FALLS LINKSfallsnetwork.neura.edu.au › wp-content › uploads › 2014 › 02 › ...living in residential aged care facilities: A simple screen based on easily collectible measures

CEC Falls Prevention Hospital Package 2

Care Home Falls Screen (CaHFRiS) 4

New Resources and Conferences 6 New resources, websites and upcoming meetings.

Abstacts 7 Recent abstracts from the research literature.

Network Information 18 How to join and communicate through the network.

Inside this Issue

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FALLS LINKSVolume 8, Issue 4, 2013 Newsletter of the NSW Falls Prevention Network

This year the NSW Falls Prevention Network celebrates 20 years as a network promoting falls prevention and injury minimising harm from falls to a wide network of health professionals, community service and residential aged care providers.

This issue includes articles on:

• The CEC Falls Prevention Hospital Package

• Care Home Falls Screen (CaHFRiS)

fallsnetwork.neura.edu.au

Welcome

“Falls Prevention is Everyone’s Business®”

Ingrid Hutchinson, Maree Connolly and Lorraine Lovitt, NSW Falls Prevention Program, Clinical Excellence Commission with resources to support the implementation of NSQHSS, Standard 10: Preventing Falls and Harm from Falls.

http://fallsnetwork.neura.edu.au

Falls Links Vol 8, Issue 4 , 2013 NSW Falls Prevention Network

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CEC Falls Prevention Hospital PackageDeveloped by the NSW Falls Prevention Program, Clinical Excellence Commission (CEC)

The Australian Commission on Safety and Quality in Health Care (ACSQHC) has developed the National Safety and Quality Health Service Standard (NSQHSS). The Standards are designed to assist health organisations to deliver safe and high quality care and this includes providing an emphasis on engaging with patients, family and carers in the planning and delivery of care.

The Clinical Excellence Commission (CEC) NSW Falls Prevention Program has developed the CEC Hospital Package of resources to assist Local Health Districts/Networks with the implementation of the NSQHSS, Standard 10: Preventing Falls and Harm from Falls.

The new resources are now available on the CEC website:

http://www.cec.health.nsw.gov.au/programs/falls-prevention

Standard 10 requires all patients admitted to hospital to be screened for falls risk (10.5) and if any falls risk is identifiedaFallsAssessmentisrequired(10.6).TheCEChasundertakenaprocesstoreviewfallsriskscreentoolsandagreedto(inadultpopulations)theOntarioModifiedStratifySydneyScoringtoolandhasdevelopedaFallsRisk Assessment and Management Plan (FRAMP) tool to support clinical decisions in regards to the implementation ofsuitableinterventions.TherehasbeensignificantconsultationwithstafffromLHDsandaprocessofapproval(9thJuly)throughtheStateFormsManagementCommittee.TheCECiscurrentlyfinalisingasuiteoffallsresourcesfor paediatric services.

Included in these resources is a workbook to support implementation of Standard 10; audit tools, post fall guide and supportinginformation,aformtoassiststaffinthereviewofaseriousfallsincidentandinformationforpatients,families,carers.TherearealsoPowerPointpresentationsthatcanbeusedinwardeducationsessionsforstaff.

A list of the hospital package resources is on the next page.

If you have any further questions please email [email protected] or phone Ingrid Hutchinson on 0292695516.

http://www.cec.health.nsw.gov.au/programs/falls-prevention

mailto:falls.program%40cec.health.nsw.gov.au?subject=CEC%20Hospital%20Package

NSW Falls Prevention Network Falls Links Vol 8, Issue 4, 2013

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A falls risk screening tool for use in Residential Aged Care to identify high risk fallers: CaHFRiS (Care Home Falls Screen)This tool was developed by Julie Whitney and colleagues and published in the Archives of Gerontology and Geriatricsin2012(55:690-695).

Overview

This screening tool was developed from a prospective study in 7 residential care facilities in the UK involving240residents(aged>60years)whowerestableforatleast6weeksfollowingahospitaladmission,anddidnothaveabedboundillnessorprognosisindicatingmortalitywithin6months.Themeanagewas84(SD8.6)and64%werefemale.

Information collected 2 weeks prior to collecting prospective falls included; demographics, medical history, medication use (from prescription charts) falls in the previous year and use of walking aids. MMSE scores were used for cognitive function and physical function was measured using the Barthel score. Impulsivity wasmeasuredusingquestionsspecificallydesignedforthisstudy.Theyincluded:

• Doestheparticipanttendtobeimpulsivewhenmovingaround?(Impulsivitywasdefinedas “rushingtocarryoutanactivitywithoutthinkingaboutitfirst”(yes=1,no=2).

Howoftendoestheparticipantdothefollowing?

• Trytositupbeforegettingrightuptothechair/toilet/bed;

• Attempttostandbeforewheelchairbrakeshavebeenapplied/footplatesmovedorwalkingframe placed in front of them;

• Trytowalkwithouthelpwhenaskednotto.

(Answerstothesequestionswereachoiceofnever/NA(=0),occasionally(=1),often(=2),frequently(=3),veryfrequently(=4).

Thefinalimpulsivityscorewasthesumofanswerstoalloftheabovequestions.

Results

Thisstudyfoundthat50.4%ofparticipantsfelloneormoretimesinthe6monthfollowupperiod.The121fallershadatotalof281falls(range1-16,mean2.3)andequatingto2.8fallsperpersonperyear.Injurieswererecordedfor23%ofparticipantswhofell,with3%sustainingafracture.

AnMMSEscore<24wasrecordedfor89%ofparticipantsandthemeanMMSEwas13.5(SD=7.1).Themajority of participants did not have a formal diagnosis of dementia recorded. Of those with an MMSE <24, 57%hadatleastonefallinthefollowupperiod.

Those participants who fell had worse physical function as determined by the Barthel score, worse standing balance, more impulsivity and disturbed behaviour and poorer cognition (MMSE). Fallers were on more medications including hypnotic/anxyolitic, antidepressant and anti platelet medications. Fallers also had more falls in the previous year and were more likely to use a mobility aid.

Sevenindependentpredictorsoffallerstatuswereidentifiedintheseparticipantsusinglogisticregressionanalysis and these are presented in the table below.

Predictor of faller status Odds ratio (OR) 95%ConfidenceIntervals(CI)

MMSE <17 2.17 1.11 - 4.24

ImpulsivityScore≥2 2.78 1.46-5.31

Standingbalancescore<6 2.40 1.17-4.96

Requiring a walking frame 2.07 1.06-4.04

Falling in the previous year 3.46 1.77-6.81

Hypnotic/anxiolytic medication 3.75 1.25 - 11.21

Antidepressant medication 2.92 1.51-5.64


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Sevenindependentpredictorsoffallerstatuswereidentifiedintheseparticipantsusinglogisticregressionanalysis and these are presented in the table below. A tool was developed incorporating these factors which allowedthedeterminationofanabsoluteprobabilityoffallingovera6monthperiod,withanabsoluteriskofzeroforthosewithnoriskfactorsto100%forthosewith6ormoreriskfactors.ThistoolnamedtheCareHomeFalls Risk Screen (CaHFRiS) is shown below.

Thisscreeningtoolidentifiesanolderresident’sfallsriskfactorsandcanbeusedtotailorinterventionsforthisperson.Forexampleifmedicationssuchhypnotic/anxiolyticsandantidepressantswereidentifiedasbeingprescribed for an older resident, a medication review could be recommended as an intervention. This could also be used to prompt discussion on other evidence based intervention for preventing falls in residential aged care facilities such as Vitamin D supplementation (Cameron et al 2012).

The authors commented that ‘the role of exercise remains unclear and if it is included, it must address problems.... suchastrainingtocontrolimpulsivemobilityandsafeuseofwalkingframes’(Whitneyetal2012,page694).

Conclusion

Thisstudyidentifiedindependentpredictorsoffallerstatusforresidentsinresidentialagedcareandincorporatedtheseintoascreeningtoolthatprovidesanabsoluteriskoffallsinthenext6months.Theseriskfactors include measures of behaviour, cognition, balance and mobility and medication use.

A PDF version of the tool can be downloaded from:

http://fallsnetwork.neura.edu.au/wordpress/wp-content/uploads/2011/03/CAHFRIS-screen-Final1.pdf

References:

Cameron, I.D., Gillespie, L.D., Robertson, M.C., Murray, G.R., Hill, K.D., Cumming R.G.,, Kerse N.(2012). Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database of Systematic Reviews 2012(Issue 12).

Whitney,J.,Close,J.C.T.,Lord,S.R.,Jackson,S.H.D.(2012).Identificationofhighriskfallersamongolderpeopleliving in residential aged care facilities: A simple screen based on easily collectible measures. Archives of GerontologyandGeriatrics,55,690-695.

http://fallsnetwork.neura.edu.au/wordpress/wp-content/uploads/2011/03/CAHFRIS-screen-Final.pdf


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New Resources and Websites

Care of the Confused Hospitalised Older Persons (CHOPS)

http://www.aci.health.nsw.gov.au/chops

This website provides information on identifying and managing confusion in the older person.

Resources include:

• tools for risk assessment of confusion

• strategies for management of delirium

• series of educational videos on delirium forhealthprofessionalsincludingCarer’sexperiences with delirium.

King’s Fund - Ideas that change health care

http://www.kingsfund.org.uk/topics

TheKing’sFundisanindependentcharityworkingtoimprovehealthandhealthcareinEngland.Thissitehasinformation on a range of health care and social issues topics such as integrated care, patient centred leadership. One of the latest papers is on the System wide cost of falls in older people in Torbay (Devon UK). This community has a highproportion(26%)over65yearscomparedwiththeEnglandaverageof16%.

This report can be accessed at:

http://www.kingsfund.org.uk/publications/exploring-system-wide-costs-falls-older-people-torbay

Themainfindingsofthisstudywere:

• Peopleover65yearswhofellandwerehospitalisedhadhospital,community and social costs that were about 4 times the cost of their admission in the 12 months following the acute hospital admission episode.

• When they looked at the costs before and after admission they found that the most striking increase was in community care costs (which included community hospital inpatient and community health visits costs) and thesewereupby160%comparedtoa37%increaseinsocialcarecostsanda35%increasinacutehospitalcarecosts

• Over the 12 months following the acute hospital admission for a fall costs were70%higherthaninthe12monthspriortoafall

• Inthistudytheyfoundevidenceofsignificantundercodingofco-morbidities for patients who had a fall particulalry with respect to dementia.

1 © The King’s Fund 2013

Exploring the system-wide costs of falls in older people in Torbay

Authors Yang Tian James Thompson David Buck Lara Sonola

August 2013

Key messagesn One in three people aged over 65, and half of those aged over 80, fall at

least once a year (Todd and Skelton 2004). Falls are the commonest cause of death from injury in the over 65s, and many falls result in fractures and/or head injuries. Falls cost the NHS more than £2 billion per year and also have a knock-on effect on productivity costs in terms of carer time and absence from work (Snooks et al 2011). With the number of people aged 65 and over predicted to increase by 2 million by 2021, costs are set to rise further.

n Treatment and rehabilitation for falls patients are often poorly integrated, and one way to help design better services is to look more closely at where the costs of treating patients are incurred across health, community and social care services.

n This paper uses Torbay’s unique patient-level linked data set to explore the cost of the care pathway for older people admitted to hospital as a result of a fall by tracking their care costs in the 12 months before and after their fall. This is the first time, to our knowledge, that such detailed analysis of the costs in the health and social care system has been carried out in relation to falls patients in England. – On average, the cost of hospital, community and social care services for

each patient who fell were almost four times as much in the 12 months after admission for a fall as the costs of the admission itself.

– Over the 12 months that followed admission for falls, costs were 70 per cent higher than in the 12 months before the fall.

– Comparing the 12 months before and after a fall, the most dramatic increase was in community care costs (160 per cent), compared to a 37 per cent increase in social care costs and a 35 per cent increase in acute hospital care costs.

– While falls patients in this study accounted for slightly more than 1 per cent of Torbay’s over-65 population, in the 12 months that followed a fall, spending on their care accounted for 4 per cent of the whole annual inpatient acute hospital spending, and 4 per cent of the whole local adult social care budget.

http://www.aci.health.nsw.gov.au/chops

http://www.kingsfund.org.uk/topics

http://www.kingsfund.org.uk/publications/exploring-system-wide-costs-falls-older-people-torbay


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ReviewsThe impact of falls prevention on participation in daily occupations of older adults following discharge: a systematic review and meta-analysis

Pritchard E, Brown T, Lalor A, Haines T.

Disabil. Rehabil. 2013; ePub(ePub): ePub.

(Copyright©2013,Informa-TaylorandFrancisGroup)DOI10.3109/09638288.2013.814720PMID23865907

Abstract

PURPOSE: To investigate the impact of falls intervention programmes on participation of older adults returning home to live, following discharge from hospital.

METHOD: A systematic review of peer-reviewed articles and grey literature was completed. Limits were set for articles published in English, dated 1990-2012. Inclusion criteria included randomised control trials with older adults(≥65years)thatusedaneffectivefallsinterventionandaparticipationmeasure,followingdischargefromhospital or emergency department. Two independent researchers assessed the studies for eligibility. Research risk of bias was evaluated using the PEDro scale (range 1-10). A meta-analysis of the selected articles was completed.

RESULTS:Fivestudiesfulfilledtheinclusioncriteriaandmeasuredparticipationoutcomesshort-term.(<sixmonthspost-discharge,n=488)andlong-term(6–12monthspost-discharge,n=571).Theresultsindicatedthatfallsinterventionsprovidedapositiveimprovementinpatients’participationlevel(p=0.042,p=0.026).However,theeffectsizewassmallat0.20and0.21.

CONCLUSIONS:Themeta-analysisfindingsindicatethatthereisacausalassociationbetweenfallsinterventionsandparticipationindailyoccupationswitholderadultspost-discharge.Althoughtheeffectsizewassmall,practice implications of this study suggest that participation needs to be considered in future falls prevention research

IMPLICATIONS FOR REHABILITATION:

• Fallsinterventionsforolderadultsfollowingdischargehomefromhospital,increaseparticipationinlife situations to a small extent.

• Healthprofessionalscanincludeafocusonfallspreventionprogrammeswitholderadultstopromote participation.

Sensor technologies aiming at fall prevention in institutionalized old adults: A synthesis of current knowledge

Kosse NM, Brands K, Bauer JM, Hortobagyi T, Lamoth CJ.

Int. J. Med. Inform. 2013; ePub(ePub): ePub.

Affiliation:UniversityMedicalCenterGroningen,UniversityofGroningen,CenterforHumanMovementSciences,Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands. Electronic address: [email protected].

(Copyright©2013,ElsevierPublishing)DOI10.1016/j.ijmedinf.2013.06.001PMID23845790

Abstract

BACKGROUND: Falls are a serious health problem in old adults especially in nursing home residents and hospitalized patients. To prevent elderly from falling, sensors have been increasingly used in intramural care settings. However, there is no clear overview of the current used technologies and their results in fall prevention.

OBJECTIVES: The present study reviews sensor systems that prevent falls in geriatric patients living in an intramural setting and describe fall rates, fall-related injuries, false alarms, and user experience associated with such systems.

METHODS: We conducted a systematic search for studies that used sensor technologies with the aim to prevent falls in institutionalized geriatric patients.

RESULTS: A total of 12 studies met the search criteria. Three randomized clinical trials reported no reductions infallratebutthreebefore-afterstudiesreportedsignificantreductionsof2.4-37fallsper1000patientdays.Althoughtherewasupto77%reductioninfall-relatedinjuriesandtherewasrelativelylow,16%,rateoffalse

AbstractsRecent abstracts from the research literature


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alarms,thecurrentdataareinconsistentwhethercurrentsensortechnologiesareeffectiveinreducingthenumberoffallsininstitutionalizedgeriatricpatients.Theoccurrenceoffalsealarms(16%)wastoohightomaintainfullattentionofthenursingstaff.Additionallyincludingtheusersopinionanddemandsindevelopingandintroducingsensor systems into intramural care settings seems to be required to make an intervention successful.

CONCLUSION: The evidence is inconsistent whether the current sensor systems can prevent falls and fall-related injuries in institutionalized elderly. Further research should focus more comprehensively on user requirements andeffectivewaysusingintelligentalarms.

Analytical review: focus on fall screening assessments

Lee J, Geller AI, Strasser DC.

PMR 2013;5(7):609-621.

Affiliation:DepartmentofRehabilitationMedicine,EmoryUniversity,Atlanta,GA

(Copyright © 2013, American Academy of Physical Medicine and Rehabilitation, Publisher Elsevier Publishing)

DOI10.1016/j.pmrj.2013.04.001PMID23880047

Abstract

BACKGROUND: Falls and their associated injuries profoundly impact health outcomes, functional independence, and health care expenses, particularly for the ever-increasing elderly population. This systematic search and review assessed the current evidence for the role of fall screening assessments.

OBJECTIVE: To review the current evidence for fall risk screening assessments in community-dwelling (outpatient), inpatient medical and surgical wards, inpatient rehabilitation centers, and postrehabilitation outpatient settings.

DATA SOURCES: MEDLINE and Embase (January 1980 to December 2012).

STUDY SELECTION: Prospective validation studies of acute medical or surgical inpatients, acute rehabilitation inpatients, outpatients who completed acute inpatient rehabilitation, or community-dwelling elderly.

DATAEXTRACTION:Sensitivity,specificity,positivepredictivevalue,negativepredictivevalue,receiveroperatingcharacteristics with area under the curve.

RESULTS:Wesummarizedkeyfindingsfrom6literaturereviews.Wethenidentified31articles:12studiesincommunitysetting,13intheacutemedicalinpatientorsurgicalinpatientsetting,and6studiesintherehabilitation setting. Twenty-two studies not previously reviewed were included, and 9 studies previously reviewed were considered relevant and were included to allow comparison with data from the studies not previously reviewed.

CONCLUSION: We recommend consideration of 7 assessment tools to be used in conjunction with overall clinical evaluationtoassessfallsrisk:theTimedUpandGoTestwithacutoffof>12.34secondsandFunctionalGaitAssessmentamongcommunity-dwellingelderly;StThomasRiskAssessmentToolinmedicalinpatients<65yearsold and surgical inpatients; Hendrich fall risk model II in medical inpatients; 10-Minute Walk Test in patients in poststroke rehabilitation; and Berg Balance Scale or the Step Test in patients in poststroke rehabilitation who had fallen during their inpatient stay.

Epidemiology and Risk factorsA profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital

CrehanF,O’SheaD,RyanJM,HorganF.

Irish Med. J. 2013;106(6):173-176.

Affiliation:StVincent’sUniversityHospital,ElmPark,[email protected]

(Copyright © 2013, Winstone Publishing) DOI unavailable PMID 23909153

Abstract

Ireland has an ageing population and the elderly are over-represented in Emergency Departments (ED)--a quarter of these presentations resulting from falls. A prospective study design was employed using a convenience sample toprofileelderlyfallersreferredforphysiotherapyinED.Forty-subjectswereassessedover14weeks.Mean

Abstracts ContinuedRecent abstracts from the research literature


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agewas84.88years(s.d.7.3)and31(77.5%)werefemale.Alldemonstratedslowwalkingspeedand26(65%)demonstratedpoorgripstrength.Aquarterofsubjectsreportedfearoffallingand30(75%)wereclassifiedasfrail. Elderly fallers in ED are a frail group of socially vulnerable patients who demonstrate a risk of further falls. Osteoporosishadbeendiagnosedin9(22.5%)subjects--alowprevalencecomparedwithinternationalresearch,but25(62.5%)subjectshadneverhadaDEXAscan.Theprevalenceoffrailtyinthesampleofelderlyfallersinthisstudywasveryhigh(75%).

Predictors of fracture from falls reported in hospital and residential care facilities: a cross-sectional study

Chari S, McRae P, Varghese P, Ferrar K, Haines TP.

BMJ Open 2013; 3(8): 2013-002948.

Affiliation:FallsPrevention,SafetyandQualityUnit,RoyalBrisbaneandWomen’sHospital,QueenslandHealth,Australia.

(Copyright©2013,BMJPublishingGroup)DOI10.1136/bmjopen-2013-002948PMID23906949

Abstract

OBJECTIVES: Fall-related fractures are associated with substantial human and economic costs. An improved understanding of the predictors of fall-related fractures in healthcare settings would be useful in developing future interventions. The objective of this study was to identify such predictors by exploring associations between fall-related factors and fracture outcomes through logistic regression analysis of routinely collected fall incident data.

DESIGN: Retrospective cross-sectional study.

SETTING: 197 public healthcare facilities in Queensland, Australia.

PARTICIPANTS: We included data from incident reports completed after falls among admitted adult hospital patients(n=24218falls,229fractures)andaged-careresidents(n=8980falls,74fractures)betweenJanuary2007 and November 2009.

PRIMARY AND SECONDARY OUTCOMES: The outcomes of interest were fall-related predictors of fracture.

RESULTS: Hospital patients who reported to have been screened for their risk of falling at admission were less likelytofractureafterafall(OR:0.60,95%CI0.41to0.89)thanthosewhohadnotbeenscreened.Further,fallsfromstanding(OR:2.08,95%CI1.22to3.55)andfallswhilewalking(OR:1.86,95%CI1.32to2.62)wereassociated with higher fracture odds than falls during other activities. In line with these results, falls while reachinginstanding(OR:3.51,95%CI1.44to8.56)andfallswhilewalking(OR:2.11,95%CI1.24to3.58)werealso predictive of fracture in the adjusted residential care model.

CONCLUSIONS:Ourfindingsindicatethatscreeningofhospitalpatientsfortheirriskoffallingmaycontributetowards the prevention of fall-related injury. Falls from upright postures appear to be more likely to result in fractures than other falls in healthcare settings. Further prospective research is warranted.

Classification of falls in stroke rehabilitation - not all falls are the same

Hanger HC, Wills KL, Wilkinson T.

Clin. Rehabil. 2013; ePub(ePub): ePub.

Affiliation:ThePrincessMargaretHospital,Christchurch,NewZealand.

(Copyright©2013,SagePublications)DOI10.1177/0269215513496801PMID23881335

Abstract

OBJECTIVE:Todevelopapracticaltaxonomyoffallsandtodeterminewhetherthesedifferentfallgroupshavedifferentoutcomes.

DESIGN: Descriptive study examining patient characteristics at the time of each fall and iterative development of falls taxonomy.

SETTING: An inpatient stroke rehabilitation ward.

METHODS:Allfallsover21monthswerereviewedretrospectively.Casenoteswerereviewedandeachpatient’s


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leveloffunctioningatthetimeoffall,togetherwithadmissionprofileanddischargeoutcomes,werecollected.Outcomes for fallers (as opposed to falls) were compared using the predominant fall type.

RESULTS:Therewere241fallsin122patientsandmostfallsoccurredaroundthebed(196(81%)falls).Toileting-relatedfallsoccurredin54patients(22.4%).Thetaxonomyproposessevenmainfalltypes.Onefalltype(‘I’mgivingitago’)appearedquitedifferentandwasassociatedwithbetterfunctioningattimeoffallandbetteroutcomes.Otherfalltypeswererelatedtohighdependencyneeds,visuospatialdifficultiesordelirium.Medication-related falls were uncommon in this cohort.

CONCLUSIONS:Thefallstaxonomydevelopedshowedfourmaintypesoffallswithdifferent,butoverlapping,patientcharacteristicsattimeoffallwithdifferentoutcomes.Differentfall-preventionstrategiesmayberequiredfor each group.

Osteoarthritis and falls in the older person

Ng CT, Tan MP.

Age Ageing 2013; ePub(ePub): ePub.

Affiliation:DivisionofRheumatology,DepartmentofMedicine,FacultyofMedicine,UniversityofMalaya,50603Kuala Lumpur, Malaysia.

(Copyright©2013,OxfordUniversityPress)DOI10.1093/ageing/aft070PMID23864423

Abstract

Osteoarthritisandfallsarecommonconditionsaffectingolderindividualswhichareassociatedwithdisabilityand escalating health expenditure. It has been widely assumed that osteoarthritis is an established risk factor for falls in older people. The relationship between osteoarthritis and falls has, quite surprisingly, not been adequately elucidated,andpublishedreportshavebeenconflicting.Ourreviewoftheexistingliteraturehasfoundlimitedevidence supporting the current assumption that the presence of osteoarthritis is associated with increased risk of falls with suggestions that osteoarthritis may actually be protective against falls related fractures. In addition, joint arthroplasty appears to increase the risk of falls in individuals with osteoarthritis.

Risk factors for single and recurrent falls: A prospective study of falls in community dwelling seniors without cognitive impairment

Wu TY, Chie WC, Yang RS, Kuo KL, Wong WK, Liaw CK.

Prev. Med. 2013; ePub(ePub): ePub.

Affiliation:InstituteofEpidemiologyandPreventiveMedicineandDepartmentofPublicHealth,CollegeofPublicHealth, National Taiwan University, 5F, No. 17, Hsu-Chow Rd., Taipei City, Taiwan, 100; Department of Family Medicine,RenaiBranch,TaipeiCityHospital,10F,No.10,Sec.4,Ren-AiRd.,TaipeiCity,Taiwan,106.Electronicaddress:[email protected].

(Copyright©2013,ElsevierPublishing)DOI10.1016/j.ypmed.2013.07.012PMID23872174

Abstract

OBJECTIVE: To contribute evidence towards heterogeneity in risk factors for single and recurrent falls.

METHOD: This is a prospective study conducted in Taiwan. Participants were randomly selected from the examinees of the annual health examination in 2010. Participants were interviewed with a detailed questionnaire and followed up one year later. Predictor variables included socio-demographic characteristics, medical conditions, laboratory data, and risk factors for osteoporosis. The outcome was falls in the ensuing 12 months.

RESULTS:Themeanageofthe653completerswas75.6±6.4.Half(48.7%)werewomen.Fallersandrecurrentfallerscomprised14.5%and6.0%oftheparticipants,respectively.Blurredvision(adjustedoddsratio(aOR):1.93,95%confidenceinterval(CI):1.02-3.67),minimaloutdooractivities(aOR:2.28,95%CI:1.06-4.88),andoveractivethyroid/parathyroid(aOR:3.49,95%CI:1.29-9.50)wereassociatedwithsinglefalls.Frailty(aOR:2.81,95%CI:1.11-7.09),decreasedbodyheight(aOR:3.15,95%CI:1.52-6.54)andtakingsedatives/hypnotics(aOR:4.23,95%CI:2.06-8.67)wereassociatedwithrecurrentfalls.Previousfalls(aOR:2.64,95%CI:1.44-4.84forsinglefalls;aOR:5.26,95%CI:2.61-10.60forrecurrentfalls)wereassociatedwithallfalls.

CONCLUSION:Differentinterventionstrategiesshouldbedevelopedforsingleandrecurrentfallers.



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Does substance abuse contribute to further risk of falls in dementia

Ataollahi Eshkoor S, Hamid TA, Hassan Nudin SS, Yoke Mun C.

Aging Neuropsychol. Cogn. 2013; ePub(ePub): ePub.

Affiliation:InstituteofGerontology,UniversitiPutraMalaysia,Selangor,Malaysia.

(Copyright©2013,Informa-TaylorandFrancisGroup)DOI10.1080/13825585.2013.819067PMID23883099

Abstract

This study aimed to predict the risk of falls by focusing on substance abuse in the elderly with dementia. Our nationalcross-sectionalsurveyincluded1210elderlyMalaysiandementedsubjects.Thestudyidentifiedtheeffectsofage,ethnicity,sexdifferences,maritalstatus,educationallevel,andsubstanceabuseonthelikelihoodof falls in the elderly with dementia. The multivariate logistic regression model was used to analyze data collected fromsamples.Theprevalenceoffallswasabout17%amongsubjectsandsignificantlyincreasedwithage(p=.006).Furthermore,theresultsshowedthatage(OR=1.03),ethnicity(OR=1.69),substanceabuse(OR=1.68),andfemalesex(OR=1.45)significantlyenhancedtheriskoffallsinrespondents(p<.05).Educationallevelandmaritalstatushadnosignificanteffectsonthelikelihoodoffalls(p>.05).However,thefindingsprovidedevidenceofanadditionaleffectofsubstanceabuseonfurtherriskoffallsinolderadultswithdementia.

Risk factors associated with visiting or not visiting the accident & emergency department after a fall

SchefferAC,VanhensbroekPB,vanDijkN,LuitseJS,GoslingsJC,LuigiesRH,deRooijSE.

BMC Health Serv. Res.2013;13(1):286.

(Copyright©2013,BioMedCentral)DOI10.1186/1472-6963-13-286PMID23890164

Abstract

BACKGROUND:Littleisknownabouttheprevalenceofmodifiableriskfactorsoffallinginelderlypersonswithafall-history who do not visit the Accident and Emergency (A&E) Department after one or more falls. The objective ofthisstudywastodeterminetheprevalenceofmodifiableriskfactorsinapopulationthatvisitedtheA&EDepartment after a fall (A&E group) and in a community-dwelling population of elderly individuals with a fall history who did not visit the A&E Department after a fall (non-A&E group).

METHODS:Twocohortswereincludedinthisstudy.Thefirstcohortincluded547individuals65yearsandolderwho were visited at home by a mobile fall prevention team. The participants in this cohort had fall histories but did not visit the A&E Department after a previous fall. These participants were age- and gender-matched to persons who visited the A&E Department for care after a fall. All participants were asked to complete the CAREFALL Triage Instrument.

RESULTS:ThemeannumberofmodifiableriskfactorsinpatientswhodidnotvisittheA&EDepartmentwas2.9,compared to 3.8 in the group that visited the A&E Department (p<0.01). All risk factors were present in both groups but were more prevalent in the A&E group, except for the risk factors of balance and mobility (equally prevalent in both groups) and orthostatic hypotension (less prevalent in the A&E group). The risk factors of polypharmacy, absence of orthostatic hypotension, fear of falling, impaired vision, mood and high risk of osteoporosis were all independently associated with visiting the A&E Department.

CONCLUSION:Allmodifiableriskfactorsforfallingwerefoundtobesharedbetweencommunity-dwellingelderlyindividuals with a fall history who visited the A&E Department and those who did not visit the Department, although the prevalence of these factors was somewhat lower in the A&E group. Preventive strategies aimed both at patients presenting to the A&E Department after a fall and those not presenting after a fall could perhaps reduce the number of recurrent falls, the occurrence of injury and the frequency of visits to the A&E Department.

The elimination half-life of benzodiazepines and fall risk: two prospective observational studies

de Vries OJ, Peeters G, Elders P, Sonnenberg C, Muller M, Deeg DJ, Lips P.


Affiliation:InternalMedicine,SectionofGeriatricMedicine,VUUniversityMedicalCenter,DeBoelelaan1117-4A35, Amsterdam, Netherlands 1081HV, Netherlands.


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(Copyright © 2013, Oxford University Press) DOI 10.1093/ageing/aft089 PMID 23900130

Abstract

BACKGROUND: the STOPP criteria advise against the use of long-acting benzodiazepines (LBs). OBJECTIVE: to study whether LBs are associated with a higher fall risk than short-acting benzodiazepines (SBs) (elimination half-life ≤10h).

METHODS: we used base-line data and prospective fall follow-up from the Longitudinal Aging Study Amsterdam, a longitudinal cohort study including 1,509 community-dwelling older persons (Study 1) and from a separate fall preventionstudywith564olderpersonsafterafall(Study2).Timetothefirstfallafterinclusionandnumberoffallsinthefirstyearafterinclusionweretheprimaryendpoints.

RESULTS:bothinStudy1andStudy2theuseofSBswasassociatedwithtimetothefirstfall,hazardratio(HR)1.62(95%CI:1.03-2.56)andHR1.64(95%CI:1.19-2.26),respectively.LBswerenotsignificantlyassociatedwithtimetofirstfall,HR1.40(0.85-2.31)andHR1.08(0.72-1.62).Inbothstudies,theuseofSBswasalsoassociatedwithnumberoffalls,oddsratio(OR)1.28(95%CI:1.01-1.61)andOR1.37(95%CI:1.10-1.70).LBswerenotsignificantlyassociatedwithnumberoffalls,OR1.23(0.96-1.57)and1.10(0.82-1.48).

CONCLUSIONS: the use of SBs is not associated with a lower fall risk compared with LBs. The use of both SBs and LBs by old persons should be strongly discouraged.

Falls in the general elderly population: a 3- and 6- year prospective study of risk factors using data from the longitudinal population study ‘Good ageing in Skane’

Stenhagen M, Ekström H, Nordell E, Elmståhl S.

BMC Geriatr. 2013; 13(1): 81.

(Copyright©2013,BioMedCentral)DOI10.1186/1471-2318-13-81PMID23919320

Abstract

BACKGROUND: Accidental falls in the elderly are a major health problem, despite extensive research on risk factors and prevention. Only a limited number of multifactorial, long-term prospective studies have been performed on risk factors for falls in the general elderly population. The aim of this study was to identify risk factors predicting falls in a general elderly population after three and six years, using a prospective design.

METHODS:Theprevalenceof38riskfactorswasrecordedatabaselineassessmentof1763subjects(aged60--93years). The incidence of one or more falls was recorded after three and six years. The predicted risk of falling, after exposure to the various risk factors, was analysed in a multiple logistic regression model, adjusted for age and sex,andpresentedasoddsratios(OR).Aprincipalcomponentanalysis(PCA),includingthestatisticalsignificantfactors, was also performed to identify thematic, uncorrelated components associated with falls.

RESULTS:Theuseofneuroleptics(OR3.30,95%CI:1.15--9.43),heartfailurewithsymptoms(OR1.88,95%CI:1.17--3.04)andlowwalkingspeed(OR1.77,95%CI:1.28--2.46)wereprominentindividualriskfactorsforfalls.InthePCA,threemaincomponentspredictingfallswereidentified:reducedmobility,OR2.12(95%CI1.54--2.91),heartdysfunction,OR1.66(95%CI1.26--2.20)andfunctionalimpairmentincludingnocturia,OR1.38(95%CI1.01-1.88).

CONCLUSIONS:Threemaincomponentspredictingfallswereidentifiedinageneralelderlypopulationafterthree and six years: reduced mobility, heart dysfunction and functional impairment including nocturia. The use of neuroleptic drugs was also a prominent individual risk factor, although the prevalence was low. Heart failure withsymptomswasasignificantriskfactorforfallsandmaybeofclinicalimportanceastheprevalenceofthiscondition in the elderly is increasing worldwide. There is need for further research on the relation between heart failure and falls in the elderly, as the treatment for this condition is poorly documented in this demographic. The findingsofthisstudymaybevaluableinthedevelopmentofinterventionprogrammesaimedatsustainable,long-term reduction of falls in the elderly.

Inappropriate prescribing in older fallers presenting to an Irish emergency department

McMahon CG, Cahir CA, Kenny RA, Bennett K.




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Affiliation:EmergencyMedicine,StJames’sHospital,TrinityCollegeDublin,Dublin8,Ireland.

(Copyright © 2013, Oxford University Press) DOI 10.1093/ageing/aft114 PMID 23927888

Abstract

BACKGROUND: certain medications increase falls risk in older people.

OBJECTIVE:toassessifprescribingmodificationoccursinolderfallspresentingtoanemergencydepartment(ED).

DESIGN: before-and-after design: presentation to ED with a fall as the index event.

SUBJECTS:over70’swhopresentedtoEDwithafallovera4-yearperiod.

METHODS:dispensedmedicationinthe12monthspre-andpost-fallwasidentifiedusingaprimarycarereimbursementservicespharmacyclaimsdatabase.ScreeningToolofOlderPerson’sPIP(STOPP)andBeersprescribingcriteriawereappliedtoidentifypotentiallyinappropriateprescribing(PIP).Polypharmacywasdefinedasfourormoreregularmedicines.PsychotropicmedicationwasidentifiedusingtheWHOAnatomicalTherapeuticChemicalclassificationsystem.ChangesinprescribingwerecomparedusingMcNemar’stest(significanceP<0.05).

RESULTS:Onethousandsixteenpatientswereeligibleforanalysis;53.1%hadatleastoneSTOPPcriteriapre-fallwithnochangepost-fall(53.7%,P=0.64).Beerscriteriawereidentifiedin44.0%pre-fall,withnochangepost-fall(41.5%,P=0.125).Themostsignificantindividualindicatorstochangewereneuroleptics,whichdecreasedfrom17.5to14.7%(P=0.02)andlong-actingbenzodiazepinesdecreasedfrom10.7to8.6%(P=0.005).Polypharmacywasobservedin63%andwasstronglypredictiveofPIP,OR4.0(95%CI3.0,5.32).Ahighprevalenceofpsychotropicmedicationwasidentifiedpre-fall:anxiolytics(15.7%),antidepressants(26%),hypnosedatives(30%).Newinitiationofanxiolyticsandhypnosedativesoccurredin9-15%,respectively,post-fall.

CONCLUSION:asignificantprevalenceofPIPwasobservedinolderfallerspresentingtotheED.Nosubstantialimprovements in PIP occurred in the 12 months post-fall, suggesting the need for focused intervention studies to be undertaken in this area.

Risk AssessmentRelationship between occurrence of falls and fall-risk scores in an acute care setting using the Hendrich II fall risk model

Swartzell KL, Fulton JS, Friesth BM.

Medsurg. Nurs. 2013; 22(3): 180-187.

Affiliation:Ortholndy,Indianapolis,IN,USA.

(Copyright©2013,JannettiPublications)DOIunavailablePMID23865279

Abstract

INTRODUCTION: Falls are a common clinical problem in the acute care setting, and fall-related injuries can include fractures, subdural hematomas, excessive bleeding, and even death (Hitcho et al., 2004). Several instruments are usedclinicallytoestimateapatient’sriskoffalling.TheSTRATIFY(Oliver,Britton,Seed,Martin,&Hopper,1997),the Morse Fall Scale (Morse, Black, Oberle, & Donahue, 1989), and the Hendrich II Fall Risk Model (Hendrich, Bender, & Nyhuis, 2003) are three instruments widely used in clinical practice by nurses. To be clinically useful, a fall risk assessment instrument should be easy to use with only a small number of items, perform consistently across target populations, and have evidence-based scoring and good inter-rater reliability. Oliver (2008), author of the STRATIFY tool, questioned the merits of any instrument used to assess fall risk in hospital inpatients in the absence of interventions to modify the risk factors. Too often, patient assessment and assignment of a score become required tasks and resulting data do not drive interventions.

PURPOSE: The purpose of this study was to explore the relationship between scores on the Hendrich II Fall Risk Model (HIIFRM) and fall occurrence as recorded in the medical record for patients diagnosed with diabetes mellitus, stroke, or heart failure in an acute care inpatient setting. METHOD: To determine if a relationship existed between the occurrence of a fall and the HIIFRM score, the study used a random sample of patients who fell duringadmissionandamatchedcontrolgroupofpatientswhodidnotfall.Fallcaseswereidentifiedbasedonan


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admission Medical Severity-Diagnosis Related Group (MS-DRG) (Schmidt & Stegman, 2008) of stroke or secondary InternationalClassificationofDiseases(9threvision)(ICD-9)code(Hart,Stegman,&Ford,2009)ofheartfailureor diabetes. Non-faller matched controls were selected at random from the same admission MS-DRG or secondary ICD-9 code as the fall case and matched for admission month/year.

DISCUSSION:ThisstudyfoundHIIFRMscorestoberelatedsignificantlytofallsinthesampleofpatientswithdiabetes, but not in the sample of patients with heart failure. Although the HIIFRM demonstrated statistically significantmeandifferencesinscoresbetweenpatientswhofellandthosewhodidnot,clinicallytheinstrumentfailedtoidentify44%ofpatientswhodidfallasbeingathighriskforfalling.Giventhenegativeconsequencesassociatedwithfalling,notidentifying44%ofhigh-riskpatientscanhavesignificantclinicalimplications.

CONCLUSIONS: In this study, HIIFRM scores were related to falls among inpatients in an acute care hospital who hadadiabetesdiagnosis,butnotaheartfailurediagnosis.Thedifferencesbetweenpatientgroupsbasedonmedical diagnoses suggest the instrument does not perform equally across patient groups, nursing skill levels, orclinicalunits.Thoughthefindingsarestatisticallysignificant,theclinicalconcemrnremainsthatalargepercentage of patients who fell were scored as low risk using the HIIFRM instrument. At some level, every patient admitted to an acute care hospital is at risk for falls. Patients sick enough to be in the hospital have underlying disease, are receiving physiologically altering medications and treatments, and are likely experiencing pain, fatigue, anxiety, sleep disturbance, and other symptoms that interfere with cognitive and physical functioning. The key to preventing falls among hospitalized patients may lie in addressing how the hospital environment creates risk. Nurses should continue to improve the ability to assess fall risk and implement interventions that modify or eliminate risk when possible.

Diagnosing delirium in older emergency department patients: Validity and reliability of the Delirium Triage Screen and the Brief Confusion Assessment Method

Han JH, Wilson A, Vasilevskis EE, Shintani A, Schnelle JF, Dittus RS, Graves AJ, Storrow AB, Shuster J, Ely EW.

Ann. Emerg. Med. 2013; ePub(ePub): ePub.

Affiliation:CenterforQualityAging,VanderbiltUniversitySchoolofMedicine,Nashville,TN;DepartmentofEmergency Medicine, Vanderbilt University School of Medicine, Nashville, TN. Electronic address: [email protected].

(Copyright © 2013, American College of Emergency Physicians, Publisher Elsevier Publishing)

DOI10.1016/j.annemergmed.2013.05.003PMID23916018

Abstract

STUDYOBJECTIVE:Deliriumisacommonformofacutebraindysfunctionwithprognosticsignificance.Healthcareprofessionalscaringforolderemergencydepartment(ED)patientsmissdeliriuminapproximately75%ofcases.This error results from a lack of available measures that can be performed rapidly enough to be incorporated into clinical practice. Therefore, we developed and evaluated a novel 2-step approach to delirium surveillance for the ED.

METHODS:ThisprospectiveobservationalstudywasconductedatanacademicEDinpatientsaged65yearsorolder. A research assistant and physician performed the Delirium Triage Screen (DTS), designed to be a highly sensitiverule-outtest,andtheBriefConfusionAssessmentMethod(bCAM),designedtobeahighlyspecificrule-in test for delirium. The reference standard for delirium was a comprehensive psychiatrist assessment using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. All assessments were independentlyconductedwithin3hoursofoneanother.Sensitivities,specificities,andlikelihoodratioswiththeir95%confidenceintervals(95%CIs)werecalculated.

RESULTS:Of406enrolledpatients,50(12.3%)haddeliriumdiagnosedbythepsychiatristreferencestandard.TheDTSwas98.0%sensitive(95%CI89.5%to99.5%),withanexpectedspecificityofapproximately55%forbothraters.TheDTS’snegativelikelihoodratiowas0.04(95%CI0.01to0.25)forbothraters.Asthecomplement,thebCAMhadaspecificityof95.8%(95%CI93.2%to97.4%)and96.9%(95%CI94.6%to98.3%)andasensitivityof84.0%(95%CI71.5%to91.7%)and78.0%(95%CI64.8%to87.2%)whenperformedbythephysicianandresearchassistant,respectively.ThepositivelikelihoodratiosforthebCAMwere19.9(95%CI12.0to33.2)and25.2(95%CI13.9to46.0),respectively.IftheresearchassistantDTSwasfollowedbythephysicianbCAM,thesensitivityofthiscombinationwas84.0%(95%CI71.5%to91.7%)andspecificitywas95.8%(95%



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CI93.2%to97.4%).IftheresearchassistantperformedboththeDTSandbCAM,thiscombinationwas78.0%sensitive(95%CI64.8%to87.2%)and97.2%specific(95%CI94.9%to98.5%).IfthephysicianperformedboththeDTSandbCAM,thiscombinationwas82.0%sensitive(95%CI69.2%to90.2%)and95.8%specific(95%CI93.2%to97.4%).

CONCLUSION:InolderEDpatients,this2-stepapproach(highlysensitiveDTSfollowedbyhighlyspecificbCAM)mayenablehealthcareprofessionals,regardlessofclinicalbackground,toefficientlyscreenfordelirium.Larger,multicentertrialsareneededtoconfirmthesefindingsandtodeterminetheeffectoftheseassessmentsondelirium recognition in the ED.

Fear of FallingPhysical function and fear of falling 2 years after the health-promoting randomized controlled trial: Elderly persons in the risk zone

ZidénL,Häggblom-KronlöfG,GustafssonS,Lundin-OlssonL,Dahlin-IvanoffS.

Gerontologist 2013; ePub(ePub): ePub.

Affiliation:*AddresscorrespondencetoLenaZidén,Instituteofneuroscienceandphysiology/physiotherapy,University of Gothenburg, P.O. Box 455, SE-405 30 Göteborg, Sweden. E-mail: [email protected].

(Copyright©2013,OxfordUniversityPress)DOI10.1093/geront/gnt078PMID23906550

Abstract

PURPOSE:Toinvestigatetheeffectsof2differenthealth-promotinginterventionsonphysicalperformance,fearof falling, and physical activity at 3-month, 1-year, and 2-year follow-ups of the study Elderly Persons in the Risk Zone.

DESIGN AND METHODS: A randomized, three-armed, single-blind, and controlled study in which 459 independent and community-dwelling people aged 80 years or older were included. A single preventive home visit including health-promoting information and advice and 4 weekly senior group meetings focused on health strategies and peer learning, with a follow-up home visit, were compared with control. Functional balance, walking speed, fear offalling,fallsefficacy,andfrequencyofphysicalactivitiesweremeasured3months,1year,and2yearsafterbaseline.

RESULTS:Therewerenoorlimiteddifferencesbetweenthegroupsatthe3-monthand1-yearfollow-ups.At2 years, the odds ratio for having a total score of 48 or more on the Berg Balance scale compared with control was1.75(confidenceinterval1.09-2.83)forapreventivehomevisitand1.87(confidenceinterval1.16-3.02)fortheseniormeetings.Asignificantlylargerproportionofinterventionparticipantsthancontrolsmaintainedwalkingspeedandreportedhigherfallsefficacy.At1and2years,asignificantlyhigherproportionofinterventionparticipants performed regular physical activities than control.

IMPLICATIONS: Both a preventive home visit and senior meetings reduced the deterioration in functional balance, walkingspeed,andfallsefficacyafter2years.Thelong-termeffectsofbothinterventionsindicateapositiveimpact on postponement of physical frailty among independent older people.

Intervention StudiesMinimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults

Almeida TL, Alexander NB, Nyquist LV, Montagnini ML, Santos A CS, Rodrigues G HP, Negrão CE, Trombetta IC, Wajngarten M.

J. Aging Phys. Act. 2013; 21(3): 241-259.

Affiliation:HeartInstitute(InCor),SãoPauloUniversityMedicalSchool,SãoPaulo,Brazil.

(Copyright © 2013, Human Kinetics Publishers)

DOIunavailablePMID23860552


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Abstract

Fewstudieshaveevaluatedthebenefitofprovidingexercisetounderprivilegedolderadultsatriskforfalls.Economicallyandeducationallydisadvantagedolderadultswithpreviousfalls(meanage79.06,SD=4.55)wererandomizedto4moofmultimodalexerciseprovidedasfullysupervisedcenter-based(FS,n=45),minimallysupervisedhome-based(MS,n=42),ortononexercisecontrols(C,n=32).Comparinggroupsonthemeanchangein fall-relevant mobility task performance between baseline and 4 mo and compared with the change in C, both FS andMShadsignificantlygreaterreductionintimedup-and-go,F(2,73)=5.82,p=.004,η2p=.14,andincreaseintandem-walkspeed,F(2,73)=7.71,p<.001η2p=.17.ChangeinperformancedidnotstatisticallydifferbetweenFS and MS. In community-dwelling economically and educationally disadvantaged older adults with a history of falls, minimally supervised home-based and fully supervised center-based exercise programs may be equally effectiveinimprovingfall-relevantfunctionalmobility.

Using video-elicitation to assess risks and potential falls reduction strategies in long term care

VieiraER,O’RourkeHM,MarckPB,HunterKF.

Disabil. Rehabil. 2013; ePub(ePub): ePub.

Affiliation:DepartmentofPhysicalTherapy,FloridaInternationalUniversity,Miami,FL,USA.

(Copyright © 2013, Informa - Taylor and Francis Group)

DOI10.3109/09638288.2013.821183PMID23924252

Abstract

PURPOSE: To assess the ability to use and the usefulness of video-elicitation to study risks and potential ways to reduce transfer-related falls in long term care.

METHOD: A qualitative research study was conducted in a long term care facility and included a purposeful sampleof16subjects(6residents,6healthcareproviders,and4familymembers).Fieldobservations,interviews,video-recordings of assisted transfers, and video-elicitation sessions were conducted with the participants. The interviews and video-elicitation sessions were digitally recorded, transcribed and coded independently by at least 2 analysts. The codes were organized under themes.

RESULTS:Sixthemesrelatedtorisksandreductionoftransfer-relatedfallswereidentified-environment,behaviors,healthconditions,specificactivities,knowledgeandawareness,andbalancingvalues.

CONCLUSIONS: We were able to implement the novel participatory video-elicitation method developed and it was useful to identify risks and risk reduction strategies. Therefore, video-elicitation may be used in future studies to inform the design and testing of interventions to reduce transfer-related falls among LTC residents. Implications for Rehabilitation Falls are common among long term care residents. Visual-elicitation is a useful tool to be used in rehabilitation to assess risks and possible measures to reduce falls. The video-elicitation sessions optimized the ability and engaged residents, health care providers, and family members on providing information and discussing risks and potential measures to reduce transfer-related falls.

Community fall prevention programs: Comparing three InSTEP models by levels of intensity

KramerBJ,CreekmurB,MitchellMN,RoseD,PynoosJ,RubensteinLZ.

J. Aging Phys. Act. 2013; ePub(ePub): ePub.

Affiliation:VAGreaterLosAngelesHealthcareSystemGeriatricResearchEducationClinicalCenter,LosAngeles,CA.

(Copyright © 2013, Human Kinetics Publishers) DOI unavailable PMID 23945593

Abstract

The Fall Prevention Center of Excellence designed three progressive intensity fall prevention program models, Increasing Stability Through Evaluation and Practice (INSTEP) to reduce risk in community-dwelling older adults. Each model included physical activity, medical risk and home safety components and was implemented as a 12-week program for small class sizes (12-15 persons) in community and senior centers. Change in fall rates and fall risk factors was assessed using a battery of performance tests, self-reports of function and fall diaries in a three-groupwithin-subjects(n=200)designmeasuredatbaseline,immediatelypostintervention,andat3-and



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9-months post-intervention. Overall, participants experienced a reduction in falls, improved self-perception of gaitandbalance,andimproveddynamicgaitfunctional.ThemediumintensityInSTEPmodelsignificantly(p=.003) reduced self-reported falls in comparison to the other models. InSTEP is a feasible model for addressing fall risk reduction in community-dwelling older adults.

Using Stake’s qualitative case study approach to explore implementation of evidence-based practice

Boblin SL, Ireland S, Kirkpatrick H, Robertson K.

Qual. Health Res. 2013.

(Copyright © 2013, Sage Publications) DOI 10.1177/1049732313502128 PMID unavailable

Abstract

Although the use of qualitative case study research has increased during the past decade, researchers have primarilyreportedontheirfindings,withlessattentiongiventomethods.Whenmethodsweredescribed,theyfollowed the principles of Yin; researchers paid less attention to the equally important work of Stake. When Stake’smethodswereacknowledged,researchersfrequentlyusedthemalongwithYin’s.Concurrentapplicationoftheirmethodsdidnottakeintoaccountdifferencesinthephilosophiesofthesetwocasestudyresearchers.Yin’sresearchispostpositivistwhereasStake’sisconstructivist.Thus,thephilosophicalassumptionstheyusedtoguidetheirworkweredifferent.InthisarticlewedescribehowweusedStake’sapproachtoexploretheimplementation of a falls-prevention best-practice guideline. We focus on our decisions and their congruence withStake’srecommendations,embedourdecisionswithinthecontextofresearchingthisphenomenon,describerationale for our decisions, and present lessons learned.

A home-based training program improves caregivers’ skills and dementia patients’ aggressive behaviors: A randomized controlled trial

Huang HL, Kuo LM, Chen YS, Liang J, Huang HL, Chiu YC, Chen ST, Sun Y, Hsu WC, Shyu YI.

Am. J. Geriatr. Psychiatry 2013; ePub(ePub): ePub.

Affiliation:DepartmentofGerontologicalCareandManagement,ChangGungUniversityofScienceandTechnology, Taoyuan, Taiwan.

(Copyright © 2013, American Association for Geriatric Psychiatry, Publisher Elsevier)

DOI10.1016/j.jagp.2012.09.009PMID23933422

Abstract

OBJECTIVE:Toinvestigatetheeffectsofanindividualized,home-basedcaregiver-trainingprogramforcaregiversof elderly patients with dementia and behavioral problems.

METHODS: Using a randomized clinical trial in the neurologic clinics of two hospitals and a community care management center in northern Taiwan, we tested an individualized home-based caregiver-training program for managing behavioral problems, with referrals to community services and telephone consultation. Participants werepatientswithdementiaandtheircaregivers(N=129):63intheinterventiongroupand66inthecontrolgroup. The control group received only written instructions and social telephone follow-ups. Behavioral problems ofelderlydementiapatientswereassessedbytheChineseversionoftheCohen-MansfieldAgitationInventory,communityform.Familycaregivers’outcomesweremeasuredbytheAgitationManagementSelf-efficacyScaleand the Preparedness and Competence Scales. These instruments were administered before the program and 2 weeks,3months,and6monthsafterward.

RESULTS: Family caregivers who received the individualized home-based training program had better preparedness(t=2.72,df=127,p<0.01),competence(t=4.77,df=126,p<0.001),andoverallself-efficacy(t=3.81,df=127,p<0.001)at3monthsthanthoseinthecontrolgroup.Moreover,thegrowthratebytreatmentinteractioneffectwassignificantforcaregivercompetence(t=2.25,df=127,p<0.05)andoverallself-efficacyformanagingbehavioralproblems(t=2.16,df=127,p<0.05).Theprobabilityofphysicallyaggressivebehaviorforpatients in the intervention group decreased from 0.27 to 0.12.

CONCLUSION:Ourindividualizedhome-basedcaregiver-trainingprogramimprovedcaregivers’preparedness,competence,andself-efficacyformanagingproblematicbehaviorsanddecreasedphysicalaggressivenessofelderly patients with dementia.


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NSW Falls Prevention Network BackgroundThe NSW Falls Prevention Network was established in 1993. The role of this network has grown since its inception and now includes:

•Meetings for discussion of falls related issues;• Disseminationofresearchfindingsbothlocaland

international;• Sharing resources developed and exploration

of opportunities to combine resources in joint initiatives;

• Encouragement of collaborative projects and research;

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The NSW Falls Prevention Network activities are part of the implementation of the NSW Falls Prevention Policy funded by the NSW Ministry of Health.

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