Morse Scale Research Articles

The influence of patient motivation on the motor function restoration during stroke recovery. Preliminary results of a clinical study

BACKGROUND: Acute cerebrovascular accidents lead to disability. The most important task is the rehabilitation and adaptation of these patients to society. Impaired motivation reduces the effectiveness of rehabilitation measures. AIMS: To assess the motivation of patients during stroke recovery; identify relationships between the level of motivation, duration and type of stroke, and cognitive and demographic indicators; and determine the influence of the patient’s initial level of motivation on the effectiveness of the rehabilitation. MATERIALS AND METHODS: This prospective study analyzed 36 patients with hemiparesis in the early and late recovery period of stroke. All patients were assessed according to the international classification of functioning, disability, and health; functional independence scale; Rivermead mobility index; degree of paresis according to the Medical Research Committee scale; level of spasticity according to the Ashford scale; risk of falls assessment according to the Morse scale; assessment of function of the upper and lower extremities using the Fugl–Meyer test; and balance assessment using the Berg scale. RESULTS: A significant positive correlation was found between the patient’s motivation and cognitive indicators: the integral level of the BTLD (r=0.653; p=0) and the integral indicator of the Mini-Mental State Examination (r=0.536; p=0.001). No convincing evidence supports the connection between the motivation level and indicators as such sex, age, body mass index, time since stroke, stroke type and location, pain level, functional independence level, and motor impairment. Although a trend toward greater positive changes in functional recovery of the arm, leg, balance, and overall independence was observed, no significant difference was found between groups. CONCLUSION: A significant relationship was found between motivation and cognitive functions, which can serve as predictors of the motivation level of patients when planning rehabilitation activities. A trend toward positive changes in functional recovery of the arm, leg, balance, and overall independence was found in patients with high motivation levels.

Assessment of the Impact of Home-Based Hospitalization on Health Outcomes: An Observational Study.

In Portugal, evidence of clinical outcomes within home-based hospitalization programs remains limited. Despite the adoption of homebased hospitalization services, it is still unclear whether these services represent an effective way to manage patients compared with inpatient hospital care. Therefore, the aim of this study was to evaluate the outcomes of home-based hospitalization compared with conventional hospitalization in a group of patients with a primary diagnosis of infectious, cardiovascular, oncological, or 'other' diseases. An observational retrospective study using anonymized administrative data to investigate the outcomes of home-based hospitalization (n = 209) and conventional hospitalization (n = 192) for 401 Portuguese patients admitted to CUF hospitals (Tejo, Cascais, Sintra, Descobertas, and the Unidade de Hospitalização Domiciliária CUF Lisboa). Data on demographics and clinical outcomes, including Barthel index, Braden scale, Morse scale, mortality, and length of hospital stay, were collected. The statistical analysis included comparison tests and logistic regression. The study found no statistically significant differences between patients' admission and discharge for the Barthel index, Braden scale, and Morse scale scores, for both conventional and home-based hospitalizations. In addition, no statistically significant differences were found in the length of stay between conventional and home-based hospitalization, although patients diagnosed with infectious diseases had a longer stay than patients with other conditions. Although the mortality rate was higher in home-based hospitalization compared to conventional hospitalization, the mortality risk index (higher in home-based hospitalization) assessed at admission was a more important predictor of death than the type of hospitalization. The study found that there were no significant differences in outcomes between conventional and home-based hospitalization. Home-based hospitalization was found to be a valuable aspect of patient- and family-centered care. However, it is noteworthy that patients with infectious diseases experienced longer hospital stays.

Impact of Timely Assessment for Risk of Fall by Using Morse Scale in Adult Medical & Surgical Unit of Tertiary Care Hospital in Pakistan

Background: Patient falls in healthcare settings are a significant concern, impacting patient safety and healthcare outcomes. The Morse Fall Scale (MFS) has been widely recognized as an effective tool for assessing fall risk among hospitalized patients. Despite its widespread use, there is a need for a comprehensive evaluation of its effectiveness, implementation challenges, and the perceptions of healthcare staff towards its utility. Objective: This study aims to evaluate the effectiveness of the MFS in reducing patient falls in a tertiary care hospital and to assess healthcare staff's perceptions regarding its usability and impact on patient care. Methods: A retrospective data analysis was conducted, examining fall events from July 2020 to December 2020, before the implementation of the MFS, and from January 2021 to May 2021, after its implementation. The study included all adult patients admitted to the medical and surgical units, excluding those from ambulatory care units and the emergency department. Staff perceptions were gauged through a survey assessing the ease of use, time efficiency, and effectiveness of the MFS in identifying high-risk patients. Data analysis utilized SPSS version 25 for statistical evaluation. Results: The implementation of the MFS was associated with a significant reduction in fall rates, from a total of 9 falls in the six months prior to implementation to zero falls in the five months post-implementation. Survey results indicated that 89% of nurses found the MFS quick and easy to use, 63% reported that it took less than 3 minutes to complete an assessment, 98% found the scale easy to understand, 95% stated it helped identify high-risk patients, and 97% felt comfortable tailoring interventions based on the MFS scores. Conclusion: The MFS effectively reduced fall rates in the hospital setting, with healthcare staff affirming its ease of use and effectiveness in identifying at-risk patients. These findings support the continued use and further refinement of the MFS as a critical component of patient safety strategies.

Optimalisasi Manajemen Risiko Jatuh pada Pasien Psikiatri Melalui Penggunaan Tool Asesmen yang Tepat

This study aims to identify fall management problems in psychiatric patients, conduct analysis, develop action plans, implement psychiatric fall management innovations, and evaluate the use of appropriate assessment tools in the psychiatric population. The method used is a case report using the ADDIE approach. The results showed that the attitude and involvement of nurses in managing falls were high (99.42% and 98.86%). However, the results of the focus group discussion (FGD) in the psychiatric room found data that the fall risk assessment tool currently used, namely the fall Morse scale (FMS), has not accommodated the condition of psychiatric patients. Namely, there is no assessment of psycho-pharmaceutical drugs, sedative drugs, and patient activity and elimination. Evaluation of the successful implementation of appropriate fall risk assessment tools in the psychiatric population is seen from the nurses' opinions about the ease of using the tools, the ease in assessing a patient's risk of falling, and the means of accommodating the conditions of psychiatric patients. The result is that 62% recommend using the Wilson-Sims Fall Risk Assessment Tool (WSFRAT), and 38% recommend using the Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT). In conclusion, using appropriate fall risk assessment tools in the psychiatric population can reduce the incidence of falls and make it easier for nurses to assess the risk of falls in psychiatric patients.
 
 Keywords: Patient Safety, Risk Management, Psychiatry, Fall Risk Assessment Tool

Cognitive status of hospitalized therapeutic elderly patients

Relevance. In connection with the trend toward an increase in life expectancy and aging of the population, the issue of timely detection and treatment of geriatric disorders in elderly and senile patients becomes relevant. The aim of the study is to analyze cognitive impairment in hospitalized elderly and senile patients.Materials and methods. The study involved 93 patients older than 75 years, namely 63 women (80,2±5,0 years) and 30 men (80,2±6,4 years). All patients underwent a brief geriatric examination. The probability of frailty syndrome was assessed using the "Age is not a barrier" questionnaire, the risk of falls was assessed using the Morse scale. Cognitive status was determined using the MINI-COG questionnaire and the Mini-Mental State Examination (MMSE) scale. The data of biochemical blood tests (creatinine, uric acid, glucose, total cholesterol and lipid spectrum, K, Na) were also taken into account.Results. Normal cognitive status was recorded in women 2,5 times more often than in men. Patients with dementia were more likely to be obese than those without dementia (70% versus 35%; χ2=4,46; p=0,035). Cognitive impairment was accompanied by a decrease in physical functioning: the risk of falls on the Morse scale in the group of patients with dementia was 25% (p=0,038) higher, and the score on the "Age is not a barrier" test was 45% (p=0,009) worse than in patients without dementia. Patients with dementia tended to hyperuricemia and hypokalemia. Spearman's correlation analysis revealed inverse relationships between MMSE scores and the presence of arterial hypertension (r=–0,43; p<0,05) and type 2 diabetes (r=–0,33; p<0,05), with physical functioning ("Age is not a barrier": r=–0,49; p<0,05 / Morse: r=–0,41; p<0,05), with uric acid level (r=–0,61; p<0,05) and creatinine (r=–0,37; p<0,05). The presence of arterial hypertension and diabetes mellitus was combined with a more pronounced decrease in cognitive potential.Conclusions. The share of elderly patients reached 80% of all hospitalized persons. Dementia is 25% more common in men than in women. The presence of arterial hypertension, type 2 diabetes, and obesity increased the risk of dementia. The presence of dementia limits the physical functioning of patients by 45% and increases the risk of falls by 25%.

Analysis of fall risk increasing drugs on Morse Fall Scale in geriatric patients (a study at geriatric outpatient clinic Airlangga University Teaching Hospital)

Falls are the geriatric syndromes that become one of the main causes of injury, even death in the elderly. It is known that one of the risk factors for falling is the use of certain drugs that have the effect of orthostatic hypotension, sedation, balance disruptions, and other side effects. This study aims to examine the risk of falling based on Morse scale of geriatric patient that use fall-risk drug. Retrospective data were taken from e-prescriptions for geriatric patients and interviews with the patients to determine the risk of falling based on the Morse scale. The results showed that 115 patients who used the fall-risk drug had an average risk of falling from mild to moderate. The high fall-risk drug used by most patients was gabapentin (43%), the moderate fall-risk drug was candesartan (60%), and the low fall-risk drug was furosemide (9%). Patients with the total of 71% received a combination of two to four fall-risk drugs. Total MFRS of ≥6 was 53% patients, meaning that the patients’ using of drugs needed to be evaluated. From the results of statistical analysis, it was found that the number of fall risk drugs received by patients was not associated to the risk of falling in geriatric patients, while increasing the dose of high fall-risk drugs such as gabapentin, increased the fall risk level in geriatric patients. From the result of this study, it is known that fall-risk drugs are widely used by patients, hence it is necessary to increase the awareness of falling in geriatric patients.

Retrospective analysis of nurse-administered fall assessment scales in the Epilepsy Monitoring Unit

IntroductionInpatient falls within the Epilepsy Monitoring Unit (EMU) are a common, and potentially preventable adverse event contributing to morbidity for patients living with epilepsy. Accurate fall risk screening is important to identify and efficiently allocate proper safety measures to high-risk patients, especially in EMUs with limited resources. We sought to compare existing screening tools for the ability to predict falls in the EMU. MethodsThis is a retrospective, single-center, case-controlled, comparative analysis of 7 nurse-administered fall risk assessment tools (NAFRAT) of patients admitted to the Vanderbilt University Medical Center (VUMC) EMU. Analysis of categorical data was compared using chi-square analysis while quantitative distributions were compared using student’s t-test. ResultsA total of 56 patient records (28 falls and 28 controls) were included in the analysis. Epilepsy Monitoring Unit falls were most common within the first 3 days of admission (p = .0094). Pre-admission documentation of falls was a strong predictor of falls within the EMU (p < .0001). Epilepsy Monitoring Unit falls were associated with documented falls after EMU discharge (p = .011). The John Hopkins fall risk assessment tool (JHFRAT) accurately stratified fall risk in the fall group compared to the control (p = .008), however, none of the 7 NAFRATs demonstrated significant categorical differences among the epilepsy subgroups. There was a significant difference in the distribution of quantitative scores, higher in the fall group according to the Morse Fall Scale (MFS) (p = 0.012), JHFRAT (p = 0.003), Schmid Fall Risk Assessment Scale (p = 0.029) and Hester-Davis Scale (p = 0.049). The modified Conley (p = 0.03) and Morse scale (p = 0.025) demonstrated differences in the distribution of quantitative scores in the epilepsy subgroups. ConclusionThe findings of this study demonstrate variable accuracy of NAFRATs in assessing fall risk among patients admitted to the EMU, particularly among patients with epilepsy. The findings underscore the need for a validated, EMU-specific, fall assessment tool that accurately stratifies fall risk and inform efficient use of patient-specific fall prevention resources and protocols.

Risco de quedas e seus fatores associados na pessoa idosa hospitalizada

Abstract Objective To analyze the risk of falls and its association with demographic and clinical variables, cognitive status, risk of sarcopenia and frailty among older adults hospitalized in a medical clinic of a university hospital. Method A quantitative, observational, cross-sectional analytical study of 60 older adults hospitalized in the medical clinic of a university hospital in São Paulo city, São Paulo state, Brazil, was carried out. Questionnaires collecting demographic profile and clinical data, the Mini-Mental State Examination, Morse Scale, SARC-F Scale and Tilburg Frailty Indicator were applied. Descriptive analyses and the Kolmogorov-Smirnov normality test were performed. Spearman’s correlation test was used for quantitative variables and the Mann-Whitney U-test for categorical variables. Multiple linear regression was used to identify the associations and a significance level of 5% was adopted. Results The study sample comprised predominantly individuals that were female, aged 60-79 years and without a partner. Overall, 80% had cognitive impairment, 88.3% were diagnosed as frail, 60% were at risk for sarcopenia, and 75% had a high risk of falls during hospitalization. Cognitive impairment, frailty and sarcopenia risk were associated with risk of falls in the hospitalized older adults. Conclusion High risk of falls in the hospitalized older adults was directly associated with the presence of cognitive impairment, frailty syndrome and sarcopenia risk, confirming that these factors warrant attention from managers and nursing professionals.

&lt;br/&gt; RISCO DE QUEDA NOS IDOSOS: MAIS VALE PREVENIR QUE REMEDIAR! &lt;br/&gt;

Introduction: The Episodes of falls in the elderly are considered a public health problem. Physiological, behavioral and environmental changes, such as architectural barriers, are the main factors of risk for the occurrence of episodes of falls within elderly. The objective of this study is to evaluate the risk of falls in polymedicated elderly people, aged 75 years or over, in a civil parish area of a Community Care Unit of the Central Alentejo Health Center Group. Methodology: A cross-sectional, descriptive study with a quantitative approach was carried out involving 53 elderly people, to whom fall risk assessment instruments were applied, namely the Morse Scale and an observation grid. Results: Of the population studied (N = 53), 33 elderly people had already suffered episodes of falls, the main reason being the imbalance. All seniors are polymedicated, taking at least 4 different medications per day. As for current health problems, the most prevalent are vision problems, high blood pressure, rheumatic diseases and hearing problems. In relation to the physical environment at home, there was the presence of numerous risk factors/architectural barriers that can potentiate the occurrence of falls as well as a lack of knowledge regarding them. Conclusion: It is concluded that it is necessary to establish health-promoting community intervention strategies that contribute to the training and awareness of the elderly in the adoption of measures to prevent falls. Keywords: Accidental Falls; Aged; Polypharmacy; Public Health.

&lt;br/&gt; OS IDOSOS E AS QUEDAS – INTERVIR PARA PREVENIR &lt;br/&gt;

Introduction: Population ageing is a reality of our society, but quality of life, level of dependence and autonomy are a challenge for our elderly, caregivers, and health teams. Falls can occur at any age, but are more frequent in the elderly, constituting a serious public health problem due to the resulting comorbidities and the fact that they can lead to death. Objective: To assess the effect of fall prevention in users aged over 65 years followed-up by an Integrated Continuous Care Team (ECCI) of the Health Care Centre Grouping of Alentejo Central (Agrupamento de Centros de Saúde do Alentejo Central – ACES AC). Methodology: A quasi-experimental pre-test/post-test study with a quantitative approach. 17 patients monitored in ECCI were included. Assessment instrument: Morse Scale (application of the National Network for Integrated Continuous Care (RNCCI)), applied to patients to determine their risk of falling. Intervention carried out following the priorities identified on the basis of the diagnosis made. Statistical treatment using the software IBM SPSS Statistics Version 24. Results: After identifying medium and high risk of falling in more than 80% of the elderly, we found that 23.5% of the elderly already had a history of falling, followed by educational interventions and dissemination of the project. Conclusion: The intervention of the community team with the elderly at home is essential to reduce the number of falls. Conducting the assessment and determining the risk factors allows professionals to define strategies to reduce falls and their consequences. Keywords: Community Nursing; Elderly; Falls; Prevention.

Hypotensive effects of drug combinations in elderly and old patients with controlled arterial hypertension

Aim. To assess the frequency of arterial hypotension, orthostatic hypotension, low blood pressure (BP) and their clinical manifestations in the group of elderly and senile patients with a controlled course of arterial hypertension (AH), taking combinations of drugs based on an angiotensin-converting enzyme inhibitor (ACE inhibitor).Materials and methods. The study included 171 male and female residents of Krasnodar Territory with drug-controlled AH (blood pressure - BP less than 140/90 mm Hg in the background of previous antihypertensive therapy containing an ACE inhibitor perindopril), and with diseases of atherosclerotic genesis. All patients were questioned, tested for balance control, assessed for the risk of falls according to the Morse scale, hypotension in orthostasis was determined, measured office BP, carried out daily monitoring of BP with the determination of the time indices of hypotension and low BP.Results. Most often patients took a combination of ACE inhibitors with calcium channel blockers (CCB) (28.1% of cases), beta-blockers (BB) (27.1%) or diuretics (29.1%). Assessing the risk of falls on the Morse scale, there was a significantly lower level in patients who took the combination of perindopril with CCB compared with those who received perindopril with BB (15 versus 25 points respectively, p=0.039). Patients receiving perindopril and CCB lost balance in the “legs together” position in 19.3% and in the “tandem” or “semi-tandem” position of the feet in 29.8% of cases, that could be compared to the group taking perindopril and a diuretic (22% and 33.9%, respectively) and significantly lower than in the groups with perindopril and BB therapy (34.5% and 50.9%, respectively, p1=0.037, p2=0.043). The time index of low systolic and diastolic BP during therapy with perindopril and CCB was significantly lower than the corresponding indicator in the groups of patients treated with perindopril and BB (22% and 17% versus 27% and 21%, respectively, p1=0,009, p2=0,024), and the time index of low systolic BP for the combination of perindopril and diuretic is lower than for the combination of perindopril and BB (23% versus 27%, respectively, p=0.023).Conclusion. The data obtained on the frequency of arterial hypotension, orthostatic hypotension and low BP in the group of elderly and senile patients indicate the advisability of further studying the risks of drug hypotension in order to better personalize the treatment of AH.

Assessment of lower urinary tract symptoms as part of falls screening: Knowledge and practice of health care workers involved in the management of older people

Falling is a public health problem that could be prevented by screening at-risk populations. Several tools exist, some of which assess lower urinary tract symptoms (LUTS). Our aim was to examine knowledge and practice regarding the assessment of LUTS when screening for fall risk in older people. The knowledge and practices of geriatric caregivers regarding falls risk screening were surveyed by an online self-administered questionnaire, consisting of 6 to 29 questions depending on the responses. A descriptive analysis of the responses was performed. Of 120 caregivers approached, 71 responded to the questionnaire (92% female, median age 44 years [40.5-50.7]). Most respondents were nurses (58%). 51 were aware of at least one fall risk screening tool, and 23 felt they assessed at least one LUTS. The 3 most known tools were the Timed up and go test (n=16), the unipodal stance time (n=10) and the Morse scale (n=8). 33 used fall risk screening tools, and 15 felt they assessed at least one SBAU. The 3 most used tools were the Timed up and go test (n=6), the STRATIFY scale (n=5) and the Morse scale (n=4). Most fall risk screening tools known or used by caregivers involved in the care of the older adult do not assess LUTS.

Effect of Telenursing on Caregiver Burden of Care and Incidence of some Complications in Patients with Acute Stroke Discharged from Neurological Wards: A Randomized Control Trial

Background: Brain stroke is the main cause of death and disability worldwide. This disease can cause major complications in patients and place a great burden of care on caregivers. Therefore, this study was conducted to determine the effect of telenursing on the burden of care in caregivers and the rate of complications in patients with acute brain stroke discharged from neurological wards. Methods: This two-arm parallel-group single-blind randomized clinical trial study was carried out on 72 patients with acute brain stroke discharged from neurological wards in Qom, Iran, in 2019. The patients and their caregivers were divided to control and intervention groups using random block allocation. In addition to the usual training of the ward, the intervention group received training and counseling based on their needs through phone calls for 4 weeks. However, the control group received only the usual ward training. Immediately after discharge from the hospital and 1 month later, the average care load in caregivers and urinary problems, bedsores, and the number of falls in patients were measured. A demographic questionnaire, Caregiver Burden Inventory, Braden Scale, Morse Scale, and a urinary problem checklist were used for data collection. The data were analyzed using the chi-square test, Mann-Whitney U test, independent t-test, and paired t-test by SPSS software (version 24). Results: After the intervention, the mean scores of the caregiver’s burden of care in the control and counseling groups were 35.22 ± 17.215 and 8.00 ± 7.556, respectively (P &lt; 0.001). In addition, the counseling group experienced remarkably fewer urinary problems (P &lt; 0.001) and falling (P = 0.011). Conclusions: This study showed that telenursing reduced the burden of care in caregivers and decreased urinary tract infections and the number of falls in patients with acute stroke. Therefore, nurses and healthcare providers can use this program to improve the lifestyle of patients with acute brain stroke and their caregivers.

Гематологические индексы – возможный маркер субклинического воспаления у больных ишемической болезнью сердца старческого возраста и долгожителей

Aim. To study the possibility of using hematological indices as markers of subclinical inflammation in very elderly patients and centenarians with coronary artery disease (CAD). Materials and Methods: The cross-sectional study enrolled 127 patients; 93 patients with CAD – in the study group, 34 patients without CAD – in the control group. The mean age of patients reached 88.2±5.3 years (76–98 years); 48.8% were over 90 years of age. The ratio of the number of neutrophils to lymphocytes (NLR), neutrophils to monocytes (NMR), platelets to lymphocytes (PLR), lymphocytes to monocytes (LMR) and the systemic immune-inflammation index (SII) were determined. Interleukin-6 (IL-6) was determined in all patients, tumor necrosis factor (TNF)-α – in 49 patients. Results. In patients with coronary artery disease, the mean content of leukocytes was significantly higher than in the control group (6.1±1.5 and 5.4±1.5×109/l, respectively, p=0.02), and platelets were less (212±60 and 243±78×109/l, respectively, p=0.02). The platelet-lymphocyte ratio (139±54 and 185±87, p=0.001), neutrophils-monocytes ratio (12.4±13.4 and 20.8±22.0; р=0.04) and systemic immune-inflammatory index (554±345 and 762±616; p=0.02) were lower in patients with CAD. In patients with heart failure, a significantly higher content of leukocytes was revealed (6.5±1.7 and 5.7±1.4×109/l, respectively, p=0.009). A direct correlation was established between NLR and the concentration of IL-6 (r=0.26; p=0.003), as well as an inverse correlation with the content of TNF-α (r=-0.3; p=0.03). Inverse correlation was registered between the NLR and functional abilities of patients (for Barthel index: r=-0.35; p&lt;0.0001; for IADL scale: r=-0.34; p&lt;0.0001). There was a direct correlation between NLR and the risk of falls by the Morse scale (r=0.38; p=0.001). Direct relationships between TLR and IL-6 (r=0.18; p=0.04), ESR (r=0.20; p=0.02) and the values of the Morse Fall Scale (r=0.43; p&lt;0.0001) were observed. An inverse correlation was registered between TLR and TNF-α (r=-0.43; p=0.002), Barthel index (r=-0.20; p=0.02), IADL scale (r=-0.21; p=0.01) and bone mineral density in the femur (r=-0.2; p=0.03). A direct correlation of systemic immune-inflammation index with IL-6 (r=0.24; p=0.006) and the values of the Morse Fall Scale (r=0.49; p&lt;0.0001), as well as an inverse relationship with TNF-α (r=-0.36; p=0.01), Barthel index (r=-0.26; p=0.02) and IADL scale (r=-0.3; p=0.001) were observed. Conclusion. Various hematological indices can be used as markers of subclinical inflammation in patients with coronary artery disease in old age and in centenarians.

Outcomes of surgery in patients 90 years of age and older: A retrospective cohort study

BackgroundImportant trade-offs of risks versus benefits of surgery need to be discussed with older adults, in particular nonagenarians who are candidates for surgery. Data that examine specific outcomes of surgical interventions in this age group are sparse. We aimed to evaluate the clinical presentation and postoperative outcomes of nonagenarians undergoing surgery. MethodsA retrospective cohort study of consecutive patients 90 years of age and older who underwent surgery between 2014 and 2018 in general surgical ward of a large-volume academic center. Subgroups were designed according to type of surgery (elective versus emergency surgery) and diagnosis (oncology versus non-oncology).Preoperative assessments included Malnutrition Universal Screening Tool, Norton Scale, Morse Scale, Katz, and Lawton-Brody indices. ResultsA total of 198 nonagenarians underwent surgery, of which 38% were elective and 62% were emergency surgery. Median follow-up was 26 months. More patients in the elective group compared with the emergency group had oncology diagnoses (42.1% and 14.7%, respectively, P < .001), resided preoperatively at home (93.4% and 77.9%, respectively, P = .003), and were functionally independent (71.1% and 41.8%, respectively, P = .0005). Postoperative 30-day mortality frequency was 6.6% in the elective group and 39.3% in the emergency group (P < .001). Two-year survival frequency of non-oncology group was 72.7% in elective surgeries and 40.6% in emergency surgeries (P < .001). Two-year survival frequency of oncology group was 37% in elective surgeries and 27.8% in emergency surgeries (P = .12). ConclusionElective surgery in adults aged 90 and above can be safely performed with acceptable 2-year outcomes. Emergency surgery for oncology diagnoses carries dismal outcomes, so palliative approaches should be considered.

Diabetic Foot Ulcers and Risk Fall in People with Type 2 Diabetes Mellitus in BLUD RSUD Dr. Ben Mboi Manggarai Regency, NTT

The prevalence of diabetes mellitus in Manggarai Regency in 2019 is 535 people and some of them have diabetic foot ulcers. Patients with diabetic foot ulcers had a higher risk of falling than others.This study was to determine the risk factors for diabetic foot ulcers and the risk of falls in patients with type 2 diabetes mellitus. A quantitative study using a cross-sectional study was conducted at BLUD RSUD dr. Ben Mboi in April-June 2020 (n = 51).The sampling technique used was purposive sampling with a questionnaire of diabetic foot screening and risk stratification form and Morse scale. Logistic regression results showed that there was a significant relationship between claudication (AOR: 8.409, 95% CI 1.664-42.500, p value 0.010), history of previous diabetic foot ulcers (AOR: 5,680, 95% CI 1,151-28,035, p value 0.033) with diabetic foot ulcers. There was a significant relationship between hypertension (AOR: 0.152, 95% CI 0.028-0.834, p value 0.030), diabetic foot ulcers (AOR: 11.392, 95% CI 1.277-101.651, p value 0.029) with the risk of falling for patients with type 2 diabetes mellitus. Assessment of the risk of diabetic foot ulcers and the risk of falls should be done in patients with diabetes mellitus with or without neuropathy peripheral

Анализ факторов риска падений и аудит программы профилактики падений в многопрофильном стационаре

Aim. To explore the organization of the activities of nurses in the prevention of falls and injuries of patients in the multidisciplinary hospital for compliance with the requirements of the quality management system. Materials and methods. Retrospective analysis of 1600 medical records of patients admitted to the surgical and therapeutic department of the multidisciplinary hospital, assessment of the risk of falls using the Morse scale, interviews of medical personnel, audit of the hospital using quality management system approaches. Results. Most of the patients in the hospital, despite of the profile, have a low and medium risk of falls, regardless of age, but due to the underlying disorders and concomitant diseases, as well as restrictions imposed by the disease, the presence of falls in the anamnesis. To assess the risk of falls in a medical organization for adult patients, it is advisable to use the Morse Fall Scale (MFS) in dynamics with fixation in the medical documentation in accordance with the adopted regulations. We have confirmed 70% compliance of the fall prevention program in the multidisciplinary hospital with the practical guidelines of Roszdravnadzor for the safety of medical care. Conclusions. In the context of limited resources, a differentiated approach to the prevention of falls in the medical organization will contribute to the decrease and absence of injuries.

Fall incidence in hospitalized patients and prediction of its risk factors using a weighted Poisson model

AimFalls in hospital as a major cause of disability and death threaten patients’ safety and quality of life. We studied fall incidence in hospital, and predicted its risk factors using weighted Poisson (WP) model versus other models.MethodThis cross-sectional study was performed on the patients referred to two central hospitals in Qazvin, Iran between 2017 and 2019. The data were collected using the Morse scale and fall reporting forms in the hospital patient safety units (288 falls). Factors including age, gender, time of fall, fall location, cause of fall and its complications, drugs administrated, disease history, post-fall care measures, presence of companion, and length of hospital stay were assessed. The WP model was compared with other models.ResultsFall incidence was 2.5 per 1000 patient days. Among them, 62.5% were elderly (mean age 65.7 ± 19.21 yr). Using the WP model, age, gender, fall location and fall cause, drugs administered, post-fall care measures (P < 0.001), and the presence of companion were identified as risk factors for falling (P < 0.001) Older females, those without a companion, and those without post-fall care measures and with medication history were at a higher risk. Falls from bed were the prevalent type of fall (IRR = 1.65). Falls in the internal ward were lower than in other wards (IRR = 0.67).ConclusionThe WP model is suggested as an appropriate model to predict fall risk factors. Fall rate may be reduced by combining information on risk factors with the strategies of training nurses or caregivers, or making possible changes in patients’ environment.

Risco de quedas associado a terapia medicamentosa em pacientes hospitalizados

The risk of falls and the administration of medications are related to the safety of hospitalized patients. Thus, this study aimedto identify classes of drugs and drug interactions that increase the risk of hospital falls. This was a quantitative, cross-sectionalstudy, in the southern region of Brazil, with 612 patients from inpatient units. Data were collected using a specific instrumentfor demographic data, Morse Scale and medical chart analysis from June to August 2015. In the univariate statistical analysis,absolute and relative frequencies were used and in the bivariate analysis, a chi-squared test with a level of 5% significancewas used. 612 patients participated in the study, with use of drugs that act on the cardiovascular and nervous systemsprevailing. The main classes of drugs related to high risk of falls were antiparkinsonian (76.2%) and calcium channel blockers(57.1%). The number of medications was also associated with a high risk of falling, present in 56.2% of patients using fiveor more drugs. 2,187 drug interactions were identified, of which 9.1% were potentiating the risk of falls, among the drugsinvolved in serious or contraindicated interactions there was a higher frequency among patients taking morphine (16.5%)and metoclopramide (6.0%). The most frequent serious interaction was morphine and tramadol (7.7%). It was observedthat drugs frequently used by hospitalized patients are associated with an increased risk of falls and that the existence ofpotential drug interactions also can increase the risk of falls. Knowing the profile of the drugs used and their relationship withthe risk of falls in the hospital environment helps administrators implement preventive actions.

Risco de quedas e determinantes sociais em idosos residentes em uma comunidade rural

Objective: To evaluate the risk of falls and to identify the social determinants associated with them in the elderly living in a rural community. Methodology: Quantitative, cross-sectional, descriptive, and correlational study, performed in a probabilistic sample, randomly selected, with an estimated frequency of 50% and with an acceptable margin of error of 5% and a confidence level of 95%. Study carried out at the Primary Health Care level, in a Personalized Health Care Unit, of the Northern Region of Portugal. The randomly selected sample consisted of 321 people over the age of 65, with a mean age of 76.11 ± 6.79, living in the community, of whom 175 (54.5%) were female and 146 (45.5%) were male. Data collection was done through the straightforward filling out of an evaluation protocol, using the Morse scale. Results: The Morse scale allowed us to verify that 33.0% of the sample presented a low risk of falling and 7.2% a high risk. The risk of falls was associated with age, sex, the fact that the elderly lives with other relatives, the unmarried, those with the lowest incomes and those who receive support. Conclusion: Social determinants have an impact on the risk of falls and should be considered in fall prevention programs.