Measures

Following the recommendations of the Prevention of Falls Network Europe (ProFaNE), a fall was defined in the surveys as “an unexpected event where you come to rest on the ground, floor or lower level.”³¹ “Recurrent fallers” were patients who experienced two or more falls in six months. “Severe” fall-related injury was defined as seeking medical treatment, severe pain, head injury, fracture, or change from independent to assisted living. The six-month time period was chosen because it balances capturing enough falls with limiting recall bias, and it facilitates comparison with another study that used the same time period.^13,32 The physical component score (PCS) and mental component score (MCS) of quality of life were obtained using the Veterans RAND 12-item Health Survey (VR-12). With a mean of 50, the VR-12 scale is standardized to the general U.S. population.^22,23 The baseline survey provided falls history, quality of life, and perceived health. Nurses at the preoperative assessment clinic scored functional dependence using the Barthel Index of Activities of Daily Living. A score of 100 indicates functional independence.²⁴ Incontinence and impaired mobility were obtained from the corresponding item on the Barthel Index. Neurologic disease was defined as stroke, hemiplegia, paraplegia, quadriplegia, Parkinson Disease, or multiple sclerosis. Patients indicated their race during surgery registration using hospital-specified options. The clinic physician judged metabolic activity capability by asking the patient to describe his or her most strenuous physical activity. ASA physical status was extracted from operating room documentation. All data were extracted from the SATISFY-SOS baseline health survey and from the electronic medical record (MetaVision, iMDsoft, Needham, MA).