Objective: To identify factors that explain differences in patients with high and low levels of fear of falling after a hip fracture. Design: Cross-sectional study in 10 skilled nursing facilities... Show moreObjective: To identify factors that explain differences in patients with high and low levels of fear of falling after a hip fracture. Design: Cross-sectional study in 10 skilled nursing facilities in the Netherlands. Patients: A total of 100 patients aged ≥ 65 years admitted to a skilled nursing facility after a hip fracture. Methods: Participants were divided into 2 groups; low and high level of fear of falling, based on median Falls Efficacy Score - International. Data relating to factors that might explain fear of falling were collected, including demographic variables, aspects of functioning, psychological factors, and comorbidities. For every factor a univariate logistic regression was conducted. For the multivariate regression model a backward procedure was used in which variables with p < 0.05 were included. Results: Walking ability and activities of daily living before fracture, number of complications, activities of daily living after fracture, anxiety and self-efficacy were significantly associated univariately with fear of falling. Multivariate analysis showed that walking ability before fracture (odds ratio (OR) 0.34, 95% confidence interval (CI) 0.14-0.83), activities of daily living after fracture (OR 0.89, 95% CI 0.80-0.99), and anxiety (OR 1.22, 95% CI 1.05-1.42) were independently associated with fear of falling. Conclusion: Impaired walking ability before fracture, impaired activities of daily living after fracture, and increased anxiety help distinguish between older persons with high and low levels of fear of falling after hip fracture. Because the last 2 factors are modifiable, this information enables the development of specific interventions for older persons with a high level of fear of falling. Show less
OBJECTIVE Although geriatric rehabilitation (GR) is beneficial for restoration of activities and participation after hospitalization of vulnerable older persons, little is known about the optimal... Show moreOBJECTIVE Although geriatric rehabilitation (GR) is beneficial for restoration of activities and participation after hospitalization of vulnerable older persons, little is known about the optimal organization of care of these postacute facilities. This study examines the relationship of patient volume and service concentration with successful GR (short length of stay and discharge home) in skilled nursing facilities (SNFs). DESIGN A national multicenter retrospective cohort study. SETTING AND PARTICIPANTS All patients indicated for GR in a Dutch SNF. MEASUREMENTS Nurses filled out digital registration forms from patient records. Patients were studied in 3 predefined diagnostic groups: total joint replacement, traumatic injuries, and stroke. Facility characteristics were obtained by structured telephone interviews with facility managers. Volume was based on the number of discharges in a 3-month period and categorized in low-, medium-, and high-volume facilities. Concentration was defined at the organizational level in which the population consists of 80% or more of 1 or 2 diagnostic groups, with the prerequisite of having a minimum of 10 rehabilitation beds. RESULTS From 88 facilities, 2269 GR patients (mean age 78.2 years [SD 9.7]; 68.2% female) were included. The median length of stay in the SNF was 45 days (interquartile range 23-81), 57% of the patients were discharged home, and 9.8% died during GR. Of patients with total joint replacement (n = 501), concentration was related to successful rehabilitation (odds ratio 5.7; 95% confidence interval 1.3-24.3; P = .020, adjusted for age and gender); this relationship was not found for patients with traumatic injuries or stroke. Volume showed no relation with successful rehabilitation in any of the 3 diagnostic groups. CONCLUSION This study may indicate that concentration in an SNF, as a proxy for specialization, favors successful GR in total joint replacement. This relationship was not found for the traumatic injuries or stroke groups, or for volume. The relation on functional outcome in GR needs further investigation. Show less
Visschedijk, J.; Balen, R. van; Hertogh, C.; Achterberg, W. 2012
OBJECTIVE: To determine the prevalence of fear of falling (FoF) in patients after a hip fracture, to investigate the relation with time after fracture, and to assess associations between FoF and... Show moreOBJECTIVE: To determine the prevalence of fear of falling (FoF) in patients after a hip fracture, to investigate the relation with time after fracture, and to assess associations between FoF and other psychological factors. DESIGN: Cross-sectional study performed between September 2010 and March 2011 in elderly patients after a hip fracture. SETTING: Ten postacute geriatric rehabilitation wards in Dutch nursing homes. PARTICIPANTS: A total of 100 patients aged ≥65 years with a hip fracture admitted to a geriatric rehabilitation ward. MEASUREMENTS: FoF and related concepts such as falls-related self-efficacy, depression, and anxiety were measured by means of self-assessment instruments. RESULTS: Of all patients, 36% had a little FoF and 27% had quite a bit or very much FoF. Scores on the Falls Efficacy Scale-International were 30.6 in the first 4 weeks after hip fracture, 35.6 in the second 4 weeks, and 29.4 in the period ≥8 weeks after fracture. In these 3 periods, the prevalence rates of FoF were 62%, 68%, and 59%, respectively. Significant correlations were found between FoF and anxiety (P < .001), and self-efficacy (P < .001). CONCLUSION: In these patients with a hip fracture, FoF is common and is correlated with anxiety and falls-related self-efficacy. During rehabilitation, FoF is greatest in the second 4 weeks after hip fracture. More studies are needed to explore the determinants of FoF and develop interventions to reduce FoF and improve outcome after rehabilitation. Show less
Visschedijk, J.; Achterberg, W.; Balen, R. van; Hertogh, C. 2010
The objective of this review was to systematically describe and analyze fear of falling (FoF) in patients after a hip fracture, focusing on measurement instruments for FoF, the prevalence of FoF,... Show moreThe objective of this review was to systematically describe and analyze fear of falling (FoF) in patients after a hip fracture, focusing on measurement instruments for FoF, the prevalence of FoF, factors associated with FoF, and interventions that may reduce FoF. Fifteen relevant studies were found through a systematic literature review, in which the PubMed, Embase, PsychINFO, and CINAHL databases were searched. Some of these studies indicated that 50% or more of patients with a hip fracture suffer from FoF, although adequate instruments still have to be validated for this specific group. FoF was associated with several negative rehabilitation outcomes, such as loss of mobility, institutionalization, and mortality. FoF was also related to less time spent on exercise and an increase in falls, although knowledge about risk factors, the prevalence over a longer time period, and the exact causal relations with important health outcomes is limited. Most studies suffer from selection bias by excluding patients with physical and cognitive disorders. Hence, more research is required, including in patients who are frail and have comorbidities. Only when knowledge such as this becomes available can interventions be implemented to address FoF and improve rehabilitation outcomes after a hip fracture. Show less
