Preventing falls and assessing the quality of care for falls in older adults.

摘要

Background. Falls are a major health problem among older adults. Patient reports are increasingly used to assess the quality of health care services. A better understanding of effective interventions to prevent falls and the measurement of the quality of falls care might lead to development of programs to improve falls care in older adults.;Methods. A systematic review and meta-analysis of randomized clinical trials was conducted to identify effective interventions to prevent falls in older adults. To study the relationship between patient ratings of health care and technical quality of care, we used data from the Assessing Care of Vulnerable Elders (ACOVE) Study, an observational cohort study of vulnerable older patients from two managed care organizations. To study the relationship between patient-reported assessments and medical record-based measures of the quality of falls care, we used data from the ACOVE-2 Study, a controlled clinical trial of community-dwelling older adults.;Results. A multifactorial falls risk assessment and management program was the most effective component on reducing the risk of falls and the monthly fall rate. Exercise interventions also had a beneficial effect on these two falls outcomes. There was no relationship between patient ratings of health care and technical quality of care in older adults. When examining the relationship between patient-reported assessments and medical record-based measures of the quality of falls care, the medical record identified only 42% of patients reporting multiple falls or an injurious fall. Patients tended to underreport elements of falls care documented in the medical record. There was little correlation between patient-level interview-based score and chart-based scores of the quality of falls care.;Conclusion. This study found that multifactorial falls risk assessment and management programs are most effective at reducing falls risk and the rate of falling. When assessing the quality of falls care in older adults, patient reported assessments and medical record based assessments do not have a high level of agreement. Future work is needed to develop programs to improve falls care and a quality assessment system for falls care.