A qualitative description of falls in a neuro-rehabilitation unit: the use of a standardised fall report including the International Classification of Functioning (ICF) to describe activities and environmental factors

IntroductionThere is a consistent body of evidence supporting the role of cognitive functions, particularly executive function, in the elderly and in neurological conditions which become more frequent with ageing. The aim of our study was to assess the role of different domains of cognitive functions to predict balance and fall risk in a sample of adults with various neurological conditions in a rehabilitation setting.MethodsThis was a prospective, cohort study conducted in a single centre in the UK. 114 participants consecutively admitted to a Neuro-Rehabilitation Unit were prospectively assessed for fall accidents. Baseline assessment included a measure of balance (Berg Balance Scale) and a battery of standard cognitive tests measuring executive function, speed of information processing, verbal and visual memory, visual perception and intellectual function. The outcomes of interest were the risk of becoming a faller, balance and fall rate.ResultsTwo tests of executive function were significantly associated with fall risk, the Stroop Colour Word Test (IRR 1.01, 95% CI 1.00–1.03) and the number of errors on part B of the Trail Making Test (IRR 1.23, 95% CI 1.03–1.49). Composite scores of executive function, speed of information processing and visual memory domains resulted in 2 to 3 times increased likelihood of having better balance (OR 2.74 95% CI 1.08 to 6.94, OR 2.72 95% CI 1.16 to 6.36 and OR 2.44 95% CI 1.11 to 5.35 respectively).ConclusionsOur results show that specific subcomponents of executive functions are able to predict fall risk, while a more global cognitive dysfunction is associated with poorer balance.

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“…The flow of patients into the study and the characteristics of those agreeing and declining study participation are described elsewhere [ 46 ].…”

Section: Resultsmentioning

confidence: 99%

“…Fall rate (95% CI) per 100 days hospital stay was 1.33 (1.04 to 1.67) ( Table 2 ). Falls characteristics are described in an earlier published paper [ 46 ].…”

Section: Resultsmentioning

confidence: 99%

The Role of Cognitive Factors in Predicting Balance and Fall Risk in a Neuro-Rehabilitation Setting

et al. 2016

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“…, Saverino et al . ); and (4) older patient age in some rehabilitation settings (Frisina et al . , Kwan et al .…”

Section: Introductionmentioning

confidence: 99%

“…While the nature of falls is in part dependent on patient context (Saverino et al . ), mixed neurorehabilitation settings are potentially contextually incongruous with TBI rehabilitation settings. Therefore, the generalisability of falls research in mixed neurorehabilitation settings to the TBI rehabilitation context is problematic.…”

Section: Introductionmentioning

confidence: 99%

The characteristics of falls in an inpatient traumatic brain injury rehabilitation setting

McKechnie

Fisher

Pryor

2015

Journal of Clinical Nursing

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“…These cues may serve as red lights that predict the next fall and thus lead to early fall risk evaluation and intervention when needed. For that, intervention programs should be based on a multi-disciplinary approach, and apply models such as the ICF that were found to be relevant to fall rehabilitation [53]. Intervention should apply performance-based ecological assessments to map body dysfunctions that predict falls in real life context.…”

Section: Discussionmentioning

confidence: 99%

The Relationships Between Fall Risk, Depression, Executive Dysfunctions and Daily Life of Older Adults

Engel‐Yeger

Zilbershlag

2020

Preprint

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Background: Falling is a major problem in older adults that may significantly reduce health and quality of life (QOL). Body dysfunctions that include depression, cognitive decline and executive dysfunctions may elevate fall risk and impair daily activities and QOL. Yet, most studies evaluate these body dysfunctions using laboratory measures in clinical settings. The present study aimed to: (1) compare these body dysfunctions between high/low risk fallers (2) examine the relationship between these body dysfunctions among the high risk fallers (3) explore the specific contribution of fall risk as a mediator between depression, executive dysfunctions and daily life. Methods: Participants were 123 older adults who live in the community. Depression and cognitive status were measured by the GDS-15 and the MoCA. Fall risk was determined by a questionnaire supported by the Time Up and Go test (TUG). Executive functions (EF) were assessed by the BRIEF-A and the aEFPT medication management assessment. Daily activity performance was measured by the Barthel Index of ADL and the Instrumental ADL Scale. QOL was measured by the World Health Organization Quality of Life Brief Questionnaire. Results: High fall risk was prevalent among 32% of the sample. High risk fallers had significantly lower cognitive level, higher depression, lower EF, lower daily activity performance and lower QOL. Among the high risk group, lower EF as measured in BRIEF-A scales correlated with lower performance of daily activities and lower QOL. SEM model revealed that fall risk mediated between depression, executive dysfunctions and daily life. Conclusions: Depression and executive dysfunctions are more prevalent in older adults with high fall risk and are significantly related to their daily activity performance and to their QOL. Community fall-prevention and rehabilitation programs should screen for fall risk and related body dysfunctions as expressed during daily activity performance and understand their impacts on people’s QOL.

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A qualitative description of falls in a neuro-rehabilitation unit: the use of a standardised fall report including the International Classification of Functioning (ICF) to describe activities and environmental factors

Cited by 11 publications

References 26 publications

The Role of Cognitive Factors in Predicting Balance and Fall Risk in a Neuro-Rehabilitation Setting

The Role of Cognitive Factors in Predicting Balance and Fall Risk in a Neuro-Rehabilitation Setting

The characteristics of falls in an inpatient traumatic brain injury rehabilitation setting

The Relationships Between Fall Risk, Depression, Executive Dysfunctions and Daily Life of Older Adults

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