Profiling the risk factors associated with falls in older people with diabetes receiving at-home nursing care: Retrospective analysis of an Australian aged care provider database

Examining frailty phenotypes of community-dwelling older adults in Taiwan using the falls risk for older people in the community - Taiwan version (Tw-FROP-Com)

BACKGROUND

Falls are the second leading cause of accidental injury-related deaths among Taiwanese adults aged 65 and older. This study examined the association between Fried frailty phenotypes and fall risk in this population.

MATERIALS AND METHODS

A cross-sectional study was conducted in Keelung City with 375 participants from an Elderly Fall Prevention Program. Frailty was assessed using the modified Fried criteria: weakness, slowness, exhaustion, low physical activity, and unintentional weight loss. Participants with 0-2 criteria were classified as non-frail, and those with 3 or more as frail. Fall risk was evaluated using the Taiwan version of the Falls Risk for Older People in the Community (Tw-FROP-Com), a 28-item tool scoring 0-60 across 13 risk factors.

RESULTS

Participants had a mean age of 75.4 ± 6.8 years; 76.0% were female, 18.7% were frail, and 32.7% had fallen in the past year. Those with a fall history had higher rates of weakness (56.7%), slowness (49.6%), and frailty (26.1%). Regression analysis showed that weakness (β = 0.64), slowness (β = 0.21), exhaustion (β = 1.28), unintentional weight loss (β = 3.99), and low physical activity (β = 0.88) were significantly associated with increased fall risk. Frailty explained over 50% of fall risk variance, with unintentional weight loss as the strongest predictor.

CONCLUSION

Unintentional weight loss is the most significant predictor of fall risk among frailty traits. Individual frailty components better predict fall risk than composite frailty measures.

Investigation of factors associated with pressure ulcer in patients receiving home care services via path analysis

BACKGROUND

Recent trends indicate a rise in the number of elderly and bedridden patients enrolled in home care programs, leading to an increased occurrence of complications such as pressure ulcers within the home health care setting.

OBJECTIVE

The primary objective of this research was to ascertain the prevalence of pressure ulcers and identify the associated factors in adults who were recipients of home health care services.

METHOD

This study, adopting a cross-sectional design, encompassed a sample of 566 patients who sought services from the Home Health Care Unit in a specific province in Turkey. The timeframe for data collection spanned from August to November 2022, during which two primary instruments were employed: the "Demographic Characteristics Form" and two specific scales - the "Braden Pressure Ulcer Risk Assessment Scale" and the "ITAKI Falls Risk Scale."

FINDINGS

In this study, the average age of patients receiving home health care services was identified as 75.9 years, with a standard deviation of 15.1 years. Furthermore, 73.7 % of these patients were classified as being at risk for developing pressure ulcers. The study identified a direct correlation between the risk of BRADEN pressure ulcers and the escalation in scores across several parameters. These parameters included "Addiction Status," delineated as a spectrum from addicted to non-addicted, the "Number of Medical Diagnoses," quantified on a scale, the "State of Consciousness," categorized from clear to confused, and the scores derived from the "ITAKI" scale.

CONCLUSION

The findings of this study highlight the significance of pressure ulcers as a critical health issue among patients receiving home care services. It underscores the necessity for home care nurses to be acutely aware of the risk factors associated with pressure ulcers among high-risk patients.

Identification of Contributing Factors of Falls and Non-Fall Accidents Among Home Care Clients: A Retrospective Study Using Incident Reports

To prevent falls and other accidents among home care clients, it is essential to gather high-quality information on the factors contributing to the accidents. Incident reporting systems are used in home care units to generate information for risk management. This study aimed to explore the contributing factors of falls and non-fall accidents among home care clients and to evaluate the accuracy of the information on contributing factors gained from the incident reporting system. An existing dataset was used—safety incident reports concerning accidents involving home care clients. The incident reports (n = 323) were stored in the social- and health care organization’s incident reporting database from 2018 to 2020. The free-text narratives describing factors contributing to the event’s occurrence were analyzed using inductive content analysis, and the frequencies of the main category codes were recorded. The results were then compared with the frontline managers’ analyses of the narratives, where the managers used the classification of contributing factors provided by the system. According to incident reports, intrinsic (person-specific), behavior-related and extrinsic (environment-related) factors contributed to accidents among home care clients. Intrinsic and behavior-related factors were reported more often than extrinsic factors. The classified information on contributing factors did not correspond in all respects to the descriptions in the incident reports. To ensure high-quality information for safety management, incident reporting tools must be appropriate for use in the home care context. Both the reporter of an adverse event and the individual responsible for analyzing the report play essential roles in identifying contributing factors of accidents.

Prevalence of falls, incontinence, malnutrition, pain, pressure injury and restraints in home care: A narrative review

Global demographic changes and the strategy of 'ageing in place' will increase the importance of home care in the future. To deliver safe and high-quality care, clinical data on nursing-sensitive indicators and transparency are needed. A comprehensive narrative review of the literature was conducted to describe the prevalence and incidence of nursing-sensitive indicators, namely, falls, incontinence, malnutrition, pain, pressure injury and restraints in home care. A literature search was carried out in May 2021 in PubMed and CINAHL, and 28 studies were included. Data were extracted using two extraction tables designed for this review. Prevalence and incidence rates varied widely and internationally within each indicator. The prevalence range for falls was 4.8%-48%; urinary incontinence, 33.7%-62.5%; malnutrition, 20%-57.6%; pain, 6.5%-68.5%; pressure injury, 16%-17.4% and physical restraints, 5%-24.7%. Due to various measurements and different instruments, the rates are not comparable. The use of standardised measurement and risk assessment tools to assess nursing-sensitive indicators in home care is needed to implement suitable interventions and to prevent these indicators.