alexa Detection and management of falls and instability in vulnerable elders by community physicians.
Medicine

Medicine

Journal of Gerontology & Geriatric Research

Author(s): Rubenstein LZ, Solomon DH, Roth CP, Young RT, Shekelle PG,

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Abstract 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. Copyright 2004 American Geriatrics Society This article was published in J Am Geriatr Soc and referenced in Journal of Gerontology & Geriatric Research

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