Falls in the General Hospital: Association With Delirium, Advanced Age, and Specific Surgical Procedures

Lakatos, Barbara E.; Capasso, Virginia; Mitchell, Monique; Kilroy, Susan; Lussier-Cushing, Mary; Sumner, Laura; Repper-DeLisi, Jennifer; Kelleher, Erin P.; DeLisle, Leslie; Cruz, Constance; Stern, Theodore A.

doi:10.1176/appi.psy.50.3.218

Cited by 103 publications

(89 citation statements)

References 42 publications

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“…In some women, it may be better to postpone operative intervention until the patient has a more stable cardiovascular function. The incidence of venous thromboembolism also increases with age [8]. In general, urogynecological operations are associated with a moderate risk of thromboembolism.…”

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confidence: 99%

“…Additional factors increasing surgical morbidity include longer operation time, excessive blood loss, and general anesthesia. Third, cognitive impairment and the use of benzodiazepines increases with age, as does the risk for falls and fractures [8,9]. Cognitively impaired elderly patients often develop postoperative delirium, which is associated with increased mortality, falls, and respiratory complications such as pneumonia.…”

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confidence: 99%

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Climbing a long hill: pelvic floor surgery and the need for geriatric urogynecology

Betschart

Rizk

2014

Int Urogynecol J

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The topic of geriatric urogynecology is receiving much attention lately as a public health priority because of the global increase in female life expectancy and the significant risk of associated pelvic floor dysfunctions. Statistics from the USA project that in 2050, 25 % of the population will be >60 years and that those >85 will increase from a population of 1.9 % in 2010 to 4.3 % in 2050 [1]. The urogynecological community should thus expect to face a worldwide and progressively growing demand from patients seeking care for pelvic floor dysfunctions. One study predicted >50 % increased demand for urogynecological services over the next 40 years [2].The changing female demographics is accompanied by a considerable interest in the contemporary literature to standardize the indications, techniques, and outcomes of surgical treatment of pelvic floor dysfunctions. Only a few reports appreciate that increasing age of our female population is an intrinsic biological variable interfering with the standardization process [3]. Women aged >80 years undergoing urogynecological surgery have a 13.6 higher risk of postoperative death than their younger counterparts. In the majority of cases, the cause of death is not directly related to the procedure [4]. Despite the obvious need for operative intervention among these elderly women and the strong evidence for the inherent morbidity and mortality of this treatment option, there is scarce urogynecological data on the risks and specific perioperative management in this patient group. Ageing influences lower urinary tract symptoms (LUTS), pelvic floor function, and perioperative and postoperative courses. The higher postoperative morbidity rate is also an important factor that is often overlooked in most surgical studies. Main concerns when treating elderly women are:(1) Functional aging with myogenic and neurological changes (2) Polypharmacy (3) Impaired cognitive function and risk of delirium First, considering functional aging, it is traditionally believed that aging is simply a physiological phenomenon caused by a gradual and exponential decline in the functional reserve. Aging, however, is a complex and evolutionary spectrum of innate and progressive events affecting molecules, cells, and the entire organism and is caused by free radicals, nonenzymatic glycosylation, and apoptosis [5]. The entire process is under the control of the endocrine systems-mainly growth hormone, estrogens, and androgens-with significant acceleration of the pace of ageing in women than in men [5]. Aging induces ultrastructural alterations in the urinary bladder that include apoptosis of the detrusor muscle, widening of the intercellular tight junctions, and degeneration of the axonal innervation [6]. These lesions may contribute to the development of functional disorders such as higher postvoid residual volumes, postoperatively impaired voiding dysfunction, or sensory micturition disturbances. The mechanism by which aging changes in the pelvic organs, particularly the urinary bladder, can influen...

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confidence: 99%

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confidence: 99%

Climbing a long hill: pelvic floor surgery and the need for geriatric urogynecology

Betschart

Rizk

2014

Int Urogynecol J

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“…At the same time, more than two thirds of these patients were concentrated in three types of service -medical, orthopedics and neurological -that are already known to be related to a set of prevalent pathologies (such as the diseases in the circulatory system and respiratory tract) and the characteristics inherent to this age group (2,17) . (18) . It is known that many elderly patients have the hypoactive subtype that is more difficult to detect, unlike patients who have more expressive signs and symptoms; the hyperactive subtype is more easily detected.…”

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confidence: 99%

Analysis of a health team's records and nurses' perceptions concerning signs and symptoms of delirium

Silva

Marques

2011

Rev. Latino-Am. Enfermagem

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Análisis de registros producidos por el equipo de salud y de la percepción de los enfermeros sobre las señales y síntomas de delirioEsta investigación pretendió conocer la dimensión del subdiagnóstico de la confusión aguda/delirio, al analizar los registros producidos por el equipo de salud y percepción de los enfermeros sobre este fenómeno. Fue desarrollado en un hospital universitario central de Portugal. Delineada dentro del paradigma cuantitativo, utilizando la técnica documental y la entrevista. La muestra obtenida, por la aplicación de la Escala de Confusión NeeCham, fue de 111 enfermos con diagnóstico de confusión aguda/delirio, internados en unidades de cuidados agudos médicos y quirúrgicos. Se identificó una tasa de subdiagnóstico del fenómeno de 12,6% en los registros y de 30,6% teniendo en cuenta la percepción de los enfermeros. En 8,1% de los 111 casos, no fue identificado cualquier indicador de confusión aguda/delirio. Solamente, 4,5% de los enfermos tenían el fenómeno diagnosticado. Los resultados apuntan para la dificultad en identificar la confusión aguda/delirio, con implicaciones para la calidad de los cuidados, sugiriendo la necesidad de adoptar medidas formativas dirigidas a los equipos de salud.

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“…Hospitalization increases the risk for falls [1]. In US hospitals, fall rates range from 3.3-11.5 falls per 1,000 patient days, with about 25% of in-hospital falls resulting in injury [2].…”

Section: Introductionmentioning

confidence: 99%

Assessing the Effectiveness of Engaging Patients and Their Families in the Three-Step Fall Prevention Process Across Modalities of an Evidence-Based Fall Prevention Toolkit: An Implementation Science Study (Preprint)

Duckworth¹,

Adelman²,

Belategui³

et al. 2018

Preprint

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Background: Patient falls are a major problem in hospitals. The development of a Patient-Centered Fall Prevention Toolkit, Fall TIPS (Tailoring Interventions for Patient Safety), reduced falls by 25% in acute care hospitals by leveraging health information technology to complete the three-step fall prevention process: 1) conduct fall risk assessments 2) develop tailored fall prevention plans with the evidencebased interventions and 3) consistently implement the plan. We learned that Fall TIPS was most effective when patients and family were engaged in all three steps of the fall prevention process. Over the past decade our team developed three Fall TIPS modalities: the original EHR version, a laminated paper version that uses color to provide clinical decision support linking patient-specific risk factors to the interventions, and a bedside display version that automatically populates the bedside monitor with the patient's fall prevention plan based on clinical documentation in the electronic health record. The relative effectiveness of each Fall TIPS modality for engaging patients and family in the three-step fall prevention process was unknown.Objective: The purpose of this study is to examine if the Fall TIPS modality impacts patient engagement in the three-step fall prevention process and thus Fall TIPS efficacy. Methods:To assess patient engagement in the three-step fall prevention process, random audits were conducted with the question: "Does the patient/family member know their fall prevention plan?" Audits were also conducted to measure adherence, defined by the presence of the Fall TIPS poster at the bedside. Champions from three hospitals reported data from April-June 2017 on six Neurology and seven Medical units. Peer-to-peer feedback to reiterate the best practice for patient engagement was central to data collection.Results: 1209 audits were submitted for the patient engagement measure and 1401 for presence of the Fall TIPS poster at the bedside. All units reached 80% adherence for both measures. Some units maintained high levels of patient engagement and adherence with the poster protocol. Others showed improvement over time, reaching clinically significant adherence (>80%) by the final month of data collection. Conclusions:Each Fall TIPS modality effectively facilitates patient engagement in the three-step fall prevention process, suggesting all three can be used to integrate evidence-based fall prevention practices into clinical workflow. The three Fall TIPS modalities may prove an effective strategy for spread, allowing diverse institutions to choose the modality the fits with the organizational culture and health information technology infrastructure.

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Falls in the General Hospital: Association With Delirium, Advanced Age, and Specific Surgical Procedures

Cited by 103 publications

References 42 publications

Climbing a long hill: pelvic floor surgery and the need for geriatric urogynecology

Climbing a long hill: pelvic floor surgery and the need for geriatric urogynecology

Analysis of a health team's records and nurses' perceptions concerning signs and symptoms of delirium

Assessing the Effectiveness of Engaging Patients and Their Families in the Three-Step Fall Prevention Process Across Modalities of an Evidence-Based Fall Prevention Toolkit: An Implementation Science Study (Preprint)

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