养老机构睡眠障碍老人跌倒风险的危险因素研究

目的 了解养老机构睡眠障碍老人跌倒风险的影响因素。方法 采用便利抽样法,应用一般资料调查表、Morse跌倒评估量表、死亡焦虑量表和Kolcaba舒适状况量表对河北省7所养老机构内60岁及以上的睡眠障碍老人进行调查。结果 445例养老机构睡眠障碍老人中,高跌倒风险者为220例（49.4%）。Logistic回归分析结果显示,高舒适状况、不使用助行器和无下肢疾病是养老机构睡眠障碍老人跌倒风险的保护因素（P<0.05）,使用助眠药和高死亡焦虑是养老机构睡眠障碍老人跌倒风险的危险因素（P<0.05）。结论 养老机构睡眠障碍老人跌倒风险较高,护理人员可采用积极沟通、心理疏导、健康知识宣教等方式降低跌倒风险,预防跌倒发生。     

How can we keep patients with dementia safe in our acute hospitals? A review of challenges and solutions

Maintaining patient safety in acute hospitals is a global health challenge. Traditionally, patient safety measures have been concentrated on critical care and surgical patients. In this review the medical literature was reviewed over the last ten years on aspects of patient safety specifically related to patients with dementia. Patients with dementia do badly in hospital with frequent adverse events resulting in the geriatric syndromes of falls, delirium and loss of function with increased length of stay and increased mortality. Contributory factors include inadequate assessment and treatment, inappropriate intervention, discrimination, low staff levels and lack of staff training. Unfortunately there is no one simple solution to this problem, but what is needed is a multifactorial, multilevel approach at the seven levels of care – patient, task, staff, team, environment, organisation and institution.Improving safety and quality of care for patients with dementia in acute hospitals will benefit all patients and is an urgent priority for the NHS.     

Medication Management Model as Experiential Education Tool for Students of Pharmacy

SUMMARY

A visiting nurse association (VNA) and a college of pharmacy sought cost-effective models by which consultant pharmacy services could be offered at a rural branch office to improve medication management for high-risk patients. Through a collaborative relationship with the Albany College of Pharmacy, the Eddy VNA used the structure and support of the Partners in Care Foundation (The Model) Medication Management Model to simultaneously provide patient services and train Doctor of Pharmacy candidates. The Model brings the pharmacist into the homecare team to provide pharmaceutical care and can provide the framework by which pharmacist preceptors and interns can effectively provide services to high-risk patients identified through the agency's CQI process. Results from program implementation with 100 Medicaid waiver patients indicate positive staff response and an overall 43% acceptance rate with prescribers and suggest that this is a cost-effective medication management service with implications for adaptation by other HHAs.     

Role of Geriatric Syndromes in the Management of Atrial Fibrillation in Older Adults: A Narrative Review

Objectives

Atrial fibrillation (AF) is common in older adults and associated with increased risk of cardiovascular events including thromboembolism. However, less is known about its association with noncardiovascular events, especially geriatric syndromes and conditions such as dementia, depression, impaired physical function, polypharmacy, falls, and poor quality of life. This review aims to help healthcare professionals integrate the special needs of older adults into their management of AF.

Association Between the Discrepancy in Self-Reported and Performance-Based Physical Functioning Levels and Risk of Future Falls Among Community-Dwelling Older Adults: The Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS)

Objectives

A discrepancy in self-reported and performance-based physical functioning levels is often observed among older adults. We investigated the association of discrepancy in self-reported and performance-based physical functioning levels with risk of future falls among community-dwelling older adults.

FROM THE EDITOR

No abstract available for this article.     

Gait and activity in the elderly: Implications for community falls-prevention and treatment programmes

Falls are the major cause of accidents in the elderly. Falls result from the interaction of medical, psychosocial and age-related changes with environmental conditions. Since many of these factors are amenable to change, theoretically many falls are preventable. As part of a multi-method community fall prevention programme we developed a gait assessment method (ELGAM). We report here on the association between ELGAM parameters and measures of social and physical activity, tested among 36 elderly community-dwelling persons. Social and physical activity were associated with only some of the gait parameters (turning head while walking and walking speed). However, the findings about gait are consistent with other research based on larger samples, and some of the findings from intervention research. Together they suggest the importance of social and physical activity in fall prevention programmes.     

Identifying Appropriate Nursing Home Resources to Reduce Fall-Related Emergency Department Transfers

ObjectivesTo describe potentially avoidable fall-related transfers to the emergency department (ED), and to identify infrastructure, training needs, and resources deemed appropriate for implementation in nursing homes (NHs) to decrease fall-related transfers to EDs.DesignA multi-method design, including (1) in-depth case review by an expert panel, (2) structured discussion with NH stakeholders, and (3) appropriateness rating.Setting and ParticipantsFall-related transfers were identified from the prospective reporting of every unplanned hospital transfer occurring within 21 months, collected during the INTERCARE study in 11 Swiss NHs.MethodsEighty-one fall-related transfers were rated for avoidability by a 2-round expert panel. NH stakeholders were consulted to discuss key implementable resources for NHs to mitigate potentially avoidable fall-related transfers. A questionnaire composed of 21 contextually adapted resources was sent to a larger group of stakeholders, to rate the appropriateness for implementation in NHs. χ² tests were used to assess whether avoidability was associated with an ED visit and to describe transfers. The RAND/UCLA method for appropriateness was used to determine appropriate resources.ResultsOne of 4 fall-related transfers were rated as potentially avoidable. A positive association was found between an ED visit and a rating of avoidability (χ² (1, N = 81) = 18.0, P < .001). Fourteen resources, including developing partnerships with outpatient clinics to access imaging services and strengthening geriatric expertise in nursing homes through clinical training and advanced nurse practitioners, were rated as appropriate by NH stakeholders for NH implementation to reduce potentially avoidable fall-related ED transfers.Conclusions and ImplicationsAccess to diagnostic equipment, geriatric expertise, and clinical training is essential to reduce fall-related potentially avoidable transfers from NHs. Implementing and supporting advanced practice nurses or nurses in extended roles provides NH directors, policymakers, and health care institutions with the possibility of re-engineering resources to limit unnecessary transfers, which are detrimental for resident quality of care and costly for the health system.     

Aerobic Dancing in a Long-term Care Facility

No abstract available for this article.