When Elders Leave Hospital, Falls Are Big Reason They Return

Saumya Joseph wrote . . . . . . . . .

Preventing falls among elderly patients who’ve just left the hospital is an important part of keeping them safe, a large U.S. study shows.

When elderly patients are discharged, one of the major reasons they end up back in the hospital is that they’ve suffered a fall, researchers found.

“Hospitals spend a lot of time thinking about fall risk while the patient is in the hospital, but there’s much less attention to the patient after discharge,” said principal investigator Geoffrey Hoffman of the University of Michigan School of Nursing.

Fall prevention efforts need to continue as the patient moves from the hospital to home, or elsewhere, he said.

Hoffman and colleagues analyzed data on more than 8.3 million patients, age 65 and above, who were hospitalized in 2013 and 2014. About 14% of the patients were readmitted within 30 days of being discharged.

Among these patients, about 5% were readmitted due to injuries caused by falling, making it the third leading cause of readmissions after blood poisoning due to bacteria and heart failure.

The prevalence of falls after discharge suggests there is a gap in the quality of care provided before and after patients leave the hospital, Hoffman said.

“Promoting mobility in and outside the hospital is critical,” Hoffman told Reuters Health by phone.

Medicare, the government insurance program for older Americans, penalizes hospitals when patients fall. To minimize these penalties, hospitalized patients at high risk of falling may be discouraged from getting up and moving around without assistance. This enforced immobility could increase the risk of falls after discharge, the researchers noted.

While hospitals already have programs in place to prevent readmissions due to other post-discharge complications, the current findings suggest these programs should also include fall prevention, the researchers write in JAMA Network Open.

Preventing falls requires multifaceted interventions, some of which are beyond the hospital’s control, said Tamara Konetzka, a researcher at the University of Chicago who has studied patient safety but who was not involved in the new study.

These interventions include physical and occupational therapy to improve balance, medication review to avoid drugs that may contribute to dizziness, and home modification efforts such as installing handrails and removing rugs or slippery surfaces.

Patients who had fallen in the past, and those with impaired cognition, had a higher risk of being readmitted for any reason, the researchers found – particularly if they went home after discharge, rather than to a skilled nursing facility.

“You essentially can’t change someone’s cognition or the fact that they have fallen previously. What type of care they receive following a hospital stay and where they receive it can be modified,” Matthew Titmuss, assistant vice president of value management at the Hospital for Special Surgery in New York, told Reuters Health by email.

“Falls are often the initial trigger for a trajectory of decline among older adults – a trajectory including functional limitations, multiple hospitalizations, and long-term nursing home use,” Konetzka told Reuters Health by email. “Reducing falls may thus have much broader implications for health outcomes.”

Source: Reuters

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Video: 7 Step Challenge to Prevent Falls

Falls can be serious events, even fatal ones. One in 3 people over 65 years of age fall each year. The number increases as you get older.

Drs. Shan Liu and Katie Davenport, who are emergency physicians, walk you through how to avoid falls and what to do in case of a fall.

Watch video at You Tube (6:48 minutes) . . . . .

Falls Lead to Declines in Seniors

More than half of elderly patients (age 65 and older) who visited an emergency department because of injuries sustained in a fall suffered adverse events – including additional falls, hospitalization and death – within 6 months. The results of a study examining how risk factors predict recurrent falls and adverse events were published online yesterday in Annals of Emergency Medicine (“Revisit, Subsequent Hospitalization, Recurrent Fall and Death within 6 Months after a Fall among Elderly Emergency Department Patients”).

Seniors who fall and end up in the ER are more likely to have additional medical problems in the future.

“Our study shows an even higher rate of adverse events than previous studies have,” said lead study author Jiraporn Sri-on, MD, of Navamindradhiraj University in Bangkok, Thailand. “Patients taking psychiatric and/or sedative medications had even more adverse events. This is concerning because these types of drugs are commonly prescribed for elderly patients in community and residential care settings.”

Of patients who visited the emergency department for injuries sustained in a fall, 7.7 percent developed adverse events within 7 days, 21.4 percent developed adverse events within 30 days and 50.3 percent developed adverse events within 6 months. Within 6 months, 22.6 percent had at least one additional fall, 42.6 percent revisited the emergency department, 31.1 percent had subsequent hospitalization and 2.6 percent had died.

Risk factors associated with adverse events within 6 months of an emergency department visit for a fall included diabetes, polypharmacy (five or more medications), and psychiatric and/or sedative medications.

“Emergency physicians have a tremendous opportunity to reduce the very high adverse event rate among older emergency patients who have fallen,” said Dr. Sri-on. “Fall guidelines exist and work needs to be done to increase their implementation in emergency departments so patients can be educated on how not to fall again once they have been discharged from the emergency department.”

The American College of Emergency Physicians recently produced and promoted a public education video urging people to take the “7 Step Fall Challenge” to help prevent falls.

Source: American College of Emergency Physicians

9 Fall Produce Picks to Add to Your Plate

Holly Larson wrote . . . . .

The sun is setting sooner, the nights are getting cooler and wool socks are starting to sound like a cozy idea. This is the perfect time to celebrate the seasonal gems of autumn! Head to your local market and fill your basket with these fall produce picks.

Pumpkin

“Fall is nature’s bounty — you get these rich, hearty vegetables that are satisfying as the weather cools off,” says Judy Caplan, MS, RDN. “Pumpkin is my favorite; [it’s] full of fiber and vitamin A. These nutrients are a good way to boost immunity as flu season rolls around.” Caplan likes making muffins or bread with pumpkin puree and whole-wheat flour. “Throw in some ground flax seeds and chopped walnuts for an omega-3 boost,” she says.

Beets

Beets are edible from their leafy greens down to the bulbous root. The leaves are similar to spinach and are delicious sautéed. The grocery store most likely will carry red beets; your local farmers market may have more interesting varieties, such as golden or bull’s blood, which has a bullseye pattern of rings. The red color in beets is caused by a phytochemical called betanin, making beet juice a natural alternative to red food coloring. Beets are rich in naturally occurring nitrates and may help to support healthy blood pressure. Roasting or steaming beets whole takes the fuss out of peeling — the skin easily slides off after cooking. They’re also delicious raw, shredded and tossed in salads or thinly sliced and baked into chips.

Sweet Potato

Sweet potatoes charge ahead of white potatoes in terms of fiber and vitamin A. “Sweet potatoes actually make a great breakfast,” suggests Caplan. “Bake them in the oven until they’re soft ahead of time. At breakfast, warm one up in the microwave and add a teaspoon of a buttery spread made with butter and olive oil and a sprinkle of cinnamon powder. This makes a hearty breakfast when paired with hot chocolate.

Spaghetti Squash

Spaghetti squash is a fun, kid-friendly vegetable that is a lower-calorie and gluten-free alternative to grain-based pasta. Cut it in half to reveal a pocket of seeds; scoop those out and pop the two halves into the microwave or oven and cook until tender. Scrape a fork into the flesh and spaghetti-like strands appear! Voilà! Toss with pesto or marinara sauce for a quick veggie side dish.

Kale

Kale is a current media darling — from food writers to restaurant chefs, and farmers markets to school cafeterias — we can’t get enough of this luscious leafy green and with good reason. Kale is a nutrient powerhouse. It tastes sweeter after a frost and can survive a snowstorm. If you plant kale in your garden, you can dig it out of the snow and serve fresh salad in January! One cup of raw kale has only 8 calories and is loaded with vitamins A, C and K as well as manganese. Kale is great sautéed and cooked in soup, but is also excellent raw in salad; simply remove tough stems, slice into thin slivers and pair with something a bit sweet such as carrots or apples. One advantage of using kale for your leafy greens is that you can add your dressing ahead of time; the kale becomes more tender and delicious, not wilted.

Pears

When we can buy fruits year-round, we tend to forget they do have a season. However, pears are the most delicious in the fall when they’re at their peak. Pears are unique in that they do not ripen on the tree; they will ripen at room temperature after they’re picked. How do you know when they are ready to eat? Check the neck! If the fruit near the stem gives to a little pressure, it is ripe. There are a wide range of pear flavors and textures. And, just like apples, some are excellent eaten fresh while others are best cooked or canned for the winter. Try pears on the grill, poached in red wine, tucked into a panini, pureed into soup or a smoothie, or simply sliced with cheese and wine. If you eat the peel too, one medium pear has 6 grams of fiber – that’s 20 percent of the daily recommendation!

Okra

Okra is commonly fried, but also is wonderful in more nutritious dishes. Around the world, chefs cherish the thickening properties of the seed pods in dishes from Louisiana gumbo to Indian curries and other stews. If you wish to minimize the thickening property, try okra briefly stir-fried. The pods are high in vitamins K and C, a good source of fiber and folate and low in calories. At the market, look for pods that are no longer than 4 inches and are bright green in color and firm to the touch.

Parsnips

Parsnips are cousins to carrots — they have the same root shape but with white flesh. They’re typically eaten cooked, but also can be eaten raw. One-half cup of cooked parsnips is full of fiber (3 grams) and more than 10 percent of the daily values of vitamin C and folate. Try these pale beauties roasted, pureed into soup or mashed. You can even top a shepherd’s pie with mashed parsnips instead of the traditional mashed potatoes!

Cranberries

Fall is the time to get to know these tart berries and their wealth of nutritional benefits. Cranberries may help protect from urinary tract infection. They contain a compound called proanthocyanidin that prevents harmful bacteria from sticking to your bladder wall. Fresh and dried cranberries pair well with a variety of meats and poultry. Fresh cranberries can be eaten raw but are often cooked. Dried cranberries are delicious in grain and vegetable salads and make a healthy snack on the go.

Source: Academy of Nutrition and Dietetics

Exercise May Prevent Harmful Falls in Men

Males made greater gains than women, study says.

Regular exercise reduces older men’s risk of serious injuries from falls, a new study finds.

“The physical activity program was more effective in reducing the rate of serious fall injuries in men than in women,” said study author Dr. Thomas Gill, a professor of geriatrics at Yale University, in New Haven, Conn.

Although the findings were mixed, they suggest that moderate exercise may help prevent serious falls, the leading cause of injury in people 70 and older, Gill said in a university news release.

The study included more than 1,600 inactive women and men, aged 70 to 89, randomly assigned to either a long-term, moderate exercise regimen or to a health education program.

The physical activity sessions included walking and flexibility, strength and balance training.

Compared to those in the health education group, men in the workout group had a 38 percent lower risk of serious fall injuries, a 53 percent lower risk of fall-related fractures, and a 59 percent lower rate of fall injuries requiring hospitalization.

The exercise program did not appear to reduce women’s risk of serious fall injuries, according to the study published online Feb. 3 in the journal BMJ.

The men in the exercise group boosted their physical activity levels more than the women, and also had greater improvements in gait, balance and muscle strength, the researchers said.

“The results from the current study support continued evaluation of the physical activity program for possible widespread implementation in the community,” Gill said.

Source: U.S. Department of Health and Human Services