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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.
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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
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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.
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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
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Hirata R, Katsuki NE, Shimada H, Nakatani E, Shikino K, Saito C, Amari K, Oda Y, Tokushima M, Tago M. The Administration of Lemborexant at Admission is Not Associated with Inpatient Falls: A Multicenter Retrospective Observational Study. Int J Gen Med 2024; 17:1139-1144. [PMID: 38559594 PMCID: PMC10979668 DOI: 10.2147/ijgm.s452278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose There has been no large-scale investigation into the association between the use of lemborexant, suvorexant, and ramelteon and falls in a large population. This study, serving as a pilot investigation, was aimed at examining the relationship between inpatient falls and various prescribed hypnotic medications at admission. Patients and Methods This study was a sub-analysis of a multicenter retrospective observational study conducted over a period of 3 years. The target population comprised patients aged 20 years or above admitted to eight hospitals, including chronic care, acute care, and tertiary hospitals. We extracted data on the types of hypnotic medications prescribed at admission, including lemborexant, suvorexant, ramelteon, benzodiazepines, Z-drugs, and other hypnotics; the occurrence of inpatient falls during the hospital stay; and patients' background information. To determine the outcome of inpatient falls, items with low collinearity were selected and included as covariates in a forced-entry binary logistic regression analysis. Results Overall, 150,278 patients were included in the analysis, among whom 3,458 experienced falls. The median age of the entire cohort was 70 years, with men constituting 53.1%. Binary logistic regression analysis revealed that the prescription of lemborexant, suvorexant, and ramelteon at admission was not significantly associated with inpatient falls. Conclusion The administration of lemborexant, suvorexant, and ramelteon at admission may not be associated with inpatient falls.
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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
| | - Hitomi Shimada
- Shimada Hospital of Medical Corporation Chouseikai, Saga, Japan
| | - Eiji Nakatani
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Department of Community-Oriented Medical Education, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | - Kaori Amari
- Department of Emergency Medicine, Saga-Ken Medical Centre Koseikan, 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
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
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Piotrkowska R, Mędrzycka-Dąbrowska WA, Tomaszek L. Timed Up and Go test score and factors associated with a moderate-to-high risk of future falls in patients scheduled for vascular surgeries-a cross-sectional study. Front Public Health 2024; 12:1363828. [PMID: 38577292 PMCID: PMC10991680 DOI: 10.3389/fpubh.2024.1363828] [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: 12/31/2023] [Accepted: 03/12/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Peripheral artery and aorta diseases contribute to complex consequences in various areas, as well as increasing physical and mental discomfort resulting from the progressive limitation or loss of functional capacities, in particular in relation to walking, decreased endurance during physical exercise, a drop in effort tolerance, and pain suffered by patients. Limitations in functional capacities also increase the risk of falls. Most falls take place during the performance of simple activities. The aim of this study was to investigate factors associated with moderate-to-high risk of future falls in patients scheduled for vascular surgeries. Methods This cross-sectional study included patients aged 33-87, scheduled for vascular surgeries. Based on the Timed Up and Go test, patients were categorized as having a moderate-to-high (≥ 10 s) or low risk of falls. Multiple logistic regression was carried out to assess the relationship between fall-risk levels and independent sociodemographic and clinical variables. Results Forty-eight percent of patients were categorized as having a moderate-to-high risk of future falls. Females (OR = 1.67; Cl95%: 1.07-2.60) and patients who suffered from hypertension (OR = 2.54; Cl95%: 1.19-5.40) were associated with a moderate-to-high risk of future falls. The Barthel Index correlated negatively (OR = 0.69; Cl95%: 0.59-0.80), while age correlated positively with fall-risk levels (OR = 1.07; Cl95%: 1.02-1.12). Conclusion Factors that may be associated with a moderate-to-high risk of future falls in patients scheduled for vascular surgeries include age, female gender, hypertension, and the Barthel Index.
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Affiliation(s)
- Renata Piotrkowska
- Department of Surgical Nursing, Medical University of Gdansk, Gdańsk, Poland
- Clinic of Cardiac and Vascular Surgery, University Clinical Center, Gdańsk, Poland
| | | | - Lucyna Tomaszek
- Department of Specialist Nursing, Faculty of Medicine and Health Sciences, Kraków Academy of Andrzej Frycz Modrzewski, Kraków, Poland
- Institute of Tuberculosis and Lung Diseases, Rabka-Zdrój Branch, Rabka-Zdrój, Poland
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Murata H, Tashiro S, Sakamoto H, Ishida R, Kuwabara M, Matsuda K, Shiokawa Y, Hirano T, Momozaki R, Maeda K, Wakabayashi H, Yamada S. Impact of rehabilitation dose on body mass index change in older acute patients with stroke: a retrospective observational study. Front Nutr 2023; 10:1270276. [PMID: 38115884 PMCID: PMC10728649 DOI: 10.3389/fnut.2023.1270276] [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: 07/31/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
Background It is established that a low body mass index (BMI) correlates with a diminished home discharge rate and a decline in activities of daily living (ADL) capacity among elderly stroke patients. Nevertheless, there exists a paucity of knowledge regarding strategies to mitigate BMI reduction during the acute phase. This investigation seeks to elucidate the impact of rehabilitation dose, as determined by both physical and occupational therapy, on BMI alterations, positing that a heightened rehabilitation dose could thwart BMI decline. Methods This retrospective, observational study was conducted in the stroke unit of a university hospital. Enrollees comprised individuals aged ≥65 years, hospitalized for stroke, and subsequently relocated to rehabilitation facilities between January 2019 and November 2020. The percentage change in BMI (%ΔBMI) was calculated based on BMI values at admission and discharge. Multivariate multiple regression analysis was employed to ascertain the influence of rehabilitation dose on %ΔBMI. Results A total of 187 patients were included in the analysis, of whom 94% experienced a reduction in BMI during acute hospitalization. Following adjustment for sociodemographic and clinical factors, multivariable analyzes revealed a positive association between rehabilitation dose and %ΔBMI (β = 0.338, p < 0.001). Conclusion The findings of this study suggest that, in the context of acute stroke treatment, an augmented rehabilitation dose is associated with a diminished decrease in BMI.
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Affiliation(s)
- Hiroyasu Murata
- Department of Rehabilitation Medicine, Kyorin University Hospital, Mitaka, Japan
| | - Syoichi Tashiro
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Mitaka, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hayato Sakamoto
- Department of Rehabilitation Medicine, Kyorin University Hospital, Mitaka, Japan
| | - Rika Ishida
- Department of Rehabilitation Medicine, Kyorin University Hospital, Mitaka, Japan
| | - Mayuko Kuwabara
- Department of Rehabilitation Medicine, Kyorin University Hospital, Mitaka, Japan
| | - Kyohei Matsuda
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | | | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Mitaka, Japan
| | - Ryo Momozaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Shinjuku, Japan
| | - Shin Yamada
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Mitaka, Japan
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Lee J, Jung JH, Kim J, Jeong C, Ha J, Kim MH, Lee JM, Chang SA, Baek KH, Han K, Lim DJ. Associations between body composition and the risk of fracture according to bone mineral density in postmenopausal women: a population-based database cohort study. Eur J Endocrinol 2023; 189:527-536. [PMID: 37995142 DOI: 10.1093/ejendo/lvad156] [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: 09/12/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE We aimed to investigate the associations of body composition and the risk of fracture in postmenopausal women, stratified based on bone mineral density. METHODS A population-based cohort study using the database of the National Screening Program for Transitional Ages with women aged 66 years was performed. Bone mineral density was categorized as normal, osteopenia, and osteoporosis. The following body mass index (BMI) categories for general obesity were used: underweight (<18.5), normal (18.5-22.9), overweight (23-24.9), obese (25-29.9), and severely obese (≥30 kg/m2). Waist circumference (WC) used for central obesity assessment was categorized into 5 groups. Newly diagnosed fracture during the follow-up period defined based on ICD-10 codes was the primary outcome. RESULTS During 7.7 ± 1.4 years of follow-up, 41 672 (17.9%) participants experienced any fracture, 20 326 (8.7%) experienced vertebral fractures (VFs), and 2883 (1.2%) experienced hip fractures (HFs). The adjusted hazard ratios (aHRs) for any fracture showed a progressive increase with higher BMI and WC categories in individual with osteopenia and osteoporosis. Regarding VF, aHR was highest in severely obese individuals with osteoporosis (aHR [95% CI], 3.45 [2.99-3.97]) and in individuals with WC ≥ 95 cm with osteoporosis (4.79 [4.09-5.60]). The aHR [95% CI] for HF was highest in the underweight group with osteopenia (1.94 [1.16-3.27]) and osteoporosis (2.96 [2.15-4.10]). In central obesity individuals with WC ≥ 95 cm, aHR [95% CI] for HF was 2.80 [1.91-4.91]. CONCLUSIONS General obesity and central obesity are not protective against any fracture, VF and HF in postmenopausal women with osteopenia or osteoporosis.
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Affiliation(s)
- Jeongmin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Jin-Hyung Jung
- Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon 16419, Republic of Korea
| | - Jinyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Chaiho Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu 11765, Republic of Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Min-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Jung-Min Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Sang-Ah Chang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Ki-Hyun Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Ragheb J, Norcott A, Benn L, Shah N, McKinney A, Min L, Vlisides PE. Barriers to delirium screening and management during hospital admission: a qualitative analysis of inpatient nursing perspectives. BMC Health Serv Res 2023; 23:712. [PMID: 37386400 DOI: 10.1186/s12913-023-09681-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/10/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Delirium in hospitalized patients is a major public health issue, yet delirium is often unrecognized and missed during inpatient admission. The objective of this study was to identify barriers to delirium screening, identification, and management from a nursing perspective on inpatient, acute care units. METHODS This was a pre-implementation, diagnostic evaluation study to determine current practice patterns and potential barriers to optimizing delirium care at a major university hospital. A qualitative approach was used, which included focus groups of inpatient nurses working on major medical and surgical acute care units. Focus groups were conducted until signs of thematic saturation were present, and data were analyzed via inductive thematic analysis, without predetermined theories or structures. A consensus approach was utilized for transcript coding, and final themes were generated after multiple reviews of initial themes against transcript datasets. RESULTS Focus group sessions (n = 3) were held with 18 nurses across two major inpatient units. Nurses reported several barriers to successful delirium screening and management. Specific challenges included difficulty with using delirium screening tools, an organizational culture not conducive to delirium prevention, and competing clinical priorities. Proposed solutions were also discussed, including decision-support systems with automated pager alerts and associated delirium order sets, which may help improve delirium care coordination and standardization. CONCLUSION At a major university hospital, nurses affirm the difficulty experienced with delirium screening and identification, particularly due to screening tool challenges, cultural barriers, and clinical workload. These impediments may serve as targets for a future implementation trial to improve delirium screening and management.
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Affiliation(s)
- Jacqueline Ragheb
- Department of Anesthesiology, University of Michigan Medical School, 1H247 UH, 1500 East Medical Center Drive, Ann Arbor, MI, SPC-5048, 48109-5048, USA
| | - Alexandra Norcott
- Department of Internal Medicine, Division of Geriatric & Palliative Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Lakeshia Benn
- Department of Inpatient Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
- College of Health Professions & McAuley School of Nursing, University of Detroit Mercy, Detroit, MI, USA
| | - Nirav Shah
- Department of Anesthesiology, University of Michigan Medical School, 1H247 UH, 1500 East Medical Center Drive, Ann Arbor, MI, SPC-5048, 48109-5048, USA
| | - Amy McKinney
- Department of Anesthesiology, University of Michigan Medical School, 1H247 UH, 1500 East Medical Center Drive, Ann Arbor, MI, SPC-5048, 48109-5048, USA
| | - Lillian Min
- Department of Internal Medicine, Division of Geriatric & Palliative Medicine, Michigan Medicine, Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Department of Internal Medicine, Division of Geriatric Research, Education, and Clinical Centers (GRECC), Ann Arbor, MI, USA
| | - Phillip E Vlisides
- Department of Anesthesiology, University of Michigan Medical School, 1H247 UH, 1500 East Medical Center Drive, Ann Arbor, MI, SPC-5048, 48109-5048, USA.
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, USA.
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Wilczyński K, Gorczyca M, Grabarczyk M, Szewieczek J. Neuropsychiatric Symptoms as Indicators of Fall Risk in Geriatric Inpatients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050887. [PMID: 37241119 DOI: 10.3390/medicina59050887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/29/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: It is well established that patients with cognitive impairment are at a higher risk of falls. However, the impact of coexisting neuropsychiatric symptoms on the overall risk of falls in hospitalized geriatric individuals with and without dementia has not been extensively studied. This cross-sectional study will assess the association between neuropsychiatric symptoms and fall risk in geriatric individuals analyzed by sex. Materials and Methods: A total of 234 patients, both with and without dementia, admitted to the geriatric ward at Leszek Giec Upper-Silesian Medical Centre of the Silesian Medical University in Katowice, Poland, between January 2019 and January 2020 were included in this study. The Neuropsychiatric Inventory-Questionnaire was used to assess the presence of neuropsychiatric symptoms. Increased fall risk was defined by Berg scores of ≤40. Results: The mean age of the study group was 80.7 ± 6.6, and women accounted for 62.8% of the study population. Apathy was the most common neuropsychiatric symptom, affecting 58.1% of patients, and it was the most common symptom among people with dementia, affecting 67.80% of patients. The receiver operating characteristics curve analysis revealed that a high fall risk was significantly associated with the total number of neuropsychiatric symptoms (≥4) and the total intensity of these symptoms (≥6). For women, high fall risk was associated with three or more neuropsychiatric symptoms and a total neuropsychiatric symptom intensity score of at least 6. For men, the association of high fall risk with the total number of NPS was not significant; a total NPS intensity score of 10 or more was associated with high fall risk. Multivariate logistic regression analysis identified associations with fall risk for hallucinations. Conclusions: Our results suggest that the presence of neuropsychiatric symptoms, particularly hallucinations is associated with an increased risk of falls in geriatric inpatients. In addition, the cumulative total of NPS and their cumulative intensity are both independently associated with an increased risk of falls. These results suggest that fall prevention strategies should include the management of neuropsychiatric symptoms in hospitalized geriatric individuals.
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Affiliation(s)
- Krzysztof Wilczyński
- Department of Geriatrics, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, Ziołowa 45/47, 40-635 Katowice, Poland
| | - Marta Gorczyca
- Department of Anatomy, Institute of Medicine, University of Opole, Oleska 48, 45-052 Opole, Poland
- Faculty of Medical Sciences, University of Applied Sciences, Ujejskiego 12, 48-300 Nysa, Poland
| | - Małgorzata Grabarczyk
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, Medyków 18, 40-752 Katowice, Poland
| | - Jan Szewieczek
- Department of Geriatrics, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, Ziołowa 45/47, 40-635 Katowice, Poland
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Ardaneh M, Fararouei M, Hassanzadeh J. Falls leading to fracture and nutrition among older adults: a case-control study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:18. [PMID: 36915191 PMCID: PMC10009923 DOI: 10.1186/s41043-023-00361-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Injurious falls, especially those leading to bone fracture, are major causes of death and disability among older people. Our aim was to measure the association of nutritional factors and physical activity with falls leading to fracture among Iranian older adults. METHODS This is the second phase of a previously published case-control study on 300 patients and 590 controls. RESULTS In addition to the socio-economic factors that were reported before, our results revealed that consumption of fish, vegetables, fruits, and nuts reduced the risk of falling, whereas consumption of cheese, red meat, and sweets raised the risk of falls among the participants. CONCLUSION The results of our study suggested that diets rich in fish meat fruits and vegetables should be encouraged in the everyday life of older adults. We suggest health officials to take these important results into consideration when planning protective measures.
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Affiliation(s)
- Mahdieh Ardaneh
- Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Mohammad Fararouei
- Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran.
| | - Jafar Hassanzadeh
- Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
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Damoiseaux-Volman BA, van Schoor NM, Medlock S, Romijn JA, van der Velde N, Abu-Hanna A. External validation of the Johns Hopkins Fall Risk Assessment Tool in older Dutch hospitalized patients. Eur Geriatr Med 2023; 14:69-77. [PMID: 36422821 PMCID: PMC9686262 DOI: 10.1007/s41999-022-00719-0] [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: 07/07/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Fall prevention is a safety goal in many hospitals. The performance of the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) in older inpatients is largely unknown. We aimed to assess the JHFRAT performance in a large sample of Dutch older inpatients, including its trend over time. METHODS We used an Electronic Health Records (EHR) dataset with hospitalized patients (≥ 70), admitted for ≥ 24 h between 2016 and 2021. Inpatient falls were extracted from structured and free-text data. We assessed the association between JHFRAT and falls using logistic regression. For test accuracy, we calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Discrimination was measured by the AUC. For calibration, we plotted the predicted fall probability with the actual probability of falls. For time-related effects, we calculated the AUC per 6 months (using data of patients admitted during the 6 months' time interval) and plotted these different AUC values over time. Furthermore, we compared the model (JHFRAT and falls) with and without adjusting for seasonal influenza, COVID-19, spring, summer, fall or winter periods. RESULTS Data included 17,263 admissions with at least 1 JHFRAT measurement, a median age of 76 and a percentage female of 47%. The in-hospital fall prevalence was 2.5%. JHFRAT [OR = 1.11 (1.03-1.20)] and its subcategories were significantly associated with falls. For medium/high risk of falls (JHFRAT > 5), sensitivity was 73%, specificity 51%, PPV 4% and NPV 99%. The overall AUC was 0.67, varying over time between 0.62 and 0.71 (for 6 months' time intervals). Seasonal influenza did affect the association between JHFRAT and falls. COVID-19, spring, summer, fall or winter did not affect the association. CONCLUSIONS Our results show an association between JHFRAT and falls, a low discrimination by JHFRAT for older inpatients and over-prediction in the calibration. Improvements in the fall-risk assessment are warranted to improve efficiency.
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Affiliation(s)
- Birgit A Damoiseaux-Volman
- Department of Medical Informatics, Amsterdam UMC-Location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Room J1B-109, Postbus 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Natasja M van Schoor
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Stephanie Medlock
- Department of Medical Informatics, Amsterdam UMC-Location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Room J1B-109, Postbus 22660, 1100 DD, Amsterdam, The Netherlands
| | - Johannes A Romijn
- Department of Medicine, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC-Location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Room J1B-109, Postbus 22660, 1100 DD, Amsterdam, The Netherlands
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11
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Incidence, Associated Factors, and Outcome of Delirium among Patients Admitted to ICUs in Oman. Crit Care Res Pract 2022; 2022:4692483. [PMID: 36245554 PMCID: PMC9553487 DOI: 10.1155/2022/4692483] [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: 02/22/2022] [Accepted: 09/24/2022] [Indexed: 11/26/2022] Open
Abstract
Background The incidence of delirium is high up to 46.3% among patients admitted to ICU. Delirium is linked to negative patient outcomes like increased duration of mechanical ventilation use, prolonged ICU stay, increased mortality rate, and healthcare costs. Despite the importance of delirium and its consequences that are significant, there is a scarcity of studies which explored delirium in Oman. Objectives This study was conducted to assess the incidence of delirium, the association between the selected predisposing factors and precipitating factors with delirium, determine the predicators of delirium, and evaluate its impacts on ICU mortality and ICU length of stay among ICU patients in Oman. Methods A multicenter prospective observational design was used. A total of 153 patients were assessed two-times a day by bedside ICU nurses through the Intensive Care Delirium Screening Checklist (ICDSC). Results The results revealed that the delirium incidence was 26.1%. Regression analysis showed that sepsis, metabolic acidosis, nasogastric tube use, and APACHE II score were independent predictors for delirium among ICU patients in Oman and delirium had significant impacts on ICU length of stay and mortality rate. Conclusion Delirium is common among ICU patients and it is associated with negative consequences. Multidisciplinary prevention strategies should be implemented to identify and treat the modifiable risk factors.
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12
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Magnuszewski L, Wojszel A, Kasiukiewicz A, Wojszel ZB. Falls at the Geriatric Hospital Ward in the Context of Risk Factors of Falling Detected in a Comprehensive Geriatric Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10789. [PMID: 36078502 PMCID: PMC9518316 DOI: 10.3390/ijerph191710789] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
It is only by knowing the most common causes of falls in the hospital that appropriate and targeted fall prevention measures can be implemented. This study aimed to assess the frequency of falls in a hospital geriatrics ward and the circumstances in which they occurred and evaluate the parameters of the comprehensive geriatric assessment (CGA) correlating with falls. We considered medical, functional, and nutritional factors associated with falls and built multivariable logistic regression analysis models. A total of 416 (median age 82 (IQR 77-86) years, 77.4% women) hospitalizations in the geriatrics ward were analyzed within 8 months. We compared the results of a CGA (including health, psycho-physical abilities, nutritional status, risk of falls, frailty syndrome, etc.) in patients who fell and did not fall. Fourteen falls (3.3% of patients) were registered; the rate was 4.4 falls per 1000 patient days. They most often occurred in the patient's room while changing position. Falls happened more frequently among people who were more disabled, had multimorbidity, were taking more medications (certain classes of drugs in particular), had Parkinson's disease and diabetes, reported falls in the last year, and were diagnosed with orthostatic hypotension. Logistic regression determined the significant independent association between in-hospital falls and a history of falls in the previous 12 months, orthostatic hypotension, Parkinson's disease, and taking statins, benzodiazepines, and insulin. Analysis of the registered falls that occurred in the hospital ward allowed for an analysis of the circumstances in which they occurred and helped to identify people at high risk of falling in a hospital, which can guide appropriate intervention and act as an indicator of good hospital care.
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Affiliation(s)
- Lukasz Magnuszewski
- Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
- Doctoral Studies, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
| | - Aleksandra Wojszel
- Student’s Scientific Society at the Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
| | - Agnieszka Kasiukiewicz
- Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
| | - Zyta Beata Wojszel
- Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
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13
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Zhang M, Zhang X, Gao L, Yue J, Jiang X. Incidence, predictors and health outcomes of delirium in very old hospitalized patients: a prospective cohort study. BMC Geriatr 2022; 22:262. [PMID: 35351018 PMCID: PMC8966247 DOI: 10.1186/s12877-022-02932-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/10/2022] [Indexed: 02/08/2023] Open
Abstract
Background Delirium is a common complication that leads to poor health outcomes in older patients undergoing treatment. Due to severe consequences, early recognition of high-risk patients and risk factors for delirium are crucial in the prompt initiation of prevention measures. However, research in medically hospitalized patients aged ≥80 years remains limited. This study aimed to determine the incidence, predictors and health outcomes of delirium in very old (aged ≥80 years) hospitalized patients in China. Methods A prospective study was conducted in individuals aged ≥80 years admitted to geriatric departments. Potential risk factors were assessed within 24 h after hospital admission. Screening for delirium was performed on admission and every 48 h thereafter for 14 days and assessed if acute mental status changes were observed. During hospitalization, health outcomes were recorded daily. Results Incident delirium occurred in 109 of 637 very old hospitalized patients (17.1%). The independent predictors of delirium in hospitalized patients aged 80 and over were cognitive function impairment [OR 17.42, 95% CI:(7.47–40.64)], depression [OR 9.30, 95% CI: (4.59–18.84)], CCI ≥ 5 [OR 4.21, 95% CI: (1.48–12.01)], sleep deprivation [OR 3.89, 95% CI: (1.71–8.82)], infection [OR 3.33, 95% CI: (1.70–6.54)], polypharmacy (≥5 medications) [OR 2.85, 95% CI: (1.51–5.39)], constipation [OR 2.58, 95% CI: (1.33–5.02)], and emergency admission [OR 2.13, 95% CI: (1.02–4.45)]. Patients with delirium had significantly longer hospital stays(P < 0.001) and higher percentages of physical restraint use(P < 0.001) and falls (P = 0.001) than those without delirium,. Conclusion The incidence of delirium was high in hospitalized patients aged ≥80 years admitted to the geriatric department and was associated with prolonged hospital stay and higher rates of physical restraint use and falls. In this population, the most important independent risk factors for incident delirium were cognitive function impairment and depression. Health care professionals should recognize and initiate interventions for delirium early in geriatric patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02932-9.
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Affiliation(s)
- Meng Zhang
- West China School of Nursing, Sichuan University/ Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xuemei Zhang
- West China School of Nursing, Sichuan University/ Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Langli Gao
- West China School of Nursing, Sichuan University/ Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaolian Jiang
- West China School of Nursing, Sichuan University, Chengdu, NO. 37 GuoXue Road, Chengdu, 610041, Sichuan province, China.
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14
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Akgün Ö, Oudshoorn C, Mattace-Raso FUS, Egberts A. Anticholinergic Drug Use on Admission and the Risk of In-Hospital Falls in Older Hospitalized Patients. Clin Interv Aging 2022; 17:277-285. [PMID: 35313670 PMCID: PMC8934155 DOI: 10.2147/cia.s357818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/05/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose In-hospital falls, especially among older patients, are a major and underestimated problem. Several studies have suggested a possible association between anticholinergic drug use and falls, but the results are inconclusive and studies focusing on in-hospital falls are scarce. The aim of the present study was to investigate whether anticholinergic drug exposure on admission is associated with in-hospital falls. Patients and Methods This retrospective chart review study was conducted in the Erasmus MC University Medical Center, Rotterdam, the Netherlands. Patients aged 65 years and older, who were acutely admitted to the geriatric ward between 2012 and 2015, were included. Anticholinergic drug exposure was determined with the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden scale (ACB) and the list of Chew. Logistic regression was used to investigate the possible association between anticholinergic drug exposure and in-hospital falls. Analyses were adjusted for age, sex, fall history, fall as reason for admission, number of drugs on admission, use of a mobility aid and delirium. Results A total of 905 patients were included, of which 94 patients experienced one or more in-hospital falls. Each additional anticholinergic drug in use, according to the ARS, was associated with an increased odd of experiencing a fall (OR = 1.49, 95% CI: 1.06–2.10). Other measures, ie anticholinergic drug use (yes/no) and different categories of anticholinergic drug burden, measured with the ARS, ACB and list of Chew, were all not associated with in-hospital falls. Conclusion Anticholinergic drug exposure on admission is possibly not a main risk factor for in-hospital falls among older patients.
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Affiliation(s)
- Özge Akgün
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Christian Oudshoorn
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Francesco U S Mattace-Raso
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Angelique Egberts
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Franciscus Gasthuis & Vlietland, Rotterdam & Schiedam, the Netherlands
- Correspondence: Angelique Egberts, Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Room Rg-527, PO Box 2040, Rotterdam, CA, 3000, the Netherlands, Tel +31 10 70 35979, Fax +31 10 70 34768, Email
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15
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Hoedl M, Eglseer D, Bernet N, Everink I, Gordon AL, Lohrmann C, Osmancevic S, Saka B, Schols JMGA, Thomann S, Bauer S. Which factors influence the prevalence of institution-acquired falls? Results from an international, multi-center, cross-sectional survey. J Nurs Scholarsh 2021; 54:462-469. [PMID: 34919335 PMCID: PMC9542022 DOI: 10.1111/jnu.12758] [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: 08/30/2021] [Revised: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Falls are a highly prevalent problem in hospitals and nursing homes with serious negative consequences such as injuries, increased care dependency, or even death. The aim of this study was to provide a comprehensive insight into institution-acquired fall (IAF) prevalence and risk factors for IAF in a large sample of hospital patients and nursing home residents among five different countries. DESIGN This study reports the outcome of a secondary data analysis of cross-sectional data collected in Austria, Switzerland, the Netherlands, Turkey, and the United Kingdom in 2017 and 2018. These data include 58,319 datapoints from hospital patients and nursing home residents. METHODS Descriptive statistics, statistical tests, logistic regression, and generalized estimating equation (GEE) models were used to analyze the data. FINDINGS IAF prevalence in hospitals and nursing homes differed significantly between the countries. Turkey (7.7%) had the highest IAF prevalence rate for hospitals, and Switzerland (15.8%) had the highest IAF prevalence rate for nursing homes. In hospitals, our model revealed that IAF prevalence was associated with country, age, care dependency, number of medical diagnoses, surgery in the last two weeks, and fall history factors. In nursing homes, care dependency, diseases of the nervous system, and fall history were identified as significant risk factors for IAF prevalence. CONCLUSIONS This large-scale study reveals that the most important IAF risk factor is an existing history of falls, independent of the setting. Whether a previous fall has occurred within the last 12 months is a simple question that should be included on every (nursing) assessment at the time of patient or resident admission. Our results guide the development of tailored prevention programs for persons at risk of falling in hospitals and nursing homes.
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Affiliation(s)
- Manuela Hoedl
- Medical University of Graz, Institute of Nursing Science, Graz, Austria
| | - Doris Eglseer
- Medical University of Graz, Institute of Nursing Science, Graz, Austria
| | - Niklaus Bernet
- Division of Nursing, Department of Health, Bern University of Applied Sciences, Bern, Switzerland
| | - Irma Everink
- Department Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK.,East Midlands Academic Health Sciences Network Patient Safety Collaborative, Nottingham, UK.,NIHR Applied Research Collaboration - East Midlands (ARC-EM), Nottingham, UK
| | - Christa Lohrmann
- Medical University of Graz, Institute of Nursing Science, Graz, Austria
| | | | - Bülent Saka
- Istanbul Faculty of Medicine, Department Internal Medicine, İstanbul Tıp Fakültesi Çapa - Fatih, Istanbul University, LIstanbul, Turkey
| | - Jos M G A Schols
- Department Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Silvia Thomann
- Division of Nursing, Department of Health, Bern University of Applied Sciences, Bern, Switzerland
| | - Silvia Bauer
- Medical University of Graz, Institute of Nursing Science, Graz, Austria
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16
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Kato Y, Kitamura S, Katoh M, Hirano A, Senjyu Y, Ogawa M, Maeda H, Mukaino M, Hirano S, Sakurai H, Shibata S, Otaka Y. Stroke Patients with Nearly Independent Transfer Ability are at High Risk of Falling. J Stroke Cerebrovasc Dis 2021; 31:106169. [PMID: 34735899 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106169] [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] [Received: 03/24/2021] [Revised: 09/25/2021] [Accepted: 10/10/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To examine the relationship between patients' transfer ability and fall risk in stroke patients during hospitalization. MATERIALS AND METHODS We retrospectively enrolled 237 stroke patients who were transferred to a convalescent rehabilitation ward from acute wards in the same hospital. Using incident reports, we investigated their fall rates and activity status at the falls according to their transfer abilities, which were assessed with Functional Independence Measure (FIM) transfer scores. The bi-weekly time trend of fall rates in all patients and in three subgroups based on FIM transfer scores of 1-3, 4-5, and 6-7, and activity status at the falls, were investigated. In addition, changes of patients' transfer ability on admission, at the first fall, and at discharge were investigated among falling patients. RESULTS The fall rate was the greatest in patients with a FIM transfer score of 4 (14.3 times/1000 person-days). The majority of falls for patients with a FIM transfer score of 1 occurred at the activity status of "on the bed" and "sitting", while three quarters of patients with a FIM score of 7 had falls during "standing" and "walking". No longitudinal trend in fall rates was found overall; however, the fall rate trends differed depending on the FIM transfer score. The majority of the patients who fell required full assistance for transfers upon admission but required no assistance at discharge. CONCLUSIONS Fall risk differed among patients with various transfer abilities; the greatest risk was in those who needed minimal assistance for transfers.
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Affiliation(s)
- Yoshitaka Kato
- Department of Rehabilitation, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake, Aichi, Toyoake 470-1192, Japan.
| | - Shin Kitamura
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan; Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan.
| | - Masaki Katoh
- Department of Rehabilitation, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake, Aichi, Toyoake 470-1192, Japan; Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
| | - Asuka Hirano
- Department of Rehabilitation, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake, Aichi, Toyoake 470-1192, Japan.
| | - Yuki Senjyu
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
| | - Mao Ogawa
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
| | - Hirofumi Maeda
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
| | - Satoshi Hirano
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
| | - Hiroaki Sakurai
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan.
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
| | - Yohei Otaka
- Department of Rehabilitation, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake, Aichi, Toyoake 470-1192, Japan; Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
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17
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Ouchi K, Liu S, Tonellato D, Keschner YG, Kennedy M, Levine DM. Home hospital as a disposition for older adults from the emergency department: Benefits and opportunities. J Am Coll Emerg Physicians Open 2021; 2:e12517. [PMID: 34322684 PMCID: PMC8295243 DOI: 10.1002/emp2.12517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/27/2021] [Accepted: 07/01/2021] [Indexed: 12/03/2022] Open
Abstract
The $1 trillion industry of acute hospital care in the United States is shifting from inside the walls of the hospital to patient homes. To tackle the limitations of current hospital care in the United States, on November 25, 2020, the Center for Medicare & Medicaid Services announced that the acute hospital care at home waiver would reimburse for "home hospital" services. A "home hospital" is the home-based provision of acute services usually associated with the traditional inpatient hospital setting. Prior work suggests that home hospital care can reduce costs, maintain quality and safety, and improve patient experiences for select acutely ill adults who require hospital-level care. However, most emergency physicians are unfamiliar with the evidence of benefits demonstrated by home hospital services, especially for older adults. Therefore, the lead author solicited narrative inputs on this topic from selected experts in emergency medicine and home hospital services with clinical experience, publications, and funding on home hospital care. Then we sought to identify information most relevant to the practice of emergency medicine. We outline the proven and potential benefits of home hospital services specific to older adults compared to traditional acute care hospitalization with a focus on the emergency department.
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Affiliation(s)
- Kei Ouchi
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Shan Liu
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Daniel Tonellato
- Department of Emergency MedicineMedStar Georgetown University HospitalWashingtonDistrict of ColumbiaUSA
- Department of Emergency MedicineGeorgetown University School of MedicineWashingtonDistrict of ColumbiaUSA
| | - Yonatan G. Keschner
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Maura Kennedy
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - David M. Levine
- Harvard Medical SchoolBostonMassachusettsUSA
- Division of General Internal Medicine and Primary CareBrigham and Women's HospitalBostonMassachusettsUSA
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18
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Tan GJ, Tan MP, Luben RN, Wareham NJ, Khaw KT, Myint PK. The relationship between alcohol intake and falls hospitalization: Results from the EPIC-Norfolk. Geriatr Gerontol Int 2021; 21:657-663. [PMID: 34156750 DOI: 10.1111/ggi.14219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 01/10/2023]
Abstract
AIM To evaluate the relationship between habitual alcohol consumption and the risk of falls hospitalization. METHODS The EPIC-Norfolk is a prospective population-based cohort study in Norfolk, UK. In total, 25 637 community dwelling adults aged 40-79 years were recruited. Units of alcohol consumed per week were measured using a validated Food Frequency Questionnaire. The main outcome was the first hospital admission following a fall. RESULTS Over a median follow-up period of 11.5 years (299 211 total person years), the cumulative incidence function (95% confidence interval) of hospitalized falls at 121-180 months for non-users, light (>0 to ≤7 units/week), moderate (>7 to ≤28 units/week) and heavy (>28 units/week) were 11.08 (9.94-12.35), 7.53 (7.02-8.08), 5.91 (5.29-6.59) and 8.20 (6.35-10.56), respectively. Moderate alcohol consumption was independently associated with a reduced risk of falls hospitalization after adjustment for most major confounders (hazard ratio = 0.88; 95% confidence interval 0.79-0.99). The relationship between light alcohol consumption and falls hospitalization was attenuated by gender differences. Alcohol intake higher than the recommended threshold of 28 units/week was associated with an increased risk of falls hospitalization (hazard ratio 1.40 [1.14-1.73]). CONCLUSIONS Moderate alcohol consumption appears to be associated with a reduced risk of falls hospitalization, and intake above the recommended limit is associated with an increased risk. This provides incentive to limit alcohol consumption within the recommended range and has important implications for public health policies for aging populations. Geriatr Gerontol Int 2021; 21: 657-663.
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Affiliation(s)
- Guo Jeng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia
| | - Robert N Luben
- Clinical Gerontology Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge
- Cambridge, UK
| | | | - Kay-Tee Khaw
- Clinical Gerontology Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge
- Cambridge, UK
| | - Phyo Kyaw Myint
- Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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19
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Ardaneh M, Fararouei M, Hassanzadeh J. Factors Contributing to Falls Leading to Fracture among Older Adults. JOURNAL OF POPULATION AGEING 2021. [DOI: 10.1007/s12062-021-09326-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Kim J, Lee S, Kim SS, Lee JP, Kim JS, Jung JG, Yoon SJ, Kim KP, Park CK, Kim YH. Association between body mass index and fragility fracture in postmenopausal women: a cross-sectional study using Korean National Health and Nutrition Examination Survey 2008-2009 (KNHANES IV). BMC WOMENS HEALTH 2021; 21:60. [PMID: 33563259 PMCID: PMC7871625 DOI: 10.1186/s12905-021-01209-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/03/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The present study examined the relationship between body mass index (BMI) and the risk for fragility fractures in postmenopausal Korean women. METHODS Among subjects who participated in the 4th Korea National Health and Nutrition Examination Survey (2008-2009), 2114 women ≥ 40 years of age were included. BMI was based on standards set by the Korean Society for the Study of Obesity, as follows: < 18.5 kg/m2, underweight; 18.5 ≤ to < 25 kg/m2, normal weight; and ≥ 25 kg/m2, obese. Subjects were also divided into three groups according to the location of fragility fracture: spine, hip, or wrist. RESULTS The mean (± SD) rate of fragility fracture was significantly different among the three groups: 5.9 ± 2.9% (underweight), 1.1 ± 0.3% (normal weight), and 3.0 ± 0.7% (obese) (p = 0.001). After correcting for age, family history, and treatment history of osteoporosis and rheumatoid arthritis, smoking and drinking status, and level of exercise, multivariable regression analysis revealed that the odds ratio for fragility fracture in the underweight group was 5.48 [95% confidence interval (CI) 1.80-16.73] and 3.33 (95% CI 1.61-6.87) in the obese group. After subdividing fragility fractures into vertebral and non-vertebral, the odds ratio for vertebral fracture in the underweight group was 5.49 (95% CI 1.31-23.09) times higher than that in the normal weight group; in the obese group, the non-vertebral fracture odds ratio was 3.87 (95% CI 1.45-10.33) times higher. Analysis of non-vertebral fractures in the obese group revealed an odds ratio for fracture 22.05 (95% CI 1.33-365.31) times higher for hip fracture and 3.85 (95% CI 1.35-10.93) times higher for wrist fracture. CONCLUSIONS Obesity and underweight increased the risk for fragility fractures in postmenopausal Korean women.
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Affiliation(s)
- Jihan Kim
- Department of Family Medicine, Sejong Trinium Woman's Hospital, Sejong, Korea.,Department of Family Medicine, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-Gu, Daejeon, 35015, Korea
| | - Sami Lee
- Department of Family Medicine, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-Gu, Daejeon, 35015, Korea.
| | - Sung Soo Kim
- Department of Family Medicine, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-Gu, Daejeon, 35015, Korea
| | - Jong-Pyo Lee
- Department of Obstetrics and Gynecology, Sejong Trinium Woman's Hospital, Sejong, Korea
| | - Jong Sung Kim
- Department of Family Medicine, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-Gu, Daejeon, 35015, Korea
| | - Jin Gyu Jung
- Department of Family Medicine, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-Gu, Daejeon, 35015, Korea
| | - Seok Jun Yoon
- Department of Family Medicine, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-Gu, Daejeon, 35015, Korea
| | - Kyu Pil Kim
- Department of Family Medicine, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Chan-Keol Park
- Division of Rheumatology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Yong-Hwan Kim
- Department of Orthopedic Surgery, Chungnam National University Hospital, Daejeon, Korea
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21
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Sluggett JK, Lalic S, Hosking SM, Ilomӓki J, Shortt T, McLoughlin J, Yu S, Cooper T, Robson L, Van Dyk E, Visvanathan R, Bell JS. Root cause analysis of fall-related hospitalisations among residents of aged care services. Aging Clin Exp Res 2020; 32:1947-1957. [PMID: 31728845 DOI: 10.1007/s40520-019-01407-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Fall-related hospitalisations from residential aged care services (RACS) are distressing for residents and costly to the healthcare system. Strategies to limit hospitalisations include preventing injurious falls and avoiding hospital transfers when falls occur. AIMS To undertake a root cause analysis (RCA) of fall-related hospitalisations from RACS and identify opportunities for fall prevention and hospital avoidance. METHODS An aggregated RCA of 47 consecutive fall-related hospitalisations for 40 residents over a 12-month period at six South Australian RACS was undertaken. Comprehensive data were extracted from RACS records including nursing progress notes, medical records, medication charts, hospital summaries and incident reports by a nurse clinical auditor and clinical pharmacist. Root cause identification was performed by the research team. A multidisciplinary expert panel recommended strategies for falls prevention and hospital avoidance. RESULTS Overall, 55.3% of fall-related hospitalisations were among residents with a history of falls. Among all fall-related hospitalisations, at least one high falls risk medication was administered regularly prior to hospitalisation. Potential root causes of falling included medication initiations and dose changes. Root causes for hospital transfers included need for timely access to subsidised medical services or radiology. Strategies identified for avoiding hospitalisations included pharmacy-generated alerts when medications associated with an increased risk of falls are initiated or changed, multidisciplinary audit and feedback of falls risk medication use and access to subsidised mobile imaging services. CONCLUSIONS This aggregate RCA identified a range of strategies to address resident and system-level factors to minimise fall-related hospitalisations.
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Affiliation(s)
- Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia.
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia.
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
| | - Sarah M Hosking
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
- Centre of Research Excellence in Frailty and Healthy Ageing, National Health and Medical Research Council of Australia, Adelaide, SA, Australia
| | - Jenni Ilomӓki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | | | - Solomon Yu
- Centre of Research Excellence in Frailty and Healthy Ageing, National Health and Medical Research Council of Australia, Adelaide, SA, Australia
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Tina Cooper
- Resthaven Incorporated, Adelaide, SA, Australia
| | | | - Eleanor Van Dyk
- Pharmacy Department, Alfred Health, Melbourne, VIC, Australia
| | - Renuka Visvanathan
- Centre of Research Excellence in Frailty and Healthy Ageing, National Health and Medical Research Council of Australia, Adelaide, SA, Australia
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
- Centre of Research Excellence in Frailty and Healthy Ageing, National Health and Medical Research Council of Australia, Adelaide, SA, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Blandfort S, Gregersen M, Rahbek K, Juul S, Damsgaard EM. Analgesic and psychoactive medications and the risk of falls in relation to delirium in single-bed rooms compared to multiple-bed rooms in geriatric inpatients. Aging Clin Exp Res 2020; 32:1493-1499. [PMID: 31463922 DOI: 10.1007/s40520-019-01335-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/21/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previously, we demonstrated a substantial reduction of delirium incidence among geriatric patients after relocating from old hospital buildings with multiple-bed rooms to a new hospital with single-bed rooms. AIMS To investigate whether (1) the reduced incidence of delirium in single-bed rooms was associated with a simultaneous change in medication use, (2) the relocation had affected the incidence of falls, (3) the use of analgesics and psychoactive medications was associated with the risk of delirium and falls. METHODS We included 461 admissions to the old wards and 553 admissions to the new wards. Delirium was assessed by the Confusion Assessment Method. Data on drug use and falls during hospitalization were extracted from medical records. RESULTS There was no difference in drug use between the wards. In the new wards, patients who had experienced delirium had a much higher risk of falls than patients without delirium, while in the old wards this contrast was small. The risk of delirium was increased among patients who received antipsychotic drugs and anti-dementia drugs, Patients who received these drugs had an insignificantly increased risk of falls. CONCLUSION Medication of analgesics and psychoactive drugs was similar in the old and new wards. In single-bed rooms, but not in multiple-bed rooms there was a much higher risk of falls among inpatients that developed delirium than among other patients. Patients who had used antipsychotics and anti-dementia drugs during hospitalization had increased risk of developing delirium and an insignificantly higher risk of falls.
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Affiliation(s)
- Sif Blandfort
- Department of Geriatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Merete Gregersen
- Department of Geriatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Kirsten Rahbek
- Department of Geriatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Svend Juul
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Else Marie Damsgaard
- Department of Geriatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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Health, Functional and Nutritional Determinants of Falls Experienced in the Previous Year-A Cross-Sectional Study in a Geriatric Ward. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134768. [PMID: 32630725 PMCID: PMC7369737 DOI: 10.3390/ijerph17134768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022]
Abstract
Falls are a serious health problem in older adults. A limited number of studies assessed their multifactorial nature in geriatric ward patients. The aim of this study is to explore health, functional and nutritional correlates of experiencing fall(s) in the previous year by older inpatients. A cross-sectional study of patients admitted to the department of geriatrics was conducted. A "faller status" was defined based on positive history of falls in the previous 12 months. Health, functional and nutritional factors associated with falls were evaluated, and multivariable logistic regression analysis models were built. A total of 358 patients (median age 82 (IQR 76-86) years, 77.9% women) were recruited, 43.9% of whom reported falls. The "fallers" presented with a significantly higher number of chronic diseases, higher prevalence of Parkinson's disease, peripheral arterial disease, chronic osteoarthritis, more frequently reported urinary incontinence and were dependent on others for daily living activities. They had significantly worse results for the assessment of gait, balance and frailty status. The Mini Nutritional Assessment-Short Form scores and the mean value of serum albumin were significantly lower in the fallers' group. Parkinson's disease (OR = 2.82, CI-1.07-7.45; p = 0.04) and osteoarthritis (OR = 2.08, CI-1.02-4.23; p = 0.04) were the main variables for the outcome prediction, according to the direct multivariable logistic regression analysis. Our findings suggest that Parkinson's disease and osteoarthritis are the main predictors independently associated with a history of falls in patients admitted to the geriatric ward, although the influence of some factors may be underestimated due to the tendency of not taking the history of falls in very frail, functionally dependent and bedridden individuals.
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Nagai T, Tanimoto K, Tomizuka Y, Uei H, Nagaoka M. Nutrition status and functional prognosis among elderly patients with distal radius fracture: a retrospective cohort study. J Orthop Surg Res 2020; 15:133. [PMID: 32264913 PMCID: PMC7140562 DOI: 10.1186/s13018-020-01657-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/27/2020] [Indexed: 11/16/2022] Open
Abstract
Background Distal radius fractures (DRF) are common in the elderly and are typically caused falls. Malnutrition has also been identified as a poor prognostic factor in elderly patients with fractures. However, the relationship between nutritional status and subsequent falls and functional prognosis for DRF in the elderly is not clear. The aim of the present study was to investigate the association between nutritional status and functional prognosis in elderly patients with DRF. Methods Study participants included 229 outpatients who required surgical treatment for DRF. The patients’ clinical information, including age, sex, body mass index, bone mineral density, geriatric nnutritional risk index (GNRI), total number of drugs being treated with on admission, use of drugs for osteoporosis, comorbidity severity, the Barthel Index (BI), presence of subsequent falls, fracture type, postoperative follow-up period, and Mayo wrist score was reviewed. Subjects were further divided into two groups according to their GNRI: the malnutrition group and the normal group. Propensity score matching was used to confirm factors affecting the BI and subsequent falls. Results Thirty-one patients (13.5%) presented with malnutrition before surgery for DRF. According to multiple liner regression analysis, the GNRI positively affected the efficiency of the BI (β = 0.392, 95% confidence interval [CI], 0.001 to 0.351, p = 0.039). Furthermore, on logistic regression analysis, subsequent falls were associated with serum albumin levels (odds ratio = 0.033, 95% CI, 0.002 to 0.477, p = 0.012). Conclusion Malnutrition impaired improvement of activities of daily living (ADL) and increased the incidence of subsequent falls. Improvement of nutritional status before DRF surgery may further improve ADL and prevent falls.
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Affiliation(s)
- Takako Nagai
- Department of Rehabilitation Medicine, Nihon University Hospital, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, 1018309, Japan. .,Department of Orthopedic Surgery, Osumi Hospital, Tokyo, Japan.
| | - Koji Tanimoto
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Yoshiaki Tomizuka
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Hiroshi Uei
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Masahiro Nagaoka
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan
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25
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Assessment of factors that increase risk of falling in older women by four different clinical methods. Aging Clin Exp Res 2020; 32:483-490. [PMID: 31115877 DOI: 10.1007/s40520-019-01220-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Women aged 65 years and over are at increased risk of falling. Falls in this age group increase the risk of morbidity and mortality. AIMS The aim of the present study was to find the most common factors that increase the risk of falling in older women, by using four different assessment methods. METHODS 682 women, who attended a geriatric outpatient clinic and underwent comprehensive geriatric assessment, were included in the study. History of falling last year, the Timed Up and Go (TUG) test, Performance-Oriented Mobility Assessment (POMA), and 4-m walking speed test were carried out on all patients. RESULTS The mean age (SD) of patients were 74.4 (8.5) years. 31.5% of women had a history of falling in the last year. 11%, 36.5%, and 33.3% of patients had a falling risk according to POMA, TUG and 4-m walking speed test, respectively. We identified the following risk factors that increase the risk of falling, according to these four methods: urinary incontinence, dizziness and imbalance, using a walking stick, frailty, dynapenia, higher Charlson Comorbidity Index and Geriatric Depression Scale score, and lower basic and instrumental activities of daily living scores (p < 0.05). We found a significant correlation between all the assessment methods (p < 0.001). CONCLUSION There is a strong relationship between fall risk and dizziness, using a walking stick, dynapenia, high number of comorbidities, low functionality, and some geriatric syndromes such as depression, frailty, and urinary incontinence in older women. Therefore, older women should routinely be screened for these risk factors.
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26
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Shenvi C, Kennedy M, Austin CA, Wilson MP, Gerardi M, Schneider S. Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool. Ann Emerg Med 2020; 75:136-145. [PMID: 31563402 PMCID: PMC7945005 DOI: 10.1016/j.annemergmed.2019.07.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 12/31/2022]
Abstract
Agitation and delirium are common reasons for older adults to seek care in the emergency department (ED). Providing care for this population in the ED setting can be challenging for emergency physicians. There are several knowledge translation gaps in how to best screen older adults for these conditions and how to manage them. A working group of subject-matter experts convened to develop an easy-to-use, point-of-care tool to assist emergency physicians in the care of these patients. The tool is designed to serve as a resource to address the knowledge translation and implementation gaps that exist in the field. The purpose of this article is present and explain the Assess, Diagnose, Evaluate, Prevent, and Treat tool. Participants were identified with expertise in emergency medicine, geriatric emergency medicine, geriatrics, and psychiatry. Background literature reviews were performed before the in-person meeting in key areas: delirium, dementia, and agitation in older adults. Participants worked electronically before and after an in-person meeting to finalize development of the tool in 2017. Subsequent work was performed electronically in the following months and additional expert review sought. EDs are an important point of care for older adults. Behavioral changes in older adults can be a manifestation of underlying medical problems, mental health concerns, medication adverse effects, substance abuse, or dementia. Five core principles were identified by the group that can help ensure adequate and thorough care for older adults with agitation or delirium: assess, diagnose, evaluate, prevent, and treat. This article provides background for and explains the importance of these principles related to the care of older adults with agitation. It is important for emergency physicians to recognize the spectrum of underlying causes of behavioral changes and have the tools to screen older adults for those causes, and methods to treat the underlying causes and ameliorate their symptoms.
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Affiliation(s)
- Christina Shenvi
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC.
| | - Maura Kennedy
- Massachusetts General Hospital Department of Emergency Medicine and Harvard Medical School, Boston, MA
| | - Charles A Austin
- Department of Internal Medicine, Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - Michael P Wilson
- University of Arkansas for Medical Sciences, Department of Emergency Medicine, Little Rock, AR
| | - Michael Gerardi
- Department of Emergency Medicine, Morristown Medical Center, Morristown, NJ; Coalition on Psychiatric Emergencies
| | - Sandy Schneider
- American College of Emergency Physicians, Irving, TX; Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, TX; Hofstra Northwell School of Medicine, Hempstead, NY
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Implementation of Fall Preventions Over the Past 15 Years: Impact on Inpatient Injury and Insights for the Future. J Nurs Care Qual 2020; 35:365-371. [PMID: 31972784 DOI: 10.1097/ncq.0000000000000468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hospital fall rates have changed minimally with preventive measures; however, the effect on injury rate is unclear. PURPOSE The purpose was to determine whether fall-related injuries have changed over time. METHODS A retrospective comparison was done of 1134 adult inpatient falls in 2017 to 1235 falls in 2001-2002 for injury and fall circumstances. Separate comparisons were made of patient characteristics by service line for 2017. RESULTS Severe fall injuries declined from 6% to 2.4%. Elimination issues remained the most common circumstance (38.9% and 42%). In 2017, malnutrition (31.6%), low function (61.4%), fall history (26.3%), and use of high-risk medications (83.2%) were common in patients who fell. Predictors of falls with injury by patient population were as follows: surgery-male gender (P = .01), low function (P = .006), elimination issues (P = .04); oncology-low function (P = .04); and neurology-low function (P = .02). CONCLUSIONS Severe fall-related injuries have decreased in the past 15 years. The most common circumstance for falls remains elimination issues.
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Maldonado JR, Sher YI, Benitez-Lopez MA, Savant V, Garcia R, Ament A, De Guzman E. A Study of the Psychometric Properties of the "Stanford Proxy Test for Delirium" (S-PTD): A New Screening Tool for the Detection of Delirium. PSYCHOSOMATICS 2019; 61:116-126. [PMID: 31926650 DOI: 10.1016/j.psym.2019.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Delirium is a prevalent neuropsychiatric disorder associated with increased morbidity and mortality. Half the cases remain misdiagnosed. OBJECTIVE Assess the effectiveness of the Stanford Proxy Test for Delirium (S-PTD) in detecting delirium in an inpatient setting. METHODS This is a comparison study. Daily assessment with S-PTD, by the patient's nurse, and a neuropsychiatric assessment by a psychiatrist. Assessments were blinded. Inclusion criteria included 18 years or older. Exclusion criteria included patient's or surrogate's unwillingness to participate, inability to consent if a surrogate was not available, and inability to communicate in English or Spanish. A total of 309 patients were approached: 27 declined participation, 4 were excluded, and 278 subjects were followed up throughout their hospital stay. In the end, 78 were excluded for lack of neuropsychiatric assessment, S-PTD, or both. One was excluded for lack of demographic data. The sensitivity and specificity of the S-PTD in detecting delirium when compared with a neuropsychiatric assessment. RESULTS Participants were on average 60.8 years old and 54.3% were male. Patients who developed delirium were, on average, older (15.12 y, confidence interval: 8.94-21.32). A total of 199 patients were analyzed; 43 patients (21.6%) met criteria for delirium. S-PTD detected 67 days with delirium (16.5%) of 405 hospital days, while neuropsychiatric evaluation identified 83 (20.5%). S-PTD had a sensitivity of 80.72% and a specificity of 90.37%. CONCLUSION S-PTD is an effective, comprehensive, and simple screening tool for delirium, which is robust despite fluctuating symptoms and lack of cooperation. The use of S-PTD may enhance early diagnosis of delirium.
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Affiliation(s)
- Jose R Maldonado
- Consultation-Liaison Psychiatry Service, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
| | - Yelizaveta I Sher
- Consultation-Liaison Psychiatry Service, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Mario Alberto Benitez-Lopez
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
| | - Vidushi Savant
- Consultation-Liaison Psychiatry Service, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Renee Garcia
- Consultation-Liaison Psychiatry Service, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Andrea Ament
- Consultation-Liaison Psychiatry Service, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Earl De Guzman
- Consultation-Liaison Psychiatry Service, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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Bott N, Wexler S, Drury L, Pollak C, Wang V, Scher K, Narducci S. A Protocol-Driven, Bedside Digital Conversational Agent to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults: Case Control Pre-Post Study. J Med Internet Res 2019; 21:e13440. [PMID: 31625949 PMCID: PMC6913375 DOI: 10.2196/13440] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/21/2019] [Accepted: 08/19/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hospitalized older adults often experience isolation and disorientation while receiving care, placing them at risk for many inpatient complications, including loneliness, depression, delirium, and falls. Embodied conversational agents (ECAs) are technological entities that can interact with people through spoken conversation. Some ECAs are also relational agents, which build and maintain socioemotional relationships with people across multiple interactions. This study utilized a novel form of relational ECA, provided by Care Coach (care.coach, inc): an animated animal avatar on a tablet device, monitored and controlled by live health advocates. The ECA implemented algorithm-based clinical protocols for hospitalized older adults, such as reorienting patients to mitigate delirium risk, eliciting toileting needs to prevent falls, and engaging patients in social interaction to facilitate social engagement. Previous pilot studies of the Care Coach avatar have demonstrated the ECA's usability and efficacy in home-dwelling older adults. Further study among hospitalized older adults in a larger experimental trial is needed to demonstrate its effectiveness. OBJECTIVE The aim of the study was to examine the effect of a human-in-the-loop, protocol-driven relational ECA on loneliness, depression, delirium, and falls among diverse hospitalized older adults. METHODS This was a clinical trial of 95 adults over the age of 65 years, hospitalized at an inner-city community hospital. Intervention participants received an avatar for the duration of their hospital stay; participants on a control unit received a daily 15-min visit from a nursing student. Measures of loneliness (3-item University of California, Los Angeles Loneliness Scale), depression (15-item Geriatric Depression Scale), and delirium (confusion assessment method) were administered upon study enrollment and before discharge. RESULTS Participants who received the avatar during hospitalization had lower frequency of delirium at discharge (P<.001), reported fewer symptoms of loneliness (P=.01), and experienced fewer falls than control participants. There were no significant differences in self-reported depressive symptoms. CONCLUSIONS The study findings validate the use of human-in-the-loop, relational ECAs among diverse hospitalized older adults.
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Affiliation(s)
- Nicholas Bott
- Clinical Excellence Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
- Department of Psychology, PGSP-Stanford Consortium, Palo Alto, CA, United States
| | | | - Lin Drury
- Pace University, New York, NY, United States
| | | | | | - Kathleen Scher
- Jamaica Hospital Medical Center, New York, NY, United States
| | - Sharon Narducci
- Jamaica Hospital Medical Center, New York, NY, United States
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de Souza AB, Maestri RN, Röhsig V, Lorenzini E, Alves BM, Oliveira D, Gatto DC. In-hospital falls in a large hospital in the south of Brazil: A 6-year retrospective study. Appl Nurs Res 2019; 48:81-87. [DOI: 10.1016/j.apnr.2019.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/08/2019] [Accepted: 05/27/2019] [Indexed: 11/17/2022]
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Age-Dependent Oxidative Stress Elevates Arginase 1 and Uncoupled Nitric Oxide Synthesis in Skeletal Muscle of Aged Mice. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:1704650. [PMID: 31205583 PMCID: PMC6530149 DOI: 10.1155/2019/1704650] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/04/2019] [Indexed: 12/21/2022]
Abstract
Aging is associated with reduced muscle mass (sarcopenia) and poor bone quality (osteoporosis), which together increase the incidence of falls and bone fractures. It is widely appreciated that aging triggers systemic oxidative stress, which can impair myoblast cell survival and differentiation. We previously reported that arginase plays an important role in oxidative stress-dependent bone loss. We hypothesized that arginase activity is dysregulated with aging in muscles and may be involved in muscle pathophysiology. To investigate this, we analyzed arginase activity and its expression in skeletal muscles of young and aged mice. We found that arginase activity and arginase 1 expression were significantly elevated in aged muscles. We also demonstrated that SOD2, GPx1, and NOX2 increased with age in skeletal muscle. Most importantly, we also demonstrated elevated levels of peroxynitrite formation and uncoupling of eNOS in aged muscles. Our in vitro studies using C2C12 myoblasts showed that the oxidative stress treatment increased arginase activity, decreased cell survival, and increased apoptotic markers. These effects were reversed by treatment with an arginase inhibitor, 2(S)-amino-6-boronohexanoic acid (ABH). Our study provides strong evidence that L-arginine metabolism is altered in aged muscle and that arginase inhibition could be used as a novel therapeutic target for age-related muscle complications.
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Sillner AY, Holle CL, Rudolph JL. The Overlap Between Falls and Delirium in Hospitalized Older Adults: A Systematic Review. Clin Geriatr Med 2019; 35:221-236. [PMID: 30929884 DOI: 10.1016/j.cger.2019.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Falls frequently occur in persons with cognitive impairment, including delirium. This article presents a systematic review of the association between falls and delirium in adults aged 65 years or older. For the studies that compared falls and delirium, the risk ratio was consistently elevated (median RR 4.5, range 1.4-12.6) and statistically significant in all but one study. These results suggest that falls and delirium are inextricably linked. There is a need to further refine fall risk assessment tools and protocols to specifically include delirium for consideration as a risk factor that needs additional assessment and management.
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Affiliation(s)
- Andrea Yevchak Sillner
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center (650), 830 Chalkstone Avenue, Providence, RI 02908 USA; College of Nursing, The Pennsylvania State University, 201 Nursing Sciences Building, University Park, PA 16802, USA
| | - Cynthia L Holle
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center (650), 830 Chalkstone Avenue, Providence, RI 02908 USA
| | - James L Rudolph
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center (650), 830 Chalkstone Avenue, Providence, RI 02908 USA; Department of Medicine, Warren Alpert Medical School, Brown University, Box G-A1, Providence, RI 02912, USA; Center of Gerontology and Health Research, Brown University School of Public Health, Providence, RI, USA.
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Risk Factors for Poor Functional Recovery, Mortality, Recurrent Fractures, and Falls Among Patients Participating in a Fracture Liaison Service Program. J Am Med Dir Assoc 2019; 20:1129-1136.e1. [PMID: 30723057 DOI: 10.1016/j.jamda.2018.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/09/2018] [Accepted: 12/16/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE A fracture liaison service (FLS) for patients with fractures is a promising approach for improving outcomes, but barriers to the successful implementation of an FLS remain. The factors influencing the outcomes of patients already receiving FLS care are unclear. DESIGN A prospective multicenter cohort study. SETTINGS AND PARTICIPANTS Patients with incident hip and clinical vertebral fractures treated at 2 institutions between January 2014 and June 2016 were prospectively enrolled. Demographic profiles, comorbidities, prior fracture experiences, T scores, Fracture Risk Assessment Tool (FRAX) scores, and serum markers were examined. MEASURES Self-reported functional status (at the 4th month), mortality, recurrent fractures, and falls (at the 2-year follow-up). RESULTS Of 712 patients screened for eligibility, 600 (84%) participants (age 78 ± 10 years) were enrolled in the FLS program. At 4 months, 58%, 53%, and 60% of the participants reported improved mobility, self-care, and daily activities after FLS care, respectively. After 2 years, 85 (14%) died, 36 (6%) developed recurrent fractures, and 199 (33%) had 1 or more fall episodes. Multivariate logistic regression showed that neurologic disorders, heart disease, and diabetes were associated with a decreased probability of functional recovery. Cox regression showed that older age and chronic kidney disease (CKD) were predictive of increased mortality, whereas heart disease was correlated with an increased refracture risk. Older age and cancer or osteoarthritis were associated with a higher risk of falls. Importantly, a higher body mass index predicted a lower risk of mortality and a higher probability of improved self-care but a higher risk of fall at follow-up. CONCLUSIONS/IMPLICATIONS We discovered that comorbidities including CKD, heart disease, cancer, and osteoarthritis could influence short-term functional changes, survival, and the risk of refractures or falls among patients participating in FLSs. These factors are expected to aid in prognosis estimation and management planning for those with fractures.
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Aljawadi MH, Khoja AT, Alhammad AM, AlOtaibi AD, Al-Shammari SA, Khoja TA. The prevalence of benzodiazepines utilization and its association with falls among Saudi older adults; results from the Saudi national survey for elderly Health (SNSEH). Saudi Pharm J 2018; 26:1112-1119. [PMID: 30532631 PMCID: PMC6260491 DOI: 10.1016/j.jsps.2018.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/30/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE First, to determine benzodiazepines prevalence (BDZs) among Saudi older adults (SOA); Second, to quantify the association between BDZs use and falls among SOA. Third, to determine falls effect on all-cause mortality among SOA. METHODS This is a cross-sectional study that used the Saudi National Survey for Elderly Health; a nationally-representative, population-based survey. Participants were asked about BDZs use and falls history during the 12 months prior to the interview. Demographics, medications, comorbidities and housing conditions were used as covariates. Multiple imputation was used to impute missing data. Modified poisson multivariable regression was used to study the association between BDZs and falls. Cox- proportional hazard regression was used to determine falls effect on mortality over nine years period. RESULTS Among 2946 SOA, BDZs prevalence was 4%. Around 13% reported falls. In the multivariable regression, relative risk (RR) of falls was 2 comparing BDZs users to non-users (95CI%: 1.02-3.99). Antidepressants (RR = 1.72; 95%CI: 1.10-2.74), laxatives (RR = 1.38; 95%CI: 1.11-1.7), low body mass index (RR = 1.94; 95%CI: 1.33-2.84), mild cognitive impairment (RR = 1.56; 95%CI: 1.21-2.03), high door steps (RR = 1.54; 95%CI: 1.23-1.93) and insufficient illumination (RR = 1.38; 95%CI: 1.11-1.71) increased falls risk. Lastly, the hazard ratio of falls on death was 1.48 (95%CI: 1.17, 1.89) over nine years. CONCLUSION Despite the recommendation against BDZs use among older adults, still there were subjects who were prescribed these drugs. falls are common among SOA. Preventive strategies such medication therapy management, nutrition improvement, elderly-friendly housing structures can reduce the prevalence of falls and consequent increase in mortality among SOA.
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Affiliation(s)
- Mohammad H. Aljawadi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah T. Khoja
- Public Health and Family Medicine Departments, College of Medicine, Al-Imam Muhammad ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Abdullah M. Alhammad
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Azzam D. AlOtaibi
- Department of Medicine, College of Medicine, Al-Imam Muhammad ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Sulaiman A. Al-Shammari
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Tawfik A. Khoja
- Executive Board, Health Ministers’ Council for the Cooperation Council States, Saudi Arabia
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Duque AF, Post ZD, Orozco FR, Lutz RW, Ong AC. A Proactive Approach to High Risk Delirium Patients Undergoing Total Joint Arthroplasty. J Arthroplasty 2018; 33:1171-1176. [PMID: 29174758 DOI: 10.1016/j.arth.2017.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Delirium is a common complication among elderly patients undergoing total joint arthroplasty (TJA). Its incidence has been reported from 4% to 53%. The Centers for Medicare and Medicaid Services consider delirium following TJA a "never-event." The purpose of this study is to evaluate a simple perioperative protocol used to identify delirium risk patients and prevent its incidence following TJA. METHODS Our group developed a protocol to identify and prevent delirium in patients undergoing TJA. All patients were screened and scored in the preoperative assessment, on criteria such as age, history of forgetfulness, history of agitation or visual hallucinations, history of falls, history of postoperative confusion, and inability to perform higher brain functions. Patients were scored on performance in a simple mental examination. The patients were classified as low, medium, or high risk. Patients who were identified as high risk were enrolled in a delirium avoidance protocol that minimized narcotics and emphasized nursing involvement and fluids administration. RESULTS Five of 7659 (0.065%) consecutive TJA patients from 2010 to 2015 developed delirium. A total of 422 patients were identified as high risk. All 5 patients who suffered delirium were within the high risk group. No low or medium risk patients suffered a delirium complication. Three (0.039%) patients suffered drug-induced delirium, 1 (0.013%) had delirium related to alcohol withdrawal, and 1 (0.013%) had delirium after a systemic infection. CONCLUSION This protocol is effective in identifying patients at high delirium risk and diminishing the incidence of this complication by utilizing a simple screening tool and perioperative protocol.
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Affiliation(s)
- Andres F Duque
- The Rothman Institute of Orthopaedics at Thomas Jefferson University, Egg Harbor Township, New Jersey
| | - Zachary D Post
- The Rothman Institute of Orthopaedics at Thomas Jefferson University, Egg Harbor Township, New Jersey
| | - Fabio R Orozco
- The Rothman Institute of Orthopaedics at Thomas Jefferson University, Egg Harbor Township, New Jersey
| | - Rex W Lutz
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Alvin C Ong
- The Rothman Institute of Orthopaedics at Thomas Jefferson University, Egg Harbor Township, New Jersey
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Abstract
PURPOSE OF REVIEW To highlight the importance of nutrition in older adults undergoing a rehabilitation program. Geriatric rehabilitation aims at the recovery of physical abilities for a largely independent life in the community. The term 'geriatric rehabilitation' is wide and includes inpatient and ambulatory care as well as rehabilitation programs in hospitals, also outside geriatric wards. The role of nutrition is therefore not clearly defined, but an association between declined functional status and low nutritional status is evident. RECENT FINDINGS An association has been identified between malnutrition and low physical function or lower rehabilitation effect, respectively. In intervention trials with nutritional care (additional energy or protein), a number of benefits for muscle mass, muscle strength, physical function, or the outcomes quality of life and rehospitalization were identified. In this context, the combination of exercise and adequate nutrition seems to be beneficial. SUMMARY Geriatric patients undergoing a rehabilitation program outside inpatient, ambulatory, or hospitalization care need an adequate supply of energy and nutrients. Malnutrition must be avoided, ideally before starting rehabilitation. Nutritional interventions are most beneficial in combination with exercise training.
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Affiliation(s)
- Rebecca Diekmann
- Department for Health Services Research, Assistance Systems and Medical Devices, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Deloumeau A, Moltó A, Roux C, Briot K. Determinants of short term fracture risk in patients with a recent history of low-trauma non-vertebral fracture. Bone 2017; 105:287-291. [PMID: 28842362 DOI: 10.1016/j.bone.2017.08.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/30/2017] [Accepted: 08/19/2017] [Indexed: 12/16/2022]
Abstract
Low-trauma fractures tend to cluster in time, and subsequent fractures have a role in increased morbidity and mortality in osteoporotic patients. The aim of this study was to identify the risk factors of short-term subsequent non-vertebral fracture (NVF). Patients were included from the Fracture Liaison Service (FLS) which provides assessment for osteoporosis to all in-hospital patients admitted for a low-trauma NVF in the Orthopaedics department. Location and date of occurrence of previous fractures, risk factors for osteoporosis and falls were collected. Bone mineral density was measured at the lumbar spine and total hip; presence of vertebral fractures was evaluated using vertebral fracture assessment (VFA). Nine hundred and fifty patients were included (84% women; 75±12years), with a mean T-score at the femoral neck of -2.3±1.0. Four hundred and sixty eight (49%) patients were in the FLS because of a hip fracture. Using multivariable analysis, the risk of being in the FLS with a previous fracture ≤3years before was associated with: history of fall in the year before the admission (OR=2.75, CI 95% 1.55-4.93), history of severe low-trauma NVF (OR=2.54; CI 95% 1.45-4.52), and BMI lower than 20kg/m2 (OR=2.45, CI 95% 1.25-4.87); age older than 78years-old was protective to the risk of re-fracture (OR=0.44, CI 95% 0.24-0.80). Some risk factors (age, history of fall and of previous severe non-vertebral fracture) can help in the selection of patients at high risk of refracture, who should receive the highest priority for a treatment.
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Affiliation(s)
- Aude Deloumeau
- Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France.
| | - Anna Moltó
- Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France; U1153 Institut National de la Santé et de la Recherche Médicale, PRESS Sorbonne Paris Cité, Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France
| | - Christian Roux
- Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France; U1153 Institut National de la Santé et de la Recherche Médicale, PRESS Sorbonne Paris Cité, Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France
| | - Karine Briot
- Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France; U1153 Institut National de la Santé et de la Recherche Médicale, PRESS Sorbonne Paris Cité, Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France.
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Cruz A, Tosoli Gomes AM, Parreira PM, Oliveira DCD. Tradução e adaptação transcultural do Hospitalized Elderly Needs Awareness Scale (Henas) para a língua portu- guesa (Brasil e Portugal). AQUICHAN 2017. [DOI: 10.5294/aqui.2017.17.4.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivos: traducir y adaptar el Hospitalized Elderly Needs Awareness Scale (Henas) para el portugués de Brasil y de Portugal. Metodología: se siguieron los procedimientos metodológicos de adaptación cultural y lingüística: traducción inicial, síntesis de las traducciones, retroversión, evaluación por comité de expertos de la equivalencia semántica, idiomática, cultural y conceptual. La versión adaptada fue probada (pre-test) con aplicación de la escala a 249 enfermeros brasileños y portugueses en el 2014. Resultados: no se encontraron palabras o expresiones consideradas divergentes, a excepción de la palabra awareness en el título del instrumento y de la expresión medical acuity del ítem K. De acuerdo con la fase IV del proceso de traducción y adaptación cultural, el comité de expertos planteó alterar la expresión 75 años o más por 65 años o más en la introducción del instrumento. En la versión portuguesa de Brasil, solo se reemplazó la palabra sanita por vaso sanitário. En cuanto la versión adaptada, los participantes no presentaron dudas ni refirieron dificultades en completar el instrumento. Conclusiones: el proceso de traducción y adaptación cultural del Henas para la lengua portuguesa siguió las etapas recomendadas internacionalmente y del cual se obtuvo equivalencia semántica, idiomática, cultural y conceptual. Son necesarias nuevas investigaciones para evaluar otras propiedades del instrumento y su comportamiento en muestras distintas
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Suitability of functional evaluation embedded in serious game rehabilitation exercises to assess motor development across lifespan. Gait Posture 2017; 57:35-39. [PMID: 28564622 DOI: 10.1016/j.gaitpost.2017.05.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/11/2017] [Accepted: 05/23/2017] [Indexed: 02/02/2023]
Abstract
The aim of this study was to determine if the results of activities performed using specially developed serious games for physical rehabilitation could be used as an indicator of the natural maturation and decline of motor control in healthy participants. Eighty-one participants (19 children (5-15 years old), 40 adults (18-65 years old) and 22 aged subjects (60-88 years old) participated in this study. Motions performed were recorded using the Kinect sensor. Three different exercises embedded in the games were used to assess upper limb, trunk and lower limb control. The trial duration and accuracy, measures of gross motor function and fine motor control, respectively, were computed for each participant. ANOVA tests shows statistically significant differences between the three groups for duration (53±15, 27±10 and 119±30s for children, adults and elderly subjects respectively) and accuracy (87±5, 89±10 and 70±8% for children, adults and elderly subjects respectively). The slopes of the curves that approximated the evolution of the performance over various ages are coherent with previous studies about motor control development and physiological decline. The proposed solution, i.e. serious games rehabilitation exercises coupled to motion analysis, seems to be an interesting tool to assess global motor function. Further studies are needed to study the influence of pathologies on the studied parameters.
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Dudzińska-Griszek J, Szuster K, Szewieczek J. Grip strength as a frailty diagnostic component in geriatric inpatients. Clin Interv Aging 2017; 12:1151-1157. [PMID: 28794619 PMCID: PMC5538538 DOI: 10.2147/cia.s140192] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Frailty has emerged as a key medical syndrome predictive of comorbidity, disability, institutionalization and death. As a component of the five frailty phenotype diagnostic criteria, patient grip strength deserves attention as a simple and objective measure of the frailty syndrome. The aim of this study was to assess conditions that influence grip strength in geriatric inpatients. PATIENTS AND METHODS The study group consisted of 80 patients aged 78.6±7.0 years [Formula: see text], with 68.8% women, admitted to the Department of Geriatrics. A comprehensive geriatric assessment was complemented with assessment for the frailty phenotype as described by Fried et al for all patients in the study group. Functional assessment included Barthel Index of Activities of Daily Living (Barthel Index), Instrumental Activities of Daily Living Scale and Mini-Mental State Examination. RESULTS Three or more frailty criteria were positive in 32 patients (40%), while 56 subjects (70%) fulfilled the frailty criterion of weakness (grip strength test). Multivariate linear regression analysis revealed that two independent measures showed positive association with grip strength - Mini-Mental State Examination score (β=0.239; P=0.001) and statin use (β=0.213; P=0.002) - and four independent measures were negatively associated with grip strength - female sex (β=-0.671; P<0.001), C-reactive protein (β=-0.253; P<0.001), prior myocardial infarction (β=-0.190; P=0.006) and use of an antidepressant (β=-0.163; P=0.018). Low physical activity was identified as the only independent qualitative frailty component associated with 2-year mortality in multivariate logistic regression analysis after adjustment for age and sex (odds ratio =6.000; 95% CI =1.357-26.536; P=0.018). CONCLUSION Cognitive function, somatic comorbidity and medical treatment affect grip strength as a measure of physical frailty in geriatric inpatients. Grip strength was not predictive of 2-year mortality in this group.
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Affiliation(s)
- Joanna Dudzińska-Griszek
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Karolina Szuster
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jan Szewieczek
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Kłak A, Raciborski F, Targowski T, Rzodkiewicz P, Bousquet J, Samoliński B. A growing problem of falls in the aging population: A case study on Poland – 2015–2050 forecast. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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