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AMDA Long Term Care Medicine - 2012


B31 - An Update on the Clinical Practice Guideline for Falls in the Long Term Care Setting


Mar 9, 2012 3:30pm ‐ Mar 9, 2012 5:00pm

Standard: $24.00

Description

Accreditation
The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
The American Medical Directors Association designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of management 1.5 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
This session will give an update to the Clinical Practice Guidelines (CPGs) for falls in the long term care setting - 2011 and focus in particular on recent changes in evaluation, management, and monitoring of the fall risk resident in the long term care setting.

Learning Objectives(s):

  • Explain appropriate recognition and evaluation of the fall risk resident in the long term care setting.
  • Discuss the non-pharmacological interdisciplinary management of the fall risk resident in the long term care setting.
  • Discuss pharmacological management options if any for the fall risk long term care resident.
  • Describe specific principles relative to monitoring and reevaluation of the fall risk resident in the long term care setting.


Speakers(s):
Charles A. Cefalu, MD, MS; Barbara Resnick, PhD, ANP

Disclosure(s):
Charles A. Cefalu, MD, MS - Boehringer Ingelheim: Speaker's Bureau. Barbara Resnick, PhD, ANP has no financial disclosures to report.

References(s):
Sorock GS, Quigley PA, Rutledge MK, et al. Central nervous system medication changes and falls in nursing home residents. Geriatr Nurs 2009; 30(5): 334-340. 2. Cameron ID, Murray GR, Gillespie LD, et al. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD005465. doi: 10.1002/14651858.CD005465.pub2 3. Leveille SG, Jones RN, Kiely DK, et al. Chronic musculoskeletal pain and the occurrence of falls in an older population. JAMA 2009; 302(20): 2214-2221. 4. Laessoe U, Hoeck HC, Simonsen O, et al. Fall risk in an active elderly population-Can it be assessed? J Negat Results Biomed 2007; 6: 2. doi: 10.1186/1477-5751-6-2 5. Shanthi GS, Krishnaswamy B. Risk factors for falls in elderly. J Indian Acad Geriatr 2005; 2: 57-60. 6. Stalenhoef PA, Diederiks JPM, Knottnerus JA, et al. The construction of a patient record-based risk model for recurrent falls among elderly people living in the community. Fam Pract 2000; 17: 490-496. 7. Pandya N, Bookhart B, Mody SH, et al. Study of anemia in long term care (SALT): Prevalence of anemia and its relationship with the risk of falls in nursing home residents. Curr Med Res Opin 2008; 24(8): 2139-2149. 8. Dharmarajan TS, Avula S, Norkus EP. Anemia increases risk for falls in hospitalized older adults: An evaluation of falls in 362 hospitalized, ambulatory, LTC, and community patients. J Am Med Dir Assoc 2007; 8(3 Suppl 2): e9-e15. 9. Volpato S, Leveille SG, Blaum C, et al. Risk factors for falls in older disabled women with diabetes: the women's health and aging study. J Gerontol A Biol Sci Med Sci. 2005; 60(12): 1539-1545. 10. Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Ann Intern Med 1994; 121: 442-451. 11. Onen F, Higgins S, Onen SH. Falling asleep-related injured falls in the elderly. J Am Med Dir Assoc 2009; 10(3): 207-210. 12. Brassington GS, King AC, Bliwise DL. Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64-99 years. J Am Geriatr Soc 2000; 48(10): 1234-1240. 13. Ooi WL, Hossain M, Lipsitz LA. The association between orthostatic hypotension and recurrent falls in nursing home residents. Am J Med 2000; 108(2): 106-111. 14. Johnson L, Buckley JG, Harley C, et al. Use of single vision eyeglasses improves precision and safety when elderly habitual multifocal wearers negotiate a raised surface. J Am Geriatr Soc 2008; 56(10): 178-180. 15. Tinetti ME, Kumar C. The patient who falls: "It's always a trade-off." JAMA 2010; 303(3): 258-266. 16. Hien LT, Cumming RG, Cameron ID, et al. Atypical antipsychotic medications and risk of falls in residents of aged care facilities. J Am Geriatr Soc 2005; 53(8): 1290-1295. 17. Frech DD, Campbell R, Spehar A, et al. Drugs and falls in community-dwelling older people: A national veterans study. Clin Ther 2006; 28(4): 619-630. 18. Gangavati AS, Kiely DK, Kulchycki LK, et al. Prevalence and characteristics of traumatic intracranial hemorrhage in elderly fallers presenting to the emergency department without focal findings. J Am Geriatr Soc 2009; 57: 1470-1474. 19.Tinetti ME, Williams TF, Mayewski R. Fall Risk Index for elderly patients based on number of chronic disabilities. Am J Med 1986; 80: 429-434. 20. Mathias S, Nayak US, Isaacs B. Balance in elderly patients: The "get-up and go" test. Arch Phys Med Rehabil 1986; 67: 387-389. 21. Capezuti E, Wagner L, Brush BL, et al. Bed and toilet height as potential environmental risk factors. Clin Nurs Res 2008; 17(1): 50-66. 22. Sylliaas H, Idland G, Sandvik L, et al. Does mortality of the aged increase with the number of falls? Results from a nine-year follow-up study. Eur J Epidemiol 2009; 24(7): 351-355. Epub 2009 May 19. 23. Batchelor F, Hill K, Mackintosh S, Said C. What works in falls prevention after stroke? A systematic review and meta-analysis. Stroke 2010; 41; 1715-1722. doi: 10.1161/STROKEAHA.109.570390 24. Kilgore, C. Fall-prevention efforts must be multifaceted. Caring for the Ages 2010; 11(6): 26. 25. Carpenito-Moyet LJ. Nursing Diagnosis: Application to Clinical Practice (12th ed.). 2008. Philadelphia: Lippincott Williams & Wilkins. 26. Ryan JW, Spellbring AM. Implementing strategies to decrease risk of falls in older women. J Gerontol Nurs 1996; 22(12): 25-31. 27.Binkley N, Ramamurthy R, Krueger D. Low vitamin D status: Definition, prevalence, consequences, and correction. Endocrinol Metab Clin North Am 2010; 39(2): 287-301. 28. Kalyani R R, Stein B, Valiyil R, et al. Vitamin D treatment for the prevention of falls in older adults: systematic review and meta-analysis. J Am Geriatr Soc 2010; 58: 1299-1310 29. American Geriatrics Society, British Geriatrics Society. Clinical Practice Guidelines: Prevention of Falls in Older Persons. 2010. New York: American Geriatrics Society. Available at: http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010/. 30. Hasegawa J, Kuzuya M, Iguchi A. Urinary incontinence and behavioral symptoms are independent risk factors for recurrent and injurious fall, respectively, among residents in long-term care facilities. Arch Gerontol Geriatr 2010; 50(1): 77-81. 31. Chiarelli PE, Mackenzie LA, Osmotherly PG. Urinary incontinence is associated with an increase in falls: a systematic review. Aust J Phyiother 2009; 55(2): 89-95. 32.Brown JS, Vittinghoff E, Wyman JF, et al. Urinary incontinence: Does it increase risk for falls and fractures? Study of Osteoporotic Fracture Research Group. JAGS 2000; 48(7): 721-725. 33. Wallace C, Reiber GE, LeMaster J, et al. Incidence of falls, risk factors for falls, and fall-related fractures in individuals with diabetes and a prior foot ulcer. Diabetes Care 2002; 25: 1983-1986. doi: 10.2337/diacare.25.11.1983 34.Conner-Kerr T, Templeton MS. Chronic fall risk among aged individuals with type 2 diabetes. Ostomy Wound Manage 2002; 48: 23-35. 35.Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services. F222

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