STUDIO PROSPETTICO PER LA VALUTAZIONE DEI FATTORI DI RISCHIO DELLE CADUTE NELLE RESIDENZE SANITARIE ASSISTENZIALI (RSA) PER ANZIANI. FALL RISK ASSESSMENT IN INSTITUTIONALIZED ELDERLY LONGITUDINAL STUDY - FRAILS
Tesi di Dottorato
Data di Pubblicazione:
2015
Citazione:
STUDIO PROSPETTICO PER LA VALUTAZIONE DEI FATTORI DI RISCHIO DELLE CADUTE NELLE RESIDENZE SANITARIE ASSISTENZIALI (RSA) PER ANZIANI. FALL RISK ASSESSMENT IN INSTITUTIONALIZED ELDERLY LONGITUDINAL STUDY - FRAILS / A. Castaldo ; relatore: L.M. Bergamaschini. DIPARTIMENTO DI SCIENZE BIOMEDICHE E CLINICHE "L. SACCO", 2015 Nov 19. 28. ciclo, Anno Accademico 2015. [10.13130/castaldo-anna_phd2015-11-19].
Abstract:
Keywords: falls; risk factors; older; nursing homes
Introduction
Falls are common in older persons and sometimes lead to unfavorable outcomes, as traumas and hip fracture. The elderly living in nursing homes are at greater risk of injury resulting from a fall, due to a higher degree of frailty. Some factors are more associated to falls and especially to traumatic falls: functional deficiency, use of aids for walking, osteoporosis, postural instability, deficit of balance and gait; chronic disease, cognitive impairment, and polytherapy use of psychotropic drugs, new environments, previous falls (1,2). The guidelines on the prevention of falls in older people recommend the evaluation of risk factors, as a key element to prevent further falls and, especially, trauma secondary to falls (3,4).
Aim of the study and Methods
In order to know the risk factors associated with falls, the incidence of falls and traumatic falls in people cared for in nursing home, it was performed a prospective observational study with 12 months of follow up (October 2013 - September 2014).
For every resident we detect the functional, cognitive and nutritional status, comorbidity, number and type of drugs, risk of falling, number and outcomes of falls. It was used univariate and multivariate logistic regression to estimate the predictive role of clinical variables on people who had fallen. Results were considered significant at a level of p value <0.05 and a confidence interval of 95%, with two-tailed test.
Results
The study, carried out in two nursing homes in Milan, involved 409 residents of which 331 in ordinary units, and in 78 specialized units for dementia, predominantly women (82%) with a mean age of 83 years (± 9.4).
Most of the residents had a total dependence (43.8%) or severe (32.8%) in the activities of daily living (Barthel index median: 26) and mild (11%), moderate (20%) or severe (42%) cognitive impairment, detected by the Mini Mental State Examination. Residents showed an average 6.30 (± 2.2) disease with moderate severity (2.24 ± 0.47), derived by the average of 13 categories of the Cumulative Illness Rating Scale. In 117 residents it was detected a risk of malnutrition: moderate (11.5%) or high (17.1%), using the Malnutrition Universal Screening Tool. However only 67 residents were underweight (body mass index: 0 to 18.49).
In one of the nursing home 83% (185/223) had a risk of falling, with a median value of 5, detected by the Conley Scale (≥2 values are indicative of risk). In the second RSA, based on the scores of Tinetti Balance Assessment Tool, 106/186 residents were at risk of falling, including 31.2% lower and 25.8% higher, while 80 residents were not considered at risk, because they did not walk. About 40% of the residents were restrained with one or more restraint and at 286/409 residents (70%) were applied to bilateral bed rails.
The residents took an average of 8.5 (± 3.4) active ingredients per day (median 8, range 0-19), of which an average of 4.8 (± 2.2) drugs at risk (median 5, range 0-14 ) which include cardiovascular drugs, agents on metabolism/alimentary tract and acting on the nervous system.
In the observation period 111/409 (27%) residents fell, of which 54 had a lesion from mild to severe. It was detected an average of 1.26 (± 0.48) falls/resident, with a range from 1 to 10 and a higher percentage (and statistically significant) of falls among males (28/75) compared with women (83/334 ) and the residents cared for in special unit for dementia (29/78) than residents in ordinary units (83/331).
Multivariate logistic regression confirmed statistically significant risk factors: type of nursing home unit, level of dependence in activities of daily living, previous falls, psycholeptics. Residents
Tipologia IRIS:
Tesi di dottorato
Keywords:
cadute; fattori di rischio; anziani; residenze assistenziali ( falls; risk factors; older; nursing homes)
Elenco autori:
A. Castaldo
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