[CBO guidelines to prevent accidental falls in the elderly: how can it be used in the institutionalized elderly?]. / CBO richtlijn preventie van valincidenten bij ouderen: wat kunnen verpleeghuizen hiermee?

Fall incidents occur frequently in the community dwelling elderly and even more in the institutionalised elderly. Fall-related research data indicate positive effects of a multifactorial intervention targeted on prevention of falls and fall-related injuries. In November 2004 the guideline "Prevention of fall incidents in the elderly" developed by The Dutch Institute for Healthcare Improvement (CBO) was published. This guideline pays attention to the risk factors for falling and the prevention of fall incidents in all settings. The highlights for nursing homes are: all nursing home patients are at risk; perform a fall risk assessment to direct fall preventive activities; together with specific fall prevention for the patient general fall prevention for the institute has to be undertaken; a multifactorial approach is indicated. In nursing homes it is possible to perform such approach multidisciplinary.

CBO Richtlijn Preventie van valincidenten bij ouderen: wat kunnen verpleeghuizen hiermee?

Fall incidents occur frequently in the community dwelling elderly and even more in the institutionalised elderly. Fall-related research data indicate positive effects of a multifactorial intervention targeted on prevention of falls and fall-related injuries.In November 2004 the guideline "Prevention of fall incidents in the elderly" developed by The Dutch Institute for Healthcare Improvement (CBO) was published. This guideline pays attention to the risk factors for falling and the prevention of fall incidents in all settings. The highlights for nursing homes are: 1.all nursing home patients are at risk;2.perform a fall risk assessment to direct fall preventive activities;3.together with specific fall prevention for the patient general fall prevention for the institute has to be undertaken;4.a multifactorial approach is indicated. In nursing homes it is possible to perform such approach multidisciplinary.

[Functional mobility tests of proclivity for falls in nursing home patients]. / Functionele mobiliteitstests voor het valrisico bij verpleeghuispatiënten. Een literatuuronderzoek naar de diagnostische waarde.

Falls of nursing home patients can lead to serious injury and the start or increase of a downwards spiral as far as functional dependence is concerned. Interventions aimed at fall prevention can be successful, therefore it is important to be able to detect patients with a high risk of falling. Medline helped to research literature covering the diagnostic value (sensitivity and specificity) of the available functional (or performance-oriented) mobility tests. Thirteen prospective studies were found with descriptions of tests which make it possible to predict the risk of falling. The tests showed a large variation in the already limited sensitivity and to a lesser degree a variation in specificity. Although further research on functional mobility tests specifically for nursing homes is necessary, the Performance-oriented mobility assessment (POMA) is a reasonable test that can be used in a nursing home environment.

The diagnostic value of colour duplex ultrasound for symptomatic carotid stenosis in clinical practice.

We assessed the accuracy of colour duplex ultrasound for the detection of severe (70-99%) symptomatic carotid stenosis in a clinical setting, in order to assess whether it could make carotid angiography unnecessary. In 152 patients with a transient ischaemic attack or nondisabling ischaemic stroke in the carotid distribution, we compared the degree of colour duplex ultrasound stenosis with angiographic stenosis by receiver-operating-characteristic analysis. The angiograms were evaluated by blinded observers, and compared with routine reports of the colour duplex examination. We computed the sensitivity and specificity of colour duplex, and the number of angiograms and sonographic studies needed to prevent one stroke within 3 years, taking into account the risks of angiography, and the risks and efficacy of endarterectomy. The estimates were adjusted for nonverification bias. We found 34 patients (22%) with a severe (70-99%) symptomatic carotid stenosis. In 16 patients (11%) the symptomatic artery was occluded. The sensitivity and specificity of duplex ultrasound were 76% and 85%, respectively. The number of patients needed to undergo angiography to prevent one stroke was reduced from almost 200 to 33, when colour duplex was used as a preoperative examination. After adjustment for the effects of nonverification, the sensitivity dropped to 58% and the number of duplex studies needed to prevent one stroke would double. The number of angiograms needed after positive duplex sonography would be virtually unaffected. Were colour duplex sonography to have been the sole preoperative investigation, the number needed to diagnose to prevent one stroke within 3 years would be approximately 350, more than twice as many as with the combined diagnostic strategy. The diagnostic accuracy of colour duplex sonography in clinical practice seems less impressive than previous studies have suggested, but it remains an effective way to select patients for angiography. Its use as a single preoperative assessment cannot be recommended.