A student-led demonstration project on fall prevention in a long-term care facility

Falls are a frequent and serious problem facing people aged 65 and older. The incidence of falls increases with greater numbers of intrinsic and extrinsic risk factors and can be reduced by risk modification and targeted interventions. Falls account for 70% of accidental deaths in persons aged 75 and older. Mortality due to falls is significantly higher for older adults living in extended care facilities versus those living in the community. Our objective was to evaluate the effectiveness of a fall prevention training program in a long-term care setting. A single-group repeated-measure design was used, guided by the Precede-Proceed framework. A comprehensive review of the literature and a concept analysis guided the development of testing and educational materials for all nursing and ancillary facility staff. Preliminary testing provided baseline data on knowledge related to fall prevention. Pre- and posttests, a fall prevention newsletter, and informational brochures were distributed to nursing staff and ancillary personnel at training sessions. Certified nursing assistant (CNA) champions were identified and given peer leadership training. "Quick Tips" fall prevention badges were also distributed to staff. Graduate students led interdisciplinary environmental rounds weekly, and new falls were reviewed on a daily basis by the interdisciplinary team. A 60-day posttest evaluated retention of fall prevention knowledge. Fall rates at baseline and for 2 months after the intervention were compared. Preliminary survey data revealed fall prevention learning opportunities, with a pretest mean score of 86.78%. Qualitative data were coded and revealed specific learning gaps in intrinsic, extrinsic, and organizational causes of falls. The 60-day posttest mean score was 90.69%; a paired t test (t score = -1.050; P = .057) suggested that learning may have taken place; however, differences in scores did not reach statistical significance. The fall rate before training was 16.1%; 30-day posttraining fall rate was 12.3%, and 60-day postintervention fall rate was 9%. Based on the program results, the model was expanded from long-term care to the university hospital system and outpatient clinics in the same community. The collaboration between a school of nursing and 1 long-term care facility led to the adoption of a significant quality improvement program that was subsequently extended to a local hospital and clinic system. Student-led projects designed to teach community service learning can be meaningful and can lead to changes in patient safety and quality of care.     

Interprofessional education in a student-led emergency department: A realist evaluation

ABSTRACT

This article reports a realist evaluation undertaken to identify factors that facilitated or hindered the successful implementation of interprofessional clinical training for undergraduate students in an emergency department. A realist evaluation provides a framework for understanding how the context and underlying mechanisms affect the outcome patterns of an intervention. The researchers gathered both qualitative and quantitative data from internal documents, semi-structured interviews, observations, and questionnaires to study what worked, for whom, and under what circumstances in this specific interprofessional setting. The study participants were medical, nursing, and physiotherapy students, their supervisors, and two members of the emergency department’s management staff. The data analysis indicated that the emergency ward provided an excellent environment for interprofessional education (IPE), as attested by the students, supervisors, and the clinical managers. An essential prerequisite is that the students have obtained adequate skills to work independently. Exemplary conditions for IPE to work well in an emergency department demand the continuity of effective and encouraging supervision throughout the training period and supervisors who are knowledgeable about developing a team.     

老年人跌倒预防临床实践指南的质量评价及内容分析

目的 对国内外老年人跌倒预防临床实践指南进行质量评价和内容分析,为构建适合中国的老年人跌倒预防临床实践指南提供参考。方法 计算机检索美国国立实践技术指南库、国际指南协作网、英国国家卫生与临床优化研究所指南网、苏格兰校际指南网、加拿大安大略注册护士协会、澳大利亚Joanna Briggs Institute（JBI）循证卫生保健中心,以及PubMed、Embase、CINAHL、中国知网、万方数据库、中国生物医学文摘数据库中涉及老年人跌倒预防的相关指南。采用临床实践指南评价工具对纳入指南进行质量评价,并对指南的内容进行分析。结果 共纳入13篇临床实践指南,其中2篇为A级推荐、9篇为B级推荐、2篇为C级推荐。临床实践指南评价工具6个领域的平均得分分别为范围和目的96.01%、清晰性81.34%、参与人员64.24%、严谨性51.60%、应用性51.28%、独立性44.44%。经内容分析,最终得出7个方面27项与跌倒预防相关的内容。结论 目前国内外跌倒预防临床实践指南的总体质量不佳,指南在制定的严谨性、应用性和编辑独立性方面均有待提高,老年人跌倒预防临床实践指南的内容宽泛,有待进一步完善。     

跌倒风险管理在预防社区老年人群跌倒中的应用

目的：探讨跌倒风险管理团队在提高社区老年人群防跌倒能力中的效果。方法：将60例社区老年人群随机分为管理组和对照组各30例。对照组老年人进行日常小区的娱乐健身活动,管理组除对照组的活动外,还接受跌倒风险管理：疾病筛查、药物指导、健康教育、功能训练、家居环境的改造。分别于初评时、干预第4周及第8周3个时期对受试者进行Tinetti步态和平衡测试、修订版跌倒效能量表（MFES）测试。结果：干预后第4周、第8周,管理组Tinetti步态和平衡测试均较干预前明显提高（P<0.01）,但干预4周和8周时差异无统计学意义,干预后第4周、第8周,管理组MFES评分均不断提高（P<0.01）,对照组干预前后2种评分差异均无统计学意义,干预后各时间点管理组以上2种评分均更高于对照组（P<0.01）。结论：及早发现有跌倒风险的社区老年人群,给予及时跌倒风险管理干预,能提高社区老年人群的防跌倒能力,缓解恐惧跌倒的心理,提高生活质量。     

Exercise for fall prevention and osteoporosis treatment

The recent meta-analyses of many randomized controlled trials that examined the effectiveness of exercise on the fall frequency and the bone mineral density were reviewed. All of the various exercise programs showed the significant reduction of the number of falls. In addition, the bone mineral density also increased with aerobics, resistance training, and walking in the lumbar spine and increased with walking in the femoral neck. Although exercise programs have not yet showed evidence for fracture prevention, it seemed to reduce the risk of fall and osteoporosis.     

Criteria for evaluation of measurement properties of clinical balance measures for use in fall prevention studies

Work Package 3 of the Prevention of Falls Network Europe has evaluated measurement properties of clinical balance measures to be used to: (1) select participants for interventions with the goal to prevent falls in older people, and (2) assess the results of such intervention on balance function. Inclusion in a fall prevention study may be based on measures identifying subjects who have impaired balance or increased risk of future falls. We propose that an appropriate statistical method to analyse discriminative ability of a balance measure is discriminant analysis or logistic regression analysis. The optimal cut-off score is best determined by plotting a receiver-operating-characteristic curve for different cut-off values. The evaluation of predictors for risk of future falls should be based on a study design with a prospective data collection of falls. Sensitivity to change is a measurement property needed to evaluate the outcome of an intervention. The standardized response mean is frequently encountered in the literature and is recommended as a statistical measure of sensitivity to change in the context of an intervention study. Adequate reliability is a prerequisite for consistent measurement. Relative reliability may be reported as an intraclass correlation coefficient and absolute reliability as the within-subject standard deviation (s(w)), also called standard error of measurement. When measurement error is proportional to the score, calculation of a coefficient of variation can be considered. In a second paper, the authors will evaluate clinical balance measures for use in fall prevention studies based upon criteria recommended in this report.     

老年人跌倒预防措施研究进展

跌倒是一个世界性的公共卫生问题。跌倒的主要人群为老年人,每年因为跌倒,导致众多的公共卫生支出以及对跌倒患者的生活造成严重的损害。本文从发生跌倒的相关因素、老年人跌倒研究的评定方法及测评工具、跌倒的预防措施及老年人跌倒的研究不足等方面,对老年人跌倒预防措施进行综述。     

抑郁症住院患者跌倒危险因素及预防措施

目的:分析抑郁症住院患者跌倒的相关危险因素,探讨有效的护理方法和防范措施.方法:对56例住院患者跌倒的原因以及相关因素进行分析,并采用条件Logistic回归模型筛选其危险因素.结果:抑郁患者跌倒与抑郁程度、步态异常、服用安眠药以及抗抑郁药有关.结论:强调预防为主的管理理念,加强防跌倒管理方案的落实,针对跌倒高危因素采取相应的综合干预措施,并针对危险因素进行个体化预防.     

A fall prevention program for the home environment

Falls are the leading cause of injury, death, and disability among people older than 65. When elders fall, they sustain such injuries as hip, spine, hand, and/or pelvic fractures. The prognosis after such a fall is poor--only half of older adults hospitalized for hip fractures are able to return home or live independently again. Even without injury, falls cause a loss of confidence that results in reduced physical activity, increased dependency, and social withdrawal. As a home care agency dealing with a geriatric population, our goal was to develop a user-friendly fall prevention program that would promote multidisciplinary assessment and intervention. We have developed a preventive approach through which clinicians and patients can collaborate on preventing falls in the home and maintaining our patients' first priority: quality of life.