Assessing Vision in Elderly Patients Admitted to Hospital Following a Fall

Introduction: Falls are a major cause of morbidity and mortality in older people, and those with reduced visual acuity are twice as likely to fall as those with normal eyesight. Accordingly, NICE guidelines recommend assessment of vision as part of a multi-factorial risk assessment in older people, who present for medical attention, because of a fall. Methods: We included all patients admitted to a senior health ward at St George’s hospital because of a fall. A baseline audit was conducted in May 2020. Our primary intervention was a departmental teaching session with subsequent first cycle data. We trialled the ‘Lookout! Bedside vision check for falls prevention’ recommended by the Royal College of Physicians. Our secondary intervention was designing an ‘initial assessment’ proforma to include a section for sensory impairment followed by a second cycle data collection. Results: Our initial results showed that none of the 24 patients admitted with a fall had any form of documented visual assessment. Using a simple bedside vision check tool, we found 22% (n=2) of screened patients had significantly impaired vision. Following our teaching session, 50% (n=7) of patients had some form of visual assessment on admission and after introduction of the proforma, this increased to 56% (n=5). Visual risk factors were identified in multiple patients, including outdated prescriptions for corrective glasses. Discussion: Identifying reversible visual risk factors may reduce recurrent falls and subsequent complications as well as hospital admissions in older patients. A teaching session was found to be effective, however a ‘proforma’ may encourage more sustainable improvements. The reduction in ophthalmology and optometry services during the Covid-19 pandemic will inevitably increase the prevalence of visual risk factors. Effects including delayed eyesight tests and cataract operations. It is therefore more important now than ever, to ensure bedside assessment of vision in older adults presenting to hospital, with a fall and proactively in falls prevention strategies.

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Increasing Physical Activity In Older Australians to Reduce Falls: A Program Evaluation

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2021.1956 ◽

2021 ◽

Author(s):

Kristy Robson ◽

Nazmul Ahasan ◽

Carly Barnes ◽

Kylie Murphy ◽

Rodney Pope

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Older People ◽

Falls Prevention ◽

Activity Levels ◽

Risk Of Falling ◽

Post Intervention ◽

Falls Risk ◽

Physical Activity Levels

Purpose: As people age, they are at greater risk of injurious falls. Falling has a significant impact not only on the individual but also the wider community. Undertaking physical activity is effective in reducing the rate of falls in this population. Therefore, providing targeted education during group-based falls prevention programs may increase the awareness and amount of physical activity older people undertake to assist in reducing their risk of falling. Methods: A longitudinal cohort design involving a pre-post intervention survey was conducted over an eight-month period with community-dwelling older adults who participated in a fall-prevention program. Participants were N = 161 (123 female and 38 male), aged 65 years and over, with the most common age bracket being 75 to 84 years. Demographic information was collected at baseline. It included falls history and self-reported physical activity levels. Immediately post-intervention, self-reported changes in the awareness of the role of physical activity and awareness of falls risks were measured. Six months post-intervention, participants self-reported their physical activity levels and post-program fall history. Results: An increase in awareness of the role of physical activity in reducing falls risk as well as falls risk factors was reported in most participants after completing the program. Despite this, only around a third of participants increased their physical activity levels during the six months after the program even though a decrease in falls rates was noted. Conclusions: The targeted education within the falls prevention program demonstrated an increase in awareness of falls risk factors and the importance of regular physical activity to minimise the risk of falling. However, this awareness did not seem to result in an increase in the amount of physical activity participants undertook after the program, even though falls rates across the participants reduced. Further research is needed to explore why older people who understand the benefits of undertaking regular physical activity did not increase their activity levels.

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106 Responding to the First Fall to Prevent the Second: Successful RCT in Reducing Falls using a Person Centred Approach for Older Fallers Presenting to Emergency Departments

Age and Ageing ◽

10.1093/ageing/afz164.106 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv18-iv27

Author(s):

Keith Hill ◽

Anna Barker ◽

Peter Cameron ◽

Leon Flicker ◽

Glenn Arendts ◽

...

Keyword(s):

Older People ◽

Emergency Departments ◽

Hospital Admissions ◽

Controlled Trial ◽

Falls Prevention ◽

Significant Group ◽

Risk Factor Management ◽

Fall Injuries ◽

Significant Difference ◽

Secondary Outcomes

Abstract Background The majority of older people who fall and present to Emergency Departments (EDs) are reported not to receive guideline level care to reduce future risk of falls. The aim of this randomized controlled trial was to evaluate whether RESPOND, a 6-month telephone-based patient-centred program had an effect on falls and fall injuries in older people presenting to ED after a fall. Methods 541 older fallers who presented to a WA or Victorian ED were recruited (inclusion criteria: discharged home <72 hours, could walk without hands-on assistance, use a telephone, and no cognitive impairment (MMSE>23). Intervention participants (n=263, mean age=73) received the RESPOND intervention, comprising (1) home-based risk assessment; (2) six months telephone-based education, coaching, goal setting and support for evidence-based risk factor management; and (3) linkages to existing services; while controls (n=260, mean age=73) received usual care. Primary outcomes were falls and fall injuries in the 12-month follow-up. Secondary outcomes included ED presentations, hospital admissions, fractures, death, falls risk, falls efficacy and quality of life. Results Falls rate was significantly lower in the RESPOND group (incidence rate ratio 0.65 [95%CI 0.43-0.99]; p=0.042). Although there was no significant difference in fall injuries (p=0.374), the rate of fractures was significantly lower in the RESPOND group (p=0.03). There were no significant group differences in other secondary outcomes. Conclusion The RESPOND falls prevention program reduced falls and fractures, in older people presenting to the ED with a fall. Key learnings for translation include: potential scalability and sustainability of a patient-centred and predominantly telephone-based program.

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Assessing the scalability of an integrated falls prevention service for community-dwelling older people: a mixed methods study

BMC Geriatrics ◽

10.1186/s12877-021-02717-6 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Susan Calnan ◽

Karen Lee ◽

Sheena McHugh

Keyword(s):

Older People ◽

Hospital Admissions ◽

Assessment Tool ◽

Scale Up ◽

Community Dwelling ◽

Falls Prevention ◽

Online Questionnaire ◽

Qualitative Feedback ◽

Prevention Service ◽

Community Dwelling Older People

Abstract Background There is growing acknowledgement of the need for a phased approach to scaling up health interventions, beginning with an assessment of ‘scalability’, that is, the capacity of an individual intervention to be scaled up. This study aims to assess the scalability of a multi-component integrated falls prevention service for community-dwelling older people and to examine the applicability of the Intervention Scalability Assessment Tool (ISAT). The ISAT consists of 10 domains for consideration when determining the scalability of an intervention, and each domain comprises a series of questions aimed at examining readiness for scale-up. Methods Multiple methods were used sequentially as recommended by the ISAT: a review of policy documents, results from a service evaluation and falls-related literature; one-to-one interviews (n = 11) with key stakeholders involved in management and oversight of the service; and a follow-up online questionnaire (n = 10) with stakeholders to rate scalability and provide further feedback on reasons for their scores. Results Three of the ISAT domains were rated highly by the participants. Analysis of the qualitative feedback and documents indicated that the issue of falls prevention among older people was of sufficient priority to warrant scale-up of the service and that the service aligned with national health policy priorities. Some participants also noted that benefits of the service could potentially outweigh costs through reduced hospital admissions and serious injuries such as hip fracture. The remaining domains received a moderate score from participants, however, indicating considerable barriers to scale-up. In the qualitative feedback, barriers identified included the perceived need for more healthcare staff to deliver components of the service, for additional infrastructure such as adequate room space, and for an integrated electronic patient management system linking primary and secondary care and to prevent duplication of services. Conclusions Plans to scale up the service are currently under review given the practical barriers that need to be addressed. The ISAT provides a systematic and structured framework for examining the scalability of this multi-component falls prevention intervention, although the iterative nature of the process and detailed and technical nature of its questions require considerable time and knowledge of the service to complete.

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Unplanned admissions and readmissions in older people: a review of recent evidence on identifying and managing high-risk individuals

Reviews in Clinical Gerontology ◽

10.1017/s0959259814000082 ◽

2014 ◽

Vol 24 (3) ◽

pp. 228-237 ◽

Cited By ~ 2

Author(s):

Bronagh Walsh

Keyword(s):

Risk Factors ◽

At Risk ◽

Older People ◽

Hospital Admissions ◽

Unplanned Admission ◽

Policy And Practice ◽

Admission Rates ◽

Poor Outcomes ◽

Unplanned Hospital Admissions ◽

Unplanned Admissions

SummaryRising unplanned hospital admissions are a problem in ageing populations worldwide. These admissions are associated with poor outcomes for older people, contribute to rising health care costs and impede the provision of planned care. Policy and practice in recent years has focused on identification of those at risk of unplanned admission and early intervention via a range of admission avoidance services. Despite this, unplanned admissions in older people continue to rise, and managing demand for unplanned care remains a priority. Questions remain about the risk factors for unplanned admission and the best approaches to identifying and intervening with those at risk. This review explores recent evidence on admission rates, risk factors for unplanned admission in older people, identification of those at highest risk and interventions to avert unplanned admission.

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Risk factors of hospital admissions and recurrent emergency department visits among pediatric asthma patients

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc.51-1586725862 ◽

2020 ◽

pp. 1011-1015

Author(s):

Abdullah Aldamigh ◽

Afaf Alnefisah ◽

Abdulrahman Almutairi ◽

Fatima Alturki ◽

Suhailah Alhtlany ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Hospital Admissions ◽

Pediatric Asthma ◽

Emergency Department Visits ◽

Asthma Patients

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Risk Factors and Family Support for Limitations in ADL among Older People in Urban China

Hallym International Journal of Aging ◽

10.2190/ha.11.1.b ◽

2009 ◽

Vol 11 (1) ◽

pp. 13-32

Author(s):

Yi Liu ◽

Keming Yang

Keyword(s):

Risk Factors ◽

Older People ◽

Family Support ◽

Urban China

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Correspondence on ‘Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases’

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-219542 ◽

2020 ◽

pp. annrheumdis-2020-219542 ◽

Cited By ~ 1

Author(s):

Sibel Zehra Aydin ◽

Elliot Hepworth ◽

Peter Tugwell

Keyword(s):

Risk Factors ◽

Rheumatic Diseases ◽

Hospital Admissions ◽

Inflammatory Rheumatic Diseases

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Impact of an integrated community-based model of care for older people with complex conditions on hospital emergency presentations and admissions: a step-wedged cluster randomized trial

BMC Health Services Research ◽

10.1186/s12913-021-06668-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jennifer Mann ◽

Fintan Thompson ◽

Robyn McDermott ◽

A. Esterman ◽

Edward Strivens

Keyword(s):

Older People ◽

Older Persons ◽

Hospital Admissions ◽

Community Dwelling ◽

Trial Registration ◽

Significant Finding ◽

Complex Needs ◽

Primary Practice ◽

The Impact ◽

Open Arch

Abstract Background Health systems must reorient towards preventative and co-ordinated care to reduce hospital demand and achieve positive and fiscally responsible outcomes for older persons with complex needs. Integrated care models can improve outcomes by aligning primary practice with the specialist health and social services required to manage complex needs. This paper describes the impact of a community-facing program that integrates care at the primary-secondary interface on the rate of Emergency Department (ED) presentation and hospital admissions among older people with complex needs. Methods The Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) study is a multicentre randomised controlled trial with a stepped wedge cluster design. General practitioners (GPs; n = 14) in primary practice within the Cairns region are considered ‘clusters’ each comprising a mixed number of participants. 80 community-dwelling persons over 70 years of age if non-Indigenous and over 50 years of age if Indigenous were included at baseline with no new participants added during the study. Clusters were randomly assigned to one of three steps that represent the time at which they would commence the OPEN ARCH intervention, and the subsequent intervention duration (3, 6, or 9 months). Each participant was its own control. GPs and participants were not blinded. The primary outcomes were ED presentations and hospital admissions. Data were collected from Queensland Health Casemix data and analysed with multilevel mixed-effects Poisson regression modelling to estimate the effectiveness of the OPEN ARCH intervention. Data were analysed at the cluster and participant levels. Results Five clusters were randomised to steps 1 and 2, and 4 clusters randomised to step 3. All clusters (n = 14) completed the trial accounting for 80 participants. An effect size of 9% in service use (95% CI) was expected. The OPEN ARCH intervention was found to not make a statistically significant difference to ED presentations or admissions. However, a stabilising of ED presentations and a trend toward lower hospitalisation rates over time was observed. Conclusions While this study detected no statistically significant change in ED presentations or hospital admissions, a plateauing of ED presentation and admission rates is a clinically significant finding for older persons with complex needs. Multi-sectoral integrated programs of care require an adequate preparation period and sufficient duration of intervention for effectiveness to be measured. Trial registration The OPEN ARCH study received ethical approval from the Far North Queensland Human Research Ethics Committee, HREC/17/QCH/104–1174 and is registered on the Australian and New Zealand Trials Registry, ACTRN12617000198325p.

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Validation of questionnaire-reported chest wall abnormalities with a telephone interview in Swiss childhood cancer survivors

BMC Cancer ◽

10.1186/s12885-021-08425-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rahel Kasteler ◽

Christa Lichtensteiger ◽

Christina Schindera ◽

Marc Ansari ◽

Claudia E. Kuehni ◽

...

Keyword(s):

Risk Factors ◽

Cancer Survivors ◽

Childhood Cancer ◽

Chest Wall ◽

Daily Life ◽

Well Being ◽

Childhood Cancer Survivors ◽

Thoracic Wall ◽

Medical Attention ◽

The Impact

Abstract Background Chest wall abnormalities are a poorly studied complication after treatment for childhood cancer. Chest wall abnormalities are not well-described in the literature, and little is known on the impact on daily life of survivors. Methods We investigated prevalence and risk factors of chest wall abnormalities in childhood cancer survivors in a nationwide, population-based cohort study (Swiss Childhood Cancer Survivor Study) with a questionnaire survey. We then interviewed a nested sample of survivors to validate types of chest wall abnormalities and understand their impact on the daily life of survivors. Results Forty-eight of 2382 (95%CI 2–3%) survivors reported a chest wall abnormality. Risk factors were older age at cancer diagnosis (16–20 years; OR 2.5, 95%CI 1.0–6.1), lymphoma (OR 3.8, 95%CI 1.2–11.4), and central nervous system tumors (OR 9.5, 95%CI 3.0–30.1) as underlying disease, and treatment with thoracic radiotherapy (OR 2.0, 95%CI 1.0–4.2), surgery to the chest (OR 4.5, 95%CI 1.8–11.5), or chemotherapy (OR 2.9, 95%CI 1.0–8.1). The nature of the chest wall abnormalities varied and included thoracic wall deformities (30%), deformations of the spine (5%) or both (55%), and scars (10%). Chest wall abnormalities affected daily life in two thirds (13/20) of those who reported these problems and necessitated medical attention for 15 (75%) survivors. Conclusion It is important that, during follow-up care, physicians pay attention to chest wall abnormalities, which are rare late effects of cancer treatment, but can considerably affect the well-being of cancer survivors.

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