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Detection and Management of Falls and Instability in Vulnerable Elders by Community Physicians
Author(s) -
Rubenstein Laurence Z.,
Solomon David H.,
Roth Carol P.,
Young Roy T.,
Shekelle Paul G.,
Chang John T.,
MacLean Catherine H.,
Kamberg Caren J.,
Saliba Debra,
Wenger Neil S.
Publication year - 2004
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2004.52417.x
Subject(s) - medicine , medical record , physical examination , falls in older adults , injury prevention , poison control , balance problems , comorbidity , balance (ability) , orthostatic vital signs , physical therapy , gerontology , emergency medicine , blood pressure , psychiatry , surgery
Objectives: To investigate quality of care for falls and instability provided to vulnerable elders. Design: Six process of care quality indicators (QIs) for falls and instability were developed and applied to community‐living persons aged 65 and older who were at increased risk of death or decline. QIs were implemented using medical records and patient interviews. Setting: Northeastern and southwestern United States. Participants: Three hundred seventy‐two vulnerable elders enrolled in two senior managed care plans. Measurements: Percentage of QIs satisfied concerning falls or mobility disorders. Results: Of the 372 consenting vulnerable elders with complete medical records, 57 had documentation of 69 episodes of two or more falls or fall with injury during the 13‐month study period (14% of patients fell per year, 18% incidence). Double this frequency was reported at interview. An additional 22 patients had documented mobility problems. Clinical history of fall circumstances, comorbidity, medications, and mobility was documented from 47% of fallers and two or more of these four elements from 85%. Documented physical examination was less complete, with only 6% of fallers examined for orthostatic blood pressure, 7% for gait or balance, 25% for vision, and 28% for neurological findings. The evaluation led to specific recommendations in only 26% of cases, but when present they usually led to appropriate treatment modalities. Mobility problems without falls were evaluated with gait or balance examination in 23% of cases and neurological examination in 55%. Conclusion: Community physicians appear to underdetect falls and gait disorders. Detected falls often receive inadequate evaluation, leading to a paucity of recommendations and treatments. Adhering to guidelines may improve outcomes in community‐dwelling older adults.