Chronic kidney disease and recurrent falls in nursing home residents: A retrospective cohort study

Hall, Rasheeda K.; Landerman, Lawrence R.; O’Hare, Ann M.; Anderson, Ruth A.; Colón‐Emeric, Cathleen

doi:10.1016/j.gerinurse.2014.12.012

Cited by 13 publications

(24 citation statements)

References 29 publications

(32 reference statements)

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“…The association between earlier stages of kidney disease and falls has been less well studied. Prior studies have shown modest associations between measures of kidney function and a self-reported history of recurrent falls (7,(16)(17)(18).…”

Section: Discussionmentioning

confidence: 96%

Association of Reduced eGFR and Albuminuria with Serious Fall Injuries among Older Adults

Bowling

Bromfield²,

Colantonio³

et al. 2016

CJASN

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Background and objectives Falls are common and associated with adverse outcomes in patients on dialysis. Limited data are available in earlier stages of CKD.Design, setting, participants, & measurements We analyzed data from 8744 Reasons for Geographic and Racial Differences in Stroke Study participants $65 years old with Medicare fee for service coverage. Serious fall injuries were defined as a fall-related fracture, brain injury, or joint dislocation using Medicare claims. Hazard ratios (HRs) for serious fall injuries were calculated by eGFR and albumin-to-creatinine ratio (ACR). Among 2590 participants with CKD (eGFR,60 ml/min per 1.73 m 2 or ACR$30 mg/g), cumulative mortality after a serious fall injury compared with age-matched controls without a fall injury was calculated.Results Overall, 1103 (12.6%) participants had a serious fall injury over 9.9 years of follow-up. The incidence rates per 1000 person-years of serious fall injuries were 21.7 (95% confidence interval [95% CI], 20.3 to 23.2), 26.6 (95% CI, 22.6 to 31.3), and 38.3 (95% CI, 31.2 to 47.0) at eGFR levels $60, 45-59, and ,45 ml/min per 1.73 m 2 , respectively, and 21.3 (95% CI, 20.0 to 22.8), 31.7 (95% CI, 27.5 to 36.5), and 42.2 (95% CI, 31.3 to 56.9) at ACR levels ,30, 30-299, and $300 mg/g, respectively. Multivariable adjusted HRs for serious fall injuries were 0.91 (95% CI, 0.76 to 1.09) and 1.09 (95% CI, 0.86 to 1.37) for eGFR=45-59 and ,45 ml/min per 1.73 m 2 , respectively, versus eGFR$60 ml/min per 1.73 m 2 and 1.31 (95% CI, 1.11 to 1.54) and 1.81 (95% CI, 1.30 to 2.50) for ACR=30-299 and $300 mg/g, respectively, versus ACR,30 mg/g. Among participants with CKD, cumulative 1-year mortality rates among patients with a serious fall and age-matched controls were 21.0% and 5.5%, respectively.Conclusions Elevated ACR but not lower eGFR was associated with serious fall injuries. Evaluation for fall risk factors and fall prevention strategies should be considered for older adults with elevated ACR.

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Section: Discussionmentioning

confidence: 96%

Association of Reduced eGFR and Albuminuria with Serious Fall Injuries among Older Adults

Bowling

Bromfield²,

Colantonio³

et al. 2016

CJASN

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“…Patients in this study were also younger, and less frail than in our study population (less cognitive impairment, less depression, and less immobility) [ 4 ]. In a retrospective study in nursing home patients with a history of falls, a decreased eGFR was not an (in)dependent risk factor for recurrent falling or injurious falls [ 16 ]. The study population was comparable in age and kidney function (35% had a decreased eGFR vs. 38% in our study population), but had a higher use of a walking aid.…”

Section: Discussionmentioning

confidence: 99%

“…However, a large part of the CKD population will never progress to ESKD and therefore never need RRT. The few studies that assessed the association between falling and CKD found inconsistent findings [ 4 , 13 – 16 ]. Two studies showed no association, but these studies focused on recurrent falling in nursing home residents only or on serious fall incidents [ 4 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…The few studies that assessed the association between falling and CKD found inconsistent findings [ 4 , 13 – 16 ]. Two studies showed no association, but these studies focused on recurrent falling in nursing home residents only or on serious fall incidents [ 4 , 16 ]. Other studies that did show an association were post hoc analyses of medication randomized controlled trials [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Accidental falling in community-dwelling elderly with chronic kidney disease

et al. 2018

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PurposeThe aim of the current study was to evaluate the association between a decreased estimated glomerular filtration rate (eGFR) and accidental falling in elderly patients who visited the day clinic of the department of geriatric medicine of the University of Medical Center Utrecht (UMCU).Study designA cross-sectional analysis with people aged ≥ 65 years of the Utrecht Cardiovascular Cohort was performed. Patients were stratified into different stages of kidney disease (< 45, 45–59, and ≥ 60 ml/min per 1.73 m2). Logistic regression models were used to evaluate the association between chronic kidney disease and falling.ResultsOur analysis included 1000 participants with a mean age 79.4 (± 6.6) years, of whom 38% had an eGFR of < 60 ml/min per 1.73 m2 and 17% < 45 ml/min per 1.73 m2. Univariate analysis showed a significant higher prevalence [odds ratio 1.75 (95% confidence interval 1.21–2.53; p ≤ 0.01)] of falling in the population with an eGFR < 45 ml/min per 1.73 m2 compared to patients with an eGFR ≥ 60 ml/min per 1.73 m2. After correcting for multiple potential confounders in the multivariate analysis, this association was no longer present.ConclusionsIn geriatric patients ≥ 65 years, patients with a decreased eGFR fall more often than patients with a preserved kidney function. This seems to be related with the risk profile of patients with CKD and not with a decreased eGFR itself, as after correcting for potential confounders no association remained. Nevertheless, accidental falling is a highly prevalent problem in the elderly CKD population. Therefore, nephrologists should actively ask about accidental falling, and thereby screen for high-risk patients.

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“…Baseado em evidências que mostram a promoção da saúde como arcabouço conceitual e metodológico que contribui para a transformação da lógica das ações de saúde (4) , questiona-se sobre a capacidade dos profissionais de promoverem o cuidado direcionado para as necessidades individuais.…”

Section: Introductionunclassified

Learning culture in nephrology / Cultura de aprendizagem em nefrologia / La cultura del aprendizaje en nefrología

et al. 2016

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Objetivo: identificar conhecimento da equipe de enfermagem sobre cuidado com paciente em hemodiálise. Metodologia: trata-se de estudo qualitativo do tipo pesquisa ação, realizado com toda a equipe, 12 profissionais de enfermagem em clínica de hemodiálise, perguntas norteadoras, observação e registro foram usados na coleta, em junho de 2014, aprovação comitê de ética em pesquisa CAAE: 0422.0.045.000-11. Resultados: identificou-se a necessidade de ampliação do conhecimento sobre os cuidados com paciente em hemodiálise. Existe imprecisão na formulação de conceitos, características do tratamento e necessidade de ampliar conhecimento sobre a doença renal. Além da reduzida quantidade de profissionais que facilitem a aprendizagem e realizem orientações sobre o autocuidado no processo de adaptação com o tratamento hemodialítico. Conclusões: portanto, defende-se que os profissionais devam exercer a consciência crítica para o processo contínuo de formação para promover o cuidado apoiado.

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Chronic kidney disease and recurrent falls in nursing home residents: A retrospective cohort study

Cited by 13 publications

References 29 publications

Association of Reduced eGFR and Albuminuria with Serious Fall Injuries among Older Adults

Association of Reduced eGFR and Albuminuria with Serious Fall Injuries among Older Adults

Accidental falling in community-dwelling elderly with chronic kidney disease

Learning culture in nephrology / Cultura de aprendizagem em nefrologia / La cultura del aprendizaje en nefrología

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