Tesi sul tema "Falls"

Patient falls present challenges in acute care settings. It was unknown if hourly patient rounding using an electronic whiteboard system (EWS) impacted fall rates on a 16-bed surgical unit in a community hospital in Philadelphia, PA. The clinical questions for this project were what impact does the EWS have on hourly patient rounding and fall rates, and what impact does patient rounding logs have on hourly patient rounding and fall rates. Roy’s adaptation model, capacity building, and Kurt Lewin’s change theory were the theoretical and conceptual frameworks used in this project. Descriptive analyses were used to interpret data from the EWS and patient rounding logs completed on 220 randomly selected patients, in two nursing units, totaling 7,689 patient rounds. A quantitative correlational design determined the impact of the EWS on hourly patient rounding. A chi-square (χ²) test of independence determined the expected and actual numbers of missed and completed patient rounds. The results indicated a statistically significant relationship between the EWS and hourly patient rounding, X ² = (1, N = 7,689) = 371.3; p = < 0.05. A statistically significant relationship was found between hourly patient rounding completed on dayshift compared to nightshift, X ² = (1, N = 7,689) = 38.7, p = < 0.05. However, using the EWS did not reduce fall rates on the control unit (n = 7.04). The findings of this project support the use of an EWS to enhance hourly patient rounding and is being considered as a standard of care for the future.

Background and Purpose: Falls are the leading cause of accidental death among older adults. Reducing falls risk is one of the major safety concerns for older persons. More than one-third of people 65 years and older will experience one or more falls per year and nearly half of the people over 80 years of age will fall at least once each year. A key initial step in reducing falls is identifying those persons at highest risk so that they can be assessed and prescribed appropriate interventions. Therefore, the purpose of this study was to examine the capacity of a number of field and laboratory tests to identify fallers in a sample of older independently-living, community-dwelling persons. Participants: 66 healthy, independently living older persons, ages 60 and older. Method: During three visits to the laboratory, participants performed various field and laboratory balance tests. Field tests included the Timed Up and Go Test (TUG), the One-Leg Stand Test (OLS), the Functional Reach Test (FR), and the Tinetti Performance Oriented Mobility Assessment (POMA). The laboratory tests included a center of pressure (COP) test with time-to-boundary (TTB) measurements on a force platform, and dynamic posturography using the Proprio 5000. Each participant was classified as a “faller” or “non-faller” based on whether he or she recalled experiencing a fall within the past year. Results: Receiver-operated characteristics (ROC) curve analyses (specificity and sensitivity throughout the measurement ranges) revealed the OLS and TUG field tests and selected Proprio 5000 and TTB variables had the best capacity to distinguish fallers from non-fallers. For both field and laboratory tests one-way ANOVA revealed between-group differences similar to those indicated by the ROC results. Discussion and Conclusion: Both selected field and laboratory tests could identify fallers (16 out of 66). In addition, the laboratory tests revealed balance decrements in specific planes of motion that provide information concerning directional falls risk and a offer a framework for the prescription of interventions to reduce that risk.

Falls, with and without injury, in acute care hospitals are quite common but can be prevented if appropriate interventions are in place to address this issue. It is imperative that nurses assess fall risks of all patients admitted to the hospital and advocate for appropriate interventions to prevent falls in those who are found to be at risk. The purpose of this project was to recommend changes to the current fall prevention protocol in the project facility, an acute care hospital, based on best practices identified in a systematic review of the literature. At the time of the project, the hospital had a high rate of falls. The clinical practice question addressed by this project focused on the evidence-based fall prevention interventions that have resulted in a decreased fall rate among patients on medical-surgical units in an acute inpatient hospital setting. This doctoral project was informed by Kolcaba's theory of caring, and the major source of evidence was a systematic review of the literature focusing on fall prevention. Findings indicated that identification of fall risk factors and implementation of multifactorial fall prevention interventions, such as fall prevention teams, unit fall team champions and use of a fall risk scale, can reduce falls on medical surgical units in acute care hospitals. It was recommended that a multidisciplinary fall prevention team be developed in conjunction with unit fall team champions and that a fall risk scale be used to bridge the practice gap. If implemented, these changes may benefit patients, nurses, and the organization as a whole through decreased falls, lengths of stay, and health care costs.

Falls are a contributing factor to increased morbidity in the elderly and chronically ill populations and can affect overall quality of life. The literature indicates that oncology patients are a particularly vulnerable population who are further at risk for falls due to increased age, treatment related fatigue, side effects of medications, co-morbidities, decreased muscle tone, altered mental status, and anemia. Although patients with cancer are at a high risk for falls, this is not a well-documented patient problem in the nursing literature. This study examined the validity of the use of the Morse Fall Assessment Tool for use with Bone Marrow Transplant patients and explored other variables that might influence fall outcomes. This study was a retrospective chart review. The sample consisted of a total of 59 patients, which included 29 fallers and 30 non-fallers on a bone marrow transplant unit. There were 22 males and 37 females, ranging in age from 20 to 70 with a mean age of 53.9 (SD= 12.2).The results of this study indicate that there is a significant difference between fallers' (M= 43.8) and non-fallers' (M= 26.8) scores on the Morse Fall Scale (p= 0.000). Significant differences between groups were found with history of falls (p= 0.042), secondary diagnosis (p= 0.015), and muscle weakness (p= 0.025). Laboratory results from fallers and non-fallers revealed significant differences in platelet count (p= 0.003), BUN (p= 0.032), glucose (p= 0.009), and phosphorous (p= 0.001). This is the first study to document falls in the bone marrow transplant population. This study should be a stimulus for future studies conducted in the oncology and/or bone marrow transplant population. Studying falls in these patients is essential to understanding the physiological risk factors that may contribute to patient falls. Findings lay the foundation for studying falls in the bone marrow transplant population. It is crucial to study falls in this population in order to make appropriate assessments and interventions to keep this population free from injury.

Introduction The consequences of falling can be fatal to elderly. The mortality, morbidity and the risk ofanxiety and depression increases following a fall. Drug prescription is a preventable fall risk,making the association between antihypertensive medications and risk of falling an importantarea of investigation. Aim Compile the results from studies which have examined the effect of initiating or changing theantihypertensive medication on fall risk in people aged 60 years or older. Methods Data sources: MEDLINE and Cochrane databases. Study selection: Original articles ofcohort-, case control-, case crossover-, cross-sectional- and randomized controlled trial type,published between January 2000 and May 2019 and written in English were included. Dataassessment: 6 studies met the criteria and were included. Study quality was assessed for eachstudy. Results Three studies found significant short-term increase in fall risk, regardless of drug type. Onestudy discovered an 18% increase in fall risk for every 5-day gap in treatment. Two studiesevaluated antihypertensive drug types separately and found contradictive results of thiazidediuretics on short-term fall risk. Calcium channel blockers showed a protective effect andbeta blockers an increased risk during the first 3 weeks after initiating treatment. Conclusions No consistent consensus was seen regarding the short-term fall risk in separateantihypertensive drug types, though most studies agree in a short-term risk increase aftergeneral antihypertensive treatment initiation or change.

The objectives of the study were to determine the incidence of falls, the prevalence of fear of falling and fall risk factors and consequences in adults with rheumatoid arthritis (RA). 559 community dwelling adults with RA, aged 18 to 88 years (mean age 62; 69% female) participated in this prospective cohort study. Patients were recruited from four outpatient clinics in the Northwest of England and followed for 1 year after clinical assessment, using monthly falls calendars and telephone calls. Outcome measures included fall occurrence, reason for fall, type and severity of injuries, fractures, fall location, lie-times, use of health services and functional ability. Risk factors for falls included lower limb muscle strength, postural stability, number of swollen and tender joints, functional status, history of falling, fear of falling, pain, fatigue and medication. Data on demographics, vision, co-morbidities, history of surgery, fractures, and joint replacements were also recorded.535 participants followed for one year had a total of 598 falls. 36.4% participants (95% CI 32% to 41%) reported falling with an incidence rate of 1313/1000 person-years at risk or 1.11 falls per person. Over one third of the falls were reportedly caused by hips, knees or ankle joints giving way. Over half of all the falls resulted in moderate injuries, including head injuries (n=27) and fractures (n=26). Univariate logistic regression showed that falls risk was independent of age and gender. A history of falls in the previous one year was a strong medical fall predictor with an odds ratio (OR) for a single fall=3.3 and for multiple falls OR=4.3. Fear of falling was an important self-reported psychological predictor, with the risk increasing by 10% with each point above 7 (up to 28) in the Short FES-I score. The inability to complete the Four Test Balance Scale due to poor balance was a strong postural fall predictor (OR 2.3). The most significant functional predictor of falls was the functional Health Assessment Questionnaire score, and each additional point attained in the score (1-4) nearly doubled the risk of further falls. Multivariate logistic regression revealed that when taken in combination with other factors, a history of multiple falls in the previous one year was the most significant predictive risk factor (OR=5.3) and overall the model accounted for 71% of variation. The most significant modifiable risk factors were swollen and tender lower limb joints (hip, knee and ankle) (OR=1.7), psychotropic medication (OR=1.8) and increasing fatigue (OR=1.13) with this model accounting for 68% of variation. Adults of all ages with RA are at high risk of falls and fall-related injuries, fractures and head injuries. In clinical practice, high risk falls patients with RA can be identified by asking whether patients have fallen in the past year. The management of swollen and tender lower limb joints, fatigue and consideration of psychotropic medicines may be the most effective strategy to reduce falls in this group of patients. Fear of falling, pain, lower limb strength and poor balance are other useful clinical indicators that may be modified to prevent falls.

Falls in older adults are a serious and increasing problem for the NHS. Due to their multifactorial causes falls are difficult to prevent but research suggests that assessment and early interventions of those at risk of falling can help reduce fall frequency and consequently alleviate the health service burden and improve quality of life for older adults. The overall objective of this work was to investigate postural stability in persons over the age of 65 years to understand why this age group are susceptible to falls. Three main research aims were pursued (i) establish the scale of the issue of falls in older adults; (ii) develop an assessment system to measure postural stability; (iii) determine the conditions that compromise postural stability and assess awareness of this compromised stability. Firstly the existing literature was reviewed and a large scale analysis of accident reports from a sample of UK care homes was carried out. The results showed that falls are a serious issue for older adults residing in care homes, but also that accident reports are not necessarily reliable and some institutions may underreport falls. Pilot work in the early stages of the research process developed an accurate and reliable system to measure levels of postural stability. A Wii balance board was interfaced with a computer based kinematic assessment tool to measure postural stability whilst carrying out a variety of computerised secondary tasks. This assessment system was then used to fulfil the final research aim of investigating postural stability in older adults when loaded with various secondary tasks. Older adults’ postural stability was found to be compromised when undertaking a concurrent visuomotor task, but critically the results showed that this group were unaware of this compromise. The implications of these findings are discussed and further research directions are suggested.

Falls among the elderly is a health concern affecting multiple patients annually. Hospice patients and those with multiple comorbidities are at the greatest risk of falling and sustaining injuries from falls. Aromatherapy has been used for reducing multiple symptoms as well as for decreasing falls. The practice-focused question explored whether an education program on using aromatherapy for fall prevention would increase knowledge of this intervention for an interdisciplinary group of hospice staff. The design was developed using Knowles's theory of andragogy and Bloom's taxonomy. Thirteen staff members from the same facility participated in the education program. The program was targeted to educate staff who worked with hospice patients about implementing the intervention in their practice. The program was also offered facility-wide to allow all staff the opportunity to increase their knowledge in using the intervention in their fall- reduction programs. Assessment tools including pretest, posttest, and evaluations were completed by all program participants. Using a Likert scale to calculate participant responses, results revealed an increase in knowledge gained from 15% to 60%. The participants rated the program favorably with a mean score of 4.4 to 4.6 out of 5. This program would be beneficial to hospice caregivers and a broader range of staff members including nonhospice nurses, therapists, and providers who are interested in decreasing falls in their patient population. The program would also be of interest to accrediting bodies, hospice, palliative care, oncologic, and geriatric organizations for alternative fall-reduction interventions. Reducing falls will result in a positive social change by decreasing fall-related injuries costs and improving quality at end-of-life.

Introduction. Patient falls occur frequently in the acute hospital setting and are one of the most common adverse events experienced by hospitalised patients. In-hospital falls have negative outcomes for patients, causing injuries in up to half of those who fall. Falls in hospital create additional costs for health services due to increased length of stay (LOS), and greater health resource use. In contrast to much research focused on in-hospital falls worldwide, little is known about the rate, contributing factors and outcomes of inpatient falls in the state sector in South African hospitals. At the research hospital, a Falls Policy has been in place since 2013. The chosen falls risk screening tool, the Morse Falls Scale (MFS), had not been locally validated, and therefore its ability to accurately discriminate between patients who fall and patients who do not fall was unknown. A focused analysis of local falls incident reporting, and a description of contributory factors and consequences of falls, could better inform and target falls and fall injury prevention. Furthermore, this research may assist in service development and refining the Falls Policy. Methodology. The aim of this study was to obtain broad-based data on the magnitude of patient falls, and to identify factors contributing to falls. The aim was achieved in two parts, the first was a retrospective record review design. Predictive risk factors for falls were explored by comparing two patient groups, a Fall-Group and a Non-fall Group. In the FallGroup, further objectives related to describing circumstances surrounding fall events, including activities patients were performing at the time of the fall, the time of day and day of week the fall occurred, locations of fall events, and the clinical consequences sustained as a result of the fall. The use of the existing falls risk screening tool, the MFS, as well as its predictive accuracy to correctly identify patients at increased risk of falling was investigated. Second, a survey of nurses at the research hospital was undertaken to examine nurses' knowledge, attitudes and beliefs around the Falls Policy and current falls prevention practices. Results. There were 171 reported fall events during the ten-month period, representing 11.77% of adverse events and a falls rate of 0.73 per 1000 patient occupied bed days (POBD) during this time. Significant predictive risk factors for falling were a longer LOS and having a greater number of comorbid conditions. While the mean age of the sample was 50.0 years (SD=17.3 years), the Fall Group was significantly older than the Non-fall Group (p = .004). There were significantly more deaths in the Fall Group (p = .001), and this group had a longer average LOS (p < .001) compared to the Non-fall Group. The only sub-scale from the MFS that was significantly associated with falls was walking status. Minor-moderate clinical consequences were experienced as a result of the fall in 97% of cases (n=124). This study demonstrated that the MFS in use in the hospital has a low predictive accuracy of 55% at the current cut-off score of 50. At this score, the MFS has a sensitivity of 35.9% and a specificity of 75.4%. While an initial MFS was found in each of the cases, there was only evidence of a repeat MFS in 13 participants (9.7%) in the Fall Group. The nursing survey showed 70% of respondents had not had training on the Falls Policy (n=93) and only 37% (n=49) reported receiving regular feedback on fall rates. Receptiveness of most (66%, n=91) nurses to more training in falls prevention is encouraging. Discussion. The fall rate of 0.73 falls per POBD was lower than expected when compared to international studies. At the research hospital, when the Falls Policy was introduced in 2013, a fall was not defined in the policy and as highlighted in the nursing survey, there still appears to be lack of clarity on the fall definition. The MFS had a low predictive accuracy at the current cut-off score. The low sensitivity and specificity of the MFS in this setting may be due to the MFS not being updated regularly as per the Falls Policy. A further reason for the MFS poor predictive value may be the younger age group found in this sample when compared to international studies where the scale has performed better. Recommendations. The poor predictive value of the current risk screening tool found in this study is concerning. Therefore, further investigation into whether the MFS performs better if it is updated more frequently, and if completed in full, as per the Falls Policy, is recommended. Alternatively, the hospital should consider all patients with multiple comorbidities and those with longer length of stays at high risk, and provide interventions to minimise risk as per the Falls Policy. Future research into factors contributing to fall events and falls prevention should follow a prospective design and be supported at management as well as ward level. Further investigation into the most appropriate way to reduce harm from falls is recommended at the research site. Conclusion. This descriptive study provides a starting point for the hospital to examine the Falls Policy and falls prevention strategies currently in use. It is hoped that the study will contribute to local awareness-raising and capacity-building and help the hospital evaluate current practice and set a baseline for improvement.

Syftet med studien var att undersöka hur fallfrekvensen var fördelad mellan män och kvinnor, hur antalet fall var fördelade i åldersgrupperna över respektive under 80 år, när de flesta fallolyckor i det egna hemmet inträffade och om fallen medförde några konsekvenser.Studien var en retrospektiv registerstudie och inkluderade fall hos personer i eget boende med trygghetslarm och/eller hjälp av nattpatrull. Fallolyckorna registrerades på ett instrument som var speciellt utvecklat för projektet. Data från en sex månaders studie med totalt 510 fall av 213 individer analyserades. Resultatet visade att det var främst äldre personer över 80 år som föll och som hamnade på sjukhus. Fallen inträffade oftast förmiddagar och eftermiddagar. Få fall inträffade mellan klockan 00-09. Kvinnorna föll framförallt under december månad. Antal fall som ledde till sjukhusvård var 4.5 % och av dessa var nästan alla individer över 80 år och flertalet var kvinnor. Av de fall som ledde till sjukhusvård inträffade 39 % vid första och enda fallet. Då många vårdtagare föll ett flertal gånger och antalet fall kunde vara mycket högt bör de fallförebyggande åtgärderna ses över. Downton fallriskindex skulle kunna vara ett komplement till övriga fallpreventioner i hemmet. Studien ger användbar data med möjlighet att till exempel utforma hemtjänstens schema utifrån studieresultatet och på så sätt minska antalet fallolyckor i hemmen.

This study assessed falls efficacy and confidence-related changes among participants attending the a Matters of Balance/Volunteer Lay Leader (AMOB/VLL) falls prevention program for older adults, based on their residential location. Data were examined from 431 older Texans enrolled in AMOB/VLL during a two-year period, and assessed at baseline and post-intervention. Results indicate that participants significantly increased falls efficacy, reduced activity interference due to their health, and decreased the number of days limited from usual activity. Regression models show that participants, despite entering the program with lower reported health status, reported greater rates of positive change for falls efficacy and health interference compared with their baseline pre-intervention counterparts. Overall program attendance and attendance at major sessions showed the greatest influence. Findings contribute to the understanding of cognitive restructuring and strengthening variations with falls prevention program outcomes.

Background: Healthcare workers are ranked among one of the top occupations for musculoskeletal disorder (MSD) injuries that affect the muscles, the bones, the nervous system and due to repetitive motion tasks (Centers for Disease Control and Prevention, 2017). Numerous high-risk patient handling tasks such as lifting, transferring, ambulating and repositioning of patients cause injuries that can be prevented when evidence-based solutions are used for safe patient handling and mobility (SPHM) tasks. Purpose: The purpose of this quality improvement project was to evaluate the knowledge and attitudes of orthopedic nurses regarding the use of SPHM algorithms as the standard of care when transferring patients. Theoretical Framework. Lewin’s Theory of Change Methods. A quasi-experimental pretest-post-test design was utilized in this evidenced-based practice project. Results. Descriptive statistics that evaluated pre and post questionnaires of the orthopedic nurses noted nurses displayed behavioral and attitudinal intent to use the SPHM algorithms as the standard of care to improve patient outcomes by decreasing falls. Although the behavioral beliefs and attitudes reflected acknowledgement of SPHM skills and knowledge, nursing did not improve in their documentation of SPH fall risk as two separate tools were required on each patient. Conclusions: SPHM evidenced-based standards do guide staff to critically examine how to safely transfer and mobilize a patient. Patient fall rates did decrease during educational sessions, prompting the need for on-going education of all staff on the unit that transfers patients. The findings from this quality project may encourage future practice approaches to use of the safe patient handling (SPH) fall risk assessment tool for all patients to prevent patient falls.

Falls are a significant health problem for the ageing population as health outcomes decline as 30% of people over the age of 65 experience at least one fall annually. Prevention interventions are well established in the literature but falls continue in high numbers in Australia, in line with global trends. General practitioners are well situated to reduce falls for community dwelling older people but research is unclear which interventions are effective in the general practice context. Using a systematic review methodology with meta-analysis this review has addressed the question of which interventions are applicable in the general practice context. This study has identified falls risk screening, medication screening and management, and general practitioner training and education to be effective interventions to reduce falls in older people.

Title from PDF of title page (University of Missouri--Columbia, viewed on March 10, 2010). The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Thesis advisor: Dr. Mihail Popescu. Includes bibliographical references.

This study argues that American foreign policy (AFP) represented continuity rather than change from the collapse of the Berlin Wall in 1989 to the fall of Baghdad in 2003. During this time, the US pursued a hegemonic strategy that aimed to preserve its unipolar moment in the new American century. However, this argument is challenged by two sets of AFP literature. The first sees the 1990s as a period of inconsistency in AFP strategy, and the second identifies post-9/11 policy as a revolutionary change in AFP. This study‘s analysis goes below the surface of AFP‘s to its deep structure (hidden agendas). In contrast to the majority of AFP literature, it argues the 1990s were not a fragmented era but that AFP showed continuity rather than change, and the strategy of hegemony was already in operation. Likewise, putting aside the rhetoric of the Bush II administration, post-9/11 policy cannot be understood except in the context of AFP‘s hegemonic strategy of the post-Cold War (CW) era and 9/11 was no more than a terrorist attack carried out by a terrorist group. However, to serve US hegemonic agenda that was on hold from the early 1990s, the attack was deliberately exaggerated and portrayed as an existential threat to the US. The study does not deny the political fragmentation in the 1990s or ignore the effects of 9/11 on AFP strategy. Therefore, to critique the two sets of literature, the research assesses the impact of domestic politics on the ability of US officials‘ to build on America‘s unipolar moment. In doing so, this study highlights several aspects of US domestic division that curtailed the ability of bureaucrats to handle FP issues. This also demonstrates that AFP‘s failure in the 1990s was not on the strategic planning level but in its domestic context. Congress emerged as a counterweight to the leadership of the president. Societal groups gained unprecedented influence over policy-making as a result of the collapse of the Soviet Union. This status changed after 9/11 when a new external enemy appeared. The president regained his supreme role and Congress‘s role retreated. Under these circumstances, the study concludes that an unchanging AFP strategy gave the basis for the emergence of an explicit American hegemony.

This thesis examined the characteristics of falls leading to emergency department visits among middle-aged adults in Queensland. The study improved the understanding of the determinants, circumstances, and consequences of falls among middle-aged adults. It provided evidence to justify the need to target this age group for fall prevention, and has significant implications for developing evidence-based intervention policies and programs that aim to reduce the future burden of falls in this population in later life.