Fall-related emergency department visits involving alcohol among older adults

Missed opportunities: the detection and management of at-risk drinking and illicit drug use in acutely hospitalized patients

At-risk alcohol and illicit drug use are risk factors for disease and in-hospital complications. This study investigated whether clinicians document substance use in the electronic records of acutely hospitalized internal medicine patients. Alcohol and illicit drug positive patients were identified using prospectively gathered substance use data from a study sample comprising 2,872 patients included from November 2016 to December 2017 at an internal medicine hospital in Oslo, Norway. These data were unknown to hospital staff. Whether physicians recorded quantitative substance use assessments and interventions was examined in patients with study-verified alcohol use in excess of low-risk guidelines (Alcohol Use Disorder Identification Test-4 scores [AUDIT-4] of ≥5 for women and ≥7 for men) and/or illicit drug use (one or more illicit drug detected by liquid chromatography-mass spectrometry [LC-MS] analysis). Among 548 study-verified alcohol-positive patients, physicians documented quantity and frequency (QF) of use in 43.2% (n = 237) and interventions in 22.0% (n = 121). Alcohol interventions were associated with harmful drinking (AUDIT-4 ≥9 points; adjusted odds ratio [AOR] = 4.87; 95% CI: 2.54-9.31; p < 0.001) and QF assessments (AOR = 3.66; 95% CI: 1.13-11.84; p = 0.02). Among 157 illicit-positive patients, drug use was described quantitatively in 34.4% (n = 54) and interventions in 26.0% (n = 40). The rate of quantitative alcohol and illicit drug use assessment by hospital physicians is poor, with a correspondingly low intervention rate. Important opportunities for attenuating or intervening in at-risk alcohol and illicit drug use are missed.

Risk Factors for Fall-Related Mild Traumatic Brain Injuries Among Older Adults: A Systematic Review Highlighting Research Gaps

Mild traumatic brain injury (mTBI) is commonly undiagnosed, delaying treatment and recovery. Approximately 80% of mTBIs in older adults stem from falls, yet the predictive factors remain unclear. This systematic review aimed to examine the risk factors for fall-related mTBIs among older adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol and the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed (Prospero ID: CRD42023377847). The scope included prospective studies analyzing the risk factors for fall-related mTBIs in adults ≥ 60 years. The primary outcome measure was the relative risk for fall-related mTBIs, and the secondary outcomes were fall rate, total falls, and faller/non-faller count among those with and without an mTBI. CINAHL Plus, Health Source: Nursing Academic Edition, Nursing and Allied Health Database, Medline via PubMed, SPORTDiscus, and Web of Science were searched on 4 November 2022 and 31 May 2024. Additional electronic searches were conducted. Two authors planned to screen the articles and assess the quality and risk of bias, with a third author adjudicating disagreements. Results were to be presented in a narrative synthesis. The database search yielded 434 records; 410 titles and abstracts were screened after deduplication, and 71 reports underwent a full-text review. No prospective observational studies were eligible because they did not fulfil the following: (1) focus on an mTBI (46 records); (2) exclusively assess individuals aged ≥60 (20 records); or (3) examine falls (5 records). Given the devastating consequences of fall-related mTBIs among older adults, there is an urgent need to identify the risk factors to improve screening and intervention.

Prevalence of indications of alcohol and drug use among patients treated for injurious falls by Emergency Medical Services in the USA

OBJECTIVE

The association between alcohol consumption and increased injuries from falls is well established, but there is a lack of data on the prevalence of substance use by fall type. This study aims to describe the distribution of alcohol and drug involvement in injurious falls.

METHODS

Using the 2019 National Emergency Medical Services (EMS) Information System data set, we identified 1 854 909 patients injured from falls requiring an EMS response and determined the fall location (eg, indoors or on street/sidewalk). We analysed data on the EMS clinician's notation of alcohol or drug involvement and Glasgow Coma Scale.

RESULTS

Overall, for 7.4% of injurious falls, there was a notation of substance use: 6.5% for alcohol alone, 0.6% for drugs and 0.3% for alcohol and drugs. 21.2% of falls that occurred on a street or sidewalk had a notation of substance use. Substance use prevalence was highest, at 30.3%, in the age group 21-64 years, for falls occurring on streets and sidewalks, without syncope or heat illness as contributing factors. Reported substance use involvement was more frequent for men compared with women for each location type. Glasgow Coma Scale scores indicative of moderate or severe trauma were more prevalent among falls involving alcohol and/or drugs.

CONCLUSIONS

Overall, one in five injurious falls on streets and sidewalks and requiring EMS attention involved substance use, and these numbers likely underestimate the true burden. As cities seek to expand nightlife districts, design strategies to protect pedestrians from falls should be enacted.

Orbital Trauma Epidemiologic Characteristics by Life Stage

Study Design

Retrospective database review.

Objective

This study aims to characterize and compare the epidemiological factors of orbital trauma between life stages by utilizing the National Electronic Injury Surveillance System (NEISS), a nationally representative database.

Methods

The NEISS was queried for orbital injuries from 2013 to 2022. Demographic data, injury type, injury location, and product related to injury were compared across life stages defined as 0-5 years (young children), 6-17 years (adolescents), 18-64 years (working adults), and >65 years (elderly adults).

Results

7846 orbital injuries were reported in the NEISS from 2013-2022. Incidence increased in all age groups over the study period but was highest in elderly adults. There was a bimodal distribution in the frequency of orbital trauma, with peaks occurring at age<20 and around age 80. Adolescents were most likely to be injured by sports-related products while young children and elderly adults were more likely to be injured by household products. Orbital fractures were the most common type of injury across all age groups (40.6%), with the highest rate observed in working adults. Elderly adults were more likely to be admitted to the hospital compared to working adults (RR 1.62 [1.49-1.77]).

Conclusions

The rate of orbital trauma is increasing over time, especially in elderly adults, highlighting the need for increased and improved preventative and education measures. The age-specific epidemiological factors identified in this study may help improve detection and management of injuries and guide public health initiatives.

A retrospective study of the injury patterns seen in fatal falls downstairs

INTRODUCTION

Fatal falls involving stairs are often associated with advanced age, intoxication, acute natural pathology and less commonly - the involvement of a third-party. The injury patterns seen in these cases are often complex and from a medico-legal standpoint, determining third-party involvement based on pathology alone can prove a significant challenge. Classifying the manner of death in such cases, can become particularly complex when the injury pattern appears inconsistent with a simple fall downstairs, or there is an absence of eye-witness testimony.

AIM

To explore the circumstances and injury patterns seen in cases of fatal falls downstairs which were classified as accidental vs. undetermined by the coroners.

STUDY DESIGN

This retrospective study explored the injury patterns present in all cases of fatal falls downstairs referred to the Office of the State Pathologist (OSP) over a 10-year-period (2012-2022) (n = 51).

RESULTS

Fatal falls downstairs which were classified as undetermined were found to have a greater number of craniofacial fractures, spinal fractures and intracranial injuries when compared to accidental falls. Undetermined staircase deaths also displayed more significant fracturing involving the facial skeleton.

CONCLUSION

Ultimately, where there is a question of third-party involvement, the Post-Mortem Examination (PME) findings alone cannot determine the manner of death. The pathologist's examination may identify injuries that are inconsistent with a simple fall downstairs, but it is the coroner who must conduct a thorough investigation into the circumstances of the fatal fall and ultimately determine the classification of the death.

Alcohol use is associated with intracranial hemorrhage in older emergency department head trauma patients

Objectives

Falls are common in adults aged 65 years and older and are the leading cause of traumatic brain injuries in this age group. Alcohol use may increase the risk of falls as well as the severity of resultant injuries. The aim of this study was to examine the association between self-reported alcohol use and the prevalence of intracranial hemorrhage (ICH) in this patient group.

Methods

This was a secondary analysis of the Geriatric Head Trauma Short Term Outcomes Project (GREAT STOP), a study of older adults with blunt head trauma from a fall. We determined the characteristics of every fall event, including patient demographics and medical history, and clinical signs and symptoms related to head trauma. Self-reported alcohol use was categorized as none, occasionally, weekly, or daily. We defined ICH as any acute ICH detected by computed tomography scan. We evaluated the association between alcohol use frequency and ICH, adjusted for patient factors and head injury risk factors.

Results

Of 3128 study participants, 18.2% (n = 567) reported alcohol use: 10.3% with occasional use, 1.9% with weekly use, and 6.0% with daily use. ICH was more common in patients who used alcohol (20.5%, 22.0%, and 25.1% for occasional, weekly, and daily alcohol users, respectively, vs. 12.0% for non-users, p < 0.001). The frequency of alcohol use was independently associated with ICH, adjusted for patient and head injury risk factors. The adjusted odds ratios (with 95% confidence intervals) for occasional, weekly, and daily alcohol users increased from 2.0 (1.5‒2.8) to 2.1 (1.1‒4.1) and 2.5 (1.7‒3.6), respectively, and showed the characteristics of dose‒response effect.

Conclusions

Alcohol use in older adult emergency department patients with head trauma is relatively common. Self-reported alcohol use appears to be associated with a higher risk of ICH in a dose-dependent fashion. Fall prevention strategies may need to consider alcohol mitigation as a modifiable risk factor.

Alcohol and substance use in older adults with treatment-resistant depression

INTRODUCTION

Alcohol and substance use are increasing in older adults, many of whom have depression, and treatment in this context may be more hazardous. We assessed alcohol and other substance use patterns in older adults with treatment-resistant depression (TRD). We examined patient characteristics associated with higher alcohol consumption and examined the moderating effect of alcohol on the association between clinical variables and falls during antidepressant treatment.

METHODS

This secondary and exploratory analysis used baseline clinical data and data on falls during treatment from a large randomized antidepressant trial in older adults with TRD (the OPTIMUM trial). Multivariable ordinal logistic regression was used to identify variables associated with higher alcohol use. An interaction model was used to evaluate the moderating effect of alcohol on falls during treatment.

RESULTS

Of 687 participants, 51% acknowledged using alcohol: 10% were hazardous drinkers (AUDIT-10 score ≥5) and 41% were low-risk drinkers (score 1-4). Benzodiazepine use was seen in 24% of all participants and in 21% of drinkers. Use of other substances (mostly cannabis) was associated with alcohol consumption: it was seen in 5%, 9%, and 15% of abstainers, low-risk drinkers, and hazardous drinkers, respectively. Unexpectedly, use of other substances predicted increased risk of falls during antidepressant treatment only in abstainers.

CONCLUSIONS

One-half of older adults with TRD in this study acknowledged using alcohol. Use of alcohol concurrent with benzodiazepine and other substances was common. Risks-such as falls-of using alcohol and other substances during antidepressant treatment needs further study.

Alcohol and Substance Use Among the Working Age Population: A Nationwide Study of Fall-Related Emergency Department Visits

OBJECTIVE

Prior studies have linked fall-related emergency department (ED) visits among older adults to alcohol use. Characteristics related to falls in the working age population (WAP; 15-64 years) may vary with alcohol and substance use. This study aimed to identify factors associated with fall-related ED visits related to alcohol and substance use in the WAP.

METHOD

Using nationally representative 2019-2020 National Hospital Ambulatory Medical Care Survey data, fall-related ED visits within 72 hours were stratified by indication of alcohol use, substance use, and concurrent alcohol and substance use. Descriptive statistics accounting for the survey's complex design were used along with multivariable logistic regression to identify associated factors.

RESULTS

Between 2019 and 2020, an estimated 10,800,000 fall-related ED visits occurred among the WAP, with 51.7% related to alcohol use, substance use, or both. Multivariable logistic regression analysis revealed that the WAP with fall-injury ED visits were associated with alcohol use (adjusted odds ratio [AOR] = 2.3, 95% CI [1.0, 5.9]) or concurrent alcohol and substance use (AOR = 8.5, 95% CI [1.6, 43.0]), and individuals with alcohol and substance use with a depression diagnosis are twice as likely to visit EDs with fall injuries.

CONCLUSIONS

Individuals with alcohol and substance use with depression were twice as likely to visit EDs for fall injuries. Higher fall-related ED visits in the WAP were attributed to alcohol and substance use. Identified factors could improve injury prevention and timely intervention among the WAP in the United States.

Emergency Department Visits for Alcohol-Associated Falls Among Older Adults in the United States, 2011 to 2020

STUDY OBJECTIVE

The aim of this study was to examine the epidemiology of alcohol-associated fall injuries among older adults aged ≥65 years in the United States.

METHODS

We included emergency department (ED) visits for unintentional fall injuries by adults from the National Electronic Injury Surveillance System-All Injury Program during 2011 to 2020. We estimated the annual national rate of ED visits for alcohol-associated falls and the proportion of these falls among older adults' fall-related ED visits using demographic and clinical characteristics. Joinpoint regression was performed to examine trends in alcohol-associated ED fall visits between 2011 and 2019 among older adult age subgroups and to compare these trends with those of younger adults.

RESULTS

There were 9,657 (weighted national estimate: 618,099) ED visits for alcohol-associated falls, representing 2.2% of ED fall visits during 2011 to 2020 among older adults. The proportion of fall-related ED visits that were alcohol-associated was higher among men than among women (adjusted prevalence ratio [aPR]=3.6, 95% confidence interval [CI] 2.9 to 4.5). The head and face were the most commonly injured body parts, and internal injury was the most common diagnosis for alcohol-associated falls. From 2011 to 2019, the annual rate of ED visits for alcohol-associated falls increased (annual percent change 7.5, 95% CI 6.1 to 8.9) among older adults. Adults aged 55 to 64 years had a similar increase; a sustained increase was not detected in younger age groups.

CONCLUSION

Our findings highlight the rising rates of ED visits for alcohol-associated falls among older adults during the study period. Health care providers in the ED can screen older adults for fall risk and assess for modifiable risk factors such as alcohol use to help identify those who could benefit from interventions to reduce their risk.

Could reasons for admission help to screen unhealthy alcohol use in emergency departments? A multicenter French study

Background

Many patients admitted to general emergency departments (EDs) have a pattern of drinking that could lead to future alcohol-related complications. However, it is often difficult to screen these patients in the context of emergency. The aim of this study is to analyze whether reasons for admission could help to screen patients who have an unhealthy alcohol use.

Method

Patients were recruited among six public hospital ED in France, between 2012 and 2014. During a one-month period in each hospital, anonymous questionnaires including sociodemographic questions, AUDIT-C and RAPS4-QF were administered to each patients visiting the ED. The reason for admission of each patient was noted at the end of their questionnaire by the ED practitioner.

Results

Ten thousand Four hundred twenty-one patients were included in the analysis. Patients who came to the ED for injuries and mental disorders were more likely to report unhealthy alcohol use than non-harmful use or no use. Among male patients under 65 years old admitted to the ED for a mental disorder, 24.2% drank more than four drinks (40 g ethanol) in typical day at least four time a week in the last 12 months. Among these patients, 79.7% reported daily or almost daily heavy episodic drinking (HED, 60 g ethanol), and all were positive on the RAPS4-QF.

Conclusion

This study highlights that unhealthy alcohol use is frequent among ED patients and particularly among those who come for injuries or mental disorders. Men under 65 years old with a mental disorder require special attention because of their increased prevalence of daily or almost daily HED.

Substance use and pre-hospital crash injury severity among U.S. older adults: A five-year national cross-sectional study

BACKGROUND

Alcohol and drug use (substance use) is a risk factor for crash involvement.

OBJECTIVES

To assess the association between substance use and crash injury severity among older adults and how the relationship differs by rurality/urbanicity.

METHODS

We pooled 2017-2021 cross-sectional data from the United States National Emergency Medical Service (EMS) Information System. We measured injury severity (low acuity, emergent, critical, and fatal) predicted by substance use, defined as self-reported or officer-reported alcohol and/or drug use. We controlled for age, sex, race/ethnicity, road user type, anatomical injured region, roadway crash, rurality/urbanicity, time of the day, and EMS response time. We performed a partial proportional ordinal logistic regression and reported the odds of worse injury outcomes (emergent, critical, and fatal injuries) compared to low acuity injuries, and the predicted probabilities by rurality/urbanicity.

RESULTS

Our sample consisted of 252,790 older adults (65 years and older) road users. Approximately 67%, 25%, 6%, and 1% sustained low acuity, emergent, critical, and fatal injuries, respectively. Substance use was reported in approximately 3% of the population, and this proportion did not significantly differ by rurality/urbanicity. After controlling for patient, crash, and injury characteristics, substance use was associated with 36% increased odds of worse injury severity. Compared to urban areas, the predicted probabilities of emergent, critical, and fatal injuries were higher in rural and suburban areas.

CONCLUSION

Substance use is associated with worse older adult crash injury severity and the injury severity is higher in rural and suburban areas compared to urban areas.

Alcohol and aging - An area of increasing concern

Alcohol use is increasing among adults 65 and older and the size of this population is expanding rapidly. Aging is associated with systemic inflammation, sleep disturbances, cancers, cognitive decline, and increased risk of injury and death from falls and other accidents. Alcohol misuse exacerbates and accelerates these age-related changes. Older drinkers are more sensitive to acute alcohol-induced impairments in memory, coordination, reaction time, and driving performance. Oxidative stress and DNA damage resulting from chronic heavy alcohol consumption contribute to an increased risk of cancer, liver disease, and cardiovascular disease. Medication use increases with age and many medications prescribed to older adults can interact negatively with alcohol. The rapid expansion of the population aged 65 and older, combined with higher levels of alcohol use and AUD in the Baby Boomer cohort than the preceding generation, could significantly increase the burden of alcohol on the healthcare system resulting from AUD and alcohol-related injuries and diseases. Screening and brief intervention for hazardous alcohol use among older patients along with education regarding potential interactions between alcohol and medications could substantially reduce the risk of harms from alcohol but currently is underutilized.

Association of walking pace and fall-related injury among Chinese older adults: Data from the SAGE survey

OBJECTIVE

Falls are an important public health issue that poses a threat to the health of senior people and reduces their ability to maintain independence, which in turn reduces poor quality of life. Several studies have demonstrated a positive relationship between physical function and fall, it remains unclear whether there is an association between gait speed and fall-related injuries among the aging population, which represent the largest proportion of older adults in China. Therefore, the aim of this study was to examine the association between gait speed and fall-related injuries among older Chinese adults.

METHODS

Data from the Global Ageing and Adult Health Survey (2007-2010) were analyzed. A stratified multi-stage cluster sampling design was used to collect the survey data. A total of 7558 Chinese adults aged 60 or older were included in this study. A 4-m walking test was used to assess gait speed. Fall-related injuries were self-reported by study participants. The binary logistic regression model was employed to examine the association between gait speed and fall-related injuries while controlling for age, sex, education years, smoking, alcohol consumption, and chronic diseases.

RESULTS

The mean age of the sample of older Chinese adults was 69.70 ± 7.10 years (females accounted for 52.6%). The results showed that a normal gait speed was negatively correlated with fall-related injury (odds ratio = 1.20) when adjusting for all covariates. Moreover, a binary regression analysis showed that a normal gait speed was only negatively correlated with fall-related injury in male participants (odds ratio = 1.32). There were no significant results in rapid gait speed and fall-related injuries.

CONCLUSION

The results suggest that a slow gait speed may predict a higher risk of fall-related injuries among older Chinese adults, especially older male adults. Further studies are needed to verify our findings.

Recurrent risk of hospitalization among older people with problematic alcohol use: a multiple failure-time analysis with a discontinuous risk model

BACKGROUND AND AIMS

Older people with problematic alcohol use vary in psychosocial functioning, age of onset for problem drinking and use of other drugs. The study measured the differential risks of all-cause, alcohol-, polydrug- and psychiatric-related repeated hospitalizations among older people with problematic alcohol use.

DESIGN

A linked register-based cohort study with discontinuous multiple-failure (time-to-repeated-event) data. Hospitalization and mortality were considered as failure.

SETTING

Sweden, March 2003-November 2017, using data from the Addiction Severity Index (ASI) register linked to National Inpatient Register and the Swedish cause of death register.

PARTICIPANTS

Participants aged 50 years and older (n = 1741; 28.2% women), with one or more alcohol problem days in the 30 days before an ASI assessment.

MEASUREMENTS

Five mutually exclusive latent classes of problematic alcohol use, identified with 11 ASI items, were the independent variables: 'late onset with fewer consequences (LO:FC; reference group)'; 'early onset/prevalent multi-dimensional problems (EO:MD)'; 'late onset with co-occurring anxiety and depression (LO:AD)'; 'early onset with co-occurring psychiatric problems (EO:PP)'; and 'early onset with major alcohol problem (EO:AP)'. Covariates included socio-demographic characteristics, previous hospitalization and Elixhauser comorbidity index. Outcome measurements included recurrent hospitalization and/or mortality due to: (a) all-cause, (b) alcohol-related disorders and diseases (c) polydrug use and (d) other psychiatric disorders.

FINDINGS

During the study period, more than 75% were hospitalized at least once or died. 57.3% were hospitalized with alcohol-related, 8.5% with polydrug use and 18.5% with psychiatric-related diagnoses. Compared with LO:FC, EO:PP had higher risk for all-cause [adjusted hazard ratio (aHR) = 1.27, 95% confidence interval (CI) = 1.02-1.59] and alcohol-related (aHR = 1.34, 95% CI = 1.02-1.75) hospitalizations. Adjusted risks for polydrug-related hospitalization were 2.55, 95% CI = 1.04-6.27 for EO:MD and 2.62, 95% CI = 1.07-6.40 for EO:PP. Adjusted risk for psychiatric-related hospitalization was higher for LO:AD (aHR = 1.78, 95% CI = 1.16-2.73 and EO:PP (aHR = 2.03, 95% CI = 1.22-3.38).

CONCLUSIONS

Older addiction service users in Sweden have varying risks of hospitalization due to alcohol use, polydrug use and psychiatric disorders. Older people with problematic alcohol use who have multiple needs and are assessed in social services may benefit from earlier interventions with an integrated focus on substance use and mental health.

Severe Ground Fall Injury Associated with Alcohol Consumption in Geriatric Patients

This study investigated characteristics of geriatric patients sustaining ground fall injury related to alcohol consumption and analyzed factors associated with the severity of such injuries in both alcohol- and non-alcohol-related cases. We retrospectively reviewed geriatric patients sustaining ground falls who were admitted to six university hospitals from 2011 to 2018. Patients were classified into alcohol and non-alcohol groups. Their general characteristics, clinical characteristics, and factors of injury severity were analyzed. A total of 31,177 patients were reviewed. Factors significantly associated with alcohol-related ground-fall injuries were: male, 65~84 years old, injury time other than 06:00~11:59, transportation to emergency department (ED) by ambulance and from other hospitals, injured in residential facilities, transportation areas, public or commercial facilities, activities other than paid or unpaid, non-slippery floor, obstacles, concrete floor, and absence of lights. Factors associated with severe injury after ground fall in alcohol-related cases were: male, injury time at between 06:00 and 17:59, transportation to the ED via ambulance from other hospitals, injured in residential facility, and slippery floor. Risk factors for severity in alcohol-related geriatric fall injury included: male sex, daytime injury, transportation by ambulance, injury in a residential facility, and slippery floor condition. Prophylactic measures and therapeutic interventions by ED teams are needed for the management of such cases.

Predictors and prevalence of hazardous alcohol use in middle-late to late adulthood in Europe

Objectives: Even low to moderate levels of alcohol consumption can have detrimental health consequences, especially in older adults (OA). Although many studies report an increase in the proportion of drinkers among OA, there are regional variations. Therefore, we examined alcohol consumption and the prevalence of hazardous alcohol use (HAU) among men and women aged 50+ years in four European regions and investigated predictors of HAU.Methods: We analyzed data of N = 35,042 participants of the European SHARE study. We investigated differences in alcohol consumption (units last week) according to gender, age and EU-region using ANOVAs. Furthermore, logistic regression models were used to examine the effect of income, education, marital status, history of a low-quality parent-child relationship and smoking on HAU, also stratified for gender and EU-region. HAU was operationalized as binge drinking or risky drinking (<12.5 units of 10 ml alcohol/week).Results: Overall, past week alcohol consumption was 5.0 units (±7.8), prevalence of HAU was 25.4% within our sample of European adults aged 50+ years. Male gender, younger age and living in Western Europe were linked to both higher alcohol consumption and higher risks of HAU. Income, education, smoking, a low-quality parent-child relationship, living in Northern and especially Eastern Europe were positively associated with HAU. Stratified analyses revealed differences by region and gender.Conclusions: HAU was highly prevalent within this European sample of OA. Alcohol consumption and determinants of HAU differed between EU-regions, hinting to a necessity of risk-stratified population-level strategies to prevent HAU and subsequent alcohol use disorders.

Physical Activity and Diet in a Global Pandemic: An Investigation of the Impact of COVID-19 on Factors Relevant for Musculoskeletal Health at Two Different Stages of the Lifecourse

Background

Physical activity, nutrition and other lifestyle factors play important roles in maintaining musculoskeletal health. The coronavirus disease (COVID-19) originated in late 2019, spread globally to be declared a pandemic by the World Health Organisation in March 2020, and led to widespread behaviour change. The aim of this study was to use two existing cohorts, the Hertfordshire Cohort Study (HCS) and Health and Employment After Fifty Study (HEAF), to understand how wave one of the COVID-19 pandemic impacted lifestyle factors associated with musculoskeletal health in the UK.

Methods

125 eligible participants, 65 males and 60 females (drawn from the HCS study, median (IQR) age 84.3 (82.4-86.6) years, all Caucasian, and community dwelling) were contacted by telephone and asked to complete a questionnaire administered by a trained researcher. Data collection occurred over the period July 2020 to February 2021. 2469 participants, 1086 men and 1383 women (drawn from the HEAF study, median age 65.7 (62.0-69.3) years, mostly Caucasian and community dwelling) completed an online questionnaire in March 2021.

Results

In HCS, 47% respondents reported being less physically active than before the pandemic (and only 5% more so), 27% said they consumed less alcohol compared to pre-pandemic times (and only 3% more so), and 18% reported eating less than before, although quality of diet was generally unchanged over this timeframe surveyed. In HEAF, 44% participants said they were less active than before the pandemic, while 17% reported being more active. The majority of participants reported no changes in alcohol consumption and diet; however, 19% said they drank more than before (32% of which was above recommended levels), 16% said their diet was less healthy, and 19% reported eating more than before.

Conclusion

We have reported the experience of the first wave of the COVID-19 pandemic among participants of two Caucasian community dwelling UK cohorts, highlighting the impact of the pandemic on lifestyle factors associated with musculoskeletal health. Changed physical activity levels were reported in a high proportion of respondents in both studies; an investigation of reversibility of these changes is required.

Hospital Admission Rate, Cumulative Hospitalized Days, and Time to Admission Among Older Persons With Substance Use and Psychiatric Conditions

Background

Substance use among older persons occurs with medical and psychiatric comorbidities. This study examined the associations of substance use disorder (SUD), psychiatric, and dual diagnoses with 12-month cumulative hospitalized days, hospital admission rate and number of days to first hospitalization.

Methods

The cohort of 3,624 individuals (28.2% women) aged 50 years or older was assessed for substance use severity in 65 Swedish municipalities during March 2003-May 2017. Addiction Severity Index data were linked to hospital discharge records and crime statistics. The outcomes were (a) 12-month cumulative hospitalized days; (b) Hospital admission rate, and (c) days to first hospitalization. Generalized linear regression techniques investigated associations between outcomes and SUD, psychiatric and dual diagnoses at admission.

Results

During 2003-2017, 73.5% of the participants were hospitalized. Twelve-month hospitalized days were positively associated with SUD (Incidence rate ratio (IRR) = 1.41, 95%CI: 1.26-1.58), dual diagnosis (IRR = 2.03, 95%CI: 1.74-2.36), and psychiatric diagnoses (IRR = 2.51, 95%CI: 2.09-3.01). Hospital admission rate was positively associated with SUD (IRR = 4.67, 95%CI: 4.28-5.08), dual diagnosis (IRR = 1.83, 95%CI: 1.64-2.04), and psychiatric diagnoses (IRR = 1.73, 95%CI: 1.55-1.92). Days to first hospitalization were negatively associated with SUD (IRR = 0.52, 95%CI: 0.47-0.58), dual diagnosis (IRR = 0.57, 95%CI: 0.50-0.65), and psychiatric diagnoses (IRR = 0.83, 95%CI: 0.73-0.93). The marginal effects of SUD and/or mental disorders increased with age for all outcomes, except for days to first hospitalization.

Conclusion

Three of four older persons assessed for substance use severity were later hospitalized. Substance use disorders, dual diagnoses and other mental disorders were the primary reasons for hospitalization and were associated with longer stays, earlier hospitalization, and repeated admissions. Sensitizing service providers to old age substance use and sharing data across the care continuum could provide multiple points of contact to reduce the risk of hospitalizations among older persons with problematic substance use.

Patient and provider factors associated with receipt and delivery of brief interventions for unhealthy alcohol use in primary care

BACKGROUND

Unhealthy alcohol use is a serious and costly public health problem. Alcohol screening and brief interventions are effective in reducing unhealthy alcohol consumption. However, rates of receipt and delivery of brief interventions vary significantly across healthcare settings, and relatively little is known about the associated patient and provider factors.

METHODS

This study examines patient and provider factors associated with the receipt of brief interventions for unhealthy alcohol use in an integrated healthcare system, based on documented brief interventions in the electronic health record. Using multilevel logistic regression models, we retrospectively analyzed 287,551 adult primary care patients (and their 2952 providers) who screened positive for unhealthy drinking between 2014 and 2017.

RESULTS

We found lower odds of receiving a brief intervention among patients exceeding daily or weekly drinking limits (vs. exceeding both limits), females, older age groups, those with higher medical complexity, and those already diagnosed with alcohol use disorders. Patients with other unhealthy lifestyle activities (e.g., smoking, no/insufficient exercise) were more likely to receive a brief intervention. We also found that female providers and those with longer tenure in the health system were more likely to deliver brief interventions.

CONCLUSIONS

These findings point to characteristics that can be targeted to improve universal receipt of brief intervention.

On the Move clinic: A fall prevention nurse practitioner-driven model of care

Falls in older adults are common and interventions to reduce associated morbidity and mortality remain difficult to implement. This quality improvement project evaluated On the Move, a new clinic designed to provide tailored recommendations to reduce falls risk, based on an adaptation of CDC's STEADI: a falls risk screening, assessment and intervention guide. 89 participants were referred by primary care and emergency services. A nurse practitioner assessed modifiable physical, behavioral and environmental risk factors and utilized motivational interviewing and education to guide participants in developing an intervention plan. A physical therapist assessed gait/balance, the need for ongoing PT services and provided brief counseling. Participants received a 6-week phone call and 12-week follow up visit. Measurements, including 30-second chair stands, Timed Up and Go, 4-Item Dynamic Gait Index, and Activities-Specific Balance Confidence Scale all showed significant improvement. Participants made behavioral changes to reduce risk, and plans to continue exercise.

High-Risk Periods for Adult Traumatic Brain Injuries: A Nationwide Population-Based Study

INTRODUCTION

There is minimal existing available information on nationwide seasonal peaks in traumatic brain injuries (TBIs). This lack of information is an impediment to the effective development of prevention programs, societal policies, and hinders the resourcing of medical emergency services. Our current aim is to study nationwide population-based high-risk periods TBI over a 15-year study period in Finland.

METHODS

Nationwide databases were searched for all admissions with a TBI diagnosis and later for deaths of persons ≥16 years of age during 2004-2018. The search included all hospitals that provide acute TBI care in Finland.

RESULTS

The study period included 69,231 TBI-related hospital admissions (men = 62%). We found that for men, the highest rate of TBIs occurred on Saturdays, whereas women experience the highest rate of TBIs on Mondays. The highest rate of TBIs in men occurred in July, while women experienced the highest rate of TBIs in January. TBI-related hospital admissions (incidence risk ratio [IRR] 1.090, 95% CI 1.07-1.11, p < 0.0001) and mortality within 30 days after TBI (hazard ratio [HR] 1.057, 95% CI 1.001-1.116, p = 0.0455) were more common on public holidays and weekends than on weekdays. There was an increasing trend in the proportion of TBI-related hospital admissions occurring on public holidays and weekends from 2004 (31.5%) to 2018 (33.4%) (p = 0.0007). In summer months, TBI-related hospital admissions (IRR 1.10, 95% CI 1.08-1.12, p < 0.0001) and 30-day mortality (HR 1.069, 95% CI 1.010-1.131, p = 0.0211) were more common than in other months. TBIs occurred more often in younger and healthier individuals on these index days and times. In terms of specific public holidays, the TBI risk was overall higher on New Year's Eves and Days (IRR 1.40, 95% CI 1.25-1.58, p < 0.0001) and Midsummer's Eves and Days (IRR 1.36, 95% CI 1.20-1.54, p < 0.0001), compared to nonworking days. This finding was significant in both genders.

CONCLUSIONS

TBI-related hospital admissions and mortality were more common on public holidays, weekends, and in summer months in Finland. People who sustained TBIs on these days were on average younger and healthier. The occurrence of TBIs on public holidays and weekends is increasing at an alarming rate.

Characteristics of fall-related head injury versus non-head injury in the older adults

Background

This study aimed to examine the characteristics of older adults patients who suffered a head injury after a ground-level fall in comparison to non-head injury patients as well as the factors associated with severity in those with head injury only.

Methods

Patients were classified into two groups, the head injury group and the non-head injury group. The characteristics were compared and factors associated with head injury were evaluated. Factors relating to severe injury in the head injury group were also investigated.

Results

The head injury group comprised 42 % of a study subjects. Male sex; fall time of 18:00–23:59; fall location of medical facility, transportation area, and public or commercial facility; fall in an outdoor area; fall during daily activity; alcohol ingestion; fall from stairs; non-slippery floor conditions; concrete flooring; sloped flooring; and presence of obstacles on the floor were risk factors for head injury in the older adults after a ground-level fall. Male sex and age over 70 years; fall time of 00:00–05:59; fall in a residential facility; fall in an indoor area; fall during daily activity; fall from stairs; non-slippery floor conditions; and presence of obstacles on the floor were factors associated with severe injury in the head injury group.

Conclusions

Male sex with advanced age, indoor fall, and the presence of obstacles on the floor were risk factors for severe injury in the head injury group in older adults individuals who suffered a ground-level fall. It is necessary to develop appropriate ground-level fall prevention programs by evaluating the individual and environmental characteristics of older adults patients.