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Richard W Sattin

Publications and source records attributed to Richard W Sattin.

9 recordsLinked to original sources
PubMed2005

A self-assessment tool was reliable in identifying hazards in the homes of elders.

BACKGROUND AND OBJECTIVES: Falls are a leading cause of fatal and nonfatal injuries, particularly among the elderly. A reliable instrument for self-assessment of home falls hazards would facilitate screening for falls risk. This study examined the reliability of self-assessment of home falls hazards by elderly women. METHODS AND SETTING: Participants were 52 elderly women, aged 67 to 97. All evaluations were performed in the participants' homes. Home falls hazards were evaluated independently by study participants and by trained observers. RESULTS: Kappa statistics indicated good to excellent agreement for most of the environmental factors. However, observers were significantly more likely than the study participants to report certain tripping hazards, particularly objects in walkways. CONCLUSION: This home checklist is an important step towards a reliable self-report instrument for measuring home falls hazards. Self-assessment appears to be a reliable method for assessing many putative hazards of falling in the home. However, our findings raise questions regarding the reliable assessment of tripping hazards.

Accidental Falls↗
PubMed2005

Impact of a falls menu-driven incident-reporting system on documentation and quality improvement in nursing homes.

PURPOSE: Data from incident-reporting systems have been used successfully in disciplines other than health care to improve safety. This study tested the effect of a falls menu-driven incident-reporting system (MDIRS) on quality-improvement efforts in nursing homes. DESIGN AND METHODS: Following instrument development and testing, the intervention occurred over a 4-month period in three intervention nursing homes using the MDIRS matched with three homes using their existing narrative incident report to document falls. Data on fall incidents were collected from facility incident reports, and comparisons in incident-report documentation were made between the intervention and control groups. The minutes from quality-improvement meetings were examined to see how incident-report data were used for fall-prevention strategies. RESULTS: Almost one third of nursing home residents among the six facilities fell during the 4-month study period. Intervention nursing homes had significantly better documentation of fall characteristics on the incident reports than did the control nursing homes. Although only one nursing home fully implemented the MDIRS intervention, all three facilities identified strengths of the system. IMPLICATIONS: The MDIRS can have a significant impact in improving how nursing staff assess residents following a fall incident. Traditional narrative methods of documenting adverse incidents are time consuming and may not yield sufficient and accurate data. This model has the potential to enhance quality-improvement efforts and augment the current system of adverse incident reporting in nursing homes.

Accidental Falls↗
PubMed2005

Evaluating potentially modifiable risk factors for prevalent and incident nocturia in older adults.

OBJECTIVES: To examine associations between nocturia and potentially modifiable risk factors in older adults. DESIGN: Secondary analysis of cross-sectional and longitudinal data. SETTING: Respondents were selected using population-based sampling, drawing from a single Michigan county in 1983. They were followed through 1990. PARTICIPANTS: Community-living adults aged 60 and older. MEASUREMENTS: Episodes of nocturia, development of nocturia at 2 years after baseline survey, age, sex, hypertension, diabetes mellitus, drinking fluids before bedtime, amount of fluid intake before bedtime, diuretic use, and 24-hour coffee intake. All measures were self-reported. RESULTS: Bivariate cross-sectional analysis revealed significant associations with two or more episodes of nocturia for hypertension (odds ratio (OR)=1.7, 95% confidence interval (CI)=1.37-2.1), diabetes mellitus (OR=1.51, 95% CI=1.1-2.0), diuretic use (OR=1.7, 95% CI=1.3-2.1), age (OR=1.05 per additional year over 60, 95% 1.03-1.06), and number of cups of coffee (OR=0.93 for each cup of coffee, 95% CI=0.89-0.97). In multivariate analysis, hypertension (OR=1.52, 95% CI=1.2-1.9), diuretic use (OR=1.3, 95% 95% CI=1.0-1.7), and age (OR=1.04 per additional year over 60, 95% 1.03-1.06) were independently associated with two or more nocturia episodes per night. No baseline factors predicted future development of nocturia (save for age, in one model). CONCLUSION: Hypertension, older age, and diuretic use were independently associated with two or more episodes of nocturia in cross-sectional analysis. No baseline factor was related to the development of nocturia over a 2-year interval in this sample. Nighttime fluid intake and coffee intake, practices providers commonly target in patients with nocturia, were not associated with nocturia in this population-based sample of community-living older adults.

Age Distribution↗
PubMed2005

Reduction in fear of falling through intense tai chi exercise training in older, transitionally frail adults.

OBJECTIVES: To determine whether an intense tai chi exercise program could reduce fear of falling better than a wellness education (WE) program in older adults who had fallen previously and meet criteria for transitioning to frailty. DESIGN: Cluster-randomized, controlled trial of 48 weeks' duration. SETTING: Ten matched pairs of congregate living facilities in the greater Atlanta area. PARTICIPANTS: Sample of 291 women and 20 men, aged 70 to 97. MEASUREMENTS: Activity-related fear of falling using the Activities-Specific Balance Confidence Scale (ABC) and the Fall Efficacy Scale at baseline and every 4 months for 1 year. Demographics, time to first fall and all subsequent falls, functional measures, Centers for Epidemiologic Studies Depression Scale, medication use, level of physical activity, comorbidities, and adherence to interventions. RESULTS: Mean ABC was similar in both cohort groups at the time of randomization but became significantly higher (decreased fear) in the tai chi cohort at 8 months (57.9 vs 49.0, P<.001) and at study end (59.2 vs 47.9, P<.001). After adjusting for covariates, the mean ABC after 12 months of intervention was significantly greater in the tai chi group than in the WE group, with the differences increasing with time (mean difference at 12 months=9.5 points, 95% confidence interval=4.8-14.2, P<.001). CONCLUSION: Tai chi led to a significantly greater reduction in fear of falling than a WE program in transitionally frail older adults. The mean percentage change in ABC scores widened between tai chi and WE participants over the trial period. Tai chi should be considered in any program designed to reduce falling and fear of falling in transitionally frail older adults.

Accidental Falls↗
PubMed2003

Intense tai chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial.

OBJECTIVES: To determine whether an intense tai chi (TC) exercise program could reduce the risk of falls more than a wellness education (WE) program in older adults meeting criteria for transitioning to frailty. DESIGN: Randomized, controlled trial of 48 weeks duration. SETTING: Twenty congregate living facilities in the greater Atlanta area. PARTICIPANTS: Sample of 291 women and 20 men aged 70 to 97. MEASUREMENTS: Demographics, time to first fall and all subsequent falls, functional measures, Sickness Impact Profile, Centers for Epidemiologic Studies-Depression Scale, Activities-specific Balance Confidence Scale, Falls Efficacy Scales, and adherence to interventions. RESULTS: The risk ratio (RR) of falling was not statistically different in the TC group and the WE group (RR=0.75, 95% confidence interval (CI)=0.52-1.08), P=.13). Over the 48 weeks of intervention, 46% (n=132) of the participants did not fall; the percentage of participants that fell at least once was 47.6% for the TC group and 60.3% for the WE group. CONCLUSION: TC did not reduce the RR of falling in transitionally frail, older adults, but the direction of effect observed in this study, together with positive findings seen previously in more-robust older adults, suggests that TC may be clinically important and should be evaluated further in this high-risk population.

Accidental Falls↗
PubMedDate not supplied

Blast lung injury.

Current trends in global terrorism mandate that emergency medical services, emergency medicine and other acute care clinicians have a basic understanding of the physics of explosions, the types of injuries that can result from an explosion, and current management for patients injured by explosions. High-order explosive detonations result in near instantaneous transformation of the explosive material into a highly pressurized gas, releasing energy at supersonic speeds. This results in the formation of a blast wave that travels out from the epicenter of the blast. Primary blast injuries are characterized by anatomical and physiological changes from the force generated by the blast wave impacting the body's surface, and affect primarily gas-containing structures (lungs, gastrointestinal tract, ears). "Blast lung" is a clinical diagnosis and is characterized as respiratory difficulty and hypoxia without obvious external injury to the chest. It may be complicated by pneumothoraces and air emboli and may be associated with multiple other injuries. Patients may present with a variety of symptoms, including dyspnea, chest pain, cough, and hemoptysis. Physical examination may reveal tachypnea, hypoxia, cyanosis, and decreased breath sounds. Chest radiography, computerized tomography, and arterial blood gases may assist with diagnosis and management; however, they should not delay diagnosis and emergency interventions in the patient exposed to a blast. High flow oxygen, airway management, tube thoracostomy in the setting of pneumothoraces, mechanical ventilation (when required) with permissive hypercapnia, and judicious fluid administration are essential components in the management of blast lung injury.

Blast Injuries↗
PubMedDate not supplied

The CDC traumatic brain injury surveillance system: characteristics of persons aged 65 years and older hospitalized with a TBI.

OBJECTIVE: To examine the epidemiologic and clinical characteristics of older persons (ie, those aged 65-74, 75-84, and > or = 85 years) hospitalized with traumatic brain injury (TBI). METHODS: Data from the 1999 CDC 15-state TBI surveillance system were analyzed. RESULTS: In 1999, there were 17,657 persons 65 years and older hospitalized with TBI in the 15 states for an age-adjusted rate of 155.9 per 100,000 population. Rates among persons aged 65 years or older increased with age and were higher for males. Most TBIs resulted from fall- or motor vehicle (MV)-traffic-related incidents. Most older persons with TBI had an initial TBI severity of mild (73.4%); however, the proportions of both moderate and severe disability for those discharged alive and of in-hospital mortality were relatively high (23.5%, 9.7%, and 12%, respectively). Persons who fell were also more likely to have had 3 or more comorbid conditions than were those who sustained a TBI from an MV-traffic incident. CONCLUSIONS: TBI is a substantial public health problem among older persons. As the population of older persons continues to increase in the United States, the need to design and implement proven and cost-effective prevention measures that focus on the leading causes of TBI (unintentional falls and MV-traffic incidents) becomes more urgent.

Accidental Falls↗