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Jones AE, Kennedy M, Hayden EM, Ouchi K, N Shankar K, Chary A, Li A, Loughlin KM, White B, Franco-Garcia E, Dellheim V, Liu SW. A protocol to determine the acceptability and feasibility of a pilot intervention emergency department virtual observation unit fall prevention program. Pilot Feasibility Stud 2024; 10:79. [PMID: 38762531 PMCID: PMC11102199 DOI: 10.1186/s40814-024-01502-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 04/30/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND As a third of all community dwellers aged 65+ fall each year, falls are common reasons for older adults to present to an Emergency Department (ED). Although EDs should assess patients' multifactorial fall risks to prevent future fall-related injuries, this frequently does not occur. We describe our protocol to determine the feasibility, acceptability, and safety of a pilot ED Virtual Observation Unit (VOU) Falls program. METHODS To ensure standardized conduct and reporting, the Standard Protocol Items for Intervention Trials (SPIRIT) guidelines will be used. The VOU is a program where patients are sent home from the ED but are part of a virtual observation unit in that they can call on-call ED physicians while they are being treated for conditions such as cellulitis, congestive heart failure, or pneumonia. A paramedic conducts daily visits with the patient and facilitates a telemedicine consult with an ED physician. VOU nursing staff conduct daily assessments of patients via telemedicine. The ED VOU Falls program is one of the VOU pathways and is a multi-component fall prevention program for fall patients who present after an ED visit. The paramedic conducts a home safety evaluation, a Timed Up and Go Test (TUG). During the VOU visit, the ED physician conducts a telemedicine visit, while the paramedic is visiting the home, to review patients' fall-risk-increasing drugs and their TUG test. We will determine feasibility by calculating rates of patient enrollment refusal, and adherence to fall-risk prevention recommendations using information from 3-month follow-up telephone calls, as well as qualitative interviews with the paramedics. We will determine the acceptability of the ED VOU Falls program based on patient and provider surveys using a Likert scale. We will ask VOU nursing staff to report any safety issues encountered while the patient is in the ED VOU Falls program (e.g., tripping hazards). We will use the chi-square test or Fisher's exact test for categorical variables, Student's t-test for continuous variables, and Mann-Whitney for nonparametric data. We will review interview transcripts and generate codes. Codes will then be extracted and organized into concepts to generate an overall theme following grounded theory methods. This is a pilot study; hence, results cannot be extrapolated. However, a definite trial would be the next step in the future to determine if such a program could be implemented as part of fall prevention interventions. DISCUSSION This study will provide insights into the feasibility and acceptability of a novel ED VOU Falls program with the aim of ultimately decreasing falls. In the future, such a program could be implemented as part of fall prevention interventions.
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Affiliation(s)
- Abigail E Jones
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA
| | - Kalpana N Shankar
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA
| | - Anita Chary
- Departments of Emergency Medicine and Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Angel Li
- Valley Health System, Las Vegas, NV, USA
| | | | - Benjamin White
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Esteban Franco-Garcia
- Department of Internal Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, USA
| | | | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Barati M, Jormand H, Khazaei S, Bashirian S, Sadri M, Afshari M. Factors affecting subsequent dose of COVID-19 vaccine uptake based on BASNEF model among older adults. BMC Infect Dis 2024; 24:18. [PMID: 38166817 PMCID: PMC10763401 DOI: 10.1186/s12879-023-08903-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Vaccination is a primary prevention approach to preventing disease by disconnecting the transmission chain. The current study utilized a BASNEF model framework to identify factors influencing subsequent doses of COVID-19 vaccination among older adults. METHODS This cross-sectional study was performed in the west of Iran in May 2022. The participants were selected via multi-stage sampling. Finally, 1120 participants contributed to the present study. The questionnaire consisted of three sections: a) Socio-demographic characteristics, b) cognitive impairments tests, and c) Questionnaire about the subsequent dose of COVID-19 vaccine uptake based on the BASNEF model. Data were analyzed using the software IBM AMOS-20 and SPSS-23 via one-way analysis of variance (ANOVA) and independent sample T-tests were used, too. The significance level of statistical tests was regarded as less than 0.05. RESULTS The presented results of analyzing 50% of the variance of vaccination intention as the dependent variable (R square = 0.497) and 10% of the behavior variance as the dependent variable (R square = 0.104) can be explained based on the BASNEF model. The enabling factors (β = 0.636, p < 0.001) and the intention (β = 0.322, p < 0.001) were important factors for subsequent doses of COVID-19 vaccine uptake in older adults. CONCLUSION So, planning and implementing promotional intervention programs for older people (over 65; 80), females, illiterate, widows and divorced, good economic status, and urban areas is essential. It seems that enabling factors such as free vaccinations, vaccination inaccessible places such as public social security agencies, social supports such as involvement of the government and physicians, and improving information by the medium or knowledge-sharing experience, which can be further used to enhance the acceptance of subsequent doses of COVID-19 uptake in older adults.
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Affiliation(s)
- Majid Barati
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences and Department of Public Health, Asadabad School of Medical sciences, Asadabad, Iran, Hamadan, IR, Iran
| | - Hanieh Jormand
- Urology and Nephrology Research Center, Hamadan University of Medical Sciences, Hamadan, IR, Iran.
| | - Salman Khazaei
- Department of Epidemiology, School of Public and Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, IR, Iran
| | - Saeed Bashirian
- Department of Public Health, School of Public Health and Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, IR, Iran
| | - Mohadeseh Sadri
- Iranian Research Center on Aging, University of Social Walfare and Rehablitation Sciences, Tehran, IR, Iran
| | - Maryam Afshari
- Department of Public Health, School of Public Health and Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, IR, Iran
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Salis F, Zanda F, Cherchi F, Puxeddu B, Sanna L, Scudu C, Serreli S, Stanisci L, Cossu E, Mandas A. Diabetes mellitus, malnutrition, and sarcopenia: The bond is not explained by bioelectrical impedance analysis in older adults. J Med Life 2023; 16:1170-1177. [PMID: 38024829 PMCID: PMC10652670 DOI: 10.25122/jml-2023-0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/10/2023] [Indexed: 12/01/2023] Open
Abstract
As people age, their risk of diabetes mellitus (DM) and sarcopenia increases due to the decline in muscle mass and strength. Bioelectrical impedance analysis (BIA) is a method used to detect changes in body composition. The primary aim of the study was to determine the distribution of BIA variables among a group of non-DM people and two groups of patients with controlled and uncontrolled DM. The secondary aim was to establish the independent association between BIA-derived data, lipidic assets, and the prevalence of metabolic syndromes with DM. This study included a total of 235 participants who were categorized into three groups based on the presence of diabetes mellitus (DM) and their glycated hemoglobin (HbA1c) levels: non-DM, controlled DM (HbA1c≤7.0%), and uncontrolled DM (HbA1c>7.0%). Waist circumference (p=0.005), bone (p<0.001), muscular (p<0.001), and appendicular skeletal mass (p<0.001) were lower in the non-DM group, while sarcopenic risk (p<0.001), total cholesterol (p<0.001), and LDL (p<0.001), were higher. Grip strength (p<0.001), visceral fat (p=0.01), and phase angle (p=0.04) were significantly lower in non-DM than uncontrolled DM patients, as well as the number of drugs taken (p=0.014). A multivariate analysis highlighted that LDL (coefficient -0.006, p=0.01) was negatively associated, while bone mass (coefficient 0.498, p=0.0042) was positively associated with DM uncontrol. Our study shows that BIA may not be the ideal tool for distinguishing between elderly individuals with and without DM, as it can be affected by numerous covariates, including potential differences in glucometabolic and cardiovascular control.
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Affiliation(s)
- Francesco Salis
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Francesca Zanda
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federica Cherchi
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Benedetta Puxeddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luisa Sanna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Chiara Scudu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Silvia Serreli
- Department of Medicine, Surgery, and Pharmacy, University of Sassari, Sassari, Italy
| | - Lorenzo Stanisci
- Department of Medicine, Surgery, and Pharmacy, University of Sassari, Sassari, Italy
| | - Efisio Cossu
- University Hospital Azienda Ospedaliero-Universitaria of Cagliari, Cagliari, Italy
| | - Antonella Mandas
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- University Hospital Azienda Ospedaliero-Universitaria of Cagliari, Cagliari, Italy
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