Falls After Hospital Discharge: A Randomized Clinical Trial of Individualized Multimodal Falls Prevention Education.

Accidental Falls / prevention & control Aged Aged, 80 and over Humans Patient Discharge Patient Education as Topic Single-Blind Method
Accidental falls Patient discharge Patient education Randomized controlled trial

Journal

The journals of gerontology. Series A, Biological sciences and medical sciences
ISSN: 1758-535X
Titre abrégé: J Gerontol A Biol Sci Med Sci
Pays: United States
ID NLM: 9502837

Informations de publication

Date de publication:
16 08 2019
Historique:
received: 06 09 2018
pubmed: 6 2 2019
medline: 12 6 2020
entrez: 6 2 2019
Statut: ppublish

Résumé

Older people are at high risk of falls after hospital discharge. The study aimed to evaluate the effect of providing individualized falls prevention education in addition to usual care on falls rates in older people after hospital discharge compared to providing a social intervention in addition to usual care. A randomized clinical trial at three hospitals in Western Australia: participants followed for 6 months after discharge. Baseline and outcomes measured by assessors masked to group allocation. Participants: aged 60 years and over, admitted for rehabilitation. Eligibility included: cognitively able to undertake education (Abbreviated mental test score >7/10). Intervention: tailored education comprising patient video and workbook, structured discussion and goal setting led by trained therapist. Main outcomes: falls in the 6 months after discharge; proportion of participants sustaining one or more falls. There were 382 (194 intervention; 188 control) participants (mean age 77.7 [SD 8.7] years). There were 378 falls (fall rate per 1,000 patient-days, 5.9 intervention; 5.9 control) reported by 164 (42.9%) participants in the 6 months following hospital discharge; 188 (49.7%) of these falls were injurious. There were no significant differences in falls rates between intervention and control groups: (adjusted IRR, 1.09; 95% CI [0.78 to 1.52]) or the proportion of participants who fell once or more (adjusted OR, 1.37; 95% CI [0.90 to 2.07]). Providing individualized falls prevention education prior to discharge did not reduce falls at home after discharge. Further research is warranted to investigate how to reduce falls during this high-risk transition period.

Sections du résumé

BACKGROUND
Older people are at high risk of falls after hospital discharge. The study aimed to evaluate the effect of providing individualized falls prevention education in addition to usual care on falls rates in older people after hospital discharge compared to providing a social intervention in addition to usual care.
METHODS
A randomized clinical trial at three hospitals in Western Australia: participants followed for 6 months after discharge. Baseline and outcomes measured by assessors masked to group allocation. Participants: aged 60 years and over, admitted for rehabilitation. Eligibility included: cognitively able to undertake education (Abbreviated mental test score >7/10). Intervention: tailored education comprising patient video and workbook, structured discussion and goal setting led by trained therapist. Main outcomes: falls in the 6 months after discharge; proportion of participants sustaining one or more falls.
RESULTS
There were 382 (194 intervention; 188 control) participants (mean age 77.7 [SD 8.7] years). There were 378 falls (fall rate per 1,000 patient-days, 5.9 intervention; 5.9 control) reported by 164 (42.9%) participants in the 6 months following hospital discharge; 188 (49.7%) of these falls were injurious. There were no significant differences in falls rates between intervention and control groups: (adjusted IRR, 1.09; 95% CI [0.78 to 1.52]) or the proportion of participants who fell once or more (adjusted OR, 1.37; 95% CI [0.90 to 2.07]).
CONCLUSIONS
Providing individualized falls prevention education prior to discharge did not reduce falls at home after discharge. Further research is warranted to investigate how to reduce falls during this high-risk transition period.

Identifiants

DOI: 10.1093/gerona/glz026 PMID: 30721940 PMC: PMC7330456
pubmed: 30721940
pii: 5307055
doi: 10.1093/gerona/glz026
pmc: PMC7330456
doi:

Types de publication

Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1511-1517

Informations de copyright

© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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Auteurs

Anne-Marie Hill (AM)

School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.

Steven M McPhail (SM)

School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
Centre for Functioning and Health Research, Metro South Health, Buranda, Queensland, Australia.

Terry P Haines (TP)

School of Primary and Allied Health Care, Monash University, Clayton, Victoria, Australia.

Meg E Morris (ME)

Healthscope and La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Victoria, Australia.

Christopher Etherton-Beer (C)

Western Australian Centre for Health & Ageing, Medical School, University of Western Australia, Crawley, Western Australia, Australia.

Ronald Shorr (R)

Malcom Randall VA Medical Center, Geriatric Research Education and Clinical Center (GRECC), Gainesville, Florida.
College of Medicine, University of Florida, Gainesville.

Leon Flicker (L)

Western Australian Centre for Health & Ageing, Medical School, University of Western Australia, Crawley, Western Australia, Australia.

Max Bulsara (M)

Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.

Nicholas Waldron (N)

Department of Aged Care and Rehabilitation, Armadale Kelmscott Memorial Hospital, East Metropolitan Health Service, Armadale, Western Australia, Australia.

Den-Ching A Lee (DA)

School of Primary and Allied Health Care, Monash University, Clayton, Victoria, Australia.

Jacqueline Francis-Coad (J)

School of Physiotherapy, Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.

Amanda Boudville (A)

Department of Aged Care and Rehabilitation, St John of God Midland Public and Private Hospital, Midland, Western Australia, Australia.

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Classifications MeSH

questionsmedicales.fr › Environnement et santé publique › Santé publique › Accidents › Chutes accidentelles › Falls After Hospital Discharge: A Randomized...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Falls After Hospital Discharge: A Randomized...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Falls After Hospital Discharge: A Randomized...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Falls After Hospital Discharge: A Randomized...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Continuité des soins › Sortie du patient › Falls After Hospital Discharge: A Randomized...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services de médecine préventive › Éducation pour la santé › Éducation du patient comme sujet › Falls After Hospital Discharge: A Randomized...
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