Browsing by Subject "falls"

Now showing 1 - 7 of 7
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    Bleeding Risk, Physical Functioning, and Non-use of Anticoagulation Among Patients with Stroke and Atrial Fibrillation
    (2014-08) Schmid, Arlene A.; Ofner, Susan; Shorr, Ronald I; Williams, Linda S.; Bravata, Dawn M.
    Background: Atrial fibrillation (AF) is common among people with stroke. Anticoagulation medications can be used to manage the deleterious impact of AF after stroke, however may not be prescribed due to concerns about post-stroke falls and decreased functioning. Thus, the purpose of this study was to identify, among people with stroke and AF, predictors of anticoagulation prescription at hospital discharge. Methods: This is a secondary analysis of a retrospective cohort study of data retrieved via medical records, including: National Institutes of Health Stroke Scale score; Functional Independence Measure (FIM) motor score (motor or physical function); ambulation on 2nd day of hospitalization; Morse Falls Scale (fall risk); and HAS-BLED score (Hypertension; Abnormal renal and liver function; Stroke; Bleeding; Labile INRs; Elderly > 65; and Drugs or alcohol). Data analyses included bivariate comparisons between people with and without anticoagulation at discharge. Logistic-regression modeling was used to assess predictors of discharge anti-coagulation. Results: There were 334 subjects included in the analyses, average age was 75 years old. Anticoagulation was prescribed at discharge for 235 (70%) of patients. In the adjusted regression analyses, only the FIM motor score (adjusted OR = 1.015, 95%CI 1.001-1.028) and the HAS-BLED score (adjusted OR = 0.36, 95%CI 0.22-0.58) were significantly associated with anticoagulation prescription at discharge. Conclusion: It appears that in this sample, post-stroke anti-coagulation decisions appear to be made based on clinical factors associated with bleed risk and motor deficits or physical functioning. However, opportunities may exist for improving clinician documentation of specific reasoning for non-anticoagulation prescription.
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    Circumstances and consequences of falls among people with chronic stroke
    (2013) Schmid, Arlene A.; Yaggi, H. Klar; Burrus, Nicholas; McClain, Vincent; Austin, Charles; Ferguson, Jared; Fragoso, Carlos; Sico, Jason J.; Miech, Edward J.; Matthias, Marianne S.; Williams, Linda S.; Bravata, Dawn M.
    Falls are common after stroke; however, circumstances and consequences are relatively unknown. Our objectives were to identify the differences between fallers and non-fallers among people with chronic stroke, identify the circumstances of fall events, and examine the consequences of the falls. This is a secondary data analysis; all participants included sustained a stroke. Variables included demographics, stroke characteristics, and comorbidities. Falls were collected via self-report, and circumstances and consequences were derived from participant description of the event and categorized as appropriate. Among 160 participants, 53 (33%) reported a fall during the 1 yr period. Circumstances of falls were categorized as intrinsic or extrinsic. Location and circumstance of the fall were included: 70% occurred at home and 40% were associated with impaired physical or mental state (e.g., inattention to tying shoes). Additionally, 21% of falls were associated with activities of daily living and mobility and 34% with slips or trips. The majority who fell sustained an injury (72%). Injuries ranged from bruising to fractures, and 55% of those with an injury sought medical care (32% to emergency department). Poststroke falls are associated with an alarming rate of injury and healthcare utilization. Targeting mental and physical states may be key to fall prevention.
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    Daily Situational Brief, December 25, 2014
    (MESH Coalition, 12/25/14) MESH Coalition
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    Fall Prevention at a Local Fitness Center
    (2022-05-01) Parker, Kirsten; Bednarski, Julie; Department of Occupational Therapy, School of Health and Human Sciences; Armstrong, Isabel
    Abstract Falls are the leading cause of fatal and nonfatal injuries in adults over the age of 65 with 1 in 4 experiencing a fall in their lifetime (Stark et al., 2018). With a growing number of community-dwelling older adult clientele returning to the gym following the Covid-19 pandemic, the leadership at a fitness center in Fishers, IN found a gap in their services. A collaboration began between an Indiana University Doctor of Occupational Therapy capstone student and this a fitness center in Fishers, IN club to develop and implement an evidence-based fall prevention program through an occupational therapy lens to meet the needs of the older adult clients at a fitness center in Fishers, IN An eight-week program was administered, and results suggest an increase in group members’ balance-related self-confidence scores utilizing the Activities-specific Balance Confidence (ABC) Scale as a pre and posttest. Program satisfaction was measured through use of a nonstandardized survey and analyzed for sustainability purposes of the program.
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    Occupational Therapy Interventions to Support Aging in Place: A Rapid Systematic Review
    (2020-05) Brown, Tori; Kidwell, Hannah; Priest, Paige; Sellers, Abbey; Serino, Anna; Spencer, Brooke; Chase, Anthony; Petrenchik, Terry; Department of Occupational Therapy, School of Health and Human Sciences
    This rapid systematic review discusses the evidence of 30 studies for the effectiveness of occupational therapy (OT) in supporting aging in place, or safely living in one’s home independently. Many older adults suffer from at least one disability, which can be a threat to both independence and safety. Further, falls and injuries raise healthcare costs, which can include nursing facility housing. The transition from living in one’s home to living in a long-term care facility dramatically impacts occupational participation and performance. Supporting aging in place increases safety, quality of life, and independence in one’s home environment. In order to support aging in place, we looked at the effectiveness of multiple occupational therapy interventions that targeted occupational performance and participation, quality of life, falls and hospital readmissions, and community mobility. Overall, we found strong evidence to support the effectiveness of these client centered occupational therapy interventions for improving aging in place in community dwelling older adults and preventing negative health outcomes.
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    Occupational Therapy's Role in Low Vision: A Doctoral Capstone Experience
    (2023-05) Ellis, Nicole; Bednarski, Julie; Department of Occupational Therapy, School of Health and Human Sciences; Holmes, Patricia
    Occupational therapists have a role in treating low vision clients. Vision impacts everything a person does during the day. Research shows most occupational therapists do not address low vision despite it being within the scope of practice. Barriers to addressing low vision include time, comfort, and cost. The capstone student collaborated with the therapy supervisor at a skilled nursing facility and found a gap from literature to practice. When low vision is not addressed, this can lead to occupational deprivation and occupational injustice. The capstone student collaborated with the site to create a low vision evidence-based resource with emphasis on vision and falls to increase therapist knowledge and confidence with addressing low vision and promoting holistic care. The results of the survey indicated the therapists found the resource helpful. Overall, the capstone project promoted occupational justice for current and future skilled nursing home residents through the inclusion of low vision screenings and interventions.
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    Prevalence, predictors, and outcomes of poststroke falls in acute hospital setting
    (2010) Schmid, Arlene A.; Wells, Carolyn K; Concato, John; Dallas, Mary I; Lo, Albert C.; Nadeau, Steven E; Williams, Linda S.; Peixoto, Aldo J; Gorman, Mark; Boice, John L.; Struve, Frederick; McClain, Vincent; Bravata, Dawn M.
    Abstract—Falls are a serious medical complication following stroke. The objectives of this study were to (1) confirm the prevalence of falls among patients with stroke during acute hospitalization, (2) identify factors associated with falls during the acute stay, and (3) examine whether in-hospital falls were associated with loss of function after stroke (new dependence at discharge). We completed a secondary analysis of data from a retrospective cohort study of patients with ischemic stroke who were hospitalized at one of four hospitals. We used logistic regression to identify factors associated with inpatient falls and examine the association between falls and loss of function. Among 1,269 patients with stroke, 65 (5%) fell during the acute hospitalization period. We found two characteristics independently associated with falls: greater stroke severity (National Institutes of Health Stroke Scale [NIHSS] 8, adjusted odds ratio [OR] = 3.63, 95% confidence interval [CI]: 1.46–9.00) and history of anxiety (adjusted OR = 4.90, 95% CI: 1.70–13.90). Falls were independently associated with a loss of function (adjusted OR = 9.85, 95% CI: 1.22–79.75) even after adjusting for age, stroke severity, gait abnormalities, and past stroke. Stroke severity (NIHSS 8) may be clinically useful during the acute inpatient setting in identifying those at greatest risk of falling. Given the association between falls and poor patient outcomes, rehabilitation interventions should be implemented to prevent falls poststroke.