Zoekresultaten

Movement registration and analysis for fall risk assessment in the hospital: lessons from an observational pilot study

BackgroundA valuable opportunity for reducing the fall incidence in hospitals, is alerting nurses when a patient is about to fall. For such a fall prevention system, more knowledge is needed on what occurs right before a fall. This can be achieved with a stereo camera that automatically detects (and records) dangerous situations.MethodsInpatients with a high risk of falling are selected for inclusion. A fall-risk questionnaire is administered and falls are logged during their stay. A stereo-camera (3D BRAVO-EagleEye system) is mounted in the ceiling and monitors the bed with surroundings. A baseline recording is made to improve the algorithms behind the alert system. When a fall or dangerous situation is detected, monitoring data preceding the incident is stored. Data is analyzed to assess 1) the quality of the system and 2) the prevalence of dangerous situations. Interviews with senior nurses are included in the evaluation.ResultsData collection is ongoing (Currently n=18; falls=1), and currently consists of ±62 hour of baseline recordings and ±24 hour of event-based recordings. These recordings include false positives as well as actual high risk situations.ConclusionsDespite the initial enthusiasm of the participating departments, inclusion of participants is slow, and the number of falls lower than expected. Possible explanations for this have been discussed with the involved senior nurses. With the monitoring data we gained more insight into the occurrence of dangerous situations, but to be able to reliably predict falls, more data on actual fallsshould be recorded.

The effect of interventions anticipated to improve plantar intrinsic foot muscle strength on fall-related dynamic function in adults: a systematic review

Background The plantar intrinsic foot muscles (PIFMs) have a role in dynamic functions, such as balance and propulsion, which are vital to walking. These muscles atrophy in older adults and therefore this population, which is at high risk to falling, may benefit from strengthening these muscles in order to improve or retain their gait performance. Therefore, the aim was to provide insight in the evidence for the effect of interventions anticipated to improve PIFM strength on dynamic balance control and foot function during gait in adults. Methods A systematic literature search was performed in five electronic databases. The eligibility of peer-reviewed papers, published between January 1, 2010 and July 8, 2020, reporting controlled trials and pre-post interventional studies was assessed by two reviewers independently. Results from moderate- and high-quality studies were extracted for data synthesis by summarizing the standardized mean differences (SMD). The GRADE approach was used to assess the certainty of evidence. Results Screening of 9199 records resulted in the inclusion of 11 articles of which five were included for data synthesis. Included studies were mainly performed in younger populations. Low-certainty evidence revealed the beneficial effect of PIFM strengthening exercises on vertical ground reaction force (SMD: − 0.31-0.37). Very low-certainty evidence showed that PIFM strength training improved the performance on dynamic balance testing (SMD: 0.41–1.43). There was no evidence for the effect of PIFM strengthening exercises on medial longitudinal foot arch kinematics. Conclusions This review revealed at best low-certainty evidence that PIFM strengthening exercises improve foot function during gait and very low-certainty evidence for its favorable effect on dynamic balance control. There is a need for high-quality studies that aim to investigate the effect of functional PIFM strengthening exercises in large samples of older adults. The outcome measures should be related to both fall risk and the role of the PIFMs such as propulsive forces and balance during locomotion in addition to PIFM strength measures.

Engaging community-dwelling older adults in fall prevention programs

Introduction: Fall rates and fall-related injuries among community-dwelling older adults (≥65 years) are expected to increase rapidly, due to the aging population worldwide. Fall prevention programs (FPPs), consisting of strength and balance exercises, have been proven effective in reducing fall rates among older adults. However, these FPPs have not reached their full potential as most programs are under-enrolled. Therefore, this study aims to identify promising strategies that promote participation in FPPs among community-dwelling older adults. Methods: This is an exploratory qualitative study. Previously, barriers and facilitators for participation in FPPs by older adults had been identified. Next, six strategies had been designed using the Intervention Mapping approach: (1) reframing; (2) informing about benefits; (3) raising awareness of risks; (4) involving social environment; (5) offering tailored intervention; (6) arranging practicalities. Strategies were validated during semi-structured interviews with communitydwelling older adults (n = 12) at risk of falling. Interviews were audio-recorded, transcribed, and analyzed following a qualitative thematic methodology, with a hybrid approach. Results: All strategies were considered important by at least some of the respondents. However, two strategies stood out: (1) reframing ‘aging’ and ‘fall prevention’: respondents preferred to be approached differently, taking a ‘life course’ perspective about falls, and avoiding confronting words; and (2) ‘informing about benefits’ (e.g., ‘living independently for longer’); which was mentioned to improve the understanding of the relevance of participating in FPPs. Other strategies were considered important to take into account too, but opinions varied more strongly. Discussion: This study provides insight into potential strategies to stimulate older adults to participate in FPPs. Results suggest that reframing ‘aging’ and ‘fall prevention’ may facilitate the dialogue about fall prevention, by communicating differently about the topic, for example ‘staying fit and healthy’, while focusing on the benefits of participating in FPPs. Gaining insight into the strategies’ effectiveness and working mechanisms is an area for future research. This could lead to practical recommendations and help professionals to enhance older adults’ participation in FPPs. Currently, the strategies are further developed to be applied and evaluated for effectiveness in multiple field labs in a central Dutch region (Utrecht).

Falling through the revenue management gap

Vallen : incidentie en risicofactoren bij patiënten met eenberoerte, een systematisch literatuuronderzoek

Falls are common after stroke. This article presents a literature review of the incidence and risk factors of falls and the consequences for professionals working with stroke patients. It is important to consider the specific problems after stroke. Depression and cognitive impairments were found to be risk factors for fall incidents after stroke. In the relevant literature many different risk factors and circumstances are described. When patients move from bed to chair, walk to the bathroom and the first few days after the patient is discharged to another setting, - all these circumstances showed high percentages of falling. A fall during hospital stay is a significant risk factor for future fall incidents. A reliable index to measure the fall risk is not (yet) available. But scores on the Barthel Index and the Timed-Up-and-Go test can be used as fall risk indicators. Fear of falling is an important complication after a fall and therefore it is recommended prior to discharge to inquire about the patient’s self efficacy in maintaining balance. Few intervention studies use the number of falls as an outcome measure. Exercising balance following a mass training protocol seems to diminish the risk of falling.

Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons: a systematic review.

BACKGROUND: fear of falling (FOF) is a major health problem among the elderly living in communities, present in older people who have fallen but also in older people who have never experienced a fall. The aims of this study were 4-fold: first, to study methods to measure FOF; second, to study the prevalence of FOF among fallers and non-fallers; third, to identify factors related to FOF; and last, to investigate the relationship between FOF and possible consequences among community-dwelling older persons. METHODS: several databases were systematically searched, and selected articles were cross-checked for other relevant publications. RESULTS: a systematic review identified 28 relevant studies among the community-dwelling elderly. Due to the many different kinds of measurements used, the reported prevalence of FOF varied between 3 and 85%. The main risk factors for developing FOF are at least one fall, being female and being older. The main consequences were identified as a decline in physical and mental performance, an increased risk of falling and progressive loss of health-related quality of life. CONCLUSION: this review shows that there is great variation in the reported prevalence of FOF in older people and that there are multiple associated factors. Knowledge of risk factors of FOF may be useful in developing multidimensional strategies to decrease FOF and improve quality of life. However, the only identified modifiable risk factor of FOF is a previous fall. In order to measure the impact of interventions, a uniform measurement strategy for FOF should be adopted, and follow-up studies should be conducted.