INTERVENTIONS FOR THE PREVENTION

Interventions For The Prevention Of Falls In The Older People In Hospital Settings

Abstract

To describe the diagnostic accuracy and practical application of the Peter James Centre Falls Risk Assessment Tool (PJC-FRAT), a multidisciplinary falls risk screening and intervention deployment instrument. In phase 1, the accuracy of the PJC-FRAT was prospectively compared to a gold standard (the STRATIFY) on a cohort of subacute hospital patients (n = 122). In phase 2, the PJC-FRAT was temporally reassessed using a subsequent cohort (n = 316), with results compared to those of phase 1. Primary outcomes were falls (events), fallers (patients who fell), and hospital completion rates of the PJC-FRAT. In phase 1, PJC-FRAT accuracy of identifying fallers showed sensitivity of 73% (bootstrap 95% confidence interval CI = 55, 90) and specificity of 75% (95% CI = 66, 83), compared with the STRATIFY (cutoff = 2/5) sensitivity of 77% (95% CI = 59, 92) and specificity of 51% (95% CI = 41, 61). This difference was not significant. In phase 2, accuracy of nursing staff using the PJC-FRAT was lower. PJC-FRAT completion rates varied among disciplines over both phases: nurses and physiotherapists, =90%; occupational therapists, =82%; and medical officers, =57%. The PJC-FRAT was practical and relatively accurate as a predictor of falls and a deployment instrument for falls prevention interventions, although continued staff education may be necessary to maintain its accuracy.

Table of Content

Abstract2

Table of Content3

CHAPTER I5

1. Introduction5

Background of the study6

Purpose of the study6

CHAPTER II7

Literature Review7

Medication review7

Vitamin D supplementation7

Nursing care facilities: multifactorial interventions9

Multifactorial interventions - combined data9

Exploratory analysis of multifactorial trials guided by individual comprehensive geriatric assessments10

Exploratory analysis of multifactorial trials with data on participants with cognitive impairment10

Hospitals: single interventions11

Supervised exercise interventions11

Environment/assistive technology interventions12

Hospitals: multifactorial interventions12

Exercises + environment/assistive technology + knowledge interventions12

Medication (drug target) + environment/assistive technology + other interventions13

Medication (drug target) + social environment + knowledge+ other interventions13

Complications of the interventions14

Economic evaluations14

Vitamin D supplementation15

Multifactorial interventions15

Adverse effects16

Potential biases in the review process18

CHAPTER III19

Methods19

Setting19

Participants19

Falls risk screening tools19

Staff education20

Measurement of falls and fallers21

Data collection21

CHAPTER IV22

Results22

CHAPTER V24

Discussion24

References27

Appendix46

CHAPTER I

1. Introduction

Programs to address the problem of falls in hospitals and the community have received much recent investigation and Although there is extensive evidence for the community setting, in the hospital setting the evidence is modest and in need of greater attention . Falls risk screening tools are a component of many hospital-based programs. These tools are used to identify patients at high risk for falls and to facilitate the delivery of certain interventions to selected patients. Inaccuracy of such screening tools can lead to inappropriate distribution of valuable falls prevention resources, contributing to failure of falls prevention programs. Thus, it is imperative to establish the diagnostic accuracy of such tools and, where necessary, identify alternative tools that may be able to distribute resources more effectively. (Morse 1989)

A number of falls risk screening tools have been described and their diagnostic accuracy examined in the hospital setting and; however, few studies have prospectively and concurrently administered alternative tools. Comparison of screening tools administered to separate sets of patients results in ...