Prediction of falls using a risk assessment tool in the acute care setting

Παπαϊωάννου, Αλεξάνδρα; Parkinson, William; Cook, Richard J.; Ferko, Nicole; Coker, Esther; Adachi, Jonathan D.

doi:10.1186/1741-7015-2-1

Cited by 119 publications

(144 citation statements)

References 21 publications

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“…The majority of these DRGs were not surprising, given that previous risk factor studies in the hospital setting have highlighted the importance of cognition, neurological disorders such as stroke and Parkinson' s disease, and history of serious falls-related injuries such as hip fractures as important risk factors for falls. 8,19,32 Another recent study highlighted the interaction between these major contributors to falls risk, reporting that 45% of hip fracture patients who fell in hospital after an operation were delirious on the day of the fall. 33 Only "respiratory infections/ inflammation" was a common DRG associated with falls which has not been previously reported as a falls risk factor in hospital studies (12% within this DRG fell during their hospitalisation).…”

Section: Discussionmentioning

confidence: 99%

Falls in the acute hospital setting — impact on resource utilisation

Vu¹,

Walsh²

2007

Aust. Health Review

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Objective: To determine the resource utilisation of patients who fall within an acute metropolitan hospital.Design: Retrospective observational study, part of a larger falls prevention project in a 323-bed acute care, tertiary teaching hospital in Melbourne, Australia. A review of falls incidents was undertaken for all patient admissions for 18 months from January 2002, excluding the Day Procedure Unit, Intensive Care Unit, Coronary Care Unit and the Emergency Department. Procedure:The most common diagnosis related groups (DRGs) associated with fallers were identified, and within each DRG, fallers were matched to non-fallers by age and gender. Difference in hospital length of stay (LOS) and disparity in resource consumption by these two groups were calculated. Results:The DRG with the highest proportion of fallers was "Dementia and other chronic disturbances of cerebral function" (24%). Three of the top six DRGs had significantly longer LOS for fallers compared with non-fallers ("Delirium", "Stroke" and "Respiratory conditions") (P<0.05). Hospital-related costs were significantly higher for fallers compared with non-fallers for the DRG "Stroke with severe/complicating diagnosis/procedure" only (P< 0.05).Conclusions: Inpatient LOS and total associated costs for patients who fell and were classified among the DRGs with the highest proportion of fallers were substantially higher than those of matched non-fallers. Effective falls prevention activities targeting these high-risk groups should be a priority, in the context of broader falls preven- FALLS AMONG OLDER PEOPLE are widely recognised as a major public health problem. One third of people aged 65 years and over living in the community fall each year. [1][2][3] The incidence of falls is reported to be higher in inpatient (hospital) settings, including acute care, aged care and rehabilitation wards. There are wide variations in the reported falls rate in acute care hospitals, ranging from 2% to 5% of all admissions, 4,5 and between 2.9 and 18.2 falls per 1000 bed-days. 6,7 Within this setting, fallers are commonly those admitted to medical or neurological wards. 8,9 Similarly, almost half of patients in some high risk groups, such as those with stroke, fall at least once during their hospitalisation. 10 In Aus- What is known about the topic? Falls are a common problem in hospitals; however there is little research on the association of diagnosis related groups (DRGs) and falls. What does this paper add?DRGs of dementia (24%), delirium (22%) and "Other disorders of the nervous system with catastrophic or severe complications or co-morbidity" (22%) were the DRGs with the highest proportion of patients who fell while in hospital. Falls in the acute hospital setting were shown to have a substantial effect on length of stay and costs associated with hospitalisation. What are the implications for practitioners?In addition to general falls prevention strategies, practitioners need to target falls prevention activities to patients in DRGs with a higher proportion...

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Section: Discussionmentioning

confidence: 99%

Falls in the acute hospital setting — impact on resource utilisation

Vu¹,

Walsh²

2007

Aust. Health Review

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“…18 Sensitivity of the original scale was 78% and specificity was 83%. This scale placed patients into categories of high risk (!45), medium risk (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44), and low risk ( 20). The meta-analysis by Harrington et al stated that the MFS had significantly higher sensitivity, but lower specificity than that of STRATIFY.…”

Section: Risk Stratificationmentioning

confidence: 99%

“…23 Common themes that indicate increased risk of patient falls between these 3 tools, and others, include assessment for previous falls or admission secondary to falling, presence of mental confusion or agitation, necessity for frequent toileting, and altered gait or mobility. 9,13,14,19,21,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] One of the most common populations studied and cited as high risk of falls is the older adult (!65). 8,16,17,[27][28][29][30][42][43][44][45][46][47][48] Medications including benzodiazepines, anticonvulsants, antihypertensives, antidepressants, and sleep aids have also been targeted as high-risk medications.…”

Section: Risk Stratificationmentioning

confidence: 99%

Inpatient Falls

Cumbler

Simpson

Rosenthal

et al. 2013

The Neurohospitalist

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In this 2 part series, analysis of the risk stratification tools that are available, definition for the scope of the problem, and potential solutions through a review of the literature are presented. A systematic review was used to identify articles for risk stratification and interventions. Three risk stratification systems are discussed, St Thomas's Risk Assessment Tool in Falling Elderly Inpatients, Morse Fall Scale, and the Hendrich Fall Risk Model. Of these scoring systems, the Hendrich Fall Risk Model is the easiest to use and score. Predominantly, multifactorial interventions are used to prevent patient falls. Education and rehabilitation are common themes in studies with statistically significant results. The second article presents a guide to implementing a quality improvement project around hospital falls. A 10-step approach to Plan-Do-Study-Act (PDSA) cycles is described. Specific examples of problems and analysis are easily applicable to any institution. Furthermore, the sustainability of interventions and targeting new areas for improvement is discussed. Although specific to falls in the hospitalized patient, the goal is to present a stepwise approach which is broadly applicable to other areas requiring quality improvement.

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“…Questionnaires filled out by (i) clinical staff [41][42][43][44][45], (ii) the subjects themselves [46,47], or (iii) by telephone interviews [48] represent one of the most prevalent approaches for fall risk assessment in the clinic. While questionnaires can reach out to large cohorts in an efficient manner, a number of limitations are associated with this form of data collection; for questionnaires filled out by employees, well-trained staff are required in order to avoid bias; self-reported questionnaires can only measure explicit knowledge and this knowledgeespecially in the elderly-is often not an objective reflection of the truth [6].…”

Section: Deficits In Common Testsmentioning

confidence: 99%

Kinematic measures for assessing gait stability in elderly individuals: a systematic review

Hamacher

Singh

Dieën

et al. 2011

J. R. Soc. Interface.

340

281

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Falls not only present a considerable health threat, but the resulting treatment and loss of working days also place a heavy economic burden on society. Gait instability is a major fall risk factor, particularly in geriatric patients, and walking is one of the most frequent dynamic activities of daily living. To allow preventive strategies to become effective, it is therefore imperative to identify individuals with an unstable gait. Assessment of dynamic stability and gait variability via biomechanical measures of foot kinematics provides a viable option for quantitative evaluation of gait stability, but the ability of these methods to predict falls has generally not been assessed. Although various methods for assessing gait stability exist, their sensitivity and applicability in a clinical setting, as well as their cost-effectiveness, need verification. The objective of this systematic review was therefore to evaluate the sensitivity of biomechanical measures that quantify gait stability among elderly individuals and to evaluate the cost of measurement instrumentation required for application in a clinical setting. To assess gait stability, a comparative effect size (Cohen's d ) analysis of variability and dynamic stability of foot trajectories during level walking was performed on 29 of an initial yield of 9889 articles from four electronic databases. The results of this survey demonstrate that linear variability of temporal measures of swing and stance was most capable of distinguishing between fallers and non-fallers, whereas step width and stride velocity prove more capable of discriminating between old versus young (OY) adults. In addition, while orbital stability measures (Floquet multipliers) applied to gait have been shown to distinguish between both elderly fallers and non-fallers as well as between young and old adults, local stability measures (ls) have been able to distinguish between young and old adults. Both linear and nonlinear measures of foot time series during gait seem to hold predictive ability in distinguishing healthy from fall-prone elderly adults. In conclusion, biomechanical measurements offer promise for identifying individuals at risk of falling and can be obtained with relatively low-cost tools. Incorporation of the most promising measures in combined retrospective and prospective studies for understanding fall risk and designing preventive strategies is warranted.

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Prediction of falls using a risk assessment tool in the acute care setting

Cited by 119 publications

References 21 publications

Falls in the acute hospital setting — impact on resource utilisation

Falls in the acute hospital setting — impact on resource utilisation

Inpatient Falls

Kinematic measures for assessing gait stability in elderly individuals: a systematic review

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Prediction of falls using a risk assessment tool in the acute care setting

Cited by 119 publications

References 21 publications

Falls in the acute hospital setting &mdash; impact on resource utilisation

Falls in the acute hospital setting &mdash; impact on resource utilisation

Inpatient Falls

Kinematic measures for assessing gait stability in elderly individuals: a systematic review

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Falls in the acute hospital setting — impact on resource utilisation

Falls in the acute hospital setting — impact on resource utilisation