Developing an audit checklist to assess outdoor falls risk

Falls by older people (aged 65+ years) are linked to disability and a decrease in mobility, presenting a challengeto active ageing. As such, older fallers represent a vulnerable road user group. Despite this, there is little researchinto the causes and prevention of outdoor falls. This paper develops an understanding of environmental factorsthat cause falls or fear of falling by using go-along interviews with recent fallers to explore how they navigate theoutdoor environment, and which aspects of it they perceive facilitate or hinder their ability to go outdoors and fearof falling. While there are a number of audit checklists that are focused on assessing the indoor environment forrisk or fear of falls, nothing exists for the outdoor environment. Many existing street audit tools are focusedon general environmental qualities and have not been designed with an older population in mind. This paperpresents a checklist that assesses aspects of the environment that are most likely to encourage or hinder those whoare at risk of falling outdoors, it is developed through accounting for the experiences and navigational strategies ofelderly individuals. The audit checklist can assist occupational therapists, urban planners, designers and managers inworking to reduce the occurrence of outdoor falls among this vulnerable user group

Flexor Tendon Sheath Ganglions: Results of Surgical Excision

The purpose of our study was to review the clinical features and determine the results following surgical excision of a flexor tendon sheath ganglion. A retrospective analysis of 24 consecutive patients (25 ganglions) who underwent excision of a painful flexor tendon sheath ganglion by the same surgeon was performed. The patient’s medical and operative records were reviewed. Each patient was invited to return for an evaluation, which consisted of a clinical interview, completion of a questionnaire, and physical examination. Those patients that were unable to return underwent a detailed telephone interview. Sixteen patients returned for a clinical evaluation, while eight patients underwent a telephone interview. There were 15 women and nine men, with an average age of 43 years (range, 21–68 years). The dominant hand was involved in 15 patients. The long finger was most commonly involved (11 cases). The ganglion arose from the A1 pulley in 13 cases, between the A1 and A2 pulleys in three cases, and from the A2 pulley in nine cases. At an average follow-up of 18.5 months (range, 5–38 months), all of the patients were satisfied with their final result. No patient developed a recurrence and all returned to their previous functional level. There were two minor complications that resolved uneventfully; one patient experienced mild incisional tenderness, while an additional patient experienced transient digital nerve paresthesias. We conclude that surgical excision is a simple, safe, and effective method for treating a painful ganglion of the digital flexor tendon sheath

Substance Abuse Associated with Elder Abuse in the United States

Background: Substance abuse by either victim or perpetrator has long been associated with violence and abuse. Sparse research is available regarding elder abuse and its association with substance abuse. Objective: The objective of this study was to evaluate the association of state-reported domestic elder abuse with regional levels of substance abuse. Methods: Census demographic and elder abuse data were sorted into substate regions to align with the substance use treatment-planning regions for 2269 US counties. From the 2269 US counties there were 229 substate regions in which there were 213,444 investigations of abuse. For the other Ns (reports and substantiations) there were fewer counties and regions. See first sentence of data analyses and first sentence of results. Results: Elder abuse report rates ranged from .03 to .41% (80 regions), investigation rates .001 to .34% (229 regions), and substantiation rates 0 to .22% (184 regions). Elder abuse investigations and substantiations were associated with various forms of substance abuse. Higher investigation rates were significantly associated with a higher rate of any illicit drug use in the past month, a lower median household income, lower proportion of the population graduated high school, and higher population of Hispanics. Higher substantiation rates were significantly associated with higher rate of illicit drug use in the past month and higher population of Hispanics. Conclusion: It may be worthwhile for administrators of violence programs to pay particular attention to substance abuse among their clients and in their community’s environment, especially if older persons are involved. Scientific Significance: Measures of documented elder abuse at the county level are minimal. To be able to associate substance abuse with elder abuse is a significant finding, realizing that the substance abuse can be by the victim or the perpetrator of elder abuse