Carri Casteel

Workplace Violence Prevention Programs in Psychiatric Units and Facilities

Psychiatric health care providers have high rates of workplace violence victimization, yet little is known about the strategies used by facilities to reduce violence. This study compared workplace violence prevention (WVP) programs in psychiatric units and facilities in California and New Jersey. Information was collected through interviews, a facility walk-through, and a review of written policies and training material. A similar proportion of hospitals in both states had WVP training programs. A higher proportion of hospitals in California had written WVP policies, and a higher proportion of New Jersey hospitals had implemented environmental and security modifications to reduce violence. Legislation is one of many potential approaches to increase workplace violence prevention programs in health care settings.

Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE): A Cluster-Randomized Pragmatic Trial of a Multifactorial Fall Injury Prevention Strategy: Design and Methods

Background Fall injuries are a major cause of morbidity and mortality among older adults. We describe the design of a pragmatic trial to compare the effectiveness of an evidence-based, patient-centered multifactorial fall injury prevention strategy to an enhanced usual care. Methods Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) is a 40-month cluster-randomized, parallel-group, superiority, pragmatic trial being conducted at 86 primary care practices in 10 health care systems across United States. The 86 practices were randomized to intervention or control group using covariate-based constrained randomization, stratified by health care system. Participants are community-living persons, ≥70 years, at increased risk for serious fall injuries. The intervention is a comanagement model in which a nurse Falls Care Manager performs multifactorial risk assessments, develops individualized care plans, which include surveillance, follow-up evaluation, and intervention strategies. Control group receives enhanced usual care, with clinicians and patients receiving evidence-based information on falls prevention. Primary outcome is serious fall injuries, operationalized as those leading to medical attention (nonvertebral fractures, joint dislocation, head injury, lacerations, and other major sequelae). Secondary outcomes include all fall injuries, all falls, and well-being (concern for falling; anxiety and depressive symptoms; physical function and disability). Target sample size was 5,322 participants to provide 90% power to detect 20% reduction in primary outcome rate relative to control. Results Trial enrolled 5,451 subjects in 20 months. Intervention and follow-up are ongoing. Conclusions The findings of the STRIDE study will have important clinical and policy implications for the prevention of fall injuries in older adults.

Reporting Crime Victimizations to the Police and the Incidence of Future Victimizations: A Longitudinal Study

Background Law enforcement depends on cooperation from the public and crime victims to protect citizens and maintain public safety; however, many crimes are not reported to police because of fear of repercussions or because the crime is considered trivial. It is unclear how police reporting affects the incidence of future victimization. Objective To evaluate the association between reporting victimization to police and incident future victimization. Methods We conducted a retrospective cohort study using National Crime Victimization Survey 2008–2012 data. Participants were 12+ years old household members who may or may not be victimized, were followed biannually for 3 years, and who completed at least one follow-up survey after their first reported victimization between 2008 and 2012. Crude and adjusted generalized linear mixed regression for survey data with Poisson link were used to compare rates of future victimization. Results Out of 18,657 eligible participants, 41% participants reported to their initial victimization to police and had a future victimization rate of 42.8/100 person-years (PY) (95% CI: 40.7, 44.8). The future victimization rate of those who did not report to the police (59%) was 55.0/100 PY (95% CI: 53.0, 57.0). The adjusted rate ratio comparing police reporting to not reporting was 0.78 (95%CI: 0.72, 0.84) for all future victimizations, 0.80 (95% CI: 0.72, 0.90) for interpersonal violence, 0.73 (95% CI: 0.68, 0.78) for thefts, and 0.95 (95% CI: 0.84, 1.07) for burglaries. Conclusions Reporting victimization to police is associated with fewer future victimization, underscoring the importance of police reporting in crime prevention. This association may be attributed to police action and victim services provisions resulting from reporting.

How to engage small retail businesses in workplace violence prevention: Perspectives from small businesses and influential organizations

BACKGROUND Small retail businesses experience high robbery and violent crime rates leading to injury and death. Workplace violence prevention programs (WVPP) based on Crime Prevention Through Environmental Design reduce this risk, but low small business participation limits their effectiveness. Recent dissemination models of occupational safety and health information recommend collaborating with an intermediary organization to engage small businesses. METHODS Qualitative interviews with 70 small business operators and 32 representatives of organizations with small business influence were conducted to identify factors and recommendations for improving dissemination of a WVPP. RESULTS Both study groups recommended promoting WVPPs through personal contacts but differed on other promotion methods and the type of influential groups to target. Small business operators indicated few connections to formal business networks. CONCLUSIONS Dissemination of WVPPs to small businesses may require models inclusive of influential individuals (e.g., respected business owners) as intermediaries to reach small businesses with few formal connections.

Antihypertensive Adherence Trajectories Among Older Adults in the First Year After Initiation of Therapy

BACKGROUND Adherence to antihypertensives is suboptimal, but previous methods of quantifying adherence fail to account for varying patterns of use over time. We sought to improve classification of antihypertensive adherence using group-based trajectory models, and to determine whether individual factors predict adherence trajectories. METHODS We identified older adults initiating antihypertensive therapy during 2008-2011 using a 20% sample of Medicare (federal health insurance available to US residents over the age of 65) beneficiaries enrolled in parts A (inpatient services), B (outpatient services), and D (prescription medication). We developed monthly adherence indicators using prescription fill dates and days supply data in the 12 months following initiation. Adherence was defined as having at least 80% of days covered. Logistic models were used to identify trajectory groups. Bayesian information criterion and trajectory group size were used to select the optimal trajectory model. We compared the distribution of covariates across trajectory groups using multivariable logistic regression. RESULTS During 2008-2011, 282,520 Medicare beneficiaries initiated antihypertensive therapy (mean age 75 years, 60% women, 84% White). Six trajectories were identified ranging from perfect adherence (12-month adherence of 0.97, 40% of beneficiaries) to immediate stopping (12-month adherence of 0.10, 18% of beneficiaries). The strongest predictors of nonadherence were initiation with a single antihypertensive class (adjusted odds ratio = 2.08 (95% confidence interval: 2.00-2.13)), Hispanic (2.93 (2.75-3.11)) or Black race/ethnicity (2.04 (1.95-2.13)), and no prior history of hypertension (2.04 (2.00-2.08)) (Area under the receiving operating characteristic curve: 0.53). CONCLUSIONS There is substantial variation in antihypertensive adherence among older adults. Certain patient characteristics are likely determinants of antihypertensive adherence trajectories.

Falls Risks and Prevention Behaviors Among Community-Dwelling Homebound and Non-Homebound Older Adults:

The objectives were to examine falls risk factors to determine how the magnitude of risk may differ between homebound and non-homebound older adults, and to describe falls prevention behaviors and participation in falls prevention education. A cross-sectional survey was conducted with convenience samples of community-dwelling older adults recruited through Meals on Wheels programs (homebound, n = 80) and senior centers (non-homebound, n = 84) in North Carolina. Data were collected during home visits and included an interview and medication inventory. Multivariate negative binomial regression with robust variance estimation modeled risk factors for falls. Risk factors for falls observed in both the homebound and non-homebound populations are consistent with what is known in the literature. However, the magnitude of the risk was higher in the homebound than in the non-homebound population with respect to vision impairments, number of high-risk and over-the-counter medications, and use of walking aids .Few participants reported participating in a falls prevention program.

Risk of motor vehicle crash for older adults after receiving a traffic charge: A case–crossover study

ABSTRACT Objective: After the age of 65, the number of motor vehicle crashes per mile driven increases. Traffic-related charges issued by law enforcement can help identify drivers who are at a higher risk of having a crash. This study examines the relationship between motor vehicle crashes and traffic-related charges among older adult drivers. Methods: Iowa Department of Transportation crash data from 2011–2012 were linked with Iowa Court Information System data for moving violations that occurred during 2009–2012 for drivers over the age of 50. A time-stratified case–crossover design was used matching on time periods 1 year apart. Case exposure was defined as having a traffic-related charge 30 days before the crash. Control exposure was the same 30-day time period 1 year before the crash for each individual. Conditional logistic regression was used to analyze the self-matched pairs. Additional time periods of 31–60, 61–90, 91–120, 121–150, 151–180, and 181–210 days before the crash were also assessed. Results: There were 38,171 adults at least 50 years of age with an Iowa drivers license who were involved in a crash in Iowa between 2011 and 2012. In addition, 13,129 adults over the age of 50 received a charge during 2009–2012. Relative to the control time period, experiencing a traffic-related charge in the 30-day time period before the crash increased the risk of a crash by 21% (odds ration [OR] = 1.21, 95% confidence interval [CI], 1.03–1.42) for all drivers included in the study. This crash risk was similar for adults aged 50–64 (OR = 1.20, 95% CI, 1.00–1.45) and adults 65 and older (OR = 1.24, 95% CI, 0.90–1.72). In the 30 days after receiving a traffic-related charge, the risk of a crash was also increased for crashes occurring in adverse weather (OR = 1.79, 95% CI, 1.12–2.84) or during night, dawn, or twilight (OR = 1.89, 95% CI, 1.31–2.72). Conclusions: A traffic-related charge for an adult over the age of 50 indicates an increased risk of experiencing a crash in the 30 days following the charge. The risk for crashes occurring in adverse conditions or outside of daylight hours was also increased in the 30 days after receiving a traffic-related charge. The risk of experiencing a crash decreases as time passes after receiving a charge. Measures to restrict or increase driving safety during these conditions could help reduce the crash risk for older adults who receive a traffic-related charge.

PW 0591 Comprehensive programs to reduce violence in the workplace

Background Workplace violence is a leading cause of occupational death and injury worldwide, impacting all industries and occupations. Businesses can reduce the burden of violence by implementing comprehensive prevention programs. However, the majority of businesses globally have not implemented these. One successful model uses an interdisciplinary threat management team to prioritize prevention strategies and to identify, investigate, and respond to potential threats. Objective Using data from a wide range of work settings in the United States, we examined characteristics of violent events, types of existing prevention strategies, a model for a comprehensive threat management program, and an evaluation of this model. Methods Data were collected from several study phases. To describe types of violent events and their outcomes, workplace violent event data were collected from a large multinational company and a large University. To identify the types of prevention strategies implemented, 164 large and mid-sized businesses in the US were surveyed. A model strategy for threat management was developed and evaluated in a large multinational company in the United States. Results The most common types of workplace events included threatening behavior/bullying (43.2%), behavioral issue/suicidal (27.8%), assault (21.5%), and partner violence/stalking (6.1%). Smaller businesses reported a higher prevalence of bullying, while communicated threats were more common in large businesses. Large businesses were more likely to have violence prevention programs in place than mid-sized businesses. For example, more than 90% of large businesses reported having threat management teams compared with 74% of mid-sized businesses. Training in a model strategy for threat management led to significant increases in investigated events, leading to referrals for support and corrective action to remedy the threat. Conclusion Violence prevention strategies can reduce the burden of workplace violence. Filling gaps in small and mid-sized businesses is a priority, as is understanding dynamics of workplace violence globally.

71 Falls prevention among ambulatory and homebound older adults

Purpose Much is known about risk factors and prevention strategies for falls among community-dwelling older adults. However, little is known about how fall risks and falls prevention behaviours may differ between two community-dwelling groups: ambulatory and homebound. This study examined fall risks and behaviours among homebound, compared to non-homebound, older adults. Methods Data were collected in North Carolina March 2011–September 2013. Ambulatory older adults were recruited at local senior centres, and homebound older adults through Meals on Wheels. Participants were at least 65 years of age, not wheelchair bound, and able to read and write English. An in-home interview, home safety assessment, and medication review were conducted. Interview questions assessed: fall risk factors, falls prevention program participation and implementation of recommended falls prevention behaviours. Negative binomial regression modelled the association between demographic, fall risk factors and number of falls, adjusting for health status. Results 164 older adults participated: 84 ambulatory (mean age: 75.3 ± 7.3); 80 homebound (mean age: 79.6 ± 8.1). Homebound participants were older, in poorer health and reported limiting activities due to a fear of falling, compared to ambulatory participants (p < 0.01). Homebound older adults completed fewer recommended falls prevention behaviours, including exercise, having throw rugs and avoiding step stools. Ambulatory participants, compared to homebound participants had higher fall rates associated with medication (rate ratio (IDR) = 1.54, 95% CI = 1.26–1.89 vs. IDR = 1.33, 95% CI = 1.00–1.75) and fear of falling (IDR = 1.59, 95% CI = 0.71–3.54 vs. IDR = 1.34, 95% CI = 0.59–3.03). Among all participants, very few reported participating in falls prevention programs (7.3%). Conclusions Results suggest that homebound older adults are at higher risk for falling and implement fewer prevention strategies than ambulatory older adults Significance Evidence-based falls prevention strategies have been developed primarily among ambulatory populations. This study demonstrates that these strategies need to be adapted for homebound populations.

SAVIR hosts dynamic conference

Nearly 200 injury researchers met in New Orleans, Louisiana, USA, this past March for SAVIRs Fifth Biennial National Conference. The theme of the conference was “Maximizing Injury Research to Benefit All”, which focused on how injury research can promote positive behaviours and policies with impact throughout the lifespan and across diverse populations. Since SAVIRs first national conference at the Columbus Childrens Hospital in Ohio in 2007, SAVIR has worked to bring the injury science community together to develop injury prevention and control research, policy, practice and teaching. The 2015 conference featured a distinguished group of speakers, workshops highlighting contemporary methods in injury prevention and control, panels of journal editors and federal project officers offering guidance to students and early-stage investigators, and an awards luncheon to recognise the great accomplishments of researchers in the field. The SAVIR …