La sicurezza dei pazienti anziani nel setting dell assistenza domiciliare: una revisione della letteratura sulla gestione delle cadute Bianchi CBNA, Giuffrida F, Palumbo D, Galizi MC, Damiani G, Milanese GM Cooperativa OSA Operatori Sanitari Associati Università Cattolica del S. Cuore Roma
Introduzione (1) Why fall prevention is important (CDC 2008) Falls can be devastating. About 1 out of 10 falls among older adults result in a serious injury, such as a hip fracture or head injury, that requires hospitalization. In addition to the physical and emotional pain, many people need to spend at least a year recovering in a long-term care facility. Some never return to their homes. Falls can be deadly. Falls are the leading cause of injury deaths among older adults. The rate of fall-related deaths among older adults in the United States has risen significantly over the past decade. In 2004, falls were responsible for 14,900 deaths. Falls are costly. Fall-related injuries among older adults, especially among older women, are associated with substantial economic costs. In 2000, direct medical costs for fatal and nonfatal fall injuries totaled $19 billion. As the number of older adults increases dramatically over the next few decades, so will the economic burden of falls. Falls are preventable. The opportunity to help reduce falls among older adults has never been better. Today, there are effective fall prevention interventions that can be used in community settings. By offering effective fall prevention programs in our communities, we can reduce falls and help older adults live better, longer lives
Introduzione (2) 2011-2012 National Patient Safety Goals -NPSG.09.02.01 Reduce the risk of falls Protocollo Monitoraggio degli Eventi Sentinella - Lista degli eventi sentinella 1. Procedura in paziente sbagliato 2. Procedura chirurgica in parte del corpo sbagliata... 9. Morte o grave danno per caduta di paziente
Obiettivi attraverso una revisione sistematica della letteratura, analizzare le evidenze in tema di gestione delle cadute negli anziani che ricevono assistenza domiciliare in termini di fattori di rischio ed interventi di prevenzione
Materiali e Metodi FONTI PubMed, Cochrane, Scopus, letteratura grigia, siti istituzionali PAROLE CHIAVE accidental falls, aged, home care services, risk factors, management, patient safety Criteri di inclusione Lingua inglese, spagnolo, francese,italiano Periodo: 1998-2012 Popolazione anziana >60 Setting: Home care Analisi di fattori di rischio/ strategie di management Criteri di esclusione Commentary, letters, revisioni setting domiciliare senza profilo sanitario Campioni di anziani che vivono in caso ma non rientrano in programmi di home care (community dwelling)
Risultati (1) Disegno dello studio Paese 6 1 1 4 4 caso controllo coorte trasversale trial clinico altro 5 1 1 9 USA Canada Australia Spagna Numerosità del campione: max 2.304 min 109 Focus su fattori di rischio : 9 studi Focus su strategie di prevenzione: 7 studi
Risultati (2) Fattori di rischio Intrinseci Sintomi depressivi Comorbidità (>> patologie neurologiche e cardiovascolari) Disturbi di equilibrio/deambulazione Alterazioni della vista Ambientali Estrinseci Precedenti cadute Paura di cadere Polifarmacologia (>> antipsicotici e antidepressivi) Consumo di alcol Sensazione di isolamento sociale Ostacoli (es. animali domestici) Mancanza dispositivi di sicurezza
Risultati (3) Strategie di prevenzione Utilizzo di strumenti validati per valutare il profilo di rischio della popolazione in home care Prevedere interventi di prevenzione e monitoraggio il più possibile multidisciplinari (non solo infermieri e fisioterapisti ma anche farmacisti, nutrizionisti etc.) * nota su preconference: >specialisti medici >rischio errori Formazione di care-giver e famigliari Formazione degli operatori coinvolti nell assistenza
Discussione (1) Quale profilo di rischio? This description of a high fall-risk group may also describe many home care clients. Analysis of a linked dataset showed that clients receiving home care were significantly more likely to have been admitted to hospital for falls or fall-related injuries than others of the same age who did not receive home care. Fall prevention strategies and programs need to be provided specifically for the home care population. They need to take into consideration, the specific needs of this group their isolation, decreased mobility and their dependency. (Smith and Gill 2008)
Discussione (2) Quale efficacia degli interventi? 1 solo trial clinico che confronta due gruppi che ricevono Multifactorial and Interdisciplinary Team Approach vs usual care Number of slips and trips was greatly reduced; no statistically significant difference in the number of falls between the interdisciplinary and the usual care group at either baseline or 6- month follow-up. However, secondary analysis of subgroups showed that the interdisciplinary team approach significantly decreased self-reported falls for older persons 85 years or older with a fear of falling, hearing impairment, cardiovascular or musculoskeletal disorder and impairments in activities of daily living. (Markle-Reid M, 2010)
(Lang 2006) - Problematic communication and coordination among services sectors,providers,caregivers,family and clients - Technology in an uncontrolled and unregolated setting - Lack of standards Conclusioni (Gombar 2011) - Do not consider falls a normal part of illness or the end of life - Expect clinicians to report falls as a part of the documentation for each patient - the fall management program should address each family s needs holistically