Screening for falls risk in the ED - study outline and progress

Transcription

1 Screening for falls risk in the ED - study outline and progress Dr Anne Tiedemann Prince of Wales Medical Research Institute

2 NSW Health funded study: Development and validation of a falls risk screening tool for use in Emergency Departments (ED) Chief investigator: A/Prof Jacqui Close Assoc investigators: Prof Stephen Lord, Dr Anne Tiedemann, Dr Cathie Sherrington Research Assistants: Teresa Orr, Kerrie Atkins Participating hospitals: Prince of Wales Royal North Shore Study commenced: November 2007

3 Development and validation of a falls risk screening tool for the use in the ED BACKGROUND: The ED An area which allows for the easy identification of fallers. Fall injuries addressed but not underlying cause/ prevention strategies The evidence suggests that these people benefit from a multi-disciplinary assessment in a Falls Clinic type setting (Close et al 1999, Davison et al 2005). BUT the number of fallers presenting to the ED would generate an enormous case load for most Falls Clinics irrespective of where they are run. So, a screening tool is needed.

4 Development and validation of a falls risk screening tool for the use in the ED AIM: To develop and validate a screening tool for use in the Emergency Department (ED) to identify different levels of falls risk and thus guide onward referral for different levels of intervention.

5 Development and validation of a falls risk screening tool for the use in the ED Previous research in this area: Close et al, 2003, PROFET proforma Previous falls, falling indoors, inability to get off floor after fall, 4+meds Russell et al, 2009, FROP-COM screen Previous falls, observed balance, assistance needed for domestic ADLs Carpenter et al 2009 Nonhealing foot sores, depression (self reported), previous falls, unable to cut own toenails

6 Development and validation of a falls risk screening tool for the use in the ED SUBJECTS: 440 people aged 70 years and over who attend and are subsequently discharged from the POWH ED and RNSH ED

7 Patients aged 70yrs + attending ED and seen by ASET Attending ED with a fall or history of 2 or more falls in past year? Is patient discharged? Does patient live at home (not NH or hostel), speak English and have live in carer if cognitively impaired? Consent to take part in study? If YES, physical assessment, falls history conducted plus 6 month falls follow-up

8 Assessment measures

9 Development and validation of a falls risk screening tool for the use in the ED RECRUITMENT: 2 phases -tool development sample (POWH) -external validation (RNSH) POWH recruitment complete (n=218) Falls follow-up to be completed in Sept 2009 RNSH- 128 recruits to date Hope to complete recruitment early 2010

10 Baseline characteristics POWH sample Age (mean, SD, range) 80.96, 6.4, 70-98yrs Gender 121 (55%) female Presented to ED with fall? 196 (90%) ED presentations past yr? 35% had at least one Sit to stand Mean 21.5sec 61% failed to complete <12sec TUGT Mean 19.9sec 66% failed to complete <12sec Medications (mean, SD, range) 5.8, 3.7, 0-20 Used a walking aid 78 (36%) 58% arthritis Med conditions 43% vis impairment 21% diabetes

11 Development and validation of a falls risk screening tool for the use in the ED ISSUES: Time to recruit/ assess Few appropriate participants Admission/ MAU Hostel/ Nursing home Poor English Already in a research study