Release Notes for the ALC2026A Manual

The effort to monitor the prevalence of falls at the facility level with transfer to the hospital is very important for protecting the health of facility residents. Studies show that such falls can leave up to 50%–65% of residents with fears that impact both their functional abilities and social activities (Magaziner et al., 1997). Identifying falls risk factors can help facilities reduce incidence of falls among their residents through clinical and non-clinical practices (Arling et al., 2014). Studies have shown that falls account for 10% of visits to the emergency department and six percent of urgent hospitalizations among elderly people (Tinetti, 2003).

The effort to monitor the prevalence of falls at the facility level with transfer to the hospital is very important for protecting the health of facility residents. Studies show that such falls can leave up to 50% of those aged 60 years and older with fears that impact both their functional abilities and social activities (García-Martínez et al., 2024). Identifying falls risk factors can help facilities reduce incidence of falls among their residents through clinical and non-clinical practices (CDC, 2016). Falls account for about 3 million emergency department visits each year among elderly people (CDC, 2024).

Selected References

• Arling, P. A., et al. (2014). "Communication and effectiveness in a US nursing home quality-improvement collaborative." Nurs Health Sci 16(3): 291-297.
• Magaziner J, Lydick E, Hawkes W, Fox KM, Zimmerman SI, Epstein RS, Hebel JR. Excess mortality attributable to hip fracture in white women aged 70 years and older. Am J Public Health. 1997 Oct;87(10):1630-6.
• Tinetti ME. Clinical practice. Preventing falls in elderly persons. N Engl J Med. 2003 Jan 2;348(1):42-9.

• Centers for Disease Control and Prevention. (2016). Behavioral Risk Factor Surveillance System (BRFSS) data. Retrieved from https://www.cdc.gov/steadi/
• Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2024). Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. Retrieved March 11, 2024, from https://wisqars.cdc.gov/
• García-Martínez, A., García-Rosa, S., Gil-Rodrigo, A., et al. (2024). Prevalence and outcomes of fear of falling in older adults with falls at the emergency department: A multicentric observational study. European Geriatric Medicine, 15(6), 1281–1289. https://doi.org/10.1007/s41999-024-00992-1

This measure addresses advance care planning as one facet of high-quality care for older adults. The aim of advance care planning is to ensure that care near the end of life aligns with the patient’s wishes (IOM, 2014). Advanced care planning is associated with improved health outcomes for older adults, including reducing hospitalizations, intensive care unit (ICU) admissions, and hospital and ICU lengths of stay (Brinkman-Stoppelenburg, 2014; Hall et al., 2011; Khandelwal et al., 2015; Martin et al., 2016). However, most older adults do not have advance care planning conversations with their clinicians even though there is consensus among diverse stakeholders that advance care planning is a key component of high-quality care (NQF 2006; IOM, 2014).

This measure addresses advance care planning as one facet of high-quality care for older adults. The aim of advance care planning is to ensure that care near the end of life aligns with the patient’s wishes (Sedini et al., 2022). Timely advanced care planning is associated with less aggressive care in the last 30 days of life, including fewer hospital deaths, fewer hospital and ICU admissions, and fewer visits to the ED (Weissman et al., 2021). However, most older adults do not have advance care planning conversations with their clinicians even though there is consensus among diverse stakeholders that advance care planning is a key component of high-quality care (NQF 2006; IOM, 2014; Yadav et al., 2017).

Selected References

• Brinkman-Stoppelenburg, A., Rietjens, J. A., & van der Heide, A. (2014). The effects of advance care planning on end-of-life care: a systematic review. Palliative Medicine, 28(8), 1000-1025.
• Hall, S., Kolliakou, A., Petkova, H., Froggatt, K., & Higginson, I. J. (2011). Interventions for improving palliative care for older people living in nursing homes. Cohrane Database of Systematic Reviews, 3.
• Khandelwal, N., Kross, E. K., Engelberg, R. A., Coe, N. B., Long, A. C., & Curtis, J. R. (2015). Estimating the effect of palliative care interventions and advance care planning on ICU utilization: a systematic review. Critical Care Medicine, 43(5), 1102-1111.
• Martin, R. S., Hayes, B., Gregorevic, K., & Lim, W. K. (2016). The effects of advance care planning interventions on nursing home residents: a systematic review. Journal of the American Medical Directors Association, 17(4), 284-293.

• Sedini, C., Biotto, M., Crespi Bel'skij, L. M., Moroni Grandini, R. E., & Cesari, M. (2022). Advance care planning and advance directives: An overview of the main critical issues. Aging Clinical and Experimental Research, 34(3), 325–330. https://doi.org/10.1007/s40520-021-02001-y
• Weissman, J. S., Reich, A. J., Prigerson, H. G., Gazarian, P., Tjia, J., Kim, D., Rodgers, P., & Manful, A. (2021). Association of advance care planning visits with intensity of health care for Medicare beneficiaries with serious illness at the end of life. JAMA Health Forum, 2(7), e211829. https://doi.org/10.1001/jamahealthforum.2021.1829
• Yadav, K. N., Gabler, N. B., Cooney, E., Kent, S., Kim, J., Herbst, N., Mante, A., Halpern, S. D., & Courtright, K. R. (2017). Approximately one in three US adults completes any type of advance directive for end-of-life care. Health Affairs, 36(7), 1244–1251. https://doi.org/10.1377/hlthaff.2017.0175