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1.
J Med Internet Res. 2019 Jan 21;21(1):e10008. doi: 10.2196/10008.

Assessing the Effectiveness of Engaging Patients and Their Families in the Three-Step Fall Prevention Process Across Modalities of an Evidence-Based Fall Prevention Toolkit: An Implementation Science Study.

Author information

1
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States.
2
NewYork-Presbyterian Hospital, Columbia University, Manhattan, NY, United States.
3
Montefiore Medical Center, Bronx, NY, United States.
4
Harvard Medical School, Boston, MA, United States.

Abstract

BACKGROUND:

Patient falls are a major problem in hospitals. The development of a Patient-Centered Fall Prevention Toolkit, Fall TIPS (Tailoring Interventions for Patient Safety), reduced falls by 25% in acute care hospitals by leveraging health information technology to complete the 3-step fall prevention process-(1) conduct fall risk assessments; (2) develop tailored fall prevention plans with the evidence-based interventions; and (3) consistently implement the plan. We learned that Fall TIPS was most effective when patients and family were engaged in all 3 steps of the fall prevention process. Over the past decade, our team developed 3 Fall TIPS modalities-the original electronic health record (EHR) version, a laminated paper version that uses color to provide clinical decision support linking patient-specific risk factors to the interventions, and a bedside display version that automatically populates the bedside monitor with the patients' fall prevention plan based on the clinical documentation in the EHR. However, the relative effectiveness of each Fall TIPS modality for engaging patients and family in the 3-step fall prevention process remains unknown.

OBJECTIVE:

This study aims to examine if the Fall TIPS modality impacts patient engagement in the 3-step fall prevention process and thus Fall TIPS efficacy.

METHODS:

To assess patient engagement in the 3-step fall prevention process, we conducted random audits with the question, "Does the patient/family member know their fall prevention plan?" In addition, audits were conducted to measure adherence, defined by the presence of the Fall TIPS poster at the bedside. Champions from 3 hospitals reported data from April to June 2017 on 6 neurology and 7 medical units. Peer-to-peer feedback to reiterate the best practice for patient engagement was central to data collection.

RESULTS:

Overall, 1209 audits were submitted for the patient engagement measure and 1401 for the presence of the Fall TIPS poster at the bedside. All units reached 80% adherence for both measures. While some units maintained high levels of patient engagement and adherence with the poster protocol, others showed improvement over time, reaching clinically significant adherence (>80%) by the final month of data collection.

CONCLUSIONS:

Each Fall TIPS modality effectively facilitates patient engagement in the 3-step fall prevention process, suggesting all 3 can be used to integrate evidence-based fall prevention practices into the clinical workflow. The 3 Fall TIPS modalities may prove an effective strategy for the spread, allowing diverse institutions to choose the modality that fits with the organizational culture and health information technology infrastructure.

KEYWORDS:

clinical decision support; fall prevention; fall prevention toolkit; health information technology; implementation science; patient safety

PMID:
30664454
DOI:
10.2196/10008
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2.
J Gerontol Nurs. 2019 Jan 1;45(1):23-30. doi: 10.3928/00989134-20190102-04.

Older Adults' Perceptions of Their Fall Risk and Prevention Strategies After Transitioning from Hospital to Home.

Abstract

Falls are common adverse events following hospital discharge. However, prevention programs are not tailored for older patients transitioning home. To inform development of transitional fall prevention programs, nine older adults designated as being at risk of falls during hospitalization who were recently discharged home were asked about their perceptions of fall risk and prevention, as well as their knowledge and opinion of materials from the Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths & Injuries Initiative. Using the constant comparative method, five themes were identified: Sedentary Behaviors and Limited Functioning; Prioritization of Social Involvement; Low Perceived Fall Risk and Attribution of Risk to External Factors; Avoidance and Caution as Fall Prevention; and Limited Falls Prevention Information During Transition from Hospital to Home. Limited awareness of and engagement in effective fall prevention may heighten recently discharged older adults' risks for falls. Prevention programs tailored to the post-discharge period may engage patients in fall prevention, promote well-being and independence, and link hospital and community efforts. [Journal of Gerontological Nursing, 45(1), 23-30.].

3.
Rev Gaucha Enferm. 2019 Jan 10;40(spe):e20180306. doi: 10.1590/1983-1447.2019.20180306.

Implementation of patient safety centers and the healthcare-associated infections.

[Article in English, Portuguese; Abstract available in Portuguese from the publisher]

Author information

1
Universidade Federal do Rio Grande do Norte (UFRN), Escola de Saúde. Natal, Rio Grande do Norte, Brasil.

Abstract

OBJECTIVE:

To verify the implementation of the Patient Safety Center and its relation to the control of Healthcare-associated Infections in hospitals of Natal.

METHOD:

Quantitative, cross-sectional study. The sample consisted of 28 infection control professionals from 12 hospitals. Data were collected between February and August 2017, through a semi-structured questionnaire.

RESULTS:

The Patient Safety Center was implemented in nine hospitals. Among the protocols implemented, the patient identification (66.70%), hand hygiene (50%) and fall prevention (50%) were the most important ones. Hospitals with the Center affirmed they develop patient safety training activities together with the professionals. 44.5% reported effective communication.

CONCLUSION:

Although the actions implemented do not fully comply with the recommendations of the National Health Surveillance Agency, most of these actions are directly related to the control of infections in services.

PMID:
30652809
DOI:
10.1590/1983-1447.2019.20180306
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4.
J Acquir Immune Defic Syndr. 2019 Jan 3. doi: 10.1097/QAI.0000000000001953. [Epub ahead of print]

Chronic Distal Sensory Polyneuropathy is a Major Contributor to Balance Disturbances in Persons Living with HIV.

Author information

1
Health Sciences International, University of California, San Diego, 8950 La Jolla Village Dr, San Diego, CA 92037, USA.
2
Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA.
3
VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161, USA.
4
HIV Neurobehavioral Research Centre, 220 Dickinson St, San Diego, CA 92103, USA.
5
Department of Neurosciences, University of California, 9500 Gilman Dr, La Jolla, CA 92093, USA.

Abstract

BACKGROUND:

Medical comorbidities accumulate in older persons living with HIV (PLWH), causing disability and reduced quality of life. Sensory neuropathy and polypharmacy may contribute to balance difficulties and falls. The contribution of neuropathy is understudied.

OBJECTIVE:

To evaluate the contribution of chronic distal sensory polyneuropathy (cDSPN) to balance disturbances among PLWH.

METHODS:

Ambulatory PLWH and HIV- adults (N=3,379) were prospectively studied. All participants underwent a neurologic examination to document objective abnormalities diagnostic of cDSPN and reported neuropathy symptoms including pain, paresthesias and numbness. Participants provided detailed information regarding balance disturbance and falls over the previous ten years. Balance disturbances were coded as minimal or none and mild-to-moderate. Covariates included age, HIV disease and treatment characteristics and medications (sedatives, opioids, antihypertensives).

RESULTS:

Eleven percent of participants reported balance disturbances at some time during the last ten years; the rate in PLWH participants exceeding that for HIV- (odds ratio [OR] 2.59, 95% CI 1.85-3.64). Fifty-two percent met criteria for cDSPN. Balance problems were more common in those with cDSPN (OR=3.3 [2.6-4.3]). Adjusting for relevant covariates, balance disturbances attributable to cDSPN were more frequent among HIV+ than HIV- (interaction p=0.001). Among individuals with cDSPN, older participants were much more likely to report balance disturbances than younger ones.

CONCLUSIONS:

Chronic distal sensory polyneuropathy contributes to balance problems in PLWH. Assessments of cDSPN in older PLWH should be a clinical priority to identify those at risk and to aid in fall prevention and the ensuing consequences, including bone fractures, subdural hematoma, hospital admissions and fatal injury.

5.
J Trauma Nurs. 2019 Jan/Feb;26(1):50-58. doi: 10.1097/JTN.0000000000000415.

Increasing Referrals to a Community Paramedicine Fall Prevention Program Through Implementation of a Daily Management System.

Author information

1
Division of Trauma, Department of Surgery, Maine Medical Center, Portland; and University of Southern Maine, Portland.

Abstract

This quality improvement project was undertaken to improve trauma service referral compliance to an existing home-based elderly fall prevention program through the implementation of a daily management system (DMS). Operational excellence, a hospital-wide initiative, provided the foundation for improvement efforts. This initiative went through a series of 5 plan, do, study, and act (PDSA) cycles and demonstrated significant improvement in referrals from 0% to 100%. Compliance with referrals after the retirement of the key performance indicator remained high at 95.5%. Results from this project provided support for the framework set forth in DMS and PDSA improvement methodologies as a feasible option to implement quality and process improvement projects. Further study in this area is warranted.

6.
Int J Med Inform. 2019 Feb;122:63-69. doi: 10.1016/j.ijmedinf.2018.11.006. Epub 2018 Nov 27.

A data-driven and practice-based approach to identify risk factors associated with hospital-acquired falls: Applying manual and semi- and fully-automated methods.

Author information

1
University of Florida, College of Nursing, United States; University of Florida, Center for Latin American Studies, United States; University of Florida, Florida Blue Center for Health Care Quality, United States; University of Florida, Informatics Institute, United states. Electronic address: rlucero@ufl.edu.
2
University of Florida, College of Liberal Arts and Sciences, United States.
3
RTI International, Research Park Triangle, NC, United States.
4
University of Florida, College of Nursing, United States; University of Florida, Informatics Institute, United states.
5
Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA, United States.
6
UF Health-Shands Hospital, Gainesville, FL, United States.
7
University of Florida, College of Public Health and Health Professions, United States; University of Florida, College of Medicine, United States.

Abstract

BACKGROUND AND PURPOSE:

Electronic health record (EHR) data provides opportunities for new approaches to identify risk factors associated with iatrogenic conditions, such as hospital-acquired falls. There is a critical need to validate and translate prediction models that support fall prevention clinical decision-making in hospitals. The purpose of this study was to explore a combined data-driven and practice-based approach to identify risk factors associated with falls.

PROCEDURES:

We conducted an observational case-control study of EHR data from January 1, 2013 to October 31, 2013 from 14 medical-surgical units of a tertiary referral teaching hospital. Patients aged 21 or older admitted to medical surgical units were included in the study. Manual and semi- and fully-automated methods were used to identify fall risk factors across four prediction models. Sensitivity, specificity, and the Area under the Receiver Operating Characteristic (AUROC) curve were calculated for all models using 10-fold cross validation.

FINDINGS:

We confirmed the significance of a set of valid fall risk factors (i.e., age, gender, fall risk assessment, history of falling, mental status, mobility, and confusion) and identified set of new risk factors (i.e., # of fall risk increasing drugs, hemoglobin level, physical therapy initiation, Charlson Comorbity Index, nurse skill mix, and registered nurse staffing ratio) based on the most precise prediction approach, namely stepwise regression.

CONCLUSIONS:

The use of semi- and fully-automated approaches with expert clinical knowledge over expert or data-driven only approaches can significantly improve identifying patient, clinical, and organizational risk factors of iatrogenic conditions, including hospital-acquired falls.

KEYWORDS:

Data driven; Data mining; Data modelling; Electronic health record; Expert knowledge; Falls

PMID:
30623785
DOI:
10.1016/j.ijmedinf.2018.11.006
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7.
J Clin Med. 2019 Jan 7;8(1). pii: E52. doi: 10.3390/jcm8010052.

Acute Effects of Intermittent Versus Continuous Bilateral Ankle Plantar Flexor Static Stretching on Postural Sway and Plantar Pressures: A Randomized Clinical Trial.

Author information

1
Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid 28040, Spain. eva.hache2@hotmail.com.
2
Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcón 28922, Spain. marta.losa@urjc.es.
3
Departament of Physiotherapy and Podiatry, Premium Madrid, Madrid 28017, Spain. josemarcha@hotmail.com.
4
Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid 28040, Spain. ribebeva@ucm.es.
5
Department of Nursing, University Center of Plasencia, University of Extremadura, Plasencia 10600, Spain. patibiom@unex.es.
6
Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Faculty of Health Sciences, Universidad de León, Ponferrada 24401, León, Spain. ccall@unileon.es.
7
Research, Health and Podiatry Unit, Department of Health Sciences. Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol 15403, Spain. daniellopez@udc.es.
8
Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid 28040, Spain. david.rodriguez2@universidadeuropea.es.
9
Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid 28670, Spain. david.rodriguez2@universidadeuropea.es.

Abstract

BACKGROUND:

Postural balance and fall efficacy (self-perceived confidence in performing daily physical activities) have been found to be risk factors associated with falls in older adults. Stretching is one intervention that has been investigated to improve balance and therefore reduce fall risk. Various forms of stretching have been evaluated with different outcomes, but there is a lack of knowledge about the effect of stretching (continuous and intermittent) on plantar pressures and balance. Therefore, the aim of the present study was to analyze the effects of stretching (continuous and intermittent) of the bilateral ankle plantar flexors on plantar pressures and static balance.

METHODS:

A randomized clinical trial was carried out. Forty-eight healthy subjects (42 females and 6 males) were recruited in an outpatient clinic. Subjects were randomly assigned to an intermittent stretching group (five sets of 1 min; 15 s of rest) or a continuous stretching group (2 min of continuous stretching) of the plantar flexors. Plantar pressures and balance using stabilometry were measured before and after stretching.

RESULTS:

There were significant differences between intermittent and continuous stretching in rearfoot maximum pressure, forefoot surface area, and center of pressure surface area with eyes open.

CONCLUSIONS:

Bilateral intermittent stretching of the ankle plantar flexors was found to be more effective than continuous stretching for the reduction of rearfoot maximum pressure and improved balance.

KEYWORDS:

muscle stretching exercise; platform; postural balance; stabilometry

PMID:
30621009
DOI:
10.3390/jcm8010052
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8.
J Aging Health. 2019 Jan 7:898264318822381. doi: 10.1177/0898264318822381. [Epub ahead of print]

Trends in Geospatial Drivers of Fall-Related Hospitalizations and Asset Mapping of Fall Prevention Interventions for Vulnerable Older Adults.

Author information

1
1 University of Central Florida, Orlando, USA.
2
2 Texas A&M University, College Station, USA.
3
3 University of Georgia, Athens, USA.
4
4 University of Connecticut, Storrs, USA.
5
5 Dallas-Fort Worth Hospital Council Foundation, Fort Worth, TX, USA.
6
6 United Way of Tarrant County; Fort Worth, TX, USA.
7
7 Florida Department of Health Bureau of Vital Statistics, Jacksonville, USA.

Abstract

OBJECTIVE:

Given that one in four older adults suffer potentially preventable falls annually, we aimed to identify areas with (a) delivery gaps of evidence-based programs (EBPs) targeting fall prevention among older adults, namely A Matter of Balance (AMOB), and (b) high rates of fall-related hospitalizations-hotspots.

METHOD:

Analyses included multiple geospatially linked datasets.

RESULTS:

EBPs were delivered ≥1 time in 84 counties in 2012 and 90 counties in 2014. Factors associated with EPB delivery gaps (absence; p<.05) included high-density older adult areas, non-fall-related hospitalization hotspots, lower population density, nonmetropolitan areas, high-density Hispanic adult areas, and areas with limited access to home health care agencies. Hotspots for fall-related hospitalization numbered 64 in 2012 and 62 in 2014. Factors associated with hotspots included low-density older adult areas, having AMOB delivered ≥1 time annually, high population density, and high-density Hispanic adult areas.

DISCUSSION:

In resource-finite settings (e.g., the aging services sector), identifying high priority areas allows for precise allocation of limited resources.

KEYWORDS:

falls; health; health policy; public policy

9.
J Neuroeng Rehabil. 2019 Jan 7;16(1):3. doi: 10.1186/s12984-018-0478-4.

Dynamic balance and instrumented gait variables are independent predictors of falls following stroke.

Author information

1
Department of Physiotherapy, The University of Melbourne, Parkville, VIC, 3010, Australia. bower@unimelb.edu.au.
2
School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Sippy Downs, 4556, Australia.
3
Department of Physiotherapy, Singapore General Hospital, Bukit Merah, Singapore, 169608, Singapore.
4
Department of Physiotherapy, The University of Melbourne, Parkville, VIC, 3010, Australia.
5
Department of Physiotherapy, Epworth HealthCare, Richmond, VIC, 3121, Australia.
6
La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, 3086, Australia.
7
Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia.

Abstract

BACKGROUND:

Falls are common following stroke and are frequently related to deficits in balance and mobility. This study aimed to investigate the predictive strength of gait and balance variables for evaluating post-stroke falls risk over 12 months following rehabilitation discharge.

METHODS:

A prospective cohort study was undertaken in inpatient rehabilitation centres based in Australia and Singapore. A consecutive sample of 81 individuals (mean age 63 years; median 24 days post stroke) were assessed within one week prior to discharge. In addition to comfortable gait speed over six metres (6mWT), a depth-sensing camera (Kinect) was used to obtain fast-paced gait speed, stride length, cadence, step width, step length asymmetry, gait speed variability, and mediolateral and vertical pelvic displacement. Balance variables were the step test, timed up and go (TUG), dual-task TUG, and Wii Balance Board-derived centre of pressure velocity during static standing. Falls data were collected using monthly calendars.

RESULTS:

Over 12 months, 28% of individuals fell at least once. The faller group had increased TUG time and reduced stride length, gait speed variability, mediolateral and vertical pelvic displacement, and step test scores (P < 0.001-0.048). Significant predictors, when adjusted for country, prior falls and assistance (i.e., physical assistance and/or gait aid use) were stride length, step length asymmetry, mediolateral pelvic displacement, step test and TUG scores (P < 0.040; IQR-odds ratio(OR) = 1.37-7.85). With comfortable gait speed as an additional covariate, to determine the additive benefit over standard clinical assessment, only mediolateral pelvic displacement, TUG and step test scores remained significant (P = 0.001-0.018; IQR-OR = 5.28-10.29).

CONCLUSIONS:

Reduced displacement of the pelvis in the mediolateral direction during walking was the strongest predictor of post-stroke falls compared with other gait variables. Dynamic balance measures, such as the TUG and step test, may better predict falls than gait speed or static balance measures.

KEYWORDS:

Accidental falls; Gait; Outcome assessment; Postural balance; Stroke

10.
Cyberpsychol Behav Soc Netw. 2018 Dec 31. doi: 10.1089/cyber.2018.0261. [Epub ahead of print]

Three-Dimensional Augmented Reality System for Balance and Mobility Rehabilitation in the Elderly: A Randomized Controlled Trial.

Author information

1
1 Department of Biomedical Engineering, College of Medicine, Keimyung University , Daegu, Korea.
2
2 Department of Rehabilitation Medicine, KCOMWEL Gyeonggi Hospital , Hwaseong, Korea.
3
3 Dental Instrumentation R&BD Platform, Seoul National University Dental Hospital , Seoul, Korea.
4
4 Department of Physical Therapy, Eulji Hospital , Seoul, Korea.
5
5 Biostatistics Collaboration Unit, Yonsei University College of Medicine , Seoul, Korea.
6
6 Department of Rehabilitation Medicine, Eulji Hospital, Eulji University School of Medicine , Seoul, Korea.

Abstract

We attempted to evaluate the clinical efficiency of a novel three-dimensional interactive augmented reality system (3D-ARS) for balance and mobility rehabilitation. This system enables participant training with a realistic 3D interactive balance exercise and assessing movement parameters and joint angles by using a kinetic sensor system. We performed a randomized controlled trial in a general hospital. Thirty-six participants (age, 56-76 years) who could independently walk and stand on one leg were recruited. The participants were randomly assigned to either group. The control group (n = 18) underwent a conventional physical fitness program such as lower-extremity strengthening and balance training thrice per week for 1 month. The experimental group (n = 18) experienced 3D-ARS training thrice per week (1 session = 30 minutes) for 4 weeks. Training comprised a balloon game for hip exercise, cave game for knee exercise, and rhythm game for one-leg balance exercise. Lower-extremity clinical scale scores, fall index, and automatic balance score were measured by using Tetrax® posturography before, during, and after training. Significant group (3D-ARS vs. control) × time (before and after exercise) interaction effect was observed for Berg balance scale (BBS) scores (p = 0.04) and timed-up-and-go (TUG; p < 0.001). Overall improvements occurred in stability index, weight distribution index, fall risk index, and Fourier transformations index of posturography for both groups. However, score changes were significantly greater in the 3D-ARS group. Significant group × time interaction effect was observed for the fall risk index. This demonstrates that the 3D-ARS system can improve balance in the elderly more effectively.

KEYWORDS:

aged; fall risk; postural balance; rehabilitation; virtual reality exposure therapy

11.
Geriatr Nurs. 2018 Dec 27. pii: S0197-4572(18)30414-2. doi: 10.1016/j.gerinurse.2018.11.005. [Epub ahead of print]

Older hospital inpatients' fall risk factors, perceptions, and daily activities to prevent falling.

Author information

1
School of Nursing, Oregon Health & Science University, Portland, OR, United States. Electronic address: kiyoshi@ohsu.edu.
2
School of Nursing, Oregon Health & Science University, Portland, OR, United States.
3
Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States.
4
School of Medicine, Oregon Health & Science University, Portland, OR, United States; Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, United States.

Abstract

PURPOSE:

To identify associations among patient fall risk factors, perceptions, and daily activities to improve patient engagement with fall prevention among hospitalized older adults.

BACKGROUND:

The risk of falling increases for older patients but few researchers have reported patient-centered measures on this topic.

METHODS:

Surveys and chart reviews of inpatients aged ≥ 65 with Morse Falls Scale scores of ≥ 45. Measurements included validated tools and the modified Fall Behavioral Scale-Inpatient (FaB-I).

RESULTS:

A fall within 3 months before hospitalization was associated with an increased level of importance to preventing falls and higher FaB-I score (more fall prevention behaviors) but decreased level of confidence related to preventing falls (p < 0.05). Perception measures (concern: r = 0.52; patient activation: r = 0.46) were positively associated with FaB-I (p < 0.001).

CONCLUSIONS:

Addressing patient-centered measures such as perceptions of and daily activities for fall prevention could add value to existing fall prevention programs.

KEYWORDS:

Fall prevention; Hospitalized older adult; Patient engagement

12.
JAMA Intern Med. 2018 Dec 28. doi: 10.1001/jamainternmed.2018.5406. [Epub ahead of print]

Association of Long-term Exercise Training With Risk of Falls, Fractures, Hospitalizations, and Mortality in Older Adults: A Systematic Review and Meta-analysis.

Author information

1
Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France.
2
UPS/Inserm UMR1027, University of Toulouse III, Toulouse, France.

Abstract

Importance:

Long-term exercise benefits on prevalent adverse events in older populations, such as falls, fractures, or hospitalizations, are not yet established or known.

Objective:

To systematically review and investigate the association of long-term exercise interventions (≥1 year) with the risk of falls, injurious falls, multiple falls, fractures, hospitalization, and mortality in older adults.

Data Sources:

PubMed, Cochrane Central Register of Controlled Trials, SportDiscus, PsychInfo, and Ageline were searched through March 2018.

Study Selection:

Exercise randomized clinical trials (RCTs) with intervention length of 1 year or longer, performed among participants 60 years or older.

Data Extraction and Synthesis:

Two raters independently screened articles, abstracted the data, and assessed the risk of bias. Data were combined with risk ratios (RRs) using DerSimonian and Laird's random-effects model (Mantel-Haenszel method).

Main Outcomes and Measures:

Six binary outcomes for the risk of falls, injurious falls, multiple falls (≥2 falls), fractures, hospitalization, and mortality.

Results:

Forty-six studies (22 709 participants) were included in the review and 40 (21 868 participants) in the meta-analyses (mean [SD] age, 73.1 [7.1] years; 15 054 [66.3%] of participants were women). The most used exercise was a multicomponent training (eg, aerobic plus strength plus balance); mean frequency was 3 times per week, about 50 minutes per session, at a moderate intensity. Comparator groups were often active controls. Exercise significantly decreased the risk of falls (n = 20 RCTs; 4420 participants; RR, 0.88; 95% CI, 0.79-0.98) and injurious falls (9 RTCs; 4481 participants; RR, 0.74; 95% CI, 0.62-0.88), and tended to reduce the risk of fractures (19 RTCs; 8410 participants; RR, 0.84; 95% CI, 0.71-1.00; P = .05). Exercise did not significantly diminish the risk of multiple falls (13 RTCs; 3060 participants), hospitalization (12 RTCs; 5639 participants), and mortality (29 RTCs; 11 441 participants). Sensitivity analyses provided similar findings, except the fixed-effect meta-analysis for the risk of fracture, which showed a significant effect favoring exercisers (RR, 0.84; 95% CI, 0.70-1.00; P = .047). Meta-regressions on mortality and falls suggest that 2 to 3 times per week would be the optimal exercise frequency.

Conclusions and Relevance:

Long-term exercise is associated with a reduction in falls, injurious falls, and probably fractures in older adults, including people with cardiometabolic and neurological diseases.

13.
Int Marit Health. 2018;69(4):243-247. doi: 10.5603/IMH.2018.0039.

Patterns of injury amongst cruise ship passengers requiring hospitalisation.

Author information

1
Florida International University-Herbert Wertheim School of Medicine, Miami, Florida, USA. wyoisom@gmail.com.

Abstract

BACKGROUND:

The number of commercial cruise ship passengers continues to rise and is projected to reach 27.2 million passengers worldwide in 2018. Accidental injury aboard these ships can result in serious morbidity and mortality. This study examines the injury mechanisms, patterns, demographics, and outcomes of these injuries which are serious enough to require hospitalisation in order to facilitate administrative, financial, and medical decision making to aid in injury prevention and treatment.

MATERIALS AND METHODS:

This is a cross-sectional, retrospective, registry-based study of adult patients sustaining injury while on a cruise ship admitted to a Level I Trauma Centre in the United States over a 2-year period. Data on demographics, injury type and severity, surgical management, hospital charges, length of stay, mortality, and discharge disposition were recorded.

RESULTS:

Sixty seven patients were identified and included in the analysis. 70.1% of patients were 65 or older and a majority were female (59.7%). The most common mechanism of injury was a ground level fall (79.1%), and the most common injury encountered was a femur fracture (52.2%) which involved the acetabulo-femoral joint in 85.7% of cases. Traumatic brain injuries were uncommon occurring in 7.5% of cases. There were no fatalities in this series.

CONCLUSIONS:

The most common injuries aboard cruise ships requiring hospitalisation occur in the geriatric population as a result of a ground level fall. Most commonly, the injuries are long bone fractures, with femur fractures occurring most frequently and accounting for over half of all injuries sustained. Resources and protocols for pre-hospital management of cruise ship injuries should prioritise these patients, and fall prevention measures for this demographic should be mandatory aboard all cruise ships.

KEYWORDS:

cruise ship; injury; trauma; travel medicine

PMID:
30589063
DOI:
10.5603/IMH.2018.0039
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14.
Int J Qual Health Care. 2018 Dec 21. doi: 10.1093/intqhc/mzy243. [Epub ahead of print]

High quality of care did not imply increased hospital spending- nationwide cohort study among hip fracture patients.

Author information

1
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N, Denmark.
2
Department of Orthopaedic Surgery, Horsens Regional Hospital, Sundvej 30, Horsens, Denmark.
3
Department of Public Health, Aarhus University, Bartholins Alle 2, Aarhus, Denmark.
4
Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus N, Denmark.
5
Department of Orthopaedic Surgery, Aarhus University Hospital, Tage Hansens Gade, Aarhus N, Denmark.
6
Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg, Denmark.

Abstract

Objective:

To examine whether fulfilment of process performance measures reflecting national guidelines is associated with in-hospital costs among hip fracture patients.

Design:

Nationwide, population-based follow-up study.

Setting:

Public hospitals in Denmark.

Participants:

A total of 20 458 patients 65 years or older admitted with a hip fracture between 2010 and 2013.

Intervention:

Quality of care defined as fulfilment of process performance measures reflecting recommendations from national clinical guidelines, which previously have been shown to be associated with lower mortality and readmission risk. The measures included systematic pain assessment; mobilisation within 24 h post-operatively; assessment of basic mobility before admission and discharge; and receiving a rehabilitation programme before discharge, anti-osteoporotic medication and fall prevention.

Main outcome measures:

Total costs defined as the sum of hospital costs used for treating the individual patients according to the Danish Reference Cost Database.

Results:

Within the index admission, fulfilling 50 to >75% of the performance measures was associated with lower adjusted costs (EUR 2643) than was fulfilling 0-50% of these measures (EUR 3544). The lower costs were mainly due to savings on further treatment and fewer bed days. Mobilisation within 24 h after surgery and assessment for need of anti-osteoporotic medication were associated with the largest cost differences, corresponding to adjusted cost differences of EUR 3030 and EUR 3538, respectively. The cost difference was lower when all costs related to hospitalisation within the first year were considered.

Conclusions:

These findings indicate that high quality of care does not imply higher hospital spending and may be associated with cost savings.

15.
J Nurs Manag. 2018 Dec 19. doi: 10.1111/jonm.12742. [Epub ahead of print]

Impact of level of nurse experience on falls in medical surgical units.

Author information

1
The MetroHealth System, Cleveland, Ohio.

Abstract

AIM:

To describe nurse-specific and patient risk factors present at the time of a patient fall on medical surgical units within an academic public health care system.

BACKGROUND:

The incidence of falls can be devastating for hospitalized patients and their families. Few studies have investigated how patient and nurse-specific factors can decrease the occurrence of falls in hospitals.

METHOD:

In this retrospective cohort study, data were gathered on all patients who experienced a fall during January 2012 to December 2013.

RESULTS:

Falls were reduced dramatically when the number of nurses on the unit increased to five or six. Patient falls occurred most often when either the least experienced or most experienced nursing staff were providing care.

CONCLUSION:

Patient falls in hospitals can be influenced not only by patient-specific factors, but also by nurse staffing and experience level.

IMPLICATIONS FOR NURSING MANAGEMENT:

Findings from this study highlight factors which may contribute to hospital-based falls prevention initiatives and are amenable to nursing management decisions.

KEYWORDS:

Comorbidity-Polypharmacy Score; falls; hospital-acquired conditions; level of nurse experience; nurse sensitive indicators; staffing

16.
Rejuvenation Res. 2018 Dec 19. doi: 10.1089/rej.2018.2102. [Epub ahead of print]

The relationship between sleep duration, falls and muscle mass:A cohort study in Chinese, elderly population.

Fu L1, Yu X2, Zhang W3,4, Han P5, Li K6, Ma Y7, Jia L8, Yu H9, Chen X10, Hou L11, Wang L12, Guo Q13.

Author information

1
Tianjin, China ; 121439728@qq.com.
2
Tianjin, China ; 178477127@qq.com.
3
Tianjin, China.
4
Tianjin Medical University, Tianjin, China ; 841029653@qq.com.
5
Tianjin, China ; 670087821@qq.com.
6
Tianjin, China ; 409576186@qq.com.
7
Tianjin, China ; 505866331@qq.com.
8
Tianjin, China ; 434813385@qq.com.
9
Tianjin, China ; 690707712@qq.com.
10
Tianjin, China ; 1334427886@qq.com.
11
Tianjin, China ; 1124867996@qq.com.
12
Tianjin, China ; 928923326@qq.com.
13
TEDA International Cardiovascular Hospital, Department of Rehabilitation Medicine, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University,, Tianjin, China ; guoqijp@gmail.com.

Abstract

OBJECTIVE:

Epidemiological studies report that more than half of people over the age of 65 years suffer from variable sleep problems. In this study, we conducted a cohort study to investigate the relation between sleep duration on muscle mass and function within a Chinese, community-dwelling elderly population.

METHOD:

Our study population consisted of residents living in the township central hospital of suburban Tianjin, China. We measured muscle strength and walk speed. We divided sleep duration into the following four groups: <7h, 7-8h, >8-9h, >9h.

RESULTS:

A total of 902 participants completed the 3-year follow up. We observed a U-shaped relationship between sleep duration and fall risk. Compared to the 7-8h group, the fall risk within the <7h group was 3.67(2.59, 5.42) times higher, and the fall risk within the >9h group was 2.35 (1.29, 3.52) times higher. After adjustment, muscle mass declined by -6.82% (-11.27%, -3.83%) in the <7h group.

CONCLUSION:

In summary, we observed a U-shaped relationship between sleep duration and falls. Short sleep duration have negative relationship with muscle mass decline in a Chinese, community-dwelling, elderly population.

17.
J Surg Res. 2019 Feb;234:283-286. doi: 10.1016/j.jss.2018.09.044. Epub 2018 Oct 23.

Falls in the Bathroom: A Mechanism of Injury for All Ages.

Author information

1
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California.
2
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California. Electronic address: kinaba@surgery.usc.edu.
3
Keck School of Medicine, University of Southern California, Los Angeles, California.
4
Department of Emergency Medicine, LAC+USC Medical Center, University of Southern California, Los Angeles, California.

Abstract

BACKGROUND:

When ground-level falls occur in the bathroom, there is particular potential for morbidity and mortality given the high density of hard surfaces. Risk factors are not clearly defined by the existing literature. The objective of this study was to define the epidemiology, injury patterns, and outcomes after falls in the bathroom.

MATERIALS AND METHODS:

All patients presenting to LAC+USC Medical Center (01/2008-05/2015) after a fall in the bathroom (ICD-9 code E884.6) were included. Demographics, injury data, investigations, procedures, and outcomes were collected.

RESULTS:

Fifty-seven patients were included, with mean age 45 y (range 0-92). All ages were affected, with ages 41-60 y at highest risk. Common comorbidities included cardiovascular disease (n = 23, 40%), neuromuscular disorders (n = 13, 23%), and diabetes (n = 9, 16%). Ten patients (18%) were intoxicated. Home medications included antihypertensives (n = 18, 32%), antipsychotics (n = 9, 16%), and anticoagulants (n = 8, 14%). Common investigations included X-rays (n = 41, 72%) and CT scans of the head (n = 20, 35%). The most frequent injuries were contusion/laceration (n = 45, 79%), fracture (n = 12, 21%), and traumatic brain injury (n = 7, 12%). Most patients did not require hospital admission (n = 46, 81%), although 4 (7%) needed intensive care unit care and operative intervention (ORIF [n = 2, 4%] or craniectomy [n = 2, 4%]). Mortality was low (n = 1, 2%). Most patients were discharged home (n = 40, 70%).

CONCLUSIONS:

All ages, especially 41-60 y, are susceptible to falls in the bathroom. Despite the potential for serious injury, most do not require hospital admission. Risk factors include drugs/alcohol, cardiovascular disease, neuromuscular disorders, and diabetes. Efforts to minimize fall risk should be directed toward these individuals.

KEYWORDS:

Accidental falls; Bathroom falls; Elderly; Ground-level falls; Trauma

18.
J Clin Nurs. 2018 Dec 5. doi: 10.1111/jocn.14724. [Epub ahead of print]

Caring for the older person with cognitive impairment in hospital: Qualitative analysis of nursing personnel reflections on fall events.

Author information

1
Menzies Health Institute Queensland, Griffith University, QLD, Australia.
2
Gold Coast Hospital and Health Service, QLD, Australia.
3
School of Nursing & Midwifery, Griffith University, QLD, Australia.
4
Bond University, QLD, Australia.

Abstract

AIMS AND OBJECTIVES:

To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall.

BACKGROUND:

While there are evidence-based clinical guidelines for the prevention and management of falls and for the care of older people with cognitive impairment, the falls rates for older people with cognitive impairment are three times as high as those without.

DESIGN:

Critical incident technique.

METHODS:

Eleven registered and two enrolled nurses and four assistants in nursing working in one subacute and two acute wards within two hospitals of a tertiary level health service in south-east Queensland. Individual semistructured interviews focused on two past events when a patient with cognitive impairment had fallen in hospital: one when there was minimal harm and the second when there was significant harm. Thematic analysis was undertaken. The COREQ checklist was followed.

RESULTS:

Three themes emerged from 23 reflective accounts of fall events: "direct observation is confounded by multiple observers" and "knowing the person has cognitive impairment is not enough," and "want to rely on the guideline but unsure how to enact it." While participants were aware of the falls prevention policy and techniques available to prevent falls, the implementation of these was challenging due to the complexity of care required by the older person with cognitive impairment.

CONCLUSIONS:

Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy.

RELEVANCE TO CLINICAL PRACTICE:

To reduce falls, nurses can involve the family to support "knowing the patient" to enable prediction of impulsive actions; shift the focus of in-service from lectures to specific case presentations, with collaborative analysis on person-focused strategies to prevent falls in older people with cognitive impairment; and reconsider the sitter role from simple observer to assistant, focused on ambulation and supporting independence in activities of daily living.

KEYWORDS:

dementia; falls; hospitalised patients; older patients; patient safety

19.
Clin Epidemiol. 2018 Nov 8;10:1627-1637. doi: 10.2147/CLEP.S181138. eCollection 2018.

Fall injuries, associated deaths, and 30-day readmission for subsequent falls are increasing in the elderly US population: a query of the WHO mortality database and National Readmission Database from 2010 to 2014.

Author information

1
Acute Care Surgery Division, Department of Surgery, Iowa City, IA, USA, ksromanowski@ucdavis.edu.
2
Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA.

Abstract

Purpose:

Clinicians anecdotally noted that elderly patients who suffered from traumatic injuries (falls or other injuries) often re-present and are readmitted with fall injuries. Herein, we hypothesized that fall injuries and fall-related deaths and readmissions are increasing over time, and assessed whether the overall rates of death, hospital admission, and 30-day readmission due to falls increased from 2010 to 2014 in the elderly population (≥65) in the US.

Patients and methods:

The WHO mortality database and the National Readmission Database (NRD) were queried to assess rates of deaths and hospital admissions and 30-day readmissions associated with fall injuries in the elderly population that presented with trauma. Descriptive statistics were obtained. The generalized linear mixed modeling (GLMM) framework was utilized to examine the relationship between fixed-effect predictor variables and the dichotomous outcome, indicating readmission within 30 days of previous discharge while accounting for hospital clustering with a random intercept.

Results:

Fall-related death increased by 1.4% from 2010 to 2014. Similarly, the hospital admission rate increased by 2% and was mainly associated with increased admission of elderly 65-74 years old. Approximately 55% of the fall patients were placed in nursing facilities in 2010, and this rate increased by 3% from 2010 to 2014. Thirty-day readmission rates for fall and trauma patients remained stable from 2010 to 2014. However, the rate of fall patients readmitted within 30 days for a subsequent fall increased from 15.6% to 17.4% between 2010 and 2014.

Conclusion:

Our data indicate a steady increase in deaths and admissions for fall injuries in the elderly population. Strikingly, the incidence of readmission for a subsequent fall is increasing. With the aging population, this trend is likely to continue and highlights the need for elderly social support systems and fall prevention programs.

KEYWORDS:

National Readmission Database; WHO mortality database; elderly; falls

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

20.
Aging Clin Exp Res. 2018 Dec 4. doi: 10.1007/s40520-018-1082-y. [Epub ahead of print]

Short-Physical Performance Battery (SPPB) score is associated with falls in older outpatients.

Author information

1
Department of Medicine and Surgery, University of Parma, Parma, Italy.
2
Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy.
3
Department of Medicine and Surgery, University of Parma, Parma, Italy. andrea.ticinesi@unipr.it.
4
Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy. andrea.ticinesi@unipr.it.

Abstract

BACKGROUND:

The capacity of Short-Physical Performance Battery (SPPB) test to discriminate between fallers and non-fallers is controversial, and has never been compared with fall risk assessment-specific tools, such as Performance-Oriented Mobility Assessment (POMA).

AIM:

To verify the association of SPPB and POMA scores with falls in older outpatients.

METHODS:

451 older subjects (150 males, mean age 82.1 ± 6.8) evaluated in a geriatric outpatient clinic for suspected frailty were enrolled in this cross-sectional study. Self-reported history of falls and medication history were carefully assessed. Each participant underwent comprehensive geriatric assessment, including SPPB, POMA, Geriatric Depression Scale (GDS), mini-mental state examination (MMSE) and mini-nutritional assessment-short form (MNA-SF). Multivariate logistic regression and receiver-operating characteristic (ROC) analyses were performed to determine the factors associated with the status of faller.

RESULTS:

245 (54.3%) subjects were identified as fallers. They were older and had lower SPPB and POMA test scores than non-fallers. At ROC analysis, SPPB (AUC 0.676, 95% CI 0.627-0.728, p < 0.001) and POMA (AUC 0.677, 95% CI 0.627-0.726, p < 0.001) scores were both associated with falls. At multivariate logistic regression models, SPPB total score (OR 0.83, 95% CI 0.76-0.92, p < 0.001), POMA total score (OR 0.94, 95% CI 0.91-0.98, p = 0.002) and SPPB balance score alteration (OR 2.88, 95% CI 1.42-5.85, p = 0.004), but not POMA balance subscale score alteration, were independently associated with recorded falls, as also GDS, MMSE and MNA-SF scores.

CONCLUSIONS:

SPPB total score was independently associated with reported falls in older outpatients, resulting non-inferior to POMA scale. The use of SPPB for fall risk assessment should be implemented.

KEYWORDS:

Balance; Comprehensive geriatric assessment; Falls; Frailty

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