Dawn M. Dalby

Risk Factors for Falling Among Community-Based Seniors

Background: Falling constitutes a significant risk to the health and well-being of seniors. Although a number of risk factors have been established within the literature for falling, limited work has differentiated risk factors for 1-time versus recurrent or multiple fallers. Methods: The purpose of this research was to examine 2 relationships: (1) the risk factors for nonfallers versus fallers (1+ falls); and (2) the risk factors for nonfallers/1-time fallers versus multiple fallers (2+ falls). All participants (n = 453) were subjects within 5 different fall intervention programs funded through the Falls Prevention Initiative sponsored by Health Canada and Veterans Affairs Canada. In total, 5 project sites funded in Ontario conducted independent fall intervention programs. At the onset of their programs and at the completion of their programs, each project site assessed all of their subjects or a predetermined number of seniors (if the subject pool was extensive) using 2 instruments, namely the interRAI Community Health Assessment and the Berg Balance Scale, so that comparisons could be made between sites. Results: Of the 453 individuals, 67% of the sample was classified as nonfallers, with 33% classified as experiencing 1 or more falls. Risk factors significant within the model examining nonfallers versus 1+ fallers included increased medication use and a previous history of falling. For the second analyses, examining 0 falls/1 fall versus recurrent fallers, the following factors were associated with increased risk: medication use, previous history of falling, and compromised activities of daily living (ADL). Fourteen percent of the sample experienced 2+ falls. Conclusions: It is important to distinguish fallers based on fall status because recurrent or multiple fallers are more likely to benefit from fall prevention efforts. Using a standardized and comprehensive tool such as the interRAI-CHA would assist researchers in making comparisons between different research groups.

A Pharmacist Consultation Service in Community-Based Family Practices: A Randomized, Controlled Trial in Seniors:

Objective: To conduct a pilot study for a larger randomized trial investigating the efficacy and cost-effectiveness of a pharmacist consultation (PC) program for elderly patients in family practice. Design: Randomized, observer-blinded, controlled trial with two patient groups: PC and control. The study pharmacist interviewed each PC program participant in their physicians office, prepared a letter, and reviewed the drug regimen recommendations in the letter with the physician. The number and types of recommendations made, the proportion of the pharmacists recommendations implemented by physicians, and daily medication use and costs at the end of six months are reported. Setting: One hundred thirty-two patients aged 65 years and older from four family practices in Stoney Creek, Ontario, Canada, who regularly were taking four or more medications. Results: Patient participation rates demonstrated feasibility: 191 patients were eligible, with 132 (69.1%) of these consenting to be enrolled. A mean ± SD of 3.0 ± 1.7 recommendations per patient were made for 62 (93.9%) of 66 patients in the PC group, and 77.8% (119/153) of these recommendations were implemented or partially implemented by the physicians. After six months, the mean numbers of medication units were 14.7 ± 10.8 and 13.9 ± 8.2, p = 0.66. The mean daily medication costs were

Prevalence and predictors of human papillomavirus infection in women in Ontario, Canada

2.73 ± 1.78 and

Home Care Quality Indicators (HCQIs) Based on the MDS-HC

2.47 ± 1.78, p = 0.43 in the control and PC groups, respectively. Conclusions: This pilot study demonstrated the need, the feasibility, and the potential effects of the PC program. The results were used to design a larger trial in which physicians rather than patients were randomized to further evaluate the program.