"14 407 primary care patients registered with 12 randomly selected general practices from three regions in England (total list size: 92 255 patients).
Main outcome measures The incidence of significant harm considered at least 'probably avoidable' and the nature of the safety incidents.
Results The rate of significant harm considered at least probably avoidable was 35.6 (95% CI 23.3 to 48.0) per 100 000 patient-years (57.9, 95% CI 42.2 to 73.7, per 100 000 based on a sensitivity analysis). Overall, 74 cases of avoidable harm were detected, involving 72 patients. Three types of incident accounted for more than 90% of the problems: problems with diagnosis accounted for 45/74 (60.8%) primary incidents, followed by medication-related problems (n=19, 25.7%) and delayed referrals (n=8, 10.8%). In 59 (79.7%) cases, the significant harm could have been identified sooner (n=48) or prevented (n=11) if the GP had taken actions aligned with evidence-based guidelines."
While I've observed these discussions for some time, this is my first occasion weighing in.
I happened to have looked up hip pads recently in the Cochrane database. Indeed, they may minimally reduce risk of hip fracture from fall but compliance is poor even in the midst of concerted efforts to the contrary. I'm not aware of their regular use in this country but can't speak of elsewhere in the world.
I don't have any information regarding helmets.
James Loeffelholz, MD, CPE, FACP, FAAPL
System Director of Clinical Value
BOZEMAN HEALTH 915 Highland Boulevard Bozeman, MT 59715 Tel: 406.414.5124
Fax: 406.414.1070 firstname.lastname@example.org www.bozemanhealth.org
I'm not aware of research regarding helmets and fall-related injury in the elderly. Most data about helmet effectiveness comes from sports. As an avid motorcyclist, I always wear a helmet and full-length suit manufactured by Aerostich in Duluth, MN with armor at hips, knees, spine, elbows, and shoulders . . . the data for motorcycle helmets are strongest for reducing risk of skull fracture and somewhat less robust for reducing intracranial bleed.
The forces generated in a fall on an adult head can be considerable. Helmets disperse that energy over the surface of the skull, but the momentum is still there for the smaller brain of the elderly patient to move inside the skull – which usually leads to bleeds by tearing the already-stretched superficial vessels. Thus the prospective benefit may be lessened . . .