Falls and Fear of Falling among Persons Who Receive Housing Adaptations—Results from a Quasi-Experimental Study in Sweden
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Study Context
2.2. Sample
2.3. Intervention
2.4. Assessments
2.5. Data Analysis
2.6. Ethical Considerations
3. Results
4. Discussion
Additional Methodological Considerations
5. Conclusions
6. Trial Registration
Acknowledgments
Author Contributions
Conflicts of Interest
References
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, SBU. Omhändertagande av äldre Som Inkommer Akut Till Sjukhus—Med Fokus på SköRa äldre. En Systematisk Litteraturöversikt; Caring for elderly who arrive urgently to hospital—focusing on frail elderly people. A systematic literature review; Swedish Agency for Health Technology Assessment and Assessment of Social Services, SBU: Stockholm, Sweden, 2014; ISBN 978-91-85413-62-1. (In Swedish) [Google Scholar]
- Collerton, J.; Kingston, A.; Bond, J.; Davies, K.; Eccles, M.P.; Jagger, C.; Kirkwood, T.B.; Newton, J.L. The Personal and Health Service Impact of Falls in 85 Year Olds: Cross-Sectional Findings from the Newcastle 85+ Cohort Study. PLoS ONE 2012, 7, e33078. [Google Scholar] [CrossRef] [PubMed]
- Matsuda, P.N.; Shumway-Cook, A.; Ciol, M.A.; Bombardier, C.H.; Kartin, D.A. Understanding Falls in Multiple Sclerosis: Association of Mobility Status, Concerns About Falling, and Accumulated Impairments. Phys. Ther. 2012, 92, 407–415. [Google Scholar] [CrossRef] [PubMed]
- Pin, S.; Spini, D. Impact of falling on social participation and social support trajectories in a middle-aged and elderly European sample. SSM Popul. Health 2016, 2, 382–389. [Google Scholar] [CrossRef]
- Stenhagen, M.; Ekström, H.; Nordell, E.; Elmståhl, S. Accidental falls, health-related quality of life and life satisfaction: A prospective study of the general elderly population. Arch. Gerontol. Geriatr. 2014, 28, 95–100. [Google Scholar] [CrossRef] [PubMed]
- Alamgir, H.; Muazzam, S.; Nasrullah, M. Unintentional falls mortality among elderly in the United States: Time for action. Injury 2012, 43, 2065–2071. [Google Scholar] [CrossRef] [PubMed]
- Siracuse, J.J.; Odell, D.D.; Gondek, S.P.; Odom, S.R.; Kasper, E.M.; Hauser, C.J.; Moorman, D.W. Health care and socioeconomic impact of falls in the elderly. Am. J. Surg. 2012, 203, 335–338. [Google Scholar] [CrossRef] [PubMed]
- Heinrich, S.; Rapp, K.; Rissmann, U.; Becker, C.; König, H.-H. Cost of falls in old age: A systematic review. Osteoporos. Int. 2010, 21, 891–902. [Google Scholar] [CrossRef] [PubMed]
- Gillespie, L.D.; Robertson, M.C.; Gillespie, W.J.; Sherrington, C.; Gates, S.; Clemson, L.M.; Lamb, S.E. Interventions for preventing falls in older people living in the community. Cochrane Database Syst. Rev. 2012. [Google Scholar] [CrossRef]
- Robinovitch, S.N.; Feldman, F.; Yang, Y.; Schonnop, R.; Leung, P.M.; Sarraf, T.; Sims-Gould, J.; Loughin, M. Video capture of the circumstances of falls in elderly people residing in long-term care: An observational study. Lancet 2013, 381, 47–54. [Google Scholar] [CrossRef]
- Timsina, L.R.; Willetts, J.L.; Brennan, M.J.; Marucci-Wellman, H.; Lombardi, D.A.; Courtney, T.K.; Verma, S.K. Circumstances of fall-related injuries by age and gender among community-dwelling adults in the United States. PLoS ONE 2017, 12, e0176561. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization (WHO). World Report on Disability; WHO Press: Geneva, Switzerland, 2011; ISBN 978-92-4-156418-2. [Google Scholar]
- Allen, N.E.; Schwarzel, A.K.; Canning, C.G. Recurrent falls in Parkinson’s disease: A systematic review. Parkinson’s Dis. 2013. [Google Scholar] [CrossRef] [PubMed]
- Ambrosea, A.F.; Paula, G.; Hausdorff, J.M. Risk factors for falls among older adults: A review of the literature. Maturitas 2013, 75, 51–61. [Google Scholar] [CrossRef] [PubMed]
- Deandrea, S.; Lucenteforte, E.; Bravi, F.; Foschi, R.; LaVecchia, C.; Negri, E. Risk Factors for Falls in Community-dwelling Older People: A Systematic Review and Meta-analysis. Epidemiology 2010, 21, 658–668. [Google Scholar] [CrossRef] [PubMed]
- Lamb, S.E.; Jørstad-Stein, E.C.; Hauer, K.; Becker, C. Development of a Common Outcome Data Set for Fall Injury Prevention Trials: The Prevention of Falls Network Europe Consensus. J. Am. Geriatr. Soc. 2015, 53, 1618–1622. [Google Scholar] [CrossRef] [PubMed]
- Denkinger, M.D.; Lukas, A.; Nikolaus, T.; Hauer, K. Factors associated with fear of falling and associated activity restriction in community-dwelling older adults: A systematic review. Am. J. Geriatr. Psychiatry 2015, 23, 72–86. [Google Scholar] [CrossRef] [PubMed]
- Kumar, A.; Carpenter, H.; Morris, R.; Iliffe, S.; Kendrick, D. Which factors are associated with fear of falling in community-dwelling older people? Age Ageing 2014, 43, 76–84. [Google Scholar] [CrossRef] [PubMed]
- Kader, M.; Iwarsson, S.; Odin, P.; Nilsson, M.H. Fall-related activity avoidance in relation to a history of falls or near falls, fear of falling and disease severity in people with Parkinson’s disease. BMC Neurol. 2016, 16, 84. [Google Scholar] [CrossRef] [PubMed]
- Townsend, E.A.; Polatajko, H.J. Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-Being & Justice through Occupation; CAOT Publications ACE: Ottawa, ON, Canada, 2007; ISBN 9781895437768. [Google Scholar]
- Fänge, A.; Iwarsson, S. Changes in ADL dependence and aspects of usability following housing adaptation —A longitudinal perspective. AJOT 2005, 59, 296–304. [Google Scholar] [CrossRef] [PubMed]
- Peterson, I.; Lilja, M.; Hammel, J.; Kottorp, A. Impact of home modification services on ability in everyday life for people ageing with disabilities. J. Rehabil. Med. 2008, 40, 253–260. [Google Scholar] [CrossRef] [PubMed]
- Stark, S.; Keglovits, M.; Arbesman, M.; Lieberman, D. Effect of home modification interventions on the participation of community-dwelling adults with health conditions: A systematic review. AJOT 2017, 71, 7102290010p1–7102290010p11. [Google Scholar] [CrossRef] [PubMed]
- Wahl, H.W.; Fänge, A.; Oswald, F.; Gitlin, L.N.; Iwarsson, S. The home environment and disability-related outcomes in aging individuals: What is the empirical evidence? Gerontologist 2009, 49, 355–367. [Google Scholar] [CrossRef] [PubMed]
- Fänge, A.; Iwarsson, S. Changes in accessibility and usability in housing: An exploration of the housing adaptation process. Occup. Ther. Int. 2005, 12, 44–59. [Google Scholar] [CrossRef] [PubMed]
- Keal, M.D.; Pierse, N.; Howden-Chapman, P.; Cunningham, C.; Cunningham, M.; Guria, J.; Baker, M.G. Home modifications to reduce injuries from falls in the home injury prevention intervention (HIPI) study: A cluster-randomised controlled trial. Lancet 2015, 385, 231–238. [Google Scholar] [CrossRef]
- Ministry of Health and Social Affairs. The Housing Adaptation Act; SFS 1992:1547; Ministry of Health and Social Affairs: Stockholm, Sweden, 1992.
- Chase, C.A.; Mann, K.; Wasek, S.; Arbesman, M. Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults. AJOT 2012, 66, 284–291. [Google Scholar] [CrossRef] [PubMed]
- Thordardottir, B.; Chiatti, C.; Ekstam, L.; Malmgren Fänge, A. Heterogeneity of characteristics amon housing adaptation clients in Sweden—Relationship to participation and self-rated health. Int. J. Environ. Res. Public Health 2016, 13, 91. [Google Scholar] [CrossRef] [PubMed]
- Szanton, S.L.; Thorpe, R.J.; Boyd, C.; Tanner, E.K.; Leff, B.; Agree, E.; Xue, Q.-L.; Allen, J.K.; Seplaki, C.L.; Weiss, C.O.; et al. Community aging in place, advancing better living for elders: A bio-behavioral-environmental intervention to improve function and health-related quality of Life in disabled older adults. JAGS 2011, 59, 2314–2320. [Google Scholar] [CrossRef] [PubMed]
- Fänge, A.; Iwarsson, S. Challenges in the development of strategies for housing adaptation evaluations. SJOT 2007, 14, 140–149. [Google Scholar] [CrossRef] [PubMed]
- Malmgren Fänge, A.; Lindberg, K.; Iwarsson, S. Housing adaptations from the perspectives of Swedish occupational therapists. Scand. J. Occup. Ther. 2013, 20, 228–240. [Google Scholar] [CrossRef] [PubMed]
- Ekstam, L.; Carlsson, G.; Chiatti, C.; Nilsson, M.; Malmgren Fänge, A. A research-based strategy for managing housing adaptations: Study protocol for a quasi-experimental trial. BMC Health Serv. Res. 2014, 14, 602. [Google Scholar] [CrossRef] [PubMed]
- Boverket, National Board of Housing, Planning and Building. Bostadsanpassningsbidragen 2012, Housing Adaptation Grants 2012; Boverket, National Board of Housing, Planning and Building: Karlskrona, Sweden, 2013. no 34. (In Swedish) [Google Scholar]
- Iwarsson, S.; Slaug, B. Housing Enabler. A Method for Rating/Screening and Analyzing Accessibility Problems in Housing; Wallin & Dalholm: Lund, Sweden, 2010. [Google Scholar]
- Freitas, S.; Simões, M.R.; Alves, L.; Vicente, M. Montreal Cognitive Assessment (MoCA): Validation Study for Vascular Dementia. J. Int. Neuropsychol. Soc. 2012, 18, 1031–1040. [Google Scholar] [CrossRef] [PubMed]
- Nasreddine, A.S.; Phillips, N.A.; Bédirian, V.; Charbonneau, S.; Whitehead, V.; Collin, I.; Cummings, J.L.; Chertkow, H. The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool for Mild Cognitive Impairment. JAGS 2005, 53, 695–699. [Google Scholar] [CrossRef] [PubMed]
- Sonn, U.; Asberg, K.H. Assessment of activities of daily living in the elderly. A study of a population of 76-years olds in Gothenburg, Sweden. Scand. J. Rehbil. Med. 1991, 23, 193–202. [Google Scholar]
- Iwarsson, S.; Isacsson, Å.; Lanke, J. ADL dependence in the elderly population living in the community: The influence of functional limitations and physical environmental demand. Occup. Ther. Int. 1998, 5, 173–193. [Google Scholar] [CrossRef]
- Iwarsson, S.; Horstmann, V.; Sonn, U. Assessment of dependence in daily activities combined with a self-rating of difficulty. J. Rehabil. Med. 2009, 41, 150–156. [Google Scholar] [CrossRef] [PubMed]
- Ministry of Enterprise and Innovation. The Swedish Planning and Building Act; SFS 2010:900; Ministry of Enterprise and Innovation: Stockholm, Sweden, 2010.
- Gray, P.; Hildebrand, K. Fall risk factors in Parkinson’s disease. J. Neurosci. Nurs. 2000, 32, 222. [Google Scholar] [CrossRef] [PubMed]
- Kempen, G.I.; Yardley, L.; Van Haastregt, J.C.; Zijlstra, G.R.; Beyer, N.; Hauer, K.; Todd, C. The Short FES-I: A shortened version of the falls efficacy scale-international to assess fear of falling. Age Ageing 2008, 37, 45–50. [Google Scholar] [CrossRef] [PubMed]
- Yardley, L.; Beyer, N.; Hauer, K.; Kempen, G.; Piot-Ziegler, C.; Todd, C. Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing 2005, 34, 614–619. [Google Scholar] [CrossRef] [PubMed]
- Xu, T.; Clemson, L.; O’Loughlin, K.; Lannin, N.A.; Dean, C.; Koh, G. Risk factors for falls in community stroke survivors: A systematic review and meta-analysis. Arch. Phys. Med. Rehabil. 2017. [Google Scholar] [CrossRef] [PubMed]
- Medical Research Council (MRC). Developing and Evaluating Complex Interventions. 2008. Available online: www.mrc.ac.uk/complexinterventionsguidance (accessed on 15 September 2017).
- Hannan, M.T.; Gagnon, M.M.; Aneja, J.; Jones, R.N.; Cupples, L.A.; Lipsitz, L.A.; Samelson, E.J.; Leveille, S.G.; Kiel, D.P. Optimizing the tracking of falls in studies of older participants: comparison of quarterly telephone recall with monthly falls calendars in the MOBILIZE Boston study. Am. J. Epidemiol. 2010, 171, 1031–1036. [Google Scholar] [CrossRef] [PubMed]
- Scheffer, A.C.; Schuurmans, M.J.; van Dijk, N.; van der Hooft, T.; de Rooij, S.E. Fear of falling: Measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing 2008, 37, 19–24. [Google Scholar] [CrossRef] [PubMed]
- Kendrick, D.; Kumar, A.; Carpenter, H.; Zijlstra, G.A.R.; Skelton, D.A.; Cook, J.R.; Stevens, Z.; Belcher, C.M.; Haworth, D.; Gawler, S.J.; et al. Exercise for reducing fear of falling in older people living in the community. Cochrane Database Syst. Rev. 2014. [Google Scholar] [CrossRef]
- Zijlstra, G.A.R.; Van Haastregt, J.C.M.; Van Rossum, E.; Van Eijk, J.T.; Yardley, L.; Kempen, G.I. Interventions to reduce fear of falling in Community-living older people: A systematic review. J. Am. Geriatr. Soc. 2007, 55, 603–615. [Google Scholar] [CrossRef] [PubMed]
- Petersson, I.; Anders Kottorp, A.; Bergström, J.; Lilja, M. Longitudinal changes in everyday life after home modifications for people aging with disabilities. SJOT 2009, 16, 78–87. [Google Scholar] [CrossRef] [PubMed]
T1—Total Sample (n = 196) | Intervention Sites (n = 90) | Control Site (n = 106) | p | ||||
---|---|---|---|---|---|---|---|
n | % or mean ± SD | n | % or mean ± SD | n | % or mean ± SD | ||
Gender | 0.780 | ||||||
– Men | 72 | 37% | 34 | 38% | 38 | 36% | |
– Women | 124 | 63% | 56 | 62% | 68 | 64% | |
Age | 0.314 | ||||||
– ≤64 | 29 | 15% | 15 | 17% | 14 | 13% | |
– 65–74 | 37 | 19% | 22 | 24% | 15 | 14% | |
– 75–84 | 82 | 42% | 34 | 38% | 48 | 45% | |
– ≥85 | 44 | 22% | 17 | 19% | 27 | 26% | |
– missing | 4 | 2% | 2 | 2% | 2 | 2% | |
Living arrangements | 0.549 | ||||||
– living alone | 113 | 57% | 52 | 58% | 61 | 58% | |
– living with others | 82 | 42% | 37 | 41% | 45 | 42% | |
– missing | 1 | 1% | 1 | 1% | 0 | 0% | |
Education (in years) | 189 | 9.7 ± 3.2 | 83 | 9.7 ± 3.1 | 106 | 9.6 ± 3.2 | 0.775 |
Dependent on walking aids a | |||||||
– outside the home | 137 | 70% | 60 | 67% | 77 | 73% | 0.363 |
– entrance | 132 | 67% | 57 | 63% | 75 | 71% | 0.336 |
– inside the home | 122 | 62% | 53 | 59% | 69 | 65% | 0.403 |
Dependent on wheelchairs a | |||||||
– outside the home | 63 | 32% | 36 | 40% | 27 | 25% | 0.046 |
– entrance | 43 | 22% | 24 | 27% | 19 | 18% | 0.175 |
– inside the home | 31 | 16% | 21 | 23% | 10 | 9% | 0.015 |
Social activities outside with others | 0.188 | ||||||
– never/yearly | 57 | 29% | 26 | 29% | 31 | 29% | |
– monthly | 55 | 28% | 29 | 32% | 26 | 25% | |
– weekly or daily | 79 | 40% | 31 | 35% | 48 | 45% | |
– missing | 5 | 3% | 4 | 4% | 1 | 1% | |
Social activities outside alone | 0.113 | ||||||
– never/yearly | 85 | 43% | 45 | 50% | 40 | 38% | |
– monthly | 19 | 10% | 8 | 9% | 11 | 10% | |
– weekly or daily | 85 | 43% | 32 | 36% | 53 | 50% | |
– missing | 7 | 4% | 5 | 5% | 2 | 2% | |
Cognitive impairment b | >0.001 | ||||||
– 26–30 | 48 | 24% | 26 | 29% | 22 | 21% | |
– 18–25 | 87 | 44% | 50 | 55% | 37 | 35% | |
– 10–17 | 13 | 7% | 7 | 8% | 6 | 6% | |
– missing | 48 | 25% | 7 | 8% | 41 | 38% | |
ADL dependence c | 157 | 12.1 ± 5.8 | 71 | 12.2 ± 6.7 | 86 | 12.0 ± 4.9 | 0.554 |
Number of functional limitations a | 196 | 4.7 ± 1.9 | 90 | 4.5 ± 1.9 | 106 | 4.9 ± 1.9 | 0.107 |
T1 | T2 | T3 | |||||||
---|---|---|---|---|---|---|---|---|---|
% or mean ± SD | p | n | % or mean ± SD | p | n | % or mean ± SD | p | n | |
Fallen in the last 6 months (% Yes) | 0.951 | 0.041 | |||||||
- Intervention | 53.3% | 90 | - | 55.4% | 65 | ||||
- Control | 53.8% | 106 | - | 71.8% | 78 | ||||
Total sample | 53.6% | 196 | - | 64.3% | 143 | ||||
Number of falls in the last 6 months (mean) | 0.493 | 0.638 | |||||||
- Intervention | 2.4 ± 5.5 | 90 | - | 1.4 ± 3.4 | 65 | ||||
- Control | 1.9 ± 5.4 | 106 | - | 2.1 ± 11.5 | 78 | ||||
Total sample | 2.2 ± 5.5 | 196 | - | 1.7 ± 8.8 | 145 | ||||
Near falls in the last 6 months (% Yes) | 0.801 | 0.116 | |||||||
- Intervention | 60.9% | 87 | - | 50.0% | 60 | ||||
- Control | 59.6% | 104 | - | 57.1% | 77 | ||||
Total sample | 60.2% | 191 | - | 54.0% | 137 | ||||
Number of near falls in the last 6 month (mean) | 0.536 | 0.273 | |||||||
- Intervention | 4.7 ± 12.4 | 90 | - | 4.4 ± 13.5 | 78 | ||||
- Control | 3.8 ± 7.8 | 106 | - | 2.6 ± 4.7 | 65 | ||||
Total sample | 4.3 ± 10.2 | 196 | - | 3.4 ± 9.7 | 143 | ||||
Afraid of falling (% Yes) | 0.083 | 0.267 | 0.001 | ||||||
- Intervention | 79.8% | 84 | 79.4% | 68 | 82.8% | 58 | |||
- Control | 76.2% | 105 | 71.4% | 91 | 66.7% | 78 | |||
Total sample | 77.8% | 189 | 75.8% | 153 | 73.1% | 134 | |||
Fear of falling (mean) a | <0.001 | 0.036 | < 0.001 | ||||||
- Intervention | 18.2 ± 5.7 | 66 | 14.9 ± 5 | 52 | 16.1 ± 4.9 | 45 | |||
- Control | 14.1 ± 5.3 | 87 | 13.2 ± 4.2 | 73 | 13.2 ± 4.7 | 61 | |||
Total sample | 15.9 ± 5.8 | 153 | 13.9 ± 4.6 | 125 | 14.4 ± 5.0 | 106 |
∆ T2–T1 | ∆ T3–T2 | ∆ T3–T1 | |||||||
---|---|---|---|---|---|---|---|---|---|
% or Mean ± SD | p | n | % or Mean ± SD | p | n | % or Mean ± SD | p | n | |
Fallen in the last 6 months (% Yes) | |||||||||
- Intervention | - | - | - | - | - | - | 2.1% | 0.800 | 65 |
- Control | - | - | - | - | - | - | 18.0% | 0.013 | 78 |
Total sample | - | - | - | - | - | - | 10.8% | 0.047 | 143 |
Number of falls in the last 6 months (mean) | 0.512 | ||||||||
- Intervention | - | - | - | - | - | - | –0.9 ± 4.5 | 65 | |
- Control | - | - | - | - | - | - | 0.1 ± 11.4 | 78 | |
Total sample | - | - | - | - | - | - | –0.4 ± 9 | 143 | |
Near falls in the last 6 months (% Yes) | |||||||||
- Intervention | - | - | - | - | - | - | –10.9% | 0.189 | 60 |
- Control | - | - | - | - | - | - | –2.5% | 0.739 | 78 |
Total sample | - | - | - | - | - | - | –6.2% | 0.263 | 137 |
Number of near falls in the last 6 month (mean) | 0.857 | ||||||||
- Intervention | - | - | - | - | - | - | –1.0 ± 19.4 | 65 | |
- Control | - | - | - | - | - | - | –1.1 ± 7.5 | 78 | |
Total sample | - | - | - | - | - | - | –0.9 ± 13.8 | 143 | |
Afraid of falling (% Yes) | |||||||||
- Intervention | –0.4% | 0.958 | 84 | 3.3% | 0.504 | 68 | 3.0% | 0.680 | 58 |
- Control | –4.8% | 0.449 | 105 | –4.8% | 0.504 | 91 | –9.5% | 0.155 | 78 |
Total sample | –2.0% | 0.669 | 189 | –2.7% | 0.603 | 153 | –4.6% | 0.339 | 134 |
Fear of falling (mean) a | 0.005 | 0.228 | 0.094 | ||||||
- Intervention | –3.3 ± 5.1 | 43 | 1.1 ± 4.4 | 35 | –2.4 ± 5.3 | 35 | |||
- Control | –0.4 ± 5.3 | 68 | 0.0 ± 3.7 | 51 | –0.4 ± 5.6 | 56 | |||
Total sample | –1.5 ± 5.4 | 111 | 0.4 ± 4.0 | 86 | –1.1 ± 5.5 | 91 |
Outcomes (Intervention vs. Control) | Between-Group Difference | p value | ||
---|---|---|---|---|
Mean | (95% Confidence Interval) | |||
Assessment | ||||
T1 | 0.72 | –0.38 | 1.82 | 0.20 |
T2 | –2.04 | –3.35 | –0.72 | < 0.001 |
T3 | 1.42 | –0.17 | 3.01 | 0.08 |
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Carlsson, G.; Nilsson, M.H.; Ekstam, L.; Chiatti, C.; Malmgren Fänge, A. Falls and Fear of Falling among Persons Who Receive Housing Adaptations—Results from a Quasi-Experimental Study in Sweden. Healthcare 2017, 5, 66. https://doi.org/10.3390/healthcare5040066
Carlsson G, Nilsson MH, Ekstam L, Chiatti C, Malmgren Fänge A. Falls and Fear of Falling among Persons Who Receive Housing Adaptations—Results from a Quasi-Experimental Study in Sweden. Healthcare. 2017; 5(4):66. https://doi.org/10.3390/healthcare5040066
Chicago/Turabian StyleCarlsson, Gunilla, Maria H. Nilsson, Lisa Ekstam, Carlos Chiatti, and Agneta Malmgren Fänge. 2017. "Falls and Fear of Falling among Persons Who Receive Housing Adaptations—Results from a Quasi-Experimental Study in Sweden" Healthcare 5, no. 4: 66. https://doi.org/10.3390/healthcare5040066