The Measura pairing

CareGuard reviews the facility. Measura handles the clinical measurement on the resident side. They are separate organizations that share a building and a view of what actually harms older adults.

The division of labor

Falls

The fall-prevention items in a facility review are environmental — flooring, lighting, clutter, bed height, supervision. They are necessary and they are not sufficient, because a large share of falls in long-term care start inside the resident rather than on the floor. Orthostatic hypotension — a drop of at least 20 mmHg systolic or 10 mmHg diastolic within three minutes of standing — has a pooled prevalence of 22.2% in community-dwelling older people and 23.9% in long-term care settings: roughly one resident in four.

Measuring the drop is a clinical act. Removing the cause is usually a medication decision. Fixing the hallway is a facility decision. All three have to happen, and they belong to different people — which is exactly why the pairing exists. The fall prevention items · deprescribing.

Cognition

Cognitive assessment on the clinical side gives a facility something it otherwise lacks: a measured baseline and a measured change, rather than an impression that a resident “seems more confused lately.” That is what makes it possible to tell a medication effect from progression, and it is the precondition for the DWARAA work. Assessment of individual care needs.

What Measura actually measures

The assessment set is physiological rather than questionnaire-based, which is what makes it usable in a resident who cannot reliably self-report:

• Metabolic rate — measured rather than calculated from an equation.
• Body composition — bioimpedance analysis, which separates weight change into lean mass and fat rather than treating the scale as the finding.
• Autonomic nervous system assessment — the system that fails first in the orthostatic drop that produces falls.
• Sudomotor function — a small-fiber autonomic measure.
• Substrate utilization — carbohydrate versus fat oxidation.
• Respiratory — oxygen saturation.
• Ankle-brachial index and plethysmography — peripheral arterial circulation, which bears directly on wound healing and on the pressure injuries a monthly skin check looks for.

Glycemic control, blood pressure and vascular health are not a separate subject from cognition and falls in an older adult; they are the same subject measured differently. Well-being and cognitive enhancement.

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The evidence on orthostatic hypotension

A 2020 systematic review and meta-analysis pooled 20 community studies (24,967 people aged 60 and over) and six long-term-care studies (2,694 residents). Pooled prevalence was 22.2% in community-dwelling older people (95% CI 17 to 28) and 23.9% in long-term care settings (95% CI 18.2 to 30.1) — roughly one resident in four.

A 2024 systematic review of 184 studies, which informed the World Falls Guidelines, found orthostatic hypotension associated with falls at an unadjusted odds ratio of 1.39 (95% CI 1.18 to 1.64) over a 12-month reporting interval — smaller than stroke (1.90) or peripheral arterial disease (1.82), and still substantial across a whole building.

On mortality, be careful with the number

A meta-analysis of 13 prospective studies and 121,913 patients found orthostatic hypotension associated with all-cause death at RR 1.50 (95% CI 1.24 to 1.81), incident coronary heart disease RR 1.41, heart failure RR 2.25 and stroke RR 1.64. In the subgroup aged 65 and over the mortality association was not statistically significant — 1.26 (95% CI 0.99 to 1.62). The headline figure is therefore not the one to quote at a nursing-home population, and it is not quoted here.

Antihypertensive intensity and serious fall injury

A competing-risk analysis of 4,961 community-living adults over 70 with hypertension found adjusted hazard ratios for serious fall injury of 1.40 (95% CI 1.03 to 1.90) with moderate-intensity antihypertensive treatment and 1.28 (95% CI 0.91 to 1.80) with high-intensity treatment, compared with non-users. Among the 503 participants who had already had a fall injury the hazard ratios rose to 2.17 (0.98 to 4.80) and 2.31 (1.01 to 5.29). A previous fall is the signal that changes the calculation.

References

1. Saedon NI, Tan MP, Frith J 2020. The prevalence of orthostatic hypotension: a systematic review and meta-analysis. Journals of Gerontology Series A 75(1):117-122. [systematic review and meta-analysis] · PMID 30169579 · doi:10.1093/gerona/gly188
2. Bourke R, et al. 2024. Cardiovascular disorders and falls among older adults: a systematic review and meta-analysis. Journals of Gerontology Series A 79(2). [systematic review and meta-analysis, 184 studies] · PMID 37738307 · doi:10.1093/gerona/glad221
3. Ricci F, et al. 2015. Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies. European Heart Journal 36(25):1609-17. [meta-analysis, 121,913 patients] · PMID 25852216 · doi:10.1093/eurheartj/ehv093
4. Tinetti ME, et al. 2014. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Internal Medicine 174(4):588-95. [competing-risk cohort, 4,961 adults over 70] · PMID 24567036 · doi:10.1001/jamainternmed.2013.14764

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Ask for a safety review of your facility

A CareGuard safety review walks the building against 189 items in 54 categories and reports what it finds to you, not to your site manager. The registration form takes the facility and a contact for the ownership group; scope is settled in the conversation that follows.