Related Experiment Video
Updated: Jun 4, 2026
Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication
Published on: December 11, 2013
Evaluation of cardiovascular fall risk assessment and managment in Dutch fall clinics comparing current practice to
A C Pronk1,2, R Schroten1,2, L J Seppala1,2
1Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
Insights
Cardiovascular disorders are key fall risk factors. Dutch fall clinics show varied practices in assessing these risks, with staff availability and expertise being major barriers to guideline implementation.
Area of Science:
- Gerontology
- Cardiology
- Health Services Research
Background:
- Cardiovascular disorders are significant risk factors for falls, particularly in cases of unexplained recurrent falls.
- International guidelines recommend a standard cardiovascular risk assessment, but implementation remains a challenge.
- This study investigates the gap between recommended practices and actual clinical application in fall clinics.
Purpose of the Study:
- To map the daily practice of cardiovascular fall risk assessment and management in Dutch fall clinics.
- To compare guideline recommendations (work-as-imagined) with actual practice (work-as-done).
- To identify barriers hindering the implementation of cardiovascular fall risk assessment guidelines.
Main Methods:
- The Functional Resonance Analysis Method (FRAM) was employed to visualize work-as-imagined and work-as-done.
- Guideline input was based on the Dutch guideline on fall prevention and ESC syncope guidelines.
- Data on actual practice and barriers were collected through semi-structured interviews with Dutch fall clinic professionals.
Main Results:
- Initial cardiovascular risk factor assessments (e.g., ECG) were consistent with guidelines across clinics.
- Significant variability was observed in further cardiovascular assessments (e.g., head-up tilt testing), with four distinct FRAM models identified.
- Key barriers included unavailability of staff, knowledge gaps, lack of expertise, and insufficient resources.
Conclusions:
- Discrepancies exist between recommended cardiovascular fall risk assessment protocols and current practices in Dutch fall clinics.
- A structured care pathway is proposed to standardize and optimize cardiovascular fall risk management.
- Addressing identified barriers and developing standardized pathways are crucial for improving cardiovascular fall prevention in older adults.
Background:
Cardiovascular disorders are important fall risk factors, especially in unexplained recurrent falls. According to (international) guidelines, a standard workup of cardiovascular fall risk factors is indicated; however, its implementations is lagging. This study aimed to map the daily practice of cardiovascular fall risk assessment and management in Dutch fall clinics, comparing guideline recommendations (work-as-imagined) with actual practice (work-as-done), and to identify barriers to implementation.
Methods:
The functional resonance analysis method (FRAM) was used to visualize work-as-imagined and work-as-done. Input for work-as-imagined was the Dutch guideline on fall prevention, which follows the ESC syncope guideline recommendations where applicable. Work-as done and barriers for guideline implementation were derived from semi-structured interviews with Dutch fall clinic professionals.
Results:
Fourteen participants from eight fall clinics participated. Work-as-done related to the initial assessment of cardiovascular fall risk factors (e.g., ECG recording), was in line with work-as-imagined and implemented across the participating fall clinics. For the implementation of further cardiovascular assessments (e.g., head-up tilt testing), significant variability was observed across fall clinics, resulting in four different work-as-done FRAM models. The variations were mainly driven by the following barriers: unavailability of staff, gaps in knowledge, lack of expertise, and lack of resources.
Conclusion:
This study highlights important discrepancies between recommended cardiovascular fall risk assessment protocols and current practices in Dutch fall clinics. A structured care pathway could help standardize and optimize cardiovascular fall risk practices. Addressing the identified barriers to implementation and development in standardized care pathways could facilitate the implementation of the care pathway and optimize cardiovascular fall prevention practices in older adults.
Related Concept Videos
01:30Heart Failure VII: Nursing Interventions
01:17Aortic Regurgitation IV: Nursing Management
01:23Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:28Mitral Regurgitation IV: Nursing Management
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:30Venous Thrombosis IV: Nursing Management