Download Document 8945916

Undergraduate
Category:HealthSciences
DegreeLevel:PharmD
AbstractID:1289
PharmDstudents:HelenChoi,SooJinKim
Advisor:CarlaBouwmeester,PharmD,BCPS,FASCP
Assessing the effectiveness of the Fall Risk Assessment Tool (FRAT) v.2
in a high-risk geriatric population living in the community
BACKGROUND&SIGNIFICANCE
•  Approximately2.5millionelderlyadultsaretreatedin
theemergencydepartmentforfallinjurieseachyear
resulHngindirectmedicalcostsofabout34billion
dollarsannually
•  Fallingoncedoublestheriskoffallingagain
•  Fallscausesignificantdisability,hospitalizaHon,lossof
independence,anddiminishedqualityoflife
•  Fallsarethemostcommoncauseofinjuryintheelderly
populaHonalthoughtheyarehighlypreventable
•  Anumberoffallriskassessmenttools(MorseFallScale,
STRATIFY,TimedUp,GoTest)arebeingusedtodayby
healthcareprofessionalsbuttheymaynotbeclinically
meaningfulforpaHentswhoarealreadyathighriskof
falling
DATA&RESULTS
Assessment:AmongthepaHentswhodidnotfallintheprevious6
months,addiHonaldatawerecollectedaccordingtotheFRATV.2.
!Elder!Service!Plan!of!HHSI!!!Fall!Risk!Assessment!Tool!(FRAT)!!!!Name:!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!MRN:!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Date:!!!!!!!!!!!!!!
Assessment'Type:'
Criteria!
PACE!for!>6!
months!
AND!
Fell!<6!months!
Intake'''
Assessment!
Yes,!STOP!
No,!
continue!
Cognitive!
Safety'awareness''
'
Usually'
Sometimes'
Rarely'
Unknown'
MoCA'
'
Normal'
Mild'
Moderate'
Severe'
Unknown'
Environmental!
Safety'risks'
present?'
Is'an'assistive'
device'required?'
'
Yes'
No'
Unknown'
No'
Unknown'
If'YES,'used:'
Usually'
Sometimes'
Rarely'
Vision''
Adequate'
Impaired'
Moderately'
impaired'
Highly'
impaired'
Severely'
impaired'
Unknown!
'Initial'''
Semi2annual'''
'Annual!
Description!
Yes:!Patient!is!at!high!risk!due!to!fall!
in!past!6!months!!
No:!Continue!assessment!to!
determine!fall!risk!
'
Demonstrates'and/or'adheres'to'safety'
recommendations.'
''Usually:'752100%'
''Sometimes:'50274%'
''Rarely:'<50%'
Normal!cognition:'27230'
Mild!impairment:!18226'
Moderate!impairment:'10217'
Severe!impairment:'<10'
Unknown:'unable'to'perform'testing'or'
visually(impaired.'
!
(Examples:'cords,'scatter'rugs,'poor'
lighting,'bathroom'hazards,'clutter,'
access'to'emergency'call)'
Check'NO'if'an'assistive'device'is'not'
required.'
If'an'assistive'device'is'requiredZ'check'
frequency'of'use:'
''Usually:'752100%'
''Sometimes:'50274%'
''Rarely:'<50%'
Adequate:'Sees'fine'detail,'including'
regular'print'in'books'
Medical!
Anxiety'
CHF'
COPD'
Diabetes'
Epilepsy/Seizure'
Multiple'sclerosis'
Neuropathy'
Parkinson’s'
disease'
Spinal'stenosis'
Stroke/CVA'
Vertigo'
Medications!
Anticholinergics'
YES!NO!
'
'
'
'
'
'
'
'
'
'
'
YES!NO
'
Anticonvulsants'
Antihistamines''
Antipsychotics'
Benzodiazepines'
Diuretics'
Insulin'
Narcotics'
Non2benzo''
hypnotics'
SSRI/SNRI'
Sulfonylureas'
TCAs'
'
'
'
'
'
'
'
'
'
'
'
'
Alcohol!use!
Pain!
Impaired:'Sees'large'print'but'not'
regular'print'in'books'
Moderately!impaired:'Limited'visionZ'
not'able'to'see'newspaper'headlines,'
but'can'identify'objects''
'
Highly!impaired:'Object'identification'
in'question,'but'eyes'appear'to'follow'
objects'
78.6
Gender, (%
female)
69.12
BMI, mean
28.8
ThestudywasconductedatHarborHealthServices,Inc.
locatedinMaZapan,MAandinvolvedpaHentsenrolledin
aProgramofAll-inclusiveCarefortheElderly(PACE).An
interdisciplinaryteam(IDT)ofmedical,rehabilitaHon,
socialservices,pharmacy,anddietaryprofessionals
createdasecondversionoftheFRAT.
InclusionCriteria:populaHonenrolledinthePACE
programforatleast6months,residinginacommunity
se^ng(home,assistedlivingfacility,orseniorhousing)
andassessedbytheIDTbetweenJulyandAugust2015.
ExclusionCriteria:PACEparHcipantslivinginaskilled
nursingfacilityorlong-termcarefacility.
!
Medications:!
Scheduled'medications'(do'not'include'
PRN'or'“as'needed”'medications)'
'
Yes:'currently'prescribed''
No:'not'prescribed'
'
74% of the falls resulted in no injury or only minor injury.
Current'alcohol'use'by'SW'assessment'
!
!
Incontinent!
Stress'
Day'
Night'
Day/night'
Incontinent!!(regardless'of'supplies)'
Stress:'occasional'release'of'urine'
when'sneezing,'coughing,'laughing,'or'
lifting'
'
Day:'incontinent'during'the'day'
(including'naps)'
Table2:SeverityofFalls
'
Night:'incontinent'while'sleeping'
'
'
Day/night:'incontinent'during'both'
'
v.2.3'(2/1/16)'©'2015'Elder'Service'Plan'of'Harbor'Health'Services,'Inc'
VerHgo
Stroke/CVA
SpinalStenosis
TotalFalls(n=35)
#offalls %offalls
F1:Noinjury
18
51.43
F2:Minorinjury
8
22.86
F3:Moderateinjury 6
17.14
F4:Majorinjury
5.71
2
Parkinson'sDisease
Neuropathy
MoCA (% pts)
METHOD
Outcome: Severity of Falls
Fall severity was determined by the Quality Assurance nurse
based on National PACE Association standards.
From total of 35 falls, 1 was found to be unknown in severity.
Diagnoses
Table 1: Baseline
Characteristics (n=52)
Age, mean
The fall rate per member per month was 0.11
Yes:'>3'months'in'the'lower'extremity'
Urinary!
incontinence!!
'
Continent'
Unknown'
'
'
Severely!impaired:'No'vision'or'sees'
only'light,'colors,'or'shapesZ'eyes'do'not'
appear'to'follow'objects'
ToassesstheeffecHvenessoftheFallRiskAssessmentTool
(FRAT)v.2topredictthenumberandseverityoffallsina
populaHonofolderadultswithahighbaselinefallrisk
'
Diagnosis:!
Check'YES'if'the'diagnosis'is'listed'in'
the'current'medical'problems.''
'
'
AIM
Outcome: Number of Falls
There were a total of 35 unique falls during the six months
following initial FRAT v.2 assessment.
CONCLUSION
MulHpleSclerosis
Mild
28.85
Epilepsy/Seizures
Moderate
23.08
Diabetes
Severe
9.62
Unknown
38.46
BaselineanalysisofFRATv.2isnowcompleteandphase2
analysiswillcommencetopredictthecorrelaHonof6-month
riskandtheseverityoffallsinthishigh-riskgeriatric
populaHon.
COPD
CHF
Anxiety
0
2
4
6
8
10
12
14
16
MedicaJons
REFERENCES
TricyclicAnHdepressants
Sulfonylureas
SSRIs/SNRIs
Non-benzohypnoHcs
NarcoHcs
Insulin
DiureHcs
Benzodiazepines
AnHpsychoHcs
AnHhistamines
AnHconvulsants
AnHcholinergics
0
5
10
15
20
25
30
CentersforDiseaseControlandPrevenHon,NaHonalCenter
forInjuryPrevenHonandControl.
Web–basedInjuryStaHsHcsQueryandReporHngSystem
(WISQARS)[online].AccessedAugust15,2013
IRBreviewwasnotrequired,howeverprojectwasapprovedby
theQualityAssuranceandPerformanceImprovement
commi?eeattheclinicsite.