Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.P.H.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 39-43).

Thesis (M.S.)--University of Michigan, 1990.

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.

No description available.

Yes / Falls are the most common safety incident reported by acute hospitals. In England national guidance recommends delivery of a multifactorial falls risk assessment (MFRA) and interventions tailored to address individual falls risk factors. However, there is variation in how these practices are implemented. This study aimed to explore the variation by examining what supports or constrains delivery of MFRAs and tailored interventions in acute hospitals. A realist review of literature was conducted with searches completed in three stages: (1) to construct hypotheses in the form of Context, Mechanism, Outcome configurations (CMOc) about how MFRAs and interventions are delivered, (2) to scope the breadth and depth of evidence available in Embase to test the CMOcs, and (3) following prioritisation of CMOcs, to refine search strategies for use in multiple databases. Citations were managed in EndNote; titles, abstracts, and full texts were screened, with 10% independently screened by two reviewers. Two CMOcs were prioritised for testing labelled: Facilitation via MFRA tools, and Patient Participation in interventions. Analysis indicated that MFRA tools can prompt action, but the number and type of falls risk factors included in tools differ across organisations leading to variation in practice. Furthermore, the extent to which tools work as prompts is influenced by complex ward conditions such as changes in patient condition, bed swaps, and availability of falls prevention interventions. Patient participation in falls prevention interventions is more likely where patient directed messaging takes individual circumstances into account, e.g., not wanting to disturb nurses by using the call bell. However, interactions that elicit individual circumstances can be resource intensive and patients with cognitive impairment may not be able to participate despite appropriately directed messaging. Organisations should consider how tools can be developed in ways that better support consistent and comprehensive identification of patients' individual falls risk factors and the complex ward conditions that can disrupt how tools work as facilitators. Ward staff should be supported to deliver patient directed messaging that is informed by their individual circumstances to encourage participation in falls prevention interventions, where appropriate. PROSPERO: CRD42020184458. / This research is funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research (HSDR) Programme (project number NIHR129488).

published_or_final_version / Nursing Studies / Master / Master of Nursing

Falls risk factor assessment is the first step in the development of appropriate intervention strategies for the prevention of falls. However, few multifactorial, validated falls risk assessments exist which are suitable for use in busy clinical settings. This project aimed to develop a reliable and valid falls risk assessment that was feasible for use in various clinical settings. The QuickScreen Clinical Falls Risk Assessment was developed and evaluated via four methods; a) the test-retest reliability of the measures was assessed with 30 community-dwelling older people, b) the concurrent validity of the measures was assessed by comparison with performance in the Physiological Profile Assessment, c) the predictive validity of the measures was assessed by comparison of performance with prospective falls in two studies involving large samples of community dwelling older people and d) the feasibility of the assessment was evaluated with 40 clinicians who trialled the assessment with their patients. The QuickScreen clinical falls risk assessment consists of eight measures, including previous falls, total medications, psychoactive medications, visual acuity, touch sensation, the sit to stand test, the near tandem stand test and the alternate step test. The test-retest reliability of the assessment measures was acceptable (intraclass correlation coefficients ranged from 0.56 to 0.89) and the assessment measures discriminated between multiple fallers and non-multiple fallers with relative risk values ranging from 1.4 to 2.5. The clinicians that trialled the assessment reported that it was quick and easy to administer and that it assisted in the management of their elderly patients. These results show that the QuickScreen Clinical Falls Risk Assessment has proven validity, test-retest reliability and is practical for use in a variety of clinical settings.

Falls risk factor assessment is the first step in the development of appropriate intervention strategies for the prevention of falls. However, few multifactorial, validated falls risk assessments exist which are suitable for use in busy clinical settings. This project aimed to develop a reliable and valid falls risk assessment that was feasible for use in various clinical settings. The QuickScreen Clinical Falls Risk Assessment was developed and evaluated via four methods; a) the test-retest reliability of the measures was assessed with 30 community-dwelling older people, b) the concurrent validity of the measures was assessed by comparison with performance in the Physiological Profile Assessment, c) the predictive validity of the measures was assessed by comparison of performance with prospective falls in two studies involving large samples of community dwelling older people and d) the feasibility of the assessment was evaluated with 40 clinicians who trialled the assessment with their patients. The QuickScreen clinical falls risk assessment consists of eight measures, including previous falls, total medications, psychoactive medications, visual acuity, touch sensation, the sit to stand test, the near tandem stand test and the alternate step test. The test-retest reliability of the assessment measures was acceptable (intraclass correlation coefficients ranged from 0.56 to 0.89) and the assessment measures discriminated between multiple fallers and non-multiple fallers with relative risk values ranging from 1.4 to 2.5. The clinicians that trialled the assessment reported that it was quick and easy to administer and that it assisted in the management of their elderly patients. These results show that the QuickScreen Clinical Falls Risk Assessment has proven validity, test-retest reliability and is practical for use in a variety of clinical settings.