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Mansi MK, Chockalingam N, Chatzistergos PE. The enhanced paper grip test can substantially improve community screening for the risk of falling. Gait Posture 2024; 108:157-163. [PMID: 38091629 DOI: 10.1016/j.gaitpost.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Lower-limb strength measures can enhance falls risk assessment but due to the lack of clinically applicable methods, such measures are not included in current screening. The enhanced paper grip test (EPGT) is a simple-to-use and cost-effective test that could fill this gap. However, its outcome measure (EPGT force) has not yet been directly linked to the risk of falling. RESEARCH QUESTION Is the EPGT a good candidate for falls risk screening in older people in the community? METHODS Seventy-one older people living independently in the community were recruited for this prospective observational study (median age 69 y, range 65y-79y). Lower-limb and whole-body strength were assessed at baseline using the EPGT and a standardised hand-grip method respectively. Incident falls were recorded monthly for a year through follow-up telephone conversations. The capacity of individual strength measures to predict falls and to enhance an established falls risk assessment tool (FRAT) commonly used by UK's national health service (NHS) was assessed using binomial logistic regression. The analysis was repeated for the subset of participants without history of falling at baseline (prediction of first-ever falls). RESULTS Increased EPGT force and increased symmetry in strength between limbs were significantly associated with reduced risk of falling. Compared to the NHS-FRAT, the EPGT correctly classified more people (73% vs 69%), it achieved higher sensitivity (56% vs 26%) and higher negative predictive value (76% vs 68%). Complementing the NHS-FRAT with the EPGT produced a more comprehensive model that correctly classified 91% of participants and achieved 98% specificity, 81% sensitivity, 89% negative and 96% positive predictive value. Replacing the EPGT with hand-grip strength consistently undermined prediction accuracy. The EPGT remained highly accurate when focused on the prediction of first-ever falls. SIGNIFICANCE The EPGT can substantially enhance falls screening in the community. These results can also inform effective personalised strength exercise interventions.
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Affiliation(s)
- Mahmoud K Mansi
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Panagiotis E Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK.
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Blunt Eye Trauma: Epidemiology, Prognostic Factors and Visual Outcome-A 10-Year Retrospective Study. J Craniofac Surg 2023; 34:e36-e38. [PMID: 35973118 DOI: 10.1097/scs.0000000000008932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/07/2022] [Indexed: 01/11/2023] Open
Abstract
The aim of this study is to define the accompanying prognostic factors and evaluate the final visual acuity of patients presenting with blunt eye trauma. The data of this study included the demographic characteristics of the patients, the mechanism of injury, initial and final visual acuities and accompanying pathologies. A total of 259 eyes of 259 patients who presented with blunt eye trauma were included. Eighty-three percent of the patients were male. The most common mechanisms are beaten, accidents, and falls. The visual acuity of the patient at admission was no perception of light, and the final visual acuity was also no perception of light. The incidence of blunt eye trauma was more common in males and in advanced age. A higher final visual acuity level is achieved with successful management of concomitant pathologies.
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Bruce J, Hossain A, Lall R, Withers EJ, Finnegan S, Underwood M, Ji C, Bojke C, Longo R, Hulme C, Hennings S, Sheridan R, Westacott K, Ralhan S, Martin F, Davison J, Shaw F, Skelton DA, Treml J, Willett K, Lamb SE. Fall prevention interventions in primary care to reduce fractures and falls in people aged 70 years and over: the PreFIT three-arm cluster RCT. Health Technol Assess 2021; 25:1-114. [PMID: 34075875 DOI: 10.3310/hta25340] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Falls and fractures are a major problem. OBJECTIVES To investigate the clinical effectiveness and cost-effectiveness of alternative falls prevention interventions. DESIGN Three-arm, pragmatic, cluster randomised controlled trial with parallel economic analysis. The unit of randomisation was the general practice. SETTING Primary care. PARTICIPANTS People aged ≥ 70 years. INTERVENTIONS All practices posted an advice leaflet to each participant. Practices randomised to active intervention arms (exercise and multifactorial falls prevention) screened participants for falls risk using a postal questionnaire. Active treatments were delivered to participants at higher risk of falling. MAIN OUTCOME MEASURES The primary outcome was fracture rate over 18 months, captured from Hospital Episode Statistics, general practice records and self-report. Secondary outcomes were falls rate, health-related quality of life, mortality, frailty and health service resource use. Economic evaluation was expressed in terms of incremental cost per quality-adjusted life-year and incremental net monetary benefit. RESULTS Between 2011 and 2014, we randomised 63 general practices (9803 participants): 21 practices (3223 participants) to advice only, 21 practices (3279 participants) to exercise and 21 practices (3301 participants) to multifactorial falls prevention. In the active intervention arms, 5779 out of 6580 (87.8%) participants responded to the postal fall risk screener, of whom 2153 (37.3%) were classed as being at higher risk of falling and invited for treatment. The rate of intervention uptake was 65% (697 out of 1079) in the exercise arm and 71% (762 out of 1074) in the multifactorial falls prevention arm. Overall, 379 out of 9803 (3.9%) participants sustained a fracture. There was no difference in the fracture rate between the advice and exercise arms (rate ratio 1.20, 95% confidence interval 0.91 to 1.59) or between the advice and multifactorial falls prevention arms (rate ratio 1.30, 95% confidence interval 0.99 to 1.71). There was no difference in falls rate over 18 months (exercise arm: rate ratio 0.99, 95% confidence interval 0.86 to 1.14; multifactorial falls prevention arm: rate ratio 1.13, 95% confidence interval 0.98 to 1.30). A lower rate of falls was observed in the exercise arm at 8 months (rate ratio 0.78, 95% confidence interval 0.64 to 0.96), but not at other time points. There were 289 (2.9%) deaths, with no differences by treatment arm. There was no evidence of effects in prespecified subgroup comparisons, nor in nested intention-to-treat analyses that considered only those at higher risk of falling. Exercise provided the highest expected quality-adjusted life-years (1.120), followed by advice and multifactorial falls prevention, with 1.106 and 1.114 quality-adjusted life-years, respectively. NHS costs associated with exercise (£3720) were lower than the costs of advice (£3737) or of multifactorial falls prevention (£3941). Although incremental differences between treatment arms were small, exercise dominated advice, which in turn dominated multifactorial falls prevention. The incremental net monetary benefit of exercise relative to treatment valued at £30,000 per quality-adjusted life-year is modest, at £191, and for multifactorial falls prevention is £613. Exercise is the most cost-effective treatment. No serious adverse events were reported. LIMITATIONS The rate of fractures was lower than anticipated. CONCLUSIONS Screen-and-treat falls prevention strategies in primary care did not reduce fractures. Exercise resulted in a short-term reduction in falls and was cost-effective. FUTURE WORK Exercise is the most promising intervention for primary care. Work is needed to ensure adequate uptake and sustained effects. TRIAL REGISTRATION Current Controlled Trials ISRCTN71002650. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 34. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Anower Hossain
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK.,Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Emma J Withers
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Susanne Finnegan
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Chen Ji
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Chris Bojke
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Roberta Longo
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Susie Hennings
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Ray Sheridan
- General Medicine/Care of the Elderly, Royal Devon and Exeter Hospital, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Katharine Westacott
- Elderly Care Department, Warwick Hospital, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Shvaita Ralhan
- Gerontology Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Finbarr Martin
- St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John Davison
- Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Fiona Shaw
- Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dawn A Skelton
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jonathan Treml
- Geriatric Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Keith Willett
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK.,College of Medicine and Health, University of Exeter, Exeter, UK.,Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Lamb SE, Bruce J, Hossain A, Ji C, Longo R, Lall R, Bojke C, Hulme C, Withers E, Finnegan S, Sheridan R, Willett K, Underwood M. Screening and Intervention to Prevent Falls and Fractures in Older People. N Engl J Med 2020; 383:1848-1859. [PMID: 33211928 DOI: 10.1056/nejmoa2001500] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Community screening and therapeutic prevention strategies may reduce the incidence of falls in older people. The effects of these measures on the incidence of fractures, the use of health resources, and health-related quality of life are unknown. METHODS In a pragmatic, three-group, cluster-randomized, controlled trial, we estimated the effect of advice sent by mail, risk screening for falls, and targeted interventions (multifactorial fall prevention or exercise for people at increased risk for falls) as compared with advice by mail only. The primary outcome was the rate of fractures per 100 person-years over 18 months. Secondary outcomes were falls, health-related quality of life, frailty, and a parallel economic evaluation. RESULTS We randomly selected 9803 persons 70 years of age or older from 63 general practices across England: 3223 were assigned to advice by mail alone, 3279 to falls-risk screening and targeted exercise in addition to advice by mail, and 3301 to falls-risk screening and targeted multifactorial fall prevention in addition to advice by mail. A falls-risk screening questionnaire was sent to persons assigned to the exercise and multifactorial fall-prevention groups. Completed screening questionnaires were returned by 2925 of the 3279 participants (89%) in the exercise group and by 2854 of the 3301 participants (87%) in the multifactorial fall-prevention group. Of the 5779 participants from both these groups who returned questionnaires, 2153 (37%) were considered to be at increased risk for falls and were invited to receive the intervention. Fracture data were available for 9802 of the 9803 participants. Screening and targeted intervention did not result in lower fracture rates; the rate ratio for fracture with exercise as compared with advice by mail was 1.20 (95% confidence interval [CI], 0.91 to 1.59), and the rate ratio with multifactorial fall prevention as compared with advice by mail was 1.30 (95% CI, 0.99 to 1.71). The exercise strategy was associated with small gains in health-related quality of life and the lowest overall costs. There were three adverse events (one episode of angina, one fall during a multifactorial fall-prevention assessment, and one hip fracture) during the trial period. CONCLUSIONS Advice by mail, screening for fall risk, and a targeted exercise or multifactorial intervention to prevent falls did not result in fewer fractures than advice by mail alone. (Funded by the National Institute of Health Research; ISRCTN number, ISRCTN71002650.).
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Affiliation(s)
- Sarah E Lamb
- From the Institute of Health Research, University of Exeter (S.E.L., C.H., R.S.), and Royal Devon and Exeter Hospital (R.S.), Exeter, the Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick (J.B., C.J., R. Lall, E.W., S.F., M.U.), and University Hospitals Coventry and Warwickshire (M.U.), Coventry, Leeds Institute of Health Sciences, University of Leeds, Leeds (R. Longo, C.B.), and the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford (K.W.) - all in the United Kingdom, and the Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (A.H.)
| | - Julie Bruce
- From the Institute of Health Research, University of Exeter (S.E.L., C.H., R.S.), and Royal Devon and Exeter Hospital (R.S.), Exeter, the Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick (J.B., C.J., R. Lall, E.W., S.F., M.U.), and University Hospitals Coventry and Warwickshire (M.U.), Coventry, Leeds Institute of Health Sciences, University of Leeds, Leeds (R. Longo, C.B.), and the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford (K.W.) - all in the United Kingdom, and the Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (A.H.)
| | - Anower Hossain
- From the Institute of Health Research, University of Exeter (S.E.L., C.H., R.S.), and Royal Devon and Exeter Hospital (R.S.), Exeter, the Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick (J.B., C.J., R. Lall, E.W., S.F., M.U.), and University Hospitals Coventry and Warwickshire (M.U.), Coventry, Leeds Institute of Health Sciences, University of Leeds, Leeds (R. Longo, C.B.), and the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford (K.W.) - all in the United Kingdom, and the Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (A.H.)
| | - Chen Ji
- From the Institute of Health Research, University of Exeter (S.E.L., C.H., R.S.), and Royal Devon and Exeter Hospital (R.S.), Exeter, the Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick (J.B., C.J., R. Lall, E.W., S.F., M.U.), and University Hospitals Coventry and Warwickshire (M.U.), Coventry, Leeds Institute of Health Sciences, University of Leeds, Leeds (R. Longo, C.B.), and the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford (K.W.) - all in the United Kingdom, and the Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (A.H.)
| | - Roberta Longo
- From the Institute of Health Research, University of Exeter (S.E.L., C.H., R.S.), and Royal Devon and Exeter Hospital (R.S.), Exeter, the Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick (J.B., C.J., R. Lall, E.W., S.F., M.U.), and University Hospitals Coventry and Warwickshire (M.U.), Coventry, Leeds Institute of Health Sciences, University of Leeds, Leeds (R. Longo, C.B.), and the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford (K.W.) - all in the United Kingdom, and the Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (A.H.)
| | - Ranjit Lall
- From the Institute of Health Research, University of Exeter (S.E.L., C.H., R.S.), and Royal Devon and Exeter Hospital (R.S.), Exeter, the Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick (J.B., C.J., R. Lall, E.W., S.F., M.U.), and University Hospitals Coventry and Warwickshire (M.U.), Coventry, Leeds Institute of Health Sciences, University of Leeds, Leeds (R. Longo, C.B.), and the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford (K.W.) - all in the United Kingdom, and the Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (A.H.)
| | - Chris Bojke
- From the Institute of Health Research, University of Exeter (S.E.L., C.H., R.S.), and Royal Devon and Exeter Hospital (R.S.), Exeter, the Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick (J.B., C.J., R. Lall, E.W., S.F., M.U.), and University Hospitals Coventry and Warwickshire (M.U.), Coventry, Leeds Institute of Health Sciences, University of Leeds, Leeds (R. Longo, C.B.), and the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford (K.W.) - all in the United Kingdom, and the Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (A.H.)
| | - Claire Hulme
- From the Institute of Health Research, University of Exeter (S.E.L., C.H., R.S.), and Royal Devon and Exeter Hospital (R.S.), Exeter, the Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick (J.B., C.J., R. Lall, E.W., S.F., M.U.), and University Hospitals Coventry and Warwickshire (M.U.), Coventry, Leeds Institute of Health Sciences, University of Leeds, Leeds (R. Longo, C.B.), and the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford (K.W.) - all in the United Kingdom, and the Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (A.H.)
| | - Emma Withers
- From the Institute of Health Research, University of Exeter (S.E.L., C.H., R.S.), and Royal Devon and Exeter Hospital (R.S.), Exeter, the Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick (J.B., C.J., R. Lall, E.W., S.F., M.U.), and University Hospitals Coventry and Warwickshire (M.U.), Coventry, Leeds Institute of Health Sciences, University of Leeds, Leeds (R. Longo, C.B.), and the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford (K.W.) - all in the United Kingdom, and the Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (A.H.)
| | - Susanne Finnegan
- From the Institute of Health Research, University of Exeter (S.E.L., C.H., R.S.), and Royal Devon and Exeter Hospital (R.S.), Exeter, the Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick (J.B., C.J., R. Lall, E.W., S.F., M.U.), and University Hospitals Coventry and Warwickshire (M.U.), Coventry, Leeds Institute of Health Sciences, University of Leeds, Leeds (R. Longo, C.B.), and the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford (K.W.) - all in the United Kingdom, and the Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (A.H.)
| | - Ray Sheridan
- From the Institute of Health Research, University of Exeter (S.E.L., C.H., R.S.), and Royal Devon and Exeter Hospital (R.S.), Exeter, the Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick (J.B., C.J., R. Lall, E.W., S.F., M.U.), and University Hospitals Coventry and Warwickshire (M.U.), Coventry, Leeds Institute of Health Sciences, University of Leeds, Leeds (R. Longo, C.B.), and the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford (K.W.) - all in the United Kingdom, and the Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (A.H.)
| | - Keith Willett
- From the Institute of Health Research, University of Exeter (S.E.L., C.H., R.S.), and Royal Devon and Exeter Hospital (R.S.), Exeter, the Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick (J.B., C.J., R. Lall, E.W., S.F., M.U.), and University Hospitals Coventry and Warwickshire (M.U.), Coventry, Leeds Institute of Health Sciences, University of Leeds, Leeds (R. Longo, C.B.), and the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford (K.W.) - all in the United Kingdom, and the Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (A.H.)
| | - Martin Underwood
- From the Institute of Health Research, University of Exeter (S.E.L., C.H., R.S.), and Royal Devon and Exeter Hospital (R.S.), Exeter, the Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick (J.B., C.J., R. Lall, E.W., S.F., M.U.), and University Hospitals Coventry and Warwickshire (M.U.), Coventry, Leeds Institute of Health Sciences, University of Leeds, Leeds (R. Longo, C.B.), and the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford (K.W.) - all in the United Kingdom, and the Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (A.H.)
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Vidne-Hay O, Fogel Levin M, Luski S, Moisseiev J, Moisseiev E. Blunt ocular trauma in patients over 70: Clinical characteristics and prognosis. Eur J Ophthalmol 2020; 31:2705-2709. [PMID: 32715795 DOI: 10.1177/1120672120946579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the mechanisms and outcomes of open globe injuries (OGIs) in patients 70 years or older. METHODS A retrospective chart review of patients from two large academic centers in Israel who were underwent surgery for OGI. Data was collected from surgical and clinic charts. Anatomical and functional results were recorded as well any additional surgeries and complications. RESULTS Thirty-two eyes of 32 patients were included. The mechanism of OGI consisted of blunt trauma with ocular rupture secondary to falls. All eyes underwent immediate primary closure of the corneal and scleral lacerations. Additional surgeries were performed in 34.3% of cases. In 31.2% of cases additional surgery was not required, and in 21.9% of cases the damage was so devastating that additional procedures were not recommended. Four patients (12.5%) chose not to undergo additional surgery. Mean visual acuity at presentation was 2.24 ± 0.72 logMAR and it improved to 1.92 ± 0.89 logMAR at final follow-up (p = 0.002). VA at presentation was significantly correlated to final VA (p < 0.001). CONCLUSIONS OGI in the elderly represents a unique group. It is mostly related to falls, with a female predominance and a poor visual prognosis. In this patient population, general health concerns and increased risks of anesthesia require special attention. Care should be taken to educate elderly patients and their caretakers on how to avoid falls.
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Affiliation(s)
- Orit Vidne-Hay
- Department of Ophthalmology, Sheba Medical Centre, Ramat Gan, Israel
| | - Miri Fogel Levin
- Department of Ophthalmology, Sheba Medical Centre, Ramat Gan, Israel
| | - Shahar Luski
- Department of Ophthalmology, Tel Aviv Medical Centre, Tel Aviv, Israel
| | - Joseph Moisseiev
- Department of Ophthalmology, Sheba Medical Centre, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Moisseiev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Meir Medical Centre, Kfar Saba, Israel
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Stockwell-Smith G, Adeleye A, Chaboyer W, Cooke M, Phelan M, Todd JA, Grealish L. Interventions to prevent in-hospital falls in older people with cognitive impairment for further research: A mixed studies review. J Clin Nurs 2020; 29:3445-3460. [PMID: 32578913 DOI: 10.1111/jocn.15383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND While advances in falls prevention in the adult population have occurred, the care requirements for older patients with cognitive impairment at risk of falling are less established. OBJECTIVES To identify interventions to prevent in-hospital falls in older patients with cognitive impairment for further research and describe the strategies used to implement those interventions. DESIGN A seven-stage mixed studies review was used. METHODS Seven electronic databases were searched. The SPIDER framework guided the review question and selection of search terms. The Mixed Methods Assessment Tool was used to appraise the quality of research studies, and the Quality Improvement Minimum Quality Data Set was used to appraise the quality of quality improvement projects. A convergent qualitative synthesis was used to analyse the extracted data. The adapted PRISMA guideline informed the procedures. RESULTS Ten projects (five quality improvements and five researches) were included. Five themes emerged from the synthesis: engaging with families in falls prevention, assessing falls risk to identify interventions, extending nursing observation through technology, conducting a medication review and initiating nonpharmacological delirium prevention interventions. Implementation was not well described and commonly focused on capital investment to initiate a falls prevention programme and education to introduce staff to the new techniques for practice. CONCLUSIONS Emerging research and quality improvement studies demonstrate that effective falls prevention with this vulnerable population is possible but requires further investigation before widespread practice recommendations can be made. Further research and quality improvement in this area should consider adoption of an implementation framework to address sustainability. RELEVANCE TO CLINICAL PRACTICE Reducing falls in older people with cognitive impairment requires nurses to work more closely with pharmacists, occupational therapists and social workers to develop strategies that work and are sustainable.
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Affiliation(s)
| | - Adeniyi Adeleye
- Central Queensland University-Mackay Campus, Mackay, QLD, Australia
| | - Wendy Chaboyer
- School of Nursing & Midwifery, Griffith University, Southport, QLD, Australia.,Healthcare Practice and Survivorship Program, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Marie Cooke
- School of Nursing & Midwifery, Griffith University, Southport, QLD, Australia.,Healthcare Practice and Survivorship Program, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | | | - Jo-Anne Todd
- School of Nursing & Midwifery, Griffith University, Southport, QLD, Australia
| | - Laurie Grealish
- School of Nursing & Midwifery, Griffith University, Southport, QLD, Australia.,Healthcare Practice and Survivorship Program, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Gold Coast Health, Gold Coast, QLD, Australia
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7
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Finnegan S, Bruce J, Seers K. What enables older people to continue with their falls prevention exercises? A qualitative systematic review. BMJ Open 2019; 9:e026074. [PMID: 30992291 PMCID: PMC6500202 DOI: 10.1136/bmjopen-2018-026074] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To review the qualitative literature that explores the barriers and facilitators to continued participation in falls prevention exercise after completion of a structured exercise programme. DESIGN A systematic literature review with thematic synthesis of qualitative studies exploring older adults' experiences of continued participation in falls prevention exercise. DATA SOURCES Comprehensive searches were conducted in MEDLINE, PSYCHinfo, AMED, ASSIA, CINAHL and EMBASE from inception until November 2017. Additional studies were identified via searches of reference lists and citation tracking of relevant studies. ELIGIBILITY CRITERIA Qualitative or mixed methods studies exploring experiences of community-dwelling older adults (65 years and over) participation in a falls prevention exercise programme including their experience of ongoing participation in exercise after the completion of a structured exercise programme. DATA EXTRACTION AND SYNTHESIS Key characteristics including aim, participant characteristics, method of data collection, underpinning qualitative methodology and analytical approach were extracted and independently checked. Thematic synthesis was used to integrate findings. RESULTS From 14 studies involving 425 participants, we identified three descriptive themes: identity, motivators/deterrents and nature of the intervention and one overarching analytical theme: agency. CONCLUSIONS Older people have their own individual and meaningful rationale for either continuing or stopping exercise after completion of a structured falls prevention exercise programme. Exploring these barriers and facilitators to continued exercise is key during the intervention phase. It is important that health care professionals get to know the older person's rationale and offer the best evidence-based practice and support to individuals, to ensure a smooth transition from their structured intervention towards longer-term exercise-related behaviour. PROSPERO REGISTRATION NUMBER CRD42017082637.
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Affiliation(s)
- Susanne Finnegan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Julie Bruce
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Kate Seers
- RCN RI, Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
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Shovlin E, Kunkel D. A survey to explore what information, advice and support community-dwelling people with stroke currently receive to manage instability and falls. Disabil Rehabil 2017; 40:3191-3197. [PMID: 28903613 DOI: 10.1080/09638288.2017.1376356] [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] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe and determine the benefits of the information and support services currently offered to people with stroke experiencing instability and falls. METHODS A cross-sectional survey study. Two hundred and fifty-six surveys were sent out to community stroke groups in Hampshire and the Isle of Wight, as well as to people with stroke on a patient register. RESULTS One hundred and twenty-five surveys were returned. A total of 107 participants (86%) reported instability and 62 (50%) had experienced a fall in the preceding year; 29 (28%) had reportedly received information on falls prevention. Forty-four participants (43%) sought help from health professionals following instability and falls; just over half reported that the information they received was useful. One quarter (n = 11) of those seeking help were referred on to falls clinics; all attended and 86% felt attending had been beneficial. However, only one participant was followed up by these clinics. CONCLUSIONS Findings suggest that the majority of people with stroke who have experienced instability and falls did not receive any information and support, with very few referred on to falls clinics. Health professionals play a key role in information provision and facilitating access to falls prevention programs. Further research is required to determine the most effective ways to implement current guidelines to manage instability and falls in this high-risk group. Implications for rehabilitation: Many community-dwelling people with stroke did not receive any information, help or support after experiencing instability and falls. Clinicians must stress that falls are a complication, not an expectation, post-stroke. Information on falls prevention and available support services should be offered to individuals prior to discharge from hospital, in GP practices and in rehabilitation settings. All individuals with stroke seeking health professional help following instability and falls should be referred on to falls clinics for individualized multifactorial assessment and intervention to comply with current guidelines.
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Affiliation(s)
- Eleanor Shovlin
- a Department of Health Sciences , University of Southampton , Southampton , UK
| | - Dorit Kunkel
- a Department of Health Sciences , University of Southampton , Southampton , UK
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Finnegan S, Bruce J, Skelton DA, Withers EJ, Lamb SE. Development and delivery of an exercise programme for falls prevention: the Prevention of Falls Injury Trial (PreFIT). Physiotherapy 2017; 104:72-79. [PMID: 28801033 PMCID: PMC5840509 DOI: 10.1016/j.physio.2017.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 06/15/2017] [Indexed: 11/27/2022]
Abstract
Objective This paper describes the development and implementation of an exercise intervention to prevent falls within The Prevention of Fall Injury Trial (PreFIT), which is a large multi-centred randomised controlled trial based in the UK National Health Service (NHS). Design Using the template for intervention description and replication (TIDieR) checklist, to describe the rationale and processes for treatment selection and delivery of the PreFIT exercise intervention. Participants Based on the results of a validated falls and balance survey, participants were eligible for the exercise intervention if they were at moderate or high risk of falling. Interventions Intervention development was informed using the current evidence base, published guidelines, and pre-existing surveys of clinical practice, a pilot study and consensus work with therapists and practitioners. The exercise programme targets lower limb strength and balance, which are known, modifiable risk factors for falling. Treatment was individually tailored and progressive, with seven recommended contacts over a six-month period. Clinical Trials Registry (ISCTRN 71002650).
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Affiliation(s)
- Susanne Finnegan
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry CV4 7AL, UK.
| | - Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry CV4 7AL, UK.
| | - Dawn A Skelton
- Institute of Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
| | - Emma J Withers
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry CV4 7AL, UK.
| | - Sarah E Lamb
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry CV4 7AL, UK; Nuffield Department of Orthopaedics Rheumatology & Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK.
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10
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A History of Falls Should Be Recorded in All Preoperative Patients. EBioMedicine 2016; 12:30-31. [PMID: 27614394 PMCID: PMC5078580 DOI: 10.1016/j.ebiom.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/02/2016] [Indexed: 12/05/2022] Open
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Bruce J, Lall R, Withers EJ, Finnegan S, Underwood M, Hulme C, Sheridan R, Skelton DA, Martin F, Lamb SE. A cluster randomised controlled trial of advice, exercise or multifactorial assessment to prevent falls and fractures in community-dwelling older adults: protocol for the prevention of falls injury trial (PreFIT). BMJ Open 2016; 6:e009362. [PMID: 26781504 PMCID: PMC4735205 DOI: 10.1136/bmjopen-2015-009362] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Falls are the leading cause of accident-related mortality in older adults. Injurious falls are associated with functional decline, disability, healthcare utilisation and significant National Health Service (NHS)-related costs. The evidence base for multifactorial or exercise interventions reducing fractures in the general population is weak. This protocol describes a large-scale UK trial investigating the clinical and cost-effectiveness of alternative falls prevention interventions targeted at community dwelling older adults. METHODS AND ANALYSIS A three-arm, pragmatic, cluster randomised controlled trial, conducted within primary care in England, UK. Sixty-three general practices will be randomised to deliver one of three falls prevention interventions: (1) advice only; (2) advice with exercise; or (3) advice with multifactorial falls prevention (MFFP). We aim to recruit over 9000 community-dwelling adults aged 70 and above. Practices randomised to deliver advice will mail out advice booklets. Practices randomised to deliver 'active' interventions, either exercise or MFFP, send all trial participants the advice booklet and a screening survey to identify participants with a history of falling or balance problems. Onward referral to 'active' intervention will be based on falls risk determined from balance screen. The primary outcome is peripheral fracture; secondary outcomes include number with at least one fracture, falls, mortality, quality of life and health service resource use at 18 months, captured using self-report and routine healthcare activity data. ETHICS AND DISSEMINATION The study protocol has approval from the National Research Ethics Service (REC reference 10/H0401/36; Protocol V.3.1, 21/May/2013). User groups and patient representatives were consulted to inform trial design. Results will be reported at conferences and in peer-reviewed publications. A patient-friendly summary of trial findings will be published on the prevention of falls injury trial (PreFIT) website. This protocol adheres to the recommended SPIRIT Checklist. Amendments will be reported to relevant regulatory parties. TRIAL REGISTRATION NUMBER ISRCTN 71002650; Pre-results.
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Affiliation(s)
- Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Emma J Withers
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Susanne Finnegan
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Claire Hulme
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Finbarr Martin
- Older Persons' Unit, Guys and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, UK
| | - Sarah E Lamb
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
- Nuffield Department of Orthopaedics Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
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Abstract
Anxiety disorders are highly prevalent among the elderly and are associated with increased disability, poor quality of life, and cognitive impairment. Despite this high prevalence and associated morbidities, anxiety disorders in late life are underreported and understudied. In this article, we discuss the epidemiology, disease presentation, and current treatment of anxiety disorders in older adults. We also discuss limitations in the current understanding of such disorders in this population, as well as future research directions that may reveal the mechanisms and rationale for treatment regimens for anxiety disorders in late life. We present material on the application of the Research Domain Criteria (RDoC) model to geriatric anxiety. Finally, we describe optimal management strategies of anxiety disorders.
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13
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Zhang XY, Shuai J, Li LP. Vision and Relevant Risk Factor Interventions for Preventing Falls among Older People: A Network Meta-analysis. Sci Rep 2015; 5:10559. [PMID: 26020415 PMCID: PMC4447164 DOI: 10.1038/srep10559] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/20/2015] [Indexed: 11/23/2022] Open
Abstract
Our study objective was to determine the effect of vision intervention and combinations of different intervention components on preventing falls and fall-related injuries among older people. Six electronic databases were searched to identify seven articles published before May, 2014. We conducted a systematic review of data from seven randomized controlled trails and identified eight regimens: vision intervention alone (V), vision plus exercise (referred to as physical exercise) interventions (V + E), vision plus home hazard interventions (V + HH), vision plus exercise plus home hazard interventions (V + E + HH), vision plus exercise plus sensation interventions (V + E + S), vision plus hearing interventions (V + H), vision plus various risk factor assessment and interventions (V + VRF), and the control group (C, no intervention group). The main outcome was the incidence of falls during the follow-up period. Seven papers included 2723 participants. Network meta-analysis of seven trials, using pairwise comparisons between each intervention, indicated there was no significant difference. However, there was a trend in which intervention incorporating V + VRF had more advantages than any other combination of interventions. In conclusion, V + VRF proves to be more effective than other V combination interventions in preventing falls in older people (≥65 years of age). V alone appears less effective in our network meta-analysis.
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Affiliation(s)
- Xin-Yi Zhang
- Injury Prevention Research Center, Medical College of Shantou University, Shantou, Guangdong, China
| | - Jian Shuai
- Injury Prevention Research Center, Medical College of Shantou University, Shantou, Guangdong, China
| | - Li-Ping Li
- Injury Prevention Research Center, Medical College of Shantou University, Shantou, Guangdong, China
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How Much Are We Willing to Pay to Prevent A Fall? Cost-Effectiveness of a Multifactorial Falls Prevention Program for Community-Dwelling Older Adults. Can J Aging 2012; 31:121-37. [DOI: 10.1017/s0714980812000074] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RÉSUMÉCette étude a examiné le rapport coût-efficacité d’un programme multifactoriel de prévention des chutes et a évalué le compromis entre les coûts supplémentaires d’un tel programme et une augmentation de la réduction des chutes accidentelles. Le rapport coût-efficacité a été évalué en utilisant le rapport coût-efficacité différentiel traditionnel (RCED) et cadre de régression de l’avantage net (CRAN). En utilisant du CRAN, la prise de décision a été officialisée par l’incorporation, a priori, d’une predisposition à payer (PAP). Les résultats n’ont pas fourni preuve qu’un programme multifactoriel de prévention des chutes a été rentable. L’adhésion des participants au recommandations allaient de faible (41,3%) à modéré (21,1%), à élevé (37,6%). Un défi futur sera de comprendre plus clairement la relation entre la personne âgée qui habite à une communauté avec les risques de chutes qui sont potentiellement modifiables, le respect des recommandations concernant les facteurs de risque multifactoriels, les coûts, et les effets qui en résultent de pratiques pour prévenir les chutes. Les futures évaluations économiques des interventions pour éviter les chutes restent nécessaires et devraient tenir compte du CRAN afin que les outils de régression puissent faciliter l’analyse coût-efficacité.
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Gormley KJ. Falls prevention and support: translating research, integrating services and promoting the contribution of service users for quality and innovative programmes of care. Int J Older People Nurs 2011; 6:307-14. [DOI: 10.1111/j.1748-3743.2011.00303.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Lamb SE, Becker C, Gillespie LD, Smith JL, Finnegan S, Potter R, Pfeiffer K. Reporting of complex interventions in clinical trials: development of a taxonomy to classify and describe fall-prevention interventions. Trials 2011; 12:125. [PMID: 21586143 PMCID: PMC3127768 DOI: 10.1186/1745-6215-12-125] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 05/17/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions for preventing falls in older people often involve several components, multidisciplinary teams, and implementation in a variety of settings. We have developed a classification system (taxonomy) to describe interventions used to prevent falls in older people, with the aim of improving the design and reporting of clinical trials of fall-prevention interventions, and synthesis of evidence from these trials. METHODS Thirty three international experts in falls prevention and health services research participated in a series of meetings to develop consensus. Robust techniques were used including literature reviews, expert presentations, and structured consensus workshops moderated by experienced facilitators. The taxonomy was refined using an international test panel of five health care practitioners. We assessed the chance corrected agreement of the final version by comparing taxonomy completion for 10 randomly selected published papers describing a variety of fall-prevention interventions. RESULTS The taxonomy consists of four domains, summarized as the "Approach", "Base", "Components" and "Descriptors" of an intervention. Sub-domains include; where participants are identified; the theoretical approach of the intervention; clinical targeting criteria; details on assessments; descriptions of the nature and intensity of interventions. Chance corrected agreement of the final version of the taxonomy was good to excellent for all items. Further independent evaluation of the taxonomy is required. CONCLUSIONS The taxonomy is a useful instrument for characterizing a broad range of interventions used in falls prevention. Investigators are encouraged to use the taxonomy to report their interventions.
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Affiliation(s)
- Sarah E Lamb
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Campus, Coventry, UK.
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17
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Turner S, Arthur G, Lyons RA, Weightman AL, Mann MK, Jones SJ, John A, Lannon S. Modification of the home environment for the reduction of injuries. Cochrane Database Syst Rev 2011; 2011:CD003600. [PMID: 21328262 PMCID: PMC7003565 DOI: 10.1002/14651858.cd003600.pub3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Injury in the home is common, accounting for approximately a third of all injuries. The majority of injuries to children under five and people aged 75 and older occur at home. Multifactorial injury prevention interventions have been shown to reduce injuries in the home. However, few studies have focused specifically on the impact of physical adaptations to the home environment and the effectiveness of such interventions needs to be ascertained. OBJECTIVES To determine the effect of modifications to the home environment on the reduction of injuries due to environmental hazards. SEARCH STRATEGY We searched The Cochrane Library, MEDLINE, EMBASE and other specialised databases. We also scanned conference proceedings and reference lists. We contacted the first author of all included randomised controlled trials. The searches were last updated to the end of December 2009, and were not restricted by language or publication status. SELECTION CRITERIA Randomised controlled trials. DATA COLLECTION AND ANALYSIS Two authors screened all abstracts for relevance, outcome and design. Two authors independently assessed methodological quality and extracted data from each eligible study. We performed meta-analysis to combine effect measures, using a random-effects model. We assessed heterogeneity using an I(2) statistic and a Chi(2) test. MAIN RESULTS We found 28 published studies and one unpublished study. Only two studies were sufficiently similar to allow pooling of data for statistical analyses. Studies were divided into three groups; children, older people and the general population/mixed age group. None of the studies focusing on children or older people demonstrated a reduction in injuries that were a direct result of environmental modification in the home. One study in older people demonstrated a reduction in falls and one a reduction in falls and injurious falls that may have been due to hazard reduction. One meta-analysis was performed which examined the effects on falls of multifactorial interventions consisting of home hazard assessment and modification, medication review, health and bone assessment and exercise (RR 1.09, 95% CI 0.97 to 1.23). AUTHORS' CONCLUSIONS There is insufficient evidence to determine whether interventions focused on modifying environmental home hazards reduce injuries. Further interventions to reduce hazards in the home should be evaluated by adequately designed randomised controlled trials measuring injury outcomes. Recruitment of large study samples to measure effect must be a major consideration for future trials. Researchers should also consider using factorial designs to allow the evaluation of individual components of multifactorial interventions.
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Affiliation(s)
- Samantha Turner
- Swansea UniversitySchool of MedicineGrove BuildingSingleton ParkSwanseaUKSA2 8PP
| | - Geri Arthur
- School of MedicinePublic Health Wales; Swansea UniversityGrove BuildingSingleton ParkSwanseaUKSA2 8PP
| | - Ronan A Lyons
- Swansea UniversitySchool of MedicineGrove BuildingSingleton ParkSwanseaUKSA2 8PP
| | - Alison L Weightman
- Information Services, Cardiff UniversitySupport Unit for Research Evidence (SURE)1st Floor, Neuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - Mala K Mann
- Information Services, Cardiff UniversitySupport Unit for Research Evidence (SURE)1st Floor, Neuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - Sarah J Jones
- Cardiff UniversityPublic Health Wales; Department of Primary Care and Public HealthHeath ParkCardiffUKCF14 4XN
| | - Ann John
- School of MedicinePublic Health Wales; Swansea UniversityGrove BuildingSingleton ParkSwanseaUKSA2 8PP
| | - Simon Lannon
- Cardiff UniversityWelsh School of ArchitectureBute BuildingCardiffUKCF10 3NB
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Schoon Y, Hoogsteen-Ossewaarde ME, Scheffer AC, Van Rooij FJM, Rikkert MGMO, De Rooij SE. Comparison of different strategies of referral to a fall clinic: how to achieve an optimal casemix? J Nutr Health Aging 2011; 15:140-5. [PMID: 21365168 DOI: 10.1007/s12603-011-0027-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
UNLABELLED OBJECTIVE To study the potential differences in patient characteristics between two referral methods to a fall clinic, specifically: case-finding of patients admitted to an emergency department because of a fall, compared to direct referral to the fall clinic via the general practitioner. DESIGN Cross-sectional study. SETTING Fall clinics in two university teaching hospitals in the Netherlands. PARTICIPANTS Three hundred community-dwelling older people aged 65 years or over currently attending the fall clinics in Nijmegen (Group 1, n=154) and in Amsterdam (Group 2, n=146). MEASUREMENTS Patients were referred by a general practitioner (Group 1) or were selected using the Carefall Triage Instrument (CTI) after visiting the emergency department (Group 2). In all patients, modifiable risk factors for recurrent falls were assessed. RESULTS Group 1 had less modifiable risk factors for falling (a mean of 4 (SD 1.6) vs. a mean of 5 (SD 1.5) in Group 2, p < 0.001). Compared to Group 2, Group 1 had more prevalent " recurrent falling (≥ 2 falls)" (p=0.001) and "assisted living in homes for the aged" (p=0.037). "Fear of falling", "mobility and balance problems", "home hazards" and "osteoporosis" were significantly less prevalent in Group 1. CONCLUSION This study suggests that patients referred to a multidisciplinary fall prevention clinic by their general practitioner have a different risk profile than those selected by case finding using the CTI. These differences have consequences for the reach of secondary care for fall-preventive interventions and will probably influence the effectiveness and efficiency of a fall prevention program.
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Affiliation(s)
- Y Schoon
- Department of Geriatric Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
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Lowton K, Laybourne AH, Whiting DG, Martin FC. Can Fire and Rescue Services and the National Health Service work together to improve the safety and wellbeing of vulnerable older people? Design of a proof of concept study. BMC Health Serv Res 2010; 10:327. [PMID: 21129185 PMCID: PMC3003656 DOI: 10.1186/1472-6963-10-327] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 12/03/2010] [Indexed: 11/10/2022] Open
Abstract
Background Older adults are at increased risk both of falling and of experiencing accidental domestic fire. In addition to advanced age, these adverse events share the risk factors of balance or mobility problems, cognitive impairment and socioeconomic deprivation. For both events, the consequences include significant injury and death, and considerable socioeconomic costs for the individual and informal carers, as well as for emergency services, health and social care agencies. Secondary prevention services for older people who have fallen or who are identifiable as being at high risk of falling include NHS Falls clinics, where a multidisciplinary team offers an individualised multifactorial targeted intervention including strength and balance exercise programmes, medication changes and home hazard modification. A similar preventative approach is employed by most Fire and Rescue Services who conduct Home Fire Safety Visits to assess and, if necessary, remedy domestic fire risk, fit free smoke alarms with instruction for use and maintenance, and plan an escape route. We propose that the similarity of population at risk, location, specific risk factors and the commonality of preventative approaches employed could offer net gains in terms of feasibility, effectiveness and acceptability if activities within these two preventative approaches were to be combined. Methods/Design This prospective proof of concept study, currently being conducted in two London boroughs, (Southwark and Lambeth) aims to reduce the incidence of both fires and falls in community-dwelling older adults. It comprises two concurrent 12-month interventions: the integration of 1) fall risk assessments into the Brigade's Home Fire Safety Visit and 2) fire risk assessments into Falls services by inviting older clinic attendees to book a Visit. Our primary objective is to examine the feasibility and effectiveness of these interventions. Furthermore, we are evaluating their acceptability and value to key stakeholders and services users. Discussion If our approach proves feasible and the risk assessment is both effective and acceptable, we envisage advocating a partnership model of working more broadly to fire and rescue services and health services in Britain, such that effective integration of preventative services for older people becomes routine for an ageing population.
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Affiliation(s)
- Karen Lowton
- King's College London, Institute of Gerontology, Strand, London, UK.
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Ganz DA, Yano EM, Saliba D, Shekelle PG. Design of a continuous quality improvement program to prevent falls among community-dwelling older adults in an integrated healthcare system. BMC Health Serv Res 2009; 9:206. [PMID: 19917122 PMCID: PMC2779811 DOI: 10.1186/1472-6963-9-206] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 11/16/2009] [Indexed: 11/21/2022] Open
Abstract
Background Implementing quality improvement programs that require behavior change on the part of health care professionals and patients has proven difficult in routine care. Significant randomized trial evidence supports creating fall prevention programs for community-dwelling older adults, but adoption in routine care has been limited. Nationally-collected data indicated that our local facility could improve its performance on fall prevention in community-dwelling older people. We sought to develop a sustainable local fall prevention program, using theory to guide program development. Methods We planned program development to include important stakeholders within our organization. The theory-derived plan consisted of 1) an initial leadership meeting to agree on whether creating a fall prevention program was a priority for the organization, 2) focus groups with patients and health care professionals to develop ideas for the program, 3) monthly workgroup meetings with representatives from key departments to develop a blueprint for the program, 4) a second leadership meeting to confirm that the blueprint developed by the workgroup was satisfactory, and also to solicit feedback on ideas for program refinement. Results The leadership and workgroup meetings occurred as planned and led to the development of a functional program. The focus groups did not occur as planned, mainly due to the complexity of obtaining research approval for focus groups. The fall prevention program uses an existing telephonic nurse advice line to 1) place outgoing calls to patients at high fall risk, 2) assess these patients' risk factors for falls, and 3) triage these patients to the appropriate services. The workgroup continues to meet monthly to monitor the progress of the program and improve it. Conclusion A theory-driven program development process has resulted in the successful initial implementation of a fall prevention program.
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Affiliation(s)
- David A Ganz
- VA Greater Los Angeles HSR&D Center of Excellence, 16111 Plummer Street, Sepulveda, CA 91343, USA.
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Lyons RA, John A, Brophy S, Jones SJ, Johansen A, Kemp A, Lannon S, Patterson J, Rolfe B, Sander LV, Weightman A. Modification of the home environment for the reduction of injuries. Cochrane Database Syst Rev 2006:CD003600. [PMID: 17054179 DOI: 10.1002/14651858.cd003600.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Injury in the home is extremely common, accounting for around a third of all injuries. The majority of injuries of children under five and people aged 75 and over, occur at home. Multifactorial injury prevention interventions have been shown to reduce injuries in the home. However, few studies have focused specifically on the impact of physical adaptations to the home environment and the effectiveness of such interventions needs to be ascertained. OBJECTIVES To review the evidence for the effect on injuries of modification of the home environment with a primary focus on interventions to reduce physical hazards. SEARCH STRATEGY We searched The Cochrane Library, MEDLINE, EMBASE, National Research Register and other specialised databases. We also scanned conference proceedings and reference lists. In addition, we contacted experts and trialists in the field. The searches were not restricted by language or publication status. The searches were last updated in December 2004. SELECTION CRITERIA Randomised controlled trials. DATA COLLECTION AND ANALYSIS All abstracts were screened by two authors for relevance, outcome and design. Two authors independently assessed methodological quality and extracted data from each eligible study. MAIN RESULTS We found 18 published and one unpublished trials. Trials were not sufficiently similar to allow pooling of data by statistical analyses, so this review takes a narrative form. Studies were divided into three groups based on the primary population sample; children (five studies), older people (14 studies) and the general population/mixed age group (no studies). None of the studies focusing on children demonstrated a reduction in injuries that might have been due to environmental adaptation in the home; one study reported a reduction in injuries and in hazards but the two could not be linked. Of the 14 included studies in older people, none demonstrated a reduction in injuries due to hazard reduction, although two demonstrated a reduction in falls that could be due to hazard reduction. AUTHORS' CONCLUSIONS There is insufficient evidence to determine the effects of interventions to modify environmental home hazards. Further interventions to reduce hazards in the home should be evaluated by adequately designed randomised controlled trials measuring injury outcomes. Recruitment of large study samples to measure effect must be a major consideration for future trials.
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Affiliation(s)
- R A Lyons
- University of Wales Swansea, Swansea Clinical School, Grove Building, Singleton Park, Swansea, UK.
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