Journal Article10.1111/ACEM.14279
Moving the needle on fall prevention: A Geriatric Emergency Care Applied Research (GEAR) Network scoping review and consensus statement.
Nada Hammouda,Chris Carpenter,William W. Hung,Adriane Lesser,Sylviah Nyamu,Shan W. Liu,Cameron J. Gettel,Aaron Malsch,Edward M. Castillo,Savannah Forrester,Kimberly Souffront,Samuel Vargas,Elizabeth M. Goldberg +12 more
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TL;DR: The Geriatric Emergency Medicine Applied Research Falls core (GEAR-Falls) as mentioned in this paper was created to identify existing research gaps and to prioritize future fall research foci, including fall screening and prevention efforts.
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Abstract: BACKGROUND Although falls are common, costly, and often preventable, emergency department (ED)-initiated fall screening and prevention efforts are rare. The Geriatric Emergency Medicine Applied Research Falls core (GEAR-Falls) was created to identify existing research gaps and to prioritize future fall research foci. METHODS GEAR's 49 transdisciplinary stakeholders included patients, geriatricians, ED physicians, epidemiologists, health services researchers, and nursing scientists. We derived relevant clinical fall ED questions and summarized the applicable research evidence, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. The highest-priority research foci were identified at the GEAR Consensus Conference. RESULTS We identified two clinical questions for our review (1) fall prevention interventions (32 studies) and (2) risk stratification and falls care plan (19 studies). For (1) 21 of 32 (66%) of interventions were a falls risk screening assessment and 15 of 21 (71%) of these were combined with an exercise program or physical therapy. For (2) 11 fall screening tools were identified, but none were feasible and sufficiently accurate for ED patients. For both questions, the most frequently reported study outcome was recurrent falls, but various process and patient/clinician-centered outcomes were used. Outcome ascertainment relied on self-reported falls in 18 of 32 (56%) studies for (1) and nine of 19 (47%) studies for (2). CONCLUSION Harmonizing definitions, research methods, and outcomes is needed for direct comparison of studies. The need to identify ED-appropriate fall risk assessment tools and role of emergency medical services (EMS) personnel persists. Multifactorial interventions, especially involving exercise, are more efficacious in reducing recurrent falls, but more studies are needed to compare appropriate bundle combinations. GEAR prioritizes five research priorities: (1) EMS role in improving fall-related outcomes, (2) identifying optimal ED fall assessment tools, (3) clarifying patient-prioritized fall interventions and outcomes, (4) standardizing uniform fall ascertainment and measured outcomes, and (5) exploring ideal intervention components.
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Citations
Validation and comparison of fall screening tools for predicting future falls among older adults.
TL;DR: In this article , a 13-month study using a probability-based representative panel of the US population recruited from NORC at the University of Chicago's National Frame was conducted to investigate the ability of fall screening tools to predict future falls.
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Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments
TL;DR: In this paper , an automated clinical decision support (CDS) system was developed for identifying and referring older adult ED patients at risk of future falls. But, the fall screening tools have been poorly adopted due to ED staff/provider burden and lack of workflow integration.
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Inclusion of older adults in emergency department clinical research: Strategies to achieve a critical goal
Katherine M. Hunold,Elizabeth M. Goldberg,Jeffrey M. Caterino,Ula Hwang,Timothy F. Platts-Mills,Manish N. Shah,Tony Rosen +6 more
TL;DR: In this article, the authors present important considerations and proven strategies for successful inclusion of older adults in emergency care research relating to study design, participant recruitment and retention, and sources of support for investigators.
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Balancing Vision With Pragmatism: The Geriatric Emergency Department Guidelines-Realistic Expectations From Emergency Medicine and Geriatric Medicine.
TL;DR: In 2014, the Geriatric Emergency Department (GED) Guidelines were published and endorsed by four major medical organizations as mentioned in this paper , which characterized the complex needs of the older ED patient and current best practices with the goal of promoting more cost-effective and patient-centered care.
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The History of Geriatric Emergency Medicine
TL;DR: Geriatric Emergency Medicine (GEM) emerged as a subspecialty as these individuals systematically identified its distinctive knowledge, skills, competencies, literature, champions, research, fellowship programs, service lines, staffing, accredited geriatric emergency departments, and now its own journal as mentioned in this paper .
References
The Modified Otago Exercises Prevent Grip Strength Deterioration Among Older Fallers in the Malaysian Falls Assessment and Intervention Trial (MyFAIT).
Lin Kiat Liew,Maw Pin Tan,Pey June Tan,Sumaiyah Mat,Lokman Abdul Majid,Keith D. Hill,Mazlina Mazlan +6 more
TL;DR: In addition to benefits in mobility and balance, the OEP also prevents deterioration in upper limb strength and change in grip strength over 6 months significantly favored the O EP group.
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Older adult falls prevention behaviors 60 days post-discharge from an urban emergency department after treatment for a fall
Kalpana Narayan Shankar,Kalpana Narayan Shankar,Nicole J. Treadway,Nicole J. Treadway,Alyssa Taylor,Alyssa Taylor,Alan H. Breaud,Elizabeth W. Peterson,Jonathan Howland,Jonathan Howland +9 more
TL;DR: Findings indicate a low rate of initiating fall prevention behaviors following an ED visit for a fall-related injury among community-dwelling older adults, and highlight the ED visit as an important, but underutilized, opportunity to mobilize health care resources for people at high risk for subsequent falls.
Falling behind? Understanding implementation science in future emergency department management strategies for geriatric fall prevention.
Chris Carpenter,Alexander X. Lo +1 more
TL;DR: A 1-year chart review of elderly patients presenting to an urban academic ED following falls found four patient-level characteristics were significantly associated with better guideline adherence: older age, more comorbid conditions, residing in an assisted living facility, and admission to either an inpatient or an observation unit.
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A Cost-Effectiveness Analysis of a Randomized Control Trial of a Tailored, Multifactorial Program to Prevent Falls Among the Community-Dwelling Elderly.
David B. Matchar,David B. Matchar,Kirsten Y. Eom,Kirsten Y. Eom,Pamela W. Duncan,Mina Lee,Rita Sim,Nirmali Sivapragasam,Christopher T. C. Lien,Marcus Eng Hock Ong +9 more
TL;DR: The intervention was, overall, not cost- effective, compared to usual care, however, the program was cost-effective among healthier subgroups, and even potentially cost-saving among individuals with sufficient reserve to benefit.
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Care Transition Decisions After a Fall-related Emergency Department Visit: A Qualitative Study of Patients' and Caregivers' Experiences.
TL;DR: This data indicates that falls are a leading cause of injury‐related emergency department visits and may serve as a sentinel event for older adults, leading to physical and psychological injury.
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