Are elderly haemodialysis patients at risk of falls and postural hypotension?

Roberts, Russell; Kenny, Rose Anne; Brierley, Elizabeth J.

doi:10.1023/b:urol.0000022866.07751.4a

Cited by 43 publications

(42 citation statements)

References 21 publications

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“…We found that low predialysis SBP, male gender, increased comorbidity, and a history of falls were predictive of recurrent falls. The relationship between predialysis SBP and falls is not surprising and has been reported in both the geriatric and nephrology literature (16,19). Of importance, BP is the only potentially modifiable risk factor identified, and our data argue in favor of raising predialysis BP targets in older HD patients who report previous falls.…”

Section: Discussionmentioning

confidence: 59%

“…Previous reports of falls in the dialysis population are limited to a few retrospective or short-term prospective studies (15)(16)(17). These suggest that the prevalence of falls in the elderly hemodialysis (HD) population is at least as high as in individuals without uremia in the community (16,17) and that the incidence of fall events may be higher (15). No long-term prospective studies have been reported in this population to determine accurately the annual incidence of falls or to examine the risk factors for falls.…”

mentioning

confidence: 99%

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Falls and Fall-Related Injuries in Older Dialysis Patients

Cook

Tomlinson

Donaldson

et al. 2006

Clinical Journal of the American Society of Nephrology

178

174

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Dialysis patients are increasingly older and more disabled. In community-dwelling seniors without kidney disease, falls commonly predict hospitalization, the onset of frailty, and the need for institutional care. Effective fall prevention strategies are available. On the basis of retrospective data, it was hypothesized that the fall rates of older (>65 yr) chronic outpatient hemodialysis (HD) patients would be higher than published rates for community-dwelling seniors (0.6 to 0.8 falls/patientyear). It also was hypothesized that risk factors for falls in dialysis outpatients would include polypharmacy, dialysis-related hypotension, cognitive impairment, and decreased functional status. Using a prospective cohort study design, HD patients who were >65 yr of age at a large academic dialysis unit were recruited. All study participants underwent baseline screening for fall risk factors. Patients were followed prospectively for a minimum of 1 yr. Falls were identified through biweekly patient interviews in the HD unit. A total of 162 patients (mean age 74.7 yr) were recruited; 57% were male. A total of 305 falls occurred in 76 (47%) patients over 190.5 person-years of follow-up (fall-incidence 1.60 falls/person-year). Injuries occurred in 19% of falls; 41 patients had multiple falls. Associated risk factors included age, comorbidity, mean predialysis systolic BP, and a history of falls. In the HD population, the fall risk is higher than in the general community, and fall-related morbidity is high. Better identification of HD patients who are at risk for falls and targeted fall intervention strategies are required.

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Section: Discussionmentioning

confidence: 59%

mentioning

confidence: 99%

Falls and Fall-Related Injuries in Older Dialysis Patients

Cook

Tomlinson

Donaldson

et al. 2006

Clinical Journal of the American Society of Nephrology

178

174

View full text Add to dashboard Cite

show abstract

“…Although not clearly identifiable as "fallers," individuals at most risk for falling tended to have multiple comorbid conditions, take multiple medications, have low predialysis systolic BP, and experience difficulties when walking (23). Multiple explanations for the association between increased fall risk and impaired renal function, such as the high number of concomitant comorbid conditions and dialysis-related precipitants (postdialysis fluid shifts and hypotension), have been proposed (25). It is interesting that falls were associated with a two-fold risk for mortality even after adjustment for common predictive markers (26).…”

Section: Frailtymentioning

confidence: 99%

Dialysis in Late Life

Jassal¹,

Watson²

2009

Clinical Journal of the American Society of Nephrology

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As a result of the changing dialysis demographics, nephrologists are increasingly faced with problems traditionally considered to be geriatric issues. The specialty of nephrology has often been seen as using intensive, expensive, and complex technologies for patient care. Dialysis programs have evolved into highly efficient, fast-paced units that accommodate a rapid turnover of patients. They are in direct contrast to geriatric programs, which use geriatric principles to offer simple, multidimensional, holistic care to frail older patients. Finding the balance between nephrology and geriatric skill sets is a particular challenge for up-and-coming nephrologists who have an interest in geriatric nephrology. This mini-review addresses some of the challenges, increases awareness of specific issues, and highlights new opportunities in this field.

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“…Earlier studies have demonstrated an increased risk for falls in dialysis patients (4,18,28,(32)(33)(34)(35)(36)(37). Age, diabetes, motor strength, medication use (including antidepressants), a failed walking test, previous fall episodes, and visual impairment are all risk factors for falls (33)(34)(35)(36)(37)(38)(39). Fall prevention is important because the incidence of hip fracture with fall and the 1-year mortality rate related to a hip fracture are increased in the dialysis population (36).…”

Section: Patient Fallsmentioning

confidence: 99%

“…About 40% of the time the professional respondents stated they did not know the cause of the fall. Several strategies may help to reduce the risk for falls (34)(35)(36)(37)(38)(39), including monitoring orthostatic BP, staff education, use of evidence-based tools for fall assessment (such as assessment of gait and vision), gait assistance for high-risk patients, controlling clutter, and use of in-floor patient weight scales.…”

Section: Patient Fallsmentioning

confidence: 99%

Patient and Facility Safety in Hemodialysis

Garrick

Kliger

Stefanchik

2012

Clinical Journal of the American Society of Nephrology

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SummaryPatient safety is the foundation of high-quality health care. More than 350,000 patients receive dialysis in the United States, and the safety of their care is ultimately the responsibility of the facility medical director. The medical director must establish a culture of safety in the dialysis unit and lead the quality assessment and performance improvement process. Several lines of investigation, including surveys of patients and dialysis professionals, have helped to identify important areas of safety risk in dialysis facilities. Among these are lapses in communication, medication errors, patient falls, errors in machine and membrane preparation, failure to follow established policies, and lapses in infection control. The quality assessment and performance improvement process should include a dedicated safety team to focus on specifically identified areas of risk and to establish outcome goals guided by best practices and agreed-upon measures of success. A safety questionnaire can be given to patients and staff and the responses evaluated to improve understanding of the prevailing attitudes and concerns about safety. By sharing these results, openly acknowledging the challenges, and using a blame-free root cause process to identify action plans, the facility can begin to establish a culture of safety.

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Are elderly haemodialysis patients at risk of falls and postural hypotension?

Cited by 43 publications

References 21 publications

Falls and Fall-Related Injuries in Older Dialysis Patients

Falls and Fall-Related Injuries in Older Dialysis Patients

Dialysis in Late Life

Patient and Facility Safety in Hemodialysis

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