'I've always done what I was told by the medical people': a qualitative study of the reasons why older adults attend multifactorial falls risk assessments mapped to the Theoretical Domains Framework.

OBJECTIVES: Multifactorial falls risk assessments reduce the rate of falls in older people and are recommended by international guidelines. Despite their effectiveness, their potential impact is often constrained by barriers to implementation. Attendance is an issue. The aim of this study was to explore why older people attend community-based multifactorial falls risk assessment clinics, and to map these reasons to a theoretical framework. DESIGN: This is a qualitative study. Semi-structured interviews were conducted and analysed thematically. Each theme and subtheme were then mapped onto the Theoretical Domains Framework (TDF) to identify the determinants of behaviour. PARTICIPANTS: Older adults (aged 60 and over) who attended community-based multifactorial falls risk assessments. RESULTS: Sixteen interviews were conducted. Three main themes explained participants' reasons for attending the multifactorial risk assessment; being that 'type of person', being 'linked in' with health and community services and having 'strong social support'. Six other themes were identified, but these themes were not as prominent during interviews. These were knowing what to expect, being physically able, having confidence in and being positive towards health services, imagining the benefits given previous positive experiences, determination to maintain or regain independence, and being 'crippled' by the fear of falling. These themes mapped on to nine TDF domains: 'knowledge', 'skills', 'social role and identity', 'optimism', 'beliefs about consequences', 'goals', 'environmental context and resources', 'social influences' and 'emotion'. There were five TDF domains that were not relevant to the reasons for attending. CONCLUSIONS: These findings provide theoretically based factors that influence attendance which can be used to inform the development of interventions to improve attendance to falls prevention programmes.

Medication reconciliation: time to save? A cross-sectional study from one acute hospital.

PURPOSE: Medication errors during transitional care are an important patient safety issue. Medication reconciliation is an established intervention to reduce such errors. Current evidence has not demonstrated an associated reduction in healthcare costs, however, with complexity and resource intensity being identified as issues. The aims of this study were to examine an existing process of medication reconciliation in terms of time taken, to identify factors associated with additional time, and to determine if additional time is associated with detecting errors of clinical significance. METHODS: A cross-sectional study was conducted. Issues arising during medication reconciliation incurring a time burden additional to the usual process were logged and quantified by pharmacists. Regression analyses investigated associations between patient characteristics and clinically significant errors and additional time. Cost for additional time in terms of hospital pharmacist salary was calculated. RESULTS: Eighty-nine patients were included. Having a personal record of medication at admission (OR 3.30, 95% CI: (1.05 to 10.42), p = 0.004) was a significant predictor of additional time. No significant associations were found between the occurrence of clinically significant error and additional time (p > 0.05). The most common reason for additional time was clarifying issues pertaining to primary care medication information. Projected annual 5-year costs for the mean additional time of 3.75 min were €1.8-1.9 million. CONCLUSIONS: Spending additional time on medication reconciliation is associated with economic burden and may not yield benefit in terms of capturing clinically significant errors. There is a need to improve communication of medication information between primary and secondary care.

Morbidity and Mortality Following Relocation of Highly Dependent Long-Term Care Residents: A Retrospective Analytical Study.

In recent years, 1,200 long-term care facility (LTCF) beds have been closed in Ireland, resulting in residents being transferred between facilities. The current study examined morbidity and mortality in residents relocated between LTCFs. The outcomes were studied for residents who transferred between LTCFs compared to residents who did not move (i.e., controls). A retrospective analysis was performed recording demographic data and markers of function and frailty. As a measure of morbidity, new antidepressant medication prescriptions and antibiotic drug use were examined. Mortality at 30 and 90 days was recorded. In total, 76 transferred residents and 62 control residents were studied. Both groups were highly dependent and had a high 90-day mortality rate (18.4% versus 17.7%). Higher prescription rates of antibiotic drugs occurred among relocated residents prior to transfer (59.2% versus 27.4%, p = 0.017). Residents who transferred had a greater number of new antidepressant medication prescriptions than control residents (19.7% versus 8.1%, p = 0.05). Proper planning and vigilance by staff are essential to minimize any distress caused to residents during times of relocation. [Journal of Gerontological Nursing, 42(11), 34-38.].

Assessment of the visual status of older adults on an orthopedic unit.

PURPOSE. To examine the visual status of a cohort of older adults on an orthopedic unit to determine their level of available vision to complete everyday activities in the hospital setting. METHOD. A convenience sample of 50 people was recruited. A visual history was obtained, and participants' glasses were inspected. Distance acuity, reading acuity, and contrast sensitivity were assessed using standardized screening charts. RESULTS. Of participants, 26% did not have their glasses with them until prompted, and 85% had glasses in poor condition. When tested wearing their habitual correction, 6% had low vision, 2% were blind, 41% had reading acuities worse than 20/25, and 28% had contrast sensitivity deficits. CONCLUSION. Visual impairment is prevalent in older adults, yet visual function is not routinely screened in hospitals. Occupational therapists should routinely inquire about patients' visual status, inspect their glasses, and encourage regular eye examinations. Failure to address vision could lead to inaccurate evaluation results.