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Jiang H, Yuan H, Tee S, Lam Nogueira OCB. Perspectives and experiences of community-dwelling older adults who experience falling: A qualitative meta-synthesis. Int J Nurs Sci 2024; 11:276-285. [PMID: 38707695 PMCID: PMC11064561 DOI: 10.1016/j.ijnss.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/24/2024] [Accepted: 03/07/2024] [Indexed: 05/07/2024] Open
Abstract
Objectives This study aimed to systematically review and synthesize the perspectives and experiences of community-dwelling older adults who experience falling, to inform the subsequent development of fall prevention and management interventions, and to provide recommendations for healthcare policy and practice. Methods The review was a qualitative meta-aggregation study following the JBI qualitative systematic review methodology. Databases searched included Medline (through PubMed), CINAHL, PsycINFO, Embase, and the Web of Science. Peer-reviewed articles published in the English language from January 2010 to May 2023 were retrieved. The JBI Qualitative Assessment and Review Instrument (JBI-QARI) was used to assess the quality of the methodology. The ConQual ranking system was used to establish confidence in the synthesized findings. The protocol was registered with PROSPERO (CRD 42023421789). Results This review included ten qualitative studies with an overall quality score of 60%-90%. Data extracted from eligible studies resulted in 59 findings, which were then aggregated into seven categories based on the similarity in meaning. Three synthesized findings were generated and rated as moderate for synthesized finding 2 and low for synthesized finding 1 and 3 on the ConQual score. Synthesized finding 1: Older adults experience physical injuries and pain, restricted daily activities, and limitations in social activities, reduction or loss of in independence, and have feelings of fear and helplessness. Synthesized finding 2: After experiencing a fall, older adults reflect on the cause of the fall and recognize and interpret the risk factors. Synthesized finding 3: Older adults' reflections on the causes and impact of falls reveal both positive and negative reactions. They perceive a number of strategies for coping with falls and their consequences, such as using assistive devices, correcting risk factors, seeking medical help, and receiving ongoing physical and psychological attention. Conclusions Healthcare providers should pay attention to the feelings and experiences of older adults after falling, as well as their reflection on the causes and impacts of falling, and develop tailored plans for intervention. There is also a need for longitudinal studies to examine the longer-term impact of falls on older adults to provide insights into the stability and changes in their reflections, perceptions, attitudes, and preventive behaviors over time.
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Affiliation(s)
- Huimin Jiang
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China
| | - Haobin Yuan
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China
| | - Stephen Tee
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, England, UK
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Alfaro Hudak KM, Adibah N, Cutroneo E, Liotta M, Sanghera A, Weeks-Gariepy T, Strunz E, Rein DB. Older adults' knowledge and perception of fall risk and prevention: a scoping review. Age Ageing 2023; 52:afad220. [PMID: 38016017 DOI: 10.1093/ageing/afad220] [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: 05/12/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Falls are a leading cause of injury and mortality among older adults. While multiple strategies are effective at reducing fall risk, uptake is low. Understanding how older adults think about fall risk and prevention activities can inform outreach initiatives and engagement. METHODS We systematically searched PubMed, SCOPUS and Google Scholar for articles published between January 2015 and April 2023. Studies were eligible if they reported on knowledge or perception of fall risk and/or prevention among community-dwelling older adults. RESULTS We included 53 studies from 20 different countries. Over half of the studies used qualitative methods, 19 used quantitative, and three used mixed methods. Most of the older adults could identify some fall risk factors and the consequences of falls. However, many older adults did not view themselves as at-risk for falls. Some older adults consider falls an inevitable part of ageing, while others believe that falls can be prevented. Cultural context may play a role in shaping these beliefs. Several studies reported on older adults' experiences and the perceived barriers and facilitators of participating in fall prevention activities. CONCLUSION Improving the accuracy of older adults' perceptions of their own fall risk and highlighting the fact that many falls are preventable are two key messages that may help motivate older adults to take action to prevent falls. Older adults cite their healthcare provider as a trusted source of prevention information, and clinicians can leverage this opportunity to inform and motivate older adult patients about fall prevention.
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Affiliation(s)
- Katelin M Alfaro Hudak
- Public Health department, NORC at the University of Chicago, Chicago, IL, USA
- Texas A&M AgriLife Research, Texas A&M University, El Paso, TX, USA
| | - Nada Adibah
- Public Health department, NORC at the University of Chicago, Chicago, IL, USA
| | - Erin Cutroneo
- Public Health department, NORC at the University of Chicago, Chicago, IL, USA
| | - Madeleine Liotta
- Public Health department, NORC at the University of Chicago, Chicago, IL, USA
| | - Anmol Sanghera
- Public Health department, NORC at the University of Chicago, Chicago, IL, USA
| | - Tracy Weeks-Gariepy
- Centers for Disease Control and Prevention (CDC) Foundation, Atlanta, GA, USA
| | - Eric Strunz
- Centers for Disease Control and Prevention (CDC) Foundation, Atlanta, GA, USA
| | - David B Rein
- Public Health department, NORC at the University of Chicago, Chicago, IL, USA
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Alharbi AA, Al Amer HS, Albalwi AA, Muthaffar MY, Alshehre YM, Albalawi HF, Alshaikhi TE. Cross-Cultural Adaptation and Psychometric Properties of the Arabic Version of the Fall Risk Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085606. [PMID: 37107888 PMCID: PMC10139053 DOI: 10.3390/ijerph20085606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/22/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
A simple, valid, and reliable self-assessment fall-risk questionnaire in Arabic is needed to significantly promote awareness and develop fall-prevention programs. This study translated and adapted the Fall Risk Questionnaire (FRQ) into Arabic and determined its validity and reliability among Saudi Arabian older adults in two phases: (1) cross-culturally adapting the FRQ into Arabic and (2) assessing the adapted questionnaire's psychometric properties in two sessions with 110 Arabic-speaking participants aged ≥65 years. Pearson's r showed that the Arabic FRQ had a significant moderate negative relationship with the Berg Balance Scale and fair-to-moderate positive correlations with Five Time Sit to Stand and Time Up and Go. The receiver operating characteristic curve indicated a significant area under the curve = 0.81. The cut-off score was 7.5 and associated with 73.7% sensitivity and 73.6% specificity. Internal consistency was estimated as good, with Cronbach's α = 0.77. Deletion of item 1 slightly increased Cronbach's α to 0.78. The Arabic FRQ demonstrated excellent test-retest reliability, with an intraclass correlation coefficient = 0.95 (95% CI: 0.92-0.97). It is highly valid and reliable in providing valuable data for evaluating fall risk in adults aged ≥65 years and for consulting a specialist for further investigation if necessary.
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Affiliation(s)
- Ahmad A. Alharbi
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia
- Correspondence: ; Tel.: +966-504366366; Fax: +966-144562786
| | - Hamad S. Al Amer
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Abdulaziz A. Albalwi
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Majed Y. Muthaffar
- Department of Physical Therapy, King Fahad Hospital, Madinah 42392, Saudi Arabia
| | - Yousef M. Alshehre
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Hani F. Albalawi
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Turky E. Alshaikhi
- Department of Languages and Translation, Faculty of Arts and Education, University of Tabuk, Tabuk 71491, Saudi Arabia
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Meekes WMA, Leemrijse CJ, Korevaar JC, Stanmore EK, van de Goor LIAM. Implementing Falls Prevention in Primary Care: Barriers and Facilitators. Clin Interv Aging 2022; 17:885-902. [PMID: 35686030 PMCID: PMC9171056 DOI: 10.2147/cia.s354911] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Limited information is available concerning primary care providers’ encountered barriers and facilitators when implementing falls prevention and providing interventions in a real-life setting. This study aimed to identify barriers and facilitators when i) implementing a falls risk assessment strategy at GP practices and among community nurses and ii) providing evidence-based falls prevention interventions in a real-life setting to independently living, frail older people. Methods A researcher’s journal was maintained during the implementation of a falls risk assessment strategy, which entailed notes from informal conversations with GPs, practice nurses and community nurses. After implementation, two online focus groups with GPs, practice and community nurses, physio- and exercise therapists were conducted. Data were thematically analyzed. Results Data were collected from 32 GPs, 13 practice nurses, eight community nurses, nine physiotherapists, and two exercise therapists. The GPs and nurses acknowledged that falls prevention is part of their job, meaningful, and that they have sufficient knowledge and skills to offer falls prevention. Collaboration, a previously implemented care program for older people, resources, reimbursement for interventions, and patients’ motivation, awareness and health issues were considered to be important factors for the implementation of falls prevention. Physio- and exercise therapists described collaboration with different disciplines, receiving sufficient referrals, reimbursements, intensity and set-up of the interventions, and patients’ motivation, expectations, goals, self-confidence, awareness, and health issues as important factors when providing falls prevention interventions. Conclusion This study identified care provider-, context-, patient-, and innovation (strategy)-related barriers and facilitators when implementing falls prevention and providing interventions in primary care. Development of a more successful implementation strategy should focus on intensifying collaboration, reimbursement for interventions, availability of resources, and patients’ lack of motivation and health issues. Hence, falls prevention may become more structurally applied, reducing a major threat for the quality of life of independently living older people.
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Affiliation(s)
- Wytske M A Meekes
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Nivel, Utrecht, Netherlands
| | | | | | - Emma K Stanmore
- School of Health Sciences, University of Manchester, Manchester, UK and Manchester Academic Health Science Centre (MAHSC), Manchester, UK
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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: 4] [Impact Index Per Article: 2.0] [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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Koh L, Mackenzie L, Meehan M, Grayshon D, Lovarini M. The understanding and experience of falls among community-dwelling adults aged 50 and over living with mental illness: A qualitative study. Aging Ment Health 2022; 27:789-796. [PMID: 35139702 DOI: 10.1080/13607863.2022.2036949] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Compared to the general older population, older adults living with mental illness are at greater risk of falling and these risks can be present from middle age. This study aimed to explore the understanding of falls and the experiences community-dwelling adults aged 50 years and over living with mental illness who have had a fall, and to identify any falls prevention strategies valued by them. METHODS A qualitative descriptive approach was adopted. Ten adults with past experience of falls were recruited at a community mental health service in Sydney, Australia. Semi-structured interviews were conducted between July and September 2018. Interviews were transcribed verbatim and data were thematically analysed. RESULTS Three major themes emerged: (1) making sense of falls, (2) being self-reliant and enduring the consequences of falls, and (3) preventing future falls - perceptions and strategies. Most participants in this study were uncertain about the cause of their falls and seemed to have limited understanding of falls risk factors. They were also less likely to seek help after a fall, despite an injury. Consequences of falls included physical injuries and negative emotional impacts experienced following a fall. Most participants expressed a certain degree of concern regarding future falls, however, their strategy to prevent falls was to simply "be careful." CONCLUSION Adults aged over 50 years and living with mental illness in the community need support to identify and manage their falls risk. Fall prevention interventions tailored to the needs of this population are needed.
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Affiliation(s)
- Ling Koh
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Lynette Mackenzie
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Mandy Meehan
- Northern Beaches Older People's Mental Health Service (OPMHS), Brookvale, New South Wales, Australia
| | - Diane Grayshon
- Royal North Shore/Ryde Community Mental Health Service, Eastwood, New South Wales, Australia
| | - Meryl Lovarini
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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Meekes WMA, Leemrijse CJ, Weesie YM, van de Goor IAM, Donker GA, Korevaar JC. Falls prevention at GP practices: a description of daily practice. BMC FAMILY PRACTICE 2021; 22:190. [PMID: 34548022 PMCID: PMC8454103 DOI: 10.1186/s12875-021-01540-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND General practitioners (GPs) can be considered the designated professionals to identify high fall risk and to guide older people to fall preventive care. Currently it is not exactly known how GPs treat this risk. This study aims to investigate GPs' daily practice regarding fall preventive care for frail older patients. METHODS Sixty-five GPs from 32 Dutch practices participated in this study for a period of 12 months. When a GP entered specific International Classification of Primary Care-codes related to frailty and/or high fall risk in their Electronic Health Records, a pop-up appeared asking "Is this patient frail?". If the GP confirmed this, the GP completed a short questionnaire about patient's fall history and fear of falling (FOF), and the fall preventive care provided. RESULTS The GPs completed questionnaires regarding 1394 frail older patients aged ≥75. Of 20% of these patients, the GPs did not know whether they had experienced a fall or not. The GPs did not know whether a FOF existed in even more patients (29%). Of the patients with a fall history and/or a FOF (N = 726), 37% (N = 271) received fall preventive care. Two main reasons for not offering fall preventive care to these patients were: I) the patient finds treatment too intensive or too much of a hassle (37%), and II) the GP identified a high fall risk but the patient did not acknowledge this (14%). When patients were treated for high fall risk, the GP and the physiotherapist were the most frequently involved health care providers. The involved health care providers most often treated mobility limitations, cardiovascular risk factors, and FOF. CONCLUSIONS The results from this study show that GPs were frequently not aware of their frail patient's fall history and/or FOF and that the majority of the frail older patients with a fall history and/or FOF did not receive fall preventive care. Developing systematic screening strategies for the primary care setting enhancing the identification of high fall risk and the provision of fall preventive care may improve patients' quality of life and reduce health care costs.
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Affiliation(s)
- Wytske M A Meekes
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, Netherlands.
- NIVEL, Otterstraat 118-124, 3513 CR, Utrecht, Netherlands.
| | | | | | - Ien A M van de Goor
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, Netherlands
| | - Gé A Donker
- NIVEL, Otterstraat 118-124, 3513 CR, Utrecht, Netherlands
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Finnegan S, Bruce J, Seers K. Life after falls prevention exercise - experiences of older people taking part in a clinical trial: a phenomenological study. BMC Geriatr 2021; 21:91. [PMID: 33517904 PMCID: PMC7849142 DOI: 10.1186/s12877-021-02037-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022] Open
Abstract
Background There is little evidence about the lived experience of older people who have completed a falls prevention exercise programme and their life beyond their intervention. Method A phenomenological interview study with 23 participants (12 females), mean age 81 years (range 74–93 years), residing in their own homes across England, who had participated in a falls prevention exercise intervention within the Prevention of Falls Injury Trial (PreFIT). The aims were to explore their experiences of:
being in a clinical trial involving exercise. exercise once their falls prevention intervention had finished.
Interpretative data analysis was informed by van Manen’s (1997) framework for phenomenological data. Results Analysis of interviews about experiences of participating in PreFIT and what happened once the falls intervention ended identified five themes: Happy to help; Exercise behaviours; “It keeps me going”; “It wasn’t a real fall”; and Loss. Participants did not continue their specific exercises after they had completed the intervention. They preferred walking as their main exercise, and none reported preventing falls as a motivator to continue exercising. Participant experiences suggest that they have their own ideas about what constitutes a fall and there is disparity between their interpretation and the definition used by healthcare professionals and researchers. Conclusion Despite good intentions and perceived benefits, on-going participation in falls prevention exercises beyond a structured, supervised intervention was not a priority for these older people. Promoting continuation of falls prevention exercises post-intervention is just as challenging as promoting uptake to and adherence during exercise programmes. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02037-9.
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Affiliation(s)
- Susanne Finnegan
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
| | - Julie Bruce
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Shankar KN, Lin F, Epino H, Temin E, Liu S. Emergency department falls: a longitudinal analysis of revisits and hospitalisations between patients who fall and patients who did not fall. BMJ Open 2020; 10:e041054. [PMID: 33303454 PMCID: PMC7733199 DOI: 10.1136/bmjopen-2020-041054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Older adult falls are a national issue comprising 3 million emergency department (ED) visits and significant mortality. We sought to understand whether ED revisits and hospitalisations for fallers differed from non-fall patients through a secondary analysis of a longitudinal, statewide cohort of patients. DESIGN We performed a secondary analysis using the non-public Patient Discharge Database and the ED data from the California Office of Statewide Health Planning and Development. This is a 5-year, longitudinal observational dataset, which was used to assess outcomes for fallers and non-fall patients, defined as anyone who did not carry a fall diagnosis during this time period. SETTING 2005-2010 non-public Patient Discharge Database and the ED Data from the state of California. PARTICIPANTS Older adults 65 years and older MAIN OUTCOME MEASURE: ED revisits and hospitalisations for fallers and non-fall patients. RESULTS Patients who came to the ED with an index visit of a fall were more likely to be discharged home after their fall (61.1% vs 45.0%, p<0.001). Fallers who were discharged or hospitalised after their index visit were more likely to come back to the ED for a fall related complaint compared with non-fallers (median time: 151 days vs 352 days, p<0.001 and hospitalised: 45 days vs 119 days, p<0.01) and fallers who were initially discharged also returned to the ED sooner for a non-fall related complaint (median time: 325 days vs 352 days, p<0.001). CONCLUSION Fall patients tend to be discharged home more often after their index visit, but returned to the ED sooner compared with their non-fall counterparts. Given a faller's rates of ED revisits and hospitalisations, EDs should consider a fall as a poor prognostic indicator for future healthcare utilisation.
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Affiliation(s)
- Kalpana N Shankar
- Department of Emergency Medicine, Boston University Medical Campus, Boston, Massachusetts, USA
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Henry Epino
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elizabeth Temin
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shan Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Samson M, Davenport K, Rizzo C, Liu SW. Stand Up and Fight Falls: Can a Video Intervention Help Reduce Falls in the Geriatric Population? Cureus 2020; 12:e11508. [PMID: 33354452 PMCID: PMC7744203 DOI: 10.7759/cureus.11508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Falls are a major source of morbidity and mortality in the geriatric population. However, efforts to reduce falls have had limited success. This study examines if a video intervention presented in the ED to patients who have fallen could improve fall education and reduce future falls. Methods: Patients 65 years and older who presented to a large academic ED for a fall between June and December 2017 were identified via triage note for an intercept study. Patients who did not speak English, who were cognitively impaired, or whose condition was too acute (determined by providing physician) were excluded. Sixty-two eligible and consenting patients were shown a six-minute video intervention with recommendations to prevent future falls. Primary objectives include (1) whether patients found the recommendations reasonable to implement and (2) rate of implementation. Secondary aims were (3) perceived health status between patients who followed the recommendations versus those who did not and (4) rates of recurrent falls and ED revisits between the two groups. Data were analyzed using the Newcombe-Wilson Score Method and Fisher's exact two-tailed t-tests. Results: Of 62 patients enrolled, 38 were retained at a six-month follow-up. Ninety-two percent of patients found the video intervention to be a reasonable education tool. At six months, 44.7% of patients implemented behavioral changes discussed in the video, and 21.1% had at least one new fall, with no significant difference between people who implemented video interventions and those who did not (23.5% and 19.0%, difference 0.045, 95% CI [-0.24 to 0.34], p=1.0). The rate of return to the ED at six months for all patients was 31.6%, with no significant difference between the two groups (23.5% versus 38.1%, difference 0.146, 95% CI [-0.18 to 0.43], p=0.49). Difference in the proportion of people feeling the same or better between the two groups was not significant at either the one-month (66.7% versus 75.0%, difference 0.083, 95% CI [-0.21 to 0.34], p=0.75) or six-month follow up (64.7% versus 47.6%, difference 0.171, 95% CI [-0.17 to 0.46], p=0.34). Conclusion: This study found that while most patients find behavioral interventions feasible and reasonable to implement, only half actually make changes to their lives to reduce the risk of falling. This suggests that identifying and limiting barriers to implementation should be a priority in future studies, along with exploring the relationship between interventions and health status, ED revisits, and recurrent falls.
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Affiliation(s)
- Margot Samson
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Kathleen Davenport
- Emergency Medicine, University of North Carolina Hospital, Chapel Hill, USA.,Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Caroline Rizzo
- Emergency Medicine, Massachussetts General Hospital, Boston, USA
| | - Shan W Liu
- Emergency Medicine, Massachusetts General Hospital, Boston, USA.,Emergency Medicine, Harvard Medical School, Boston, USA
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O' Keeffe A, O' Grady S, Cronin F, Dolan C, O' Hea A, O' Shea KL, Naughton C. Evaluation of an emergency department falls pathway for older people: A patient chart review. Int Emerg Nurs 2020; 51:100869. [PMID: 32354620 DOI: 10.1016/j.ienj.2020.100869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Abstract
The number of older adults presenting to EDs following a fall continues to rise, yet falls management often ignores opportunities for secondary falls risk reduction. Advanced Nurse Practitioners (ANPs) in EDs have an important clinical leadership role in improving outcomes for this group of patients. AIM This study describes the development of an ANP led falls pathway in an ED to improve safe discharge. It evaluates compliance with the pathway and referrals to community falls prevention services. It also draws comparison with baseline practice as recorded in 2014. METHODS The Falls Pathway involves four steps: 1) screening at triage (3 questions), 2) risk stratification (low, medium, high), 3) risk assessment (lying and standing blood pressure (B/P), timed-up and go (TUG), 4-AT for delirium screening, polypharmacy), and 4) referral to community falls services. We undertook a 12-month chart review of all patients aged 65 years or older presenting following a fall to the ANP service in 2018. We compared data to a baseline audit in 2014; descriptive and Chi squared statistics were used to examine the data. RESULTS The 2018 audit involved 77 patients representing 27% of ANP caseload. A repeat fall occurred in 42% (32/77) of cases and 35% (22/77) reported a fear of falling. The Falls Pathway was initiated in nearly 80% (62/77) of patients and compliance with falls risk assessment ranged from 42% for lying and standing B/P to 75% for TUG. In 2014, a review of 59 patient charts showed 27% (16/59) experienced a repeat fall, but other risk factors such as fear of falling were not recorded. In 2018, the majority of patients (88%) discharged home were referred to community falls prevention services compared to 22% in 2014. CONCLUSION The Falls Pathway improved falls risk assessment in the ED, identified opportunities for risk reduction and optimised referral to community falls services. The pathway continues to be a valuable tool but requires resources for ongoing implementation among the wider ED team.
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Affiliation(s)
| | - Sile O' Grady
- Mercy University Hospital, Cork City, Co Cork, Ireland.
| | - Finola Cronin
- North Lee Community Health, Cork City, Co Cork, Ireland.
| | - Clodagh Dolan
- Mercy University Hospital, Cork City, Co Cork, Ireland.
| | - Ann O' Hea
- Mercy University Hospital, Cork City, Co Cork, Ireland.
| | - Katie Louise O' Shea
- School of Nursing and Midwifery, College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, College Road, Cork T12 AK54, Ireland.
| | - Corina Naughton
- UCC School of Nursing and Midwifery, Professor in Clinical Nursing in Older Person HealthCare, School of Nursing and Midwifery, College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, College Road, Cork T12 AK54, Ireland.
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Lee R, Moreland B. Aging without injury in the United States requires action today. JOURNAL OF SAFETY RESEARCH 2019; 70:272-274. [PMID: 31848005 PMCID: PMC7001090 DOI: 10.1016/j.jsr.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/02/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION In 2017, unintentional injuries were the seventh leading cause of death among older adults (age ≥ 65), resulting in over 55,000 deaths. Falls accounted for more than half of these deaths. Given that older adults are the fastest growing age group in the United States, we can anticipate that injuries will become an even greater health concern in the near future. METHODS Aging without injury is possible. There are evidence-based strategies that can reduce falls. However, older adults may not realize that falls can be prevented or they may be afraid to admit their fear of falling or difficulty with walking as these issues may signal their inability to live independently. RESULTS In this commentary, we will highlight what the Centers for Disease Control and Prevention is doing to prevent older adult falls. We also highlight the importance of broadening older adults' awareness about falls to successfully empower them to begin contemplating and preparing to adopt fall prevention strategies that can help them age in place. CONCLUSIONS Older adult falls are common and can result in severe injury and death but they can be prevented. Broadening older adults' awareness about falls can empower them to take the actions necessary to reduce their fall risk. Practical applications: Increasing awareness about falls can help older adults, healthcare providers, and local and state health departments take steps to reduce fall risk.
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Affiliation(s)
- Robin Lee
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 4770 Buford Highway, Atlanta, GA 30341, United States.
| | - Briana Moreland
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 4770 Buford Highway, Atlanta, GA 30341, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, United States
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