Post Fall Research Articles

S1940 Barrett's Esophagus With Multiple Neuroendocrine Tumors

INTRODUCTION: Neuroendocrine tumors are a rare group of cancers that can occur in many different organs. Due to their rarity and variable presentation, they are not well understood. In contrast, Barrett’s esophagus is a well-known condition frequently associated with the development of esophageal adenocarcinoma. Identifying an association between two conditions is often helpful in forming timely diagnoses and treatment plans. Here we present a rare case of Barrett’s esophagus and multiple neuroendocrine tumors. CASE DESCRIPTION/METHODS: A 73-year-old male presented to the hospital status post fall due to altered mental status. Relevant past medical history included GERD, Barrett's esophagus, and gastric adenocarcinoma which was treated with surgery and chemoradiation 6 years prior. Head CT revealed lesions in the frontal lobe and the cerebellum (Figure 1). Further investigation with a CT chest, abdomen, and pelvis showed additional lesions in the bilateral lung lobes and the left trochanter (Figure 2). Biopsies of the esophagus and stomach on esophagogastroduodenoscopy (EGD) showed Barrett's esophagus with no presence of gastric metaplasia (Figure 3). A subsequent biopsy of the trochanter was performed. Pathology results were positive for synaptophysin, chromogranin, CK7, and CK20 at both biopsy sites. Ultimately, the patient was placed on hospice. DISCUSSION: The rarity of neuroendocrine tumors and their ability to manifest in many different organs often makes diagnosis difficult. As with this patient, the nature of the lesions was initially unclear due to the various tissues involved. Synaptophysin and chromogranin are specific to neuroendocrine tumors which were found in both the esophagus and trochanter. CK7 and CK20 which are markers usually found in gastrointestinal mucosa, were unusually found in the trochanter. Furthermore, biopsies of the esophagus and stomach were negative for gastric adenocarcinoma. This indicates that these new lesions were not due to a recurrence of the patient’s prior stomach cancer. Although brain and lung biopsies were not conducted due to their invasive nature, the sporadic and isodense appearance of these lesions on radiography suggest that they are likely additional neuroendocrine tumors. Further research is needed to determine if these findings are coincidental or if there is a true association between Barrett’s esophagus and neuroendocrine tumors, as this may allow for prompt diagnosis and treatment.Figure 1.: CT of the head showing an isodense lesion in the cerebellum as marked by the red arrow.Figure 2.: CT of the left trochanter showing an isolated bone lesion as marked by the red arrow.Figure 3.: Biopsy of the esophagus demonstrating a high degree of dysplasia with numerous neuroendocrine cells.

Using a Post Fall Assessment Simulation to Examine Nurse Thought Processes.

The prevalence of injurious falls is high in the Veterans Health Administration (VHA) and a major patient safety issue. The VHA is embracing technology such as simulation to improve patient care. Little is known regarding nurse thought processes while undergoing a post fall assessment simulation in the VHA. This article examines the benefit of using an evidence-based post fall simulation to improve nurse assessment skills while providing opportunity for practice without harm to patients.

Non-occupational falls from ladders in men 50 years and over: Contributing factors and impact

BackgroundResearch into falls from ladders in older men in the non-occupational setting is limited, yet such falls are increasing. AimTo explore non-occupational falls from ladders in older men presenting to a major trauma centre; identify factors influencing ladder climbing behaviour and explore the post fall impacts. MethodsWe conducted a retrospective review of medical records of men aged 50 years and older admitted to a major trauma centre following a non-occupational ladder fall between February 2011 and December 2013. Interviews were conducted with a sample of men (and their partners where possible) after discharge from hospital. The Late Life Functional Disability Instrument-computer adaptive testing (LLFDI-CAT) was administered to determine pre-and post-fall function. Basic descriptive analysis was undertaken on medical record data. Thematic analysis was used with the socioecological (SE) model as an interpretive frame. ResultsOf 86 men included in the study (range 50–85 years, mean age 64.7 years), 27% sustained severe trauma. The median length of stay was 4 days. Fourteen interviews were conducted with 19 participants (12 men, 7 spouses). The most salient pre-fall factor was a lack of assessment of risk, reflecting individual and community factors. Post fall impacts were identified in all domains of the SE model. A statistically significant decrease in self-reported post-fall compared with pre-fall LLFDI-CAT scores for interviewed men was found, despite seven having minor trauma (Injury Severity Score [ISS]<12) on admission. ConclusionLadder fall injuries cause marked morbidity, often with life changing impacts, even with minor trauma. Contributing factors are multifactorial. Injury prevention strategies should address these factors.

60 Post Inpatient Fall Medical Assessment (PIFMA) Performa Quality Improvement Project

Abstract Introduction Inpatient falls are the most commonly reported patient safety incidents and in the United Kingdom, there are 250,000 reported falls per year 1. A rapid response report (RRR) issued in 2011 by the NPSA highlighted need for improvement in identifying fractures and neurological observations. These figures reflect significant implications to patients’ health and financial burden to the NHS. Aims To improve assessment and documentation of inpatient falls assessment. Methods Two PDSA cycles were completed. First PDSA cycle established a baseline of post fall assessment and documentation in which raising awareness and teaching (RAT) to junior doctors was done. Second PDSA cycle identified room for further improvement and post inpatient fall medical assessment (PIFMA) Performa was developed to aid assessment and documentation for use of junior doctors. Feedback regarding the usefulness of the PIFMA Performa was collected via survey. Results The RAT intervention involved 30 patients of the Elderly wards in November and December 2017 and the PIFMA intervention involved 29 patients in all Medical wards in January and February 2019. The PIFMA Performa improved the time taken to review patients as per doctors survey. On comparing the RAT against PIFMA Performa interventions, documentation improved in the categories of physical examination (from 80% to 97%), neurological observations (from 49% to 98%), medication review (from 53% to 83%), and measuring lying standing blood pressure (from 83% to 90%). Conclusions Feedback from junior doctors states that the PIFMA Performa was certainly a very useful guidance tool and help to speed up documentation. These improvements only translated if junior doctors utilize the PIFMA Performa and so this is now being implemented in the trust policy. Further PDSA cycle can reassess if improvements truly represent the population cross-section.

An inventive and innovative system to detect fall of old aged persons – a novel attempt with IoT, sensors and data analytics to prevent the post fall effects

An inventive and innovative system to detect fall of old aged persons – a novel attempt with IoT, sensors and data analytics to prevent the post fall effects

An inventive and innovative system to detect fall of old aged persons – a novel attempt with IoT, sensors and data analytics to prevent the post fall effects

According to the statistics of national council on aging (NCOA), these days rate of deaths in the old aged people has reached a critical state that for every 11 seconds an older adult is being treated for a fall and for every 19 minutes a death is taking place. Statistics by north eastern Ohio state reveals that, the rate of emergency room treatment of fall related injuries in persons aged 75 and older approached 80 per 1,000 per year in women and 60 per 1,000 per year in men. Falls in elders vary from that of the falls in kids, as the healing power in the old people slackens with their age. We present a frugal and affordable system that could monitor the motion of the old people and can detect their fall. We use IoT, sensors and data analytics to build this system. The system is tested for its functioning and is fool proof.

15 The Outcome of Post Fall Intervention Analysis in Medical Department, Sungai Buloh Hospital

Abstract Introduction Incident reporting form does not capture the exact mechanism of falls. With the increment in the number of falls in Medical Department, Falls Intervention Team (FIT) was formed in March 2018. Objectives The objective of this study was to analyse factors that lead to falls in medical wards based on falls incident reporting form (HSB-MED-FORM-017) and post fall investigation form (HSB-MED-FORM-023). Methods There were 82 incidents in the Medical Department since March 2018 till now. However 26/82 data were missing (excluded), only 56 post fall investigation forms were analysed. Data were cross-tabulated via Chi square in SPSS version 23. Results 33/56 fallers were among the younger age group (&amp;lt; 65 years), majority being males (82%). Most fallers were categorized with high risk (36/56) according to Morse Fall Scale. The common falls area is within the 4 bedded cubicle (82%) which is away from nursing counter. The commonest location is bedside (40/56, 71%). Most of the falls (22/56, 39%) occurred during night shift (9pm – 7am). Majority of the falls happened while patients were trying to get out the bed (20/56). Falls while going to and in the toilet (21/56), were associated with the younger age group &amp;lt; 65 (18/21, p &amp;lt; 0.005). 18/21 (85%) in the elderly group (age &amp;gt; 65) fell due to extrinsic factors, (p &amp;lt; 0.016). However there was no correlation in age for intrinsic factor and environment as the cause for falls. Faller who needs supervision assistance is closely related to extrinsic factor for falls (p &amp;lt; 0.058). The commonest cause of falls in this cohort is due to intrinsic factor (51/56, 91%). Conclusion FIT has benefitted the department in understanding falls incidences and characteristics. Future studies need to incorporate strategies to maximize and evaluate ongoing adherence to interventions in hospital falls prevention programs.

3101 Barrett's Esophagus With Metastatic Neuroendocrine Tumor

INTRODUCTION: Neuroendocrine tumors are a rare group of cancers that can occur in many different organs. Due to their rarity and variable presentation, they are not well understood. In contrast, Barrett's esophagus is a well-known condition frequently associated with the development of esophageal adenocarcinoma. A review of literature has shown only 8 cases demonstrating an association between neuroendocrine tumors and Barrett's esophagus. CASE DESCRIPTION/METHODS: A 73-year-old male presented to the hospital status post fall due to altered mental status. Relevant past medical history included GERD, Barrett's esophagus, and gastric adenocarcinoma which was treated with surgery and chemoradiation 6 years prior. Imaging of the head revealed metastatic lesions. Further investigation with a CT chest, abdomen, and pelvis showed metastatic lesions in the bilateral lung lobes and the left trochanter. Biopsies of the esophagus and stomach on esophagogastroduodenoscopy (EGD) showed Barrett's esophagus with no presence of gastric metaplasia. A biopsy of the trochanter was also performed. Pathology results were positive for synaptophysin, chromogranin, CK7, and CK20, at both sites of biopsy for the esophagus and trochanter. Ultimately, the patient was placed on hospice. DISCUSSION: Neuroendocrine carcinomas of the esophagus are rare, accounting for 0.4-5.9% of all esophageal carcinomas. The rarity of neuroendocrine tumors and their ability to manifest in many different organs often makes diagnosis difficult. As with this patient, the origin of metastatic disease was initially unclear due to the multiple sites involved. Synaptophysin and chromogranin are specific to neuroendocrine tumors which were found in both the esophagus and trochanter. CK7 and CK20 are markers usually found in gastrointestinal mucosa, suggesting that the esophagus was the primary site of cancer. Furthermore, biopsies of the esophagus and stomach were positive for Barrett's esophagus and negative for metaplasia of the stomach, indicating that these metastatic lesions were not from a recurrence of the patient's prior gastric cancer. Further research is needed to determine if these findings are coincidental or if there is a true association between Barrett's esophagus and neuroendocrine tumors.

25 The Post Fall Review- An Opportunity to Intervene for Bone Health

Abstract Background Falls are a common occurrence in Irish hospitals and can result in much morbidity and mortality for our patients. According to NICE guidelines, a multi-factorial falls risk assessment should be carried out for those patients at risk of falling, including assessment of osteoporosis risk and medication review. In practice, the post falls assessment is a golden opportunity to assess Osteoporosis risk and adequate bone protection. Methods We compiled a list of patient falls registered on the Datix incident reporting system for our five wards over a three-month period from 13/10/18-15/1/19. We looked at the note post fall from the reviewing doctor and documented whether bone protection was addressed and also whether a known history of osteoporosis was documented. This was done on our electronic patient record system. Results A total of 106 falls were recorded during this time period. 87% of falls had a documented review post fall. 83 reviews were by the intern on call and team reviewed in 54 cases, often after the intern. 2 of the notes documented whether or not the patient had a known history of Osteoporosis. There was no mention about the presence or absence of bone protection in any of the notes. 14%(15) patients were on bone protection. 37%(40) were on vitamin D or calcium. 2 patients sustained a fracture in their fall. Conclusion This audit highlights that bone protection and osteoporosis risk are rarely being addressed post fall. To improve this we are going to give education on post falls assessment (including evaluating osteoporosis risk and assessing current bone protection or need for bone protection) to incoming intern groups and doctors on teams assessing falls. We will reaudit 3 months after this education to evaluate whether there has been an improvement.

How to Prevent Falls and Fall-Related Injuries: A Virtual Breakthrough Series Collaborative in Long Term Care

Aims: To reduce preventable falls and fall related injuries in State Veterans Homes (SVHs), we conducted a virtual breakthrough series (VBTS) quality improvement collaborative.Methods: Participating teams attended educational calls, received coaching, and submitted reports on process changes. Outcomes for the project included fall rates (total number of falls divided by the total number of census days reported) and fall injury rates (total number of falls with any injury divided by the total number of census days reported). Outcomes were tracked 6 months before, during, and after the project and compared using a Poisson regression model.Results: Twenty-six SVHs participated and implemented 27 unique interventions. The most commonly implemented interventions included post fall huddles, staff education, and intentional rounding. There was significant improvement in the fall related injury rate (injuries per 100 census days), decreasing from 7.4 before, to 6.6 during (p = 0.009) and 5.6 after (p = 0.005) the VBTS. The minor injury rate (minor injuries per 100 census days) decreased significantly from 6.4 during the VBTS to 5.8 (p = 0.000) after the VBTS. There was no statistically significant decrease in total fall rates or major injury rates.Conclusion: Lessons learned may be of interest to other SVH facilities seeking to improve their falls prevention program.

VISUAL HALLUCINATIONS AS A SAFETY CONCERN IN THE ELDERLY

Introduction Between 30 and 40 percent of community-dwelling- people over the age of 65 years, and 50 percent of those in long-term facilities, fall each year. Fall-related injuries are associated with significant subsequent morbidity: the decline in functional status, increased likelihood of nursing home placement, and greater use of medical services. Complications arising from falls are the leading cause of death from injury in the geriatric population as mortality is three times higher for seniors sustaining falls compared to the younger individuals. Falls in older individuals are most often due to multiple causes, including age-related declines in balance and gait, superimposed by acute illness, medication, and cognitive impairment. Gait physiology includes the presence of at least two out of three intact sensory systems (visual, vestibular and somatosensory). With a diminished proprioception response due to age-related decline, impairment in either visual or vestibular system compromises gait and balance. In addition, the annual incidence of falling is approximately twice as high for patients with cognitive impairment and dementia as it is for people with no cognitive impairment. In the elderly, visual hallucinations have been particularly associated with dementia, delirium, visual impairment, and social isolation. As for prevalence, estimates vary widely from 10 to 29% of the elderly outpatients experienced visual hallucinations. Current literature is lacking data regarding falls associated with visual hallucinations. Methods We present a case of an elderly female who was found on the ground status post fall out of her wheelchair while trying to run from new onset visual hallucinations that varied from two men to headless animals. Her initial assessment included delirium with possible underlying undiagnosed dementia (MOCA 20, MMSE 24/30), ruling out other causes of visual hallucinations including Lewy Body Dementia, Charles Bonnet and medication-induced psychosis. Results As with many new-onset psychotic symptoms, organic causes were ruled out with negative findings on CT Head, Xray of femur and hip. Dementia workup including EEG was completed with negative findings. She continued to experience vivid visual hallucinations of animals and children during her hospital stay. Conclusions Due to the limited research evaluating any causal relationships between visual hallucinations and falls in the geriatric population, further studies are recommended to assess the presence or absence of this causality. It is also crucial to screen for visual impairments, including visual hallucinations, in the high-risk geriatric population to minimize the fall risk and associated morbidity and mortality. Falls in older persons can occur commonly and are major factors threatening the independence of older individuals. This research was funded by: Funding Not applicable

Interrelated Neuromuscular and Clinical Risk Factors That Contribute to Falls.

Neuromuscular and clinical factors contribute to falls among older adults, yet the interrelated nature of these factors is not well understood. We investigated the relationships between these factors and how they contribute to falls, which may help optimize fall risk assessment and prevention. A total of 365 primary care patients (age = 77 ± 7, 67% female) were included from the Boston Rehabilitative Impairment Study of the Elderly. Neuromuscular measures included leg strength and leg velocity, trunk extensor endurance, and knee range of motion. Clinical measures included memory, executive function, depressive symptoms, pain, sensory loss, vision, comorbidity, physical activity, mobility self-efficacy, and psychiatric medication. Factor analysis was used to evaluate clustering of factors. Negative binomial regression assessed the relationship of factors with three-year fall rate. Interactions were tested to examine whether clinical factors modified the relationship between neuromuscular factors and falls. Three factors emerged: (i) neuromuscular factors, pain, and self-efficacy; (ii) memory; and (iii) executive function. Having three neuromuscular impairments predicted higher fall rate (incidence rate ratio [95% confidence interval]: 3.39 [1.82-6.32]) but was attenuated by memory (1.69 [1.10-2.61]), mobility self-efficacy (0.99 [0.98-0.99]), psychiatric medication use (1.54 [1.10-2.14]), and pain (1.13 [1.04-1.23]). Pain modified the relationship between neuromuscular impairment burden (number of neuromuscular impairments) and falls. Having three neuromuscular impairments was associated with a higher fall rate in patients with high levels of pain (5.73 [2.46-13.34]) but not among those with low pain. Neuromuscular impairment burden was strongly associated with fall rate in older adults with pain. These factors should be considered together during fall risk assessment, post fall assessment, and prevention.

Abstract TP448: Post-Stroke Fall Prevention Strategies

Background: Fall prevention strategies are developed to prevent falls in the general patient population. Stroke patients, however, present with unique deficits that increase their potential for falls. There is strong evidence that creating a better understanding of the factors contributing to post stroke falls, and pairing stroke specific interventions with current fall prevention strategies, will result in improved patient safety. Purpose: The primary Objective of this study was to identify the unique characteristics of stroke patients that place them at higher risk for falls, and develop strategies and practices that reflect awareness of stroke deficits. The secondary Objective of this study was to demonstrate the feasibility of preventing harm through reducing the opportunity for injury. Methods: This study reviewed 174 falls occurring from 2015 to 2018 in an Inpatient Rehabilitation unit (IRU) and an Ortho/Neuro unit. The data was obtained through post fall huddle reports which include: diagnosis, gender, stroke location, circumstances precipitating the fall, National Institute of Stroke Scales (NIHSS), and timing of fall. Results: Of 174 falls on the IRU and Ortho/Neuro units, 51% [88/174] of the patients had a stroke diagnosis, 49% [85/174] were identified as “other”. Exclusion of “other” diagnosis resulted in a sample size of 88 patients, comprised of 44% female and 56% male. Of the patients included, 10% had bilateral infarcts, 41% right brain, and 43% left brain infarcts. The circumstances precipitating falls included: 22% during transfers, 32% during toileting, and 36% from falling out of bed/chair, or were unattended. NIHSS and timing of fall were not found to be statistically significant in this study. Conclusion: Identification of a stroke patient’s potential for falling, and development of prevention strategies, may increase the safety on the unit. In addition to current fall prevention strategies, stroke patients should have toileting and purposefully rounding plans developed prior to the start of shift, with an emphasis on transferring and toileting assistance needs. These plans should be shared during shift huddles and bedside report. Due to the relatively small sample size, further studies would be benefited by a larger sample group.

Scaphoid Cysts: Literature Review of Etiology, Treatment, and Prognosis.

Background: Cystic lesions of the carpal bones are rare entities that are infrequently reported in the literature. Scaphoid intraosseous cystic lesions represent a rare subset of carpal bone cysts. This review aims to summarize the available evidence on the evaluation and treatment of scaphoid cystic lesions to help guide clinical management. Methods: Systematic electronic searches were performed using PubMed, Ovid, and Embase databases. Studies included were graded for their risk of bias. Pooled descriptive statistics were performed on incidence, etiology, physical exam findings, treatment, and follow-up. Results: A total of 38 patients representing 41 scaphoid cystic lesions were pooled from 27 articles. Patients presented with wrist pain without fracture (n = 27), pathological fracture (n = 9), swelling only (n = 1), or were asymptomatic (n = 4). Cystic lesions of the scaphoid were initially revealed on imaging with radiographs alone (n = 22), radiographs in combination with computed tomography (CT) (n = 10) or magnetic resonance imaging (n = 6), CT alone (n = 1), or using all 3 modalities (n = 2). Intraosseous ganglia were identified most frequently (n = 31), followed by "bone cyst-like pathological change" (n = 3), unicameral bone cysts (n = 2), aneurysmal bone cysts (n = 2), primary hydatid cysts (n = 2), and cystic like changes post fall (n = 1). Treatment modalities included curettage and bone graft (n = 39) or below-elbow cast (n = 2). On follow-up (average of 21.3 months; n = 40), all patients improved clinically after treatment and were found to have full wrist range of motion without pain (n = 31), slightly reduced grip strength (n = 3), limited range of motion (n = 2), or persistent mild discomfort (n = 2). Conclusions: Scaphoid cystic lesions are most commonly intraosseous ganglia, but can include other etiologies as well. The main presenting symptom is radial wrist pain that usually resolves after treatment. The presence of intracarpal cystic lesions should be considered in the differential diagnosis of wrist pain.

A Fall Prevention Quality Improvement Project in a Long Term Care Facility: Critical Analysis

Falls are a main health burden among seniors, particularly in long term care facilities. A fall prevention quality improvement project was initiated in a geriatric care organization in Ontario, Canada. The purpose of this article is to critically analyze this quality improvement project for reducing fall incident rates by using a Six Sigma model. This quality improvement project consists of conducting a root cause analysis in post fall huddles, “Falling Star” program, and providing fall prevention education for residents and families. The strengths of this quality improvement process include the root cause analysis in post fall huddles and fall prevention education. Some limitations in this quality improvement process include insufficient collaboration with inter-professional team members and the exclusion of residents who are at fall risk, but had not fallen. Three recommendations are provided to increase the possibility of success for this project, including a monthly inter-professional fall safety meeting, the expansion of the “Falling Star” program for all residents at risk of falls, and staff education and training

Fall Recovery Subactivity Recognition With RGB-D Cameras

Accidental falls have been identified as a cause of mortality for elders who live alone around the globe. Following a fall, additional injury can be sustained if proper fall recovery techniques are not followed. These secondary complications can be reduced if the person had access to safe recovery procedures or were assisted, either by a person or a robot. We propose a framework for in situ robotic assistance for post fall recovery scenarios. In order to assist autonomously robots need to recognize an individual's posture and subactivities (e.g., falling, rolling, move to hands and knees, crawling, and push up through legs, sitting or standing). Human body skeleton tracking through RGB-D pose estimation methods fail to identify the body parts during key phases of fall recovery due to high occlusion rates in fallen, and recovering, postures. To address this issue, we investigated how low-level image features can be leveraged to recognize an individual's subactivities. Depth cuboid similarity features (DCSFs) approach was improved with M-partitioned histograms of depth cuboid prototypes, integration of activity progression direction, and outlier spatiotemporal interest point removal. Our modified DCSF algorithm was evaluated on a unique RGB-D multiview dataset, achieving 87.43 ± 1.74% accuracy in the extensive 3003 $({{\boldsymbol{C}}_{10}^{15}})$ combinations of training-test groups of 15 subjects in 10 trials. This result was significantly larger than the nearest competitor, and faster in the training phase. This work could lead to more accurate in situ robotic assistance for fall recovery, saving lives for victims of falls.

Literature review and meta-analysis of risk factors for delayed post-traumatic stress disorder in older adults after a fall.

To test the hypothesis that post-traumatic stress disorder (PTSD) can appear after a fall and try to identify predictive factors for its development in older fallers. Systematic literature review and meta-analyses of studies on PTSD post fall in older subjects. One hundred seventy-seven indexed articles were identified, of which three had complete data on PTSD post fall in older subjects. Only the odds ratio of the association between history of fall and occurrence of PTSD was significant (odds ratio = 2.79 (95% CI, 1.03-7.53). The trend in our results, even though limited, reveals two groups of subjects: frail subjects that are at risk of developing PTSD and subjects who seem to be resistant to its development. A clear description of these two groups may help us identify the population at risk for delayed PTSD who could then benefit from dedicated treatment. Copyright © 2016 John Wiley & Sons, Ltd.

Use of fall risk increasing drugs in residents of retirement villages: a pilot study of long term care and retirement home residents in Ontario, Canada.

BackgroundFalls continue to be a problem for older people in long-term care (LTC) and retirement home (RH) settings and are associated with significant morbidity and health care use. Fall-risk increasing drugs (FRIDs) are known to increase fall risk and represent modifiable risk factors. There are limited data regarding the use of FRIDs in contemporary LTC and RH settings, and it has not been well documented to what extent medication regimens are reviewed and modified for those who have sustained falls. The objective of this study is to characterize medication related fall risk factors in LTC and RH residents and on-going use of medications known to increase fall risk.MethodsRetrospective chart review of residents aged >65 who sustained one or more falls living in LTC or RH settings.Results105 residents who fell one or more times during 2009–2010 were identified with a mean age of 89 years, a mean of nine scheduled medications and seven diagnoses, and 83 % were women. Residents in LTC were ostensibly at higher risk for falls relative to those in RH settings as suggested by higher proportion of residents with multiple falls, multiple comorbidities, comorbidities that increase fall risk and visual impairment. Post fall injuries were sustained by 42 % of residents, and residents in RH sustained more injuries relative to LTC residents (47 vs 34 %). Use of FRIDs such as benzodiazepines, antipsychotic, antidepressant and various antihypertensive drugs was common in the present sample. No medication regimen changes were noted in the 6-month post fall period.ConclusionsThe present study documented common use FRIDs by LTC and RH residents with multiple falls. These potentially modifiable falls risk factors are not being adequately addressed in contemporary practice, demonstrating that there is much room for improvement with regards to the safe and appropriate use of medications in LTC and RH residents.

O-023: The reality of a Portuguese Emergency Department (ED) post fall evaluation: A retrospective analysis

O-023: The reality of a Portuguese Emergency Department (ED) post fall evaluation: A retrospective analysis

Immediate and longitudinal effects of incorporating health literacy and cultural competency into a yearlong pharmacy curriculum

ObjectiveTo determine the immediate and longitudinal effects of incorporating health literacy and cultural competency (HL-CC) concepts into one semester of pharmacy school. MethodsHL-CC concepts were incorporated into three fall semester courses for first-year professional pharmacy students. Students completed a 23-item Likert-type health literacy instrument (perceptions, understanding, and application) and the Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals—Student Version (IAPCC-SV©, Campinha-Bacote, 2007) pre–post fall semester (n = 53, 100% response rate) and post-spring semester (no concept incorporation, n = 52, 98% response rate). Data were analyzed using Wilcoxon signed rank tests to examine the differences between pre- and post-semesters for the health literacy assessments and the IAPCC-SV© assessments. ResultsStudents’ perceptions, understanding, and application of health literacy principles had significant improvements in the fall semester, but some attrition was seen after the spring semester. Students’ cultural competency levels increased during the fall, and their overall IAPCC-SV© scores did not significantly change during the spring. ConclusionsIntegrating HL-CC concepts throughout one semester can be useful for improving pharmacy students’ knowledge and skills in these areas. Concepts should be reinforced throughout the curricula to maintain their knowledge and skills.