increased, then shock-absorbing flooring would be a dominant strategy. Fracture outcomes were imprecise; however, hip fractures reduced from 30 in 1000 falls on concrete to 18 in 1000 falls on wooden sub-floors (OR 0.59, 95% CI 0.45 to 0.78; one study; very low-quality evidence). Staff found moving wheeled equipment harder on shock-absorbing floors leading to workplace adaptations. Very low-quality evidence suggests staff injuries were no less frequent on rigid floors. CONCLUSION Evidence favouring shock-absorbing flooring is uncertain and of very low quality. Robust research following a core outcome set is required, with attention to wider staff workplace implications. TRIAL REGISTRATION PROSPERO CRD42019118834 .
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Affiliation(s)
- Amy Drahota
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK.
| | - Lambert M Felix
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - James Raftery
- Wessex Institute, University of Southampton, Alpha House, Enterprise Road, Southampton, SO16 7NS, UK
| | - Bethany E Keenan
- School of Engineering, Cardiff University, Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK
| | - Chantelle C Lachance
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK
| | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive East, Burnaby, British Columbia, V5A 1S6, Canada
| | - Chris Markham
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK
| | - Andrew C Laing
- Department of Kinesiology, University of Waterloo, B.C. Matthews Hall, Waterloo, Ontario, N2L 3G1, Canada
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