Falls: are rural elders at greater risk?

Designing the Home Falls and Accidents Screening Tool (HOME FAST): Selecting the Items

The Home Falls and Accidents Screening Tool (HOME FAST) was developed as a screening instrument for use in a community preventive care trial for older people. This paper describes the first stage of the development of this screening tool. The objectives of the study were (i) to review existing home safety measures, (ii) to field test an instrument containing a pool of home safety items with the goal of identifying those hazards associated with falls in the home and (iii) to select the items for inclusion in a 25-item tool using an expert panel.

The field testing took place in a rural area of Australia, where the pooled checklist was used to evaluate hazards within the homes of 83 older people. No individual hazards were associated with the risk of falls at home and, although participants who had experienced falls had a higher mean number of home hazards (mean = 13.7, SD 8.2), the differences between fallers and non-fallers was not significant. Items relevant to a rural population were indicated through field testing. Further psychometric testing of the HOME FAST and a meaningful method of scoring the checklist are now warranted.

Prospective analysis of the risk factors for falls in lymphoma patients

PURPOSE

To explore the risk factors for falls in lymphoma patients receiving chemotherapy.

METHODS

Lymphoma patients (203) who received chemotherapy were prospectively recruited and analyzed. Eligible participants were followed up by weekly telephone contact for 6 months or until the time of a fall or death. Risk factors for falling in lymphoma patients were identified using univariate regression analysis and multivariate binary logistic regression analysis.

RESULTS

Of the 203 cases, 13.3% (27 cases) had a fall during follow-up. Univariate regression analysis showed the following risk factors for falls in lymphoma patients: gender (P = 0.023), Eastern Cooperative Oncology Group (ECOG) performance status score (P < 0.0001), cancer stage (P < 0.0001), extranodal involvement (P = 0.041), serum lactate dehydrogenase (LDH) level (P < 0.0001), revised International Prognostic Index (R-IPI) (P < 0.0001), history of falls (P < 0.0001), gait (P < 0.0001), cognitive condition (P = 0.029) and intravenous catheter placement (P < 0.0001). Multivariate binary logistic regression analysis found four independent factors significantly associated with the risk of falling in lymphoma patients: female gender (P = 0.042), later stage (P = 0.021), R-IPI (P = 0.030), and intravenous catheter placement (P = 0.001).

CONCLUSIONS

Gender, stage, R-IPI, and intravenous catheter placement were independent risk factors for falls in patients with lymphoma. Lymphoma patients with these four risk factors should receive particular attention and fall prevention education to reduce the incidence of falls. The R-IPI may be a new predictor of falling in lymphoma patients and may aid in the management of falls.

The lived experience of oldest-old rural adults

The author elicited the lived experience of 19 oldest-old adults (13 women, all White, mean age 90.7 years, range 85-98 years) who lived alone in the rural Midwest to describe their everyday activities, concerns and struggles, and adaptive strategies. In-depth interviews (59 total) were audiotaped, transcribed, and analyzed in an interpretive phenomenological tradition of thematic analysis, interpretation of paradigm cases, and interpretation of exemplars. Participants described how historical, cultural, and environmental contexts shaped their everyday thoughts, activities, and what was meaningful to them. Findings can guide health care professionals to evaluate and develop community services and help significant others (family, friends, neighbors) understand what oldest-old rural adults need to remain at home.

Falls in a community of older adults: findings and implications for practice

The purpose of this study was to describe the falls that occurred over a 5-year period in a group of older adults living in a continuing care retirement community (CCRC) and to test two models, one mediating whether or not the individual fell and the second the number of falls the individual experienced. Of the 312 participants, 177 (57%) residents experienced at least one fall. There were a total of 594 falls with the mean number of falls per person being 1.9 (SD = 3.0), and the range of falls from 1 to 19. Age, gender, and neurologic disease significantly influenced whether or not a fall occurred. Mental health, regular use of alcohol, and neurologic problems all significantly influenced the number of falls that occurred.

Zones of prevention: the geography of fall injuries in the elderly

Our investigation of the geography of fall injuries considers the relationship between injury prevention and contextual approaches to health research. We use a geographic information system (GIS) to describe the pattern of emergency department reported falls of the elderly in the Capital Health Region, an administrative health area in Alberta, Canada. We used empirical Bayes estimates to obtain a geographic measure of fall incidence over the study area and a cluster detection statistic to measure the presence of a significant spatial cluster in the region. Inner-city Edmonton had the highest incidence of risk, suburban Edmonton the lowest, and surrounding rural regions and smaller communities had more moderate fall incidence. We argue that descriptive geography can enhance the effectiveness of injury prevention programs by identifying zones of high risk, even when the individual-level and contextual factors that explain the underlying patterns are unknown.

Factors contributing to falls in elderly men living in the community

The purpose of this study was to investigate factors related to falls in elder men and the differences between those who fall and those who do not. A convenience sample (n = 71) of men age 65-87 was interviewed, and their activity levels, mental status, mobility status, and weight were evaluated. Most men (73%) had fair to good mental status, minimal (35%) to moderate (56%) activity levels, and average (30%) or high (49%) weight. Fifty-two percent reported falling in the past 2 years: 43% of these men fell once, 19% fell two or three times, and 38% fell four or more times. Only two variables were significant (P <.05) between men who fell and those who did not: Low weight and slow gait time. Poor balance approached significance at P =.0512. In ambulatory elderly men, those who were underweight with slow gait time and poor balance were most at risk for falling.

Falls in a community of older adults: putting research into practice

This study described the incidences of falls and injuries related to those falls in a community of older adults. It used a convenience sample of 220 older adults in a continuing care retirement community. Over a 2-year period, all residents who had a witnessed or reported fall were evaluated by a nurse or nurse practitioner and completed a Falls Data form. There were 154 falls, most of which occurred between noon and midnight, within the residents' apartments, when walking (63%) or transferring (19%). Only 16 (10%) of the falls resulted in a fracture. The number of falls was the only variable associated with having an injurious fall. Individuals who had atrial fibrillation or neurological problems, were not married, and did not adhere to a regular exercise program were more likely to have multiple falls. The findings were used by the nurse practitioner to educate residents about falls in their community and to develop interventions to decrease the risk and incidences of falls.

Review of the literature on falls among the elderly

PURPOSE

To review and summarize the literature from nursing, medical, and ancillary fields on falls among the elderly. Major injuries from falls are associated with mortality, especially among the elderly. Researchers indicate that, in many cases, falls can be prevented. A summary of the available literature provides information which can be used to plan interventions.

ORGANIZING FRAMEWORK

Over 100 publications, 1979-1996 related to falls by elderly were reviewed. Descriptive terms used for searching MEDLINE were falls, elderly, and accidents. Literature from several disciplines was reviewed.

FINDINGS

Fall risk can be predetermined and nursing actions can be taken to reduce the occurrence and severity of falls.

CONCLUSIONS

To reduce the deleterious effects of falls in the elderly, knowledge-based practice is essential.