Technology Utilization in Fall Prevention

Mobile health (mHealth) technologies for fall prevention among older adults in low-middle income countries: bibliometrics, network analysis and integrative review

Introduction

mHealth technologies offer promising solutions to reduce the incidence of falls among older adults. Unfortunately, publications on their application to Low-Middle Income Countries (LMIC) settings have not been collectively examined.

Methods

A triadic research design involving bibliometrics, network analysis, and model-based integrative review was conducted to process articles (n = 22) from 629 publications extracted from major databases using keywords related to mHealth, falls prevention, and LMIC. The web-based application Covidence and stand-alone VosViewer software were used to process data following previously published review standards.

Results

Published articles in the field feature multidisciplinary authorships from multiple scholars in the domains of health and technology. Network analysis revealed the most prominent stakeholders and keyword clusters related to mHealth technology features and applications in healthcare. The papers predominantly focused on the development of mHealth technology, usability, and affordances and less on the physiologic and sociologic attributes of technology use. mHealth technologies in low and middle-income countries are mostly smartphone-based, static, and include features for home care settings with fall detection accuracy of 86%-99.62%. Mixed reality-based mobile applications have not yet been explored.

Conclusion

Overall, key findings and information from the articles highlight a gradually advancing research domain. Outcomes reinforce the need to expand the focus of mHealth investigations to include emerging technologies, update current technology models, create a more human-centered technology design, test mHealth technologies in the clinical setting, and encourage continued cooperation between and among researchers from various fields and environments.

Experiences With an In-Bed Real-Time Motion Monitoring System on a Geriatric Ward: Mixed Methods Study

BACKGROUND

Older adults now make up about two-thirds of hospital admissions, with up to 50% experiencing cognitive impairments such as dementia. These patients often struggle with adherence to care plans and maintaining regular day or night cycles, presenting challenges for nurses. Hospitals are typically unprepared to manage this patient population, resulting in increased nurse workload and challenges like managing motor agitation, which can lead to falls or accidental removal of medical devices.

OBJECTIVE

This study aimed to (1) assess how an in-bed real-time motion monitoring system (IRMS) impacts nurses' perceptions of physical and mental stress, (2) evaluate the IRMS's effect on the care process, (3) explore ethical implications like patient autonomy and privacy, and (4) understand how nurses acquire knowledge about the technology and how this affects their assessment of the IRMS.

METHODS

The IRMS, which provides real-time motion monitoring and bed edge or exit information, was implemented in the geriatric ward of a university medical center. The study followed a monocentric, explorative evaluation design using a mixed methods approach. It lasted 24 weeks and had two phases. In Phase 0 (6 weeks), patients received standard care. In Phase 1 (18 weeks), the IRMS was introduced. Initial data were gathered through focus groups and participant observations during manufacturer training sessions. At the end of the intervention, a survey, a second focus group, and an interview were conducted to capture nurses' experiences. The study follows the Good Reporting of a Mixed Method Study (GRAMMS) checklist for reporting.

RESULTS

Initial training sessions with 12 participants (10 nurses and 2 physiotherapists) showed varying levels of engagement, with the second session demonstrating more optimism and interprofessional collaboration. A total of 10 questionnaires were completed (10/21, 48%). Survey results showed that 80% (8/10) of nurses found the IRMS valuable for assessing the quality of work, and 90% (9/10) were willing to continue using it. The system was regarded as reliable for monitoring bed edge and exit events. Usability was positively rated, with minimal concerns about documentation burden. Focus group discussions (n=3 per session) indicated that nurses viewed the system as reliable and appreciated its role in reducing anxiety related to fall prevention. However, concerns about patient privacy and monitoring were raised. Nurses expressed a willingness to continue using the IRMS but reaffirmed their ability to care for patients without it.

CONCLUSIONS

Nurses had a generally positive attitude toward the IRMS, recognizing its benefits, particularly for nighttime monitoring. Although its effectiveness in preventing falls remains inconclusive, the system helps reduce nurses' fear of falls and enhances their responsiveness. The study highlights the broader impact of the IRMS beyond fall prevention and stresses the importance of thoughtful integration into health care practice.

Effectiveness of PEER Intervention on Older Adults' Physical Activity Time Series Using Smoothing Spline ANOVA

Falls are a major cause of injury among older adults. The Physio-fEedback Exercise pRogram (PEER) combines physio-feedback, cognitive reframing, and guided exercises to reduce fall risk. However, its impact on physical activity (PA) over time is underexplored. Functional time-series analysis offers insight into behavior patterns and sustainability. This preliminary study assessed PEER's effectiveness in improving PA levels immediately and over time. A total of 64 community-dwelling older adults were cluster-randomized into PEER ( N = 33 ) or control groups ( N = 31 ) . Participants wore Fitbit trackers, generating time-series data on activity. The PEER group completed an 8-week program, while the control group received CDC fall prevention pamphlets. PA data were analyzed using smoothing spline analysis of variance (SSANOVA), chosen for its flexibility in modeling complex, non-linear relationships in time-series data and its ability to handle skewed distributions and repeated measures. Unlike traditional parametric models, SSANOVA decomposes temporal trends into interpretable components, capturing both smooth trends and abrupt changes, such as those occurring on group workout days. This capability ensures robust and nuanced analysis of intervention effects. Results showed PEER participants significantly increased evenly and had very active minutes and reduced sedentary behavior during the intervention. No significant effect was found for light active minutes. Specifically, during the intervention period, PEER participants engaged in an average of 6.7% fewer sedentary minutes per day, 13.8% additional fairly active minutes per day, and 2.8% additional very active minutes per day compared to the control group. While the reduction in sedentary minutes and increase in fairly active minutes were not statistically significant, the increase in very active minutes was significant. However, our functional time-series analysis revealed these improvements diminished over the 15-week follow-up, indicating challenges in maintaining PA. In conclusion, PEER boosts PA and reduces sedentary behavior short-term, but strategies are needed to sustain these benefits. In conclusion, PEER boosts PA and reduces sedentary behavior short-term, but strategies are needed to sustain these benefits. Public health policies should emphasize technology-driven fall risk assessments, community-based prevention programs, and initiatives that promote physical activity, home safety, and chronic condition management.

Use of Hearing Aids Embedded with Inertial Sensors and Artificial Intelligence to Identify Patients at Risk for Falling

OBJECTIVE

To compare fall risk scores of hearing aids embedded with inertial measurement units (IMU-HAs) and powered by artificial intelligence (AI) algorithms with scores by trained observers.

STUDY DESIGN

Prospective, double-blinded, observational study of fall risk scores between trained observers and those of IMU-HAs.

SETTING

Tertiary referral center.

PATIENTS

Two hundred fifty participants aged 55-100 years who were at risk for falls.

INTERVENTIONS

Fall risk was categorized using the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) test battery consisting of the 4-Stage Balance, Timed Up and Go (TUG), and 30-Second Chair Stand tests. Performance was scored using bilateral IMU-HAs and compared to scores by clinicians blinded to the hearing aid measures.

MAIN OUTCOME MEASURES

Fall risk categorizations based on 4-Stage Balance, Timed Up and Go (TUG), and 30-Second Chair Stand tests obtained from IMU-HAs and clinicians.

RESULTS

Interrater reliability was excellent across all clinicians. The 4-Stage Balance and TUG showed no statistically significant differences between clinician and HAs. However, the IMU-HAs failed to record a response in 12% of TUG trials. For the 30-Second Chair Stand test, there was a significant difference of nearly one stand count, which would have altered fall risk classification in 21% of participants.

CONCLUSIONS

These results suggest that fall risk as determined by the STEADI tests was in most instances similar for IMU-HAs and trained observers; however, differences were observed in certain situations, suggesting improvements are needed in the algorithm to maximize accurate fall risk categorization.

Causes and global, regional, and national burdens of traumatic brain injury from 1990 to 2019

PURPOSE

Traumatic brain injury (TBI), currently a major global public health problem, imposes a significant economic burden on society and families. We aimed to quantify and predict the incidence and severity of TBI by analyzing its incidence, prevalence, and years lived with disability (YLDs). The epidemiological changes in TBI from 1990 to 2019 were described and updated to provide a reference for developing prevention, treatment, and incidence-reducing measures for TBI.

METHODS

A secondary analysis was performed on the incidence, prevalence, and YLDs of TBI by sex, age group, and region (n = 21,204 countries and territories) between 1990 and 2019 using the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. Proportions in the age-standardized incidence rate due to underlying causes of TBI and proportions of minor and moderate or severe TBI were also reported.

RESULTS

In 2019, there were 27.16 million (95% uncertainty intervals (UI): 23.36 - 31.42) new cases of TBI worldwide, with age-standardized incidence and prevalence rates of 346 per 100,000 population (95% UI: 298 - 401) and 599 per 100,000 population (95% UI: 573 - 627), respectively. From 1990 to 2019, there were no significant trends in global age-standardized incidence (estimated annual percentage changes: -0.11%, 95% UI: -0.18% - -0.04%) or prevalence (estimated annual percentage changes: 0.01%, 95% UI: -0.04% - 0.06%). TBI caused 7.08 million (95% UI: 5.00 - 9.59) YLDs in 2019, with age-standardized rates of 86.5 per 100,000 population (95% UI: 61.1 - 117.2). In 2019, the countries with higher incidence rates were mainly distributed in Central Europe, Eastern Europe, and Australia. The 2019 global age-standardized incidence rate was higher in males than in females. The 2019 global incidence of moderate and severe TBI was 182.7 per 100,000 population, accounting for 52.8% of all TBI, with falls and road traffic injuries being the main causes in most regions.

CONCLUSIONS

The incidence of moderate and severe TBI was slightly higher in 2019, and TBI still accounts for a significant portion of the global injury burden. The likelihood of moderate to severe TBI and the trend of major injury under each injury cause from 1990 to 2019 and the characteristics of injury mechanisms in each age group are presented, providing a basis for further research on injury causes in each age group and the future establishment of corresponding policies and protective measures.

Investigating the biomechanics of falls in older adults in long-term care using a video camera: a scoping review

BACKGROUND

Falls are a worrying and growing phenomenon worldwide that especially affects the elderly. With the development of technology, one way of studying the real-life falls that occur in healthcare settings is by using video cameras.

AIMS

To (a) map the patterns of the research on real-life falls among older adults in healthcare settings as assessed with digital video camera supports; and (b) highlight the advances, the evidence produced, and the gaps still present regarding the biomechanics of falls as assessed technologically.

METHODS

A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. CINAHL, PubMed and Google Scholar were searched. All studies regarding falls investigated with video cameras among older individuals in healthcare settings published from 1st January 1990 to 1st January 2022 were eligible. Findings were summarised according to the Patterns, Advances, Gaps, Evidence and Recommendations framework for Scoping Reviews.

RESULTS

In total, 1943 studies were retrieved, and 16 met the inclusion criteria. Studies were mostly conducted in Canada. They described the real-life falls that occurred mainly in common and living areas of long-term facilities among older individuals, mainly females. Thirteen studies investigated falls through biomechanics, while three provided advances in the reliability of the measures as collected with video cameras. Studies reported that the biomechanics of a fall, reflecting the direction of the fall and protective responses, increase or decrease the likelihood of serious impact. In addition, the direction of the landing after a fall has been determined as having a significant impact on the severity and outcome of the fall.

CONCLUSION

The use of video cameras to investigate the biomechanics of falls is a well-established research area that offer interesting insight regarding (a) how to prevent falls and their injuries and (b) the direction of the research in the field of falls.

Feasibility and acceptability of the HOLObalance telerehabilitation system compared with standard care for older adults at risk of falls: the HOLOBalance assessor blinded pilot randomised controlled study

BACKGROUND

Falls have high socioeconomic costs. Information and communication technologies may support provision and monitoring of multisensory (MSR) physiotherapy programmes. The HOLOBalance platform used augmented reality holograms to provide patient-centred, individualised MSR.

OBJECTIVES

To determine the platform's safety, acceptability and feasibility, investigate functional gait and dynamic balance benefits and provide data for a definitive trial.

DESIGN AND SETTING

Single-blinded pilot randomised controlled feasibility study. Interventions were conducted at clinical sites or participants' homes in three European countries.

PARTICIPANTS

Community-dwelling older adults (median age 73 years; 64.2% female) at risk of falls were enrolled (May 2020-August 2021).

METHODS

Participants were randomised to an 8-week clinic or home-based telerehabilitation MSR or OTAGO (control group) programme. Compliance, satisfaction, and adverse events determined feasibility. Clinical outcomes, assessed (blinded) within one-week prior to and post-intervention, included functional gait assessment (FGA), Mini BESTest and cognitive function.

RESULTS

Randomisation to completion rate was 76.15% with 109 participants recruited (n = 289 screened). Drop-out rate was similar between groups. Adverse events were reported (n = 3) in the control group. Sixty-nine percent would recommend the HOLOBalance intervention. Findings were similar for the home and clinic-based arms of each intervention; data was combined for analysis. FGA (95%CI [1.63, 4.19]) and Mini-BESTest (95%CI [1.46, 3.93]) showed greater improvement in the HOLOBalance group with a clinically meaningful change of 4/30 noted for the FGA.

CONCLUSIONS

HOLObalance was feasible to implement and acceptable to older adults at risk of falls, with FGA and Mini-BEST improvements exceeding those for the OTAGO programme. A definitive trial is warranted.

Association between frailty status and falling in older adults with hip fracture: a cross-sectional study

OBJECTIVES

There is limited research on the relationship between frailty status and falls in hip fractures in older participants. This study aimed to investigate the relationship between frailty and falls in older adults who had experienced a hip fracture.

METHODS

From June 2023 to January 2024, the study population comprised 253 hip fracture patients aged 60 years and over. They were admitted to the orthopedic department of a tertiary care hospital. We excluded participants with incomplete information. The 5-item FRAIL scale (Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight) was used to assess frailty status and the patient's self-reported falls. We analyzed the relationship between frailty and falls in older hip fracture patients using logistic regression models, subgroup analyses, and stratified analyses.

RESULTS

Finally, 174 older participants with hip fractures were identified in this study, where 155 (89.1%) had falls. Among 155 falls, 39 (78.0%) were in the robust group, 65 (91.5%) were in the pre-frail group, and 51 (96.2%) were in the frail group. An analysis revealed that among more than 60 years old hip fracture patients, each additional point in frailty score was significantly linked to a higher likelihood of experiencing a fall (OR: 1.97, 95% CI: 1.10-3.52, p < 0.05). While frailty appeared as a categorical variable, this association was stronger with an OR of 2.68 (95% CI: 0.71-10.21) in the pre-frailty group and 7.95 (95% CI: 1.11-57.08), compared to the robust group (p for trend < 0.005). In subgroup analyses, an interaction was observed between frailty and falling according to sex. In stratified analyses, the relationship between frailty status and fall significantly differed between the male and female groups (male OR: 1.49, 95% CI: 0.71 -3.13; female OR: 7.54, 95% CI: 1.13 - 50.32, p for interaction = 0.035).

CONCLUSIONS

The study revealed a notable correlation between frailty and falls, with gender and frailty showing an interaction impact on the increased occurrence of falls. Therefore, further research across diverse disease populations is needed to explore the link between frailty status and falls. Large-scale prospective studies are necessary to clarify the causality of this relationship.

CLINICAL TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2300073031).

Towards human-centered AI and robotics to reduce hospital falls: finding opportunities to enhance patient-nurse interactions during toileting

Introduction: Patients who are hospitalized may be at a higher risk for falling, which can result in additional injuries, longer hospitalizations, and extra cost for healthcare organizations. A frequent context for these falls is when a hospitalized patient needs to use the bathroom. While it is possible that "high-tech" tools like robots and AI applications can help, adopting a human-centered approach and engaging users and other affected stakeholders in the design process can help to maximize benefits and avoid unintended consequences. Methods: Here, we detail our findings from a human-centered design research effort to investigate how the process of toileting a patient can be ameliorated through the application of advanced tools like robots and AI. We engaged healthcare professionals in interviews, focus groups, and a co-creation session in order to recognize common barriers in the toileting process and find opportunities for improvement. Results: In our conversations with participants, who were primarily nurses, we learned that toileting is more than a nuisance for technology to remove through automation. Nurses seem keenly aware and responsive to the physical and emotional pains experienced by patients during the toileting process, and did not see technology as a feasible or welcomed substitute. Instead, nurses wanted tools which supported them in providing this care to their patients. Participants envisioned tools which helped them anticipate and understand patient toileting assistance needs so they could plan to assist at convenient times during their existing workflows. Participants also expressed favorability towards mechanical assistive features which were incorporated into existing equipment to ensure ubiquitous availability when needed without adding additional mass to an already cramped and awkward environment. Discussion: We discovered that the act of toileting served more than one function, and can be viewed as a valuable touchpoint in which nurses can assess, support, and encourage their patients to engage in their own recovery process as they perform a necessary and normal function of life. While we found opportunities for technology to make the process safer and less burdensome for patients and clinical staff alike, we believe that designers should preserve and enhance the therapeutic elements of the nurse-patient interaction rather than eliminate it through automation.

Nurses' perspectives on inpatient falls in a large academic hospital in South Africa

BACKGROUND

Falls risk assessment tools, including the Morse Falls Scale, have been used for years, and yet falls remain key adverse events in hospitals. Nurses are key role players in falls prevention and can champion patient safety.

OBJECTIVES

The aim of the study was to explore ward nurses' attitudes, knowledge and practices regarding the use of falls risk assessment tools, institutional falls policy and falls prevention.

METHODS

A survey design was used. All permanent ward nurses were eligible to participate, and a convenience sample was used.

RESULTS

Nurses endorsed the Morse Falls Scale, recommended by institutional policy, as effective in reducing falls and indicated that incident reporting measured progress on monitoring fall events. Falls prevention training was scanty; however, nurses were keen for further education of falls.

CONCLUSION

Effective falls risk management needs to extend beyond promulgating policy and actively address nursing and patient education.Contribution: This study adds to the sparse literature regarding nursing practice and falls prevention in a developing country. Recommendations for change have been made.

Optimizing a Technology-Based Body and Mind Intervention to Prevent Falls and Reduce Health Disparities in Low-Income Populations: Protocol for a Clustered Randomized Controlled Trial

BACKGROUND

The lack of health care coverage, low education, low motivation, and inconvenience remain barriers to participating in fall prevention programs, especially among low-income older adults. Low-income status also contributes to negative aging self-perceptions and is associated with a high perceived barrier to care. Existing fall prevention intervention technologies do not enable participants and practitioners to interact and collaborate, even with technologies that bring viable strategies to maintain independence, prevent disability, and increase access to quality care. Research is also limited on the use of technology to enhance motivation and help individuals align their perception with physiological fall risk. We developed a novel, 8-week Physio-Feedback Exercise Program (PEER), which includes (1) technology-based physio-feedback using a real-time portable innovative technology-the BTrackS Balance Tracking System, which is reliable and affordable, allows for home testing, and provides feedback and tracks balance progression; (2) cognitive reframing using the fall risk appraisal matrix; and (3) peer-led exercises focusing on balance, strength training, and incorporating exercises into daily activities.

OBJECTIVE

This study consists of 3 aims. Aim 1 is to examine the effects of the technology-based PEER intervention on fall risk, dynamic balance, and accelerometer-based physical activity (PA). Aim 2 is to examine the effects of the PEER intervention on fall risk appraisal shifting and negative self-perceptions of aging. Aim 3 is to explore participants' experiences with the PEER intervention and potential barriers to accessing and adopting the technology-based PEER intervention to inform future research.

METHODS

This is an intention-to-treat, single-blinded, parallel, 2-arm clustered randomized controlled trial study. We will collect data from 340 low-income older adults at baseline (T1) and measure outcomes after program completion (T2) and follow-up at 3 months (T3) and 6 months (T4). Participants will be enrolled if they meet all the following inclusion criteria: aged ≥60 years, cognitively intact, and able to stand without assistance. Exclusion criteria were as follows: a medical condition precluding exercise or PA, currently receiving treatment from a rehabilitation facility, plan to move within 1 year, hospitalized >3 times in the past 12 months, and does not speak English or Spanish.

RESULTS

As of August 2023, the enrollment of participants is ongoing.

CONCLUSIONS

This study addresses the public health problem by optimizing a customized, technology-driven approach that can operate in low-resource environments with unlimited users to prevent falls and reduce health disparities in low-income older adults. The PEER is a novel intervention that combines concepts of physio-feedback, cognitive reframing, and peer-led exercise by motivating a shift in self-estimation of fall risk to align with physiological fall risk to improve balance, PA, and negative aging self-perception.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05778604; https://www.clinicaltrials.gov/ct2/show/study/NCT05778604.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51899.

Emerging Applications for Computer Vision and Artificial Intelligence in Management of the Cardiovascular Patient

Artificial intelligence and telemedicine promise to reshape patient care to an unprecedented extent, leading to a safer and more sustainable work environment and improved patient care. In this article, we summarize how these emerging technologies can be used in the care of cardiovascular patients in such ways as fall detection and prevention, virtual nursing, remote case support, automation of instrument counts in the operating room, and efficiency optimization in the cardiovascular suite.

Requests for Compensation in Cases Involving Patients' Falls in Healthcare Settings: A Retrospective Analysis

Falls are the most frequent adverse events recorded in healthcare facilities. By employing a multifaceted strategy to ensure prevention interventions that are specific to the patient type and environmental risk management, risk factor evaluation may help to reduce falls in the hospital setting. Patient falls are one of the main causes of lawsuits against hospitals, which has led to the development of validated instruments that are beneficial in treating the patient after the incident and effective in minimizing the frequency of falls. The aim of our study is to evaluate compensation claims asserting healthcare culpability in situations where a patient fell in a hospital setting. The collected data relate to judgments issued in Italy until December 2022 regarding 30 episodes of falls that occurred between 2003 and 2018. Our research revealed that approximately 50% of Italian healthcare organizations lose the case in court when a patient falls in a hospital setting and dies or is injured. In half of these cases, the failure of the medical staff to use protective equipment against falls is what led to the court's acceptance of the compensation claim. In order to improve the quality of healthcare services, fall prevention techniques must continue to be implemented.

Smartphones and Threshold-Based Monitoring Methods Effectively Detect Falls Remotely: A Systematic Review

In the US, at least one fall occurs in at least 28.7% of community-dwelling seniors 65 and older each year. Falls had medical costs of USD 51 billion in 2015 and are projected to reach USD 100 billion by 2030. This review aims to discuss the extent of smartphone (SP) usage in fall detection and prevention across a range of care settings. A computerized search was conducted on six electronic databases to investigate the use of remote sensing technology, wireless technology, and other related MeSH terms for detecting and preventing falls. After applying inclusion and exclusion criteria, 44 studies were included. Most of the studies targeted detecting falls, two focused on detecting and preventing falls, and one only looked at preventing falls. Accelerometers were employed in all the experiments for the detection and/or prevention of falls. The most frequent course of action following a fall event was an alarm to the guardian. Numerous studies investigated in this research used accelerometer data analysis, machine learning, and data from previous falls to devise a boundary and increase detection accuracy. SP was found to have potential as a fall detection system but is not widely implemented. Technology-based applications are being developed to protect at-risk individuals from falls, with the objective of providing more effective and efficient interventions than traditional means. Successful healthcare technology implementation requires cooperation between engineers, clinicians, and administrators.

Pharmacist Intervention in Portuguese Older Adult Care

Healthy ageing has become one of the most significant challenges in a society with an increasing life expectancy. Older adults have a greater prevalence of chronic disease, with the need for multiple medications to appropriately control these issues. In addition to their health concerns, ageing individuals are prone to loneliness, dependence, and economic issues, which may affect their quality of life. Governments and health professionals worldwide have developed various strategies to promote active and healthy ageing to improve the quality of life of older adults. Pharmacists are highly qualified health professionals, easily accessible to the population, thus playing a pivotal role in medication management. Their proximity to the patient puts them in a unique position to provide education and training to improve therapeutic adherence and identify medication-related problems. This paper aims to address the importance of Portuguese community pharmacists in the medication management of older adults, emphasising their intervention in health promotion, patient education, medication-related problems, deprescription, dose administration aids, and medication review and reconciliation. We also discuss home delivery services and medication management in long-term care facilities.

Falls in older adults: a practical approach

BACKGROUND

Falls are a major problem in public health since they are an important cause of morbidity and mortality. To evaluate the risk of fall and prescribe preventive interventions may be a challenging task.

OBJECTIVES

The objectives of this study are to summarize the most relevant information on the topic "falls in the elderly" and to give a critical view and practical clinical approach on this topic.

METHODS

In March 2022, a search of Pubmed database was performed, using the terms "fall elderly", fall prevention", "fall risk", with the following parameters: five years, review, systematic review, meta-analysis, practice guidelines.

RESULTS

There are several risk factors for falls that can be grouped in different areas (psychosocial, demographic, medical, medication, behavioral, environmental). The clinical evaluation of an older adult prone to falls must include identification of risk factors through history and examination and identification of risk of falls through an assessment tool such as gait velocity, functional reach test, timed up and go, Berg balance test, and miniBEST test. Fall prevention strategies can be single or multiple, and physical activity is the most cited. Technology can be used to detect and prevent falls.

CONCLUSION

A systematic approach to the older patient in risk of falls is feasible and may impact fall prevention.

Continuous Video Monitoring: Readiness for Growth

BACKGROUND

A large academic medical center in the Pacific Northwest successfully introduced continuous video monitoring (CVM) as an adjunct measure to replace sitter use when appropriate. Adoption of the technology was influenced by nurse enculturation, standard work, data tracking management, and patient/family engagement. The purpose of this article is to identify critical data metrics to inform expansion of CVM programs when determining readiness for growth.

PROBLEM

There is a lack of literature to advise organizations on needed data and metrics to inform growth readiness of CVM programs. Specific indicators can support initiatives to achieve financial support for program expansion.

APPROACH

CVM readiness for expansion is evident when metrics such as utilization rates, wait-list expansion, frontline staff perception, and sitter patient population outgrow current camera capacity.

CONCLUSION

Successful metric analysis can inform initiatives to grow CVM programs, which, in turn, support a culture of safety at large academic medical centers for at-risk populations.