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Hoffman GJ, Ha J, Li J. Association of Medicare Home Health Ratings With Older Adult Fall Injuries: An Instrumental Variables Analysis. J Am Med Dir Assoc 2024; 25:105013. [PMID: 38729215 DOI: 10.1016/j.jamda.2024.03.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/29/2024] [Accepted: 03/29/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVES To understand the role of high-quality home health care for fall prevention. DESIGN A 100% sample of national Medicare claims and home health survey data (2015-2017) were used to assess fall injuries and receipt of a fall risk assessment among recently hospitalized Medicare fee-for-service home health users aged ≥66 years. Subanalyses examined patients by prior fall history status and hospital admission diagnosis type (eg, neurologic, respiratory, cardiovascular, infection, and orthopedic diagnoses). An instrumental variables design addressed potential endogeneity in home health care use by patient fall risk. SETTING AND PARTICIPANTS Home health agencies and Medicare fee-for-service beneficiaries. METHODS Multivariate regression and instrumental variables. RESULTS Among 962,610 patients with hospital discharges to home health, being treated by home health agencies with the highest star ratings in a person's zip code was associated with a 1.8-percentage point (ppt) (95% CI: 0.1, 3.5; P = .03) higher likelihood of receipt of fall risk assessment. There was no overall change in 30-day (-0.6 ppt, 95% CI: -1.3, 0.1; P = .09), 15-day (-0.3 ppt, 95% CI: -0.0.8, 0.2; P = .35), or 7-day fall injury risk (-0.2 ppt, 95% CI: -0.5, 0.1; P = .22), but a 1.9-ppt (95% CI: -3.9, -0.02; P = .048) lower 30-day fall injury risk for individuals with a history of falls. Effects were directionally similar by diagnosis type. CONCLUSIONS AND IMPLICATIONS Fall injury risk is reduced at higher-rated home health agencies. Star ratings may be adequate indicators of quality for key outcomes not explicitly measured in the ratings.
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Affiliation(s)
- Geoffrey J Hoffman
- Department of Systems, Population and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Jinkyung Ha
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jun Li
- Public Administration and International Affairs Department, Maxwell School of Citizenship & Public Affairs, Syracuse University, Syracuse, NY, USA; Aging Studies Institute, Syracuse University, Syracuse, NY, USA
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Implementing a quality improvement program to reduce falls and increase patient medication satisfaction in an academic medical center. Geriatr Nurs 2023; 49:207-211. [PMID: 36207230 DOI: 10.1016/j.gerinurse.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hospitalized older adult medication-related falls are common and understudied. LOCAL PROBLEM There were organizational educational gaps identified in assisting nurses to recognize and mitigate medication associated side effects that may predispose hospitalized older adults to fall. METHODS A quality improvement project that utilized pre and post-test design. An eLearning module was developed and distributed to registered nurses in a medical unit. INTERVENTIONS Eighty registered nurses participated in an eLearning module that included patient and family centered evidence-based guidelines and teach-back guides related to medication fall safety. RESULTS An increase in overall (2.2%) medication patient satisfaction scores and decrease (8%) in falls for patients > 65 years old over a 4-month period. CONCLUSIONS There is benefit of implementing a structured medication fall risk education program for nurses on a medical unit. Patient satisfaction related to communication about medications and a reduction in falls was impacted by this interdisciplinary intervention.
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Crawley MR, Chapman AJ, Koestner A, Pounders S, Krech L, Lypka M, Fisk C, Iskander G. Fall Risk Identification Throughout the Continuum of Care for Elderly Trauma Patients: An Injury Prevention Initiative. Injury 2022; 53:3715-3722. [PMID: 36075779 DOI: 10.1016/j.injury.2022.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 08/06/2022] [Accepted: 08/29/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Falls are the second leading cause of trauma-related deaths worldwide. Identifying fall risk patients and initiating interventions reduces injuries and mortality, particularly in the elderly. The primary aim of this retrospective study was to identify missed opportunities for fall risk identification and intervention for geriatric trauma patients. PATIENTS AND METHODS In this retrospective observational cohort study, the trauma registry was queried to identify geriatric patients admitted for a fall over 36 months. The electronic medical record (EMR) was reviewed to evaluate patients' fall risk in the 12 months prior to the index fall admission. The EMR was also queried for repeat falls within 12 months after discharge, and to determine if fall prevention education was provided at discharge. RESULTS 597 patients met inclusion criteria; 68.3% were female. 64.7% were at risk for falling in the year before admission. 2% had documented fall prevention education at discharge. 32% of patients fell again within a year of discharge and 19.4% were readmitted for a repeat fall. Patients at high risk for falls (on the Hester-Davis scale) were significantly more likely to be readmitted (p = 0.005) and expire within six months (p = 0.033) than moderate risk patients. Mortality at 12 months post-admission for all patients was 19.4%. CONCLUSION This large study demonstrated that geriatric trauma patients admitted for a fall were already at risk for falling in the 12 months prior to admission. This is a novel finding that presents a substantial prevention opportunity for healthcare systems. Education and implementation of proven techniques to prevent falls as soon as at-risk patients are identified has the potential to change the course for a patient who may not only fall, but also fall again. This proactive approach could significantly impact the fall epidemic in our elderly population.
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Affiliation(s)
- Meaghan R Crawley
- Spectrum Health Butterworth Hospital, Trauma Services, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Alistair J Chapman
- Spectrum Health Butterworth Hospital, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA; Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Amy Koestner
- Spectrum Health Butterworth Hospital, Trauma Services, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Steffen Pounders
- Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Laura Krech
- Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA.
| | - Matthew Lypka
- Spectrum Health Office of Research and Education, Biostatistics Core, 15 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Chelsea Fisk
- Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - Gaby Iskander
- Spectrum Health Butterworth Hospital, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA
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Vincenzo JL, Patton SK, Lefler LL, Falvey JR, McElfish PA, Curran G, Wei J. Older Adults' Perceptions Regarding the Role of Physical Therapists in Fall Prevention: A Qualitative Investigation. J Geriatr Phys Ther 2022; 45:E127-E136. [PMID: 33782360 PMCID: PMC8589106 DOI: 10.1519/jpt.0000000000000304] [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] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Falls are a leading cause of injury, morbidity, and mortality among older adults. Physical therapists are underutilized for fall prevention despite strong evidence and recommendations regarding their effectiveness. The purpose of this study was to explore older adults' awareness of and perceptions regarding the role of physical therapists for fall prevention. A secondary purpose of the study was to identify barriers to utilization of preventive rehabilitation services. METHODS A qualitative, descriptive, phenomenological approach was used. Participant demographics and fall history were obtained with a standard questionnaire. Four focus groups were conducted with 27 community-dwelling older adults (average age = 78 years). Focus groups were recorded, transcribed, and coded using thematic analysis. RESULTS Surveys indicated 37% of participants experienced a fall in the last year and 26% reported sustaining an injury. Four main themes and 5 subthemes about older adults' perceptions of physical therapy providers emerged: (1) awareness of fall prevention (subthemes: I can or have taken action to prevent falls, I don't think about it, and I am more careful); (2) learning how to fall and being able to get up from the floor; (3) limited knowledge regarding the role of physical therapists for fall prevention; and (4) a physical therapist should be seen for a specific problem, or after a fall (subthemes: perceived need and costs, and access requires a doctor's prescription). CONCLUSION Older adults lack awareness about the role of physical therapists for fall prevention, believing they should only seek treatment from a physical therapist to address a specific problem, or after a fall. The profession should consider addressing misconceptions and underutilization by educating the public that physical therapists can and do play an important role in the prevention of falls. Being explicit about the prevention of falls throughout an older adults' episode of care may further help reinforce the role of physical therapists for fall prevention and improve dissemination of this knowledge.
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Affiliation(s)
- Jennifer L Vincenzo
- Department of Physical Therapy, College of Health Professions, University of Arkansas for Medical Sciences, Fayetteville
| | - Susan Kane Patton
- Department of Nursing, College of Education and Health Professions, University of Arkansas, Fayetteville
| | - Leanne L Lefler
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock
| | - Jason R Falvey
- Departments of Physical Therapy and Rehabilitation Science and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Pearl A McElfish
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Fayetteville
| | - Geoffrey Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, and Central Arkansas Veterans Healthcare System, Little Rock
| | - Jeanne Wei
- Department of Geriatrics, College of Medicine, Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock
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Baixinho CL, Madeira C, Alves S, Henriques MA, Dixe MDA. Falls and Preventive Practices among Institutionalized Older People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137577. [PMID: 35805247 PMCID: PMC9265891 DOI: 10.3390/ijerph19137577] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 01/10/2023]
Abstract
The present study about falls among the older adult population essentially explores bio-physiological factors. In light of the complexity of the factors that cause these accidents, it is important to identify the safety and self-care practices of institutionalized older adults and their relationship with falls in order to introduce prevention measures and personalized cognitive–behavioral strategies. The objective of this study was to: (a) determine the frequency of falls and their recurrence among institutionalized older adults, and (b) to associate the occurrence of falls among institutionalized adults with or without cognitive impairment to communication and safety practices. This was a quantitative, correlational, and longitudinal study with 204 institutionalized older adults living in two long-term care facilities in Portugal. The Scale of Practices and Behaviors for Institutionalized Elderly to Prevent Falls was administered to the sample. The prevalence of falls at a 12-month follow-up was 41.6%, of which 38.3% were recurring episodes. Older adults with cognitive decline showed lower mean scores for safety practices. Further research with larger samples should explore the relationships between communication and safety practices and falls, their recurrence, and fear of new falls.
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Affiliation(s)
- Cristina Lavareda Baixinho
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal;
- Correspondence:
| | - Carla Madeira
- Vila Franca Hospital, 2600-009 Vila Franca de Xira, Portugal; (C.M.); (S.A.)
| | - Silvia Alves
- Vila Franca Hospital, 2600-009 Vila Franca de Xira, Portugal; (C.M.); (S.A.)
| | - Maria Adriana Henriques
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal;
| | - Maria dos Anjos Dixe
- Center for Innovative Care and Health Technology (ciTechcare), School of Health Sciences of Polytechnic of Leiria, Polytechnic of Leiria, 2410-541 Leiria, Portugal;
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Wright JR, Koch-Hanes T, Cortney C, Lutjens K, Raines K, Shan G, Young D. Planning for Safe Hospital Discharge by Identifying Patients Likely to Fall After Discharge. Phys Ther 2022; 102:6448020. [PMID: 34935968 DOI: 10.1093/ptj/pzab264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/15/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Acute care physical therapists recommend discharge locations and services in part to help prevent falls during post-discharge recovery. Therapists may use standardized tests to inform their recommendation decisions, but evidence linking test scores with fall risk after discharge is lacking. The primary purpose of this study was to explore the associations between Tinetti Performance-Oriented Mobility Assessment (POMA) and Activity Measure for Post-Acute Care Inpatient Mobility Short Form (AM-PAC IMSF) scores and falls in the first 30 days after hospital discharge. Anticipating that agreement between therapist recommendations and discharge locations and services (discharge agreement), age, and sex could impact those associations, these factors were included in this investigation. METHODS In this observational cohort study, 258 hospitalized patients consented to medical record data extraction and answered a phone survey 30 days after discharge to report whether they had experienced a fall since leaving the hospital. POMA and AM-PAC IMSF tests were administered for every patient. Participants' age, sex, diagnosis, last POMA score, last AM-PAC IMSF score, physical therapist discharge recommendations, actual discharge location and services, discharge date, and phone number were collected from their medical records. RESULTS When analyzed alone, higher POMA scores were associated with lower odds of falling, but the association was not significant after adjustment for other factors. Neither AM-PAC IMSF scores, age, nor sex were associated with falls. Discharge agreement, however, was associated with 59% lower odds of falling after adjustment for other factors. CONCLUSION Participants, who were discharged to the location with the services recommended by their physical therapist, were less likely to fall. Tinetti POMA and AM-PAC IMSF scores did not discriminate well participants who would fall. IMPACT Findings in this study inform those involved in discharge planning on the value of implementing physical therapist recommendations in reducing fall risk after hospital discharge. LAY SUMMARY If physical therapist discharge recommendations are implemented, patients are less likely to fall during the month after hospital discharge. Balance and mobility test scores may provide therapists valuable information, but they are limited in their ability to identify who will fall after discharge.
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Affiliation(s)
- Jonathan R Wright
- Doctor of Physical Therapy Program, Rocky Mountain University of Health Professions, Provo, Utah, USA
| | - Trisha Koch-Hanes
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Ciera Cortney
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Kathryn Lutjens
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Kristopher Raines
- Physical Therapist Assistant Program, Carrington College, Las Vegas, Nevada, USA
| | - Guogen Shan
- Epidemiology and Biostatistics Program, School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Daniel Young
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
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Wang SC, Lee DC, Lee YH, Chang YP, Chu IL. Effects of multimedia-based fall prevention education on the knowledge, attitudes, or behaviors of patients. Jpn J Nurs Sci 2021; 19:e12455. [PMID: 34558193 DOI: 10.1111/jjns.12455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/30/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Patient safety is regarded as a critical quality monitoring indicator for medical institutions. The effects of a multimedia-based patient education intervention on knowledge, attitudes, and behaviors regarding fall prevention were observed. METHODS The study had a quasi-experimental research design and enrolled 140 participants. Seventy participants in the experimental group received multimedia-based patient education and a health education leaflet, while those in the control group received only the health education leaflet. A structured questionnaire was used for data collection at baseline, and a posttest was applied after the intervention. RESULTS The participants were predominantly treated in the gastroenterology department (45.7%), followed by the pulmonology department (33.6%). A total of 86.4% of patients had not experienced a fall within 3 months. After the intervention, the average scores for all variables in the experimental group were higher than those in the control group. The results indicate that attitudes, knowledge, and behaviors regarding fall prevention among patients in the pulmonology department were higher than those among patients in the gastroenterology department; the differences were statistically significant. CONCLUSION The individualized health education content was of substantial significance for patients with different disease backgrounds and facilitated changes in their knowledge, attitudes, and behaviors regarding falls. RELEVANCE TO CLINICAL PRACTICE Multimedia-based patient education influenced inpatients' knowledge, attitudes, and behaviors for preventing falls.
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Affiliation(s)
- Su-Ching Wang
- Department of Nursing, St. Martin De Porres Hospital, Chiayi City, Taiwan
| | - De-Chih Lee
- Department of Information Management, Da-Yeh University, Changhua, Taiwan
| | - Yi-Hua Lee
- National Health Research Institutes, Zhunan, Taiwan
| | - Yuan-Ping Chang
- Department of Nursing, Fooyin University, Kaohsiung City, Taiwan
| | - I-Lien Chu
- Health Evaluation Center, St. Martin De Porres Hospital, Chiayi City, Taiwan
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Practice What We Preach: Beginning a Journey to Embrace Patient-Centered Outcomes Research. NURSING REPORTS 2021; 11:728-740. [PMID: 34968346 PMCID: PMC8608128 DOI: 10.3390/nursrep11030068] [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: 07/28/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Patient-centered outcomes research seeks to answer patient-centered questions. The process includes varied locations and individuals throughout the care continuum to address individual differences and constraints in implementation and dissemination. Problem: This paper intends to answer this question: do academic nurses practice what they preach by assisting patient-centered outcomes research and researchers through their engagement with patients, caregivers, and other community stakeholder partners in nursing research? Approach: This paper provides an overview of how academic nurses in a single institution (the University of Texas Medical Branch at Galveston School of Nursing) began to embrace patient-centered outcomes research. Conclusion: Whether academic nurses are practicing what they preach in terms of patient-centered outcomes research remains uncertain. More examples from academia are required to make that determination. Academic nurses worldwide have embarked on a steep learning curve to embrace patient-centered outcomes research. This journey will require patience and a systematic strategy.
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Naseri C, McPhail SM, Morris ME, Haines TP, Etherton-Beer C, Shorr R, Flicker L, Bulsara M, Lee DCA, Francis-Coad J, Waldron N, Hill AM. Tailored Education Increased Capability and Motivation for Fall Prevention in Older People After Hospitalization. Front Public Health 2021; 9:683723. [PMID: 34414157 PMCID: PMC8369365 DOI: 10.3389/fpubh.2021.683723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/28/2021] [Indexed: 12/25/2022] Open
Abstract
Recently hospitalized older people are at risk of falls and face barriers to undertaking fall prevention strategies after they return home from hospital. The authors examined the effects of tailored education delivered by physiotherapists on the knowledge (capability) and the motivation of older people to engage in fall prevention after hospital discharge. Utilizing data gathered from a recent trial, data was analyzed from 390 people who were 60 years and over without impaired cognition (>7/10 abbreviated mental test score) and discharged from three Australian hospitals. Motivation and capability were measured at baseline in the hospital and at 6-months after hospital discharge by blinded assistants using structured surveys. Bivariate analysis using generalized linear modeling explored the impact of education on the capability and motivation. Engagement in fall prevention strategies was entered as an independent variable during analysis to determine associations with capability and motivation. The education significantly improved capability [-0.4, 95% CI (-0.7, -0.2), p < 0.01] and motivation [-0.8, 95% CI (-1.1, -0.5), p < 0.01] compared with social-control at the time of hospital discharge. In contrast, social-control participants gained capability and motivation over the 6-months, and no significant differences were found between groups in capability [0.001, 95% CI (-0.2, 0.2), p = 0.9] and motivation [-0.01, 95% CI (-0.3, 0.3), p = 0.9] at follow-up. Tailored fall prevention education is recommended around hospital discharge. Participants still needed to overcome barriers to falls prevention engagement post hospitalization. Thus, tailored education along with direct clinical services such as physiotherapy and social supports is warranted for older people to avoid falls and regain function following hospitalization.
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Affiliation(s)
- Chiara Naseri
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Faculty of Health, School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, QLD, Australia
| | - Meg E Morris
- Healthscope Academic and Research Collaborative in Health, La Trobe University, Bundoora, VIC, Australia.,College of Healthcare Sciences, James Cook University, Douglas, QLD, Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Christopher Etherton-Beer
- Royal Perth Hospital, Perth, WA, Australia.,Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, WA, Australia
| | - Ronald Shorr
- Malcom Randall Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center, Gainesville, FL, United States.,College of Medicine, University of Florida, Gainesville, FL, United States
| | - Leon Flicker
- Royal Perth Hospital, Perth, WA, Australia.,Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, WA, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Den-Ching A Lee
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Jacqueline Francis-Coad
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Nicholas Waldron
- Department of Geriatric Rehabilitation, Armadale Health Service, Department of Health, Perth, WA, Australia
| | - Anne-Marie Hill
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
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Nguyen T, Combs EM, Wright PJ, Corbett CF. Reducing Fall Risks Among Visually Impaired Older Adults. Home Healthc Now 2021; 39:186-193. [PMID: 34190702 DOI: 10.1097/nhh.0000000000000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Falls are the leading cause of death due to unintentional injuries in the older adult population, and fall-related death rates among older adults are escalating annually. Visual deficits are underrecognized and underdiagnosed, which increases fall risk. The purpose of this article is to provide a review of the common types of visual impairment, their etiology, and treatment and to present strategies to reduce falls among older adults with visual impairments. Both traditional home safety interventions and emerging technology-based interventions to reduce falls are described. Appropriate use of both traditional and emerging fall prevention interventions may reduce fall risk and falls among older adult home healthcare patients.
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Collins CE, Chandra A, Nguyen B, Schultz K, Mathew P, Chen T, Renshaw S, Rose KM, Santry HP. The Rose-Colored Glasses of Geriatric Fall Patients: Inconsistencies Between Knowledge of Risk Factors for and Actual Causes of Falls. Gerontol Geriatr Med 2020; 6:2333721420967884. [PMID: 33173805 PMCID: PMC7588762 DOI: 10.1177/2333721420967884] [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] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/09/2020] [Accepted: 09/26/2020] [Indexed: 11/16/2022] Open
Abstract
Background Falls are the leading cause of fatal injury, and most common cause of non-fatal trauma, among older adults. We sought to elicit older patient's perspectives on fall risks for the general population as well as contributions to any personal falls to identify opportunities to improve fall education. Methods Ten patients with a history of falls from inpatient trauma and outpatient geriatric services were interviewed. Transcripts were analyzed independently by five individuals using triangulation and constant comparison (NVivo11, QSR International) to compare fall risks to fall causes. Results All patients reported that either they (9/10 participants) or someone they knew (8/10) had fallen. Despite this, only two personally worried about falling. Patient perceptions of fall risks fell into seven major themes: physiologic decline (8/10); underestimating limitations (7/10); environmental hazards (7/10), lack of awareness/rushing (4/10), misuse/lack of walking aids (3/10); positional transitions (2/10), and improper footwear (1/10). In contrast, the most commonly reported causes of personal falls were lack of awareness/rushing (7/10), environmental hazards (3/10), misuse/lack of walking aids (2/10), improper footwear (2/10), physiologic decline (2/10), underestimating limitations (1/10) and positional transitions (1/10). In general tended to attribute their own falls to their surroundings and were less likely to attribute physical or psychological limitations. Conclusion Despite participants identifying falls as a serious problem, they were unlikely to worry about falling themselves. Participants were able to identify common fall risks. However, when speaking about personal experience, they were more likely to blame environmental hazards or rushing, and minimized the role of physiologic decline and personal limitations.
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Affiliation(s)
| | - Arnav Chandra
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Bryan Nguyen
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Kurt Schultz
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Pawan Mathew
- University of Massachusetts Medical School, Worcester, MA, USA
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Naseri C, McPhail SM, Haines TP, Morris ME, Shorr R, Etherton-Beer C, Netto J, Flicker L, Bulsara M, Lee DCA, Francis-Coad J, Waldron N, Boudville A, Hill AM. Perspectives of older adults regarding barriers and enablers to engaging in fall prevention activities after hospital discharge. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1710-1722. [PMID: 32337796 PMCID: PMC7513672 DOI: 10.1111/hsc.12996] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 02/04/2020] [Accepted: 03/18/2020] [Indexed: 05/05/2023]
Abstract
Older adults recently discharged from hospital are at high risk of functional decline and falls. A tailored fall prevention education provided at hospital discharge aimed to improve the capacity of older adults to engage in falls prevention activities. What remains unknown are the factors affecting behaviour change after hospital discharge. This study identified the perceived barriers and enablers of older adults to engagement in fall prevention activities during the 6-month period post-discharge. An exploratory approach using interpretative phenomenological analysis focused on the lived experience of a purposive sample (n = 30) of participants. All were recruited as a part of an RCT (n = 390) that delivered a tailored fall prevention education program at three hospital rehabilitation wards in Perth, Australia. Data were collected at 6-month post-discharge using semi-structured telephone surveys. Personal stories confirmed that some older adults have difficulty recovering functional ability after hospital discharge. Reduced physical capability, such as experiences of fatigue, chronic pain and feeling unsteady when walking were barriers for participants to safely return to their normal daily activities. Participants who received the tailored fall education program reported positive effects on knowledge and motivation to engage in fall prevention. Participants who had opportunities to access therapy or social supports described more positive experiences of recovery compared to individuals who persevered without assistance. A lack of physical and social support was associated with apprehension and fear toward adverse events such as falls, injuries, and hospital readmission. The lived experience of participants following hospital discharge strongly suggested that they required more supports from both healthcare professionals and caregivers to ensure that their needs were met. Further research that evaluates how to assist this population to engage in programs that will mitigate the high risk of falls and hospital readmissions is required.
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Affiliation(s)
- Chiara Naseri
- School of Physiotherapy and Exercise Sciences, Faculty of Health Science, Curtin University, Perth, WA, Australia
| | - Steven M. McPhail
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia
| | - Terry P. Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, VC, Australia
| | - Meg E. Morris
- Healthscope & La Trobe Centre for Sport & Exercise Medicine Research, La Trobe University, Melbourne, VC, Australia
| | - Ronald Shorr
- Malcom Randall VA Medical Center, Geriatric Research Education and Clinical Center (GRECC), Gainesville, FL, USA
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christopher Etherton-Beer
- Western Australian Centre for Health & Ageing, University of Western Australia, Royal Perth Hospital Unit, Perth, WA, Australia
| | - Julie Netto
- School of Occupational Therapy and Social Work, Faculty of Health Science, Curtin University, Perth, WA, Australia
| | - Leon Flicker
- Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia, Perth, WA, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Den-Ching A. Lee
- School of Primary and Allied Health Care, Monash University, Melbourne, VC, Australia
| | - Jacqueline Francis-Coad
- School of Physiotherapy, Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Nicholas Waldron
- Department of Geriatric Rehabilitation, Department of Health, Armadale Health Service, Perth, WA, Australia
| | - Amanda Boudville
- Department of Aged Care and Rehabilitation, St John of God Health Care, Midland, WA, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Sciences, Faculty of Health Science, Curtin University, Perth, WA, Australia
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13
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Abstract
IMPORTANCE To date, measurement and treatment of older adult fall injury has been siloed within specific care settings, such as a hospital or within a nursing home or community. Little is known about changes in fall risk across care settings. Understanding the occurrence of falls across settings has implications for measuring and incentivizing high-value care across care settings. OBJECTIVE To estimate the risk of older adult fall injury within and across discrete periods during a 12-month care episode anchored by an acute hospitalization. DESIGN, SETTING, AND PARTICIPANTS This cohort study is a longitudinal analysis of 12-month periods that include an anchor hospital stay using national data from 2006 to 2014. Participants included older (aged ≥65 years) Medicare fee-for-service beneficiaries from the Health and Retirement Study. Weekly fall injury rates were computed for 4 periods compared with the anchor hospitalization: at baseline (1-6 months before hospitalization), just before (<1 month before hospitalization), just after (<1 month after hospitalization), and at follow-up (1-6 months after hospitalization). Piecewise logistic regression models estimated weekly marginal risk of fall injury within each period, adjusting for sociodemographic and health characteristics. Fall injury risks for high-risk beneficiaries with a fall injury during the anchor hospitalization were also estimated. Data analysis was performed from November 2019 to April 2020. MAIN OUTCOMES AND MEASURES Fall injuries. RESULTS In total, 10 106 anchor hospitalizations for 4101 beneficiaries (mean [SD] age, 77.1 [7.6] years; 5912 hospitalizations among women [58.5%]) were identified. The overall fall injury risk was 0.77%. In adjusted models, marginal increases in weekly fall injury risk just before hospitalization (0.27 percentage points [95% CI, 0.22 to 0.33 percentage points], or 30.0%; P < .001) were 4 times greater than decreases just after hospitalization (-0.18 percentage points [95% CI, -0.23 to -0.13 percentage points], or -9.2%; P < .001)]. A greater risk differential before and after hospitalization was observed for patients with an inpatient fall injury (1.89 percentage points [95% CI, 1.37 to 2.40], or 309.8%; P < .001; vs -0.39 percentage points [95% CI, -0.73 to -0.04], or -11.6%; P = .03). CONCLUSIONS AND RELEVANCE An episode-based assessment of fall injury illustrates substantial variability in period-specific risks over an extended period including an anchor hospitalization. Risk transitions between periods include sizable increases just before hospitalization that do not fully subside after hospital discharge. Financial incentives to coordinate hospital and posthospital care for patients at risk for fall injury are needed. These could include bundled payments for fall injury episodes that incentivize coordination across settings.
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Affiliation(s)
- Geoffrey J. Hoffman
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Mary E. Tinetti
- Department of Medicine (Geriatrics), Yale University, New Haven, Connecticut
- School of Public Health, Yale University, New Haven, Connecticut
| | - Jinkyung Ha
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Neil B. Alexander
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
- Geriatric Research Education Clinical Center, VA Medical Center, Ann Arbor, Michigan
| | - Lillian C. Min
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
- Geriatric Research Education Clinical Center, VA Medical Center, Ann Arbor, Michigan
- Veterans Affairs Center for Clinical Management and Research, VA Medical Center, Ann Arbor, Michigan
- Institute for Social Research, University of Michigan, Ann Arbor
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14
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Tzeng HM, Okpalauwaekwe U, Lyons EJ. Barriers and Facilitators to Older Adults Participating in Fall-Prevention Strategies After Transitioning Home from Acute Hospitalization: A Scoping Review. Clin Interv Aging 2020; 15:971-989. [PMID: 32612356 PMCID: PMC7323788 DOI: 10.2147/cia.s256599] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/10/2020] [Indexed: 01/11/2023] Open
Abstract
Purpose Approximately, 14% of older adults aged 65 years and over experience a fall within 1 month post-hospital discharge. Adequate self-management may minimize the impact of these falls; however, research is lacking on why some older adults engage in self-management to prevent falls while others do not. Methods We conducted a scoping review to identify barriers and facilitators to older adults participating in fall-prevention strategies after transitioning home from acute hospitalization. Eligibility criteria were peer-reviewed journal articles published during 2009-2019 which were written in English and contained any of the following keywords or their synonyms: "fall-prevention," "older adults," "post-discharge" and "transition care." We systematically and selectively summarized the findings of these articles using the Joanna Briggs Institute guidelines and the PRISMA-ScR reporting guidelines. Seven bibliographic databases were searched: PubMed/MEDLINE, ERIC, CINAHL, Cochrane Library, Scopus, PsycINFO, and Web of Science. We used the Capability-Opportunity-Motivation-Behavior (COM-B) model of health behavior change as a framework to guide the content, thematic analysis, and descriptive results. Results Seventeen articles were finally selected. The most frequently mentioned barriers and facilitators for each COM-B dimension differed. Motivation factors include such as older adults lacking inner drive and self-denial of being at risk for falls (barriers) and following-up with older adults and correcting inaccurate perceptions of falls and fall-prevention strategies (facilitators). Conclusion This scoping review revealed gaps and future research areas in fall prevention relative to behavioral changes. These findings may enable tailoring feasible fall-prevention interventions for older adults after transitioning home from acute hospitalization.
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Affiliation(s)
- Huey-Ming Tzeng
- The University of Texas Medical Branch, School of Nursing, Galveston, TX, USA
| | - Udoka Okpalauwaekwe
- University of Saskatchewan, College of Medicine, Saskatoon, Saskatchewan S7N 2Z4, Canada
| | - Elizabeth J Lyons
- University of Texas Medical Branch, Department of Nutrition and Metabolism, School of Health Professions, Galveston, TX, USA
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15
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Hoffman GJ, Liu H, Alexander NB, Tinetti M, Braun TM, Min LC. Posthospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older. JAMA Netw Open 2019; 2:e194276. [PMID: 31125100 PMCID: PMC6632136 DOI: 10.1001/jamanetworkopen.2019.4276] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Falls are common among older adults, particularly those with previous falls and cognitive impairment and in the postdischarge period. Hospitals have financial incentives to reduce both inpatient falls and hospital readmissions, yet little is known about whether fall-related injuries (FRIs) are common diagnoses for 30-day hospital readmissions. OBJECTIVE To compare fall-related readmissions with other leading rehospitalization diagnoses, including for patients at greatest risk of readmission. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of the Hospital Cost and Utilization Project's Nationwide Readmissions Database of nationally representative US hospital discharges among Medicare beneficiaries aged 65 years and older from January 1, 2013, to November 30, 2014. The prevalence and ranking of FRIs compared with other diagnostic factors for 30-day unplanned hospital-wide readmissions were determined, overall and for 2 acute geriatric cohorts, classified by fall injury or cognitive impairment diagnoses observed at the index admission. Analyses were also stratified by patient discharge disposition (home, home health care, skilled nursing facility). Analyses were conducted from February 1, 2018, to February 26, 2018. MAIN OUTCOMES AND MEASURES Unplanned hospital-wide readmission within 30 days of discharge. RESULTS From the database, 8 382 074 eligible index admissions were identified, including 746 397 (8.9%) in the FRI cohort and 1 367 759 (16.3%) in the cognitive impairment cohort. Among the entire 8 382 074-discharge cohort, mean (SD) age was 77.7 (7.8) years and 4 736 281 (56.5%) were female. Overall, 1 205 962 (14.4%) of index admissions resulted in readmission, with readmission rates of 12.9% for those with a previous fall and 16.0% for patients with cognitive impairment. Overall, FRIs ranked as the third-leading readmission diagnosis, accounting for 60 954 (5.1%) of all readmission diagnoses. Within the novel acute geriatric cohorts, FRIs were the second-leading diagnosis for readmission both for patients with an FRI at index admission (10.3% of all readmission diagnoses) and those with cognitive impairment (7.0% of all readmission diagnoses). For those with an FRI at index admission and discharged home or to home health care, FRIs were the leading readmission diagnosis. CONCLUSIONS AND RELEVANCE This study found that posthospital FRIs were a leading readmission diagnosis, particularly for patients originally admitted with a FRI or cognitive impairment. Targeting at-risk hospitalized older adults, particularly those discharged to home or home health care, is an underexplored, cost-effective mechanism with potential to reduce readmissions and improve patient care.
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Affiliation(s)
- Geoffrey J. Hoffman
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Haiyin Liu
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor
| | - Neil B. Alexander
- Geriatric Research Education and Clinical Care Center (GRECC), VA Medical Center, Ann Arbor, Michigan
- Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor
| | - Mary Tinetti
- Division of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- School of Public Health, Yale University, New Haven, Connecticut
| | - Thomas M. Braun
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Lillian C. Min
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor
- Veterans Affairs Center for Clinical Management and Research (CCMR), VA Medical Center, Ann Arbor, Michigan
- Institute for Social Research, University of Michigan, Ann Arbor
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16
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Hoffman GJ, Shuman CJ, Montie M, Anderson CA, Titler MG. Caregivers' views of older adult fall risk and prevention during hospital-to-home transitions. Appl Nurs Res 2019; 47:10-15. [PMID: 31113538 DOI: 10.1016/j.apnr.2019.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/15/2019] [Accepted: 03/24/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Geoffrey J Hoffman
- University of Michigan School of Nursing, 400 N. Ingalls, Room 4352, Ann Arbor, MI 48109-5482, United States of America.
| | - Clayton J Shuman
- University of Michigan School of Nursing, United States of America
| | - Mary Montie
- Detroit Medical Center, United States of America
| | | | - Marita G Titler
- University of Michigan School of Nursing, United States of America
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