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Clinical Intervention Effect of a Predictive Model Constructed Based on Risk Factors for Falls in Elderly Patients during Hospitalization. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4983254. [PMID: 36193201 PMCID: PMC9525773 DOI: 10.1155/2022/4983254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022]
Abstract
Falls in elderly patients are an important cause of fractures, functional impairment, and mortality. In this paper, a questionnaire was used to collect information on fall history, balance function and sensory function from patients over 65 years of age. In the analysis, the presence or absence of falls was used as a factor, and a corresponding prediction model was constructed using methods such as univariate analysis and regression analysis. This survey found that in the past year, 60% of the patients had fallen, 16.67% had one fall, 33.33% had two falls, and 50% had three or more falls; model specificity is 61.54%, the sensitivity is 71.43%, and the misjudgment is 38.46%. The model has good specificity and sensitivity and a small misjudgment rate; so, the model is more reasonable. This paper selects several sensitivity indices that have a certain impact on the risk of falling and makes a satisfactory forecast, which can provide a theoretical basis for the prevention of the risk of falls in elderly patients during hospitalization.
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Merminod G, Weber O, Vaucher C, Semlali I, Terrier A, Decosterd I, Rubli Truchard E, Singy P. Communication About Chronic Pain in Older Persons' Social Networks: Study Protocol of a Qualitative Approach. Front Public Health 2021; 9:764584. [PMID: 34805077 PMCID: PMC8595239 DOI: 10.3389/fpubh.2021.764584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
A lack of social relations appears to impact on health and life expectancy among the older persons. The quality and diversity of social relations are correlated with good health and well-being in later life. Chronic pain is a crucial issue in aging population. Effective communication between the older persons with chronic pain, their relatives and the actors of the healthcare system facilitates the management of this condition. Studies on communication in later life generally do not consider the older persons' social network as a whole, focusing only a specific segment (e.g., family or medical staff). This lack of scientific data prevents the actors of the healthcare system from offering solutions to bridge clinically relevant communication gaps. As a consequence, our study has three objectives: (1) to identify how the older persons perceive communication about chronic pain with their social network; (2) to identify their unmet communication needs; (3) to develop recommendations that improve communication about chronic pain in later life. The study will be divided into two phases. The first phase will meet objectives 1 and 2. It will involve individual interviews with about 50 people over 75 years old suffering from chronic pain and without major cognitive or auditory troubles. In this phase, we will apply a multi-layered analysis. We will map the older persons' personal network and identify their communication practices and needs, by combining content and discourse analysis with social network theories. The second phase of the study will aim at recommendations based on the results of the first phase (objective 3). It will require focus groups with different sets of stakeholders (older persons, relative caregivers, health professionals, decision-makers). In the second phase, we will use content analysis to pinpoint the concerns and suggestions for action. The results will be disseminated on three levels: (1) to the scientific world (specialists in the field of health and aging and health communication); (2) to health practitioners working with older persons; (3) to society at large, with a focus on institutions and groups directly concerned by the issue.
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Affiliation(s)
- Gilles Merminod
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Orest Weber
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Carla Vaucher
- Institute of Social Sciences, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Imane Semlali
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Anamaria Terrier
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Isabelle Decosterd
- Pain Center, Service of Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eve Rubli Truchard
- Geriatrics and Geriatric Rehabilitation Service and Chair of Geriatric Palliative Care, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Pascal Singy
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Yoshikawa A, Ramirez G, Smith ML, Foster M, Nabil AK, Jani SN, Ory MG. Opioid Use and the Risk of Falls, Fall Injuries and Fractures among Older Adults: A Systematic Review and Meta-Analysis. J Gerontol A Biol Sci Med Sci 2021; 75:1989-1995. [PMID: 32016284 DOI: 10.1093/gerona/glaa038] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is increasing concern about opioid use as a pain treatment option among older adults. Existing literature implies an association between opioid use and fracture, increasing the risk of death and disabilities; yet, this relationship with other fall-related outcomes has not been fully explored. We performed a meta-analysis to evaluate the associations between opioid use and adverse health outcomes of falls, fall injuries, and fractures among older adults. METHODS A systematic literature search was conducted using nine databases: Medline, Embase, CINAHL, PsycInfo, Global Health, Northern Light Sciences Conference Abstracts, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We log-transformed effect sizes (relative risk [RR], odds ratio [OR], and hazard ratio [HR]) to compute pooled risk estimates comparable across the studies. The random-effects model was applied to calculate the pooled risk estimates due to heterogeneity. Meta-regressions explored differences in risk estimates by analysis method, study design, setting, and study quality. RESULTS Thirty studies, providing 34 relevant effect sizes, met the inclusion criteria for this meta-analysis. Overall, opioid use was significantly associated with falls, fall injuries, and fractures, with effect sizes ranging from 0.15 to 0.71. In meta-regressions, no selected factors explained heterogeneity. CONCLUSION While heterogeneity is present, results suggest an increased risk of falls, fall injuries, and fractures among older adults who used opioids. Findings highlight the need for opioid education and nonopioid-related pain management interventions among older adults to decrease fall-related risk.
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Affiliation(s)
- Aya Yoshikawa
- Center for Population Health and Aging, Texas A&M University, College Station
| | - Gilbert Ramirez
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, College Station.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station.,Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens
| | - Margaret Foster
- Medical Sciences Library, Texas A&M University, College Station
| | - Anas K Nabil
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station
| | - Sagar N Jani
- Center for Population Health and Aging, Texas A&M University, College Station.,Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station
| | - Marcia G Ory
- Center for Population Health and Aging, Texas A&M University, College Station.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station
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Pérez-Ros P, Vila-Candel R, Martínez-Arnau FM. A home-based exercise program focused on proprioception to reduce falls in frail and pre-frail community-dwelling older adults. Geriatr Nurs 2020; 41:436-444. [DOI: 10.1016/j.gerinurse.2020.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 12/27/2022]
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Kulakci Altintas H, Korkmaz Aslan G. Incidence of falls among community-dwelling older adults in Turkey and its relationship with pain and insomnia. Int J Nurs Pract 2019; 25:e12766. [PMID: 31313430 DOI: 10.1111/ijn.12766] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 03/06/2019] [Accepted: 06/05/2019] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to determine the incidence of falls among community-dwelling older adults and the impact of pain and insomnia on falls. METHODS This cross-sectional study recruited 659 older adults. Pain was assessed by the Geriatric Pain Measure, and insomnia was assessed by the Insomnia Severity Index. The history of falls was assessed within the last 12 months. Risk factors for falls were determined using logistic regression analysis. RESULTS The incidence of falls within the last year was 37.2%. Based on the analyses, pain and insomnia were found to be risk factors for falls. CONCLUSION In this study, falls were observed as a common problem among community-dwelling older adults, and pain and insomnia were determined as risk factors for falls. Therefore, pain and insomnia should be addressed when prevention of falls among community-dwelling older adults are planned by health care professionals including nurses.
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Geerse DJ, Roerdink M, Marinus J, van Hilten JJ. Walking adaptability for targeted fall-risk assessments. Gait Posture 2019; 70:203-210. [PMID: 30901621 DOI: 10.1016/j.gaitpost.2019.02.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/30/2019] [Accepted: 02/19/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Most falls occur during walking and are due to trips, slips or misplaced steps, which suggests a reduced walking adaptability. The objective of this study was to evaluate the potential merit of a walking-adaptability assessment for identifying prospective fallers and risk factors for future falls in a cohort of stroke patients, Parkinson's disease patients, and controls (n = 30 for each group). RESEARCH QUESTION Does an assessment of walking-adaptability improve the identification of fallers compared to generic fall-risk factors alone? METHODS This study comprised an evaluation of subject characteristics, clinical gait and balance tests, a quantitative gait assessment and a walking-adaptability assessment with the Interactive Walkway. Subjects' falls were registered prospectively with falls calendars during a 6-month follow-up period. Generic and walking-related fall-risk factors were compared between prospective fallers and non-fallers. Binary logistic regression and Chi-square Automatic Interaction Detector analyses were performed to identify fallers and predictor variables for future falls. RESULTS In addition to fall history, obstacle-avoidance success rate and normalized walking speed during goal-directed stepping correctly classified prospective fallers and were predictors of future falls. Compared to the use of generic fall-risk factors only, the inclusion of walking-related fall-risk factors improved the identification of prospective fallers. SIGNIFICANCE If cross-validated in future studies with larger samples, these fall-risk factors may serve as quick entry tests for falls prevention programs. In addition, the identification of these walking-related fall-risk factors may help in developing falls prevention strategies.
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Affiliation(s)
- Daphne J Geerse
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands.
| | - Melvyn Roerdink
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands
| | - Johan Marinus
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jacobus J van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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Altintas HK, Aslan GK, Sısman NY, Kesgin MT. Effects of Pain and Sleep Quality on Falls Among Nursing Home Residents in Turkey. Res Gerontol Nurs 2018; 11:257-264. [PMID: 30230519 DOI: 10.3928/19404921-20180810-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/06/2018] [Indexed: 11/20/2022]
Abstract
The current study was conducted to detect the incidence of falls among individuals in nursing homes, as well as the impact of pain and sleep quality on falls. The sample for this cross-sectional study comprised 291 older adults. Pain was assessed using the Geriatric Pain Measure and insomnia was assessed using the Insomnia Severity Index. Incidence of falls within the past 1 year was 40.9%. Risk factors for falling were determined using logistic regression analysis. Based on the analysis, being single (odds ratio [OR] = 2.502, 95% confidence interval [CI] [1.155, 6.195]) and experiencing pain (OR = 2.841, 95% CI [1.195-6.754]) were risk factors for falling. In the current study, falling was seen as a common problem among older adults. Pain in particular should be addressed when planning the prevention of falls in nursing homes. [Res Gerontol Nurs. 2018; 11(5):257-264.].
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Liu S, Zhu Y, Chen W, Wang L, Zhang X, Zhang Y. Demographic and socioeconomic factors influencing the incidence of ankle fractures, a national population-based survey of 512187 individuals. Sci Rep 2018; 8:10443. [PMID: 29992987 PMCID: PMC6041313 DOI: 10.1038/s41598-018-28722-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/27/2018] [Indexed: 12/01/2022] Open
Abstract
This study aimed to investigate the population-based incidence rate of ankle fracture and associated risk factors in China. All the data on ankle fractures were available from the China National Fracture Survey (CNFS) conducted between January and May in 2015. All eligible household members were sampled from 8 provinces, 24 urban cities and 24 rural counties in China, using stratified random sampling and the probability proportional to size method. Questionnaires were sent to every participant for data collection and quality control was accomplished by our quality control team members. A total of 512187 valid questionnaires were collected and relevant data were abstracted and analyzed. One hundred and ninety patients sustained 193 ankle fractures in 2014, indicating the incidence rate was 37.1 (95% CI, 31.8–42.4)/100,000 person-year. Alcohol consumption, living alone and average sleep time <7 h/d were identified as independent risk factors for ankle fracture in both males and females. Previous history of fracture was identified as significant risk factor of ankle fracture in females but not in males. Therefore, specific public health policies focusing on decreasing alcohol consumption and encouraging individuals to obtain sufficient sleep should be implemented. Individuals living alone should focus more on healthcare, especially in those with previous fracture.
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Affiliation(s)
- Song Liu
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China
| | - Wei Chen
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China
| | - Lin Wang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China
| | - Xiaolin Zhang
- Department of statistics and epidemiology, Hebei Medical University, Shijiazhuang, Hebei, 050000, P.R. China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China. .,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China.
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Delespierre T, Denormandie P, Bar-Hen A, Josseran L. Empirical advances with text mining of electronic health records. BMC Med Inform Decis Mak 2017; 17:127. [PMID: 28830417 PMCID: PMC5568397 DOI: 10.1186/s12911-017-0519-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 08/04/2017] [Indexed: 11/20/2022] Open
Abstract
Background Korian is a private group specializing in medical accommodations for elderly and dependent people. A professional data warehouse (DWH) established in 2010 hosts all of the residents’ data. Inside this information system (IS), clinical narratives (CNs) were used only by medical staff as a residents’ care linking tool. The objective of this study was to show that, through qualitative and quantitative textual analysis of a relatively small physiotherapy and well-defined CN sample, it was possible to build a physiotherapy corpus and, through this process, generate a new body of knowledge by adding relevant information to describe the residents’ care and lives. Methods Meaningful words were extracted through Standard Query Language (SQL) with the LIKE function and wildcards to perform pattern matching, followed by text mining and a word cloud using R® packages. Another step involved principal components and multiple correspondence analyses, plus clustering on the same residents’ sample as well as on other health data using a health model measuring the residents’ care level needs. Results By combining these techniques, physiotherapy treatments could be characterized by a list of constructed keywords, and the residents’ health characteristics were built. Feeding defects or health outlier groups could be detected, physiotherapy residents’ data and their health data were matched, and differences in health situations showed qualitative and quantitative differences in physiotherapy narratives. Conclusions This textual experiment using a textual process in two stages showed that text mining and data mining techniques provide convenient tools to improve residents’ health and quality of care by adding new, simple, useable data to the electronic health record (EHR). When used with a normalized physiotherapy problem list, text mining through information extraction (IE), named entity recognition (NER) and data mining (DM) can provide a real advantage to describe health care, adding new medical material and helping to integrate the EHR system into the health staff work environment. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0519-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Delespierre
- Institut du Bien Vieillir Korian, 21-25 rue Balzac, 75008, Paris, France. .,Research lab: EA 4047, UFR des Sciences de la Santé Simone Veil, UVSQ Université Paris-Saclay, 2 Avenue de la Source de la Bièvre, Montigny le Bretonneux, 78180, France.
| | | | - A Bar-Hen
- UFR de Mathématiques et Informatique, Université de Paris Descartes, 45 rue des Saints-Pères, Paris, 75006, France
| | - L Josseran
- Research lab: EA 4047, UFR des Sciences de la Santé Simone Veil, UVSQ Université Paris-Saclay, 2 Avenue de la Source de la Bièvre, Montigny le Bretonneux, 78180, France
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Suárez Fernández C, Fernández S, Formiga F, Camafort M, Cepeda Rodrigo M, Rodrigo JC, Díez-Manglano J, Pose Reino A, Reino P, Tiberio G, Mostaza JM. Antithrombotic treatment in elderly patients with atrial fibrillation: a practical approach. BMC Cardiovasc Disord 2015; 15:143. [PMID: 26530138 PMCID: PMC4632329 DOI: 10.1186/s12872-015-0137-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/26/2015] [Indexed: 12/23/2022] Open
Abstract
Background Atrial fibrillation (AF) in the elderly is a complex condition. It has a direct impact on the underuse of antithrombotic therapy reported in this population. Discussion All patients aged ≥75 years with AF have an individual yearly risk of stroke >4 %. However, the risk of hemorrhage is also increased. Moreover, in this population it is common the presence of other comorbidities, cognitive disorders, risk of falls and polymedication. This may lead to an underuse of anticoagulant therapy. Direct oral anticoagulants (DOACs) are at least as effective as conventional therapy, but with lesser risk of intracranial hemorrhage. The simplification of treatment with these drugs may be an advantage in patients with cognitive impairment. The great majority of elderly patients with AF should receive anticoagulant therapy, unless an unequivocal contraindication. DOACs may be the drugs of choice in many elderly patients with AF. Summary In this manuscript, the available evidence about the management of anticoagulation in elderly patients with AF is reviewed. In addition, specific practical recommendations about different controversial issues (i.e. patients with anemia, thrombocytopenia, risk of gastrointestinal bleeding, renal dysfunction, cognitive impairment, risk of falls, polymedication, frailty, etc.) are provided.
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Affiliation(s)
| | - Suárez Fernández
- Hospital Universitario de La Princesa, Grupo de Riesgo Vascular de la SEMI, Madrid, España. .,Servicio de Medicina Interna, Hospital Universitario de La Princesa, C/Diego de León 62, 28006, Madrid, Spain.
| | - Francesc Formiga
- Hospital Universitari de Bellvitge, Grupo de Riesgo Vascular de la SEMI, Hospitalet de Llobregat, Barcelona, España
| | - Miguel Camafort
- Atrial Fibrillation Unit (UFA), Internal Medicine Department, Hospital Clinic. University of Barcelona. Research Group in Cardiovascular Risk, Nutrition and Aging. Area. 'August Pi i Sunyer' Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Jose Cepeda Rodrigo
- Hospital Vega Baja de Orihuela, Grupo de Riesgo Vascular de la SEMI, Orihuela, Alicante, España
| | - Jesús Díez-Manglano
- Hospital Royo Villanova, Grupo de Riesgo Vascular de la SEMI, Zaragoza, España
| | | | - Pose Reino
- Complexo Hospitalario Universitario de Santiago, Grupo de Riesgo Vascular de la SEMI, Santiago de Compostela, España
| | - Gregorio Tiberio
- Hospital Virgen del Camino, Grupo de Riesgo Vascular de la SEMI, Pamplona, España
| | - Jose María Mostaza
- Hospital Carlos III, Grupo de Riesgo Vascular de la SEMI, Madrid, España
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