Practices and behaviors of professionals after falls in institutionalized elderly with and without cognitive decline

ABSTRACT Falls are a major problem in nursing homes due to their high prevalence and impact on the functioning of elderly. Objective: This study aims to: a) construct and validate a scale for assessing the practices and behaviors of professionals from nursing homes after falls in elderly; b) describe practices and behaviors after falls; and c) associate practices and behaviors with professionals’ length of experience, training and age. Methods: This is a correlational study, conducted in a sample of 152 professionals from six nursing homes. The study adhered to all of the Declaration of Helsinki principles. Results: The scale constructed has a Cronbach’s alpha of 0.938. The 12 items of the scale are grouped into two factors. The most expressive indicators are the communication of fall episodes that result in severe injuries (4.64 ± 0.812) and the communication of falls that result in injuries and need intervention from health technicians (4.61 ± 0.832). We found no significant statistical difference between length of professional experience, training and age when associated with professional practices and behaviors after falls in elderly (p > 0.05). Conclusion: Future studies should investigate the association of post-fall professional practices and behaviors with fear of another fall, fall recurrence, and changes in functioning of the elderly following a fall.

Download Full-text

Prevalence of falls in elderly in Brazil: a countrywide analysis

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2011000900015 ◽

2011 ◽

Vol 27 (9) ◽

pp. 1819-1826 ◽

Cited By ~ 69

Author(s):

Fernando Vinholes Siqueira ◽

Luiz Augusto Facchini ◽

Denise Silva da Silveira ◽

Roberto Xavier Piccini ◽

Elaine Tomasi ◽

...

Keyword(s):

Low Socioeconomic Status ◽

Urban Areas ◽

Female Gender ◽

The Elderly ◽

Cross Sectional Study ◽

Cross Sectional ◽

Low Socioeconomic ◽

The North ◽

High Prevalence ◽

Falls In Elderly

We conducted a cross-sectional study of a sample of 6,616 elderly living in urban areas of 100 municipalities in 23 Brazilian states, who responded to questions on the occurrence of falls in the 12 months prior to the interview, and occurrence of fractures due to the falls. The prevalence of falls among the elderly was 27.6% (95%CI: 26.5-28.7). Among those reporting falls, 11% had suffered fractures as a result. Of the elderly, 36% had received guidance about the precautions necessary to prevent falls, and about 1% had required surgery. Falls were associated with female gender, older age, low socioeconomic status, obesity and sedentary lifestyles. The prevalence of falls differed significantly between the North and other regions of Brazil. The study shows a high prevalence of falls, and underlines the need for preventive strategies targeting modifiable risk factors.

Download Full-text

Falls in institutionalized elderly with and without cognitive decline A study of some factors

Dementia & Neuropsychologia ◽

10.1590/1980-57642018dn13-010014 ◽

2019 ◽

Vol 13 (1) ◽

pp. 116-121 ◽

Cited By ~ 4

Author(s):

Cristina Lavareda Baixinho ◽

Maria dos Anjos Dixe ◽

Carla Madeira ◽

Sílvia Alves ◽

Maria Adriana Henriques

Keyword(s):

Cognitive Decline ◽

Statistical Significance ◽

The Elderly ◽

Timed Up And Go ◽

Safety Practices ◽

Institutionalized Elderly ◽

Mental Deterioration ◽

High Prevalence ◽

Fall Risks ◽

And Behaviors

ABSTRACT. Falls in long-stay institutions for elderly people have a high prevalence, contributing to the physical and mental deterioration of institutionalized elderly. Objective: To determine the prevalence of falls among institutionalized elderly with and without cognitive decline, and to characterize the practices and behaviors of those with and without cognitive decline in managing fall risks, and relate them to some factors. Methods: The present correlational study was carried out with a sample of 204 institutionalized elderly, 50% of whom had cognitive decline. Results: The elderly with cognitive decline (40.2%) fell less often than those who did not have cognitive decline (42.2%) (p>0.05). Safety practices and behaviors were better in the elderly with cognitive decline (p<0.05). Most of the elderly with cognitive decline who fell took benzodiazepines (65.9%), in contrast with those without cognitive decline (32.2%). It was observed that 81.4% of the elderly without cognitive decline and 43.9% of those with cognitive decline who fell had a performance of over 12 seconds on the Timed Up and Go Test, where differences reached statistical significance in both groups of elderly. Conclusion: Data collected in the present study further the knowledge on risk factors in the genesis of falls and on the behavior of elderly with and without cognitive decline in maintaining their safety in self-care and accessibility.

Download Full-text

The Se.Ko.Ph. study: a European multicentre study on falls in elderly subjects living in residential homes

Geriatric Care ◽

10.4081/gc.2017.6712 ◽

2017 ◽

Vol 3 (1) ◽

Author(s):

Aladar Bruno Ianes ◽

Giorgio Ricci ◽

For the Se.Ko.Ph. Study Group

Keyword(s):

Risk Factors ◽

Nursing Homes ◽

Multicentre Study ◽

Clinical Status ◽

The Elderly ◽

Elderly Subjects ◽

Risk Of Falling ◽

Increased Risk ◽

Risk Factors For Falls ◽

Falls In Elderly

The aim was to investigate risk factors for falls in elderly people living in residential nursing homes. An observational, prospective, multicentre study was conducted between March 2010 and March 2011 investigating falls in elderly residents living in residential nursing homes (4 Italian¸ 4 French and 5 German nursing homes). A number of risk factors were assessed as well as details of the fall (dynamics, reasons, location and time of occurrence). Differences were observed between the countries related to different nursing practices. Fallers comprised 36.5% of all residents and approximately 40% were injured as a consequence. Six logistic regression models were created to assess which fallrelated variables had the most impact, and showed subjects with faecal incontinence had a lower risk of falling, while subjects afflicted with dementia and visual impairment showed an increased risk of falling. Higher Tinetti scores were found to be related to an increased fall risk. Falls in the elderly occur due to complex interactions between demographic, physical, behavioural and environmental risk factors. Differences between countries in fall rates were seen, probably due to different medical practices, use of aids and restraints, and characteristics of the populations (<em>i.e.</em> the Italian residents tended to be more cognitively impaired and more impaired in balance and gait compared to the French and German residents). There was evidence that subjects with a better clinical status fall more frequently, whereas non-fallers had a worse clinical status and therefore tended to be more bedridden.

Download Full-text

High Prevalence of Valvular Disease Found in the Elderly

Internal Medicine News ◽

10.1016/s1097-8690(05)70492-3 ◽

2005 ◽

Vol 38 (1) ◽

pp. 50

Author(s):

MITCHEL L. ZOLER

Keyword(s):

The Elderly ◽

Valvular Disease ◽

High Prevalence

Download Full-text

The Unusual Cruelty of Nursing Homes Behind Bars

Federal Sentencing Reporter ◽

10.1525/fsr.2020.32.5.264 ◽

2020 ◽

Vol 32 (5) ◽

pp. 264-271

Author(s):

Rachel E. López

Keyword(s):

Nursing Homes ◽

Human Dignity ◽

Prison Population ◽

Financial Burden ◽

The Elderly ◽

The United States ◽

Term Care ◽

Trained Staff ◽

State Prisons ◽

The Cost

The elderly prison population continues to rise along with higher rates of dementia behind bars. To maintain the detention of this elderly population, federal and state prisons are creating long-term care units, which in turn carry a heavy financial burden. Prisons are thus gearing up to become nursing homes, but without the proper trained staff and adequate financial support. The costs both to taxpayers and to human dignity are only now becoming clear. This article squarely addresses the second dimension of this carceral practice, that is the cost to human dignity. Namely, it sets out why indefinitely incarcerating someone with dementia or other neurocognitive disorders violates the Eighth Amendment of the United States Constitution’s prohibition on cruel and unusual punishment. This conclusion derives from the confluence of two lines of U.S. Supreme Court precedent. First, in Madison v. Alabama, the Court recently held that executing someone (in Madison’s case someone with dementia) who cannot rationally understand their sentence amounts to cruel and unusual punishment. Second, in line with Miller v. Alabama, which puts life without parole (LWOP) sentences in the same class as death sentences due to their irrevocability, this holding should be extended to LWOP sentences. Put another way, this article explains why being condemned to life is equivalent to death for someone whose neurodegenerative disease is so severe that they cannot rationally understand their punishment.

Download Full-text

Predictors of Mortality in Board and Care Homes

OMEGA - Journal of Death and Dying ◽

10.2190/2t9v-bntp-91eg-ejmu ◽

1997 ◽

Vol 36 (1) ◽

pp. 77-87 ◽

Cited By ~ 3

Author(s):

Nicholas G. Castle

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Social Services ◽

Long Term Care ◽

Significant Proportion ◽

The Elderly ◽

Term Care ◽

Care Facilities ◽

Board And Care

Long-term care institutions have emerged as dominant sites of death for the elderly. However, studies of this trend have primarily examined nursing homes. The purpose of this research is to determine demographic, functional, disease, and facility predictors and/or correlates of death for the elderly residing in board and care facilities. Twelve factors are found to be significant: proportion of residents older than sixty-five years of age, proportion of residents who are chair- or bed-fast, proportion of residents with HIV, bed size, ownership, chain membership, affiliation with a nursing home, number of health services provided other than by the facility, the number of social services provided other than by the facility, the number of social services provided by the facility, and visits by Ombudsmen. These are discussed and comparisons with similar studies in nursing homes are made.

Download Full-text

Risk Management in nursing homes: an Italian experience in 2019

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1172 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M F Furmenti ◽

F Bert ◽

M Rucci ◽

U Fiandra ◽

A Scarmozzino ◽

...

Keyword(s):

Risk Management ◽

Nursing Homes ◽

Management Practices ◽

Well Being ◽

The Elderly ◽

Management Plan ◽

Management Policy ◽

Insurance Company ◽

Term Care ◽

Starting Point

Abstract Background The ageing of the European population leads to an increasing demand for Long-Term Care services. The security and well-being of the elderly population hosted in nursing homes (NHs) needs an effective Risk Management policy, officially sanctioned in Italy by the so-called “Legge Gelli” n.24 (March 8th, 2017) and the Directive 2011/24/EU on the application of patients' rights in cross-border healthcare. In order to verify the effective application of common “best practices” in terms of Risk Management in NHs, a tool useful to analyse risk management attitudes in Northern Italy was conceived and applied in a sample of NHs. Methods The tool, developed in collaboration with the health insurance company SHAM Italia, is composed of 124 items (with a dichotomous answer -YES/NO) on topics related to various Risk Management practices. This tool was submitted in a face-to-face interview to several Directors (Health Directors or Nursing Coordinators) of NHs in the Piedmont Region. A list of randomly-chosen NHs was contacted: 4 of them were selected for the pilot study and compiled the questionnaire. Answers were gathered and analyzed through Microsoft Excel. Results Only the 25% of NHs has a Risk Management plan with objectives and indicators of effectiveness and uses Risk Analysis instruments for a pre- and post-” risk detection. Only one has employees working mainly on Risk Management alone. The 75% of the reported events were “Adverse Events”, and all the NHs (100%) have a protocol for a patient voluntary departure or for fall prevention or for bedsores prevention; while 50% have a protocol for prevention of aggressions towards operators or for patients' suicide prevention. Conclusions This work provides a starting point to face new challenges that are looming on the European Health-care Systems: the care for the elderlies needs to be perfected to reduce inefficiencies, cut useless costs and improve safety of patients in the NHs setting. Key messages Despite safety of older patients in nursing homes is not only important but mandatory in Italy, risk management tools for this setting are lacking in literature. A new tool applied in Italian nursing homes showed that risk management needs to be implemented in practice and these results can be extended to European context.

Download Full-text