Untitled Document

Research

Jane E. Mahoney

M.D., University of California-San Francisco
Associate Professor, Department of Medicine
jm2@medicine.wisc.edu
http://www2.medicine.wisc.edu/home/people-search/people/staff/863/MAHONEY_JANE_E/

Assessment of Falls Risk After Hospitalization; Interventions to Decrease the Risk of Falls and Improve Mobility

My research has focused on the effects of hospitalization and acute medical illness on impairing mobility and increasing falls risk for older adults. We have provided strong evidence that older adults are at high risk for loss of walking independence when they become hospitalized. Using multicenter data, we found that one in eight hospitalized older adults lost the ability to walk independently. One-fourth of these did not regain walking ability three months later. This research will help clinicians target at-risk older adults for more intensive rehabilitation to prevent loss of walking ability.

Not only does decline in walking occur frequently during hospitalization, but we have found that loss of mobility is associated with increased risk for falls after discharge. In an earlier study, we found a high incidence of falls in the month after discharge. To follow up on this we conducted a large epidemiologic study in the Madison area called Project HEAL, where we evaluated patients who required home nursing services following hospital discharge. We found a marked increase in falls in the post-hospitalization period. The rate of falls was highest in the first two weeks after hospitalization, and remained high over the subsequent month. Approximately 10% of falls resulted in rehospitalizations due to injuries.

We determined risk factors for falls in this frail elderly population. Previous use of an assistive device, particularly a walker, placed patients at higher risk, as did a greater number of hospitalizations in the year prior. We found a number of potentially reversible factors associated with falls. These included poorer balance at hospital discharge, probable delirium, and use of first generation tricyclic antidepressants.

We have also analyzed data from a large database called Project HOPE, which looked at changes in functioning after hospital discharge in a number of sites across the United States. We found that a pre-hospital assistive device predicted not only falls, but also decline in functioning and loss of walking independence with hospitalization. These patients may well benefit from targeted interventions during hospitalization to maintain their mobility. We have developed a nursing intervention that utilizes a mobility aide to assist high-risk older adults to walk six times per day during hospitalization. We are currently evaluating this program for feasibility and efficacy.

We have also developed an algorithm for falls assessment and intervention that can be implemented by health professionals in a community-health setting. We are conducting a randomized trial to evaluate the efficacy of this intervention in decreasing falls and preventing hospitalizations and loss of function.

Representative Publications
Kiehn, K., Mahoney, J., Jones, A.N., & Hansen, K.E. (2009). Vitamin D supplement intake in elderly fallers. J. Am. Geriatr. Soc., 57(1), 176-177.

Hook, M.L., Heidrich, S.M., & Mahoney, J.E. (2008). Beliefs about fall risk and fall prevention behavior in high-risk community dwelling older adults. Paper presented at the National State of the Science Conferences, Washington, DC, October, 2008.

Schmitz, A., Silder, A., Heiderscheit, B.C., Mahoney, J., & Thelen, D.G. (2008). Differences in lower extremity muscular activation during walking between healthy older and young adults. Journal of Electromyography and Kinesiology, 2008 Dec. 10 [Epub ahead of print].

Hook, M.L., Mahoney, J.E., & Heidrich, S.M. (2007). Exploring relationship between risk representation, prevention, and falling in high risk elders using the Common Sense Model. Poster presented at the 60th Annual Scientific Meeting of the Gerontological Society of America, San Francisco, CA.

Mahoney, J.E., Shea, T.A., Przybelski, R., Jaros, L., Gangnon, R., Cech, S., & Schwalbe, A. (2007). Kenosha County falls prevention study: a randomized, controlled trial of an intermediate-intensity, community-based multifactorial falls intervention. J. Am. Geriatr. Soc., 55(4), 489-98.

Mahoney, J.E., Glysch, R.L., Guilfoyle, S.M., Hale, L.J., & Katcher, M.L. (2005). Trends, risk factors, and prevention of falls in older adults in Wisconsin. W.M.J., 104(1), 22-8.

Elliott, M.E., Drinka, P.J., Krause, P., Binkley, N.C., & Mahoney, J.E. (2004). Osteoporosis assessment strategies for male nursing home residents. Maturitas, 48, 225-233.

Callen, B.L., Mahoney, J.E., Grieves, C.B., Wells, T.J., & Enloe, M. (2004). Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital. Geriatr. Nurs., 25(4), 212-7.

Callen, B.L., Mahoney, J.E., Wells, T.J., Enloe, M., & Hughes, S. (2004). Admission and discharge mobility of frail hospitalized older adults. Medsurg. Nurs., 13(3), 156-63, quiz 164.

Gunter-Hunt, G., Mahoney, J.E., & Sieger, C.E. (2002). A comparison of state advance directive documents. The Gerontologist, 42, 51-60.

Gray, S.L., Mahoney, J., Blough, T. (2001). Medication compliance in elderly patients receiving home health services following hospital discharge. Ann. Pharmacother., 35, 539-45.

Elliott, M.E., Drinka, P.J., Krause, P., Mahoney, J.E., & Binkley, N.C. (2001). Osteoporosis in institutionalized male veterans: Common but under-recognized. J. Bone Miner. Res., 16(Suppl 1), M349.

Gray, S.L., Hisrich, M., & Mahoney, J. (2000). Psychotropic medication use in older patients referred for evaluation of falls. Ann. Pharmacother., 34, 265.

Mahoney, J.E., Eisner, J., Havighurst, T., Gray, S., & Palta, M. (2000). Problems of older adults living alone after hospitalization. J. Gen. Int. Med., 15, 611-19.

Mahoney, J. (2000). Improving recovery of function after hospitalization. J. Am. Geriatr. Soc., 48, 1730-31.

Mahoney, J.E, Sager, M.A., & Jalaluddin, M. (1999). Use of an ambulation assistive device predicts functional decline associated with hospitalization. J. Gerontology Medical Sciences, 54A, M83-M88.

Hansen, K., Mahoney, J., & Palta, M. (1999). Risk factors for lack of recovery of ADL independence after hospital discharge. J. Am. Geriatr. Soc., 47, 360-365.

Gray, S.L., Mahoney, J., & Blough, D. (1999). Adverse drug events in elderly patients receiving home health services. Ann. Pharmacother., 3, 1147-1153.

Mahoney, J.E. (1999). Falls in the elderly: Office-based evaluation, prevention, and treatment. Cleveland Clinic Journal of Medicine, 66, 181-189.

Mahoney, J.E. (1999). Gender differences in hallway ambulation by older adults hospitalized for medical illness. Wisc. Med. J., 8, 40-43.

Mahoney, J.E. (1998). Immobility and falls. Clinics in Geriatric Medicine, 14(4), 699-726.

Mahoney, J.E., Sager, M.A., & Jalaluddin, M. (1998). New walking dependence associated with hospitalization for acute medical illness: Incidence and significance. J. Gerontology Medical Sciences, 53A, M307-312.

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