BACKGROUND:Inpatient falls are common and result in significant patient morbidity.OBJECTIVE:To identify predictors of serious injury being found on imaging studies of inpatients evaluated after a fall.DESIGN:Retrospective study.SETTING:An 1171‐bed urban academic medical center.PATIENTS:All inpatients who fell on thirteen medical and surgical units from January 1 to December 31, 2006.MEASUREMENTS:Patient characteristics, circumstances surrounding falls, fall‐related injuries, and length of stay were collected through review of incident reports and computerized medical records. Primary outcome of fall‐related injury was determined by evidence of injury on imaging studies within two weeks of the fall. Univariate and multivariate logistic regression were used to calculate adjusted odds ratios (ORs) for injury after an inpatient fall.RESULTS:A total of 513 patients had 636 falls during the study time period. Fall incidence rate was 1.97 falls per 1,000 patient days. 95 patients (19%) fell multiple times (range, 2‐6 events); 74% of the falls occurred in patients who were previously assessed as being “at risk” by the nursing staff. Multivariate analysis, adjusting for age and sex, found evidence of trauma after a fall (OR = 24.6, P < 0.001) and ambulatory status (OR = 7.3, P < 0.01) to be independent predictors of injury being found on imaging studies.CONCLUSIONS:Inpatient falls are common despite high‐risk patients being identified. After adjusting for age and sex, evidence of trauma and ambulatory status were independent predictors of an injury being found on imaging studies after an inpatient fall. Journal of Hospital Medicine 2010;5:63–68. © 2010 Society of Hospital Medicine.

Falls are prevalent among older adults and can lead to injury, hospitalization, and increased healthcare costs. Environmental hazards, medications, vision problems, and impairments in strength, gait, or balance can increase fall risk. A multifactorial fall-risk assessment including a fall history, physical exam, gait and balance evaluation, and environmental assessment is recommended for all older adults who present with a fall or problem with gait or balance. Multiple-component exercise programs, tai chi, vitamin D supplementation, withdrawal of psychotropic medications, and early cataract surgery have all been shown to reduce fall rates. Multifactorial interventions that include medication review, vision correction, management of orthostasis, environmental modification, and balance, strength, and gait training can also be beneficial in preventing falls.

Introduction Social isolation is a major public health concern, as isolated individuals are at increased risk of poor overall health, as well as at increased risk of unhealthy behaviors. During the COVID‐19 pandemic, social distancing strategies have led to increased rates of loneliness and social isolation. There is a clear need for strategies to mitigate the effects of social isolation and loneliness on the mental and physical health of older adults. In this study, we sought to better understand how voice‐controlled intelligent personal assistants (VIPAs) could be leveraged to reduce loneliness and social isolation among home‐bound older adults. Methods Patients and geriatric experts were recruited to use VIPA devices (Google Home) in their homes for 4 weeks and then provide feedback. No prior training was provided. Geriatric experts were recruited via email solicitation from the Northwestern Medicine Geriatrics Clinic, and patients were solicited directly from geriatric primary care physicians. The investigators used qualitative analysis to identify codes and overarching themes. Results A total of 288 comments were received from 16 participants. Eight major themes were identified: Administrative, Companionship, Home Control, Education, Emergencies, Entertainment, Health and Well‐Being, and Reminders. Discussion Results demonstrate that VIPAs can be useful across multiple domains and potentially play a role in providing physical, social, and cognitive stimulation to home‐bound older adults. VIPAs have a wide range of functionality, many of which could be implemented to focus on common geriatric syndromes and may ultimately be a tool to help mitigate social isolation and the consequential loneliness.

Hall, Jenny et al 2016 Technology Enabled Care (TEC) Introduction: Public service reform in Scotland is focusing on prevention and early intervention with the aim of breaking cycles of inequality and poverty. Public bodies are expected to play a full part in delivering these improved outcomes with leaders and their teams working collaboratively across organizational boundaries to ensure that services are shaped around the needs and demands of individuals and communities.The Scottish Government's 2020 Vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting.NHS Highland health board in Scotland covers an area of over 32,500 square km. With a population of 320,000 it is one of the largest and most sparsely populated Health Boards in the UK. NHS Highland care home places for older adults are provided by care homes owned and managed by a mixture of local authority/health board, private organisations and the voluntary sector. In the care home sector improved outcomes for individuals are expected to come about by preventing adverse situations through the use of anticipatory care and planned care models.Latest care home census data indicates that close to 57% of care home residents in the NHS Highland area are affected by dementia (both medical and non-medically diagnosed). Access to specialist psychiatric expertise for staff and for residents affected by dementia presents challenges in this rural context due to long gaps between consultant visits and the anxiety and stress related to travel to secondary care for appointments in between consultant visits. TEC psychiatric clinics have been introduced to address these challenges.Practice Change Implemented: Nurse led TEC older adult psychiatry clinics were introduced in three rural care homes in NHS Highland with the aim of providing improved access to psychiatric care services, reducing unnecessary admissions, reducing antipsychotic use for people with dementia and improving the management of behavioural and psychiatric symptoms of dementia.Hall; Technology Enabled Care (TEC) provision for the care home sector in the Scottish Highlands: video conferencing in care homes.Stakeholder groups involved in the psychiatric clinics included the service provider (NHS Highland), technology enabler and facilitator (Scottish Centre for Telehealth and Telecare, SCTT), care home managers and staff, care home residents/family members, occasional care home users (day care and lunch clubs) and other wider community users such as GPs, social workers, hospital consultants, pharmacists, community nurses.Key Findings and Highlights: The direct impact on residents has been quicker assessment, treatment review and regular monitoring. Residents and family members believe that it is more responsive to their needs.