Risk Factors of Recurrent Falls Among Older Adults Admitted to the Trauma Surgery Department

Falls affect more than 29 million American adults ages ≥65 years annually. Many older adults experience recurrent falls requiring medical attention. These recurrent falls may be prevented through screening and intervention. In 2014 to 2015, records for 199 older adult patients admitted from a major urban teaching hospital’s emergency department were queried. Open-ended variables from clinicians’ notes were coded to supplement existing closed-ended variables. Of the 199 patients, 52 (26.1%) experienced one or more recurrent falls within 365 days after their initial fall. Half (50.0%) of all recurrent falls occurred within the first 90 days following discharge. A large proportion of recurrent falls among older adults appear to occur within a few months and are statistically related to identifiable risk factors. Prevention and intervention strategies, delivered either during treatment for an initial fall or upon discharge from an inpatient admission, may reduce the incidence of recurrent falls among this population.

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The Geriatric Acute and Post-Acute Fall Prevention Intervention (GAPcare) II: A Mixed Methods Study Protocol to Assess the Feasibility, Acceptability, and Usability of Apple Watch in Older Emergency Department Patients with Falls (Preprint)

10.2196/preprints.24455 ◽

2020 ◽

Author(s):

Daniel H Strauss ◽

Natalie M Davoodi ◽

Margaret Healy ◽

Christopher L Metts ◽

Roland C Merchant ◽

...

Keyword(s):

Older Adults ◽

Emergency Department ◽

High Risk ◽

Rhode Island ◽

Older Adult ◽

Fall Prevention ◽

Field Testing ◽

Ease Of Use ◽

Structured Interviews ◽

Recurrent Falls

BACKGROUND Falls are a common problem among older adults that lead to injury, emergency department (ED) visits, and institutionalization. The Apple Watch can detect falls and alert caregivers and clinicians that help is needed and could be used to objectively collect data on gait, fitness, and falls as part of clinical trials; however, little is known about the ease of use of this technology among older adult ED patients - a population at high risk of recurrent falls. OBJECTIVE We will examine the feasibility, acceptability, and usability of the Apple Watch series 4 paired with the iPhone and our research app “Rhode Island FitTest” (RIFitTest) among older adult ED patients seeking care for falls. METHODS We will conduct field-testing with older adult ED patients (n=25) who sustained a fall and their caregivers (n=5) to determine whether they can use the Apple Watch, iPhone, and app either (1) continuously or (2) periodically (with or without telephone assistance from the research staff) to assess gait, fitness and/or falls over time. During the initial encounter, participants will receive training in the Apple Watch, iPhone, and our research app. They will receive an illustrated training manual and a number to call if they have questions about the research protocol or device usage. Participants will complete surveys and cognitive and motor assessments on the app during the study period. At the conclusion of the study, we will solicit participant feedback through semi-structured interviews. Qualitative data will be summarized using framework matrix analyses. Sensor and survey response data will be analyzed using descriptive statistics. RESULTS Study recruitment will continue until 30 participants are enrolled. CONCLUSIONS GAPcare II will provide insights into the feasibility, acceptability, and usability of the Apple Watch, iPhone, and the RIFitTest app in the population most likely to benefit from the technology – older adults at high risk of recurrent falls. In the future, wearables could be used as part of fall prevention interventions to prevent injury before it occurs. CLINICALTRIAL NCT04304495

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Mortality and associated risk factors for older adults admitted to the emergency department: a hospital cohort

BMC Geriatrics ◽

10.1186/s12877-018-0833-0 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Carmen García-Peña ◽

Mario Ulises Pérez-Zepeda ◽

Leslie Viridiana Robles-Jiménez ◽

Sergio Sánchez-García ◽

Ricardo Ramírez-Aldana ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Emergency Department ◽

Associated Risk Factors

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Predicting Unscheduled Emergency Department Return Visits Among Older Adults: Population-Based Retrospective Study (Preprint)

10.2196/preprints.22491 ◽

2020 ◽

Author(s):

Rai-Fu Chen ◽

Kuei-Chen Cheng ◽

Yu-Yin Lin ◽

I-Chiu Chang ◽

Cheng-Han Tsai

Keyword(s):

Older Adults ◽

Emergency Department ◽

Health Insurance ◽

Chronic Illness ◽

Length Of Stay ◽

Prediction Model ◽

Older Adult ◽

National Health Insurance ◽

Research Database ◽

Return Visits

BACKGROUND Unscheduled emergency department return visits (EDRVs) are key indicators for monitoring the quality of emergency medical care. A high return rate implies that the medical services provided by the emergency department (ED) failed to achieve the expected results of accurate diagnosis and effective treatment. Older adults are more susceptible to diseases and comorbidities than younger adults, and they exhibit unique and complex clinical characteristics that increase the difficulty of clinical diagnosis and treatment. Older adults also use more emergency medical resources than people in other age groups. Many studies have reviewed the causes of EDRVs among general ED patients; however, few have focused on older adults, although this is the age group with the highest rate of EDRVs. OBJECTIVE This aim of this study is to establish a model for predicting unscheduled EDRVs within a 72-hour period among patients aged 65 years and older. In addition, we aim to investigate the effects of the influencing factors on their unscheduled EDRVs. METHODS We used stratified and randomized data from Taiwan’s National Health Insurance Research Database and applied data mining techniques to construct a prediction model consisting of patient, disease, hospital, and physician characteristics. Records of ED visits by patients aged 65 years and older from 1996 to 2010 in the National Health Insurance Research Database were selected, and the final sample size was 49,252 records. RESULTS The decision tree of the prediction model achieved an acceptable overall accuracy of 76.80%. Economic status, chronic illness, and length of stay in the ED were the top three variables influencing unscheduled EDRVs. Those who stayed in the ED overnight or longer on their first visit were less likely to return. This study confirms the results of prior studies, which found that economically underprivileged older adults with chronic illness and comorbidities were more likely to return to the ED. CONCLUSIONS Medical institutions can use our prediction model as a reference to improve medical management and clinical services by understanding the reasons for 72-hour unscheduled EDRVs in older adult patients. A possible solution is to create mechanisms that incorporate our prediction model and develop a support system with customized medical education for older patients and their family members before discharge. Meanwhile, a reasonably longer length of stay in the ED may help evaluate treatments and guide prognosis for older adult patients, and it may further reduce the rate of their unscheduled EDRVs.

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Communicating with the Older Adult Cancer Patient

Psycho-Oncology ◽

10.1093/med/9780190097653.003.0085 ◽

2021 ◽

pp. 678-684

Author(s):

Patricia A. Parker ◽

Smita C. Banerjee ◽

Beatriz Korc-Grodzicki

Keyword(s):

Risk Factors ◽

Older Adults ◽

Cognitive Impairment ◽

Psychological Distress ◽

Cancer Patients ◽

Older Adult ◽

Adult Population ◽

Healthcare Providers ◽

Multiple Morbidity ◽

Older Adult Population

The older adult population continues to increase. Among all known risk factors for developing cancer, the most important is growing old. Thus, caring for older adults with cancer is of increasing importance. This chapter describes important considerations involved in communicating with cancer patients including sensory impairment, cognitive impairment, multiple morbidity, polypharmacy, and psychological distress. It also describes how stereotyping and ageism affect communication with older adults with cancer. Finally, the chapter discusses ways to facilitate communication with older adult cancer patients and their families and provides an example of a training program that was created specifically to enhance communication between healthcare providers and older adult cancer patients and their families.

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Risk of falls and fear of falling in older adults residing in public housing in Ontario, Canada: findings from a multisite observational study

BMC Geriatrics ◽

10.1186/s12877-019-1399-1 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Melissa Pirrie ◽

Guneet Saini ◽

Ricardo Angeles ◽

Francine Marzanek ◽

Jenna Parascandalo ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Public Housing ◽

Fear Of Falling ◽

Vegetable Consumption ◽

Fruit And Vegetable Consumption ◽

Medical Attention ◽

Fruit And Vegetable ◽

The Past ◽

Risk Factors For Falls

Abstract Background Falls in older adults is a widely researched topic. However, older adults residing in public housing are a vulnerable population that may have unique risk factors for falls. This study aims to describe the prevalence and risk factors for falls, fear of falling, and seeking medical attending for falls in this population. Methods Sociodemographic and health-related data was collected as part of a community-based health assessment program with older adults in public housing. Three pre-screening questions identified individuals at potential risk for falls; individuals who screened positive performed the objective Timed Up and Go (TUG) test. Logistic regression was used to evaluate risk factors for four outcome variables: falls in the past year, seeking medical attention for falls, fear of falling, and objectively measured fall risk via TUG test. Results A total of 595 participants were evaluated, of which the majority were female (81.3%), white (86.7%), did not have a high school diploma (50.0%), and reported problems in mobility (56.2%). The prevalence of falls in the past year was 34.5%, seeking medical attention for falls was 20.2% and fear of falling was 38.8%. The TUG test was completed by 257 participants. Notably, males had significantly reduced odds of seeking medical attention for a fall (OR = 0.50, 95%CI 0.25–0.98) and having a fear of falling (OR = 0.42, 95%CI 0.24–0.76); daily fruit and vegetable consumption was associated with decreased odds of having a fall in the past year (OR = 0.55, 95%CI 0.37–0.83), and alcohol consumption was associated with increased odds of fear of falling (OR = 1.72, 95%CI 1.03–2.88). Conclusion Older adults residing in public housing have unique risk factors associated with social determinants of health, such as low fruit and vegetable consumption, which may increase their risk for falls. The findings of this study can be used to inform falls interventions for this population and identify areas for further research.

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MORTALITY AND ASSOCIATED RISK FACTORS FOR OLDER ADULTS VISITING THE EMERGENCY DEPARTMENT

Innovation in Aging ◽

10.1093/geroni/igx004.453 ◽

2017 ◽

Vol 1 (suppl_1) ◽

pp. 108-108

Author(s):

C. Garcia-Pena ◽

P. Tella ◽

L. Robles ◽

U. Perez

Keyword(s):

Risk Factors ◽

Older Adults ◽

Emergency Department ◽

Associated Risk Factors

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Risk Factors for Serious Suicide Attempts: Difference Between Older and Younger Attempters in the Emergency Department

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.607811 ◽

2021 ◽

Vol 11 ◽

Author(s):

Dong Wook Kim ◽

Seo Eun Cho ◽

Jae Myeong Kang ◽

Soo Kyun Woo ◽

Seung-Gul Kang ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Emergency Department ◽

Suicide Attempt ◽

Old Age ◽

Rating Scale ◽

Suicide Attempts ◽

Interpersonal Stress ◽

Suicide Attempters ◽

Male Sex

Objective: Suicide attempts of the older adults are known to be more serious than that of the younger adults. Despite its major social impact in South Korea, the behavioral mechanism of serious suicide attempt (SSA) in old people remains to be elucidated. Thus, we investigated the risk factors for SSA in older and younger suicide attempters in the emergency department.Methods: Demographic data, clinical information, and the level of seriousness of suicide with Risk Rescue Rating Scale were compared between older (age ≥65) and younger (age <65) adults who visited the emergency department for a suicide attempt. Regression analyses were performed to identify the risk factors for SSA in these two groups.Results: Among 370 patients, 37 were older adults (10%; aged 74.41 ± 6.78), more likely to have another medical disease (p < 0.001), and a higher suicide completion rate (16.2 vs. 5.4%, p = 0.023). In the younger group, old age (B = 0.090, p < 0.001), male sex (B = −0.038, p = 0.019), and impression of schizophrenia (B = 0.074, p = 0.027) were associated with a higher risk-rescue ratio and interpersonal stress condition was associated with a lower risk-rescue ratio (B = −0.045, p = 0.006). In the older group, however, no variables were included significant in the regression model for the Risk Rescue Rating Scale.Conclusions: Demographic and clinical factors such as old age, male sex, interpersonal stress, and impression of schizophrenia were associated with lethality in the younger suicide attempters. However, no factors were associated with SSA in the older adult group. Different mechanisms may underly the lethality in old age suicide.

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FALL INJURY CHARACTERISTICS ASSOCIATED WITH EMERGENCY DEPARTMENT VISITS AND HOSPITALIZATIONS AMONG OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.1836 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S495-S495

Author(s):

Namkee G Choi ◽

Diana M DiNitto ◽

Mark E Kunik

Keyword(s):

Older Adults ◽

Emergency Department ◽

Fall Prevention ◽

Emergency Department Visits ◽

The Body ◽

Medical Attention ◽

Healthcare Use ◽

Fall Injuries ◽

Injury Characteristics ◽

Fall Injury

Abstract Fall injuries and related healthcare use among older adults are increasing in the US. Based on the 2013-2017 US National Health Interview Survey public use data, this study examined fall injury characteristics that are associated with emergency department (ED) visits and hospitalizations among those aged ≥60 years who received medical attention for their fall injuries within a 91-day reference period (N=1,840). Our findings show that nearly a third of these older adults received care from emergency medical services (EMS), presumably for a “lift assist” to get off the floor and/or for ED or hospital transport; a little more than one-third had an ED visit only; and a little less than a fifth had an overnight hospital stay. Multivariable analysis showed that hip and head injuries, face injuries, and broken bones/fractures (from any type of injury) were likelier causes of hospitalization than injuries to other parts of the body. Fall injuries sustained inside the home, falls from loss of balance/dizziness, and living alone were also more likely to result in hospitalization, while fall injuries that occurred away from home and those with lung disease and memory problems were associated with higher risk of ED use only. These healthcare use data indicate the significant toll that fall injuries exact upon older adults and healthcare system. Fall prevention programs should target risk factors that are specific to serious injuries and be made more accessible. Strategies for implementing scalable, adaptable, and measurable fall prevention models by EMS providers and ED staff are also needed.

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104 Sociodemographic, Cognitive & Physical Function Characteristics among Older Adult Fallers with and without Cognitive Frailty: Preliminary Results

Age and Ageing ◽

10.1093/ageing/afz164.104 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv18-iv27

Author(s):

Resshaya Murukesu ◽

Devinder Kaur Ajit Singh ◽

Suzana Shahar ◽

Ponnusamy Subramaniam

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Physical Function ◽

Older Adult ◽

Verbal Learning ◽

Community Dwelling ◽

Step Test ◽

Medical Attention ◽

Categorical Variables ◽

Cognitive Frailty

Abstract Introduction Older adults with frailty and cognitive impairment are more susceptible to falls. The risk factor of falls and faller profiles among older adults in general has been established. However, information regarding potential risk factors and faller patterns among older adults with cognitive frailty is limited. Objective To examine the sociodemographic, cognitive and physical function characteristics of fallers with and without cognitive frailty. Methods A total of 133 community dwelling older adults aged 60 years and above were screened at three older adult activity centres in Kuala Lumpur. Sociodemographic details were obtained via interview. Cognitive Frailty was identified using the Clinical Dementia Rating Scale and Fried Frailty Index. Cognitive function was assessed using the Mini Mental State Examination (MMSE), Digit Span (DS) test and Ray Auditory Verbal Learning Test (RAVLT). The Senior Fitness test was used to asses physical function. Characteristics of falls were documented using a self-administered questionnaire. Data was descriptively analysed; independent T-test was used for continuous variables and chi-square test was used for categorical variables. Results Prevalence of falls was 21.1% (n=28). Within fallers, 42.9% (n=12) were cognitively frail and 57.1% (n=16) were not. Fallers with cognitive frailty were significantly older (mean age = 72.31±5.29) (p<0.001), had lower MMSE scores (p<0.01), lower 2 Minute Step test scores (p<0.001) and lower Lawton Instrumental Activities of Daily Living scores (p<0.05). Descriptively, fallers with cognitive frailty were mostly recurrent fallers (67%), sustained falls outdoors due to ‘slip and fall’ and majority sought medical attention after the fall(s). Conclusion Fallers with cognitive frailty were older and had lower physical and cognitive function as compared to those without. There is a need to further understand the relationship between falls and cognitive frailty in order to provide holistic fall prevention and management strategies. Acknowledgement of grant UKM(DCP-2017-002/2) and Ministry of Higher Education(LRGS/BU/2012/UKM-UKM/K/01).

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Assessment of metabolic syndrome risk factors among rural-dwelling older adults requires innovation: partnerships and a mobile unit can help

Quality in Ageing and Older Adults ◽

10.1108/qaoa-12-2017-0052 ◽

2018 ◽

Vol 19 (4) ◽

pp. 251-260

Author(s):

Martha R. Crowther ◽

Cassandra D. Ford ◽

Latrice D. Vinson ◽

Chao-Hui Huang ◽

Ernest Wayde ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Metabolic Syndrome ◽

At Risk ◽

Rural Communities ◽

Older Adult ◽

Healthcare Team ◽

Mobile Unit ◽

Content Type ◽

Rural Elders

Purpose Older adults are at risk for developing metabolic syndrome (MSX). Given the growing rural older adult population and the unknown prevalence rate of MSX in rural communities, the purpose of this paper is to assess the risk factors for MSX among rural elders. Design/methodology/approach Individuals aged 55+ from four West Alabama rural communities were assessed by an interdisciplinary healthcare team via a mobile unit (n=216). Descriptive analyses and analysis of variances (ANOVA) were conducted to assess the effect of gender, race and community on the number of risk factors of MSX among rural elders. Findings Results of a three-way ANOVA revealed a significant interaction between gender, age and community on the number of MSX risk factors [F (16,193)= 2.41, p <0.01]. Rural communities with lower social economic status (SES) and predominantly African American residents were at higher risk for developing MSX compared to communities with higher SES [F(3, 68) = 7.42, p<0.05]. Practical implications Findings suggest low SES rural communities are at risk of developing MSX. Innovative approaches such as mobile healthcare delivery are crucial to providing quality healthcare and preventive health screens to underserved rural older adult communities. Originality/value Limited research is available on assessing rural midlife and older adults at risk for metabolic syndrome largely due to lack of communication or transportation infrastructure and their history of negative experiences with public institutions. This research demonstrates that these barriers can be addressed.

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