Community-dwelling seniors who present to the emergency department with a fall do not receive Guideline care and their fall risk profile worsens significantly: a 6-month prospective study
Community-dwelling seniors who present to the emergency department with a fall do not receive Guideline care and their fall risk profile worsens significantly: a 6-month prospective study
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DOI：
10.1007/s00198-005-0032-7
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发表时间：
2006-05-01
影响因子：
4
通讯作者：
McKay, HA
中科院分区：
文献类型：
--
作者：
Salter, AE;Khan, KM;McKay, HA
简介：跌倒风险是骨折风险的主要因素;实施减少跌倒计划仍然是卫生专业人员和政策制定者面临的挑战。材料与方法：我们的目的是（1）确定54名老年人在急诊科（艾德）跌倒后接受的护理是否符合国际推荐的“指南护理”，（2）前瞻性评估该队列6个月内跌倒风险的变化。参与者是70岁或70岁以上的男性和女性，他们在向城市大学三级护理医院急诊科提出与跌倒相关的投诉后出院回到社区。美国老年医学会（AGS）指南护理通过就诊后急诊科病历检查、每月提交的福尔斯每日患者日记、患者访谈和医生核对（如需要）进行记录。在研究开始和6个月的随访中，我们通过Lord的生理特征评估（PPA），功能状态，平衡信心，抑郁，体力活动和其他因素来测量参与者的生理特征。结果：我们发现，只有2的54（3.7%）的跌倒者谁提出的艾德得到照顾符合AGS指南。基线生理跌倒风险评分将研究人群分类为比65岁对照组高1.7 SD的风险，在6个月随访期间，平均跌倒风险评分显著增加（即福尔斯风险更高）（1.7 +/- 1.6 vs 2.2 +/- 1.6，p=0.000;福尔斯风险高29.5%）。此外，功能能力[100（15）vs 95（25），p=0.002]、平衡信心[82.5（44.4）vs 71.3（58.7），p=0.000]和抑郁[0（2）vs 0（3），p=0.000]均在6个月内恶化。在指数艾德访视的6个月内，5名参与者遭受了6次跌倒相关骨折。讨论内容：我们的结论是，这组社区居住的跌倒者，谁提出了艾德护理的临床资料表明，进一步福尔斯和骨折的高风险，没有接受指南的护理，并在他们的跌倒风险恶化了29.5%。这一护理差距，至少在一个中心，建议进一步调查替代方法，以提供准则标准的卫生服务。
Introduction: Fall risk is a major contributor to fracture risk; implementing fall reduction programmes remains a challenge for health professionals and policy-makers. Materials and methods: We aimed to (1) ascertain whether the care received by 54 older adults after an emergency department (ED) fall presentation met internationally recommended 'Guideline Care', and (2) prospectively evaluate this cohort's 6-month change in fall risk profile. Participants were men and women aged 70 years or older who were discharged back into the community after presenting to an urban university tertiary-care hospital emergency department with a fall-related complaint. American Geriatric Society (AGS) guideline care was documented by post-presentation emergency department chart examination, daily patient diary of falls submitted monthly, patient interview and physician reconciliation where needed. Both at study entry and at a 6-month followup, we measured participants physiological characteristics by Lord's Physiological Profile Assessment (PPA), functional status, balance confidence, depression, physical activity and other factors. Results: We found that only 2 of 54 (3.7%) of the fallers who presented to the ED received care consistent with AGS Guidelines. Baseline physiological fall risk scores classified the study population at a 1.7 SD higher risk than a 65-year-old comparison group, and during the 6-month followup period the mean fall-risk score increased significantly (i.e. greater risk of falls) (1.7 +/- 1.6 versus 2.2 +/- 1.6, p=0.000; 29.5% greater risk of falls). Also, functional ability [100 (15) versus 95 (25), p=0.002], balance confidence [82.5 (44.4) versus 71.3 (58.7), p=0.000] and depression [0 (2) versus 0 (3), p=0.000] all worsened over 6 months. Within 6 months of the index ED visit, five participants had suffered six fall-related fractures. Discussion: We conclude that this group of community-dwelling fallers, who presented for ED care with a clinical profile suggesting a high risk of further falls and fracture, did not receive Guideline care and worsened in their fall risk profile by 29.5%. This gap in care, at least in one centre, suggests further investigation into alternative approaches to delivering Guideline standard health service.