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"Falls"
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Where is Niagara Falls?
People from all over the world come to explore Niagara: among them the daredevils determined to tumble down or walk across the falls on tightrope. Learn about the hare-brained stunts and how the falls were formed and how--one day--they will disappear.
Book
A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries
Injuries from falls are major contributors to death and complications in older adults. In this pragmatic, cluster-randomized trial, a multifactorial intervention that was administered by nurses did not result in a significantly lower rate of first adjudicated serious fall injury than enhanced usual care.
Journal Article
One job town : work, belonging, and betrayal in Northern Ontario
\"There's a pervasive sense of betrayal in areas scarred by mine, mill and factory closures. Steven High's One Job Town delves into the long history of deindustrialization in the paper-making town of Sturgeon Falls, Ontario, located on Canada's resource periphery. Much like hundreds of other towns and cities across North America and Europe, Sturgeon Falls has lost their primary source of industry, resulting in the displacement of workers and their families. One Job Town takes us into the making of a culture of industrialism and the significance of industrial work for mill-working families. One Job Town approaches deindustrialization as a long term, economic, political, and cultural process, which did not begin and simply end with the closure of the local mill in 2002. High examines the work-life histories of fifty paper mill workers and managers, as well as city officials, to gain an in-depth understanding of the impact of the formation and dissolution of a culture of industrialism. Oral history and memory are at the heart of One Job Town, challenging us to rethink the relationship between the past and the present in what was formerly known as the industrialized world.\"-- Provided by publisher.
Book
ADHERENCE TO INTERVENTIONS AT A FALL CLINIC: PRELIMINARY DESCRIPTIVE DATA FROM A SINGLE ACADEMIC INSTITUTION
Abstract
Background
Falls and fall-related injuries are major public health concerns. Approximately 50 billion dollars are spent on annual medical costs related to falls. Fall prevention is a priority for promoting active and healthy aging in older adults. Fall prevention clinics enable focused evaluation, identification, and treatment of modifiable risk factors, specifically for falls; however, their effectiveness is dependent upon patient adherence to preventive interventions.
Methods
We analyzed patients aged > 65 years who visited our fall clinic between February 2021 and February 2023. We took an interdisciplinary approach to improve adherence to recommendations, including follow-up phone calls by a dedicated nurse to confirm adherence, nurse-directed interventions such as Tai Chi sessions, and home environment assessments by a social worker.
Results
48 patients were included in this analysis, with a mean age of 84 (65-99), and 85% were female. Fall-specific risk factors identified included impairment of strength, gait, or balance (96%); use of fall-risk-increasing medications (54%); problems with feet affecting gait (40%); visual impairment (29%); and postural hypotension (6%). The adherence rates for our interventions were 48% for physical therapy referrals, 28% for podiatry referrals, 36% for ophthalmology referrals, 47% for other referrals, 75% for vitamin D prescriptions, and 50% for assistive device prescriptions.
Conclusions
There is room for improvement in adherence to referrals. A larger sample size and longer follow-up period are required to investigate factors related to non-adherence. The delivery of both verbal and written recommendations, the identification of each patient’s barriers, and same-day referrals may help improve adherence.
Journal Article
Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial
Falls are the most frequent adverse events that are reported in hospitals. We examined the effectiveness of individualised falls-prevention education for patients, supported by training and feedback for staff, delivered as a ward-level programme.
Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge, cluster-randomised study, undertaken during a 50 week period. Units were randomly assigned to intervention or control groups by use of computer-generated, random allocation sequences. We included patients admitted to the unit during the study with a Mini-Mental State Examination (MMSE) score of more than 23/30 to receive individualised education that was based on principles of changes in health behaviour from a trained health professional, in addition to usual care. We provided information about patients' goals, feedback about the ward environment, and perceived barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by patients. The coprimary outcome measures were patient rate of falls per 1000 patient-days and the proportion of patients who were fallers. All analyses were by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials registry, number ACTRN12612000877886).
Between Jan 13, and Dec 27, 2013, 3606 patients were admitted to the eight units (n=1983 control period; n=1623 intervention period). There were fewer falls (n=196, 7·80/1000 patient-days vs n=380, 13·78/1000 patient-days, adjusted rate ratio 0·60 [robust 95% CI 0·42–0·94], p=0·003), injurious falls (n=66, 2·63/1000 patient-days vs 131, 4·75/1000 patient-days, 0·65 [robust 95% CI 0·42–0·88], p=0·006), and fallers (n=136 [8·38%] vs n=248 [12·51%] adjusted odds ratio 0·55 [robust 95% CI 0·38 to 0·81], p=0·003) in the intervention compared with the control group. There was no significant difference in length of stay (intervention median 11 days [IQR 7–19], control 10 days [6–18]).
Individualised patient education programmes combined with training and feedback to staff added to usual care reduces the rates of falls and injurious falls in older patients in rehabilitation hospital-units.
State Health Research Advisory Council, Department of Health, Government of Western Australia.
Journal Article