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1

The effects of fall prevention trials on depressive symptoms and fear of falling among the aged: A systematic review  

Microsoft Academic Search

Firstly, to explore whether depressive symptoms and fear of falling have been used as outcome measures in fall prevention trials. Secondly, to determine the effects of fall prevention trials on these variables among the aged. A literature search covering various medical databases was conducted to identify randomised controlled trials regarding the effects of fall prevention programmes on depressive symptoms and

N. Sjösten; S. Vaapio; S.-L. Kivelä

2008-01-01

2

Thoughts on effective falls prevention intervention on a population basis  

Microsoft Academic Search

The prevention of accidental injury associated with falls in older people is a public health target in many countries. Older people make up a large and increasing percentage of the population. As people grow older, they are at increasing risk of falling and suffering injury from falling. Falls are not an inevitable result of ageing, but they are the most

Dawn A. Skelton; Chris J. Todd

2005-01-01

3

A cost-effectiveness analysis of a proposed national falls prevention program.  

PubMed

Falls are a major health concern for elderly people and cause substantial health care costs. The authors used meta-analytic findings on the effectiveness of fall prevention interventions to determine cost-effectiveness of a proposed Medicare fall prevention program for people who experience a recent fall. Using published clinical trial data, the authors constructed a population-based economic model and estimated that, in the base case, the program could prevent a half million people from falling again within a year. From the model, under most circumstances the cost-effectiveness ratio is less than $1500 per person prevented from experiencing a recurrent fall. Paying for a fall prevention program to increase the use of evidence-based interventions would be a cost-effective use of Medicare dollars. PMID:20934620

Wu, Shinyi; Keeler, Emmett B; Rubenstein, Laurence Z; Maglione, Margaret A; Shekelle, Paul G

2010-11-01

4

Study protocol for prevention of falls: A randomized controlled trial of effects of vitamin D and exercise on falls prevention  

PubMed Central

Background Falls are the leading cause of unintentional injury and injury-related death among older people. In addition to physical activity, vitamin D also may affect balance and neuromuscular function. Low serum 25-hydroksivitamin D level increases the risk of bone loss, falls and fractures. Thus, an appropriate exercise program and sufficient vitamin D intake may significantly improve not only functional balance, but also balance confidence. Balance represents a complex motor skill determined by reaction time, muscle strength, and speed and coordination of movement. Methods/Design A 2-year randomized double-blind placebo-controlled vitamin D and open exercise trial of 409 home-dwelling women 70 to 80 years of age comprising four study arms: 1) exercise + vitamin D (800 IU/d), 2) exercise + placebo, 3) no exercise + vitamin D (800 IU/d), 4) no exercise + placebo. In addition to monthly fall diaries, general health status, life style, bone health, physical functioning, and vitamin D metabolism will be assessed. The primary outcomes are the rate of falls and fall-related injuries. Secondary outcomes include changes in neuromuscular functioning (e.g. body balance, muscle strength), ADL- and mobility functions, bone density and structure, cardiovascular risk factors, quality of life and fear of falling. Discussion The successful completion of this trial will provide evidence on the effectiveness of exercise and vitamin D for falls reduction. Trial Registration ClinicalTrial.gov -register (NCT00986466).

2012-01-01

5

The effectiveness of a multidisciplinary QI activity for accidental fall prevention: Staff compliance is critical  

PubMed Central

Background Accidental falls among inpatients are a substantial cause of hospital injury. A number of successful experimental studies on fall prevention have shown the importance and efficacy of multifactorial intervention, though success rates vary. However, the importance of staff compliance with these effective, but often time-consuming, multifactorial interventions has not been fully investigated in a routine clinical setting. The purpose of this observational study was to describe the effectiveness of a multidisciplinary quality improvement (QI) activity for accidental fall prevention, with particular focus on staff compliance in a non-experimental clinical setting. Methods This observational study was conducted from July 2004 through December 2010 at St. Luke’s International Hospital in Tokyo, Japan. The QI activity for in-patient falls prevention consisted of: 1) the fall risk assessment tool, 2) an intervention protocol to prevent in-patient falls, 3) specific environmental safety interventions, 4) staff education, and 5) multidisciplinary healthcare staff compliance monitoring and feedback mechanisms. Results The overall fall rate was 2.13 falls per 1000 patient days (350/164331) in 2004 versus 1.53 falls per 1000 patient days (263/172325) in 2010, representing a significant decrease (p?=?0.039). In the first 6?months, compliance with use of the falling risk assessment tool at admission was 91.5% in 2007 (3998/4368), increasing to 97.6% in 2010 (10564/10828). The staff compliance rate of implementing an appropriate intervention plan was 85.9% in 2007, increasing to 95.3% in 2010. Conclusion In our study we observed a substantial decrease in patient fall rates and an increase of staff compliance with a newly implemented falls prevention program. A systematized QI approach that closely involves, encourages, and educates healthcare staff at multiple levels is effective.

2012-01-01

6

Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention  

Microsoft Academic Search

Cheng P-T, Wu S-H, Liaw M-Y, Wong AMK, Tang F-T. Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention. Arch Phys Med Rehabil 2001;82:1650-4. Objective: To determine the role of symmetrical body-weight distribution training in preventing falls among patients with hemiplegic stroke. Design: A prospective study using a standing biofeedback trainer. Setting: Hospital-based rehabilitation units. Patients:

Pao-Tsai Cheng; Shu-Hsia Wu; Mei-Yun Liaw; Alice M. K. Wong; Fuk-Tan Tang

2001-01-01

7

Fall prevention in the elderly  

PubMed Central

Summary Falls are frequent in the elderly and affect mortality, morbidity, loss of functional capacity and institutionalization. In the older patient the incidence of falls can sometimes be underestimated, even in the absence of a clear cognitive impairment, because it is often difficult to reconstruct the dynamics. It is quite common that forms due to syncope are associated with retrograde amnesia and in 40 to 60% of the cases falls happen in the absence of witnesses. The pathogenesis of falls is often multifactorial, due to physiological age-related changes or more properly pathological factors, or due to the environment. The identification of risk factors is essential in the planning of preventive measures. Syncope is one of major causes of falls. About 20% of cardiovascular syncope in patients older than 70 appears as a fall and more than 20% of older people with Carotid Sinus Syndrome complain of falls as well as syncope. These data clearly state that older patients with history of falls should undergo a cardiovascular and neuroautonomic assessment besides the survey of other risk factors. Multifactorial assessment requires a synergy of various specialists. The geriatrician coordinates the multidisciplinary intervention in order to make the most effective evaluation of the risk of falling, searching for all predisposing factors, aiming towards a program of prevention. In clear pathological conditions it is possible to enact a specific treatment. Particular attention must indeed be paid to the re-evaluation of drug therapy, with dose adjustments or withdrawal especially for antihypertensive, diuretics and benzodiazepines. The Guidelines of the American Geriatrics Society recommend modification of environmental hazards, training paths, hip protectors and appropriate use of support tools (sticks, walkers), which can be effective elements of a multifactorial intervention program. Balance exercises are also recommended. In conclusion, an initial assessment, supported by a comprehensive cardiovascular and neuroautonomic evaluation, allows for reaching a final diagnosis in most cases, demonstrating a key role in the real identification of the etiology of the fall and implementing the treatment measures.

Ungar, Andrea; Rafanelli, Martina; Iacomelli, Iacopo; Brunetti, Maria Angela; Ceccofiglio, Alice; Tesi, Francesca; Marchionni, Niccolo

2013-01-01

8

Preventative effect of exercise against falls in the elderly: a randomized controlled trial  

Microsoft Academic Search

Summary  The present study was conducted to determine the effect of 5-month exercise program on the prevention of falls in the elderly.\\u000a The exercise training, which consisted of calisthenics, body balance training, muscle power training, and walking ability\\u000a training 3 days\\/week improved the indices of the flexibility, body balance, muscle power, and walking ability and reduced\\u000a the incidence of falls compared with

J. Iwamoto; H. Suzuki; K. Tanaka; T. Kumakubo; H. Hirabayashi; Y. Miyazaki; Y. Sato; T. Takeda; H. Matsumoto

2009-01-01

9

The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials  

PubMed Central

Objective To determine whether, and to what extent, fall prevention exercise interventions for older community dwelling people are effective in preventing different types of fall related injuries. Data sources Electronic databases (PubMed, the Cochrane Library, Embase, and CINAHL) and reference lists of included studies and relevant reviews from inception to July 2013. Study selection Randomised controlled trials of fall prevention exercise interventions, targeting older (>60 years) community dwelling people and providing quantitative data on injurious falls, serious falls, or fall related fractures. Data synthesis Based on a systematic review of the case definitions used in the selected studies, we grouped the definitions of injurious falls into more homogeneous categories to allow comparisons of results across studies and the pooling of data. For each study we extracted or calculated the rate ratio of injurious falls. Depending on the available data, a given study could contribute data relevant to one or more categories of injurious falls. A pooled rate ratio was estimated for each category of injurious falls based on random effects models. Results 17 trials involving 4305 participants were eligible for meta-analysis. Four categories of falls were identified: all injurious falls, falls resulting in medical care, severe injurious falls, and falls resulting in fractures. Exercise had a significant effect in all categories, with pooled estimates of the rate ratios of 0.63 (95% confidence interval 0.51 to 0.77, 10 trials) for all injurious falls, 0.70 (0.54 to 0.92, 8 trials) for falls resulting in medical care, 0.57 (0.36 to 0.90, 7 trials) for severe injurious falls, and 0.39 (0.22 to 0.66, 6 trials) for falls resulting in fractures, but significant heterogeneity was observed between studies of all injurious falls (I2=50%, P=0.04). Conclusions Exercise programmes designed to prevent falls in older adults also seem to prevent injuries caused by falls, including the most severe ones. Such programmes also reduce the rate of falls leading to medical care.

2013-01-01

10

Effects of an Intervention to Increase Bed Alarm Use to Prevent Falls in Hospitalized Patients  

PubMed Central

Background Bed alarm systems intended to prevent hospital falls have not been formally evaluated. Objective To investigate whether an intervention aimed at increasing bed alarm use decreases hospital falls and related events. Design Pair-matched, cluster randomized trial over 18 months. Nursing units were allocated by computer-generated randomization on the basis of baseline fall rates. Patients and outcome assessors were blinded to unit assignment; outcome assessors may have become unblinded. (ClinicalTrials.gov registration number: NCT00183053) Setting 16 nursing units in an urban community hospital. Patients 27 672 inpatients in general medical, surgical, and specialty units. Intervention Education, training, and technical support to promote use of a standard bed alarm system (intervention units); bed alarms available but not formally promoted or supported (control units). Measurements Pre–post difference in change in falls per 1000 patient-days (primary end point); number of patients who fell, fall-related injuries, and number of patients restrained (secondary end points). Results Prevalence of alarm use was 64.41 days per 1000 patient-days on intervention units and 1.79 days per 1000 patient-days on control units (P = 0.004). There was no difference in change in fall rates per 1000 patient-days (risk ratio, 1.09 [95% CI, 0.85 to 1.53]; difference, 0.41 [CI, ?1.05 to 2.47], which corresponds to a greater difference in falls in control vs. intervention units) or in the number of patients who fell, injurious fall rates, or the number of patients physically restrained on intervention units compared with control units. Limitation The study was conducted at a single site and was slightly underpowered compared with the initial design. Conclusion An intervention designed to increase bed alarm use in an urban hospital increased alarm use but had no statistically or clinically significant effect on fall-related events or physical restraint use. Primary Funding Source National Institute on Aging.

Shorr, Ronald I.; Chandler, A. Michelle; Mion, Lorraine C.; Waters, Teresa M.; Liu, Minzhao; Daniels, Michael J.; Kessler, Lori A.; Miller, Stephen T.

2013-01-01

11

Using senior volunteers as peer educators: What is the evidence of effectiveness in falls prevention?  

PubMed

Peer education models are well established as a means of delivering health and social welfare information. Common themes identified in regard to peer education are that information sharing and transfer take place; attempts are made to influence knowledge, attitudes or behaviour; that it occurs between people who share similar characteristics or experiences; and that it relies on influential members of a social group or category. Although it is most often associated with younger age-groups, there is growing evidence of involvement of older people as peer educators. As part of community-based fall prevention interventions, there is considerable scope for contribution by peer mentors. This paper explores the theoretical basis for using senior volunteers as peer educators, discusses advantages and disadvantages of this model of service delivery for health promotion of older people and, specifically, reviews the evidence for effectiveness in relation to fall prevention. PMID:19243369

Peel, Nancye M; Warburton, Jeni

2009-03-01

12

Fall prevention and vitamin D in the elderly: an overview of the key role of the non-bone effects  

PubMed Central

Preventing falls and fall-related fractures in the elderly is an objective yet to be reached. There is increasing evidence that a supplementation of vitamin D and/or of calcium may reduce the fall and fracture rates. A vitamin D-calcium supplement appears to have a high potential due to its simple application and its low cost. However, published studies have shown conflicting results as some studies failed to show any effect, while others reported a significant decrease of falls and fractures. Through a 15-year literature overview, and after a brief reminder on mechanism of falls in older adults, we reported evidences for a vitamin D action on postural adaptations - i.e., muscles and central nervous system - which may explain the decreased fall and bone fracture rates and we underlined the reasons for differences and controversies between published data. Vitamin D supplementation should thus be integrated into primary and secondary fall prevention strategies in older adults.

2010-01-01

13

Tailored Prevention of Inpatient Falls  

PubMed Central

Patient falls and fall-related injuries are serious problems in hospitals. The Fall TIPS application aims to prevent patient falls by translating routine nursing fall risk assessment into a decision support intervention that communicates fall risk status and creates a tailored evidence-based plan of care that is accessible to the care team, patients, and family members. In our design and implementation of the Fall TIPS toolkit, we used the Spiral Software Development Life Cycle model. Three output tools available to be generated from the toolkit are bed poster, plan of care, and patient education handout. A preliminary design of the application was based on initial requirements defined by project leaders and informed by focus groups with end users. Preliminary design partially simulated the paper version of the Morse Fall Scale currently used in hospitals involved in the research study. Strengths and weaknesses of the first prototype were identified by heuristic evaluation. Usability testing was performed at sites where research study is implemented. Suggestions mentioned by end users participating in usability studies were either directly incorporated into the toolkit and output tools, were slightly modified, or will be addressed during training. The next step is implementation of the fall prevention toolkit on the pilot testing units.

ZUYEV, LYUBOV; BENOIT, ANGELA N.; CHANG, FRANK Y.; DYKES, PATRICIA C.

2011-01-01

14

EFFECTS OF MOVEABLE PLATFORM TRAINING IN PREVENTING SLIP-INDUCED FALLS IN OLDER ADULTS  

PubMed Central

Identifying effective interventions is vitalin preventing slip-induced fall accidents in older adults. The purpose of the current study was to evaluate the efficacy of moveable platform training in improving recovery reactions and reducing fall frequency in older adults. Twenty-four older adults were recruited and randomly assigned to two groups (training and control). Both groups underwent three sessions including baseline slip, training, and transfer of training on a slippery surface. Both groups experienced two slips on a slippery surface, one during the baseline and the other (after two weeks) during the transfer of training session. In the training session, the training group underwent twelve simulated slips using a moveable platform while the control group performed normal walking trials. Kinematic, kinetic, and EMG data were collected during all the sessions. Results indicated a reduced incidence of falls in the training group during the transfer of training trial as compared to the control group. The training group was able to transfer proactive and reactive control strategies learned during training to the second slip trial. The proactive adjustments include increased center-of-mass velocity and transitional acceleration after training. Reactive adjustments include reduction in muscle onset and time to peak activations of knee flexors and ankle plantarflexors, reduced ankle and knee coactivation, reduced slip displacement, and reduced time to peak knee flexion, trunk flexion, and hip flexion velocities. In general, the results indicated a beneficial effect of perturbation training in reducing slip severity and recovery kinematics in healthy older adults.

Parijat, Prakriti; Lockhart, Thurmon E

2011-01-01

15

Translating a multifactorial fall prevention intervention into practice: a controlled evaluation of a fall prevention clinic.  

PubMed

Although multifactorial fall prevention interventions have been shown to reduce falls and injurious falls, their translation into clinical settings has been limited. This article describes a hospital-based fall prevention clinic established to increase availability of preventive care for falls. Outcomes for 43 adults aged 65 and older seen during the clinic's first 6 months of operation were compared with outcomes for 86 age-, sex-, and race-matched controls; all persons included in analyses received primary care at the hospital's geriatrics clinic. Nonsignificant differences in falls, injurious falls, and fall-related healthcare use according to study group in multivariate adjusted models were observed, probably because of the small, fixed sample size. The percentage experiencing any injurious falls during the follow-up period was comparable for fall clinic visitors and controls (14% vs 13%), despite a dramatic difference at baseline (42% of clinic visitors vs 15% of controls). Fall-related healthcare use was higher for clinic visitors during the baseline period (21%, vs 12% for controls) and decreased slightly (to 19%) during follow-up; differences in fall-related healthcare use according to study group from baseline to follow-up were nonsignificant. These findings, although preliminary because of the small sample size and the baseline difference between the groups in fall rates, suggest that being seen in a fall prevention clinic may reduce injurious falls. Additional studies will be necessary to conclusively determine the effects of multifactorial fall risk assessment and management delivered by midlevel providers working in real-world clinical practice settings on key outcomes, including injurious falls, downstream fall-related healthcare use, and costs. PMID:20370859

Moore, Meghann; Williams, Barbara; Ragsdale, Sally; Logerfo, James P; Goss, J Richard; Schreuder, Astrid B; Phelan, Elizabeth A

2010-02-01

16

Translating a Multifactorial Fall Prevention Intervention into Practice: A Controlled Evaluation of a Fall Prevention Clinic  

PubMed Central

Although multifactorial fall prevention interventions have been shown to reduce falls and injurious falls, their translation into clinical settings has been limited. We describe a hospital-based, fall prevention clinic established to increase availability of preventive care for falls. Outcomes for forty-three adults aged 65+ seen during the clinic’s first six months of operation were compared to outcomes for 86 age-, gender-, and race-matched controls; all persons included in analyses received primary care at the hospital’s geriatrics clinic. Non-significant differences in falls, injurious falls, and fall-related healthcare use by study group in multivariate adjusted models were observed, likely due to the small, fixed sample size. The percent experiencing any injurious falls during the follow-up period was comparable for fall clinic visitors and controls (14% vs. 13%), despite a dramatic difference at baseline (42% of clinic visitors vs. 15% of controls). Fall-related healthcare use was higher for clinic visitors during the baseline period (21%, vs. 12% for controls) and decreased slightly (to 19%) during follow-up; differences in fall-related healthcare use by study group from baseline to follow-up were non-significant. These findings, although preliminary due both to the small sample size and the baseline difference between the groups in fall rates, suggest that being seen in a fall prevention clinic may reduce injurious falls. Additional studies will be necessary to conclusively determine the effects of multifactorial fall risk assessment and management delivered by mid-level providers working in real-world, clinical practice settings on key outcomes, including injurious falls, downstream fall-related healthcare use, and costs.

Moore, Meghann; Williams, Barbara; Ragsdale, Sally; LoGerfo, James P.; Goss, J. Richard; Schreuder, Astrid B.; Phelan, Elizabeth A.

2010-01-01

17

Fall Prevention in Acute Care Hospitals  

PubMed Central

Context Falls cause injury and death for persons of all ages, but risk of falls increases markedly with age. Hospitalization further increases risk, yet no evidence exists to support short-stay hospital-based fall prevention strategies to reduce patient falls. Objective To investigate whether a fall prevention tool kit (FPTK) using health information technology (HIT) decreases patient falls in hospitals. Design, Setting, and Patients Cluster randomized study conducted January 1, 2009, through June 30, 2009, comparing patient fall rates in 4 urban US hospitals in units that received usual care (4 units and 5104 patients) or the intervention (4 units and 5160 patients). Intervention The FPTK integrated existing communication and workflow patterns into the HIT application. Based on a valid fall risk assessment scale completed by a nurse, the FPTK software tailored fall prevention interventions to address patients’ specific determinants of fall risk. The FPTK produced bed posters composed of brief text with an accompanying icon, patient education handouts, and plans of care, all communicating patient-specific alerts to key stakeholders. Main Outcome Measures The primary outcome was patient falls per 1000 patient-days adjusted for site and patient care unit. A secondary outcome was fall-related injuries. Results During the 6-month intervention period, the number of patients with falls differed between control (n=87) and intervention (n=67) units (P=.02). Site-adjusted fall rates were significantly higher in control units (4.18 [95% confidence interval {CI}, 3.45-5.06] per 1000 patient-days) than in intervention units (3.15 [95% CI, 2.54-3.90] per 1000 patient-days; P=.04). The FPTK was found to be particularly effective with patients aged 65 years or older (adjusted rate difference, 2.08 [95% CI, 0.61-3.56] per 1000 patient-days; P=.003). No significant effect was noted in fall-related injuries. Conclusion The use of a fall prevention tool kit in hospital units compared with usual care significantly reduced rate of falls.

Dykes, Patricia C.; Carroll, Diane L.; Hurley, Ann; Lipsitz, Stuart; Benoit, Angela; Chang, Frank; Meltzer, Seth; Tsurikova, Ruslana; Zuyov, Lyubov; Middleton, Blackford

2011-01-01

18

Preventing Falls in the Hospital  

MedlinePLUS Videos and Cool Tools

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19

Prevention of fall incidents in patients with a high risk of falling: design of a randomised controlled trial with an economic evaluation of the effect of multidisciplinary transmural care  

Microsoft Academic Search

BACKGROUND: Annually, about 30% of the persons of 65 years and older falls at least once and 15% falls at least twice. Falls often result in serious injuries, such as fractures. Therefore, the prevention of accidental falls is necessary. The aim is to describe the design of a study that evaluates the efficacy and cost-effectiveness of a multidisciplinary assessment and

Geeske MEE Peeters; Oscar J de Vries; Petra JM Elders; Saskia MF Pluijm; Lex M Bouter; Paul Lips

2007-01-01

20

Effectiveness of a community-based multifaceted fall-prevention intervention in active and independent older Chinese adults  

PubMed Central

Objective: To evaluate the effectiveness of an 18-month multifaceted intervention designed to reduce the incidence of falls in community-living older adults in China. Methods: A population-based community trial evaluated by before-and-after cross-sectional surveys. Four residential communities were randomised to either a multifaceted intervention or a control condition. Baseline information was collected from a sample of older adults in each community. A 1-year annual fall rate was calculated after an 18-month comprehensive intervention. Results: After intervention, 7.19% of the intervention community sample reported falls, compared with 17.86% of the control community sample (p<0.000). The annual fall rate decreased by 10.52% in the intervention communities, whereas the difference in control communities was not statistically significant. Conclusions: Multifaceted interventions in community settings may be useful in preventing falls among older people, and can be applied in similar settings in China.

Xia, Q H; Jiang, Y; Niu, C J; Tang, C X; Xia, Z L

2009-01-01

21

Cost effectiveness of patient education for the prevention of falls in hospital: economic evaluation from a randomized controlled trial  

PubMed Central

Background Falls are one of the most frequently occurring adverse events that impact upon the recovery of older hospital inpatients. Falls can threaten both immediate and longer-term health and independence. There is need to identify cost-effective means for preventing falls in hospitals. Hospital-based falls prevention interventions tested in randomized trials have not yet been subjected to economic evaluation. Methods Incremental cost-effectiveness analysis was undertaken from the health service provider perspective, over the period of hospitalization (time horizon) using the Australian Dollar (A$) at 2008 values. Analyses were based on data from a randomized trial among n = 1,206 acute and rehabilitation inpatients. Decision tree modeling with three-way sensitivity analyses were conducted using burden of disease estimates developed from trial data and previous research. The intervention was a multimedia patient education program provided with trained health professional follow-up shown to reduce falls among cognitively intact hospital patients. Results The short-term cost to a health service of one cognitively intact patient being a faller could be as high as A$14,591 (2008). The education program cost A$526 (2008) to prevent one cognitively intact patient becoming a faller and A$294 (2008) to prevent one fall based on primary trial data. These estimates were unstable due to high variability in the hospital costs accrued by individual patients involved in the trial. There was a 52% probability the complete program was both more effective and less costly (from the health service perspective) than providing usual care alone. Decision tree modeling sensitivity analyses identified that when provided in real life contexts, the program would be both more effective in preventing falls among cognitively intact inpatients and cost saving where the proportion of these patients who would otherwise fall under usual care conditions is at least 4.0%. Conclusions This economic evaluation was designed to assist health care providers decide in what circumstances this intervention should be provided. If the proportion of cognitively intact patients falling on a ward under usual care conditions is 4% or greater, then provision of the complete program in addition to usual care will likely both prevent falls and reduce costs for a health service. Trial registration Australia and New Zealand Clinical Trials Register: ACTRN12608000015347.

2013-01-01

22

Prevention of falls in older patients.  

PubMed

Falls are one of the most common geriatric syndromes threatening the independence of older persons. Between 30 and 40 percent of community-dwelling adults older than 65 years fall each year, and the rates are higher for nursing home residents. Falls are associated with increased morbidity, mortality, and nursing home placement. Most falls have multiple causes. Risk factors for falls include muscle weakness, a history of falls, use of four or more prescription medications, use of an assistive device, arthritis, depression, age older than 80 years, and impairments in gait, balance, cognition, vision, and activities of daily living. Physicians caring for older patients should ask about any falls that have occurred in the past year. Assessment should include evaluating the circumstances of the fall and a complete history and physical examination, looking for potential risk factors. The most effective fall prevention strategies are multifactorial interventions targeting identified risk factors, exercises for muscle strengthening combined with balance training, and withdrawal of psychotropic medication. Home hazard assessment and modification by a health professional also is helpful. PMID:16035686

Rao, Shobha S

2005-07-01

23

It takes a village to prevent falls: reconceptualizing fall prevention and management for older adults.  

PubMed

Systematic evidence reviews support the efficacy of physical activity programs and multifactorial strategies for fall prevention. However, community settings in which fall prevention programs occur often differ substantially from the research settings in which efficacy was first demonstrated. Because of these differences, alternative approaches are needed to judge the adequacy of fall prevention activities occurring as part of standard medical care or community efforts. This paper uses the World Health Organization Innovative Care for Chronic Conditions (ICCC) framework to rethink how fall prevention programs might be implemented routinely in both medical and community settings. Examples of innovative programs and policies that provide fall prevention strategies consistent with the ICCC framework are highlighted, and evidence where available is provided on the effects of these strategies on processes and outcomes of care. Finally, a "no wrong door" approach to fall prevention and management is proposed, in which older adults who are found to be at risk of falls in either a medical or community setting are linked to a standard fall risk evaluation across three domains (physical activity, medical risks, and home safety). PMID:18676787

Ganz, D A; Alkema, G E; Wu, S

2008-08-01

24

Fall prevention in hospitals: an integrative review.  

PubMed

This article summarizes research and draws overall conclusions from the body of literature on fall prevention interventions to provide nurse administrators with a basis for developing evidence-based fall prevention programs in the hospital setting. Data are obtained from published studies. Thirteen articles are retrieved that focused on fall interventions in the hospital setting. An analysis is performed based on levels of evidence using an integrative review process. Multifactoral fall prevention intervention programs that included fall-risk assessments, door/bed/patient fall-risk alerts, environmental and equipment modifications, staff and patient safety education, medication management targeted to specific types, and additional assistance with transfer and toileting demonstrate reduction in both falls and fall injuries in hospitalized patients. Hospitals need to reduce falls by using multifactoral fall prevention programs using evidence-based interventions to reduce falls and injuries. PMID:21862700

Spoelstra, Sandra L; Given, Barbara A; Given, Charles W

2011-08-23

25

Fall Safety for Kids: How to Prevent Falls  

MedlinePLUS

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26

Fall TIPS: Strategies to Promote Adoption and Use of a Fall Prevention Toolkit  

PubMed Central

Patient falls are serious problems in hospitals. Risk factors for falls are well understood and nurses routinely assess for fall risk on all hospitalized patients. However, the link from nursing assessment of fall risk, to identification and communication of tailored interventions to prevent falls is yet to be established. The Fall TIPS (Tailoring Interventions for Patient Safety) Toolkit was developed to leverage existing practices and workflows and to employ information technology to improve fall prevention practices. The purpose of this paper is to describe the Fall TIPS Toolkit and to report on strategies used to drive adoption of the Toolkit in four acute care hospitals. Using the IHI “Framework for Spread” as a conceptual model, the research team describes the “spread” of the Fall TIPS Toolkit as means to integrate effective fall prevention practices into the workflow of interdisciplinary caregivers, patients and family members.

Dykes, Patricia C.; Carroll, Diane L.; Hurley, Ann; Gersh-Zaremski, Ronna; Kennedy, Ann; Kurowski, Jan; Tierney, Kim; Benoit, Angela; Chang, Frank; Lipsitz, Stuart; Pang, Justine; Tsurkova, Ruslana; Zuyov, Lyubov; Middleton, Blackford

2009-01-01

27

A wearable airbag to prevent fall injuries.  

PubMed

We have developed a wearable airbag that incorporates a fall-detection system that uses both acceleration and angular velocity signals to trigger inflation of the airbag. The fall-detection algorithm was devised using a thresholding technique with an accelerometer and gyro sensor. Sixteen subjects mimicked falls, and their acceleration waveforms were monitored. Then, we developed a fall-detection algorithm that could detect signals 300 ms before the fall. This signal was used as a trigger to inflate the airbag to a capacity of 2.4 L. Although the proposed system can help to prevent fall-related injuries, further development is needed to miniaturize the inflation system. PMID:19846379

Tamura, Toshiyo; Yoshimura, Takumi; Sekine, Masaki; Uchida, Mitsuo; Tanaka, Osamu

2009-10-20

28

Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults.  

PubMed

This systematic review explored the impact of fall prevention programs and home modifications on falls and the performance of community-dwelling older adults. It was conducted as part of the American Occupational Therapy Association's Evidence-Based Practice Project. Thirty-three articles were analyzed and synthesized. The strongest results were found for multifactorial programs that included home evaluations and home modifications, physical activity or exercise, education, vision and medication checks, or assistive technology to prevent falls. Positive outcomes included a decreased rate of functional decline, a decrease in fear of falling, and an increase in physical factors such as balance and strength. The strength of the evidence for physical activity and home modification programs provided individually was moderate. Implications for practice, education, and research are also discussed. PMID:22549593

Chase, Carla A; Mann, Kathryn; Wasek, Sarah; Arbesman, Marian

29

Fall prevention and vitamin D in the elderly: an overview of the key role of the non-bone effects  

Microsoft Academic Search

Preventing falls and fall-related fractures in the elderly is an objective yet to be reached. There is increasing evidence that a supplementation of vitamin D and\\/or of calcium may reduce the fall and fracture rates. A vitamin D-calcium supplement appears to have a high potential due to its simple application and its low cost. However, published studies have shown conflicting

Cedric Annweiler; Manuel Montero-Odasso; Anne M Schott; Gilles Berrut; Bruno Fantino; Olivier Beauchet

2010-01-01

30

What Are Ways to Prevent Falls and Related Fractures?  

MedlinePLUS

... What Are Ways to Prevent Falls and Related Fractures? Fast Facts: An Easy-to-Read Series of ... 122 KB) Español Related Resources Preventing Falls and Fractures Osteoporosis and Falls Osteoporosis and Falls (??) Partner ...

31

Preventing falls in your elderly patients.  

PubMed

An elderly patient who falls is at significant risk for disability or death. In this article, Dr Costa explains how a carefully taken history, detailed physical examination, and appropriate laboratory studies can help to discern the cause of a fall. He also describes a multifaceted approach to preventing falls in elderly patients that involves a partnership of the physician, the patient, and the family. PMID:1985306

Costa, A J

1991-01-01

32

Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus.  

PubMed

The prevention of injury associated with falls in older people is a public health target in many countries around the world. Although there is good evidence that interventions such as multifactorial fall prevention and individually prescribed exercise are effective in reducing falls, the effect on serious injury rates is unclear. Historically, trials have not been adequately powered to detect injury endpoints, and variations in case definition across trials have hindered meta-analysis. It is possible that fall-prevention strategies have limited effect on falls that result in injuries or are ineffective in populations who are at a higher risk of injury. Further research is required to determine whether fall-prevention interventions can reduce serious injuries. Prevention of Falls Network Europe (ProFaNE) is a collaborative project to reduce the burden of fall injury in older people through excellence in research and promotion of best practice (www.profane.eu.org). The European Commission funds the network, which links clinicians, members of the public, and researchers worldwide. The aims are to identify major gaps in knowledge in fall injury prevention and to facilitate the collaboration necessary for large-scale clinical research activity, including clinical trials, comparative research, and prospective meta-analysis. Work is being undertaken in a 4-year program. As a first step, the development of a common set of outcome definitions and measures for future trials or meta-analysis was considered. PMID:16137297

Lamb, Sarah E; Jørstad-Stein, Ellen C; Hauer, Klaus; Becker, Clemens

2005-09-01

33

[Musculoskeletal rehabilitation and bone. Prevention of fall-related fractures in elderly].  

PubMed

Fall-related fracture in elderly is one of the big issues in our aging society. A major cause of fractures in elderly is fall. Therefore, the prevention of falls is essential for the prevention of fractures in elderly. Various risk factors of falls such as physical fragility, cognitive decline and visual problem have been reported. The effective way for prevention of falls is the modification of the risk factors for falls. Especially, exercise has been known effective. In addition to prevention of falls, we should explore the appropriate approach to modify fall direction, defensive reaction, local shock absorption, which are closely related to fall-related fracture risk. PMID:20354322

Otaka, Yohei

2010-04-01

34

National Fall Prevention Workshop: stepping up pan-Canadian coordination.  

PubMed

About one in three Canadian seniors will experience a fall at least once each year. Such falls are the leading cause of injury-related hospitalizations among older people. Apart from causing injury, falls can result in chronic pain, reduced quality of life and, in severe cases, death. Psychological effects of a fall may cause a post-fall syndrome that includes dependence on others for daily activities, loss of autonomy, confusion, immobilization and depression. Falls and the resulting injuries often occur due to a combination of factors, including health conditions associated with aging such as vision problems, osteoporosis, dementia and symptoms of a chronic disease. They can be due to the side effects of medications, environmental hazards and risk-taking behaviours. Fall prevention initiatives and strategies are taking place in all provinces and territories and at the national level. To enhance the collaborative understanding of these initiatives, a National Fall Prevention Workshop was held at the Canadian Injury Prevention and Safety Promotion Conference in Vancouver, British Columbia, on 17 November 2011. The Workshop was co-hosted by the British Columbia Injury Research and Prevention Unit (BCIRPU) and the Public Health Agency of Canada (PHAC). Fall prevention leads from each province and territory were invited to present their most recent activities and their plans. PMID:23046805

2012-09-01

35

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil)  

PubMed Central

Background Falling in older age is a major public health concern due to its costly and disabling consequences. However very few randomised controlled trials (RCTs) have been conducted in developing countries, in which population ageing is expected to be particularly substantial in coming years. This article describes the design of an RCT to evaluate the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people. Methods/design Multicentre parallel-group RCT involving 612 community-dwelling men and women aged 60 years and over, who have fallen at least once in the previous year. Participants will be recruited in multiple settings in Sao Paulo, Brazil and will be randomly allocated to a control group or an intervention group. The usual care control group will undergo a fall risk factor assessment and be referred to their clinicians with the risk assessment report so that individual modifiable risk factors can be managed without any specific guidance. The intervention group will receive a 12-week Multifactorial Falls Prevention Program consisting of: an individualised medical management of modifiable risk factors, a group-based, supervised balance training exercise program plus an unsupervised home-based exercise program, an educational/behavioral intervention. Both groups will receive a leaflet containing general information about fall prevention strategies. Primary outcome measures will be the rate of falls and the proportion of fallers recorded by monthly falls diaries and telephone calls over a 12 month period. Secondary outcomes measures will include risk of falling, fall-related self-efficacy score, measures of balance, mobility and strength, fall-related health services use and independence with daily tasks. Data will be analysed using the intention-to-treat principle.The incidence of falls in the intervention and control groups will be calculated and compared using negative binomial regression analysis. Discussion This study is the first trial to be conducted in Brazil to evaluate the effectiveness of an intervention to prevent falls. If proven to reduce falls this study has the potential to benefit older adults and assist health care practitioners and policy makers to implement and promote effective falls prevention interventions. Trial registration ClinicalTrials.gov (NCT01698580)

2013-01-01

36

Prevention of fall incidents in patients with a high risk of falling: design of a randomised controlled trial with an economic evaluation of the effect of multidisciplinary transmural care  

PubMed Central

Background Annually, about 30% of the persons of 65 years and older falls at least once and 15% falls at least twice. Falls often result in serious injuries, such as fractures. Therefore, the prevention of accidental falls is necessary. The aim is to describe the design of a study that evaluates the efficacy and cost-effectiveness of a multidisciplinary assessment and treatment of multiple fall risk factors in independently living older persons with a high risk of falling. Methods/Design The study is designed as a randomised controlled trial (RCT) with an economic evaluation. Independently living persons of 65 years and older who recently experienced a fall are interviewed in their homes and screened for risk of recurrent falling using a validated fall risk profile. Persons at low risk of recurrent falling are excluded from the RCT. Persons who have a high risk of recurrent falling are blindly randomised into an intervention (n = 100) or usual care (n = 100) group. The intervention consists of a multidisciplinary assessment and treatment of multifactorial fall risk factors. The transmural multidisciplinary appraoch entails close cooperation between geriatrician, primary care physician, physical therapist and occupational therapist and can be extended with other specialists if relevant. A fall calendar is used to record falls during one year of follow-up. Primary outcomes are time to first and second falls. Three, six and twelve months after the home visit, questionnaires for economic evaluation are completed. After one year, during a second home visit, the secondary outcome measures are reassessed and the adherence to the interventions is evaluated. Data will be analysed according to the intention-to-treat principle and also an on-treatment analysis will be performed. Discussion Strengths of this study are the selection of persons at high risk of recurrent falling followed by a multidisciplinary intervention, its transmural character and the evaluation of adherence. If proven effective, implementation of our multidisciplinary assessment followed by treatment of fall risk factors will reduce the incidence of falls. Trial registration Current Controlled Trials ISRCTN11546541.

Peeters, Geeske MEE; de Vries, Oscar J; Elders, Petra JM; Pluijm, Saskia MF; Bouter, Lex M; Lips, Paul

2007-01-01

37

Evidence-based clinical practice in falls prevention: a randomised controlled trial of a falls prevention service  

Microsoft Academic Search

Aims: Evidence-based guidelines recommend a range of treatments for falls and injury prevention. We undertook a randomised trial of a falls prevention service to screen for falls risk factors and recommend to GPs an evidenced base prescription for falls prevention. Methods: All patients who presented with a fall to the Emergency Department at Flinders Medical Centre over a 22-week period

Craig Whitehead; Rachel Wundke; Maria Crotty; Paul Finucane

2003-01-01

38

Acute care patient falls: evaluation of a revised fall prevention program following comparative analysis of psychiatric and medical patient falls.  

PubMed

Eliminating falls and fall-associated injuries are priorities in health care. This study examined the impact of revised fall prevention interventions on psychiatric and medical patient falls. After policy revisions were well established, psychiatric falls diminished and medical falls increased. A contributing factor to the medical population finding was policy intervention noncompliance. PMID:20974102

Yates, Kimberly M; Creech Tart, Rebecca

2010-08-04

39

Process factors explaining the ineffectiveness of a multidisciplinary fall prevention programme: A process evaluation  

Microsoft Academic Search

BACKGROUND: Falls are a major health threat to older community-living people, and initiatives to prevent falls should be a public health priority. We evaluated a Dutch version of a successful British fall prevention programme. Results of this Dutch study showed no effects on falls or daily functioning. In parallel to the effect evaluation, we carried out a detailed process evaluation

Michel HC Bleijlevens; Marike RC Hendriks; Jolanda CM van Haastregt; Erik van Rossum; Gertrudis IJM Kempen; Joseph PM Diederiks; Harry FJM Crebolder; Jacques ThM van Eijk

2008-01-01

40

Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial  

Microsoft Academic Search

Objective To determine the effectiveness of a multifaceted podiatry intervention in preventing falls in community dwelling older people with disabling foot pain.Design Parallel group randomised controlled trial.Setting University health sciences clinic in Melbourne, Australia.Participants 305 community dwelling men and women (mean age 74 (SD 6) years) with disabling foot pain and an increased risk of falling. 153 were allocated to

Martin J Spink; Hylton B Menz; Mohammad R Fotoohabadi; Elin Wee; Karl B Landorf; Keith D Hill; Stephen R Lord

2011-01-01

41

Management of falls in older persons: a prescription for prevention.  

PubMed

Although falls are a common cause of injury in older persons, they are not just a normal part of the aging process. The American Geriatrics Society and British Geriatrics Society recommend that all adults older than 65 years be screened annually for a history of falls or balance impairment. An individualized risk assessment should be performed, with corresponding multifactorial intervention, for those who report a single fall and have unsteadiness; who report two or more falls; who report difficulties with gait or balance; or who seek medical attention because of a fall. The following components should be included in multifactorial interventions: exercise, particularly balance, strength, and gait training; modification of the home environment; minimization of medications, especially psychoactive medications; management of postural hypotension; and management of foot problems and footwear. These interventions are effective in decreasing falls and fall-related injuries in the community and nursing home settings, as well as in decreasing the number of persons who fall in the subacute hospital setting. Prevention of falls and, most importantly, of injury and death is possible. An evidence-based fall prevention prescription may be used to efficiently accomplish management. PMID:22150660

Moncada, Lainie Van Voast

2011-12-01

42

A collaborative approach to fall prevention.  

PubMed

Collaboration among health-care providers has emerged as a key factor in improving client care. The authors describe the Geriatric Emergency Management-Falls Intervention Team (GEM-FIT) project, a nurse-led research initiative to improve fall prevention in older adults through interdisciplinary collaboration. Public health nurses and occupational therapists assessed participants before and after fall-prevention interventions and fou modest improvements in participant outcomes and reductions in modifiable risk factors. The project resulted in successful collaboration, interdisciplinary teamwork and improved service delivery to participants. Among the challenges were delayed timelines, complex issues outside the project protocol and communication difficulties. The authors, who served on the project team, make recommendations for health-care professionals interested in initiating similar projects. PMID:22128708

Merrett, Angela; Thomas, Patricia; Stephens, Anne; Moghabghab, Rola; Gruneir, Marilyn

2011-10-01

43

[Preventing falls in people with cognitive impairment].  

PubMed

The residence Eleusis in Poissy (78) is a nursing home for dependent elderly people, it specialises in the care of people with severe cognitive impairment. It offers weekly workshops in fall prevention. This is geared towards motor, cognitive and behavioural components in order to take into account the person as a whole. PMID:23133898

Helbourg, Elodie; Meyer, Céline

44

The role of exercise in falls prevention for older patients.  

PubMed

Falls prevention is a key area of health promotion that is familiar to all nurses who work with older people. However, the suggestion that t'ai chi should be used as a prevention intervention may be new to many nurses. The evidence supporting t'ai chi and many other forms of exercise have been evaluated within the National Institute for Clinical Evidence (NICE) falls guidance. This should enable nurses to look at the prevention interventions that they currently recommend and question the evidence for or against their effectiveness. Nurses should also be able to identify factors that may present as barriers to participation. PMID:15151003

Hainsworth, Terry

45

Falls and their prevention in elderly people: what does the evidence show?  

PubMed

A large proportion of falls and fall injuries in older people is due to multiple risk factors, many of which probably can be modified or eliminated with targeted fall prevention interventions. These interventions must be feasible, sustainable, and cost effective to be practical for widespread use. The most promising prevention strategies involve multidimensional fall risk assessment and exercise interventions. Incorporating these intervention strategies whenever feasible into a fall prevention program seems to be the most effective means for fall prevention in older adults. PMID:16962843

Rubenstein, Laurence Z; Josephson, Karen R

2006-09-01

46

Fall TIP: Validation of Icons to Communicate Fall Risk Status and Tailored Interventions to Prevent Patient Falls  

PubMed Central

This paper reports on the development and validation of a set of icons designed to communicate fall risk status and tailored interventions to prevent patient falls in hospitals. The icons will populate a fall prevention toolkit to provide actionable alerts to nurses, nursing assistants, and other interdisciplinary health care team members and educational materials for patients and families in acute hospital settings.

Hurley, Ann C.; Dykes, Patricia C.; Carroll, Diane L.; Dykes, John S.; Middleton, Blackford

2011-01-01

47

Frequently observed risk factors for fall-related injuries and effective preventive interventions: a multihospital survey of nurses' perceptions.  

PubMed

There is an urgent need to prioritize the risk factors for injurious falls and effective interventions in nursing practice. Registered nurses perceived that the most frequently observed risk factors were confusion, gait problems, Alzheimer disease, disorientation, and inability to follow safety instructions. The most effective interventions were keeping hospital bed brakes locked, keeping floor surfaces clean/dry, using appropriate footwear for patients, maintaining a call light within reach, and reducing tripping hazards. PMID:23117794

Tzeng, Huey-Ming; Yin, Chang-Yi

48

Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial  

PubMed Central

Objective To determine the effectiveness of a multifaceted podiatry intervention in preventing falls in community dwelling older people with disabling foot pain. Design Parallel group randomised controlled trial. Setting University health sciences clinic in Melbourne, Australia. Participants 305 community dwelling men and women (mean age 74 (SD 6) years) with disabling foot pain and an increased risk of falling. 153 were allocated to a multifaceted podiatry intervention and 152 to routine podiatry care, with 12 months’ follow-up. Interventions Multifaceted podiatry intervention consisting of foot orthoses, advice on footwear, subsidy for footwear ($A100 voucher; £65; €74), a home based programme of foot and ankle exercises, a falls prevention education booklet, and routine podiatry care for 12 months. The control group received routine podiatry care for 12 months. Main outcome measures Proportion of fallers and multiple fallers, falling rate, and injuries resulting from falls during follow-up. Results Overall, 264 falls occurred during the study. 296 participants returned all 12 calendars: 147 (96%) in the intervention group and 149 (98%) in the control group. Adherence was good, with 52% of the participants completing 75% or more of the requested three exercise sessions weekly, and 55% of those issued orthoses reporting wearing them most of the time. Participants in the intervention group (n=153) experienced 36% fewer falls than participants in the control group (incidence rate ratio 0.64, 95% confidence interval 0.45 to 0.91, P=0.01). The proportion of fallers and multiple fallers did not differ significantly between the groups (relative risk 0.85, 0.66 to 1.08, P=0.19 and 0.63, 0.38 to 1.04, P=0.07). One fracture occurred in the intervention group and seven in the control group (0.14, 0.02 to 1.15, P=0.07). Significant improvements in the intervention group compared with the control group were found for the domains of strength (ankle eversion), range of motion (ankle dorsiflexion and inversion/eversion), and balance (postural sway on the floor when barefoot and maximum balance range wearing shoes). Conclusions A multifaceted podiatry intervention reduced the rate of falls in community dwelling older people with disabling foot pain. The components of the intervention are inexpensive and relatively simple to implement, suggesting that the programme could be incorporated into routine podiatry practice or multidisciplinary falls prevention clinics. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12608000065392.

2011-01-01

49

Effects of risk-based multifactorial fall prevention on health-related quality of life among the community-dwelling aged: a randomized controlled trial  

Microsoft Academic Search

BACKGROUND: This study aimed to assess the effects of a risk-based, multifactorial fall prevention programme on health-related quality of life among the community-dwelling aged who had fallen at least once during the previous 12 months. METHODS: The study is a part of a single-centre, risk-based, multifactorial randomised controlled trial. The intervention lasted for 12 months and consisted of a geriatric

Sari Vaapio; Marika Salminen; Tero Vahlberg; Noora Sjösten; Raimo Isoaho; Pertti Aarnio; Sirkka-Liisa Kivelä

2007-01-01

50

Falls prevention through community intervention – A Swedish example  

Microsoft Academic Search

In order to control and reduce fall-related injuries, particularly among women over the age of 55, a safety management and falls prevention campaign was structured and implemented during 2006–2007 in the small industrial town of Södertälje, Sweden. A local campaign was launched to recruit falls prevention agents, to inform key target groups in the local community, and to educate older

Tore J. Larsson; Mona-Lisa Hägvide; Maria Svanborg; Lena Borell

2010-01-01

51

[Falls and osteoporotic fractures prevention units: proposed Osteoporosis, Falls and Fractures Group of the Spanish Society of Geriatrics and Gerontology].  

PubMed

Since forming the Osteoporosis, Falls and Fractures Group of the Spanish Society (GOCF) of Geriatrics and Gerontology (SEGG) a review was performed of the epidemiology of falls, along with a description of measures that have shown a degree of effectiveness in prevention. We also present the proposal of a common basic model of action in fall prevention units, mainly addressed to the community. Finally, a consensus model falls register is presented, common to community level and institutional areas, with the objective of being useful and easy to fill in at any care level. PMID:21945012

Duaso, Enric; Casas, Alvaro; Formiga, Francesc; Lázaro Del Nogal, Montserrat; Salvà, Antoni; Marcellán, Teresa; Navarro, Carmen

2011-09-25

52

Effects of risk-based multifactorial fall prevention on health-related quality of life among the community-dwelling aged: a randomized controlled trial  

PubMed Central

Background This study aimed to assess the effects of a risk-based, multifactorial fall prevention programme on health-related quality of life among the community-dwelling aged who had fallen at least once during the previous 12 months. Methods The study is a part of a single-centre, risk-based, multifactorial randomised controlled trial. The intervention lasted for 12 months and consisted of a geriatric assessment, guidance and treatment, individual instruction in fall prevention, group exercise, lectures on themes related to falling, psychosocial group activities and home exercise. Of the total study population (n = 591, 97% of eligible subjects), 513(251 in the intervention group and 262 in the control group) participated in this study. The effect of the intervention on quality of life was measured using the 15D health-related quality of life instrument consisting of 15 dimensions. The data were analysed using the chi-square test or Fisher's exact test, the Mann-Whitney U-test and logistic regression. Results In men, the results showed significant differences in the changes between the intervention and control groups in depression (p = 0.017) and distress (p = 0.029) and marginally significant differences in usual activities (p = 0.058) and sexual activity (p = 0.051). In women, significant differences in the changes between the groups were found in usual activities (p = 0.005) and discomfort/symptoms (p = 0.047). For the subjects aged 65 to 74 years, significant differences in the changes between the groups were seen in distress (p = 0.037) among men and in usual activities (p = 0.011) among women. All improvements were in favour of the intervention group. Conclusion Fall prevention produced positive effects on some dimensions of health-related quality of life in the community-dwelling aged. Men benefited more than women.

Vaapio, Sari; Salminen, Marika; Vahlberg, Tero; Sjosten, Noora; Isoaho, Raimo; Aarnio, Pertti; Kivela, Sirkka-Liisa

2007-01-01

53

A Culture of Safety: Nursing Rounds As Falls Prevention Best Practice Dr. Judith Moran-Peters, RN, DNSc, CNA, BC  

Microsoft Academic Search

The purpose is to describe the effect of hourly nursing rounds on prevention of falls in hospitalized patients. Implication for practice: The information presented will increase nurses' knowledge regarding the effectiveness of fall prevention nursing activities. Recommendation: direct care nurses making hourly point-of-care rounds on their clinical units will experience positive outcomes in preventing patient falls. Problem: National Patient Safety

Diane Peyser; Angela Neglia

54

Preventing Falls in Older Adults Who Live in Community Settings  

MedlinePLUS

Preventing Falls in Older Adults Who Live in Community Settings: U.S. Preventive Services Task Force Recommendation Summaries for Patients are a service provided by Annals to help patients better understand the ...

55

[Muscle and bone health as a risk factor of fall among the elderly. Fall prevention strategy in dementia].  

PubMed

Fall prevention interventions for patients with dementia are broadly classified into those aimed at the patients themselves and those aimed at caregivers and the living environment. The former includes exercise programs, but these interventions have a low adherence and have not led to decreases in the incidence of falls. The latter includes comprehensive, multidisciplinary measures that are conducted at medical and welfare facilities commonly used by elderly with dementia, such as fall risk assessment, dementia care management, and education for caregivers. Although comprehensive, multidisciplinary interventions for fall prevention that focus on fall risk management were shown to be effective, their effects with specific regard to elderly with dementia have not been sufficiently elucidated, and remain a future issue. PMID:18515946

Soyano, Ayako; Suzuki, Mizue

2008-06-01

56

Engaging Community-Based Organizations in Fall Prevention Education  

ERIC Educational Resources Information Center

|Falls are a major public health problem for older adults, and community-based organizations play a key role in educating seniors about falls prevention (FP). We conducted a qualitative process evaluation at six sites to report community-based centers' perspectives on adoption, adaptation, and sustainability of an evidence-based multifactorial FP…

Kramer, B. Josea; Vivrette, Rebecca L.; Rubenstein, Laurence Z.

2011-01-01

57

Preventing Falls: How to Develop Community-Based Fall Prevention Programs for Older Adults.  

National Technical Information Service (NTIS)

Falls are a major threat to the health and independence of older adults, people aged 65 and older. Each year in the United States, nearly one-third of older adults experience a fall. Falls can be devastating. About one out of ten falls among older adults ...

D. Wallace H. Falk I. Arias J. L. Gerberding M. Ballesteros

2008-01-01

58

Preventing Falls | NIH MedlinePlus the Magazine  

MedlinePLUS

... of this page please turn Javascript on. Feature: Osteoporosis Preventing Falls Past Issues / Winter 2011 Table of ... next to your bed Free NIH Videos About Osteoporosis The NIHSeniorHealth Web site features five brief, informative ...

59

Patient Education to Prevent Falls Among Older Hospital Inpatients  

Microsoft Academic Search

Background: Falls are a common adverse event during hospitalization of older adults, and few interventions have been shown to prevent hem.\\u000aMethods: This study was a 3-group randomized trial to evaluate the efficacy of 2 forms of multimedia patient education compared with usual care for the prevention of in-hospital falls. Older hospital patients (n = 1206) admitted to a mixture

Terry P Haines; Anne-Marie Hill; Keith D Hill; Steven McPhail; David Oliver; Sandra Brauer; Tammy Hoffmann; Christopher Beer

2011-01-01

60

"The balancing act"-- Licensed practical nurse experiences of falls and fall prevention: a qualitative study  

PubMed Central

Background Falls are common in old age and may have serious consequences. There are many strategies to predict and prevent falls from occurring in long-term care and hospitals. The aim of this study was to describe licensed practical nurse experiences of predicting and preventing further falls when working with patients who had experienced a fall-related fracture. Licensed practical nurses are the main caretakers that work most closely with the patients. Methods A qualitative study of focus groups interviews and field observations was done. 15 licensed practical nurses from a rehabilitation ward and an acute ward in a hospital in northern Sweden were interviewed. Content was analyzed using qualitative content analysis. Results The result of the licensed practical nurse thoughts and experiences about risk of falling and fall prevention work is represented in one theme, “the balancing act”. The theme includes three categories: “the right to decide”, “the constant watch”, and “the ongoing negotiation” as well as nine subcategories. The analysis showed similarities and differences between rehabilitation and acute wards. At both wards it was a core strategy in the licensed practical nurse work to always be ready and to pay attention to patients’ appearance and behavior. At the rehabilitation ward, it was an explicit working task to judge the patients’ risk of falling and to be active to prevent falls. At the acute ward, the words “risk of falling” were not used and fall prevention were not discussed; instead the licensed practical nurses used for example “dizzy and pale”. The results also indicated differences in components that facilitate workplace learning and knowledge transfer. Conclusions Differences between the wards are most probably rooted in organizational differences. When it is expected by the leadership, licensed practical nurses can express patient risk of falling, share their observations with others, and take actions to prevent falls. The climate and the structure of the ward are essential if licensed practical nurses are to be encouraged to routinely consider risk of falling and implement risk reduction strategies.

2012-01-01

61

Preventing in-hospital newborn falls: a literature review.  

PubMed

In-hospital newborn falls are arguably one of the most underresearched and underreported issues for organizations that care for newborn patients. From the few published statistics of in-hospital fall rates, we know that perhaps 600 to 1,600 newborn falls occur annually. Many of these falls can result in injury or even death of the newborn, legal issues for the institution, and severe emotional stress to the caregiver(s) and parents. Therefore, we searched the literature to ascertain causation and associated risks associated with in-hospital newborn falls. This is an important issue for nurses to understand because not only can the newborn be harmed due to a fall, but the actual newborn fall can also elicit strong feelings of guilt and culpability in the caregiver(s). This article reviews the literature to examine what is known about the factors associated with in-hospital newborn falls, to explore prevention measures, and to present best practices for how to adopt safe-sleep policy to prevent newborn falls. PMID:24013477

Matteson, Tara; Henderson-Williams, Audery; Nelson, Jessica

62

Fall prevention modulates decisional saccadic behavior in aging  

PubMed Central

As society ages and frequency of falls increases in older adults, counteracting motor decline is a challenging issue for developed countries. Physical activity based on aerobic and strength training as well as motor activity based on skill learning both help benefit balance and reduce the risk of falls, as assessed by clinical or laboratory measures. However, how such programs influence motor control is a neglected issue. This study examined the effects of fall prevention (FP) training on saccadic control in older adults. Saccades were recorded in 12 participants aged 64–91 years before and after 2.5 months training in FP. Traditional analysis of saccade timing and dynamics was performed together with a quantitative analysis using the LATER model, enabling us to examine the underlying motor control processes. Results indicated that FP reduced the rate of anticipatory and express saccades in inappropriate directions and enhanced that of express saccades in the appropriate direction, resulting in decreased latency and higher left-right symmetry of motor responses. FP reduced within-participant variability of saccade duration, amplitude, and peak velocity. LATER analysis suggested that FP modulates decisional thresholds, extending our knowledge of motor training influence on central motor control. We introduce the Threshold Interval Modulation with Early Release-Rate of rIse Deviation with Early Release (TIMER-RIDER) model to account for the results.

Coubard, Olivier A.

2012-01-01

63

[Fall risk and fracture. Exercise for fall prevention in the elderly].  

PubMed

On the basis of evidence obtained in previous studies, this paper outlines effective music therapy programs for group instructions and the basic contents of exercise and training that the elderly are able to do at home by themselves in their daily lives to reduce the risk of falls. The contents of effective exercise and training are to take a series of steps as quickly as possible, back and forth and to the right and left, in a standing position in combination with vertical movement in large amplitude for center of gravity. Furthermore, simple movements such as obeying an order of "right face", as well as dynamic movements that mostly involve higher brain functions such as instant thinking and judgment, are more effective. It should be noted that it is not sufficient for instructors to merely demand that the elderly do effective exercise. To prevent falls by the participants and to also obtain comprehensive effects such as satisfaction, amusement, and quality of life (QOL) , it is important to pay appropriate attention to parts other than the narrowly-defined evidence elements, such as modifications to maintain compliance and consideration of people with locomotive syndrome. PMID:23628686

Kamioka, Hiroharu; Mutoh, Yoshiteru; Shimura, Hiroko

2013-05-01

64

Designing adverse event prevention programs using quality management methods: the case of falls in hospital  

Microsoft Academic Search

Objective. From a public health perspective, the effectiveness of any prevention program depends on integrated medical and managerial strategies. In this way, quality management methods drawn from organization and business management can help design prevention programs. The aim of this study was to analyze the potential value of these methods in the specific context of preventing falls in hospital. Setting.

CATHERINE GRENIER-SENNELIER; ISABELLE LOMBARD; CATHERINE JENY-LOEPER; MARIE-CHRISTINE MAILLET-GOURET; ETIENNE MINVIELLE

2002-01-01

65

Occupational therapy in fall prevention: current evidence and future directions.  

PubMed

Falls are a serious public health concern among older adults in the United States. Although many fall prevention recommendations exist, such as those published by the American Geriatrics Society (AGS) and the British Geriatrics Society (BGS) in 2010, the specific role of occupational therapy in these efforts is unclear. This article presents a scoping review of current published research documenting the role of occupational therapy in fall prevention interventions among community-dwelling older adults, structured by the AGS and BGS guidelines. We identified evidence for occupational therapy practitioner involvement in fall prevention in environmental modifications, exercise, and multifactorial and multicomponent interventions. Although research documenting the efficacy of occupational therapy interventions is identified as part of the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; American Occupational Therapy Association, 2008), we identified little or no such research examining interventions to modify behaviors (e.g., fear of falling), manage postural hypotension, recommend appropriate footwear, and manage medications. Although occupational therapy is represented in the fall prevention research, the evidence for the profession's role in many areas is still lacking. PMID:22394524

Leland, Natalie E; Elliott, Sharon J; O'Malley, Lisa; Murphy, Susan L

66

Why Do Patients in Acute Care Hospitals Fall? Can Falls Be Prevented?  

PubMed Central

Objective Obtain the views of nurses and assistants as to why patients in acute care hospitals fall. Background Despite a large quantitative evidence base for guiding fall risk assessment and not needing highly technical, scarce, or expensive equipment to prevent falls, falls are serious problems in hospitals. Methods Basic content analysis methods were used to interpret descriptive data from 4 focus groups with nurses (n = 23) and 4 with assistants (n = 19). A 2-person consensus approach was used for analysis. Results Positive and negative components of 6 concepts—patient report, information access, signage, environment, teamwork, and involving patient/family—formed 2 core categories: knowledge/communication and capability/actions that are facilitators or barriers, respectively, to preventing falls. Conclusion Two conditions are required to reduce patient falls. A patient care plan including current and accurate fall risk status with associated tailored and feasible interventions needs to be easily and immediately accessible to all stakeholders (entire healthcare team, patients, and family). Second, stakeholders must use that information plus their own knowledge and skills and patient and hospital resources to carry out the plan.

Dykes, Patricia C.; Carroll, Diane L.; Hurley, Ann C.; Benoit, Angela; Middleton, Blackford

2011-01-01

67

The population approach to falls injury prevention in older people: findings of a two community trial  

PubMed Central

Background There is a sound rationale for the population-based approach to falls injury prevention but there is currently insufficient evidence to advise governments and communities on how they can use population-based strategies to achieve desired reductions in the burden of falls-related injury. The aim of the study was to quantify the effectiveness of a streamlined (and thus potentially sustainable and cost-effective), population-based, multi-factorial falls injury prevention program for people over 60 years of age. Methods Population-based falls-prevention interventions were conducted at two geographically-defined and separate Australian sites: Wide Bay, Queensland, and Northern Rivers, NSW. Changes in the prevalence of key risk factors and changes in rates of injury outcomes within each community were compared before and after program implementation and changes in rates of injury outcomes in each community were also compared with the rates in their respective States. Results The interventions in neither community substantially decreased the rate of falls-related injury among people aged 60 years or older, although there was some evidence of reductions in occurrence of multiple falls reported by women. In addition, there was some indication of improvements in fall-related risk factors, but the magnitudes were generally modest. Conclusions The evidence suggests that low intensity population-based falls prevention programs may not be as effective as those that are intensively implemented.

2010-01-01

68

Practice Development Section Paper 1 Older People's Perspectives on Fall Risk and Fall Prevention Programs: A Literature Review  

PubMed Central

Despite evidence supporting fall prevention methods, fall-related injury and death rates continue to rise. Understanding older people’s views on fall risk and prevention will help nurses and other health professionals in the design of fall prevention strategies that will broaden their scope, reach, and adoption. This literature review synthesized 19 qualitative and quantitative studies examining older people’s perspectives about fall risk and prevention using a social ecological framework. Three themes emerged about fall risk; fearing vulnerability, maintaining autonomy and independence, and interpreting risk. Four themes emerged about fall prevention programs; influence of participant and program characteristics, need for personal relevance and preference, maintaining autonomy and independence, and increased support for and access to programs. Implications for practice include individual, interpersonal, organizational and community level considerations for improving fall prevention efforts.

McMahon, Siobhan; Talley, Kristine M.; Wyman, Jean F.

2011-01-01

69

Emerging concept: 'central benefit model' of exercise in falls prevention.  

PubMed

Falls are a common geriatric syndrome and are the third leading cause of chonic disability worldwide. Falls are not random events and occur, at least in part, due to impaired physiological function, such as impaired balance, and cognitive impairment. The clinical syndrome of falls is important for Sports and Exercise Medicine Clinicians as there is Level 1 evidence that targeted exercise prescription is an effective intervention strategy. The widely accepted dogma is that improved physical function, balance and muscle strength, underlies the effectiveness of the exercise in reducing falls. However, findings from randomised controlled trials suggest that exercise reduce falls via mechanisms other than improved physiological function. The authors propose that improved cognitive function - specifically, executive functions - and associated functional plasticity may be an important yet underappreciated mechanism by which the exercise reduces falls in older adults. PMID:22522589

Liu-Ambrose, Teresa; Nagamatsu, Lindsay S; Hsu, Chun Liang; Bolandzadeh, Niousha

2012-04-20

70

A student-led demonstration project on fall prevention in a long-term care facility.  

PubMed

Falls are a frequent and serious problem facing people aged 65 and older. The incidence of falls increases with greater numbers of intrinsic and extrinsic risk factors and can be reduced by risk modification and targeted interventions. Falls account for 70% of accidental deaths in persons aged 75 and older. Mortality due to falls is significantly higher for older adults living in extended care facilities versus those living in the community. Our objective was to evaluate the effectiveness of a fall prevention training program in a long-term care setting. A single-group repeated-measure design was used, guided by the Precede-Proceed framework. A comprehensive review of the literature and a concept analysis guided the development of testing and educational materials for all nursing and ancillary facility staff. Preliminary testing provided baseline data on knowledge related to fall prevention. Pre- and posttests, a fall prevention newsletter, and informational brochures were distributed to nursing staff and ancillary personnel at training sessions. Certified nursing assistant (CNA) champions were identified and given peer leadership training. "Quick Tips" fall prevention badges were also distributed to staff. Graduate students led interdisciplinary environmental rounds weekly, and new falls were reviewed on a daily basis by the interdisciplinary team. A 60-day posttest evaluated retention of fall prevention knowledge. Fall rates at baseline and for 2 months after the intervention were compared. Preliminary survey data revealed fall prevention learning opportunities, with a pretest mean score of 86.78%. Qualitative data were coded and revealed specific learning gaps in intrinsic, extrinsic, and organizational causes of falls. The 60-day posttest mean score was 90.69%; a paired t test (t score = -1.050; P = .057) suggested that learning may have taken place; however, differences in scores did not reach statistical significance. The fall rate before training was 16.1%; 30-day posttraining fall rate was 12.3%, and 60-day postintervention fall rate was 9%. Based on the program results, the model was expanded from long-term care to the university hospital system and outpatient clinics in the same community. The collaboration between a school of nursing and 1 long-term care facility led to the adoption of a significant quality improvement program that was subsequently extended to a local hospital and clinic system. Student-led projects designed to teach community service learning can be meaningful and can lead to changes in patient safety and quality of care. PMID:17923288

Bonner, Alice; MacCulloch, Patricia; Gardner, Terri; Chase, Chantel W

71

Efficacy of falls prevention interventions: protocol for a systematic review and network meta-analysis  

PubMed Central

Background Falls are a leading cause of morbidity and mortality in older adults. Although numerous trials of falls prevention interventions have been completed, there is extensive variation in their intervention components and clinical context, such that the key elements of an effective falls prevention program remain unclear to patients, clinicians, and policy-makers. Our objective is to identify the most effective interventions and combinations of interventions that prevent falls though a systematic review and meta-analysis, including a network meta-analysis. Methods/Design We will search for published (e.g., MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Ageline) and unpublished (e.g., trial registries, dissertations) randomised clinical trials (RCTs) in all languages examining interventions to prevent falls compared to usual care or other falls prevention interventions among adults aged ?65 years from all settings (e.g., community, acute care, long-term care, and rehabilitation). The primary outcomes are number of injurious falls and number of hospitalizations due to falls. Secondary outcomes include falls rate, number of fallers, number of emergency room visits due to falls, number of physician visits due to falls, number of fractures, costs, and number of intervention-related harms (e.g., muscle soreness related to exercise). We will calibrate our eligibility criteria amongst the team and two independent team members will screen the literature search results in duplicate. Conflicts will be resolved through team discussion. A similar process will be used for data abstraction and quality appraisal with the Cochrane risk of bias tool. Our results will be synthesized descriptively and a random effects meta-analysis will be conducted if the studies are deemed methodologically, clinically, and statistically (e.g., I2<60%) similar. If appropriate, a network meta-analysis will be conducted, which will allow the comparison of interventions that have not been compared in head-to-head RCTs, as well as the effectiveness of interventions. Discussion We will identify the most effective interventions and combinations of interventions that prevent falls in older people. Our results will be used to optimize falls prevention strategies, and our goal is to ultimately improve the health of seniors internationally. Trial registration PROSPERO registry number: CRD42013004151

2013-01-01

72

Efeito preventivo da fisioterapia na redução da incidência de quedas em pacientes com Doença de Alzheimer Preventive effect of the physical therapy to minimize the occurrence of falls in patients with Alzheimer's Disease  

Microsoft Academic Search

SUMMARY The purpose of this review is to provide better understanding of the preventive effect resulted by the Physical Therapy in- tervention to minimize the occurrence of falls in patients with Alzheimer Disease. The Alzheimer Disease is the main cause of dementia between aged people. In recent years it has been showing an increase in the number of patients proportional

Tetsadê CB Piermartiri; Naaraí Camboim Bezerra; Alexandre Ademar Hoeller

73

Falls Prevention: Unique to Older Adults  

MedlinePLUS

... help: Sleep medications. Keep sleep medications to a minimum and follow your doctors instructions carefully. Many older ... will keep symptoms and side effects to a minimum for as long as possible. The most common ...

74

[Fall risk and fracture. Diagnosing sarcopenia and sarcopenic leg to prevent fall and fracture: its difficulty and pit falls].  

PubMed

Diagnosis of sarcopenia is based on the combination of physical-performance assessment and muscle-mass measurement. Physical performance was estimated by gait speed and grip strength. Common measuring procedures for skeletal muscle mass were dual energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) . Skeletal muscle mass index (SMI) was calculated from following formula ; [SMI (kg/m(2)) = (arm lean mass + leg lean mass) /height(2)] . Sarcopenia and sarcopenic leg are associated with poor body balance, falls, and subsequent fracture. Treatment of sarcopenia may result in successful prevention of fall and fracture for frail elderly. PMID:23628684

Hida, Tetsuro; Harada, Atsushi

2013-05-01

75

A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomised controlled trial (RCT)  

Microsoft Academic Search

Objective: to evaluate the effectiveness of a multifactorial intervention on incidence of falls in psychogeriatric nursing home patients. Design: cluster-randomised controlled 12-month trial. Setting: psychogeriatric wards in 12 nursing homes in The Netherlands. Participants: psychogeriatric nursing home patients (n = 518). Intervention: a general medical assessment and an additional specific fall risk evaluation tool, applied by a multidisciplinary fall prevention

JACQUES C. L. NEYENS; B. P. J. Dijcks; J. W. R. Twisk; J. M. G. A. Schols; J. C. M. van Haastregt; Witte de L

2009-01-01

76

Cost effectiveness of preventing falls and improving mobility in people with Parkinson disease: protocol for an economic evaluation alongside a clinical trial  

Microsoft Academic Search

BACKGROUND: Cost of illness studies show that Parkinson disease (PD) is costly for individuals, the healthcare system and society. The costs of PD include both direct and indirect costs associated with falls and related injuries. METHODS: This protocol describes a prospective economic analysis conducted alongside a randomised controlled trial (RCT). It evaluates whether physical therapy is more cost effective than

Jennifer J Watts; Jennifer L McGinley; Frances Huxham; Hylton B Menz; Robert Iansek; Anna T Murphy; Emma R Waller; Meg E Morris

2008-01-01

77

Slow Down and Concentrate: Time for a Paradigm Shift in Fall Prevention among People with Parkinson's Disease?  

PubMed Central

Introduction. We know little about how environmental challenges beyond home exacerbate difficulty moving, leading to falls among people with Parkinson's (PwP). Aims. To survey falls beyond home, identifying challenges amenable to behaviour change. Methods. We distributed 380 questionnaires to PwP in Southern England, asking participants to count and describe falls beyond home in the previous 12 months. Results. Among 255 responses, 136?PwP (diagnosed a median 8 years) reported falling beyond home. They described 249 falls in detail, commonly falling forward after tripping in streets. Single fallers (one fall in 12 months) commonly missed their footing, walking, or changing position and recovered to standing alone or with unfamiliar help. Repeat fallers (median falls, two) commonly felt shaken or embarrassed and sought medical advice. Very frequent fallers (falling at least monthly; median falls beyond home, six) commonly fell backward, in shops and after collapse but often recovered to standing alone. Conclusion. Even independently active PwP who do not fall at home may fall beyond home, often after tripping. Falling beyond home may result in psychological and/or physical trauma (embarrassment if observed by strangers and/or injury if falling backwards onto a hard surface). Prevention requires vigilance and preparedness: slowing down and concentrating on a single task might effectively prevent falling.

Stack, Emma L.; Roberts, Helen C.

2013-01-01

78

Patients' perspectives of falling while in an acute care hospital and suggestions for prevention  

PubMed Central

Patient falls and falls with injury are the largest category of reportable incidents and a significant problem in hospitals. Patients are an important part of fall prevention; therefore, we asked patients who have fallen about reason for fall and how falls could be prevented. There were two categories for falls: the need to toilet coupled with loss of balance and unexpected weakness. Patients asked to be included in fall risk communication and asked to be part of the team to prevent them from falling. Nurses need to share a consistent and clear message that they are there for patient safety.

Carroll, Diane L.; Dykes, Patricia C.; Hurley, Ann C.

2011-01-01

79

Inpatient fall prevention programs as a patient safety strategy: a systematic review.  

PubMed

Falls are common among inpatients. Several reviews, including 4 meta-analyses involving 19 studies, show that multicomponent programs to prevent falls among inpatients reduce relative risk for falls by as much as 30%. The purpose of this updated review is to reassess the benefits and harms of fall prevention programs in acute care settings and to identify factors associated with successful implementation of these programs. We searched for new evidence using PubMed from 2005 to September 2012. Two new, large, randomized, controlled trials supported the conclusions of the existing meta-analyses. An optimal bundle of components was not identified. Harms were not systematically examined, but potential harms included increased use of restraints and sedating drugs and decreased efforts to mobilize patients. Eleven studies showed that the following themes were associated with successful implementation: leadership support, engagement of front-line staff in program design, guidance of the prevention program by a multidisciplinary committee, pilot-testing interventions, use of information technology systems to provide data about falls, staff education and training, and changes in nihilistic attitudes about fall prevention. Future research would advance knowledge by identifying optimal bundles of component interventions for particular patients and by determining whether effectiveness relies more on the mix of the components or use of certain implementation strategies. PMID:23460095

Miake-Lye, Isomi M; Hempel, Susanne; Ganz, David A; Shekelle, Paul G

2013-03-01

80

A multidisciplinary fall prevention program for elderly persons: a feasibility study.  

PubMed

Falling is a common problem among elderly people and has many negative consequences. In the Netherlands, there is a need for effective fall prevention interventions aimed at elderly persons with an increased risk of falling. For this reason, we adapted a successful British fall prevention program comprising a medical occupational therapy assessment to the Dutch health care setting. This article describes the adaptation of this program and a pilot study to assess its feasibility in Dutch health care according to the implementers of the intervention as well as the participants (n = 21). This study showed that the Dutch intervention protocol is feasible in Dutch health care for both participants and implementers of the program. However, minor refinement of the intervention is warranted to improve its feasibility. The structured approach to adapt and pretest an intervention protocol appeared to be essential when aiming to implement a complex intervention program in a different health care setting. PMID:18555160

Hendriks, Marike R C; Bleijlevens, Michel H C; van Haastregt, Jolanda C M; de Bruijn, Fleur H; Diederiks, Joseph P M; Mulder, Wubbo J; Ruijgrok, Joop M; Stalenhoef, Paul A; Crebolder, Harry F J M; van Eijk, Jacques Th M

81

Translating Fall Incidence Data into Fall-Preventive Measures in Geriatric Wards – A Survey in Belgian Hospitals  

Microsoft Academic Search

Background: Fall incidents and their negative outcomes represent a considerable problem in hospitals, especially in geriatric wards, and require implementation of strategies to prevent these undesirable events. For this reason, the College of Geriatrics, a body funded by the Belgian Government to set up quality improvement initiatives in geriatric wards, selected ‘Fall prevention in Belgian hospitals’ as a quality project

Joke Coussement; Eddy Dejaeger; Margareta Lambert; Nele Van Den Noortgate; Leen De Paepe; Steven Boonen; Didier Schoevaerdts; Koen Milisen

2009-01-01

82

Fall prevention in the elderly: analysis and comprehensive review of methods used in the hospital and in the home.  

PubMed

Falls in the elderly are a significant problem both in and out of the hospital. The Deficit Reduction Act of 2005 and the Fiscal Year 2009 Inpatient Prospective Payment System Final Rule, as outlined by the Centers for Medicare & Medicaid Services, placed on hospitals the financial burden of fall prevention for falls (ie, hospital-acquired conditions) that could have been prevented by following evidence-based guidelines. Multifaceted and individualized programs have been created to prevent falls in the elderly. Many of these interventions are based on expert opinion and statistical trends. Our review of the literature revealed that the risk of fall is only slightly greater in the hospital environment than in the home and that there is no medical evidence that evidence-based guidelines are effective in fall prevention. PMID:21724919

Clyburn, Terry A; Heydemann, John A

2011-07-01

83

Definitions and methods of measuring and reporting on injurious falls in randomised controlled fall prevention trials: a systematic review  

PubMed Central

Background The standardisation of the assessment methodology and case definition represents a major precondition for the comparison of study results and the conduction of meta-analyses. International guidelines provide recommendations for the standardisation of falls methodology; however, injurious falls have not been targeted. The aim of the present article was to review systematically the range of case definitions and methods used to measure and report on injurious falls in randomised controlled trials (RCTs) on fall prevention. Methods An electronic literature search of selected comprehensive databases was performed to identify injurious falls definitions in published trials. Inclusion criteria were: RCTs on falls prevention published in English, study population ? 65 years, definition of injurious falls as a study endpoint by using the terms "injuries" and "falls". Results The search yielded 2089 articles, 2048 were excluded according to defined inclusion criteria. Forty-one articles were included. The systematic analysis of the methodology applied in RCTs disclosed substantial variations in the definition and methods used to measure and document injurious falls. The limited standardisation hampered comparability of study results. Our results also highlight that studies which used a similar, standardised definition of injurious falls showed comparable outcomes. Conclusions No standard for defining, measuring, and documenting injurious falls could be identified among published RCTs. A standardised injurious falls definition enhances the comparability of study results as demonstrated by a subgroup of RCTs used a similar definition. Recommendations for standardising the methodology are given in the present review.

2012-01-01

84

Bed-exit alarms. A component (but only a component) of fall prevention.  

PubMed

Patient falls are a common cause of morbidity, nonfatal injuries, and trauma-related hospitalizations in the United States. Sometimes, they're even fatal. Falls typically occur either while the patient is getting into or out of bed or shortly after the patient has exited the bed. One means of helping to reduce the number of patient falls is the bed-exit alarm. Such alarms can be either built-in devices incorporated into the beds themselves or stand-alone units consisting of a portable control unit and a pressure- or position-sensitive sensor. They can serve as an "early warning system" alerting nursing staff when patients attempt to leave their beds unassisted. However, bed-exit alarms do not themselves prevent falls--a fact that is not always clearly understood. To be effective, they need to be implemented with care and with a clear understanding of their limitations. In this article, we describe the types of stand-alone bed-exit alarms currently available on the market and provide guidance to facilities on how to implement them effectively. We also review the elements of an effective fall-prevention program and recount one hospital's success in reducing patient falls. We are in the process of conducting a comparative evaluation of a number of bed-exit alarms, which will be published in an upcoming issue of Health Devices. PMID:15202335

2004-05-01

85

The development of a falls prevention and management toolkit for hospices.  

PubMed

In 2008 a small group of people in the UK were brought together at the invitation of the charity Help the Hospices and with the support of the National Patient Safety Agency to create a falls prevention and management toolkit. The purpose of the toolkit was to assist hospices to manage and if possible prevent falls in their in-patient units and day care centres.This Falls Prevention Working Group put together a policy, care plan, and incident report form designed to enable an accurate and effective assessment of patients' needs and minimise harm while supporting patient independence. A draft version of the toolkit was trialled by nine hospices in 2009. Following revision, a final version was published on the Help the Hospices and Patient Safety First websites in 2010 and introduced with workshops in two separate locations in the UK. This paper provides an overview of the development process and presents evidence, albeit limited, that in-patient falls in hospices are reducing. The toolkit provides outcome measures of better patient care in falls management and prevention. PMID:23971308

Fisher, Simon

2013-05-01

86

Randomized Controlled Trial Comparing Tailoring Methods of Multimedia-Based Fall Prevention Education for Community-Dwelling Older Adults  

PubMed Central

OBJECTIVE We attempted to determine whether multimedia fall prevention education using different instructional strategies increases older adults’ knowledge of fall threats and their fall prevention behaviors. METHOD Fifty-three community-dwelling older adults were randomized to two educational groups or a control group. Multimedia-based educational interventions to increase fall threats knowledge and encourage fall prevention behaviors had two tailoring strategies: (1) improve content realism for individual learners (authenticity group) and (2) highlight program goals and benefits while using participants’ content selections (motivation group). Knowledge was measured at baseline and 1-mo follow-up. Participants recorded prevention behaviors for 1 mo. RESULTS Intervention group participants showed greater knowledge gains and posttest knowledge than did control group participants. The motivation group engaged in more prevention behaviors over 1 mo than did the other groups. CONCLUSION Tailoring fall prevention education by addressing authenticity and motivation successfully improved fall threats knowledge. Combining motivational strategies with multimedia education increased the effectiveness of the intervention in encouraging fall prevention behaviors.

Schepens, Stacey L.; Panzer, Victoria; Goldberg, Allon

2012-01-01

87

A protocol for evidence-based targeting and evaluation of statewide strategies for preventing falls among community-dwelling older people in Victoria, Australia  

Microsoft Academic Search

BackgroundFalls are a significant threat to the safety, health and independence of older citizens. Despite the now substantial evidence about effective falls prevention interventions, translation into falls reductions has not yet been fully realised. While the hip fracture rate is decreasing, the number and rate of fall-related hospital admissions among older people is increasing. The challenge now is to deliver

Lesley Day; Caroline F Finch; Keith D Hill; Terry P Haines; Lindy Clemson; Margaret Thomas; Catherine Thompson

2010-01-01

88

Randomised factorial trial of falls prevention among older people living in their own homes  

Microsoft Academic Search

Objective To test the effectiveness of, and explore interactions between, three interventions to prevent falls among older people. Design A randomised controlled trial with a full factorial design. Setting Urban community in Melbourne, Australia. Participants 1090 aged 70 years and over and living at home. Most were Australian born and rated their health as good to excellent; just over half

Lesley Day; Brian Fildes; Ian Gordon; Michael Fitzharris; Harold Flamer; Stephen Lord; Victoria Melbourne; Australia Ian Gordon

2002-01-01

89

Do Dual Tasks Have an Added Value Over Single Tasks for Balance Assessment in Fall Prevention Programs? A Mini-Review  

Microsoft Academic Search

Background: The Prevention of Falls Network Europe (ProFaNE) aims to bring together European researchers and clinicians to focus on the development of effective falls prevention programs for older people. One of the objectives is to identify suitable balance assessment tools. Assessment procedures that combine a balance task with a cognitive task may be relevant since part of all falls occurs

A. Zijlstra; T. Ufkes; D. A. Skelton; L. Lundin-Olsson; W. Zijlstra

2008-01-01

90

The strategic development of the NSW Health Plan for Prevention of Falls and Harm from Falls Among Older People: 2011-2015; translating research into policy and practice.  

PubMed

With our rapidly ageing population there is an urgent imperative to minimise the rate of falls and associated injuries. A key challenge to public health is to better conceptualise and contextualise falls prevention evidence for more effective policy making and practice. This paper describes how NSW Health adopted the Nutbeam and Bauman Stages of Research and Evaluation Model in the strategic development of the NSW Health Plan for Prevention of Falls and Harm from Falls Among Older People: 2011-2015. Research evidence has been comprehensively applied to every stage of the development of the Plan and research and evaluation is a key action area within the new Plan. The Stages of Research and Evaluation Model provides a useful overarching framework for policy makers to contextualise and more effectively apply research evidence throughout the policy making process from problem definition to program monitoring. PMID:21632003

Milat, Andrew J; Monger, Claire; Smith, Joanne; Bauman, Adrian; Redman, Sally; Goodger, Brendan

2011-06-01

91

How big does the effect of an intervention have to be? Application of two novel methods to determine the smallest worthwhile effect of a fall prevention programme: a study protocol  

PubMed Central

Introduction This project concerns the identification of the smallest worthwhile effect (SWE) of exercise-based programmes to prevent falls in older people. The SWE is the smallest effect that justifies the costs, risks and inconveniences of an intervention and is used to inform the design and interpretation of systematic reviews and randomised clinical trials. Methods and analysis This study will comprise two different methodological approaches: the benefit-harm trade-off method and the discrete choice experiment to estimate the SWE of exercise interventions to prevent falls in older people. In the benefit-harm trade-off method, hypothetical scenarios with the benefits, costs, risks and inconveniences associated with the intervention will be presented to each participant. Then, assuming a treatment effect of certain magnitude, the participant will be asked if he or she would choose to have the intervention. The size of the hypothetical benefit will be varied up and down until it is possible to identify the SWE for which the participant would choose to have the intervention. In the discrete choice experiment, the same attributes (benefits, costs, risks and inconveniences) with varying levels will be presented as choice sets, and participants will be asked to choose between these choice sets. With this approach, we will determine the probability that a person will consider the effects of an intervention to be worthwhile, given the particular costs, risks and inconveniences. For each of the two approaches, participants will be interviewed in person and on different occasions. A subsample of the total cohort will participate in both interviews. Ethics and dissemination This project has received Ethics Approval from the University of Sydney Human Ethics Committee (Protocol number: 14404). Findings will be disseminated through conference presentations, seminars and peer-reviewed scientific journals.

Franco, Marcia Rodrigues; Ferreira, Manuela L; Howard, Kirsten; Sherrington, Catherine; Rose, John; Haines, Terry P; Ferreira, Paulo

2013-01-01

92

The Role of Culture and Diversity in the Prevention of Falls among Older Chinese People.  

PubMed

ABSTRACTThis grounded-theory study explored the perceptions of Chinese older people, living in England, on falls and fear of falling, and identified facilitators and barriers to fall prevention interventions. With a sample of 30 Chinese older people, we conducted two focus groups and 10 in-depth interviews in Mandarin or Cantonese. Interview transcripts, back translated, were analyzed using N6. Constant comparative analysis highlighted a range of health-seeking behaviors after a fall: Chinese older people were reluctant to use formal health services; talking about falls was avoided; older people hid falls from their adult children to avoid worrying them; and fatalistic views about falls and poor knowledge about availability and content of interventions were prevalent. Cost of interventions was important. Chinese older adults valued their independence, and cultural intergenerational relations had an impact on taking action to prevent falls. Cultural diversity affects older adults' acceptance of fall prevention interventions. PMID:21401976

Horton, Khim; Dickinson, Angela

2011-03-15

93

Community falls prevention for people who call an emergency ambulance after a fall: an economic evaluation alongside a randomised controlled trial  

PubMed Central

Objective: we estimated the cost-effectiveness of a community falls prevention service compared with usual care from a National Health Service and personal social services perspective over the 12 month trial period. Design: a cost-effectiveness and cost utility analysis alongside a randomised controlled trial Setting: community. Participants: people over 60 years of age living at home or in residential care who had fallen and called an emergency ambulance but were not taken to hospital. Interventions: referral to community fall prevention services or usual health and social care. Measurements: incremental cost per fall prevented and incremental cost per Quality-Adjusted Life Years (QALYs) Results: a total of 157 participants (82 interventions and 75 controls) were used to perform the economic evaluation. The mean difference in NHS and personal social service costs between the groups was £-1,551 per patient over 1 year (95% CI: £-5,932 to £2,829) comparing the intervention and control groups. The intervention patients experienced on average 5.34 fewer falls over 12 months (95% CI: ?7.06 to ?3.62). The mean difference in QALYs was 0.070 (95% CI: ?0.010 to 0.150) in favour of the intervention group. Conclusion: the community falls prevention service was estimated to be cost-effective in this high-risk group. Current Controlled Trials ISRCTN67535605. (controlled-trials.com)

Sach, Tracey H.; Logan, Philippa A.; Coupland, Carol A. C.; Gladman, John R. F.; Sahota, Opinder; Stoner-Hobbs, Valarie; Robertson, Kate; Tomlinson, Vicki; Ward, Marie; Avery, Anthony J.

2012-01-01

94

Differing approaches to falls and fracture prevention between Australia and Colombia  

PubMed Central

Falls and fractures are major causes of morbidity and mortality in older people. More importantly, previous falls and/or fractures are the most important predictors of further events. Therefore, secondary prevention programs for falls and fractures are highly needed. However, the question is whether a secondary prevention model should focus on falls prevention alone or should be implemented in combination with fracture prevention. By comparing a falls prevention clinic in Manizales (Colombia) versus a falls and fracture prevention clinic in Sydney (Australia), the objective was to identify similarities and differences between these two programs and to propose an integrated model of care for secondary prevention of fall and fractures. A comparative study of services was performed using an internationally agreed taxonomy. Service provision was compared against benchmarks set by the National Institute for Health and Clinical Excellence (NICE) and previous reports in the literature. Comparison included organization, administration, client characteristics, and interventions. Several similarities and a number of differences that could be easily unified into a single model are reported here. Similarities included population, a multidisciplinary team, and a multifactorial assessment and intervention. Differences were eligibility criteria, a bone health assessment component, and the therapeutic interventions most commonly used at each site. In Australia, bone health assessment is reinforced whereas in Colombia dizziness assessment and management is pivotal. The authors propose that falls clinic services should be operationally linked to osteoporosis services such as a “falls and fracture prevention clinic,” which would facilitate a comprehensive intervention to prevent falls and fractures in older persons.

Gomez, Fernando; Curcio, Carmen Lucia; Suriyaarachchi, Pushpa; Demontiero, Oddom; Duque, Gustavo

2013-01-01

95

Best practice in fall prevention: roles of informal caregivers, health care providers and the community.  

PubMed

Falls are an important public health problem for older adults, resulting in significant morbidity and mortality, as well as healthcare costs. Evidence supports the assessment of older adults' fall risks and implementation of interventions to reduce these risks. Older adults are the key stakeholder in preventing falls, but need the support of their informal caregivers, healthcare providers, and community groups. This article addresses the roles of these additional stakeholders in providing and supporting best practices in fall prevention. Together these stakeholders can assist older adults in self-management of fall prevention, based on the preferences of the individual, local resources, and available programmes and healthcare services. PMID:22078020

Lach, Helen W; Krampe, Jean; Phongphanngam, Sutthida

2011-12-01

96

Process factors explaining the ineffectiveness of a multidisciplinary fall prevention programme: A process evaluation  

PubMed Central

Background Falls are a major health threat to older community-living people, and initiatives to prevent falls should be a public health priority. We evaluated a Dutch version of a successful British fall prevention programme. Results of this Dutch study showed no effects on falls or daily functioning. In parallel to the effect evaluation, we carried out a detailed process evaluation to assess the feasibility of our multidisciplinary fall prevention programme. The present study reports on the results of this process evaluation. Methods Our fall prevention programme comprised a medical and occupational-therapy assessment, resulting in recommendations and/or referrals to other services if indicated. We used self-administered questionnaires, structured telephone interviews, structured recording forms, structured face-to-face interviews and a plenary group discussion to collect data from participants allocated to the intervention group (n = 166) and from all practitioners who performed the assessments (n = 8). The following outcomes were assessed: the extent to which the multidisciplinary fall prevention programme was performed according to protocol, the nature of the recommendations and referrals provided to the participants, participants' self-reported compliance and participants' and practitioners' opinions about the programme. Results Both participants and practitioners judged the programme to be feasible. The programme was largely performed according to protocol. The number of referrals and recommendations ensuing from the medical assessment was relatively small. Participants' self-reported compliance as regards contacting their GP to be informed of the recommendations and/or referrals was low to moderate. However, self-reported compliance with such referrals and recommendations was reasonable to good. A large majority of participants reported they had benefited from the programme. Conclusion The results of the present study show that the programme was feasible for both practitioners and participants. Main factors that seem to be responsible for the lack of effectiveness are the relatively low number of referrals and recommendations ensuing from the medical assessments and participants' low compliance as regards contacting their GP about the results of the medical assessment. We do not recommend implementing the programme in its present form in regular care. Trial registration ISRCTN64716113

Bleijlevens, Michel HC; Hendriks, Marike RC; van Haastregt, Jolanda CM; van Rossum, Erik; Kempen, Gertrudis IJM; Diederiks, Joseph PM; Crebolder, Harry FJM; van Eijk, Jacques ThM

2008-01-01

97

Fall prevention practices in adult medical-surgical nursing units described by nurse managers.  

PubMed

The purpose of this article was to describe nursing practices (e.g., assessment, interventions) around fall prevention, as perceived by nurse managers in adult, medical-surgical nursing units. One hundred forty nurse managers from 51 hospitals from across the United States participated. Descriptive frequencies are used to describe nurse manager responses. The most commonly used fall risk assessment tool was the Morse Fall Risk Assessment Tool (40%). The most common fall prevention interventions included bed alarms (90%), rounds (70%), sitters (68%), and relocating the patient closer to the nurses' station (56%). Twenty-nine percent of nurse managers identified physical restraints as an intervention to prevent falls whereas only 10% mentioned ambulation. No nurse manager identified that RN hours per patient-day were adjusted to prevent falls or fall-related injuries. More work is needed to build systems that ensure evidence-based nursing interventions are consistently applied in acute care. PMID:20921126

Shever, Leah L; Titler, Marita G; Mackin, Melissa Lehan; Kueny, Angela

2010-10-04

98

A failed fall prevention study in an acute care setting: lessons from the swamp.  

PubMed

Designing and implementing fall intervention studies in acute care settings presents researchers with a number of challenges. To date, there are no fall prevention interventions that have unequivocal empirical support in these settings. Based on the best available evidence a multistrategy fall prevention program was implemented using a pretest-post-test design over a 12-month period. The results indicated no reduction in the fall rate. Contrary to the expected result, the fall rate increased post the implementation of the multistrategy fall prevention program. To assist other researchers understand the contextual and methodological barriers to conducting fall prevention research in acute care settings, this paper discusses the difficulties experienced in this study. PMID:11811315

O'Connell, B; Myers, H

2001-04-01

99

Evaluation of a fall-prevention program in older people after femoral neck fracture: a one-year follow-up  

Microsoft Academic Search

Summary  A randomized, controlled fall-prevention study including 199 patients operated on for femoral neck fracture reduced inpatient\\u000a falls and injuries. No statistically significant effects of the intervention program could be detected after discharge. It\\u000a seems that fall-prevention must be part of everyday life in fall-prone old people.\\u000a \\u000a \\u000a \\u000a Introduction  This study evaluates whether a postoperative multidisciplinary, multifactorial fall-prevention program performed by a geriatric

M. Berggren; M. Stenvall; B. Olofsson; Y. Gustafson

2008-01-01

100

Predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people  

PubMed Central

Background Despite emerging evidence that foot problems and inappropriate footwear increase the risk of falls, there is little evidence as to whether foot-related intervention strategies can be successfully implemented. The aim of this study was to evaluate adherence rates, barriers to adherence, and the predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people. Methods The intervention group (n = 153, mean age 74.2 years) of a randomised trial that investigated the effectiveness of a multifaceted podiatry intervention to prevent falls was assessed for adherence to the three components of the intervention: (i) foot orthoses, (ii) footwear advice and footwear cost subsidy, and (iii) a home-based foot and ankle exercise program. Adherence to each component and the barriers to adherence were documented, and separate discriminant function analyses were undertaken to identify factors that were significantly and independently associated with adherence to the three intervention components. Results Adherence to the three components of the intervention was as follows: foot orthoses (69%), footwear (54%) and home-based exercise (72%). Discriminant function analyses identified that being younger was the best predictor of orthoses use, higher physical health status and lower fear of falling were independent predictors of footwear adherence, and higher physical health status was the best predictor of exercise adherence. The predictive accuracy of these models was only modest, with 62 to 71% of participants correctly classified. Conclusions Adherence to a multifaceted podiatry intervention in this trial ranged from 54 to 72%. People with better physical health, less fear of falling and a younger age exhibited greater adherence, suggesting that strategies need to be developed to enhance adherence in frailer older people who are most at risk of falling. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12608000065392.

2011-01-01

101

The effect of visual impairment on patients' falls risk.  

PubMed

When older people fall it can result in injuries and adversely affect quality of life. People with visual impairment are at greater risk of falling. This article explores the risk of falling and preventive assessment in patients with visual impairment, whether they are in long-term care settings or living in their own homes. Five types of visual impairment common to older people are discussed. The importance of assessment for falls prevention and suggestions for practice are highlighted. PMID:24067043

Newton, Mel; Sanderson, Allyson

2013-10-01

102

Role of the musculoskeletal system and the prevention of falls.  

PubMed

Approximately 30% of older adults fall at least once per year, with falls being the leading cause of fatal and nonfatal injuries for individuals in this age group. Because of projected increases in the older adult population, the annual cost of fatal and nonfatal fall-related injuries is estimated to reach $32.4 billion in 2020. Falls in older adults are likely due to an interaction of multiple risk factors, including vitamin D deficiency, diminished strength and coordination, depression, multiple medications, and home hazards. Ultimately, the evidence supports a multifaceted approach to screening for fall-related risk factors and targeting treatment to address specific risks for each patient. While keeping in mind that the patient is the product of the dynamic interaction of body, mind, and spirit, the osteopathic physician is well suited to provide comprehensive, patient-centered care. PMID:22302742

Fraix, Marcel

2012-01-01

103

Falling towards forgetfulness: synaptic decay prevents spontaneous recovery of memory.  

PubMed

Long after a new language has been learned and forgotten, relearning a few words seems to trigger the recall of other words. This "free-lunch learning" (FLL) effect has been demonstrated both in humans and in neural network models. Specifically, previous work proved that linear networks that learn a set of associations, then partially forget them all, and finally relearn some of the associations, show improved performance on the remaining (i.e., nonrelearned) associations. Here, we prove that relearning forgotten associations decreases performance on nonrelearned associations; an effect we call negative free-lunch learning. The difference between free-lunch learning and the negative free-lunch learning presented here is due to the particular method used to induce forgetting. Specifically, if forgetting is induced by isotropic drifting of weight vectors (i.e., by adding isotropic noise), then free-lunch learning is observed. However, as proved here, if forgetting is induced by weight values that simply decay or fall towards zero, then negative free-lunch learning is observed. From a biological perspective, and assuming that nervous systems are analogous to the networks used here, this suggests that evolution may have selected physiological mechanisms that involve forgetting using a form of synaptic drift rather than synaptic decay, because synaptic drift, but not synaptic decay, yields free-lunch learning. PMID:18725945

Stone, James V; Jupp, Peter E

2008-08-22

104

Fall prevention in the community: what older people say they need.  

PubMed

Uptake of and adherence to fall prevention interventions is often poor and we know little about how older people's perceptions of and beliefs about fall prevention interventions affect uptake. This study aimed to explore older people's perceptions of the facilitators and barriers to participation in fall prevention interventions. We undertook a qualitative study with older people who had taken part in, declined to participate or adhere to fall prevention interventions using semi-structured interviews (n=65), and 17 focus groups (n=122) with older people (including 32 South Asian and 30 Chinese older people) in primary and community care settings in the South of England. A number of factors acted as either barriers or facilitators to uptake of interventions. Older people also made recommendations for improving access to interventions. Community nurses are ideally placed to screen older people, identify those at risk of falling and refer them to appropriate interventions as well as providing health promotion and education. PMID:21471918

Dickinson, Angela; Machen, Ina; Horton, Khim; Jain, Deepak; Maddex, Ted; Cove, Jenny

2011-04-01

105

Falls  

Microsoft Academic Search

Falls in older people are very common and for some the consequences can be devastating. The clinical assessment, management and investigation of patients who present with falls can be challenging for the non-specialist, and multiple guidelines and algorithms have been published to aid that process. This article has been prepared as a concise reference that reviews the most recent evidence

Rose A. Kenny; Roman Romero-Ortuno; Lisa Cogan

2009-01-01

106

Postural Control in Multiple Sclerosis: Implications for Fall Prevention  

Microsoft Academic Search

People with multiple sclerosis (MS) often have poor postural control, which likely underlies their increased risk of falls.\\u000a Based on several studies of balance and gait in MS, it appears that the primary mechanisms underlying the observed changes\\u000a are slowed somatosensory conduction and impaired central integration. This review of the published research on balance, gait,\\u000a and falls in people with

Michelle H. Cameron; Stephen Lord

2010-01-01

107

Preventing falls on an elderly care rehabilitation ward  

Microsoft Academic Search

Objective: Comparison of two flooring types – carpet and vinyl – in the bed areas, and two modes of physiotherapy – conventional therapy and additional leg strengthening exercises – in avoiding falls.Design: Randomized 2 × 2 controlled trial.Setting: Elderly care rehabilitation ward in a community hospital.Subjects: Fifty-four consecutive patients referred for rehabilitation.Outcome measures: The incidence of falls, and the change

I P Donald; K. Pitt; E. Armstrong; H. Shuttleworth

2000-01-01

108

Martial arts fall training to prevent hip fractures in the elderly  

Microsoft Academic Search

Summary  Hip fractures are a common and serious consequence of falls. Training of proper fall techniques may be useful to prevent hip\\u000a fractures in the elderly. The results suggested that martial arts fall techniques may be trainable in older individuals. Better\\u000a performance resulted in a reduced impact force.\\u000a \\u000a \\u000a \\u000a Introduction  Hip fractures are a common and serious consequence of falls. Fall training may

B. E. Groen; E. Smulders; D. de Kam; J. E. J. Duysens; V. G. M. Weerdesteijn

2010-01-01

109

Bayesian hierarchical modeling for a non-randomized, longitudinal fall prevention trial with spatially correlated observations  

PubMed Central

Because randomization of participants is often not feasible in community-based health interventions, non-randomized designs are commonly employed. Non-randomized designs may have experimental units that are spatial in nature, such as zip codes that are characterized by aggregate statistics from sources like the U.S. census and the Centers for Medicare and Medicaid Services. A perennial concern with non-randomized designs is that even after careful balancing of influential covariates, bias may arise from unmeasured factors. In addition to facilitating the analysis of interventional designs based on spatial units, Bayesian hierarchical modeling can quantify unmeasured variability with spatially correlated residual terms. Graphical analysis of these spatial residuals demonstrates whether variability from unmeasured covariates is likely to bias the estimates of interventional effect. The Connecticut Collaboration for Fall Prevention is the first large-scale longitudinal trial of a community-wide healthcare intervention designed to prevent injurious falls in older adults. Over a two-year evaluation phase, this trial demonstrated a rate of fall-related utilization at hospitals and emergency departments by persons 70 years and older in the intervention area that was 11 per cent less than that of the usual care area, and a 9 per cent lower rate of utilization from serious injuries. We describe the Bayesian hierarchical analysis of this non-randomized intervention with emphasis on its spatial and longitudinal characteristics. We also compare several models, using posterior predictive simulations and maps of spatial residuals.

Murphy, T. E.; Allore, H. G.; Leo-Summers, L.; Carlin, B. P.

2012-01-01

110

Scales for assessing self-efficacy of nurses and assistants for preventing falls  

PubMed Central

Aim This paper is a report of the development and testing of the Self-Efficacy for Preventing Falls Nurse and Assistant scales. Background Patient falls and fall-related injuries are traumatic ordeals for patients, family members and providers, and carry a toll for hospitals. Self-efficacy is an important factor in determining actions persons take and levels of performance they achieve. Performance of individual caregivers is linked to the overall performance of hospitals. Scales to assess nurses and certified nursing assistants’ self-efficacy to prevent patients from falling would allow for targeting resources to increase SE, resulting in improved individual performance and ultimately decreased numbers of patient falls. Method Four phases of instrument development were carried out to (1) generate individual items from eight focus groups (four each nurse and assistant conducted in October 2007), (2) develop prototype scales, (3) determine content validity during a second series of four nurse and assistant focus groups (January 2008) and (4) conduct item analysis, paired t-tests, Student’s t-tests and internal consistency reliability to refine and confirm the scales. Data were collected during February–December, 2008. Results The 11-item Self-Efficacy for Preventing Falls Nurse had an alpha of 0·89 with all items in the range criterion of 0·3–0·7 for item total correlation. The 8-item Self-Efficacy for Preventing Falls Assistant had an alpha of 0·74 and all items had item total correlations in the 0·3–0·7 range. Conclusions The Self-Efficacy for Preventing Falls Nurse and Self-Efficacy for Preventing Falls Assistant scales demonstrated psychometric adequacy and are recommended to measure bedside staff’s self-efficacy beliefs in preventing patient falls.

Dykes, Patricia C.; Carroll, Diane; McColgan, Kerry; Hurley, Ann C.; Lipsitz, Stuart R.; Colombo, Lisa; Zuyev, Lyubov; Middleton, Blackford

2011-01-01

111

Prevention of Damage to Falling Fruits and Vegetables.  

National Technical Information Service (NTIS)

This invention relates to and has among its objects the provision of novel methods for the reduction of damage to falling articles such as fruits and vegetables. Damage to fruits or vegetables dropped into receptacles is reduced by filling the receptacles...

J. M. Krochta

1979-01-01

112

Characteristics of Patient Fall Prevention Programs in Level 1 Veterans Administration Medical Centers.  

National Technical Information Service (NTIS)

The study describes the incidence and characteristics of Patient Fall Prevention Programs in Level I Veterans Administration Medical Centers using the nursing process conceptual framework. The program was defined as a structural series of activities usual...

D. R. Hines

1986-01-01

113

Heterogeneity of Falls Among Older Adults: Implications for Public Health Prevention  

PubMed Central

Objectives We examined risk factors for falls among older people according to indoor and outdoor activity at the time of the fall and explored risk factors for seriously injurious falls. Methods Data came from MOBILIZE Boston, a prospective cohort study of 765 community-dwelling women and men, mainly aged 70 years or older. Over 4.3 years, 1737 falls were recorded, along with indoor or outdoor activity at the time of the fall. Results Participants with poor baseline health characteristics had elevated rates of indoor falls while transitioning, walking, or not moving. Healthy, active people had elevated rates of outdoor falls during walking and vigorous activity. For instance, participants with fast, rather than normal, gait speed, had a rate ratio of 7.36 (95% confidence interval [CI] = 2.54, 21.28) for outdoor falls during vigorous activity. The likelihood of a seriously injurious fall also varied by personal characteristics, activity, and location. For example, the odds ratio for serious injury from an outdoor fall while walking outside compared to inside a participant’s neighborhood was 3.31 (95% CI = 1.33, 8.23). Conclusions Fall prevention programs should be tailored to personal characteristics, activities, and locations.

Kelsey, Jennifer L.; Procter-Gray, Elizabeth; Hannan, Marian T.; Li, Wenjun

2012-01-01

114

A Case Control Study to Improve Accuracy of an Electronic Fall Prevention Toolkit  

PubMed Central

Patient falls are a serious and commonly report adverse event in hospitals. In 2009, our team conducted the first randomized control trial of a health information technology-based intervention that significantly reduced falls in acute care hospitals. However, some patients on intervention units with access to the electronic toolkit fell. The purpose of this case control study was to use data mining and modeling techniques to identify the factors associated with falls in hospitalized patients when the toolkit was in place. Our ultimate aim was to apply our findings to improve the toolkit logic and to generate practice recommendations. The results of our evaluation suggest that the fall prevention toolkit logic is accurate but strategies are needed to improve adherence with the fall prevention intervention recommendations generated by the electronic toolkit.

Dykes, Patricia C.; I-Ching, Evita Hou; Soukup, Jane R.; Chang, Frank; Lipsitz, Stuart

2012-01-01

115

Vitamin D Treatment for the Prevention of Falls in Older Adults: Systematic Review and Meta-Analysis  

PubMed Central

Objectives To systematically review and quantitatively synthesize the effect of vitamin D therapy on fall prevention in older adults. Design Systematic review and meta-analysis. Setting MEDLINE, CINAHL,Web of Science, EMBASE, Cochrane Library, LILACS, bibliographies of selected articles, and previous systematic reviews through February 2009 were searched for eligible studies. Participants Older adults (aged ?60 years) who participated in randomized controlled trials that investigated the effectiveness of vitamin D therapy in the prevention of falls and used an explicit fall definition. Measurements Two authors independently extracted data including study characteristics, quality assessment, and outcomes. The I2 statistic was used to assess heterogeneity in a randomeffects model. Results Of 1,679 potentially relevant articles, 10 studies met inclusion criteria. In pooled analysis, vitamin D therapy (200-1000IU) reduced falls by 14% (relative risk [RR] 0.86;95% confidence interval 0.79-0.93;I2=7%) compared to calcium or placebo; number needed to treat=15. The following subgroups had significant fall reductions: community-dwelling (age<80 years), adjunctive calcium supplementation, no history of fractures/falls, duration>6 months, cholecalciferol, and dose?800 IU. Meta-regression demonstrated no linear association of vitamin D dose or duration with treatment effect. Post-hoc analysis, including 7 additional studies (17 total) without explicit fall definitions, yielded smaller benefit (RR 0.92,0.87-0.98) and more heterogeneity (I2=36%) but found significant intergroup differences favoring adjunctive calcium versus none (p=0.001). Conclusion Vitamin D treatment effectively reduces the risk of falls in older adults. Future studies should investigate whether particular populations or treatment regimens may have greater benefit.

Kalyani, Rita Rastogi; Stein, Brady; Valiyil, Ritu; Manno, Rebecca; Maynard, Janet W.; Crews, Deidra

2010-01-01

116

Journey to a safe environment: fall prevention in an emergency department at a level I trauma center.  

PubMed

Predicting which patients will fall is a challenging task, especially in the often unpredictable setting of an emergency department of a Level I Trauma Center. Unfortunately, there is a great potential for falls to occur in this environment. Fall risk assessment tools used in inpatient settings do not adequately capture the risk factors of patients presenting to the emergency department. The ability to accurately identify patients at risk for falling at the point of entry is the first step toward preventing patient harm. Once patients are identified as at risk for a fall, the next challenge is to be sure that they do not fall. We created the KINDER1 Fall Risk Assessment Tool for use in the emergency department. This instrument was specifically designed for the rapid identification of patients at risk for a fall as well as the re-evaluation of patients for fall risk throughout their stay in the emergency department. Once we had an appropriate assessment tool, our next challenge was for staff to consistently apply fall prevention interventions. Performing a mini-root cause analysis on each fall showed trends and in turn led to the design and implementation of specific fall prevention interventions to motivate the nursing staff to focus on fall prevention that the ED nursing leadership used to select change strategies. With improved identification of fall risk patients and consistent application of innovative prevention strategies, we were able to show a trend toward reduction of falls and fall-related injuries in our emergency department. PMID:23380299

Alexander, Danette; Kinsley, Terry L; Waszinski, Christine

2013-02-04

117

Effectiveness of a Multifaceted Intervention on Falls in Nursing Home Residents  

Microsoft Academic Search

OBJECTIVES: To evaluate the effectiveness of a multifac- eted, nonpharmaceutical intervention on incidence of falls and fallers. DESIGN: Prospective, cluster-randomized, controlled 12- month trial. SETTING: Six community nursing homes in Germany. PARTICIPANTS: Long-stay residents (n ? 981) aged 60 and older; mean age 85; 79% female. INTERVENTIONS: Staff and resident education on fall prevention, advice on environmental adaptations, progres- sive

Clemens Becker; Martina Kron; Ulrich Lindemann; Elisabeth Sturm; Barbara Eichner; Barbara Walter-Jung; Thorsten Nikolaus

2003-01-01

118

Falls after Discharge from Hospital: Is There a Gap between Older Peoples' Knowledge about Falls Prevention Strategies and the Research Evidence?  

ERIC Educational Resources Information Center

|Purpose: The aim of this study was to examine whether older people are prepared to engage in appropriate falls prevention strategies after discharge from hospital. Design and Methods: We used a semi-structured interview to survey older patients about to be discharged from hospital and examined their knowledge regarding falls prevention strategies…

Hill, Anne-Marie; Hoffmann, Tammy; Beer, Christopher; McPhail, Steven; Hill, Keith D.; Oliver, David; Brauer, Sandra G.; Haines, Terry P.

2011-01-01

119

Can volunteer companions prevent falls among inpatients? A feasibility study using a pre-post comparative design  

Microsoft Academic Search

BACKGROUND: Falls in hospital are frequent and their consequences place an increased burden on health services. We evaluated a falls prevention strategy consisting of the introduction of volunteers to 'sit' with patients identified as being at high risk of falling. METHODS: Two four bed 'safety bays' located on medical wards in two hospitals within southern Adelaide were used. Ward fall

Lynne C Giles; Denise Bolch; Robyn Rouvray; Beth McErlean; Craig H Whitehead; Paddy A Phillips; Maria Crotty

2006-01-01

120

Outcomes from the implementation of a facility specific evidence-based falls prevention intervention program in residential aged care  

Microsoft Academic Search

For residents in long-term care facilities, falling is a major concern requiring preventive intervention. A prospective cohort study measured the impact of falls reduction following the implementation of evidence-based fall prevention interventions in nine Australian residential care facilities. An external project team provided a comprehensive audit of current practice. Facilitated by an action research approach, interventions were individualized to facility

Jennifer C. Nitz; Elizabeth Cyarto; Sharon Andrews; Marcia Fearn; Stephanie Fu M. Phty; Terrence Haines; Betty Haralambous; Keith Hill; Susan Hunt; Emma Lea; Kirsten Moore; Emma Renehan

121

Falls-prevention programs for older ambulatory community dwellers: from public health research to health promotion policy  

Microsoft Academic Search

Summary Objectives:Falls result in significant morbidity and mortality among the elderly. The purpose was to review the public health research literature on falls prevention among community-dwelling older adults and derive evidence-based implications for health promotion policy. Methods:CINAHL, COCHRANE, EMBASE, MEDLINE, and PUBMED databases were used to search the research literature concerning falls epidemiology, injury mechanisms, and falls-prevention strategies published during

Ray Marks; John P. Allegrante

2004-01-01

122

Community-based health efforts for the prevention of falls in the elderly.  

PubMed

Falls are a major public health problem in the elderly population. The associated health care cost is great. It has therefore become an important public health matter to evaluate those interventions that might be effective in reducing the risk of falls. Risk factors that predict an increased risk of falling are described. We discuss interventions that can be employed in the community to reduce the risk of falls and associated injuries by discipline, including physiotherapy, occupational therapy, and physician-led interventions. We also discuss the cost-effectiveness of such interventions. PMID:21472088

Hanley, Alan; Silke, Carmel; Murphy, John

2010-12-20

123

Community-based health efforts for the prevention of falls in the elderly  

PubMed Central

Falls are a major public health problem in the elderly population. The associated health care cost is great. It has therefore become an important public health matter to evaluate those interventions that might be effective in reducing the risk of falls. Risk factors that predict an increased risk of falling are described. We discuss interventions that can be employed in the community to reduce the risk of falls and associated injuries by discipline, including physiotherapy, occupational therapy, and physician-led interventions. We also discuss the cost-effectiveness of such interventions.

Hanley, Alan; Silke, Carmel; Murphy, John

2011-01-01

124

Falls prevention within the Australian general practice data model: methodology, information model, and terminology issues.  

PubMed

The iterative development of the Falls Risk Assessment and Management System (FRAMS) drew upon research evidence and early consumer and clinician input through focus groups, interviews, direct observations, and an online questionnaire. Clinical vignettes were used to validate the clinical model and program logic, input, and output. The information model was developed within the Australian General Practice Data Model (GPDM) framework. The online FRAMS implementation used available Internet (TCP/IP), messaging (HL7, XML), knowledge representation (Arden Syntax), and classification (ICD10-AM, ICPC2) standards. Although it could accommodate most of the falls prevention information elements, the GPDM required extension for prevention and prescribing risk management. Existing classifications could not classify all falls prevention concepts. The lack of explicit rules for terminology and data definitions allowed multiple concept representations across the terminology-architecture interface. Patients were more enthusiastic than clinicians. A usable standards-based online-distributed decision support system for falls prevention can be implemented within the GPDM, but a comprehensive terminology is required. The conceptual interface between terminology and architecture requires standardization, preferably within a reference information model. Developments in electronic decision support must be guided by evidence-based clinical and information models and knowledge ontologies. The safety and quality of knowledge-based decision support systems must be monitored. Further examination of falls and other clinical domains within the GPDM is needed. PMID:12807809

Liaw, Siaw-Teng; Sulaiman, Nabil; Pearce, Christopher; Sims, Jane; Hill, Keith; Grain, Heather; Tse, Justin; Ng, Choon-Kiat

2003-06-04

125

Falls Prevention within the Australian General Practice Data Model: Methodology, Information Model, and Terminology Issues  

PubMed Central

The iterative development of the Falls Risk Assessment and Management System (FRAMS) drew upon research evidence and early consumer and clinician input through focus groups, interviews, direct observations, and an online questionnaire. Clinical vignettes were used to validate the clinical model and program logic, input, and output. The information model was developed within the Australian General Practice Data Model (GPDM) framework. The online FRAMS implementation used available Internet (TCP/IP), messaging (HL7, XML), knowledge representation (Arden Syntax), and classification (ICD10-AM, ICPC2) standards. Although it could accommodate most of the falls prevention information elements, the GPDM required extension for prevention and prescribing risk management. Existing classifications could not classify all falls prevention concepts. The lack of explicit rules for terminology and data definitions allowed multiple concept representations across the terminology–architecture interface. Patients were more enthusiastic than clinicians. A usable standards-based online-distributed decision support system for falls prevention can be implemented within the GPDM, but a comprehensive terminology is required. The conceptual interface between terminology and architecture requires standardization, preferably within a reference information model. Developments in electronic decision support must be guided by evidence-based clinical and information models and knowledge ontologies. The safety and quality of knowledge-based decision support systems must be monitored. Further examination of falls and other clinical domains within the GPDM is needed.

Liaw, Siaw-Teng; Sulaiman, Nabil; Pearce, Christopher; Sims, Jane; Hill, Keith; Grain, Heather; Tse, Justin; Ng, Choon-Kiat

2003-01-01

126

Formative evaluation of the telecare fall prevention project for older veterans  

PubMed Central

Background Fall prevention interventions for community-dwelling older adults have been found to reduce falls in some research studies. However, wider implementation of fall prevention activities in routine care has yielded mixed results. We implemented a theory-driven program to improve care for falls at our Veterans Affairs healthcare facility. The first project arising from this program used a nurse advice telephone line to identify patients' risk factors for falls and to triage patients to appropriate services. Here we report the formative evaluation of this project. Methods To evaluate the intervention we: 1) interviewed patient and employee stakeholders, 2) reviewed participating patients' electronic health record data and 3) abstracted information from meeting minutes. We describe the implementation process, including whether the project was implemented according to plan; identify barriers and facilitators to implementation; and assess the incremental benefit to the quality of health care for fall prevention received by patients in the project. We also estimate the cost of developing the pilot project. Results The project underwent multiple changes over its life span, including the addition of an option to mail patients educational materials about falls. During the project's lifespan, 113 patients were considered for inclusion and 35 participated. Patient and employee interviews suggested support for the project, but revealed that transportation to medical care was a major barrier in following up on fall risks identified by nurse telephone triage. Medical record review showed that the project enhanced usual medical care with respect to home safety counseling. We discontinued the program after 18 months due to staffing limitations and competing priorities. We estimated a cost of $9194 for meeting time to develop the project. Conclusions The project appeared feasible at its outset but could not be sustained past the first cycle of evaluation due to insufficient resources and a waning of local leadership support due to competing national priorities. Future projects will need both front-level staff commitment and prolonged high-level leadership involvement to thrive.

2011-01-01

127

Medication-related falls in the elderly: causative factors and preventive strategies.  

PubMed

People are living to older age. Falls constitute a leading cause of injuries, hospitalization and deaths among the elderly. Older people fall more often for a variety of reasons: alterations in physiology and physical functioning, and the use (and misuse) of medications needed to manage their multiple conditions. Pharmacological factors that place the elderly at greater risk of drug-related side effects include changes in body composition, serum albumin, total body water, and hepatic and renal functioning. Drug use is one of the most modifiable risk factors for falls and falls-related injuries. Fall-risk increasing drugs (FRIDs) include drugs for cardiovascular diseases (such as digoxin, type 1a anti-arrhythmics and diuretics), benzodiazepines, antidepressants, antiepileptics, antipsychotics, antiparkinsonian drugs, opioids and urological spasmolytics. Psychotropic and benzodiazepine drug use is most consistently associated with falls. Despite the promise of a more favourable side-effect profile, evidence shows that atypical antipsychotic medications and selective serotonin reuptake inhibitor antidepressants do not reduce the risk of falls and hip fractures. Despite multiple efforts with regards to managing medication-associated falls, there is no clear evidence for an effective intervention. Stopping or lowering the dose of psychotropic drugs and benzodiazepines does work, but ensuring a patient remains off these drugs is a challenge. Computer-assisted alerts coupled with electronic prescribing tools are a promising approach to lowering the risk of falls as the use of information technologies expands within healthcare. PMID:22550966

Huang, Allen R; Mallet, Louise; Rochefort, Christian M; Eguale, Tewodros; Buckeridge, David L; Tamblyn, Robyn

2012-05-01

128

Falls, aging, and disability.  

PubMed

Falls are a major public health problem, contributing to significant morbidity and mortality among older adults in the United States. This article summarizes and compares (1) fall prevalence rates, (2) fall risk factors, (3) consequences of falls, and (4) current knowledge about fall prevention interventions between community-dwelling older adults and people aging with physical disability. In this latter group, the article focuses on individuals with multiple sclerosis, late-effects of polio, muscular dystrophies, and spinal cord injuries. PMID:20494282

Finlayson, Marcia L; Peterson, Elizabeth W

2010-05-01

129

Falls prevention advice and visual feedback to those at risk of falling: study protocol for a pilot randomized controlled trial  

PubMed Central

Background Studies have shown that functional strength and balance exercises can reduce the risk of falling in older people if they are done on a regular basis. However, the repetitive nature of these exercises; combined with the inherent lack of feedback of progress may discourage seniors from exercising in the home, thereby rendering such an intervention ineffective. This study hypothesizes that the use of visual feedback and multimodal games will be more effective in encouraging adherence to home rehabilitation than standard care; thereby promoting independence and improving the quality of life in older adults at risk of falling. Methods A pllel-group pilot randomized controlled trial with 3 groups of participants will be conducted in the home for 12 weeks. Participants will include older adults who have been identified as at risk of falling (n?=?48), over the age of 65, living in the community, and suitable for a home exercise intervention. The primary outcome is adherence to exercise. Secondary outcomes include: variability in stride length, stride time and double support time (DST); walking speed; Timed up and go test (TUG); Falls Efficacy Scale International (FES-I); CONFbal scale; Romberg’s test; and quality of life measures (SF-12 and EuroQol EQ-5D). Qualitative assessments on personal experiences with rehabilitation tools will be done before and after the trial. Discussion This study will investigate the use of visual feedback and engaging multimodal activities to address the problem of non-compliance to home exercises for falls rehabilitation. One of the unique qualities of this study is the adaptation of special participatory design methods through which the end users (fallers) will be involved in the design of the proposed rehabilitation tools at various stages of the design process. Trial registration ISRCTN79967470

2013-01-01

130

[Prevention of falls by elderly people in oral health care practices  

Microsoft Academic Search

Oral health care practices are ever more frequently visited by frail elderly people. Frail elderly people are at risk for fall accidents due to intrinsic and extrinsic factors. Intrinsic factors are patient-related and extrinsic factors are environment-related. Significant intrinsic fall risk factors for elderly people are orthostatic and postprandial hypotension. The most important effect of hypotension is cerebral hypoperfusion, which

S. H. Smit; P. de Baat; J. M. Schols; C. de Baat

2010-01-01

131

Falling towards Forgetfulness: Synaptic Decay Prevents Spontaneous Recovery of Memory  

Microsoft Academic Search

Long after a new language has been learned and forgotten, relearning a few words seems to trigger the recall of other words. This “free-lunch learning” (FLL) effect has been demonstrated both in humans and in neural network models. Specifically, previous work proved that linear networks that learn a set of associations, then partially forget them all, and finally relearn some

James V. Stone; Peter E. Jupp

2008-01-01

132

Psychosocial Issues in Engaging Older People with Physical Activity Interventions for the Prevention of Falls  

ERIC Educational Resources Information Center

|This article presents an overview of the psychosocial factors that influence older people's participation in physical activity interventions to prevent falls. The importance of psychosocial factors is stressed inasmuch as interventions will be rendered useless if they do not successfully gain the active participation of older people. The theory…

Nyman, Samuel R.

2011-01-01

133

Development of a Fall Prevention Survey to Determine Educational Needs for Primary Care Providers  

Microsoft Academic Search

Quality indicators are standardized measures of health care quality. We designed a survey to assess how knowledge, attitude, and organizational practices might affect healthcare provider behaviors in meeting quality indicators for fall prevention to plan curricula for a continuing educational intervention. The survey was pilot tested in the Veterans Affairs (VA) in a small stratified sample. Some items that had

B. Josea Kramer; David A. Ganz; Rebecca L. Vivrette; Judith O. Harker; Karen R. Josephson; Debra Saliba

2010-01-01

134

Framework for preventing accidental falls in hospitals - management plan for ADL, medication and medical conditions.  

PubMed

Prevention and reduction of medical accidents is essential. Among medical accidents, accidental falls remain a serious problem. While "assessment score sheets" have already been used in hospitals to prevent accidental falls, satisfactory results have not actually been achieved. In this study, we aim to establish a methodology for preventing accidental falls. We consider that the 'management plan' for each patient includes three factors. A plan of instructions for patients on actions they can take for safety in their ADL (Activities of Daily Living) is essential as a base. Second, a plan to keep up with any short term change in a patient's state is needed, because the state of a hospitalized patient will usually be temporarily affected by medication and changing medical conditions. We develop a model for preventing accidental falls, which enable us to design appropriate management plan for each patient. Then, we develop a prototype system based on the designed model. Finally, we address the result of verification of the model, by applying the prototype system into actual cases in hospitals. PMID:19592884

Kato, Shogo; Tsuru, Satoko; Iizuka, Yoshinori

2009-01-01

135

Prevention of falls in the elderly trial (PROFET): a randomised controlled trial  

Microsoft Academic Search

Summary Background Falls in elderly people are a common presenting complaint to accident and emergency departments. Current practice commonly focuses on the injury, with little systematic assessment of the underlying cause, functional consequences, and possibilities for future prevention. We undertook a randomised controlled study to assess the benefit of a structured inderdisciplinary assessment of people who have fallen in terms

Jacqueline Close; Margaret Ellis; Richard Hooper; Edward Glucksman; Stephen Jackson; Cameron Swift

1999-01-01

136

The Interdisciplinary Nature of Unintended Fall Prevention among Older Adults: Renewed Emphasis Needed on Underlying Psychological Constructs  

Microsoft Academic Search

Prevention of unintended falls among adults is a major public health focus. Previous researchers have indicated the importance of addressing the physiological issues impacting fall risk, as well as the inclusion of activities designed to improve self efficacy regarding the completion of activities of daily living. However, less published research has examined the impact of psychological variables impacting falls efficacy.

John F. Yannessa

137

Strategy to prevent falls in the Thai elderly: a controlled study integrated health research program for the Thai elderly.  

PubMed

Instability or falls are one of the important warning symptoms of underlying serious illness among the elderly, so many studies have concentrated on the risk factors for falls. However, a study involving a strategic method to reduce the incidence of falls is the next step and is the main objective of this study. 1,043 elderly subjects living in the urban area around Siriraj Hospital Medical School, Bangkok, were recruited, 585 of them were allocated to the study group and 458 subjects to the control group. A leaflet containing information on important risk factors of falls within their community was enclosed with a follow-up postcard in the study group only. In addition, this particular group was allowed free access to the geriatric clinic at Siriraj Hospital if there was any health problem. All of them received a postcard asking about any falls which had occurred over the previous 2 months on 6 occasions and a telephone call if the postcards were not returned to the team. The percentage of elderly who kept in contact was 92.5 per cent, 90.6 per cent, 89.3 per cent, 89.2 per cent, 86.2 per cent and 85.45 per cent for the first to final follow-up respectively. After one year of longitudinal study, the overall incidence of falls was 6.6 per cent in the study group and 10.1 per cent in the control group. The incidence of falls began to show a statistically significant difference between the two groups at the fourth and sixth episodes of follow-up (P = 0.002 and 0.004). The Kaplan-Meier survival analysis also revealed a statistically significant difference in the incidence of falls between the two groups (P =0.01). In conclusion, the incidence of falls was significantly reduced in the study group and a repeated campaign to alert the elderly to the risk of falling is a cost-effective way of fall prevention among the healthy elderly in the community. PMID:12081122

Assantachai, Prasert; Chatthanawaree, Wichai; Thamlikitkul, Visanu; Praditsuwan, Rungnirand; Pisalsarakij, Dujpratana

2002-02-01

138

An examination of the impact of gender and veteran status on falls among community-dwelling seniors: implications for targeting falls prevention activities.  

PubMed

The objective of this study was to broaden our understanding of the specific characteristics of community-dwelling seniors who are at increased risk of falling and becoming injured, by paying particular attention to gender and veteran status. The 137 respondents included 69 senior male veterans and 68 seniors in the general population. Results indicated that the veterans were at higher risk of falling than the general senior population, and were at higher risk of becoming injured after falling. Senior women were at less risk of falling and becoming injured than the veterans, but were at higher risk than the senior nonveteran men. It is imperative to target screening and falls prevention activities at these and other specific subgroups in the senior population that are at high risk of falling and becoming injured. PMID:19241648

Weeks, Lori E

139

Effectiveness of simple balancing training program in elderly patients with history of frequent falls  

PubMed Central

Objective: To study the effectiveness of simply-performed balancing exercises in fall prevention. Design: Pre- and post-trial. Setting: University hospital from January 2009 to May 2010. Participants: Elderly with falls in the previous year. Intervention: Simple balancing exercise was performed at home every day and was recorded in the booklet. Measurements: New falling events and a battery of balancing abilities including the Timed Up and Go Test (TUGT), chair stand, functional reach, and Berg balance scale-short form were evaluated at baseline, 3-, 6-, 9-, and 12-month periods. Fear of falling and quality of life scores were assessed at baseline and 12-month periods. Results: 146 subjects were recruited, 116 female (79.5%) with a mean age of 67.1 years. At the end of the study, 49% of participants had not fallen. All of the balancing abilities were compared between frequent and infrequent fallers and were significantly improved (P < 0.001) except for functional reach in the frequent fall group. Most subjects (72%–79%) complied well with the exercise program. However, compliance had no effect on balancing abilities. About 36.4% of participants had adverse events from exercise, of which knee pain was the top ranked. The quality of life and the fall efficacy scores increased significantly at the end of the study. Factors affecting falling were compliance with exercise (adjusted odds ratio [OR]: 2.55, 95% confidence intervals [CI]: 1.04, 6.30) and a history of falling ?3 times in the previous year (adjusted OR: 3.76, 95% CI: 1.18, 11.98). Conclusion: Performing simply-designed balancing exercises, at least 3 days per week, can increase balancing abilities, and decrease fall rates in the elderly with a history of previous falls. However, strategies to encourage elderly compliance may prevent falling.

Kuptniratsaikul, Vilai; Praditsuwan, Rungnirand; Assantachai, Prasert; Ploypetch, Teerada; Udompunturak, Suthipol; Pooliam, Julaporn

2011-01-01

140

Tailored Education for Older Patients to Facilitate Engagement in Falls Prevention Strategies after Hospital Discharge--A Pilot Randomized Controlled Trial  

PubMed Central

Background The aims of the study were to evaluate the effect of providing tailored falls prevention education in hospital on: i) engagement in targeted falls prevention behaviors in the month after discharge: ii) patients’ self-perceived risk and knowledge about falls and falls prevention strategies after receiving the education. Methods A pilot randomized controlled trial (n?=?50): baseline and outcome assessments conducted by blinded researchers. Participants: hospital inpatients 60 years or older, discharged to the community. Participants were randomized into two groups. The intervention was a tailored education package consisting of multimedia falls prevention information with trained health professional follow-up, delivered in addition to usual care. Outcome measures were engagement in falls prevention behaviors in the month after discharge measured at one month after discharge with a structured survey, and participants’ knowledge, confidence and motivation levels before and after receiving the education. The feasibility of providing the intervention was examined and falls outcomes (falls, fall-related injuries) were also collected. Results Forty-eight patients (98%) provided follow-up data. The complete package was provided to 21 (84%) intervention group participants. Participants in the intervention group were significantly more likely to plan how to safely restart functional activities [Adjusted odds ratio 3.80, 95% CI (1.07, 13.52), p?=?0.04] and more likely to complete other targeted behaviors such as completing their own home exercise program [Adjusted odds ratio 2.76, 95% CI (0.72, 10.50), p?=?0.14] than the control group. The intervention group was significantly more knowledgeable, confident and motivated to engage in falls prevention strategies after receiving the education than the control group. There were 23 falls (n?=?5 intervention; n?=?18 control) and falls rates were 5.4/1000 patient days (intervention); 18.7/1000 patient days (control). Conclusion This tailored education was received positively by older people, resulted in increased engagement in falls prevention strategies after discharge and is feasible to deliver to older hospital patients. Trial registration The study was registered with the Australian New Zealand Clinical Trials Registry; ACTRN12611000963921 on 8th November 2011.

Hill, Anne-Marie; Etherton-Beer, Christopher; Haines, Terry P.

2013-01-01

141

Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis  

PubMed Central

Objective To evaluate the effectiveness of multifactorial assessment and intervention programmes to prevent falls and injuries among older adults recruited to trials in primary care, community, or emergency care settings. Design Systematic review of randomised and quasi-randomised controlled trials, and meta-analysis. Data sources Six electronic databases (Medline, Embase, CENTRAL, CINAHL, PsycINFO, Social Science Citation Index) to 22 March 2007, reference lists of included studies, and previous reviews. Review methods Eligible studies were randomised or quasi-randomised trials that evaluated interventions to prevent falls that were based in emergency departments, primary care, or the community that assessed multiple risk factors for falling and provided or arranged for treatments to address these risk factors. Data extraction Outcomes were number of fallers, fall related injuries, fall rate, death, admission to hospital, contacts with health services, move to institutional care, physical activity, and quality of life. Methodological quality assessment included allocation concealment, blinding, losses and exclusions, intention to treat analysis, and reliability of outcome measurement. Results 19 studies, of variable methodological quality, were included. The combined risk ratio for the number of fallers during follow-up among 18 trials was 0.91 (95% confidence interval 0.82 to 1.02) and for fall related injuries (eight trials) was 0.90 (0.68 to 1.20). No differences were found in admissions to hospital, emergency department attendance, death, or move to institutional care. Subgroup analyses found no evidence of different effects between interventions in different locations, populations selected for high risk of falls or unselected, and multidisciplinary teams including a doctor, but interventions that actively provide treatments may be more effective than those that provide only knowledge and referral. Conclusions Evidence that multifactorial fall prevention programmes in primary care, community, or emergency care settings are effective in reducing the number of fallers or fall related injuries is limited. Data were insufficient to assess fall and injury rates.

2008-01-01

142

Effectiveness of a Community-Based Multifactorial Intervention on Falls and Fall Risk Factors in Community-Living Older Adults: A Randomized, Controlled Trial  

Microsoft Academic Search

Objective. The purpose of this study was to evaluate the effectiveness of a 12-month community-based intervention on falls and risk factors (balance, lower extremity strength, and mobility) in community-living older adults. Methods. Four hundred fifty-three sedentary adults (65 years old or older) were randomized to either a multifaceted intervention (3 times a week group exercise, 6 hours of fall prevention

Anne Shumway-Cook; Ilene F. Silver; Mary LeMier; Sally York; Peter Cummings; Thomas D. Koepsell

2007-01-01

143

Effects of fall injury type and discharge placement on mortality, hospitalization, falls, and ADL changes among older people in Taiwan.  

PubMed

A longitudinal study was conducted to investigate the effects of injury type and discharge placement on mortality, falls, hospital admissions, and changes in activities of daily living (ADLs) over a 12-month period among older fallers. Of 762 community-dwelling people aged 65 years or older who visited an emergency department (ED) of a general hospital in Taiwan due to a fall, 273 sustained a hip fracture, 157 had a vertebral fracture, 47 had a distal forearm fracture, 102 had a traumatic brain injury, and 183 had soft-tissue injuries. Results showed that, compared to patients with a soft-tissue injury, those with TBI had significantly higher risks of dying (rate ratio (RR)=3.59) and hospital admissions (RR=3.23) and better improvement in ADLs (1.93 points) at 6 months post-injury, and those who sustained a hip fracture (4.26 and 4.41 points), a vertebral fracture (3.81 and 3.83 points), or a distal-forearm fracture (2.80 and 2.80 points) had significantly better improvement in ADLs at 6 and 12 months post-injury. Patients discharged to a nursing home had a significantly increased risk of death (RR=2.08) and hospital admission (RR=2.05) than those returning to their usual residence during the first year post-injury. No significant differences in the occurrence of falls during the first post-injury year were found among patients with different injury types or between those with different discharge placements. In conclusion, among the five major fall injury types in older people, TBIs result in the highest risk of death and hospital admissions, while hip and vertebral fractures exhibited the largest improvement during the first year after injury. Additionally, nursing home care may be associated with increased risks of death and hospital admissions than home care. In addition to primary prevention of falls, further research to investigate mechanisms leading to TBIs during a fall is needed to facilitate effective secondary fall-prevention programs for older people. PMID:22878142

Yu, Wen-Yu; Hwang, Hei-Fen; Hu, Ming-Hsia; Chen, Chih-Yi; Lin, Mau-Roung

2012-08-09

144

Radar walking speed measurements of seniors in their apartments: technology for fall prevention.  

PubMed

Falls are a significant cause of injury and accidental death among persons over the age of 65. Gait velocity is one of the parameters which have been correlated to the risk of falling. We aim to build a system which monitors gait in seniors and reports any changes to caregivers, who can then perform a clinical assessment and perform corrective and preventative actions to reduce the likelihood of falls. In this paper, we deploy a Doppler radar-based gait measurement system into the apartments of thirteen seniors. In scripted walks, we show the system measures gait velocity with a mean error of 14.5% compared to the time recorded by a clinician. With a calibration factor, the mean error is reduced to 10.5%. The radar is a promising sensing technology for gait velocity in a day-to-day senior living environment. PMID:23365880

Cuddihy, Paul E; Yardibi, Tarik; Legenzoff, Zachary J; Liu, Liang; Phillips, Calvin E; Abbott, Carmen; Galambos, Colleen; Keller, James; Popescu, Mihail; Back, Jessica; Skubic, Marjorie; Rantz, Marilyn J

2012-01-01

145

Falls prevention and support: translating research, integrating services and promoting the contribution of service users for quality and innovative programmes of care.  

PubMed

Falls are a significant threat to the safety, health and independence of older citizens. Despite the substantial evidence that is available around effective falls prevention programmes and interventions, their translation into falls reduction programmes and policies has yet to be fully realised. While hip fracture rates are decreasing, the number and incidence of fall-related hospital admissions among older people continue to rise. Given the demographic trends that highlight increasing numbers of older people in the UK, which is broadly reflected internationally, there is a financial and social imperative to minimise the rate of falls and associated injuries. Falling is closely aligned to growing older (Slips, Trips and Falls Update: From Acute and Community Hospitals and Mental Health Units in England and Wales, Department of Health, HMSO, London, 2010). According to the World Health Organization, around 30% of older people aged over 65 and 50% of those over 80 will fall each year (Falls Fact Sheet Number 344, WHO, Geneva, 2010). Falls happen as a result of many reasons and can have harmful consequences, including loss of mobility and independence, confidence and in many cases even death (Cochrane Database Syst Rev 15, 2009, 146; Slips, Trips and Falls Update: From Acute and Community Hospitals and Mental Health Units in England and Wales, Department of Health, HMSO, London, 2010; Falling Standards, Broken Promises: Report of the National Audit of Falls and Bone Health in Older People 2010, Health Care Quality Improvement Partnership, London, 2011). What is neither fair nor correct is the common belief by old and young alike that falls are just another inconvenience to put up with. The available evidence justifiably supports the view that well-organised services, based upon national standards and expert guidance, can prevent future falls among older people and reduce death and disability from fractures. This paper will draw from the UK, as an exemplar for policy and practice, to discuss the strategic direction of falls prevention programmes for older people and the partnerships that need to exist between researchers, service providers and users of services to translate evidence to the clinical setting. Second, it will propose some mechanisms for disseminating evidence to healthcare professionals and other stakeholders, to improve the quality and capacity of the clinical workforce. PMID:22078021

Gormley, Kevin J

2011-12-01

146

Generalization of gait adaptation for fall prevention: from moveable platform to slippery floor  

NSDL National Science Digital Library

A person's ability to transfer the acquired improvements in the control of center of mass (COM) state stability to slips induced in everyday conditions can have profound theoretical and practical implications for falls prevention. This study investigated the extent to which such generalization could take place. A training group (N=8) initially experienced 24 right-side slips in blocked-and-random order (from the first unannounced, novel slip, S-1 to the last, S-24) resulting from release of a low-friction moveable platform in walking. They then experienced a single unannounced slip while walking on an oil-lubricated vinyl floor surface (V-T). A control group (N=8) received only one unannounced slip on the same slippery floor (V-C). Results demonstrated that the incidence of balance loss and fall on V-T was comparable to that on S-24. In both trials fall and balance loss incidence was significantly reduced in comparison with that on S-1 or on V-C, resulting from significant improvements in the COM state stability. The observed generalization indicates that the control of COM stability can be optimally acquired to accommodate alterations in environmental constraints, and it may be broadly coded and easily modifiable within the CNS. Because of such mechanisms, it is possible that the locomotor-balance skills acquired with the aid of low friction moveable platforms can translate into resisting falls encountered in daily living.

Tanvi Bhatt (University of Illinois); Yi-Chun Clive Pai (University of Illinois)

2008-09-05

147

Generalization of Gait Adaptation for Fall Prevention: From Moveable Platform to Slippery Floor  

PubMed Central

A person's ability to transfer the acquired improvements in the control of center of mass (COM) state stability to slips induced in everyday conditions can have profound theoretical and practical implications for fall prevention. This study investigated the extent to which such generalization could take place. A training group (n = 8) initially experienced 24 right-side slips in blocked-and-random order (from the 1st unannounced, novel slip, S-1 to the last, S-24) resulting from release of a low-friction moveable platform in walking. They then experienced a single unannounced slip while walking on an oil-lubricated vinyl floor surface (V-T). A control group (n = 8) received only one unannounced slip on the same slippery floor (V-C). Results demonstrated that the incidence of balance loss and fall on V-T was comparable to that on S-24. In both trials, fall and balance-loss incidence was significantly reduced in comparison with that on S-1 or on V-C, resulting from significant improvements in the COM state stability. The observed generalization indicates that the control of COM stability can be optimally acquired to accommodate alterations in environmental constraints, and it may be broadly coded and easily modifiable within the CNS. Because of such mechanisms, it is possible that the locomotor-balance skills acquired with the aid of low-friction moveable platforms can translate into resisting falls encountered in daily living.

Bhatt, T.; Pai, Y. C.

2009-01-01

148

Children can't fly: a program to prevent childhood morbidity and mortality from window falls.  

PubMed

"Children Can't Fly" is a health education program developed by the New York City Department of Health to combat the high incidence of child mortality and morbidity due to falls from windows. The success of the program, begun in 1972, in drastically reducing death and injury persuaded the New York City Board of Health to amend the Health Code in 1976 to require that landlords provide window guards in apartments where children ten years old and younger reside. The law is the first and only one of its kind in the nation. The program has four major components: 1) reporting of falls by hospital emergency rooms and police precincts, followed up by counseling, referral, and data collecting by public health nurses; 2) a media campaign to inform the public and elevate their awareness of the hazards; 3) community education for prevention through door-to-door hazard identification, counseling by outreach workers, community organization efforts with schools, tenant groups, clinics, churches, health care providers, etc; 4) provision of free, easily installed window guards to families with young children living in high-risk areas. Significant reduction in falls resulted, particularly in the Bronx, where reported falls declined 50 percent from 1973 to 1975. The program is one solution to an urgent urban problem which other cities might consider to avert the loss of life and limb, and the corollary financial burden for hospitalization, rehabilitation, and maintenance of the injured and permanently disabled. PMID:596496

Spiegel, C N; Lindaman, F C

1977-12-01

149

Preventing disability and falls in older adults: a population-based randomized trial.  

PubMed Central

OBJECTIVES. Because preventing disability and falls in older adults is a national priority, a randomized controlled trial was conducted to test a multicomponent intervention program. METHODS. From a random sample of health maintenance organization (HMO) enrollees 65 years and older, 1559 ambulatory seniors were randomized to one of three groups: a nurse assessment visit and follow-up interventions targeting risk factors for disability and falls (group 1, n = 635); a general health promotion nurse visit (group 2, n = 317); and usual care (group 3, n = 607). Data collection consisted of a baseline and two annual follow-up surveys. RESULTS. After 1 year, group 1 subjects reported a significantly lower incidence of declining functional status and a significantly lower incidence of falls than group 3 subjects. Group 2 subjects had intermediate levels of most outcomes. After 2 years of follow-up, the differences narrowed. CONCLUSIONS. The results suggest that a modest, one-time prevention program appeared to confer short-term health benefits on ambulatory HMO enrollees, although benefits diminished by the second year of follow-up. The mechanisms by which the intervention may have improved outcomes require further investigation.

Wagner, E H; LaCroix, A Z; Grothaus, L; Leveille, S G; Hecht, J A; Artz, K; Odle, K; Buchner, D M

1994-01-01

150

Nursing staff's awareness of keeping beds in the lowest position to prevent falls and fall injuries in an adult acute surgical inpatient care setting.  

PubMed

High beds are a safety concern. This qualitative study used pre-existing nurse interview data and confirmed nurses' awareness of the importance of keeping patient beds in the lowest position. Lowering the bed helps promote patient safety and prevent falls. PMID:23243783

Tzeng, Huey-Ming; Yin, Chang-Yi; Anderson, Allison; Prakash, Atul

151

Nursing staff's awareness of keeping beds in the lowest position to prevent falls and fall injuries in an adult acute surgical inpatient care setting  

PubMed Central

High beds are a safety concern. This qualitative study used pre-existing nurse interview data and confirmed nurses’ awareness of the importance of keeping patient beds in the lowest position. Lowering the bed helps promote patient safety and prevent falls.

Tzeng, Huey-Ming; Yin, Chang-Yi; Anderson, Allison; Prakash, Atul

2013-01-01

152

Reporting of complex interventions in clinical trials: development of a taxonomy to classify and describe fall-prevention interventions  

PubMed Central

Background Interventions for preventing falls in older people often involve several components, multidisciplinary teams, and implementation in a variety of settings. We have developed a classification system (taxonomy) to describe interventions used to prevent falls in older people, with the aim of improving the design and reporting of clinical trials of fall-prevention interventions, and synthesis of evidence from these trials. Methods Thirty three international experts in falls prevention and health services research participated in a series of meetings to develop consensus. Robust techniques were used including literature reviews, expert presentations, and structured consensus workshops moderated by experienced facilitators. The taxonomy was refined using an international test panel of five health care practitioners. We assessed the chance corrected agreement of the final version by comparing taxonomy completion for 10 randomly selected published papers describing a variety of fall-prevention interventions. Results The taxonomy consists of four domains, summarized as the "Approach", "Base", "Components" and "Descriptors" of an intervention. Sub-domains include; where participants are identified; the theoretical approach of the intervention; clinical targeting criteria; details on assessments; descriptions of the nature and intensity of interventions. Chance corrected agreement of the final version of the taxonomy was good to excellent for all items. Further independent evaluation of the taxonomy is required. Conclusions The taxonomy is a useful instrument for characterizing a broad range of interventions used in falls prevention. Investigators are encouraged to use the taxonomy to report their interventions.

2011-01-01

153

A national survey of services for the prevention and management of falls in the UK  

PubMed Central

Background The National Health Service (NHS) was tasked in 2001 with developing service provision to prevent falls in older people. We carried out a national survey to provide a description of health and social care funded UK fallers services, and to benchmark progress against current practice guidelines. Methods Cascade approach to sampling, followed by telephone survey with senior member of the fall service. Characteristics of the service were assessed using an internationally agreed taxonomy. Reported service provision was compared against benchmarks set by the National Institute for Health and Clinical Excellence (NICE). Results We identified 303 clinics across the UK. 231 (76%) were willing to participate. The majority of services were based in acute or community hospitals, with only a few in primary care or emergency departments. Access to services was, in the majority of cases, by health professional referral. Most services undertook a multi-factorial assessment. The content and quality of these assessments varied substantially. Services varied extensively in the way that interventions were delivered, and particular concern is raised about interventions for vision, home hazard modification, medication review and bone health. Conclusion The most common type of service provision was a multi-factorial assessment and intervention. There were a wide range of service models, but for a substantial number of services, delivery appears to fall below recommended NICE guidance.

Lamb, Sarah E; Fisher, Joanne D; Gates, Simon; Potter, Rachel; Cooke, Matthew W; Carter, Yvonne H

2008-01-01

154

What do community-dwelling Caucasian and South Asian 60-70 year olds think about exercise for fall prevention?  

PubMed Central

Background: strategies to prevent falls often recommend regular exercise. However, 40% of over 50s in the UK report less physical activity than is recommended. Even higher rates of sedentary behaviour have been reported among South Asian older adults. Objective: to identify salient beliefs that influence uptake and adherence to exercise for fall prevention among community-dwelling Caucasian and South Asian 60–70 year olds in the UK. Methods: we undertook an ethnographic study using participant observation, 15 focus groups (n = 87; mean age = 65.7 years) and 40 individual semi-structured interviews (mean age = 64.8 years). Data analysis used framework analysis. Results: young older adults do not acknowledge their fall risk and are generally not motivated to exercise to prevent falls. Those who had fallen are more likely to acknowledge risk of future falls. Whilst many of the beliefs about falls and exercise expressed were very similar between Caucasians and South Asians, there was a tendency for South Asians to express fatalistic beliefs more often. Conclusion: fall prevention should not be the focus of strategies to increase uptake and adherence to exercise. The wider benefits of exercise, leading to an active healthy lifestyle should be encouraged.

Horne, Maria; Speed, Shaun; Skelton, Dawn; Todd, Chris

2009-01-01

155

Process-evaluation of a home visit programme to prevent falls and mobility impairments among elderly people at risk.  

PubMed

This paper describes the results of a detailed evaluation of the intervention process of a multifactorial home visit programme aimed at preventing falls and mobility impairments among elderly persons living in the community. The aim of the study is to provide insight in factors related to the intervention process that may have influenced the effectiveness of this home visit programme. The programme consisted of five home visits performed by a community nurse over a period of 1 year. During the home visits the participants were screened for risk factors potentially influencing falls and mobility. The screening was followed by recommendations, referrals, and other actions aimed at dealing with the hazards observed. Data regarding the intervention process were gathered by means of interviews with nurses and participants, and by means of structured forms and questionnaires administered by the nurses during the intervention period. We conclude that our 1-year multifactorial home visit programme consisting of five home visits is feasible for nurses and participants. Despite this, it seems to be an unsuitable intervention technique to reduce falls and mobility impairments among elderly people at risk. PMID:12135821

van Haastregt, Jolanda C M; van Rossum, Erik; Diederiks, Jos P M; de Witte, Luc P; Voorhoeve, Peter M; Crebolder, Harry F J M

2002-08-01

156

Accident patterns and prevention measures for fatal occupational falls in the construction industry  

Microsoft Academic Search

Contributing factors to 621 occupational fatal falls have been identified with respect to the victim's individual factors, the fall site, company size, and cause of fall. Individual factors included age, gender, experience, and the use of personal protective equipment (PPE). Accident scenarios were derived from accident reports. Significant linkages were found between causes for the falls and accident events. Falls

Chia-Fen Chi; Tin-Chang Chang; Hsin-I Ting

2005-01-01

157

Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals  

PubMed Central

Background Theories of behavior change indicate that an analysis of barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses' opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore. Methods Nurses were surveyed to identify their perceptions regarding barriers to implementation of clinical practice guidelines in their practice setting. The validated questionnaire, 'Barriers and facilitators assessment instrument', was administered to nurses (n = 1830) working in the medical, surgical, geriatric units, at five acute care hospitals in Singapore. Results An 80.2% response rate was achieved. The greatest barriers to implementation of clinical practice guidelines reported included: knowledge and motivation, availability of support staff, access to facilities, health status of patients, and, education of staff and patients. Conclusion Numerous barriers to the use of the Fall Prevention Clinical Practice Guideline have been identified. This study has laid the foundation for further research into implementation of clinical practice guidelines in Singapore by identifying barriers to change in acute care settings.

Koh, Serena SL; Manias, Elizabeth; Hutchinson, Alison M; Donath, Susan; Johnston, Linda

2008-01-01

158

Falls in the elderly  

PubMed Central

Abstract Objective To provide family physicians with a practical, evidence-based approach to fall prevention in the elderly. Sources of information MEDLINE was searched using terms relevant to falls among the elderly in the community and in institutions. Relevant English-language papers published from 1980 to July 2010 were reviewed. Relevant geriatric society guidelines were reviewed as well. Main message Falls are a common and serious health problem with devastating consequences. Several risk factors have been identified in the literature. Falls can be prevented through several evidence-based interventions, which can be either single or multicomponent interventions. Identifying at-risk patients is the most important part of management, as applying preventive measures in this vulnerable population can have a profound effect on public health. Conclusion Family physicians have a pivotal role in screening older patients for risk of falls, and applying preventive strategies for patients at risk.

Al-Aama, Tareef

2011-01-01

159

Extent of implementation of evidence-based fall prevention practices for older patients in home health care.  

PubMed

This study determined the extent to which fall risk assessment and management practices for older patients were implemented in Medicare-certified home health agencies (HHAs) in a defined geographic area in southern New England that had participated in evidence-based fall prevention training between October 2001 and September 2004. The standardized in-service training sessions taught home health nurses and rehabilitation therapists how to conduct assessments for five evidence-based risk factors for falls in older adults--mobility impairments, balance disturbances, multiple medications, postural hypotension, and home environmental hazards--using techniques shown to be efficacious in clinical trials. Twenty-six HHAs participated in these in-service training sessions; 19 of these participated in a survey of nurses and rehabilitation therapists between October 2004 and September 2005. Self-reported assessment and management practices implemented with older patients during home healthcare visits were measured in this survey, and HHA-level measures for each fall risk factor were constructed based on proportions of clinicians reporting assessment and management practices that were recommended in the fall prevention training sessions. For all fall risk factors except postural hypotension, 80% or more of clinicians in all HHAs reported implementing recommended fall risk management practices. Greater variation was found regarding fall risk assessment practices, with fewer than 70% of clinicians in one or more HHAs reporting recommended assessment practices for all risk factors. Results suggest that evidence-based training for home healthcare clinicians can stimulate fall risk assessment and management practices during home health visits. HHA-level comparisons hold the potential to illustrate the extent of diffusion of evidence-based fall prevention practices within and between agencies. PMID:18284538

Fortinsky, Richard H; Baker, Dorothy; Gottschalk, Margaret; King, Mary; Trella, Patricia; Tinetti, Mary E

2008-02-13

160

An exercise intervention to prevent falls in Parkinson's: an economic evaluation  

PubMed Central

Background People with Parkinson’s (PwP) experience frequent and recurrent falls. As these falls may have devastating consequences, there is an urgent need to identify cost-effective interventions with the potential to reduce falls in PwP. The purpose of this economic evaluation is to compare the costs and cost-effectiveness of a targeted exercise programme versus usual care for PwP who were at risk of falling. Methods One hundred and thirty participants were recruited through specialist clinics, primary care and Parkinson’s support groups and randomised to either an exercise intervention or usual care. Health and social care utilisation and health-related quality of life (EQ-5D) were assessed over the 20 weeks of the study (ten-week intervention period and ten-week follow up period), and these data were complete for 93 participants. Incremental cost per quality adjusted life year (QALY) was estimated. The uncertainty around costs and QALYs was represented using cost-effectiveness acceptability curves. Results The mean cost of the intervention was £76 per participant. Although in direction of favour of exercise intervention, there was no statistically significant differences between groups in total healthcare (?£128, 95% CI: -734 to 478), combined health and social care costs (£-35, 95% CI: -817 to 746) or QALYs (0.03, 95% CI: -0.02 to 0.03) at 20 weeks. Nevertheless, exploration of the uncertainty surrounding these estimates suggests there is more than 80% probability that the exercise intervention is a cost-effective strategy relative to usual care. Conclusion Whilst we found no difference between groups in total healthcare, total social care cost and QALYs, analyses indicate that there is high probability that the exercise intervention is cost-effective compared with usual care. These results require confirmation by larger trial-based economic evaluations and over the longer term.

2012-01-01

161

Stumbling with optimal phase reset during gait can prevent a humanoid from falling.  

PubMed

The human biped walking shows phase- dependent transient changes in gait trajectory in response to external brief force perturbations. Such responses, referred to as the stumbling reactions, are usually accompanied with phase reset of the walking rhythm. Our previous studies provided evidence, based on a human gait experiment and analyses of mathematical models of gait in the sagittal plane, that an appropriate amount of phase reset in response to a perturbation depended on the gait phase at the perturbation and could play an important role for preventing the walker from a fall, thus increasing gait stability. In this paper, we provide a further material that supports this evidence by a gait experiment on a biped humanoid. In the experiment, the impulsive force perturbations were applied using push-impacts by a pendulum-like hammer to the back of the robot during gait. The responses of the external perturbations were managed by resetting the gait phase with different delays or advancements. The results showed that appropriate amounts of phase resetting contributed to the avoidance of falling against the perturbation during the three-dimensional robot gait. A parallelism with human gait stumbling reactions was discussed. PMID:16969676

Nakanishi, Masao; Nomura, Taishin; Sato, Shunsuke

2006-09-13

162

Older Adults Attending Georgia Senior Centers Increase Preventive Behaviors for Falls and Fractures Following a Community-Based Intervention  

Microsoft Academic Search

A community-based intervention to reduce risk factors related to falls and fractures administered to Georgians participating in the Older Americans Act (OAA) congregate meal-site program (N = 691, mean age = 75, 84% female, 45% Black and 55% White, convenience sample) was evaluated. The intervention consisted of 16 weekly sessions, with 8 focused on prevention of falls and fractures, and all 16 including a

Jennifer Teems; Dorothy B. Hausman; Joan G. Fischer; Jung Sun Lee; Mary Ann Johnson

2011-01-01

163

Models for effective prevention.  

PubMed

The social influence models do provide some optimism for primary prevention efforts. Prevention programs appear most effective when 1) the target behavior of the intervention has received increasing societal disapproval (such as cigarette smoking), 2) multiple years of behavioral health education are planned, and 3) community-wide involvement or mass media complement a school-based peer-led program (45,46). Short-term programs and those involving alcohol use have had less favorable outcomes. Future research in primary prevention should address concerns of high-risk groups and high-risk countries, such as lower income populations in the United States or countries that have large adolescent homeless populations. The utilization of adolescent leaders for program dissemination might be particularly critical in these settings. A second major and global concern should focus upon alcohol use and alcohol-related problems. In many communities adolescent alcohol use is normative and even adult supported. Thus, young people are getting quite inconsistent messages on alcohol from their schools, from TV, from peers, and from parents. This inconsistency may translate into many tragic and avoidable deaths for young people. Clearly, in the area of alcohol-related problems, community-wide involvement may be necessary. A third direction for prevention research should involve issues of norms, access, and enforcement including policy interventions, such as involve the availability of cigarette vending machines or the ease of under-age buying or levels of taxation. These methods affect adolescents more acutely since their financial resources, for the most part, are more limited. These policy level methods also signify to adolescents what adults consider appropriate.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1390786

Perry, C L; Kelder, S H

1992-07-01

164

The Patient Who Falls  

PubMed Central

Falls are common health events that cause discomfort and disability for older adults and stress for caregivers. Using the case of an older man who has experienced multiple falls and a hip fracture, this article, which focuses on community-living older adults, addresses the consequences and etiology of falls; summarizes the evidence on predisposing factors and effective interventions; and discusses how to translate this evidence into patient care. Previous falls; strength, gait, and balance impairments; and medications are the strongest risk factors for falling. Effective single interventions include exercise and physical therapy, cataract surgery, and medication reduction. Evidence suggests that the most effective strategy for reducing the rate of falling in community-living older adults may be intervening on multiple risk factors. Vitamin D has the strongest clinical trial evidence of benefit for preventing fractures among older men at risk. Issues involved in incorporating these evidence-based fall prevention interventions into outpatient practice are discussed, as are the trade-offs inherent in managing older patients at risk of falling. While challenges and barriers exist, fall prevention strategies can be incorporated into clinical practice.

Tinetti, Mary E.; Kumar, Chandrika

2013-01-01

165

Vision and agility training in community dwelling older adults: Incorporating visual training into programs for fall prevention  

PubMed Central

This study aimed to examine the effect of visual training on obstacle course performance of independent community dwelling older adults. Agility is the ability to rapidly alter ongoing motor patterns, an important aspect of mobility which is required in obstacle avoidance. However, visual information is also a critical factor in successful obstacle avoidance. We compared obstacle course performance of a group that trained in visually driven body movements and agility drills, to a group that trained only in agility drills. We also included a control group that followed the American College of Sports Medicine exercise recommendations for older adults. Significant gains in fitness, mobility and power were observed across all training groups. Obstacle course performance results revealed that visual training had the greatest improvement on obstacle course performance (22%) following a 12 week training program. These results suggest that visual training may be an important consideration for fall prevention programs.

Reed-Jones, Rebecca J.; Dorgo, Sandor; Hitchings, Maija K.; Bader, Julia O.

2012-01-01

166

Vision and agility training in community dwelling older adults: incorporating visual training into programs for fall prevention.  

PubMed

This study aimed to examine the effect of visual training on obstacle course performance of independent community dwelling older adults. Agility is the ability to rapidly alter ongoing motor patterns, an important aspect of mobility which is required in obstacle avoidance. However, visual information is also a critical factor in successful obstacle avoidance. We compared obstacle course performance of a group that trained in visually driven body movements and agility drills, to a group that trained only in agility drills. We also included a control group that followed the American College of Sports Medicine exercise recommendations for older adults. Significant gains in fitness, mobility and power were observed across all training groups. Obstacle course performance results revealed that visual training had the greatest improvement on obstacle course performance (22%) following a 12 week training program. These results suggest that visual training may be an important consideration for fall prevention programs. PMID:22206782

Reed-Jones, Rebecca J; Dorgo, Sandor; Hitchings, Maija K; Bader, Julia O

2011-12-27

167

Outcomes from the implementation of a facility-specific evidence-based falls prevention intervention program in residential aged care.  

PubMed

For residents in long-term care facilities, falling is a major concern requiring preventive intervention. A prospective cohort study measured the impact of falls reduction following the implementation of evidence-based fall prevention interventions in 9 Australian residential care facilities. An external project team provided a comprehensive audit of current practice. Facilitated by an action research approach, interventions were individualized to be facility- and patient-specific and included the following: environmental modifications such as low beds and height-adjustable chairs, movement alarms, hazard removal, and hip protectors. Participants included 670 residents and 650 staff from 9 facilities across 3 states. A significant reduction of falls were observed per site in the proportion of fallers (P = .044) and single fallers (P = .04). However, overall the number of falls was confounded by multiple falls in residents. Reduction in fallers was sustained in the 6-month follow-up phase. Positive outcomes from interventions varied between facilities. Further research is necessary to target frequent fallers. PMID:22209195

Nitz, Jennifer; Cyarto, Elizabeth; Andrews, Sharon; Fearn, Marcia; Fu, Stephanie; Haines, Terrence; Haralambous, Betty; Hill, Keith; Hunt, Susan; Lea, Emma; Moore, Kirsten; Renehan, Emma; Robinson, Andrew

2011-12-30

168

CONNECT for quality: protocol of a cluster randomized controlled trial to improve fall prevention in nursing homes  

PubMed Central

Background Quality improvement (QI) programs focused on mastery of content by individual staff members are the current standard to improve resident outcomes in nursing homes. However, complexity science suggests that learning is a social process that occurs within the context of relationships and interactions among individuals. Thus, QI programs will not result in optimal changes in staff behavior unless the context for social learning is present. Accordingly, we developed CONNECT, an intervention to foster systematic use of management practices, which we propose will enhance effectiveness of a nursing home Falls QI program by strengthening the staff-to-staff interactions necessary for clinical problem-solving about complex problems such as falls. The study aims are to compare the impact of the CONNECT intervention, plus a falls reduction QI intervention (CONNECT + FALLS), to the falls reduction QI intervention alone (FALLS), on fall-related process measures, fall rates, and staff interaction measures. Methods/design Sixteen nursing homes will be randomized to one of two study arms, CONNECT + FALLS or FALLS alone. Subjects (staff and residents) are clustered within nursing homes because the intervention addresses social processes and thus must be delivered within the social context, rather than to individuals. Nursing homes randomized to CONNECT + FALLS will receive three months of CONNECT first, followed by three months of FALLS. Nursing homes randomized to FALLS alone receive three months of FALLs QI and are offered CONNECT after data collection is completed. Complexity science measures, which reflect staff perceptions of communication, safety climate, and care quality, will be collected from staff at baseline, three months after, and six months after baseline to evaluate immediate and sustained impacts. FALLS measures including quality indicators (process measures) and fall rates will be collected for the six months prior to baseline and the six months after the end of the intervention. Analysis will use a three-level mixed model. Discussion By focusing on improving local interactions, CONNECT is expected to maximize staff's ability to implement content learned in a falls QI program and integrate it into knowledge and action. Our previous pilot work shows that CONNECT is feasible, acceptable and appropriate. Trial Registration ClinicalTrials.gov: NCT00636675

2012-01-01

169

The Role of the Pharmacist in Falls Prevention in the Elderly  

Microsoft Academic Search

Background: Falls are a significant health care problem, resulting in significant morbidity and mortality in the elderly population. Previous research has shown that medications play a contributing role in falls. It has also been shown that multifactorial interventions can reduce the risk of falls in community dwelling or institutional ized patients. Even though there are a significant number of publications

Cheryl A. Wiens

170

Quality Indicators for the Management and Prevention of Falls and Mobility Problems in Vulnerable Elders  

Microsoft Academic Search

alls and mobility problems are two of the most com- mon and serious concerns facing older adults. In ad- dition to reducing function and causing considerable morbidity and mortality, falls and instability precipitate premature nursing home admissions. Impaired gait and balance, which rank among the most significant under- lying causes of falls, are also common consequences of falls. Because older

Laurence Z. Rubenstein; Christopher M. Powers; Catherine H. MacLean

2001-01-01

171

Effects of lower extremity muscle fatigue on the outcomes of slip-induced falls  

Microsoft Academic Search

Slip-induced fall accidents continue to be a significant cause of fatal injuries and economic losses. Identifying the risk factors causing slip-induced falls is key to developing better preventive measures to reduce fall accidents. Although epidemiological studies suggest localised muscle fatigue may be one of the risk factors for slip-induced falls, there has been no documented biomechanical study examining the relationship

Prakriti Parijat; Thurmon E. Lockhart

2008-01-01

172

Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis  

Microsoft Academic Search

Objective To evaluate the effectiveness of multifactorial assessment and intervention programmes to prevent falls and injuries among older adults recruited to trials in primary care, community, or emergency care settings.Design Systematic review of randomised and quasi-randomised controlled trials, and meta-analysis.Data sources Six electronic databases (Medline, Embase, CENTRAL, CINAHL, PsycINFO, Social Science Citation Index) to 22 March 2007, reference lists of

S Gates; J D Fisher; M W Cooke; Y H Carter; S E Lamb

2008-01-01

173

A protocol for an individualised, facilitated and sustainable approach to implementing current evidence in preventing falls in residential aged care facilities  

Microsoft Academic Search

BACKGROUND: Falls are common adverse events in residential care facilities. Commonly reported figures indicate that at least 50% of residents fall in a 12 month period, and that this figure is substantially higher for residents with dementia. This paper reports the protocol of a project which aims to implement evidence based falls prevention strategies in nine residential aged care facilities

Betty Haralambous; Terry P Haines; Keith Hill; Kirsten Moore; Jennifer Nitz; Andrew Robinson

2010-01-01

174

Executive Function Is Independently Associated with Performances of Balance and Mobility in Community-Dwelling Older Adults after Mild Stroke: Implications for Falls Prevention  

Microsoft Academic Search

Background: Stroke survivors have a high incidence of falls. Impaired executive-controlled processes are frequent in stroke survivors and are associated with falls in this population. Better understanding of the independent association between executive-controlled processes and physiological fall risk (i.e. performances of balance and mobility) could enhance future interventions that aim to prevent falls and to promote an independent lifestyle among

Teresa Liu-Ambrose; Marco Y. C. Pang; Janice J. Eng

2007-01-01

175

Design of a continuous quality improvement program to prevent falls among community-dwelling older adults in an integrated healthcare system  

Microsoft Academic Search

BACKGROUND: Implementing quality improvement programs that require behavior change on the part of health care professionals and patients has proven difficult in routine care. Significant randomized trial evidence supports creating fall prevention programs for community-dwelling older adults, but adoption in routine care has been limited. Nationally-collected data indicated that our local facility could improve its performance on fall prevention in

David A Ganz; Elizabeth M Yano; Debra Saliba; Paul G Shekelle

2009-01-01

176

Older People's Views of Falls-Prevention Interventions in Six European Countries  

ERIC Educational Resources Information Center

|Purpose: Our study identified factors common to a variety of populations and settings that may promote or inhibit uptake and adherence to falls-related interventions. Design and Methods: Semistructured interviews to assess perceived advantages and barriers to taking part in falls-related interventions were carried out in six European countries…

Yardley, Lucy; Bishop, Felicity L.; Beyer, Nina; Hauer, Klaus; Kempen, Gertrudis I. J. M.; Piot-Ziegler, Chantal; Todd, Chris J.; Cuttelod, Therese; Horne, Maria; Lanta, Kyriaki; Holt, Anne Rosell

2006-01-01

177

Laboratory Review: The Role of Gait Analysis in Seniors’ Mobility and Fall Prevention  

Microsoft Academic Search

Walking is a complex motor task generally performed automatically by healthy adults. Yet, by the elderly, walking is often no longer performed automatically. Older adults require more attention for motor control while walking than younger adults. Falls, often with serious consequences, can be the result. Gait impairments are one of the biggest risk factors for falls. Several studies have identified

Stephanie A. Bridenbaugh; Reto W. Kressig

2011-01-01

178

Effects of submaximal fatiguing contractions on the components of dynamic stability control after forward falls.  

PubMed

The present study aimed to investigate the effect of lower extremity muscle fatigue on the dynamic stability control of physically active adults during forward falls. Thirteen participants (body mass: 70.2kg, height: 175cm) were instructed to regain balance with a single step after a sudden induced fall from a forward-leaning position before and after the fatigue protocol. The ground reaction forces were collected using four force plates at a sampling rate of 1080Hz. Kinematic data were recorded with 12 vicon cameras operating at 120Hz. Neither the reaction time nor the duration until touchdown showed any differences (p>0.05). The ability of the subjects to prevent falling did not change after the fatigue protocol. In the fatigued condition, the participants demonstrated an increase in knee flexion during the main stance phase and an increased time to decelerate the horizontal CM motion (both p<0.05). Significant (p<0.05) decreases were seen post-fatigue in average horizontal and vertical force and maximum knee and ankle joint moments. The fatigue related decrease in muscle strength did not affect the margin of stability, the boundary of the base of support or the position of the extrapolated centre of mass during the forward induced falls, indicating an appropriate adjustment of the motor commands to compensate the deficit in muscle strength. PMID:21237674

Walsh, Mark; Peper, Andreas; Bierbaum, Stefanie; Karamanidis, Kiros; Arampatzis, Adamantios

2011-01-14

179

Fall and Injury Prevention in Older People Living in Residential Care Facilities A Cluster Randomized Trial  

Microsoft Academic Search

Results: During the 34-week follow-up period, 82 residents (44%) in the intervention program sustained a fall compared with 109 residents (56%) in the control group (risk ratio, 0.78 (95% CI, 0.64 to 0.96)). The adjusted odds ratio was 0.49 (CI, 0.37 to 0.65), and the adjusted incidence rate ratio of falls was 0.60 (CI, 0.50 to 0.73). Each of 3

Jane Jensen; Lillemor Lundin-Olsson; Lars Nyberg; Yngve Gustafson

180

Effect of flame spray coating on falling film evaporation for multi effect distillation system  

Microsoft Academic Search

Horizontal tube falling film evaporators find various applications like multi effect distillation for sea water desalination, power and process applications, refrigeration applications, etc. In this system, latent heat released inside the tube due to condensation is transferred to the falling film on the tube surface resulting in convective evaporation. Among many heat transfer enhancement techniques, thermal spray coatings enjoy diverse

Raju Abraham; A. Mani

2012-01-01

181

The quality of English-language websites offering falls-prevention advice to older members of the public and their families.  

PubMed

Falls among older people are a major public health issue. Increasing numbers of older people are accessing the internet for health-related information, including information on falls risk and prevention. However, we are aware of no study that has assessed the quality of such websites. Using techniques for conducting systematic literature reviews, we evaluated English-language websites offering falls-related advice to members of the public. Forty-two websites were identified using popular search engines; these were assessed using evidence-based guidelines and codes of conduct on coverage of falls-related information, credibility and senior friendliness. Overall, scores were poor for coverage of falls information and credibility, although they were higher for senior friendliness. Few of the websites had been recently updated and none provided individually-tailored advice. We conclude that websites have fallen short of their potential to provide accessible, evidence-based information on the risks of falls and their prevention. PMID:22447877

Whitehead, Sarah H; Nyman, Samuel R; Broaders, Freya; Skelton, Dawn A; Todd, Chris J

2012-03-01

182

The Effects of a Walking Exercise Program on Fall-Related Fitness, Bone Metabolism, and Fall-Related Psychological Factors in Elderly Women  

Microsoft Academic Search

The purpose of this study was to determine the effects of a 3-month walking exercise program with ankle weights on fall-related fitness, bone metabolism, and fall-related psychological factors. Fall-related fitness was determined from strength, balance, agility, aerobic endurance, muscle mass, and fat mass measures. Bone metabolism was measured using bone density, hormones, and biochemical markers. Fall-related psychological factors included fear

Eun Jung Yoo; Tae Won Jun; Steven A. Hawkins

2010-01-01

183

Legionnaires` disease: Seeking effective prevention  

SciTech Connect

During the Bicentennial summer of 1976, American Legion Conventioneers in Philadelphia suffered a dramatic epidemic that left 34 dead. Near the end of 1976, scientists at the Centers for Disease Control (CDC) in Atlanta discovered the bacterium that caused Legionnaires` disease and named it Legionella. Nearly two decades later, a wealth of scientific information exists about the organism, its health effects, epidemiology, microbiology, aquatic ecology, molecular biology, immunology, pathophysiology, etc. Fortunately, for the engineer seeking to prevent Legionnaires` disease, it is unnecessary to master this complexity; the practice of prevention requires understanding a few, straightforward facts. The purpose of this paper is to present four messages about Legionnaires` disease that provide a conceptual framework to guide the crucial role of practical prevention. Those messages are: Legionnaires` disease is important; Legionnaires` disease is an environmental disease; Legionnaires` disease is preventable; and Legionnaires` disease prevention requires the right strategy.

Millar, J.D.; Morris, G.K.; Shelton, B.G. [PathCon Labs., Norcross, GA (United States)

1997-01-01

184

Children can't fly: a program to prevent childhood morbidity and mortality from window falls  

Microsoft Academic Search

`Children Can't Fly' is a health education program developed by the New York City Department of Health to combat the high incidence of child mortality and morbidity due to falls from windows. The success of the program, begun in 1972, in drastically reducing death and injury persuaded the New York City Board of Health to amend the Health Code in

Charlotte N Spiegel; Francis C Lindaman

1995-01-01

185

Falls Prevention within the Australian General Practice Data Model: Methodology, Information Model, and Terminology Issues  

Microsoft Academic Search

The iterative development of the Falls Risk Assessment and Management System (FRAMS) drew upon research evidence and early consumer and clinician input through focus groups, interviews, direct observations, and an online questionnaire. Clinical vignettes were used to validate the clinical model and program logic, input, and output. The information model was developed within the Australian General Practice Data Model (GPDM)

Siaw-Teng Liaw; Nabil Sulaiman; Christopher Pearce; Jane Sims; Keith Hill; Heather Grain; Justin Tse; Choon-Kiat Ng

2003-01-01

186

[Fall risk and fracture. Falls and fractures in patients with neurological disorders].  

PubMed

Neurological disorders are frequently associated with risk factors for falls, such as gait and balance disorders, deficits of lower extremity strength, sensation and coordination, in addition to cognitive impairments. Patients with various kinds of neurological disorders, including Parkinson's disease, Parkinson's syndrome, amyotrophic lateral sclerosis, peripheral neuropathy, stroke, etc, easily suffer from falls. To prevent falls among such patients, treatments of the underlying neurological diseases and assessments risk factors for falls are most important to cope effectively with these patients. In general, maintenance of the appropriate environment, consideration of the injury prevention, rehabilitation for increasing muscular strength, etc, are useful for the prevention of falls in patients with neurological disorders. PMID:23628680

Tamaoka, Akira

2013-05-01

187

Effective injury prevention in soccer.  

PubMed

Sports participation is accompanied by risk of injury, and each specific sport has its own unique injury profile. One of the goals of a sports medicine professional is injury prevention, and the past decade has seen numerous reports on the outcomes of injury-prevention studies. Health care professionals have been particularly vigilant in attempting to reduce common injuries in soccer, beginning with work in the early 1980s to the rigorous randomized trials of today. The use of a structured, generalized warm-up program has been shown to be effective in preventing common soccer injuries, reducing overall injury rates by approximately 30%. Given the number of individuals who play soccer worldwide, any injury reductions will likely have an impact on public health. It is an important goal of the sports medicine community to inform physicians and other sports medicine professionals about the effectiveness of prevention programs to increase use and compliance. PMID:20424412

Kirkendall, Donald T; Dvorak, Jiri

2010-04-01

188

[Fall risk and fracture. Vitamin D and falls/fractures].  

PubMed

Vitamin D affects both bone and muscle. Recent meta-analyses of high-quality trials showed that both native vitamin D and active forms of vitamin D3 significantly reduced the risk of vertebral and non-vertebral fractures. These anti-fracture efficacies of vitamin D are considered to be mainly exerted through direct effects on mineral metabolism. In addition, recent evidence suggests that vitamin D significantly prevents falls, to indirectly reduce fall-related fractures. The preventive effect on falls by vitamin D is considered to be exerted through effects on muscle, at least in part. Eldecalcitol, a new active vitamin D3 analogue, increases bone mineral density and shows greater evident anti-fracture efficacy than alfacalcidol. However, its effects in preventing falls remain unclear and warrant clarification. PMID:23628682

Miyakoshi, Naohisa

2013-05-01

189

Falls and their effects on people with rheumatoid arthritis  

Microsoft Academic Search

Falls in adults and older people are a major public health concern in terms of mortality, morbidity and costs to health and social services. Rheumatoid arthritis (RA) is linked to an increased risk of falls resulting in osteoporotic fractures, due to lower limb joint involvement resulting in impaired mobility, balance and postural stability (Armstrong et al., 2005; Huusko et al.,

E Stanmore; C Todd; J Oldham; T ONeill; D Skelton

2010-01-01

190

Understanding, comprehensibility and acceptance of an evidence-based consumer information brochure on fall prevention in old age: a focus group study  

Microsoft Academic Search

Background  Evidence-based patient and consumer information (EBPI) is an indispensable component of the patients' decision making process\\u000a in health care. Prevention of accidental falls in the elderly has gained a lot of public interest during preceding years.\\u000a Several consumer information brochures on fall prevention have been published; however, none fulfilled the criteria of an\\u000a EBPI. Little is known about the reception

Sabine Lins; Andrea Icks; Gabriele Meyer

2011-01-01

191

Randomised controlled trial of prevention of falls in people aged >=75 with severe visual impairment: the VIP trial  

Microsoft Academic Search

Objectives To assess the efficacy and cost effectiveness of a home safety programme and a home exercise programme to reduce falls and injuries in older people with low vision. Design Randomised controlled trial. Setting Dunedin and Auckland, New Zealand. Participants 391 women and men aged ? 75 with visual acuity of 6\\/24 or worse who were living in the community;

A John Campbell; M Clare Robertson; Steven J La Grow; Ngaire M Kerse; Gordon F Sanderson; Robert J Jacobs; Dianne M Sharp; Leigh A Hale

2005-01-01

192

The effectiveness of wrist guards for reducing wrist and elbow accelerations resulting from simulated forward falls.  

PubMed

The effectiveness of wrist guards and modifying elbow posture for reducing impact-induced accelerations at the wrist and elbow, for the purpose of decreasing upper extremity injury risk during forward fall arrest, has not yet been documented in living people. A seated human pendulum was used to simulate the impact conditions consistent with landing on outstretched arms during a forward fall. Accelerometers measured the wrist and elbow response characteristics of 28 subjects following impacts with and without a wrist guard, and with elbows straight or slightly bent. Overall, the wrist guard was very effective, with significant reductions in peak accelerations at the elbow in the axial and off-axis directions, and in the off-axis direction at the wrist by almost 50%. The effect of elbow posture as an intervention strategy was mixed; a change in magnitude and direction of the acceleration response was documented at the elbow, while there was little effect at the wrist. Unique evidence was presented in support of wrist guard use in activities like in-line skating where impacts to the hands are common. The elbow response clearly shows that more proximal anatomical structures also need to be monitored when assessing the effectiveness of injury prevention strategies. PMID:20841619

Burkhart, Timothy A; Andrews, David M

2010-08-01

193

Middle College. National Dropout Prevention Center/Network Newsletter. Volume 17, Number 4, Fall 2005  

ERIC Educational Resources Information Center

|The "National Dropout Prevention Newsletter" is published quarterly by the National Dropout Prevention Center/Network. This issue contains the following articles: (1) College As A Bridge to High School Graduation (Terry Cash); (2) 2005 NDPN Crystal Star Awards of Excellence; (3) Mott Middle College (Chery S. Wagonlander); (4) Gateway to College:…

Duckenfield, Marty, Ed.

2005-01-01

194

Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial  

PubMed Central

Objective To determine whether the provision of single lens distance glasses to older wearers of multifocal glasses reduces falls. Design Parallel randomised controlled trial stratified by recruitment site and source of referral, with 13 months’ follow-up and outcome assessors blinded to group allocation. Setting Community recruitment and treatment room assessments in Sydney and Illawarra regions of NSW, Australia. Participants 606 regular wearers of multifocal glasses (mean age 80 (SD 7) years). Inclusion criteria included increased risk of falls (fall in previous year or timed up and go test >15 seconds) and outdoor use of multifocal glasses at least three times a week. Interventions Provision of single lens distance glasses with recommendations for wearing them for walking and outdoor activities compared with usual care. Main outcome measures Number of falls and injuries resulting from falls during follow-up. Results Single lens glasses were provided to 275 (90%) of the 305 intervention group participants within two months; 162 (54%) of the intervention group reported satisfactory use of distance glasses for walking and outdoor activities for at least 7/12 months after dispensing. In the 299 intervention and 298 control participants available to follow-up, the intervention resulted in an 8% reduction in falls (incidence rate ratio 0.92, 95% confidence interval 0.73 to 1.16). Pre-planned sub-group analyses showed that the intervention was effective in significantly reducing all falls (incidence rate ratio 0.60, 0.42 to 0.87), outside falls, and injurious falls in people who regularly took part in outside activities. A significant increase in outside falls occurred in people in the intervention group who took part in little outside activity. Conclusions With appropriate counselling, provision of single lens glasses for older wearers of multifocal glasses who take part in regular outdoor activities is an effective falls prevention strategy. The intervention may be harmful, however, in multifocal glasses wearers with low levels of outdoor activity. Trial registration Clinical trials NCT00350855.

2010-01-01

195

Fall Prevention: 6 Tips to Prevent Falls  

MedlinePLUS

... expect Long term care: Early planning pays off Memory loss: 7 tips to improve your memory see all in Healthy retirement Dependent seniors (5) ... expect Long term care: Early planning pays off Memory loss: 7 tips to improve your memory Older ...

196

[Cost]effectiveness of withdrawal of fall-risk increasing drugs versus conservative treatment in older fallers: design of a multicenter randomized controlled trial (IMPROveFALL-study)  

PubMed Central

Background Fall incidents represent an increasing public health problem in aging societies worldwide. A major risk factor for falls is the use of fall-risk increasing drugs. The primary aim of the study is to compare the effect of a structured medication assessment including the withdrawal of fall-risk increasing drugs on the number of new falls versus 'care as usual' in older adults presenting at the Emergency Department after a fall. Methods/Design A prospective, multi-center, randomized controlled trial will be conducted in hospitals in the Netherlands. Persons aged ?65 years who visit the Emergency Department due to a fall are invited to participate in this trial. All patients receive a full geriatric assessment at the research outpatient clinic. Patients are randomized between a structured medication assessment including withdrawal of fall-risk increasing drugs and 'care as usual'. A 3-monthly falls calendar is used for assessing the number of falls, fallers and associated injuries over a one-year follow-up period. Measurements will be at three, six, nine, and twelve months and include functional outcome, healthcare consumption, socio-demographic characteristics, and clinical information. After twelve months a second visit to the research outpatient clinic will be performed, and adherence to the new medication regimen in the intervention group will be measured. The primary outcome will be the incidence of new falls. Secondary outcome measurements are possible health effects of medication withdrawal, health-related quality of life (Short Form-12 and EuroQol-5D), costs, and cost-effectiveness of the intervention. Data will be analyzed using an intention-to-treat analysis. Discussion The successful completion of this trial will provide evidence on the effectiveness of withdrawal of fall-risk increasing drugs in older patients as a method for falls reduction. Trial Registration The trial is registered in the Netherlands Trial Register (NTR1593)

2011-01-01

197

What Works in Prevention: Principles of Effective Prevention Programs  

Microsoft Academic Search

The high prevalence of drug abuse, delinquency, youth violence, and other youth problems creates a need to identify and disseminate effective prevention strategies. General principles gleaned from effective interventions may help prevention practitioners select, modify, or create more effective programs. Using a review-of-reviews approach across 4 areas (substance abuse, risky sexual behavior, school failure, and juvenile delinquency and violence), the

Maury Nation; Cindy Crusto; Abraham Wandersman; Karol L. Kumpfer; Diana Seybolt; Erin Morrissey-Kane; Katrina Davino

2003-01-01

198

Evaluation of the effect of patient education on rates of falls in older hospital patients: Description of a randomised controlled trial  

PubMed Central

Background Accidental falls by older patients in hospital are one of the most commonly reported adverse events. Falls after discharge are also common. These falls have enormous physical, psychological and social consequences for older patients, including serious physical injury and reduced quality of life, and are also a source of substantial cost to health systems worldwide. There have been a limited number of randomised controlled trials, mainly using multifactorial interventions, aiming to prevent older people falling whilst inpatients. Trials to date have produced conflicting results and recent meta-analyses highlight that there is still insufficient evidence to clearly identify which interventions may reduce the rate of falls, and falls related injuries, in this population. Methods and design A prospective randomised controlled trial (n = 1206) is being conducted at two hospitals in Australia. Patients are eligible to be included in the trial if they are over 60 years of age and they, or their family or guardian, give written consent. Participants are randomised into three groups. The control group continues to receive usual care. Both intervention groups receive a specifically designed patient education intervention on minimising falls in addition to usual care. The education is delivered by Digital Video Disc (DVD) and written workbook and aims to promote falls prevention activities by participants. One of the intervention groups also receives follow up education training visits by a health professional. Blinded assessors conduct baseline and discharge assessments and follow up participants for 6 months after discharge. The primary outcome measure is falls by participants in hospital. Secondary outcome measures include falls at home after discharge, knowledge of falls prevention strategies and motivation to engage in falls prevention activities after discharge. All analyses will be based on intention to treat principle. Discussion This trial will examine the effect of a single intervention (specifically designed patient education) on rates of falls in older patients in hospital and after discharge. The results will provide robust recommendations for clinicians and researchers about the role of patient education in this population. The study has the potential to identify a new intervention that may reduce rates of falls in older hospital patients and could be readily duplicated and applied in a wide range of clinical settings. Trial Registration ACTRN12608000015347

Hill, Anne-Marie; Hill, Keith; Brauer, Sandra; Oliver, David; Hoffmann, Tammy; Beer, Christopher; McPhail, Steven; Haines, Terry P

2009-01-01

199

Evaluation of the Frails' Fall Efficacy by Comparing Treatments (EFFECT) on reducing fall and fear of fall in moderately frail older adults: study protocol for a randomised control trial  

PubMed Central

Background Falls are common in frail older adults and often result in injuries and hospitalisation. The Nintendo® Wii™ is an easily available exercise modality in the community which has been shown to improve lower limb strength and balance. However, not much is known on the effectiveness of the Nintendo® Wii™ to improve fall efficacy and reduce falls in a moderately frail older adult. Fall efficacy is the measure of fear of falling in performing various daily activities. Fear contributes to avoidance of activities and functional decline. Methods This randomised active-control trial is a comparison between the Nintendo WiiActive programme against standard gym-based rehabilitation of the older population. Eighty subjects aged above 60, fallers and non-fallers, will be recruited from the hospital outpatient clinic. The primary outcome measure is the Modified Falls Efficacy Scale and the secondary outcome measures are self-reported falls, quadriceps strength, walking agility, dynamic balance and quality of life assessments. Discussions The study is the first randomised control trial using the Nintendo Wii as a rehabilitation modality investigating a change in fall efficacy and self-reported falls. Longitudinally, the study will investigate if the interventions can successfully reduce falls and analyse the cost-effectiveness of the programme. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000576022

2011-01-01

200

Evaluation of the Frails' Fall Efficacy by Comparing Treatments (EFFECT) on reducing fall and fear of fall in moderately frail older adults: study protocol for a randomised control trial  

Microsoft Academic Search

Background  Falls are common in frail older adults and often result in injuries and hospitalisation. The Nintendo® Wii™ is an easily available exercise modality in the community which has been shown to improve lower limb strength and balance.\\u000a However, not much is known on the effectiveness of the Nintendo® Wii™ to improve fall efficacy and reduce falls in a moderately frail

Boon Chong Kwok; Kaysar Mamun; Manju Chandran; Chek Hooi Wong

2011-01-01

201

The effects of a walking exercise program on fall-related fitness, bone metabolism, and fall-related psychological factors in elderly women.  

PubMed

The purpose of this study was to determine the effects of a 3-month walking exercise program with ankle weights on fall-related fitness, bone metabolism, and fall-related psychological factors. Fall-related fitness was determined from strength, balance, agility, aerobic endurance, muscle mass, and fat mass measures. Bone metabolism was measured using bone density, hormones, and biochemical markers. Fall-related psychological factors included fear of falling and falls efficacy. A 2 × 2 factorial with repeated measures design was used. All subjects were community-dwelling elderly women who volunteered to participate, and randomly were assigned to either an exercise group (n = 11) or a control group (n = 10). Results revealed significant changes in upper body strength, leg strength, aerobic endurance, and body composition. Additionally, hormones and biochemical markers changed significantly over time. Trunk fat and fear of falling changed differently among the two groups. In conclusion, this study suggests that a 3-month walking exercise program with ankle weights may have positive effects on fall-related fitness, bone metabolism, and fall-related psychological factors. PMID:21058209

Yoo, Eun Jung; Jun, Tae Won; Hawkins, Steven A

2010-10-01

202

Inpatient Falls  

PubMed Central

In this 2 part series, analysis of the risk stratification tools that are available, definition for the scope of the problem, and potential solutions through a review of the literature are presented. A systematic review was used to identify articles for risk stratification and interventions. Three risk stratification systems are discussed, St Thomas’s Risk Assessment Tool in Falling Elderly Inpatients, Morse Fall Scale, and the Hendrich Fall Risk Model. Of these scoring systems, the Hendrich Fall Risk Model is the easiest to use and score. Predominantly, multifactorial interventions are used to prevent patient falls. Education and rehabilitation are common themes in studies with statistically significant results. The second article presents a guide to implementing a quality improvement project around hospital falls. A 10-step approach to Plan-Do-Study-Act (PDSA) cycles is described. Specific examples of problems and analysis are easily applicable to any institution. Furthermore, the sustainability of interventions and targeting new areas for improvement is discussed. Although specific to falls in the hospitalized patient, the goal is to present a stepwise approach which is broadly applicable to other areas requiring quality improvement.

Cumbler, Ethan U.; Simpson, Jennifer R.; Rosenthal, Laura D.; Likosky, David J.

2013-01-01

203

Usability and acceptability of a website that provides tailored advice on falls prevention activities for older people.  

PubMed

This article presents the usability and acceptability of a website that provides older people with tailored advice to help motivate them to undertake physical activities that prevent falls. Views on the website from interviews with 16 older people and 26 sheltered housing wardens were analysed thematically. The website was well received with only one usability difficulty with the action plan calendar. The older people selected balance training activities out of interest or enjoyment, and appeared to carefully add them into their current routine. The wardens were motivated to promote the website to their residents, particularly those who owned a computer, had balance problems, or were physically active. However, the participants noted that currently a minority of older people use the Internet. Also, some older people underestimated how much activity was enough to improve balance, and others perceived themselves as too old for the activities. PMID:19218310

Nyman, Samuel R; Yardley, Lucy

2009-03-01

204

Mediating effects of psychosocial factors on concerns about falling and daily activity in a multicomponent cognitive behavioral group intervention  

Microsoft Academic Search

Objectives: Concerns about falling, or fear of falling, is highly common in old age and has adverse consequences. The development and understanding of interventions to reduce concerns about falling are therefore relevant. This study explored the mediating effects of psychosocial factors on trajectories of concerns about falling and daily activity in a multicomponent cognitive behavioral group intervention.Method: The study sample

G. A. Rixt Zijlstra; Jolanda C. M. van Haastregt; Jacques Th. M. van Eijk; Luc P. de Witte; Ton Ambergen; Gertrudis I. J. M. Kempen

2011-01-01

205

Falls: Epidemiology, Pathophysiology, and Relationship to Fracture  

PubMed Central

Falls are common in the elderly, and frequently result in injury, disability, and institutionalization. Although the causes of falls are complex, most falls result from an interaction between individual characteristics that increase an individual's propensity to fall and acute mediating risk factors that provide the opportunity to fall. Predisposing risk factors include age-associated changes in strength and balance, age-associated comorbidities such as osteoarthritis, visual impairment and dementia, psychotropic medications, and certain footwear. Fewer studies have focused on acute precipitating factors, but environmental and situational factors are clearly important to the risk of falls. Approximately 30% of falls result in an injury that requires medical attention and with fractures occurring in approximately 10% of falls. Fractures associated with falls are multi-factorial in origin. In addition to the traditional risk factors for falls, the fall descent, fall impact, and bone strength are all important determinants of whether a fracture will occur as a result of an event. In recent years, numerous studies have been directed toward the development of effective fall and fall-related fracture prevention interventions.

Berry, Sarah D.; Miller, Ram

2009-01-01

206

Inferential cascade control of multi-effect falling-film evaporator  

Microsoft Academic Search

Multi-effect falling-film evaporators are widely used in food and dairy industries. Due to the increasing application of multi-effect falling film evaporators, the tight control of these processes is very important. Because of large time delay and process disturbances, the robust and accurate control of total solid concentration in product is difficult. In this paper, by using inferential cascade control, the

M. Karimi; A. Jahanmiri; M. Azarmi

2007-01-01

207

Older Adults' Participation in a Community-Based Falls Prevention Exercise Program: Relationships between the Easy Tool, Program Attendance, and Health Outcomes  

ERIC Educational Resources Information Center

|Purpose of the Study: The Exercise Assessment Screening for You (EASY) tool was developed to encourage older adults at every functional level to be more physically active. The purposes of this study were to examine characteristics of older adults who participated in an evidence-based falls prevention program by their entry to EASY tool scores,…

Smith, Matthew Lee; Ory, Marcia G.; Ahn, SangNam; Bazzarre, Terry L.; Resnick, Barbara

2011-01-01

208

Moving Forward in Fall Prevention: An Intervention to Improve Balance Among Older Adults in Real-World Settings  

PubMed Central

Objectives. We investigated the effectiveness of a group-based exercise intervention to improve balancing ability among older adults delivered in natural settings by staff in local community organizations. Methods. The main component of the intervention consisted of biweekly group-based exercise sessions conducted over 12 weeks by a professional, coupled with home-based exercises. In a quasiexperimental design, 10 community organizations working with older adults offered the intervention to groups of 5 to 15 persons concerned about falls, while 7 organizations recruited similar groups to participate in the control arm of the study. Participants (98 experimental and 102 control) underwent balance assessments by a physiotherapist at registration and 3 months later. Results. Eighty-nine percent of participants attended the 3-month measurement session (n=177). A linear regression analysis showed that after adjusting for baseline levels of balance and demographic and health characteristics, the intervention significantly improved static balance and mobility. Conclusion. Structured, group-based exercise programs offered by community organizations in natural settings can successfully increase balancing ability among community-dwelling older adults concerned about falls.

Robitaille, Yvonne; Laforest, Sophie; Fournier, Michel; Gauvin, Lise; Parisien, Manon; Corriveau, Helene; Trickey, Francine; Damestoy, Nicole

2005-01-01

209

An effective community-academic partnership to extend the reach of screenings for fall risk.  

PubMed

Older adults should be screened for fall risk annually. Community providers (people without formal medical training who work with older adults in senior centers or aging services) may be a viable group to expand the reach of screenings. Our community-academic partnership developed a program to increase and assess fall risk screenings by community providers. Community sites hosted training workshops and screening events. Community screenings were well attended and received by providers and older adults. With administrative support from the regional fall prevention coalition and technical support from academia, community providers screened 161 older adults from a broad geographic area. Twenty-one community providers completed the training. Knowledge and confidence surveys demonstrated improvements before and after training (P<.001). Skills assessments demonstrated mastery of most skills, but some providers required additional training. Provider feedback indicated screening procedures were complex. Future projects will examine this model using simplified screening procedures. PMID:23968584

Schrodt, Lori A; Garbe, Kathie C; Chaplin, Rebecca; Busby-Whitehead, Jan; Shubert, Tiffany E

2013-08-22

210

Senior lifestyles and injury prevention: evaluating the effectiveness of an injury prevention program for older adults.  

PubMed

The purpose of this multicenter, before-and-after observational study was to determine whether a short educational intervention was associated with improvement in self-reported safety behavior in older adults. We developed 4 original injury prevention presentations with companion testing materials: Motor Vehicle Safety, Fall Prevention, Pedestrian Safety, and Home Safety. Participants also completed pre-post Short Form Health Survey Instrument (SF-12) quality-of-life surveys. Of 414 participants, 226 completed follow-up testing and SF-12 surveys, for a 54.6% response rate. Those who completed either Pedestrian or Home Safety program showed no significant changes (P > .05) in either test scores or SF-12, and they comprised 61.9% of the final sample. Participants in the Motor Vehicle Safety and Fall Prevention programs accounted for 38.1% of the final sample and did show significant improvements between pre-post test scores. Only Fall Prevention participants showed significant differences in pre-post SF-12 scores. In the Fall Prevention group, numerous SF-12 subscores from the initial survey were significantly inversely correlated with pretest scores, and improvements in some SF-12 subscores correlated with improvements in test scores. Findings from the Fall Prevention group suggest that seniors with quality-of-life limitations may be aware of their increased risk and more willing to make changes to enhance safety. Further study is needed because many questions regarding optimal approaches to injury prevention in the aging demographic remain unanswered. PMID:19543017

Koestner, Amy; Walters, Madonna R; Mattice, Connie; Manion, Pat; Seguin, Cara

211

Comparison of tai chi vs. strength training for fall prevention among female cancer survivors: study protocol for the GET FIT trial  

PubMed Central

Background Women with cancer are significantly more likely to fall than women without cancer placing them at higher risk of fall-related fractures, other injuries and disability. Currently, no evidence-based fall prevention strategies exist that specifically target female cancer survivors. The purpose of the GET FIT (Group Exercise Training for Functional Improvement after Treatment) trial is to compare the efficacy of two distinct types of exercise, tai chi versus strength training, to prevent falls in women who have completed treatment for cancer. The specific aims of this study are to: 1) Determine and compare the efficacy of both tai chi training and strength training to reduce falls in older female cancer survivors, 2) Determine the mechanism(s) by which tai chi and strength training each reduces falls and, 3) Determine whether or not the benefits of each intervention last after structured training stops. Methods/Design We will conduct a three-group, single-blind, parallel design, randomized controlled trial in women, aged 50–75 years old, who have completed chemotherapy for cancer comparing 1) tai chi 2) strength training and 3) a placebo control group of seated stretching exercise. Women will participate in supervised study programs twice per week for six months and will be followed for an additional six months after formal training stops. The primary outcome in this study is falls, which will be prospectively tracked by monthly self-report. Secondary outcomes are maximal leg strength measured by isokinetic dynamometry, postural stability measured by computerized dynamic posturography and physical function measured by the Physical Performance Battery, all measured at baseline, 3, 6 and 12 months. The sample for this trial (N=429, assuming 25% attrition) will provide adequate statistical power to detect at least a 47% reduction in the fall rate over 1 year by being in either of the 2 exercise groups versus the control group. Discussion The GET FIT trial will provide important new knowledge about preventing falls using accessible and implementable exercise interventions for women following chemotherapy for cancer. ClinicalTrials.gov NCT01635413

2012-01-01

212

Fall-Risk Evaluation and Management: Challenges in Adopting Geriatric Care Practices  

ERIC Educational Resources Information Center

|One third of older adults fall each year, placing them at risk for serious injury, functional decline, and health care utilization. Despite the availability of effective preventive approaches, policy and clinical efforts at preventing falls among older adults have been limited. In this article we present the burden of falls, review evidence…

Tinetti, Mary E.; Gordon, Catherine; Sogolow, Ellen; Lapin, Pauline; Bradley, Elizabeth H.

2006-01-01

213

Physical therapy approaches to reduce fall and fracture risk among older adults  

Microsoft Academic Search

Falls and fall-related injuries, such as fractures, are a growing problem among older adults, often causing longstanding pain, functional impairments, reduced quality of life and excess health-care costs and mortality. These problems have led to a variety of single component or multicomponent intervention strategies to prevent falls and subsequent injuries. The most effective physical therapy approach for the prevention of

Maarit Piirtola; Harri Sievänen; Kirsti Uusi-Rasi; Pekka Kannus; Saija Karinkanta

2010-01-01

214

Fall-Risk Evaluation and Management: Challenges in Adopting Geriatric Care Practices  

ERIC Educational Resources Information Center

One third of older adults fall each year, placing them at risk for serious injury, functional decline, and health care utilization. Despite the availability of effective preventive approaches, policy and clinical efforts at preventing falls among older adults have been limited. In this article we present the burden of falls, review evidence…

Tinetti, Mary E.; Gordon, Catherine; Sogolow, Ellen; Lapin, Pauline; Bradley, Elizabeth H.

2006-01-01

215

Effects of Relative Humidity on the Coalescence of Small Precipitation Drops in Free Fall  

Microsoft Academic Search

Observations of the effects of relative humidity on coalescence are limited to studies using supported drops or streams of drops, and the results are contradictory. In this paper, findings are presented on the effect of high and low relative humidity on collisions between freely falling drops. Comparisons between the collision outcomes (coalescence, bounce, and temporary coalescence with and without satellite

Harry T. Ochs III; Kenneth V. Beard; Neil F. Laird; Donna J. Holdridge; Daniel E. Schaufelberger

1995-01-01

216

Mt. Hood Community College Institutional Effectiveness (IE) Report Fall 2001.  

ERIC Educational Resources Information Center

|This report examines the indicators of institutional effectiveness for Mount Hood Community College (MHCC) (Oregon). The document reports on five institutional goals: (1) knowledge-based workforce education and services; (2) access for members of the community and development of an environment in which diversity thrives; (3) economic development,…

Walleri, R. Dan

217

The effect of walking on falls in older people: the 'Easy Steps to Health' randomized controlled trial study protocol  

PubMed Central

Background Falls in older people continue to be a major public health issue in industrialized countries. Extensive research into falls prevention has identified exercise as a proven fall prevention strategy. However, despite over a decade of promoting physical activity, hospitalisation rates due to falls injuries in older people are still increasing. This could be because efforts to increase physical activity amongst older people have been unsuccessful, or the physical activity that older people engage in is insufficient and/or inappropriate. The majority of older people choose walking as their predominant form of exercise. While walking has been shown to lower the risk of many chronic diseases its role in falls prevention remains unclear. This paper outlines the methodology of a study whose aims are to determine: if a home-based walking intervention will reduce the falls rate among healthy but inactive community-dwelling older adults (65 + years) compared to no intervention (usual activity) and; whether such an intervention can improve risk factors for falls, such as balance, strength and reaction time. Methods/Design This study uses a randomised controlled trial design. A total of 484 older people exercising less than 120 minutes per week will be recruited through the community and health care referrals throughout Sydney and neighboring regions. All participants are randomised into either the self-managed walking program group or the health-education waiting list group using a block randomization scheme. Outcome measures include prospective falls and falls injuries, quality of life, and physical activity levels. A subset of participants (n = 194) will also receive physical performance assessments comprising of tests of dynamic balance, strength, reaction time and lower limb functional status. Discussion Certain types of physical activity can reduce the risk of falls. As walking is already the most popular physical activity amongst older people, if walking is shown to reduce falls the public health implications could be enormous. Conversely, if walking does not reduce falls in older people, or even puts older people at greater risk, then health resources targeting falls prevention need to be invested elsewhere. Trial Registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000380099

2011-01-01

218

EFFECTIVENESS OF AN ALCOHOL RELAPSE PREVENTION PROGRAM  

Microsoft Academic Search

This study investigated the effectiveness of a Relapse Prevention Program (RPP) and its subunits in preventing relapse among recovering alcoholics. Research on the major theories of alcoholism and related treatments were presented to establish a rationale for the utilization of RPP as a viable counseling approach. Structured interviews were developed to provide information on relapse rates, intensity of treatment, the

JAMES MICHAEL OCONNELL

1987-01-01

219

Agroeconomic effect of soil solarization on fall-planted lettuce ( Lactuca sativa)  

Microsoft Academic Search

The effects of summer soil solarization on the production and economics of four lettuce cultivars were evaluated in two plantings conducted during the fall growing season of 2001, to determine the feasibility of integrating strip-solarization in plasticulture cropping systems. Soil was solarized for 53 and 34 days for the first and second plantings, respectively, using transparent (T3, T4) and black

Julio E Hasing; Carl E Motsenbocker; Charles J Monlezun

2004-01-01

220

The effects of fall-risk-increasing drugs on postural control: a literature review.  

PubMed

Meta-analyses showed that psychotropic drugs (antidepressants, neuroleptics, benzodiazepines, antiepileptic drugs) and some cardiac drugs (digoxin, type IA anti-arrhythmics, diuretics) are associated with increased fall risk. Because balance and gait disorders are the most consistent predictors of future falls, falls due to use of these so-called fall-risk-increasing drugs (FRIDs) might be partly caused by impairments of postural control that these drugs can induce. Therefore, the effects of FRIDs on postural control were examined by reviewing literature. Electronic databases and reference lists of identified papers were searched until June 2013. Only controlled research papers examining the effects of FRIDs on postural control were included. FRIDs were defined according to meta-analyses as antidepressants, neuroleptics, benzodiazepines, antiepileptic drugs, digoxin, type IA anti-arrhythmics, and diuretics. Ninety-four papers were included, of which study methods for quantifying postural control, and the effects of FRIDs on postural control were abstracted. Postural control was assessed with a variety of instruments, mainly evaluating aspects of body sway during quiet standing. In general, postural control was impaired, indicated by an increase in parameters quantifying body sway, when using psychotropic FRIDs. The effects were more pronounced when people were of a higher age, used psychotropics at higher daily doses, with longer half-lives, and administered for a longer period. From the present literature review, it can be concluded that psychotropic drugs cause impairments in postural control, which is probably one of the mediating factors for the increased fall risk these FRIDs are associated with. The sedative effects of these drugs on postural control are reversible, as was proven in intervention studies where FRIDs were withdrawn. The findings of the present literature review highlight the importance of using psychotropic drugs in the older population only at the lowest effective dose and for a limited period of time. PMID:24005984

de Groot, Maartje H; van Campen, Jos P C M; Moek, Marije A; Tulner, Linda R; Beijnen, Jos H; Lamoth, Claudine J C

2013-11-01

221

Effects of trench migration on fall of stagnant slabs into the lower mantle  

NASA Astrophysics Data System (ADS)

Global seismic tomography has recently revealed horizontal slabs near the upper and lower mantle boundary beneath the Northwestern Pacific region. Although physical mechanisms that could produce such slab stagnation have been proposed based on numerical simulations, there has been little research into what occurs after slab stagnation. We proposed trench advance and trench jumps as effective mechanisms related to the fall of stagnant slabs into the lower mantle, and our numerical simulations of temperature and fluid flow associated with slab subduction in a 2-D box model confirmed these mechanisms. Our results indicate that a supply of slab material associated with further slab subduction after slab stagnation plays an important role in differentiating further slab stagnation from the falling of slabs into the lower mantle. A shortage of material supply would produce extended slab stagnation near the 660-km boundary for ringwoodite to perovskite + magnesiowüstite phase transformation, whereas downward force due to further slab subduction on a stagnant slab would enhance its fall into the lower mantle. The behaviors of falling stagnant slabs were not affected by Clapeyron slope values associated with phase equilibrium transformation within the range from -3.0 to 0.0 MPa/K. Compared with models of normal mantle viscosity, a high-viscosity lower mantle played a role in hindering the fall of slabs into the lower mantle, resulting in complicated shapes and slow falling velocities. Lower mantle viscosity structure also affected slab behavior. Slabs tended to stagnate when a low-viscosity zone (LVZ) existed just below a depth of 660 km because friction between the slab and the LVZ was weak there. Slab stagnation around a depth of 660 km also occurred when a high-viscosity zone existed below a depth of 1200 km and acted as a resistive force against a slab, even if the slab existed in the lower part of the upper mantle.

Yoshioka, S.; Naganoda, A.

2010-12-01

222

Effect of Pre-Impact Movement Strategies on the Impact Forces Resulting From a Lateral Fall  

PubMed Central

Approximately 90% of hip fractures in older adults result from falls, mostly from landing on or near the hip. A three-dimensional, 11-segment, forward dynamic biomechanical model was developed to investigate whether segment movement strategies prior to impact can affect the impact forces resulting from a lateral fall. Four different pre-impact movement strategies, with and without using the ipsilateral arm to break the fall, were implemented using paired actuators representing the agonist and antagonist muscles acting about each joint. Proportional-derivative feedback controller controlled joint angles and velocities so as to minimize risk of fracture at any of the impact sites. It was hypothesized that (a) use of active knee, hip and arm joint torques during the pre-contact phase neither affects the whole body kinetic energy at impact nor the peak impact forces on the knee, hip, or shoulder; and (b) muscle strength and reaction time do not considerably affect peak impact forces. The results demonstrate that, compared with falling laterally as a rigid body, an arrest strategy that combines flexion of the lower extremities, combined with an axial rotation to progressively present the posterolateral aspects of the thigh, pelvis and then torso, can reduce the peak hip impact force by up to 56%. A 30% decline in muscle strength did not markedly affect the effectiveness of that fall strategy. However, a 300 ms delay in implementing the movement strategy inevitably caused hip impact forces consistent with fracture unless the arm was used to break the fall prior to the hip impact.

Lo, J.; Ashton-Miller, J. A.

2008-01-01

223

Effectiveness of Preventive Child Health Care.  

National Technical Information Service (NTIS)

There is growing controversy concerning the effectiveness of preventive child health care. This paper examined policy statements and the empirical literature to provide a more data based analysis of this important question. Several authors have recently s...

W. Shadish

1981-01-01

224

Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study  

PubMed Central

What is already known about this subject In observational studies, several drugs have been associated with an increased fall risk. A meta-analysis in 1999 found a significant association for neuroleptics, antidepressants, sedatives, diuretics, type IA antiarrhythmics, and digoxin. Nevertheless, knowledge on the effect of withdrawal of these drugs on fall risk is scarce. Only one randomized controlled trial has been carried out in 1999, showing a significantly lowered fall risk after withdrawal of sedatives and antidepressants in community-dwelling older persons. What this study adds This study indicates that withdrawal of all fall-risk-increasing drugs, including both cardiovascular and psychotropic drugs, is an effective intervention for lowering of falls incidence. This effect appears to be highest for withdrawal of cardiovascular drugs. Aims Falling in older persons is a frequent and serious clinical problem. Several drugs have been associated with increased fall risk. The objective of this study was to identify differences in the incidence of falls after withdrawal (discontinuation or dose reduction) of fall-risk-increasing drugs as a single intervention in older fallers. Methods In a prospective cohort study of geriatric outpatients, we included 139 patients presenting with one or more falls during the previous year. Fall-risk-increasing drugs were withdrawn, if possible. The incidence of falls was assessed within 2 months of follow-up after a set 1 month period of drug withdrawal. Multivariate adjustment for potential confounders was performed with a Cox proportional hazards model. Results In 67 patients, we were able to discontinue a fall-risk-increasing drug, and in eight patients to reduce its dose. The total number of fall incidents during follow-up was significantly lower in these 75 patients, than in those who continued treatment (mean number of falls: 0.3 vs. 3.6; P value 0.025). The hazard ratio of a fall during follow-up was 0.48 (95% confidence interval (CI) 0.23, 0.99) for overall drug withdrawal, 0.35 (95% CI 0.15, 0.82) for cardiovascular drug withdrawal and 0.56 (95% CI 0.23, 1.38) for psychotropic drug withdrawal, after adjustment for age, gender, use of fall-risk-increasing drugs, baseline falls frequency, comorbidity, Mini-Mental State Examination score, and reason for referral. Conclusions Withdrawal of fall-risk-increasing drugs appears to be effective as a single intervention for falls prevention in a geriatric outpatient setting. The effect was greatest for withdrawal of cardiovascular drugs.

van der Velde, Nathalie; Stricker, Bruno H Ch; Pols, Huib A P; van der Cammen, Tischa J M

2007-01-01

225

Cancer Preventive Effect of Morinda citrifolia (Noni)  

Microsoft Academic Search

A BSTRACT : Morinda citrifolia (Noni) has been extensively used in folk medicine by Polynesians for over 2,000 years. It has been reported to have broad thera- peutic effects, including anticancer activity, in both clinical practice and labo- ratory animal models. The mechanism for these effects remains unknown. The hypothesis that Morinda citrifolia possesses a cancer preventive effect at the

M. Y. Wang; C. Su

2001-01-01

226

Effect of Lower Limb Strength on Falls and Balance of the Elderly  

PubMed Central

Objective To assess the effect of lower limb strength on falls and balance in community-dwelling elderly persons by a health status questionnaire, evaluation of lower limb strength and balance. Method A total of 86 subjects (age 69.8±5.3) were categorized into one of two groups, "Fallers" and "Non-fallers". Thirty one participants who had reported the experience of having fallen unexpectedly at least once in the past year were assigned into the group "Fallers", and the remaining 55 subjects having no fall history in the past year, "Non-fallers". A self-assessment questionnaire was taken. Lower limb strength was measured by a "Chair stand test". Balance was measured by the stability index of the fall risk test protocol of Balance System SD® (Biodex, New York, USA). The differences between the two groups were compared and the correlation between lower limb strength and balance were analyzed. Results The questionnaire demonstrated no significant differences between two groups. The "Chair stand test" showed a significantly less for the "Fallers" (p<0.05). The stability index was significantly greater in the "Fallers" group (p<0.05). There was a moderate negative correlation between the "Chair stand test" and the "Stability index" (R=-0.576, p<0.01). Conclusion This study suggests that the "Chair stand test" is a useful screening process for lower limb strength which correlates to risk for falls and balance in the elderly.

Cho, Kang Hee; Bok, Soo Kyung; Hwang, Seon Lyul

2012-01-01

227

Effectiveness of bullying and violence prevention programs.  

PubMed

Workplace bullying is a significant occupational health problem worldwide. Nurses are vulnerable to workplace bullying. During interactions with staff nurses, occupational health nurses have crucial opportunities to identify victims of workplace bullying and provide effective techniques for preventing and managing workplace bullying behaviors. The purpose of this systematic review was to identify best practices for preventing and managing workplace bullying among staff nurses. The best method found to control and stop workplace bullying involves cognitive rehearsal of responses to common bullying behaviors. Translation of the 3-hour workplace bullying prevention and management program is discussed. PMID:20873686

Stagg, Sharon J; Sheridan, Daniel

2010-09-23

228

Should Older People in Residential Care Receive Vitamin D to Prevent Falls? Results of a Randomized Trial  

Microsoft Academic Search

OBJECTIVES: To determine whether vitamin D supple- mentation can reduce the incidence of falls and fractures in older people in residential care who are not classically vi- tamin D deficient. DESIGN: Randomized, placebo-controlled double-blind, trial of 2 years' duration. SETTING: Multicenter study in 60 hostels (assisted living facilities) and 89 nursing homes across Australia. PARTICIPANTS: Six hundred twenty-five residents (mean

Leon Flicker; Robert J. MacInnis; G Dip Epi Biostat; Sam C. Scherer; Kate E. Mead; Caryl A. Nowson; Chris Lowndes; John L. Hopper; John D. Wark

2005-01-01

229

Falls and Fractures  

MedlinePLUS

... to the local senior center helps you stay healthy. The good news is that there are simple ways you can prevent most falls. Take The Right Steps If you take care of your overall health, you may be able ...

230

Fall Risk Assessment for Older Adults: The Hendrich II Fall Risk Model  

Microsoft Academic Search

symptoms of dizziness, and known categories of medications increasing risk.10 This tool screens for primary prevention of falls and is integral in a post-fall assessment for the secondary prevention of falls. TARGET POPULATION: The Hendrich II Fall Risk Model is intended to be used in the acute care setting to identify adults at risk for falls. The Model is being

Deanna Gray-Miceli; Sherry A. Greenberg

231

The BIOTELEKINESY home care service: A holistic concept to prevent fall among the elderly based on ICT and computer vision  

Microsoft Academic Search

The increasingly ageing population and the healthcare expenses explosion urge for innovative solutions strongly related to prevention, improvement of quality of life and maintaining an independent life as long as possible. Therefore, the core of the BIOTELEKINESY project is to provide an innovative ICT based interface with a holistic approach to detect and prevent as early as possible in the

C. Barelle; E. Vellidou; D. Koutsouris

2010-01-01

232

Prevent CO Poisoning  

MedlinePLUS

... CDC Features Current Features Breast Cancer Awareness Childhood Obesity Falls Prevention FoodCORE Got Mice? Know Hepatitis B ... 6, 2013 Content source: National Center for Environmental Health, Division of Environmental Hazards and Health Effects, Air Pollution & Respiratory Health Branch ...

233

The patient who falls: "It's always a trade-off".  

PubMed

Falls are common health events that cause discomfort and disability for older adults and stress for caregivers. Using the case of an older man who has experienced multiple falls and a hip fracture, this article, which focuses on community-living older adults, addresses the consequences and etiology of falls; summarizes the evidence on predisposing factors and effective interventions; and discusses how to translate this evidence into patient care. Previous falls; strength, gait, and balance impairments; and medications are the strongest risk factors for falling. Effective single interventions include exercise and physical therapy, cataract surgery, and medication reduction. Evidence suggests that the most effective strategy for reducing the rate of falling in community-living older adults may be intervening on multiple risk factors. Vitamin D has the strongest clinical trial evidence of benefit for preventing fractures among older men at risk. Issues involved in incorporating these evidence-based fall prevention interventions into outpatient practice are discussed, as are the trade-offs inherent in managing older patients at risk of falling. While challenges and barriers exist, fall prevention strategies can be incorporated into clinical practice. PMID:20085954

Tinetti, Mary E; Kumar, Chandrika

2010-01-20

234

Effects of obesity on slip-induced fall risks among young male adults  

PubMed Central

Obesity is associated with structural and functional limitations with impairment of normal gait. Although falls have been identified as the most common cause of injuries in the obese, the mechanisms associated with increased fall risk among the obese population are still unknown. The purpose of this study was to investigate the influence of gait adaptations of the obese individuals and its implication on risk of slip initiations as measured by friction demand characteristics. To exclude the aging and gender effects, a total of ten healthy young male adults participated in the study. Kinematic and kinetic data were collected using a three-dimensional motion analysis system and force plates while subjects were walking at their self-selected walking pace. Results indicated that young obese adults walked similarly as their lean counterparts except for exhibiting greater step width and higher transversal friction demand, suggesting that slip-induced fall risks are similar along the horizontal direction, but increased along the transversal direction under certain floor conditions.

Wu, Xuefang; Lockhart, Thurmon E.; Yeoh, Han T.

2012-01-01

235

Cost-effectiveness of stroke prevention  

Microsoft Academic Search

Stroke is a preventable disease and there are several interventions that might have an important role in reducing the burden of disease. Economic appraisal of these different interventions is essential as resources are scarce and it is logical to attempt to obtain the greatest reduction in disease for the lowest cost. Anticoagulation for non-rheumatic atrial fibrillation is highly effective, but

Shah Ebrahim

2000-01-01

236

Cost-effectiveness of cervical cancer prevention.  

PubMed

Cost-effectiveness analyses are an important tool for the evaluation and modification of many health care services. Given the variety of screening tests and treatments available for cervical cancer screening and prevention, the costs associated with these options and with their alternatives, and the differences in resources and settings in which these tests are applied worldwide, cost-effectiveness analyses evaluation can be very useful to help determine best practices. PMID:23318570

Esselen, Katharine M; Feldman, Sarah

2013-03-01

237

The cancer preventive effects of edible mushrooms.  

PubMed

An increasing body of scientific literature suggests that dietary components may exert cancer preventive effects. Tea, soy, cruciferous vegetables and other foods have been investigated for their cancer preventive potential. Some non-edible mushrooms like Reishi (Ganoderma lucidum) have a history use, both alone and in conjunction with standard therapies, for the treatment of various diseases including cancer in some cultures. They have shown efficacy in a number of scientific studies. By comparison, the potential cancer preventive effects of edible mushrooms have been less well-studied. With similar content of putative effective anticancer compounds such as polysaccharides, proteoglycans, steroids, etc., one might predict that edible mushrooms would also demonstrate anticancer and cancer preventive activity. In this review, available data for five commonly-consumed edible mushrooms: button mushrooms (Agaricus bisporus), A. blazei, oyster mushrooms (Pleurotus ostreatus), shiitake mushrooms (Lentinus edodes), and maitake (Grifola frondosa) mushrooms is discussed. The results of animal model and human intervention studies, as well as supporting in vitro mechanistic studies are critically evaluated. Weaknesses in the current data and topics for future work are highlighted. PMID:22583406

Xu, Tongtong; Beelman, Robert B; Lambert, Joshua D

2012-12-01

238

[When children fall].  

PubMed

Second only to traffic accidents, accidental falling is the most significant cause of death in children. Included in this category is a special group of accidents--falling from a height--where preventative measures would give good results. Cases of child abuse have also been found in this group. From 1989 to 1994 64 children, 19 girls and 45 boys, were treated in our surgical department after accidental falls. There were 99 injuries in all, most of them caused by falls from heights less than 2.5 m. Only two children suffered penetrating injuries. Two of the 64 children died from cerebral injuries after falling from great heights. One child died from heart tamponade, caused by rupture of the right auricle after falling down a steep staircase. One child survived a fall from a great height despite multiple injuries. In such cases, treatment is dependent on a multiple trauma team being available on a 24-hour basis. Measures to prevent falls in the home, as well as in children's playgrounds and in kindergartens are not only very important, but also easy to apply. Suspicion of child abuse must be raised where unusual injuries are observed in children who have reportedly fallen from low heights. PMID:9667124

Solheim, K

1998-06-20

239

Efficacy of a multifaceted podiatry intervention to improve balance and prevent falls in older people: study protocol for a randomised trial  

Microsoft Academic Search

BACKGROUND: Falls in older people are a major public health problem, with at least one in three people aged over 65 years falling each year. There is increasing evidence that foot problems and inappropriate footwear increase the risk of falls, however no studies have been undertaken to determine whether modifying these risk factors decreases the risk of falling. This article

Martin J Spink; Hylton B Menz; Stephen R Lord

2008-01-01

240

Analyzing the problem of falls among older people  

PubMed Central

Falls are a serious problem facing the elderly. The prevention of falls that contribute to disability, mainly in elderly people, is an important issue. Ensuring the greatest possible functionality for elderly people is an important element in the prevention of disability. This paper analyzes the importance of falls, risk factors for falls, and interventions to prevent falls. Recent publications as well as research regarding the prevention and rehabilitation for falls are reviewed.

Dionyssiotis, Yannis

2012-01-01

241

Lasers effects on enamel for caries prevention  

NASA Astrophysics Data System (ADS)

The aim of this study was to ascertain whether laser irradiation is able to reduce caries incidence. For this purpose, the effects of laser on enamel and on fluoride uptake were discussed. Current literature regarding the preventive effect of laser irradiation on dental hard tissue has been reviewed. An evaluation of the results of the available in vitro and in vivo studies on the efficacy of anticaries and induced changes on enamel by laser irradiation were also performed. Articles were selected using the Medline, Web of Science, Embase, and Cochrane databases, and the results of these studies were described. The most common lasers employed for caries prevention on enamel are Nd:YAG; CO2; Er:YAG; Er,Cr:YSGG; and argon. The percentage of inhibition of dental caries varied from 30 to 97.2%, and the association with fluoride has demonstrated the best results on inhibition of caries development. Laser irradiation under specific conditions can change the crystallographic properties of apatite crystals, increasing the acid resistance of lased enamel. The combined treatment of laser irradiation with fluoride propitiates an expressive fluoride uptake, reducing the progression of carieslike lesions, and this treatment is more effective than laser or fluoride alone. Available data suggest that lasers combined with fluoride is a promising treatment in caries prevention.

Ana, P. A.; Bachmann, L.; Zezell, D. M.

2006-05-01

242

The nursing rounds system: effect of patient's call light use, bed sores, fall and satisfaction level.  

PubMed

The nursing round system (NRS) means checking patients on an hourly basis during the A (0700-2200 h) shift and once every 2 h during the B (2200-0700 h) by the assigned nursing staff. The overall goal of this prospective study is to implement an NRS in a major rehabilitation centre-Sultan Bin Abdulaziz Humanitarian City-in the Riyadh area of the Kingdom of Saudi Arabia. The purposes of this study are to measure the effect of the NRS on: (i) the use of patient call light; (ii) the number of incidences of patients' fall; (iii) the number of incidences of hospital-acquired bed sores; and (iv) the level of patients' satisfaction. All patients hospitalized in the male stroke unit will be involved in this study. For the period of 8 weeks (17 December 2009-17 February 2010) All Nursing staff on the unit will record each call light and the patient's need. Implementation of the NRS would start on 18 February 2010 and last for 8 weeks, until 18 April 2010. Data collected throughout this period will be compared with data collected during the 8 weeks period immediately preceding the implementation of the NRS (17 December 2009-17 February 2010) in order to measure the impact of the call light use. The following information were collected on all subjects involved in the study: (i) the Demographic Information Form; (ii) authors' developed NRS Audit Form; (iii) Patient Call Light Audit Form; (iv) Patient Fall Audit Record; (v) Hospital-Acquired Bed Sores Audit Form; and (vi) hospital developed Patient Satisfaction Records. The findings suggested that a significant reduction on the use of call bell (P < 0.001), a significant reduction of fall incidence (P < 0.01) while pressure ulcer reduced by 50% before and after the implementation of NRS. Also, the implementation of NRS increased patient satisfaction by 7/5 (P < 0.05). PMID:21605271

Saleh, Bassem S; Nusair, Hussam; Al Zubadi, Nariman; Al Shloul, Shams; Saleh, Usama

2011-06-01

243

Selection effects and prevention program outcomes.  

PubMed

A primary goal of the paper is to provide an example of an evaluation design and analytic method that can be used to strengthen causal inference in nonexperimental prevention research. We used this method in a nonexperimental multisite study to evaluate short-term outcomes of a preventive intervention, and we accounted for effects of two types of selection bias: self-selection into the program and differential dropout. To provide context for our analytic approach, we present an overview of the counterfactual model (also known as Rubin's causal model or the potential outcomes model) and several methods derived from that model, including propensity score matching, the Heckman two-step approach, and full information maximum likelihood based on a bivariate probit model and its trivariate generalization. We provide an example using evaluation data from a community-based family intervention and a nonexperimental control group constructed from the Washington State biennial Healthy Youth Survey (HYS) risk behavior data (HYS n?=?68,846; intervention n?=?1,502). We identified significant effects of participant, program, and community attributes in self-selection into the program and program completion. Identification of specific selection effects is useful for developing recruitment and retention strategies, and failure to identify selection may lead to inaccurate estimation of outcomes and their public health impact. Counterfactual models allow us to evaluate interventions in uncontrolled settings and still maintain some confidence in the internal validity of our inferences; their application holds great promise for the field of prevention science as we scale up to community dissemination of preventive interventions. PMID:23417667

Hill, Laura G; Rosenman, Robert; Tennekoon, Vidhura; Mandal, Bidisha

2013-12-01

244

Eleven Components of Effective Drug Abuse Prevention Curricula.  

ERIC Educational Resources Information Center

|This review examined school-based drug abuse prevention programs for 1989-94. From a literature review and interviews with a panel of experts in prevention research, 11 key components of effective prevention curricula were identified. These components are listed and discussed briefly. Dissemination of effective prevention programs is discussed.…

Dusenbury, Linda; Falco, Mathea

1995-01-01

245

Assessing prevention effectiveness using data to drive program decisions.  

PubMed Central

The measure of the effectiveness of health promotion and disease prevention activities is the impact of prevention policies, programs, and practices on public health and clinical medicine. Assessing prevention effectiveness involves continuing quantitative analysis of health outcomes resulting from prevention practices. Additionally, assessment involves evaluation of disease- and injury-prevention activities, including their medical, legal, ethical, and economic impacts. Although assessing the effectiveness of prevention activities involves measuring efficacy, safety, and cost, the primary criterion is to improve health at a reasonable cost, not merely to contain costs. Policy makers can use the results of assessments to set priorities in public health. The authors use case studies to illustrate various approaches to evaluating prevention programs, including programs for preventing measles, breast cancer, and diabetic retinopathy. Rigorous evaluation of the effectiveness of prevention activities is essential to the wide acceptance of preventive interventions and the willingness to pay for them.

Thacker, S B; Koplan, J P; Taylor, W R; Hinman, A R; Katz, M F; Roper, W L

1994-01-01

246

Non-pharmaceutical prevention of hip fractures – a cost-effectiveness analysis of a community-based elderly safety promotion program in Sweden  

Microsoft Academic Search

BACKGROUND: Elderly injuries are a recognized public health concern and are due to two factors; osteoporosis and accidental falls. Several osteoporosis pharmaceuticals are considered cost-effective, but intervention programs aiming at preventing falls should also be subjected to economic evaluations. This study presents a cost-effectiveness analysis of a community-based elderly safety promotion program. METHODS: A five-year elderly safety promotion program combining

Pia Johansson; Siv Sadigh; Per Tillgren; Clas Rehnberg

2008-01-01

247

Evaluation of Accelerometer-Based Fall Detection Algorithms on Real-World Falls  

PubMed Central

Despite extensive preventive efforts, falls continue to be a major source of morbidity and mortality among elderly. Real-time detection of falls and their urgent communication to a telecare center may enable rapid medical assistance, thus increasing the sense of security of the elderly and reducing some of the negative consequences of falls. Many different approaches have been explored to automatically detect a fall using inertial sensors. Although previously published algorithms report high sensitivity (SE) and high specificity (SP), they have usually been tested on simulated falls performed by healthy volunteers. We recently collected acceleration data during a number of real-world falls among a patient population with a high-fall-risk as part of the SensAction-AAL European project. The aim of the present study is to benchmark the performance of thirteen published fall-detection algorithms when they are applied to the database of 29 real-world falls. To the best of our knowledge, this is the first systematic comparison of fall detection algorithms tested on real-world falls. We found that the SP average of the thirteen algorithms, was (mean±std) 83.0%±30.3% (maximum value?=?98%). The SE was considerably lower (SE?=?57.0%±27.3%, maximum value?=?82.8%), much lower than the values obtained on simulated falls. The number of false alarms generated by the algorithms during 1-day monitoring of three representative fallers ranged from 3 to 85. The factors that affect the performance of the published algorithms, when they are applied to the real-world falls, are also discussed. These findings indicate the importance of testing fall-detection algorithms in real-life conditions in order to produce more effective automated alarm systems with higher acceptance. Further, the present results support the idea that a large, shared real-world fall database could, potentially, provide an enhanced understanding of the fall process and the information needed to design and evaluate a high-performance fall detector.

Bagala, Fabio; Becker, Clemens; Cappello, Angelo; Chiari, Lorenzo; Aminian, Kamiar; Hausdorff, Jeffrey M.; Zijlstra, Wiebren; Klenk, Jochen

2012-01-01

248

Free Fall  

NSDL National Science Digital Library

In this activity, students investigate the acceleration of falling objects by observing objects of different masses and surface areas as they fall. They build a computer model to represent the relationships they observe, and they use the model to test various hypotheses.

Trout, Charlotte

249

Enhancing the safety of hospitalization by reducing patient falls  

Microsoft Academic Search

The iatrogenic nature of hospitalization places patients at risk of falling, injury, and death. In this article, the major principles of providing protective and preventive interventions are outlined. The principles are the establishment of a multifaceted fall prevention program that targets fall interventions according to each etiologic factor; the recognition that fall protective and prevention interventions are distinct and serve

Janice M. Morse

2002-01-01

250

Experiments in Free Fall  

ERIC Educational Resources Information Center

|A model lift containing a figure of Albert Einstein is released from the side of a tall building and its free fall is arrested by elastic ropes. This arrangement allows four simple experiments to be conducted in the lift to demonstrate the effects of free fall and show how they can lead to the concept of the equivalence of inertial and…

Art, Albert

2006-01-01

251

Fall Risk Increasing Drugs: The Effect on Injuries of the Frail Elderly Estimated from Administrative Data  

Microsoft Academic Search

Society benefits on a large scale from improved medical care and pharmaceuticals. The prescription of pharmaceuticals, however, also carries risks such as the possibility of an increased risk of falls, which may lead to severe injuries and increased health expenditures associated with these injuries. This study investigates the influence of several fall risk increasing drugs (FRIDs) on the number of

Thomas K. Bauer; Katharina Lindenbaum; Magdalena Stroka; Susanne Ahrens; Frank Verheyen

2011-01-01

252

Effect of crust temperature and water content on acrylamide formation during baking of white bread: Steam and falling temperature baking  

Microsoft Academic Search

The effect of crust temperature and water content on acrylamide formation was studied during the baking of white bread. To assess the effect of over-baking, we used a full factorial experimental design in which the baking time was increased by 5 and 10min at each baking temperature. Additional experiments were performed with steam baking and falling temperature baking. Immediately after

Lilia Ahrné; Claes-Göran Andersson; Per Floberg; Johan Rosén; Hans Lingnert

2007-01-01

253

A new multi-effect desalination system with heat pipes by falling film evaporation in the vacuum  

Microsoft Academic Search

An innovative multi-effect heat pipes desalination system with falling film evaporation is presented, in which the evaporation and the condensation is in the negative pressure. The system makes use of the heat pipe to insulate heat source and cold source, has high heat transfer efficiency and effectively avoids producing salt on the surface of pipe because the system operates in

Penghui Gao; Lixi Zhang; Hefei Zhang

2009-01-01

254

Mediating mechanisms in a school-based drug prevention program: first-year effects of the Midwestern Prevention Project.  

PubMed

Describes (a) the effects of a social-influences-based drug prevention program (the Midwestern Prevention Project) on the mediating variables it was designed to change and (b) the process by which the effects on mediating variables changed use of drugs (tobacco, alcohol, and marijuana). Students in 42 middle schools and junior high schools in Kansas City, Missouri, and Kansas City, Kansas, were measured in the fall of 1984 (N = 5,065) and again 1 year later (N = 5,008) after 24 of the schools had been through the program. Compared to students in control schools, students in program schools became less likely to express belief in the positive consequences of drug use, less likely to indicate that they would use such drugs in the future, more likely to report that their friends were less tolerant of drug use, and more likely to believe that they were better able to communicate with their friends about drug or school problems. Change in perceptions of friends' tolerance of drug use was the most substantial mediator of program effects on drug use. There was evidence that intentions to use and beliefs about the positive consequences of use may also mediate program effects on drug use. PMID:1879388

MacKinnon, D P; Johnson, C A; Pentz, M A; Dwyer, J H; Hansen, W B; Flay, B R; Wang, E Y

1991-01-01

255

Falling Feather  

NSDL National Science Digital Library

In this physics activity, learners recreate Galileo's famous experiment, in which he dropped a heavy weight and a light weight from the top of the Leaning Tower of Pisa to show that both weights fall at the same acceleration. Learners prove that Galileo was correct by comparing how fast a feather and coin fall in a tube attached to a vacuum. Use this activity to help learners explore acceleration and terminal velocity as well as how air resistance plays a role in how fast things fall.

Exploratorium, The

2012-07-12

256

Once Is Enough: A Guide to Preventing Future Fractures  

MedlinePLUS

... and Fractures Caídas y fracturas (Falls and Fractures) Preventing Falls and Fractures Partner Resources Falls and Fractures (NIA) Falls and Older Adults (NIH Senior Health) Caídas y fracturas (NIA) Director’s Comments: Preventing Falls

257

Falling Asteroids  

NSDL National Science Digital Library

The goal of this game is to protect four cities from falling asteroids. To do this you must shoot them as they fall, either by clicking on the screen or by using a detonator (hitting the space bar) to destroy them all. You receive ten points for every surviving city at the end of each level. Cities are replaced every fifth level, but if all of your cities are destroyed, the game is over!

2010-01-01

258

Long-run effects of falling cellulosic ethanol production costs on the US agricultural economy  

NASA Astrophysics Data System (ADS)

Renewable energy production has been expanding at a rapid pace. New advances in cellulosic ethanol technologies have the potential to displace the use of petroleum as a transportation fuel, and could have significant effects on both the agricultural economy and the environment. In this letter, the effects of falling cellulosic ethanol production costs on the mix of ethanol feedstocks employed and on the US agricultural economy are examined. Results indicate that, as expected, cellulosic ethanol production increases by a substantial amount as conversion technology improves. Corn production increases initially following the introduction of cellulosic technology, because producers enjoy new revenue from sales of corn stover. After cellulosic ethanol production becomes substantially cheaper, however, acres are shifted from corn production to all other agricultural commodities. Essentially, this new technology could facilitate the exploitation of a previously under-employed resource (corn stover), resulting in an improvement in overall welfare. In the most optimistic scenario considered, 68% of US ethanol is derived from cellulosic sources, coarse grain production is reduced by about 2%, and the prices of all food commodities are reduced modestly.

Campiche, Jody L.; Bryant, Henry L.; Richardson, James W.

2010-01-01

259

Effects of a complex intervention on fall risk in the general practitioner setting: a cluster randomized controlled trial  

PubMed Central

Purpose To study the feasibility of first, reaching functionally declined, but still independent older persons at risk of falls through their general practitioner (GP) and second, to reduce their physiological and psychological fall risk factors with a complex exercise intervention. We investigated the effects of a 16-week exercise intervention on physiological (function, strength, and balance) and psychological (fear of falling) outcomes in community-dwelling older persons in comparison with usual care. In addition, we obtained data on adherence of the participants to the exercise program. Methods Tests on physical and psychological fall risk were conducted at study inclusion, and after the 16-week intervention period in the GP office setting. The 16-week intervention included progressive and challenging balance, gait, and strength exercise as well as changes to behavioral aspects. To account for the hierarchical structure in the chosen study design, with patients nested in GPs and measurements nested in patients, a three-level linear mixed effects model was determined for analysis. Results In total, 33 GPs recruited 378 participants (75.4% females). The mean age of the participants was 78.1 years (standard deviation 5.9 years). Patients in the intervention group showed an improvement in the Timed-Up-and-Go-test (TUG) that was 1.5 seconds greater than that showed by the control group, equivalent to a small to moderate effect. For balance, a relative improvement of 0.8 seconds was accomplished, and anxiety about falls was reduced by 3.7 points in the Falls Efficacy Scale–International (FES-I), in the intervention group relative to control group. In total, 76.6% (N = 170) of the intervention group participated in more than 75% the supervised group sessions. Conclusion The strategy to address older persons at high risk of falling in the GP setting with a complex exercise intervention was successful. In functionally declined, community-dwelling, older persons a complex intervention for reducing fall risks was effective compared with usual care.

Freiberger, Ellen; Blank, Wolfgang A; Salb, Johannes; Geilhof, Barbara; Hentschke, Christian; Landendoerfer, Peter; Halle, Martin; Siegrist, Monika

2013-01-01

260

Host effects on fitness in two strains of the fall armyworm (Noctuidae) and a parasitoid of the family Eulophidae  

Technology Transfer Automated Retrieval System (TEKTRAN)

The fall armyworm is known to be a pest of many species of the family Poaceae. In this study we compared the effects of two host plants (Zea mays and Cynodon nlemfuensis var. nlemfuensis) on survivorship of two strains of the FAW and the parasitoid Euplectrus platyhypenae....

261

Patient safety during assistant propelled wheelchair transfers – The effect of the seat cushion on risk of falling  

Microsoft Academic Search

This paper is a report of a study of the effect of the seat cushion on risk of falling from a wheelchair. Two laboratory studies and simulated assistant propelled wheelchair transfers were conducted with four healthy female participants. For the laboratory studies there were three independent variables – trunk posture (upright\\/flexed forward), seat cushion (flat polyurethane\\/propad low profile), and feet

Olanrewaju O. Okunribido

2012-01-01

262

Overstory-specific effects of litter fall on the microbial carbon turnover in a mature deciduous forest  

Microsoft Academic Search

Mature deciduous forests can serve as important carbon (C) sinks, but the C storage differs significantly in dependency on the tree species. To specify the significance of overstory-specific effects of litter fall on the soil microbial C turnover, we have investigated the 13C isotopic signature of microbial biomarker phospholipid fatty acids (PLFAs). Samples were taken under pure Fagus sylvatica and

Christel Baum; Mirko Fienemann; Stephan Glatzel; Gerd Gleixner

2009-01-01

263

Common Factors in Effective HIV Prevention Programs  

Microsoft Academic Search

We propose a set of common factors in evidence-based interventions (EBI) for HIV prevention, which cut across theoretical\\u000a models of behavior change. Three existing literatures support this agenda: (1) Common factors in psychotherapy; (2) core elements\\u000a from the Centers for Disease Control and Prevention EBIs; and (3) component analyses of EBI. To stimulate discussion among\\u000a prevention researchers, we propose a

Mary Jane Rotheram-Borus; Dallas Swendeman; Diane Flannery; Eric Rice; David M. Adamson; Barbara Ingram

2009-01-01

264

An analysis of falls occurring in patients with stroke on an acute rehabilitation unit.  

PubMed

Falls are a common occurrence in stroke patients admitted to a rehabilitation unit. This study evaluates the effect of current fall risk screening and prevention strategies on the number of falls in stroke patients admitted to an acute rehabilitation facility. All stroke patients admitted to a designated acute rehabilitation unit were considered at risk for falls by virtue of their diagnosis. These patients were studied retrospectively during a 24-month period. Wheelchair lap belts and bedrails were provided to all patients admitted to the unit. Further measures consisting of bed and chair alarms, enclosed beds, and placement in rooms close to the nursing station were implemented with high-fall risk patients. One hundred seventeen (15.5%) of the 754 patients in this study fell. The fall index rate was 8.2 falls, based on patient care days during the study period. No injury was observed in 143 of 159 fall cases (90%). In 13 cases (8%) there were only minor injuries, and 3 falls (2%) resulted in serious injuries. Current preventive strategies decrease the number of falls and the severity of fall-related injuries. Patients who do fall are cognitively impaired on admission and have lower ambulation speed. PMID:18517145

Rabadi, Meheroz H; Rabadi, Freny M; Peterson, Margaret

265

The efficacy of a specific balance-strategy training programme for preventing falls among older people: a pilot randomised controlled trial  

Microsoft Academic Search

Background: older people participate in exercise programmes to reduce the risk of falls but no study has investigated a speciWc balance strategy training intervention presented in a workstation format for small groups. Objective: to determine whether a speciWc balance strategy training programmeme delivered in a workstation format was superior to a community based exercise class programme for reducing falls. Design:

JENNIFER C. NITZ; NANCY LOW CHOY

266

Assessing the cumulative effects of exposure to selected benzodiazepines on the risk of fall-related injuries in the elderly.  

PubMed

ABSTRACTBackground: The use of benzodiazepines is associated with increased risk of fall-related injuries in the elderly. However, it is unclear if the risks vary across the products and how they depend on the pattern of use and dosage. Specifically, the possibility of cumulative effects of past benzodiazepine use has not been thoroughly investigated.Methods: We used the administrative database for a cohort of 23,765 new users of benzodiazepines, aged 65 years and older, in Quebec, Canada, between 1990 and 1994. The associations between the use of seven benzodiazepines and the risk of fall-related injuries were assessed using several statistical models, including a novel weighted cumulative exposure model. That model assigns to each dose taken in the past a weight that represents the importance of that dose in explaining the current risk of fall.Results: For flurazepam, the best-fitting model indicated a cumulative effect of doses taken in the last two weeks. Uninterrupted use of flurazepam in the past months was associated with a highly significant increase in the risk of fall-related injuries (HR = 2.83, 95% CI: 1.45-4.34). The cumulative effect of a 30-day exposure to alprazolam was 1.27 (1.13-1.42). For temazepam, the results suggested a potential withdrawal effect.Conclusions: Mechanisms affecting the risk of falls differ across benzodiazepines, and may include cumulative effects of use in the previous few weeks. Thus, benzodiazepine-specific analyses that account for individual patterns of use should be preferred over simpler analyses that group different benzodiazepines together and limit exposure to current use or current dose. PMID:22059800

Sylvestre, Marie-Pierre; Abrahamowicz, Michal; Capek, Radan; Tamblyn, Robyn

2011-11-08

267

Developing effective prevention services for the real world: a prevention service development model.  

PubMed

A Prevention Service Development Model (PSDM) is presented as an approach to develop, prevention programs that are both effective and that are readily adopted for implementation in community settings. The model is an integration of concepts and methods from two fields, prevention research and marketing research as applied to new service development. Questions that are posed at each stage of the PSDM are described. Studies from the development of two preventive interventions are presented to illustrate research at several of the stages of the model. PMID:15909790

Sandler, Irwin; Ostrom, Amy; Bitner, Mary Jo; Ayers, Tim S; Wolchik, Sharlene; Daniels, Vicki-Smith

2005-06-01

268

The Effects of Medicaid and CHIP Policy Changes on Receipt of Preventive Care among Children  

PubMed Central

Objective To examine changes in children's receipt of well-child and preventive dental care in Medicaid/Children's Health Insurance Program (CHIP) in two states that adopted policies aimed at promoting greater preventive care receipt. Data Sources The 2004–2008 Medicaid/CHIP claims and enrollment data from Idaho and Kentucky. Study Design Logistic and hazard pre–post regression models, controlling for age, gender, race/ethnicity, and eligibility category. Data Extraction Methods Claims and enrollment data were de-identified and merged. Principal Findings Increased reimbursement had a small, positive association with well-child care in Idaho, but no consistent effects were found in Kentucky. A premium forgiveness program in Idaho was associated with a substantial increase (between 20 and 113 percent) in receipt of any well-child care and quicker receipt of well-child care following enrollment. In Kentucky, children saw modest increases in receipt of preventive dental care and received such care more quickly following increased dental reimbursement, while the move to managed care in Idaho was associated with a small increase in receipt of preventive dental care. Conclusions Policy changes such as reimbursement increases, incentives, and delivery system changes can lead to increases in preventive care use among children in Medicaid and CHIP, but reported preventive care receipt still falls short of recommended levels.

Kenney, Genevieve M; Marton, James; Klein, Ariel E; Pelletier, Jennifer E; Talbert, Jeffery

2011-01-01

269

Fall-risk evaluation and management: challenges in adopting geriatric care practices.  

PubMed

One third of older adults fall each year, placing them at risk for serious injury, functional decline, and health care utilization. Despite the availability of effective preventive approaches, policy and clinical efforts at preventing falls among older adults have been limited. In this article we present the burden of falls, review evidence concerning the effectiveness of fall-prevention services, describe barriers for clinicians and for payers in promoting these services, and suggest strategies to encourage greater use of these services. The challenges are substantial, but strategies for incremental change are available while more broad-based changes in health care financing and clinical practice evolve to better manage the multiple chronic health conditions, including falls, experienced by older Americans. PMID:17169927

Tinetti, Mary E; Gordon, Catherine; Sogolow, Ellen; Lapin, Pauline; Bradley, Elizabeth H

2006-12-01

270

The risk factors related to falling in elderly females.  

PubMed

The purpose of this study was to explore the relationship between muscle strength and functional mobility and falls in women aged 65 and over. Thirty-one female subjects with a mean age of 69.57 +/- 4.89 years (65-78) were enrolled in the study. Demographic properties, body mass index, comorbid medical conditions, smoking, the number of medications taken, and fall characteristics were recorded. Knee flexor and extensor strength of the dominant extremity was measured by Biodex isokinetic system, and physical capacity was assessed with a 6-minute walk test. Cognitive status was evaluated by the Mini-Mental State Examination, and disability in daily activities was determined with the Barthel Index. Twelve subjects (38.7%) reported experiencing a fall in the previous year. Eight (25.8%) had experienced a fall outside the home and 4 (12.9%) inside the home. Nine subjects had fallen once, 2 subjects twice, and 1 subject had fallen 3 times. Six (19.4%) subjects reported a fracture after falling. Muscle strength of the knee extensors and flexors and work capacity was similar between those who had fallen and those who had not. The risk factors related to falling were evaluated, but no related factor was determined. Fear of falling was found to be high in patients who had fallen in the previous year. In conclusion, knee extensor and flexor strength are not significant factors in falls or the risk of falling for elderly women, particularly those who are able to function independently. Balance tests in current use are not effective predictors of falls in older adults who live independently and who do not have any significant health problem. These results suggest that there may be a significant interactive effect of the many causal factors that we need to address. Further study is needed to develop new assessment tools for active elderly people to help prevent falls and fall-related injuries. PMID:18267178

Keskin, Dilek; Borman, Pinar; Ersöz, Murat; Kurtaran, Aydan; Bodur, Hatice; Akyüz, Müfit

271

Biomechanical Evaluation of Injury Severity Associated with Patient Falls from Bed  

Microsoft Academic Search

This study investigated the severity of injuries associated with falling from bed and the effectiveness of injury-prevention strategies. Injury criteria were calculated for head- and feet-first falls from six bed heights onto a tiled surface and floor mat. These values indicated a 25% chance of experiencing a serious head injury as a result of falling feet-first from a bed height

Bonnie Bowers; Lloyd J; Lee W; Powell-Cope G; Baptiste A. Rehabil Nurs; States Bartsch AJ; Simpson AK; Annu Symp

2008-01-01

272

Falling Faster  

NSDL National Science Digital Library

In this activity about gravity (page 6 of the PDF), learners will come to understand how all objects will fall at the same rate, but that air will slow things down. This is a simple activity (it uses only two pieces of paper) that provides an excellent "Wow!" moment.

Cosi

2009-01-01

273

Students fall for Fall Meeting  

NASA Astrophysics Data System (ADS)

From Boston to Beijing, thousands of students traveled to San Francisco for the 2011 AGU Fall Meeting. Of those who participated, 183 students were able to attend thanks to AGU's student travel grant program, which assists students with travel costs and seeks to enrich the meeting through ethnic and gender diversity. Students at Fall Meeting enjoyed a variety of programs and activities designed to help them better network with their peers, learn about new fields, and disseminate their research to the interested public. More than 800 students attended AGU's first annual student mixer, sharing drinks and ideas with fellow student members and future colleagues as well as forging new friendships and intellectual relationships.

Smedley, Kara

2012-02-01

274

Child abuse prevention: what works? The effectiveness of home visiting programs for preventing child maltreatment  

Microsoft Academic Search

The purpose of each paper in the National Child Protection Clearinghouse's Child Abuse Prevention: What Works? project is to document research concerning the effectiveness of different types of child maltreatment

Daryl J Higgins; Leah M Bromfield; Nick Richardson

275

Bicycle helmet effectiveness in preventing injury and death  

Microsoft Academic Search

This case—bicycle helmet effectiveness—is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine.This case examines the cost-effectiveness of three interventions to increase utilization of

Lloyd F. Novick; Martha Wojtowycz; Cynthia B. Morrow; Sally M. Sutphen

2003-01-01

276

Effects of Voluntary Public Reporting on the Nurse Sensitive Measures of Falls and Falls with Injury in Hospitals: A Massachusetts Perspective  

Microsoft Academic Search

Background: Interest and efforts in the health care industry to be transparent by collecting and publicly reporting performance measures about healthcare quality and cost has increased in recent years. The National Quality Forum (NQF) endorsed a set of 15 national quality measures for nursing-sensitive care that could be used for public accountability and quality improvement, including measures of patient falls

Patricia Noga

2011-01-01

277

Effect of the “squat protective response” on impact velocity during backward falls  

Microsoft Academic Search

Risk for injury during a fall depends on the position and velocity of the body segments at the moment of impact. One technique for reducing impact velocity is to absorb energy in the lower extremity muscles during descent, as occurs during squatting or sitting. However, the protective value of this response may depend on the time during descent when the

Stephen N. Robinovitch; Rebecca Brumer; Jessica Maurer

2004-01-01

278

The contribution of staff call light response time to fall and injurious fall rates: an exploratory study in four US hospitals using archived hospital data  

PubMed Central

Background Fall prevention programs for hospitalized patients have had limited success, and the effect of programs on decreasing total falls and fall-related injuries is still inconclusive. This exploratory multi-hospital study examined the unique contribution of call light response time to predicting total fall rates and injurious fall rates in inpatient acute care settings. The conceptual model was based on Donabedian's framework of structure, process, and health-care outcomes. The covariates included the hospital, unit type, total nursing hours per patient-day (HPPDs), percentage of the total nursing HPPDs supplied by registered nurses, percentage of patients aged 65 years or older, average case mix index, percentage of patients with altered mental status, percentage of patients with hearing problems, and call light use rate per patient-day. Methods We analyzed data from 28 units from 4 Michigan hospitals, using archived data and chart reviews from January 2004 to May 2009. The patient care unit-month, defined as data aggregated by month for each patient care unit, was the unit of analysis (N = 1063). Hierarchical multiple regression analyses were used. Results Faster call light response time was associated with lower total fall and injurious fall rates. Units with a higher call light use rate had lower total fall and injurious fall rates. A higher percentage of productive nursing hours provided by registered nurses was associated with lower total fall and injurious fall rates. A higher percentage of patients with altered mental status was associated with a higher total fall rate but not a higher injurious fall rate. Units with a higher percentage of patients aged 65 years or older had lower injurious fall rates. Conclusions Faster call light response time appeared to contribute to lower total fall and injurious fall rates, after controlling for the covariates. For practical relevance, hospital and nursing executives should consider strategizing fall and injurious fall prevention efforts by aiming for a decrease in staff response time to call lights. Monitoring call light response time on a regular basis is recommended and could be incorporated into evidence-based practice guidelines for fall prevention.

2012-01-01

279

Comparative Effectiveness of Several Agents for Preventing Postoperative Adhesions  

Microsoft Academic Search

Postoperative adhesions (PAs) are usually clinically asymptomatic. Symptomatic cases, however, may present with chronic abdominal and pelvic pain, infertility, and intestinal obstruction; and they may require intensive, costly therapeutic modalities. Various agents have been used to prevent PAs, but the results indicate general suboptimal effectiveness. Our objective was to evaluate the comparative effectiveness of two pharmacologic agents for preventing PA:

Jehat Kutlay; Yusuf Ozer; Burak Is?k; Hulagu Kargici

2004-01-01

280

Relationship between location and activity in injurious falls: an exploratory study  

Microsoft Academic Search

BACKGROUND: Knowledge about the circumstances under which injurious falls occur could provide healthcare workers with better tools to prevent falls and fall-related injuries. Therefore, we assessed whether older persons who sustain an injurious fall can be classified into specific fall types, based on a combination of fall location and activity up to the moment of the fall. In addition, we

Michel HC Bleijlevens; Joseph PM Diederiks; Marike RC Hendriks; Jolanda CM van Haastregt; Harry FJM Crebolder; Jacques ThM van Eijk

2010-01-01

281

Falling Water  

NSDL National Science Digital Library

Students drop water from different heights to demonstrate the conversion of waterâs potential energy to kinetic energy. They see how varying the height from which water is dropped affects the splash size. They follow good experiment protocol, take measurements, calculate averages and graph results. In seeing how falling water can be used to do work, they also learn how this energy transformation figures into the engineering design and construction of hydroelectric power plants, dams and reservoirs.

Integrated Teaching And Learning Program

282

Characteristics of Hospitalized Cancer Patients Who Fall.  

PubMed

Fall prevention for hospitalized patients is an important nursing quality indicator. Current studies do not describe characteristics of hospitalized patients with cancer who fall, although these patients have been noted to have higher fall and injury rates. This descriptive study represents an initial attempt to identify characteristics of patients hospitalized with cancer who fall compared with adult medical-surgical hospitalized patients who fall. We found that many characteristics of our sample were similar to those of other patients who had experienced a fall during their hospitalization. PMID:20177392

Capone, Luann J; Albert, Nancy M; Bena, James F; Morrison, Shannon M

2010-02-19

283

Characteristics of hospitalized cancer patients who fall.  

PubMed

Fall prevention for hospitalized patients is an important nursing quality indicator. Current studies do not describe characteristics of hospitalized patients with cancer who fall, although these patients have been noted to have higher fall and injury rates. This descriptive study represents an initial attempt to identify characteristics of patients hospitalized with cancer who fall compared with adult medical-surgical hospitalized patients who fall. We found that many characteristics of our sample were similar to those of other patients who had experienced a fall during their hospitalization. PMID:20516815

Capone, Luann J; Albert, Nancy M; Bena, James F; Morrison, Shannon M

284

Portable, Non-Invasive Fall Risk Assessment in End Stage Renal Disease Patients on Hemodialysis  

PubMed Central

Patients with end stage renal diseases (ESRD) on hemodialysis (HD) have high morbidity and mortality due to multiple causes, one of which is dramatically higher fall rates than the general population. The mobility mechanisms that contribute to falls in this population must be understood if adequate interventions for fall prevention are to be achieved. This study utilizes emerging non-invasive, portable gait, posture, strength, and stability assessment technologies to extract various mobility parameters that research has shown to be predictive of fall risk in the general population. As part of an ongoing human subjects study, mobility measures such as postural and locomotion profiles were obtained from five (5) ESRD patients undergoing HD treatments. To assess the effects of post-HD-fatigue on fall risk, both the pre- and post-HD measurements were obtained. Additionally, the effects of inter-HD periods (two days vs. three days) were investigated using the non-invasive, wireless, body-worn motion capture technology and novel signal processing algorithms. The results indicated that HD treatment influenced strength and mobility (i.e., weaker and slower after the dialysis, increasing the susceptibility to falls while returning home) and inter-dialysis period influenced pre-HD profiles (increasing the susceptibility to falls before they come in for a HD treatment). Methodology for early detection of increased fall risk – before a fall event occurs – using the portable mobility assessment technology for out-patient monitoring is further explored, including targeting interventions to identified individuals for fall prevention.

Lockhart, Thurmon E.; Barth, Adam T.; Zhang, Xiaoyue; Songra, Rahul; Abdel-Rahman, Emaad; Lach, John

2011-01-01

285

Applying root cause analysis to improve patient safety: decreasing falls in postpartum women  

Microsoft Academic Search

ObjectiveTo investigate the effectiveness of interventions to prevent falls designed through hazard analysis using root cause analysis.DesignProspective longitudinal study. Under preceding root cause analysis, root factors were classified into four major categories: environment and facilities, procedure, individual, and communication. Among them, communication, environment and facilities were recognised as the most vital factors to facilitate intervention accordingly. The fall prevention programme

K. H. Chen; L. R. Chen; S. Su

2010-01-01

286

Grass species and endophyte effects on survival and development of fall armyworm (Lepidoptera: Noctuidae).  

PubMed

Grass selections including 10 zoysiagrasses, 18 paspalums, 34 Bermuda grasses, tall fescue, creeping red fescue, and perennial ryegrasses with and without endophyte were evaluated for potential resistance to fall armyworm, Spodoptera frugiperda (J. E. Smith), larvae. Laboratory evaluations assessed the degree of antibiosis among >70 grass lines to first-instar fall armvworms. When all parameters measured were considered, the trend in resistance to fall armyworm among endophyte-infected (E+) and endophyte-free (E-) cool season grasses from greatest to least was: 'Dawson' E+ > APR 1234 > 'Dawson' E- > 'Rosalin' E+ > Lp 5425, 'Rosalin' E-, ATF 480 > 'Tulsa' or: E+ slender creeping red fescue > E+ turf- type perennial ryegrass > E- slender creeping red fescue > E+ forage-type perennial ryegrass > E- forage-type perennial ryegrasses, and E+ tall fescue > E- turf-type tall fescue. Among warm season grasses larval weight gain was reduced on all zoysiagrasses. Larval weight gain also was lower on the Bermuda grasses 'Tifsport', 'Tifgreen', 97-4, 97-14, 97-22, 97-28, 97-39, 97-40,97-54, 98-15, 98-30, and 98-45 than when larvae were fed 'Tulsa' tall fescue or the diet control. Only APR1234 and 'Dawson' creeping red fescue reduced larval survival to the same extent that was observed for zoysiagrasses. Survival on Bermuda grasses was least on 97-8. Seashore paspalums were only rarely less susceptible to fall armyworm than tall fescue, although pupal weights were consistently lower on 'Temple 1' and 'Sea Isle 1' paspalums than that on 'Tulsa' tall fescue. Genetic resistance to key grass pests can reduce insecticide use and simplify management of these cultivars. PMID:12020031

Braman, S K; Duncan, R R; Engelke, M C; Hanna, W W; Hignight, K; Rush, D

2002-04-01

287

Residual Effects from Fish Wheel Capture and Handling of Yukon River Fall Chum Salmon  

Microsoft Academic Search

Since 1996, U.S. Fish and Wildlife Service biologists have annually used fish wheels to capture migrating adult fall chum salmon Oncorhynchus keta in the main-stem Yukon River, Alaska, and estimated their abundance via mark–recapture methods. In each year of the study, the mark rate of captured fish at a site near Rampart has been substantially greater than rates observed at

Jeffrey F. Bromaghin; Tevis J. Underwood; Raymond F. Hander

2007-01-01

288

Effect of Fall Turnover on Terminal Carbon Metabolism in Lake Mendota Sediments  

PubMed Central

The carbon and electron flow pathways and the bacterial populations responsible for the transformation of H2-CO2, formate, methanol, methylamine, acetate, ethanol, and lactate were examined in eutrophic sediments collected during summer stratification and fall turnover. The rate of methane formation averaged 1,130 ?mol of CH4 per liter of sediment per day during late-summer stratification versus 433 ?mol of CH4 per liter of sediment per day during the early portion of fall turnover, whereas the rate of sulfate reduction was 280 ?mol of sulfate per liter of sediment per day versus 1,840 ?mol of sulfate per liter of sediment per day during the same time periods, respectively. The sulfate-reducing population remained constant while the methanogenic population decreased by one to two orders of magnitude during turnover. The acetate concentration increased from 32 to 81 ?mol per liter of sediment while the acetate transformation rate constant decreased from 3.22 to 0.70 per h, respectively, during stratification versus turnover. Acetate accounted for nearly 100% of total sedimentary methanogenesis during turnover versus 70% during stratification. The fraction of 14CO2 produced from all 14C-labeled substrates examined was 10 to 40% higher during fall turnover than during stratification. The addition of sulfate, thiosulfate, or sulfur to stratified sediments mimicked fall turnover in that more CO2 and CH4 were produced. The addition of Desulfovibrio vulgaris to sulfate-amended sediments greatly enhanced the amount of CO2 produced from either [14C]methanol or [2-14C]acetate, suggesting that H2 consumption by sulfate reducers can alter methanol or acetate transformation by sedimentary methanogens. These data imply that turnover dynamically altered carbon transformation in eutrophic sediments such that sulfate reduction dominated over methanogenesis principally as a consequence of altering hydrogen metabolism.

Phelps, T. J.; Zeikus, J. G.

1985-01-01

289

Lava Falls Rapid in Grand Canyon; effects of late Holocene debris flows on the Colorado River  

USGS Publications Warehouse

Lava Falls Rapid is the most formidable reach of whitewater on the Colorado River in Grand Canyon and is one of the most famous rapids in the world. Debris flows in 1939, 1954, 1955, 1966, and 1995, as well as prehistoric events, completely changed flow through the rapid. Floods cleared out much of the increased constrictions, but releases from Glen Canyon Dam, including the 1996 controlled flood, are now required to remove the boulders deposited by the debris flows.

Webb, Robert H.; Melis, Theodore S.; Griffiths, Peter G.; Elliott, John G.; Cerling, Thure E.; Poreda, Robert J.; Wise, Thomas W.; Pizzuto, James E.

1999-01-01

290

Effectiveness of Personal Protective Measures to Prevent Lyme Disease  

PubMed Central

After the manufacture of Lyme vaccine was discontinued in 2002, strategies to prevent Lyme disease (LD) have focused on personal protective measures. Effectiveness of these measures has not been conclusively demonstrated. The aim of our case–control study was to assess the effectiveness of personal preventive measures in a highly disease-endemic area. Case-patients were persons with LD reported to Connecticut’s Department of Public Health and classified as having definite, possible, or unlikely LD. Age-matched controls without LD were identified. Study participants were interviewed to assess the practice of preventive measures and to obtain information on occupational and recreational risk factors. Use of protective clothing was 40% effective; routine use of tick repellents on skin or clothing was 20% effective. Checking one’s body for ticks and spraying property with acaricides were not effective. We concluded that use of protective clothing and of tick repellents (on skin or clothing) are effective in preventing LD.

Muehlenbein, Catherine; Cartter, Matthew; Hayes, Edward B.; Ertel, Starr; Shapiro, Eugene D.

2008-01-01

291

Does Fall History Influence Residential Adjustments?  

PubMed Central

Purpose of the study:?To determine whether reported falls at baseline are associated with an older adult’s decision to make a residential adjustment (RA) and the type of adjustment made in the subsequent 2 years.?Design and Methods:?Observations (n = 25,036) were from the Health and Retirement Study, a nationally representative sample of community-living older adults, 65 years of age and older. At baseline, fall history (no fall, 1 fall no injury, 2 or more falls no injury, or 1 or more falls with an injury) and factors potentially associated with RA were used to predict the initiation of an RA (i.e., moving, home modifications, increased use of adaptive equipment, family support, or personal care assistance) during the subsequent 2 years.?Results:?Compared with those with no history of falls, individuals with a history of falls had higher odds of making any RA. Among those making an RA, individuals with an injurious fall were more likely than those with no history of a fall to start using adaptive equipment or increase their use of personal care assistance.?Implications:?The higher initiation of RAs among fallers may indicate proactive steps to prevent future falls and may be influenced by interactions with the health care system. To optimize fall prevention efforts, older adults would benefit from education and interventions addressing optimal use of RAs before falls occur.

Leland, Natalie; Porell, Frank; Murphy, Susan L.

2011-01-01

292

Fall mechanisms, bone strength, and hip fractures in elderly men and women in Taiwan  

Microsoft Academic Search

Summary  Three modifiable factors of fall direction, poor bone strength, and depression were associated with an increased risk of hip\\u000a fractures for elderly men and women; fall direction was a much stronger predictor than the other two. When a fall occurs,\\u000a changing fall direction may be most effective to prevent hip fractures.\\u000a \\u000a \\u000a \\u000a \\u000a Introduction  A matched case-control study was conducted to identify risk

H.-F. Hwang; H.-D. Lee; H.-H. Huang; C.-Y. Chen; M.-R. Lin

2011-01-01

293

Effective HIV prevention: the indispensable role of social science  

PubMed Central

This paper examines the ways in which HIV prevention is understood including “biomedical”, “behavioural”, “structural”, and “combination” prevention. In it I argue that effective prevention entails developing community capacity and requires that public health addresses people not only as individuals but also as connected members of groups, networks and collectives who interact (talk, negotiate, have sex, use drugs, etc.) together. I also examine the evaluation of prevention programmes or interventions and argue that the distinction between efficacy and effectiveness is often glossed and that, while efficacy can be evaluated by randomized controlled trials, the evaluation of effectiveness requires long-term descriptive strategies and/or modelling. Using examples from a number of countries, including a detailed account of the Australian HIV prevention response, effectiveness is shown to be dependent not only on the efficacy of the prevention technology or tool but also on the responses of people – individuals, communities and governments – to those technologies. Whether a particular HIV prevention technology is adopted and its use sustained depends on a range of social, cultural and political factors. The paper concludes by calling on biomedical and social scientists to work together and describes a “social public health”.

Kippax, Susan

2012-01-01

294

Fall detection sensor for fall protection airbag  

Microsoft Academic Search

The fall detection sensor for fall protection airbag was investigated to evaluate the airbag system. There are several methods to detect the fall: contact to the ground and detection of free fall. The problems with both methods are discussed. Since the usability of the latter come into practical use, tests in the future standard of airbag are discussed.

K. Fukaya

2002-01-01

295

Unintentional Falls in Older Adults: A Methodological Historical Review.  

PubMed

ABSTRACTPubMed lists over 6,000 references (700 reviews) on unintentional falls in older adults. This article traces key methodological milestones in the application of epidemiologic methods since the earliest publications in the late 1940s. Within the context of advances in case definition, sampling, measurement, research design, and statistical analysis, the article reviews estimates of frequency of occurrence, risk factor associations, morbidity and mortality consequences, demonstration of the multiple risk factor theory of falls using fall prevention interventions, and the challenges of fall risk prediction models. Methodological explanations are provided for observed heterogeneities, and the case is presented for moving beyond undifferentiated lists of risk factors by focusing on balance and gait as the factors through which the mechanistic effects of distal risk factors can be understood. Moreover, the case is made to advance our statistical analyses by looking at interactions among intrinsic risk factors and between intrinsic, extrinsic, and environmental factors. PMID:21356155

Speechley, Mark

2011-03-01

296

Improving staff reports of falls in assisted living.  

PubMed

This study examined falls data reported by staff to (a) describe characteristics of falls in this population and (b) analyze the quality and utility of the data available from incident reports (IRs) to improve fall prevention. Data from 34 incident reports were analyzed. Descriptive and frequency analyses were conducted to describe fall characteristics, use of assistive devices, high-risk medication use, and prevalence of omitted data on IRs. Thirty-four falls occurred among 15 residents (age, M = 84 years). More than half resulted in injury. Significant omissions of data were noted in the IRs, which may have limited full analysis of fall events and the ability to communicate about health outcomes of these events and the prevention of subsequent falls. This study provides data about falls in assisted living and recommendations for enhanced data collection to support the monitoring of falls risk and the prevention of future falls. PMID:23983004

Silva-Smith, Amy L; Kluge, Mary Ann; Lecompte, Michelle; Snook, Alison

2013-08-27

297

A wearable system for pre-impact fall detection  

Microsoft Academic Search

Unique features of body segment kinematics in falls and activities of daily living (ADL) are applied to make automatic detection of a fall in its descending phase, prior to impact, possible. Fall-related injuries can thus be prevented or reduced by deploying fall impact reduction systems, such as an inflatable airbag for hip protection, before the impact. In this application, the

M. N. Nyan; Francis E. H. Tay; E. Murugasu

2008-01-01

298

Effects of Hyporheic Exchange Flows on Egg Pocket Water Temperature in Snake River Fall Chinook Salmon Spawning Areas  

SciTech Connect

The development of the Snake River hydroelectric system has affected fall chinook salmon smolts by shifting their migration timing to a period when downstream reservoir conditions are unfavorable for survival. Subsequent to the Snake River chinook salmon fall-run Evolutionary Significant Unit being listed as Threatened under the Endangered Species Act, recovery planning has included changes in hydrosystem operations to improve water temperature and flow conditions during the juvenile chinook salmon summer migration period. In light of the limited water supplies from the Dworshak reservoir for summer flow augmentation, and the associated uncertainties regarding benefits to migrating fall chinook salmon smolts, additional approaches for improved smolt survival need to be evaluated. This report describes research conducted by PNNL that evaluated relationships among river discharge, hyporheic zone characteristics, and egg pocket water temperature in Snake River fall chinook salmon spawning areas. The potential for improved survival would be gained by increasing the rate at which early life history events proceed (i.e., incubation and emergence), thereby allowing smolts to migrate through downstream reservoirs during early- to mid-summer when river conditions are more favorable for survival. PNNL implemented this research project throughout 160 km of the Hells Canyon Reach (HCR) of the Snake River. The hydrologic regime during the 2002?2003 sampling period exhibited one of the lowest, most stable daily discharge patterns of any of the previous 12 water years. The vertical hydraulic gradients (VHG) between the river and the riverbed suggested the potential for predominantly small magnitude vertical exchange. The VHG also showed little relationship to changes in river discharge at most sites. Despite the relatively small vertical hydraulic gradients at most sites, the results from the numerical modeling of riverbed pore water velocity and hyporheic zone temperatures suggested that there was significant vertical hydrologic exchange during all time periods. The combined results of temperature monitoring and numerical modeling indicate that only two sites were significantly affected by short-term (hourly to daily) large magnitude changes in discharge. Although the two sites exhibited acute flux reversals between river water and hyporheic water resulting from short-term large magnitude changes in discharge, these flux reversals had minimal effect on emergence timing estimates. Indeed, the emergence timing estimates at all sites was largely unaffected by the changes in river stage resulting from hydropower operations at Hells Canyon Dam. Our results indicate that the range of emergence timing estimates due to differences among the eggs from different females can be as large as or larger than the emergence timing estimates due to site differences (i.e., bed temperatures within and among sites). We conclude that during the 2002-2003 fall chinook salmon incubation period, hydropower operations of Hells Canyon Dam had an insignificant effect on fry emergence timing at the study sites. It appears that short-term (i.e., hourly to daily) manipulations of discharge from the Hells Canyon Complex during the incubation period would not substantially alter egg pocket incubation temperatures, and thus would not affect fry emergence timing at the study sites. However, the use of hydropower operational manipulations at the Hells Canyon Complex to accelerate egg incubation and fry emergence should not be ruled out on the basis of only one water year's worth of study. Further investigation of the incubation environment of Snake River fall chinook salmon is warranted based on the complexity of hyporheic zone characteristics and the variability of surface/subsurface interactions among dry, normal, and wet water years.

Hanrahan, Timothy P.; Geist, David R.; Arntzen, Evan V.; Abernethy, Cary S.

2004-09-24

299

Characteristics of Effective School-Based Substance Abuse Prevention  

Microsoft Academic Search

This study summarizes, using meta-analytic techniques, results from 94 studies of school-based prevention activities that examined alcohol or other drug use outcomes. It set out to determine what features of school-based substance abuse prevention programs are related to variability in the size of program effects. It asked (1) Which populations (e.g., high risk vs. general population) should be targeted for

Denise C. Gottfredson; David B. Wilson

2003-01-01

300

Preventive Effects of Puerarin on Alcohol-induced Osteonecrosis  

Microsoft Academic Search

Alcohol can induce adipogenesis by bone marrow stromal cells and may cause osteonecrosis of the femoral head. Currently, there\\u000a are no medications available to prevent alcohol-induced osteonecrosis. We hypothesized puerarin, a Chinese herbal medicine\\u000a with antioxidative and antithrombotic effects, can prevent alcohol-induced adipogenesis and osteonecrosis. Both bone marrow\\u000a stromal cells (in vitro) and mice (in vivo) were treated either with

Yisheng Wang; Li Yin; Yuebai Li; Peilin Liu; Quanjun Cui

2008-01-01

301

Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial  

PubMed Central

Objective To evaluate whether a programme of multifactorial home visits reduces falls and impairments in mobility in elderly people living in the community. Design Randomised controlled trial with 18 months of follow up. Setting Six general practices in Hoensbroek, the Netherlands. Participants 316 people aged 70 and over living in the community, with moderate impairments in mobility or a history of recent falls. Intervention Five home visits by a community nurse over a period of one year. Visits consisted of screening for medical, environmental, and behavioural factors causing falls and impairments in mobility, followed by specific advice, referrals, and other actions aimed at dealing with the observed hazards. Main outcome measures Falls and impairments in mobility. Results No differences were found in falls and mobility outcomes between the intervention and usual care groups. Conclusion Multifactorial home visits had no effects on falls and impairments in mobility in elderly people at risk who were living in the community. Because falls and impairments in mobility remain a serious problem among elderly people, alternative strategies should be developed and evaluated.

van Haastregt, Jolanda C M; Diederiks, Jos P M; van Rossum, Erik; de Witte, Luc P; Voorhoeve, Peter M; Crebolder, Harry F J M

2000-01-01

302

A model of the effects of flow fluctuations on fall Chinook salmon spawning habitat availability in the Columbia River  

SciTech Connect

Previously we reported that about 30% to 60% of the area predicted to be used by fall Chinook salmon (Oncorhynchus tshawytscha) for spawning in the Hanford Reach of the Columbia River did not contain redds. One explanation for the overprediction of habitat was that our model did not incorporate streamflow fluctuation. Daily fluctuation in flow caused by load-following operations (power generation to meet short-term electrical demand) at Priest Rapids Dam, situated at the upper end of the Hanford Reach, changes the hydraulic characteristics to which fish respond in selecting redd sites. The purpose of the study described here was to examine the effect of flow changes on spawning habitat modeling and, in particular, to look at the connection between spawning and the variability and persistence of habitat variables caused by rapid changes in flow resulting from load-following operations at Priest Rapids Dam. We found that spawning habitat use by fall Chinook salmon was consistent with previous fall Chinook salmon studies in the Reach. Dynamic variables that were based on hourly time series were used to account for the variability in habitat as a result of flow fluctuations. The analysis showed that the proportion of velocities that fell within the range of 1.0 to 2.5 m/s differed significantly between locations that were predicted to be spawning by the logistic regression model where spawning actually occurred and locations that were predicted to be spawning where spawning did not occur. However, the resulting sequential logistic regression model that incorporated the dynamic variables did not provide significant improvement in the percentage of errors for areas predicted to be spawning; the model’s overprediction errors still ranged from 63% to 78%. We suggest that while flow fluctuation may affect spawning habitat and individual fish behavior, the high correlation between time-averaged velocities and the proportion of hourly velocities that fell within the most favorable range negated any improvements in model predictions.

Geist, David R.; Murray, Christopher J.; Hanrahan, Timothy P.; Xie, YuLong

2008-12-01

303

Effective plasma volume in cirrhosis with ascites. Evidence that a decreased value does not account for renal sodium retention, a spontaneous reduction in glomerular filtration rate (GFR), and a fall in GFR during drug-induced diuresis  

PubMed Central

A reduction in effective (nonportal) plasma volume is considered the basis for renal sodium retention, a spontaneous reduction in glomerular filtration rate (GFR), and a fall in GFR occurring during drug-induced diuresis in patients with cirrhosis and ascites. In the present study the concept of a reduced effective plasma volume in cirrhosis is challenged by two lines of evidence, even though effective plasma volume itself could not be measured. (a) Total plasma volume failed to rise in 10 patients with the spontaneous loss of ascites, the appearance of sodium in the urine, and a rise in GFR. Portal pressure remained constant in these patients as ascites left, suggesting that effective plasma volume had not increased while portal plasma volume decreased. (b) Reduction of GFR could not be prevented in five patients with cirrhosis and ascites while total plasma volume was prevented from falling with albumin infusions during drug-induced diuresis. Reduction of GFR during drug-induced diuresis in 15 patients with cirrhosis and ascites was completely reversed with saline infusion despite continued diuresis with the identical drugs, excluding drug nephrotoxicity as the cause for the reduced GFR. The ascites of cirrhosis might no longer be regarded as a cause of effective plasma volume contraction, stimulating renal sodium retention and a reduction in GFR. More likely, this form of ascites is a result of plasma volume expansion and sodium retention. The causes for renal sodium retention and a spontaneous reduction in GFR remain unknown. The cause for a fall in GFR during drug-induced diuresis also remains unknown, but effective plasma volume contraction and drug nephrotoxicity seem excluded. Images

Lieberman, Fred L.; Ito, Sosuke; Reynolds, Telfer B.

1969-01-01

304

Prevention and treatment of systemic glucocorticoid side effects  

PubMed Central

Background Systemic glucocorticoids are used in dermatologic practice for various diseases including connective tissue disorders, bullous diseases, and many other dermatologic conditions. Patients with these diseases are at times treated with long-term courses of glucocorticoids, which place them at increased risk for glucocorticoid-induced side effects. Therefore, dermatologists must be knowledgeable of risks related to glucocorticoid use and be familiar with guidelines to manage them. Objective To provide an update of recent advances in the prevention and treatment of major glucocorticoid-induced side effects. Methods Review of the literature Results Data regarding the prevention and treatment of glucocorticoid-induced side effects are presented. Conclusion This review should help dermatologists optimally manage and prevent glucocorticoid-induced side effects.

Moghadam-Kia, Siamak; Werth, Victoria P.

2009-01-01

305

Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise  

Microsoft Academic Search

Objective: To compare the effectiveness of unsupervised home and supervised group exercise on parameters related to risk of falling among older adults.Design: Prospective, single-blind, randomized and controlled trial.Setting: Nursing home.Subjects: The subjects were selected from 535 independent individuals who resided in a nursing home. Forty-two older adults, aged > 65 years, with risk of falling were recruited, and 32 of

Hülya Donat

2007-01-01

306

Lower Extremity Assistance for Parachutist (LEAP) Program. Quantification of the Biomechanics of the Parachute Landing Fall and Implications for a Device to Prevent Injuries.  

National Technical Information Service (NTIS)

This report presents results from two experiments conducted for the lower extremity assistance for parachutist (LEAP) program. These experiments are part of a systematic effort to develop a device to prevent lower extremity injuries to airborne soldiers. ...

H. P. Crowell T. A. Treadwell J. A. Faughn K. L. Leiter A. A. Woodward

1995-01-01

307

Effect of soft shell hip protectors on pressure distribution to the hip during sideways falls  

Microsoft Academic Search

Introduction  While hip protectors represent a promising strategy for preventing hip fractures, clinical efficacy has been limited by poor\\u000a user compliance. Soft shell protectors may be more acceptable to users than traditional hard shell designs. However, before\\u000a embarking on clinical trials to assess efficacy, laboratory experiments are required to determine how soft shell protectors\\u000a affect the force applied during impact to

A. C. Laing; S. N. Robinovitch

2008-01-01

308

Prevention of osteoporosis: Cost-effectiveness of different pharmaceutical treatments  

Microsoft Academic Search

The cost-effectiveness of different pharmaceutical programmes to prevent osteoporosis has been compared. The following pharmaceutical treatments were analysed and compared: calcium supplementation, etidronate and calcitonin. As a benchmark for comparison, oestrogen replacement therapy, in the form of both pills and plaster, was also included in the analysis. The cost-effectiveness of different strategies for particular age groups was analysed. Finally, the

A. Ankjaer-Jensen; O. Johnell

1996-01-01

309

Effectiveness of interventions to prevent work-related eye injuries  

Microsoft Academic Search

Objective: The objective of this review was to describe the effectiveness of interventions designed to prevent work-related eye injuries in construction, manufacturing, and agricultural industries. Two types of interventions were of interest: (1) effectiveness of different types of eye protection and\\/or environmental controls in the workplace, and (2) evaluation of behavioral interventions focused on increasing the use of eye protection

Hester J Lipscomb

2000-01-01

310

["A matter of balance--Netherlands": an effective intervention to reduce concerns about falls and related avoidance of activity in older people].  

PubMed

Concerns about falls and related avoidance behavior are common among older people and may lead to decreased quality of life, decreased physical and psychosocial functioning, and premature admission to a nursing home. In a randomized controlled trial among 540 community-dwelling older people we studied the feasibility and effects of a cognitive behavioral program on concerns about falls, related avoidance of activity, and falls. Data of the process evaluation obtained from participants in the intervention group (n = 280) and the trainers (n = 6) showed that the program was considered as feasible by the trainers, and positively judged by participants and trainers. Furthermore, participants experienced benefits from attending the program (61% still reported benefits one year after the program). Prior to the start of the program 26% of the participants of the intervention dropped out, yet, among the participants who started the program completion was high (84%). The effect evaluation showed positive outcomes for concerns about falls, related avoidance of activity, and daily activity at 2 months (after the program) when comparing the intervention group with the control group (n = 260). Long-term effects were also shown for, amongst others, concerns about falls and recurrent falls. Following these positive results the cognitive behavioral group program is currently made available to geriatric care settings nationwide in the Netherlands. PMID:23082409

Zijlstra, G A R; van Haastregt, J C M; Kempen, G I J M

2012-09-01

311

Effect of Stroke on Fall Rate, Location and Predictors: A Prospective Comparison of Older Adults with and without Stroke  

PubMed Central

Background The literature suggests that stroke is a major risk factor for falls, but there is a lack of prospective, controlled studies which quantify fall-risk after stroke. The purpose of this study was to compare the rates, location and predictors among individuals recently discharged home from stroke rehabilitation to age and sex matched controls. Methodology/Principal Findings A sample of 80 people with stroke and 90 controls received baseline assessments of balance, mobility and balance confidence. Falls were recorded prospectively over 13 months for both groups. Group differences in fall rates and contribution of clinical measures to falls were determined using negative binomial regression. Fall location was compared between groups using ?2 statistics. The rate of falls for individuals with stroke was 1.77 times the rate for the control group. People with stroke were more likely to fall at home. Poorer balance (Berg Balance Scale) was associated with greater falls for both stroke and control groups (incidence rate ratio [IRR]: 0.908 and IRR: 0.877 respectively). A faster Timed Up and Go Test was associated with greater falls for the stroke group (IRR: 0.955) while better walking endurance (Six Minute Walk Test) was associated with greater falls for the controls (IRR: 1.004). Balance confidence was not an independent predictor in either group. Conclusions Individuals recently discharged home are at greater risk of falling than individuals without stroke. Attention to home environment is warranted. Balance function can predict falls for both people with stroke and age and sex matched controls. Increased mobility may increase exposure to fall opportunities.

Simpson, Lisa A.; Miller, William C.; Eng, Janice J.

2011-01-01

312

Effectiveness of Fluoride in Preventing Caries in Adults  

Microsoft Academic Search

To date, no systematic reviews have found fluoride to be effective in preventing dental caries in adults. The objective of this meta-analysis was to examine the effectiveness of self-and professionally applied fluoride and water fluoridation among adults. We used a random-effects model to estimate the effect size of fluoride (absolute difference in annual caries increment or relative risk ratio) for

S. O. Griffin; E. Regnier; P. M. Griffin; V. Huntley

2007-01-01

313

Role of physical activity in the occurrence of falls and fall-related injuries in community-dwelling adults over 50 years old.  

PubMed

Abstract Purpose: This study examined the effect of the type, level and amount of physical activity in falls and fall-related injuries. Method: Participants were 506 community-dwelling adults aged >50 years (390 women: 67.7?±?6.8 years and 116 men: 69.6?±?6.6 years). Falls, fall-related injuries (slight and severe), and physical activity (type, level and energy expenditure) were evaluated by questionnaires. Confounders included co-morbidities, fear of falling, environmental hazards and physical fitness. Results: After adjustment for confounders, logistic analysis revealed that the likelihood of falling decreased by 2% for each 100 metabolic expenditure (MET-min/week) of total physical activity and increased by 5% for each 100 MET-min/week of vigorous-intensity physical activity; total physical activity >1125 MET-min/week and vigorous physical activity <500 MET-min/week were identified as cut-off values discriminating non-fallers from fallers. Compared to the low physical activity level, increased physical activity levels diminished the likelihood of the occurrence of severe fall-related injuries by 76% (moderate) and 58% (high; p?fall-related injuries by decreasing falls and by safeguarding against severe injuries when falls occur. At least 1125 MET-min/week of total physical activity including >500 MET-min/week of vigorous intensity seems to prevent falls and, therefore, fall-related injuries. Implications for Rehabilitation Being sufficiently active reduces fall-related injuries by reducing falls and by safeguarding against severe injury when falls occur For each additional amount of total physical activity there is a corresponding direct (due to the effect of isolated physical actvivity) and indirect (due to the subject gaining in fitness) decrease in the risk of falling and thus injury. Vigorous physical activity leads to an increase in total physical activity; however, it also leads to an increase in the risk of falling and injury Total physical activity of at least 1125 MET-min/week with equal or lower than 500 MET-min/week (i.e. less than ?1 h/week, according IPAQ criteria) of vigorous intensity significantly reduces falls and therefore injury. PMID:23594055

Pereira, Catarina L N; Baptista, Fátima; Infante, Paulo

2013-04-17

314

Effects of combined-sewer overflows and urban runoff on the water quality of Fall Creek, Indianapolis, Indiana  

USGS Publications Warehouse

This report describes the effects of combined-sewer overflows (CSO's) and urban runoff on the water quality of Fall Creek during summer 1987 by comparing the water quality of base flow with that of storm runoff and by comparing water quality in the urbanized area with that in the less urbanized area upstream from the CSO's. Data were collected at three streamflow-gaging stations located upstream from, downstream from, and in the middle of 27 CSO's on Fall Creek. The most downstream station also was immediately downstream from the discharge of filter backwash from a water-treatment plant for public supply. Concentrations of dissolved oxygen measured at the station in the middle of the CSO's were less than the Indiana minimum ambient water-quality standard of 4.0 mg/L during all storms. Concentra- tions of ammonia, oxygen demand, copper, lead, zinc, and fecal coliform bacteria at the stations down- stream from the CSO's were much larger during runoff than during base flow. Increased concentrations of oxygen demand in storm runoff probably were caused by combined-sewer overflows, urban runoff, and the resuspension of organic material deposited on the streambed. Some of the increased concentrations of lead, zinc, and probably copper can be attributed to the discharge and resuspension of material back- washed from filters at the water-treatment plant.

Martin, J. D.

1995-01-01

315

The potential effects of floor impact surfaces on infant head injury outcome during a short fall.  

PubMed

When considering cases of infant head injury as a result of a short fall, investigators often have to base their opinions on the potential severity of a head injury on a scene description and/or photographic evidence of the potential impact surfaces. While variation in the attenuation properties of typical domestic surfaces and underlying support structures have been reported in the literature, this study investigates whether there is a need to consider the nature and composition of specific potential impact floor surfaces/sites, within a scene, prior to providing an opinion about the likely head impact injury outcome. An instrumented headform was impacted within a suspected crime scene to determine whether different potential impact sites posed different risks of producing head injury. The impact acceleration-time waveform, for the headform, was shown to vary considerably across the floor. By applying recognized head impact injury risk measures (peak g and head injury criterion), it was illustrated that the risk of an infant sustaining a significant head injury could vary considerably, depending upon the exact point of impact with the floor. This study highlights the potential for variation in impact force across a scene and illustrates the need to consider surface composition at specific sites across the entire potential impact area, since the risk of head injury can vary significantly. Caution should therefore be exercised when expressing opinions based solely on verbal, written or photographic evidence of head impact surfaces, without due consideration of the specific area onto which a head might have impacted. PMID:22021589

Jones, M D; Theobald, P S

2011-10-01

316

Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review.  

PubMed

The aim of this review was to recommend training strategies that improve the functional capacity in physically frail older adults based on scientific literature, focusing specially in supervised exercise programs that improved muscle strength, fall risk, balance, and gait ability. Scielo, Science Citation Index, MEDLINE, Scopus, Sport Discus, and ScienceDirect databases were searched from 1990 to 2012. Studies must have mentioned the effects of exercise training on at least one of the following four parameters: Incidence of falls, gait, balance, and lower-body strength. Twenty studies that investigated the effects of multi-component exercise training (10), resistance training (6), endurance training (1), and balance training (3) were included in the present revision. Ten trials investigated the effects of exercise on the incidence of falls in elderly with physical frailty. Seven of them have found a fewer falls incidence after physical training when compared with the control group. Eleven trials investigated the effects of exercise intervention on the gait ability. Six of them showed enhancements in the gait ability. Ten trials investigated the effects of exercise intervention on the balance performance and seven of them demonstrated enhanced balance. Thirteen trials investigated the effects of exercise intervention on the muscle strength and nine of them showed increases in the muscle strength. The multi-component exercise intervention composed by strength, endurance and balance training seems to be the best strategy to improve rate of falls, gait ability, balance, and strength performance in physically frail older adults. PMID:23327448

Cadore, Eduardo Lusa; Rodríguez-Mañas, Leocadio; Sinclair, Alan; Izquierdo, Mikel

2013-04-01

317

The Role of Falls in Fracture Prediction  

Microsoft Academic Search

Close to 75% of hip and non-hip fractures occur among seniors age 65 years and older. Notably, the primary risk factor for\\u000a a hip fracture is a fall, and over 90% of all fractures occur after a fall. Thus, critical for the understanding and prevention\\u000a of fractures at later age is their close relationship with muscle weakness and falling. In fact,

Heike A. Bischoff-Ferrari

318

Cost-Effectiveness of Antiretroviral Therapy for Prevention  

PubMed Central

Recent empirical studies and analyses have heightened interest in the use of expanded antiretroviral therapy (ART) for prevention of HIV transmission. However, ART is expensive, approximately $600 per person per year, raising issues of the cost and cost-effectiveness of ambitious ART expansion. The goal of this review is to equip the reader with the conceptual tools and substantive background needed to understand and evaluate the policy and programmatic implications of cost-effectiveness assessments of ART for prevention. We provide this review in six sections. We start by introducing and explaining basic concepts of health economics as they relate to this issue, including resources, costs, health metrics (such as Disability-Adjusted Life Years), and different types of economic analysis. We then review research on the cost and cost-effectiveness of ART as treatment, and on the cost-effectiveness of traditional HIV prevention. We describe critical issues in the epidemic impact of ART, such as suppression of transmission and the role of the acute phase of infection. We then present a conceptual model for conducting and interpreting cost-effectiveness analyses of ART as prevention, and review the existing preliminary estimates in this area. We end with a discussion of future directions for programmatic demonstrations and evaluation.

Kahn, James G; Marseille, Elliot A; Bennett, Rod; Williams, Brian G; Granich, Reuben

2011-01-01

319

PLCO News, Fall/Winter 1998  

Cancer.gov

PLCO News, Fall/Winter 1998 Volume 1, Number 2 ----- Fall/Winter 1998 TABLE OF CONTENTS Notes from theNCI's PLCO Project Office Meet John GohaganMeet Phil Prorok From Lab to Life Possible prostate cancer prevention with vitamin E and selenium

320

Effects of whole body vibration on bone mineral density and falls: results of the randomized controlled ELVIS study with postmenopausal women  

Microsoft Academic Search

Summary  We determined whether the effect of exercise on bone mineral density (BMD) and falls can be enhanced by whole body vibration\\u000a (WBV). In summary, the multi-purpose exercise training was effective to increase lumbar BMD but added WBV did not enhance\\u000a this effect. However, falls were lowest in the exercise program combined with WBV.\\u000a \\u000a \\u000a \\u000a \\u000a Introduction  WBV is a new approach to reduce

S. von Stengel; W. Kemmler; K. Engelke; W. A. Kalender

2011-01-01

321

Gender Differences in Utilization of Effective Cardiovascular Secondary Prevention: A Cleveland Clinic Prevention Database Study  

PubMed Central

Background Previous studies have suggested that women with cardiovascular disease may receive less aggressive care than men. Using a large cardiology database from a tertiary referral center, we sought to determine if treatment differences still persist in the current era. Methods We analyzed data on 2462 patients who were referred for secondary prevention to the Preventive Cardiology Clinic at The Cleveland Clinic Foundation between 1997 and 2004. The primary objective was to evaluate use of effective secondary preventive therapies, by gender, as outlined in the ACC/AHA guidelines, such as antiplatelet therapy, beta-blockers, statins, and angiotensin-converting enzyme (ACE) inhibitors. Multivariate logistic regression analysis was performed to assess the independent effect of gender on all cause mortality. Results Women were older (62.2 ± 11.1 vs. 59.4 ± 11.0, p < 0.001) and more likely to be hypertensive (68.1% vs. 56.1%, p < 0.001) than men. Overall, women were more likely than men to have higher baseline C-reactive protein (CRP) (6.14 ± 13.4 vs. 4.9 ± 10.7, p < 0.001), low-density lipoprotein cholesterol (LDL-C) (135 ± 66 vs. 116 ± 46, p < 0.001), high-density lipoprotein cholesterol (HDL-C) (52 ± 17 vs. 41 ± 11, p < 0.001), and total cholesterol (238 ± 98 vs. 202 ± 65, p < 0.001). Women were less likely to be on antiplatelet therapy (76.6 % vs. 85.0%, p < 0.001) and statins or any lipid-lowering therapy (62.6% vs. 67.1%, p = 0.04) compared with men on presentation. Conclusions Even in the current era, women with established cardiovascular disease continue to receive less aggressive care than men. They are less likely to be on aspirin and statin therapy. More aggressive efforts should be made to treat both men and women with standard secondary preventive efforts.

CHO, LESLIE; HOOGWERF, BYRON; HUANG, JULIE; BRENNAN, DANIELLE M.; HAZEN, STANLEY L.

2010-01-01

322

Cost-Effectiveness of a School-Based Obesity Prevention Program  

ERIC Educational Resources Information Center

|Background: A school-based obesity prevention study (Medical College of Georgia FitKid Project) started in the fall of 2003 in 18 elementary schools. Half of the schools were randomized to an after-school program that included moderate-to-vigorous physical activity, healthy snacks, homework assistance, and academic enrichment. All third graders…

Wang, Li Yan; Gutin, Bernard; Barbeau, Paule; Moore, Justin B.; Hanes, John, Jr.; Johnson, Maribeth H.; Cavnar, Marlo; Thornburg, Janet; Yin, Zenong

2008-01-01

323

The Fort McMurray Demonstration Project in Social Marketing: no demonstrable effect on already falling injury rates following intensive community and workplace intervention.  

PubMed

The Fort McMurray Demonstration Project in Social Marketing attempted to achieve mutually reinforcing effects from thematically coordinated educational and awareness efforts in the community as a whole and in the workplace and the inclusion of occupational safety within the framework of a community health promotion project. The study community was Fort McMurray, a small, industrial city in northern Alberta. The Mistahiai Health Region, several hundred kilometers to the west and also dominated by one city, Grande Prairie, served as the reference community. The intervention was based on media and events staged at public events, with supporting educational activities in schools and the community. It relied heavily on community-based partners and volunteers. Data on healthcare utilization of selected preventable injuries were obtained from Alberta Health for the time period 1990-1996 for the Regional Health Authorities of Northern Lights, where the only large population centre is Fort McMurray, and Mistahia. Age-adjusted aggregate injury rates were analyzed for evidence of an effect of the intervention. Severity was measured by proxy, using the number of diagnostic claims submitted for reimbursement for medical services in a given year. The communities differed in age-specific injury rates, with Fort McMurray showing higher rates for residents aged less than 55. Young adults and older adolescents showed higher levels of severity. Injury rates fell substantially and at similar rates in both communities over the five-year period. However, in both communities injury rates were already falling before the intervention in Fort McMurray began and continued to fall at about the same rate, slowing toward the end of the period. No evidence was found for an effect of the Project or for acceleration of the reduction in injury frequency in the intervention area. Over the period, fewer medical services were delivered in office settings and more in emergency rooms, in both communities. The Fort McMurray Demonstration Project in Social Marketing achieved an intensity of intervention and community participation that is unlikely to be sustainable in other communities. Despite this level of effort, the study did not achieve an unequivocal, demonstrable reduction in injury frequency above what was already occurring. This may have been due to a more powerful trend manifested as injury reduction across the province. PMID:19521753

Guidotti, Tee L; Deb, Pooja; Bertera, Robert; Ford, Lynda

2009-10-01

324

Coenzyme Q10: Can It Prevent Statin Side Effects?  

MedlinePLUS

... is not universally recommended for preventing statin side effects. Coenzyme Q10 is a substance made naturally by your body. As a supplement, it's usually sold as a capsule and is marketed under brand names such as Co-Q10, Coenzyme Q10, LiQsorb, Liquid Co-Q10 and Q-Gel. Some researchers think ...

325

The Effects of HMO Penetration on Preventable Hospitalizations  

Microsoft Academic Search

Objective. To examine the effects of health maintenance organization (HMO) penetration on preventable hospitalizations. Data Source. Hospitalinpatientdischarge abstracts for932 urban countiesin22states from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), hospital data from American Hospital Association (AHA) annual survey, and population characteristics and health care capacity data from Health Resources and Services Administration (HRSA) Area Resource File

Chunliu Zhan; Marlene R. Miller; Herbert Wong; Gregg S. Meyer

2004-01-01

326

False Fame Prevented: Avoiding Fluency Effects Without Judgmental Correction  

Microsoft Academic Search

Three studies show a way to prevent fluency effects independently of judgmental correction strategies by identifying and procedurally blocking the sources of fluency variations, which are assumed to be embodied in nature. For verbal stimuli, covert pronunciations are assumed to be the crucial source of fluency gains. As a consequence, blocking such pronunciation simulations through a secondary oral motor task

Sascha Topolinski; Fritz Strack

2010-01-01

327

Effectiveness of Diabetic Therapeutic Footwear in Preventing Reulceration  

Microsoft Academic Search

OBJECTIVE — To review the evidence for the effectiveness of therapeutic footwear in pre- venting foot reulceration in individuals with diabetes and foot risk factors. RESEARCH DESIGN AND METHODS — We conducted a structured literature review based on a Medline search for studies of therapeutic footwear that examined prevention of reulceration. Nine published articles were identified. Characteristics of the study

MATTHEW L. MACIEJEWSKI; GAYLE E. REIBER; DOUGLAS G. SMITH; CAROLYN WALLACE; SHANE HAYES; EDWARD J. BOYKO

2004-01-01

328

Anger and Violence Prevention: Enhancing Treatment Effects through Booster Sessions  

ERIC Educational Resources Information Center

|This study was designed to evaluate the effectiveness of booster sessions on the maintenance of intervention gains following an anger management prevention program: "Student Created Aggression Replacement Education Program" ("SCARE"). Participants who had completed the "SCARE" program a year earlier were randomly assigned into either a booster…

Bundy, Alysha; McWhirter, Paula T.; McWhirter, J. Jeffries

2011-01-01

329

Effective Dropout Prevention and College Attendance Programs for Latino Students.  

ERIC Educational Resources Information Center

|This paper reviews research related to effective secondary school programs aimed at dropout prevention and increasing college enrollment rates for at-risk Latino youth. The review identifies programs that have demonstrated a significant impact on dropout rates, college attendance, school performance, or related outcomes in rigorous evaluations;…

Fashola, Olatokunbo S.; Slavin, Robert E.

330

Effective Approach Toward Prevention and Rehabilitation in Geriatrics  

Microsoft Academic Search

The purpose of this paper is to present an effective approach toward the prevention and rehabilitation of a geriatric population living within a community, in assisted living facilities or in nursing homes. A group-based progressive strength training program can help individuals reach their own personal functional fitness goals and promote future independence, improve balance, coordination, range of motion, flexibility, and

Patricia A. Brill

1999-01-01

331

Preventive Interventions for Preterm Children: Effectiveness and Developmental Mechanisms  

PubMed Central

This article provides an integrative review of the effectiveness of and possible developmental mechanisms associated with preventive interventions for preterm children. An analysis of randomized clinical trials carried out within the last 15 years was framed within a contemporary developmental model emphasizing the role of parental adjustments to preterm children’s characteristics. Evidence suggested positive outcomes could be understood in terms of improvements in developmental pathways associated with parental sensitive-responsiveness and child participation in intensive intervention-oriented child care. Implications for the critical role of the Medical Home model for preventive interventions for preterm children were discussed.

Guralnick, Michael J.

2012-01-01

332

Cost-effectiveness of smoking prevention measures in adolescents  

Microsoft Academic Search

Introduction  In view of the serious health risks and high costs to the health care system of tobacco consumption, getting young people\\u000a to avoid smoking is an important element of preventive health care. The aim of this study was to give an overview of the scientific\\u000a literature on cost-effectiveness in smoking preventive interventions within this age group.\\u000a \\u000a \\u000a \\u000a Methods  A literature search was

Andrej Rasch; Wolfgang Greiner

2008-01-01

333

Preventing Neurocognitive Late Effects in Childhood Cancer Survivors  

PubMed Central

Neurocognitive late effects are common sequelae of cancer in children, especially in those who have undergone treatment for brain tumors or in those receiving prophylactic cranial radiation therapy to treat leukemia. Neurocognitive morbidity in attention, executive functioning, processing speed, working memory, and memory frequently occurs and contributes to declines in intellectual and academic abilities. Oncologists are faced with the challenge of using the most effective, often the most intense, therapy to achieve the primary goal of medical success, balanced with the desire to prevent adverse late effects. Not all children with similar diagnoses and treatment have identical neurocognitive outcomes; some do very poorly and some do well. Attention now turns to the reliable prediction of risk for poor outcomes and then, using risk-adapted therapy, to preserve neurocognitive function. Prevention of late effects through rehabilitative strategies, continuation of school, and pharmacotherapy will be explored.

Askins, Martha A.; Moore, Bartlett D.

2013-01-01

334

Decline and Fall At the White HouseA Longitudinal Analysis of Communication Effects  

Microsoft Academic Search

To isolate the long-range effects of Watergate media exposure per se, regression analysis was used to control for the pre-Watergate levels of political effect variables and usual levels of communication behavior. Data were obtained from a longitudinal study of younger and older voters measured during the political campaigns of 1972 and 1974 and in the midst of the Senate Watergate

Jack M. McLeod; Jane D. Brown; Lee B. Becker; Dean A. Ziemke

1977-01-01

335

Simulation of the effect of topography and tree falls on stand dynamics and stand structure of tropical forests  

Microsoft Academic Search

Canopy gaps induced by tree falls have an important ecological role in forest communities since they act on forest sylvigenesis, dynamics and specific composition, mainly through modifications of the light context they involve. Some factors responsible for tree fall occurrences become more influent on sloping areas, particularly crown asymmetry. We have already shown in previous work (Robert, 2001) that slope

Audrey Robert

2003-01-01

336

Falling Feather  

NSDL National Science Digital Library

This site from the Exploratorium presents a demonstration showing that the acceleration of gravity is the same for different objects. The site contains a materials list, assembly instructions for creating the vacuum, and basic procedures for the demonstration. Also provided is an explanation of gravitation effects, freefall, and terminal velocity.

2009-12-11

337

Self-reported falls and fall-related injuries among persons aged > or =65 years--United States, 2006.  

PubMed

Each year, an estimated one third of older adults fall, and the likelihood of falling increases substantially with advancing age. In 2005, a total of 15,802 persons aged > or =65 years died as a result of injuries from falls. However, the number of older adults who fall and are not injured or who sustain minor or moderate injuries and seek treatment in clinics or physician offices is unknown. To estimate the percentage of older adults who fell during the preceding 3 months, CDC analyzed data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated that approximately 5.8 million persons aged > or =65 years, or 15.9% of all U.S. adults in that age group, fell at least once during the preceding 3 months, and 1.8 million (31.3%) of those who fell sustained an injury that resulted in a doctor visit or restricted activity for at least 1 day. The percentages of women and men who fell during the preceding 3 months were similar (16.4% versus 15.2%, respectively), but women reported significantly more fall-related injuries than men (35.7% versus 24.6%, respectively). The effect these injuries have on the quality of life of older adults and on the U.S. health-care system reinforces the need for broader use of scientifically proven fall-prevention interventions. PMID:18322444

2008-03-01

338

HIV treatment as prevention: population effect vs. individual protection?  

PubMed

There are compelling data suggesting that antiretroviral (ARV) drugs can prevent the transmission of HIV: 1) ARV therapy reduces the intrinsic risk of transmission by cutting down the viral load in infected people; 2) ARVs may be used to prevent transmission in uninfected subjects who experienced high risk exposures. Despite these encouraging preliminary results, there are several questions that need to be answered before recommending the use of ARV among uninfected subjects: 1) the efficacy of these strategies amongst women is not yet established; 2) the cost-effectiveness of pre-exposure prophylaxis (PrEP) in the long term is undefined since PrEP efficacy may depend on adherence; 3) treating uninfected individuals may be counter-effective, as it may increase risky behavior due to the belief that ARV drugs have unlimited protective power. In conclusion, the public-health use of ARV drugs represents a new paradigm in the field of HIV prevention. However, ARV treatment cannot be considered as a substitute for other measures for preventing transmission but a complement to individual protection. In particular, post-exposure prophylaxis may be used in selected cases, whereas PrEP appears to be a highly costly method with limited public-health potential and possible safety concerns. PMID:23471446

Ippolito, G; Rezza, G

339

SOIL TEMPERATURE AND FALL FREEZE-THAW EFFECTS ON INFILTRATION AND SOIL MOISTURE MOVEMENT  

Microsoft Academic Search

The quantity of spring snowmelt infiltration and runoff depends on the antecedent soil moisture conditions at the time of soil freezing. Determining the soil moisture status at any particular time during the freezing process requires an understanding of vertical distribution of liquid and frozen water content within the soil profile. This study investigated the effects of soil freezing and thawing

F. C. Kahimba

2006-01-01

340

Effects of trench migration on fall of stagnant slabs into the lower mantle  

Microsoft Academic Search

Global seismic tomography has recently revealed horizontally lying slabs near the upper and lower mantle boundary beneath the Northwestern Pacific region. Although physical mechanisms that could produce such slab stagnation have been proposed based on numerical simulations, there has been little research into what occurs after slab stagnation. We proposed trench advance and trench jumps as effective mechanisms related to

Shoichi Yoshioka; Aya Naganoda

2010-01-01

341

Effects of trench migration on fall of stagnant slabs into the lower mantle  

Microsoft Academic Search

Global seismic tomography has recently revealed horizontal slabs near the upper and lower mantle boundary beneath the Northwestern Pacific region. Although physical mechanisms that could produce such slab stagnation have been proposed based on numerical simulations, there has been little research into what occurs after slab stagnation. We proposed trench advance and trench jumps as effective mechanisms related to the

S. Yoshioka; A. Naganoda

2010-01-01

342

Predictors of falling in older Maryland drivers: a structural-equation model.  

PubMed

Falls can impair health and reduce quality of life among older adults. Although many factors are related to falling, few analyses examine causal models of this behavior. In this study, factors associated with falling were explored simultaneously using structural-equation modeling. A variety of cognitive, physical-performance, and health measures were administered to 694 older adult drivers from the state of Maryland. The observed and latent variables of age, cognitive ability, physical functioning, health, and falling behavior were used to create a causal model. The model revealed that being older was associated with declines in cognition, and such cognitive declines predicted increased falling. Similarly, poorer health was related to poorer physical functioning, which, in turn, also predicted increased falling. This model indicates that in addition to existing fall-prevention interventions aimed at improving physical functioning, interventions to improve cognition and health might also be effective. It is speculated that fear of falling, which often results in reduced mobility among older adults, might account for the lack of a direct relationship between age and falling. This hypothesis should be examined in further research. PMID:17090804

Vance, David E; Ball, Karlene K; Roenker, Daniel L; Wadley, Virginia G; Edwards, Jerri D; Cissell, Gayla M

2006-07-01

343

Daily physical activity and the use of a walking aid in relation to falls in elderly people in a residential care setting  

Microsoft Academic Search

Summary.   Physical activity is usually considered as an important component of a healthy lifestyle, including a preventive effect on\\u000a the risk of falls in the elderly. The relationship between physical activity and falls is complex: physical activity is a\\u000a prerequisite to maintain neuromuscular functioning, necessary to keep balance and to react to a fall, but a higher level of\\u000a physical

W. C. Graafmans; P. T. A. M. Lips; G. J. Wijlhuizen; S. M. F. Pluijm; L. M. Bouter

2003-01-01

344

Results of research to develop cost effective biomonitoring at oil shale lease tracts. Phase I. Fall sampling report  

SciTech Connect

This report presents the results of censuses conducted during October 1981 to estimate the fall abundance of small mammals and avifauna on replicate plots in the vicinity of Federal Tract C-a (Rio Blanco Oil Shale Company). The objectives of the fall censuses were to evaluate alternative census techniques, test assumptions vital to the use of indices and abundance estimators, determine cost-functions associated with monitoring efforts, and estimate variance components needed to devise optimal monitoring designs. Analyses of the fall census data on small mammal abundance were performed.

Skalski, J.R.; Fitzner, R.E.; Gano, K.A.

1982-05-01

345

Falling Less in Kansas: Development of a Fall Risk Reduction Toolkit  

PubMed Central

Falls are a serious health risk for older adults. But for those living in rural and frontier areas of the USA, the risks are higher because of limited access to health care providers and resources. This study employed a community-based participatory research approach to develop a fall prevention toolkit to be used by residents of rural and frontier areas without the assistance of health care providers. Qualitative data were gathered from both key informant interviews and focus groups with a broad range of participants. Data analysis revealed that to be effective and accepted, the toolkit should be not only evidence based but also practical, low-cost, self-explanatory, and usable without the assistance of a health care provider. Materials must be engaging, visually interesting, empowering, sensitive to reading level, and appropriate for low-vision users. These findings should be useful to other researchers developing education and awareness materials for older adults in rural areas.

Radebaugh, Teresa S.; Bahner, Candace A.; Ballard-Reisch, Deborah; Epp, Michael; Hale, LaDonna S.; Hanley, Rich; Kendrick, Karen; Rogers, Michael E.; Rogers, Nicole L.

2011-01-01

346

Identifying Roof Fall Predictors Using Fuzzy Classification  

NASA Astrophysics Data System (ADS)

Microseismic monitoring involves placing geophones on the rock surfaces of a mine to record seismic activity. Classification of microseismic mine data can be used to predict seismic events in a mine to mitigate mining hazards, such as roof falls, where properly bolting and bracing the roof is often an insufficient method of preventing weak roofs from destabilizing. In this study, six months of recorded acoustic waveforms from microseismic monitoring in a Pennsylvania limestone mine were analyzed using classification techniques to predict roof falls. Fuzzy classification using features selected for computational ease was applied on the mine data. Both large roof fall events could be predicted using a Roof Fall Index (RFI) metric calculated from the results of the fuzzy classification. RFI was successfully used to resolve the two significant roof fall events and predicted both events by at least 15 hours before visual signs of the roof falls were evident.

Bertoncini, C. A.; Hinders, M. K.

2010-02-01

347

Is Prevention of Ventilator Associated Pneumonia Cost Effective?  

Microsoft Academic Search

\\u000a The prevention of VAP appears to be a cost effective endeavor based on the healthcare costs and morbidity associated with\\u000a this nosocomial infection. Infection control measures should be integrated into a systematic program for general application\\u000a to all patients requiring mechanical ventilation at a particular hospital (36,37). Additionally, attention needs to be focused on the emergence of antibiotic-resistant bacterial infections

Marin H. Kollef

348

Effects of preventive home visits to elderly people  

Microsoft Academic Search

OBJECTIVES--To assess the effect of preventive home visits by public health nurses on the state of health of and use of services by elderly people living at home. DESIGN--Randomised controlled trial. SETTING--General population of elderly people in one of the southern regions of the Netherlands. SUBJECTS--580 subjects aged between 75 and 84 years randomly allocated to intervention (292) or control

E van Rossum; C M Frederiks; H Philipsen; K Portengen; J Wiskerke; P Knipschild

1993-01-01

349

Non-syncopal falls in the elderly in relation to home environments  

Microsoft Academic Search

Methods of prevention of falls in the home may differ for healthy and frail individuals. We therefore sought to determine whether measures of health and functioning in older persons are more useful in predicting falls at home not involving home hazards (non-environmental falls) than falls at home related to home hazards (environmental falls), and whether these relationships differ among those

M. E. Northridge; M. C. Nevitt; J. L. Kelsey

1996-01-01

350

False fame prevented: avoiding fluency effects without judgmental correction.  

PubMed

Three studies show a way to prevent fluency effects independently of judgmental correction strategies by identifying and procedurally blocking the sources of fluency variations, which are assumed to be embodied in nature. For verbal stimuli, covert pronunciations are assumed to be the crucial source of fluency gains. As a consequence, blocking such pronunciation simulations through a secondary oral motor task decreased the false-fame effect for repeatedly presented names of actors (Experiment 1) as well as prevented increases in trust due to repetition for brand names and names of shares in the stock market (Experiment 2). Extending this evidence beyond repeated exposure, we demonstrated that blocking oral motor simulations also prevented fluency effects of word pronunciation on judgments of hazardousness (Experiment 3). Concerning the realm of judgment correction, this procedural blocking of (biasing) associative processes is a decontamination method not considered before in the literature, because it is independent of exposure control, mood, motivation, and post hoc correction strategies. The present results also have implications for applied issues, such as advertising and investment decisions. PMID:20438220

Topolinski, Sascha; Strack, Fritz

2010-05-01

351

Effects of dietary canola oil level on growth, fatty acid composition and osmoregulatory ability of juvenile fall chinook salmon ( Oncorhynchus tshawytscha)  

Microsoft Academic Search

This study assessed refined canola oil (CO) as a supplemental dietary lipid source for juvenile fall chinook salmon, Oncorhynchus tshawytscha, parr with respect to possible effects on their growth and osmoregulatory performance and body composition. Diets with equal protein (?57%) and lipid (?19%) content (dry weight basis) were supplemented with lipid from either anchovy oil (AO) or CO with AO

Amelia A. M. Grant; Daniel Baker; Dave A. Higgs; Colin J. Brauner; Jeffrey G. Richards; Shannon K. Balfry; Patricia M. Schulte

2008-01-01

352

Steady-state experimental studies on a multi-effect thermal regeneration solar desalination unit with horizontal tube falling film evaporation  

Microsoft Academic Search

A special desalinization unit which utilizes solar or waste energy has been developed and tested indoors. In thisunit, a relatively large fraction of latent and sensible heat of condensation along with brine is successfully recycled and utilized. It is used to preheat and evaporate the feedstock due to the multi-effect thermal regenerative process. Since the falling film evaporation is used

Chen Ziqian; Zheng Hongfei; He Kaiyan; Ma Chaochen

2007-01-01

353

Comparative effectiveness of several agents for preventing postoperative adhesions.  

PubMed

Postoperative adhesions (PAs) are usually clinically asymptomatic. Symptomatic cases, however, may present with chronic abdominal and pelvic pain, infertility, and intestinal obstruction; and they may require intensive, costly therapeutic modalities. Various agents have been used to prevent PAs, but the results indicate general suboptimal effectiveness. Our objective was to evaluate the comparative effectiveness of two pharmacologic agents for preventing PA: nadroparine calcium (low-molecular-weight heparin, or LMWH) and aprotinin, as well as a barrier agent, sodium hyaluronate/carboxymethycellulose (SCMC). Our subjects were 40 male Wistar-Albino rats divided into four groups, each consisting of 10 rats, which underwent standard cecal abrasion preceding midline laparotomy. In the control group (group 1) 1 ml of 0.9% NaCl was administered intraperitoneally before abdominal closure. In the three preventive groups, 100 U AXa (anti factor X activity) LMWH, 1800 IU aprotinin, and SCMC were administered intraperitoneally to groups 2, 3, and 4, respectively. Relaparotomy was performed on the 14th postoperative day. Visceral and abdominal wall adhesions were scored in a blinded fashion. The adhesion scores (mean +/- SD) for groups 1, 2, 3, and 4 were 2.00 +/- 0.67, 0.6.00 +/- 0.84, 1.10 +/- 0.74, and 0.20 +/- 0.42, respectively. The differences in the adhesion scores among all three preventive groups (groups 2, 3, 4) were statistically significant when compared with the control group ( p < 0.001, p = 0.017, p < 0.001, respectively). Intraperitoneal SCMC and administration of LMWH were more effective than giving aprotinin. PMID:15184999

Kutlay, Jehat; Ozer, Yusuf; Isik, Burak; Kargici, Hulagu

2004-06-08

354

The Fall and Fall of Gary Hart.  

ERIC Educational Resources Information Center

The fall of Gary Hart, brought about because of his indiscretions during the 1988 presidential campaign, should not be treated exclusively as a consequence of Hart's moral failings. Rather, the fall of Hart can be traced to a complex of factors including bad judgment, the near total control that the press exercises over the political agenda, and…

Rowland, Robert C.

355

Explanations for side effect aversion in preventive medical treatment decisions  

PubMed Central

Objective Many laypeople demonstrate excessive sensitivity to negative side effects of medical treatments, which may lead them to refuse beneficial therapies. This Internet-based experiment investigated three possible explanations for such “side effect aversion.” One was derived from mental accounting, one examined the mere presence of a side effect, and one focused on computational difficulties. Design Participants (N = 5,379) were presented with a hypothetical cancer preventive treatment situation that was or was not accompanied by one or two small side effects. The side effects were either beneficial or harmful. In all conditions the net absolute risk reduction associated with the treatment was 15%. Main Outcome Measures Participants indicated their willingness to accept treatment and their perceptions of the treatment’s effects on their overall cancer risk. Results Data were consistent only with the “mere presence” explanation of side effect aversion, the idea that side effects act as a strong negative cue that directly affects treatment appraisal. The number of negative side effects did not influence treatment willingness. Conclusion Side effect aversion is a challenge to informed decision making. Specific mechanisms that produce side effect aversion should be identified.

Waters, Erika A.; Weinstein, Neil D.; Colditz, Graham A.; Emmons, Karen

2008-01-01

356

Vitamin D status, postural sway, and the incidence of falls in elderly community-dwelling Japanese women  

Microsoft Academic Search

Introduction  There is little evidence of a preventive effect of vitamin D on falling in Japanese populations. The purpose of this study\\u000a was to evaluate the effect of vitamin D status on postural sway, muscle strength, and the incidence of falls in elderly community-dwelling\\u000a Japanese women. This study utilized a cross-sectional design for postural sway and muscle strength as outcomes and

Kazutoshi Nakamura; Rieko Oshiki; Koki Hatakeyama; Tomoko Nishiwaki; Kimiko Ueno; Mitsue Nashimoto; Toshiko Saito; Yasuo Tsuchiya; Yoko Okuda; Masaharu Yamamoto

2006-01-01

357

Reducing falls among older people in hospital.  

PubMed

Thousands of patients fall on hospital wards each year, leading to potentially devastating consequences for them and their families. Falls among inpatients usually arise from a complex combination of risk factors, including dementia, delirium, incontinence and medication. This article discusses the FallSafe project that aimed to reduce falls in inpatient settings. The results suggested a 25 per cent reduction in falls on average across the wards involved. The project also had a positive effect on patients and staff. A case study of a staff nurse involved in leading the project on her ward and the care bundle that comprised the project intervention are explored. PMID:22792696

Dean, Erin

2012-06-01

358

The Way Things Fall  

NSDL National Science Digital Library

This web page provides an introduction to the motion of objects due to gravity. Topics covered include free fall and acceleration due to gravity, with or without an initial velocity, and the effects of air resistance. Simple equations are integrated along with a short experiment related to Galileo's classic ramp experiment. A lesson plan for teachers is provided. This item is part of an extensive collection, "From Stargazers to Starships" that uses space exploration and space science to introduce concepts in physics and astronomy. Translations in Spanish and French are available.

Stern, David

2005-09-22

359

Evaluating the effectiveness of educational interventions to prevent delirium.  

PubMed

The aim of this study was to combine knowledge about how clinicians learn with a review of educational interventions to prevent delirium in hospitalised patients. The primary aim was to evaluate the effectiveness of approaches to delirium education. A detailed search of educational and medical databases was undertaken. The type of intervention used was classified according to the PRECEED model of Green and colleagues, using factors relevant to behaviour change in health promotion. The effectiveness of the intervention was determined by assessing changes in staff performance and patient outcomes. Nineteen studies of variable design and quality were identified. Studies using predisposing, enabling and reinforcing strategies together were more often effective in producing changes in staff behaviour and patient outcomes. Education and guidelines used together or in combination have little effect. When strategies to enable and reinforce changes in clinical practice are used together with education sessions, outcomes for patients are more positive. PMID:22176561

Wand, Anne Pamela Frances

2011-05-03

360

The effect of pramipexole therapy on balance disorder and fall risk in Parkinson's disease at early stage: clinical and posturographic assessment.  

PubMed

The aim of this study was to determine balance problems and severity and ratio of postural instability of newly diagnosed, early stage Parkinson's patients who did not receive any antiparkinson treatment before, to evaluate fall risk clinically and posturographically and to examine the effects of pramipexole on these signs and symptoms. Detailed posturographic assessments which involved central vestibular, visual, peripheric vestibular somatosensory field tests were applied to both patient and control subjects and fall risk was determined. There was not statistically significant difference between patients and control subjects before and after drug therapy in the assesment of fall risk in posturography and there was not any improvement with drug usage in the patient group. However, in the analysis of subsystems separately, only the involvement in central vestibular field was more severe and could appear at all positions in Parkinson's patients comparing with the control group, and pramipexole was partially effective in improving this disorder. Central vestibular field is the subsystem that should be examined with first priority. Posturography is relatively reliable in defining fall risk and postural instability ratio in Parkinson's disease. But it should be considered that clinical assessment tools can be more sensitive in the evaluation of balance and postural disorders and in the follow-up of the response to drug therapy. PMID:22919514

Güler, Sibel; Bir, Levent Sinan; Akdag, Beyza; Ard?c, Fusun

2012-08-05

361

The Effect of Pramipexole Therapy on Balance Disorder and Fall Risk in Parkinson's Disease at Early Stage: Clinical and Posturographic Assessment  

PubMed Central

The aim of this study was to determine balance problems and severity and ratio of postural instability of newly diagnosed, early stage Parkinson's patients who did not receive any antiparkinson treatment before, to evaluate fall risk clinically and posturographically and to examine the effects of pramipexole on these signs and symptoms. Detailed posturographic assessments which involved central vestibular, visual, peripheric vestibular somatosensory field tests were applied to both patient and control subjects and fall risk was determined. There was not statistically significant difference between patients and control subjects before and after drug therapy in the assesment of fall risk in posturography and there was not any improvement with drug usage in the patient group. However, in the analysis of subsystems separately, only the involvement in central vestibular field was more severe and could appear at all positions in Parkinson's patients comparing with the control group, and pramipexole was partially effective in improving this disorder. Central vestibular field is the subsystem that should be examined with first priority. Posturography is relatively reliable in defining fall risk and postural instability ratio in Parkinson's disease. But it should be considered that clinical assessment tools can be more sensitive in the evaluation of balance and postural disorders and in the follow-up of the response to drug therapy.

Guler, Sibel; Bir, Levent Sinan; Akdag, Beyza; Ard?c, Fusun

2012-01-01

362

Falls in Nursing Homes  

MedlinePLUS

... Lives & Protecting People Home & Recreational Safety Motor Vehicle Safety Traumatic ... serious are these falls? Why do falls occur more often in nursing homes? What are the most common causes of ...

363

Caffeinated coffee does not acutely affect energy intake, appetite, or inflammation but prevents serum cortisol concentrations from falling in healthy men.  

PubMed

Our aim in this crossover study was to investigate the acute effects of caffeinated and decaffeinated coffee consumption on appetite feelings, energy intake, and appetite-, inflammation-, stress-, and glucose metabolism-related markers. Sixteen healthy men (age range, 21-39 y; BMI range, 19.7-28.6 kg/m(2)) received in a random order on 3 separate occasions a standard breakfast snack with 200 mL of either caffeinated coffee (3 mg caffeine/kg body weight), decaffeinated coffee, or water (control). Before intervention (-15 min) and at standard time points following breakfast consumption (0, 15, 30, 60, 90, 120, 150, and 180 min), participants recorded their appetite feelings and we collected blood samples for measurements of circulating glucose, insulin, cortisol, and appetite- and inflammation-related markers. At 180 min, participants consumed a meal ad libitum. The appetite-related ratings, the appetite plasma hormonal responses as well as the plasma glucose, serum insulin, and plasma and serum inflammatory marker responses did not show an overall intervention effect or a time x intervention interaction. Ad libitum energy intake did not differ among the 3 interventions. However, a significant intervention effect (P = 0.04) and a time x intervention interaction (P-interaction = 0.02) were found for serum cortisol; cortisol concentrations were significantly higher following the caffeinated coffee intervention, compared to control, at 60 min and thereafter. In conclusion, the usually consumed amount of caffeinated coffee does not have short-term effects on appetite, energy intake, glucose metabolism, and inflammatory markers, but it increases circulating cortisol concentrations in healthy men. PMID:21346100

Gavrieli, Anna; Yannakoulia, Mary; Fragopoulou, Elizabeth; Margaritopoulos, Dimitris; Chamberland, John P; Kaisari, Panagiota; Kavouras, Stavros A; Mantzoros, Christos S

2011-02-23

364

Earthquake Disaster Prevention Support Tool – Visualization of Prevention Effectiveness by Utilizing Augmented Reality  

Microsoft Academic Search

\\u000a Japan has faced major problems with large-scale earthquake countermeasures due to its location in an earthquake zone. The\\u000a Building Standards Act of Japan has been amended since previous major earthquake damage and new buildings have been built\\u000a with a safer design than ever before. However, measures against falling or overturning of furniture, which could injure people\\u000a inside buildings, are not

Kyoko Yoshida; Masahiro Urabe; Hayato Tsuchiya; Yasuki Iizuka; Kayo Iizuka

365

Technology Innovation Enabling Falls Risk Assessment in a Community Setting  

Microsoft Academic Search

Approximately one in three people over the age of 65 will fall each year, resulting in significant financial, physical, and\\u000a emotional cost on the individual, their family, and society. Currently, falls are managed using on-body sensors and alarm\\u000a pendants to notify others when a falls event occurs. However these technologies do not prevent a fall from occurring. There\\u000a is now

Cliodhna Ni Scanaill; Chiara Garattini; Barry R. Greene; Michael J. McGrath

2011-01-01

366

Falls and falls efficacy: the role of sustained attention in older adults  

PubMed Central

Background Previous evidence indicates that older people allocate more of their attentional resources toward their gait and that the attention-related changes that occur during aging increase the risk of falls. The aim of this study was to investigate whether performance and variability in sustained attention is associated with falls and falls efficacy in older adults. Methods 458 community-dwelling adults aged ? 60 years underwent a comprehensive geriatric assessment. Mean and variability of reaction time (RT), commission errors and omission errors were recorded during a fixed version of the Sustained Attention to Response Task (SART). RT variability was decomposed using the Fast Fourier Transform (FFT) procedure, to help characterise variability associated with the arousal and vigilance aspects of sustained attention. The number of self-reported falls in the previous twelve months, and falls efficacy (Modified Falls Efficacy Scale) were also recorded. Results Significant increases in the mean and variability of reaction time on the SART were significantly associated with both falls (p < 0.01) and reduced falls efficacy (p < 0.05) in older adults. An increase in omission errors was also associated with falls (p < 0.01) and reduced falls efficacy (p < 0.05). Upon controlling for age and gender affects, logistic regression modelling revealed that increasing variability associated with the vigilance (top-down) aspect of sustained attention was a retrospective predictor of falling (p < 0.01, OR = 1.14, 95% CI: 1.03 - 1.26) in the previous year and was weakly correlated with reduced falls efficacy in non-fallers (p = 0.07). Conclusions Greater variability in sustained attention is strongly correlated with retrospective falls and to a lesser degree with reduced falls efficacy. This cognitive measure may provide a novel and valuable biomarker for falls in older adults, potentially allowing for early detection and the implementation of preventative intervention strategies.

2011-01-01

367

[The influence of falls on the quality of life of the aged].  

PubMed

The objective of this study is to analyze the effect of falls and their consequences on the quality of life of elderly people living in a low-income community in the city of Rio de Janeiro. This article is part of an explorative research conducted at CLAVES, using quantitative and qualitative methods. In this study we used quantitative data about falls and quality of life. 72 elderly aged over 60 years participated in the study. 51,4% of them were females, 20,8% lived alone and 37,5% admitted having suffered a fall during the last year. Among the most frequently mentioned consequences were fractures (24,3%), the fear of falling (88,5%), abandonment of activities (26,9%), change of habits (23,1%) and immobilization (19%). The analysis showed that falls have influence upon in the quality of life of the aged. The WHOQOL-Bref domain scores showed a reduction in the means of the group that had suffered falls during the last year in comparison to those who didn't fall, and the difference was more significant in the psychological field. In short, falls are frequent among the elderly and bring consequences that change the quality of life of these people in a negative way. Their incidence can be avoided by identifying the causes and developing appropriate preventive measures. PMID:18813626

Ribeiro, Adalgisa Peixoto; de Souza, Edinilsa Ramos; Atie, Soraya; de Souza, Amaro Crispim; Schilithz, Arthur Orlando

368

Reinterpreting Dissemination of Prevention Programs as Widespread Implementation with Effectiveness and Fidelity.  

ERIC Educational Resources Information Center

|This article urges a reexamination of the concept of dissemination of health-related prevention programs. The article discusses factors that serve as sustaining conditions for dissemination of prevention programs including: (1) the nature of preventive intervention and parameters of effective community-based prevention praxis; (2) aspects of the…

Elias, Maurice J.

369

Fall classification by machine learning using mobile phones.  

PubMed

Fall prevention is a critical component of health care; falls are a common source of injury in the elderly and are associated with significant levels of mortality and morbidity. Automatically detecting falls can allow rapid response to potential emergencies; in addition, knowing the cause or manner of a fall can be beneficial for prevention studies or a more tailored emergency response. The purpose of this study is to demonstrate techniques to not only reliably detect a fall but also to automatically classify the type. We asked 15 subjects to simulate four different types of falls-left and right lateral, forward trips, and backward slips-while wearing mobile phones and previously validated, dedicated accelerometers. Nine subjects also wore the devices for ten days, to provide data for comparison with the simulated falls. We applied five machine learning classifiers to a large time-series feature set to detect falls. Support vector machines and regularized logistic regression were able to identify a fall with 98% accuracy and classify the type of fall with 99% accuracy. This work demonstrates how current machine learning approaches can simplify data collection for prevention in fall-related research as well as improve rapid response to potential injuries due to falls. PMID:22586477

Albert, Mark V; Kording, Konrad; Herrmann, Megan; Jayaraman, Arun

2012-05-07

370

Commentary: Eight Ways to Prevent Cancer: a framework for effective prevention messages for the public  

PubMed Central

Research over the past 40 years has convincingly shown that lifestyle factors play a huge role in cancer incidence and mortality. The public, though, can often discount the preventability of cancer. That health information on the Internet is a vast and often scientifically suspect commodity makes promoting important and sound cancer prevention messages to the pubic even more difficult. To help address these issues and improve the public’s knowledge of, and attitudes toward, cancer prevention, there need to be concerted efforts to create evidence-based, user-friendly information about behaviors that could greatly reduce overall cancer risk. Toward this end, we condensed the current scientific evidence on the topic into eight key behaviors. While not an end in themselves, “8 Ways to Stay Healthy and Prevent Cancer” forms an evidence-based and targeted framework that supports broader cancer prevention efforts.

Dart, Hank; Wolin, Kathleen Y.; Colditz, Graham A.

2013-01-01

371

Recurrent Falls in Parkinson's Disease: A Systematic Review  

PubMed Central

Most people with Parkinson's disease (PD) fall and many experience recurrent falls. The aim of this review was to examine the scope of recurrent falls and to identify factors associated with recurrent fallers. A database search for journal articles which reported prospectively collected information concerning recurrent falls in people with PD identified 22 studies. In these studies, 60.5% (range 35 to 90%) of participants reported at least one fall, with 39% (range 18 to 65%) reporting recurrent falls. Recurrent fallers reported an average of 4.7 to 67.6 falls per person per year (overall average 20.8 falls). Factors associated with recurrent falls include: a positive fall history, increased disease severity and duration, increased motor impairment, treatment with dopamine agonists, increased levodopa dosage, cognitive impairment, fear of falling, freezing of gait, impaired mobility and reduced physical activity. The wide range in the frequency of recurrent falls experienced by people with PD suggests that it would be beneficial to classify recurrent fallers into sub-groups based on fall frequency. Given that there are several factors particularly associated with recurrent falls, fall management and prevention strategies specifically targeting recurrent fallers require urgent evaluation in order to inform clinical practice.

Allen, Natalie E.; Schwarzel, Allison K.; Canning, Colleen G.

2013-01-01

372

The KAP Evaluation of Intervention on Fall-Induced Injuries among Elders in a Safe Community in Shanghai, China  

PubMed Central

Background To evaluate the effect of an intervention on fall induced injuries of elderly people in a safe-community in Shanghai and to discuss an intervention model that is proper for the community to generalize. Methodology/Principal Findings Five neighborhood areas in a Safe Community were purposively selected. All individuals aged 60 years or over in five neighborhoods were prospective participants. From randomly selected prospective households with elders, 2,889 (pre intervention) and 3,021 (post intervention) elderly people were included in the study. Knowledge, Attitude and Practice Model (KAP) questionnaires were used at the pre- and post-intervention phase for fall-induced injury prevention in the community. Descriptive statistics and chi-square tests were used. After the intervention, knowledge about the prevention of fall-induced injuries increased, as did attitudes, beliefs and good behaviors for fall prevention. Behavior modification was most notable with many behavior items changing significantly (p value<0.0001). Conclusions/ Significance The integrated program for reducing fall-related injuries in the community was effective in improving fall prevention among the elderly, but the intervention still needs further improvement.

Zhang, Ling-ling; Dalal, Koustuv; Yin, Ming-min; Yuan, De-guo; Andrews, Johanna Yvonne; Wang, Shu-mei

2012-01-01

373

Effects of Temporary Tributary Use on Escapement Estimates of Adult Fall Chinook Salmon in the Deschutes River, Oregon  

Microsoft Academic Search

International managers use escapement estimates of the Deschutes River, Oregon, population of fall Chinook salmon Oncorhynchus tshawytscha to forecast abundance and assess population health. Fish are externally marked in the Deschutes River, and a subsample of the marked fish is recovered on the spawning grounds to provide data for estimating escapement. Escapement would be overestimated if some of the marked

George P. Naughton; Michael A. Jepson; Christopher A. Peery; Christopher V. Brun; Jennifer C. Graham

2009-01-01

374

EFFECTS OF FALL APPLICATION OF BROILER LITTER AND RYE WINTER COVER CROP ON COTTON YIELD AND SOIL N DYNAMICS  

Technology Transfer Automated Retrieval System (TEKTRAN)

This experiment was conducted on a Leeper silty clay loam soil at Mississippi Agricultural and Forestry Experimental Station (MAFES), Mississippi State, MS, in 2003 and will continue to 2006 to identify if rye winter cover crop over seeded to fall applied broiler litter benefits cotton growth and yi...

375

Lighting and perceptual cues: Effects on gait measures of older adults at high and low risk for falls  

PubMed Central

Background The visual system plays an important role in maintaining balance. As a person ages, gait becomes slower and stride becomes shorter, especially in dimly lighted environments. Falls risk has been associated with reduced speed and increased gait variability. Methods Twenty-four older adults (half identified at risk for falls) experienced three lighting conditions: pathway illuminated by 1) general ceiling-mounted fixtures, 2) conventional plug-in night lights and 3) plug-in night lights supplemented by laser lines outlining the pathway. Gait measures were collected using the GAITRite© walkway system. Results Participants performed best under the general ceiling-mounted light system and worst under the night light alone. The pathway plus night lights increased gait velocity and reduced step length variability compared to the night lights alone in those at greater risk of falling. Conclusions Practically, when navigating in more challenging environments, such as in low-level ambient illumination, the addition of perceptual cues that define the horizontal walking plane can potentially reduce falls risks in older adults.

2011-01-01

376

The effect of cocurrent and countercurrent gas shear on entrance region mass transfer in turbulent falling liquid films  

Microsoft Academic Search

Predictions of average film thickness and mass transfer coefficients in the entrance region of gas absorption with high cocurrent and countercurrent gas flow in a turbulent falling film are presented. The model used is a modified van Driest eddy diffusivity in the inner wall region and an interface damping eddy diffusivity in the outher region of the film modified to

S.-M. Yih Alhambra

1989-01-01

377

Proposal for a multiphase fall model based on real-world fall recordings with body-fixed sensors.  

PubMed

Falls are by far the leading cause of fractures and accidents in the home environment. The current Cochrane reviews and other systematic reviews report on more than 200 intervention studies about fall prevention. A recent meta-analysis has summarized the most important risk factors of accidental falls. However, falls and fall-related injuries remain a major challenge. One novel approach to recognize, analyze, and work better toward preventing falls could be the differentiation of the fall event into separate phases. This might aid in reconsidering ways to design preventive efforts and diagnostic approaches. From a conceptual point of view, falls can be separated into a pre-fall phase, a falling phase, an impact phase, a resting phase, and a recovery phase. Patient and external observers are often unable to give detailed comments concerning these phases. With new technological developments, it is now at least partly possible to examine the phases of falls separately and to generate new hypotheses.The article describes the practicality and the limitations of this approach using body-fixed sensor technology. The features of the different phases are outlined with selected real-world fall signals. PMID:23184296

Becker, C; Schwickert, L; Mellone, S; Bagalà, F; Chiari, L; Helbostad, J L; Zijlstra, W; Aminian, K; Bourke, A; Todd, C; Bandinelli, S; Kerse, N; Klenk, J

2012-12-01

378

Effects of exercise and nutrition on postural balance and risk of falling in elderly people with decreased bone mineral density: randomized controlled trial pilot study  

Microsoft Academic Search

Objective : To compare the effect of calcium\\/vitamin D supplements with a combination of calcium\\/vitamin D supplements and exercise\\/protein on risk of falling and postural balance. Design : Randomized clinical trial. Setting : University hospital physiotherapy department. Subjects : Twenty-four independently living elderly females aged 65 years and older with osteopenia or osteoporosis and mean total hip T-score (SD) of

Jaap Swanenburg; Eling Douwe de Bruin; Marguerite Stauffacher; Theo Mulder; Daniel Uebelhart

2007-01-01

379

Effects of Flow and Spill on the Migratory Behavior and Survival of Juvenile Fall and Summer Chinook Salmon in John Day Reservior : Annual Report 1987.  

SciTech Connect

Juvenile fall chinook salmon, Oncorhynchus tshawytscha, were freeze branded, coded wire tagged, and released into the Columbia River in the tailrace below McNary Dam during the summers of 1981--1983. The objectives of the study were to examine the effects of river flow on the passage time and migrational behavior of the juveniles and to subsequently assess any relationship to adult survival. This report details adult recovery data to June 1987. 2 refs., 11 tabs.

Miller, David R.; Glorgi, Albert E.

1987-12-01

380

Organised Crime Prevention in the Netherlands: Exposing the Effectiveness of Preventive Measures  

Microsoft Academic Search

The preventive approach against organised crime has gained much attention \\u000asince the early 1990s. On an international level as well as on a national one \\u000avarious preventive measures against organised crime have been developed. This \\u000ais certainly true in the European Union and the Netherlands. This introduction \\u000achapter is divided into three sections. The first looks at the developments that

Schoot van der C. R. A

2006-01-01

381

Effects of a Comprehensive Police Suicide Prevention Program  

PubMed Central

Background: Police suicides are an important problem, and many police forces have high rates. Montreal police suicide rates were slightly higher than other Quebec police rates in the 11 years before the program began (30.5/100,000 per year vs. 26.0/100,000). Aims: To evaluate Together for Life, a suicide prevention program for the Montreal police. Methods: All 4,178 members of the Montreal police participated. The program involved training for all officers, supervisors, and union representatives as well as establishing a volunteer helpline and a publicity campaign. Outcome measures included suicide rates, pre-post assessments of learning, focus groups, interviews, and follow-up of supervisors. Results: In the 12 years since the program began the suicide rate decreased by 79% (6.4/100,000), while other Quebec police rates had a nonsignificant (11%) increase (29.0/100,000). Also, knowledge increased, supervisors engaged in effective interventions, and the activities were highly appreciated. Limitations: Possibly some unidentified factors unrelated to the program could have influenced the observed changes. Conclusions: The decrease in suicides appears to be related to this program since suicide rates for comparable populations did not decrease and there were no major changes in functioning, training, or recruitment to explain the differences. Comprehensive suicide prevention programs tailored to the work environment may significantly impact suicide rates.

Mishara, Brian L.; Martin, Normand

2012-01-01

382

Preventive effect of pidotimod on reactivated toxoplasmosis in mice.  

PubMed

As one of food-borne parasitic diseases, toxoplasmosis entails the risk of developing reactivation in immunocompromised patients. The synthetic dipeptide pidotimod is a potent immunostimulating agent that improves the immunodefenses in immunodepression. To investigate the efficacy of pidotimod as a preventive treatment, we used a murine model of reactivated toxoplasmosis with cyclophosphamide (CY)-induced immunosuppression. Pidotimod administration significantly restored the body weight and spleen organ index, increased survival time (from 70 to 90%), and decreased the parasitemia (from 80 to 35%) of CY-induced mice with reactivated toxoplasmosis. Cytokine profiles and CD4(+) T cells subpopulation analyses by Cytometric Bead Array and flow cytometry demonstrated that pidotimod treatment resulted in a significant upregulation of pro-inflammatory cytokines (IFN-?, TNF-?, and IL-2) and Th1 cells (from 3.73 ± 0.39 to 5.88 ± 0.46%) after CY induction in infected mice. Additionally, histological findings and parasite DNA quantification revealed that mice administered with pidotimod had a remarkable reduction of parasite burden (two-log) and amelioration of histopathology in the brains. The in vitro studies showed that pidotimod significantly restored concanavalin A-induced splenocyte proliferation and pro-inflammatory cytokines in the supernatants of splenocyte culture. It could be concluded that the administration of pidotimod in immunocompromised mice significantly increases the Th1-biased immune response, prolongs survival time, and ameliorates the load of parasites in the blood. This is the first report of the preventive effect of pidotimod on reactivated toxoplasmosis. PMID:23774843

Huo, Xing-Xing; Wang, Lin; Chen, Zhao-Wu; Chen, He; Xu, Xiu-Cai; Zhang, Ai-Mei; Song, Xiao-Rong; Luo, Qing-Li; Xu, Yuan-Hong; Fu, Yu; Wang, Hua; Du, Jian; Cai, Yi-Hong; Lun, Zhao-Rong; Lu, Fang-Li; Wang, Yong; Shen, Ji-Long

2013-06-18

383

[Passive smoking--health consequences and effects of exposure prevention].  

PubMed

Passive smoking is the third leading but preventable cause of death worldwide. It is associated with an elevated risk of developing acute respiratory diseases, obstructive lung disorders, lung cancer, and cardiovascular disease. Whereas the dose-response relationship between second-hand smoke exposure and respiratory diseases is likely to be linear, a non-linear dose-response curve has been observed with respect to acute cardiovascular events. This explains the disproportionately high risk of myocardial infarction among passive smokers as compared to unexposed individuals. Over the last ten years, exposure to second-hand smoke has declined in Germany, but it is still substantial. With passive smoking in the home being a difficult target for preventive measures, public smoking bans have recently been shown to greatly reduce second-hand smoke-related morbidity and mortality. In addition, such measures are usually well tolerated and highly relevant regarding legal aspects related to workplace issues. This article summarises the current evidence on the health consequences of passive smoking and on the favourable effects of public smoking bans. PMID:18041691

Raupach, T; Radon, K; Nowak, D; Andreas, S

2007-11-28

384

House fire injury prevention update. Part II. A review of the effectiveness of preventive interventions  

PubMed Central

Objective—To evaluate and summarize the house fire injury prevention literature. Methods—MEDLINE (1983 to March 1997) was searched by keyword: fire, burn, etiology, cause, prevention, epidemiology, and smoke detector/alarm. ERIC (1966 to March 1997) and PSYCLIT (1974 to June 1997) were searched by keyword: as above, and safety, skills, education, and training. Other sources included references of retrieved publications, review articles, and books; Injury Prevention hand search; government documents; and internet sources. Sources relevant to residential fire injury prevention were selected, evaluated, and summarized. Results—Forty three publications were selected for review, including seven randomized controlled trials, nine quasiexperiments, two natural experiments, 21 prospective cohort studies, two cross sectional surveys, one case report, and one program evaluation. These studies examined the following types of interventions: school (9), preschool (1), and community based educational programs (5); fire response training programs for children (7), blind adolescents (2), and mentally retarded adults (5) and children (1); office based counseling (4); home inspection programs (3); smoke detector giveaway campaigns (5); and smoke detector legislation (1). Conclusions—This review of house fire prevention interventions underscores the importance of program evaluation. There is a need for more rigorous evaluation of educational programs, particularly those targeted at schools. An evidence based, coordinated approach to house fire injury prevention is critical, given current financial constraints and the potential for program overload for communities and schools.

Warda, L.; Tenenbein, M.; Moffatt, M.

1999-01-01

385

Connect: An Effective Community-Based Youth Suicide Prevention Program  

ERIC Educational Resources Information Center

|Youth suicide prevention is an important public health issue. However, few prevention programs are theory driven or systematically evaluated. This study evaluated Connect, a community-based youth suicide prevention program. Analysis of pre and posttraining questionnaires from 648 adults and 204 high school students revealed significant changes in…

Bean, Gretchen; Baber, Kristine M.

2011-01-01

386

Veterans' fall risk profile: a prevalence study  

PubMed Central

The Veterans Health Administration (VHA) serves the health care needs of an adult, predominantly male, and aging population. The aging profile of VHA patients is 25% greater than the civilian sector (DVA 2001). Aged patients are at higher risk for falls. In February 2002, 6 VHA medical centers profiled their inpatients’ fall risk profile as one aspect of program initiatives targeted at reducing veterans’ fall risk and fall-related injuries, participating in a one-day collection of fall risk measurement using the Morse Fall Scale (MFS) for all inpatients (n=1819), acute and long-term care units. Data results are reported for age, MFS score, and the relationship between age and score, and by type of ward/unit, ie, predominately acute and critical care or long-term care. The results of this prevalence study documented that the veteran inpatient population are at high-risk for anticipated physiological falls. This Veteran Integrated Services Network-wide Deployment of an Evidence-based Program to Prevent Patient Falls study was completed as part of a nationally funded clinical initiative, National Program Initiative 20-006-1.

Quigley, Patricia A; Palacios, Polly; Spehar, Andrea M

2006-01-01

387

Non-pharmacological means to prevent fractures among older adults.  

PubMed

Bone fractures affecting elderly people are a true public health burden, because they represent one of the most important causes of long-standing pain, functional impairment, disability, and death among this population. Compromised bone strength (osteoporosis) and falling, alone, or more frequently in combination, are the two independent and immediate risk factors of elderly people's fractures through which all the other, more distant risk factors, such as aging, inactivity, poor nutrition, smoking, use of alcohol, diseases, medications, functional impairments, and disabilities, operate. Of these two, falling, not osteoporosis, is the strongest single risk factor for a fracture. The most usual occurrence resulting in a fracture of an older adult is a 'simple' fall from standing height or less. Although in general terms this type of trauma is mild or moderate only (compared with, for example, motor vehicle collisions), to the specific injury site these traumas are high-impact injuries often creating forces clearly exceeding the breaking strength of the bone. Therefore, fractures affecting elderly people should be called 'fall-induced high-impact injuries' instead of the commonly used, partly misleading terms of osteoporotic fractures or minimal-trauma fractures. Prevention of elderly people's fractures consists of prevention of osteoporosis and of falling, and prevention of fractures using injury-site protection. Concerning osteoporosis, maximizing peak bone mass and preventing bone loss by regular exercise, calcium, and vitamin D, and, treatment of established osteoporosis with bone-specific drugs, have a strong scientific basis. In fall prevention, regular strength and balance training, reducing psychotropic medication, and diet supplementation with vitamin D and calcium have been shown to be effective. The multifaceted risk factor-assessing and modifying interventions have also been successful in preventing falls among the older adults by simultaneously affecting many of the risk factors of falling. Finally, concerning injury-site protection, padded strong-shield hip protectors whose effectiveness is scientifically proven seem to be a promising option in preventing hip fractures. PMID:16019730

Kannus, Pekka; Uusi-Rasi, Kirsti; Palvanen, Mika; Parkkari, Jari

2005-01-01

388

External Validity of Physical Activity Interventions for Community-Dwelling Older Adults with Fall Risk: A Quantitative Systematic Literature Review  

PubMed Central

Aim To appraise the external validity of physical activity interventions designed to reduce falls among community-dwelling older adults, using the reach, efficacy/effectiveness, adoption, implementation, and maintenance framework. Background Falls are a globally common, significant, and preventable problem. The efficacy of physical activity interventions to reduce falls among older adults is well established. Translation of this research into practice is slow as evidenced by persistently low proportions of older adults who engage in physical activities and the rising incidence of falls. Data Sources Four electronic databases were searched for relevant studies published between 2000 and 2010. Studies that examined the effects of physical activity interventions designed to reduce falls among community dwelling older adults were included in this review (n = 46). Review Methods This was a quantitative systematic review with narrative synthesis. The reach, efficacy/effectiveness, adoption, implementation, and maintenance framework guided the identification, appraisal, and synthesis of indicators representing study validity. Results The majority of studies in this review described indicators representing internal validity. Details about indicators representing external validity were reported infrequently, limiting the generalizability of fall-preventive physical activity interventions in diverse cultures and social contexts over time. Conclusions To foster translational research in real world settings, additional programmatic intervention research is needed that: (a) targets diverse populations; (b) incorporates theories of behavioural change; (c) describes and operationalizes critical content that enables replication and translation; (d) tests innovative measures of fall risk and physical activity; and (e) evaluates feasibility and acceptability.

McMahon, Siobhan; Fleury, Julie

2012-01-01

389

Effects of surface tension and contact angle on sensible heating and boiling incipience in dielectric falling films  

SciTech Connect

Predicting the point of incipient boiling is of paramount importance for reliable operation of liquid-cooled microelectronic heat sources during power transients. This study focuses on heat transfer from a simulated multichip module to a falling film. Experiments have been performed to develop an understanding of the influence of surface tension and wetting characteristics in sensible heat transfer and boiling incipience in free-falling dielectric (FC-72) liquid films. A correlation for the space-average heat transfer coefficient is presented which shows clear departure of FC-72 data from correlations obtained for fluids with higher surface tension. The boiling results reveal that the vanishingly small contact angle of FC-72 precluded the application of correlations currently employed to predict incipience. Also, the temperature overshoot commonly encountered upon boiling incipience in wetting fluids was nonexistent in all the experimental runs. 14 refs., 12 figs.

Marsh, W.J.; Mudawwar, I.

1988-01-01

390

Risk Factors Associated With Injury Attributable to Falling Among Elderly Population With History of Stroke  

PubMed Central

Background and Purpose Stroke survivors are at high risk for falling. Identifying physical, clinical, and social factors that predispose stroke patients to falls may reduce further disability and life-threatening complications, and improve overall quality of life. Methods We used 5 biennial waves (1998–2006) from the Health and Retirement Study to assess risk factors associated with falling accidents and fall-related injuries among stroke survivors. We abstracted demographic data, living status, self-evaluated general health, and comorbid conditions. We analyzed the rate ratio (RR) of falling and the OR of injury within 2 follow-up years using a multivariate random effects model. Results We identified 1174 stroke survivors (mean age±SD, 74.4±7.2 years; 53% female). The 2-year risks of falling, subsequent injury, and broken hip attributable to fall were 46%, 15%, and 2.1% among the subjects, respectively. Factors associated with an increased frequency of falling were living with spouse as compared to living alone (RR, 1.4), poor general health (RR, 1.1), time from first stroke (RR, 1.2), psychiatric problems (RR, 1.7), urinary incontinence (RR, 1.4), pain (RR, 1.4), motor impairment (RR, 1.2), and past frequency of ?3 falls (RR, 1.3). Risk factors associated with fall-related injury were female gender (OR, 1.5), poor general health (OR, 1.2), past injury from fall (OR, 3.2), past frequency of ?3 falls (OR, 3.1), psychiatric problems (OR, 1.4), urinary incontinence (OR, 1.4), impaired hearing (OR, 1.6), pain (OR, 1.8), motor impairment (OR, 1.3), and presence of multiple strokes (OR, 3.2). Conclusions This study demonstrates the high prevalence of falls and fall-related injuries in stroke survivors, and identifies factors that increase the risk. Modifying these factors may prevent falls, which could lead to improved quality of life and less caregiver burden and cost in this population.

Divani, Afshin A.; Vazquez, Gabriela; Barrett, Anna M.; Asadollahi, Marjan; Luft, Andreas R.

2010-01-01

391

Fungal Diversity of Norway Spruce Litter: Effects of Site Conditions and Premature Leaf Fall Caused By Bark Beetle Outbreak  

Microsoft Academic Search

Fungi play an important role in leaf litter decomposition due to their ability to break down the lignocellulose matrix, which\\u000a other organisms are unable to digest. However, little is known regarding the factors affecting components of fungal diversity.\\u000a Here, we quantified richness of internal fungi in relation to litter nutrient and phenolic concentrations, sampling season\\u000a (spring or fall), and premature

K. Przyby?; P. Karolewski; J. Oleksyn; A. ?ab?dzki; P. B. Reich

2008-01-01

392

Effect of dieldrin in the glue line of oak plywood panels in preventing ...  

Treesearch

Description: For many years the lumber industry has been seeking improved ... is the addition of toxic chemicals in plywood glues to prevent infestations or restrict ... the toxic additives are effective in preventing certain types of insect damage.

393

Rock falls landslides in Abruzzo (Central Italy) after recent earthquakes: morphostructural control  

NASA Astrophysics Data System (ADS)

Recent earthquakes show that damages due to collateral effects could, in some cases exceed the economic and social losses directly connected to the seismic shaking. The earthquake heavily damaged urban areas and villages and induced several coseismic deformations and geomorphologic effects, including different types of instability such as: rock falls, debris falls, sink holes, ground collapses, liquefaction, etc. Among the effects induced by the seismic energy release, landslides are one of the most significant in terms of hazard and related risk, owing to the occurrence of exposed elements. This work analyzes the geomorphological effects, and particularly the rock falls, which occurred in the L'Aquila area during and immediately after the April 2009 earthquake. The analysis is focused mainly on the rock fall distribution related to the local morphostructural setting. Rock falls occurred mostly on calcareous bedrock slopes or on scarps developed on conglomerates and breccias of Quaternary continental deposits. Geological and geomorphological surveys have outlined different types of rock falls on different morpho-structural settings, which can be summarized as follow: 1)rock falls on calcareous faulted homoclinal ridges; 2)rock falls on calcareous rock slopes of karst landforms; 3)rock falls on structural scarps on conglomerates and breccias of Quaternary continental deposits. The first type of rockfall occurred particularly along main gorges carved on calcareous rocks and characterised by very steep fault slopes and structural slopes (i.e. San Venanzio Gorges, along the Aterno river). In these cases already unstable slopes due to lithological and structural control were triggered as rockfalls also at high distance from the epicentre area. These elements provide useful indications both at local scale, for seismic microzonation studies and seismic risk prevention, and at regional scale, for updating studies and inventory of landslides.

Piacentini, T.; Miccadei, E.; Di Michele, R.; Esposito, G.

2012-04-01

394

Effect of muscle and post-mortem rate of pH and temperature fall on antioxidant enzyme activities in beef.  

PubMed

The aim of this study was to investigate the effect of muscle, inner and outer Musculus biceps femoris (IBF and OBF respectively) and Musculus longissimus dorsi (LD), on the post-mortem rate of pH and temperature fall, and the activity of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) during simulated retail display. At day 0 of display (2 days post-mortem), the CAT and GSH-Px activities were lower in IBF than in OBF and LD (P<0.001), and the SOD activity was lower in OBF compared to IBF and LD (P<0.001). At day 10 of display, SOD and CAT activities had decreased in all three muscles compared to day 0 (P<0.001), whereas the GSH-Px activity did increase with time of display. Across muscles, there were significant relationships between temperature fall, colour, lipid and colour stability and antioxidant enzyme activities. PMID:23273481

Pastsart, Umaporn; De Boever, Maarten; Claeys, Erik; De Smet, Stefaan

2012-11-16

395

Sensory impairment in hip-fracture patients 65 years or older and effects of hearing/vision interventions on fall frequency  

PubMed Central

Aim: Examine the effect of nursing interventions to improve vision and hearing, systematic assessment, and referral to sensory specialists on falling. Methods: Controlled intervention trial targeting hip fracture patients, 65 years and older, living at home and having problems seeing/reading regular print (VI) or hearing normal speech (HI). Intervention group = 200, control group = 131. The InterRAI-AcuteCare (RAI-AC) and the Combined-Serious-Sensory-Impairment interview guide (KAS-Screen) were used. Follow-up telephone calls were done every third month for one year. Results: Mean age was 84.2 years, 79.8% were female, and 76.7% lived alone. HI was detected in 80.7% and VI in 59.8%. Falling was more frequent among the intervention group (P = 0.003) and they also more often moved to a nursing home (P < 0.001) and were dependent walking up stairs (P = 0.003). Conclusions: This study could not document the effect of intervention on falling, possibly because of different base line characteristics (more females, P = 0.018, and more living alone P = 0.011 in the intervention group), differences in nursing care between subjects, and different risk factors. Interventions to improve sensory function remain important in rehabilitation, but have to be studied further.

Grue, Else V; Kirkevold, Marit; Mowinchel, Petter; Ranhoff, Anette H

2009-01-01

396

1991 Fall Meeting Report  

NASA Astrophysics Data System (ADS)

The AGU 1991 Fall Meeting, held in San Francisco December 9-13, was the largest national AGU meeting ever held. Meeting participation continued the steady growth trend set throughout the previous decade. A total of 4,037 papers and posters were presented, and by Friday noon of the meeting over 5,500 members had registered.Several special events were scheduled to inform and engage members on societal and programmatic aspects of our science. AGU's Committee on Education and Human Resources sponsored an open forum that addressed opportunities and problems associated with dual-career couples. A discussion of NASA's strategic plan by Berrien Moore and Joseph Alexander drew a large audience, and a special session on societal aspects of the Mt. Pinatubo eruption drew an overflow crowd. Two special lectures— “Plumes, Plates, and Deep Earth Structure” by Don L. Anderson and “New Frontiers in Aeronomy: Effects of Global Atmospheric Change” by P. M. Banks-also drew overflow crowds.

Chapman, David S.

397

Cognitive work analysis to evaluate the problem of patient falls in an inpatient setting  

PubMed Central

Objective To identify factors in the nursing work domain that contribute to the problem of inpatient falls, aside from patient risk, using cognitive work analysis. Design A mix of qualitative and quantitative methods were used to identify work constraints imposed on nurses, which may underlie patient falls. Measurements Data collection was done on a neurology unit staffed by 27 registered nurses and utilized field observations, focus groups, time–motion studies and written surveys (AHRQ Hospital Survey on Patient Culture, NASA-TLX, and custom Nursing Knowledge of Fall Prevention Subscale). Results Four major constraints were identified that inhibit nurses' ability to prevent patient falls. All constraints relate to work processes and the physical work environment, opposed to safety culture or nursing knowledge, as currently emphasized. The constraints were: cognitive ‘head data’, temporal workload, inconsistencies in written and verbal transfer of patient data, and limitations in the physical environment. To deal with these constraints, the nurses tend to employ four workarounds: written and mental chunking schemas, bed alarms, informal querying of the previous care nurse, and informal video and audio surveillance. These workarounds reflect systemic design flaws and may only be minimally effective in decreasing risk to patients. Conclusion Cognitive engineering techniques helped identify seemingly hidden constraints in the work domain that impact the problem of patient falls. System redesign strategies aimed at improving work processes and environmental limitations hold promise for decreasing the incidence of falls in inpatient nursing units.

Lopez, Karen Dunn; Cary, Michael P; Kanak, Mary F

2010-01-01

398

[The prevention of negative side effects in homeochemotherapy].  

PubMed

The purpose of the present study was to identity ways to prevent negative side effects in homechemotherapy. We conducted continuous hepatic arterial infusion chemotherapy (CHAI) in 122 cases of unresectable hepatic metastases from colorectal cancer. We continuously administered 5-FU at 250 mg/day for 7 days using a pump system. We also conducted systemic chemotherapy (FP therapy) in 145 cases of advanced or recurrent colorectal cancer in our outpatient clinic. Based on these experiences, we analyzed the problems of homeochemotherapy. The rate of negative side effects was 15.1% with CHAI. More than half were cases of abdominal pain. Because we had established an observation system for emergency cases, there were no fatal accidents. With FP therapy, about 40% of patients had gastrointestinal discomfort, but the rate of those with higher than grade 3 was low (1-2%). We conclude that it is very important to establish a hospital system to respond quickly to any negative effects of homeochemotherapy. PMID:12146017

Takahashi, Keiichi; Mori, Takeo; Ohue, Masayuki; Yamaguchi, Tatsuro

2002-07-01

399

Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study  

PubMed Central

Summary Background Falls in elderly people are a major health burden, especially in the long-term care environment. Yet little objective evidence is available for how and why falls occur in this population. We aimed to provide such evidence by analysing real-life falls in long-term care captured on video. Methods We did this observational study between April 20, 2007, and June 23, 2010, in two long-term care facilities in British Columbia, Canada. Digital video cameras were installed in common areas (dining rooms, lounges, hallways). When a fall occurred, facility staff completed an incident report and contacted our teams so that we could collect video footage. A team reviewed each fall video with a validated questionnaire that probed the cause of imbalance and activity at the time of falling. We then tested whether differences existed in the proportion of participants falling due to the various causes, and while engaging in various activities, with generalised linear models, repeated measures logistic regression, and log-linear Poisson regression. Findings We captured 227 falls from 130 individuals (mean age 78 years, SD 10). The most frequent cause of falling was incorrect weight shifting, which accounted for 41% (93 of 227) of falls, followed by trip or stumble (48, 21%), hit or bump (25, 11%), loss of support (25, 11%), and collapse (24, 11%). Slipping accounted for only 3% (six) of falls. The three activities associated with the highest proportion of falls were forward walking (54 of 227 falls, 24%), standing quietly (29 falls, 13%), and sitting down (28 falls, 12%). Compared with previous reports from the long-term care setting, we identified a higher occurrence of falls during standing and transferring, a lower occurrence during walking, and a larger proportion due to centre-of-mass perturbations than base-of-support perturbations. Interpretation By providing insight into the sequences of events that most commonly lead to falls, our results should lead to more valid and effective approaches for balance assessment and fall prevention in long-term care.

Robinovitch, Stephen N; Feldman, Fabio; Yang, Yijian; Schonnop, Rebecca; Lueng, Pet Ming; Sarraf, Thiago; Sims-Gould, Joanie; Loughin, Marie

2012-01-01

400

Knowledge of Extrinsic Fall Risk Factors in Elders 65 Years and Older: The efficacy of an education program  

Microsoft Academic Search

Falls are a serious health problem in people over 65-years-old. It is estimated that one out of every three people in this population fall each year. Furthermore, 85% of falls occur in the home as a result of preventable extrinsic risk factors. Currently, there is limited research evaluating seniors awareness of fall prevention within the home. The purpose of this

Nicole Horst; Jennifer Tuttle; Kristina Walter

2000-01-01

401

Could martial arts fall training be safe for persons with osteoporosis?: a feasibility study  

Microsoft Academic Search

BACKGROUND: Osteoporosis is a well-established risk factor for fall-related hip fractures. Training fall arrest strategies, such as martial arts (MA) fall techniques, might be useful to prevent hip fractures in persons with osteoporosis, provided that the training itself is safe. This study was conducted to determine whether MA fall training would be safe for persons with osteoporosis extrapolated from the

Brenda E Groen; Ellen Smulders; Jacques Duysens; W. G. J. M. van Lankveld; Vivian Weerdesteyn

2010-01-01

402

Prevention Effectiveness Case Study: Institutionalizing Prevention of Group B Streptococcal Infections  

Microsoft Academic Search

The value of cooperation between clinicians and laboratorians is scarcely controversial, yet failure to assure adequate laboratory participation in implementing new programs can have serious clinical consequences. The recent example of preventing group B streptococcal (GBS) disease in newborns is illustrative. Neonatal GBS infection can lead to death, long term disability, and substantial direct and indirect health care costs, while

Anne Schuchat

403

Designing an Effective Prevention Program: Principles Underlying the Rand Smoking and Drug Prevention Experiment.  

ERIC Educational Resources Information Center

|This paper describes the Project ALERT program (Adolescent Learning Experiences in Resistance Training) which was established by the Rand Corporation to prevent smoking and drug use among seventh graders. The program is based on the social influence model of drug use initiation. Curriculum features are described including motivation to resist and…

Ellickson, Phyllis L.

404

Hair-Loss Preventing Effect of Grateloupia elliptica  

PubMed Central

This study was conducted to evaluate the effect of Grateloupia elliptica, a seaweed native to Jeju Island, Korea, on the prevention of hair loss. When immortalized rat vibrissa dermal papilla cells were treated with extract of G. elliptica, the proliferation of dermal papilla cells significantly increased. In addition, the G. elliptica extract significantly inhibited the activity of 5?-reductase, which converts testosterone to dihydrotestosterone (DHT), a main cause of androgenetic alopecia. On the other hand, the G. elliptica extract promoted PGE2 production in HaCaT cells in a dose-dependent manner. The G. elliptica extract exhibited particularly high inhibitory effect on LPS-stimulated IL-12, IL-6, and TNF-? production in lipopolysaccharide (LPS)-stimulated bone marrow-derived dendritic cells. The G. elliptica extract also showed inhibitory activity against Pityrosporum ovale, a main cause of dandruff. These results suggest that G. elliptica extract has the potential to treat alopecia via the proliferation of dermal papilla, 5?-reductase inhibition, increase of PGE2 production, decrease of LPS-stimulated pro-inflammatory cytokines and inhibitory activity against Pityrosporum ovale.

Kang, Jung-Il; Kim, Sang-Cheol; Han, Sang-Chul; Hong, Hye-Jin; Jeon, You-Jin; Kim, Bora; Koh, Young-Sang; Yoo, Eun-Sook; Kang, Hee-Kyoung

2012-01-01

405

Hair-Loss Preventing Effect of Grateloupia elliptica.  

PubMed

This study was conducted to evaluate the effect of Grateloupia elliptica, a seaweed native to Jeju Island, Korea, on the prevention of hair loss. When immortalized rat vibrissa dermal papilla cells were treated with extract of G. elliptica, the proliferation of dermal papilla cells significantly increased. In addition, the G. elliptica extract significantly inhibited the activity of 5?-reductase, which converts testosterone to dihydrotestosterone (DHT), a main cause of androgenetic alopecia. On the other hand, the G. elliptica extract promoted PGE2 production in HaCaT cells in a dose-dependent manner. The G. elliptica extract exhibited particularly high inhibitory effect on LPS-stimulated IL-12, IL-6, and TNF-? production in lipopolysaccharide (LPS)-stimulated bone marrow-derived dendritic cells. The G. elliptica extract also showed inhibitory activity against Pityrosporum ovale, a main cause of dandruff. These results suggest that G. elliptica extract has the potential to treat alopecia via the proliferation of dermal papilla, 5?-reductase inhibition, increase of PGE2 production, decrease of LPS-stimulated pro-inflammatory cytokines and inhibitory activity against Pityrosporum ovale. PMID:24116284

Kang, Jung-Il; Kim, Sang-Cheol; Han, Sang-Chul; Hong, Hye-Jin; Jeon, You-Jin; Kim, Bora; Koh, Young-Sang; Yoo, Eun-Sook; Kang, Hee-Kyoung

2012-01-01

406

Effect of Education on Prevention of Domestic Violence against Women  

PubMed Central

Objective Family violence, specifically domestic violence, has been identified by the medical community as a serious, no remitting epidemic with adverse health consequences. World Health Organization(WHO) has stated that violence against women is a priority issue in the fields of health and human rights. A quasi experimental study were conducted in different faculties of Tehran University of Medical Sciences to determine the effect of teaching on prevention of domestic violence against female employees. Methods Forty four women working in various faculties of Tehran University of Medical Sciences in 2004 were selected. A designed questionnaire was given to the participants to identify kinds, causes and consequences of domestic violence. Then an educational booklet was given to subjects. This booklet contained information about kinds, causes and consequences of domestic violence and how to manage them. To compare the impact of teaching, the same questionnaires were distributed among the subjects after six months. The questionnaire was specifically tested for content validity. Results The results indicated that the incidence rate of domestic violence pre test and post test education was 5.17%. Conclusion Our study showed that education had no effect on domestic violence. Solving problems relating to domestic violence due to cardinal roots in short time seems to be impossible and impracticable.

Noughani, Fatemeh

2011-01-01

407

Prevention of Slip-Related Backward Balance Loss: Effect of Session Intensity and Frequency on Long-Term Retention  

PubMed Central

Objective To examine effects of session intensity (number of slip exposures) and frequency on retention of acquired adaptation for prevention of backward balance loss following repeated-slip training. Setting Biomechanics research laboratory. Participants Healthy young subjects (N=46; 21 males). Intervention Twenty-four subjects experienced a high-intensity session of 24 repeated right-side slips; 12 received additional single-slip sessions at a frequency of 1-week, 2-week, and 1-month, while the rest got no ancillary training. Another 24 subjects received a low-intensity initial session of a single slip; 12 received the same high-frequency ancillary training, while the rest got none. All groups were retested with a single-slip, 4 months after first session. Main Outcome Measures Incidence of backward balance loss, gait stability, and limb support. Results The high-intensity groups irrespective of ancillary training displayed similar improvements in all 3 outcome measures. Remarkably, the low-intensity group receiving ancillary training also significantly improved in all measures, with retention comparable to that observed in the other 2 groups. A single slip exposure without ancillary sessions was insufficient to yield longer-term effect. Conclusions Frequent ancillary sessions may be unnecessary for slip-related fall prevention up to 4 months, if initial session intensity is sufficient. Furthermore, the minimum of a single slip may be as effective, if subject is exposed to frequent ancillary sessions.

Bhatt, Tanvi; Pai, Yi-Chung

2008-01-01

408

Height and surfacing as risk factors for injury in falls from playground equipment: a case-control study  

Microsoft Academic Search

OBJECTIVES: Despite the widespread promotion of safety standards no epidemiological studies have adequately evaluated their effectiveness in preventing injury in falls from playground equipment. This study evaluated the effectiveness of the height and surfacing requirements of the New Zealand standard for playgrounds and playground equipment. SETTING: Early childhood education centres and schools in two major cities in the South Island

D. J. Chalmers; S. W. Marshall; J. D. Langley; M. J. Evans; C. R. Brunton; A. M. Kelly; A. F. Pickering

1996-01-01