Moran Ryan, Ramirez Michelle, Woods Gina, Hofflich Heather, Wing Ms David, Nichols Jeanne
University of California, San Diego, La Jolla, USA.
Gerontol Geriatr Med. 2023 Jul 6;9:23337214231186460. doi: 10.1177/23337214231186460. eCollection 2023 Jan-Dec.
The median age of Americans is rising and fall risk increases with age. While the causes of falls are multifactorial, falls risk can be reduced. Only a small percentage of older-adults report being asked about fall risk or falls. The CDC has initiated a Stopping Elderly Accidents, Deaths and Injuries (STEADI) toolkit, but penetration into practice has been slow. To address this, we implemented a Falls Prevention Shared Medical Appointment (SMA) at an academic internal medicine clinic. Patients were referred to the SMA and scheduled per their preference virtually or in-person. Patients attended a nurse visit for appropriate fallrisk related screening, followed by the SMA with two physicians for review of medical history, fall screening results and implementation of fall reduction strategies. Follow-up survey of the patients assessed program effectiveness. Fifty-two patients were seen/assessed between November 2021 and February 2023 with SMAs ranging from 3 to 5 patients with an average age of 77 (=/- 6.7). Questionnaire self-reported risk factors, self-reported strength, and polypharmacy were associated with objective markers of increased fall risk. Survey results indicate acceptability of this model. Falls prevention SMAs can be effective. More work is needed to further delineate and refine cohort selection.
美国人的年龄中位数在上升，跌倒风险也会随着年龄增长而增加。虽然跌倒的原因是多方面的，但跌倒风险是可以降低的。只有一小部分老年人表示有人询问过他们的跌倒风险或跌倒情况。美国疾病控制与预防中心（CDC）已经启动了一个预防老年人事故、死亡和伤害（STEADI）工具包，但在实践中的推广速度一直很慢。为了解决这个问题，我们在一家学术性内科诊所实施了一项预防跌倒共享医疗预约（SMA）。患者被转诊至SMA，并根据他们的偏好安排虚拟或面对面就诊。患者先接受护士进行的与跌倒风险相关的适当筛查，然后与两位医生一起参加SMA，以审查病史、跌倒筛查结果并实施跌倒预防策略。对患者的随访调查评估了该项目的效果。在2021年11月至2023年2月期间，共诊治/评估了52名患者，每次SMA有3至5名患者，平均年龄为77岁（±6.7岁）。问卷调查中自我报告的风险因素、自我报告的力量和多重用药与跌倒风险增加的客观指标相关。调查结果表明该模式具有可接受性。预防跌倒的SMA可能是有效的。需要做更多工作来进一步明确和完善队列选择。
