Author(s): Davenport, Kathleen; Cameron, Amy; Samson, Margot; Lekand, Jiraporn; Liu, Shan Woo | Abstract: Introduction: Falls are a frequent reason geriatric patients visit the emergency department (ED). To help providers, the Geriatric Emergency Department Guidelines were created to establish a standard of care for geriatric patients in the ED. We conducted a survey of emergency providers to assess 1) their knowledge of fall epidemiology and the geriatric ED guidelines; 2) their current ED practice for geriatric fall patients; and 3) their willingness to conduct fall-prevention interventions.Methods: We conducted an anonymous survey of emergency providers including attending physicians, residents, and physician assistants at a single, urban, Level 1 trauma, tertiary referral hospital in the northeast United States.Results: We had a response rate of 75% (102/136). The majority of providers felt that all geriatric patients should undergo screening for fall risk factors (84%, 86/102), and most (76%, 77/102) answered that all geriatric patients screened and at risk for falls should have an intervention performed. While most (80%, 82/102) answered that geriatric falls prevention was very important, providers were not willing to spend much time on screening or interventions. Less than half (44%, 45/102) were willing to spend 2-5 minutes on a fall risk assessment and prevention, while 46% (47/102) were willing to spend less than 2 minutes.Conclusion: Emergency providers understand the importance of geriatric fall prevention but lack knowledge of which patients to screen and are not willing to spend more than a few minutes on screening for fall interventions. Future studies must take into account provider knowledge and willingness to intervene.

/pdf/fall-prevention-knowledge-attitudes-and-behaviors-a-survey-2elqyymrfz.pdf

Fall Prevention Knowledge, Attitudes, and Behaviors: A Survey of Emergency Providers

Falls are a leading cause for emergency department (ED) visits in older adults. As a fall is associated with a high risk of functional decline and further falls and many falls do not receive medical attention, the ED is ideal to initiate secondary prevention, an opportunity generally not taken. Data on trajectories to identify patients, who would profit the most form early intervention and to examine the impact of a fall event, are lacking. To tailor interventions to the individual's needs and preferences, and to address the whole scope of fall risks, we developed this longitudinal study using an extensive assessment battery including dynamic balance and aerobic fitness, but also sensor-based data. Additionally, participative research will contribute valuable qualitative data, and machine learning will be used to identify trips, slips, and falls in sensor data during daily life.This is a mixed-methods study consisting of four parts: (1) an observational prospective study, (2) a randomized controlled trial (RCT) to explore whether a diagnostic to measure reactive dynamic balance influences fall risk, (3) machine learning approaches and (4) a qualitative study to explore patients' and their caregivers' views. We will target a sample size of 450 adults of 60 years and older, who presented to the ED of the Klinikum Oldenburg after a fall and are not hospitalized. The participants will be followed up over 24 months (within four weeks after the ED, after 6, 12 and 24 months). We will assess functional abilities, fall risk factors, participation, quality of life, falls incidence, and physical activity using validated instruments, including sensor-data. Additionally, two thirds of the patients will undergo intensive testing in the gait laboratory and 72 participants will partake in focus group interviews.The results of the SeFallED study will be used to identify risk factors with high predictive value for functional outcome after a sentinel fall. This will help to (1) establish a protocol adapted to the situation in the ED to identify patients at risk and (2) to initiate an appropriate care pathway, which will be developed based on the results of this study.DRKS (Deutsches Register für klinische Studien, DRKS00025949 ). Prospectively registered on 4th November, 2021. 

/pdf/sentinel-fall-presenting-to-the-emergency-department-3vaw923a.pdf

Sentinel fall presenting to the emergency department (SeFallED) – protocol of a complex study including long-term observation of functional trajectories after a fall, exploration of specific fall risk factors, and patients’ views on falls prevention

Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments

Trends in Geriatric Emergency Medicine.

Introduction: Falls are the second leading cause of accidental or non-intentional deaths worldwide and are the most common problem as people age. The primary purpose of addressing falls is to detect, prevent, treat, and reduce their incidence and consequences. Previous studies identified that multifactorial programs, an interprofessional team, and assistive technology are required to address falls in older adults effectively. Accordingly, the research question is as follows: what are the scope, type of studies, and approaches and strategies to fall risk using technology in the existing occupational therapy literature regarding interventions to address the effects of falls in older adults on daily living? Methods: This scoping review was carried out in January 2020 through Biblioteca Virtual de Salud Espana, C.I.N.A.H.L., Cochrane Plus, OTSeeker, PubMed, Scopus, and Web of Science. Results: Twelve papers were included. We analyzed the year and journal of publication, authors’ affiliation, and design of the study, and thematic categories. There were three themes: participants’ characteristics, type of intervention, and fall approach and type of technology used. Discussion and Conclusions: The literature obtained is scarce. It is considered to still be an emerging theme, especially when considering the use of technology for occupational therapy.

Occupational Therapy and the Use of Technology on Older Adult Fall Prevention: A Scoping Review

Objective To determine whether multifactorial falls prevention interventions are effective in preventing falls, fall injuries, emergency department (ED) re-presentations and hospital admissions in older adults presenting to the ED with a fall. Design Systematic review and meta-analyses of randomised controlled trials (RCTs). Data sources Four health-related electronic databases (Ovid MEDLINE, CINAHL, EMBASE, PEDro and The Cochrane Central Register of Controlled Trials) were searched (inception to June 2018). Study selection RCTs of multifactorial falls prevention interventions targeting community-dwelling older adults (
≥
60 years) presenting to the ED with a fall with quantitative data on at least one review outcome. Data extraction Two independent reviewers determined inclusion, assessed study quality and undertook data extraction, discrepancies resolved by a third. Data synthesis 12 studies involving 3986 participants, from six countries, were eligible for inclusion. Studies were of variable methodological quality. Multifactorial interventions were heterogeneous, though the majority included education, referral to healthcare services, home modifications, exercise and medication changes. Meta-analyses demonstrated no reduction in falls (rate ratio = 0.78; 95% CI: 0.58 to 1.05), number of fallers (risk ratio = 1.02; 95% CI: 0.88 to 1.18), rate of fractured neck of femur (risk ratio = 0.82; 95% CI: 0.53 to 1.25), fall-related ED presentations (rate ratio = 0.99; 95% CI: 0.84 to 1.16) or hospitalisations (rate ratio = 1.14; 95% CI: 0.69 to 1.89) with multifactorial falls prevention programmes. Conclusions There is insufficient evidence to support the use of multifactorial interventions to prevent falls or hospital utilisation in older people presenting to ED following a fall. Further research targeting this population group is required.

/pdf/multifactorial-falls-prevention-programmes-for-older-adults-4mz3l8jfos.pdf

Multifactorial falls prevention programmes for older adults presenting to the emergency department with a fall: systematic review and meta-analysis

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Multifactorial falls prevention programmes for older adults presenting to the emergency department with a fall: systematic review and meta-analysis