Factors associated with health-related quality of life in PACE participants

Health-related quality of life (HRQoL) is an important measure of how health and illness affect the lives of older adults. This study aimed to determine the relationship between frailty, fear of falling, and depression with HRQoL in nursing home eligible community-dwelling older adults. A cross-sectional correlational design and chart review were conducted. Eighty four participants (mean age = 70.33 [SD = 6.33]) were surveyed on frailty, fear of falling, depression and physical and mental health measures of HRQoL. Increased frailty, fear of falling, and depression were associated with decreased physical and mental health and well-being. When controlling for sociodemographics, frailty and fear of falling were predictive of lower physical health and well-being whereas depression was independently predictive of lower mental health and well-being. The results of this study will assist in assessment and targeted interventions for modifiable risk factors that affect the HRQoL of nursing home eligible community-dwelling older adults.     

Predictive risk factors associated with stroke patient falls in acute care settings

The purpose of this retrospective prediction study was to evaluate potential risk factors for falls in stroke patients in the acute care setting. Charts of 202 stroke patients who experienced falls and 111 stroke patients who did not fall (N = 313) were sampled from two major medical centers in the southwestern United States. Independent variables included: demographics; side of stroke; mental, motor and sensory status; activity level ordered; medications and laboratory values. A 16-variable multiple linear regression risk-factor equation resulted in r2 = .300, a highly predictive finding (F[16,296] = 7.92, p less than .001). Final results indicate that stroke patients with a history of falls, with impaired decision-making ability, that exhibit restlessness, generalized weakness, abnormal hematocrit and are easily fatigued should be identified for surveillance, especially at night when most falls occur.     

Factors associated with falls in an inpatient palliative care unit: an exploratory study

In one inpatient palliative care unit falls were identified as a frequent and distressing, yet potentially avoidable, concern. The unit had the highest rate of falls in this long-term care setting, exceeding even that of dementia care units. No literature could be identified that examined falls in the palliative care population. The objective of the exploratory study was to examine factors associated with falls through retrospective archival data collection. Detailed information was collected on all 177 falls that occurred in the unit in 1999. Data were also gathered on patients who had not fallen for comparison. Analysis was conducted comparing risk factors of those patients who fell once and those who fell multiple times. It was found that advanced age, longer length of stay and a previous history of falls might be risk factors for future falls. Patients who fell multiple times had less symptom distress than patients who fell once.     

老年人跌倒危险因素的调查

目的:分析老年人跌倒的危险因素,为制定预防老年人跌倒的干预措施提供依据.方法:经方便取样,通过问卷访谈法调查200例60岁以上老人的跌倒状况及相关的危险因素.结果:老年人跌倒年发生率为34%,且随着年龄的增高而上升;64.4%跌倒发生在室内,主要是由腿脚无力和障碍物绊倒所致,跌倒造成的损伤主要有软组织损伤(75%)、骨折(25%),老年人跌倒是生理和心理状况、疾病、药物和生活环境等诸多因素交互作用的结果.结论:预防老年人跌倒建议采取包括安全教育、疾病治疗、用药指导、环境改造、体育锻炼等多元化的综合干预措施.     

Hypertensive management in the elderly patient at risk for falls

Purpose: Seventy percent of people over 65 years of age have hypertension, and one third of elders fall each year. These conditions frequently coexist, and each carries a risk for substantial functional decline or mortality. This article reviews the risks of and interventions to reduce falls in the elderly patient with hypertension.
Data sources: A systematic review of the published and unpublished literature and consensus panel recommendations through January 2008 are discussed.
Conclusions: Hypertension management in the frail elder at risk for fall must include a thoughtful assessment of the relative risks and benefits of treatments that are most likely to preserve function, independence, and quality of life. Stringent adherence to guidelines may not be appropriate for all patients. The periodic use of a standardized fall risk screening tool can assist the nurse practitioner (NP) to identify patients at risk for falls and adjust medication management accordingly.
Implications for practice: This article will assist the NP to weigh management options in the context of the complex elderly patient.     

Factors associated with nutrition risk among community-dwelling older adults in Thailand

This study was to investigate socio-demographic, chronic conditions and health factors associated with nutrition risk among Thai community-dwelling older adults. This was a cross-sectional study, involving 330 participants aged ≥ 60 years living in low-income suburban Chiang Mai, Northern Thailand. Of the 330 participants, 54.8% were at nutritional risk based on the Mini Nutritional Assessment. Multivariate analysis indicated factors significantly associated with nutritional risk were: aged ≥80 years (OR:8.59, 95% CI = 2.94–25.11), low income (OR: 2.35, 95% CI = 1.15–4.78), living alone (OR: 2.02, 95% CI = 0.20–0.78), moderate to severe pain (OR: 5.88, 95% CI = 2.30–15.02), dyslipidemia (OR: 5.12, 95% CI = 2.23–11.77), osteoarthritis (OR: 2.49, 95% CI = 1.14–5.48), poor physical performance (OR: 1.49, 95% CI = 1.70–3.15), and ≥1 fall in the previous year (OR: 2.22, 95% CI = 1.21–4.07). Results point to the need for multifactorial interventions to reduce risk for geriatric nutrition problems. Further studies are needed to determine effective solutions to the problem of malnutrition among older adults.     

Prospective analysis of the risk factors for falls in lymphoma patients

PurposeTo explore the risk factors for falls in lymphoma patients receiving chemotherapy.MethodsLymphoma patients (203) who received chemotherapy were prospectively recruited and analyzed. Eligible participants were followed up by weekly telephone contact for 6 months or until the time of a fall or death. Risk factors for falling in lymphoma patients were identified using univariate regression analysis and multivariate binary logistic regression analysis.ResultsOf the 203 cases, 13.3% (27 cases) had a fall during follow-up. Univariate regression analysis showed the following risk factors for falls in lymphoma patients: gender (P = 0.023), Eastern Cooperative Oncology Group (ECOG) performance status score (P < 0.0001), cancer stage (P < 0.0001), extranodal involvement (P = 0.041), serum lactate dehydrogenase (LDH) level (P < 0.0001), revised International Prognostic Index (R-IPI) (P < 0.0001), history of falls (P < 0.0001), gait (P < 0.0001), cognitive condition (P = 0.029) and intravenous catheter placement (P < 0.0001). Multivariate binary logistic regression analysis found four independent factors significantly associated with the risk of falling in lymphoma patients: female gender (P = 0.042), later stage (P = 0.021), R-IPI (P = 0.030), and intravenous catheter placement (P = 0.001).ConclusionsGender, stage, R-IPI, and intravenous catheter placement were independent risk factors for falls in patients with lymphoma. Lymphoma patients with these four risk factors should receive particular attention and fall prevention education to reduce the incidence of falls. The R-IPI may be a new predictor of falling in lymphoma patients and may aid in the management of falls.     

Assessing the risk of falls for the elderly in Basic Health Units

The world population is aging rapidly, which poses a greater challenge for the institutions involved which, in turn, require new public health policies that include the prevention of falls. The objective of this study was to assess the risk of falls in the elderly. This epidemiological, cross-sectional study was performed at a family health unit, using a quantitative approach. The sample consisted of 150 elderly individuals evaluated from January to April 2009. Data were collected using the Fall Risk Score, which was analyzed using SPSS 17.0. Of all seniors evaluated, 58.8% did not suffer falls. However, 63 seniors did suffer falls, 71.4% of this total experienced 1 to 2 falls, and the main intrinsic cause they reported was dizziness/vertigo, whereas the extrinsic cause was wet or slippery floors. Therefore, it is concluded that it is important to assess the risk of falls among the elderly so that preventive measures can be taken, with a view to maximizing their quality of life.     

The incidence and consequences of falls in stroke patients during inpatient rehabilitation: factors associated with high risk

OBJECTIVES: To determine the incidence of falls on a stroke rehabilitation unit; to assess the frequency and nature of injuries; and to identify risk factors predictive of falls, functional outcomes, and impairments. DESIGN: Retrospective cohort study. SETTING: An inpatient stroke rehabilitation unit. PARTICIPANTS: Two hundred thirty-eight consecutive stroke patient admissions. INTERVENTIONS: Incident reports completed on patients who experienced a fall while on the unit were reviewed and resultant injuries categorized (abrasions, lacerations, fractures). MAIN OUTCOME MEASURES: Stroke impairments and admission functional assessments, FIM instrument, Berg Balance Scale (BBS), and Chedoke-McMaster (CM) Stroke Impairment Inventory of fallers were compared with nonfallers. RESULTS: Of the 238 patients, 88 (37%) experienced at least 1 fall, and almost half of these (45 patients [19%]) experienced at least 2 falls. A total of 180 falls were reported over the 5-year period. Of the 180 reported falls, 33% occurred when patients were using their wheelchairs. Injuries occurred in 22% of the reported falls. These consisted of contusions (49%) and abrasions (41%), primarily of the upper (30.8%) and lower (25.6%) extremities. Only 1 fracture was reported. Fallers tended to have lower admission BBS scores (50% of patients with a score <30 fell vs 18% with a score >30, P <.01) and a lower score on the admission arm, leg, and foot components of the CM (P <.05). Patients who fell were also more likely to be apraxic (P <.014) and suffer from cognitive deficits (P <.01). Repeat fallers had lower admission FIM scores (P <.01) when compared with nonfallers. CONCLUSION: Although patients undergoing stroke rehabilitation experienced a significant number of falls, the incidence of serious injury was small. Patients who experienced at least 1 fall had significantly lower BBS, FIM, and CM arm, leg, and foot scores compared with nonfallers. These data suggest that groups of stroke patients who are at risk for falls within the rehabilitation setting can be identified by using a variety of impairment and functional assessments. This information may be potentially useful for designing interventions directed at reducing fall frequency among stroke survivors.     

Factors associated with increased risk of readmission to intensive care in Australia

Purpose  

To determine the epidemiology, in-hospital mortality, trends, patient characteristics and predictors of intensive care unit (ICU) readmission in Australia.     

A checklist for assessing the risk of falls among the elderly

The purpose of this study was to estimate the risk of falls among elderly citizens by using a checklist. This checklist was initially developed using the Delphi technique, then refined on the basis of research findings. Cross-sectional design and a purposive sample were used, with the sample selected from three sheltered housing projects (n = 302) and from Win-san district (n = 103) in Taipei, comprising 405 participants. On the basis of their experiences of falling in the previous year, participants were classified into two groups: fall (n = 202) and non-fall (n = 203). Participants in the fall group had lower scores on an SPMSQ (Short Portable Mental Status Questionnaire), took longer to complete the Get-up and Go test and were more afraid of falling. Participants who took longer than one second to complete the Get-up and Go test or had urinary frequency or incontinence problems were found to be at greater risks for falls. The elderly who lived in homes with dimly lit kitchens and clutters at entryways (or backyards) were found to be at a considerably greater risk, by 22 or 13 times respectively. This checklist can be used by care providers to identify those providing care to the elderly, those at high risk of falls, and to prevent such falls or, at least lessen the risks of falls.