Falls risk assessment, multitargeted interventions and the impact on hospital falls

There is an urgent need for inquiry to validate existing scales in the accurate assessment of falls risk. Moreover, where fall prevention projects have targeted specific risk factors of falling, such as cognitive impairment, few have measured the impact of their intervention on fall outcomes. A comparative design compared and described differences in falls data within and between two study cohorts before and after a multitargeted intervention was introduced. A cut-off score of > or = 50 using the Morse Scale was a good baseline indicator for accurate identification of fall risk and outcomes verify that the modified Morse Falls Scale, in combination with other risk factors, more accurately profiled fall risk among this population. Fall incidence among the intervention cohort did not increase significantly despite a rise in the number of hospital admissions and a significantly higher reported fall risk potential.     

Relationship between call light use and response time and inpatient falls in acute care settings

Aims and objectives. This exploratory study used archived hospital data to determine whether the call light use rate and the average call light response time contribute to the fall and the injurious fall rates in acute care settings. Background. Inpatients often use call lights to seek nurses’ attention and assistance. Although implied in patient safety, no studies have examined data related to the call light use or the response time to call lights collected via existing tracking mechanisms to monitor nursing practice. Design. The study was conducted in a Michigan community hospital and used archived hospital data for analyses for the period from February 2007–June 2008. The unit of analysis was unit‐week. Method. The call light use rate per patient‐day was calculated based on information retrieved from the call light tracking system. The average response time in seconds was used as generated from the tracking system. The fall and injurious fall rates per 1000 patient‐days were calculated based on the fall incident reports. spss was used for data analyses. One‐way anova and correlation analyses were conducted. Results. More calls for assistance related to less fall‐related patient harm. Surprisingly, longer response time to call lights also related to fewer total falls and less fall‐related patient harm. Generally speaking, more call light use related to longer response times. Conclusions. This study’s findings challenged the appropriateness of targeting the goals of reducing the frequency of call light use and the fall rates as two outcome indicators of conducting hourly patient rounds. Relevance to clinical practice. Encouraging call light use is a key to reducing injurious fall rates. Unit managers should routinely monitor the trend of the call light use rate and ensure that the call light use rate is maintained at least above the mean rate.     

不同类型量表对住院老年患者跌倒风险评估的区分效度及关系

目的总结不同类型量表对住院老年患者跌倒风险评估的区分效度及关系。方法选取2012年10月~2014年10月我院接受诊治的76例住院老年患者,由两名专业测试人员以Morse跌倒评估量表、计时起立-步行测验表以及Berg平衡量表对其跌倒风险进行准确评估,以1年是否存在着跌倒史将其分为实验组21例和对照组55例。分析各种量表的区分效度及其相关性。结果实验组Morse跌倒评估量表评分显著高于对照组,Berg平衡量表评分以及计量起立-步行测验表评分明显低于对照组,有显著性差异(P0.05)。Morse跌倒评估量表和Berg平衡量表之间呈负相关。而Morse跌倒评估量表和计时起立-步行测验表间呈正相关,具有较强一致性。结论 Morse跌倒评估量表、计时起立-步行测验表以及Berg平衡量表对住院老年患者跌倒风险评估体现出显著敏感性,且具有较佳的区分效度与相关性。     

Hospital fall risk assessment tools: a critique of the literature

There are numerous fall risk assessment tools developed for use by nurses in hospitals; however, few of them have established validity and reliability. This article will examine the current state of knowledge in regard to fall risk assessment tools through review and critique of the literature on the topic. Recommendations for future research on fall risk assessment tools will be made and a conceptual framework detailing the relationship between the variables involved in assessing the accuracy of fall risk assessment tools will be presented.     

苏州市城市社区老年人跌倒的流行现状及其危险因素分析

目的了解苏州市城市社区老年人跌倒的流行现状,探索老年人跌倒的危险因素。方法2018年4月—5月对苏州市姑苏区5家社区内≥60岁的具有本地户籍的老年人进行跌倒流行情况的调查。结果过去一年中共有195名老年人发生过238人次的跌倒,跌倒年发生率为9.79%,其中男性跌倒年发生率为8.04%,女性跌倒年发生率为10.84%。而且年龄越大,老年人跌倒发生率越高,90岁以上老年人跌倒发生率高达28.60%。多因素Logistic回归分析结果显示年龄、身体状况不适为苏州市姑苏区社区老年人跌倒的危险因素,运动为老年跌倒的保护因素。结论本次调查结果显示,苏州市城市社区老年人跌倒发生率9.79%,今后我们应针对本辖区老年人跌倒的发生因素开展干预工作,减少老年人跌倒的发生。     

坠床/跌倒高危评估在心内科患者安全管理中的应用

目的探讨在心内科应用坠床/跌倒高危评估对患者的安全管理。方法对2008年11月～2011年4月心内科收治的5311例患者进行了高危坠床/跌倒评估。结果通过坠床/跌倒高危评估在患者安全管理中的应用,减少并防范了院内坠床/跌倒发生,保证了心内科住院患者的安全,达到了安全目标。结论通过介绍坠床/跌倒高危评估在患者安全管理中的应用,提出建立高危坠床/跌倒评估体系,制定相应有效的护理措施,实施三级质量控制,减少了住院患者坠床/跌倒的发生,提高了护士的安全管理意识,融洽了护患关系,提高了患者对护理服务的满意度。     

Incidence and Characteristics of Fall-related Emergency Department Visits

Abstract. Objective: Unintentional falls are the leading cause of injury and the second most common cause of unintentional injury deaths in the United States, and place a great burden on EDs. In this study, the objective was to describe the incidence and characteristics of ED visits associated with unintentional falls in the United States.
Methods: The authors performed a secondary analysis on data from the National Center for Health Statistics' National Hospital Ambulatory Medical Care Survey for 1992–1994. An ED visit was defined as fall-related if an ICD-9-CM cause of injury code was reported as E880.0–886.9 or E888.
Results: There were an estimated 7,946,000 fall-related ED visits per year, corresponding to an annual rate of 3.1 per 100 persons (95% CI = 2.8 to 3.4). Children under 5 years of age comprised the largest proportion of visits (14%). Among those visits coded with respect to place of occurrence, the rate of visits associated with falls occurring at home (1.7/100; 95% CI = 1.6 to 1.9) was significantly higher than that associated with falls occurring in all other locations combined (1.1/100; 95% CI = 1.0 to 1.2). The mean injury severity score increased significantly with the age of the patient. Fall-related ED visits resulted in an estimated 860,000 hospitalizations, 62% of which involved individuals aged 65 years and older. An estimated $2.45 billion per year was paid for fall-related ED visits. Government sources paid all or part of 41% of visits.
Conclusions: This study reports nationally representative data describing the incidence and characteristics of fall-related ED visits. These data expand what is known about the epidemiology of falls and help to define the burden that fall injuries place on EDs in the United States. The results of this study could serve as a benchmark to evaluate the effectiveness of future fall prevention efforts.     

A Randomized Clinical Trial of Aquatic versus Land Exercise to Improve Balance, Function, and Quality of Life in Older Women with Osteoporosis

Purpose:

Despite the decreased gravitational loading that is experienced in an aquatic environment, little research has been conducted on this exercise medium for women with osteoporosis (OP). Aquatic exercise (AE) may improve function and balance, thus ultimately decreasing fall risk and the potential for hip fractures in this high-risk population.

Method:

A total of 68 women with OP, aged 60 years or older, were recruited into a randomized clinical trial evaluating the impact of AE, land exercise (LE), and no exercise (NE) on balance, functional mobility, and quality of life (QOL).

Results:

Only one balance measure (backward tandem walk) significantly improved with AE compared to LE, but this did not translate into a greater improvement in self-report function. There were no significant differences between the exercise interventions and NE, except for in ratings of global change, where participants in the AE group were three times more likely to report improvement than those in the NE group.

Conclusion:

There were no differences in balance, function, or QOL in women with OP who followed an AE or LE programme compared to those in an NE control group. However, the significant differences in backward tandem walk between the AE and LE groups and self-reported global change between the AE and NE groups warrant further investigation. Significant improvements in balance and global change suggest that AE is a viable alternative for older women with OP who have difficulty exercising on land.     

FROM THE EDITORS

Objective and Design: This study determined the consistency of falls reporting between a telephone and in-person home interview using a cross-sectional design. Response consistency between the modes according to type of telephone interviewer, layperson, or health professional was also examined. Subjects: Three-hundred sixty-six community-dwelling individuals who were at high risk for falls because of a previous stroke or hip fracture participated: 107 required proxy assistance during interviewing. Results: The telephone and home interview provided similar estimates of the percentages of individuals not falling in the past month, 90% versus 92%. The overall sensitivity of the telephone interview to identifying fallers was 97% with a corresponding specificity of 98%. McNemar's X² statistic indicated a significant difference (X² = 5.44; p < .05) between the modes on the reporting of falls such that 38 falls were reported during the telephone interview versus 31 during the home interview. Layperson telephone interviewers were able to detect fallers as successfully as health professionals. Conclusion: The findings suggest that a telephone interview performed by a trained layperson may offer a cost-reduced means of identifying community-dwelling individuals at high risk of falls. Given the strong evidence that falls prevention programs are highly successful, this cost-effective strategy to detect individuals at high risk for falls is promising for injury prevention and health promotion.     

Translation,cultural adaptation and evaluation of the psychometric properties of the Falls Risk Awareness Questionnaire (FRAQ): FRAQ-Brazil

Objective

This study aimed to translate and culturally adapt the Falls Risk Awareness Questionnaire (FRAQ) for the elderly Brazilian population as well as to evaluate the internal consistency and reliability of this instrument.

Method

The study used internationally accepted guidelines for the cross-cultural adaptation process. The questionnaire in its final Portuguese version was then applied to 120 elderly people to assess the measurement properties. The participants were interviewed twice in the first assessment (examiners 1 and 2 at an interval of 30to60minutes) and again after 2 to 7 days by examiner 1. The internal consistency was assessed with Cronbach'' s alpha coefficient. To evaluate the reliability of the intra- and inter-evaluators, the Kappa coefficient for categorical variables was used; for numeric variables, the intra-class correlation coefficient (2-way mixed model) and the respective 95% confidence intervals were used in addition to the concordance test of Bland and Altman.

Results

The Brazilian version of the FRAQ was obtained while maintaining a semantic, idiomatic, cultural and conceptual equivalence. The internal consistency was α=0.95, while for intra-examiner reliability, an intrarater correlation coefficient (ICC-3,1) of 0.91 was obtained with an intra-class correlation Kappa coefficient of 0.89 and a Bland and Altman mean difference (bias) of -0.52. Regarding the inter-examiner reliability, the ICC=0.78, Kappa=0.76 and bias=0.12.

Conclusions

The translation and cultural adaptation of the FRAQ for the elderly Brazilian population was successfully performed. The instrument demonstrated excellent reliability and internal consistency, thus making it useful for assessing the perception of the risk of a fall among elderly Brazilians.     

Effect of a Practice Guideline for Emergency Department Care of Falls in Elder Patients on Subsequent Falls and Hospitalizations for Injuries

OBJECTIVE: To determine the effect of a practice guideline for the ED management of falls in community-dwelling elders on selected health outcomes. METHODS: The experimental design was a prepost-intervention comparison with one-year pre- and post-intervention phases. The guideline was presented to emergency physicians and nurses during a two-week interval between these two periods. The intervention also included health information provided to the subjects and a one-time educational intervention directed at primary care providers. The number of falls in the year following the ED visit was determined by telephone interview. The number of hospitalizations for falls was determined from the HMO database of all health care encounters. RESULTS: 1,899 patients were eligible for the study; 1,140 pre-intervention and 759 post-intervention patients. Of these, 1,504 (79%) were interviewed by telephone 12 to 15 months after their initial ED visits. Eighteen percent of the pre-intervention and 21% of the post-intervention subjects reported at least one fall in the 12 months following their ED visits (p = 0.162). The rate of falls per 100 patient years was 36.2 in both groups. Three percent of both groups were hospitalized at least once for a fall in the year following their ED visits. One percent in each group were hospitalized for a hip fracture. CONCLUSIONS: The attempted implementation of a practice guideline for the ED management of falls in community-dwelling elders did not result in a reduction in total falls, or in hospitalizations for falls, injuries, or fractures.     

63例儿童意外伤害的危险因素分析

目的探讨儿童意外伤害的危险因素。方法回顾性分析 1992— 2 0 0 3年 10年间在我院住院进行康复治疗的 63例意外伤害儿童的临床资料。结果 <3岁组儿童意外伤害的前 3位危险因素是坠落、学步跌伤与车祸 ;3— 6岁组的主要危险因素是坠落、车祸 ;7— 14岁组则是车祸、异物砸伤等。结论意外伤害可给儿童造成永久的功能障碍和残疾 ,严重影响他们的生活质量和参与社会的能力 ,应高度关注预防儿童意外伤害的研究