BACKGROUND: Falls are common undesirable events for older adults in institutions. Even though the patient's fall risk may be scored on admission, the medication-induced fall risk may be ignored. This study developed a preliminary categorization of fall-risk-increasing drugs (FRIDs) to be added as a risk factor to the existing fall risk assessment tool routinely used in geriatric care units. METHODS: Medication use data of older adults who had experienced at least one fall during a hospital ward or a nursing home stay within a 2-year study period were retrospectively collected from patient records. Medicines used were classified into three risk categories (high, moderate and none) according to the fall risk information in statutory summaries of product characteristics (SmPCs). The fall risk categorization incorporated the relative frequency of such adverse drug effects (ADEs) in SmPCs that were known to be connected to fall risk (sedation, orthostatic hypotension, syncope, dizziness, drowsiness, changes in blood pressure or impaired balance). Also, distribution of fall risk scores assessed on admission without considering medications was counted. RESULTS: The fall-experienced patients (n = 188, 128 from the hospital and 60 from nursing home records) used altogether 1748 medicaments, including 216 different active substances. Of the active substances, 102 (47%) were categorized as high risk (category A) for increasing fall risk. Fall-experienced patients (n = 188) received a mean of 3.8 category A medicines (n = 710), 53% (n = 375) of which affected the nervous and 40% (n = 281) the cardiovascular system. Without considering medication-related fall risk, 53% (n = 100) of the patients were scored having a high fall risk (3 or 4 risk scores). CONCLUSION: It was possible to develop a preliminary categorization of FRIDs basing on their adverse drug effect profile in SmPCs and frequency of use in older patients who had experienced at least one documented fall in a geriatric care unit. Even though more than half of the fall-experienced study participants had high fall risk scores on admission, their fall risk might have been underestimated as use of high fall risk medicines was common, even concomitant use. Further studies are needed to develop the FRID categorization and assess its impact on fall risk.

• MeSH
• geriatrické hodnocení MeSH
• hodnocení rizik MeSH
• lidé MeSH
• nežádoucí účinky léčiv * diagnóza   epidemiologie   MeSH
• pečovatelské domovy MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• úrazy pádem * MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

Aim: The aim of study was to determine the presence of selected risk factors and the level of the fall risk in hospitalized pediatric patients. Method: A record sheet was used to gather the empirical data, which included risk assessment tool Humpty Dumpty Scale – Inpatient. Sample: The sample consisted of 100 pediatric patients (63 boys, 37 girls) admitted at the Clinic of Children and Adolescents of the University Hospital in Martin at the age of 8 months to 18 years. The average age of the children was 5.6 ± 4.96 years. The fall risk assessment was carried out within 24 hours after the child was admitted to hospital. Results: Of the risk factors for the fall, hospitalized children were: respiratory (54%), gastrointestinal (12 %), neurological (11 %) and psychiatric diseases (7 %), taking laxatives (12 %). Most children (69 %) were hospitalized with a family member. Additional risk factors included: established peripheral venous cannula (66 %), limited mobility (52 %), visual impairment (17 %), altered cognitive function (44 %), baby in the crib (51 %), diagnostic procedure in anesthesia (10 %). The assessment tool Humpty Dumpty Scale – Inpatient average score was at a high risk level of falling (13.65 ± 2.35). High risk of fall (≥ 12 points) was 79 % of children, average fall risk score was 14.5 ± 1.82. Conclusion: The presence of fall risk factors in hospitalized children underline the need to address attention this issue. The use of the assessment tool has identified that most children are at high risk of falling, which could lead to further testing for real-time use under the conditions of our clinical practice. Numerous representation of high-risk children points to the importance of preventative measures.

• MeSH
• dítě hospitalizované * MeSH
• hodnocení rizik MeSH
• rizikové faktory MeSH
• úrazy pádem MeSH

Pády pacientů patří k nejčastějším nežádoucím událostem ve zdravotnických zařízeních a jsou považovány za indikátor kvality ošetřovatelské péče. Součástí prevence pádů je aktivní vyhledávání rizikových pacientů prostřednictvím screeningových hodnotících metod. Existuje mnoho škál na posouzení rizika pádů u dospělé populace, ale ty jsou pro pediatrické pacienty nevhodné. Jednou ze světově známých a používaných metod vhodných k zachycení rizika pádů u dětí od 12 měsíců věku je škála General Risk Assessment for Pediatric Inpatient Falls Scale (GRAF PIF). Příspěvek seznamuje čtenáře s tímto screeningovým nástrojem a předkládá výsledky hodnocení rizika pádů u dětí prostřednictvím této nové škály a Humpty Dumpty škály doporučené metodikou sledování nežádoucích událostí Ústavu zdravotnických informací a statistiky České republiky. Výsledky ukázaly pouze mírnou shodu mezi zvolenými testy k hodnocení rizika pádů. Vyšší riziko pádů hodnocené škálou GRAF PIF bylo zjištěno u dětí, které byly hospitalizovány bez rodičů, u chlapců, u dětí na JIP a u dětí s hendikepem.

Patient falls belong to the most frequent adverse events in healthcare institutions and they are considered to be a quality indicator of nursery care. Active search for risk patients by means of screening evaluation methods is a part of falls prevention. There are many scales for evaluation of the risk of falls in adult population, but these are not suitable for paediatric patients. One of the world's well-known and used methods suitable for capturing the risk of falls in children aged from 12 months is the scale General Risk Assessment for Paediatric Inpatient Falls Scale (GRAF PIF). The paper acquaints the reader with this screening tool and presents the results of assessment of the risk of falls in children by means of this new scale and Humpty Dumpty Fall Scale. These scales have been recommended by the adverse event monitoring methodology created by Institute of Health Information and Statistics of the Czech Republic. The results showed only a slight congruence between the selected tests to assess the risk of falls. A higher risk of falls assessed with the GRAF PIF scale has been identified in children who were hospitalized without parents, in boys, in children in the ICU and in children with disabilities.

• MeSH
• dítě MeSH
• hodnocení rizik MeSH
• hospitalizace MeSH
• lidé MeSH
• úrazy pádem * MeSH
• Check Tag
• dítě MeSH
• lidé MeSH

Aim: The aim of the paper is to find, to analyse and to compare guidelines and nursing standards with a focus on assessing the risk of falls inpatients/seniors. Methods: This is a review study. Guidelines and nursing standards were searched through the websites of selected professional societies, in February 2016, using the keywords: falls, prevention, risk assessment tool, adult, older, hospital, guideline. Documents that fulfil the required criteria were analysed with a focus on the issue of assessing the risk of falling. Results: The review includes the analysis and comparison of nine guidelines and nursing standards. Assessment the risk of falls inpatients is multifactorial. It is focused on identifying key risk factors; using a measurement tools for the screening of the overall risk of falling or specific risk factors, and other clinical and functional assessment. The most recommended screening tools include the Morse Fall Scale, Hendrich Fall Risk Model and STRATIFY. Assessment is basal for the selection and implementation of multifactorial interventions. Conclusion: Assessing the risk of falls is a key strategy for the prevention of falls. A standardized assessment method identifies key risk factors at the individual level and to target specific preventive interventions.

• MeSH
• bezpečnost pacientů * MeSH
• hodnocení rizik normy   MeSH
• hospitalizovaní pacienti MeSH
• lidé MeSH
• ošetřovatelská péče MeSH
• rizikové faktory MeSH
• senioři MeSH
• směrnice jako téma * MeSH
• úrazy pádem * prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

Rizikové faktory pádů pacientů bývají často multifaktoriální. V rámci poskytování bezpečné zdravotní péče je nutné tyto faktory včas a správně detekovat. V českém prostředí je doporučeno využívat jako nejefektivnější škály Morse Fall Scale a The Conley Scale. Pro hodnocení rizika pádů u dětských pacientů neexistuje jednoznačný konsenzus.

Risk factors for patients fall are often multifactorial. As part of the provision of safe health care, risk factors must be detected in a timely and correct manner. In the Czech environment it is recommended to use Morse Fall Scale and The Conley Scale as the most effective scales. There is no clear consensus for evaluating risk factors of falls for pediatric patients.

• MeSH
• hodnocení rizik * MeSH
• lidé MeSH
• rizikové faktory MeSH
• úrazy pádem * prevence a kontrola   MeSH
• Check Tag
• lidé MeSH

Aim: To determine the correlation between pharmacotherapy and high risk of fall based on the Morse Fall Scale (MFS score ≥45) in acute and long-term care settings. Design: Aquantitative cross-sectional descriptive correlation study. Methods:The study was conducted at a University Hospitalin Martin(UHM) anda selected long-term care facility (LTC) in Martin (Slovakia) June–October 2016. The pharmacotherapeutic data were obtained from the health documentation of the respondents. The fall risk was assessed by using the MFS screening tool within 24–48 hours of admission to the facility. Results:For the group of UHM patients (n = 63), the mean MFS score for fall risk was high (60.6 ± 22.4), and the correlation (p = 0.030) between the number of medications administered in 24 hours and high risk of fall was significant. For the group of LTCpatients (n = 89), the mean MFS score for fall risk was moderate (35.4 ± 15.9). Thecorrelations were not significant. Conclusion: Pharmacotherapy is animportant fall risk factor; therefore, it is necessary to determine it within the assessment of overall fall risk. The risk management of pharmacotherapy is an effective and important multifactorial intervention in programmes of fall prevention inacute and long-term care.

• Klíčová slova
• Morse Fall Scale,
• MeSH
• dlouhodobá péče statistika a číselné údaje   MeSH
• farmakoterapie * statistika a číselné údaje   MeSH
• hodnocení rizik metody   statistika a číselné údaje   MeSH
• hospitalizace statistika a číselné údaje   MeSH
• korelace dat MeSH
• lidé středního věku MeSH
• lidé MeSH
• průřezové studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• úrazy pádem * prevence a kontrola   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH
• Geografické názvy
• Slovenská republika MeSH

Cieľ: Malnutrícia, ako jeden z významných rizikových faktorov pádu, spôsobuje u pacienta nepriaznivé následky. Progresia malnutrície a rizika pádu sa výrazne zvyšuje s vekom a prispieva k opakovanej hospitalizácii geriatrického pacienta. Cieľom je identifikovať, analyzovať a syntetizovať štúdie súvisiace s malnutríciou ako rizikovým faktorom pádu u geriatrických hospitalizovaných pacientov. Metodika: Literárny prehľad bol realizovaný v licencovaných elektronických databázach PubMed, Scopus a Web of Science za roky 2005-2022. Z celkového počtu 2743 dohľadaných štúdií sme do finálnej analýzy zaradili päť. Výsledky: Analyzované štúdie potvrdili súvislosť medzi malnutríciou a rizikom pádu u geriatrických hospitalizovaných pacientov. Veková skupina pacientov ≥ 80 rokov, BMI < 20 a prítomnosť hypoproteinémie alebo hypoalbuminémie viedli k redukcii mobility a sebestačnosti, zvýšenému riziku pádu, zvýšenej incidencii pádov a opakovaným pádom s následným zranením počas hospitalizácie. Záver: Malnutrícia u geriatrických hospitalizovaných pacientov je spojená so zhoršením mobility, zvýšeným rizikom pádu, zníženou kvalitou života až zvýšenou mortalitou. Sestra je kompetentná identifikovať rizikového pacienta a realizovať objektívny skríning rizika malnutrície a pádu počas hospitalizácie.

Aim: Malnutrition, as one of the significant risk factors for falling, causes adverse consequences for the patient. The progression of malnutrition and the risk of falling increases significantly with age and contributes to the repeated hospitalisation of the geriatric patient. Identification, analysis and synthesis of studies related to malnutrition as a risk factor for falls in hospitalised geriatric patients. Method: We carried out the literature review on licensed electronic databases PubMed, Scopus and Web of Science in the period 2005-2022. Of total number of 2,743 studies studied, we included five in the final analysis. Results: The analysed studies confirmed the association between malnutrition and the risk of falls in the geriatric patient population. Patients aged ≥ 80 years, BMI < 20 and the presence of hypoproteinaemia or hypoalbuminaemia led to reduced mobility and self-sufficiency, increased risk of falls, increased incidence of falls and recurrent falls with consequent injury during hospitalisation. Conclusion: Malnutrition in hospitalised geriatric patients is associated with impaired mobility, increased risk of falls, reduced quality of life and increased mortality. Nurses are competent in identifying the patient at risk and to carry out objective screening for the risk of malnutrition and falls during hospitalisation.

• MeSH
• hodnocení rizik MeSH
• hospitalizace MeSH
• křehký senior MeSH
• lidé MeSH
• podvýživa * MeSH
• rizikové faktory MeSH
• senioři MeSH
• úrazy pádem * MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• přehledy MeSH

PURPOSE: Fall-Risk Increasing Drugs (FRIDs) are an important and modifiable fall-risk factor. A Clinical Decision Support System (CDSS) could support doctors in optimal FRIDs deprescribing. Understanding barriers and facilitators is important for a successful implementation of any CDSS. We conducted a European survey to assess barriers and facilitators to CDSS use and explored differences in their perceptions. METHODS: We examined and compared the relative importance and the occurrence of regional differences of a literature-based list of barriers and facilitators for CDSS usage among physicians treating older fallers from 11 European countries. RESULTS: We surveyed 581 physicians (mean age 44.9 years, 64.5% female, 71.3% geriatricians). The main barriers were technical issues (66%) and indicating a reason before overriding an alert (58%). The main facilitators were a CDSS that is beneficial for patient care (68%) and easy-to-use (64%). We identified regional differences, e.g., expense and legal issues were barriers for significantly more Eastern-European physicians compared to other regions, while training was selected less often as a facilitator by West-European physicians. Some physicians believed that due to the medical complexity of their patients, their own clinical judgement is better than advice from the CDSS. CONCLUSION: When designing a CDSS for Geriatric Medicine, the patient's medical complexity must be addressed whilst maintaining the doctor's decision-making autonomy. For a successful CDSS implementation in Europe, regional differences in barrier perception should be overcome. Equipping a CDSS with prediction models has the potential to provide individualized recommendations for deprescribing FRIDs in older falls patients.

• MeSH
• lékaři * MeSH
• lidé MeSH
• náchylnost k nemoci MeSH
• průzkumy a dotazníky MeSH
• řízení rizik MeSH
• senioři MeSH
• systémy pro podporu klinického rozhodování * MeSH
• úrazy pádem prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Cílem pilotního výzkumu bylo zhodnotit validitu u tří vybraných screeningových nástrojů pro posouzení rizika pádu u hospitalizovaných seniorů na akutních oddělení interního typu. Validita byla hodnocena pomocí senzitivity, specificity, pozitivní prediktivní hodnoty a negativní prediktivní hodnoty. Výzkumný vzorek tvořilo 122 hospitalizovaných seniorů, u nichž bylo určeno riziko pádu dle Mors Fall Scale (dále MFS), modifikované škály Juráskové Zhodnocení rizika pádu u pacienta/klienta 2006 (dále Jurásková 2006) a Screeningového testu pro posouzení rizika pádu pro identifikaci pacientů ve vysokém riziku pádu (dále STRP). Následně bylo sledováno, zda u pacientů zařazených v riziku pádu k této mimořádné události po dobu jejich hospitalizace skutečně došlo či nikoli. Použitou metodou prospektivního výzkumu bylo provádění polořízených rozhovorů, studium písemných dokumentů a pozorování. Dosažené výsledky identifikovaly senzitivitu MFS 91 %, Jurásková 2006 100 %, STRP 100%. Specificita byla u MFS 2 %, Jurásková 2006 7 %, STRP 2 %. Pozitivní prediktivní hodnota MFS 17 %, Jurásková 2006 18 %, STRP 17 %. Negativní prediktivní hodnota MFS 50 %, Jurásková 2006 100 %, STRP 100 %. Výsledky naznačují, že je třeba dalších výzkumů zaměřených nejen na ověření funkčnosti posuzovaných škál, ale i na posouzení rizikových faktorů použitých ve všech třech hodnocených nástrojích v konkrétní populaci hospitalizovaných seniorů a vytvořit tak nový nástroj nebo modifikovat již využívaný, který by byl pro české gerontologické ošetřovatelství funkční a jednoduše aplikovatelný.

The goal of this pilot study was to assess the validity of the three selected screening tools that assess the risk of falls in hospitalized elderly patients in acute care settings. Validity was assessed using sensitivity, specificity, positive predictive value and negative predictive values. The research sample consisted of 122 hospitalized seniors, whose risk of falling was assessed using the Mors Fall Scale (further MFS), the modified scale patient/client fall risk assessment index by Jurásková (further Jurásková 2006) and Screening test for fall risk assessment to identify patients at high risk of falling (further STRP). Subsequently, it was observed whether the patients fell or not. The research methods used were interviews with patients, the study of written documents and observations. The results identified a sensitivity of 91% of MFS, Jurásková 2006 100%, STRP 100%. Specificity was at MFS 2%, Jurásková 2006 7%, STRP 2%. MFS Positive predictive value 17%, Jurásková 2006 18%, STRP 17%. MFS 50% Negative predictive value, Jurásková 2006 100%, STRP100%. The results suggest that further research is required aimed not only at verifying the functionality of the assessment tools used, but also to assess the risk factors used in all three instruments. Evaluating the risk factors in a specific population of hospitalized elderly could lead to the creation of a new tool, or the modification of an existing index, which would be functional and easily applicable for Czech Geriatric Nursing.

• Klíčová slova
• riziko pádu, pád, hodnotící nástroj, validita, senior,
• MeSH
• hodnocení rizik metody   statistika a číselné údaje   MeSH
• hospitalizace MeSH
• křehký senior MeSH
• lidé MeSH
• prediktivní hodnota testů MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• statistika jako téma MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH

Although entropy-based measurements of gait dynamics are becoming widely used tools for fall risk assessment, their relationship to fall occurrence is still unclear. The aim of this study was hence to compare fallers and non-fallers in terms of gait dynamics assessed by the multiscale and Shannon entropy. This study included 139 participants, aged 60-80 years, divided into two groups according to fall occurrence during a 6-month prospective observation (38 fallers, 101 non-fallers). The methodology involved the use of the Tinetti balance assessment tool (TBAT) and 5min of overground walking with 3D accelerometers located near the L5 vertebra and shanks. We analyzed 150 strides for gait complexity, an index of complexity (CI), computed from multiscale entropy (MSE) and Shannon entropy (ShE) derived from the recurrence quantification analysis. We found no significant differences between groups in MSE and CI. The TBAT total score was significantly higher in non-fallers (P=0.033), however, both groups showed low risk of falls. ShE in the anterior-posterior direction from trunk and in the medial-lateral direction from the shanks were both significantly higher in fallers (P=0.020; P=0.024). ShE was negatively correlated with CI, the shank ShE in the vertical direction was positively correlated with TBAT. Taken together, our findings suggest that MSE is not able to distinguish between highly functional groups, whereas Shannon entropy seems to be sufficient in fall risk prediction.

• MeSH
• chůze (způsob) fyziologie   MeSH
• entropie * MeSH
• hodnocení rizik metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• posturální rovnováha fyziologie   MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• úrazy pádem prevence a kontrola   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH