BACKGROUND: Approximately one-third of community dwelling elderly people (age ≥65 years) falls each year contributing to over 2 million elderly emergency department (ED) visits for falls annually. The cost of care for fatal falls by elderly patients in the US was $179 million in 2000, and was $19 billion for non-fatal falls. The risk of falling increases with various risk factors including advancing age. Despite the frequency and costs associated with elderly falls, it is not clear what evaluation elderly fallers receive in the ED, after the ED, and the outcomes of the care provided. OBJECTIVES: We sought to examine the ED and post-ED workup of elderly fallers, and to compare this evaluation to that recommended by published ED fall evaluation and treatment guidelines. We also examined the disposition of these patients and the rate of adverse events which occurred within 1 year of discharge. METHODS: This study was a retrospective chart review of elderly ED fall patients from one urban teaching hospital with >90,000 visits per year. Patients aged ≥65 years who had an ED visit in 2012 with fall related ICD-9 codes E880-886, E888 and who had been seen by a primary care physician (PCP) within our hospital network during the past 3 years were included. We excluded patients who were transferred to our hospital and subsequent visits related to the original fall. We randomly selected 350 eligible patients for chart review. We adapted our data collection instrument from published fall evaluation recommendations including the American Geriatric Society. Categorical data were presented as percentages and continuous data were recorded as mean with standard deviation (SD) if normally distributed or medians with inter-quartile ranges (IQR) if non-normally distributed. RESULTS: A random sample of 450 charts were taken, 100 were subsequently excluded for erroneous identification. The average age was 80 (SD±9) years; 124 (35%) were male, with an average Charlson comorbidity index of 7.6 (SD 2.9). In terms of history, 251/350 (72%) took 5 or more medications, 144/350 (41%) had their visual acuity checked in the past 12 months, and 34/350 (10%) had fallen two or more times in the past 3 months. In the physical exam, only 43/350 (12%) had orthostatics done. 168/350 (48%) patients had their extremity strength recorded, of these 16/168 (10%) had decreased muscle strength. Only 128/350 (37%) patients had their gait recorded, of which 108/128 (84%) were noted to have an abnormal gait. Basic chemistry laboratory tests and hematology were sent on 199/350 (57%) of patients in the ED. X-rays were taken of 275/350 (79%) patients, and CTs were taken of 184/350 (53%) patients in the ED. 277/350 (79%) patients were discharged to their place of preadmission residence from the ED, ED observation unit, or hospital while 70/350 (20%) were discharged to a skilled rehab facility, all after being admitted to the hospital. 196/350 (56%) patients returned to the ED for any reason within 1 year of discharge, averaging 2.4 ± 1.9 visits. 161/350 (46%) patients were hospitalized within 1 year after discharge, averaging 2 ± 1.4 hospital admissions. 23 (7%) of patients died within 1 year after discharge. CONCLUSION: The comprehensive evaluation of falls for well-established risk factors and causes appears to be poor in this academic medical center ED. While results may not be generalizable to other EDs, the results suggest that standardized evaluation and treatment guidelines are needed.

Problem: The Centers for Disease Control and Prevention indicates that falls are the “leading cause of injury death and the most common cause of nonfatal injuries and hospital admission for trauma among people ages 65 and older.”1 Falls can have significant economic consequences to the individual and payer sources. To address these consequences, telerehabilitation was hypothesized to be a suitable supplement for fall screening efforts. Several sources concluded that support for synchronous telerehab was underdeveloped in the literature. Purpose: The purpose of this study was to explore the acceptability, feasibility, reliability, and validity of telehealth-delivered fall screening among community-dwelling older adults. Procedures: This investigation implemented an experimental, quantitative, cross-sectional design employing both pretest-posttest control group and quasi-experimental static group comparisons using non-probability sampling. This study assembled a panel of experts to provide content validation for a survey tool developed to quantify an older adult’s behavioral intension to use and attitudes towards a telerehabilitation delivery system. Seven fall screening tools were investigated for agreement among remote and face-to-face raters, and for comparison with the face-to-face reference standard (Mini-BEST). Results: All three null hypotheses were rejected. Results indicate that a telerehabilitation delivery system is a reliable and valid method of screening and determining fall risk in community-dwelling older adults. This study produced a content validated, internally consistent survey instrument designed to determine attitudes and beliefs about telerehabilitation. An experimental design was able to demonstrate a positive significant change in 4 of 7 survey constructs among the intervention group after exposure to telerehabilitation as compared to post-test controls. Overall, no significant difference was calculated between face-to-face or telerehab raters, and both environments produced equivalency with scoring, fall risk classification, and ability to discern fallers from non-fallers. Results from the telerehab STEADI fall risk conclusions were calculated to be concurrently valid with the face-to-face reference standard screening tool, the Mini-BEST. Conclusions: This investigation expanded the array of remote healthcare delivery options for clinicians and clients. Further investigation in residential and community settings are recommended.

Made available in DSpace on 2014-12-17T15:16:17Z (GMT). No. of bitstreams: 1 HeloisaMJSB_DISSERT.pdf: 1667099 bytes, checksum: 389f0ddd379405a8f7a32916a7240c60 (MD5) Previous issue date: 2012-12-21 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / Introduction: Falls among older adults is a public health problem, therefore it is necessary preventive actions, however the adherence is the major problem faced by practitioners and researchers working on falls prevention programs. Objective: To evaluate the variables related to the adherence to falls prevention programs among the elderly enrolled in a Basic Health Unit (BHU). Methods: Was performed an observational cross-sectional analytical study. All elderly registered in a BHU and able to ambulate independently were invited to participate in a falls prevent program. The Elderly who Adhered to the Program (EAP) were evaluated at BHU; and the Elderly Not Adhered to the Program (ENAP) were identified and assessed at home. The assessment for both groups was performed using an evaluation form containing personal data, measures and clinical scales to assess cognitive status, balance, mobility, fear of falling, handgrip strength. Data were analyzed with SPSS 20.0. In addition to this assessment, the ENAP underwent a semi structured interview, in which we used the qualitative approach based on the figure of the Collective Subject Discourse. Results: The study included 222 elderly, 111 EAP and 111ENAP, most aged between 70 and 79 years (48.2%), female (68.5%), married (52.3%) and illiterate (47.7%). Consolidated as protective factors for adherence, worst rates of physical activity (p = 0.001), balance (p = 0.010) and cognition (p = 0.007). The interview of ENAP identified two themes: "Local implementation of programs for the prevention of falls" and "Relationship between BHU and the elderly health care," and found that the elderly who did not adhere were unable to displace and did not mention that primary care programs are related to health care in elderly. Conclusions: Elderly who do not adhere to the program differ from elderly who adhere as worst indices of cognition, balance and physical activity which implies greater risk of falling; and they were unable to participate in falls prevention program and by to be caregiver and showed displacement difficult / Introdu??o: Quedas entre idosos ? um problema de sa?de p?blica, por isso faz-se necess?rio a??es preventivas, no entanto a ades?o ? o maior problema enfrentado por pesquisadores e profissionais de sa?de que trabalham com programas de preven??o de quedas. Objetivo: Averiguar as vari?veis relacionadas ao processo de ades?o a um programa de preven??o de quedas em idosos cadastrados em uma Unidade B?sica de Sa?de (UBS). M?todos: Foi realizado um estudo observacional anal?tico de corte transversal. Todos os idosos cadastrados em uma UBS e com capacidade de deambula??o independente foram convidados a participar de um programa de preven??o de quedas. Os Idosos que Aderiram ao Programa (IAP) foram avaliados na UBS; j? os Idosos que N?o Aderiram ao Programa (INAP) foram identificados e avaliados em domic?lio. A avalia??o para ambos os grupos foi realizada por meio de uma ficha de avalia??o contendo dados pessoais e cl?nicos, escalas e medidas para avaliar o estado cognitivo, equil?brio, mobilidade, medo de cair, for?a de preens?o manual. Os dados foram analisados no software SPSS 20.0. Al?m desta avalia??o, os INAP foram submetidos a uma entrevista semiestruturada, na qual foi utilizada a abordagem qualitativa embasada na figura do Discurso do Sujeito Coletivo. Resultados: Participaram deste estudo 222 idosos, 111 IAP e 111 INAP, maioria com idade entre 70 e 79 anos (48,2%), do g?nero feminino (68,5%), casados (52,3%) e n?o alfabetizados (47,7%). Consolidaram-se como fatores de prote??o ? ades?o, piores ?ndices de pr?tica de atividade f?sica (p=0,001), equil?brio (p=0,010) e cogni??o (p=0,007). A entrevista dos INAP identificou dois temas: Local para execu??o de programas de preven??o de quedas e Rela??o entre a UBS e o cuidado em sa?de do idoso , que verificaram que os idosos n?o aderiram por impossibilidade de ir ao local de interven??o; e n?o mencionaram que programas de aten??o prim?ria est?o relacionados ao cuidado em sa?de do idoso. Conclus?es: Os idosos que n?o aderiram ao programa diferem dos idosos que aderiram quanto a piores ?ndices de cogni??o, equil?brio e pr?tica de atividade f?sica, o que pressup?e maior risco de queda; e estiveram impossibilitados de participar do programa de preven??o de quedas por ser cuidador e apresentar dificuldade de deslocamento

One and a half million people are currently living in residential care facilities; as the baby boomer generation ages, this number will increase to 3 million. Approximately 3 out of 4 residents of these facilities fall each year, and 10% to 20% of those falls result in serious injuries such as fractures, disability, and a decreased quality of living. The BOUNCE Back fall initiative is a multifactorial program that uses a systematic approach starting on admission and to re-evaluate a resident following a fall. Nursing and therapy uses the Morse Fall Scale and the Elderly Mobility Scale to assess and categorize the resident's risk for falls. Guided by Lewin's theory of change, this project was designed to assess the effectiveness of the fall initiative as a quality improvement 60-day (August 2016- September 2016) pilot study in a skilled nursing and rehabilitation facility as a potential means to reduce the number of resident falls. Sixty residents (aged 64 to 98, mean age 81) were assessed at a minimum 2 time points to determine their level of fall risk and needed intervention, within 60 minutes of admission to the facility and 7 days postadmission. De-identified pre- and post-implementation data were provided from the corporate quality measure database, entered into a spreadsheet, and numbers were compared. As a result of the fall prevention pilot, for August 2016, 5 falls occurred with no repeat fallers; September 2016, 3 falls with 1 repeat faller which is a significant decrease from 14-22 falls occurring per month for 2 consecutive years. Following implementation, the facility scored 3%-5% for the number of falls, which is below the 7% threshold set forth by the pilot facility's corporate office. Prior to the implementation of the initiative, the facility had not met the 7% fall threshold in 2 years