Nivel de cumplimiento de metas internacionales de seguridad en un Sanatorio privado 2023 / Level of compliance with international safety goals in a private Sanatorium 2023

La presente investigación pretende evaluar el nivel de cumplimiento de las metas internacionales, que representan el foco principal para la mejora de calidad y seguridad de atención de los pacientes. La seguridad del paciente involucra a todos los estudios, prácticas y acciones promovidas por las instituciones sanitarias para disminuir y eliminar los riesgos de daños innecesarios relacionados con el cuidado de la salud. Metodología: Estudio descriptivo, observacional y transversal. De fuentes primaria y secundaria, Resultados: se abordaron las metas N° 1 la cual consiste en Identificar a los pacientes correctamente y la meta N° 6 la cual se refiere a Reducir el riesgo de lesiones en pacientes como resultado de caídas. En primer lugar, se destaca el cumplimiento en la identificación correcta del paciente y en segunda instancia la mejora del cumplimiento de medidas de prevención de caídas. Conclusión: Esta proximidad de los valores obtenidos genera un aspecto positivo para mejorar la seguridad de los pacientes y que, si bien el cumplimiento de las metas no es el deseado, es cercano al porcentaje planteado. Lo que en definitiva hace a este estudio un antecedente importante en la mejora continua con vista al futuro cercano[AU]

This research aims to evaluate the level of compliance with international goals, which represent the main focus for improving the quality and safety of patient care. Patient safety involves all studies, practices and actions promoted by health institutions to reduce and eliminate the risks of unnecessary harm related to health care. Methodology: Descriptive, observational and transversal study. From primary and secondary sources, Results: goals No. 1 were addressed, which consists of Identifying patients correctly and goal No. 6, which refers to Reducing the risk of injuries in patients as a result of falls. Firstly, compliance with correct patient identification stands out and secondly, improvement in compliance with fall prevention measures. Conclusion: This proximity of the values obtained generates a positive aspect to improve patient safety and that, although the fulfillment of the goals is not as desired, it is close to the proposed percentage. Which ultimately makes this study an important precedent in continuous improvement for the near future[AU]

Esta pesquisa tem como objetivo avaliar o nível de cumprimento das metas internacionais, que representam o foco principal para a melhoria da qualidade e segurança do atendimento ao paciente. A segurança do paciente envolve todos os estudos, e ações promovidas pelas instituições de saúde para reduzir e eliminar os riscos de danos desnecessários relacionados à assistência à saúde. Metodologia: Estudo descritivo, observacional e transversal. De fontes primárias e secundárias, dependendo do indicador e do objetivo para o qual a medição está sendo realizada. Resultados: Nesta pesquisa serão abordadas as metas nº1, que consiste em Identificar corretamente os pacientes e a meta nº 6, que es Reduzir o risco de lesões nos pacientes em decorrência de quedas. Foi realizado nos dois locais. Em primeiro lugar, destaca-se o cumprimento da correta identificação do paciente e, em segundo lugar, a melhoria no cumprimento das medidas de prevenção de quedas. Conclusão: Essa proximidade dos valores obtidos gera um aspecto positivo para melhorar a segurança do paciente e que, embora o cumprimento das metas não seja o desejado, está próximo do percentual proposto. O que acaba por tornar este estudo um precedente importante na melhoria contínua com vista ao futuro próximo.

Effects of Pilates exercises on postural balance and reduced risk of falls in older adults: A systematic review and meta-analysis.

BACKGROUND: and Purpose: Pilates exercises have been recommended to improve postural balance and reduce the risk of falls in older adults. However, the certainty of these recommendations remains unclear. In this sense, our objective was to update the literature and verify the effects of Pilates on postural balance and the risk of falls in this population. METHODS: A systematic search was conducted across multiple databases, including PubMed, EMBASE, CENTRAL, CINAHL, Web of Science, SPORTDiscus, LILACS, and PEDro, on April 17, 2023. The methodological quality of the studies was assessed using the PEDro scale, and the certainty of evidence was evaluated using the GRADE system. Meta-analysis calculations were performed by standardized mean difference (SMD). RESULTS: A total of 39 studies, involving 1770 participants, were included in the systematic review. Only 14 studies exhibited satisfactory methodological quality. Evidence with very low to moderate certainty showed that Pilates was significantly superior to control groups on indicators of dynamic postural balance (SMD = 1.60 to 0.72), static postural balance (SMD = 0.37 to 0.25), and general state of balance (SMD = 0.76), but not to reduce the number and fear of falls. Furthermore, Pilates was comparable to other forms of exercise for these outcomes. CONCLUSIONS: Pilates can be recommended to enhance static and dynamic postural balance in older adults, but not to reduce the number of falls or the fear of falling. Given that no outcomes showed high certainty of evidence, future studies may alter these findings.

Awareness About Fall Risk and Measures of Fall Prevention Among Older Adults in Buraidah, Saudi Arabia.

Background Falls, particularly common among the elderly, pose significant health risks and mortality rates worldwide. Factors such as decline related to old age, gender, medical conditions, and environmental hazards contribute to falls. Prevention strategies focus on environmental modifications, exercise programs, medication reviews, and vitamin D supplementation to reduce fall risks and improve outcomes. This study aims to investigate the awareness of fall risk and measures of fall prevention among older adults in Buraidah, Qassim, Saudi Arabia, and examines the relationship between the level of awareness and various sociodemographic factors. Methodology This cross-sectional study was conducted among elderly patients at primary healthcare centers in Buraidah, Qassim province, Saudi Arabia. Data were collected via an interviewer-administered questionnaire assessing awareness and prevention of falls. Data were cleaned in Excel (Microsoft Corp., Redmond, WA, USA) and analyzed using SPSS version 29 (IBM Corp., Armonk, NY, USA). A linear regression model was used to determine the association. Statistical significance was established at a p-value of 0.05 or lower. Results Our study included 280 elderly participants, of whom 58.2% were female. The mean age was 63.7 years (SD = 4.9), and 34.6% had a bachelor's degree. Regarding fall awareness, 81.4% acknowledged preventability. Notable preventive measures included medication reviews (64.6%), eye examinations (85.7%), physical activity (82.2%), vitamin D supplementation (76.8%), and home safety devices (97.5%). Regarding fall prevention, 61.8% underwent medical examinations annually, and 65.4% had vision checkups. Higher awareness about fall risks was associated with female gender (ß = 1.394, 95% confidence interval (CI) = 0.199 to 2.589, p = 0.022), higher education (ß = 0.931, 95% CI = 0.549 to 1.314, p < 0.001), and chronic diseases (ß = -1.935, 95% CI = -3.313 to -0.556, p = 0.006). Conclusions Our study demonstrates significant awareness among elderly participants regarding fall preventability and measures. Females and those with higher education levels had higher levels of awareness. These findings highlight the importance of targeted interventions to increase awareness and preventive measures among elderly populations.

Meteorological parameters and hospital-acquired falls-A multicenter retrospective study based on 10 years of adverse events reporting system data.

Objective and rationale: Hospital-acquired falls are common and serious adverse events in medical institutions, with high incidence and injury rates. Studying the occurrence patterns of hospital-acquired falls is important for preventing falls in hospitalized patients. However, the effect of meteorological factors on hospital-acquired falls has not been elucidated. Therefore, this study explored the impact of meteorological parameters on hospital-acquired falls in Chongqing, China, and provided new ideas for the clinical prevention of falls in patients. Methods: Correlation analysis and distributed lag nonlinear models were employed to analyze the relationship between 3890 cases of hospital-acquired falls and meteorological data in 13 hospitals in 11 districts and counties in Chongqing from January 2013 to April 2023. Results: The number of hospital-acquired falls demonstrated a nonlinear correlation with the daily average relative humidity and negatively correlated with sunshine duration; however, temperature, air pressure, and wind speed were not correlated. Compared to the reference humidity (87 %), the immediate effects of daily average relative humidity (65-68 % and 90-97 %) increased the risk of hospital-acquired falls on the same day (relative risk [RR]:1.027-1.243). When the daily average relative humidity was 95-97 %, lags of 0-1 d and 8-12 d had greater effects on falls (RR:1.073-1.243). The daily average relative humidities of 62-74 % and 91-97 % were statistically significant at cumulative relative risk (CRR)of 4, 7, 10, and 14 d with a cumulative lag (CRR: 1.111-4.277). On sex and age stratification, the lag and cumulative effects of relative humidity more significantly impacted falls in women and patients aged ≥65 years. Conclusion: Daily average relative humidity had a nonlinear correlation and lag effect on hospital-acquired falls; therefore, medical institutions should pay attention to the effect of relative humidity on hospital-acquired falls in patients, especially old and female patients.

Guidelines in Practice: Safe Patient Handling and Movement.

The perioperative environment presents unique ergonomic challenges related to lifting and moving patients. These challenges place perioperative team members and patients at an increased risk for injury. The updated AORN "Guideline for safe patient handling and movement" provides perioperative nurses with guidance on safe patient handling and movement practices to help minimize the incidence of injuries to patients and health care workers. This article provides an overview of the guideline and discusses recommendations for a safe patient handling and mobility (SPHM) program, ergonomic planning and facility design, SPHM technology, an individualized SPHM and ergonomic plan, and fall risk and mobility assessments. It also includes a scenario describing concerns related to patient and perioperative team member safety. Perioperative nurses should review the guideline in its entirety and apply the recommendations for safe patient handling and movement.

Imbalance and Falls in Patients with Parkinson's Disease: Causes and Recent Developments in Training and Sensor-Based Assessment.

Imbalance and falls in patients with Parkinson's disease (PD) do not only reduce their quality of life but also their life expectancy. Aging-related symptoms as well as disease-specific motor and non-motor symptoms contribute to these conditions and should be treated when appropriate. In addition to an active lifestyle, advanced exercise training is useful and effective, especially for less medically responsive symptoms such as freezing of gait and postural instability at advanced stages. As treadmill training in non-immersive virtual reality, including dual tasks, significantly reduced the number of falls in PD patients, the mechanism(s) explaining this effect should be further investigated. Such research could help to select the most suitable patients and develop the most effective training protocols based on this novel technology. Real-life digital surrogate markers of mobility, such as those describing aspects of endurance, performance, and the complexity of specific movements, can further improve the quality of mobility assessment using wearables.

Development and External Validation of a Machine Learning-based Fall Prediction Model for Nursing Home Residents: A Prospective Cohort Study.

OBJECTIVES: To develop and externally validate a machine learning-based fall prediction model for ambulatory nursing home residents. The focus is on predicting fall occurrences within 6 months after baseline assessment through a binary classification task, aiming to provide staff with an effective and user-friendly fall-risk assessment tool. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: A total of 864 older residents living in 4 nursing homes between May 2022 and March 2023 in China. METHODS: Potential fall-risk predictors were collected through in-person interviews and assessments of anthropometric and physical function. Participants were followed for 6 months, with falls recorded by trained nurses. Seven machine learning algorithms, including Logistic Regression (LR), Gradient Boosting Machine (GBM), eXtreme Gradient Boosting (XGBoost), Random Forest (RF), Support Vector Machine (SVM), Neural Networks (NN), and Decision Tree (DT), were used to develop prediction models. Performance was evaluated using the area under the receiver operating characteristic curve (ROC-AUC) and Precision-Recall curve (PR-AUC), with calibration assessed via a calibration curve. Feature importance was visualized using SHapley Additive exPlanations (SHAP). RESULTS: The 6 selected predictors were balance, grip strength, fatigue, fall history, age, and comorbidity. The ROC-AUC for the models ranged from 0.710 to 0.750, PR-AUC from 0.415 to 0.473, sensitivity from 0.704 to 0.914, and specificity from 0.511 to 0.687 in the validation cohort. The LR model was converted into a nomogram. CONCLUSIONS AND IMPLICATIONS: The machine learning-based fall-prediction models effectively identified nursing home residents at high risk of falls. The developed nomogram can be integrated into clinical practice to enhance fall risk assessment protocols, ultimately improving patient safety and care in nursing homes.

Objective Falls Risk Assessment Using Markerless Motion Capture and Representational Machine Learning.

Falls are a major issue for those over the age of 65 years worldwide. Objective assessment of fall risk is rare in clinical practice. The most common methods of assessment are time-consuming observational tests (clinical tests). Computer-aided diagnosis could be a great help. A popular clinical test for fall risk is the five times sit-to-stand. The time taken to complete the test is the most commonly used metric to identify the most at-risk patients. However, tracking the movement of skeletal joints can provide much richer insights. We use markerless motion capture, allied with a representational model, to identify those at risk of falls. Our method uses an LSTM autoencoder to derive a distance measure. Using this measure, we introduce a new scoring system, allowing individuals with differing falls risks to be placed on a continuous scale. Evaluating our method on the KINECAL dataset, we achieved an accuracy of 0.84 in identifying those at elevated falls risk. In addition to identifying potential fallers, our method could find applications in rehabilitation. This aligns with the goals of the KINECAL Dataset. KINECAL contains the recordings of 90 individuals undertaking 11 movements used in clinical assessments. KINECAL is labelled to disambiguate age-related decline and falls risk.

Gait balance recovery after tripping: The influence of walking speed and ground inclination on muscle and joint function.

Reactive lower limb muscle function during walking plays a key role in balance recovery following tripping, and ultimately fall prevention. The objective of this study was to evaluate muscle and joint function in the recovery limb during balance recovery after trip-based perturbations during walking. Twenty-four healthy participants underwent gait analysis while walking at slow, moderate and fast speeds over level, uphill and downhill inclines. Trip perturbations were performed randomly during stance, and lower limb kinematics, kinetics, and muscle contribution to the acceleration of the whole-body centre of mass (COM) were computed pre- and post-perturbation in the recovery limb. Ground slope and walking speed had a significant effect on lower limb joint angles, net joint moments and muscle contributions to support and propulsion during trip recovery (p < 0.05). Specifically, increasing walking speed during trip recovery significantly reduced hip extension in the recovery limb and increased knee flexion, particularly when walking uphill and at higher walking speeds (p < 0.05). Gluteus maximus played a critical role in providing support and forward propulsion of the body during trip recovery across all gait speeds and ground inclinations. This study provides a mechanistic link between muscle action, joint motion and COM acceleration during trip recovery, and underscores the potential of increased walking speed and ground inclination to increase fall risk, particularly in individuals prone to falling. The findings of this study may provide guidelines for targeted exercise therapy such as muscle strengthening for fall prevention.

Force magnitude and distribution during impacts to the hip are affected differentially by body size and body composition.

Hip fractures are a severe health concern among older adults. While anthropometric factors have been shown to influence hip fracture risk, the low fidelity of common body composition metrics (e.g. body mass index) reduces our ability to infer underlying mechanisms. While simulation approaches can be used to explore how body composition influences impact dynamics, there is value in experimental data with human volunteers to support the advancement of computational modeling efforts. Accordingly, the goal of this study was to use a novel combination of subject-specific clinical imaging and laboratory-based impact paradigms to assess potential relationships between high-fidelity body composition and impact dynamics metrics (including load magnitude and distribution and pelvis deflection) during sideways falls on the hip in human volunteers. Nineteen females (<35 years) participated. Body composition was assessed via DXA and ultrasound. Participants underwent low-energy (but clinically relevant) sideways falls on the hip during which impact kinetics (total peak force, contract area, peak pressure) and pelvis deformation were measured. Pearson correlations assessed potential relationships between body composition and impact characteristics. Peak force was more strongly correlated with total mass (r = 0.712) and lean mass indices (r = 0.510-0.713) than fat mass indices (r = 0.401-0.592). Peak deflection was positively correlated with indices of adiposity (all r > 0.7), but not of lean mass. Contact area and peak pressure were positively and negatively associated, respectively, with indices of adiposity (all r > 0.49). Trochanteric soft tissue thickness predicted 59 % of the variance in both variables, and was the single strongest correlate with peak pressure. In five-of-eight comparisons, hip-local (vs. whole body) anthropometrics were more highly associated with impact dynamics. In summary, fall-related impact dynamics were strongly associated with body composition, providing support for subject-specific lateral pelvis load prediction models that incorporate soft tissue characteristics. Integrating soft and skeletal tissue properties may have important implications for improving the biomechanical effectiveness of engineering-based protective products.

The Modified Five-Item Frailty Index, Mortality, and Hospital Length of Stay in Geriatric Traumatic Fall Injuries.

This study investigates the association between frailty, measured by the modified five-item frailty index (mFI-5), with inpatient mortality and hospital length of stay for geriatric patients with fall-related injuries. Despite falls being major contributors to morbidity and mortality in those over 65, the interaction between frailty and post-fall outcomes remains underexplored. Data for patients aged 65 and above, admitted between 2014-2020 to Rhode Island Hospital's trauma service for fall-related injuries, were extracted from its Trauma Registry. Frailty scores were retrospectively assigned using mFI-5. Logistic- and linear-regression analyses examined the relationship between mFI-5 scores, mortality, and hospital length-of-stay. Among 6,782 patients (mean age: 81.7 ± 8.66 years), higher frailty scores correlated with increased inpatient mortality (OR: 1.259; 95% CI: 1.14-1.39; P<0.000) and longer hospital stays (Coeff.: 0.460; 95% CI: 0.35-0.57, P<0.000). Notably, age showed a negative association with hospital length of stay but no significant association with inpatient mortality.

Influence of test paradigm on loading dynamics during proximal femur fracture tests simulating sideways falls.

Fall-related hip fractures are a serious public health issue in older adults. As most mechanistic hip fracture risk prediction models incorporate tissue tolerance, test methods that can accurately characterize the fracture force of the femur (and factors that influence it) are imperative. While bone possesses viscoelastic properties, experimental characterization of rate-dependencies has been inconsistent in the whole-femur literature. The goal of this study was to investigate the influence of experimental paradigm on loading rate and fracture force (both means and variability) during mechanical tests simulating lateral fall loadings on the proximal femur. Six pairs of matched femurs were split randomly between two test paradigms: a 'lower rate' materials testing system (MTS) with a constant displacement rate of 60 mm/s, and a hip impact test system (HIT) comprised of a custom-built vertical drop tower utilizing an impact velocity of 4 m/s. The loading rate was 88-fold higher for the HIT (mean (SD) = 2465.49 (807.38) kN/s) compared to the MTS (27.78 (10.03) kN/s) paradigm. However, no difference in fracture force was observed between test paradigms (mean (SD) = 4096.4 (1272.6) N for HIT, and 3641.3 (1285.8) N for MTS). Within-paradigm variability was not significantly different across paradigms for either loading rate or fracture force (coefficients of variation ranging from 0.311 to 0.361). Within each test paradigm, significant positive relationships were observed between loading rate and fracture force (HIT adjusted R2 = 0.833, p = 0.007; MTS adjusted R2 = 0.983, p < 0.0001). Overall, this study provides evidence that energy-based impact simulators can be a valid method to measure femoral bone strength in the context of fall-related hip fractures. This study motivates future research to characterize potential non-linear relationships between loading rate and fracture threshold at both macro and microscales.

Promoting musculoskeletal health and preventing ill health.

Musculoskeletal conditions are highly prevalent among older adults and can have a significant impact on their quality of life. Musculoskeletal health is an important component of maintaining well-being and independence. A proactive approach is required, with nurses implementing strategies such as healthy diets and physical exercise that will support optimal health. This article considers the importance of musculoskeletal health, examines the risk factors for a decline in musculoskeletal health, and explores approaches that can improve outcomes and promote healthy ageing.

A study on the falls factors among the older adult with cognitive impairment based on large-sample data.

Introduction: This study explored the correlative factors of falls among the older adult with cognitive impairment, to provide distinct evidence for preventing falls in the older adult with cognitive impairment compared with the general older adult population. Methods: This study was based on a cross-sectional survey, with an older adult population of 124,124 was included. The data was sourced from the Elderly Care Unified Needs Assessment for Long-Term Care Insurance in Shanghai. Binary and multivariable logistic regression analyses were conducted sequentially on the correlative factors of falls. Multivariable logistic regression was performed on variables that were significant, stratified by cognitive function levels. Results: The incidence of fall in the past 90 days was 17.67% in this study. Specific variables such as gender (male), advanced age (≥80), residence with a elevator (or lift), mild or moderate disability, quality of sleep (acceptable/poor) were negatively correlated with falls, while higher education level, living alone, residence with indoor steps, unclean and untidy living environment, MCI or dementia, chronic diseases, restricted joints, impaired vision, and the use of diaper were positively correlative factors of falls. Comparing with older adult with normal cognitive functions, older adult with dementia faced a higher risk of falling due to accessibility barrier in the residence. For general older adults, less frequency of going outside and poor social interactions were positively correlated with falls, while for older adult with cognitive impairments, going outside moderately (sometimes) was found positively correlated with falls. Older adults with cognitive impairments have increased fall risks associated with chronic diseases, restricted joints, and the use of diaper. The risk of falling escalated with the greater number of chronic diseases. Discussion: For older adult with cognitive impairments, it is advisable to live with others. Additionally, creating an accessible living environment and maintaining the cleanness and tidiness can effectively reduce the risk of falls, particularly for those with MCI or dementia. Optimal outdoor activity plans should be developed separately based on the cognitive function of older adults. Older adult with dementia who have comorbidities should be paid special attention in fall prevention compared to the general older adult population.

Association between the Hopkins Falls grading scale and motor function tests in patients with multiple sclerosis.

Introduction: One of the main complications of multiple sclerosis (MS) is imbalance and walking problems that can lead to falls. This study investigated the association between a fall measurement scale called the Hopkins Falls Grading Scale (HFGS) and motor function tests in patients with MS. Material and Methods: This cross sectional study was conducted using convenience sampling on 85 patients referred to the MS Association of Mashhad, Iran, in 2023. The HFGS examined falls during the past year and divided them into 4 degrees, and the function test included the timed 25 foot walk (T25FW) test and the timed up and go (TUG) test. Kruskal-Wallis test and Spearman's correlation coefficient were used for data analysis. Results: A statistically significant association was obtained between HFGS and functional tests (T25FW and TUG) (for both P < 0.0001). A significant association was observed between the variables of age (P = 0.006), duration of the disease (P = 0.03), the use of mobility devices (P = 0.05), and HFGS. Conclusion: Considering the association between HFGS and motor function tests in MS patients, clinical experts should pay attention to patients who have slower movement and evaluate them in terms of falling status when performing motor function tests.

Test-retest reliability and minimal detectable change of four functional tests in community-dwelling older adults with high risk of falls.

Objectives: This study aimed to quantify test-retest reliability and minimal detectable change (MDC) of the four commonly used functional tests in older adults with a high risk of falling. Patients and methods: The cross-sectional study was conducted with 30 community-dwelling older adults (26 females, 4 males; mean age: 73.7±6.0 years; range, 65 to 88 years) with a high fall risk identified by the Thai falls risk assessment test between November 2018 and May 2019. Data from the 10-m walk test at a comfortable gait speed (CGS) and fast gait speed (FGS), timed up and go (TUG) test, five times sit to stand test (FTSST), and 6-min walk test (6MWT) were collected twice for each participant. The interval between test sessions was one week. Test-retest reliability was analyzed by the intraclass correlation coefficient (ICC). Standard error of measurement (SEM) and MDC at the 95% confidence interval (MDC95) were also calculated. Results: The four functional tests had ICC in the range of 0.92 to 0.97. The SEM values of the CGS, FGS, TUG, FTSST, and 6MWT were 0.06 m/sec, 0.04 m/sec, 1.10 sec, 1.30 sec, and 20.60 m, respectively. The MDC95 values of the CGS, FGS, TUG, FTSST, and 6MWT were 0.16 m/sec, 0.12 m/sec, 3.00 sec, 3.50 sec, and 57.20 m, respectively. Conclusion: All functional tests demonstrated excellent test-retest reliability. The SEM and MDC95 of all functional tests were established. These findings can help clinicians interpret the effectiveness of interventions and determine changes in functional ability over time in older adults at high risk of falls.

Determinants influencing the implementation of multifactorial falls risk assessment and multidomain interventions in community- dwelling older people: a systematic review.

BACKGROUND: Multifactorial falls risk assessment and multidomain interventions are recommended by the World guidelines for falls prevention and management. To successfully implement these interventions, it is important to understand determinants influencing the implementation. METHODS: A literature search was conducted for this systematic review on the 3 December 2021 and updated on the 3 April 2023 in five databases: PubMed (including MEDLINE), EMBASE (via Embase.com), Cochrane Central Register of Controlled Trials (via Cochrane Library), Web of Science Core Collection and CINAHL (via EBSCO). Studies were included if they reported on determinants influencing the implementation of a multifactorial falls risk assessment and/or multidomain interventions in community-dwelling older people. Editorials, opinion papers, systematic reviews and studies focusing on one population (e.g. Parkinson) were excluded. Two researchers independently screened the articles on title, abstract and full text. The quality was evaluated based on a sensitivity analysis. 'The Comprehensive Integrated Checklist of Determinants of practice' was used to categorise the determinants. RESULTS: Twenty-nine studies were included. Determinants were classified as barriers (n = 40) and facilitators (n = 35). The availability of necessary resources is the most reported determinant. Other commonly reported determinants are knowledge, intention/beliefs and motivation at the levels of older people and healthcare professionals, fitting of the intervention into current practice, communication, team and referral processes and financial (dis)incentives. CONCLUSIONS: Mapping of the barriers and facilitators is essential to choose implementation strategies tailored to the context, and to enhance the uptake and effectiveness of a multifactorial falls risk assessment and/or multidomain interventions.

Relationship between social participation, children's support, and social frailty with falls among older adults in Colombia.

Background: There is limited research on social factors related to falls among older adults. This study assessed the association between falls during the past year with social participation, children's support, relationship with children, and social frailty. Methods: Participants were 17,687 community-dwelling older adults from the SABE (Health, Well-being, and Aging, 2015) Colombia survey. Covariates included sociodemographic characteristics, environmental barriers, psychotropic intake, vision problems, memory loss, multimorbidity, and fear of falling. Results: In multivariate logistic regression analyses, being socially frail (vs. no-frail) was associated with higher odds of falls (OR=1.20; 95% confidence interval [CI], 1.10-1.32). Participating in groups (OR=1.07; 95% CI, 1.03-1.11), helping others (OR=1.04; 95% CI, 1.02-1.06), or volunteering (OR=1.09; 95% CI, 1.01-1.17) were also associated with higher odds of falls. These findings were partly explained because most group participants reside in cities where they are more exposed to environmental barriers. In contrast, receiving help, affection, and company from children (OR=0.95; 95% CI, 0.93-0.97) was associated with lower fall odds than not receiving it. Moreover, having a good relationship with children was associated with lower odds of falls (OR=0.75; 95% CI, 0.66-0.85) compared to an unsatisfactory relationship. Conclusion: Support from children and having a good relationship with them were associated with fewer falls; however, social frailty and participation in social groups were associated with more falls.

Falls prevention in older people and the role of nursing.

Falls among older individuals pose a significant public health challenge globally, impacting both individual wellbeing and healthcare systems. This article examines the importance of falls prevention in older people and the pivotal role of nursing in this domain. It presents statistics indicating the high prevalence of falls among older adults, highlighting their substantial impact on morbidity, mortality and healthcare costs. Furthermore, it discusses the multifactorial nature of fall risk factors, including age-related changes, chronic health conditions, medication use, impaired mobility, sensory deficits and environmental hazards. Nursing interventions encompass comprehensive assessments, personalised care plans, patient education and advocacy efforts aimed at reducing fall risks and enhancing safety. By addressing intrinsic and extrinsic factors contributing to falls, nurses contribute significantly to improving the quality of life for older adults and reducing the economic burden associated with fall-related injuries.

Screening for frailty and its association with activities of daily living, cognitive impairment, and falls among community-dwelling older adults in China.

OBJECTIVES: Frailty is a prevalent geriatric condition that significantly impacts the health of older adults. This study aimed to examine the prevalence of frailty among older Chinese adults aged ≥ 65 years and to assess its association with adverse geriatric outcomes. METHOD: This study included 20,724 older adults aged ≥ 65 years in Jiangsu Province, China, utilizing a random, stratified, multistage cluster sampling approach. Frailty was assessed using the 5-item FRAIL scale. Geriatric outcomes, such as independence in activities of daily living (ADL), cognitive impairment, and frequent fall events (occurring four or more times in the preceding year), were evaluated. Logistic regression models were employed to evaluate the association between frailty and geriatric outcomes, with results presented as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The mean age of the participants was 73.4 ± 6.4 years. The standardized prevalence of prefrailty and frailty was 35.2% and 10.3%, respectively. Individuals identified as prefrail or frail tended to live in rural areas, have lower educational levels, be widowed, have lower incomes, and engage in less physical activity. Prefrailty and frailty were associated with an increased risk of limitations in BADL (OR: 9.62, 95% CI: 7.43-12.46; and OR: 29.25, 95% CI: 22.42-38.17, respectively) and IADL (OR: 2.54, 95% CI 2.35-2.74; and OR: 5.19, 95% CI 4.66-5.78, respectively), positive cognitive impairment screening (OR: 1.23, 95% CI: 1.16-1.31; and OR: 1.72, 95% CI: 1.56-1.91, respectively), and frequent falls (occurring four or more times in the preceding year) (OR: 3.38, 95% CI: 2.50-4.56; and OR: 8.37, 95% CI: 6.01-11.65). The association between frailty and both limitations in BADL and falls was notably more pronounced among the younger age groups (p for interaction < 0.001). CONCLUSIONS: According to the 5-item FRAIL scale, frailty was associated with limitations in BADLs and IADLs, positive cognitive impairment screening, and recent falls among older adults living in the community. Screening for frailty in younger age groups has the potential to prevent declines in physical function and falls.