Závěrečná práce NCO NZO
1 svazek : tabulky, grafy ; 30 cm
Our study aimed to assess the prevalence of fall risk-increasing drugs (FRIDs) in a sample of community-residing older patients in Croatia and its association with negative health outcomes. An observational, cross-sectional study was conducted on older patients (65+) visiting community pharmacies in three regionally different study sites in Croatia. Data were collected using a questionnaire developed for that purpose and included components of comprehensive geriatric assessment. Prevalence of FRIDs was identified using the "Screening Tool of Older Persons Prescriptions in older adults with high fall risk" (STOPPFall). In the sample of 407 participants (median age 73 (IQR 69-70) years; 63.9 % females), 79.1 % used at least one FRID. The most common drug classes were diuretics, benzodiazepines, and opioids (in 51.1 %, 38.1 %, and 17.2 % participants, respectively). More FRIDs were prescribed to the oldest old patients (85+) and participants from poorer regions of Croatia (Slavonia) (p < 0.05). Exposition to FRIDs was identified as the significant risk factor associated with falls (OR = 1.24 (1.04-1.50); p = 0.020) and higher health-care utilization (OR = 1.29 (1.10-1.51); p = 0.001). Our study highlights the need for rationalization of FRID use. To reduce the unnecessary exposure to FRIDs in older adults, health-care professionals must consider high individualization of medication schemes regarding selection, dosing, and combinations of only necessary FRIDs.
- MeSH
- Ageism * MeSH
- Geriatric Assessment methods MeSH
- Cohort Studies MeSH
- Humans MeSH
- Polypharmacy MeSH
- Prevalence MeSH
- Cross-Sectional Studies MeSH
- Surveys and Questionnaires MeSH
- Risk Factors MeSH
- Independent Living * MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Accidental Falls * statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
- Geographicals
- Croatia MeSH
Studie se zaměřuje na trendy v počtu pádů geriatrických pacientů ve Fakultní nemocnici Olomouc v období let 2014–2023 s důrazem na rizikové faktory, jako jsou farmakoterapie a kognitivní deficit. Pády představují závažný problém, který může vést k vážným zraněním a snížení kvality života. V rámci výzkumu bylo zaznamenáno celkem 801 pádů, což odpovídá průměru 10,35 pádu na 100 hospitalizovaných pacientů. Průměrný věk pacientů se zaznamenaným pádem byl 81,4 let. Nejčastěji užívanou skupinou léků mezi těmito pacienty byla antihypertenziva, což odráží vysokou prevalenci hypertenze u starší populace. Výsledky ukazují na významný nárůst pádů po přesunu geriatrického oddělení do nových prostor. Studie poukazuje na důležitost sledování rizikových faktorů pádu u geriatrických pacientů a snahu o jejich předcházení.
The study focuses on trends in the number of falls in geriatric patients at the University Hospital Olomouc in the period 2014-2023, with an emphasis on risk factors such as drug therapy and cognitive deficit. Falls are a serious problem that can lead to serious injuries and reduced quality of life. A total of 801 falls were recorded in the study, corresponding to an average of 10.35 falls per 100 inpatients. The average age of patients with a recorded fall was 81.4 years. The most commonly used medication group among these patients was antihypertensives, reflecting the high prevalence of hypertension in the elderly population. The results show a significant increase in falls after the geriatric ward was moved to the new building. The study highlights the importance of monitoring risk factors for falls in geriatric patients and trying to prevent them.
- MeSH
- Antihypertensive Agents adverse effects MeSH
- Drug Therapy statistics & numerical data MeSH
- Inpatients statistics & numerical data MeSH
- Humans MeSH
- Drug-Related Side Effects and Adverse Reactions complications MeSH
- Risk Factors MeSH
- Aged MeSH
- Accidental Falls * statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Clinical Study MeSH
V řadě zdravotnických zařízeních jsou kliničtí farmaceuti vyzýváni, aby se aktivně podíleli na prevenci pádů pacientů. Na území Česka dosud není zavedena jednotná metodika, jak by měl klinický farmaceut v této činnosti systematicky a racionálně postupovat. Cílem článku je na základě vlastní analýzy dat tuto metodiku nabídnout. Z výsledků detailních retrospektivních analýz výstupů z činnosti klinického farmaceuta v oblasti farmakoprevence pádů a lékových auditů po pádu vyplývá, že 78 % pacientů, kteří během hospitalizace upadli, bylo starších 65 let. Věk byl následně vzat jako základní kritérium pro hodnocení medikace pacienta s ohledem na riziko pádu. Plošné rozšíření klinickofarmaceutické péče a nově zavedený systém sledování a prevence pádů v ÚVN Praha se odrazily v poklesu výskytu nežádoucího vlivu medikace na pády pacientů: v roce 2017 se jednalo o 34 % případů, v roce 2020 již jen o 13 %. Na základě našich dat a zkušeností nabízíme metodiku činnosti klinického farmaceuta v problematice pádů: 1. při poskytování systematické klinickofarmaceutická péče provádět automatickou kontrolu medikace i s ohledem na riziko pádu u pacientů nad 65 let, 2. zajistit automatické zasílání žádanek na oddělení klinické farmacie při pádu pacienta ve zdravotnickém zařízení.
Clinical pharmacists are encouraged to participate in falls prevention programs in many healthcare facilities. A uniform methodology for the work of clinical pharmacist in fall prevention has not yet been established in the Czech Republic. The aim of this work is to offer the methodology based on our own data analysis. Retrospective clinical pharmacist's output analysis was performed in two areas: fall's pharmacoprevention and post-fall drug audits. In the results 78 % of patients who fell during hospitalization were over 65 years of age. Age was subsequently taken as the basic criterion for the patient's medication evaluation with regard to the risk of falling. Thanks to the widespread expansion of clinical pharmaceutical care and the newly introduced fall prevention and monitoring system at ÚVN Prague, there was a positive trend in the incidence of medication's adverse effects on patient's falls: in 2017 it was 34 % of cases, in 2020 only 13 %. Based on our data and experience, we offer a methodology for the clinical pharmacist's activity in fall prevention: 1. performing revision of medication also with regard to the risk of falls in patients over 65 years of age, 2. ensuring the automatic requests sending to the clinical pharmacy department in the case of a patient's fall in a medical facility.
- Keywords
- lékový audit, farmakoprevence,
- MeSH
- Pharmacists MeSH
- Inpatients * MeSH
- Humans MeSH
- Hospitals MeSH
- Drug-Related Side Effects and Adverse Reactions MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Aged MeSH
- Accidental Falls * prevention & control statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
Effects of localized lower-extremity vibration on postural balance have been reported. The purpose of the current study was to investigate the effect of low-frequency vibration of calf muscles on the instrumented Timed-Up-and-Go (iTUG) test among older adults. Older adults were recruited and classified to low (n=10, age=72.9±2.8 years) and high fall risk (n=10, age=83.6±9.6) using STEADI. Vibratory system (30Hz or 40Hz), was positioned on calves along with wearable motion sensors. Participants performed the iTUG test three times, under conditions of no-vibration, 30Hz, and 40Hz vibration. Percentage differences in duration of iTUG components were calculated comparing vibration vs no-vibration conditions. Significant between-group differences were observed in iTUG (p=0.03); high fall risk participants showed reduction in the duration of turning (-10 % with 30Hz; p=0.15 and -15 % with 40Hz; p=0.03) and turning and sitting (-18 % with 30Hz; p=0.02 and -10 % with 40Hz; p=0.08). However, vibration increased turning (+18 % with 30Hz; p=0.20 and +27 % with 40Hz; p=0.12) and turning and sitting duration (+27 % with 30Hz; p=0.11 and +47 % with 40Hz; p=0.12) in low fall risk participants. Findings suggest that lower-extremity vibration affects dynamic balance; however, the level of this influence may differ between low and high fall risk older adults, which can potentially be used for assessing aging-related sensory deficits.
- MeSH
- Biomechanical Phenomena MeSH
- Risk Assessment methods MeSH
- Muscle, Skeletal physiology MeSH
- Humans MeSH
- Pilot Projects MeSH
- Movement physiology MeSH
- Postural Balance physiology MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Physical Therapy Modalities * MeSH
- Accidental Falls prevention & control statistics & numerical data MeSH
- Vibration therapeutic use MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Východiska: Jedním z ovlivnitelných rizikových faktorů v prevenci pádů pacientů je farmakoterapie. Zvyšující se počet pacientů vyšších věkových skupin bývá doprovázen polymorbiditou a s tím související polypragmázií. Cíl: Cílem příspěvku bylo posoudit vliv farmakoterapie na následky pádů pacientů velkého zdravotnického zařízení.Metoda: Kvantitativní analýzou dat z let 2012-2019 byla zjišťována závislost druhu zranění způsobených pádem na užívaných lécích, věku pacientů a oboru poskytované péče. Data byla posuzována na hladině významnosti 5 %.Výsledky: Výsledky deskriptivní statistiky prokázaly, že v době pádu užívalo 93 % pacientů farmaka a z toho 63 % pacientů užívalo v době pádu kombinaci rizikových léků. V rámci analýzy nebyla prokázána závislost druhu zranění na užívání léků (p = 0,773); na věkové kategorii (p = 0,163) ani na oboru poskytované péče (p = 0,163).Závěr: I přes neprokázanou korelaci je farmakoterapie pacientů důležitou oblastí, kterou je potřeba v rámci prevence nežádoucích událostí přehodnocovat a indikovaně korigovat.
Backround: One of the controllable risk factors in the prevention of falls in patients is pharmacotherapy. The increasing number of elderly patients is usually accompanied by polymorbidity and related polypragmasia. Aim: The aim of the paper was to assess the impact of drug therapy on the consequences of falls in patients of a large medical institution.Method: Quantitative analysis of data from 2012-2019 determined the dependence of the type of injuries caused by falls on the drugs used, the age of patients and the field of care provided. The data were assessed at a significance level of 5 %. Results: The results of descriptive statistics showed that 93 % of patients were taking drugs at the time of the fall, of which 63 % were taking a combination of high-risk drugs at the time of the fall. The analysis did not show a dependence of the type of injury on drug use (p = 0.773); on the age category (p = 0.163) or on the field of care provided (p = 0.163).Conclusion: Despite the unproven correlation, pharmacotherapy of patients is an important area that needs to be re-evaluated and corrected as indicated in the prevention of adverse events.
Although falls are more prevalent as ageing proceeds, it cannot be assumed that they happen due to ageing alone. The retrospective cohort study of data was targeted to make an analysis of prevalence of falls in anaemic patients in comparison to the non-anaemic elderly admitted to the acute geriatric department and evaluation of pertinent influence of age, gender and immobility on occurrence of falls. During the considered period of four years (2012-2016) the authors treated 9 363 elderly patients aged 79,9±8,6 years (in the majority of them 65+ years). Among them there were 8 809 non-anaemic and subgroup of 551 old anaemic patients (aged 81±7 years) with decreased haemoglobin (<110 g/l). Falls at hospital admission in average was present in 1 766 non-anaemic persons (20%) in comparison to 380 falls among anaemic patients (68,6%). Prevalence in anaemic subgroup is statistically significant higher (p<0,005). Also relation between falls and age, ADL and MMSE test and mobility is highly statistically significant (p<0,001). Meaningfully higher is occurrence of repeated falls in the anaemic subgroup in comparison to the non-anaemic one (41,2 vs 1,7%). The occurrence of falls in female gender in comparison to men is statistically significant higher in non-anaemic patients, not in anaemic group. Authors emphasize that anaemia appears to us as significant risk factor for falls in the elderly.
- MeSH
- Anemia complications MeSH
- Hospitalization * MeSH
- Humans MeSH
- Prevalence MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Accidental Falls statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
The goal is to present partial results of the programme which was carried out in order to decrease the incidence of falls of hospitalized patients. Materials and methods: In January 2018, 16 monitored departments in 4 South Bohemian hospitals started the annual intervention programme, the goal of which was to reduce the incidence of falls. The selected (intervention) nurses were responsible for the realization and coordination of the interventions of fall prevention in co-operation with the managers of selected departments. The interventions included the identification of fall risk patients and standard nursing interventions in fall risk patients (by the departments’ standards) as well as the trainings of nurses in fall prevention of hospitalized patients, individual education of patients and their close relatives, special labelling of the beds of fall risk patients, and ensuring compensation and safety aids and after-fall medical audit using interactive databases. Results: This article presents the data from only two selected departments (internal department and subsequent care department of the South Bohemian regional hospital), which recorded a decrease of falls compared to the same period in 2017. The internal department recorded 27 falls in 2018 (in 2017, there were 42 falls) and the subsequent care department recorded 18 falls in 2018 (in 2017, there were 38 falls). Conclusion: Despite all measures, we recorded falls of patients in the monitored period (January–December 2018). However, it is positive that most workplaces included in our programme recorded a decrease compared to last year.
