Nivel de cumplimiento de metas internacionales de seguridad en un Sanatorio privado 2023 / Level of compliance with international safety goals in a private Sanatorium 2023

La presente investigación pretende evaluar el nivel de cumplimiento de las metas internacionales, que representan el foco principal para la mejora de calidad y seguridad de atención de los pacientes. La seguridad del paciente involucra a todos los estudios, prácticas y acciones promovidas por las instituciones sanitarias para disminuir y eliminar los riesgos de daños innecesarios relacionados con el cuidado de la salud. Metodología: Estudio descriptivo, observacional y transversal. De fuentes primaria y secundaria, Resultados: se abordaron las metas N° 1 la cual consiste en Identificar a los pacientes correctamente y la meta N° 6 la cual se refiere a Reducir el riesgo de lesiones en pacientes como resultado de caídas. En primer lugar, se destaca el cumplimiento en la identificación correcta del paciente y en segunda instancia la mejora del cumplimiento de medidas de prevención de caídas. Conclusión: Esta proximidad de los valores obtenidos genera un aspecto positivo para mejorar la seguridad de los pacientes y que, si bien el cumplimiento de las metas no es el deseado, es cercano al porcentaje planteado. Lo que en definitiva hace a este estudio un antecedente importante en la mejora continua con vista al futuro cercano[AU]

This research aims to evaluate the level of compliance with international goals, which represent the main focus for improving the quality and safety of patient care. Patient safety involves all studies, practices and actions promoted by health institutions to reduce and eliminate the risks of unnecessary harm related to health care. Methodology: Descriptive, observational and transversal study. From primary and secondary sources, Results: goals No. 1 were addressed, which consists of Identifying patients correctly and goal No. 6, which refers to Reducing the risk of injuries in patients as a result of falls. Firstly, compliance with correct patient identification stands out and secondly, improvement in compliance with fall prevention measures. Conclusion: This proximity of the values obtained generates a positive aspect to improve patient safety and that, although the fulfillment of the goals is not as desired, it is close to the proposed percentage. Which ultimately makes this study an important precedent in continuous improvement for the near future[AU]

Esta pesquisa tem como objetivo avaliar o nível de cumprimento das metas internacionais, que representam o foco principal para a melhoria da qualidade e segurança do atendimento ao paciente. A segurança do paciente envolve todos os estudos, e ações promovidas pelas instituições de saúde para reduzir e eliminar os riscos de danos desnecessários relacionados à assistência à saúde. Metodologia: Estudo descritivo, observacional e transversal. De fontes primárias e secundárias, dependendo do indicador e do objetivo para o qual a medição está sendo realizada. Resultados: Nesta pesquisa serão abordadas as metas nº1, que consiste em Identificar corretamente os pacientes e a meta nº 6, que es Reduzir o risco de lesões nos pacientes em decorrência de quedas. Foi realizado nos dois locais. Em primeiro lugar, destaca-se o cumprimento da correta identificação do paciente e, em segundo lugar, a melhoria no cumprimento das medidas de prevenção de quedas. Conclusão: Essa proximidade dos valores obtidos gera um aspecto positivo para melhorar a segurança do paciente e que, embora o cumprimento das metas não seja o desejado, está próximo do percentual proposto. O que acaba por tornar este estudo um precedente importante na melhoria contínua com vista ao futuro próximo.

Determinants influencing the implementation of multifactorial falls risk assessment and multidomain interventions in community- dwelling older people: a systematic review.

BACKGROUND: Multifactorial falls risk assessment and multidomain interventions are recommended by the World guidelines for falls prevention and management. To successfully implement these interventions, it is important to understand determinants influencing the implementation. METHODS: A literature search was conducted for this systematic review on the 3 December 2021 and updated on the 3 April 2023 in five databases: PubMed (including MEDLINE), EMBASE (via Embase.com), Cochrane Central Register of Controlled Trials (via Cochrane Library), Web of Science Core Collection and CINAHL (via EBSCO). Studies were included if they reported on determinants influencing the implementation of a multifactorial falls risk assessment and/or multidomain interventions in community-dwelling older people. Editorials, opinion papers, systematic reviews and studies focusing on one population (e.g. Parkinson) were excluded. Two researchers independently screened the articles on title, abstract and full text. The quality was evaluated based on a sensitivity analysis. 'The Comprehensive Integrated Checklist of Determinants of practice' was used to categorise the determinants. RESULTS: Twenty-nine studies were included. Determinants were classified as barriers (n = 40) and facilitators (n = 35). The availability of necessary resources is the most reported determinant. Other commonly reported determinants are knowledge, intention/beliefs and motivation at the levels of older people and healthcare professionals, fitting of the intervention into current practice, communication, team and referral processes and financial (dis)incentives. CONCLUSIONS: Mapping of the barriers and facilitators is essential to choose implementation strategies tailored to the context, and to enhance the uptake and effectiveness of a multifactorial falls risk assessment and/or multidomain interventions.

A study on the falls factors among the older adult with cognitive impairment based on large-sample data.

Introduction: This study explored the correlative factors of falls among the older adult with cognitive impairment, to provide distinct evidence for preventing falls in the older adult with cognitive impairment compared with the general older adult population. Methods: This study was based on a cross-sectional survey, with an older adult population of 124,124 was included. The data was sourced from the Elderly Care Unified Needs Assessment for Long-Term Care Insurance in Shanghai. Binary and multivariable logistic regression analyses were conducted sequentially on the correlative factors of falls. Multivariable logistic regression was performed on variables that were significant, stratified by cognitive function levels. Results: The incidence of fall in the past 90 days was 17.67% in this study. Specific variables such as gender (male), advanced age (≥80), residence with a elevator (or lift), mild or moderate disability, quality of sleep (acceptable/poor) were negatively correlated with falls, while higher education level, living alone, residence with indoor steps, unclean and untidy living environment, MCI or dementia, chronic diseases, restricted joints, impaired vision, and the use of diaper were positively correlative factors of falls. Comparing with older adult with normal cognitive functions, older adult with dementia faced a higher risk of falling due to accessibility barrier in the residence. For general older adults, less frequency of going outside and poor social interactions were positively correlated with falls, while for older adult with cognitive impairments, going outside moderately (sometimes) was found positively correlated with falls. Older adults with cognitive impairments have increased fall risks associated with chronic diseases, restricted joints, and the use of diaper. The risk of falling escalated with the greater number of chronic diseases. Discussion: For older adult with cognitive impairments, it is advisable to live with others. Additionally, creating an accessible living environment and maintaining the cleanness and tidiness can effectively reduce the risk of falls, particularly for those with MCI or dementia. Optimal outdoor activity plans should be developed separately based on the cognitive function of older adults. Older adult with dementia who have comorbidities should be paid special attention in fall prevention compared to the general older adult population.

Assessing the Potential of Technology to Describe Resident and Staff Interactions in Assisted Living Facilities.

PURPOSE: Falls are a significant financial burden and health hazard for residents in assisted living facilities (ALFs). However, limited capacity to observe residents has hindered understanding of resident-staff interactions within rooms. The current study aimed to describe nurse-resident interactions using data from a remote technology combining computer vision and staff location tracking. METHOD: Eighty-three staff working at an urban ALF with 215 residents were trained at the initiation of the study. Remote surveillance devices were installed in 32 residences and staff and resident interactions were tracked over 170 days. RESULTS: Staff visited residents an average of 20.7 times per day for short durations (mean = 1.08 minutes). Urgent alert response times averaged 3.0 minutes, with faster response times through the mobile application (mean = 2.7 minutes) compared to in-person (mean = 3.3 minutes) response. CONCLUSION: By better understanding staff activity patterns in ALFs, this study has the potential to improve fall prevention and care for residents in ALFs. [Journal of Gerontological Nursing, 50(7), 7-11.].

Retained foreign body in nose following eye injury.

A man in his 60s presented with diminution of vision of the left eye with nasal bleeding after accidental fall. On examination his left upper eyelid was lacerated and left temporal sclera was punctured which was repaired under local anaesthesia after which he was discharged by ophthalmologists but continued to complain of pain and left nasal obstruction. A non-contrast CT of paranasal sinuses revealed fracture of medial wall of left orbit, left ethmoid haemosinus and a metallic foreign body (FB) in the septum and anterior face of sphenoid. Diagnostic nasal endoscopy performed to remove the metallic FB showed plastic splinters embedded in the mucosa of nasal cavity which was unexpected. Hence, the FB was removed in two sittings because of diagnostic dilemma.

Falls prevention in older people and the role of nursing.

Falls among older individuals pose a significant public health challenge globally, impacting both individual wellbeing and healthcare systems. This article examines the importance of falls prevention in older people and the pivotal role of nursing in this domain. It presents statistics indicating the high prevalence of falls among older adults, highlighting their substantial impact on morbidity, mortality and healthcare costs. Furthermore, it discusses the multifactorial nature of fall risk factors, including age-related changes, chronic health conditions, medication use, impaired mobility, sensory deficits and environmental hazards. Nursing interventions encompass comprehensive assessments, personalised care plans, patient education and advocacy efforts aimed at reducing fall risks and enhancing safety. By addressing intrinsic and extrinsic factors contributing to falls, nurses contribute significantly to improving the quality of life for older adults and reducing the economic burden associated with fall-related injuries.

Hospital-associated complications in frail older adults.

As the Japanese population continues to age steadily, the number of older adults requiring healthcare has increased. Evidence demonstrates that hospitalization for acute care has a negative impact on the health outcomes of older adults. Frail older adults tend to have multifactorial conditions collectively known as "geriatric syndromes." When those with these premorbid conditions are hospitalized for acute care, they tend to develop new problems such as delirium and new functional impairments. Adverse consequences of hospitalization include the risk of loss of functional independence and chronic disability. In 2019, the new concept of "hospital-associated complications" (HACs) was proposed to describe these new problems. HACs comprise five conditions: hospital-associated falls, delirium, functional decline, incontinence, and pressure injuries. This review discusses the important issues of HACs in relation to their classification, prevalence, risk factors, prevention, and management in older adults hospitalized for acute care. Robust prevention and management are imperative to address the serious consequences and escalating medical costs associated with HACs, and a multidimensional and multidisciplinary approach is key to achieving this goal. Comprehensive geriatric assessment (CGA) is the cornerstone of geriatric medicine and offers a holistic approach involving multidisciplinary and multidimensional assessments. Considerable evidence is accumulating regarding how CGA and coordinated care can improve the prognosis of hospitalized older adults. Further research is needed to understand the occurrence of HACs in this population and to develop effective preventive measures.

Comparison of Radiographic Measurement Parameters of the Wrist in Patients with and without Scaphoid Fracture after Fall on an Outstretched Hand.

PURPOSE OF THE STUDY: To investigate the effects of anatomical variations on the mechanism of scaphoid fracture by comparing the radiologic parameters of the wrist of patients with and without scaphoid fracture after a fall on an outstretched hand. MATERIAL AND METHODS: Cross-sectional comparative retrospective analysis of radiographs of patients with (Group 1, n=169) and without scaphoid fracture (Group 2, n=188). Morphometric data were measured including radial inclination (RI), radial height (RH), ulnar variance (UV), carpal height (CH) ratio, revised carpal height (RCH) ratio and palmar tilt of the distal radius (PT). Receiver operating characteristics (ROC) curve analysis was used to assess the diagnostic performance for each variable with statistically significant difference. RESULTS: The mean RI and PT degrees and RH length were statistically significantly higher, and the mean UV was lower in Group 1 compared to Group 2. No difference was determined between the groups with respect to the CH ratio and RCH ratio. With ROC curve analysis, the cut-off value with the highest odds ratio was determined as RH (Cut-off value=10.77 mm, OR=21.886). CONCLUSIONS: Although higher RI, RH, PT values and more negative ulnar variance were observed in the scaphoid fracture group compared to the non-fracture group, ROC curve analysis showed that only increased RH can be considered as a possible risk factor for scaphoid fractures after fall on an outstretched hand. KEY WORDS: radiographs, risk factor, scaphoid fracture, wrist morphology.

Developing a fall prevention program in an inpatient spinal cord injury rehabilitation unit: A participatory action research study.

IMPORTANCE: Spinal cord injury is a lifelong disability necessitating early management of falls during inpatient admissions. However, there is a paucity of research on fall prevention and management in Spinal cord injury rehabilitation. OBJECTIVE(S): This study aimed at developing a fall prevention program in an inpatient rehabilitation Spinal cord injury unit. METHOD: A participatory action research approach utilizing a before-and-after, mixed-method design was employed for this study. The study was performed at Rofaydeh Rehabilitation Hospital in Tehran, Iran, from 2021 to 2022. the study implemented Cohen's four-stage model, encompassing the design of a change program, action, observation and evaluation, and feedback stages. A purposeful sampling method was utilized to select 19 nurses and members of the rehabilitation team from the hospital, ensuring maximum diversity. Data collection involved semi-structured interviews, focus groups, and a checklist for fall prevention measures. Qualitative content analysis, alongside descriptive (frequency, mean, and standard deviation) and inferential statistics (paired t-tests and Chi-square tests), were employed for data analysis. The study adhered to COREQ guidelines. RESULTS: Falls were most common among patients aged fifty years or older (P = 0.026). Throughout the study period, men were more likely to experience falls than women (P = 0.01). Preventive interventions have led to significant improvements in indicators of patient monitoring and care, patient education, and environmental safety, as demonstrated by a paired-sample t-test (P<0.001). Moreover, factors contributing to patients' falls included "shortcomings in fall prevention policies" and "lack of knowledge and participation among patients and caregivers." Changes implemented in the Spinal Cord Injury unit involved enhancing interprofessional interactions, conducting educational workshops for patients and their companions, and identifying high-risk patients. These findings indicate a significant decrease in the incidence of falls following the intervention (P = 0.02). CONCLUSIONS: The study found that a multifaceted intervention can increase knowledge about fall risks and substantially reduce both falls and associated minor injuries.

Reduced adaptability to balance perturbations in older adults with probable cognitive impairment after a severe fall.

Falls in older individuals often result from unexpected balance disturbances during walking, necessitating the analysis of recovery strategies for effective falls prevention. This becomes particularly crucial for individuals with cognitive impairment, who face a higher fall risk compared to cognitively healthy adults. Hence, our study aimed to compare the recovery response to standardized walking perturbations on a treadmill between older adults with cognitive impairment and cognitively healthy older adults. 36 individuals with a recent history of a severe fall, leading to an emergency department visit without subsequent admission, were stratified into two groups (with and without probable cognitive impairment) based on scores of the Montreal Cognitive Assessment. Recovery performance was quantified using force plate data from a perturbation treadmill (M-Gait, Motek Medical B.V., Amsterdam, the Netherlands), specifically evaluating the number of steps needed to restore step length and width to pre perturbation baseline across two trials of nine different perturbations. Individuals with cognitive impairment (n = 18, mean age: 74.7) required significantly (p = 0.045, Cohen's d = 0.69) more steps to recover total steps after perturbations compared to cognitively healthy individuals (n = 18, mean age: 69.7). While step width recovery was similar between the groups, those with probable cognitive impairment required significantly more steps to recover their step length (p = 0.039, Cohen's d = 0.72). Thus, our findings indicate that older adults with probable cognitive impairment manifest inferior gait adaptability, especially in adapting step length, potentially underscoring a critical aspect for effective falls prevention in this population.

A 12-week Taijiquan practice improves balance control and functional fitness in fall-prone postmenopausal women.

Purpose: Falls are the leading cause of accidental death among older persons, with postmenopausal women facing a greater hazard of falling due to osteoporosis. This study aimed to examine the effects of Taijiquan practice on balance control and functional fitness in at-risk females. Methods: Chinese women who self-reported a tendency to fall and had a baseline one-leg stand test time (4.1 s in the Taijiquan group) below the national average for their age group (60-64 years: 10.9 s, 65-69 years: 9.9 s) were assigned to either a control group (n = 26, mean age = 63.9 years) or a Taijiquan group (n = 24, mean age = 63.9 years). The Taijiquan group participated in a 12-week supervised intervention, while the control group maintained their daily activities. The average duration of each exercise session was 52 min. Static balance and functional fitness were assessed at the beginning and end of the intervention. Results: After 12 weeks, the Taijiquan group significantly outperformed the control group in terms of balance, flexibility, and muscular fitness (all p < 0.05). Participants in the Taijiquan group improved their one-leg stand by 61.0% (+2.5 s, Hedge's g = 0.85), arm curl by 8.3% (+1.7 repetitions, g = 0.53), handgrip strength by 8.3% (+1.9 kg, g = 0.65), and sit-and-reach by 163.2% (+6.2 cm, g = 1.17). Conclusion: The improvement in balance, coupled with other functional fitness benefits, suggests that Taijiquan could serve as a useful exercise for older women with an elevated risk of falling.

Exergames for falls prevention in sheltered homes: a feasibility study.

Introduction: Falls prevention is a global priority given its substantial impact on older adults and cost to healthcare systems. Advances in telerehabilitation technology such as `exergaming' show potential for delivering accessible, engaging exercise programs for older adults. This study aimed to establish the feasibility, acceptability and usability of exergaming in sheltered housing. Methods: A mixed-methods study with participants randomised in 2 sheltered housing facilities to intervention (n = 1 home, 12 participants) and control (n = 1 home 2, 12 participants) provided usual care for all, (physiotherapy prescribed strength and balance exercises and falls prevention advice) and a 6-week supervised exergaming programme (MIRA) offered 3 times per week to the intervention group only. At 6 weeks, feasibility, usability and acceptability outcomes were collected and analysed using descriptive statistics; qualitative focus groups with participants and interviews with staff were also completed and thematically analysed to elicit barriers and facilitators to usability and acceptability. Results: Mean exercise per week increased from 10.6 to 14.1 minutes in the control group and 9.6 to 36.8 minutes in the intervention group. All study processes and measures appeared feasible; 72% of those invited consented to taking part and 92% completed 6-week follow-up. Individual domains for the System Usability Scores (SUS) showed participants felt `very confident' using the system with support (70%), would `like to use exergames frequently' (50%) and found the system `easy to use' (90%). However, they also felt they `needed to learn a lot at the beginning' (40%) and would `need technical support' (70%) for independent use of the exergames. Mean overall SUS was 63 reflecting moderate usability for independent use. Qualitative data indicated exergames were well received and highlighted motivational and social aspects; costs and set up. Staff also felt exergaming complemented traditional care. Discussion: Our study contributes to the evidence guiding the use of exergames to deliver suitable falls prevention interventions for older adults within sheltered housing in community settings.

Interprofessional approach to fall prevention in hospital care.

OBJECTIVE: To understand the perception and experience of health professionals regarding fall prevention practices in hospital inpatient units. METHOD: This is a qualitative exploratory and descriptive case study based on the Canadian framework of interprofessional competences. Data was collected from two focus groups, with different health professionals in each group, and thematic content analysis was used. RESULTS: Five categories were drawn up which showed intense convergence between the participants of the two focus groups, within the context of fall prevention practices: communication between professionals and patients/carers for fall prevention, interprofessional communication for fall prevention, clarification of roles for fall prevention, health education about risk and fall prevention and continuing education for fall prevention. CONCLUSION: Teamwork and collaborative practice are important for achieving good results in the prevention of falls in hospital care, but for this to happen, health professionals need to acquire the necessary competences for collaborative action.

Sleep quality and falls in middle-aged and older adults: ELSI-Brazil study.

OBJECTIVE: To verify the association between low self-reported sleep quality (LSQ) and fall in middle-aged and older adults every half-decade of life. METHOD: A cross-sectional study was conducted using data from the first wave (2015-2016) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is nationally representative. The sample consisted of 8,950 participants who were allocated into eight age groups: 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, and ≥ 85 years. The questionnaires used included self-reported sleep quality and the International Physical Activity Questionnaire short version. Fisher's exact test followed by binary logistic regression analysis was performed to identify the odds ratio of sleep quality for fall occurrence, controlled for confounding variables. RESULTS: Individuals aged 50-105 years (63.6 ± 10.2 years), 57.0% females and 43.0% males, participated in this study. Overall, 21.5% of participants experienced at least one fall. The relative frequency of participants classified as having high or LSQ remained constant across each half-decade of life. The LSQ exhibited a statistically significant OR (p < 0.05) for falls across age groups up to 84, even after accounting for confounding variables. CONCLUSION: LSQ is significantly associated with an increased occurrence of fall in adults aged >50 years, but not for ≥ 85 years regardless of sex and physical activity level.

'You Just Struggle on Your Own': Exploring Older People and Their Caregivers' Perspectives About Falls Prevention Education in Hospitals.

BACKGROUND: Providing older patients with an opportunity to participate in individualised falls preventive education, has been shown to reduce hospital falls. However, few studies have explored older peoples' perspectives of hospital falls prevention education. This study aimed to explore older people and their caregivers' knowledge and awareness about hospital falls prevention, including their reflections on the education they received when hospitalised. METHODS: A qualitative, exploratory study with focus groups and semistructured interviews was conducted. Participants were a purposively selected sample of community-dwelling older people (65+ years) admitted to a hospital in the past 5 years and caregivers of older people. Data were thematically analysed using deductive and inductive approaches, and a capability-opportunity-motivation-behaviour model was applied to understand key determinants of implementing falls education for hospitalised older people. RESULTS: Participants' [n = 46 (older people n = 37, age range 60-89 years), caregivers n = 9] feedback identified five themes: distress and disempowerment if the participant did have a hospital fall or nearly fell, anxiety and uncertainty about what behaviour was required while in hospital, insufficient and inconsistent falls prevention education, inadequate communication and underlying attitudes of ageism. Applying a behaviour change model suggested that older people and their caregivers did not develop falls prevention knowledge, awareness or motivation to engage in falls prevention behaviour. Older people were also provided with limited opportunities to engage in falls preventive behaviour while in hospital. CONCLUSION: Older people in our study received sporadic education about falls prevention during their hospital admissions which did not raise their awareness and knowledge about the risk of falls or their capability to engage in safe falls preventive behaviour. Conflicting messages may result in older people feeling confused and anxious about staying safe in hospital.

Reflections on the challenges of conducting an international multicentre randomized controlled trial of balance training in addition to pulmonary rehabilitation and its impact on fall incidence in people with COPD.

BACKGROUND: Pulmonary rehabilitation (PR) is accepted as standard care for individuals with COPD. We conducted an international, multi-centred randomized controlled trial (RCT) to determine if adding balance training to PR would reduce the incidence of falls in people with COPD. While there have been many trials investigating the effectiveness of PR, few have involved international collaboration. Successful execution of rehabilitation trials requires a significant investment of time, staffing, and resources. With the recent completion of the Balance Training for Fall Reduction in COPD RCT, we report on the design, implementation, and execution of our trial using project management phases. We also highlight our lessons learned for consideration in future multi-centre rehabilitation trials. METHODS: This was a retrospective review of the planning, preparation, timelines, and personnel training involved in the execution of this study using four of the five project management phases described by Farrell et al. in 2010: (1) initiation, (2) planning, (3) execution, and (4) monitoring and controlling. We report descriptive statistics as percentages and counts and summarize our lessons learned. RESULTS: Ten outpatient PR programs in three continents participated. Thirty-one personnel worked on the trial across all sites. Enrolment began in January 2017 and was suspended in March 2020 due to the COVID-19 pandemic. Approximately 1275 patients were screened, 455 (36%) were eligible, 258 (57%) consented, 243 (53%) participated, and 130 (61%) completed the 12-month follow-up assessment. Lessons learned through our experience included (1) ensuring awareness of funder policies and considering the impact on collaborating sites; (2) preparing for the possibility of human resource and program disruptions; (3) anticipating site dropout and having a contingency plan in place; (4) planning and monitoring process measure data before, during, and after trial initiation; (5) ensuring frequent and consistent communication with and between collaborating sites; (6) maximizing features of database platform to ensure data set completeness and controlled data access; and (7) identifying strategies for increasing patient engagement in a high-demand study. CONCLUSIONS: We identify seven lessons learned through our experience conducting an international, multicentre rehabilitation-based RCT. These lessons can provide guidance to other trialists conducting studies with similar logistics and may assist with future trial planning and implementation.

Nursing care for hospitalized older adults - fall accidents versus safe mobility: a scoping review.

OBJECTIVES: to map the constituent elements of the safe mobility concept present in hospital care for older adults. METHODS: a scoping review of 35 articles searched in databases and gray literature - BDENF/VHL, Scopus, CINAHL/EBSCO, Embase, Web of Science, PEDro, MEDLINE/PubMed and CAPES Theses and Dissertations Catalog. No time or language cut-off was established. RESULTS: none of the studies presented a clear safe mobility concept, however its constituent elements involve factors related to patient (behavioral factors, conditions, diseases, signs and symptoms, nutritional status, age, balance, strength, gait quality, sleep), the institution (environment, treatment devices, guidelines, medications and polypharmacy, material and human resources and clothing/shoes) and the nature of the interventions (related to the patient, institution and family). FINAL CONSIDERATIONS: the constituent elements of safe mobility express hospital units' capacity to guarantee care and protection from fall accidents for hospitalized older adults.

Association of oxaliplatin-containing adjuvant duration with post-treatment fall-related injury and fracture in patients with stage III colon cancer: a population-based retrospective cohort study.

PURPOSE: Oxaliplatin-containing adjuvant chemotherapy yields a significant survival benefit in stage III colon cancer and is the standard of care. Simultaneously, it causes dose-dependent peripheral neuropathy that may increase the risk of fall-related injury (FRI) such as fracture and laceration. Because these events carry significant morbidity and the global burden of colon cancer is on the rise, we examined the association between treatment with a full versus shortened course of adjuvant chemotherapy and post-treatment FRI and fracture. METHODS: In this overlap propensity score weighted, retrospective cohort study, we included patients aged ≥ 18 years with resected stage III colon cancer diagnosed 2007-2019 and treated with oxaliplatin-containing adjuvant chemotherapy (oxaliplatin plus a fluoropyrimidine; capecitabine [CAPOX] or 5-fluorouracil and leucovorin [FOLFOX]). Propensity score methods facilitate the separation of design from analysis and comparison of baseline characteristics across the weighted groups. Treatment groups were defined as 50% (4 cycles CAPOX/6 cycles FOLFOX) and > 85% (7-8 cycles CAPOX/11-12 cycles FOLFOX) of a maximal course of adjuvant chemotherapy to approximate the treatment durations received in the IDEA collaboration. The main outcomes were time to any FRI and time to fracture. We determined the subdistribution hazard ratios (sHR) estimating the association between FRI/fracture and treatment group, accounting for the competing risk of death. RESULTS: We included 3,461 patients; 473 (13.7%) received 50% and 2,988 (86.3%) received > 85% of a maximal course of adjuvant therapy. For post-treatment FRI, median follow-up was 4.6 years and total follow-up was 17,968 person-years. There were 508 FRI, 301 fractures, and 692 deaths. Treatment with > 85% of a maximal course of therapy conferred a sHR of 0.84 (95% CI 0.62-1.13) for post-treatment FRI and a sHR of 0.72 (95% CI 0.49-1.06) for post-treatment fracture. CONCLUSION: For patients with stage III colon cancer undergoing treatment with oxaliplatin-containing adjuvant chemotherapy, any potential neuropathy associated with longer durations of treatment was not found to result in greater rates of FRI and fracture. Within the limits of this retrospective study, our findings suggest concern about FRI, while mechanistically plausible, ought not to determine treatment duration.