Comprehensive Fall Risk Research Articles

Falls in A Tertiary Care Hospital—Association With Delirium: A Replication Study

Delirium has been previously implicated as a risk factor for patient falls. This is a replication study of a 2009 investigation examining the prevalence of diagnosed and undiagnosed delirium in patients who fell during their hospital stay. To determine the prevalence of delirium at our institution and to examine the relationship of falls with delirium, advanced age, and hospital procedures. Using the data collection tool developed for the 2009 study, the authors performed a retrospective review of records of 99 patients who fell during their inpatient stay. Similar information was gathered on patient demographics, fall date, fall location, hospital service type, discharge disposition, diagnosis of delirium (DD), synonyms used to describe delirium, metabolic derangements, and surgeries or procedures performed. Data were collected on the day of admission, day of the fall, and 2 days before the fall. Falls in the general hospital were associated with delirium (73% of subjects had evidence or a DD at the time of their fall), advanced age (64.5% were older than 70 years), and specific procedures and surgeries. As identified in the previous study, improving delirium recognition and treatment may reduce the number of patient falls and promote more favorable outcomes such as reduced length of stay, fewer discharges to intermediate care facilities, and prevention of fall injuries. A comprehensive fall risk assessment that includes a delirium detection tool would improve the sensitivity and specificity of these instruments to detect those at greatest risk.

Comprehensive Fall-Risk Assessment of Construction Workers Using Inertial Measurement Units: Validation of the Gait-Stability Metric to Assess the Fall Risk of Iron Workers

In construction worksites, slips, trips, and falls are major causes of fatal injuries. This fact demonstrates the need for a safety assessment method that provides a comprehensive fall-risk analysis inclusive of the effects of physiological characteristics of construction workers. In this context, this research tests the usefulness of the maximum Lyapunov exponents (Max LE) as a metric to assess construction workers’ comprehensive fall risk. Max LE, one of the gait-stability metrics established in clinical settings, estimates how the stability of a construction worker reacts to very small disruptions. In order to validate the use of Max LE, a laboratory experiment that asked a group of subjects to simulate iron workers’ walking tasks on an I-beam was designed and conducted. These tasks were designed to showcase various fall-risk profiles: walking with a comfortable walking speed presented a low fall-risk profile; carrying a one-sided load and walking at a faster speed on the I-beam both presented high fall-risk profiles. Inertial measurement unit (IMU) sensors were attached to the right ankle of participants’ bodies to collect kinematic data for the calculation of Max LE. The results showed that Max LE offers adequate distinguishing power for characterizing the fall risk of various construction workers’ tasks, and the introduced approach to compute the gait stability from IMU sensor data captured from human bodies could provide a valuable analysis of the safety-related risks present in construction workers’ motions.

Disease state fingerprint for fall risk assessment.

Fall prevention is an important and complex multifactorial challenge, since one third of people over 65 years old fall at least once every year. A novel application of Disease State Fingerprint (DSF) algorithm is presented for holistic visualization of fall risk factors and identifying persons with falls history or decreased level of physical functioning based on fall risk assessment data. The algorithm is tested with data from 42 older adults, that went through a comprehensive fall risk assessment. Within the study population the Activities-specific Balance Confidence (ABC) scale score, Berg Balance Scale (BBS) score and the number of drugs in use were the three most relevant variables, that differed between the fallers and non-fallers. This study showed that the DSF visualization is beneficial in inspection of an individual's significant fall risk factors, since people have problems in different areas and one single assessment scale is not enough to expose all the people at risk.

Qualitative Assessment of Component-Specific, Fall-Risk Screening Procedures to Create a Fall Risk Screening Form

The Day Center, Case Management, and Home Care components of a local senior health agency each have used different screening forms for assessing their clients for fall risk. A common instrument, easily administered by all components as part of their routine practice, would be helpful in systematically identifying elders at risk of falling. Developing a common screening instrument would be useful at other senior health agencies as well. To gather information on the content and features that are most useful for fall screening, based on the needs of individual geriatric care workers in each component of a local senior health agency. A semistructured interview was used to gather feedback from geriatric care workers on what was needed for universal fall risk screening. Two major themes emerged: (1) factors that are relevant in assessing fall risk and (2) factors that affect the utility of the fall risk screening procedure. Under theme 1, there were 6 categories: fall history, physical function, impairments, medications, mental and psychological status, and home environment. Under theme 2, there were 3 categories: methods of gathering information for fall risk assessment, features useful to a fall risk assessment form, and actions taken in response to fall risk assessment. The 6 fall risk categories identified in the interviews were combined with 2 other categories identified in the literature, health status and fear of falling, to produce a universal form for use by different agency components. Integrating all fall-risk categories into a universal form improves the completeness of the form used in different agency components. However, to increase the utility of fall risk screening, service plans integrated with each screening procedure need to be developed according to specific agency structures. A 3-step procedure is proposed to improve the effectiveness of fall-risk screening: (1) initial screening with an outreach worker using a quick question assessment; (2) follow-up with a more comprehensive fall risk assessment while receiving services from the Day Center, Case Management, or Home Care; and (3) a "what-to-do" action is presented for each item on the basis of each question's response on the comprehensive form. When designing a fall risk screening procedure, integrating all fall-risk factors into a single comprehensive form may not be the ideal strategy. The environment, the person who gathers the information, and the actions required to respond to information gathered should also be considered. On the basis of the results of this qualitative study, we have presented a 3-step procedure, with supporting forms to address these considerations.

Association of executive function impairment, history of falls and physical performance in older adults: a cross-sectional population-based study in eastern France.

To estimate: (1) the association between executive function (EF) impairment and falls; and (2) the association of EF impairment on tests of physical function used in the evaluation of fall risk. Cross-sectional study. Thirteen health examination centres in Eastern France. Four thousand four hundred and eighty one community-dwelling older adults without dementia aged 65 to 97 years (mean age 71.8±5.4, women 47.6%). Participants underwent a comprehensive medical assessment that included evaluations of EF using the Clock Drawing Test and of physical performance using the Timed Up and Go Test (TUG). Analysis used multivariable modified Poisson regression to evaluate the association between impaired EF and each of the fall outcomes (any fall, recurrent falls, fall-related injuries). Multivariable linear regression was used to evaluate the association between EF impairment and performance on the TUG and grip strength. EF impairment, assessed using the clock drawing test, was present in 24.9% of participants. EF impairment was independently associated with an increased risk of any fall (RR=1.13, 95% CI (1.03, 1.25)) and major soft tissue fall-related injury (RR= 2.42, 95% CI (1.47, 4.00)). Additionally, EF impairment was associated with worse performance on the TUG (p<0.0001). EF impairment among older adults without dementia was highly prevalent and was independently associated with an increased risk for falls, fall-related injuries and with decreased physical function. The use of the Clock Drawing Test is an easy to administer measure of EF that can be used routinely in comprehensive fall risk evaluations.

A cross-sectional study examining multiple mobility device use and fall status among middle-aged and older adults with multiple sclerosis

Purpose: To document the prevalence of multiple mobility device use among adults with multiple sclerosis (MS) (≥55 years) and examine the association between falls status (faller/non-faller) and the number of mobility devices used. Methods: Cross-sectional data generated through telephone interviews with 353 participants was used for this secondary analysis. Descriptive statistics were used to address the first study purpose. Multiple device use was measured by the number of devices used, which ranged from 0 (never use a cane, walker, manual wheelchair, or power wheelchair/scooter) to 4 (use all four mobility devices at least some of the time). Logistic regression analysis was used to address the second purpose, with fall status used as the dependent variable (non-fallers [<1 per year] versus fallers [≥1 per year]). Results: Just under 60% of participants reported the use of at least two mobility devices. For each additional mobility device used, the odds of being a faller increased by 1.47 times (95% CI = 1.14–1.90). Conclusion: Multiple mobility device use was common and the greater number of devices used, the greater the likelihood of being a faller. To prevent falls, this association requires further research to determine directionality.Implications for RehabilitationThe high prevalence of multiple mobility device use points to the importance of asking about all devices a person uses, not just the primary one.Regression findings point to the need for comprehensive fall risk assessment and raise questions about whether different approaches to fall prevention intervention may be required for different clients.Including discussions and education about how to select the “right” device for different activities may be useful in the context of improving mobility status and reducing fall risk. Adequate practice with each device and “refreshers” when a device is not used to regularly may also be valuable.

Identifying cognitive dysfunction using the nurses’ rapidly clinical judgment in elderly inpatients

Background/PurposeThe aim of this study was to examine the relationship between nurses’ clinical judgment on cognitive function by fall risk assessment and mini-mental state examination (MMSE) scores in elderly inpatients. MethodsWe studied 61 consecutive hospitalized patients who received both comprehensive geriatric assessment (CGA) and fall risk assessment at the Department of Geriatric Medicine in Kyoto University Hospital from January 2006 to June 2010. During the fall risk assessment at admission, primary nurses evaluated the cognitive function by four items (with or without disorientation, impaired judgment, lack of comprehension, and memory loss), while a trained clinical assistant performed CGA including MMSE. Patients were divided into three groups according to the MMSE scores. The association between the four items of judgment by nurses and MMSE scores was then studied. ResultsThe mean age was 80.1 years and 55.7% of the patients were female. The percentage of patients judged to have impaired judgment, lack of comprehension, and memory loss was higher in patients with lower MMSE scores (impaired judgment, p for trend = 0.001; lack of comprehension, p for trend = 0.043; memory loss, p for trend = 0.001). The percentage of patients judged to have at least one of the four abnormalities was also significantly higher in patients with lower MMSE scores (p for trend <0.001). However, no significant relationship was found between disorientation and the MMSE scores. Further, nurses could not detect impaired cognition by the four items in one-third of the patients with mild impairment determined by MMSE. ConclusionThese data indicate that a comprehensive evaluation using all the four items on cognitive impairment is more effective in detecting cognitive impairment in elderly than using individual items, although one-third of cognitively impaired elderly patients may miss detection despite the use of the four items. Better approaches should be developed to identify cognitively impaired elderly patients by nurses.

Development, implementation, and evaluation of a comprehensive fall risk program

The purpose was to develop and implement I'M SAFE, a comprehensive patient fall-risk assessment tool linked to a tiered-intervention falls prevention program. A fall-risk evaluation tool was incorporated into electronic nurse documentation along with risk-specific nursing interventions. Intrinsic fall rates declined significantly (preimplementation: .67 falls/1,000 patient days; postimplementation: .51 falls/1,000 patient days, p = .015) and has been sustained 2 years following implementation. The I'M SAFE tool identifies patients at increased risk for falls. When linked to a multidisciplinary fall prevention program, the incidence of preventable falls can be reduced. The program's impact has persisted across two facilities.

Rapid torque development in older female fallers and nonfallers: A comparison across lower-extremity muscles

The objective of this study was to compare reaction time, joint torque, rate of torque development, and magnitude of neuromuscular activation of lower-extremity muscles in elderly female fallers and nonfallers. Participants included 11, elderly, female fallers (71.3 ± 5.4 years) and twelve nonfallers (71.3 ± 6.2 years) who completed a fall risk questionnaire. Then, maximal, voluntary, isometric contractions of the knee and ankle muscles were performed in reaction to a visual cue to determine joint torque, rate of torque development, reaction time, and nervous activation of agonists and antagonists. Results indicated that significantly more fallers reported “dizziness upon rising”, “use of balance altering medications”, “stress or depression”, “not enough sleep”, “arthritis in lower body”, “chronic pain in lower body”, and “tiring easily while walking” (all P < 0.05). Normalized dorsiflexion and plantarflexion strength scores (summation of peak torque, rate of torque development and impulse) were lower in fallers than in nonfallers ( P < 0.05). When summed across lower-extremity muscle groups, fallers demonstrated 19% lower peak torque and 29% longer motor time ( P < 0.05). In conclusion, comprehensive fall risk screening and prevention programs should address both neuromuscular and non-muscular factors, and, weakness of the ankle dorsiflexors and plantarflexors should be further studied as potential contributors to falls in older adults.

Effectiveness of Education and Individualized Counseling in Reducing Environmental Hazards in the Homes of Community‐Dwelling Older Women

To test the effectiveness of an education and counseling intervention on reducing environmental hazards in the homes of older women. Secondary analysis from a randomized, controlled trial with two arms: fall prevention program and health education program (control). Environmental hazards were assessed at baseline and immediately posttreatment (12-weeks). Participants' homes. Two hundred seventy-two community-dwelling women aged 70 and older at risk for falling. The fall prevention program involved a comprehensive fall risk evaluation, exercise, education, individualized counseling, and referrals. The health education program included topics unrelated to fall prevention. With the exception of the fall risk evaluation conducted by a nurse practitioner, baccalaureate-prepared nurses carried out the interventions. Summed and individual scores for hazards related to the bathroom, floor surfaces, lighting, furniture, stairways, and storage areas. Environmental hazards were found in all homes, with a baseline mean+/-standard deviation of 10.7+/-2.6 total hazards and range of four to 17 hazards. Analysis of within-group changes indicated that the fall prevention group had significantly fewer bathroom, lighting, and total hazards after the intervention, whereas the health education group had significantly fewer bathroom hazards but more floor hazards. At follow-up, the fall prevention group had significantly fewer lighting hazards and total hazards than the health education group. Education and counseling have only modest effects in helping older women make recommended home modifications. To be most effective in reducing environmental hazards, fall prevention programs may need to provide and install safety devices.