Discrepancy between Patients’ and Nurses’ Estimates of Patients’ Activities of Daily Living for Fall Risk Assessment: A Quantitative Observational Study

Background: Patient falls are a serious problem in a rehabilitation unit. Although patient falls have been described in the healthcare literature for more 60 years, and many risk assessment tools have been developed, the rate of falls in hospitals in Japan has remained unchanged for the last 8 years. A previous study reported that about 50% of patients in rehabilitation estimated their fall risk lower than that estimated by their nurses. We believe that patients in rehabilitation tend to overestimate their ability to perform ADLs. Aim: To identify discrepancies between patients’ and nurses’ estimates of patients’ ability to perform activities of daily living (ADL) and clarify any relationship between the discrepancies and patient falls. Methods: Participants comprised 82 patients (42 men) admitted to a rehabilitation unit in Osaka, Japan from July to December of 2017. Patients and their nurses answered the same questionnaire about patients’ ability to perform ADL. The questionnaire was developed based on the Functional Independence Measure (FIM) and administered at admission, at 1 month after admission, and at discharge. Participants were classified into the overestimating group and the accurately estimating/underestimating group, and groups were compared using Wilcoxon rank-sum tests. Results: The mean age of participants was 76.4 years. At admission, approximately 72% of participants estimated their own ability to perform ADL higher than did the nurses. The percentage of overestimating participants dropped to 30% at discharge. Fifteen of the participants experienced a fall;all were in the overestimating group. The ADL Discrepancy and fall-assessment scores for these 15 participants were significantly higher than those of other participants. Conclusions: There are discrepancies between patients’ and nurses’ estimates of patients’ ability to perform ADL and had important significance for assessing their risk of fall. And minimizing the discrepancy may support the prevention of falls.

A poor performance in comprehensive geriatric assessment is associated with increased fall risk in elders with hypertension： a cross-sectional study

Background Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose of this study was to determine if age related systemic functional decline related with increased fall risks in elderly patients with hypertension. Methods A total of 342 elderly hypertension patients （age 79.5 ＋ 6.7 years, male 63.8%） were recruited to the study. Comprehensive geriatric assessment （CGA）, including measurements about activity of daily living （ADL）, nutrition, cognition, depression, numbers of prescription medication and number of clinical diagnosis, was conducted to evaluate the physical and mental status of each participants. Fall risk was evaluated by Morse fall scale, Tinetti perform- ance oriented mobility assessment （POMA） and history of fall in the recent years. Participants were grouped into tertiles according to CGA score. Correlation between CGA and fall risk was analyzed through SPSS 18.0. Results Participants with higher CGA score were likely to be older, had a lower body mass index （BMI）, and a higher prevalence of cardiovascular disease, chronic obstructive pulmonary disease （COPD）, cerebrovascular disease and osteoarthropathia. Participants in higher tertile of CGA score got increased prevalence of fall risk than those in lower tertile （P 〈 0.01 T3 vs. T1, P 〈 0.01 T3 vs. T2）. Correlation analysis and regression analysis showed significant association between CGA and Morse fall scale （P 〈 0.001）, as well as CGA and POMA （P 〈 0.001）. Meanwhile, CGA components also showed co-relationships with increase fall risks. After adjusting age, BMI, benzodiazepine use, cardiovascular disease, cerebrovascular disease, COPD and osteoarthropathia, both history of fall in the recent year and rising Morse fall scale were significantly associated with ADL im- pairment （OR： 2.748, 95%CI： 1.598-4.725）, （OR： 3.310, 95%CI： 1.893-5.788）. Decreased Tinetti POMA score was associated with Mini-Mental State Examination （MMSE） （OR： 4.035, 95%CI： 2.100-7.751）, ADL （OR： 2.380, 95%CI： 1.357-4.175） and shortened MNA form （MNA-SF） impairment （OR： 2.692, 95%CI： 1.147-6.319）. Conclusions In elderly adults with hypertension, impaired physical and mental function is associated with increased fall risk. Further study is required to investigate possible mediators for the association and effec- tive interventions.

Balance training in the intervention of fall risk in elderly with diabetic peripheral neuropathy: A review

Diabetic peripheral neuropathy(DPN)was the most common complications of elderly diabetic,which could contribute to an increased risk of falling.Despite the increased prevalence of elderly diabetic,high risk of falls and serious consequences of falls in elderly with DPN,It is necessary to adopt means of reducing the risk of falls in elderly with DPN.Impaired balance in the elderly with DPN was the most important risk factor of increasing falls.This review will introduce the epidemiology of falls in elderly with DPN,analysis the reasons for high risk of falls in elderly with DPN,provide a review of the development of balance training in the intervention of fall risk in elderly with DPN and offer recommendations to medical personnels on how to provide an efficient balance training for elderly with DPN.

Relationship between fall risks and activities of daily living in older individuals

Objective:To investigate the relationship between fall risks and maintaining activities of daily living in individuals aged 65 and over.Methods:This study is cross-sectional.It was conducted with 233 individuals who were aged 65 and over in Family Health Centers located in the eastern part of Turkey between February and June 2018.Results:The mean older individuals’DENN Fall Risks Assessment Scale score was 11.73±7.13,and 62.2%of the participants were in the high-risk group.Barthel Index of Activities of Daily Living(ADL)mean score was 68.03±25.36,and 45.1%of the participants were in the moderately dependent group.There was a statistically significant,negative correlationship between Barthel Index of ADL score and age and DENN Fall Risks Assessment Scale score.In addition,there was a statistically significant,positive relationship between the DENN Fall Risks Assessment Scale score and age(p<0.01).Conclusions:This study found that level of dependency and fall risks increased with the increase in age.Effective global and multidisciplinary interventions are needed to decrease older individuals’dependency levels and fall risks today when the number of older individuals is increasing.

Reliability of a new rapid step test for older women and its relationship with fall risk and leg muscle function

This study aimed to examine trial-to-trial reliability of a new clinical test, rapid reaction step cued on a screen test, and its relationship with fall risk score, independence in activity of daily living score, and various leg muscle function tests. One-hundred fifty seven older women participated in this study. Nine square plates (32 × 32 cm) were lined up with three plates. Participants stood on a center plate and were instructed to step, using one leg, to one of the other eight plates, as quickly as possible, when that plate changed in color from white to red. The mean total time and the mean total error time of rapid reaction step cued on a screen and, fall risk score, activity of daily living score, lower muscle function (isometric muscle strength: toe flexion, plantar flexion, knee extension, hip flexion;balance: one leg standing time with eye open, functional reach test;gait: 10 m walk time with maximal speed). Results: trial-to-trial reliabilities of step parameters were high (intraclass correlation coefficient [ICC] = 0.75 - 0.85). The step parameters correlated significantly with the other parameters except for toe flexion and hip flexion strengths. In conclusion, the present step test was found to evaluate physical function related to prevention of falls in older people.

Selecting the Optimal Morse Falls Scale Cut-Off Point for Patient Fall Risk

Patient falls have long been a difficult problem and topic of research in the inpatient hospital environment. Hospitals experience heavy financial burden due to patient falls. Preventing falls can improve patient outcomes as well as reduce financial burden on both the patient as well as the healthcare organization. In this study, we determine the optimal cut-off value for patients at risk for falls using a Falls Screening Tool, the Morse Falls Scale. This study was conducted at a community-owned hospital with 256 acute care private rooms and 36 critical care rooms. This study used only the admission Morse Falls Scale (MFS) score in its analysis.

Age-related fall risk characteristics in Japanese community-dwelling elderly

This study aimed to determine age-related fall risk characteristics among 2324 Japanese community-dwelling elderly through comparisons between young-old and old-old populations. Fall risk characteristics associated with “physical function”, “disease and physical symptom”, “behavior and character”, and “environment” were evaluated, and whether each individual has a high-risk symptom for each risk factor was assessed. The frequencies of individuals for all 16 risk types, which were determined by a combination of the four risk factors, were calculated. The prevalence of each risk type and the incidence of falling in each risk type were calculated within the young-old and old-old groups, and significant differences between these percentages were examined using the chi-square test. The prevalence of the no high-risk symptom group was significantly lower in the old-old group (17.0%) than in the young-old group (45.2%). Although there was no significant difference in the prevalence of the single high-risk symptom group, the prevalence of the two or more high-risk symptom groups was significantly higher in the old-old group. The incidence of fall among the elderly with high-risk symptoms did not change with age, although the incidence of fall with no high-risk symptom increased in the old-old group. Furthermore, high prevalence was observed in risk types with high-risk symptoms for “physical function” and “behavior and character”, particularly in the symptoms of gait, going up and down stairs, and fear of falling. These age-related differences are interesting and meaningful.

Effects of Mild and Severe Knee Joint Pain on the Frequency of Falls and Fall Risk in Elderly Females

This study aimed to examine differences in the frequency of falls during the past year and fall risk among 392 elderly females was categorized into five groups on the basis of the knee pain expe-rienced: no knee pain, mild unilateral knee pain, mild bilateral knee pain, severe unilateral knee pain, and severe bilateral knee pain. The subjects participated in a fall risk survey comprising 50 items representing five risk factors: “symptoms of falling”, “disease and physical symptoms”, “en-vironment”, “behavior and character”, and “physical function”. The frequency of falls during the past year, score for each risk factor, and the total fall risk score were not significantly different between the mild unilateral and mild bilateral knee pain groups, and between the severe unilateral and severe bilateral knee pain groups. Therefore, these groups were pooled to form a mild knee pain group and a severe knee pain group and analyzed. The severe knee pain group had experienced a significantly greater number of falls during the past year compared with the no knee pain group. Furthermore, the symptom of falling score was significantly higher in the severe knee pain group than in the no knee pain group, while the disease and physical symptoms score was significantly higher in the mild and severe knee pain groups than in the no knee pain group. The physical function score and total fall risk score were significantly higher in the following order: the severe knee pain group, the mild knee pain group, and the no knee pain group. Our results indicate that for elderly females who can achieve ADL independently, the degree of knee pain (mild or severe) has a marked effect on fall risk, irrespective of laterality of the pain (unilateral or bilateral). Factors such as symptoms of falling, disease and physical symptoms, and physical function are also related to fall risk in this population. Furthermore, elderly individuals with severe knee pain experience frequent falls.

Use of the Tinetti Index to Assess Fall Risk in Patients with Sequelae of Stroke

Background and Objective: The knowledge about risk of falls in patients with sequelae of stroke by applying a scale constitutes an important factor fort nurses since it allows planning for quality care and consequently improves the quality of life of such patients. The present study aimed to assess the risk of falls of patients with sequelae of stroke using Tinetti Index. Methods: Transversal descriptive study with 61 hospitalized patients. The data were collected through the application of Tinetti Index, the total score of which is 28 points. Results: The index evaluation shows que 47.9% had 19 points under the ideal score, indicating a high risk of falls, 41.7% from 24 to 28, indicating moderate risk and 10.4% from 19 to 23 points, indicating low risk of falls. The final average was (15.23), the median (16.50) and standard deviation (±11.034). Conclusions: There is a high risk of falls in this population, a quantification of impaired balance and gait anticipate the future risk of falls. The use of assessment instruments has important implications for improving the quality of life in patients with symptomatic stroke.

The correlation between white matter hyperintensity and balance disorder and fall risk:An observational, prospective cohort study

Objective: The presence of an association between white matter hyperintensity (WMH) and the risk of falls in older people is uncertain, with little supporting prospective evidence available at present. We aimed to determine whether WMH was associated with dysfunctions of balance and gait, and other sensorimotor factors leading to falls, and the independent factors related to falls in older Chinese people. The protective effect of exercise against falls was also addressed. Methods: In a representative sample of hospital-based individuals aged 50 years and older in China, the patients' history of falls, magnetic resonance imaging data, scores on the 9-item Berg Balance Scale (BBS-9) test and timed up-and-go test (TUGT), and sensorimotor measures of computerized dynamic posturography (CDP) were analyzed. Incident falls were recorded prospectively over a 12-month period. Using regression modeling, the association between the risk of falls and baseline WMH was estimated. Results: Only individuals with severe WMH were at an increased risk of falls, and CDP was more sensitive than BBS-9 in detecting WMH-related balance and gait dysfunction. However, WMH was not an independent predictor of falls. Taller height and overweight or obese body habitus were identified as novel protective factors for falls. Female, fall history, and increased TUGT score were identified as independent risk factors for falls in older Chinese people.

Physical Activation of Elderly and the Decrease of Falling Risk

A Physical Activation Program was designed and implemented with a particular emphasis in recovering of motor independence, and in an indirect manner;the increase of activities was carried out in a social context in such a way that it allowed isolated elderly to develop their ability to perform daily activities diminishing the burden on their caregivers. 30 people were randomly selected: 15 subjects in the experimental group and 15 in the control group;7 women and 8 men each group. Subjects aged between 60 - 84 years with a mean age of 78 years and a standard deviation of 6.5 were applied in a three-month Physical Activation Program with a 45-min daily sessions. Results obtained showed that physical activity in elderly, systematically improved their amplitude and joint mobility which impact directly and indirectly their quality of life, reducing their risk of falling.

Salsa Dance Could Improve Effectively to Body Balance in Elderly with Risk of Falls

Currently the number of elderly in Indonesia tends to increase. Based on 2014 Susenas data, the number of elderly in Indonesia reaches 20.24 million people (8.03%). One of the most common physical disorders in the elderly is disruption of the body’s balance and risk to falls. The risk of falling in the elderly can be prevented by doing physical exercise in the form of Salsa dance. Salsa dance has movements that can improve stability, flexibility, mobility and body balance. This study aims to analyze the effectiveness of Salsa dance on body balance in the elderly. The research method used quasi-experimental with the pre test-post test design control group. As many as 70 elderly who experienced balance disruption in the Puskemas Sarijadi had participated in this study. The sample was taken by using consecutive sampling, then divided equally between the control group and the intervention group. The instrument used to measure elderly balance is Short Physical Performance Battery (SPPB). Data analysis is carried out in two stages, namely univariate analysis using the mean, standard deviation, maximum value and minimum value and percentage;then followed by bivariate analysis using the Wilcoxon signed rank test and independent T test. The result shows that there are differences in the balance of the elderly before and after the intervention in the treatment group, whereas in the control group there were no significant differences. Therefore, it can be concluded that Salsa dance can significantly improve elderly body balance, especially if done regularly. The increase will appear significant after the intervention carried out for 10 and 20 times. It is suggested that nurses utilize Salsa dance as an alternative in dealing with symptoms of body balance disorders in the elderly. This intervention can be implemented along with other activities of the elderly in community centre health services.

老年肌少症病人跌倒风险的研究进展

从老年肌少症病人跌倒的流行病学、危险因素、风险评估、干预措施等方面进行综述,以期为预防老年肌少症病人跌倒提供相应的理论依据,旨在降低老年肌少症病人跌倒的发生率。

主观体力疲劳在老年患者肌力与跌倒风险之间的中介效应分析

目的探究主观体力疲劳在老年患者肌力与跌倒风险之间的中介效应。方法以2019年1月至2022年12月在首都医科大学附属北京友谊医院老年医学科住院的老年患者为研究对象,选取入院前1年有跌倒史的167例患者为病例组,同时选取入院前1年无跌倒史的167例患者为对照组。比较分析两组患者的临床特征。分析主观体力疲劳、肌力与老年患者跌倒风险的相关性。分析老年患者跌倒风险的独立影响因素。分析主观体力疲劳在老年患者肌力与跌倒风险之间的中介效应。结果病例组患者的体重指数、肌力低于或小于对照组,年龄、主观体力疲劳比例大于或高于对照组,差异均有统计学意义(P<0.05)。Pearson相关性分析结果显示,老年患者的主观体力疲劳与肌力呈显著负相关(r=-0.243,P<0.05),与跌倒风险呈显著正相关(r=0.160,P<0.05);老年患者的肌力与跌倒风险呈显著负相关(r=-0.240,P<0.05)。多因素logistic回归分析结果显示,体重指数、肌力是老年患者跌倒风险的独立保护因素(P<0.05),主观体力疲劳是老年患者跌倒风险的独立危险因素(P<0.05)。Model 4中介模型分析结果显示,肌力对跌倒风险的直接预测作用显著(β=0.132,t=4.311,P=0.000),当加入中介变量后,肌力对跌倒风险的直接预测作用仍然显著(β=0.121,t=2.103,P=0.000),肌力对主观体力疲劳的预测作用显著(β=0.219,t=3.151,P=0.000),主观体力疲劳对跌倒风险的预测作用显著(β=0.052,t=3.912,P=0.000)。Bootstrap检验模型分析结果显示,肌力对跌倒风险的直接效应值为0.641(95%CI 0.615~0.853),主观体力疲劳对跌倒风险的中介效应值为0.326(95%CI 0.032~0.221),95%CI不包含0,表明中介效应成立,且中介效应值占总效应的33.72%。结论主观体力疲劳是老年患者肌力与跌倒风险之间的中介变量,临床应重视老年患者主观体力疲劳的评估与干预,从而有助于降低老年患者的跌倒风险。

老年住院患者复合跌倒风险评分表的构建及应用研究

目的构建老年住院患者复合跌倒风险评分表,提高老年住院患者跌倒风险评估准确性。方法整合约翰霍普金斯跌倒评定量表和HendrichⅡ跌倒风险模型作为初始条目;采用前瞻性研究,收集42490例老年住院患者跌倒发生情况及相关风险因素,通过χ^(2)检验和logistic回归分析确定跌倒的影响因素,构建老年住院患者复合跌倒风险评分表。将复合跌倒风险评分表在1663例老年住院患者中进行验证。结果logistic回归分析得到18项危险因素,将各危险因素的风险比值比(OR)进行赋值,总分为100分。验证结果显示,老年住院患者复合跌倒风险评分表的ROC曲线下面积为0.825(95%CI:0.798~0.852),最佳截断值为7.5分,灵敏度为0.736,特异度为0.771。结论老年住院患者复合跌倒风险评分表能有效预测老年住院患者的跌倒风险,有助于临床护理人员及时筛查出高危患者,从而进行有针对性的预防干预。

老年人药物相关性跌倒预防与管理的证据总结

目的 :检索并总结老年人药物相关性跌倒预防与管理的相关证据,为降低老年人药物相关性跌倒发生率提供循证依据。方法 :按照证据资源“6S”模型自上而下依次系统检索国内外相关数据库和网站中关于老年人药物相关性跌倒预防与管理的临床决策、指南、专家共识、证据总结和系统评价,检索时限为从建库至2023年12月1日,对纳入文献进行质量评价和资料提取,根据证据汇总原则提取并整合证据。结果 :共纳入16篇文献,包括1篇临床决策、3篇指南、5篇专家共识、2篇证据总结和5篇系统评价。从跌倒风险评估、跌倒相关用药评估、预防策略、使用管理和健康教育5个方面形成了21条证据。结论 :本研究总结的老年人药物相关性跌倒预防与管理的证据内容可协助医护人员结合患者实际情况制定个性化干预方案,降低老年人药物相关性跌倒发生率。

肿瘤患者跌倒风险感知量表的编制及信效度检验

目的编制肿瘤患者跌倒风险感知量表并检验信效度,为肿瘤患者跌倒防范提供自评工具。方法通过文献回顾、专家函询、小组讨论等方式构建量表,选取407例肿瘤患者进行调查,检验量表信效度。结果肿瘤患者跌倒风险感知量表包括跌倒认知易感知性(5个条目)、生理状况易感知性(12个条目)、个人活动易感知性(5个条目)、环境因素易感知性(5个条目)、跌倒严重性感知(3个条目)5个维度共30个条目。探索性因子分析提取5个公因子,累计方差贡献率66.746%。量表总的Cronbach′sα系数为0.926,折半信度为0.672,各维度Cronbach′sα系数为0.914~0.970,折半信度为0.877~0.963。量表水平的内容效度指数为0.867,条目水平的内容效度指数为0.813~1.000。验证性因子分析结果显示,χ^(2)/df=1.845,RMSEA=0.059,GFI=0.840,CFI=0.971,NFI=0.939,AGFI=0.811,模型适配良好;AVE平方根均显著大于相关系数,各维度之间有显著相关性(均P<0.05)。结论肿瘤患者跌倒风险感知量表信效度良好,可用于肿瘤患者跌倒风险感知的评估。

自制血透患者跌倒风险评估量表与Mores量表的应用比较

目的探讨自制血透患者跌倒风险评估量表与Mores量表的应用比较差异。方法选取粤北人民医院血液净化中心2021年7月至2022年5月收治的维持性血液透析患者215例。通过自行编制的血透患者跌倒风险评估量表以及Morse跌倒评估量表对患者进行评价,分别筛选出跌倒高风险患者,并对所有患者进行至少半年的随访,观察其跌倒不良事件的发生情况,以及不同量表对其跌倒事件发生的评估价值。结果自制血透患者跌倒风险评估量表信度为89.34%,效度为87.30%。随访期间,共有35例患者发生跌倒事件,纳入观察组,余180例患者纳入对照组。两组患者使用自制血透患者跌倒风险评估量表和Morse量表,除“超过一个医学诊断”项目外,观察组各项分值以及总分均更高,且差异均有统计学意义(P<0.05)。以量表测评分值作为自变量,患者预后结局作为因变量,绘制受试者工作特征(ROC)曲线,结果发现,自制量表的约登指数高于Morse量表。结论对于血液透析患者,使用自制血透患者跌倒风险评估量表更具有针对性,与Mores量表相比,自制量表对血透患者跌倒风险的评估价值更优,为血液透析患者跌倒的早期防范提供了预测途径,值得推广应用。

居家老年人跌倒及相关损伤严重程度影响因素研究

目的 探讨居家老年人跌倒及损伤严重程度的影响因素。方法 采用回顾性调查及队列研究设计选取解放军总医院第二医学中心2022年4月~6月门诊体检老年人的病历资料及跌倒筛查问卷。共收集2 374例有效病例,根据过去1年内跌倒情况分为有跌倒史组和无跌倒史组,单次跌倒史组和多次跌史倒组,跌倒环境为居家或社区。比较组间差异情况。结果 居家老年人跌倒相关损伤率为14.7%。单次跌倒史与多次跌倒史组间损伤严重程度比较,差异有统计学意义(P<0.05)。跌倒恐惧、骨折史、视力听力问题、感觉减退与居家老年人跌倒及相关损伤严重程度显著相关(P<0.05)。结论 居家老年人跌倒及相关损伤严重程度受疾病、心理、生理多因素影响,有多次跌倒史的相关损伤更重,可通过预防骨折、减轻跌倒恐惧来降低跌倒发生率及相关损伤的风险。

基于“安全-支持-合作”模式的高危跌倒护理方案在神经内科中的应用效果

目的 探讨基于“安全-支持-合作”模式的高危跌倒护理方案在神经内科的应用效果。方法 选取2022年3月至2023年3月在钦州市第二人民医院神经内科接受治疗的患者200例,随机分为对照组和观察组,每组100例,给予对照组常规护理,观察组于对照组基础上行基于“安全-支持-合作”模式的高危跌倒护理方案,对比2组护理方法对患者跌倒预防自我管理能力(《预防跌倒自我管理行为调查问卷》评价)、跌倒风险(Morese跌倒评估量表评估)、跌倒发生率、护理满意度(纽卡斯尔护理服务满意度量表评价)的影响。结果 2组护理前的《预防跌倒自我管理行为调查问卷》、跌倒风险比较,差异无统计学意义(P>0.05);2组护理后的《预防跌倒自我管理行为调查问卷》高于护理前,且观察组高于对照组;跌倒风险则低于护理前,且观察组低于对照组(P<0.05)。观察组跌倒发生率低于对照组(P<0.05)。观察组护理满意度高于对照组(P<0.05)。结论 基于“安全-支持-合作”模式的高危跌倒护理方案应用于神经内科中可有效改善患者跌倒预防自我管理能力,降低跌倒风险,减少跌倒的发生,并提高患者护理满意度。