Neurological diseases and accidental falls of the aged

OBJECTIVE: To assess the influence of central and peripheral neurological diseases on the incidence of accidental falls of the aged. DESIGN: 1. Case-control study with cross-section at two years and 2. prospective study in a follow-up up to seven years thereafter. SETTING: Sample of a population study including all 589 inhabitants older than 70 years in three rural communities. PARTICIPANTS: 44 subjects with recurrent falls during two years' follow-up and 41 age and sex matched controls. MEASURES: Neurological diseases and evaluation, other diseases, and incidence of falls during the seven years' follow-up after the cross-section. RESULTS: Compared with the controls the fallers had more often multiple vascular lesions of the brain, extrapyramidal symptoms and signs as well as lumbar nerve root lesions. In the follow-up, cerebrovascular disease, especially with multiple lesions and residual signs of pyramidal tract lesion, Parkinson's disease, rigidity and hypokinesia were associated with increases risk of falling. In multivariate analysis signs of pyramidal tract lesion, rigidity and prior falls were predictors of falls. An increase in the incidence of falls was also associated with vascular lesion of the cerebellum, cerebral white matter hypodensity and cortical atrophy visible on CT. CONCLUSIONS: High incidence of falls was associated with chronic central nervous system diseases. Lumbar root lesions were more common among the fallers but did not increase the incidence of falls in the follow-up.Neurological diseases and evaluation, other diseases, and incidence of falls during the seven years' follow-up after the cross-section.Compared with the controls the fallers had more often multiple vascular lesions of the brain, extrapyramidal symptoms and signs as well as lumbar nerve root lesions. In the follow-up, cerebrovascular disease, especially with multiple lesions and residual signs of pyramidal tract lesion, Parkinson's disease, rigidity and hypokinesia were associated with increased risk of falling. In multivariate analysis signs of pyramidal tract lesion, rigidity, and prior falls were predictors of falls. An increase in the incidence of falls was also associated with vascular lesion of the cerebellum, cerebral white matter hypodensity and cortical atrophy visible on CT.     

Falls and confidence related quality of life outcome measures in an older British cohort

Falls are common in older subjects and result in loss of confidence and independence. The Falls Efficacy Scale (FES) and the Activities-specific Balance Confidence scale (ABC) were developed in North America to quantify these entities, but contain idiom unfamiliar to an older British population. Neither has been validated in the UK. The FES and the ABC were modified for use within British culture and the internal consistency and test-retest reliability of the modified scales (FES-UK and ABC-UK) assessed. A total of 193 consecutive, ambulant, new, and return patients (n=119; 62%) and their friends and relatives ("visitors", n=74; 38%) were tested on both scales, while the last 60 subjects were retested within one week. Internal reliability was excellent for both scales (Cronbach's alpha 0.97 (FES-UK), and 0.98 (ABC-UK)). Test-retest reliability was good for both scales, though superior for the ABC-UK (intraclass correlation coefficient 0.58 (FES-UK), 0.89 (ABC-UK)). There was evidence to suggest that the ABC-UK was better than the FES-UK at distinguishing between older patients and younger patients ([t(ABC)] = 4.4; [t(FES)] = 2.3); and between fallers and non-fallers ([t(ABC)] = 8.7; [t(FES)] = 5.0) where the t statistics are based on the comparison of two independent samples. The ABC-UK and FES-UK are both reliable and valid measures for the assessment of falls and balance related confidence in older adults. However, better test-retest reliability and more robust differentiation of subgroups in whom falls related quality of life would be expected to be different make the ABC-UK the current instrument of choice in assessing this entity in older British subjects.     

Recurrent falls are associated with increased length of stay in elderly psychiatric inpatients

OBJECTIVES: To identify factors which may contribute to prolonged length of stay in an elderly psychiatric inpatient setting. DESIGN: Retrospective case note study. METHODS: A list of all patients over the age of 65 discharged from a private psychiatric hospital over a three-year period excluding those with a length of stay of over 365 days was obtained (n = 1147). A random sample of 150 patients was selected from the study population. A case note study was then performed looking at a number of variables which have been postulated to affect length of stay. The resulting data was analysed using multivariate statistics. RESULTS: There was no statistically significant association found between baseline factors (including age, gender, cognitive impairment, marital status, order of admission and preadmission living arrangement) and length of stay. Having recurrent falls whilst an inpatient was associated with prolonged hospital stay (p = 0.0006). CONCLUSION: Experiencing recurrent falls whilst an inpatient is associated with prolonged length of stay. Recurrent falls in the elderly may be associated with both physical illness and the use of psychotropic medications. A prospective study examining factors contributing to falls would be important in decreasing fall risk and reducing length of stay.     

深圳市1997～2006年5岁以下儿童意外死亡趋势和死因分析

目的:了解深圳市5岁以下儿童意外死亡的现状与特点。方法:收集1997年～2006年深圳市5岁以下儿童意外死亡监测资料,采用SAS9.0进行统计分析。结果:10年间婴儿和5岁以下儿童意外死亡率呈下降趋势,意外死亡是1～4岁儿童的第1位死因。婴儿期主要意外死亡原因为意外窒息,1～4岁儿童主要意外死亡原因为溺水。结论:意外死亡是儿童期可避免的死亡指标,重视儿童意外死亡,加强对意外死亡的管理,最大限度地降低儿童因意外造成的死亡,提高儿童的生存水平。     

江西省鹰潭地区儿童青少年意外伤害的调查

目的调查江西省鹰潭地区儿童青少年意外伤害的现状，探讨其发生、发羼规律，为有效降低意外伤害的发生率，制定切实可行的防治措施。方法对鹰潭地区8964名儿童青少年进行问卷调查，对伤害发生年龄、性别、种类、原因、场所、伤害后果及时间分布等进行分析。结果男生意外伤害年龄高峰在12岁～组，女生高峰在9岁～组。男生伤害均明显高于女生。伤害种类以跌伤、碰伤与动物咬伤比例高，依次为47．00％、13．83％和13．15％。伤害时间主要是春季和夏季。结论针对伤害的特点，拟定不同时期的综合干预措施，既是一项政府行为，也是全社会和每个公民都需积极参与的事情。     

Mechanical restraints, rehabilitation therapies, and staffing adequacy as risk factors for falls in an elderly hospitalized population.

This case-control study of fall-related risk factors for elderly hospitalized patients hypothesized that the use of mechanical restraints, participation in a rehabilitation program, and staffing inadequacy increase the risk of falls. The study included 252 patients, also known as "cases," aged 60 to 85 years, who fell during the period between March 1 and December 31, 1993, in a large metropolitan hospital; and 250 "controls," randomly selected patients aged 60 to 85 years, who were matched with the cases in terms of length of stay to the day of the fall. Analysis using conditional logistic regression revealed that individuals who had been placed in a mechanical restraint at any point during their hospital stay prior to the fall (for the cases) or the selected day (for the controls) had approximately twice the risk of falling as did patients who had not been placed in restraints. Cases and controls showed no significant differences in terms of their participation in occupational therapy, physical therapy, or cardiac rehabilitation, and staffing adequacy was similar for both groups. While the finding of 2 to 4.7 times the risk for falls for those placed in a mechanical restraint only approached statistical significance, the results indicate that the risk of falling is highest soon after a patient has had to be placed in a mechanical restraint.     

The prevalence of peripheral intravenous cannulae and pattern of use: A point prevalence in a private hospital setting

Aims and objectives

To determine the prevalence and pattern of use of peripheral intravenous cannulae in hospital wards.

Background

Peripheral intravenous cannulae are commonly used in acute health care to directly access the bloodstream for the administration of medications, intravenous fluids and blood products. Peripheral intravenous cannulae are associated with multiple adverse events including hospital‐acquired bloodstream infection, thrombophlebitis and pain/discomfort. Administration of intravenous fluids is associated with impaired mobility and nocturia which may increase falls risk in the older people.

Design

Observational, point prevalence study.

Methods

Three private hospitals comprising a total of 1,230 beds participated in the study. Nurses recorded the presence of a peripheral intravenous cannulae, duration of insertion, state of the dressing and whether the peripheral intravenous cannulae was accessed in the previous 24 hr and for what purpose. Nurses were also asked whether they would replace the peripheral intravenous cannulae should it fail.

Results

Approximately one‐quarter of patients had a peripheral intravenous cannulae, the majority of which had been present for <24 hr. The major use of the peripheral intravenous cannulae was antibiotic administration. Administration of intravenous fluids occurred in the presence of normal oral fluid intake. Nurses would not replace one‐third of peripheral intravenous cannulae in the event of failure. A majority of patients were at increased falls risk, and one‐third of these were receiving intravenous fluids.

Conclusions

There is room for improvement in the utilisation of peripheral intravenous cannulae, particularly in removal and associated use of intravenous fluids. Alternative strategies for medication administration and timely switch to the oral route may reduce the risks associated with intravenous fluids.

Relevance to clinical practice

Vigilance is required in the use of peripheral intravenous cannulae. Consider transition of medication administration to oral intake where possible to minimise risks associated with the use of invasive devices and increased fluid intake.     

Severe accidental hypothermia: rewarming strategy using a veno-venous bypass system and a convective air warmer

Objective: To study a rewarming strategy for patients with severe accidental hypothermia using a simple veno-venous bypass in combination with a convective air warmer. Setting: Eighteen beds in a university hospital intensive care unit. Patients: Four adults admitted with a core temperature less than 30 °C. Hypothermia was caused by alcoholic intoxication in three patients and by drug overdose in one patient. Measurements and main results: All patients were rewarmed by a veno-venous bypass and in three cases a convective air warmer was also used. At a bypass flow rate of 100–300 ml/min the mean increase in core temperature was 1.15 °C/h (Range: 1.1–1.2 °C/h). One patient died 2 days after rewarming as a consequence of a reactivated pancreatitis. The other three patients survived without neurological sequelae. Conclusion: This rewarming technique seems safe and effective and allowed the controlled rewarming of our patients who suffered from severe accidental hypothermia Received: 15 September 1998 Final revision received: 4 January 1999 Accepted: 11 February 1999     

Unintentional injuries among older adults in northern Sweden – a one‐year population‐based study

Scand J Caring Sci; 2011; 25; 185–193
Unintentional injuries among older adults in northern Sweden – a one‐year population‐based study Aim: To study the epidemiology of unintentional injuries in a population of 21 000 Swedish older adults (65+) and to compare the injury incidence with similar data collected two decades earlier. Method: This is a retrospective epidemiologic cross‐sectional study based on a 1‐year data set of all the 1753 registered injury events from a well‐defined population. Result: The injury rate per 1000 individuals was three times higher in the 85+ age group than in the 65–74 age group. The rate was also higher in women than in men aged 75 and older. Fractures, especially on lower and upper extremities, were the most common injuries. Falls in residential care facilities caused the most serious injuries. In transport areas, pedestrian falls and bicyclist crashes were much more common than car crashes. Of the 1753 people injured, 42% were treated as inpatients for a total of 11 569 days; 86% of these days were caused by injury events in the home (57%) or in residential care facilities (29%). Our 65+ age group occupied 69% of all hospital bed‐days for trauma in all ages (0–102 years). Conclusion: Over the last two decades, the injury and fracture rate per 1000 individuals has increased by 40–50%, especially in the older age groups. During this time, the nursing strategy for older adults has changed in Sweden. As a result, more people live in their homes nowadays. This increase is distressing especially when we consider the current knowledge of preventive measures. The high number and proportion (>2/3) of inpatient trauma days for these age groups are a heavy burden for the medical sector. These facts call for more effective preventive measures, especially in the home and in residential care facilities, to minimize the negative health effects and the rising health costs.