November falls current awareness by Musgrove Park Hospital Library

Library Services Musgrove Park and Somerset Partnership

Current Awareness Falls This monthly Current Awareness Bulletin is produced by the Library, Musgrove Park Academy to provide staff with a range of falls-related resources to support practice. It includes recently published guidelines and research articles, news and policy items.

This guide provides a selection of resources relevant to the subject area and is not intended to be a comprehensive list. All websites have been evaluated and details are correct at the time of publications. Details correct at time of going to print. Please note that resources are continuously updated. For further help or guidance, please contact a member of library staff.

This guide has been compiled by: Jess Pawley Senior Library Assistant Musgrove Park Hospital Library Service jessica.pawley@tst.nhs.uk

Issue 1 November 2015

Contents Click on a section title to navigate contents Page Recent journal articles

Books

13 UpToDate & DynaMed

Reports, publications and resources

Training & Networking Opportunities, Conferences, Events

Literature search service

Library contact details: Library Musgrove Park Academy Musgrove Park Hospital Taunton Somerset TA1 5DA Tel: 01823 34 (2433) Fax: 01823 34 (2434) Email: library@tst.nhs.uk Blog: http://librarymph.wordpress.com @musgrovesompar

RECENT JOURNAL ARTICLES BACK TO TOP This is a list of journal articles on the topic of falls and falls prevention. Some articles are available in the library or on-line via an OpenAthens password by following the full-text link. If you would like an article which is not available as full-text then please contact library staff. Please note that abstracts are not always available for all articles.

Title: Associations between falls and general health, nutrition, dental health and medication use in Swedish home-dwelling people aged 75 years and over. Citation: Health & social care in the community, Nov 2015, vol. 23, no. 6, p. 594-604 (November 2015) Author(s): Fonad, Edit, Robins Wahlin, Tarja-Brita, Rydholm Hedman, Ann-Marie Abstract: The vast majority of elderly people in Sweden live in private homes in their communities for as long as possible. Poor health and a high risk of falls are very common among this group. This cross-sectional study investigates the association between falls and general health, appetite, dental health, and the use of multiple medications among home-dwelling men and women aged =75 years. Data were collected between October 2008 and March 2009 using a postal questionnaire. A total of 1243 people participated in the questionnaire survey (74% response rate), of which 1193 were included in the analysis. The majority of participants were women (n = 738, 62%). Falls in the previous 12-month period were reported by 434 (36%) participants. Most fallers (n = 276, 64%) were women. The majority of the fallers lived in a flat (n = 250, 58%). Poor health (aOR: 1.61; CI: 1.341.95), poor dental health (aOR: 1.22; CI: 1.07-1.39) and the use of four or more types of medication daily (aOR: 1.13; CI: 1.03-1.25) were significantly associated with falls in all participants. Poor dental health was found irrespectively of living in a flat (aOR: 1.23; CI: 1.04-1.46) or living in a house (aOR: 1.28; CI: 1.02-1.61), and both were significantly associated with falls. The use of more than four different types of medication daily (aOR: 1.25; CI: 1.11-1.41) was associated with falls for those living in a flat. The results highlight that falls are associated with poor general health, poor dental health and the use of four or more types of medication daily. Health professionals should provide health promotion education and investigate dental health and risk factors for oral disease. Likewise, medical and clinical practices of physicians and community care nurses should include assessing the risk of falling, and treatment that predisposes falls. 2015 John Wiley & Sons Ltd.

Title: Outcome of in-patient falls in hospitals with 100% single rooms and multi-bedded wards. Citation: Age and ageing, Nov 2015, vol. 44, no. 6, p. 1032-1035 (November 2015) Author(s): Singh, Inderpal, Okeke, Justin, Edwards, Chris Abstract: falls in hospital account for almost two-fifths of the patient safety incidents reported to the National Reporting and Learning System in UK. Studies have suggested an increased incidence of falls in single-bedded hospitals. to compare the outcome of in-patient falls occurring in units with 100% single rooms (SRs) and multi-bedded wards (M-BWs). SAMPLING DESIGN AND METHODS: an observational study. Retrospective standard incident reporting data (DATIX) on in-patient falls and associated injury were obtained from both sites over 18 months each. There was no change in demographics, size and characteristics of population except change in the geography of new hospitals. the total number of in-patient fall incidents reported over the 3 years was 1,749. The mean age of patients on M-BW and SR sites was 81.0 2.4 (51.3% females) and 80.3 10.3 (50.7% females), respectively. The mean incidence of falls/1,000 patient-bed days on M-BW and SR sites was 5.44 4.76 and 15.82 19.56, respectively (P < 0.01). Overall fracture incidence/1,000 patient-bed days on M-BW and SR sites was 0.07 0.48 and 0.36 1.52 (P < 0.01), respectively. The hip fracture incidence/1,000 patient-bed days on M-BW and SR sites was 0.04 0.38 and 0.15 1.00 (P < 0.01), respectively. One-year mortality from the date of first incident fall was lower in M-BWs (41.1%) compared with SRs (47.1%), but this is not significant (P = 0.12). this observational study shows a significantly increased incidence of falls and fracture in a hospital design with SRs compared with a

multi-bedded facility. Consideration should be given to increased incidence of falls and falls-related injury in SRs when deciding on the percentage of single-room provision in new hospitals to admit frail older adults. The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com. Full Text: Available from Ovid online collection in Age & Ageing

Title: Pain and falls and fractures in community-dwelling older men. Citation: Age and ageing, Nov 2015, vol. 44, no. 6, p. 973-979 (November 2015) Author(s): Munch, Troels, Harrison, Stephanie L, Barrett-Connor, Elizabeth, Lane, Nancy E, Nevitt, Michael C, Schousboe, John T, Stefanick, Marcia, Cawthon, Peggy M Abstract: pain may reduce stability and increase falls and subsequent fractures in older men. to examine the association between joint pain and any pain with falls, hip and non-spine fractures in older community-dwelling men. a cohort study. analyses included 5,993 community-dwelling men aged =65 years from the MrOS cohort. pain at hip, knee and elsewhere (any) was assessed by selfreport. Men reported falls via questionnaires mailed 3â&#x20AC;Ť× â&#x20AC;Źper year during the year following the baseline visit. Fractures were verified centrally. Mean follow-up time for fractures was 9.7 (SD 3.1) years. Logistic regression models estimated likelihood of falls and proportional hazards models estimated risk of fractures. Models were adjusted for age, BMI, race, smoking, alcohol use, medications use, comorbidities and arthritis; fracture models additionally adjusted for bone mineral density. one quarter (25%, n = 1,519) reported =1 fall; 710 reported =2 falls in the year after baseline. In multivariate models, baseline pain at hip, knee or any pain increased likelihood of =1 fall and =2 falls over the following year. For example, knee pain increased likelihood of =1 fall (odds ratio, OR 1.44; 95% confidence interval, CI 1.25-1.65) and =2 falls (OR 1.75; 95% CI 1.46-2.10). During follow-up, 936 (15.6%) men suffered a non-spine fracture (n = 217, 3.6% hip). In multivariate models, baseline pain was not associated with incident hip or non-spine fractures. any pain, knee pain and hip pain were each strong independent risk factors for falls in older men. Increased risk of falls did not translate into an increased risk of fractures. The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com. Full Text: Available from Ovid online collection in Age & Ageing

Title: The extra resource burden of in-hospital falls: a cost of falls study. Citation: The Medical journal of Australia, Nov 2015, vol. 203, no. 9, p. 367. (November 2, 2015) Author(s): Morello, Renata T, Barker, Anna L, Watts, Jennifer J, Haines, Terry, Zavarsek, Silva S, Hill, Keith D, Brand, Caroline, Sherrington, Catherine, Wolfe, Rory, Bohensky, Megan A, Stoelwinder, Johannes U Abstract: To quantify the additional hospital length of stay (LOS) and costs associated with inhospital falls and fall injuries in acute hospitals in Australia. A multisite prospective cohort study conducted during 2011-2013 in the control wards of a falls prevention trial (6-PACK). The trial included all admissions to 12 acute medical and surgical wards of six Australian hospitals. In-hospital falls data were collected from medical record reviews, daily verbal reports by ward nurse unit managers, and hospital incident reporting and administrative databases. Clinical costing data were linked for three of the six participating hospitals to calculate patient-level costs. Hospital LOS and costs associated with in-hospital falls and fall injuries for each patient admission. We found that 966 of a total of 27 026 hospital admissions (3.6%) involved at least one fall, and 313 (1.2%) at least one fall injury, a total of 1330 falls and 418 fall injuries. After adjustment for age, sex, cognitive impairment, admission type, comorbidity and clustering by hospital, patients who had an in-hospital fall had a mean increase in LOS of 8 days (95% CI, 5.8-10.4; P < 0.001) compared with non-fallers, and incurred mean additional hospital costs of $6669 (95% CI, $3888-$9450; P < 0.001). Patients with a fall-related injury had a mean increase in LOS of 4 days (95% CI, 1.8-6.6; P = 0.001) compared with

those who fell without injury, and there was also a tendency to additional hospital costs (mean, $4727; 95% CI, -$568 to $10 022; P = 0.080). Patients who experience an in-hospital fall have significantly longer hospital stays and higher costs. Programs need to target the prevention of all falls, not just the reduction of fall-related injuries.

Title: Definitions of Sarcopenia: Associations with Previous Falls and Fracture in a Population Sample. Citation: Calcified tissue international, Nov 2015, vol. 97, no. 5, p. 445-452 (November 2015) Author(s): Clynes, M A, Edwards, M H, Buehring, B, Dennison, E M, Binkley, N, Cooper, C Abstract: Sarcopenia is common in later life and may be associated with adverse health outcomes such as disability, falls and fracture. There is no consensus definition for its diagnosis although diagnostic algorithms have been proposed by the European Working Group for Sarcopenia in Older People (EWGSOP), the International Working Group on Sarcopenia (IWGS) and the Foundation for the National Institutes of Health Sarcopenia Project (FNIH). More recently, Binkley and colleagues devised a score-based system for the diagnosis of "dysmobility syndrome" in an attempt to combine adverse musculoskeletal phenotypes, including sarcopenia and osteoporosis, in order to identify older individuals at particular risk. We applied these criteria to participants from the Hertfordshire Cohort Study to define their prevalence in an unselected cohort of UK community-dwelling older adults and assess their relationships with previous falls and fracture. Body composition and areal bone mineral density were measured using dual-energy X-ray absorptiometry, gait speed was determined by a 3-m walk test and grip strength was assessed with a Jamar hand-held dynamometer. Researcheradministered questionnaires were completed detailing falls and fracture history. The prevalence of sarcopenia in this cohort was 3.3, 8.3 and 2.0 % using the EWGSOP, IWGS and related definition of FNIH, respectively; 24.8 % of individuals had dysmobility syndrome. Individuals with dysmobility reported significantly higher number of falls (last year and since the age of 45 years) (p < 0.01) than those without it, but no increased fracture rate was observed in this group (p = 0.96). Those with sarcopenia as defined by the IWGS reported significantly higher falls in the last year and prevalent fractures (falls in the last year: OR 2.51; CI 1.09-5.81; p = 0.03; fractures OR 2.50; CI 1.05-5.92; p = 0.04) but these significant associations were not seen when the EWGSOP definition was applied. The IWGS definition of sarcopenia appears to be an effective means of identifying individuals at risk of prevalent adverse musculoskeletal events.

Title: Anticholinergic Use and Recurrent Falls in Community-Dwelling Older Adults: Findings From the Health ABC Study. Citation: The Annals of pharmacotherapy, Nov 2015, vol. 49, no. 11, p. 1214-1221 (November 2015) Author(s): Marcum, Zachary A, Perera, Subashan, Thorpe, Joshua M, Switzer, Galen E, Gray, Shelly L, Castle, Nicholas G, Strotmeyer, Elsa S, Simonsick, Eleanor M, Bauer, Douglas C, Shorr, Ronald I, Studenski, Stephanie A, Hanlon, Joseph T, Health ABC Study, USA Abstract: Although it is generally accepted that anticholinergic use may lead to a fall, results from studies assessing the association between anticholinergic use and falls are mixed. In addition, direct evidence of an association between use of anticholinergic medications and recurrent falls among community-dwelling elders is not available. To assess the association between anticholinergic use across multiple anticholinergic subclasses, including over-the-counter medications, and recurrent falls. This was a longitudinal analysis of 2948 participants, with data collected via interview at year 1 from the Health, Aging and Body Composition study and followed through year 7 (1997-2004). Selfreported use of anticholinergic medication was identified at years 1, 2, 3, 5, and 6 as defined by the list from the 2015 American Geriatrics Society Beers Criteria. Dosage and duration were also examined. The main outcome was recurrent falls (=2) in an ensuing 12-month period from each medication data collection. Using multivariable generalized estimating equation models, controlling for demographic, health status/behaviors, and access-to-care factors, a 34% increase in likelihood of recurrent falls in anticholinergic users (adjusted odds ratio = 1.34; 95% CI = 0.93-1.93) was observed, but the results were not statistically significant; similar results were found with higher doses and longer duration of use. Increased point estimates suggest an association of anticholinergic use with recurrent falls, but the associations did not reach statistical significance. Future studies are needed for

more definitive evidence and to examine other measures of anticholinergic burden and associations with more intermediate adverse effects such as cognitive function. The Author(s) 2015.

Title: Reliability and validity of the Falls Efficacy Scale-International after hip fracture in patients aged =65 years. Citation: Disability and rehabilitation, Nov 2015, vol. 37, no. 23, p. 2225-2232 (November 2015) Author(s): Visschedijk, Jan H M, Terwee, Caroline B, Caljouw, Monique A A, Spruit-van Eijk, Monica, van Balen, Romke, Achterberg, Wilco P Abstract: To assess the measurement properties of the Falls Efficacy Scale-International (FES-I) in patients after a hip fracture aged = 65 years. In a sample of 100 patients, we examined the structural validity, internal consistency and construct validity. For the structural validity a confirmatory factor analysis was carried out. For construct validity predetermined hypotheses were tested. In a second sample of 21 older patients the inter-rater reliability was evaluated. The factor analysis yielded strong evidence that the FES-I is uni-dimensional in patients with a hip fracture; the Cronbach's alpha was 0.94. When testing the reliability, the intra-class correlation coefficient was 0.72, while the Standard Error of Measurement was 6.4 and the Smallest Detectable Change was 17.7 (on a scale from 16 to 64). The Spearman correlation of the FES-I with the one-item fear of falling instrument was high (r = 0.68). The correlation was moderate with instruments measuring functional performance constructs and low with instruments measuring psychological constructs. Reliability and structural validity of the FES-I in patients after a hip fracture are good. The construct validity appears more closely related to functional performance constructs than to psychological constructs, suggesting that the concept measured by the FES-I may not capture all aspects of fear of falling. Implications for Rehabilitation The Falls Efficacy Scale-International (FES-I), which is commonly used to measure fear of falling in community-dwelling older persons, can also be used to assess fear of falling in patients after a hip fracture. The reliability and the structural validity of the FES-I for these hip patients are good, whereas the construct validity of the FES-I is not optimal. The FES-I may not capture all aspects of fear of falling and may be more closely related to functional performance than to psychological concepts such as anxiety.

Title: Promoting physical activity in older people in general practice: ProAct65+ cluster randomised controlled trial. Citation: The British journal of general practice : the journal of the Royal College of General Practitioners, Nov 2015, vol. 65, no. 640, p. e731. (November 2015) Author(s): Iliffe, Steve, Kendrick, Denise, Morris, Richard, Griffin, Mark, Haworth, Deborah, Carpenter, Hannah, Masud, Tahir, Skelton, Dawn A, Dinan-Young, Susie, Bowling, Ann, Gage, Heather, ProAct65+ research team Abstract: Regular physical activity reduces falls, hip fractures, and all-cause mortality, but physical activity levels are low in older age groups. To evaluate two exercise programmes promoting physical activity among older people. Pragmatic three-arm, parallel-design cluster randomised controlled trial involving 1256 people aged =65 years (of 20 507 invited) recruited from 43 general practices in London, Nottingham, and Derby. Practices were randomised to the class-based Falls Management Exercise programme (FaME), the home-based Otago Exercise Program (OEP), or usual care. The primary outcome was the proportion reaching the recommended physical activity target 12 months post-intervention. Secondary outcomes included falls, quality of life, balance confidence, and costs. In total, 49% of FaME participants reached the physical activity target compared with 38% for usual care (adjusted odds ratio 1.78, 95% confidence interval [CI] =1.11 to 2.87, P = 0.02). Differences between FaME and usual care persisted 24 months after intervention. There was no significant difference comparing those in the OEP (43% reaching target at 12 months) and usual-care arms. Participants in the FaME arm added around 15 minutes of moderate-to-vigorous physical activity per day to their baseline level; this group also had a significantly lower rate of falls (incident rate ratio 0.74, 95% CI = 0.55 to 0.99, P = 0.042). Balance confidence was significantly improved in both intervention arms. The mean cost per extra person achieving the physical activity target was 1740. Attrition and rates of

adverse reactions were similar. The FaME programme increases self-reported physical activity for at least 12 months post-intervention and reduces falls in people aged =65 years, but uptake is low. There was no statistically significant difference in reaching the target, or in falls, between the OEP and usual-care arms. British Journal of General Practice 2015.

Title: Redesigning a falls prevention standard of practice. Citation: Nursing management, Nov 2015, vol. 46, no. 11, p. 7-9 (November 2015) Author(s): Eckes, Ellen J, Smith, Leslie

Title: Effectiveness of A Community-Based Falls Prevention Program For The Elderly. Citation: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, Nov 2015, vol. 18, no. 7, p. A540. (November 2015) Author(s): Molina, J A, Ismail, N H, Heng, B H, Leong, I Y

Title: Risk Factors for Traumatic Brain Injuries During Falls in Older Persons. Citation: The Journal of head trauma rehabilitation, Nov 2015, vol. 30, no. 6, p. E9. (2015 Nov-Dec) Author(s): Hwang, Hei-Fen, Cheng, Chui-Hsuan, Chien, Ding-Kuo, Yu, Wen-Yu, Lin, Mau-Roung Abstract: To identify risk factors for traumatic brain injuries (TBIs) during falls in older Taiwanese people. Case patients consisted of 113 patients aged 60 years or older with a moderate/severe TBI due to a fall. Two control groups: (1) 339 older patients with a soft-tissue injury; and (2) 113 with a mild-TBI due to a fall. Proxies were required to provide information for a considerable number of patients. Matched case-control study. The emergency departments of 3 general hospitals. Sociodemographic, lifestyle behavior, chronic condition, medication use, functional abilities, and fallrelated characteristics. When patients with a soft-tissue injury were assigned to the control group, men were 2.06-fold more likely to have a moderate/severe TBI than women. Subjects who took antiarrhythmics within 4 hours of a fall were 2.59-fold more likely to have a moderate/severe TBI than those who took none. Subjects who were negotiating stairs and getting in/out of the bed/chair were 3.12-fold and 2.97-fold, respectively, more likely to have a moderate/severe TBI than those who fell while walking. Falling backward and sideways was 4.07-fold and 2.30-fold, respectively, more likely to cause a moderate/severe TBI than falling forward. When patients with a mild-TBI were assigned to the control group, results were similar, with the exception that the effect of antiarrhythmic use became nonsignificant and subjects who took 2 or more medications were 3.07-fold more likely to have a moderate/severe TBI than those who took none. Avoiding a head impact during a backward or sideways fall, reducing unnecessary use of polypharmacy and antiarrhythmics, and maintaining safety during stair negotiation and bed/chair transfer may protect an elderly person from a severe brain injury.

Title: Elderly fall patients triaged to the trauma bay: age, injury patterns, and mortality risk. Citation: The American journal of emergency medicine, Nov 2015, vol. 33, no. 11, p. 1635-1638 (November 2015) Author(s): Evans, Daniel, Pester, Jonathan, Vera, Luis, Jeanmonod, Donald, Jeanmonod, Rebecca Abstract: Falls in the elderly are a significant cause of morbidity and mortality. We sought to better categorize this patient population and describe factors contributing to their falls. This is a retrospective review of geriatric patients presenting to a level 1 community trauma center. We queried our trauma database for all patients 65 years and older presenting with fall and triaged to the trauma bay from 2008 to 2013. Researchers reviewed the patients' trauma intake paperwork to assess mechanism, injury, and location of fall, whereas discharge summaries were reviewed to determine disposition, morbidity, and mortality. A total of 650 encounters were analyzed. Five hundred thirty-nine resided at home (82.9%), 110 presented from nursing homes or assisted living (16.9%), and 1 came from hospice (0.15%). Ninety-five patients died or were placed on hospice as a result of their falls (14.7%),

of which 88 came from home. Controlling for Injury Severity Score, living at home was an independent risk factor for fall-related mortality (odds ratio, 3.0). Comparing the elderly (age 65-79 years; n = 274) and the very elderly (age =80 years; n = 376), there were no differences in Injury Severity Score (P = .33), likelihood of death (P = .49), likelihood of C-spine injury (P = 1.0), or likelihood of other axial or long bone skeletal injury (P = .23-1.0). There was a trend for increased likelihood of head injury in very elderly patients (P = 0.06). Prevention measures to limit morbidity and mortality in elderly fall patients should be aimed at the home setting, where most severe injuries occur. Very elderly patients may be at increased risk for intracranial fall-related injuries. Copyright 2015 Elsevier Inc. All rights reserved.

Title: Preoperative Femoral Nerve Block for Hip Arthroscopy: A Randomized, Triple-Masked Controlled Trial. Citation: The American journal of sports medicine, Nov 2015, vol. 43, no. 11, p. 2680-2687 (November 2015) Author(s): Xing, Jerry G, Abdallah, Faraj W, Brull, Richard, Oldfield, Stephanie, Dold, Andrew, Murnaghan, M Lucas, Whelan, Daniel B Abstract: Arthroscopy has become a standard method of treatment for a variety of intra-articular hip disorders. While most arthroscopic hip procedures are performed as outpatient surgeries, patients can still experience significant postoperative pain and opioid-associated side effects. The potential benefits of a preoperative femoral nerve block (FNB) in hip arthroscopy were explored in a previous retrospective review. The study objective was to confirm these findings in a prospective randomized study. Randomized controlled trial; Level of evidence, 1. Fifty patients undergoing hip arthroscopy were included in this prospective, single-center, randomized controlled trial that was patient-, operator-, and assessor-blinded. Patients received either a preoperative ultrasound-guided FNB with 20 mL of 0.5% bupivacaine (FNB group) or normal saline (control group). Nerve blockade was confirmed via standardized sensory testing before the induction of general anesthesia. The primary endpoint was cumulative consumption of oral morphine equivalent at 24 hours after discharge. Secondary endpoints included opioid use at various time points, pain scores, Quality of Recovery (QoR-27) score, incidence of nausea and vomiting, time to discharge, block-related complications, falls at 24 hours, and patient satisfaction. Fifty patients completed the study, including 27 in the FNB group and 23 in the control group. Most patient characteristics were statistically similar between groups except for operative time, which was longer in the control group. Cumulative oral morphine consumption was lower in the FNB group at 48 hours; there was no difference at 24 hours or 7 days postoperatively. Pain scores were significantly lower up to 6 hours postoperatively in the FNB group compared with control; however, rebound pain was observed at 24 hours after discharge in patients who received FNB. There was no difference in most secondary outcomes. Importantly, a total of 6 patients in the FNB group reported falls (without injury) within the first 24 hours postoperatively compared with none in the control group. Patient satisfaction with pain control was high in both groups at all time points. Preoperative FNB may improve early pain control after hip arthroscopy. However, given the observed risk of falls, the routine use of FNB for outpatient hip arthroscopy cannot be recommended. 2015 The Author(s).

Title: Firefighting to Innovation: Using Human Factors and Ergonomics to Tackle Slip, Trip, and Fall Risks in Hospitals. Citation: Human factors, Nov 2015, vol. 57, no. 7, p. 1195-1207 (November 2015) Author(s): Hignett, Sue, Wolf, Laurie, Taylor, Ellen, Griffiths, Paula Abstract: The aim of this study was to use a theoretical model (bench) for human factors and ergonomics (HFE) and a comparison with occupational slips, trips, and falls (STFs) risk management to discuss patient STF interventions (bedside). Risk factors for patient STFs have been identified and reported since the 1950s and are mostly unchanged in the 2010s. The prevailing clinical view has been that STF events indicate underlying frailty or illness, and so many of the interventions over the past 60 years have focused on assessing and treating physiological factors (dizziness, illness, vision/hearing, medicines) rather than designing interventions to reduce risk factors at the time of the STF. Three case studies are used to discuss how HFE has been, or could be, applied to STF risk

management as (a) a design-based (building) approach to embed safety into the built environment, (b) a staff- (and organization-) based approach, and (c) a patient behavior-based approach to explore and understand patient perspectives of STF events. The results from the case studies suggest taking a similar HFE integration approach to other industries, that is, a sustainable design intervention for the person who experiences the STF event-the patient. This paper offers a proactive problem-solving approach to reduce STFs by patients in acute hospitals. Authors of the three case studies use HFE principles (bench/book) to understand the complex systems for facility and equipment design and include the perspective of all stakeholders (bedside). 2015, Human Factors and Ergonomics Society.

Title: Emerging therapeutic concepts for muscle and bone preservation/building. Citation: Bone, Nov 2015, vol. 80, p. 150-156 (November 2015) Author(s): Compston, Juliet Abstract: Loss of muscle or bone mass occurs with ageing, immobility and in association with a variety of systemic diseases. The interaction of these two processes is most evident in the major contribution of falls to the risk of fractures in the elderly population. Exercise and nutrition are key common physiological variables that allow for preservation or formation of greater muscle or bone mass. However, although several pharmacological approaches have the potential to benefit both muscle and bone health, for example vitamin D, selective androgen receptor modulators and ghrelin mimetics, clinical trials with appropriate primary outcomes are lacking. Conventional approaches to address muscle loss are being extended to include stem cell biology and conserved molecular mechanisms of atrophy/hypertrophy. Pharmacological interventions to reduce fracture risk are exploring new mechanisms of action, in particular the uncoupling of bone resorption and formation. Emerging key issues for clinical trial design include adequate phenotyping of patients (personalised medicine), optimisation of the physiological background (multimodal approach) and the use of meaningful and robust outcomes relevant to daily clinical practice. At present, effective treatments that combine beneficial effects on both muscle and bone are lacking, although this is an important target for the future. This review therefore considers current and developing strategies to improve muscle function and bone strength in separate sections. Copyright 2015 Elsevier Inc. All rights reserved.

Title: Complications and patient-reported outcome after hip fracture. A consecutive annual cohort study of 664 patients. Citation: Injury, Nov 2015, vol. 46, no. 11, p. 2206-2211 (November 2015) Author(s): Hansson, Susanne, Rolfson, Ola, 큰esson, Kristina, Nemes, Szilard, Leonardsson, Olof, Rogmark, Cecilia Abstract: The aim of every patient with hip fracture is to regain previous function but we know little about the outcome, especially patient-reported outcome. We wanted to investigate what factors influence the result one year after hip fracture, including fast-track for hip fracture patients, as well as investigating the patients' satisfaction with their rehabilitation and to what degree they regained their pre-fracture function. All patients (>20 years, non-pathological fracture, residents in the catchment area, n=664) having surgery for hip fracture at our hospital during 2011 were included in a retrospective cohort study. From medical records, information was gathered about pre-fracture condition as well as fracture type, surgical details, length of stay and whether the patient entered the hospital through the fast-track system. Medical records were scrutinised for general complications up to six months and for local complications up to one year after surgery. A postal questionnaire was sent one year after surgery inquiring about health status, pain and satisfaction along with multiplechoice questions regarding mobility and rehabilitation. Variables were analysed with linear regression or the proportional odds model. The most common general complications were new falls, pneumonia and new fractures. Deep infection was the most frequent local complication. The only significant effect of the fast-track system was shorter time to surgery (78 vs. 62% had surgery within 24h, p<0.001). A total of 29% reported to have regained their previous mobility and 30% considered the rehabilitation to be adequate. Mean value for pain VAS was 24 (SD 22) and for satisfaction 28 (SD 25). Absence of general and local complications correlated to satisfaction and hip pain. General complications correlated to loss of function. Higher age correlated to inadequate rehabilitation. General

complications seem to be the major risk factor, being the only factor affecting functional outcome and together with local complications affecting pain and satisfaction. To avoid general complications, cooperation between orthopaedic surgeons and internists may be crucial in the aftercare of hip fracture patients. A majority did not receive adequate rehabilitation and efforts need to be made to improve the rehabilitation process. Copyright 2015 Elsevier Ltd. All rights reserved.

Title: Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: A Randomized Controlled Trial. Citation: The American journal of medicine, Nov 2015, vol. 128, no. 11, p. 1225 (November 2015) Author(s): Ng, Tze Pin, Feng, Liang, Nyunt, Ma Shwe Zin, Feng, Lei, Niti, Mathew, Tan, Boon Yeow, Chan, Gribson, Khoo, Sue Anne, Chan, Sue Mei, Yap, Philip, Yap, Keng Bee Abstract: It is important to establish whether frailty among older individuals is reversible with nutritional, physical, or cognitive interventions, singly or in combination. We compared the effects of 6month-duration interventions with nutritional supplementation, physical training, cognitive training, and combination treatment vs control in reducing frailty among community-dwelling prefrail and frail older persons. We conducted a parallel group, randomized controlled trial in community-living prefrail and frail old adults in Singapore. The participants' mean age was 70.0 years, and 61.4% (n = 151) were female. Five different 6-month interventions included nutritional supplementation (n = 49), cognitive training (n = 50), physical training (n = 48), combination treatment (n = 49), and usual care control (n = 50). Frailty score, body mass index, knee extension strength, gait speed, energy/vitality, and physical activity levels and secondary outcomes (activities of daily living dependency, hospitalization, and falls) were assessed at 0 months, 3 months, 6 months, and 12 months. Frailty score and status over 12 months were reduced in all groups, including control (15%), but were significantly higher (35.6% to 47.8%) in the nutritional (odds ratio [OR] 2.98), cognition (OR 2.89), and physical (OR 4.05) and combination (OR 5.00) intervention groups. Beneficial effects were observed at 3 months and 6 months, and persisted at 12 months. Improvements in physical frailty domains (associated with interventions) were most evident for knee strength (physical, cognitive, and combination treatment), physical activity (nutritional intervention), gait speed (physical intervention), and energy (combination intervention). There were no major differences with respect to the small numbers of secondary outcomes. Physical, nutritional, and cognitive interventional approaches were effective in reversing frailty among community-living older persons. Copyright 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Title: Osteoporosis and sarcopenia in older age. Citation: Bone, Nov 2015, vol. 80, p. 126-130 (November 2015) Author(s): Edwards, M H, Dennison, E M, Aihie Sayer, A, Fielding, R, Cooper, C Abstract: Osteoporosis and sarcopenia are common in older age and associated with significant morbidity and mortality. Consequently, they are both attended by a considerable socioeconomic burden. Osteoporosis was defined by the World Health Organisation (WHO) in 1994 as a bone mineral density of less than 2.5 standard deviations below the sex-specific young adult mean and this characterisation has been adopted globally. Subsequently, a further step forward was taken when bone mineral density was incorporated into fracture risk prediction algorithms, such as the Fracture Risk Assessment Tool (FRAX) also developed by the WHO. In contrast, for sarcopenia there have been several diagnostic criteria suggested, initially relating to low muscle mass alone and more recently low muscle mass and muscle function. However, none of these have been universally accepted. This has led to difficulties in accurately delineating the burden of disease, exploring geographic differences, and recruiting appropriate subjects to clinical trials. There is also uncertainty about how improvement in sarcopenia should be measured in pharmaceutical trials. Reasons for these difficulties include the number of facets of muscle health available, e.g. mass, strength, function, and performance, and the various clinical outcomes to which sarcopenia can be related such as falls, fracture, disability and premature mortality. It is imperative that a universal definition of sarcopenia is reached soon to facilitate greater progress in research into this debilitating condition. This article is part of a Special Issue entitled "Muscle Bone Interactions". Copyright 2015 Elsevier Inc. All rights reserved.

Title: Assessing the Quality of Osteoporosis Care in Practice. Citation: Journal of general internal medicine, Nov 2015, vol. 30, no. 11, p. 1681-1687 (November 2015) Author(s): Weng, Weifeng, Hess, Brian J, Lynn, Lorna A, Lipner, Rebecca S Abstract: Patients with osteoporosis can sustain fractures following falls or other minimal trauma. This risk of fracture can be reduced through appropriate diagnostic testing, pharmacologic therapy, and other readily measured standards of care. Our aim was to develop a credible clinical performance assessment to measure physicians' quality of osteoporosis care, and determine reasonable performance standards for both competent and excellent care. This was a retrospective cohort study. Three hundred and eighty one general internists and subspecialists with time-limited board certification were included in the study. Performance rates on eight evidence-based measures were obtained from the American Board of Internal Medicine (ABIM) Osteoporosis Practice Improvement Module (PIM), a web-based tool that uses medical chart reviews to help physicians assess and improve care. We applied a patented methodology, using an adaptation of the Angoff standard-setting method and the Dunn-Rankin method, with an expert panel skilled in osteoporosis care to form a composite and establish standards for both competent and excellent care. Physician and practice characteristics, including a practice infrastructure score based on the Physician Practice Connections Readiness Survey (PPC-RS), were used to examine the validity of the inferences made from the composite scores. The mean composite score was 67.54 out of 100 maximum points with a reliability of 0.92. The standard for competent care was 46.87, and for excellent care it was 83.58. Both standards had high classification accuracies (0.95). Sixteen percent of physicians performed below the competent care standard, while 22 % met the excellent care standard. Specialists scored higher than generalists, and better practice infrastructure was associated with higher composite scores, providing some validity evidence. We developed a rigorous methodology for assessing physicians' osteoporosis care. Clinical performance feedback relative to absolute standards of care provides physicians with a meaningful approach to self-evaluation to improve patient care.

BOOKS BACK TO TOP If you are unable to find a book, or require a book that is not on this list, please ask library staff who will be able to locate the book for you using interlibrary loan. Books available to borrow Falls in older people: prevention and management Tideiksaar th 2010, 4 edition

Oxford Handbook of Geriatric Medicine Bowker et al nd 2012, 2 edition

From the back of the book: Presenting evidence-based practice throughout, this easy-to-read manual is a comprehensive guide to preventing and managing falls in hospitals and long-term care settings. Now in its fourth edition, the awardwinning guide explores the internal and external causes of falls, analyzes their consequences, provides clinical assessments for actual falls as well as risks for falling, and promotes an interdisciplinary approach to falls management. Jam-packed with practical strategies, assessment tools, and management practices, Falls in Older People includes all the medical, rehabilitative, and environmental strategies needed in any care setting to protect the safety and health of atrisk older adults.

From the back of the book: Fully updated, this second edition of the Oxford Handbook of Geriatric Medicine includes all the information required to deliver effective geriatric care. Guidance is given on a range of key treatment areas, indicating where practice differs from that of younger adults or is ill informed by evidence, where dangers lurk for the inexperienced clinician, and on the many ethical and clinical dilemmas common in geriatric practice. This accessible handbook is essential reading for all junior doctors and specialist trainees in geriatric medicine and general internal medicine, and for all medical and nursing staff who manage older people.

Taunton and SomPar NHS staff - Have you visited the EBL eBook catalogue? Follow the links below and login via OpenAthens to read online books free for 5-10 minutes each day, send requests for eBook loans or purchase suggestions Taunton & Somerset eBook catalogue

Somerset Partnership eBook catalogue

About OpenAthens 12

GUIDELINES

NICE Guidelines Falls in older people: assessing risk and prevention- NICE Guidelines [CG161] Published date: June 2013- due for review January 2016 Falls in older people- NICE Quality Standard [QS86] Published date: March 2015

UPTODATE & DYNAMED BACK TO TOP What’s new from our clinical decision-making tools on the topic of falls and falls prevention. UpToDate Access for Musgrove Park Hospital staff only DynaMed Please contact library staff for details on how to access these resources; you will need an Athens password.

REPORTS, PUBLICATIONS AND RESOURCES

NICE Pathway on Falls in Older People

Royal College of Physicians National Audit of Inpatient Falls audit report The audit was created to measure against the National Institute for Health and Care Excellence’s (NICE’s) guidance on falls assessment and prevention (NICE clinical guidance 161 (CG161)) and other patient safety guidance on preventing falls in hospital. The audit was open to all acute hospitals in England and Wales. FallSafe resources and toolkit There are several falls prevention initiatives already active within the NHS. FallSafe is not a

competing initiative, it is a major step forward in bringing together existing and new falls prevention resources, and should be used alongside the ones already in place.

AGE UK AGE UK Falls Prevention Resources AGE UK Falls Prevention Exercise- following the evidence- June 2013 This document: • Describes the evidence base for falls prevention exercise • Outlines the benefits of evidence-based falls prevention exercise for older people and health and care services • Presents a range of services delivering to the evidence

First inpatient falls audit shows serious shortfalls in hospital care Despite falls in hospitals being the most commonly reported patient safety incident in England and Wales, a report today’s reveals serious deficiencies in care. The first-ever National Audit for Inpatient Falls, reviews how well hospital trusts and local health boards prevent inpatient falls in England and Wales, which are set against the NICE guideline (CG161) on falls assessment and prevention.

TOPIC ALERTS AND UPDATES

ABSTRACTS AVAILABLE VIA LINKS BELOW - FOR FULL-TEXT PLEASE ASK LIBRARY STAFF TRIP Database Renal disease and accidental falls: a review of published evidence BMC Nephrol. 2015 Oct 29;16(1):176 FREE FULL TEXT Nutritional Guidance Improves Nutrient Intake and Quality of Life, and May Prevent Falls in Aged Persons with Alzheimer Disease Living with a Spouse (NuAD Trial). J Nutr Health Aging. 2015;19(9):901-7

TRAINING & NETWORKING OPPORTUNITIES, CONFERENCES, EVENTS BACK TO TOP Watch Your Step: 2016 National Fall Prevention Conference â&#x20AC;&#x201C; Applying Integrated Approaches- May th th 16 and 17 2016, Calgary, Canada

LITERATURE SEARCH SERVICE BACK TO TOP Looking for the latest evidence-based research but havenâ&#x20AC;&#x2122;t got time to trawl the databases? Do you need a literature search carried out? Do you need to find evidence to support an improvement? Do you want to know how something has been done elsewhere and whether it worked?

Library staff provide a literature search service for busy clinicians who are pressed for time.

To request a search please complete and return the appropriate form, providing as much information as possible. Alternatively if you would like an assisted search training session, where we will sit down with you and go through the steps of a literature search, then please contact the library. Musgrove staff click here to access literature search form Somerset Partnership staff click here to access literature search form

TRAINING AND ATHENS BACK TO TOP Most electronic resources are available via an Athens password. You can register for this via the Library intranet page, or from home at www.swice.nhs.uk and following the link for Athens selfregistration. Please note that registering from home will take longer as it will need to be verified that you are NHS staff/student on placement. The library offers training on how to access and use Athens resources, as well as an introductory course on critical appraisal. You can book a course through the Learning and Development intranet page, or by contacting the library directly.