Falls efficacy, postural balance, and risk for falls in older adults with falls-related emergency department visits: prospective cohort study.
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ABSTRACT:
SUBMITTER: Pua YH
PROVIDER: S-EPMC5740922 | biostudies-literature | 2017 Dec
REPOSITORIES: biostudies-literature
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Falls efficacy, postural balance, and risk for falls in older adults with falls-related emergency department visits: prospective cohort study.
Pua Yong-Hao YH Ong Peck-Hoon PH Clark Ross Allan RA Matcher David B DB Lim Edwin Choon-Wyn EC
BMC geriatrics 20171221 1
<h4>Background</h4>Risk for falls in older adults has been associated with falls efficacy (self-perceived confidence in performing daily physical activities) and postural balance, but available evidence is limited and mixed. We examined the interaction between falls efficacy and postural balance and its association with future falls. We also investigated the association between falls efficacy and gait decline.<h4>Methods</h4>Falls efficacy, measured by the Modified Falls Efficacy Scale (MFES), a ...[more]
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Project description:BackgroundUnscheduled emergency department return visits (EDRVs) are key indicators for monitoring the quality of emergency medical care. A high return rate implies that the medical services provided by the emergency department (ED) failed to achieve the expected results of accurate diagnosis and effective treatment. Older adults are more susceptible to diseases and comorbidities than younger adults, and they exhibit unique and complex clinical characteristics that increase the difficulty of clinical diagnosis and treatment. Older adults also use more emergency medical resources than people in other age groups. Many studies have reviewed the causes of EDRVs among general ED patients; however, few have focused on older adults, although this is the age group with the highest rate of EDRVs.ObjectiveThis aim of this study is to establish a model for predicting unscheduled EDRVs within a 72-hour period among patients aged 65 years and older. In addition, we aim to investigate the effects of the influencing factors on their unscheduled EDRVs.MethodsWe used stratified and randomized data from Taiwan's National Health Insurance Research Database and applied data mining techniques to construct a prediction model consisting of patient, disease, hospital, and physician characteristics. Records of ED visits by patients aged 65 years and older from 1996 to 2010 in the National Health Insurance Research Database were selected, and the final sample size was 49,252 records.ResultsThe decision tree of the prediction model achieved an acceptable overall accuracy of 76.80%. Economic status, chronic illness, and length of stay in the ED were the top three variables influencing unscheduled EDRVs. Those who stayed in the ED overnight or longer on their first visit were less likely to return. This study confirms the results of prior studies, which found that economically underprivileged older adults with chronic illness and comorbidities were more likely to return to the ED.ConclusionsMedical institutions can use our prediction model as a reference to improve medical management and clinical services by understanding the reasons for 72-hour unscheduled EDRVs in older adult patients. A possible solution is to create mechanisms that incorporate our prediction model and develop a support system with customized medical education for older patients and their family members before discharge. Meanwhile, a reasonably longer length of stay in the ED may help evaluate treatments and guide prognosis for older adult patients, and it may further reduce the rate of their unscheduled EDRVs.
| S-EPMC8367131 | biostudies-literature
Project description:Background/objectiveEmergency department (ED) visits have declined while excess mortality, not attributable to COVID-19, has grown. It is not known whether older adults are accessing emergency care differently from their younger counterparts. Our objective was to determine patterns of ED visit counts for emergent conditions during the COVID-19 pandemic for older adults.DesignRetrospective, observational study.SettingObservational analysis of ED sites enrolled in a national clinical quality registry.ParticipantsOne hundred and sixty-four ED sites in 33 states from January 1, 2019 to November 15, 2020.Main outcome and measuresWe measured daily ED visit counts for acute myocardial infarction (AMI), stroke, sepsis, fall, and hip fracture, as well as deaths in the ED, by age categories. We estimated Poisson regression models comparing early and post-early pandemic periods (defined by the Centers for Disease Control and Prevention) to the pre-pandemic period. We report incident rate ratios to summarize changes in visit incidence.ResultsFor AMI, stroke, and sepsis, the older (75-84) and oldest old (85+ years) had the greatest decline in visit counts initially and the smallest recovery in the post-early pandemic periods. For falls, visits declined early and partially recovered uniformly across age categories. In contrast, hip fractures exhibited less change in visit rates across time periods. Deaths in the ED increased during the early pandemic period, but then fell and were persistently lower than baseline, especially for the older (75-84) and oldest old (85+ years).ConclusionsThe decline in ED visits for emergent conditions among older adults has been more pronounced and persistent than for younger patients, with fewer deaths in the ED. This is concerning given the greater prevalence and risk of poor outcomes for emergent conditions in this age group that are amenable to time-sensitive ED diagnosis and treatment, and may in part explain excess mortality during the COVID-19 era among older adults.
| S-EPMC8242842 | biostudies-literature
Project description:Introduction. Falls among older adults (age ≥65) are a common and costly health issue. Knowing where falls occur and whether this location differs by sex and age can inform prevention strategies. Objective. To determine where injurious falls that result in emergency department (ED) visits commonly occur among older adults in the United States, and whether these locations differ by sex and age. Methods. Using 2015 National Electronic Injury Surveillance System-All Injury Program data we reviewed narratives for ED patients aged ≥65 who had an unintentional fall as the primary cause of injury. Results. More fall-related ED visits (71.6%) resulted from falls that occurred indoors. A higher percentage of men's falls occurred outside (38.3%) compared to women's (28.4%). More fall-related ED visits were due to falls at home (79.2%) compared to falls not at home (20.8%). The most common locations for a fall at home were the bedroom, bathroom, and stairs. Conclusion. The majority of falls resulting in ED visits among older adults occurred indoors and varied by sex and age. Knowing common locations of injurious falls can help older adults and caregivers prioritize home modifications. Understanding sex and age differences related to fall location can be used to develop targeted prevention messages.
| S-EPMC8669898 | biostudies-literature
Project description:Background and objectivesMany older adults adopt equipment to address physical limitations and reduce dependence on others to complete basic activities of daily living. Although a few prior studies have considered injuries associated with assistive devices for older adults, those studies focused on older adults' health and functional risks for injury. There is limited analysis of older adult injuries involving defective or malfunctioning assistive devices.Research design and methodsData from this study are from the National Electronic Surveillance System All Injury Program which collected data on consumer product-related injuries from a probability sample of 66 hospital Emergency Departments across the United States. Data from 30 776 older adult Emergency Department (ED) injury narratives from 2016 to 2020 were coded according to the assistive device involved and whether malfunctioning led to the injury. The study team manually examined all narratives in which the assistive device was coded to have malfunctioned.ResultsA total of 10 974 older adult ED cases were treated for 12 488 injuries involving a defective device. Injuries included 4 212 head and neck injuries (eg, concussion), 4 317 trunk injuries (eg, hip fractures), and 3 959 arm or leg injuries (eg, leg fracture). Of these patients, 4 586 were admitted to a hospital ward for further evaluation and treatment. Seventy percent of these patients were injured while using a walker; in contrast, wheelchairs were implicated in only 4% of the above cases. Design flaws were identified in 8 158 cases and part breakage/decoupling incidents in 2 816 cases.Discussion and implicationsOur findings provide evidence that assistive devices are actively involved in older adult injuries. Further research is needed to reduce injuries associated with assistive devices by educating patients and their careproviders about device use and assembly and developing effective methods for informing manufacturers about malfunctioning devices.
| S-EPMC10833462 | biostudies-literature
Project description:In 2011, an estimated 26.8 million US adults used prescription medications for mental illness.To estimate the numbers and rates of adverse drug event (ADE) emergency department (ED) visits involving psychiatric medications among US adults between January 1, 2009, and December 31, 2011.Descriptive analyses of active, nationally representative surveillance of ADE ED visits using the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance system and of drug prescribing during outpatient visits using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey.Medical records from national probability samples of ED and outpatient visits by adults 19 years or older were reviewed and analyzed.Antidepressants, antipsychotics, lithium salts, sedatives and anxiolytics, and stimulants.National estimates of ADE ED visits resulting from therapeutic psychiatric medication use and of psychiatric medication ADE ED visits per 10,000 outpatient visits at which psychiatric medications were prescribed.From 2009 through 2011, there were an estimated 89,094 (95% CI, 68,641-109,548) psychiatric medication ADE ED visits annually, with 19.3% (95% CI, 16.3%-22.2%) resulting in hospitalization and 49.4% (95% CI, 46.5%-52.4%) involving patients aged 19 to 44 years. Sedatives and anxiolytics, antidepressants, antipsychotics, lithium salts, and stimulants were implicated in an estimated 30,707 (95% CI, 23,406-38,008), 25,377 (95% CI, 19,051-31,704), 21,578 (95% CI, 16,599-26,557), 3620 (95% CI, 2311-4928), and 2779 (95% CI, 1764-3794) respective ADE ED visits annually. Antipsychotics and lithium salts were implicated in 11.7 (95% CI, 10.1-13.2) and 16.4 (95% CI, 13.0-19.9) ADE ED visits per 10,000 outpatient prescription visits, respectively, compared with 3.6 (95% CI, 3.2-4.1) for sedatives and anxiolytics, 2.9 (95% CI, 2.3-3.5) for stimulants, and 2.4 (95% CI, 2.1-2.7) for antidepressants. The commonly used sedative zolpidem tartrate was implicated in 11.5% (95% CI, 9.5%-13.4%) of all adult psychiatric medication ADE ED visits and in 21.0% (95% CI, 16.3%-25.7%) of visits involving adults 65 years or older, in both cases significantly more than any other psychiatric medication.Psychiatric medications are implicated in many ADEs treated in US EDs. Efforts to reduce ADEs should include adults of all ages but might prioritize medications causing high numbers and rates of ED visits.
| S-EPMC4703317 | biostudies-literature
Project description:OBJECTIVES:To evaluate the utility of routinely collected Hendrich II fall scores in predicting returns to the emergency department (ED) for falls within 6 months. DESIGN:Retrospective electronic record review. SETTING:Academic medical center ED. PARTICIPANTS:Individuals aged 65 and older seen in the ED from January 1, 2013, through September 30, 2015. MEASUREMENTS:We evaluated the utility of routinely collected Hendrich II fall risk scores in predicting ED visits for a fall within 6 months of an all-cause index ED visit. RESULTS:For in-network patient visits resulting in discharge with a completed Hendrich II score (N = 4,366), the return rate for a fall within 6 months was 8.3%. When applying the score alone to predict revisit for falls among the study population the resultant receiver operating characteristic (ROC) plot had an area under the curve (AUC) of 0.64. In a univariate model, the odds of returning to the ED for a fall in 6 months were 1.23 times as high for every 1-point increase in Hendrich II score (odds ratio (OR)=1.23 (95% confidence interval (CI)=1.19-1.28). When included in a model with other potential confounders or predictors of falls, the Hendrich II score is a significant predictor of a return ED visit for fall (adjusted OR=1.15, 95% CI=1.10-1.20, AUC=0.75). CONCLUSION:Routinely collected Hendrich II scores were correlated with outpatient falls, but it is likely that they would have little utility as a stand-alone fall risk screen. When combined with easily extractable covariates, the screen performs much better. These results highlight the potential for secondary use of electronic health record data for risk stratification of individuals in the ED. Using data already routinely collected, individuals at high risk of falls after discharge could be identified for referral without requiring additional screening resources.
| S-EPMC5937931 | biostudies-literature
Project description:OBJECTIVE:To examine mental health care received by older adults following emergency department (ED) visits for deliberate self-harm. METHODS:This retrospective cohort analysis examined 2015 Medicare claims for adults ≥65 years of age with ED visits for deliberate self-harm (N = 16 495). We estimated adjusted risk ratios (ARR) for discharge disposition, ED coding of mental disorder, and 30-day follow-up mental health outpatient care. RESULTS:Most patients (76.9%) were hospitalized with lower likelihoods observed for African American patients (ARR = 0.86, 99% CI = 0.79-0.94) and patients with either one medical comorbidity (ARR = 0.91, 99% CI = 0.83-0.99) or two to three comorbidities (ARR = 0.93, 99% CI = 0.88-0.99). Hospitalization was associated with recent depression (ARR = 1.09, 99% CI = 1.03-1.16) and recent psychiatric inpatient care (ARR = 1.13, 99% CI = 1.04-1.22). Among patients discharged to the community (n = 3818), 56.4% received an ED mental disorder diagnosis. Predictors of an ED mental disorder diagnosis included younger age (65-69 years; ARR = 1.53, 99% CI = 1.31-1.78), recent mental health care in ED (ARR = 1.50, 99% CI = 1.29-1.74) or outpatient (ARR = 1.62, 99% CI = 1.44-1.82) settings, recent diagnosis of mental disorder (ARR = 1.61, 99% CI = 1.43-1.80), and other/unknown lethality methods of self-harm (ARR = 1.24, 99% CI = 1.01-1.52). Among community discharged patients, 39.0% received 30-day follow-up outpatient mental health care, which was most strongly predicted by an ED diagnosis of mental disorder (ARR = 2.65, 99% CI = 2.25-3.12) and prior outpatient mental health care (ARR = 2.62, 99% CI = 2.28-3.00). CONCLUSION:Most older adult Medicare beneficiaries who present to EDs with self-harm are hospitalized. Of those who are discharged to the community, many are not diagnosed with mental disorder in the ED or receive timely follow-up mental health care.
| S-EPMC6579649 | biostudies-literature
Project description:IntroductionPotentially inappropriate medications (PIM) and resulting adverse health outcomes in older adults are a common occurrence. However, PIM prescriptions are still frequent for vulnerable older adults. Here, we sought to estimate the risk of hospitalization and emergency department (ED) visits associated with PIM prescriptions over different exposure periods and PIM drug categories.MethodsWe used the National Health Insurance Service-Elderly Cohort Database (NHIS-ECDB) to construct the cohort and implemented a Self-Controlled Case Series (SCCS) method. Hospitalization or ED visits during the exposure and post-exposure periods were compared to those during the non-exposure period, and six PIM drug categories were evaluated. A conditional Poisson regression model was applied, and the risk of outcomes was presented as the incidence rate ratio (IRR). All potential time-varying covariates were adjusted by year. A total of 43,942 older adults aged ≥65 y who had at least one PIM prescription and the events of either hospitalization or ED visits between Jan 2016 and Dec 2019 were selected..ResultsMean days of each exposure period was 46 d (±123); risk was highest in exposure1 (1-7 d, 37.8%), whereas it was similar during exposure2 (15-28 d), and exposure3 (29-56 d) (16.6%). The mean number of total PIM drugs administered during the study period was 7.34 (±4.60). Both hospitalization and ED visits were significantly higher in both exposure (adjusted IRR 2.14, 95% Confidence Interval (CI):2.11-2.17) and post-exposure periods (adjusted IRR 1.41, 95% CI:1.38-1.44) in comparison to non-exposure period. The risk of adverse health outcomes was highest during the first exposure period (1-14 d), but decreased gradually over time. Among the PIM categories, pain medication was used the most, followed by anticholinergics. All PIM categories significantly increased the risk of hospitalization and ED visits, ranging from 1.18 (other PIM) to 2.85 (pain medication). Sensitivity analyses using the first incidence of PIM exposure demonstrated similar results. All PIM categories significantly increased the risk of hospitalization and ED visits, with the initial period of PIM prescriptions showing the highest risk. In subgroup analysis stratified by the number of medications, PIM effects on the risk of hospitalization and ED visits remained significant but gradually attenuated by the increased number of medications.DiscussionTherefore, the development of deprescribing strategies to control PIM and polypharmacy collectively is urgent and essential.
| S-EPMC10352109 | biostudies-literature
Project description:BackgroundThe US older adult population (age ≥65 years) is increasing and may be at increased risk for severe anaphylaxis. Little is known about the health care use for acute allergic reactions (AAR), including anaphylaxis, among older adults.ObjectiveTo characterize trends in emergency department (ED) visits and hospitalizations for AAR and anaphylaxis among US older adults from 2006 to 2014 and examine factors associated with severe anaphylaxis.MethodsWe performed cross-sectional analyses of trends in ED visits and hospitalizations among older adults using data from the Nationwide Emergency Department Sample and the National (Nationwide) Inpatient Sample in 2006 to 2014. We used International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes to identify visits for AAR, including anaphylaxis. Multivariable logistic regression modeling was used to identify factors associated with severe anaphylaxis (cardiac arrest, intubation, and death).ResultsIn 2006 to 2014, older adults experienced approximately 1,019,967 AAR-related ED visits, 173,844 AAR-related hospitalizations, 93,795 anaphylaxis-related ED visits, and 72,677 anaphylaxis-related hospitalizations. Whereas AAR-related ED visit and hospitalization rates remained stable (P = .28 and .16, respectively), anaphylaxis-related ED visit and hospitalization rates increased significantly over time (37 visits/100,000 in 2006 to 51 in 2014, P < .001; and from 13 hospitalizations/100,000 in 2006 to 23 in 2014, P < .001), especially hospitalization rates for drug-related anaphylaxis (47 hospitalizations/100,000 in 2006 to 85 in 2014; P < .001). Risk factors for anaphylaxis-related death included older age and drug-related trigger.ConclusionsIn a nationally representative sample of US older adults, the rate of anaphylaxis-related ED visits and hospitalizations increased over time. Drug-related triggers represented a substantial portion of increased health care use and are a growing risk in this vulnerable population.
| S-EPMC8277683 | biostudies-literature
Project description:Older adults are more likely to require emergency department (ED) visits than others, which might be attributed to their medication use. Being able to predict the likelihood of an ED visit using prescription information and readily available data would be useful for primary care. This study aimed to predict the likelihood of ED visits using extensive medication variables generated according to explicit clinical criteria for elderly people and high-risk medication categories by applying machine learning (ML) methods. Patients aged ≥ 65 years were included, and ED visits were predicted with 146 variables, including demographic and comprehensive medication-related factors, using nationwide claims data. Among the eight ML models, the final model was developed using LightGBM, which showed the best performance. The final model incorporated 93 predictors, including six sociodemographic, 28 comorbidity, and 59 medication-related variables. The final model had an area under the receiver operating characteristic curve of 0.689 in the validation cohort. Approximately half of the top 20 strong predictors were medication-related variables. Here, an ED visit risk prediction model for older people was developed and validated using administrative data that can be easily applied in clinical settings to screen patients who are likely to visit an ED.
| S-EPMC10622449 | biostudies-literature