https://www.archives-pmr.org/article/S0003-9993(01)63215-5/pdf

Gait variability and fall risk in community-living older adults: A 1-year prospective study

The purpose of this book is to provide nurses with the best available research, thereby enabling better decisions that result in improved health care and safety practices and lead to better outcomes. Nurses often are the ones who find errors and prevent pa tient harm. In their focus on patient safety, nurses identify critical issues and research for evidence-based practice. This book is a great resource for practicing nurses, nurse educators, re searchers, leaders, and students. The Agency for Healthcare Research and Quality strongly promotes that safety and quality of health care is dependent on the availability of the best research possible and the ability to deliver results of research into the hands of practitioners, policy makers, and consumers. This text is a culmination of subject expert knowledge, practice, and research from 89 contributors who represent a broad range of nurses and senior researchers across the nation. The topics covered in this text provide excellent background for any clinician, nurse educator, or nurse leader. The topics include • evidence-based practice, • patient-centered care, • working environment for nurses, • care models, and • patient acuity. The chapters provide an easy-tounderstand guide and include a background section and analysis of the literature based on the topic presented. Practice implications are identified at the end of each chapter and guide efforts for improving quality and patient care. Research implications for each topic outline target areas for improvement and can be used by clinicians to inform and guide practice. There are also questions and issues to develop or expand thesis topics and research papers, which faculty members may find useful. A section on critical opportunities contains current topics, including wrong site surgery, communication hand offs by nurses, medication administration safety, medication reconciliation, and personal safety for nurses. These topics are very well presented with numerous research citations and examples from all areas of nursing— from patient entry to the facility to discharge and home care. The authors use exhibits, tables, guides, templates, models, and representations within each chapter and conclude with a list of references including web sites for further independent review and citation. The volumes are written in a manner that allows for quick access, and they are

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Objective: To estimate the incidence and direct medical costs for fatal and non-fatal fall injuries among US adults aged ⩾65 years in 2000, for three treatment settings stratified by age, sex, body region, and type of injury. Methods: Incidence data came from the 2000 National Vital Statistics System, 2001 National Electronic Injury Surveillance System-All Injury Program, 2000 Health Care Utilization Program National Inpatient Sample, and 1999 Medical Expenditure Panel Survey. Costs for fatal falls came from Incidence and economic burden of injuries in the United States; costs for non-fatal falls were based on claims from the 1998 and 1999 Medicare fee-for-service 5% Standard Analytical Files. A case crossover approach was used to compare the monthly costs before and after the fall. Results: In 2000, there were almost 10 300 fatal and 2.6 million medically treated non-fatal fall related injuries. Direct medical costs totaled $0.2 billion dollars for fatal and $19 billion dollars for non-fatal injuries. Of the non-fatal injury costs, 63% ($12 billion) were for hospitalizations, 21% ($4 billion) were for emergency department visits, and 16% ($3 billion) were for treatment in outpatient settings. Medical expenditures for women, who comprised 58% of the older adult population, were 2–3 times higher than for men for all medical treatment settings. Fractures accounted for just 35% of non-fatal injuries but 61% of costs. Conclusions: Fall related injuries among older adults, especially among older women, are associated with substantial economic costs. Implementing effective intervention strategies could appreciably decrease the incidence and healthcare costs of these injuries.

https://injuryprevention.bmj.com/content/injuryprev/12/5/290.full.pdf

The costs of fatal and non-fatal falls among older adults

Risk factors for falls among older adults: a review of the literature.

Background and Purpose:The Timed Up and Go (TUG) test is widely employed in the examination of elders, but definitive normative reference values are lacking. This meta-analysis provided such values by consolidating data from multiple studies.Methods:Studies reporting TUG times for apparently

/pdf/reference-values-for-the-timed-up-and-go-test-a-descriptive-2mtcipvp1c.pdf

Reference values for the timed up and go test: a descriptive meta-analysis.

https://www.archives-pmr.org/article/S0003-9993(97)90034-4/pdf

Increased gait unsteadiness in community-dwelling elderly fallers

OBJECTIVE: The Drug Regimen Unassisted Grading Scale (DRUGS) was developed and employed in testing the hypothesis that the inability to take medication independently may correlate with the presence of cognitive impairment.

DESIGN: Cross-sectional study.

SETTING: Two continuing care retirement facilities in the Greater Boston area.

PARTICIPANTS: The study population included outpatients ≥ 70 years old.

MEASUREMENTS: We developed a novel performance-based measure, the DRUGS tool, involving a step-wise progression of four tasks: (1) identification; (2) access; (3) dosage; and (4) timing.

RESULTS: Fifty-nine participants aged 84.2 ± 5.1 years (mean ± SD) completed the study. The DRUGS tool score was inversely related to age (r = -.41, P = .001). Compared with independent-living, residence in assisted-living was associated with lower DRUGS tool scores (82.0% vs 93.8%, P = .009). The DRUGS tool score was associated with self-reported Medication Management capacity (94.8% able vs 86.2% unable to take medications independently by self-report, P = .047). Both DRUGS tool score and self-reported Medication Management capacity were associated with MMSE (P = .0008 and P = .044, respectively). The multivariate model, with DRUGS tool Summary Score as the dependent variable, adjusted for age and sex, included MMSE (P = .023) and self-reported IADL (P = .038).

CONCLUSION: There is an association between performance on the DRUGS tool and level of cognitive function. The DRUGS tool represents a unique individualized, yet standardized, assessment of the ability to function independently for ambulatory older persons. It may be useful for identifying those highly functioning older persons, at an early phase of cognitive decline, in whom targeted intervention would likely be most effective and efficient. J Am Geriatr Soc 47:592–596, 1999.

Medication management capacity in highly functioning community-living older adults: detection of early deficits.

Background We tested the hypothesis that impairment in the ability to take medication independently predicts early functional decline Methods A 12-month, prospective cohort study was performed at two continuing-care retirement facilities using the Drug Regimen Unassisted Grading Scale (DRUGS) This geriatric screening tool utilizes a stepwise progression of four tasks: (i) identification, (ii) access (iii) dosage, and (iv) timing Results Forty-seven (86%) of the eligible participants completed the 12-month follow-up assessment; three were transferred to skilled nursing facilities The mean age at study entry was 842+/-51 years; 72% of the participants were women, and 68% were college educated At 12 months there was a decline in the Mini-Mental State Examination (MMSE) score (p = 029), an increase in the timed "Up and Go" test (p = 023), and a decline in the DRUGS score (p 029) Nine (18%) of the participants resided in assisted- versus independent-living situations compared with three participants (5%) at study entry (p = 031) Both 12-month DRUGS score and 12-month self-reported medication management capacity were associated with 12-month MMSE (p = 0001 and p = 019, respectively) Baseline DRUGS score was associated with 12-month MMSE and Geriatric Depression Scale scores (p = 0002 and p = 002, respectively) Both baseline DRUGS score and self-reported medication management capacity were also associated with residence in assisted-living communities at 6 months (p = 029 and p = 040, respectively) MMSE was not associated with any of the clinical outcomes

/pdf/one-year-follow-up-of-medication-management-capacity-in-5a4dc5mt4h.pdf

Helen K. Edelberg

Papers

Gait variability and fall risk in community-living older adults: A 1-year prospective study

Increased gait unsteadiness in community-dwelling elderly fallers

Medication management capacity in highly functioning community-living older adults: detection of early deficits.

One-Year Follow-Up of Medication Management Capacity in Highly Functioning Older Adults

The biology of Alzheimer's disease