Elderly Fall Risk Assessment (Elderly) Scale Using Hendrich Falls Fall and Morse Scale

Introduction: Incidence of falls in elderly become a serious problem for patients hospitalised with limited activity. There was now the patients instruments to measure risk of fall for elderly patients. The aimed of the study was to examine the differences of risk fall to the elderly by using instrument Hendrich Falls Scale (HFS) and Morse Falls Scale (MFS). Methods: A comparative-longitudinal design was used in this study. The population were elderly patients in the treatment room D2 and D3 Adi Husada's Hospital. There were 20 elderlys as a respondents which taken by using purposive sampling technique. Dependent variable was the value of measuring the risk of falling and independent variable was the instrument of HFS and MFS. Data were analyzed by using Wilcoxon Signed Rank Test with significance level α≤0.05. Result: The results showed that HFS's instrument compared with MFS in the fi rst day are equally sensitive on the presented 100%, second day: 80%, third day: 31.3%, fourth day: 20%. HFS specificity of MFS on first day compared only 64% than MFS was 100%. The statistical results tests on the both scale of assessment indicated that there were differences the value on first day p=0.180, second day p=0.58, third and fourth day p=0.001. Discussion: The use of MFS was more sensitive than HSF for detection of elderly patients with falling risk. The conclution of this results MFS's instrument was more sensitive to assess elderly with risk of fall because MFS,s points more detailed assessment. It is recommended that elderly patients with falling risk need to assess by using MFS. Further research to focus on the risk of fall assessment using HFS and MFS categories

Evaluation of Current Emergency Department Fall Risk Assessment Tools: Is An Emergency Department Specific Fall Risk Assessment Tool Needed?

Problem: The ability to accurately and quickly identify patients at high risk for falls at the point of entry into the emergency department is the most important step in fall prevention and avoiding harm. Using an inpatient falls risk assessment tool is not adequately identifying patients at risk in the emergency department setting. Multiple factors contribute to falls and are not included in the risk assessment tool. The purpose of the study was to determine if the false risk assessment tool used in the Emergency Department (ED) adequately identifies a patient at risk for falling. Methods: This study used a snowball sampling method via Facebook with a link to Survey Monkey. Results: Of the 72 nurses who completed the survey, 34.7% of the nurses thought the survey was not appropriate for the evaluation of falls in the emergency department. Even though this may not seem like many, of those 72 nurses, 47.2% of them would prefer a simpler tool. When asked what population of patients the fall risk assessment tool did not appropriately screen for, responses included intoxicated, pediatric, infants, substance abuse, dizziness, vertigo, and unconscious patients. Implication for Practice: After reviewing the literature, it would be beneficial to develop an ED fall risk assessment tool that is specific to the patient population in the emergency department. A possible future study would be to implement an ED specific fall risk assessment tool and determine the effectiveness of the risk assessment tool on predicting patient falls. Key Words: Falls, Fall risk tool, Emergency room specific falls too

External validation of a simple clinical tool used to predict falls in people with Parkinson disease

Published in final edited form as: Parkinsonism Relat Disord. 2015 August ; 21(8): 960–963. doi:10.1016/j.parkreldis.2015.05.008.BACKGROUND: Assessment of fall risk in an individual with Parkinson disease (PD) is a critical yet often time consuming component of patient care. Recently a simple clinical prediction tool based only on fall history in the previous year, freezing of gait in the past month, and gait velocity <1.1 m/s was developed and accurately predicted future falls in a sample of individuals with PD. METHODS: We sought to externally validate the utility of the tool by administering it to a different cohort of 171 individuals with PD. Falls were monitored prospectively for 6 months following predictor assessment. RESULTS: The tool accurately discriminated future fallers from non-fallers (area under the curve [AUC] = 0.83; 95% CI 0.76–0.89), comparable to the developmental study. CONCLUSION: The results validated the utility of the tool for allowing clinicians to quickly and accurately identify an individual's risk of an impending fall.Davis Phinney Foundation, Parkinson Disease Foundation, NIH, APDA. (Davis Phinney Foundation; Parkinson Disease Foundation; NIH; APDA

The Relationship Between Community Dwelling Older Adult’s Fall Risk and Beliefs of Risk for Falling in Northwest Arkansas and Bolgatanga, Ghana.

Title: The Relationship Between Community Dwelling Older Adult’s Fall Risk and Beliefs of Risk for Falling in Northwest Arkansas and Bolgatanga, Ghana. Gohman, N., Patton, S., Smith-Blair, N., Agana, C.: University of Arkansas, Fayetteville, AR Background: Older adults worldwide live with comorbidities, physical and psychological changes associated with aging. Statistically, however, older adults are more likely to die as a result of falling. As the worldwide population of individuals over 65 rises, so will the possibility for injuries from falls. Much research has been published concerning fall risk prevention, but minimal research surrounding protocols and practices for protecting against falls in developing countries has been published. Purpose: Evaluate and compare the relationship between community dwelling older adult’s fall risk and their perceived risk of falling in a developed and a developing country. Methodology: The study sample consisted of 35 participants, selected at random. A mixed method approach was used. Semi-structured interviews based on constructs of the Health Belief Model measured perceived fall risk. Risk factors for falls were determined using the Center for Disease Control (CDC) STEADI fall risk assessment tool. Results: The average age of all participants was 73 years, with 30% from NW Arkansas and 70% from Ghana. Eight subjects reported falling within the past year. The majority of subjects reported their chance of falling as low. When asked about confidence level to prevent falling, mixed reactions ranging from laughing, being concerned, to being serious were documented. Many older adults realized the complications falling would have on their physical well being, as well as the increase in burden and negative emotional effect on the caregiver. There was an overall lack of knowledge by the general population of what to do to prevent falling. The biggest barrier reported by participants to prevent falling was the layout of homes and buildings, the physical outside environment, and lack of lighting to see. There was a lack of knowledge to knowing prevention strategies, as the only benefit stated was the individual would not fall. Discussion/Results: According to the results of the STEADI assessment, only 1 out of 35 participants actually passed the fall risk assessment. There is a lack of knowledge about falling, therefore individuals were confident that they could prevent falling despite results showing their high fall risk. More people were confident in Northewst Arkansas that they could prevent falls compared to Ghana. By 2050, the global population of adults over the age of 60 is expected to reach nearly 2.1 billion, with two thirds residing in developing countries. Results from this study indicate that many older adults believe that they have low chance of falling even when their risk is high. Global awareness is needed about the seriousness of falls in this population and for prevention that will reduce injury and hospital admissions

The Use of the Get Up and Go Test as the Initial Screening Measure for Fall Risk With Community Dwelling Seniors

Falls represent a sizeable public health issue that has serious health-related consequences for both the individual and the medical system at large. Falls are one of the most common events that threaten the independence of older persons with one third of falls occurring in persons over the age of 65 and over 50% in persons over the age of 80 years (2). During an office appointment, senior adults are screened routinely for blood pressure, weight, medication adherence and lab result follow-up. One assessment that is commonly overlooked is evaluating seniors for fall risk. The purpose of this study was to explore the use of the Get Up and Go test (GUGT) as a routine screening measure for community dwelling seniors. The research questions addressed were: 1) Is self-reported fall history related to GUGT scores in community dwelling seniors? 2) Is age related to the GUGT scores for a sample of community-dwelling seniors?; and 3) Is age related to self-reported fall history for a sample of community-dwelling seniors? Recruitment of community-dwelling seniors occurred during a 3-month period at a primary care office setting in the urban San Francisco Bay area. A convenience sample of community-dwelling seniors (N=39) were recruited to participate in the study. All participants were age 65 or older, did not have a history of cognitive or neurological deficits, and were able to ambulate without the use of an assistive device such as a cane, walker or wheelchair. Participants reported fall occurrences for the last 12 months and performed the GUGT. This study did not find statistical relevance between GUGT pass or fail status and fall history. Two groups of participants are of particular interest. Nine participants with a positive fall history were able to pass the GUGT and 8 seniors who reported no fall history failed the GUGT. Consistent with previous studies (12), one fall does not necessarily signify musculoskeletal or neurological deficits and is usually related to environmental hazards. Furthermore, previous studies have shown that a single fall report is a poor predictor of fall risk and that the number of reported falls by patients is not a reliable number due to the patient under-estimating or under-reporting fall occurrences. These findings suggest that fall history may not be a sensitive measure capable of identifying all at risk seniors. Thus if only fall history is used to identify risk, then some at risk community-dwelling seniors will not be identified while others may be identified by fall history but do not exhibit mobility deficits. The relative ease in which the GUGT was performed, with minimum cost, strengthens the position that the GUGT should be performed as part of an annual examination for patients who are over the age of 65. The GUGT results can then become the sixth vital sign for patients over the age of 65 with the initial GUGT result establishing baseline results for future patient fall risk evaluation. Given this evidence, it can be concluded that at the very least, both fall history and the GUGT test should be performed annually on community-dwelling seniors over the age of 65

Digging the pupfish out of its hole: risk analyses to guide harvest of Devils Hole pupfish for captive breeding.

The Devils Hole pupfish is restricted to one wild population in a single aquifer-fed thermal pool in the Desert National Wildlife Refuge Complex. Since 1995 the pupfish has been in a nearly steady decline, where it was perched on the brink of extinction at 35-68 fish in 2013. A major strategy for conserving the pupfish has been the establishment of additional captive or refuge populations, but all ended in failure. In 2013 a new captive propagation facility designed specifically to breed pupfish was opened. I examine how a captive population can be initiated by removing fish from the wild without unduly accelerating extinction risk for the pupfish in Devils Hole. I construct a count-based PVA model, parameterized from estimates of the intrinsic rate of increase and its variance using counts in spring and fall from 1995-2013, to produce the first risk assessment for the pupfish. Median time to extinction was 26 and 27 years from spring and fall counts, respectively, and the probability of extinction in 20 years was 26-33%. Removing individuals in the fall had less risk to the wild population than harvest in spring. For both spring and fall harvest, risk increased rapidly when levels exceeded six adult pupfish per year for three years. Extinction risk was unaffected by the apportionment of total harvest among years. A demographic model was used to examine how removal of different stage classes affects the dynamics of the wild population based on reproductive value (RV) and elasticity. Removing eggs had the least impact on the pupfish in Devils Hole; RV of an adult was roughly 25 times that of an egg. To evaluate when it might be prudent to remove all pupfish from Devils Hole for captive breeding, I used the count-based model to examine how extinction risk related to pupfish population size. Risk accelerated when initial populations were less than 30 individuals. Results are discussed in relation to the challenges facing pupfish recovery compared to management of other highly endangered species

The Marco Polo mission: a sample return from a low-albedo Near Earth Object in the ESA Cosmic Vision Program 2015-2025

Marco Polo is a sample return mission to a Near-Earth Object (NEO) which was originally proposed as a joint European-Japanese mission for the scientific program Cosmic Vision 2015-2025 of the European Space Agency (ESA) in June 2007 and selected for an assessment study until fall 2009. The main goal of this mission is to return a sample from a dark taxonomic type (low albedo) NEO for detailed laboratory analysis in order to answer questions related to planetary formation, evolution and the origin of Life. In addition, it will provide detailed information on the physical and chemical properties of a body belonging to the population of potential Earth impactors, and therefore it is also directly relevant to the problems of risk assessment and mitigation. We review basic information on NEOs, potential targets for a sample return mission and the Marco Polo mission, with emphasis on their relevance to impact risk assessment and mitigation. More details on the Marco Polo mission and scientific objectives can be found in [1]

RESPOND – A patient-centred program to prevent secondary falls in older people presenting to the emergency department with a fall: Protocol for a multi-centre randomised controlled trial

Introduction: Participation in falls prevention activities by older people following presentation to the Emergency Department (ED) with a fall is suboptimal. This randomised controlled trial (RCT) will test the RESPOND program which is designed to improve older persons’ participation in falls prevention activities through delivery of patient-centred education and behaviour change strategies. Design and setting: An RCT at two tertiary referral EDs in Melbourne and Perth, Australia. Participants: Five-hundred and twenty eight community-dwelling people aged 60-90 years presenting to the ED with a fall and discharged home will be recruited. People who: require an interpreter or hands-on assistance to walk; live in residential aged care or >50 kilometres from the trial hospital; have terminal illness, cognitive impairment, documented aggressive behaviour or history of psychosis; are receiving palliative care; or are unable to use a telephone will be excluded. Methods: Participants will be randomly allocated to the RESPOND intervention or standard care control group. RESPOND incorporates: (1) home-based risk factor assessment; (2) education, coaching, goal setting, and follow-up telephone support for management of one or more of four risk factors with evidence of effective intervention; and (3) healthcare provider communication and community linkage delivered over six months. Primary outcomes are falls and fall injuries per-person-year. Discussion: RESPOND builds on prior falls prevention learnings and aims to help individuals make guided decisions about how they will manage their falls risk. Patient-centred models have been successfully trialled in chronic and cardiovascular disease however evidence to support this approach in falls prevention is limited. Trial registration. The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684)

A study of balance, gait and psychotropic drug use in relation to fall risk in nursing home residents with dementia

Falls are a major health problem in nursing home residents with dementia. In nursing homes one-third of all falls results in an injury. In order to take tailor-made preventive measures in time, the fall risk profile of each individual nursing home resident should be periodically evaluated. A systematic evaluation of fall risk should include an assessment of major contributing components, including an assessment of balance and gait, and the use of psychotropic drugs. The purpose of this study was a) to evaluate the feasibility and predictive validity of different assessment methods for balance and gait impairments in a population of nursing home residents with dementia with a specific view to predicting falls in the short term, i.e., three months, and b) to quantify the additive contribution of psychotropic drugs to fall risk in nursing home residents with dementia. Part one of this thesis describes how ambulatory nursing home residents with moderate to severe dementia participated in a prospective cohort study. This study showed that gait velocity is a feasible and valid predictor of a fall within three months. In part two of this thesis the additive contribut

Fall Risk Assessment Tools for Elderly Living in the Community: Can We Do Better?

Background Falls are a common, serious threat to the health and self-confidence of the elderly. Assessment of fall risk is an important aspect of effective fall prevention programs. Objectives and methods In order to test whether it is possible to outperform current prognostic tools for falls, we analyzed 1010 variables pertaining to mobility collected from 976 elderly subjects (InCHIANTI study). We trained and validated a data-driven model that issues probabilistic predictions about future falls. We benchmarked the model against other fall risk indicators: history of falls, gait speed, Short Physical Performance Battery (Guralnik et al. 1994), and the literature-based fall risk assessment tool FRAT-up (Cattelani et al. 2015). Parsimony in the number of variables included in a tool is often considered a proxy for ease of administration. We studied how constraints on the number of variables affect predictive accuracy. Results The proposed model and FRAT-up both attained the same discriminative ability; the area under the Receiver Operating Characteristic (ROC) curve (AUC) for multiple falls was 0.71. They outperformed the other risk scores, which reported AUCs for multiple falls between 0.64 and 0.65. Thus, it appears that both data-driven and literature-based approaches are better at estimating fall risk than commonly used fall risk indicators. The accuracy–parsimony analysis revealed that tools with a small number of predictors (~1-5) were suboptimal. Increasing the number of variables improved the predictive accuracy, reaching a plateau at ~20-30, which we can consider as the best trade-off between accuracy and parsimony. Obtaining the values of these ~20-30 variables does not compromise usability, since they are usually available in comprehensive geriatric assessments