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Rizzato A, Bozzato M, Rotundo L, Zullo G, De Vito G, Paoli A, Marcolin G. Multimodal training protocols on unstable rather than stable surfaces better improve dynamic balance ability in older adults. Eur Rev Aging Phys Act 2024; 21:19. [PMID: 38997647 PMCID: PMC11241999 DOI: 10.1186/s11556-024-00353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/26/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND There has been growing interest in using unstable devices in training protocols. This study aimed to assess the effectiveness of two multimodal exercise interventions (i.e., on stable and unstable surfaces) on dynamic balance control and lower limb strength in older adults. METHODS Sixty-two older adults were randomly assigned to two intervention groups (N = 20, stable group; N = 19, unstable group), and to a control group (N = 18). In this single-blinded randomized controlled study, the two intervention groups underwent a 12-week training program twice a week for 45 min, consisting of strength and balance exercises. The stable (ST) group performed the training program over stable surfaces, while the unstable (UNST) group over unstable surfaces. Dynamic balance was assessed by computing the center of pressure (CoP) trajectory while a driven movable platform induced an unexpected perturbation of the base of support. Specifically, we considered the following CoP-related parameters within a 2.5-s temporal window from the beginning of the perturbation: displacement (Area95), mean velocity (Unit Path), anterior-posterior first peak (FP), post perturbation variability (PPV), and maximal oscillations (ΔCoPMax). The dominant quadriceps strength was measured through an isometric maximal voluntary contraction on an instrumented chair. RESULTS Four out of five CoP-related parameters (i.e., Area95, Unit Path, ΔCoPMax, and PPV) significantly improved in the UNST group from a minimum of 14.28% (d = 0.44) to a maximum of 52.82% (d = 0.58). The ST group significantly improved only in two (i.e., ΔCoPMax, and PPV) out of five CoP-related parameters with an enhancement of 12.48% (d = 0.68) and 19.10% (d = 1.06). Both intervention groups increased the maximal isometric quadriceps strength (UNST:17.27%, d = 0.69; ST:22.29%, d = 0.98). The control group did not show changes in any of the parameters considered. CONCLUSIONS Stable surfaces promoted faster increments of muscular strength. Unstable surfaces were more effective in enhancing dynamic balance efficiency. These findings suggested the employment of multimodal training on unstable rather than stable surfaces to potentially lower the incidence of falls in older adults. TRIAL REGISTRATION NCT05769361, retrospectively registered 13 March 2023, https://clinicaltrials.gov/study/NCT05769361?lat=45.3661864&lng=11.8209139&locStr=Padova,%20Italy&distance=50&page=11&rank=107 .
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Affiliation(s)
- Alex Rizzato
- Department of Biomedical Sciences, University of Padova, Via Marzolo, 3, Padova, 35131, Italy
| | - Matteo Bozzato
- Department of Biomedical Sciences, University of Padova, Via Marzolo, 3, Padova, 35131, Italy
| | - Luca Rotundo
- Department of Biomedical Sciences, University of Padova, Via Marzolo, 3, Padova, 35131, Italy
| | - Giuseppe Zullo
- Department of Industrial Engineering, University of Padova, Via Venezia, 1, Padova, 35131, Italy
| | - Giuseppe De Vito
- Department of Biomedical Sciences, University of Padova, Via Marzolo, 3, Padova, 35131, Italy
| | - Antonio Paoli
- Department of Biomedical Sciences, University of Padova, Via Marzolo, 3, Padova, 35131, Italy
| | - Giuseppe Marcolin
- Department of Biomedical Sciences, University of Padova, Via Marzolo, 3, Padova, 35131, Italy.
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Osei-Owusu C, Dhillon S, Luginaah I. The impact of food insecurity on mental health among older adults residing in low- and middle-income countries: A systematic review. PLoS One 2024; 19:e0301046. [PMID: 38530847 PMCID: PMC10965102 DOI: 10.1371/journal.pone.0301046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
Over the past few years, food insecurity has been increasing globally due to the COVID-19 pandemic, climate change, economic downturns and conflict and a number of other intersecting factors. Older adults residing in low- and middle-income countries are more vulnerable to food insecurity. While the impacts of food insecurity on physical health outcomes have been thoroughly researched, the effect on mental health outcomes remains under-researched, especially among older adults. Hence, this systematic review aims to investigate existing literature to assess how food insecurity impacts the mental health of older persons residing in LMICs. A systematic search of six databases and Google for studies was conducted. The search was limited to studies written in English and published between 2000 to the present. We identified 725 studies, out of which 40 studies were selected for a full-text review and 12 studies were included for a final analysis. The significant finding in all the included studies was that food insecurity is associated with the worsening mental health of older adults. We also found a complex interplay of factors such as gender, age, rural/urban and health conditions associated with the aggravation of several mental health outcomes. The findings of this study illuminate the need for improved food programs to improve food security and, consequently, mental health among older adults.
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Affiliation(s)
- Cornelius Osei-Owusu
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Satveer Dhillon
- Department of Geography and Environment, Western University, London, Ontario, Canada
| | - Isaac Luginaah
- Department of Geography and Environment, Western University, London, Ontario, Canada
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Smith MC, O'Loughlin J, Karageorgiou V, Casanova F, Williams GKR, Hilton M, Tyrrell J. The genetics of falling susceptibility and identification of causal risk factors. Sci Rep 2023; 13:19493. [PMID: 37945700 PMCID: PMC10636011 DOI: 10.1038/s41598-023-44566-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
Falls represent a huge health and economic burden. Whilst many factors are associated with fall risk (e.g. obesity and physical inactivity) there is limited evidence for the causal role of these risk factors. Here, we used hospital and general practitioner records in UK Biobank, deriving a balance specific fall phenotype in 20,789 cases and 180,658 controls, performed a Genome Wide Association Study (GWAS) and used Mendelian Randomisation (MR) to test causal pathways. GWAS indicated a small but significant SNP-based heritability (4.4%), identifying one variant (rs429358) in APOE at genome-wide significance (P < 5e-8). MR provided evidence for a causal role of higher BMI on higher fall risk even in the absence of adverse metabolic consequences. Depression and neuroticism predicted higher risk of falling, whilst higher hand grip strength and physical activity were protective. Our findings suggest promoting lower BMI, higher physical activity as well as psychological health is likely to reduce falls.
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Affiliation(s)
- Matt C Smith
- Genetics of Complex Traits, College of Biomedical and Clinical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Jessica O'Loughlin
- Genetics of Complex Traits, College of Biomedical and Clinical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Vasileios Karageorgiou
- Genetics of Complex Traits, College of Biomedical and Clinical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Francesco Casanova
- Genetics of Complex Traits, College of Biomedical and Clinical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Genevieve K R Williams
- Public Health and Sports Sciences Department, University of Exeter Medical School, Exeter, UK
| | - Malcolm Hilton
- Clinical and Biomedical Science, University of Exeter Medical School, Exeter, UK
| | - Jessica Tyrrell
- Genetics of Complex Traits, College of Biomedical and Clinical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
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Li H, Liu C, Ge Z, Mu X, Wang X, Xiu M, Wang X, Li Z. Efficacy of standard operating procedures for fall protection in hospitalized patients with schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:73. [PMID: 37848486 PMCID: PMC10582107 DOI: 10.1038/s41537-023-00396-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023]
Abstract
Fall-related injury is the most common cause of functional disability and mortality in the older population. Falls in patients with schizophrenia are one of the major concerns in psychiatric hospitals. This study aimed to examine the impact of standardized operating procedures (SOP) on falls in veterans with schizophrenia. Veterans with schizophrenia were allocated to the control group (n = 345) and to the fall protection standardized operating procedures (FP-SOP) group (n = 342). Patients in the control group were given routine nursing for falls, and patients in the FP-SOP group were intervened with FP-SOP plus routine nursing. All patients were observed for one year. The study methods comply with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. We found a fall rate of 1.5% in the FP-SOP group and 4.6% in the control group, with a significant difference in the fall rate between the two groups. In addition, the difference in patient satisfaction between the two groups was statistically significant. Our findings suggest that FP-SOP is an effective strategy for fall prevention in psychiatric hospitals.
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Affiliation(s)
- Hui Li
- Hebei Province Veterans Hospital, Baoding, China
| | - Caixing Liu
- Qingdao Mental Health Center, Qingdao, China
| | - Zengyun Ge
- Qingdao Mental Health Center, Qingdao, China
| | - Xishu Mu
- Hebei Province Veterans Hospital, Baoding, China
| | - Xuan Wang
- Hebei Province Veterans Hospital, Baoding, China
| | - Meihong Xiu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Xinfu Wang
- Hebei Province Veterans Hospital, Baoding, China
| | - Zezhi Li
- Department of Nutritional and Metabolic Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China.
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Gustavsson J, Nilson F, Bonander C. Compliant sports floors and fall-related injuries: evidence from a residential care setting and updated meta-analysis for all patient care settings. Inj Prev 2023; 29:283-289. [PMID: 36564164 PMCID: PMC10423535 DOI: 10.1136/ip-2022-044713] [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: 08/10/2022] [Accepted: 11/30/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Compliant flooring may prevent fall injuries in residential care, but evidence is inconclusive. We investigate compliant sports floors and fall-related injuries in a residential care setting and update a meta-analysis from a recent systematic review on compliant flooring. METHODS A non-randomised study comparing outcomes in a residential care unit that installed sports flooring in bedrooms with four units with regular flooring in a Norwegian municipality (n=193). Data on falls were collected for a period of 46 months (323 falls on sports flooring; 414 on regular flooring). Outcomes were injurious falls per person bed-day, falls per person bed-day and injury risks per fall. Confounding was adjusted for using Andersen-Gill proportional hazards and log-binomial regression models. Random-effects inverse variance models were used to pool estimates. RESULTS Injurious fall rates were 13% lower in the unit with sports flooring (adjusted HR (aHR): 0.87 (95% CI: 0.55 to 1.37)). There was limited evidence of adverse effects on fall rates (aHR: 0.93 (95% CI: 0.63 to 1.38)) and the injury risk per fall was lower in fall events that occurred on sports floors (adjusted relative risk (RR): 0.75 (95% CI: 0.53 to 1.08)). Pooling these estimates with previous research added precision, but the overall pattern was the same (pooled RR for injurious falls: 0.66 (95% CI: 0.39 to 1.12); fall rates: 0.87 (95% CI: 0.68 to 1.12); injury risks per fall: 0.71 (95% CI: 0.52 to 0.97)). CONCLUSION Sports floors may be an alternative to novel shock-absorbing floors in care settings; however, more research is needed to improve precision.
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Affiliation(s)
- Johanna Gustavsson
- Department of Political, Historical, Religious and Cultural Studies, Karlstad University, Karlstad, Sweden
- Centre for Public Safety, Karlstads Universitet, Karlstad, Sweden
| | - Finn Nilson
- Department of Political, Historical, Religious and Cultural Studies, Karlstad University, Karlstad, Sweden
- Centre for Public Safety, Karlstads Universitet, Karlstad, Sweden
| | - Carl Bonander
- Centre for Public Safety, Karlstads Universitet, Karlstad, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Roberts M. Patient falls while under supervision: trends from incident reporting. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:508-513. [PMID: 37289705 DOI: 10.12968/bjon.2023.32.11.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In one large UK hospital trust, data from the electronic incident reporting system were studied to determine the number of falls within one division taking place while patients were under enhanced supervision. This supervision was commonly carried out by registered nurses or healthcare assistants. It was noted that, despite increased supervision, patients were still falling and when they did the degree of harm they suffered was often greater than for those patients not under supervision. It was also noted that more male patients fell under supervision than female patients, although the reasons for this were not clear, suggesting an area for further research. A large number of patients fell while in the bathroom, where they were often left alone for periods of time. This shows an increasing need to find a balance between maintaining patient dignity and ensuring patient safety.
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Affiliation(s)
- Matthew Roberts
- Anticoagulation Nurse Specialist, Queen's Medical Centre, Nottingham
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Womack JA, Murphy TE, Leo-Summers L, Bates J, Jarad S, Gill TM, Hsieh E, Rodriguez-Barradas MC, Tien PC, Yin MT, Brandt CA, Justice AC. Assessing the contributions of modifiable risk factors to serious falls and fragility fractures among older persons living with HIV. J Am Geriatr Soc 2023; 71:1891-1901. [PMID: 36912153 PMCID: PMC10258163 DOI: 10.1111/jgs.18304] [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: 10/26/2022] [Revised: 01/14/2023] [Accepted: 01/25/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Although 50 years represents middle age among uninfected individuals, studies have shown that persons living with HIV (PWH) begin to demonstrate elevated risk for serious falls and fragility fractures in the sixth decade; the proportions of these outcomes attributable to modifiable factors are unknown. METHODS We analyzed 21,041 older PWH on antiretroviral therapy (ART) from the Veterans Aging Cohort Study from 01/01/2010 through 09/30/2015. Serious falls were identified by Ecodes and a machine-learning algorithm applied to radiology reports. Fragility fractures (hip, vertebral, and upper arm) were identified using ICD9 codes. Predictors for both models included a serious fall within the past 12 months, body mass index, physiologic frailty (VACS Index 2.0), illicit substance and alcohol use disorders, and measures of multimorbidity and polypharmacy. We separately fit multivariable logistic models to each outcome using generalized estimating equations. From these models, the longitudinal extensions of average attributable fraction (LE-AAF) for modifiable risk factors were estimated. RESULTS Key risk factors for both outcomes included physiologic frailty (VACS Index 2.0) (serious falls [15%; 95% CI 14%-15%]; fractures [13%; 95% CI 12%-14%]), a serious fall in the past year (serious falls [7%; 95% CI 7%-7%]; fractures [5%; 95% CI 4%-5%]), polypharmacy (serious falls [5%; 95% CI 4%-5%]; fractures [5%; 95% CI 4%-5%]), an opioid prescription in the past month (serious falls [7%; 95% CI 6%-7%]; fractures [9%; 95% CI 8%-9%]), and diagnosis of alcohol use disorder (serious falls [4%; 95% CI 4%-5%]; fractures [8%; 95% CI 7%-8%]). CONCLUSIONS This study confirms the contributions of risk factors important in the general population to both serious falls and fragility fractures among older PWH. Successful prevention programs for these outcomes should build on existing prevention efforts while including risk factors specific to PWH.
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Affiliation(s)
- Julie A. Womack
- VA Connecticut Healthcare System, West Haven, CT
- Yale School of Nursing, West Haven, CT
| | | | | | - Jonathan Bates
- VA Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | | | | | - Evelyn Hsieh
- VA Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | - Maria C. Rodriguez-Barradas
- Infectious Diseases Section, Michael E DeBakey VA Medical Center, and Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Phyllis C. Tien
- University of California, San Francisco, and Department of Veterans Affairs, San Francisco, CA
| | | | - Cynthia A. Brandt
- VA Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | - Amy C. Justice
- VA Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
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Varpula J, Välimäki M, Pulkkinen J, Lantta T. Patient Falls in Seclusion Rooms in Psychiatric Inpatient Care: A Sociotechnical Probabilistic Risk Modeling Study. J Nurs Care Qual 2023; 38:190-197. [PMID: 36476941 PMCID: PMC9944373 DOI: 10.1097/ncq.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patient falls are a major adverse event in psychiatric inpatient care. PURPOSE To model the risk for patient falls in seclusion rooms in psychiatric inpatient care. METHODS Sociotechnical probabilistic risk assessment (ST-PRA) was used to model the risk for falls. Data sources were the research team, literature review, and exploration groups of psychiatric nurses. Data were analyzed with fault tree analysis. RESULTS The risk for a patient fall in a seclusion room was 1.8%. Critical paths included diagnosis of a psychiatric disorder, the mechanism of falls, failure to assess and prevent falls, and psychological or physical reason. The most significant individual risk factor for falls was diagnosis of schizophrenia. CONCLUSIONS Falls that occur in seclusion events are associated with physical and psychological risk factors. Therefore, risk assessment methods and fall prevention interventions considering patient behavioral disturbance and physiological risk factors in seclusion are warranted.
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Affiliation(s)
- Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland (Mr Varpula and Drs Välimäki and Lantta); Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Central South University, Hunan, China (Dr Välimäki); Hospital District of Southwest Finland, Turku, Finland (Dr Pulkkinen); and Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom (Dr Lantta)
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland (Mr Varpula and Drs Välimäki and Lantta); Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Central South University, Hunan, China (Dr Välimäki); Hospital District of Southwest Finland, Turku, Finland (Dr Pulkkinen); and Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom (Dr Lantta)
| | - Johanna Pulkkinen
- Department of Nursing Science, University of Turku, Turku, Finland (Mr Varpula and Drs Välimäki and Lantta); Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Central South University, Hunan, China (Dr Välimäki); Hospital District of Southwest Finland, Turku, Finland (Dr Pulkkinen); and Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom (Dr Lantta)
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland (Mr Varpula and Drs Välimäki and Lantta); Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Central South University, Hunan, China (Dr Välimäki); Hospital District of Southwest Finland, Turku, Finland (Dr Pulkkinen); and Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom (Dr Lantta)
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Megersa Y, Dechasa A, Shibru A, Mideksa L, Tura MR. Evidence-based practice utilisation and its associated factors among nurses working at public hospitals in West Shoa zone, central Ethiopia: a cross-sectional study. BMJ Open 2023; 13:e063651. [PMID: 36707114 PMCID: PMC9884937 DOI: 10.1136/bmjopen-2022-063651] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the utilisation of evidence-based practice (EBP) and its associated factors among nurses working in public hospitals of West Shoa zone, Oromia, central Ethiopia, in 2021. DESIGN Institution-based cross-sectional study. SETTING Government hospitals including four primary hospitals, three general hospitals and a referral hospital. The study was conducted between 10 August and 30 August 2021. PARTICIPANTS 418 randomly selected nurses working in public hospitals of West Shoa. Data were collected via a structured, self-administered questionnaire, entered into EpiData V.3.1 and exported to SPSS V.26 for analysis. OUTCOME MEASURE Utilisation of EBP (good/poor). RESULTS 52.4% (95% CI 47.6% to 57.3%) of nurses had good EBP utilisation. Level of hospital (adjusted OR (AOR) 0.456 (95% CI 0.253 to 0.821)), administrative position (AOR 2.7 (1.09 to 6.69)), level of education (AOR 0.353 (0.181 to 0.686)), knowledge about EBP (AOR 1.785, (1.13 to 2.82)), availability of time (AOR 0.523 (0.28 to 0.96)), and cooperative and supportive colleagues (AOR 0.429 (0.235 to 0.783)) were associated with good utilisation of evidence-based nursing practice. CONCLUSION The utilisation of EBP among nurses is low. Level of education, knowledge about EBP, sufficient time at the workplace, and cooperative and supportive colleagues were among the factors associated with good EBP utilisation. The healthcare system in general, hospital management specifically, needs to design strategies to improve evidence-based nursing practice in the area.
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Affiliation(s)
- Yohanis Megersa
- Nursing, Ambo University College of Medicine and Health Sciences, Ambo, Oromia, Ethiopia
| | - Abebe Dechasa
- Nursing, Ambo University College of Medicine and Health Sciences, Ambo, Oromia, Ethiopia
| | - Abera Shibru
- Public Health, Ambo University College of Medicine and Public Health, Ambo, Oromia, Ethiopia
| | - Lema Mideksa
- Nursing, Ambo University College of Medicine and Health Sciences, Ambo, Oromia, Ethiopia
| | - Meseret Robi Tura
- Nursing, Ambo University College of Medicine and Health Sciences, Ambo, Oromia, Ethiopia
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Lohman MC, Fallahi A, Mishio Bawa E, Wei J, Merchant AT. Social Mediators of the Association Between Depression and Falls Among Older Adults. J Aging Health 2023:8982643231152276. [PMID: 36633960 DOI: 10.1177/08982643231152276] [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: 01/13/2023]
Abstract
OBJECTIVES To investigate the role of social factors in the association between depression and falls among older adults. METHODS The sample included data from 3443 older adults from three waves of the Health and Retirement Study (2010-2014). A Lifestyle Questionnaire was used to measure social engagement, social network contact, and neighborhood social context. Mediating effects of social factors were estimated through causal mediation analysis. Results: Poorer social engagement and network contact were associated with greater likelihood of falls, while poorer neighborhood context was associated with greater likelihood of fall injuries. Social engagement mediated a significant portion of the effect of depression on falls (OR: 1.03, 95% CI: 1.00, 1.06), and neighborhood context mediated a portion of the effect of depression on fall injuries (OR: 1.03, 95% CI: 1.00, 1.07). Discussion: The direct and indirect impacts of social factors suggest that considering them may help improve existing fall prevention approaches.
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Affiliation(s)
- Matthew C Lohman
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Afsaneh Fallahi
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Eric Mishio Bawa
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Jingkai Wei
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
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Hodgson G, Pace A, Carfagnini Q, Ayanso A, Gardner P, Narushima M, Ismail Z, Faught BE. Risky Business: Factors That Increase Risk of Falls Among Older Adult In-Patients. Gerontol Geriatr Med 2023; 9:23337214231189930. [PMID: 37533770 PMCID: PMC10392204 DOI: 10.1177/23337214231189930] [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: 04/04/2023] [Revised: 06/08/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
In hospitals, older patients are at increased risk of falling multiple times. This study incorporated an epidemiologic cross-sectional design consisting of 4,348 older patients (≥65-year-old). Eight hundred eighty five (20.4%) in-patients experienced multiple falls while remaining participants had one fall incident. A patient fall event was recorded with age, sex, incident date, type of fall, and location. Logistic regression assessed risk factors found in patients with multiple falls compared to those with one fall. Significant differences were observed in the proportion of multiple falls: in a bed with no rails, standing, walking, and using a wheel/Geri chair (p < .05). Overall, sex, type of fall, and location were significant in predicting multiple falls (p < .05). Male patients were at 16.1% greater risk of multiple falls, when compared to females (p < .05). A fall in complex care, mental health, or respirology were more likely to experience multiple falls (OR = 2.659, 3.620, 1.593 respectively), while season had no impact.
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Affiliation(s)
| | - Alex Pace
- Brock University, St. Catharines, ON, Canada
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12
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de Smet L, Carpels A, Creten L, De Pauw L, Van Eldere L, Desplenter F, De Hert M. Prevalence and characteristics of registered falls in a Belgian University Psychiatric Hospital. Front Public Health 2022; 10:1020975. [PMID: 36388388 PMCID: PMC9651969 DOI: 10.3389/fpubh.2022.1020975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/13/2022] [Indexed: 01/28/2023] Open
Abstract
Objectives Falls in elderly patients treated in general hospitals have already been the focus of several studies. Research within psychiatric settings, however, remains limited, despite the fact that this population has a number of characteristics that could increase the fall risk. The aim of this retrospective study was to estimate the prevalence of falling in patients with a psychiatric hospital setting. Methods A retrospective descriptive chart review of falls registered in the period July 1, 2013 until June 30, 2019 in a Belgian University Psychiatric Hospital was conducted. Data were collected from the "patient related incident report and management system" (PiMS) of the hospital. All registered falls of all hospitalized patients were included in the study. Results During the 6-year study period an incidence of 4.4 falls per 1,000 patient days was found. Only 0.5% of the falls resulted in severe injury and none of these falls were fatal. Eighty percent of falls involved a patient over the age of 65. Only 25.0% of the elderly patients suffered physical consequences, while injuries were present in 31.4% of adults and 68.2% of young patients. The two most common causes of a fall were the health status (63.3%) and the behavior (55.1%) of the patient. Conclusion The estimated prevalence of falls in our study was generally in line with the rates found in literature on falls in psychiatric settings. Falls in psychiatric settings occur both in younger and older patients, suggesting that all age categories deserve sufficient attention in fall prevention policies. However, more research is necessary to improve fall prevention policies.
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Affiliation(s)
- Lynn de Smet
- University Psychiatric Center, KU Leuven, Leuven, Belgium,*Correspondence: Lynn de Smet
| | - Arnout Carpels
- University Psychiatric Center, KU Leuven, Leuven, Belgium,Public Psychiatric Care Center Rekem, Rekem, Belgium
| | - Lotte Creten
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Louise De Pauw
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Franciska Desplenter
- University Psychiatric Center, KU Leuven, Leuven, Belgium,Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Marc De Hert
- University Psychiatric Center, KU Leuven, Leuven, Belgium,Center for Clinical Psychiatry, Department of Biomedical Sciences, KU Leuven, Leuven, Belgium,Antwerp Health Law and Ethics Chair, Universiteit Antwerpen, Antwerp, Belgium
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13
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Biswas I, Adebusoye B, Chattopadhyay K. Risk factors for falls among older adults in India: A systematic review and meta‐analysis. Health Sci Rep 2022; 5:e637. [PMID: 35774830 PMCID: PMC9213836 DOI: 10.1002/hsr2.637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 02/12/2022] [Accepted: 02/17/2022] [Indexed: 12/19/2022] Open
Abstract
Background and Aim Falls are common among older adults in India. Several primary studies on its risk factors have been conducted in India. However, no systematic review has been conducted on this topic. Thus, the objective of this systematic review was to synthesize the existing evidence on the risk factors for falls among older adults in India. Methods JBI and Preferred Reporting Items for Systematic Reviews and Meta‐Analyse guidelines were followed, and two independent reviewers were involved in the process. This review included observational studies conducted among older adults (aged ≥ 60 years) residing in India, reporting any risk factor for falls as exposure and unintentional fall as the outcome. MEDLINE, EMBASE, PsycInfo, CINAHL, and ProQuest Dissertations and Theses were searched until September 24, 2020. Where possible, data were synthesized using random‐effects meta‐analysis. Results The literature search yielded 3445 records. Twenty‐two studies met the inclusion criteria of this systematic review, and 19 studies were included in the meta‐analysis. Out of the 22 included studies in the systematic review, 12 (out of 18) cross‐sectional studies, two case–control studies, and two cohort studies met more than 70% criteria in the respective Joanna Briggs Institute (JBI) checklists. Risk factors for falls among older adults in India included sociodemographic factors, environmental factors, lifestyle factors, physical and/or mental health conditions, and medical interventions. Conclusions This systematic review and meta‐analysis provided a holistic picture of the problem in India by considering a range of risk factors such as sociodemographic, environmental, lifestyle, physical and/or mental health conditions and medical intervention. These findings could be used to develop falls prevention interventions for older adults in India. Systematic Review and Meta‐Analysis Registration The systematic review and meta‐analysis protocol was registered with PROSPERO (registration number‐CRD42020204818).
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Affiliation(s)
- Isha Biswas
- Division of Epidemiology and Public Health, School of Medicine University of Nottingham Nottingham United Kingdom
| | - Busola Adebusoye
- Division of Epidemiology and Public Health, School of Medicine University of Nottingham Nottingham United Kingdom
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of Medicine University of Nottingham Nottingham United Kingdom
- The Nottingham Centre for Evidence‐Based Healthcare: A JBI Centre of Excellence Nottingham United Kingdom
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14
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Abstract
In our currently ageing society, fall prevention is important for better healthy life expectancy and sustainable healthcare systems. While active outdoor walking is recommended as adequate exercise for the senior population, falls due to tripping and slipping exist as the primary causes of severe injuries. Minimum foot clearance (MFC) is the lowest vertical height of the foot during the mid-swing phase and indicates the risk of tripping. In contrast, coefficient of friction (COF) factors determine the occurrence of falls from slipping. Optimisation of the MFC and the COF for every step cycle prevents tripping and slipping, respectively. Even after the initiation of hazardous balance loss (i.e., tripping and slipping), falls can still be prevented as long as the requirements for balance are restored. Biomechanically, dynamic balance is defined by the bodily centre of mass and by the base of support: spatially—margin of stability and temporally—available response time. Fall prevention strategies should, therefore, target controlling the MFC, the COF and dynamic balance. Practical intervention strategies include footwear modification (i.e., shoe-insole geometry and slip-resistant outsoles), exercise (i.e., ankle dorsiflexors and core stabilisers) and technological rehabilitation (i.e., electrical stimulators and active exoskeletons). Biomechanical concepts can be practically applied to various everyday settings for fall prevention among the older population.
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15
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Jung H, Lee HY, Park HA. Comparisons of Fall Prevention Activities Using Electronic Nursing Records: A Case-Control Study. J Patient Saf 2022; 18:145-151. [PMID: 35344975 PMCID: PMC9359761 DOI: 10.1097/pts.0000000000000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to compare the current fall prevention nursing practices with the evidence-based practices recommended in clinical practice guidelines according to the risk of falling and specific risk factors. METHODS The standardized nursing statements of 12,277 patients were extracted from electronic nursing records and classified into groups according to the risk of falling and individual patients' specific risk factors. The mean frequencies of the fall prevention practices in 10 categories derived from clinical practice guidelines were compared among the groups. We additionally analyzed the differences in the mean frequencies of tailored fall prevention practices according to individual patients' specific risk factors. RESULTS The nurses documented more fall prevention practices for patients at a high risk of falling and nonfallers than for patients at a low risk of falling and fallers. Specifically, the difference in nursing practices related to environmental modifications was largest between patients at a high risk of falling and those at a low risk of falling. There were also large differences in the nursing practices related to mental status, dizziness/vertigo, and mobility limitations between fallers and nonfallers. There was more documentation of tailored fall prevention practices related to mobility limitations for patient with mild lower limb weakness than for those with good power and balance. In contrast, patients with severe lower limb weakness had received fewer fall prevention practices related to mobility limitations. CONCLUSIONS The present findings emphasize that individual risk-specific nursing interventions in addition to universal precautions are crucial for preventing falls among patients.
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Affiliation(s)
- Hyesil Jung
- From the Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam
| | - Ho-Young Lee
- From the Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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16
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Shier V, Edelen MO, McMullen TL, Ahluwalia SC, Chen EK, Dalton SE, Paddock S, Rodriguez A, Sherbourne CD, Mandl S, Mota T, Saliba D. Standardized assessment of cognitive function of post-acute care patients. J Am Geriatr Soc 2022; 70:1001-1011. [PMID: 35235208 DOI: 10.1111/jgs.17652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/03/2021] [Accepted: 12/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The assessment of cognitive function in post-acute care (PAC) settings is important for understanding an individual's condition and care needs, developing better person-directed care plans, predicting resource needs and understanding case mix. Therefore, we tested the feasibility and reliability of cognitive function assessments, including the Brief Interview for Mental Status (BIMS), Confusion Assessment Method (CAM©), Expression and Understanding, and Behavioral Signs and Symptoms for patients in PAC under the intent of the IMPACT Act of 2014. METHODS We conducted a national test of assessments of four standardized cognitive function data elements among patients in PAC. One hundred and forty-three PAC settings (57 home health agencies, 28 inpatient rehabilitation facilities, 28 long-term care hospitals, and 73 Skilled Nursing Facilities) across 14 U.S. markets from November 2017 to August 2018. At least one of four cognitive function data elements were assessed in 3026 patients. We assessed descriptive statistics, percent of missing data, time to complete, and interrater reliability between paired research nurse and facility staff assessors, and assessor feedback. RESULTS The BIMS, CAM©, Expression and Understanding, and Behavioral Signs and Symptoms demonstrated low rates of missing data (less than 2%), high percent agreement, and substantial support from assessors. The prevalence of Behavioral Signs and Symptoms was low in our sample of PAC settings. CONCLUSION Findings provide support for feasibility of implementing standardized assessment of all our cognitive function data elements for patients in PAC settings. The BIMS and CAM© were adopted into federal Quality Reporting Programs in the fiscal year/calendar year 2020 final rules. Future work could consider implementing additional cognitive items that assess areas not covered by the BIMS and CAM©.
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Affiliation(s)
- Victoria Shier
- Leonard D. Schaeffer Center for Health Policy & Economics, Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
| | - Maria O Edelen
- RAND Corporation, Boston, Massachusetts, USA.,Patient Reported Outcomes Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tara L McMullen
- Pain Management, Opioid Safety, and PDMP Program Office, Veterans Health Administration, Washington, District of Columbia, USA
| | - Sangeeta C Ahluwalia
- RAND Corporation, Santa Monica, California, USA.,UCLA Fielding School of Public Health, Los Angeles, California, USA
| | | | | | - Susan Paddock
- NORC at the University of Chicago, Chicago, Illinois, USA
| | | | | | - Stella Mandl
- Division of Health Care Financing, Department of Health and Human Services, Office of Health Policy in the Office of the Assistant Secretary for Planning and Evaluation, Washington, District of Columbia, USA
| | - Teresa Mota
- Abt Associates, Cambridge, Massachusetts, USA
| | - Debra Saliba
- RAND Corporation, Santa Monica, California, USA.,UCLA Borun Center, Los Angeles, California, USA.,Los Angeles VA GRECC, Los Angeles, California, USA
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17
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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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18
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Womack JA, Murphy TE, Ramsey C, Bathulapalli H, Leo-Summers L, Smith AC, Bates J, Jarad S, Gill TM, Hsieh E, Rodriguez-Barradas MC, Tien PC, Yin MT, Brandt C, Justice AC. Brief Report: Are Serious Falls Associated With Subsequent Fragility Fractures Among Veterans Living With HIV? J Acquir Immune Defic Syndr 2021; 88:192-196. [PMID: 34506360 PMCID: PMC8513792 DOI: 10.1097/qai.0000000000002752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The extensive research on falls and fragility fractures among persons living with HIV (PWH) has not explored the association between serious falls and subsequent fragility fracture. We explored this association. SETTING Veterans Aging Cohort Study. METHODS This analysis included 304,951 6-month person- intervals over a 15-year period (2001-2015) contributed by 26,373 PWH who were 50+ years of age (mean age 55 years) and taking antiretroviral therapy (ART). Serious falls (those falls significant enough to result in a visit to a health care provider) were identified by the external cause of injury codes and a machine learning algorithm applied to radiology reports. Fragility fractures were identified using ICD9 codes and included hip fracture, vertebral fractures, and upper arm fracture and were modeled with multivariable logistic regression with generalized estimating equations. RESULTS After adjustment, serious falls in the previous year were associated with increased risk of fragility fracture [odds ratio (OR) 2.10; 95% confidence interval (CI): 1.83 to 2.41]. The use of integrase inhibitors was the only ART risk factor (OR 1.17; 95% CI: 1.03 to 1.33). Other risk factors included the diagnosis of alcohol use disorder (OR 1.49; 95% CI: 1.31 to 1.70) and having a prescription for an opioid in the previous 6 months (OR 1.40; 95% CI: 1.27 to 1.53). CONCLUSIONS Serious falls within the past year are strongly associated with fragility fractures among PWH on ART-largely a middle-aged population-much as they are among older adults in the general population.
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Affiliation(s)
- Julie A Womack
- VA Connecticut Healthcare System and Yale School of Nursing, West Haven, CT
| | | | - Christine Ramsey
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | - Harini Bathulapalli
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | | | | | - Jonathan Bates
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | | | | | - Evelyn Hsieh
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | - Maria C Rodriguez-Barradas
- Michael E DeBakey VA Medical Center, Infectious Diseases Section, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Phyllis C Tien
- Department of Veterans Affairs, University of California, San Francisco, San Francisco, CA
| | - Michael T Yin
- Columbia University Medical Center, New York, NY; and
| | - Cynthia Brandt
- VA Connecticut Healthcare System, West Haven, CT
- Yale University Schools of Medicine and Public Health, New Haven, CT
| | - Amy C Justice
- VA Connecticut Healthcare System, West Haven, CT
- Yale University Schools of Medicine and Public Health, New Haven, CT
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19
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Kohler M, Mullis J, Karrer M, Schwarz J, Saxer S. Effectiveness of a group-walking intervention for people with dementia based on quality of life and caregivers' burden. Nurs Open 2021; 8:3111-3119. [PMID: 34545697 PMCID: PMC8510748 DOI: 10.1002/nop2.1023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/31/2021] [Accepted: 07/22/2021] [Indexed: 11/10/2022] Open
Abstract
Aims To test the effectiveness of a 28‐week group‐walking intervention for person with dementia. Participants were accompanied by trained volunteers. The effectiveness was assessed according to the quality of life, ability to perform activities of daily living, independence, mobility, cognition, challenging behaviours and the burden on their caregiving relatives. Design Quasi‐experimental, one‐group, pretest–posttest trial. Methods Thirty‐two persons with dementia and their caregiving relatives were recruited. The nursing intervention consists on easy walking tours lasting three and a half hours. The walks were performed biweekly and each person with dementia had support from one or two trained volunteer helpers. Results The quality of life was stable through all seasons. The secondary outcomes were uneven. While the impairment (WHODAS) and the dependence (IADL) increased, the challenging behaviours and the burden on the caregivers were stable through all seasons.
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Affiliation(s)
- Myrta Kohler
- Institute of Applied Nursing Science, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Jeanette Mullis
- Institute of Applied Nursing Science, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Melanie Karrer
- Institute of Applied Nursing Science, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Juerg Schwarz
- Lucerne University of Applied Sciences and Arts, Luzern, Switzerland
| | - Susi Saxer
- Institute of Applied Nursing Science, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
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20
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Vaismoradi M, Jamshed S, Lorenzl S, Paal P. PRN Medicines Management for Older People with Long-Term Mental Health Disorders in Home Care. Risk Manag Healthc Policy 2021; 14:2841-2849. [PMID: 34262371 PMCID: PMC8274703 DOI: 10.2147/rmhp.s316744] [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: 04/20/2021] [Accepted: 06/02/2021] [Indexed: 12/21/2022] Open
Abstract
Older people with long-term mental health conditions who receive care in their own home are vulnerable to the inappropriate use of medications and polypharmacy given their underlying health conditions and comorbidities. Inappropriate use of pro re nata (PRN) medications in these older people can enhance their suffering and have negative consequences for their quality of life and well-being, leading to readmission to healthcare settings and the increased cost of health care. This narrative review on published international literature aims at improving our understanding of medicines management in home care and how to improve PRN medication use among older people with long-term health conditions in their own home. Accordingly, the improvement of PRN medicines management for these older people requires the development of an individualised care plan considering ‘reduction of older people’s dependence on PRN medications’, ‘empowerment of family caregivers’, and ‘support by healthcare professionals.’ PRN medication use should be reduced through deprescription and discontinuation strategies. Also, older people and their family caregivers should be encouraged to prioritize the use of non-pharmacologic methods to relieve physical and psychological problems. Besides the empowerment of family caregivers through role development, education and training about PRN medications, and involvement in decision-making, they need support by the multidisciplinary network in terms of supervision, monitoring, and home visits.
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Affiliation(s)
- Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, 8049, Norway
| | - Shazia Jamshed
- Clinical Pharmacy and Practice, Faculty of Pharmacy, University Sultan Zainal Abidin, Terengganu, 22200, Malaysia
| | - Stefan Lorenzl
- Professorship for Palliative Care, Institute of Nursing Science and -Practice, Paracelsus Medical University, Salzburg, 5020, Austria.,Department of Neurology, Klinikum Agatharied, Hausham, 83734, Germany
| | - Piret Paal
- WHO Collaborating Centre at the Institute for Nursing Science and Practice, Paracelsus Medical University, Salzburg, A-5020, Austria
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21
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Quirk SE, Koivumaa-Honkanen H, Honkanen R, Heikkinen J, Kavanagh BE, Williams LJ. Exploring the comorbidity of musculoskeletal and personality disorders among adults: a scoping review protocol. Syst Rev 2021; 10:182. [PMID: 34148544 PMCID: PMC8215781 DOI: 10.1186/s13643-021-01721-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/28/2021] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Separately, mental and musculoskeletal disorders (MSDs) are prevalent across the life course and are leading contributors to disability worldwide. While people with personality disorder (PD) have been shown to have an increased risk of certain physical health comorbidities-associations with MSDs have not been thoroughly explored. The proposed scoping review aims to explore the existing clinical- and population-based literature on the comorbidity of PD and MSDs among adults ≥ 18 years and the burden associated with their comorbidity, identify knowledge gaps on this topic, and propose recommendations for future research. METHODS This protocol describes the methodology to undertake the scoping review. It is guided by Arksey and O'Malley's framework and the extensions recommended by the Joanna Briggs Institute. A comprehensive search strategy will be used to identify relevant articles, which will be underpinned by Population, Concept, and Context (PCC) inclusion criteria. One author will perform the search and two authors will independently screen titles/abstracts followed by a full-text review for articles considered relevant. The supervising author will confirm the final selection of articles to be included. One author will extract relevant information from the articles using a predetermined charting form, while a second will perform validation of all information entered. DISCUSSION Information will be synthesised to inform a discussion of what is known regarding associations between PD and MSDs, and the burden associated with their comorbidity in different contexts, with future research directions proposed. SYSTEMATIC REVIEW REGISTRATION This protocol is registered in Open Science Framework Registries ( https://osf.io/mxbr2/ ).
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Affiliation(s)
- Shae E Quirk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia.,Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland.,Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Jeremi Heikkinen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Bianca E Kavanagh
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia
| | - Lana J Williams
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia. .,University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.
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22
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Suga S, Tanimoto C, Yayama S, Suto S, Matoba K, Sugikado T, Makimoto K. Differences in the risk of severe falls between patients aged <65 years and patients aged ≥65 years at a psychiatric hospital based on 12-year incident reports. Perspect Psychiatr Care 2021; 57:311-317. [PMID: 32567095 DOI: 10.1111/ppc.12565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study compared age differences in risk factors for falls requiring treatment in psychiatric patients. DESIGN AND METHODS An incident database was used to compare fall incidents in patients aged less than 65 years and those aged greater than or equal to 65 years. FINDINGS Approximately 30% of fallers were less than 65 years. Mental status and medication were the main risk factors. Decreased activities of daily living were associated with the most falls in patients greater than or equal to 65 years. PRACTICE IMPLICATIONS Fall risk differed between the two age groups. Medication may play a major role in falls among patients less than 65 years.
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Affiliation(s)
- Sayaka Suga
- Division of Health Sciences, Graduate school of Medicine, Osaka University, Suita, Osaka, Japan
| | - Chie Tanimoto
- Department of Nursing, School of Nursing, Ishikawa Prefectural Nursing University, Kahoku, Ishikawa, Japan
| | - So Yayama
- Department of Nursing, Faculty of Nursing, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shunji Suto
- Department of Community Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Kei Matoba
- Department of Nursing, Faculty of Nursing, Kansai Medical University, Hirakata, Osaka, Japan
| | - Toshinobu Sugikado
- Department of Nursing, Ishikawa Prefectural Takamatsu Hospital, Kahoku, Ishikawa, Japan
| | - Kiyoko Makimoto
- Division of Health Sciences, Graduate school of Medicine, Osaka University, Suita, Osaka, Japan.,Department of Nursing, School of Nursing and Rehabilitation, Konan Women's University, Kobe, Hyogo, Japan
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23
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Montejano-Lozoya R, Miguel-Montoya I, Gea-Caballero V, Mármol-López MI, Ruíz-Hontangas A, Ortí-Lucas R. Impact of Nurses' Intervention in the Prevention of Falls in Hospitalized Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176048. [PMID: 32825282 PMCID: PMC7504031 DOI: 10.3390/ijerph17176048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 01/10/2023]
Abstract
Background: Clinical safety is a crucial component of healthcare quality, focused on identifying and avoiding the risks to which patients are exposed. Among the adverse events that occur in a hospital environment, falls have a large impact (1.9–10% of annual income in acute care hospitals); they can cause pain, damage, costs, and mistrust in the health system. Our objective was to assess the effect of an educational intervention aimed at hospital nurses (systematic assessment of the risk of falls) in reducing the incidence of falls. Methods: this was a quasi-experimental study based on a sample of 581 patients in a third level hospital (Comunitat Valenciana, Spain). An educational program was given to the intervention group (n = 303), and a control group was included for comparison (n = 278). In the intervention group, the nurses participated in a training activity on the systematized assessment of the risk of falls. Analysis was undertaken using the Bayesian logistic regression model. Results: a total of 581 patients were studied (50.6% male, 49.4% female), with an average age of 68.3 (DT = 9) years. The overall incidence of falls was 1.2% (0.3% in the intervention group and 2.2% in the control group). Most of the falls occurred in people ≥65 years old (85.7%). The intervention group had a lower probability of falling than the control group (OR: 0.127; IC95%: 0.013–0.821). Neither the length of hospital stay, nor the age of the participants, had any relevant effect. Conclusions: the systematic assessment of the risk of a patient falling during hospital processes is an effective intervention to reduce the incidence of falls.
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Affiliation(s)
- Raimunda Montejano-Lozoya
- Escuela Enfermería La Fe, Valencia (Spain), adscript center of Universitat de Valencia, Research Group GREIACC, Health Research Institute La Fe, 46026 Valencia, Spain; (R.M.-L.); (I.M.-M.); (M.I.M.-L.); (A.R.-H.)
| | - Isabel Miguel-Montoya
- Escuela Enfermería La Fe, Valencia (Spain), adscript center of Universitat de Valencia, Research Group GREIACC, Health Research Institute La Fe, 46026 Valencia, Spain; (R.M.-L.); (I.M.-M.); (M.I.M.-L.); (A.R.-H.)
| | - Vicente Gea-Caballero
- Escuela Enfermería La Fe, Valencia (Spain), adscript center of Universitat de Valencia, Research Group GREIACC, Health Research Institute La Fe, 46026 Valencia, Spain; (R.M.-L.); (I.M.-M.); (M.I.M.-L.); (A.R.-H.)
- Correspondence:
| | - María Isabel Mármol-López
- Escuela Enfermería La Fe, Valencia (Spain), adscript center of Universitat de Valencia, Research Group GREIACC, Health Research Institute La Fe, 46026 Valencia, Spain; (R.M.-L.); (I.M.-M.); (M.I.M.-L.); (A.R.-H.)
| | - Antonio Ruíz-Hontangas
- Escuela Enfermería La Fe, Valencia (Spain), adscript center of Universitat de Valencia, Research Group GREIACC, Health Research Institute La Fe, 46026 Valencia, Spain; (R.M.-L.); (I.M.-M.); (M.I.M.-L.); (A.R.-H.)
| | - Rafael Ortí-Lucas
- Public Health Department, Catholic University of Valencia, 46001 Valencia, Spain;
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Francis-Coad J, Etherton-Beer C, Burton E, Naseri C, Hill AM. Effectiveness of complex falls prevention interventions in residential aged care settings: a systematic review. ACTA ACUST UNITED AC 2019; 16:973-1002. [PMID: 29634516 DOI: 10.11124/jbisrir-2017-003485] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to synthesize the best available evidence for the effectiveness of complex falls prevention interventions delivered at two or more of the following levels: resident, facility or organization, on fall rates in the residential aged care (RAC) population. INTRODUCTION Preventing falls in the high risk RAC population is a common global goal with acknowledged complexity. Previous meta-analyses have not specifically addressed complexity, described as falls prevention intervention delivery at multiple levels of a RAC organization, to determine its effect on fall outcomes. INCLUSION CRITERIA The current review considered studies that included participants who were aged 65 years and over residing in long-term care settings providing 24-hour supervision and/or care assistance.Studies that evaluated complex falls prevention interventions delivered by single discipline or multidisciplinary teams across at least two or all of the following levels: residents, RAC facility and RAC organization were eligible. Experimental study designs including randomized controlled trials, controlled clinical trials and quasi-experimental trials that reported on measures related to fall incidence were considered, namely, rate of falls (expressed as the number of falls per 1000 occupied bed days), the number of participants who became fallers (expressed as the number of participants who fell once or more) and the rate of injurious falls (expressed as the number of falls with injury per 1000 occupied bed days). METHODS A three-step search strategy was undertaken, commencing with an initial scoping search of MEDLINE and CINAHL databases prior to an extensive search of all relevant published literature, clinical trial registries and gray literature. Two independent reviewers assessed selected studies for methodological validity using the standardized critical appraisal instrument from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Data were extracted from the selected studies using the standardized data extraction tool from JBI SUMARI. Quantitative data were pooled in statistical meta-analysis for rate of falls, the number of participants who became fallers and the rate of injurious falls. Meta-analysis was conducted using a random-effect model with heterogeneity assessed using the standard Chi-squared and I index. Where statistical pooling was not possible, study findings were presented in narrative form. RESULTS Twelve studies were included in this review with seven being eligible for meta-analysis. Complex falls prevention interventions delivered at multiple levels in RAC populations did not show a significant effect in reducing fall rates (MD = -1.29; 95% CI [-3.01, 0.43]), or the proportion of residents who fell (OR = 0.76; 95% CI [0.42, 1.38]). However, a sensitivity analysis suggested complex falls prevention interventions delivered with additional resources at multiple levels had a significant positive effect in reducing fall rates (MD = -2.26; 95% CI [-3.72, -0.80]). CONCLUSIONS Complex falls prevention interventions delivered at multiple levels in the RAC population may reduce fall rates when additional staffing, expertise or resources are provided. Organizations may need to determine how resources can be allocated to best address falls prevention management. Future research should continue to investigate which combinations of multifactorial interventions are effective.
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Affiliation(s)
| | | | - Elissa Burton
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Chiara Naseri
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia.,The Western Australian Group for Evidence Informed Healthcare Practice: a Joanna Briggs Institute Centre of Excellence
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia.,The Western Australian Group for Evidence Informed Healthcare Practice: a Joanna Briggs Institute Centre of Excellence
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Handley M, Bunn F, Goodman C. Supporting general hospital staff to provide dementia sensitive care: A realist evaluation. Int J Nurs Stud 2019; 96:61-71. [PMID: 30545567 DOI: 10.1016/j.ijnurstu.2018.10.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/25/2018] [Accepted: 10/01/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND There are an increasing number of interventions to improve hospital care for patients with dementia. Evidence for their impact on staff actions and patient outcomes is, however, limited and context dependent. OBJECTIVE To explain the factors that support hospital staff to provide dementia sensitive care and with what outcomes for patients with dementia. DESIGN A realist evaluation using a two-site case study approach. SETTING Two hospital trusts in the East of England. Site 1 had a ward for patients with dementia that would address their medical and mental health needs. Site 2 used a team of healthcare assistants, who had support from dementia specialist nurses, to work with patients with dementia across the hospital. PARTICIPANTS Hospital staff who had a responsibility for inpatients with dementia (healthcare assistants, nurses, medical staff, allied healthcare professionals and support staff) (n = 36), patients with dementia (n = 28), and family carers of patients with dementia (n = 2). METHODS A three stage realist evaluation: 1) building the programme theory of what works and when; 2) testing the programme theory through empirical data (80 h non-participant observation, 42 interviews, 28 patient medical notes, 27 neuropsychiatric inventory, and documentary review); 3) synthesis and verification of findings with key stakeholders. FINDINGS The programme theory comprised six interconnected context-mechanism-outcome configurations: 1) knowledge and authority to respond to an unmet need; 2) role relevant training and opportunities for reflection; 3) clinical experts and senior staff promoting practices that are patient-focused; 4) engaging with opportunities to spend time with patients; 5) risk management as an opportunity for person-centred care; 6) valuing dementia care as skilled work. Effective interactions reduced patient distress and supported patient orientation. Training and allocation of staff time were of themselves insufficient to ensure dementia care was prioritised and valued as skilled work. Staff concerns about the consequences of adverse incidents and work pressures on the ward, even with support, took precedence and influenced the quality of their interactions with patients with dementia. A key finding linked to staff retention and developing capacity in the workforce to provide expert dementia care was that despite extra training and organisational endorsement, nursing staff did not regard dementia care as skilled nursing work. CONCLUSIONS There is increased awareness and organisational commitment to dementia-friendly healthcare in general hospitals. However, in addition to training and adapting the environment to the patient, further work is needed to make explicit the specialist skills required for effective dementia care.
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Affiliation(s)
- Melanie Handley
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, United Kingdom.
| | - Frances Bunn
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, United Kingdom.
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, United Kingdom.
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The Effect of Active Physical Training Interventions on Reactive Postural Responses in Older Adults: A Systematic Review. J Aging Phys Act 2019; 27:252-264. [PMID: 29989462 DOI: 10.1123/japa.2017-0347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND A variety of physical interventions have been used to improve reactive balance in older adults. PURPOSE To summarize the effectiveness of active treatment approaches to improve reactive postural responses in community-dwelling older adults. DESIGN Systematic review guided by PRISMA guidelines. STUDY SELECTION A literature search included the databases PubMed, OVID, CINAHL, ClinicalTrials.gov, OTseeker, and PEDro up to December 2017. Randomized controlled trials that evaluated quantitative measures of reactive postural responses in healthy adults following participation in an active physical training program were included. DATA SYNTHESIS Of 4,481 studies initially identified, 11 randomized controlled trials covering 313 participants were selected for analysis. Study designs were heterogeneous, preventing a quantitative analysis. Nine of the 11 studies reported improvements in reactive postural responses. CONCLUSIONS Several clinically feasible training methods have the potential to improve reactive postural responses in older adults; however, conclusions on the efficacy of treatment methods are limited because of numerous methodological issues and heterogeneity in outcomes and intervention procedures.
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Azarkhavarani MG, Alavi NM. Surveying the quality of prehospital emergency services for the elderly falls 2017. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2018; 7:164. [PMID: 30693301 PMCID: PMC6332656 DOI: 10.4103/jehp.jehp_86_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 09/08/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Falls are the most common cause of injuries in elderly population. This study aimed to determine the quality of prehospital emergency services (EMS) for the elderly falls in 2017. MATERIALS AND METHODS This cross-sectional study was carried out at the Pre-hospital Emergency Center of Kashan in 2017. The sample consisted of elderly people who had reported fall incidents in EMS. The questionnaire consisted of 7 areas with 54 items. Data collected by descriptive and inferential statistics of Friedman and Mann-Whitney were analyzed by SPSS v. 16 software. RESULTS The number of elderly people was 150 (58% female) and the average age was 68.22 ± 6.75 years. Most falls (88.65%) occurred at home. The average performance scores (between 0 and 2) were as follows: assessment of the scene of the incident (1.51), primary assessment of the elderly (1.46), airway management (1.64), circulation management (1.78), fixation (1.82), secondary and continuous assessment (1.59), and patient transfer (1.68). It was found that secondary assessment and transfer of the male patients were significantly higher in quality than female patients (P < 0.05). CONCLUSIONS In this research, the quality of care in all areas was reported to be desirable. It is recommended that the weaknesses of each area are investigated and the necessary strategies are taken into account such as staff training, changes in data collection forms, and training for the elderly.
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Affiliation(s)
| | - Negin Masoudi Alavi
- Medical Surgical Nursing Department, Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
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Gustavsson J, Jernbro C, Nilson F. There is more to life than risk avoidance - elderly people's experiences of falls, fall-injuries and compliant flooring. Int J Qual Stud Health Well-being 2018; 13:1479586. [PMID: 29869973 PMCID: PMC5990953 DOI: 10.1080/17482631.2018.1479586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Falls are the most common cause of injury in all ages and are especially difficult to prevent among residential care residents. Compliant flooring that absorbs energy generated within the fall, has been proposed as a measure to prevent fall-injury, however little is known regarding the implementation aspects in clinical settings. The aim of this study is to explore the experiences of falls, the risk of fall-injury, prevention in general and specifically compliant flooring as an injury preventative measure amongst frail elderly people living in a residential care facility with compliant flooring. Through this, generate a theory that further explains the underlying barriers of active prevention amongst elderly people. METHOD We used the grounded theory method and conducted semi-structured in-depth interviews with eight elderly people in residential care (data collected between February and December 2017). RESULTS The identified categories were Falling as a part of life, Fearing the consequences and A wish to prevent falls and injuries. Through the results it was clear that There is more to life than risk avoidance, permeated the interviews, therefore forming the grounded theory. The interviewees viewed falls as something common and normal, and were uninterested in focusing on the risk of falls. Although they wanted to prevent falls, it was often difficult to integrate preventative measures into their everyday life. They embraced the idea of an injury-reducing compliant flooring, however their main interests lay elsewhere, preferring to focus on social interaction and issues concerning daily activities. CONCLUSIONS The theory generated in this paper proposes explanations on the obstacles of implementing fall prevention measures in an elderly frail population. The findings give insights as to why interest and compliance for active fall prevention measures are low. We conclude that complaint flooring, from the perspective of the residents, can work well in residential care.
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Affiliation(s)
- Johanna Gustavsson
- Centre for Public Safety, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Carolina Jernbro
- Centre for Public Safety, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Finn Nilson
- Centre for Public Safety, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
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Sato S, Kakamu T, Hayakawa T, Kumagai T, Hidaka T, Masuishi Y, Endo S, Fukushima T. Predicting falls from behavioral and psychological symptoms of dementia in older people residing in facilities. Geriatr Gerontol Int 2018; 18:1573-1577. [PMID: 30230170 DOI: 10.1111/ggi.13528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 11/27/2022]
Abstract
AIM The aim of the present study was to examine whether behavioral and psychological symptoms of dementia at the time of admission could be a predictor of falls in older people with dementia residing in geriatric health service facilities. METHODS Three geriatric health services facilities located in Fukushima Prefecture, Japan, were the targeted facilities. Of the 305 people admitted between May 2013 and November 2014, 242 (74 men, 168 women) who scored ≤20 points on the Hasegawa Dementia Scale-Revised were targeted for analysis. A total of 15 items from the Long-term Care Certification Questionnaire Group 4 were used to assess behavioral and psychological symptoms of dementia, and were compared by the presence or absence of falls. RESULTS Of the 242 participants, 153 were non-fallers and 89 were fallers. After adjusting for sex, age, Revised Hasegawa Dementia Scale-Revised, degree of care (which showed a significant relationship with falls in univariate analysis), activities of daily living and history of falls, the influence of behavioral and psychological symptoms of dementia on falls was examined, and showed a significant association with falls and a significant increase of hazard ratio for the behavioral symptoms "wandering" 2.23 (95% confidence interval 1.35-3.68) and "agitation" 1.94 (95% confidence interval 1.24-3.04). CONCLUSIONS Because the risk of falling is high for residents who at the time of admission have the behavioral and psychological symptoms of dementia of "wandering" and "agitation," it is necessary to predict the possibility of falling at an early stage, monitor the residents and adjust the environment. Geriatr Gerontol Int 2018; 18: 1573-1577.
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Affiliation(s)
- Sei Sato
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takehito Hayakawa
- Research Center for Social Studies of Health and Community, Ritsumeikan University, Kyoto, Japan
| | - Tomohiro Kumagai
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yusuke Masuishi
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shota Endo
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tetsuhito Fukushima
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
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A quasi-experimental evaluation of compliant flooring in a residential care setting. PLoS One 2018; 13:e0201290. [PMID: 30048517 PMCID: PMC6062098 DOI: 10.1371/journal.pone.0201290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/12/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Fall injuries affect the lives of older people to a substantial degree. This quasi-experimental observational study investigates the potential fall injury reducing effect of a compliant flooring in a residential care setting. METHODS The allocation of the compliant flooring was non-random. Data on fall-events and individual characteristics were collected in a residential care unit during a period of 68 months. The primary outcome was the fall injury rate per fall, and a logistic regression analysis was used to test for the effect of complaint flooring. Falls per 1000 bed days was the secondary outcome, used to measure the difference in fall risk on compliant flooring versus regular flooring. RESULTS The event dataset is an unbalanced panel with repeated observations on 114 individuals, with 70% women. The mean age was 84.9 years of age, the average Body Mass Index (BMI) was 24.7, and there was a mean of 6.57 (SD: 15.28) falls per individual. The unadjusted effect estimate showed a non-significant relative risk injury reduction of 29% per fall (RR 0.71 [95% CI: 0.46-1.09]) compared to regular flooring. Re-estimating, excluding identified outliers, showed an injury risk reduction of 63% (RR 0.37 [95% CI: 0.25-0.54]). Falls per 1000 bed days showed that individuals living in apartments with compliant flooring had a fall rate of 5.3 per 1000 bed days compared to a fall rate of 8.4 per 1000 bed days among individuals living in regular apartments. This corresponds to an incidence rate ratio (IRR) of 0.63 (95% exact Poisson CI: 0.50-0.80). CONCLUSION The results of this non-randomized study indicate that compliant flooring has the potential to reduce the risk of fall injury without increasing the fall risk among older people in a Swedish residential care setting.
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Hamed A, Bohm S, Mersmann F, Arampatzis A. Exercises of dynamic stability under unstable conditions increase muscle strength and balance ability in the elderly. Scand J Med Sci Sports 2018; 28:961-971. [DOI: 10.1111/sms.13019] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2017] [Indexed: 12/20/2022]
Affiliation(s)
- A. Hamed
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
- Berlin School of Movement Science; Berlin Germany
- Department of Biomechanics; Faculty of Physical Therapy; Cairo University; Cairo Egypt
| | - S. Bohm
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
- Berlin School of Movement Science; Berlin Germany
| | - F. Mersmann
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
- Berlin School of Movement Science; Berlin Germany
| | - A. Arampatzis
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
- Berlin School of Movement Science; Berlin Germany
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Schoberer D, Eglseer D, Halfens RJG, Lohrmann C. Development and evaluation of brochures for fall prevention education created to empower nursing home residents and family members. Int J Older People Nurs 2018; 13:e12187. [PMID: 29369510 DOI: 10.1111/opn.12187] [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: 05/15/2017] [Accepted: 12/22/2017] [Indexed: 01/08/2023]
Abstract
AIMS AND OBJECTIVES In this study, we describe the development of evidence- and theory-based fall prevention educational material and its evaluation from the users' perspectives. BACKGROUND To reduce risk factors for falling in nursing homes, nursing staff must enact multifactorial fall prevention intervention programmes. A core component of these programmes is to educate residents and their family members, both verbally and in a written form. However, users can only benefit from educational material if it is based on current scientific evidence, easy to understand and process and customised. DESIGN We followed a structured procedure during the development process, while considering various aspect of quality. To assess the understandability and usefulness of the resulting educational materials, we conducted a qualitative content analysis study. METHODS The educational materials development process incorporated several iterative steps including a systematic literature search and the application of frameworks for designing and writing the materials. To evaluate the material, we performed six focus group discussions separately with residents, family members and nursing staff from two nursing homes (total of 32 participants). RESULTS Residents' brochures included clear information on avoiding external risks as well as coping strategies after a fall event. Family members' brochures were more comprehensive, including both concrete tips and outlining the advantages and disadvantages of interventions. Residents and family members had no difficulties understanding the material and tried to apply the content to their individual situations. Nursing staff commented on some ambiguities and incongruities relating to current nursing care practice. CONCLUSIONS By involving users in the development of evidence-based educational materials, nursing staff can achieve a high acceptance rate for the materials and motivate users to address the topic. IMPLICATIONS FOR PRACTICE The involvement of users is essential for developing educational material that meets users' needs. Educational material should be used as part of an overall strategy to educate residents and family members in nursing homes.
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Affiliation(s)
- Daniela Schoberer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Ruud J G Halfens
- Department of Health Services Research, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
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Abstract
Dementia is a syndrome seen most commonly in older people and characterized by a decline in cognitive performance which impacts on the person's ability to function. There are approximately 47 million people worldwide with dementia and there are 10 million new cases every year. It is a major cause of disability and dependence and impacts on the physical, psychologic, and social well-being of families and carers. Alzheimer's disease is the most common form of dementia. Gait and balance impairments are common in people with dementia and contribute to the significantly elevated risk of falls. Older people with dementia are at increased risk of injury, institutionalization, hospitalization, morbidity, and death after a fall. There is preliminary evidence, predominantly from relatively small studies, that falls and disability can be prevented in this population. However, more good-quality research is needed, both to provide some certainty around the existing evidence base as well as to explore alternate approaches to prevention, including combined cognitive-motor training and cognitive pharmacotherapy.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia
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Post-fall reporting in aged acute inpatient mental health units: an 18-month observational cohort study. Int Psychogeriatr 2017; 29:2007-2016. [PMID: 28866986 DOI: 10.1017/s1041610217001648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite the high risk of falling for people with severe mental illness, there is limited falls research in mental health settings. Therefore, the objective of this observational cohort study was to conduct a focused post-fall review of fall episodes within aged acute inpatient mental health units at one of Australia's largest publicly funded mental health organizations. METHODS A post-fall reporting tool was developed to collect intrinsic and extrinsic fall risk factors among three aged acute mental health inpatient units over an 18-month period. Descriptive and inferential analyses were conducted to describe fall risk factors and predictors of fall risk. RESULTS There were a total of 115 falls, of which the tool was used for 93 (80.9%) episodes. Falls occurred most often in consumer's bedroom/bathroom and were unwitnessed. Intrinsic risk factors were most often attributed to postural drop and losing balance during walking. However, that was in contrast to consumer's who self-reported feeling dizzy as the reason of the fall. CONCLUSIONS Based on the cohort, future falls could be reduced by targeting those aged above 82 years, or with a diagnosis of dementia. Recurrent falls during admission could be reduced by targeting those with psychotic illness and males with a diagnosis of dementia. A clearer dialogue among consumers and clinical staff reporting about fall episodes may support future remedial interventions and inform programs to reduce fall risk and assist the challenge of describing unwitnessed falls in aged acute inpatient mental health settings.
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A battery-less and wireless wearable sensor system for identifying bed and chair exits in a pilot trial in hospitalized older people. PLoS One 2017; 12:e0185670. [PMID: 29016696 PMCID: PMC5633180 DOI: 10.1371/journal.pone.0185670] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 09/18/2017] [Indexed: 11/24/2022] Open
Abstract
Falls in hospitals are common, therefore strategies to minimize the impact of these events in older patients and needs to be examined. In this pilot study, we investigate a movement monitoring sensor system for identifying bed and chair exits using a wireless wearable sensor worn by hospitalized older patients. We developed a movement monitoring sensor system that recognizes bed and chair exits. The system consists of a machine learning based activity classifier and a bed and chair exit recognition process based on an activity score function. Twenty-six patients, aged 71 to 93 years old, hospitalized in the Geriatric Evaluation and Management Unit participated in the supervised trials. They wore over their attire a battery-less, lightweight and wireless sensor and performed scripted activities such as getting off the bed and chair. We investigated the system performance in recognizing bed and chair exits in hospital rooms where RFID antennas and readers were in place. The system’s acceptability was measured using two surveys with 0–10 likert scales. The first survey measured the change in user perception of the system before and after a trial; the second survey, conducted only at the end of each trial, measured user acceptance of the system based on a multifactor sensor acceptance model. The performance of the system indicated an overall recall of 81.4%, precision of 66.8% and F-score of 72.4% for joint bed and chair exit recognition. Patients demonstrated improved perception of the system after use with overall score change from 7.8 to 9.0 and high acceptance of the system with score ≥ 6.7 for all acceptance factors. The present pilot study suggests the use of wireless wearable sensors is feasible for detecting bed and chair exits in a hospital environment.
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Gustavsson J, Rahm G, Jernbro C, Nilson F. Effects of Impact-Absorbing Flooring in Residential Care from the Perspectives of Enrolled Nurses. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/02763893.2017.1335670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Johanna Gustavsson
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - GullBritt Rahm
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Carolina Jernbro
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Finn Nilson
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
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Brown AM. Reducing Falls After Electroconvulsive Therapy: A Quality Improvement Project. J Psychosoc Nurs Ment Health Serv 2017; 55:20-29. [PMID: 28671238 DOI: 10.3928/02793695-20170619-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/28/2017] [Indexed: 11/20/2022]
Abstract
Falls after electroconvulsive therapy (ECT) in patients 60 and older have been long recognized as a major clinical care issue across many mental health care settings. The evidence base for fall prevention strategies after receiving ECT is sparse. The risk factors for falls after ECT are vast and complex in nature, especially considering existing comorbid medical conditions. The dearth of research in guiding practitioners on fall reduction interventions for this patient population illuminates a gap in mental health care quality and safety. The purpose of the current nurse-led quality improvement project was to reduce falls in patients undergoing ECT by enhancing safety measures through education and a post-ECT treatment protocol. The project did not prove to be as efficacious as anticipated as measured by fall rate outcomes. Several factors that may account for the project's findings are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 55(7), 20-29.].
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Handley M, Bunn F, Goodman C. Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review. BMJ Open 2017; 7:e015257. [PMID: 28713073 PMCID: PMC5541590 DOI: 10.1136/bmjopen-2016-015257] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To identify features of programmes and approaches to make healthcare delivery in secondary healthcare settings more dementia-friendly, providing a context-relevant understanding of how interventions achieve outcomes for people living with dementia. DESIGN A realist review conducted in three phases: (1) stakeholder interviews and scoping of the literature to develop an initial programme theory for providing effective dementia care; (2) structured retrieval and extraction of evidence; and (3) analysis and synthesis to build and refine the programme theory. DATA SOURCES PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, NHS Evidence, Scopus and grey literature. ELIGIBILITY CRITERIA Studies reporting interventions and approaches to make hospital environments more dementia-friendly. Studies not reporting patient outcomes or contributing to the programme theory were excluded. RESULTS Phase 1 combined findings from 15 stakeholder interviews and 22 publications to develop candidate programme theories. Phases 2 and 3 identified and synthesised evidence from 28 publications. Prominent context-mechanism-outcome configurations were identified to explain what supported dementia-friendly healthcare in acute settings. Staff capacity to understand the behaviours of people living with dementia as communication of an unmet need, combined with a recognition and valuing of their role in their care, prompted changes to care practices. Endorsement from senior management gave staff confidence and permission to adapt working practices to provide good dementia care. Key contextual factors were the availability of staff and an alignment of ward priorities to value person-centred care approaches. A preoccupation with risk generated responses that werelikely to restrict patient choice and increase their distress. CONCLUSIONS This review suggests that strategies such as dementia awareness training alone will not improve dementia care or outcomes for patients with dementia. Instead, how staff are supported to implement learning and resources by senior team members with dementia expertise is a key component for improving care practices and patient outcomes. TRIAL REGISTRATION NUMBER CRD42015017562.
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Affiliation(s)
- Melanie Handley
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
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Cadwell S, Dearmon V, VandeWaa EA. Reducing Falls in Residents With Dementia by Reducing Psychotropic Medication Use: Does It Work? J Nurse Pract 2017. [DOI: 10.1016/j.nurpra.2016.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rimland JM, Abraha I, Dell’Aquila G, Cruz-Jentoft A, Soiza R, Gudmusson A, Petrovic M, O’Mahony D, Todd C, Cherubini A. Effectiveness of Non-Pharmacological Interventions to Prevent Falls in Older People: A Systematic Overview. The SENATOR Project ONTOP Series. PLoS One 2016; 11:e0161579. [PMID: 27559744 PMCID: PMC4999091 DOI: 10.1371/journal.pone.0161579] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 08/08/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Falls are common events in older people, which cause considerable morbidity and mortality. Non-pharmacological interventions are an important approach to prevent falls. There are a large number of systematic reviews of non-pharmacological interventions, whose evidence needs to be synthesized in order to facilitate evidence-based clinical decision making. OBJECTIVES To systematically examine reviews and meta-analyses that evaluated non-pharmacological interventions to prevent falls in older adults in the community, care facilities and hospitals. METHODS We searched the electronic databases Pubmed, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, PsycINFO, PEDRO and TRIP from January 2009 to March 2015, for systematic reviews that included at least one comparative study, evaluating any non-pharmacological intervention, to prevent falls amongst older adults. The quality of the reviews was assessed using AMSTAR and ProFaNE taxonomy was used to organize the interventions. RESULTS Fifty-nine systematic reviews were identified which consisted of single, multiple and multifactorial non-pharmacological interventions to prevent falls in older people. The most frequent ProFaNE defined interventions were exercises either alone or combined with other interventions, followed by environment/assistive technology interventions comprising environmental modifications, assistive and protective aids, staff education and vision assessment/correction. Knowledge was the third principle class of interventions as patient education. Exercise and multifactorial interventions were the most effective treatments to reduce falls in older adults, although not all types of exercise were equally effective in all subjects and in all settings. Effective exercise programs combined balance and strength training. Reviews with a higher AMSTAR score were more likely to contain more primary studies, to be updated and to perform meta-analysis. CONCLUSIONS The aim of this overview of reviews of non-pharmacological interventions to prevent falls in older people in different settings, is to support clinicians and other healthcare workers with clinical decision-making by providing a comprehensive perspective of findings.
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Affiliation(s)
- Joseph M. Rimland
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging, Ancona, Italy
| | - Iosief Abraha
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging, Ancona, Italy
| | - Giuseppina Dell’Aquila
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging, Ancona, Italy
| | | | - Roy Soiza
- Department of Medicine for the Elderly, Woodend Hospital, Aberdeen, United Kingdom
| | | | | | - Denis O’Mahony
- Division of Geriatrics, Department of Medicine, University College Cork, Cork, Ireland
| | - Chris Todd
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging, Ancona, Italy
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Predictive and Reactive Locomotor Adaptability in Healthy Elderly: A Systematic Review and Meta-Analysis. Sports Med 2016; 45:1759-77. [PMID: 26487633 PMCID: PMC4656697 DOI: 10.1007/s40279-015-0413-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Locomotor adaptability is based on the implementation of error-feedback information from previous perturbations to predictively adapt to expected perturbations (feedforward) and to facilitate reactive responses in recurring unexpected perturbations (‘savings’). The effect of aging on predictive and reactive adaptability is yet unclear. However, such understanding is fundamental for the design and application of effective interventions targeting fall prevention. Methods We systematically searched the Web of Science, MEDLINE, Embase and Science Direct databases as well as the reference lists of the eligible articles. A study was included if it addressed an investigation of the locomotor adaptability in response to repeated mechanical movement perturbations of healthy older adults (≥60 years). The weighted average effect size (WAES) of the general adaptability (adaptive motor responses to repeated perturbations) as well as predictive (after-effects) and reactive adaptation (feedback responses to a recurring unexpected perturbation) was calculated and tested for an overall effect. A subgroup analysis was performed regarding the factor age group [i.e., young (≤35 years) vs. older adults]. Furthermore, the methodological study quality was assessed. Results The review process yielded 18 studies [1009 participants, 613 older adults (70 ± 4 years)], which used various kinds of locomotor tasks and perturbations. The WAES for the general locomotor adaptability was 1.21 [95 % confidence interval (CI) 0.68–1.74, n = 11] for the older and 1.39 (95 % CI 0.90–1.89, n = 10) for the young adults with a significant (p < 0.05) overall effect for both age groups and no significant subgroup differences. Similar results were found for the predictive (older: WAES 1.10, 95 % CI 0.37–1.83, n = 8; young: WAES 1.54, 95 % CI 0.11–2.97, n = 7) and reactive (older: WAES 1.09, 95 % CI 0.22–1.96, n = 5; young: WAES 1.35, 95 % CI 0.60–2.09, n = 5) adaptation featuring significant (p < 0.05) overall effects without subgroup differences. The average score of the methodological quality was 67 ± 8 %. Conclusions The present meta-analysis provides elaborate statistical evidence that locomotor adaptability in general and predictive and reactive adaptation in particular remain highly effective in the elderly, showing only minor, not statistically significant age-related deficits. Consequently, interventions which use adaptation and learning paradigms including the application of the mechanisms responsible for an effective predictive and reactive dynamic stability control may progressively improve older adults’ recovery performance and, thus, reduce their risk of falling. Electronic supplementary material The online version of this article (doi:10.1007/s40279-015-0413-9) contains supplementary material, which is available to authorized users.
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Handley M, Bunn F, Goodman C. Interventions that support the creation of dementia friendly environments in health care: protocol for a realist review. Syst Rev 2015; 4:180. [PMID: 26667310 PMCID: PMC4678533 DOI: 10.1186/s13643-015-0168-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/07/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Improving health-care outcomes for people living with dementia when they are admitted to hospital is a policy priority. Dementia friendly interventions in health care promote inclusion of patients and carers in decision-making and adapt practices and environments to be appropriate to the needs of people with cognitive impairment. While there has been a wealth of activity, the number of studies evaluating interventions is limited, and the majority focuses on reporting staff and organisational outcomes. By focusing on patient and carer outcomes, this review will aim to develop an explanatory account of how and in what circumstances dementia friendly environments in health care work for people living with dementia and with what outcomes. METHOD/DESIGN Realist review is a theory-driven method which seeks to produce explanatory accounts of why interventions work and specifically, what combination of components are most effective in producing particular outcomes. Stakeholder interviews, a review of the literature, and an expert steering group workshop will be used to explore the assumptions behind interventions that are designed to enhance health care for people living with dementia to understand the underlying programme theories. The review will focus on studies that report patient and carer outcomes, including involvement in decision-making, length of stay and referral to long-term care, adverse incidents (e.g. patient distress, delirium falls, nutrition and hydration and infection), antipsychotic medication prescribing, evidence of patient-centred care and patient and carer satisfaction. DISCUSSION The review will provide an explanatory model about how dementia friendly interventions in hospital settings improve outcomes for people living with dementia and their family carers and in what circumstances for future testing and evaluation of future dementia friendly initiatives. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015017562.
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Affiliation(s)
- Melanie Handley
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
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Chen PH, Chen CY, Lin YC, Chen MY. Low bone mineral density among adults with disabilities in Taiwan: A cross-sectional descriptive study. Disabil Health J 2015; 8:635-41. [PMID: 26049786 DOI: 10.1016/j.dhjo.2015.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/06/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Low bone mineral density (BMD) is a silent disease that can lead to osteoporosis and is a serious health problem worldwide. People with disabilities are especially at risk for fall-related death. OBJECTIVES To examine the prevalence of low bone mineral density and associated risk factors among adults with disabilities in Taiwan. METHODS We conducted a population-based, cross-sectional study in 2013; the participants were 572 community adults with disabilities over the age of 20 years. Statistical analyses used to evaluate the association included chi-squared tests, ANOVA, and logistic regression. RESULTS Over one-third of the participants had an intellectual disability, 26% physical disability, and the remainder had a combination of disabilities. Of the participants, 62.5% had abnormal bone mineral density, and 21.8% met the criteria for osteoporosis. After adjusting for potential confounding variables, the determinant risk factors for low bone mineral density were age (β = -.14, p = 0.002), gender (β = -.12, p = 0.004), and level of physical activity (β = .1, p = 0.024). The majority of participants with low BMD were not aware of abnormal bone density, and only 2.4% had received treatment. CONCLUSIONS This study identified a high prevalence of low bone mineral density among adults with disabilities; few of the participants possessed awareness of bone health, and very few received early treatment or information on prevention of osteoporosis. The enhancement of osteoporosis interventions and health promotion programs to prevent osteoporosis and related problems are necessary for this population.
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Affiliation(s)
- Po-Han Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Chu-Yeh Chen
- College of Nursing, Chang Gung University of Science and Technology, Taiwan
| | - Yu-Chen Lin
- Department of Health Promotion, Chiayi Bureau of Health, Taiwan
| | - Mei-Yen Chen
- College of Nursing, Chang Gung University of Science and Technology, No. 2, Chiapu Rd., West Sec., Puzi City, Chiayi County 61363, Taiwan.
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Abstract
BACKGROUND Falls in long-term care residents with dementia represent a costly but unresolved safety issue. The aim of the present study was to (1) determine the incidence of falls, fall-related injuries and fall circumstances, and (2) identify the relationship between patient characteristics and fall rate in long-term care residents with dementia. METHODS Twenty long-term care residents with dementia (80 ± 11 years; 60% male) participated. Falls were recorded on a standardized form, concerning fall injuries, time and place of fall and if the fall was witnessed. Patient characteristics (66 variables) were extracted from medical records and classified into the domains: demographics, activities of daily living, mobility, cognition and behavior, vision and hearing, medical conditions and medication use. We used partial least squares (PLS) regression to determine the relationship between patient characteristics and fall rate. RESULTS A total of 115 falls (5.1 ± 6.7 falls/person/year) occurred over 19 months, with 85% of the residents experiencing a fall, 29% of falls had serious consequences and 28% was witnessed. A combination of impaired mobility, indicators of disinhibited behavior, diabetes, and use of analgesics, beta blockers and psycholeptics were associated with higher fall rates. In contrast, immobility, heart failure, and the inability to communicate were associated with lower fall rates. CONCLUSIONS Falls are frequent and mostly unwitnessed events in long-term care residents with dementia, highlighting the need for more effective and individualized fall prevention. Our analytical approach determined the relationship between a high fall rate and cognitive impairment, related to disinhibited behavior, in combination with mobility disability and fall-risk-increasing-drugs (FRIDs).
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Gustavsson J, Bonander C, Andersson R, Nilson F. Investigating the fall-injury reducing effect of impact absorbing flooring among female nursing home residents: initial results. Inj Prev 2015; 21:320-4. [DOI: 10.1136/injuryprev-2014-041468] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/08/2015] [Indexed: 11/03/2022]
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Burton E, Cavalheri V, Adams R, Browne CO, Bovery-Spencer P, Fenton AM, Campbell BW, Hill KD. Effectiveness of exercise programs to reduce falls in older people with dementia living in the community: a systematic review and meta-analysis. Clin Interv Aging 2015; 10:421-34. [PMID: 25709416 PMCID: PMC4330004 DOI: 10.2147/cia.s71691] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective The objective of this systematic review and meta-analysis is to evaluate the effectiveness of exercise programs to reduce falls in older people with dementia who are living in the community. Method Peer-reviewed articles (randomized controlled trials [RCTs] and quasi-experimental trials) published in English between January 2000 and February 2014, retrieved from six electronic databases – Medline (ProQuest), CINAHL, PubMed, PsycInfo, EMBASE and Scopus – according to predefined inclusion criteria were included. Where possible, results were pooled and meta-analysis was conducted. Results Four articles (three RCT and one single-group pre- and post-test pilot study) were included. The study quality of the three RCTs was high; however, measurement outcomes, interventions, and follow-up time periods differed across studies. On completion of the intervention period, the mean number of falls was lower in the exercise group compared to the control group (mean difference [MD] [95% confidence interval {CI}] =−1.06 [−1.67 to −0.46] falls). Importantly, the exercise intervention reduced the risk of being a faller by 32% (risk ratio [95% CI] =0.68 [0.55–0.85]). Only two other outcomes were reported in two or more of the studies (step test and physiological profile assessment). No between-group differences were observed in the results of the step test (number of steps) (MD [95% CI] =0.51 [−1.77 to 2.78]) or the physiological profile assessment (MD [95% CI] =−0.10 [−0.62 to 0.42]). Conclusion Findings from this review suggest that an exercise program may potentially assist in preventing falls of older people with dementia living in the community. However, further research is needed with studies using larger sample sizes, standardized measurement outcomes, and longer follow-up periods, to inform evidence-based recommendations.
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Affiliation(s)
- Elissa Burton
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia ; Research Department, Silver Chain, Perth, WA, Australia
| | - Vinicius Cavalheri
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Richard Adams
- Community Services, West Gippsland Healthcare Group, Warragul, VIC, Australia
| | - Colleen Oakley Browne
- Falls Prevention for People Living with Dementia Project, Central West Gippsland Primary Care Partnership, Moe, VIC, Australia
| | - Petra Bovery-Spencer
- Falls Prevention for People Living with Dementia Project, Central West Gippsland Primary Care Partnership, Moe, VIC, Australia
| | - Audra M Fenton
- Community Services, West Gippsland Healthcare Group, Warragul, VIC, Australia
| | - Bruce W Campbell
- Allied Health, Latrobe Regional Hospital, Traralgon, VIC, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia ; Preventive and Public Health Division, National Ageing Research Institute, Melbourne, VIC, Australia
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[Dementia and otorhinolaryngologic practice]. HNO 2014; 62:621-6. [PMID: 25103990 DOI: 10.1007/s00106-014-2900-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The interaction between sensorial registration of peripheral stimuli and their central cognitive processing is not yet understood. The role of sensory deficits such as olfactory deterioration or hearing loss in the development of dementia is currently a focus of concern, with hopes of finding new diagnostic aspects and therapeutic options for multimodal treatment concepts in patients with dementia. The expertise of ENT specialists in the diagnostic and therapeutic fields of dysphagia, vestibular dysfunction and olfactory or hearing loss could make an important contribution to the development of future strategies for dealing with dementia. In this report we present up-to-date basic knowledge and ENT-specific aspects relating to the diagnostics and treatment of dementia.
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