Effect of Dissemination of Evidence in Reducing Injuries from Falls

Abstract

Background Falling is a common and morbid condition among elderly persons. Effective strategies to prevent falls have been identified but are underutilized. Methods Using a nonrandomized design, we compared rates of injuries from falls in a region of Connecticut where clinicians had been exposed to interventions to change clinical practice (intervention region) and in a region where clinicians had not been exposed to such interventions (usual-care region). The interventions encouraged primary care clinicians and staff members involved in home care, outpatient rehabilitation, and senior centers to adopt effective risk assessments and strategies for the prevention of falls (e.g., medication reduction and balance and gait training). The outcomes were rates of serious fall-related injuries (hip and other fractures, head injuries, and joint dislocations) and fall-related use of medical services per 1000 person-years among persons who were 70 years of age or older. The interventions occurred from 2001 to 2004, and the evaluations took place from 2004 to 2006. Results Before the interventions, the adjusted rates of serious fall-related injuries (per 1000 person-years) were 31.2 in the usual-care region and 31.9 in the intervention region. During the evaluation period, the adjusted rates were 31.4 and 28.6, respectively (adjusted rate ratio, 0.91; 95% Bayesian credibility interval, 0.88 to 0.94). Between the preintervention period and the evaluation period, the rate of fall-related use of medical services increased from 68.1 to 83.3 per 1000 person-years in the usual-care region and from 70.7 to 74.2 in the intervention region (adjusted rate ratio, 0.89; 95% credibility interval, 0.86 to 0.92). The percentages of clinicians who received intervention visits ranged from 62% (131 of 212 primary care offices) to 100% (26 of 26 home care agencies). Conclusions Dissemination of evidence about fall prevention, coupled with interventions to change clinical practice, may reduce fall-related injuries in elderly persons.

Reliability and validity of the Turkish version of the Performance-Oriented Mobility Assessment I

“…Muscular weakness of the lower extremities, decreased grip force, impaired postural balance, functional, and cognitive disorders, and visual problems constitute intrinsic factors, while extrinsic factors consist of multiple drug use (≥4 drugs) and environmental factors such as inadequate illumination, slippery floors, and lack of safety equipments in bathrooms. Besides, a decrease in the ability to perform daily living activities and usage of walking aids contribute to the frequency of falls [3,5,7].…”

Falls and peripheral nerve injuries: an age-dependent relationship

“…4 The rapid aging of the population and rising rate of arthritis are projected to result in a dramatic increase in the number of falls in the elderly. 26 The study of initially less clinically pronounced injuries, such as PNIs, is crucial to minimize further morbidity and mortality. In addition, it allows the age-specific allocation of health care resources for fall-injured patients.…”

“…2,4,23,26 Especially in the elderly, falls have turned into an epidemic associated with significant morbidity and mortality. 4,26 Although life-threatening injuries such as subdural hematomas and hip fractures attract a lot of attention, 4,26 less clinically pronounced injuries, such as peripheral nerve injuries (PNIs), have largely stayed out of the spotlight. PNIs do not contribute to immediate mortality, but they can significantly impact the long-term quality of life of the affected individuals.…”

Preventing falls in older people

“…This is a rate of nearly 40/1000 people attending emergency departments per year because of a fall. International rates of injurious falls (Table 1.1) range from 0.55-1.00 per person-year 29 46 47 , with serious injurious falls rates in the region of 32 per 1000 person-years 55 .…”