Fall-related injuries in a nursing home setting: is polypharmacy a risk factor?

Baranzini, Federico; Diurni, Mario; Ceccon, Francesca; Poloni, Nicola; Cazzamalli, Sara; Costantini, Chiara; Colli, Cristiano; Greco, Luigi; Callegari, Camilla

doi:10.1186/1472-6963-9-228

Cited by 93 publications

(72 citation statements)

References 30 publications

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“…The goal of the protocol is expeditious but safe care of these patients with hip fractures and multiple comorbidities. [16][17][18] A standardized order set was developed and is utilized in the emergency department as well as for admission to the hospital, postoperatively, and for discharge. Particular attention was paid to avoidance of contraindicated medications [19][20][21] that have been demonstrated to increase the risk of delirium in the elderly patient and often increase hospital length of stay.…”

Section: Methodsmentioning

confidence: 99%

Comanagement of Geriatric Patients With Hip Fractures

Rocca

Moylan

Crist

et al. 2013

Geriatr Orthop Surg Rehabil

109

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The objective of this 3-year retrospective, controlled, cohort study is to characterize an interdisciplinary method of managing geriatric patients with hip fracture. All patients aged 65 years or older admitted to a single academic level I trauma center during a 3-year period with an isolated hip fracture were included as participants for this study. Thirty-one geriatric patients with hip fracture were treated with historical methods of care (cohort 1). The comparison group of 115 similar patients was treated under a newly developed, institutional comanagement hip fracture protocol (cohort 2). There were no differences in age, sex distribution, or comorbidity distribution between the 2 cohorts. Patients requiring intensive care unit (ICU) admission decreased significantly from 48% in cohort 1 to 23% in cohort 2 (P ¼ .0091). Length of ICU stay for patients requiring ICU admission also decreased significantly, from a mean of 8.1 days in cohort 1 to 1.8 days in cohort 2 (P ¼ .024). Total hospital stay decreased significantly, from a mean of 9.9 days in cohort 1 to 7.1 days in cohort 2 (P ¼ .021). Although no decrease in in-hospital mortality rates was noted from cohort 1 to cohort 2, a trend toward decreased 1-year mortality rates was seen after implementation of the hip fracture protocol. Hospital charges decreased significantly, from US$52 323 per patient in cohort 1 to US$38 586 in cohort 2 (P ¼ .0183). Implementation of a comanagement protocol for care of geriatric patients with hip fracture, consisting of admission to a geriatric primary care service, standardized perioperative assessment regimens, expeditious surgical treatment, and continued primary geriatric care postoperatively, resulted in reductions in lengths of stay, ICU admissions, and hospital costs per patient. On an annualized basis, this represented a savings of over US$700 000 for our institution.

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Section: Methodsmentioning

confidence: 99%

Comanagement of Geriatric Patients With Hip Fractures

Rocca

Moylan

Crist

et al. 2013

Geriatr Orthop Surg Rehabil

109

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“…Conditions associated with fractures include (1) age over 85 yr; (2) agitated behavior; (3) use of a wheelchair, cane, or walker; (4) medications, including anticonvulsants, antidepressants, opioids, iron supplements, bisphosphonates, thiazides, and laxatives; and (5) polypharmacy [14][15]. Polypharmacy has been implicated in injurious falls in older adults who reside in a community, although randomized controlled trials are lacking to provide conclusive evidence [16].…”

Section: Introductionmentioning

confidence: 99%

Sociotechnical probabilistic risk modeling to predict injurious falls in community living centers

Powell‐Cope¹,

Campbell²,

Hahm³

et al. 2016

J Rehabil Res Dev

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Abstract-The goal of this study was to apply sociotechnical probabilistic risk assessment to prioritize risks and prevention strategies for serious injurious falls of residents in nursing homes. Risk modeling teams consisted of 26 clinical and nonclinical staff from three Department of Veterans Affairs community living centers and one state Veterans' nursing home. Participants met in groups several times to identify and assign probabilities to provider and resident at-risk behaviors and equipment failures. They identified prevention strategies for the failures that accounted for the highest levels of risk. Six scenarios were modeled: (1) transferring from bed to wheelchair, (2) propelling from bedside to bathroom, (3) transferring from wheelchair to toilet, (4) transferring from toilet to wheelchair, (5) propelling from bathroom to bedside, and (6) transferring from wheelchair to bed. The greatest paths of risk were for residents with impaired mobility and high fragility. A 26% reduction in injurious falls could be achieved by (1) reducing the number of unassisted transfers through a modest improvement in response time to alarms, (2) installing automatic brake locks on 90% of wheelchairs, (3) making the wheelchair maintenance process highly reliable, and (4) decreasing improper transfer techniques by 10%.

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“…Often, geriatric patients with lower extremity fractures have preexisting comorbidities that may have predisposed them to the fall that caused the fracture: dehydration, chronic urinary tract infection, dementia, and disequilibrium due to polypharmacy or other factors. 10,11 These comorbidities need optimization prior to and after surgical repair of the fractures, and may increase the risk of morbidity and mortality associated with the surgical repair.…”

Section: Introductionmentioning

confidence: 99%

Geriatric Patients With Fractures Below the Hip are Medically Similar to Geriatric Patients With Hip Fracture

Rocca

Uppal

Copeland

et al. 2014

Geriatr Orthop Surg Rehabil

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The objective of this study was to compare a cohort of geriatric patients with operatively managed isolated fractures below the hip to a cohort of geriatric patients with operatively managed isolated hip fractures. All patients greater than 59 years of age admitted to our institution for surgical care of an isolated lower extremity fracture during a 3-year period were included. Patients were divided into 2 cohorts: BTH (fracture below the subtrochanteric region of the femur) and HIP (proximal femoral fracture at subtrochanteric region or proximal). We identified 141 patients included in cohort BTH and 205 patients included in cohort HIP. HIP patients were older (P < .01) and less obese (P < .01) but were otherwise very similar. An extensive comorbidity review revealed that the 2 cohorts were similar, with the exception of an increased incidence of dementia (P ¼ .012) or glaucoma (P ¼ .04) in HIP patients and of peripheral neuropathy (P ¼ .014) in BTH patients. HIP patients were more likely to be under active antiosteoporotic medication management and were more likely to be receiving pharmacological anticoagulation at the time of admission. HIP patients and BTH patients were similar with regard to necessity of assistance with ambulation preinjury, but HIP patients were less likely to reside independently at home than were BTH patients (P < .001). HIP patients were also less likely to be discharged directly home from the hospital (P < .001). Geriatric patients with fractures below the hip are medically similar to geriatric patients with hip fracture. Medical comanagement protocols have been extensively published that improve care of geriatric patients with hip fracture; consideration should be given to similar protocol-driven medical comanagement programs for geriatric patients with fractures below the hip.

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Fall-related injuries in a nursing home setting: is polypharmacy a risk factor?

Cited by 93 publications

References 30 publications

Comanagement of Geriatric Patients With Hip Fractures

Comanagement of Geriatric Patients With Hip Fractures

Sociotechnical probabilistic risk modeling to predict injurious falls in community living centers

Geriatric Patients With Fractures Below the Hip are Medically Similar to Geriatric Patients With Hip Fracture

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