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1.
BMC Endocr Disord ; 22(1): 198, 2022 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-35941681

RESUMO

PURPOSE: The aim of this study is to explore the factors associated with the fall risk in type 2 diabetes (T2D) patients with a lacunar stroke. MATERIALS AND METHODS: We compiled data of 146 T2D patients (mean age 68 years), including the Morse fall scale data (MFS), nutrition score, self-care scale, laboratory data, and data from continuous glucose monitoring system (CGMS) from 2019 to 2021 in Shanghai Pudong Hospital. Thereby, we evaluated the associations between MFS and other clinical parameters. RESULTS: The analyses showed that there were significantly increased size and numbers of lacunar infarction (p < 0.05). Furthermore, the greater risk group had an older mean age (p < 0.05), and significant decreased estimated glomerular filtration rate (eGFR), total triglyceride (TG), while increased microalbuminuria, magnesium, lipoprotein A (LP(a)), anti-thyroid peroxidase antibody (TPOAb) (p < 0.05). However, the time in range (TIR) was very comparable (p > 0.05). The correlational study revealed the higher score of MFS was associated with the age (r = 0.41), number of lacunar infarction (r = 0.18), nutrition score (r = 0.20), self-care score (r = - 0.43), serum creatine level (r = 0.19), eGFR (r = - 0.26) (p < 0.05). The total numbers of lacunar infarction were associated with age (r = 0.36), eGFR (r = - 0.40), homocysteine level (r = 0.33) (p < 0.05). CONCLUSIONS: Age, nutrition, self-care ability, and renal function are all critical factors associated with the risk of fall in T2D with lacunar infarction. The age, eGFR, and homocysteine are closely associated with lacunar infarction, suggesting that in T2D, evaluation of kidney dysfunction, homocysteine level in the elderly can predict lacunar infarcts and falls.


Assuntos
Diabetes Mellitus Tipo 2 , Acidente Vascular Cerebral Lacunar , Acidentes por Quedas , Idoso , Glicemia , Automonitorização da Glicemia , China/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Suscetibilidade a Doenças , Homocisteína , Humanos , Fatores de Risco , Acidente Vascular Cerebral Lacunar/epidemiologia , Acidente Vascular Cerebral Lacunar/etiologia
2.
Front Public Health ; 10: 915637, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35937212

RESUMO

Objective: To investigate injury trends, injury distribution, and disease burden from three surveillance hospitals in Urumqi from 2006 to 2018. Method: Injury data from the National Injury Surveillance System (NISS) from three hospitals in Urumqi (2006 to 2018) were collected to analyze changes in the characteristics of outpatient injury cases. Years of potential life lost (YPLL) were calculated to determine the disease burden of the injury cases. Results: A total of 161,400 injury cases were recorded over 13 years, and the average age of the patient seeking medical attention was 32.4 years old. Male patients outnumbered female patients with a ratio of 1.6:1, but the proportion of female patients was greater after 45 years of age. The highest number of cases occurred in patients 15-29 years of age, accounting for 26.8% of all injury cases. Injury in females occurred most frequently in the home. A total of 41.4% of injury cases occurred while doing housework. The top three causes of injury were falls (49.7%), blunt force of an object, (13.7%), and motor vehicle accidents (MVA) (13.5%). Years of potential life lost from injury accounted for 7.39% of the total YPLL in the three hospitals. Conclusion: Males should be targeted for injury prevention and intervention in Urumqi. The prevention of falls, blunt force of objects, and MVA should be made a priority. Injury prevention strategies and targeted projects should be developed to reduce the disease burden of injury.


Assuntos
Acidentes por Quedas , Hospitais , Acidentes por Quedas/prevenção & controle , Adulto , Efeitos Psicossociais da Doença , Feminino , Humanos , Masculino
5.
Rev Lat Am Enfermagem ; 30: e3617, 2022.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-35920541

RESUMO

OBJECTIVE: analyze the falls of adult hospitalized patients and their repercussions on the Nursing worker as the second victim. METHOD: an exploratory, descriptive and qualitative study conducted in two stages - identification of falls with moderate to severe damage and the modeling of falls using the software Functional Resonance Analysis Method; and analysis of the repercussions on the worker as the second victim by means of semi-structured interviews submitted to Content Analysis, with 21 Nursing workers. RESULTS: a total of 447 falls of adult patients were identified, 12 of which with moderate to severe damage, occurred in the absence of the companion, while using sleep inducing, hypotensive or muscle strength altering medications. The modeling identified 22 functions related to the Standard Operating Procedure, to the fall prevention protocol and to the post-event actions. Of these, eight presented variability in their execution. In the second step, the categories "The complexity of care to prevent falls" and "Feelings of the second victim" emerged. CONCLUSION: falls are complex phenomena and prevention requires involvement of the patient, family and multi-professional team. The professionals involved are second victims and experience feelings of guilt, fear, anguish and helplessness. This study can contribute to the multi-professional spirit and to the early approach to second victims.


Assuntos
Acidentes por Quedas , Recursos Humanos de Enfermagem , Acidentes por Quedas/prevenção & controle , Adulto , Emoções , Humanos , Pacientes , Pesquisa Qualitativa
6.
BMC Geriatr ; 22(1): 632, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35915396

RESUMO

BACKGROUND: Falls are an important cause of injury and death of older people. Hence, analyzing the multifactorial risk of falls from past cases to develop multifactorial intervention programs is clinically significant. However, due to the small sample size, there are few studies on fall risk analysis of clinical characteristics of fallers, especially among older hospitalized patients. METHODS: We collected data on 153 inpatients who fell (age ≥ 60 years) from the hospital nursing adverse event reporting system during hospitalization at Shandong Provincial Hospital Affiliated to Shandong First Medical University, China, from January 2018 to December 2020. Patient characteristics at the time of the fall, surrounding environment, primary nurse, and adverse fall events were assessed. The enumeration data were expressed as frequency and percentage, and the chi-squared was performed between recurrent fallers and single fallers, and non-injurious and injurious fall groups. RESULTS: Cross-sectional data showed 18.3% of the 153 participants experienced an injurious fall. Compared with single fallers, a large proportion of older recurrent fallers more often experienced preexisting conditions such as cerebrovascular disease or taking hypoglycemic drugs. They were exposed to higher risks and could experience at least 3 fall times in 3 months. Besides, the credentials of their responsible nurses were often higher. Factors that increased the risk of a fall-related injury were hypoglycemic drugs (OR 2.751; 95% CI 1.114-6.795), and nursing adverse events (OR 47.571; 95% CI 14.392-157.247). Older inpatients with bed rails (OR 0.437; 95% CI 0.190-1.005) or falling at the edge of the bed (OR 0.365; 95% CI 0.138-0.964) were less likely to be injured than those without bed rails or not falling at the edge of the bed. Fall risks were significantly correlated with more severe fall-related injuries. Older patients with moderate (OR 5.517; CI 0.687-44.306) or high risk (OR 2.196; CI 0.251-19.219) were more likely to experience fall-related injuries than those with low risk. CONCLUSIONS: Older inpatient falls are an ongoing challenge in hospitals in China. Our study found that the incidence of fall-related injuries among inpatients aged ≥ 60 years remained at a minor level. However, complex patient characteristics and circumstances can contribute to fall-related injuries. This study provides new evidence on fall-related injuries of older inpatients in China. Based on the factors found in this study, regular fall-related injury epidemiological surveys that investigate the reasons associated with the injuries were crucial when considering intervention measures that could refine fall-related injuries. More prospective studies should be conducted with improved and updated multidisciplinary fall risk assessment and comprehensive geriatric assessment as part of a fall-related injury prevention protocol.


Assuntos
Acidentes por Quedas , Pacientes Internados , Acidentes por Quedas/prevenção & controle , Idoso , Estudos Transversais , Hospitais , Humanos , Hipoglicemiantes , Incidência , Estudos Prospectivos , Fatores de Risco
7.
BMC Musculoskelet Disord ; 23(1): 632, 2022 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-35780083

RESUMO

BACKGROUND: A brachial plexus injury is a rare complication of clavicle fractures. Previous case reports only examined the surgical outcomes of brachial plexus injuries that occurred after a clavicle fracture and did not report on the outcomes of conservative treatment. In this report, we present the prognosis of a patient with an acute displaced clavicle fracture accompanied by a brachial plexus injury that was conservatively treated. CASE PRESENTATION: A 51-year-old man with a middle-third clavicle fracture due to a direct trauma after falling down the stairs. A brachial plexus injury experienced symptoms, including numbness occurred in the affected upper extremity, at 1 day after the injury. The patient's motor power in the elbow, wrist, and hand decreased at 3 days after the injury. Magnetic resonance imaging (MRI) showed no loss of continuity in the brachial plexus, but showed nerve compression by displaced fracture fragments. Electromyography revealed brachial plexopathy. Conservative treatment, including a shoulder sling, was performed with satisfactory outcomes; the patient reported a 70% improvement at 6 months after the injury. CONCLUSIONS: A brachial plexus injury is a rare complication of clavicle fractures that can cause serious dysfunction of the upper extremities affected by the injury. Conservative treatment may be considered for acute nerve compression by displaced fracture fragments rather than extensive callus or granulation tissue formation to achieve a satisfactory recovery in young patients. MRI should typically be performed before making a treatment decision to examine the brachial plexus for any discontinuity or kinking.


Assuntos
Plexo Braquial , Fraturas Ósseas , Traumatismos dos Nervos Periféricos , Acidentes por Quedas , Plexo Braquial/diagnóstico por imagem , Clavícula/diagnóstico por imagem , Clavícula/cirurgia , Tratamento Conservador , Fraturas Ósseas/complicações , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
8.
ScientificWorldJournal ; 2022: 9483665, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35782907

RESUMO

Postural sway indicates controlling stability in response to standing balance perturbations and determines risk of falling. In order to assess balance and postural sway, costly laboratory equipment is required, making it impractical for clinical settings. The study aimed to develop a triaxial inertial sensor and apply machine learning (ML) algorithms for predicting trajectory of the center of pressure (COP) path of postural sway. Fifty-three healthy adults, with a mean age of 46 years, participated. The inertial sensor prototype was investigated for its concurrent validity relative to the COP path length obtained from the force platform measurement. Then, ML was applied to predict the COP path by using sensor-sway metrics as the input. The results of the study revealed that all variables from the sensor prototype demonstrated high concurrent validity against the COP path from the force platform measurement (ρ > 0.75; p < 0.001). The agreement between sway metrics, derived from the sensor and ML algorithms, illustrated good to excellent agreement (ICC; 0.89-0.95) between COP paths from the sensor metrics, with respect to the force plate measurement. This study demonstrated that the inertial sensor, in comparison to the standard tool, would be an option for balance assessment since it is of low-cost, conveniently portable, and comparable to the accuracy of standard force platform measurement.


Assuntos
Acidentes por Quedas , Equilíbrio Postural , Acidentes por Quedas/prevenção & controle , Adulto , Algoritmos , Humanos , Aprendizado de Máquina , Pessoa de Meia-Idade , Equilíbrio Postural/fisiologia
9.
Einstein (Sao Paulo) ; 20: eAO8024, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35792759

RESUMO

OBJECTIVE: To examine associations between potentially inappropriate medication, use and the risk of falls, unplanned hospitalization and death in older patients receiving initial care in a geriatric day hospital due to acute conditions. METHODS: Cohort study with older adults referred to a geriatric day hospital from 2014 to 2017 due to acute conditions. Patients were submitted to comprehensive geriatric assessment. Use of medications was analyzed according to Beers Criteria 2019. Outcome assessment was based on monthly follow-up telephone calls made over the course of one year. RESULTS: In this sample, 40.6% of patients had been prescribed at least one potentially inappropriate medication, particularly proton pump inhibitors (66.5%). Over the course of follow-up, 44.7% of patients receiving potentially inappropriate medications sustained at least one fall (p=0.0043) and 70% visited the emergency department (p=0.0452). These outcomes were more common among patients using two or more of drugs. Use of potentially inappropriate medication was associated with a 64% increase in the odds of unplanned hospitalization and a two-fold increase in risk of death. CONCLUSION: Associations between potentially inappropriate medication use and unfavorable outcomes such as falls and unplanned hospitalizations within one year of admission to a geriatric day hospital support the application of Beers Criteria and emphasize the importance of periodic prescription review, deprescription and rational use of these drugs whenever possible.


Assuntos
Pacientes Ambulatoriais , Lista de Medicamentos Potencialmente Inapropriados , Acidentes por Quedas , Doença Aguda , Idoso , Estudos de Coortes , Humanos
10.
Int J Clin Pract ; 2022: 8042915, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35832801

RESUMO

Aim: The aim of the study was to provide evidence for the prevention and reduction of falls in the elderly living in rural areas by analyzing epidemiological data of falls among the rural older people (>65 years old) and identifying the risk and protective factors. Methods: This study analyzed the sociodemographic characteristics, living environment, lifestyle, chronic disease condition, mental health, activities of daily living (ADL), and detailed information of falls of 3752 rural elderly. Rank tests, chi-square tests, and binary logistic regression were used for data analysis. Results: The prevalence of falls was 30.0%, and the 75-84-years age group had the highest fall rate (18.8%). According to the binary logistic regression analysis, six variables, including roughage intake frequency, age, gender, cane use, floor tiles, and IADL, were involved in the fall patterns. Low roughage intake (OR = 2.48, 95% CI 1.24-4.97), female gender (OR = 2.12, 95% CI 1.48-3.05), the use of a cane (OR = 2.11, 95% CI 1.08-4.10), and medium IADL (OR = 2.02, 95% CI 1.89-2.32) were the top four risk factors. Conclusion: The fall in the rural elderly was mainly due to the poor living and working conditions. Routine fall assessment could address several preventable risk factors to reduce the prevalence and mitigate the harm of falls.


Assuntos
Acidentes por Quedas , Atividades Cotidianas , Acidentes por Quedas/prevenção & controle , Idoso , Doença Crônica , Estudos Transversais , Fibras na Dieta , Feminino , Humanos , Prevalência , Fatores de Risco
11.
BMC Nephrol ; 23(1): 237, 2022 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-35794531

RESUMO

BACKGROUND: Patients with chronic kidney disease undergoing hemodialysis (HD) have a high incidence of falls. Impairment of balance function is a risk factor for falls in the general elderly, and no report examining the association between balance dysfunction and fall incidence in HD patients exists. METHODS: This prospective cohort study was conducted at a single center. The timed-up-and-go test (TUG) as a dynamic balance function was performed and length of the center of pressure (CoP) as a static balance function was measured before and after the HD session at baseline. Data of the number and detailed information of accidental falls for 1 year were collected. Multiple regression analyses were performed to assess the relationships between the number of falls and balance function. RESULTS: Forty-three patients undergoing HD were enrolled in the study. During 1 year of observation, 24 (55.8%) patients experienced accidental falls. TUG time was longer, and CoP was shorter in the post-HD session than in the pre-HD session. Adjusted multiple regression analyses showed that the number of accidental falls was independently associated with TUG time in the pre-HD session (B 0.267, p < 0.001, R2 0.413) and that in the post-HD session (B 0.257, p < 0.001, R2 0.530), but not with CoP. CONCLUSIONS: Dynamic balance was associated with fall incidence in maintenance HD patients. The evaluation and intervention of dynamic balance function might reduce the risk of falls in HD patients. TRIAL REGISTRATION: This study was carried out with the approval of the Niigata Rinko Hospital Ethics Committee (approval number 2005-92) (Registered on December 11, 2019) and registered in The University Hospital Medical Information Network (registration number 000040618 ).


Assuntos
Acidentes por Quedas , Equilíbrio Postural , Idoso , Humanos , Estudos Prospectivos , Diálise Renal/efeitos adversos , Estudos de Tempo e Movimento
12.
Age Ageing ; 51(7)2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35794851

RESUMO

BACKGROUND: no studies have examined the impact of residential medication management review (RMMR, a 24-year government subsidised comprehensive medicines review program) in Australian residential aged care facilities (RACFs) on hospitalisation or mortality. OBJECTIVE: to examine associations between RMMR provision in the 6-12 months after RACF entry and the 12-month risk of hospitalisation and mortality among older Australians in RACFs. DESIGN: retrospective cohort study. SUBJECTS: individuals aged 65-105 years taking at least one medicine, who entered an RACF in three Australian states between 1 January 2012 and 31 December 2015 and spent at least 6 months in the RACF (n = 57,719). METHODS: Cox regression models estimated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for associations between RMMR provision and mortality. Adjusted subdistribution hazard ratios were estimated for associations between RMMR provision and next (i) emergency department (ED) presentation or unplanned hospitalisation or (ii) fall-related ED presentation or hospitalisation. RESULTS: there were 12,603 (21.8%) individuals who received an RMMR within 6-12 months of RACF entry, of whom 22.2% (95%CI 21.4-22.9) died during follow-up, compared with 23.3% (95%CI 22.9-23.7) of unexposed individuals. RMMR provision was associated with a lower risk of death due to any cause over 12-months (aHR 0.96, 95%CI 0.91-0.99), but was not associated with ED presentations or hospitalisations for unplanned events or falls. CONCLUSIONS: provision of an RMMR in the 6-12 months after RACF entry is associated with a 4.4% lower mortality risk over 12-months but was not associated with changes in hospitalisations for unplanned events or falls.


Assuntos
Instituição de Longa Permanência para Idosos , Hospitalização , Acidentes por Quedas/prevenção & controle , Idoso , Austrália/epidemiologia , Humanos , Estudos Retrospectivos
13.
J Manipulative Physiol Ther ; 45(3): 196-201, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35879126

RESUMO

OBJECTIVE: The purpose of this study was to investigate whether pain intensity and catastrophizing are associated with fear of falls and the number of falls in older persons with knee osteoarthritis (OA). METHODS: A cross-sectional study was conducted involving 100 volunteers (male and female participants), 60 to 80 years old, with a diagnosis of knee OA. Patients were recruited from a physical therapy clinic in the city of São Paulo, Brazil, from March 2019 to November 2019. The following measures were used for the evaluations: Numerical Rating Pain Scale (NRPS), Pain-Related Self-Statement Scale (PRSS), and Falls Efficacy Scale. In statistical analysis, histograms were created to determine the distribution of data. Spearman's correlation coefficients (rs) were then calculated to determine the strength of the associations among the variables. The receiver operating characteristic curve was used to identify the accuracy of PRSS and NRPS in differentiating participants with a history of falls from those without. RESULTS: No significant correlation was found among the pain intensity, pain catastrophizing, fear of falling, and number of falls (rs value ranging from -0.033 to -0.167; P value ranging from .096-.743). The accuracy of PRSS and NRPS in differentiating participants with falls from those without was insufficient, with area under the curve values of 0.46 and 0.42, respectively. CONCLUSION: Pain catastrophizing and intensity were not significantly associated with fear of falling and numbers of falls in older individuals with unilateral knee OA.


Assuntos
Osteoartrite do Joelho , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Brasil , Catastrofização , Estudos Transversais , Medo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Dor , Medição da Dor , Transtornos Fóbicos
14.
J Neuroeng Rehabil ; 19(1): 81, 2022 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-35883085

RESUMO

BACKGROUND: The ability to maintain upright posture requires successful integration of multiple sensory inputs (visual, vestibular, and somatosensory). When one or more sensory systems become unreliable, the postural control system must "down-weight" (or reduce the influence of) those senses and rely on other senses to maintain postural stability. As individuals age, their ability to successfully reweight sensory inputs diminishes, leading to increased fall risk. The present study investigates whether manipulating attentional focus can improve the ability to prioritize different sensory inputs for postural control. METHODS: Forty-two healthy adults stood on a balance board while wearing a virtual reality (VR) head-mounted display. The VR environment created a multisensory conflict amongst the different sensory signals as participants were tasked with maintaining postural stability on the balance board. Postural sway and scalp electroencephalography (EEG) were measured to assess visual weighting and cortical activity changes. Participants were randomized into groups that received different instructions on where to focus their attention during the balance task. RESULTS: Following the instructions to direct attention toward the movement of the board (external focus group) was associated with lower visual weighting and better balance performance than when not given any instructions on attentional focus (control group). Following the instructions to direct attention towards movement of the feet (internal focus group) did not lead to any changes in visual weighting or balance performance. Both external and internal focus groups exhibited increased EEG alpha power (8-13 Hz) activity over the occipital cortex as compared to the control group. CONCLUSIONS: Current results suggest that directing one's attention externally, away from one's body, may optimize sensory integration for postural control when visual inputs are incongruent with somatosensory and vestibular inputs. Current findings may be helpful for clinicians and researchers in developing strategies to improve sensorimotor mechanisms for balance.


Assuntos
Atenção , Equilíbrio Postural , Acidentes por Quedas , Adulto , Eletroencefalografia , Humanos , Modalidades de Fisioterapia
15.
JAMA ; 328(2): 173-183, 2022 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-35819424

RESUMO

Importance: Patient safety is a US national priority, yet lacks a comprehensive assessment of progress over the past decade. Objective: To determine the change in the rate of adverse events in hospitalized patients. Design, Setting, and Participants: This serial cross-sectional study used data from the Medicare Patient Safety Monitoring System from 2010 to 2019 to assess in-hospital adverse events in patients. The study included 244 542 adult patients hospitalized in 3156 US acute care hospitals across 4 condition groups from 2010 through 2019: acute myocardial infarction (17%), heart failure (17%), pneumonia (21%), and major surgical procedures (22%); and patients hospitalized from 2012 through 2019 for all other conditions (22%). Exposures: Adults aged 18 years or older hospitalized during each included calendar year. Main Outcomes and Measures: Information on adverse events (abstracted from medical records) included 21 measures across 4 adverse event domains: adverse drug events, hospital-acquired infections, adverse events after a procedure, and general adverse events (hospital-acquired pressure ulcers and falls). The outcomes were the total change over time for the observed and risk-adjusted adverse event rates in the subpopulations. Results: The study sample included 190 286 hospital discharges combined in the 4 condition-based groups of acute myocardial infarction, heart failure, pneumonia, and major surgical procedures (mean age, 68.0 [SD, 15.9] years; 52.6% were female) and 54 256 hospital discharges for the group including all other conditions (mean age, 57.7 [SD, 20.7] years; 59.8% were female) from 3156 acute care hospitals across the US. From 2010 to 2019, the total change was from 218 to 139 adverse events per 1000 discharges for acute myocardial infarction, from 168 to 116 adverse events per 1000 discharges for heart failure, from 195 to 119 adverse events per 1000 discharges for pneumonia, and from 204 to 130 adverse events per 1000 discharges for major surgical procedures. From 2012 to 2019, the rate of adverse events for all other conditions remained unchanged at 70 adverse events per 1000 discharges. After adjustment for patient and hospital characteristics, the annual change represented by relative risk in all adverse events per 1000 discharges was 0.94 (95% CI, 0.93-0.94) for acute myocardial infarction, 0.95 (95% CI, 0.94-0.96) for heart failure, 0.94 (95% CI, 0.93-0.95) for pneumonia, 0.93 (95% CI, 0.92-0.94) for major surgical procedures, and 0.97 (95% CI, 0.96-0.99) for all other conditions. The risk-adjusted adverse event rates declined significantly in all patient groups for adverse drug events, hospital-acquired infections, and general adverse events. For patients in the major surgical procedures group, the risk-adjusted rates of events after a procedure declined significantly. Conclusions and Relevance: In the US between 2010 and 2019, there was a significant decrease in the rates of adverse events abstracted from medical records for patients admitted for acute myocardial infarction, heart failure, pneumonia, and major surgical procedures and there was a significant decrease in the adjusted rates of adverse events between 2012 and 2019 for all other conditions. Further research is needed to understand the extent to which these trends represent a change in patient safety.


Assuntos
Hospitalização , Segurança do Paciente , Acidentes por Quedas/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecção Hospitalar/epidemiologia , Estudos Transversais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Masculino , Medicare/estatística & dados numéricos , Medicare/tendências , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Segurança do Paciente/estatística & dados numéricos , Pneumonia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Lesão por Pressão/epidemiologia , Medição de Risco , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Estados Unidos/epidemiologia
16.
Sr Care Pharm ; 37(8): 310-316, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35879847

RESUMO

Background An 81-year-old woman with type 2 diabetes, residing in a long-term care facility, has experienced a fall after medication changes, and a few days of irregular eating. Assessment This patient may be experiencing one or more common potential adverse events related to her diabetes medications. There is a need to create individualized treatment goals in this case. Outcome After a revision of treatment goals for hypertension and diabetes, and adjustments to the medication regimen, there have been no subsequent falls and this patient reports that she feels better. Conclusion As the person with diabetes ages, quality of life should be considered when setting treatment goals. Older people can be more at risk for adverse effects of medications to treat diabetes, so a clinician should be vigilant in the identification, management, and prevention of such adverse events. Inter-professional communication is key to the safe and effective treatment of diabetes.


Assuntos
Diabetes Mellitus Tipo 2 , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Acidentes por Quedas/prevenção & controle , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Feminino , Humanos , Qualidade de Vida
17.
Artigo em Inglês | MEDLINE | ID: mdl-35886415

RESUMO

BACKGROUND: Falls are common in older adults and increase in recent years. This study aimed to examine the risk of falls associated with long-acting benzodiazepines (BZDs) or tricyclic antidepressants (TCAs) use in community-dwelling older adults. METHODS: A nationwide population-based case-crossover design was used. We screened information on 6,370,275 fall or fall fracture cases among community-dwelling elderly patients from the database of the national health insurance data warehouse in South Korea. We extracted the data of elderly patients who visited the hospital for a fall and were diagnosed with the first fall or fall fracture after prescription of long-acting BZDs (n = 1805) or TCAs (n = 554). The study used conditional logistic regression analysis to analyze the associations and stratified analysis by gender and age group to control for their confounding effects. RESULTS: Risk of falls or fall fractures increased by more than two times after taking long-acting BZDs (odds ratio [OR] = 2.16; 95% confidence interval [CI] = 1.85-2.52) or TCAs (OR = 2.13; 95% CI = 1.62-2.83). The longer the prescription period of both, the higher the risk of falls or fall fractures was (≥49 days for long-acting BZDs vs. ≥ 56 days for TCAs). CONCLUSIONS: Long-acting BZDs or TCAs should be avoided or prescribed for a shorter duration based on these adverse effects. Health care providers should focus on fall prevention practices in older adults who take such drugs.


Assuntos
Acidentes por Quedas , Fraturas Ósseas , Acidentes por Quedas/prevenção & controle , Idoso , Antidepressivos Tricíclicos/efeitos adversos , Benzodiazepinas/efeitos adversos , Estudos Cross-Over , Humanos , Vida Independente
18.
PLoS One ; 17(7): e0266521, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35793336

RESUMO

BACKGROUND: Spatiotemporal modelling techniques allow one to predict injury across time and space. However, such methods have been underutilised in injury studies. This study demonstrates the use of statistical spatiotemporal modelling in identifying areas of significantly high injury risk, and areas witnessing significantly increasing risk over time. METHODS: We performed a retrospective review of hospitalised major trauma patients from the Victorian State Trauma Registry, Australia, between 2007 and 2019. Geographical locations of injury events were mapped to the 79 local government areas (LGAs) in the state. We employed Bayesian spatiotemporal models to quantify spatial and temporal patterns, and analysed the results across a range of geographical remoteness and socioeconomic levels. RESULTS: There were 31,317 major trauma patients included. For major trauma overall, we observed substantial spatial variation in injury incidence and a significant 2.1% increase in injury incidence per year. Area-specific risk of injury by motor vehicle collision was higher in regional areas relative to metropolitan areas, while risk of injury by low fall was higher in metropolitan areas. Significant temporal increases were observed in injury by low fall, and the greatest increases were observed in the most disadvantaged LGAs. CONCLUSIONS: These findings can be used to inform injury prevention initiatives, which could be designed to target areas with relatively high injury risk and with significantly increasing injury risk over time. Our finding that the greatest year-on-year increases in injury incidence were observed in the most disadvantaged areas highlights the need for a greater emphasis on reducing inequities in injury.


Assuntos
Acidentes por Quedas , Acidentes de Trânsito , Teorema de Bayes , Humanos , Incidência , Vitória/epidemiologia
19.
BMC Geriatr ; 22(1): 582, 2022 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-35840883

RESUMO

BACKGROUND: After a fall, more than half of older people living alone are unable to get up or get help independently. Fall-related recumbency makes affected individuals aware of functional status limitations and increased vulnerability. Patient-centered therapy is needed to manage physical, psychological, and social needs. This review summarizes the current evidence on care options for the special patient population. METHODS: The scoping review used the six-step framework proposed by Arksey and O´Malley and was conducted in accordance with the modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework for scoping reviews. The literature searches were conducted in five databases and ten online archives. Articles were screened, assessed and selected using defined inclusion and exclusion criteria. Articles were included if they were published in either German or English and related to the care of long lies. Thematic synthesis was based on the literature review. RESULTS: The search yielded 1047 hits, of which 19 research papers were included. Two themes were identified: (1) acute therapy, focused on prolonged recumbency and pronounced physical effects; and (2) preventive therapy, which examined standing up training, technical aids, and social control systems in the context of fall management. CONCLUSIONS: There are a limited number of interventions that relate to the patient population. The interventions are predominantly presented independently, so there is a lack of structuring of the interventions in the form of a treatment pathway. In addition to pooling professional expertise and an interprofessional approach, it is important to continue inpatient treatment in the home setting, even though the effectiveness of interventions in a home setting has hardly been verified thus far. The solution for a missing treatment process is first of all a planned, interprofessional and intersectoral approach in therapy.


Assuntos
Acidentes por Quedas , Hospitalização , Idoso , Humanos
20.
Dtsch Med Wochenschr ; 147(14): 899-907, 2022 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-35868315

RESUMO

Prevalence and incidence of both urinary and fecal incontinence increase with age. They reduce everyday competence and quality of life in all age groups. It is often not recognized because those affected do not express their complaints, but even if the diagnosis has been made, therapy and care often remains inadequate. The aim of the article is to know types of incontinence and their treatment options for a maximum of continence according to the established continence profiles. In older, especially multimorbid frail people, urinary incontinence is not primarily to be seen as a symptom of a disease, but as a "geriatric syndrome". In the interplay of multimorbidity, environmental factors and other contextual factors that can influence each other, this must be taken into account in diagnostics and therapy. Incontinence itself leads to increased immobility, thus to falls in the elderly and to mental impairments.


Assuntos
Incontinência Fecal , Incontinência Urinária , Acidentes por Quedas/prevenção & controle , Idoso , Incontinência Fecal/diagnóstico , Incontinência Fecal/epidemiologia , Incontinência Fecal/terapia , Humanos , Prevalência , Qualidade de Vida , Incontinência Urinária/diagnóstico , Incontinência Urinária/epidemiologia , Incontinência Urinária/terapia
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