Decreased falls through multifactorial intervention in frail older adults
Frail elders have higher risk of falls, with associated morbidity and mortality. Our objective was to reduce the percentage of falls in frail elders after a multifactorial and systemic intervention. Design: before-after quasi-experimental study, with own individual as control. Scope: patient’s livin...
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2021
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/27832 |
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I10-R327-article-27832 |
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Universidad Nacional de Córdoba |
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I-10 |
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R-327 |
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Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Español |
| format |
Artículo revista |
| topic |
frail elderly accidental falls prevention & control home care services program evaluation anciano frágil accidentes por caídas prevención & control servicios de atención de salud a domicilio evaluación de programas y proyectos de Salud prevenção & controle serviços de assistência domiciliar idoso fragilizado acidentes por quedas avaliação de programas e projetos de saúde |
| spellingShingle |
frail elderly accidental falls prevention & control home care services program evaluation anciano frágil accidentes por caídas prevención & control servicios de atención de salud a domicilio evaluación de programas y proyectos de Salud prevenção & controle serviços de assistência domiciliar idoso fragilizado acidentes por quedas avaliação de programas e projetos de saúde Prevettoni, Mariana Alejandra Guenzelovich, Tami Zozaya, Maria Estefanía Giardini, Gimena Hornstein, Lucila Schapira, Marcelo Giber, Fabiana Quintar, Eugenia Perman, Gaston Decreased falls through multifactorial intervention in frail older adults |
| topic_facet |
frail elderly accidental falls prevention & control home care services program evaluation anciano frágil accidentes por caídas prevención & control servicios de atención de salud a domicilio evaluación de programas y proyectos de Salud prevenção & controle serviços de assistência domiciliar idoso fragilizado acidentes por quedas avaliação de programas e projetos de saúde |
| author |
Prevettoni, Mariana Alejandra Guenzelovich, Tami Zozaya, Maria Estefanía Giardini, Gimena Hornstein, Lucila Schapira, Marcelo Giber, Fabiana Quintar, Eugenia Perman, Gaston |
| author_facet |
Prevettoni, Mariana Alejandra Guenzelovich, Tami Zozaya, Maria Estefanía Giardini, Gimena Hornstein, Lucila Schapira, Marcelo Giber, Fabiana Quintar, Eugenia Perman, Gaston |
| author_sort |
Prevettoni, Mariana Alejandra |
| title |
Decreased falls through multifactorial intervention in frail older adults |
| title_short |
Decreased falls through multifactorial intervention in frail older adults |
| title_full |
Decreased falls through multifactorial intervention in frail older adults |
| title_fullStr |
Decreased falls through multifactorial intervention in frail older adults |
| title_full_unstemmed |
Decreased falls through multifactorial intervention in frail older adults |
| title_sort |
decreased falls through multifactorial intervention in frail older adults |
| description |
Frail elders have higher risk of falls, with associated morbidity and mortality. Our objective was to reduce the percentage of falls in frail elders after a multifactorial and systemic intervention. Design: before-after quasi-experimental study, with own individual as control. Scope: patient’s living place, in the metropolitan area of Buenos Aires city. Recruitment period: 01/10/2017-31/04/2018. Baseline assessment and 3-month follow-up. Inclusion criteria: ≥65 years with criteria of frailty according to the treating physician. Exclusion criteria: rejection of intervention or dying patient. Intervention: a health and social-care assistant systematically evaluated different dimensions for falls prevention and intervened according to need in each case in: environmental safety, prescription and training in the use of walking aids, strengthening exercises, improvement of the patient’s network of care, and medication reconciliation. The change in the percentage of people with falls in the last month (McNemar) was analyzed by intention to treat.
We included 108 people. Average age was 85.2 years (SD 6.2). Women: 79.6%. Average Barthel: 50.5 (SD 35.9). Severe or total dependence: 56.8%; dementia: 29.6%; institutionalized: 30.5%; polypharmacy: 82.4%. High risk of falls: 79.6% (95% CI 71.1-86.1). In the initial evaluation, 33.3% had fallen in the last month (95% CI 25.2-42.7). After the intervention, 13.9% (95% CI 8.6-18.6), p <0.001. Previous falls rate: 50/100 people (SD 87); posterior: 11/100 people (SD 34), p <0.001. In conclusion, this multifactorial and systemic intervention in frail elders showed a reduction of people with falls of 41.7%, and a reduction of falls rate of 78%. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2021 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/27832 |
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I10-R327-article-278322024-08-27T18:27:43Z Decreased falls through multifactorial intervention in frail older adults Disminución de caídas mediante una intervención multifactorial en adultos mayores frágiles Redução de quedas através da uma intervenção multifatorial em idosos frágeis Prevettoni, Mariana Alejandra Guenzelovich, Tami Zozaya, Maria Estefanía Giardini, Gimena Hornstein, Lucila Schapira, Marcelo Giber, Fabiana Quintar, Eugenia Perman, Gaston frail elderly accidental falls prevention & control home care services program evaluation anciano frágil accidentes por caídas prevención & control servicios de atención de salud a domicilio evaluación de programas y proyectos de Salud prevenção & controle serviços de assistência domiciliar idoso fragilizado acidentes por quedas avaliação de programas e projetos de saúde Frail elders have higher risk of falls, with associated morbidity and mortality. Our objective was to reduce the percentage of falls in frail elders after a multifactorial and systemic intervention. Design: before-after quasi-experimental study, with own individual as control. Scope: patient’s living place, in the metropolitan area of Buenos Aires city. Recruitment period: 01/10/2017-31/04/2018. Baseline assessment and 3-month follow-up. Inclusion criteria: ≥65 years with criteria of frailty according to the treating physician. Exclusion criteria: rejection of intervention or dying patient. Intervention: a health and social-care assistant systematically evaluated different dimensions for falls prevention and intervened according to need in each case in: environmental safety, prescription and training in the use of walking aids, strengthening exercises, improvement of the patient’s network of care, and medication reconciliation. The change in the percentage of people with falls in the last month (McNemar) was analyzed by intention to treat. We included 108 people. Average age was 85.2 years (SD 6.2). Women: 79.6%. Average Barthel: 50.5 (SD 35.9). Severe or total dependence: 56.8%; dementia: 29.6%; institutionalized: 30.5%; polypharmacy: 82.4%. High risk of falls: 79.6% (95% CI 71.1-86.1). In the initial evaluation, 33.3% had fallen in the last month (95% CI 25.2-42.7). After the intervention, 13.9% (95% CI 8.6-18.6), p <0.001. Previous falls rate: 50/100 people (SD 87); posterior: 11/100 people (SD 34), p <0.001. In conclusion, this multifactorial and systemic intervention in frail elders showed a reduction of people with falls of 41.7%, and a reduction of falls rate of 78%. Los adultos mayores frágiles (AMF) tienen mayor riesgo de caídas, con morbi-mortalidad asociada. Nuestro objetivo fue disminuir el porcentaje de AMF con caídas luego de una intervención multifactorial y sistémica. Estudio cuasiexperimental antes-después, propio individuo control. Ámbito: domicilio de AMF, en área metropolitana de Buenos Aires. Periodo de reclutamiento: 01/10/17-31/04/18. Evaluación basal y seguimiento a 3 meses. Criterios de inclusión: ≥65 años con criterios de fragilidad según médico tratante. Criterios de exclusión: rechazo de intervención o paciente moribundo. Intervención: un orientador (agente) socio-sanitario evaluó sistemáticamente en domicilio distintas dimensiones para prevención de caídas e intervino según necesidad en cada caso en: seguridad ambiental, indicación y capacitación en uso de apoyos de marcha, ejercicios de fortalecimiento, mejora de la red de cuidado, y conciliación de medicación. Se analizó por intención de tratar el cambio en el porcentaje de personas con caídas en el último mes (McNemar). Incluimos 108 personas, edad promedio 85,2 años (DE 6,2), mujeres 79,6%. Barthel promedio 50,5 (DE 35,9). El 56,8% tenían dependencia severa o total; 29,6% demencia; 30,5% institucionalizados; 82,4% polimedicados. El 79,6% (IC95% 71,1-86,1) tenían alto riesgo de caídas. En evaluación inicial habían sufrido caídas en el último mes 33,3% (IC95% 25,2-42,7). Post intervención, 13,9% (IC95% 8,6-18,6), p<0,001. Tasa de caídas previa: 50/100 personas (DE 87); posterior: 11/100 personas (DE 34), p< 0,001. En conclusión, esta intervención multifactorial y sistémica en AMF mostró reducción de personas con caídas de 41,7%, y tasa de caídas de 78%. Os idosos frágeis têm maior risco de quedas, com morbidade e mortalidade associadas. Nosso objetivo foi reduzir o percentual de quedas em idosos frágeis após uma intervenção multifatorial e sistêmica. Desenho: estudo quase-experimental antes-depois, com controle individual. Escopo: local de residência do paciente, na área metropolitana da cidade de Buenos Aires. Período de recrutamento: 10/01/2017 a 31/04/2018. Avaliação inicial e acompanhamento de três meses. Critérios de inclusão: ≥65 anos com critérios de fragilidade de acordo com o médico assistente. Critérios de exclusão: rejeição da intervenção ou paciente que está morrendo. Intervenção: um assistente de saúde e assistência social avaliou sistematicamente diferentes dimensões para prevenção de quedas e interveio conforme a necessidade em cada caso em: segurança ambiental, prescrição e treinamento no uso de auxiliares de marcha, fortalecimento de exercícios, melhoria da rede de atendimento do paciente, e reconciliação de medicamentos. A mudança no percentual de pessoas com quedas no último mês (McNemar) foi analisada pela intenção de tratar. Incluímos 108 pessoas. A idade média foi de 85,2 anos (DP 6,2). Mulheres: 79,6%. Barthel médio: 50,5 (DP 35,9). Dependência grave ou total: 56,8%; demência: 29,6%; institucionalizado: 30,5%; polifarmácia: 82,4%. Alto risco de quedas: 79,6% (IC95% 71,1-86,1). Na avaliação inicial, 33,3% haviam caído no último mês (IC95% 25,2-42,7). Após a intervenção, 13,9% (IC95% 8,6-18,6), p <0,001. Taxa de quedas anteriores: 50/100 pessoas (DP 87); posterior: 11/100 pessoas (DP 34), p <0,001. Concluindo, essa intervenção multifatorial e sistêmica em idosos frágeis mostrou uma redução de pessoas com quedas de 41,7% e uma taxa de quedas de 78%. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2021-06-28 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf text/html https://revistas.unc.edu.ar/index.php/med/article/view/27832 10.31053/1853.0605.v78.n2.27832 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 78 No. 2 (2021); 166-170 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 78 Núm. 2 (2021); 166-170 Revista da Faculdade de Ciências Médicas de Córdoba; v. 78 n. 2 (2021); 166-170 1853-0605 0014-6722 10.31053/1853.0605.v78.n2 spa https://revistas.unc.edu.ar/index.php/med/article/view/27832/33840 https://revistas.unc.edu.ar/index.php/med/article/view/27832/33841 Derechos de autor 2021 Universidad Nacional de Córdoba https://creativecommons.org/licenses/by-nc/4.0 |