Medicine and Health Sciences Commons^™

Short-Term Benefits From Manual Therapy As An Adjunct Treatment For Persistent Postural-Perceptual Dizziness Symptoms: A Preliminary Prospective Case Series, Brent A. Harper, Larry Steinbeck

Physical Therapy Faculty Articles and Research

Persistent dizziness and balance deficits are common, often with unknown etiology. Persistent Postural-Perceptual Dizziness (3PD) is a relatively new diagnosis with symptoms that may include dizziness, unsteadiness, or non-vertiginous dizziness and be persistent the majority of time over a minimum of 90 days. The purpose of this case series was to investigate short-term outcomes of reducing dizziness symptoms using a manual therapy intervention focused on restoring mobility in the fascia using a pragmatically applied biomechanical approach, the Fascial Manipulation^® method (FM^®), in patients with 3PD. The preliminary prospective case series consisted of twelve (n = 12) patients …

Implementation Of An Education Program To Decrease Inpatient Falls, Elizabeth M. Carpenter, Jewyl Gibson

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Inpatient falls are affecting 1 million patients across the United States every year with 25% of fall resulting in injury. Approximately 25% of falls are preventable with accurate assessment and appropriate fall precaution interventions. According to the literature, obtaining an accurate fall risk assessment is the first step in inpatient fall prevention.

LOCAL PROBLEM: Patient falls increased on 2 cardiac stepdown units in a level III trauma center in Knoxville, Tennessee. From 2020- 2022, the combined units experienced a 48% increase in patient falls. Nursing leadership identified staff knowledge deficits and inaccurate scoring of fall assessments as primary contributors …

The Role Of Occupational Therapy In The Recognition, Assessment, And Treatment Of Presbyvestibulopathy, Jennifer Hill, Ellen Hudgins, Sharon Leonard

The Open Journal of Occupational Therapy

Sensory functions decline with age, and the likelihood of having multiple sensory impairments increases with age, potentially leading to decreased physical activity and performance, decreased social participation, poorer quality of life, and greater health care spending. Presbyvestibulopathy (PVP), a diagnosis established in 2019, is a vestibular dysfunction or loss related to the aging process characterized by mild bilateral vestibular deficits, chronic dizziness, unsteadiness, gait disturbance, and/or recurrent falls. Given the potential impact of vestibular dysfunction on occupational performance and participation in meaningful activities, occupational therapy’s (OT) role in PVP is evident; however, limited literature exists specific to OT and vestibular …

Pain Is Underestimated In Older Adults With Risk Of Falls, Mustafa Atee

Research outputs 2022 to 2026

Dear Editor, I have read with great interest the Xiao et al. study examining ret-rospectively the incidence of falls and related factors in outpatient and inpatient elderly sample (n= 451) aged 65 years and above. . . .

Nurse Leader Rounding To Provide Fall Prevention Strategies, Kerri Philipbar

Student Scholarly Projects

Practice Problem: Falls while patients are hospitalized are all too common. It was identified that the 300-bed facility in Southeast Georgia had a clinical practice gap with inpatient falls. Inpatient falls cause unnecessary pain and suffering to the patient and families. In addition to the negative effects to the patients, it creates a hardship to the organization. Increased length of stay and additional testing and treatments are charged to the hospital because of a fall.

PICOT: The PICOT question for this project is as follows: In adult patients in an acute care setting (P), does nurse leader rounding to …

Association Of Fall-Related Injuries And Different Diagnoses In Older Adults Of Ontario: A Machine Learning Approach, Sorour Rostampour

Electronic Thesis and Dissertation Repository

Falls are the leading cause of injury-related hospitalizations among older adults in Canada. This study aimed to identify the most informative diagnostic categories associated with fall-related injuries (FRIs) using three machine learning algorithms: decision tree, random forest, and extreme gradient boosting tree (XGBoost). Secondary data from two Ontario health administrative databases (NACRS, DAD) covering the period 2006-2015 were analyzed. Older adults (aged ≥ 65 years) who sought treatment for FRIs in emergency departments (ED) or hospitals, as indicated by Canadian version of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10-CA) codes for falls …

Reduce Extended Length Of Stay By Reducing In-Hospital Falls, Norberto Benitez

Master's Projects and Capstones

Abstract

Problem: Every year, there are many in-hospital falls (IHFs). Nationally there are between 700,000 to 1 million falls recorded each year. Hospital falls financially burden our healthcare industry, costing approximately 34 billion annually. Context: In a local hospital in Northern California, Marin County, the microsystem has had an extraordinary number of in-hospital falls (IHFs). To date (June 2023), 13 falls have been recorded thus far; the microsystem is on track to beat the previous year's record number of 21 falls in a calendar year. Interventions: The MSN–CNL student proposed re-educating staff, resetting expectations, and reestablishing workflow. We also sought …

Rounding With A Purpose: Reducing Falls In Geriatrics Residing In A Community Living Center, Ashley Wesson

Student Scholarly Projects

Practice Problem: Falls among geriatrics continue to be a significant concern for healthcare organizations and one of the costliest healthcare problems attributed to increased morbidity and mortality rates. Falls rates in residential dwellings such as nursing homes and community living centers (CLCs) continue to rise despite fall prevention efforts.

PICOT: The PICOT question that guided this project was In geriatrics, age 65 or older, who reside in the Community Living Center (P), how does one-hour purposeful rounding (I), compared to rounding without structured set time intervals (C), affect fall reduction rates (O), within eight weeks (T)?

Evidence: In fifteen high-quality …

Effectiveness Of An Instructional Program On Decreasing Fall Incidents In Geriatric Patients With Psychiatric Disorders, Maurice Washington

DNP Scholarly Projects

Falls occur in 25% of older adults, resulting in over 8 million fatal and nonfatal injuries. In addition to the human suffering, associated medical and legal costs amount to over 50 billion dollars a year. This study examines the impact on fall rates of an evidence-based fall prevention program provided to a multidisciplinary staff on a psycho geriatric unit in Philadelphia, Pennsylvania. Staff knowledge of effective fall prevention interventions was measured before and after their participation in an evidence-based instructional workshop provided by the Project Director using the Falls Prevention Knowledge Test by Dykes et al. (2019). While there were …

Proactive Toileting: Strengthening Purposeful Hourly Rounding's Influence On Patient Falls., Brittany Pollock

Doctor of Nursing Practice Papers

The purpose of this DNP quality improvement project was to decrease patient falls on a 21-bed step-down telemetry unit in a Kentucky metropolitan hospital. This project implemented proactive toileting in conjunction with purposeful hourly nursing rounds. A pre-education survey was given one week before the education module, and a post-education survey was provided six weeks after the education module was opened. Pre- and post-survey scores were compared to assess any changes in staff’s understanding of proactive toileting and project goals. Falls were measured, and compliance with proactive toileting was monitored in the electronic health record over an 8-week course. Compared …

Effect Of A Community Hospital’S Sustainable And Enhanced Fall Prevention Quality Improvement Program On Inpatient Falls And Falls With Injury: A Before And After Study, Anne Catino

DNP Scholarly Projects

The frequency of hospital falls is a significant clinical problem and directly related to patient safety. Failure to identify potential risk factors and to implement individualized measures for fall prevention can threaten patients’ safety and lead to increased hospital length of stay, increased hospital cost, and reduced quality of life for patients. The purpose of this project was to enhance an evidence-based, fall prevention program to effect a reduction in falls and falls injury. The project is supported by a multidisciplinary hospital team and builds on a community hospital’s fall reduction program. Falls and falls with injury frequencies for 6 …

Top 10 Things To Know About Falls In Older Adults, Alexander W. Zirulnik, Shan Liu

Journal of Geriatric Emergency Medicine

No abstract provided.

Predicting The Risk Of Falling With Artificial Intelligence, Ann Aquino

Doctor of Nursing Practice (DNP) Projects

Predicting the Risk of Falling with Artificial Intelligence

Abstract

Background: Fall prevention is a huge patient safety concern among all healthcare organizations. The high prevalence of patient falls has grave consequences, including the cost of care, longer hospital stays, unintentional injuries, and decreased patient and staff satisfaction. Preventing a patient from falling is critical in maintaining a patient’s quality of life and averting the high cost of healthcare expenses.

Local Problem: Two hospitals' healthcare system saw a significant increase in inpatient falls. The fall rate is one of the nursing quality indicators, and fall reduction is a key performance indicator …

Implementing The Timed Up And Go Test To Prevent Falls, Shamika Allen

Doctor of Nursing Practice Projects

Falls are the most reported injury within the geriatric population. Behavioral health patients have the most injurious falls, with falls impacting multiple things such as staffing, cost, injury, and quality of life for the patient (Ocker et al., 2020). Currently, the standardized fall assessment for new patients upon admission is the Morse Fall Scale (MFS). This fall assessment was intended to assess the level of fall risk for patients who are on an acute medical floor during their hospital stay. The Timed Up and Go test (TUG) is a fall assessment that has been used in geriatric patients to assess …

Relationships Between Muscle Characteristics And Step Outcomes In Young And Old Adults, Kareem Abubukker

All Graduate Plan B and other Reports, Spring 1920 to Spring 2023

Background: Falls are a primary cause of mortality and morbidity in older adults. In an effort to assess falls, a number of studies have measured neurological, biomechanical, and neuromuscular function in relation to fall risk. Despite efforts, falls continue to affect the older adult population leading to subsequent impaired mobility and function. Multiple factors contribute to fall risk among older adults, however, a factor that has shown a consistent relationship with the prevalence of future falls is reduced muscle characteristics. Moreover, the ability to rapidly accelerate a limb, as captured by rate of power development (RPD), rate of velocity development …

The Psychometric Properties Of The Modified Fear Of Falling Avoidance Behavior Questionnaire In Parkinson’S Disease And Older Adults, Billy La, Arturo Aldaco, Ashley Haller

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background/purpose: The Fear of Falling Avoidance Behavior Questionnaire (FFABQ), developed in 2011 to measure fear of falling avoidance behavior, has good evidence for reliability and validity. However, a recently modified version (mFFABQ) is theorized to be easier to understand for those completing the questionnaire because the Likert responses are more logical in completing the item stem. The purpose of this study was to examine the test-retest reliability and construct validity of the mFFABQ in adults with Parkinson’s Disease (PD) and older adults aged 60-90 years. Methods: Thirty-nine participants (age 72.21 ± 9.5; 29 men, 10 women) diagnosed with PD (diagnosis …

Development Of A Multifactorial Virtual Fall Prevention Tool For Community Dwelling Older Women, Eduardo Gutierrez, Jacob James Nogra, Carol Sparks, Bradley Voels

UNLV Theses, Dissertations, Professional Papers, and Capstones

Falls are the leading causes of injury-related death in adults over the age of 65, with women sustaining more than twice the rate of fall-related fractures as men. Reduced access to in-person falls prevention programs during the COVID-19 pandemic created a need for a user-friendly guide to existing online fall prevention resources targeted at this vulnerable population. The first aim of this study was to create and make widely available a website with evidence-based resources that address a range of modifiable fall risk factors, and the second was to test its feasibility in a convenience sample of older women. The …

Physical Therapy Consultation In The Emergency Department For Older Adults With Falls: A Qualitative Study, Anita Chary, Elise Brickhouse, Beatrice Torres, Lauren Cameron-Comasco, Sangil Lee, Brittany Punches, Rachel M Skains, Aanand D Naik, Catherine C Quatman-Yates, Maura Kennedy, Lauren T Southerland, Shan Liu

Journal Articles

OBJECTIVES: Little is known about current practices in consulting physical therapy (PT) in the emergency department (ED) for older adults with falls, a practice that can reduce fall-related ED revisits. This qualitative study aimed to understand perspectives of ED staff about ED PT consultation for older adults with falls and fall-related complaints, specifically regarding perceived value and associated challenges and strategies.

METHODS: We performed focus groups and key informant interviews with emergency physicians, advanced practice clinicians, nurses, physical therapists, occupational therapists, and technicians who perform ED geriatric screenings. We used rapid qualitative analysis to identify common themes related to decisions …

Indication Of Mobility Aids And Training Of Older Patients In A Geriatric Emergency Department: Abiding By International Guidelines, Mario C. De Andrade Junior, Christian V. Morinaga, Christina M M Brito, Igor G. Moraes, Wellington P. Yamaguti, Pedro K. Curiati

Journal of Geriatric Emergency Medicine

Falls are the main cause of injuries, hospitalization, and loss of functionality among adults over 65 years of age. Thus, proper indication of assistive gait devices should be part of multidimensional fall prevention. However, many patients receive little or no professional assistance when selecting a mobility aid, and inadequate selection and use can result in a poor gait pattern.

All patients admitted to our emergency department (ED) undergo a medical evaluation, in which, based on their clinical condition, the protocol for indication and training in the use of walking aids can be triggered. Patients need to be clinically stable and …

Examination Of Geriatric Care Processes Implemented In Level 1 And Level 2 Geriatric Emergency Departments, Ilianna Santangelo, Surriya Ahmad, Shan Liu, Lauren Southerland, Christopher Carpenter, Ula Hwang, Adriane Lesser, Nicole Tidwell, Kevin Biese, Maura Kennedy

Journal of Geriatric Emergency Medicine

Background: Older adults constitute a large and growing proportion of the population and have unique care needs in the emergency department (ED) setting. The geriatric ED accreditation program aims to improve emergency care provided to older adults by standardizing care provided across accredited geriatric EDs (GED) and through implementation of geriatric-specific care processes.

Objective: The purpose of this study was to evaluate select care processes at accredited level 1 and level 2 GEDs.

Methods: This was a cross-sectional analysis of a cohort of level 1 and level 2 GEDs that received accreditation between May 7, 2018 and …

Measures Of Carotid Atherosclerosis And Fall-Related Hospitalization Risk: The Perth Longitudinal Study Of Ageing Women, Abadi K. Gebre, Marc Sim, Jack Dalla Via, Alexander J. Rodríguez, Jonathan M. Hodgson, Catherine P. Bondonno, Peter L. Thompson, Richard L. Prince, Joshua R. Lewis

Research outputs 2022 to 2026

Background and aims: We and others have identified links between cardiovascular conditions and poor musculoskeletal health. However, the relationship between measures of carotid atherosclerosis such as focal carotid plaque and common carotid intima media thickness (CCA-IMT) and falls remains understudied. This study examined the association between measures of carotid atherosclerosis and fall-related hospitalization over 11.5 years in community dwelling older women. Methods and results: 1116 older women recruited in 1998 to a five-year randomized controlled trial to examine the effect of calcium supplementation in preventing fracture and who had undertaken B-mode ultrasound in 2001 (three years after the baseline clinical …

Quality Improvement Initiatives And Interventions For Decreasing Falls In The Hospital Setting, Fredlyn Lolange

Walden Dissertations and Doctoral Studies

Patient falls in health care settings are a widespread and severe problem, and they often happen as a result of a complex set of causes. In the United States, between 3.3 and 11.5 falls occur per 1,000 patient days. Reducing the incidence of falls in a health care setting would bring significant positive change and decrease the incidence of harm to patients in the hospital setting. This staff education project’s purpose is based on addressing falls, a safety concern and a health issue that continues to put patients at an increased risk. Theories used to inform the project include the …

Access To And Utilization Of Primary Care: A Synthesis, Klaire M. Johnson

Kentucky Journal of Undergraduate Scholarship

Barriers to access and utilization of primary care affect nearly 9% of the nation’s population (USDHHS, n.d.a). These barriers are important to evaluate for members of the aging population due to increased need for health care as a result of chronic conditions and falls. Research indicates that access for the aging population is affected by a variety of factors, including: transportation, non-financial barriers, and internal factors. Issues surrounding current delivery of care, such as a workforce shortage of primary care physicians, have compounded the problem even further. While this issue has begun to be addressed through the Affordable Care Act, …

Quality Improvement Initiatives And Interventions For Decreasing Falls In The Hospital Setting, Fredlyn Lolange

Walden Dissertations and Doctoral Studies

Patient falls in health care settings are a widespread and severe problem, and they often happen as a result of a complex set of causes. In the United States, between 3.3 and 11.5 falls occur per 1,000 patient days. Reducing the incidence of falls in a health care setting would bring significant positive change and decrease the incidence of harm to patients in the hospital setting. This staff education project’s purpose is based on addressing falls, a safety concern and a health issue that continues to put patients at an increased risk. Theories used to inform the project include the …

Fall Reduction Strategies For Older Community Dwelling Americans, Heather L. Roach

Master of Public Health Capstone Presentations

Each year millions of older adults fall, and one out of five falls result in an injury that requires medical attention. In 2015 medical costs associated with falls was over $50 billion. Falls and specifically fall related injury in the older American population is a public health burden. There are many modalities that are implemented to reduce falls including management of underlying medical conditions, exercise regimens, supplementation, medication modifications, and home modifications. This project worked to identify which modalities had the greatest impact on falls. The goal of the information obtained is to inform practitioners and public health professionals that …

Inter-Step Height Variation Of Stairways And Observations Of Fall-Related Events, Chayston B. Brown, Shandon Poulsen, Chris Dakin, Sara Harper, Tyson Barrett

International Journal of Exercise Science: Conference Proceedings

INTRODUCTION: Variation in step height within a stairway could negatively impact safe stairway negotiation by decreasing step height predictability, and consequently, increasing stair users’ fall risk. Unfortunately, inter-stairway step height variability is common, particularly in older stairways, but its impact may be lessened by highlighting steps’ edges using high-contrast stripes on the top front edge of each step. Such contrast enhancement may draw greater attention to the steps’ edges and potentially enhance the precision of the edge’s estimated location. PURPOSE: To determine (1) if fall-related events are associated with greater inter-step height variation, and (2) if such fall-related events are …

Cost Analysis Of Implementing An Exercise Program For Fall And Fracture Prevention In Older Adults On Proton Pump Inhibitor Therapy, Thomas Adam Wichelmann, Nhan Dang, David H. Kruchko, Sufyan Abdulmujeeb, Eli D. Ehrenpreis

Journal of Patient-Centered Research and Reviews

Purpose: Falls have significant financial impact. Proton pump inhibitor (PPI) therapy is associated with an increased risk of falls and fractures. Exercise programs have been shown to decrease risk of falls in the elderly population and are recommended by the U.S. Preventive Services Task Force for patients over age 65 to reduce falls. Our study aimed to explore the potential financial benefit of implementing three different Centers for Disease Control and Prevention-recommended exercise-based interventions for fall prevention (Tai Chi, Stepping On, and Otago Exercise Program) in ≥ 65-year-old patients on PPI therapy.

Methods: A Markov model was developed to predict …

Functional Neuroimaging Techniques To Examine Falls And Cognition In Older Adults: A Systematic Review, Tia M. Seleem, Raphael Gabiazon

Undergraduate Student Research Internships Conference

Falls in older adults have been attributed to impaired cognition. There is potential for neuroimaging techniques to understand the biological components that are involved in the cognitive processes pertaining to falls. Therefore, the purpose of this systematic review was to analyze how functional neuroimaging can be used to examine the relationship between falls and cognition among older adults. The following five electronic databases were selected to identify peer-reviewed articles in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: 1) Medline (via OVID), 2) PsycINFO (via OVID), 3) CINAHL (via EBSCO), 4) EMBASE (via OVID), and 5) Pubmed. …

Trends In Health Outcomes Before And After Long Term Care Federal Regulations Limited Antipsychotic Medication Use: A Secondary Data Analysis, Karen Robson

Electronic Theses and Dissertations

Trends in resident falls did not significantly change, although trends in serious injury from falls declined ten years after regulations restricted antipsychotic medications in long-term care facilities. Trends in functional and continence status worsened after the regulations were implemented.

Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone

Master's Projects and Capstones

Problem

One million hospitalized people fall annually in the United States, and up to a third are preventable.

Context

Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria.

Interventions

A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions.

Measures

Outcome measures observe for total fall count and the …