1
|
Simpkins C, Yang F. Ballet practice improves neuromuscular and biomechanical responses to an unexpected standing-slip in older adults. J Neurophysiol 2024; 132:1115-1125. [PMID: 39140587 DOI: 10.1152/jn.00219.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 08/07/2024] [Accepted: 08/08/2024] [Indexed: 08/15/2024] Open
Abstract
Falls and fall-induced injuries are common and consequential in older adults. Ballet emphasizes full-body coordination, leg strength, and postural control. However, it remains unknown whether ballet can indeed reduce falls in older adults. This study examined biomechanical and neuromuscular responses of older recreational ballet dancers to an unexpected standing-slip. Twenty older ballet dancers (17 females, 3 males) and 23 age- and sex-matched nondancers (19 females, 4 males) were exposed to an unexpected slip during treadmill standing. The slip-faller rate was the primary outcome. The secondary outcomes were kinematic measurements, including dynamic gait stability, slip distance, and recovery stepping performance (step latency, duration, length, and speed). The tertiary outcome was the electromyography latency of leg muscles (bilateral tibialis anterior, medial gastrocnemius, rectus femoris, and biceps femoris). Fewer dancers fell than nondancers after the standing-slip (45% vs. 83%, P = 0.005, d = 0.970). Dancers displayed better stability at recovery foot liftoff (P = 0.006) and touchdown (P = 0.012), a shorter step latency (P = 0.020), shorter step duration (P = 0.011), faster step speed (P = 0.032), and shorter slip distance (P = 0.015) than nondancers. They also exhibited shorter latencies than nondancers for the standing leg rectus femoris (P = 0.028) and tibialis anterior (P = 0.002), and the stepping leg biceps femoris (P = 0.031), tibialis anterior (P = 0.017), and medial gastrocnemius (P = 0.030). The results suggest that older ballet dancers experience a lower fall risk and are more stable than nondancers following an unexpected standing-slip. The greater stability among dancers could be attributed to more biomechanically effective recovery stepping, possibly associated with the ballet-induced neuromuscular benefit-an earlier leg muscle activation.NEW & NOTEWORTHY This is the first study to examine how older ballet dancers respond to an unexpected external slip perturbation while standing. The results suggest that older ballet dancers experience a reduced fall risk after the slip than their nondancer counterparts. The lower fall risk can be accounted for by dancers' quicker neuromuscular reactions to the slip that result in a more effective recovery step and thus higher stability against backward falls due to the slip.
Collapse
Affiliation(s)
- Caroline Simpkins
- Department of Kinesiology and Health, Georgia State University, Atlanta, Georgia, United States
| | - Feng Yang
- Department of Kinesiology and Health, Georgia State University, Atlanta, Georgia, United States
| |
Collapse
|
2
|
Machado-Duque ME, Camacho-Arteaga L, Sabaté M, Vidal-Guitart X, Machado-Alba JE. Falls in hospitalized older adults and the use of fall risk-increasing drugs and anticholinergic medications in Colombia: a case‒control study. Front Pharmacol 2024; 15:1369200. [PMID: 39021833 PMCID: PMC11251958 DOI: 10.3389/fphar.2024.1369200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/29/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction In-hospital falls are multicausal in older hospitalized patients. Drugs with anticholinergic load and psychotropic effects can increase the risk of falling. Objective This study aimed to determine the associations between fall risk-increasing drugs (FRIDs) and the anticholinergic risk score (ARS) with falls in hospitalized older hospitalized patients. Methods This was a case‒control study of patients ≥65 years of age of either sex treated in four clinics in Colombia between 2018 and 2020. Each patient who suffered a fall during hospitalization was matched with four hospitalized patients who did not. Sociodemographic, clinical, and pharmacologic variables and the use of the ARS and FRIDs were evaluated. The risk associated with FRIDs was estimated using conditional logistic regression. Results There were 250 patients and 1,000 controls (ratio of 1:4), with a mean age of 77.4 ± 7.4 years and a predominance of men (n = 800, 64.0%). The majority of falls occurred during hospitalization (n = 192 patients, 76.8%). Polypharmacy, calcium channel blockers, antiepileptics, antipsychotics, sodium-glucose cotransporter type 2 inhibitors, and nonsteroidal anti-inflammatory drugs were associated with falls during hospitalization. With an ARS score of 3, the probability of falling during the hospital stay increased (aOR: 2.34; 95% CI: 1.64-3.32). Conclusion There is an association between suffering a fall and the use of drugs with anticholinergic load or FRIDs in hospitalized adults more than 65 years of age in Colombia.
Collapse
Affiliation(s)
- Manuel E. Machado-Duque
- Departmento de Farmacología, Terapeutica y Toxicología, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Grupo de Investigación en Farmacoepidemiologia y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma SA, Risaralda, Colombia
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autonoma de las Americas, Pereira, Colombia
| | - Lina Camacho-Arteaga
- Departmento de Farmacología, Terapeutica y Toxicología, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Departmento de Farmacología Clinica, Hospital Universitari Vall d'Hebron, Hospital Campus Vall d'Hebron Barcelona, Barcelona, Spain
- Grupo de Investigación en Farmacología Clínica, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Mónica Sabaté
- Departmento de Farmacología, Terapeutica y Toxicología, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Departmento de Farmacología Clinica, Hospital Universitari Vall d'Hebron, Hospital Campus Vall d'Hebron Barcelona, Barcelona, Spain
- Grupo de Investigación en Farmacología Clínica, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Xavier Vidal-Guitart
- Departmento de Farmacología, Terapeutica y Toxicología, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jorge E. Machado-Alba
- Grupo de Investigación en Farmacoepidemiologia y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma SA, Risaralda, Colombia
| |
Collapse
|
3
|
La Porta F, Valpiani G, Lullini G, Negro A, Pellicciari L, Bassi E, Caselli S, Pecoraro V, Govoni E. A novel multistep approach to standardize the reported risk factors for in-hospital falls: a proof-of-concept study. Front Public Health 2024; 12:1390185. [PMID: 38932769 PMCID: PMC11199548 DOI: 10.3389/fpubh.2024.1390185] [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] [Received: 02/22/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Background Uncertainty and inconsistency in terminology regarding the risk factors (RFs) for in-hospital falls are present in the literature. Objective (1) To perform a literature review to identify the fall RFs among hospitalized adults; (2) to link the found RFs to the corresponding categories of international health classifications to reduce the heterogeneity of their definitions; (3) to perform a meta-analysis on the risk categories to identify the significant RFs; (4) to refine the final list of significant categories to avoid redundancies. Methods Four databases were investigated. We included observational studies assessing patients who had experienced in-hospital falls. Two independent reviewers performed the inclusion and extrapolation process and evaluated the methodological quality of the included studies. RFs were grouped into categories according to three health classifications (ICF, ICD-10, and ATC). Meta-analyses were performed to obtain an overall pooled odds ratio for each RF. Finally, protective RFs or redundant RFs across different classifications were excluded. Results Thirty-six articles were included in the meta-analysis. One thousand one hundred and eleven RFs were identified; 616 were linked to ICF classification, 450 to ICD-10, and 260 to ATC. The meta-analyses and subsequent refinement of the categories yielded 53 significant RFs. Overall, the initial number of RFs was reduced by about 21 times. Conclusion We identified 53 significant RF categories for in-hospital falls. These results provide proof of concept of the feasibility and validity of the proposed methodology. The list of significant RFs can be used as a template to build more accurate measurement instruments to predict in-hospital falls.
Collapse
Affiliation(s)
- Fabio La Porta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giorgia Valpiani
- Research and Innovation Unit, Biostatistics and Clinical Trial Area, University Hospital of Ferrara, Ferrara, Italy
| | - Giada Lullini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Antonella Negro
- Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Emilia-Romagna, Italy
| | | | - Erika Bassi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Serena Caselli
- Unità Operativa Complessa di Medicina Riabilitativa, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Valentina Pecoraro
- Department of Laboratory Medicine and Pathology, AUSL Modena, Modena, Italy
| | - Erika Govoni
- Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Emilia-Romagna, Italy
- Unità Organizzativa Riabilitazione Ospedaliera, Dipartimento Assistenziale Tecnico e Riabilitativo, Ausl Bologna, Bologna, Italy
| |
Collapse
|
4
|
Hirata R, Katsuki NE, Yaita S, Nakatani E, Shimada H, Oda Y, Tokushima M, Aihara H, Fujiwara M, Tago M. Validation of the Saga Fall Injury Risk Model. Int J Med Sci 2024; 21:1378-1384. [PMID: 38903917 PMCID: PMC11186423 DOI: 10.7150/ijms.92837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/09/2024] [Indexed: 06/22/2024] Open
Abstract
Background: Predicting fall injuries can mitigate the sequelae of falls and potentially utilize medical resources effectively. This study aimed to externally validate the accuracy of the Saga Fall Injury Risk Model (SFIRM), consisting of six factors including age, sex, emergency transport, medical referral letter, Bedriddenness Rank, and history of falls, assessed upon admission. Methods: This was a two-center, prospective, observational study. We included inpatients aged 20 years or older in two hospitals, an acute and a chronic care hospital, from October 2018 to September 2019. The predictive performance of the model was evaluated by calculating the area under the curve (AUC), 95% confidence interval (CI), and shrinkage coefficient of the entire study population. The minimum sample size of this study was 2,235 cases. Results: A total of 3,549 patients, with a median age of 78 years, were included in the analysis, and men accounted for 47.9% of all the patients. Among these, 35 (0.99%) had fall injuries. The performance of the SFIRM, as measured by the AUC, was 0.721 (95% CI: 0.662-0.781). The observed fall incidence closely aligned with the predicted incidence calculated using the SFIRM, with a shrinkage coefficient of 0.867. Conclusions: The external validation of the SFIRM in this two-center, prospective study showed good discrimination and calibration. This model can be easily applied upon admission and is valuable for fall injury prediction.
Collapse
Affiliation(s)
- Risa Hirata
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Naoko E. Katsuki
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Shizuka Yaita
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Eiji Nakatani
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Hitomi Shimada
- Shimada Hospital of Medical Corporation Chouseikai, Saga, Japan
| | - Yoshimasa Oda
- Department of General Medicine, Yuai-Kai Foundation and Oda Hospital, Saga, Japan
| | - Midori Tokushima
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Hidetoshi Aihara
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Motoshi Fujiwara
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
| |
Collapse
|
5
|
Brown D, Simpkins C, Yang F. A systematic review of perturbation-based balance training on reducing fall risk among individuals with stroke. Clin Biomech (Bristol, Avon) 2023; 109:106078. [PMID: 37647717 DOI: 10.1016/j.clinbiomech.2023.106078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Perturbation-based balance training has been proven effective to reduce falls in older adults. However, it remains inconclusive if this training paradigm reduces falls in the stroke population. This review sought to summarize the existing literature to assess the effects of perturbation-based balance training on falls and some common fall risk factors in people with stroke. METHODS Seven databases were searched for studies, which included at least one perturbation-based balance training group and a control group. The primary outcome was the proportion of fallers, and the secondary outcomes encompassed commonly used fall risk factors: balance, balance confidence, reactive stepping characteristics, functional mobility, and muscle strength. FINDINGS This review included nine studies that enrolled 364 participants. The training protocols were significantly heterogeneous among studies, with variations in the training duration, number of sessions, session length, and type of devices used. The results indicated insufficient evidence supporting that perturbation-based balance training reduces falls in the laboratory and everyday living conditions for people with stroke. Furthermore, the effects of perturbation-based balance training on fall risk factors are also inconsistent between studies. INTERPRETATION The existing evidence does not conclusively support the reduction in falls and improvements in fall risk factors resulting from perturbation-based balance training among people with stroke. Such an inconsistent finding could be due to the small sample sizes and variations in perturbation-based balance training protocols across studies. More high-quality studies are needed to further determine the effects of perturbation-based balance training on reducing fall risk in people with stroke.
Collapse
Affiliation(s)
- Diané Brown
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
| | - Caroline Simpkins
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
| | - Feng Yang
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA.
| |
Collapse
|
6
|
Kobayashi K, Kido N, Wakabayashi S, Yamamoto K, Hihara J, Tamura M, Sakahara T. Association between fall-related serious injury and activity during fall in an acute care hospital. PLoS One 2023; 18:e0288320. [PMID: 37418434 DOI: 10.1371/journal.pone.0288320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/23/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVES Few studies have evaluated the mechanism of serious injury in acute hospitalization. Thus, the association between fall-related serious injury and activity during falls in acute care hospital remains unclear. Herein, we investigated the relationship between serious injury caused by fall and activity at the time of the fall in an acute care hospital. METHODS This retrospective cohort study was conducted at Asa Citizens Hospital. All inpatients aged 65 years and older were eligible for the study, which was conducted from April 1, 2021, through March 31, 2022. The magnitude of the association between injury severity and activity during the fall was quantified using odds ratio. RESULTS Among the 318 patients with reported falls, 268 (84.3%) had no related injury, 40 (12.6%) experienced minor injury, 3 (0.9%) experienced moderate injury, 7 (2.2%) experienced major injury. Moderate or major injuries caused by a fall was associated with the activity during the fall (odds ratio: 5.20; confidence intervals: 1.43-18.9, p = 0.013). CONCLUSION This study recognizes that falling during ambulation caused moderate or major injuries in an acute care hospital. Our study suggests that falls while ambulating in an acute care hospital were associated not only with fractures, but also with lacerations requiring sutures and brain injuries. Among the patients with moderate or major injuries, more falls occurred outside the patient's bedroom as compared with patients with minor or no injuries. Therefore, it is important to prevent moderate or major injuries related to falls that occur while the patient is walking outside their bedroom in an acute care hospital.
Collapse
Affiliation(s)
- Kosuke Kobayashi
- Department of Rehabilitation, Hiroshima City North Medical Center Asa Citizens Hospital, Asa-kita Ward, Hiroshima City, Hiroshima, Japan
| | - Naohiro Kido
- Department of Rehabilitation, Hiroshima City North Medical Center Asa Citizens Hospital, Asa-kita Ward, Hiroshima City, Hiroshima, Japan
| | - Shoji Wakabayashi
- Department of Rehabilitation, Hiroshima City North Medical Center Asa Citizens Hospital, Asa-kita Ward, Hiroshima City, Hiroshima, Japan
| | - Kyoko Yamamoto
- Department of Rehabilitation, Hiroshima City North Medical Center Asa Citizens Hospital, Asa-kita Ward, Hiroshima City, Hiroshima, Japan
| | - Jun Hihara
- Total Quality Management Center, Hiroshima City North Medical Center Asa Citizens Hospital, Asa-kita Ward, Hiroshima City, Hiroshima, Japan
| | - Masami Tamura
- Total Quality Management Center, Hiroshima City North Medical Center Asa Citizens Hospital, Asa-kita Ward, Hiroshima City, Hiroshima, Japan
| | - Tomoko Sakahara
- Total Quality Management Center, Hiroshima City North Medical Center Asa Citizens Hospital, Asa-kita Ward, Hiroshima City, Hiroshima, Japan
| |
Collapse
|
7
|
Vibration training reducing falls in community-living older adults: a pilot randomized controlled trial. Aging Clin Exp Res 2023; 35:803-814. [PMID: 36781617 PMCID: PMC9924854 DOI: 10.1007/s40520-023-02362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/31/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Although vibration training has been applied in older adults, it remains unclear if it can reduce falls. AIMS This pilot randomized-controlled trial aimed to test the effects of an 8-week vibration training program on reducing falls among community-dwelling adults. METHODS Forty-eight older adults were randomized to two groups: training and control. The training group received three weekly training sessions over eight weeks while the control group maintained their normal lifestyle over the 8-week period. Immediately before (or baseline), following (post-training), and three months after (retest) the 8-week training course, a group of fall risk factors were assessed for all participants. Each participant was also exposed to an unexpected gait-slip on a treadmill during post-training and retest sessions. Their daily-living fall incidence was collected for 12 months after the baseline test. The slip fall was the primary outcome, prospective all-cause falls were the secondary outcome, and fall risk factors acted as the tertiary ones. RESULTS The vibration training program significantly reduced the risk of slip-falls and improved all fall risk factors immediately after the training course. The training effect may be carried over for three months. The 8-week training program could also lower the number of falls between the baseline test and retest and reduce the recurrent faller rate across the 12 months after the baseline test. DISCUSSION This study indicates that vibration training might have some effects on fall-related measures in older adults. CONCLUSIONS An 8-week vibration training program could be effective to reduce falls in older adults. CLINICALTRIALS GOV REGISTRATION NUMBER NCT02694666.
Collapse
|
8
|
Simpkins C, Ahn J, Shin S, Yang F. Recovery from an unexpected standing-slip in professional ballet dancers. J Biomech 2022; 145:111366. [PMID: 36356442 DOI: 10.1016/j.jbiomech.2022.111366] [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: 04/11/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022]
Abstract
Although interventional studies have suggested that dance-based training may reduce fall risk for older adults based on unperturbed assessments, it remains unknown whether dance (particularly ballet) enhances recovery from an external perturbation. This preliminary study sought to test if and how ballet dancers respond differently to a novel standing-slip perturbation relative to non-dancers. Ten young professional ballet dancers and 10 age/sex-matched non-dancers were exposed to an unannounced slip while standing on the treadmill. Their reactions to the slip, characterized by dynamic gait stability (primary outcome), and the recovery stepping and trunk movements (secondary outcomes), were compared between groups. No significant group difference in dynamic gait stability was found at slip onset and recovery step liftoff, but dancers were more stable than non-dancers at touchdown (p = 0.046). Compared to non-dancers, dancers took a longer (p = 0.049) and faster (p = 0.007) backward recovery step and exhibited a less backward leaned trunk at all instants (p ≤ 0.026). Our study suggests that professional ballet dancers are more stable after a novel standing-slip than non-dancers. This better slip-related fall resistance among dancers could result from their more effective recovery stepping strategy and better trunk movement control after the slip. Both reactions may be attributed to ballet training, which requires frequent backward stepping and an upright trunk. Our findings could potentially provide preliminary evidence for applying ballet training to reduce balance losses and falls in people at a high fall risk. More studies are needed to examine ballet training's effects among other populations with elevated fall risk in real-life situations.
Collapse
Affiliation(s)
- Caroline Simpkins
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA
| | - Jiyun Ahn
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA
| | - Sangwon Shin
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA
| | - Feng Yang
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA.
| |
Collapse
|
9
|
Ladios-Martin M, Cabañero-Martínez MJ, Fernández-de-Maya J, Ballesta-López FJ, Belso-Garzas A, Zamora-Aznar FM, Cabrero-Garcia J. Development of a predictive inpatient falls risk model using machine learning. J Nurs Manag 2022; 30:3777-3786. [PMID: 35941786 DOI: 10.1111/jonm.13760] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 12/30/2022]
Abstract
AIM The aims of this study were to create a model that detects the population at risk of falls taking into account a fall prevention variable and to know the effect on the model's performance when not considering it. BACKGROUND Traditionally, instruments for detecting fall risk are based on risk factors, not mitigating factors. Machine learning, which allows working with a wider range of variables, could improve patient risk identification. METHODS The sample was composed of adult patients admitted to the Internal Medicine service (total, n = 22,515; training, n = 11,134; validation, n = 11,381). A retrospective cohort design was used and we applied machine learning technics. Variables were extracted from electronic medical records electronic medical records. RESULTS The Two-Class Bayes Point Machine algorithm was selected. Model-A (with a fall prevention variable) obtained better results than Model-B (without it) in sensitivity (0.74 vs. 0.71), specificity (0.82 vs. 0.74), and AUC (0.82 vs. 0.78). CONCLUSIONS Fall prevention was a key variable. The model that included it detected the risk of falls better than the model without it. IMPLICATIONS FOR NURSING MANAGEMENT We created a decision-making support tool that helps nurses to identify patients at risk of falling. When it is integrated in the electronic medical records, it decreases nurses' workloads by not having to collect information manually.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Julio Cabrero-Garcia
- Nursing Department, University of Alicante, San Vicente del Raspeig - Alicante, Spain
| |
Collapse
|
10
|
Falling Short: The Contribution of Central Insulin Receptors to Gait Dysregulation in Brain Aging. Biomedicines 2022; 10:biomedicines10081923. [PMID: 36009470 PMCID: PMC9405648 DOI: 10.3390/biomedicines10081923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Insulin resistance, which manifests as a reduction of insulin receptor signaling, is known to correlate with pathological changes in peripheral tissues as well as in the brain. Central insulin resistance has been associated with impaired cognitive performance, decreased neuronal health, and reduced brain metabolism; however, the mechanisms underlying central insulin resistance and its impact on brain regions outside of those associated with cognition remain unclear. Falls are a leading cause of both fatal and non-fatal injuries in the older population. Despite this, there is a paucity of work focused on age-dependent alterations in brain regions associated with ambulatory control or potential therapeutic approaches to target these processes. Here, we discuss age-dependent alterations in central modalities that may contribute to gait dysregulation, summarize current data supporting the role of insulin signaling in the brain, and highlight key findings that suggest insulin receptor sensitivity may be preserved in the aged brain. Finally, we present novel results showing that administration of insulin to the somatosensory cortex of aged animals can alter neuronal communication, cerebral blood flow, and the motivation to ambulate, emphasizing the need for further investigations of intranasal insulin as a clinical management strategy in the older population.
Collapse
|
11
|
Using Healthcare Resources Wisely: A Predictive Support System Regarding the Severity of Patient Falls. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3100618. [PMID: 35958052 PMCID: PMC9359836 DOI: 10.1155/2022/3100618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/15/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022]
Abstract
Background An injurious fall is one of the main indicators of care quality in healthcare facilities. Despite several fall screen tools being widely used to evaluate a patient's fall risk, they are frequently unable to reveal the severity level of patient falls. The purpose of this study is to build a practical system useful to predict the severity level of in-hospital falls. This practice is done in order to better allocate limited healthcare resources and to improve overall patient safety. Methods Four hundred and forty-six patients who experienced fall events at a large Taiwanese hospital were referenced. Eight predictors were used to ascertain the severity of patient falls solely based on the above study population. Multinomial logistic regression, Naïve Bayes, random forest, support vector machine, eXtreme gradient boosting, deep learning, and ensemble learning were adopted to establish predictive models. Accuracy, F1 score, precision, and recall were utilized to assess the models' performance. Results Compared to other learners, random forest exhibited satisfying predictive performance in terms of all metrics (accuracy: 0.844, F1 score: 0.850, precision: 0.839, and recall: 0.875 for the test dataset), and it was adopted as the base learner for a severity-level predictive system which is web-based. Furthermore, age, ability of independent activity, patient sources, use of assistive devices, and fall history within the past 12 months were deemed the top five important risk factors for evaluating fall severity. Conclusions The application of machine learning techniques for predicting the severity level of patient falls may result in some benefits to monitor fall severity and to better allocate limited healthcare resources.
Collapse
|
12
|
Oren G, Jolkovsky S, Tal S. Falls in oldest-old adults hospitalized in acute geriatric ward. Eur Geriatr Med 2022; 13:859-866. [PMID: 35776410 DOI: 10.1007/s41999-022-00660-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/09/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE The study aims to identify risk factors for falling among acutely ill older patients, hospitalized in acute geriatric ward. METHODS A retrospective study of 260 cases of patients who had fallen and 439 controls was conducted in a geriatric ward. We retrieved from the electronic hospital records data including patient demographics, medical diagnoses, and laboratory results, and drugs taken prior to the fall were reviewed. In addition, data on functional and cognitive status were recorded. Admission Morse Falls Scale for every patient was also retrieved. RESULTS The following on-admission diagnoses were associated with a higher incidence of falls during hospitalization: hypertension (84% vs. 38%), congestive heart failure (CHF), 74% vs 16%, dementia (36% vs. 5%), and delirium (36% vs 5%). A higher percentage of fallers compared to controls consumed beta blockers (69% vs. 53%), benzodiazepines (46% vs. 32%), antidepressants (33% vs. 23%), oral diabetes drugs (20% vs. 11%) and opiates (8% vs. 4%). On-admission Morse Falls Scale score was found to be higher in the patients who fell (59 vs.53). The strongest predictors of falling during hospitalization were CHF, hypertension, dementia, delirium, assisted mobility and dependence. CONCLUSION A systematic screening of risk factors for falls and identification of them might contribute to reducing the risk associated with falls during hospitalization.
Collapse
Affiliation(s)
- Gal Oren
- Acute Geriatrics Department at Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, 1, Derech Pasternak, st., Rehovot, Israel
| | - Svetlana Jolkovsky
- Geriatrics Department, Hartzfeld Hospital, Kaplan Medical Center, Gedera, Affiliated with the Hebrew University of Jerusalem, Rehovot, Israel
| | - Sari Tal
- Acute Geriatrics Department at Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, 1, Derech Pasternak, st., Rehovot, Israel. .,Geriatrics Department, Hartzfeld Hospital, Kaplan Medical Center, Gedera, Affiliated with the Hebrew University of Jerusalem, Rehovot, Israel.
| |
Collapse
|
13
|
Hagino T, Ochiai S, Senga S, Yamashita T, Saito M, Wako M, Taniguchi N, Ando T, Haro H. Validity of a fall risk assessment score sheet for patients hospitalized in general wards. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:311-318. [PMID: 35967934 PMCID: PMC9350569 DOI: 10.18999/nagjms.84.2.311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/10/2021] [Indexed: 11/09/2022]
Abstract
Falls (including fall on same level and fall to a lower level) are frequent medical accidents among hospitalized patients. We investigated the status of falls in our hospital, aiming to verify the usefulness of a fall risk assessment sheet and identify the risk factors of falls. 5219 patients who were admitted to the general wards of our hospital between April 2016 and March 2019 were studied. Patient background data and the result of risk assessment based on a fall risk assessment score sheet at admission were registered. The frequency and location of falls during hospitalization, and the impact on patients were investigated. Risk factors for falls were analyzed based on the assessment results at admission. 218 falls occurred during hospitalization in 152 of 5219 patients (2.9%). The most common location of falls was bedside (68%). Falls occurred at night in 28%. The impact of falls was level 1 in 18 patients, level 2 in 117, level 3a in 11, and level 3b in 6 (all had head injuries, and one had concurrent fracture). Fall rate was 1.1% (41/3791 patients) at risk level I, 6.8% (91/1335 patients) at level II, and 21.5% (20/93 patients) at level III. Multiple logistic regression analysis identified age, history of fall, tendency to act without pressing nurse call button, unstable gait, unstable when standing, and use of narcotic as risk factors of falls. The incidence of falls at our hospital was lower compared to previous reports, and fall risk assessment was useful overall.
Collapse
Affiliation(s)
- Tetsuo Hagino
- Department of Orthopaedic Surgery, National Hospital Organization Kofu National Hospital, Kofu, Japan
| | - Satoshi Ochiai
- Department of Orthopaedic Surgery, National Hospital Organization Kofu National Hospital, Kofu, Japan
| | - Shinya Senga
- Department of Orthopaedic Surgery, National Hospital Organization Kofu National Hospital, Kofu, Japan
| | - Takashi Yamashita
- Department of Orthopaedic Surgery, National Hospital Organization Kofu National Hospital, Kofu, Japan
| | - Masanori Saito
- Department of Orthopaedic Surgery, National Hospital Organization Kofu National Hospital, Kofu, Japan
| | - Masanori Wako
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Naofumi Taniguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Takashi Ando
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| |
Collapse
|
14
|
Fall determinants in hospitalised older patients: a nested case control design - incidence, extrinsic and intrinsic risk in Malaysia. BMC Geriatr 2022; 22:179. [PMID: 35236280 PMCID: PMC8892728 DOI: 10.1186/s12877-022-02846-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background The older person is at greater risk of falls due to multiple intrinsic and extrinsic factors. This is compounded when the elderly is admitted to hospitals, as they are acutely ill and placed in an unfamiliar environment. Delirium and polypharmacy further complicate these problems. As falls reflect quality of care with potential for grave outcomes, this study aimed to identify the extent and risk of falls in public hospitals. Methods We conducted a nested case control study in 12 public hospitals in Malaysia. In the cohort section, we screened all inpatients 60 years of age and above daily until discharge, or the end of the study period. Daily, we identified those who fell, inclusive of near falls, in the preceding 24 h. Our enumerators interviewed patients on experience of fall, and supplemented data from the nurses and caregivers. For each case, ten controls were chosen. Results The incidence of falls/near falls was 1.0 per 1000 patient days (95% CI: 0.9, 1.1). Intrinsic risk factors found to be significant included patients who were not from a nursing home or not cared for by a domestic helper prior to admission, had prior history of indoor fall either in home or hospital, had four or more clinical diagnoses or exited from the bed on the weak side. Significant extrinsic factors were the absence of transfer bar in toilet, call bells, light switches or walking aids that were not within reach, as well as not having a walking aid. Non-sturdy chair was associated with lesser falls than when sturdy chairs with armrests were present. Conclusion Querying patients for falls produced better results than incident reporting. Several intrinsic factors such as history of indoor or in-hospital fall, having four or more clinical diagnoses or exiting from weaker side and residence history may help to identify those at higher risk. Addressing significant extrinsic factors such as transfer bars and the identification of switches may help in reducing falls risk in hospitals. Trial registration This study was registered in National Medical Research Register of Malaysia (NMRR-07-772-1044; date 26/05/2008) with Ethics Approval from Medical Research and Ethics Committee (MREC: MRG-07-LOI-HSR-1).
Collapse
|
15
|
Innab AM. Nurses’ perceptions of fall risk factors and fall prevention strategies in acute care settings in Saudi Arabia. Nurs Open 2022; 9:1362-1369. [PMID: 35099122 PMCID: PMC8859041 DOI: 10.1002/nop2.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/20/2021] [Accepted: 01/09/2022] [Indexed: 11/30/2022] Open
Abstract
Aim This study aimed to explore nurses’ perceptions of the factors associated with falls and of fall prevention strategies in acute care settings in Saudi Arabia. Design This is a cross‐sectional, correlational, descriptive study. Methods Data were collected from 102 nurses using a survey on the risk factors and prevention strategies of injurious falls. Results We found that impaired balance and muscle strength, limited mobility, and an inability to follow safety instructions were reported as the top factors in falls. Multidisciplinary fall prevention strategies are effective in reducing the prevalence of falls. Nurses with higher levels of education had higher perceptions towards the risk factors of falls. Formal patient safety training, including fall prevention education programmes, were shown to reduce falls by making nurses more aware of fall risk factors and prevention strategies. The findings of this study can be used to inform managers about factors that may contribute to falls in acute care settings.
Collapse
Affiliation(s)
- Adnan M. Innab
- Nursing Administration and Education Department College of Nursing King Saud University Riyadh Kingdom of Saudi Arabia
| |
Collapse
|
16
|
Barbay K, Williams KB, Berning P. The Utility of the Modified Dionne's Egress Test as a Predictor of Falls in Adult Medical and Surgical Patients. J Nurs Adm 2021; 51:638-644. [PMID: 34817470 DOI: 10.1097/nna.0000000000001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to compare the efficacy of a modified Dionne's Egress Test (Egress) as a predictor of falls with the Morse Fall Scale (MFS) in adult medical and surgical patients in an acute care setting. BACKGROUND Nurses must identify fall risk while balancing fall prevention and early mobility in their care delivery. Fall risk screening tools alone are not enough to assist nurses in predicting patients at risk of falling. METHODS A retrospective observational study design was used to compare the Egress as a predictor of falls to the MFS. The sample included data abstracted from 197 electronic health records and internal falls data. RESULTS The Egress and the MFS are moderately and negatively correlated; however, only Egress was a significant predictor of falls. Passing the Egress, not being on benzodiazepines, and having a longer length of stay (LOS) results were associated with being less likely to fall. CONCLUSION Egress is a better predictor of falls than MFS when benzodiazepines and LOS are controlled in the model.
Collapse
Affiliation(s)
- Kathryn Barbay
- Author Affiliations: Clinical Nurse Specialist, Evidence Based Practice (Ms Barbay), Clinical Nurse, PeriCardioVascular Care Unit (Mr Berning), AdventHealth Shawnee Mission, Kansas; and Professor and Chair Emerita (Dr Williams), Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas City
| | | | | |
Collapse
|
17
|
Cunha LFCD, Baixinho CL, Henriques MA, Sousa LMM, Dixe MDA. Evaluation of the effectiveness of an intervention in a health team to prevent falls in hospitalized elderly people. Rev Esc Enferm USP 2021; 55:e03695. [PMID: 34076150 DOI: 10.1590/s1980-220x2019031403695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 09/23/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of an intervention program in practices and behaviors of a health team to prevent falls in hos pitalized elderly people. METHOD This was an action, mixed-methods, and longitudinal study that applied an intervention based on TeamSTEPPS®, and organized into five domains: team training, communication, leadership, monitoring, and mutual support. The population was nurses and nursing aides who worked at the medical service of a Portuguese hospital center. Data were obtained by consulting process records and interviews, and by applying the Scale of Practices and Behaviors of Teams for Fall Prevention. RESULTS There was improvement in all indicators of the scale, with evident progress in discussion of risk factors and preventive measures to be implemented. CONCLUSION This intervention promoted decision-making regarding the preventive measures to be applied to each elderly person and improved communication and the interest in identifying the causes of falls to prevent their recurrence.
Collapse
Affiliation(s)
| | - Cristina Lavareda Baixinho
- Escola Superior de Enfermagem de Lisboa, Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa (CIDNUR), Lisboa, Portugal.,Centro de Inovação em Tecnologias e Cuidados de Saúde (ciTechCare), Leiria, Portugal
| | - Maria Adriana Henriques
- Escola Superior de Enfermagem de Lisboa, Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa (CIDNUR), Lisboa, Portugal.,Centro de Inovação em Tecnologias e Cuidados de Saúde (ciTechCare), Leiria, Portugal
| | | | - Maria Dos Anjos Dixe
- Centro de Inovação em Tecnologias e Cuidados de Saúde (ciTechCare), Leiria, Portugal.,Escola Superior de Saúde, Instituto Politécnico de Leiria, Leiria, Portugal
| |
Collapse
|
18
|
Decalf V, Bower W, Rose G, Petrovic M, Pieters R, Eeckloo K, Everaert K. Prevalence and characteristics of incident falls related to nocturnal toileting in hospitalized patients. Acta Clin Belg 2021; 76:85-90. [PMID: 31478467 DOI: 10.1080/17843286.2019.1660022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: Although nocturia is a risk factor for incident falls in the community, studies are required to gain an understanding of incident falls related to nocturnal toileting in hospitals. The aim of this study is to describe the prevalence and characteristics of incident falls in adult hospitalized patients related to nocturnal toileting.Methods: A retrospective review of the electronic incident reporting and learning system and medical records of inpatients that had an incident fall.Results: The prevalence of toileting-related incident falls was 53% (73/137) and 28% of all incident falls were related to nocturnal toileting.Intravenous fluid infusion was associated with falls related to toileting, whereby median perfusion volume during night-time was 375 ml [IQR: 225-578 ml].Conclusions: The prevalence of nocturnal toileting-related incident falls in hospitals is high. Nocturia could be a leading cause of these incident falls. Intravenous fluid infusion might be part of the aetiology of (iatrogenic) nocturia.
Collapse
Affiliation(s)
- Veerle Decalf
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Wendy Bower
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne, Melbourne, Australia
| | - Georgie Rose
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Australia
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Ronny Pieters
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Kristof Eeckloo
- Department of Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Karel Everaert
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
19
|
Risk Factors for Fall-Related Serious Injury among Korean Adults: A Cross-Sectional Retrospective Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031239. [PMID: 33573157 PMCID: PMC7908365 DOI: 10.3390/ijerph18031239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to identify the risk factors of serious fall-related injuries by analyzing the differences between two fall groups: one with serious fall-related injuries and one without such injuries. Applying a retrospective, descriptive investigation study design, we analyzed the degree of fall-related injury and the risk factors related to serious falls by conducting a complete survey of the medical records of fall patients reported throughout one full year, 2017, at a tertiary hospital in Seoul, Korea. Among the patients with reported falls, 188 sustained no injury (63.1%), 72 sustained minor injury (24.2%), and 38 patients sustained serious injury (12.8%). The serious fall-related injuries included eight lacerations requiring suture (2.7%), 23 fractures (7.7%), five brain injuries (1.7%), and two deaths (0.7%). Analysis results indicated that taking anticoagulants/antiplatelet drugs (p = 0.016) and having a fall history (p = 0.038) were statistically significant in the differences between the group with serious injury related to falls and the group without serious injury. Logistic regression revealed that taking anticoagulant/antiplatelet drugs was the factor most significantly correlated with serious injuries related to falls (OR = 2.299, p = 0.022). Results show that it is necessary to develop a patient-tailored fall prevention activity program.
Collapse
|
20
|
Noh HM, Song HJ, Park YS, Han J, Roh YK. Fall predictors beyond fall risk assessment tool items for acute hospitalized older adults: a matched case-control study. Sci Rep 2021; 11:1503. [PMID: 33452370 PMCID: PMC7810864 DOI: 10.1038/s41598-021-81034-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 01/04/2021] [Indexed: 01/30/2023] Open
Abstract
We investigated whether clinical factors including comorbidities, medications, and laboratory results predict inpatient fall risk in older adults. The participants in this case–control study included hospitalized older adults with acute conditions who had falls during their hospital stay (case group) and 410 hospitalized older adults who did not experience falls (control group). Data on medical history, fall risk assessment (Morse Fall Scale; MFS), medications, and laboratory results were obtained. Conditional logistic regression analysis was performed to estimate the association between clinical factors and falls. Receiver operating characteristic curves and area under the curve (AUC) were used to determine whether clinical factors could discriminate between fallers and controls. We evaluated three models: (M1) MFS, (M2) M1 plus age, sex, ward, and polypharmacy, and (M3) M2 plus clinical factors. Patients with diabetes mellitus or MFS scores ≥ 45 had the highest risk of falls. Calcium channel blockers, diuretics, anticonvulsants, and benzodiazepines were associated with high fall risk. The AUC of the three models was 0.615, 0.646, and 0.725, respectively (M1 vs. M2, P = 0.042 and M2 vs. M3, P < .001). Examining clinical factors led to significant improvements in fall prediction beyond that of the MFS in hospitalized older adults.
Collapse
Affiliation(s)
- Hye-Mi Noh
- Department of Family Medicine, College of Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, 14068, Republic of Korea
| | - Hong Ji Song
- Department of Family Medicine, College of Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, 14068, Republic of Korea
| | - Yong Soon Park
- Department of Family Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, 24253, Republic of Korea
| | - Junhee Han
- Department of Statistics and Institute of Statistics, Hallym University, Chuncheon, 24252, Republic of Korea
| | - Yong Kyun Roh
- Department of Family Medicine, Kangnam Sacred Heart Hospital, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Republic of Korea.
| |
Collapse
|
21
|
Castaldi S, Principi N, Carnevali D, Tiwana N, Pietronigro A, Mosillo M, Marrazzo M, Colombo R, Avanzi GM, Corna S. Correlation between fall risk increasing drugs (FRIDs) and fall events at a rehabilitation hospital. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021397. [PMID: 35075080 PMCID: PMC8823575 DOI: 10.23750/abm.v92i6.11340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 05/28/2021] [Indexed: 11/26/2022]
Abstract
Background and aim Falls and fall-related injuries are a major public health issue which needs global attention due to its clinical and socioeconomic impact. Important risk factors for falls are polypharmacy and the assumption of so-called Fall Risk Increasing Drugs (FRIDs). Aims of our study were to investigate the associations between falls and the use of medications among inpatients by conducting a retrospective case-control study in a rehabilitation hospital in Northern Italy in 2018. Methods A Conditional Logistic Regression was performed to analyze the impact that 13 types of FRIDs individually and the number of administrated FRIDs had on the risk of falling. A second regression model was obtained adjusting the case-control matching for CIRS, Morse and Barthel scores. Results We identified 148 cases and 444 controls. 3 types of FRIDs were significantly correlated (p < 0,05) with an increased risk of falling: Antipsychotics, Antidepressants, Diuretics. Antidepressants were the only type of FRID significantly correlated (p=0,008) even in the model adjusted for CIRS, Morse and Barthel scores. The unadjusted model showed that the addition of one type of FRID to therapy was significantly associated with the fall event (p<0.05). Conclusion Assumption of drugs, in particular antidepressant and polypharmacy, can play a role in hospital falling. The fall risk assessment tools available, suffer from low specificity and sensitivity and do not assess these risk factors. A holistic approach with a multidimensional evaluation of the patient through screening tools, functional assessment tools and a full medical evaluation should be pursued to improve prediction.
Collapse
Affiliation(s)
- Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Italy, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Italy
| | - Niccolò Principi
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, Italy
| | - Davide Carnevali
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, Italy
| | - Navpreet Tiwana
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, Italy
| | - Anna Pietronigro
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, Italy
| | - Marco Mosillo
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, Italy
| | - Matteo Marrazzo
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, Italy
| | - Roberto Colombo
- Service of Bioengineering, Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Gattico-Veruno, Italy
| | | | - Stefano Corna
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Gattico-Veruno, Italy
| |
Collapse
|
22
|
Choi J, Choi SM, Lee JS, Seo SS, Kim JY, Kim HY, Kim SR. Development and validation of the fall risk perception questionnaire for patients in acute care hospitals. J Clin Nurs 2020; 30:406-414. [PMID: 33141494 DOI: 10.1111/jocn.15550] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/05/2020] [Accepted: 10/23/2020] [Indexed: 01/13/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to develop a fall risk perception questionnaire for patients admitted to acute care hospitals and to establish its reliability and validity. BACKGROUND To prevent falls during patients' hospitalisation, it is essential for them to accurately perceive their risk of falling. DESIGN This methodological study was performed to develop a fall risk perception questionnaire. METHODS After generating a preliminary questionnaire, two rounds of content validity testing were performed with nine experts. Following a pilot test, a convenience sample of 236 participants was recruited from an acute care hospital between 2 May 2018 and 15 December 2019. Construct, convergent and known-group validity of the questionnaire was evaluated, and reliability was estimated by calculating the internal consistency reliability coefficients. The study adhered to STROBE guidelines. RESULTS Exploratory factor analysis yielded a three-factor solution with 27 items. The questionnaire showed statistically significant positive correlation with the Korean Falls Efficacy Scale-International and the Morse Fall Scale, thus establishing convergent validity. For known-group comparison, Morse Fall Scale scores were categorised into two groups by cut-off score. The risk for falls group had a significantly higher perceived fall risk than the no risk for falls group, thus establishing known-group validity. Cronbach's alpha values indicated good to excellent reliability for the overall questionnaire with 27 items and for each of the three subfactors. CONCLUSIONS The fall risk perception questionnaire demonstrated satisfactory reliability and validity in an acute care hospital setting. RELEVANCE TO CLINICAL PRACTICE Because understanding patients' perceptions of their fall risk is essential for preventing falls, it is necessary to regularly assess patients' fall risk perception using tools with established reliability and validity.
Collapse
Affiliation(s)
- Jieun Choi
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Se Min Choi
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Jeong Sin Lee
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Soon Seok Seo
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Ja Yeon Kim
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Hye Young Kim
- College of Nursing, Jeonbuk Research Institute of Nursing Science, Jeonbuk National University, Jeonju-si, Korea
| | - Sung Reul Kim
- College of Nursing, Korea University Nursing Research Institute, Korea University, Seoul, Korea
| |
Collapse
|
23
|
Francis-Coad J, Hill AM, Jacques A, Chandler AM, Richey PA, Mion LC, Shorr RI. Association Between Characteristics of Injurious Falls and Fall Preventive Interventions in Acute Medical and Surgical Units. J Gerontol A Biol Sci Med Sci 2020; 75:e152-e158. [PMID: 31996903 PMCID: PMC7750680 DOI: 10.1093/gerona/glaa032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hospital falls remain common and approximately 30% of falls in hospital result in injury. The aims of the study were the following: (i) to identify the association between fall interventions present at the time of the injurious fall and injurious faller characteristics and (ii) to identify the association between fall preventive interventions present at the time of the injurious fall and the injurious fall circumstances. METHODS Secondary data analysis of deidentified case series of injurious falls across 24 acute medical/surgical units in the United States. Variables of interest were falls prevention interventions (physical therapy, bed alarm, physical restraint, room change, or a sitter) in place at the time of fall. Data were analyzed using logistic regression and hazard ratios. RESULTS There were 1,033 patients with an injurious fall, occurrence peaked between Day 1 and Day 4, with 46.8% of injurious falls having occurred by Day 3 of admission. Injurious fallers with a recorded mental state change 24 hours prior to the fall were more likely to have a bed alarm provided (adjusted odds ratio [OR] 2.56, 95% confidence interval [CI] 1.61, 4.08) and receive a physical restraint as fall prevention interventions (adjusted OR 6.36, 95% CI 4.35, 9.30). Injurious fallers restrained fell later (stay Day 6) than those without a restraint (stay Day 4) (p = .007) and had significantly longer lengths of stay (13 days vs 9 days). CONCLUSIONS On medical/surgical units, injurious falls occur early following admission suggesting interventions should be commenced immediately. Injurious fallers who had a physical restraint as an intervention had longer lengths of stay.
Collapse
Affiliation(s)
- Jacqueline Francis-Coad
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
- School of Physiotherapy and Institute of Health Research, The University of Notre Dame Australia, Fremantle
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Angela Jacques
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | | | - Phyllis A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Lorraine C Mion
- Center of Healthy Aging, Self-Management and Complex Care, The Ohio State University College of Nursing, Columbus
| | - Ronald I Shorr
- Clinical and Translational Science Institute, University of Florida, Gainesville
- Geriatric Research Education and Clinical Center (GRECC), Malcom Randall VAMC, Gainesville, Florida
- Department of Epidemiology, University of Florida, Gainesville
| |
Collapse
|
24
|
Zhao M, Li S, Xu Y, Su X, Jiang H. Developing a Scoring Model to Predict the Risk of Injurious Falls in Elderly Patients: A Retrospective Case-Control Study in Multicenter Acute Hospitals. Clin Interv Aging 2020; 15:1767-1778. [PMID: 33061328 PMCID: PMC7522431 DOI: 10.2147/cia.s258171] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/11/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Injurious falls seriously threaten the safety of elderly patients. Identifying risk factors for predicting the probability of injurious falls is an important issue that still needs to be solved urgently. We aimed to identify predictors and develop a nomogram for distinguishing populations at high risk of injurious falls from older adults in acute settings. PATIENTS AND METHODS A retrospective case-control study was conducted at three hospitals in Shanghai, China. Elderly patients with injurious falls from January 2014 to December 2018 were taken as cases, and control patients who did not have falls were randomly matched based on the admission date and the department. The data were collected through a medical record review and adverse events system. The original data set was randomly divided into a training set and a validation set at a 7:3 ratio. A nomogram was established based on the results of the univariate analysis and multivariate logistic regression analysis, and its discrimination and calibration were verified to confirm the accuracy of the prediction. The cut-off value of risk stratification was determined to help medical staff identify the high-risk groups. RESULTS A total of 115 elderly patients with injurious falls and 230 controls were identified. History of fractures, orthostatic hypotension, functional status, sedative-hypnotics and level of serum albumin were independent risk factors for injurious falls in elderly patients. The C-indexes of the training and validation sets were 0.874 (95% CI: 0.784-0.964) and 0.847 (95% CI: 0.771-0.924), respectively. Calibration curves were drawn and showed acceptable predictive performance. The cut-off values of the training and validation sets were 146.3 points (sensitivity: 73.7%; specificity: 87.5%) and 157.2 points (sensitivity: 69.2%; specificity: 85.5%), respectively. CONCLUSION The established nomogram facilitates the identification of high-risk populations among elderly patients, providing a new assessment tool to forecast the individual risk of injurious falls.
Collapse
Affiliation(s)
- Min Zhao
- School of Nursing, Fudan University, Shanghai, People's Republic of China
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Nursing, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Shuguang Li
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yun Xu
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xiaoxia Su
- School of Nursing, Fudan University, Shanghai, People's Republic of China
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Hong Jiang
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| |
Collapse
|
25
|
Lai FHY, Yan EWH, Mackenzie L, Fong KNK, Kranz GS, Ho ECW, Fan SHU, Lee ATK. Reliability, validity, and clinical utility of a self-reported screening tool in the prediction of fall incidence in older adults. Disabil Rehabil 2019; 42:3098-3105. [PMID: 30860929 DOI: 10.1080/09638288.2019.1582721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: The Chinese HomeFAST self-reported screening tool was developed to measure the number of hazards and the risk of home falls and other accidents for community-living older adults.Methods: This reliability, validity, and clinical utility study consisted of three phases. The tool's linguistic validity was established in the first phase of study, with a panel of domiciliary healthcare experts. In the second phase, the instrument yielded inter-rater reliability between community-living older adults and a group of experienced occupational therapists. Furthermore, in the third phase of study, factor analysis of the Chinese Home-FAST self-reported screening tool was conducted.Results: There was good linguistic validity, test-retest reliability and good to excellent internal consistency of the Chinese Home-FAST self-reported screening tool among older adults living in the community. Moreover, a structure with three factors - namely "Home Environment and Furniture," "Capability in Activities of Daily Living," and "Use of Devices" - was yielded from categorical principal components analysis. Clinically, the incidence of falls among this group of recruited older adults in a six-month period was 18%. The identification of seven or more hazards was associated with prediction of unplanned fall-related hospital admission with sensitivity of 83.33% and specificity of 95.83%. Conclusion: The Chinese HomeFAST self-reported screening tool is thus demonstrated to be a valid and reliable tool for measuring home hazards and can predict home falls in Chinese-speaking older adults.Implications for rehabilitationTo develop an easily understandable screening tool for older adults.Older adults can perform home safety screening on their own, and can identify potential risk of falls and other accidents at home.This can serve as a communication tool between older adults and healthcare professionals.Identified hazards can be reported to healthcare professionals for further intervention.This validated instrument can help healthcare professionals to identify higher-risk older adults in the community and thus to better prioritize their provision of professional services.
Collapse
Affiliation(s)
- Frank H Y Lai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Elaine W H Yan
- Occupational Therapy Department, Kowloon Hospital, Hong Kong
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Lidcombe NSW, Australia
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.,Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Eric C W Ho
- Occupational Therapy Department, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Silvia H U Fan
- Occupational Therapy Department, Tai Po Hospital, Hong Kong
| | - Alice T K Lee
- Occupational Therapy Department, TWGHs Jockey Club Rehabilitation Complex, Hong Kong
| |
Collapse
|
26
|
Maly J, Dosedel M, Vosatka J, Mala-Ladova K, Kubena AA, Brabcova I, Hajduchova H, Bartlova S, Tothova V, Vlcek J. Pharmacotherapy as major risk factor of falls - analysis of 12 months experience in hospitals in South Bohemia. J Appl Biomed 2019; 17:60. [PMID: 34907747 DOI: 10.32725/jab.2019.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 01/09/2019] [Indexed: 11/05/2022] Open
Abstract
This study aimed to analyze the effect of fall risk-increasing drugs (FRIDs) and drug-related factors relative to falls through clinical pharmacy service in hospitalized patients, focusing on the relevance of clinical pharmacist evaluation in the context of physician assessment. A prospective study of inpatient falls was conducted in 2017 retrieving data from 4 hospitals in South Bohemia, Czech Republic. An online database was developed to collect patient and fall-related data, and fall evaluation records. Healthcare professionals classified the overall effect of drugs on falls using Likert scale. Univariate and multivariate correlations were performed with a significance level of p < 0.05. Out of the total 280 falls (mean age of patients 77.0 years), a mean of 2.8 diagnoses with fall-related risk, 8.8 drugs, and 4.1 FRIDs per fall were identified. Incidence of falls decreased quarterly (p < 0.001). Use of FRIDs were positively associated with increasing age (p = 0.007). Clinical pharmacists were more likely to identify pharmacotherapy as the relevant fall-related risk, compared to physicians evaluation (p < 0.001). An increasing total number of prescribed drugs as well as higher number of FRIDs increased the suspicion in both professionals in the context of drug-related causes of falls.
Collapse
Affiliation(s)
- Josef Maly
- Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy, Hradec Kralove, Czech Republic
| | - Martin Dosedel
- Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy, Hradec Kralove, Czech Republic
| | - Jan Vosatka
- Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy, Hradec Kralove, Czech Republic
| | - Katerina Mala-Ladova
- Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy, Hradec Kralove, Czech Republic
| | - Ales Antonin Kubena
- Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy, Hradec Kralove, Czech Republic
| | - Iva Brabcova
- University of South Bohemia in Ceske Budejovice, Faculty of Health and Social Sciences, Institute of Nursing, Midwifery and Emergency Care, Ceske Budejovice, Czech Republic
| | - Hana Hajduchova
- University of South Bohemia in Ceske Budejovice, Faculty of Health and Social Sciences, Institute of Nursing, Midwifery and Emergency Care, Ceske Budejovice, Czech Republic
| | - Sylva Bartlova
- University of South Bohemia in Ceske Budejovice, Faculty of Health and Social Sciences, Institute of Nursing, Midwifery and Emergency Care, Ceske Budejovice, Czech Republic
| | - Valerie Tothova
- University of South Bohemia in Ceske Budejovice, Faculty of Health and Social Sciences, Institute of Nursing, Midwifery and Emergency Care, Ceske Budejovice, Czech Republic
| | - Jiri Vlcek
- Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy, Hradec Kralove, Czech Republic
| |
Collapse
|
27
|
Abstract
Falls are common among older adults. One in 3 adults aged 65 years or older and 1 in 2 adults aged 80 years or older fall each year. Interventions for prevention have been identified; however, they are often not addressed in primary care practice. Screening all older adults annually for falls can identify who will benefit from further clinical evaluation and management. Falls and the need for care from subsequent injury increase with age. They adversely affect quality of life and are a financial burden on the health care industry. As a result, risk reduction is a key focus of prevention efforts, even among very elderly persons.
Collapse
Affiliation(s)
- Elizabeth A Phelan
- From the Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington. (E.A.P., K.R.)
| | - Katherine Ritchey
- From the Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington. (E.A.P., K.R.)
| |
Collapse
|
28
|
Hill AM, Jacques A, Chandler AM, Richey PA, Mion LC, Shorr RI. In-Hospital Sequelae of Injurious Falls in 24 Medical/Surgical Units in Four Hospitals in the United States. Jt Comm J Qual Patient Saf 2018; 45:91-97. [PMID: 30269964 DOI: 10.1016/j.jcjq.2018.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/02/2018] [Accepted: 08/07/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Up to 50% of patient falls in the hospital result in injury. This study was conducted to determine whether injurious falls were associated with increased hospital length of stay (LOS), discharge to a place other than home, and in-hospital mortality. METHODS A secondary data analysis from a prospective case-control study was conducted in 24 medical/surgical units in four hospitals in the United States. Patients who fell and sustained an injury were matched with at least one control patient who was on the same unit, at the same time, for a similar number of days on the unit at the time of the fall. Data were collected by viewing patients' electronic health records, as well as the hospitals' incident reporting systems. Logistic regression and Cox regression analyses were conducted. RESULTS The 1,033 patients (mean age, 63.7 years; 510 males [49.4%]) who sustained an injurious fall were matched with 1,206 controls (mean age, 61.6 years; 486 males [40.3%]). Fallers were significantly more likely than controls to stay longer than 10 days in the hospital (odds ratio [OR], 1.59; 95% confidence interval [CI] = 1.46-1.74) and to be discharged to a place other than home (OR, 1.52; 95% CI = 1.21-1.91). CONCLUSION Compared to controls, hospital patients who sustained an injurious fall had longer LOS and were more likely discharged to a place other than home. These associations remained when controlling for patient-level confounders, suggesting that the fall altered trajectory was sustained toward these outcomes. Injurious falls were not significantly associated with increased risk of mortality.
Collapse
|
29
|
Bjarnadottir RI, Lucero RJ. What Can We Learn about Fall Risk Factors from EHR Nursing Notes? A Text Mining Study. EGEMS (WASHINGTON, DC) 2018; 6:21. [PMID: 30263902 PMCID: PMC6157016 DOI: 10.5334/egems.237] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 08/21/2018] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Hospital falls are a continuing clinical concern, with over one million falls occurring each year in the United States. Annually, hospital-acquired falls result in an estimated $34 billion in direct medical costs. Falls are considered largely preventable and, as a result, the Centers for Medicare and Medicaid Services have announced that fall-related injuries are no longer a reimbursable hospital cost. While policies and practices have been implemented to reduce falls, little sustained reduction has been achieved. Little empirical evidence supports the validity of published fall risk factors. While chart abstraction has been used to operationalize risk factors, few studies have examined registered nurses' (RNs') narrative notes as a source of actionable data. Therefore, the purpose of our study was to explore whether there is meaningful fall risk and prevention information in RNs' electronic narrative notes. METHODS This study utilized a natural language processing design. Data for this study were extracted from the publicly available Medical Information Mart for Intensive Care (MIMIC-III) database. The date comprises deidentified EHR data associated with patients who stayed in critical care units between 2001 and 2012. Text mining procedures were performed on RN's narrative notes following the traditional steps of knowledge discovery. RESULTS The corpus of data extracted from MIMIC-III database was comprised of 1,046,053 RNs' notes from 36,583 unique patients. We identified 3,972 notes (0.4 percent) representing 1,789 (5 percent) patients with explicit documentation related to fall risk/prevention. Around 10 percent of the notes (103,685) from 23,025 patients mentioned intrinsic (patient-related) factors that have been theoretically associated with risk of falling. An additional 1,322 notes (0.1 percent) from 692 patients (2 percent) mentioned extrinsic risk factors, related to organizational design and environment. Moreover, 7672 notes (0.7 percent) from 2,571 patients (7 percent) included information on interventions that could theoretically impact patient falls. CONCLUSIONS This exploratory study using a NLP approach revealed that meaningful information related to fall risk and prevention may be found in RNs' narrative notes. In particular, RNs' notes can contain information about clinical as well as environmental and organizational factors that could affect fall risk but are not explicitly recorded by the provider as a fall risk factors. In our study, potential fall risk factors were documented for more than half of the sample. Further research is needed to determine the predictive value of these factors. IMPLICATIONS FOR POLICY OR PRACTICE This study highlights a potentially rich but understudied source of actionable fall risk data. Furthermore, the application of novel methods to identify quality and safety measures in RNs' notes can facilitate inclusion of RNs' voices in patient outcomes and health services research.
Collapse
|