A Multicomponent Fall Prevention Strategy Reduces Falls at an Academic Medical Center.

PubMed

France, Dan; Slayton, Jenny; Moore, Sonya; Domenico, Henry; Matthews, Julia; Steaban, Robin L; Choma, Neesha

2017-09-01

While the reduction in fall rates has not kept pace with the reduction of other hospital-acquired conditions, patient safety research and quality improvement (QI) initiatives at the system and hospital levels have achieved positive results and provide insights into potentially effective risk reduction strategies. An academic medical center developed a QI-based multicomponent strategy for fall prevention and pilot tested it for six months in three high-risk units-the Neuroscience Acute Care Unit, the Myelosuppression/Stem Cell Transplant Unit, and the Acute Care for the Elderly Unit-before implementing and evaluating the strategy hospitalwide. The multicomponent fall strategy was evaluated using a pre-post study design. The main outcome measures were falls and falls with harm measured in events per 1,000 patient-days. Fall rates were monitored and compared for three classes of falls: (1) accidental, (2) anticipated physiologic, and (3) unanticipated physiologic. Statistical process control charts showed that the pilot units had achieved significant reductions in falls with harm during the last five months of data collection. Wald test and segmented regression analyses revealed significant improvements in pooled postintervention fall rates, stratified by fall type. The hospitalwide implementation of the program resulted in a 47% overall reduction in falls in the postintervention period. A fall prevention strategy that targeted the spectrum of risk factors produced measurable improvement in fall rates and rates of patient harm. Hospitals must continue developing, rigorously testing, and sharing their results and experiences in implementing and sustaining multicomponent fall prevention strategies. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Home-based exercise program and fall-risk reduction in older adults with multiple sclerosis: phase 1 randomized controlled trial.

PubMed

Sosnoff, Jacob J; Finlayson, Marcia; McAuley, Edward; Morrison, Steve; Motl, Robert W

2014-03-01

To determine the feasibility, safety, and efficacy of a home-based exercise intervention targeting fall risk in older adults with multiple sclerosis. A randomized controlled pilot trial. A home-based exercise program. Participants were randomly allocated to either a home-based exercise intervention group (n = 13) or a waiting list control group (n = 14). The exercise group completed exercises targeting lower muscle strength and balance three times a week for 12 weeks. The control group continued normal activity. Fall risk (Physiological Profile Assessment scores), balance (Berg Balance Scale), and walking testing prior to and immediately following the 12-week intervention. Each outcome measure was placed in an analysis of covariance with group as the between-subject factor and baseline values as the covariate. Effect sizes were calculated. Twelve participants from the control group and ten from the exercise group completed the study. There were no related adverse events. Fall risk was found to decrease in the exercise group following the intervention (1.1 SD 1.0 vs. 0.6 SD 0.6) while there was an increase in fall risk in the control group (1.9 SD 1.5 vs. 2.2 SD 1.9). Effect sizes for most outcomes were large (η(2) > 0.15). Home-based exercise was found to be feasible, safe, and effective for reducing physiological fall risk in older adults with multiple sclerosis. Our findings support the implementation of a larger trial to reduce fall risk in persons with multiple sclerosis.

Fall risk and incidence reduction in high risk individuals with multiple sclerosis: a pilot randomized control trial.

PubMed

Sosnoff, Jacob J; Moon, Yaejin; Wajda, Douglas A; Finlayson, Marcia L; McAuley, Edward; Peterson, Elizabeth W; Morrison, Steve; Motl, Robert W

2015-10-01

To determine the feasibility of three fall prevention programs delivered over 12 weeks among individuals with multiple sclerosis: (A) a home-based exercise program targeting physiological risk factors; (B) an educational program targeting behavioral risk factors; and (C) a combined exercise-and-education program targeting both factors. Randomized controlled trial. Home-based training with assessments at research laboratory. A total of 103 individuals inquired about the investigation. After screening, 37 individuals with multiple sclerosis who had fallen in the last year and ranged in age from 45-75 years volunteered for the investigation. A total of 34 participants completed postassessment following the 12-week intervention. Participants were randomly assigned into one of four conditions: (1) wait-list control (n = 9); (2) home-based exercise (n = 11); (3) education (n = 9); or (4) a combined exercise and education (n = 8) group. Before and after the 12-week interventions, participants underwent a fall risk assessment as determined by the physiological profile assessment and provided information on their fall prevention behaviors as indexed by the Falls Prevention Strategy Survey. Participants completed falls diaries during the three-months postintervention. A total of 34 participants completed postintervention testing. Procedures and processes were found to be feasible. Overall, fall risk scores were lower in the exercise groups (1.15 SD 1.31) compared with the non-exercise groups (2.04 SD 1.04) following the intervention (p < 0.01). There was no group difference in fall prevention behaviors (p > 0.05). Further examination of home-based exercise/education programs for reducing falls in individuals with multiple sclerosis is warranted. A total of 108 participants would be needed in a larger randomized controlled trial.ClinicalTrials.org #NCT01956227. © The Author(s) 2014.

Balance training reduces falls risk in older individuals with type 2 diabetes.

PubMed

Morrison, Steven; Colberg, Sheri R; Mariano, Mira; Parson, Henri K; Vinik, Arthur I

2010-04-01

This study assessed the effects of balance/strength training on falls risk and posture in older individuals with type 2 diabetes. Sixteen individuals with type 2 diabetes and 21 age-matched control subjects (aged 50-75 years) participated. Postural stability and falls risk was assessed before and after a 6-week exercise program. Diabetic individuals had significantly higher falls risk score compared with control subjects. The diabetic group also exhibited evidence of mild-to-moderate neuropathy, slower reaction times, and increased postural sway. Following exercise, the diabetic group showed significant improvements in leg strength, faster reaction times, decreased sway, and, consequently, reduced falls risk. Older individuals with diabetes had impaired balance, slower reactions, and consequently a higher falls risk than age-matched control subjects. However, all these variables improved after resistance/balance training. Together these results demonstrate that structured exercise has wide-spread positive effects on physiological function for older individuals with type 2 diabetes.

Effects of Tai Chi on Cognition and Fall Risk in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Trial.

PubMed

Sungkarat, Somporn; Boripuntakul, Sirinun; Chattipakorn, Nipon; Watcharasaksilp, Kanokwan; Lord, Stephen R

2017-04-01

To examine whether combined center- and home-based Tai Chi training can improve cognitive ability and reduce physiological fall risk in older adults with amnestic mild cognitive impairment (a-MCI). Randomized controlled trial. Chiang Mai, Thailand. Adults aged 60 and older who met Petersen's criteria for multiple-domain a-MCI (N = 66). Three weeks center-based and 12 weeks home-based Tai Chi (50 minutes per session, 3 times per week). Cognitive tests, including Logical Memory (LM) delayed recall, Block Design, Digit Span forward and backward, and Trail-Making Test Part B-A (TMT B-A), and fall risk index using the Physiological Profile Assessment (PPA). At the end of the trial, performance on LM, Block Design, and TMT B-A were significantly better for the Tai Chi group than the control group after adjusting for baseline test performance. The Tai Chi group also had significantly better composite PPA score and PPA parameter scores: knee extension strength, reaction time, postural sway, and lower limb proprioception. Combined center- and home-based Tai Chi training three times per week for 15 weeks significantly improved cognitive function and moderately reduced physiological fall risk in older adults with multiple-domain a-MCI. Tai Chi may be particularly beneficial to older adults with this condition. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Increased cognitive load leads to impaired mobility decisions in seniors at risk for falls.

PubMed

Nagamatsu, Lindsay S; Voss, Michelle; Neider, Mark B; Gaspar, John G; Handy, Todd C; Kramer, Arthur F; Liu-Ambrose, Teresa Y L

2011-06-01

Successful mobility requires appropriate decision-making. Seniors with reduced executive functioning-such as senior fallers-may be prone to poor mobility judgments, especially under dual-task conditions. We classified participants as "At-Risk" and "Not-At-Risk" for falls using a validated physiological falls-risk assessment. Dual-task performance was assessed in a virtual reality environment where participants crossed a simulated street by walking on a manual treadmill while listening to music or conversing on a phone. Those "At-Risk" experienced more collisions with oncoming cars and had longer crossing times in the Phone condition compared to controls. We conclude that poor mobility judgments during a dual-task leads to unsafe mobility for those at-risk for falls. (c) 2011 APA, all rights reserved.

Balance Training Reduces Falls Risk in Older Individuals With Type 2 Diabetes

PubMed Central

Morrison, Steven; Colberg, Sheri R.; Mariano, Mira; Parson, Henri K.; Vinik, Arthur I.

2010-01-01

OBJECTIVE This study assessed the effects of balance/strength training on falls risk and posture in older individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS Sixteen individuals with type 2 diabetes and 21 age-matched control subjects (aged 50–75 years) participated. Postural stability and falls risk was assessed before and after a 6-week exercise program. RESULTS Diabetic individuals had significantly higher falls risk score compared with control subjects. The diabetic group also exhibited evidence of mild-to-moderate neuropathy, slower reaction times, and increased postural sway. Following exercise, the diabetic group showed significant improvements in leg strength, faster reaction times, decreased sway, and, consequently, reduced falls risk. CONCLUSIONS Older individuals with diabetes had impaired balance, slower reactions, and consequently a higher falls risk than age-matched control subjects. However, all these variables improved after resistance/balance training. Together these results demonstrate that structured exercise has wide-spread positive effects on physiological function for older individuals with type 2 diabetes. PMID:20097781

Prevention of falls in older people.

PubMed

Close, Jacqueline C T

In recent years the evidence base for prevention of falls in older people has increased and associated with this has been an inevitable expansion in clinical services which attempt to localize and implement what is described in the literature. This article reviews the basic physiology implicit in maintenance of the upright posture; highlights the diversity of medical and non-medical risk factors associated with falls; describes the clinical assessment of an older person at risk of falls; reviews the evidence for intervention in the prevention of falls in older people; and acknowledges the need for a clear strategic direction to successfully prevent falls and the requirement for ongoing research as well as much needed service evaluation.

Systematic review of fall risk screening tools for older patients in acute hospitals.

PubMed

Matarese, Maria; Ivziku, Dhurata; Bartolozzi, Francesco; Piredda, Michela; De Marinis, Maria Grazia

2015-06-01

To determine the most accurate fall risk screening tools for predicting falls among patients aged 65 years or older admitted to acute care hospitals. Falls represent a serious problem in older inpatients due to the potential physical, social, psychological and economic consequences. Older inpatients present with risk factors associated with age-related physiological and psychological changes as well as multiple morbidities. Thus, fall risk screening tools for older adults should include these specific risk factors. There are no published recommendations addressing what tools are appropriate for older hospitalized adults. Systematic review. MEDLINE, CINAHL and Cochrane electronic databases were searched between January 1981-April 2013. Only prospective validation studies reporting sensitivity and specificity values were included. Recommendations of the Cochrane Handbook of Diagnostic Test Accuracy Reviews have been followed. Three fall risk assessment tools were evaluated in seven articles. Due to the limited number of studies, meta-analysis was carried out only for the STRATIFY and Hendrich Fall Risk Model II. In the combined analysis, the Hendrich Fall Risk Model II demonstrated higher sensitivity than STRATIFY, while the STRATIFY showed higher specificity. In both tools, the Youden index showed low prognostic accuracy. The identified tools do not demonstrate predictive values as high as needed for identifying older inpatients at risk for falls. For this reason, no tool can be recommended for fall detection. More research is needed to evaluate fall risk screening tools for older inpatients. © 2014 John Wiley & Sons Ltd.

Identifying Home Care Clinicians’ Information Needs for Managing Fall Risks

PubMed Central

Alhuwail, Dari

2016-01-01

Summary Objectives To help manage the risk of falls in home care, this study aimed to (i) identify home care clinicians’ information needs and how they manage missing or inaccurate data, (ii) identify problems that impact effectiveness and efficiency associated with retaining, exchanging, or processing information about fall risks in existing workflows and currently adopted health information technology (IT) solutions, and (iii) offer informatics-based recommendations to improve fall risk management interventions. Methods A case study was carried out in a single not-for-profit suburban Medicare-certified home health agency with three branches. Qualitative data were collected over a six month period through observations, semi-structured interviews, and focus groups. The Framework method was used for analysis. Maximum variation sampling was adopted to recruit a diverse sample of clinicians. Results Overall, the information needs for fall risk management were categorized into physiological, care delivery, educational, social, environmental, and administrative domains. Examples include a brief fall-related patient history, weight-bearing status, medications that affect balance, availability of caregivers at home, and the influence of patients’ cultures on fall management interventions. The unavailability and inaccuracy of critical information related to fall risks can delay necessary therapeutic services aimed at reducing patients’ risk for falling and thereby jeopardizing their safety. Currently adopted IT solutions did not adequately accommodate data related to fall risk management. Conclusion The results highlight the essential information for fall risk management in home care. Home care workflows and health IT solutions must effectively and efficiently retain, exchange, and process information necessary for fall risk management. Interoperability and integration of the various health IT solutions to make data sharing accessible to all clinicians is critical for fall risk management. Findings from this study can help home health agencies better understand their information needs to manage fall risks. PMID:27437035

Executive functioning, concern about falling and quadriceps strength mediate the relationship between impaired gait adaptability and fall risk in older people.

PubMed

Caetano, Maria Joana D; Lord, Stephen R; Brodie, Matthew A; Schoene, Daniel; Pelicioni, Paulo H S; Sturnieks, Daina L; Menant, Jasmine C

2018-01-01

Reduced ability to adapt gait, particularly under challenging conditions, may be an important reason why older adults have an increased risk of falling. This study aimed to identify cognitive, psychological and physical mediators of the relationship between impaired gait adaptability and fall risk in older adults. Fifty healthy older adults (mean±SD: 74±7years) were categorised as high or low fall risk, based on past falls and their performance in the Physiological Profile Assessment. High and low-risk groups were then compared in the gait adaptability test, i.e. an assessment of the ability to adapt gait in response to obstacles and stepping targets under single and dual task conditions. Quadriceps strength, concern about falling and executive function were also measured. The older adults who made errors on the gait adaptability test were 4.76 (95%CI=1.08-20.91) times more likely to be at high risk of falling. Furthermore, each standard deviation reduction in gait speed while approaching the targets/obstacle increased the odds of being at high risk of falling approximately three fold: single task - OR=3.10,95%CI=1.43-6.73; dual task - 3.42,95%CI=1.56-7.52. Executive functioning, concern about falling and quadriceps strength substantially mediated the relationship between the gait adaptability measures and fall risk status. Impaired gait adaptability is associated with high risk of falls in older adults. Reduced executive function, increased concern about falling and weaker quadriceps strength contribute significantly to this relationship. Training gait adaptability directly, as well as addressing the above mediators through cognitive, behavioural and physical training may maximise fall prevention efficacy. Copyright © 2017 Elsevier B.V. All rights reserved.

Use of a physiological profile to document motor impairment in ageing and in clinical groups.

PubMed

Lord, S R; Delbaere, K; Gandevia, S C

2016-08-15

Ageing decreases exercise performance and is frequently accompanied by reductions in cognitive performance. Deterioration in the physiological capacity to stand, locomote and exercise can manifest itself as falling over and represents a significant deterioration in sensorimotor control. In the elderly, falling leads to serious morbidity and mortality with major societal costs. Measurement of a suite of physiological capacities that are required for successful motor performance (including vision, muscle strength, proprioception and balance) has been used to produce a physiological profile assessment (PPA) which has been tracked over the age spectrum and in different diseases (e.g. multiple sclerosis, Parkinson's disease). As well as measures of specific physiological capacities, the PPA generates an overall 'score' which quantitatively measures an individual's cumulative risk of falling. The present review collates data from the PPA (and the physiological capacities it measures) as well as its use in strategies to reduce falls in the elderly and those with different diseases. We emphasise that (i) motor impairment arises via reductions in a wide range of sensorimotor abilities; (ii) the PPA approach not only gives a snapshot of the physiological capacity of an individual, but it also gives insight into the deficits among groups of individuals with particular diseases; and (iii) deficits in seemingly restricted and disparate physiological domains (e.g. vision, strength, cognition) are funnelled into impairments in tasks requiring upright balance. Motor impairments become more prevalent with ageing but careful physiological measurement and appropriate interventions offer a way to maximise health across the lifespan. © 2015 The Authors. The Journal of Physiology © 2015 The Physiological Society.

Sensorimotor and neuropsychological correlates of force perturbations that induce stepping in older adults.

PubMed

Sturnieks, Daina L; Menant, Jasmine; Vanrenterghem, Jos; Delbaere, Kim; Fitzpatrick, Richard C; Lord, Stephen R

2012-07-01

Inappropriate stepping in response to unexpected balance perturbations is more prevalent in older people and in those at risk of falling. This study examined responses to force-controlled waist pulls in young and older people, and sought to identify physiological and cognitive correlates of the force threshold for stepping. 242 older (79.7±4.2 years) and 15 young (29.5±5.3 years) adults underwent waist pull perturbations and assessments of physiological and neuropsychological functioning, general health and falls efficacy. Perturbation force that induced stepping, stepping strategy and number of steps were measured. The older group withstood less forceful perturbations with a feet-in-place strategy, compared to young. Likewise, older adults with high falls risk withstood less force than those with low risk. After controlling for body weight and gender, sway and lower limb strength were independent predictors of anterior stepping thresholds, reaction time was an independent predictor of posterior thresholds, and executive functioning and lower limb strength were independent predictors of the lateral thresholds. These results suggest that balance, strength and agility training, in addition to cognitive exercises may enhance the ability to withstand unexpected balance perturbations and reduce the risk of falls in older people. Copyright © 2012 Elsevier B.V. All rights reserved.

Pathogenesis and treatment of falls in elderly

PubMed Central

Pasquetti, Pietro; Apicella, Lorenzo; Mangone, Giuseppe

2014-01-01

Summary Falls in the elderly are a public health problem. Consequences of falls are increased risk of hospitalization, which results in an increase in health care costs. It is estimated that 33% of individuals older than 65 years undergoes falls. Causes of falls can be distinguished in intrinsic and extrinsic predisposing conditions. The intrinsic causes can be divided into age-related physiological changes and pathological predisposing conditions. The age-related physiological changes are sight disorders, hearing disorders, alterations in the Central Nervous System, balance deficits, musculoskeletal alterations. The pathological conditions can be Neurological, Cardiovascular, Endocrine, Psychiatric, Iatrogenic. Extrinsic causes of falling are environmental factors such as obstacles, inadequate footwear. The treatment of falls must be multidimensional and multidisciplinary. The best instrument in evaluating elderly at risk is Comprehensive Geriatric Assessment (CGA). CGA allows better management resulting in reduced costs. The treatment should be primarily preventive acting on extrinsic causes; then treatment of chronic and acute diseases. Rehabilitation is fundamental, in order to improve residual capacity, motor skills, postural control, recovery of strength. There are two main types of exercises: aerobic and muscular strength training. Education of patient is a key-point, in particular through the Back School. In conclusion falls in the elderly are presented as a “geriatric syndrome”; through a multidimensional assessment, an integrated treatment and a rehabilitation program is possible to improve quality of life in elderly. PMID:25568657

Fall prevention strategy in an emergency department.

PubMed

Muray, Mwali; Bélanger, Charles H; Razmak, Jamil

2018-02-12

Purpose The purpose of this paper is to document the need for implementing a fall prevention strategy in an emergency department (ED). The paper also spells out the research process that led to approving an assessment tool for use in hospital outpatient services. Design/methodology/approach The fall risk assessment tool was based on the Morse Fall Scale. Gender mix and age above 65 and 80 years were assessed on six risk assessment variables using χ 2 analyses. A logistic regression analysis and model were used to test predictor strength and relationships among variables. Findings In total, 5,371 (56.5 percent) geriatric outpatients were deemed to be at fall risk during the study. Women have a higher falls incidence in young and old age categories. Being on medications for patients above 80 years exposed both genders to equal fall risks. Regression analysis explained 73-98 percent of the variance in the six-variable tool. Originality/value Canadian quality and safe healthcare accreditation standards require that hospital staff develop and adhere to fall prevention policies. Anticipated physiological falls can be prevented by healthcare interventions, particularly with older people known to bear higher risk factors. An aging population is increasing healthcare volumes and medical challenges. Precautionary measures for patients with a vulnerable cognitive and physical status are essential for quality care.

Increased Cognitive Load Leads to Impaired Mobility Decisions in Seniors at Risk for Falls

PubMed Central

Nagamatsu, Lindsay S.; Voss, Michelle; Neider, Mark B.; Gaspar, John G.; Handy, Todd C.; Kramer, Arthur F.; Liu-Ambrose, Teresa Y. L.

2011-01-01

Successful mobility requires appropriate decision-making. Seniors with reduced executive functioning— such as senior fallers—may be prone to poor mobility judgments, especially under dual-task conditions. We classified participants as “At-Risk” and “Not-At-Risk” for falls using a validated physiological falls-risk assessment. Dual-task performance was assessed in a virtual reality environment where participants crossed a simulated street by walking on a manual treadmill while listening to music or conversing on a phone. Those “At-Risk” experienced more collisions with oncoming cars and had longer crossing times in the Phone condition compared to controls. We conclude that poor mobility judgments during a dual-task leads to unsafe mobility for those at-risk for falls. PMID:21463063

Gait initiation time is associated with the risk of multiple falls-A population-based study.

PubMed

Callisaya, Michele L; Blizzard, Leigh; Martin, Kara; Srikanth, Velandai K

2016-09-01

In a population-based study of older people to examine whether 1) overall gait initiation (GI) time or its components are associated with falls and 2) GI under dual-task is a stronger predictor of falls risk than under single-task. Participants aged 60-85 years were randomly selected from the electoral roll. GI was obtained with a force platform under both single and dual-task conditions. Falls were ascertained prospectively over a 12-month period. Log multinomial regression was used to examine the association between GI time (total and its components) and risk of single and multiple falls. Age, sex and physiological and cognitive falls risk factors were considered as confounders. The mean age of the sample (n=124) was 71.0 (SD 6.8) years and 58.9% (n=73) were male. Over 12 months 21.8% (n=27) of participants reported a single fall and 16.1% (n=20) reported multiple falls. Slower overall GI time under both single (RR all per 100ms 1.28, 95%CI 1.03, 1.58) and dual-task (RR 1.14, 95%CI 1.02, 1.27) was associated with increased risk of multiple, but not single falls (p<0.05). Multiple falls were also associated with slower time to first lateral movement under single-task (RR 1.90 95%CI 0.59, 1.51) and swing time under dual-task condition (RR 1.44 95%CI 1.08, 1.94). Slower GI time is associated with the risk of multiple falls independent of other risk factors, suggesting it could be used as part of a comprehensive falls assessment. Time to the first lateral movement under single-task may be the best measures of this risk. Copyright © 2016 Elsevier B.V. All rights reserved.

Effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults with risk of falls.

PubMed

Lee, Hsuei-Chen; Chang, Ku-Chou; Tsauo, Jau-Yih; Hung, Jen-Wen; Huang, Yu-Ching; Lin, Sang-I

2013-04-01

To evaluate effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults. Multicenter randomized controlled trial. Three medical centers and adjacent community health centers. Community-dwelling older adults (N=616) who have fallen in the previous year or are at risk of falling. After baseline assessment, eligible subjects were randomly allocated into the intervention group (IG) or the control group (CG), stratified by the Physiological Profile Assessment (PPA) fall risk level. The IG received a 3-month multifactorial intervention program including 8 weeks of exercise training, health education, home hazards evaluation/modification, along with medication review and ophthalmology/other specialty consults. The CG received health education brochures, referrals, and recommendations without direct exercise intervention. Primary outcome was fall incidence within 1 year. Secondary outcomes were PPA battery (overall fall risk index, vision, muscular strength, reaction time, balance, and proprioception), Timed Up & Go (TUG) test, Taiwan version of the International Physical Activity Questionnaire, EuroQol-5D, Geriatric Depression Scale (GDS), and the Falls Efficacy Scale-International at 3 months after randomization. Participants were 76±7 years old and included low risk 25.6%, moderate risk 25.6%, and marked risk 48.7%. The cumulative 1-year fall incidence was 25.2% in the IG and 27.6% in the CG (hazard ratio=.90; 95% confidence interval, .66-1.23). The IG improved more favorably than the CG on overall PPA fall risk index, reaction time, postural sway with eyes open, TUG test, and GDS, especially for those with marked fall risk. The multifactorial fall prevention program with exercise intervention improved functional performance at 3 months for community-dwelling older adults with risk of falls, but did not reduce falls at 1-year follow-up. Fall incidence might have been decreased simultaneously in both groups by heightened awareness engendered during assessments, education, referrals, and recommendations. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Fall Risk is Not Black and White

PubMed Central

Kiely, Dan K.; Kim, Dae Hyun; Gross, Alden L.; Habtemariam, Daniel A.; Leveille, Suzanne G.; Li, Wenjun; Lipsitz, Lewis A.

2015-01-01

Objective To determine whether previously reported racial differences in fall rates between White and Black/African American is explained by differences in health status and neighborhood characteristics. Design Prospective cohort Setting Community Participants The study included 550 White and 116 Black older adults in the Greater Boston area (mean age: 78 years; 36% men) who were English-speaking, able to walk across a room, and without severe cognitive impairment. Measurements Falls were prospectively reported using monthly fall calendars. The location of each fall and fall-related injuries were asked during telephone interviews. At baseline, we assessed risk factors for falls, including sociodemographic characteristics, physiologic risk factors, physical activity, and community-level characteristics. Results Over the mean follow-up of 1,048 days, 1,539 falls occurred (incidence: 806/1,000 person-years). Whites were more likely than Blacks to experience any falls (867 versus 504 falls per 1,000 person-years; RR [95% CI]: 1.77 [1.33, 2.36]), outdoor falls (418 versus 178 falls per 1,000 person-years; 1.78 [1.08, 2.92]), indoor falls (434 versus 320 falls per 1,000 person-years; 1.44 [1.02, 2.05]), and injurious falls (367 versus 205 falls per 1,000 person-years; 1.79 [1.30, 2.46]). With exception of injurious falls, higher fall rates in Whites than Blacks were substantially attenuated with adjustment for risk factors and community-level characteristics: any fall (1.24 [0.81, 1.89]), outdoor fall (1.57 [0.86, 2.88]), indoor fall (1.08 [0.64, 1.81]), and injurious fall (1.77 [1.14, 2.74]). Conclusion Our findings suggest that the racial differences in fall rates may be largely due to confounding by individual-level and community-level characteristics. PMID:26855845

Differences Between Gait on Stairs and Flat Surfaces in Relation to Fall Risk and Future Falls.

PubMed

Wang, Kejia; Delbaere, Kim; Brodie, Matthew A D; Lovell, Nigel H; Kark, Lauren; Lord, Stephen R; Redmond, Stephen J

2017-11-01

We used body-worn inertial sensors to quantify differences in semi-free-living gait between stairs and on normal flat ground in older adults, and investigated the utility of assessing gait on these terrains for predicting the occurrence of multiple falls. Eighty-two community-dwelling older adults wore two inertial sensors, on the lower back and the right ankle, during several bouts of walking on flat surfaces and up and down stairs, in between rests and activities of daily living. Derived from the vertical acceleration at the lower back, step rate was calculated from the signal's fundamental frequency. Step rate variability was the width of this fundamental frequency peak from the signal's power spectral density. Movement vigor was calculated at both body locations from the signal variance. Partial Spearman correlations between gait parameters and physiological fall risk factors (components from the Physiological Profile Assessment) were calculated while controlling for age and gender. Overall, anteroposterior vigor at the lower back in stair descent was lower in subjects with longer reaction times. Older adults walked more slowly on stairs, but they were not significantly slower on flat surfaces. Using logistic regression, faster step rate in stair descent was associated with multiple prospective falls over 12 months. No significant associations were shown from gait parameters derived during walking upstairs or on flat surfaces. These results suggest that stair descent gait may provide more insight into fall risk than regular walking and stair ascent, and that further sensor-based investigation into unsupervised gait on different terrains would be valuable.

Cognitive processing speed is related to fall frequency in older adults with multiple sclerosis.

PubMed

Sosnoff, Jacob J; Balantrapu, Swathi; Pilutti, Lara A; Sandroff, Brian M; Morrison, Steven; Motl, Robert W

2013-08-01

To examine mobility, balance, fall risk, and cognition in older adults with multiple sclerosis (MS) as a function of fall frequency. Retrospective, cross-sectional design. University research laboratory. Community-dwelling persons with MS (N=27) aged between 50 and 75 years were divided into 2 groups-single-time (n=11) and recurrent (n=16; >2 falls/12 mo) fallers-on the basis of fall history. Not applicable. Mobility was assessed using a variety of measures including Multiple Sclerosis Walking Scale-12, walking speed (Timed 25-Foot Walk test), endurance (6-Minute Walk test), and functional mobility (Timed Up and Go test). Balance was assessed with the Berg Balance Scale, posturography, and self-reported balance confidence. Fall risk was assessed with the Physiological Profile Assessment. Cognitive processing speed was quantified with the Symbol Digit Modalities Test and the Paced Auditory Serial Addition Test. Recurrent fallers had slower cognitive processing speed than single-time fallers (P ≤.01). There was no difference in mobility, balance, or fall risk between recurrent and single-time fallers (P>.05). Results indicated that cognitive processing speed is associated with fall frequency and may have implications for fall prevention strategies targeting recurrent fallers with MS. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Virtual reality applications in assessing the effect of anxiety on sensorimotor integration in human postural control.

PubMed

Widdowson, Christopher; Ganhotra, Jatin; Faizal, Mohammed; Wilko, Marissa; Parikh, Saurin; Adhami, Zainulabidin; Hernandez, Manuel E

2016-08-01

Falls are a leading cause of injury and mortality among adults over the age of 65 years. Given the strong relation between fear of falling and fall risk, identification of the mechanisms that underlie anxiety-related changes in postural control may pave the way to the development of novel therapeutic strategies aimed at reducing fall risk in older adults. First, we review potential mechanisms underlying anxiety-mediated changes in postural control in older adults with and without neurological conditions. We then present a system that allows for the simultaneous recording of neural, physiological, and behavioral data in an immersive virtual reality (VR) environment while implementing sensory and mechanical perturbations to evaluate alterations in sensorimotor integration under conditions with high postural threat. We also discuss applications of VR in minimizing falls in older adults and potential future studies.

The influence of age, anxiety and concern about falling on postural sway when standing at an elevated level.

PubMed

Sturnieks, Daina L; Delbaere, Kim; Brodie, Matthew A; Lord, Stephen R

2016-10-01

Psychological processes may influence balance and contribute to the risk of falls in older people. While a self-reported fear of falling is associated with increased postural sway, inducing fear using an elevated platform can lead to reduced sway, suggesting different underlying mechanisms whereby fear may influence balance control. This study examined changes in postural sway, muscle activity and physiological measures of arousal while standing on a 65cm elevated platform, compared to floor level, in young and older adults. The older adults were classified as fall concerned or not fall concerned based on the Falls Efficacy Scale-International and anxious or not anxious based on the Goldberg Anxiety Scale. Fall concern did not affect the physiological and sway response to the elevated platform. In response to the postural threat, the anxious participants increased their sway frequency (p=0.001) but did not reduce sway range (p=0.674). Conversely, non-anxious participants showed an adaptive tightening of balance control, effectively reducing sway range in the elevated condition (p<0.001). Generalised anxiety in older adults appears to differentially affect postural control strategies under threatening conditions. Copyright © 2016 Elsevier B.V. All rights reserved.

Supervised Balance Training and Wii Fit-Based Exercises Lower Falls Risk in Older Adults With Type 2 Diabetes.

PubMed

Morrison, Steven; Simmons, Rachel; Colberg, Sheri R; Parson, Henri K; Vinik, Aaron I

2018-02-01

This study examined the benefits of and differences between 12 weeks of thrice-weekly supervised balance training and an unsupervised at-home balance activity (using the Nintendo Wii Fit) for improving balance and reaction time and lowering falls risk in older individuals with type 2 diabetes mellitus (T2DM). Before-after trial. University research laboratory, home environment. Sixty-five older adults with type 2 diabetes were recruited for this study. Participants were randomly allocated to either supervised balance training (mean age 67.8 ± 5.2) or unsupervised training using the Nintendo Wii Fit balance board (mean age 66.1 ± 5.6). The training period for both groups lasted for 12 weeks. Individuals were required to complete three 40-minute sessions per week for a total of 36 sessions. The primary outcome measure was falls risk, which was as derived from the physiological profile assessment. In addition, measures of simple reaction time, lower limb proprioception, postural sway, knee flexion, and knee extension strength were also collected. Persons also self-reported any falls in the previous 6 months. Both training programs resulted in a significant lowering of falls risk (P < .05). The reduced risk was attributable to significant changes in reaction times for the hand (P < .05), foot (P < .01), lower-limb proprioception (P < .01), and postural sway (P < .05). Overall, training led to a decrease in falls risk, which was driven by improvements in reaction times, lower limb proprioception, and general balance ability. Interestingly, the reduced falls risk occurred without significant changes in leg strength, suggesting that interventions to reduce falls risk that target intrinsic risk factors related to balance control (over muscle strength) may have positive benefits for the older adult with T2DM at risk for falls. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Associations between cerebral amyloid and changes in cognitive function and falls risk in subcortical ischemic vascular cognitive impairment.

PubMed

Dao, Elizabeth; Best, John R; Hsiung, Ging-Yuek Robin; Sossi, Vesna; Jacova, Claudia; Tam, Roger; Liu-Ambrose, Teresa

2017-06-28

To determine the association between amyloid-beta (Aβ) plaque deposition and changes in global cognition, executive functions, information processing speed, and falls risk over a 12-month period in older adults with a primary clinical diagnosis of subcortical ischemic vascular cognitive impairment (SIVCI). This is a secondary analysis of data acquired from a subset of participants (N = 22) who were enrolled in a randomized controlled trial of aerobic exercise (NCT01027858). The subset of individuals completed an 11 C Pittsburgh compound B (PIB) scan. Cognitive function and falls risk were assessed at baseline, 6-months, and 12-months. Global cognition, executive functions, and information processing speed were measured using: 1) ADAS-Cog; 2) Trail Making Test; 3) Digit Span Test; 4) Stroop Test, and 5) Digit Symbol Substitution Test. Falls risk was measured using the Physiological Profile Assessment. Hierarchical multiple linear regression analyses determined the unique contribution of Aβ on changes in cognitive function and falls risk at 12-months after controlling for experimental group (i.e. aerobic exercise training or usual care control) and baseline performance. To correct for multiple comparisons, we applied the Benjamini-Hochberg procedure to obtain a false discovery rate corrected threshold using alpha = 0.05. Higher PIB retention was significantly associated with greater decrements in set shifting (Trail Making Test, adjusted R 2  = 35.3%, p = 0.002), attention and conflict resolution (Stroop Test, adjusted R 2  = 33.4%, p = 0.01), and information processing speed (Digit Symbol Substitution Test, adjusted R 2  = 24.4%, p = 0.001) over a 12-month period. Additionally, higher PIB retention was significantly associated with increased falls risk (Physiological Profile Assessment, adjusted R 2  = 49.1%, p = 0.04). PIB retention was not significantly associated with change in ADAS-Cog and Verbal Digit Span Test (p > 0.05). Symptoms associated with SIVCI may be amplified by secondary Aβ pathology. ClinicalTrials.gov, NCT01027858 , December 7, 2009.

Inertial measurements of free-living activities: assessing mobility to predict falls.

PubMed

Wang, Kejia; Lovell, Nigel H; Del Rosario, Michael B; Liu, Ying; Wang, Jingjing; Narayanan, Michael R; Brodie, Matthew A D; Delbaere, Kim; Menant, Jasmine; Lord, Stephen R; Redmond, Stephen J

2014-01-01

An exploratory analysis was conducted into how simple features, from acceleration at the lower back and ankle during simulated free-living walking, stair ascent and descent, correlate with age, the overall fall risk from a clinically validated Physiological Profile Assessment (PPA), and its sub-components. Inertial data were captured from 92 older adults aged 78-95 (42 female, mean age 84.1, standard deviation 3.9 years). The dominant frequency, peak width from Welch's power spectral density estimate, and signal variance along each axis, from each sensor location and for each activity were calculated. Several correlations were found between these features and the physiological risk factors. The strongest correlations were from the dominant frequency at the ankle along the mediolateral direction during stair ascent (Spearman's correlation coefficient p = - 0.45) with anterioposterior sway, and signal variance of the anterioposterior acceleration at the lower back during stair descent (p = - 0.45) with age. These findings should aid future attempts to classify activities and predict falls in older adults, based on true free-living data from a range of activities.

Risk of falls in older people during fast-walking--the TASCOG study.

PubMed

Callisaya, M L; Blizzard, L; McGinley, J L; Srikanth, V K

2012-07-01

To investigate the relationship between fast-walking and falls in older people. Individuals aged 60-86 years were randomly selected from the electoral roll (n=176). Gait speed, step length, cadence and a walk ratio were recorded during preferred- and fast-walking using an instrumented walkway. Falls were recorded prospectively over 12 months. Log multinomial regression was used to estimate the relative risk of single and multiple falls associated with gait variables during fast-walking and change between preferred- and fast-walking. Covariates included age, sex, mood, physical activity, sensorimotor and cognitive measures. The risk of multiple falls was increased for those with a smaller walk ratio (shorter steps, faster cadence) during fast-walking (RR 0.92, CI 0.87, 0.97) and greater reduction in the walk ratio (smaller increase in step length, larger increase in cadence) when changing to fast-walking (RR 0.73, CI 0.63, 0.85). These gait patterns were associated with poorer physiological and cognitive function (p<0.05). A higher risk of multiple falls was also seen for those in the fastest quarter of gait speed (p=0.01) at fast-walking. A trend for better reaction time, balance, memory and physical activity for higher categories of gait speed was stronger for fallers than non-fallers (p<0.05). Tests of fast-walking may be useful in identifying older individuals at risk of multiple falls. There may be two distinct groups at risk--the frail person with short shuffling steps, and the healthy person exposed to greater risk. Copyright © 2012 Elsevier B.V. All rights reserved.

Exercise improves gait, reaction time and postural stability in older adults with type 2 diabetes and neuropathy.

PubMed

Morrison, Steven; Colberg, Sheri R; Parson, Henri K; Vinik, Aaron I

2014-01-01

For older adults with type 2 diabetes (T2DM), declines in balance and walking ability are risk factors for falls, and peripheral neuropathy magnifies this risk. Exercise training may improve balance, gait and reduce the risk of falling. This study investigated the effects of 12weeks of aerobic exercise training on walking, balance, reaction time and falls risk metrics in older T2DM individuals with/without peripheral neuropathy. Adults with T2DM, 21 without (DM; age 58.7±1.7years) and 16 with neuropathy (DM-PN; age 58.9±1.9years), engaged in either moderate or intense supervised exercise training thrice-weekly for 12weeks. Pre/post-training assessments included falls risk (using the physiological profile assessment), standing balance, walking ability and hand/foot simple reaction time. Pre-training, the DM-PN group had higher falls risk, slower (hand) reaction times (232 vs. 219ms), walked at a slower speed (108 vs. 113cm/s) with shorter strides compared to the DM group. Following training, improvements in hand/foot reaction times and faster walking speed were seen for both groups. While falls risk was not significantly reduced, the observed changes in gait, reaction time and balance metrics suggest that aerobic exercise of varying intensities is beneficial for improving dynamic postural control in older T2DM adults with/without neuropathy. Copyright © 2014 Elsevier Inc. All rights reserved.

Reactive stepping behaviour in response to forward loss of balance predicts future falls in community-dwelling older adults.

PubMed

Carty, Christopher P; Cronin, Neil J; Nicholson, Deanne; Lichtwark, Glen A; Mills, Peter M; Kerr, Graham; Cresswell, Andrew G; Barrett, Rod S

2015-01-01

a fall occurs when an individual experiences a loss of balance from which they are unable to recover. Assessment of balance recovery ability in older adults may therefore help to identify individuals at risk of falls. The purpose of this 12-month prospective study was to assess whether the ability to recover from a forward loss of balance with a single step across a range of lean magnitudes was predictive of falls. two hundred and one community-dwelling older adults, aged 65-90 years, underwent baseline testing of sensori-motor function and balance recovery ability followed by 12-month prospective falls evaluation. Balance recovery ability was defined by whether participants required either single or multiple steps to recover from forward loss of balance from three lean magnitudes, as well as the maximum lean magnitude participants could recover from with a single step. forty-four (22%) participants experienced one or more falls during the follow-up period. Maximal recoverable lean magnitude and use of multiple steps to recover at the 15% body weight (BW) and 25%BW lean magnitudes significantly predicted a future fall (odds ratios 1.08-1.26). The Physiological Profile Assessment, an established tool that assesses variety of sensori-motor aspects of falls risk, was also predictive of falls (Odds ratios 1.22 and 1.27, respectively), whereas age, sex, postural sway and timed up and go were not predictive. reactive stepping behaviour in response to forward loss of balance and physiological profile assessment are independent predictors of a future fall in community-dwelling older adults. Exercise interventions designed to improve reactive stepping behaviour may protect against future falls. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Quality of life and fall risk in frail hospitalized elderly patients

PubMed

Öztürk, Zeynel Abidin; Özdemir, Sedat; Türkbeyler, İbrahim Halil; Demir, Zeynep

2017-11-13

Background/aim: Frailty is a complex, multifactorial, and important geriatric syndrome characterized by decline in physiological reserves and functional deficiency in multiple systems. The aim of the current study is to investigate the prevalence of frailty and to determine the correlation between quality of life (QoL) and falling risk in geriatric hospitalized patients. Materials and methods: A total of 420 patients, aged 65 years and above, were enrolled in the study. All participants were hospitalized at a university hospital in the internal medicine clinics. The Cardiovascular Health Study (CHS) frailty scale, Health-Related Quality of Life Short Form (SF-36) scale, and Hendrich II Fall Risk Model were administered to the patients. Demographic data of patients, number of chronic diseases, and information on used medication were also collected.Results: The median age of patients was 71.9 ± 6.3 years and 49.5% of the patients were female. By applying the CHS frailty scale, the proportion of frail patients was determined to be 65.5%. There were statistically significant differences among quality of life mean scores of robust, prefrail, and frail patients (P < 0.001). Frail patients had the lowest scores in all SF-36 subgroups. Eighty-three (19.8%) patients were in the low-risk group while 337 (80.2%) were high-risk according to the Hendrich II Fall Risk Model. The rate of patients with high falling risk and poor QoL reached a maximum in the frail group (96%).Conclusion: Frailty is an important geriatric syndrome in elderly hospitalized patients. Poor QoL and high falling risk are issues commonly experienced with frailty.

Physiological monitoring and analysis of a manned stratospheric balloon test program.

PubMed

Garbino, Alejandro; Blue, Rebecca S; Pattarini, James M; Law, Jennifer; Clark, Jonathan B

2014-02-01

The Red Bull Stratos Project consisted of incremental high altitude parachute jumps [maximum altitude 127,852 ft (38,969 m)] from a pressurized capsule suspended from a stratospheric helium-filled balloon. A physiological monitoring system was worn by the parachutist to provide operational medical and acceleration data and to record a unique set of data in a supersonic environment. Various physiological parameters, including heart rate (HR), respiratory rate (RR), skin temperature, and triaxial acceleration, were collected during the ascent, high altitude float, free fall, and parachute opening and descent stages of multiple low- and high altitude jumps. Physiologic data were synchronized with global positioning system (GPS) and audiovisual data for a comprehensive understanding of the environmental stressors experienced. HR reached maximum during capsule egress and remained elevated throughout free fall and landing. RR reached its maximum during free fall. Temperature data were unreliable and did not provide useful results. The highest accelerations parameters were recorded during parachute opening and during landing. During each high altitude jump, immediately after capsule egress, the parachutist experienced a few seconds of microgravity during which some instability occurred. Control was regained as the parachutist entered denser atmosphere. The high altitude environment resulted in extremely high vertical speeds due to little air resistance in comparison to lower altitude jumps with similar equipment. The risk for tumbling was highest at initial step-off. Physiological responses included elevated HR and RR throughout critical phases of free fall. The monitoring unit performed well despite the austere environment and extreme human performance activities.

Sensi-steps: Using Patient-Generated Data to Prevent Post-stroke Falls

PubMed Central

Smith, Angela; Ng, Ada; Burgess, Eleanor R.; Weingarten, Noah; Pacheco, Jennifer A.

2017-01-01

We present Sensi-steps, an application using patient-generated data (PGD) to prevent falls for geriatric and especially poststroke patients. The Sensi-steps tool incorporates a wearable wrist device, pedometer, pressure and proximity sensors, and tablet. PGD collection occurs through Timed Up and Go (TUG) tests and collection of physiological data, which is integrated into the EHR. Fall risk factor active tracking encourages new ways of shared decision-making between patients, caregivers, and practitioners. PGD will be managed at the primary care nurse or Care Manager level (see 3-tier PGD service proposal), presenting a novel way to incorporate PGD into clinical decision-support systems. We expect our solution to be easier to use routinely by the patient at home than other fall risk tracking solutions. Sensi-steps has the potential to improve patient care, help patients make informed decisions, and help clinicians understand patient-generated, environmental, and lifestyle information to deliver personalized, preventative healthcare.

The MOBILIZE Boston Study: design and methods of a prospective cohort study of novel risk factors for falls in an older population.

PubMed

Leveille, Suzanne G; Kiel, Douglas P; Jones, Richard N; Roman, Anthony; Hannan, Marian T; Sorond, Farzaneh A; Kang, Hyun G; Samelson, Elizabeth J; Gagnon, Margaret; Freeman, Marcie; Lipsitz, Lewis A

2008-07-18

Falls are the sixth leading cause of death in elderly people in the U.S. Despite progress in understanding risk factors for falls, many suspected risk factors have not been adequately studied. Putative risk factors for falls such as pain, reductions in cerebral blood flow, somatosensory deficits, and foot disorders are poorly understood, in part because they pose measurement challenges, particularly for large observational studies. The MOBILIZE Boston Study (MBS), an NIA-funded Program Project, is a prospective cohort study of a unique set of risk factors for falls in seniors in the Boston area. Using a door-to-door population-based recruitment, we have enrolled 765 persons aged 70 and older. The baseline assessment was conducted in 2 segments: a 3-hour home interview followed within 4 weeks by a 3-hour clinic examination. Measures included pain, cerebral hemodynamics, and foot disorders as well as established fall risk factors. For the falls follow-up, participants return fall calendar postcards to the research center at the end of each month. Reports of falls are followed-up with a telephone interview to assess circumstances and consequences of each fall. A second assessment is performed 18 months following baseline. Of the 2382 who met all eligibility criteria at the door, 1616 (67.8%) agreed to participate and were referred to the research center for further screening. The primary reason for ineligibility was inability to communicate in English. Results from the first 600 participants showed that participants are largely representative of seniors in the Boston area in terms of age, sex, race and Hispanic ethnicity. The average age of study participants was 77.9 years (s.d. 5.5) and nearly two-thirds were women. The study cohort was 78% white and 17% black. Many participants (39%) reported having fallen at least once in the year before baseline. Our results demonstrate the feasibility of conducting comprehensive assessments, including rigorous physiologic measurements, in a diverse population of older adults to study non-traditional risk factors for falls and disability. The MBS will provide an important new data resource for examining novel risk factors for falls and mobility problems in the older population.

Participating in a virtual reality balance exercise program can reduce risk and fear of falls.

PubMed

Singh, Devinder K A; Rajaratnam, Bala S; Palaniswamy, Vijayakumar; Pearson, Hannah; Raman, Vimal P; Bong, Pei Sien

2012-11-01

The objective of this study was to quantify the effectiveness of virtual reality balance games (VRBG) to decrease risk and fear of falls among women. Thirty six community dwelling women aged 56 and above were randomly divided into experimental (exercises using VRBG focus on improving balance) and control (conventional balance exercises) groups. Both groups attended a twice 6 weekly exercise session for an hour. Risk and fear of falls were measured with Physiological Profile Approach (PPA) and Activity Specific Balance Scale (ABC-6). Pre and post intervention differences between the groups were examined using two way repeated measures ANOVA. Both VRBG and conventional balance exercise groups had significant decrease in PPA (p<0.001) and ABC-6 (p<0.01) after the interventions. However, no significant effects were demonstrated between the groups in PPA (p=0.18) and ABC-6 (p=0.25) post intervention. Time and group interaction effect were not significant for PPA (p=0.18) and ABC-6 (p=0.45). Practising VRBG can increase balance confidence and decrease risk of falls among community dwelling women. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Intraindividual Stepping Reaction Time Variability Predicts Falls in Older Adults With Mild Cognitive Impairment.

PubMed

Bunce, David; Haynes, Becky I; Lord, Stephen R; Gschwind, Yves J; Kochan, Nicole A; Reppermund, Simone; Brodaty, Henry; Sachdev, Perminder S; Delbaere, Kim

2017-06-01

Reaction time measures have considerable potential to aid neuropsychological assessment in a variety of health care settings. One such measure, the intraindividual reaction time variability (IIV), is of particular interest as it is thought to reflect neurobiological disturbance. IIV is associated with a variety of age-related neurological disorders, as well as gait impairment and future falls in older adults. However, although persons diagnosed with Mild Cognitive Impairment (MCI) are at high risk of falling, the association between IIV and prospective falls is unknown. We conducted a longitudinal cohort study in cognitively intact (n = 271) and MCI (n = 154) community-dwelling adults aged 70-90 years. IIV was assessed through a variety of measures including simple and choice hand reaction time and choice stepping reaction time tasks (CSRT), the latter administered as a single task and also with a secondary working memory task. Logistic regression did not show an association between IIV on the hand-held tasks and falls. Greater IIV in both CSRT tasks, however, did significantly increase the risk of future falls. This effect was specific to the MCI group, with a stronger effect in persons exhibiting gait, posture, or physiological impairment. The findings suggest that increased stepping IIV may indicate compromised neural circuitry involved in executive function, gait, and posture in persons with MCI increasing their risk of falling. IIV measures have potential to assess neurobiological disturbance underlying physical and cognitive dysfunction in old age, and aid fall risk assessment and routine care in community and health care settings. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Beneficial Effects of Group-Based Exercises on Fall Risk Profile and Physical Activity Persist One-Year Post-Intervention in Older Women with Low Bone Mass: Follow-up After Withdrawal of Exercise

PubMed Central

Liu-Ambrose, Teresa YL; Khan, Karim M; Eng, Janice J; Gillies, Graham L; Lord, Stephen R; McKay, Heather A

2012-01-01

OBJECTIVE To determine whether exercise-induced reductions in fall risk are maintained in older women one year following the cessation of three types of interventions – resistance training, agility training, and general stretching. DESIGN One-year observational study. PARTICIPANTS 98 women aged 75–85 years with low bone mass. MEASUREMENTS Primary outcome measure was fall risk as measured by the Physiological Profile Assessment tool. Secondary outcome measures were current physical activity level as assessed by the Physical Activity Scale for the Elderly and formal exercise participation as assessed by interview. RESULTS At the end of the follow-up, the fall risk among former participants of all three exercise programs was maintained (i.e., still reduced) from trial completion. Mean fall risk value at the end of follow-up was 43.3% reduced compared with the mean baseline value among former participants of the Resistance Training group, 40.1% reduced in the Agility Training group, and 37.4% reduced in the general Stretching group. Physical activity levels were also maintained from trial completion. Specifically, there was a 3.8% increase in physical activity from baseline for the Resistance Training group, a 29.2% increase for the Agility Training group, and 37.7% increase for the general Stretching group. CONCLUSION After three types of group-based exercise programs, benefits are sustained for at least 12 months without further formal exercise intervention. Thus, these six-month exercise interventions appeared to act as a catalyst for increasing physical activity with resultant reductions in fall risk profile that were maintained for at least 18 months among older women with low bone mass. PMID:16181178

Fall Prediction and Prevention Systems: Recent Trends, Challenges, and Future Research Directions.

PubMed

Rajagopalan, Ramesh; Litvan, Irene; Jung, Tzyy-Ping

2017-11-01

Fall prediction is a multifaceted problem that involves complex interactions between physiological, behavioral, and environmental factors. Existing fall detection and prediction systems mainly focus on physiological factors such as gait, vision, and cognition, and do not address the multifactorial nature of falls. In addition, these systems lack efficient user interfaces and feedback for preventing future falls. Recent advances in internet of things (IoT) and mobile technologies offer ample opportunities for integrating contextual information about patient behavior and environment along with physiological health data for predicting falls. This article reviews the state-of-the-art in fall detection and prediction systems. It also describes the challenges, limitations, and future directions in the design and implementation of effective fall prediction and prevention systems.

Walking-Induced Fatigue leads to Increased Falls Risk in Older Adults

PubMed Central

Morrison, S.; Colberg, S. R.; Parson, H. K.; Neumann, S.; Handel, R.; Vinik, E. J.; Paulson, J.; Vinik, A. I.

2016-01-01

Background For older adults, falls are a serious health problem with over 30% of people over 65 suffering a fall at least once a year. One element often overlooked in the assessment of falls is whether a person’s balance, walking ability and overall falls risk is affected by performing activities of daily living such as walking. Objective This study assessed the immediate impact of incline walking at a moderate pace on falls risk, leg strength, reaction time, gait and balance in 75 healthy adults from 30 to 79 years of age. Subjects were subdivided into five equal groups based upon their age (Group 1, 30–39 years; Group 2, 40–49 years; Group 3, 50–59 years; Group 4, 60–69 years; Group 5, 70–79 years). Methods Each person’s falls risk (using the Physiological Profile Assessment), simple reaction time, leg strength, walking ability and standing balance were assessed prior to and following a period of incline walking on an automated treadmill. The walking task consisted of three 5-minute trials at a faster than preferred pace. Fatigue during walking was elicited by increasing the treadmill incline in increments of 20 (from level) every minute to a maximum of 80. Results As predicted, significant age-related differences were observed prior to the walking activity. In general, increasing age was associated with declines in gait speed, lower limb strength, slower reaction times and increases in overall falls risk. Following the treadmill task, older adults exhibited increased sway (path length 60–69 yrs; 10.2±0.7 to 12.1±0.7 cm: 70–79 yrs; 12.8±1.1 to 15.1±0.8 cm), slower reaction times (70–79 yrs; 256±6 to 287±8 ms), and declines in lower limb strength (60–69 yrs; 36±2 to 31±1 kg: 70–79 yrs; 32.3±2 to 27±1 kg). However, a significant increase in overall falls risk (pre; 0.51±0.17: post; 1.01±0.18) was only seen in the oldest group (70–79 years). For all other persons (30–69 years), changes resulting from the treadmill-walking task did not lead to a significant increase in falls risk. Conclusions As most falls occur when an individual is moving and/or fatigued, assessing functional properties related to balance, gait, strength and falls risk in older adults both at rest and following activity may provide additional insight. PMID:26825684

Fall Prediction and Prevention Systems: Recent Trends, Challenges, and Future Research Directions

PubMed Central

Rajagopalan, Ramesh; Jung, Tzyy-Ping

2017-01-01

Fall prediction is a multifaceted problem that involves complex interactions between physiological, behavioral, and environmental factors. Existing fall detection and prediction systems mainly focus on physiological factors such as gait, vision, and cognition, and do not address the multifactorial nature of falls. In addition, these systems lack efficient user interfaces and feedback for preventing future falls. Recent advances in internet of things (IoT) and mobile technologies offer ample opportunities for integrating contextual information about patient behavior and environment along with physiological health data for predicting falls. This article reviews the state-of-the-art in fall detection and prediction systems. It also describes the challenges, limitations, and future directions in the design and implementation of effective fall prediction and prevention systems. PMID:29104256

[Incidence of fall related injury in people aged 50 and above and risk factors in 8 provinces in China: a cross-sectional study].

PubMed

Guo, Y F; Ma, W J; Zhang, Q J; Yu, M; Xiao, Y Z; Guo, X L; Zhu, Y L; Liu, F; Ruan, Y; Sun, S Y; Huang, Z Z; Zheng, Y; Wu, F

2018-03-10

Objective: To estimate the incidence and distribution characteristics of fall related injury in people aged ≥50 years in 8 provinces in China and related physiological, psychological and social risk factors. Methods: Cross-sectional data were collected from adults aged ≥50 years participating in the World Health Organization (WHO) study on global ageing and adult health (SAGE) round 1 in China. Two-level hierarchical logistic model was used to identify the related factors for fall-related injury. All the models were stratified by living area (urban/rural). Results: Estimated incidence of fall related injury (road traffic injury was not included) was 3.2 %. Ageing and multiple chronic conditions ( OR =2.55, 95 %CI : 1.41-4.64) was significantly associated with the incidence of fall related injury in urban area. In rural area, depression ( OR =4.33, 95 % CI : 2.52-7.42) and multiple chronic conditions ( OR =2.46, 95 %CI : 1.37-4.41) were associated with the incidence of fall related injury. Conclusions: This study estimated the incidence of fall related injury in adults aged ≥50 years in 8 provinces in China. A significant association between multiple chronic conditions and fall related injury were found in both urban and rural residents. Targeted measures should be taken for the prevention and control of chronic diseases in elderly population.

The effect of sensor-based exercise at home on functional performance associated with fall risk in older people - a comparison of two exergame interventions.

PubMed

Gschwind, Yves J; Schoene, Daniel; Lord, Stephen R; Ejupi, Andreas; Valenzuela, Trinidad; Aal, Konstantin; Woodbury, Ashley; Delbaere, Kim

2015-01-01

There is good evidence that balance challenging exercises can reduce falls in older people. However, older people often find it difficult to incorporate such programs in their daily life. Videogame technology has been proposed to promote enjoyable, balance-challenging exercise. As part of a larger analysis, we compared feasibility and efficacy of two exergame interventions: step-mat-training (SMT) and Microsoft-Kinect® (KIN) exergames. 148 community-dwelling people, aged 65+ years participated in two exergame studies in Sydney, Australia (KIN: n = 57, SMT: n = 91). Both interventions were delivered as unsupervised exercise programs in participants' homes for 16 weeks. Assessment measures included overall physiological fall risk, muscle strength, finger-press reaction time, proprioception, vision, balance and executive functioning. For participants allocated to the intervention arms, the median time played each week was 17 min (IQR 32) for KIN and 48 min (IQR 94) for SMT. Compared to the control group, SMT participants improved their fall risk score (p = 0.036), proprioception (p = 0.015), reaction time (p = 0.003), sit-to-stand performance (p = 0.011) and executive functioning (p = 0.001), while KIN participants improved their muscle strength (p = 0.032) and vision (p = 0.010), and showed a trend towards improved fall risk scores (p = 0.057). The findings suggest that it is feasible for older people to conduct an unsupervised exercise program at home using exergames. Both interventions reduced fall risk and SMT additionally improved specific cognitive functions. However, further refinement of the systems is required to improve adherence and maximise the benefits of exergames to deliver fall prevention programs in older people's homes. ACTRN12613000671763 (Step Mat Training RCT) ACTRN12614000096651 (MS Kinect RCT).

Executive function is independently associated with performances of balance and mobility in community-dwelling older adults after mild stroke: implications for falls prevention

PubMed Central

Liu-Ambrose, Teresa; Pang, Marco; Eng, Janice J

2015-01-01

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 stroke survivors. Methods Cross-sectional analysis of 63 adults who suffered a mild stroke >1 year prior to the study, aged > or =50 years. Results Cognitive flexibility was independently associated with performances of balance and mobility in community-dwelling older adults after mild stroke, after accounting for age, quadriceps strength of the paretic side and current physical activity level. Conclusions Clinicians may need to consider cognitive function when assessing and treating impaired balance and mobility in community-dwelling older adults after mild stroke. PMID:17143004

Walking-Induced Fatigue Leads to Increased Falls Risk in Older Adults.

PubMed

Morrison, Steven; Colberg, Sheri R; Parson, Henri K; Neumann, Serina; Handel, Richard; Vinik, Etta J; Paulson, James; Vinik, Arthur I

2016-05-01

For older adults, falls are a serious health problem, with more than 30% of people older than 65 suffering a fall at least once a year. One element often overlooked in the assessment of falls is whether a person's balance, walking ability, and overall falls risk is affected by performing activities of daily living such as walking. This study assessed the immediate impact of incline walking at a moderate pace on falls risk, leg strength, reaction time, gait, and balance in 75 healthy adults from 30 to 79 years of age. Subjects were subdivided into 5 equal groups based on their age (group 1, 30-39 years; group 2, 40-49 years; group 3, 50-59 years; group 4, 60-69 years; group 5, 70-79 years). Each person's falls risk (using the Physiological Profile Assessment), simple reaction time, leg strength, walking ability, and standing balance were assessed before and after a period of incline walking on an automated treadmill. The walking task consisted of three 5-minute trials at a faster than preferred pace. Fatigue during walking was elicited by increasing the treadmill incline in increments of 2° (from level) every minute to a maximum of 8°. As predicted, significant age-related differences were observed before the walking activity. In general, increasing age was associated with declines in gait speed, lower limb strength, slower reaction times, and increases in overall falls risk. Following the treadmill task, older adults exhibited increased sway (path length 60-69 years; 10.2 ± 0.7 to 12.1 ± 0.7 cm: 70-79 years; 12.8 ± 1.1 to 15.1 ± 0.8 cm), slower reaction times (70-79 years; 256 ± 6 to 287 ± 8 ms), and declines in lower limb strength (60-69 years; 36 ± 2 to 31 ± 1 kg: 70-79 years; 32.3 ± 2 to 27 ± 1 kg). However, a significant increase in overall falls risk (pre; 0.51 ± 0.17: post; 1.01 ± 0.18) was only seen in the oldest group (70-79 years). For all other persons (30-69 years), changes resulting from the treadmill-walking task did not lead to a significant increase in falls risk. As most falls occur when an individual is moving and/or fatigued, assessing functional properties related to balance, gait, strength, and falls risk in older adults both at rest and following activity may provide additional insight. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Self-perceived gait stability modulates the effect of daily life gait quality on prospective falls in older adults.

PubMed

Weijer, R H A; Hoozemans, M J M; van Dieën, J H; Pijnappels, M

2018-05-01

Quality of gait during daily life activities and perceived gait stability are both independent risk factors for future falls in older adults. We investigated whether perceived gait stability modulates the association between gait quality and falling in older adults. In this prospective cohort study, we used one-week daily-life trunk acceleration data of 272 adults over 65 years of age. Sample entropy (SE) of the 3D acceleration signals was calculated to quantify daily life gait quality. To quantify perceived gait stability, the level of concern about falling was assessed using the Falls Efficacy Scale international (FES-I) questionnaire and step length, estimated from the accelerometer data. A fall calendar was used to record fall incidence during a six-month follow up period. Logistic regression analyses were performed to study the association between falling and SE, step length or FES-I score, and their interactions. High (i.e., poor) SE in vertical direction was significantly associated with falling. FES-I scores significantly modulated this association, whereas step length did not. Subgroup analyses based on FES-I scores showed that high SE in the vertical direction was a risk factor for falls only in older adults who had a high (i.e. poor) FES-I score. In conclusion, perceived gait stability modulates the association between gait quality and falls in older adults such that an association between gait quality and falling is only present when perceived gait stability is poor. The results of the present study indicate that the effectiveness of interventions for fall prevention, aimed at improving gait quality, may be affected by a modulating effect of perceived gait stability. Results indicate that interventions to reduce falls in older adults might sort most effectiveness in populations with both a poor physiological and psychological status. Copyright © 2018 Elsevier B.V. All rights reserved.

Effectiveness of exercise programs to reduce falls in older people with dementia living in the community: a systematic review and meta-analysis

PubMed Central

Burton, Elissa; Cavalheri, Vinicius; Adams, Richard; Oakley Browne, Colleen; Bovery-Spencer, Petra; Fenton, Audra M; Campbell, Bruce W; Hill, Keith D

2015-01-01

Objective The objective of this systematic review and meta-analysis is to evaluate the effectiveness of exercise programs to reduce falls in older people with dementia who are living in the community. Method Peer-reviewed articles (randomized controlled trials [RCTs] and quasi-experimental trials) published in English between January 2000 and February 2014, retrieved from six electronic databases – Medline (ProQuest), CINAHL, PubMed, PsycInfo, EMBASE and Scopus – according to predefined inclusion criteria were included. Where possible, results were pooled and meta-analysis was conducted. Results Four articles (three RCT and one single-group pre- and post-test pilot study) were included. The study quality of the three RCTs was high; however, measurement outcomes, interventions, and follow-up time periods differed across studies. On completion of the intervention period, the mean number of falls was lower in the exercise group compared to the control group (mean difference [MD] [95% confidence interval {CI}] =−1.06 [−1.67 to −0.46] falls). Importantly, the exercise intervention reduced the risk of being a faller by 32% (risk ratio [95% CI] =0.68 [0.55–0.85]). Only two other outcomes were reported in two or more of the studies (step test and physiological profile assessment). No between-group differences were observed in the results of the step test (number of steps) (MD [95% CI] =0.51 [−1.77 to 2.78]) or the physiological profile assessment (MD [95% CI] =−0.10 [−0.62 to 0.42]). Conclusion Findings from this review suggest that an exercise program may potentially assist in preventing falls of older people with dementia living in the community. However, further research is needed with studies using larger sample sizes, standardized measurement outcomes, and longer follow-up periods, to inform evidence-based recommendations. PMID:25709416

Timing paradox of stepping and falls in ageing: not so quick and quick(er) on the trigger.

PubMed

Rogers, Mark W; Mille, Marie-Laure

2016-08-15

Physiological and degenerative changes affecting human standing balance are major contributors to falls with ageing. During imbalance, stepping is a powerful protective action for preserving balance that may be voluntarily initiated in recognition of a balance threat, or be induced by an externally imposed mechanical or sensory perturbation. Paradoxically, with ageing and falls, initiation slowing of voluntary stepping is observed together with perturbation-induced steps that are triggered as fast as or faster than for younger adults. While age-associated changes in sensorimotor conduction, central neuronal processing and cognitive functions are linked to delayed voluntary stepping, alterations in the coupling of posture and locomotion may also prolong step triggering. It is less clear, however, how these factors may explain the accelerated triggering of induced stepping. We present a conceptual model that addresses this issue. For voluntary stepping, a disruption in the normal coupling between posture and locomotion may underlie step-triggering delays through suppression of the locomotion network based on an estimation of the evolving mechanical state conditions for stability. During induced stepping, accelerated step initiation may represent an event-triggering process whereby stepping is released according to the occurrence of a perturbation rather than to the specific sensorimotor information reflecting the evolving instability. In this case, errors in the parametric control of induced stepping and its effectiveness in stabilizing balance would be likely to occur. We further suggest that there is a residual adaptive capacity with ageing that could be exploited to improve paradoxical triggering and other changes in protective stepping to impact fall risk. © 2016 The Authors. The Journal of Physiology © 2016 The Physiological Society.

Changes in balance, functional performance and fall risk following whole body vibration training and vitamin D supplementation in institutionalized elderly women. A 6 month randomized controlled trial.

PubMed

Bogaerts, An; Delecluse, Christophe; Boonen, Steven; Claessens, Albrecht L; Milisen, Koen; Verschueren, Sabine M P

2011-03-01

Falls in the elderly constitute a growing public health problem. This randomized controlled trial investigated the potential benefit of 6 months of whole body vibration (WBV) training and/or vitamin D supplementation on balance, functionality and estimated fall risk in institutionalized elderly women. A total of 113 women (mean age: 79.6) were randomly assigned to either a WBV or a no-training group, receiving either a conventional dose (880 IU/d) or a high dose (1600 IU/d) of vitamin D3. The WBV group performed exercises on a vibration platform 3×/week. Balance was evaluated by computerized posturography. Functionality was assessed by 10 m walk test, Timed up and Go (TUG) performance and endurance capacity (Shuttle Walk). Fall risk was determined with the Physiological Profile Assessment. Performance on the 10 m walk test and on TUG improved over time in all groups. For none of the parameters, high-dose vitamin D resulted in a better performance than conventional dosing. The improvements in the WBV group in endurance capacity, walking at preferred speed, and TUG were significantly larger than the changes with supplementation alone. No additional benefit of WBV training could be detected on fall risk and postural control, although sway velocity and maximal isometric knee extension strength improved only in the WBV group. This trial showed that a high-dose vitamin D supplementation is not more efficient than conventional dosing in improving functionality in institutionalized elderly. WBV training on top of vitamin D supplementation provided an added benefit with regard to walking, TUG performance, and endurance capacity. Copyright © 2010 Elsevier B.V. All rights reserved.

Prevalence of vision loss among hospital in-patients; a risk factor for falls?

PubMed

Leat, Susan J; Zecevic, Aleksandra A; Keeling, Alexis; Hileeto, Denise; Labreche, Tammy; Brymer, Christopher

2018-01-01

Despite poor vision being a risk factor for falls, current hospital policies and practices often do not include a vision assessment at patient admission or in the hospital's incident reporting system when a fall occurs. Our purpose was to document the prevalence of vision loss in hospital general medicine units to increase awareness of poor vision as a potential risk factor for falls that occur within the hospital, and inform future preventative practice. This cross-sectional study took place in medicine units of an acute care hospital. Participants were adult in-patients. Visual acuity (VA), contrast sensitivity and stereoacuity were measured, and patients were screened for field loss, extinction and neglect. 115 participants took part (average age 67 ± 17, 48% female). Overall, 89% had a visual impairment defined as being outside the age-norms for one or more vision measure, 62% had low vision, and 36% had vision loss equivalent to legal blindness [VA equal to or poorer than 1.0 logMAR (6/60, 20/200) or ≥10x below age-norms]. There was a considerable discrepancy between the prevalence of low vision and the percentage of patients who reported an ocular diagnosis that would result in visual loss (30%). Ten patients fell during the study period, and of these 100% had visual impairment, 90% had low vision and 60% had vision loss equivalent to legal blindness, which compares to 58%, 22% and 9% for non-fallers. Similar high prevalences were found in those whose reason for admission to the hospital was a fall (92%, 63% and 33% respectively). Vision loss has a high prevalence among patients in hospital medicine units, and is higher still among those who fall. Since vision loss may be a contributing factor to falls that occur in hospitals, implementing an assessment of vision at hospital admission would be useful to alert staff to those patients who are at risk for falls due to poor vision, so that preventative measures can be applied. © 2017 The Authors Ophthalmic & Physiological Optics © 2017 The College of Optometrists.

Stochastic analysis of motor-control stability, polymer based force sensing, and optical stimulation as a preventive measure for falls

NASA Astrophysics Data System (ADS)

Landrock, Clinton K.

Falls are the leading cause of all external injuries. Outcomes of falls include the leading cause of traumatic brain injury and bone fractures, and high direct medical costs in the billions of dollars. This work focused on developing three areas of enabling component technology to be used in postural control monitoring tools targeting the mitigation of falls. The first was an analysis tool based on stochastic fractal analysis to reliably measure levels of motor control. The second focus was on thin film wearable pressure sensors capable of relaying data for the first tool. The third was new thin film advanced optics for improving phototherapy devices targeting postural control disorders. Two populations, athletes and elderly, were studied against control groups. The results of these studies clearly show that monitoring postural stability in at-risk groups can be achieved reliably, and an integrated wearable system can be envisioned for both monitoring and treatment purposes. Keywords: electro-active polymer, ionic polymer-metal composite, postural control, motor control, fall prevention, sports medicine, fractal analysis, physiological signals, wearable sensors, phototherapy, photobiomodulation, nano-optics.

Does vibration training reduce the fall risk profile of frail older people admitted to a rehabilitation facility? A randomised controlled trial.

PubMed

Parsons, J; Mathieson, S; Jull, A; Parsons, M

2016-01-01

To determine the effect of Vibration Training (VT) on functional ability and falls risk among a group of frail older people admitted to an inpatient rehabilitation unit in a regional hospital in New Zealand. A randomized controlled trial of 56 participants (mean 82.01 years in the intervention group and 81.76 years in the control group). VT targeting lower limb muscles with a frequency 30-50 Hz occurred three times per week until discharge. Amplitude progressively increased from 2 to 5 mm to allow the programme to be individually tailored to the participant. The control group received usual care physiotherapy sessions. Outcome measures were: Physiological profile assessment (PPA); and Functional Independence measure (FIM) and Modified Falls Efficacy Scale (MFES). There was a statistically significant difference observed between the two groups in terms of FIM score (F = 5.09, p = 0.03) and MFES (F = 3.52, p = 0.007) but no difference was observed in terms of PPA scores (F = 0.96, p = 0.36). Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of VT in conjunction with usual care physiotherapy in terms of improved functional ability. The study design and the small dosage of VT provided may have precluded any change in falls risk among participants. Vibration training (VT) may assist in reducing the risk of falling among at risk older people. Current pressures on health systems (ageing population, reduced hospital length of stay) necessitate the development of innovative strategies to maximise the rehabilitation potential of older people. Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of vibration training in conjunction with usual care physiotherapy in terms of improved functional ability.

Intervention to prevent further falls in older people who call an ambulance as a result of a fall: a protocol for the iPREFER randomised controlled trial.

PubMed

Mikolaizak, A Stefanie; Simpson, Paul M; Tiedemann, Anne; Lord, Stephen R; Caplan, Gideon A; Bendall, Jason C; Howard, Kirsten; Close, Jacqueline C T

2013-09-27

An increasing number of falls result in an emergency call and the subsequent dispatch of paramedics. In the absence of physical injury, abnormal physiological parameters or change in usual functional status, it could be argued that routine conveyance by ambulance to the Emergency Department (ED) is not the most effective or efficient use of resources. Further, it is likely that non-conveyed older fallers have the potential to benefit from timely access to fall risk assessment and intervention. The aim of this randomised controlled trial is to evaluate the effect of a timely and tailored falls assessment and management intervention on the number of subsequent falls and fall-related injuries for non-conveyed older fallers. Community dwelling people aged 65 years or older who are not conveyed to the ED following a fall will be eligible to be visited at home by a research physiotherapist. Consenting participants will receive individualised intervention strategies based on risk factors identified at baseline. All pre-test measures will be assessed prior to randomisation. Post-test measures will be undertaken by a researcher blinded to group allocation 6 months post-baseline. Participants in the intervention group will receive individualised pro-active fall prevention strategies from the clinical researcher to ensure that risk factors are addressed adequately and interventions carried out. The primary outcome measure will be the number of falls recorded by a falls diary over a 12 month period. Secondary outcome measures assessed six months after baseline will include the subsequent use of medical and emergency services and uptake of recommendations. Data will be analysed using the intention-to-treat principle. As there is currently little evidence regarding the effectiveness or feasibility of alternate models of care following ambulance non-conveyance of older fallers, there is a need to explore assessment and intervention programs to help reduce subsequent falls, related injuries and subsequent use of health care services. By linking existing services rather than setting up new services, this pragmatic trial aims to utilise the health care system in an efficient and timely manner. Australian New Zealand Clinical Trials Registry: ACTRN 12611000503921.

Patient centered fall risk awareness perspectives: clinical correlates and fall risk

PubMed Central

Verghese, Joe

2016-01-01

Background While objective measures to assess risk of falls in older adults have been established; the value of patient self-reports in the context of falls is not known. Objectives To identify clinical correlates of patient centered fall risk awareness, and their validity for predicting falls. Design Prospective cohort study. Setting and Participants 316 non-demented and ambulatory community-dwelling older adults (mean age 78 years, 55% women). Measurements Fall risk awareness was assessed with a two-item questionnaire, which asked participants about overall likelihood and personal risk of falling over the next 12 months. Incident falls were recorded over study follow-up. Results Fifty-three participants (16.8%) responded positively to the first fall risk awareness question about being likely to have a fall in the next 12 months, and 100 (31.6%) reported being at personal risk of falling over the next 12 months. There was only fair correlation (kappa 0.370) between responses on the two questions. Prior falls and depressive symptoms were associated with positive responses on both fall risk awareness questions. Age and other established fall risk factors were not associated with responses on both fall risk awareness questions. The fall risk awareness questionnaire did not predict incident falls or injurious falls. Conclusion Fall risk awareness is low in older adults. While patient centered fall risk awareness is not predictive of falls, subjective risk perceptions should be considered when designing fall preventive strategies as they may influence participation and behaviors. PMID:27801936

Person-Centered Fall Risk Awareness Perspectives: Clinical Correlates and Fall Risk.

PubMed

Verghese, Joe

2016-12-01

To identify clinical correlates of person-centered fall risk awareness and their validity for predicting falls. Prospective cohort study. Community. Ambulatory community-dwelling older adults without dementia (N = 316; mean age 78, 55% female). Fall risk awareness was assessed using a two-item questionnaire that asked participants about overall likelihood of someone in their age group having a fall and their own personal risk of falling over the next 12 months. Incident falls were recorded over study follow-up. Fifty-three participants (16.8%) responded positively to the first fall risk awareness question about being likely to have a fall in the next 12 months, and 100 (31.6%) reported being at personal risk of falling over the next 12 months. There was only fair correlation (κ = 0.370) between responses on the two questions. Prior falls and depressive symptoms were associated with positive responses on both fall risk awareness questions. Age and other established fall risk factors were not associated with responses on either fall risk awareness question. The fall risk awareness questionnaire did not predict incident falls or injurious falls. Fall risk awareness is low in older adults. Although person-centered fall risk awareness is not predictive of falls, subjective risk perceptions should be considered when designing fall preventive strategies because they may influence participation and behaviors. © 2016, Copyright the Author Journal compilation © 2016, The American Geriatrics Society.

Frailty and falls among adult patients undergoing chronic hemodialysis: a prospective cohort study

PubMed Central

2013-01-01

Background Patients undergoing hemodialysis are at high risk of falls, with subsequent complications including fractures, loss of independence, hospitalization, and institutionalization. Factors associated with falls are poorly understood in this population. We hypothesized that insights derived from studies of the elderly might apply to adults of all ages undergoing hemodialysis; we focused on frailty, a phenotype of physiological decline strongly associated with falls in the elderly. Methods In this prospective, longitudinal study of 95 patients undergoing hemodialysis (1/2009-3/2010), the association of frailty with future falls was explored using adjusted Poisson regression. Frailty was classified using the criteria established by Fried et al., as a combination of five components: shrinking, weakness, exhaustion, low activity, and slowed walking speed. Results Over a median 6.7-month period of longitudinal follow-up, 28.3% of study participants (25.9% of those under 65, 29.3% of those 65 and older) experienced a fall. After adjusting for age, sex, race, comorbidity, disability, number of medications, marital status, and education, frailty independently predicted a 3.09-fold (95% CI: 1.38-6.90, P=0.006) higher number of falls. This relationship between frailty and falls did not differ for younger and older adults (P=0.57). Conclusions Frailty, a validated construct in the elderly, was a strong and independent predictor of falls in adults undergoing hemodialysis, regardless of age. Our results may aid in identifying frail hemodialysis patients who could be targeted for multidimensional fall prevention strategies. PMID:24131569

Educators' emotion regulation strategies and their physiological indicators of chronic stress over 1 year.

PubMed

Katz, Deirdre A; Harris, Alexis; Abenavoli, Rachel; Greenberg, Mark T; Jennings, Patricia A

2018-04-01

Studies show teaching is a highly stressful profession and that chronic work stress is associated with adverse health outcomes. This study analysed physiological markers of stress and self-reported emotion regulation strategies in a group of middle school teachers over 1 year. Chronic physiological stress was assessed with diurnal cortisol measures at three time points over 1 year (fall, spring, fall). The aim of this longitudinal study was to investigate the changes in educators' physiological level of stress. Results indicate that compared to those in the fall, cortisol awakening responses were blunted in the spring. Further, this effect was ameliorated by the summer break. Additionally, self-reported use of the emotion regulation strategy reappraisal buffered the observed blunting that occurred in the spring. Copyright © 2017 John Wiley & Sons, Ltd.

Falls risk assessment in older patients in hospital.

PubMed

Matarese, Maria; Ivziku, Dhurata

2016-07-27

Falls are the most frequent adverse event reported in hospitals, usually affecting older patients. All hospitals in NHS organisations develop risk prevention policies that include falls risk assessment. Falls risk assessment involves the use of risk screening tools, aimed at identifying patients at increased risk of falls, and risk assessment tools, which identify a patient's risk factors for falls. Various risk screening tools have been used in clinical practice, but no single tool is able to identify all patients at risk of falls or to accurately exclude all those who are not at risk of falls. Guidelines recommend that patients aged 65 years and over who are admitted to hospital should be considered at high risk of falls and that a multifactorial falls risk assessment should be performed. Therefore, falls risk assessment tools should be used to identify the risk factors for each inpatient aged 65 years or over, in order to determine the most appropriate care plan for falls prevention and to maximise patient mobility and independence.

Development of a Fall-Risk Self-Assessment for Community-Dwelling Seniors

PubMed Central

Vivrette, Rebecca L.; Rubenstein, Laurence Z.; Martin, Jennifer L.; Josephson, Karen R.; Kramer, B. Josea

2012-01-01

Objective To determine seniors’ beliefs about falls and design a fall-risk self-assessment and educational materials to promote early identification of evidence-based fall risks and encourage prevention behaviors. Methods Focus groups with community-dwelling seniors, conducted in two phases to identify perceptions about fall risks and risk reduction and to assess face validity of the fall-risk self-assessment and acceptability of educational materials. Results Lay perception of fall risks was in general concordance with evidence-based research. Maintaining independence and positive tone were perceived as key motivators for fall prevention. Seniors intended to use information in the educational tool to stimulate discussions about falls with health care providers. Implications An evidence-based, educational fall-risk self-assessment acceptable to older adults can build on existing lay knowledge about fall risks and perception that falls are a relevant problem and can educate seniors about their specific risks and how to minimize them. PMID:21285473

The Aachen Mobility and Balance Index to measure physiological falls risk: a comparison with the Tinetti POMA Scale.

PubMed

Knobe, M; Giesen, M; Plate, S; Gradl-Dietsch, G; Buecking, B; Eschbach, D; van Laack, W; Pape, H-C

2016-10-01

The most commonly used mobility assessments for screening risk of falls among older adults are rating scales such as the Tinetti performance oriented mobility assessment (POMA). However, its correlation with falls is not always predictable and disadvantages of the scale include difficulty to assess many of the items on a 3-point scale and poor specificity. The purpose of this study was to describe the ability of the new Aachen Mobility and Balance Index (AMBI) to discriminate between subjects with a fall history and subjects without such events in comparison to the Tinetti POMA Scale. For this prospective cohort study, 24 participants in the study group and 10 in the control group were selected from a population of patients in our hospital who had met the stringent inclusion criteria. Both groups completed the Tinetti POMA Scale (gait and balance component) and the AMBI (tandem stance, tandem walk, ten-meter-walk-test, sit-to-stand with five repetitions, 360° turns, timed-up-and-go-test and measurement of the dominant hand grip strength). A history of falls and hospitalization in the past year were evaluated retrospectively. The relationships among the mobility tests were examined with Bland-Altmananalysis. Receiver-operated characteristics curves, sensitivity and specificity were calculated. The study showed a strong negative correlation between the AMBI (17 points max., highest fall risk) and Tinetti POMA Scale (28 points max., lowest fall risk; r = -0.78, p < 0.001) with an excellent discrimination between community-dwelling older people and a younger control group. However, there were no differences in any of the mobility and balance measurements between participants with and without a fall history with equal characteristics in test comparison (AMBI vs. Tinetti POMA Scale: AUC 0.570 vs. 0.598; p = 0.762). The Tinetti POMA Scale (cut-off <20 points) showed a sensitivity of 0.45 and a specificity of 0.69, the AMBI a sensitivity of 0.64 and a specificity of 0.46 (cut-off >5 points). The AMBI comprises mobility and balance tasks with increasing difficulty as well as a measurement of the dominant hand-grip strength. Its ability to identify fallers was comparable to the Tinetti POMA Scale. However, both measurement sets showed shortcomings in discrimination between fallers and non-fallers based on a self-reported retrospective falls-status.

Interventions incorporating physical and cognitive elements to reduce falls risk in cognitively impaired older adults: a systematic review.

PubMed

Booth, Vicky; Hood, Victoria; Kearney, Fiona

2016-05-01

Cognitive impairment is a risk factor for falls. Older adults with cognitive impairment (such as dementia) have an increased risk of falling compared with age-matched individuals without a cognitive impairment. To reduce falls in this population, interventions could theoretically target and train both physical and cognitive abilities. Combining and addressing cognitive components in falls rehabilitation is a novel and emerging area of healthcare. The objective of this review was to identify the effectiveness of combined cognitive and physical interventions on the risk of falls in cognitively impaired older adults. Older persons who were 65 years or older and identified as having a cognitive impairment either through diagnosis or assessment of global cognition. Multifactorial or multiple interventions where physical and cognitive elements were combined was compared against standard care or a single element intervention. Randomized controlled trials (RCTs), controlled clinical trials and experimental studies in which randomization was used. Outcomes related to falls, including falls rate, specific falls risk measures (i.e. Physiological Profile Assessment) or related clinical outcome measures (i.e. Timed Up and Go test, Tinetti and gait speed). A three-step search strategy was utilized in this review, including search of electronic databases: CENTRAL, JBISRIR, MEDLINE, EMBASE, AMED, CINAHL and PsychINFO. Initial keywords used were dementia, cognitive impairment, memory loss, exercise, rehabilitation and accidental falls. Grey literature (Google Scholar) and trials registers (Current Controlled Trials) searches were also completed. The methodological quality of included studies was assessed using Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) software. Data was extracted from articles included in the review using the standardized data extraction tool from JBI-MAStARI. A quantitative meta-analysis was performed where possible. Otherwise, data synthesis was in the form of narrative review. Sub-group analysis according to level of cognitive impairment was completed where possible. Eight RCTs were included in this review; they evaluated the effectiveness of multicomponent exercise programs, including physical and cognitive activities, music-based group exercise and mind-body tai chi on falls related outcomes. Most of the studies were of good quality with an average quality score of 7.5. Four studies reported effectiveness based on the number of falls, half of which reported a significant difference between the groups, but pooling of results into meta-analysis was not possible because of differences in reporting of the outcome. Falls related outcomes that were combined in meta-analysis included balance (Berg balance scale), functional mobility (Timed Up and Go) and gait speed (m/s). There was a statistically significant improvement in balance and gait speed following the intervention; however, the studies were too heterogeneous to be included in the analysis from the functional mobility results. Overall, multicomponent interventions incorporating both physical and cognitive components demonstrated positive effects on balance, functional mobility and gait speed when compared with a control and had significantly better effect on balance and gait speed within mild cognitive impairment populations.

Effectiveness of a fall-risk reduction programme for inpatient rehabilitation after stroke.

PubMed

Goljar, Nika; Globokar, Daniel; Puzić, Nataša; Kopitar, Natalija; Vrabič, Maja; Ivanovski, Matic; Vidmar, Gaj

2016-09-01

To evaluate effectiveness of fall-risk-assessment-based fall prevention for stroke rehabilitation inpatients. A consecutive series of 232 patients admitted for the first time to a subacute stroke-rehabilitation ward during 2010-2011 was studied in detail. The Assessment Sheet for Fall Prediction in Stroke Inpatients (ASFPSI by Nakagawa et al.) was used to assess fall-risk upon admission. Association of ASFPSI score and patient characteristics with actual falls was statistically tested. Yearly incidence of falls per 1000 hospital days (HD) was retrospectively audited for the 2006-2014 period to evaluate effectiveness of fall-risk reduction measures. The observed incidence of falls over the detailed-study-period was 3.0/1000 HD; 39% of the fallers fell during the first week after admission. ASFPSI score was not significantly associated with falls. Longer hospital stay, left body-side affected and non-extreme FIM score (55-101) were associated with higher odds of fall. Introduction of fall-risk reduction measures followed by compulsory fall-risk assessment lead to incidence of falls dropping from 7.1/1000 HD in 2006 to 2.8/1000 HD in 2011 and remaining at that level until 2014. The fall-risk-assessment-based measures appear to have led to decreasing falls risk among post-stroke rehabilitation inpatients classified as being at high risk of falls. The fall prevention programme as a whole was successful. Patients with non-extreme level of functional independence should receive enhanced fall prevention. Implications for Rehabilitation Recognising the fall risk upon the patient's admission is essential for preventing falls in rehabilitation wards. Assessing the fall risk is a team tasks and combines information from various sources. Assessing fall risk in stroke patients using the assessment sheet by Nakagawa et al. immediately upon admission systematically draws attention to the risk of falls in each individual patient.

High-speed resistance training and balance training for people with knee osteoarthritis to reduce falls risk: study protocol for a pilot randomized controlled trial.

PubMed

Levinger, Pazit; Dunn, Jeremy; Bifera, Nancy; Butson, Michael; Elias, George; Hill, Keith D

2017-08-18

The number of falls experienced by people with knee osteoarthritis (OA) is almost double the number experienced by people with no OA. The neuromuscular elements required to arrest a fall are more impaired in people with knee OA compared to their asymptomatic counterparts. Therefore, these elements may need to be incorporated into an exercise intervention to reduce the risk of falling. The aim of this study will be to examine the feasibility, safety and patient satisfaction of a high-speed resistance-training program, with and without balance exercises, in people with knee OA compared to a control group. The effect of these exercise programs on lower-limb muscle strength and physiological and functional risk factors for falls will also be examined. This study will be a pilot randomized controlled trial with a pre- and post-intervention design (outcome assessments at baseline and 8 weeks after participation commencement) comparing three groups: a control group (no intervention), a high-speed resistance-training group and a high-speed resistance-training plus balance exercises group. Thirty people with knee osteoarthritis aged 60-90 years will be recruited and randomized to one of the three groups. Feasibility and safety will be assessed by examining adherence to the exercise program, dropout rate, pain level during and following exercise, number of exercises stopped due to pain, and any adverse event or any incident that prevents the participant from completing the prescribed exercise. Secondary measures of lower-limb strength, physical function, self-reported pain and function, fear of falls, and executive function and quality of life will also be assessed. To determine statistical trends of effectiveness and hence to inform sample size for a fully powered study, analyses of the secondary outcomes will be performed to assess the changes within and between groups over time (pre-post) using repeated measure ANOVA. The results of this study will improve understanding of what type of exercise is safe and beneficial for people with knee OA to reduce their risk of falling, and hence will inform the development of a future large research trial. Australian New Zealand Clinical Trials Registry, ID: ACTRN12616001382460 . Registered on 6 October 2016.

A novel video-based paradigm to study the mechanisms underlying age- and falls risk-related differences in gaze behaviour during walking.

PubMed

Stanley, Jennifer; Hollands, Mark

2014-07-01

The current study aimed to quantitatively assess differences in gaze behaviour between participants grouped on the basis of their age and measures of functional mobility during a virtual walking paradigm. The gaze behaviour of nine young adults, seven older adults with a relatively low risk of falling and seven older adults with a relatively higher risk of falling was measured while they watched five first-person perspective movies representing the viewpoint of a pedestrian walking through various environments. Participants also completed a number of cognitive tests: Stroop task, visual search, trail making task, Mini Mental Status Examination, and reaction time, visual tests (visual acuity and contrast sensitivity) and assessments of balance (Activities Balance Confidence Scale and Berg Balance Scale) to aid in the interpretation of differences in gaze behaviour. The high risk older adult group spent significantly more time fixating aspects of the travel path than the low risk and young adult groups. High risk older adults were also significantly slower in performing a number of the cognitive tasks than young adults. Correlations were conducted to compare the extent to which travel path fixation durations co-varied with scores on the tests of visual search, motor, and cognitive function. A positive significant correlation was found between the speed of response to the incongruent Stroop task and travel path fixation duration r21  = 0.44, p < 0.05. The results indicate that our movie-viewing paradigm can identify differences in gaze behaviour between participants grouped on the basis of their age and measures of functional mobility and that these differences are associated with cognitive decline. © 2014 The Authors Ophthalmic & Physiological Optics © 2014 The College of Optometrists.

Can social dancing prevent falls in older adults? a protocol of the Dance, Aging, Cognition, Economics (DAnCE) fall prevention randomised controlled trial

PubMed Central

2013-01-01

Background Falls are one of the most common health problems among older people and pose a major economic burden on health care systems. Exercise is an accepted stand-alone fall prevention strategy particularly if it is balance training or regular participation in Tai chi. Dance shares the ‘holistic’ approach of practices such as Tai chi. It is a complex sensorimotor rhythmic activity integrating multiple physical, cognitive and social elements. Small-scale randomised controlled trials have indicated that diverse dance styles can improve measures of balance and mobility in older people, but none of these studies has examined the effect of dance on falls or cognition. This study aims to determine whether participation in social dancing: i) reduces the number of falls; and ii) improves cognitive functions associated with fall risk in older people. Methods/design A single-blind, cluster randomised controlled trial of 12 months duration will be conducted. Approximately 450 participants will be recruited from 24 self-care retirement villages that house at least 60 residents each in Sydney, Australia. Village residents without cognitive impairment and obtain medical clearance will be eligible. After comprehensive baseline measurements including physiological and cognitive tests and self-completed questionnaires, villages will be randomised to intervention sites (ballroom or folk dance) or to a wait-listed control using a computer randomisation method that minimises imbalances between villages based on two baseline fall risk measures. Main outcome measures are falls, prospectively measured, and the Trail Making cognitive function test. Cost-effectiveness and cost-utility analyses will be performed. Discussion This study offers a novel approach to balance training for older people. As a community-based approach to fall prevention, dance offers older people an opportunity for greater social engagement, thereby making a major contribution to healthy ageing. Providing diversity in exercise programs targeting seniors recognises the heterogeneity of multicultural populations and may further increase the number of taking part in exercise. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612000889853 The trial is now in progress with 12 villages already have been randomised. PMID:23675705

Can social dancing prevent falls in older adults? a protocol of the Dance, Aging, Cognition, Economics (DAnCE) fall prevention randomised controlled trial.

PubMed

Merom, Dafna; Cumming, Robert; Mathieu, Erin; Anstey, Kaarin J; Rissel, Chris; Simpson, Judy M; Morton, Rachael L; Cerin, Ester; Sherrington, Catherine; Lord, Stephen R

2013-05-15

Falls are one of the most common health problems among older people and pose a major economic burden on health care systems. Exercise is an accepted stand-alone fall prevention strategy particularly if it is balance training or regular participation in Tai chi. Dance shares the 'holistic' approach of practices such as Tai chi. It is a complex sensorimotor rhythmic activity integrating multiple physical, cognitive and social elements. Small-scale randomised controlled trials have indicated that diverse dance styles can improve measures of balance and mobility in older people, but none of these studies has examined the effect of dance on falls or cognition. This study aims to determine whether participation in social dancing: i) reduces the number of falls; and ii) improves cognitive functions associated with fall risk in older people. A single-blind, cluster randomised controlled trial of 12 months duration will be conducted. Approximately 450 participants will be recruited from 24 self-care retirement villages that house at least 60 residents each in Sydney, Australia. Village residents without cognitive impairment and obtain medical clearance will be eligible. After comprehensive baseline measurements including physiological and cognitive tests and self-completed questionnaires, villages will be randomised to intervention sites (ballroom or folk dance) or to a wait-listed control using a computer randomisation method that minimises imbalances between villages based on two baseline fall risk measures. Main outcome measures are falls, prospectively measured, and the Trail Making cognitive function test. Cost-effectiveness and cost-utility analyses will be performed. This study offers a novel approach to balance training for older people. As a community-based approach to fall prevention, dance offers older people an opportunity for greater social engagement, thereby making a major contribution to healthy ageing. Providing diversity in exercise programs targeting seniors recognises the heterogeneity of multicultural populations and may further increase the number of taking part in exercise. Australian New Zealand Clinical Trials Registry ACTRN12612000889853The trial is now in progress with 12 villages already have been randomised.

The effect of Tai Chi Chuan in reducing falls among elderly people: design of a randomized clinical trial in the Netherlands [ISRCTN98840266].

PubMed

Zeeuwe, Petra E M; Verhagen, Arianne P; Bierma-Zeinstra, Sita Ma; van Rossum, Erik; Faber, Marjan J; Koes, Bart W

2006-03-30

Falls are a significant public health problem. Thirty to fifty percent of the elderly of 65 years and older fall each year. Falls are the most common type of accident in this age group and can result in fractures and subsequent disabilities, increased fear of falling, social isolation, decreased mobility, and even an increased mortality. Several forms of exercise have been associated with a reduced risk of falling and with a wide range of physiological as well as psychosocial health benefits. Tai Chi Chuan seems to be the most promising form of exercise in the elderly, but the evidence is still controversial. In this article the design of a randomized clinical trial is presented. The trial evaluates the effect of Tai Chi Chuan on fall prevention and physical and psychological function in older adults. 270 people of seventy years and older living at home will be identified in the files of the participating general practitioners. People will be asked to participate when meeting the following inclusion criteria: have experienced a fall in the preceding year or suffer from two of the following risk factors: disturbed balance, mobility problems, dizziness, or the use of benzodiazepines or diuretics. People will be randomly allocated to either the Tai Chi Chuan group (13 weeks, twice a week) or the no treatment control group. The primary outcome measure is the number of new falls, measured with a diary. The secondary outcome measures are balance, fear of falling, blood pressure, heart rate, lung function parameters, physical activity, functional status, quality of life, mental health, use of walking devices, medication, use of health care services, adjustments to the house, severity of fall incidents and subsequent injuries. Process parameters will be measured to evaluate the Tai Chi Chuan intervention. A cost-effectiveness analysis will be carried out alongside the evaluation of the clinical results. Follow-up measurements will be collected at 3, 6 and 12 months after randomization. As far as we know this is the first trial in Europe considering Tai Chi Chuan and fall prevention. This project will answer a pragmatic research question regarding the efficacy of Tai Chi Chuan regarding fall reduction.

Fall risk: the clinical relevance of falls and how to integrate fall risk with fracture risk.

PubMed

Peeters, G; van Schoor, Natasja M; Lips, Paul

2009-12-01

In old age, 5-10% percent of all falls result in a fracture, and up to 90% of all fractures result from a fall. This article describes the link between fall risk and fracture risk in community-dwelling older persons. Which factors attribute to both the fall risk and the fracture risk? Which falls result in a fracture? Which tools are available to predict falls and fractures? Directions for the use of prediction tools in clinical practice are given. Challenges for future research include further validation of existing prediction tools and evaluation of the cost-effectiveness of treatment after screening.

What are the Main Physical Functioning Factors Associated With Falls Among Older People With Different Perceived Fall Risk?

PubMed

Moreira, Mirian N; Bilton, Tereza L; Dias, Rosangela C; Ferriolli, Eduardo; Perracini, Monica R

2017-07-01

Fall risk perceptions may influence the judgement over physical and functional competencies to avoid falls. However, few studies have explored the physical functioning characteristics associated with falls among older people with low perceived fall risk. This study aimed to identify the prevalence of falls and physical functioning factors associated with falling among community-dwelling older adults with low and high perceived fall risk. We conducted a cross-sectional population based study with 773 community-dwelling elders. Perceived fall risk was investigated using Falls Efficacy Scale International. We considered fallers those who reported at least one fall in the previous 12 months. Physical functioning measures used were grip strength, usual gait speed, sit-to-stand test, five step test, timed up and go test, one-legged stance test, anterior and lateral functional reach test. At least one fall was reported by 103 (30%) participants with low perceived fall risk and by 196 (46%) participants with high perceived fall risk. The odds of falling were lower among those with greater grip strength and with a greater stance time in one-legged test, and the odds of falling among elders with high perceived fall risk were higher among those who took more time in performing the five step test. We believe that our results highlight the need of not neglecting the risk of falls among active older adults with low perceived fall risk, particularly in those elders that show reduced stability in a small base of support and a lower leg strength. In addition, we suggest that elders with high perceived fall risk should be assessed using anticipatory postural adjustment tests. Particularly, our results may help physiotherapists to identify eligible elders with different perceptions of fall risk for tailored interventions aimed at reducing falls. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Using Dynamic Walking Models to Identify Factors that Contribute to Increased Risk of Falling in Older Adults

PubMed Central

Roos, Paulien E.; Dingwell, Jonathan B.

2013-01-01

Falls are common in older adults. The most common cause of falls is tripping while walking. Simulation studies demonstrated that older adults may be restricted by lower limb strength and movement speed to regain balance after a trip. This review examines how modeling approaches can be used to determine how different measures predict actual fall risk and what some of the causal mechanisms of fall risk are. Although increased gait variability predicts increased fall risk experimentally, it is not clear which variability measures could best be used, or what magnitude of change corresponded with increased fall risk. With a simulation study we showed that the increase in fall risk with a certain increase in gait variability was greatly influenced by the initial level of variability. Gait variability can therefore not easily be used to predict fall risk. We therefore explored other measures that may be related to fall risk and investigated the relationship between stability measures such as Floquet multipliers and local divergence exponents and actual fall risk in a dynamic walking model. We demonstrated that short-term local divergence exponents were a good early predictor for fall risk. Neuronal noise increases with age. It has however not been fully understood if increased neuronal noise would cause an increased fall risk. With our dynamic walking model we showed that increased neuronal noise caused increased fall risk. Although people who are at increased risk of falling reduce their walking speed it had been questioned whether this slower speed would actually cause a reduced fall risk. With our model we demonstrated that a reduced walking speed caused a reduction in fall risk. This may be due to the decreased kinematic variability as a result of the reduced signal-dependent noise of the smaller muscle forces that are required for slower. These insights may be used in the development of fall prevention programs in order to better identify those at increased risk of falling and to target those factors that influence fall risk most. PMID:24120280

Using dynamic walking models to identify factors that contribute to increased risk of falling in older adults.

PubMed

Roos, Paulien E; Dingwell, Jonathan B

2013-10-01

Falls are common in older adults. The most common cause of falls is tripping while walking. Simulation studies demonstrated that older adults may be restricted by lower limb strength and movement speed to regain balance after a trip. This review examines how modeling approaches can be used to determine how different measures predict actual fall risk and what some of the causal mechanisms of fall risk are. Although increased gait variability predicts increased fall risk experimentally, it is not clear which variability measures could best be used, or what magnitude of change corresponded with increased fall risk. With a simulation study we showed that the increase in fall risk with a certain increase in gait variability was greatly influenced by the initial level of variability. Gait variability can therefore not easily be used to predict fall risk. We therefore explored other measures that may be related to fall risk and investigated the relationship between stability measures such as Floquet multipliers and local divergence exponents and actual fall risk in a dynamic walking model. We demonstrated that short-term local divergence exponents were a good early predictor for fall risk. Neuronal noise increases with age. It has however not been fully understood if increased neuronal noise would cause an increased fall risk. With our dynamic walking model we showed that increased neuronal noise caused increased fall risk. Although people who are at increased risk of falling reduce their walking speed it had been questioned whether this slower speed would actually cause a reduced fall risk. With our model we demonstrated that a reduced walking speed caused a reduction in fall risk. This may be due to the decreased kinematic variability as a result of the reduced signal-dependent noise of the smaller muscle forces that are required for slower. These insights may be used in the development of fall prevention programs in order to better identify those at increased risk of falling and to target those factors that influence fall risk most. Copyright © 2013 Elsevier B.V. All rights reserved.

Effect of a Multidisciplinary Fall Risk Assessment on Falls Among Neurology Inpatients

PubMed Central

Hunderfund, Andrea N. Leep; Sweeney, Cynthia M.; Mandrekar, Jayawant N.; Johnson, LeAnn M.; Britton, Jeffrey W.

2011-01-01

OBJECTIVE: To evaluate whether the addition of a physician assessment of patient fall risk at admission would reduce inpatient falls on a tertiary hospital neurology inpatient unit. PATIENTS AND METHODS: A physician fall risk assessment was added to the existing risk assessment process (clinical nurse evaluation and Hendrich II Fall Risk Model score with specific fall prevention measures for patients at risk). An order to select either “Patient is” or “Patient is not at high risk of falls by physician assessment” was added to the physician electronic admission order set. Nurses and physicians were instructed to reach consensus when assessments differed. Full implementation occurred in second-quarter 2008. Preimplementation (January 1, 2006, to March 31, 2008) and postimplementation (April 1, 2008, to December 31, 2009) rates of falls were compared on the neurology inpatient unit and on 6 other medical units that did not receive intervention. RESULTS: The rate of falls during the 7 quarters after full implementation was significantly lower than that during the 9 preceding quarters (4.12 vs 5.69 falls per 1000 patient-days; P=.04), whereas the rate of falls on other medical units did not significantly change (2.99 vs 3.33 falls per 1000 patient-days; P=.24, Poisson test). The consensus risk assessment at admission correctly identified patients at risk for falls (14/325 at-risk patients fell vs 0/147 low-risk patients; P=.01, χ2 test), but the Hendrich II Fall Risk Model score, nurse, and physician assessments individually did not. CONCLUSION: A multidisciplinary approach to fall risk assessment is feasible, correctly identifies patients at risk, and was associated with a reduction in inpatient falls. PMID:21193651

Testing the Predictive Validity of the Hendrich II Fall Risk Model.

PubMed

Jung, Hyesil; Park, Hyeoun-Ae

2018-03-01

Cumulative data on patient fall risk have been compiled in electronic medical records systems, and it is possible to test the validity of fall-risk assessment tools using these data between the times of admission and occurrence of a fall. The Hendrich II Fall Risk Model scores assessed during three time points of hospital stays were extracted and used for testing the predictive validity: (a) upon admission, (b) when the maximum fall-risk score from admission to falling or discharge, and (c) immediately before falling or discharge. Predictive validity was examined using seven predictive indicators. In addition, logistic regression analysis was used to identify factors that significantly affect the occurrence of a fall. Among the different time points, the maximum fall-risk score assessed between admission and falling or discharge showed the best predictive performance. Confusion or disorientation and having a poor ability to rise from a sitting position were significant risk factors for a fall.

Review of fall risk assessment in geriatric populations using inertial sensors

PubMed Central

2013-01-01

Background Falls are a prevalent issue in the geriatric population and can result in damaging physical and psychological consequences. Fall risk assessment can provide information to enable appropriate interventions for those at risk of falling. Wearable inertial-sensor-based systems can provide quantitative measures indicative of fall risk in the geriatric population. Methods Forty studies that used inertial sensors to evaluate geriatric fall risk were reviewed and pertinent methodological features were extracted; including, sensor placement, derived parameters used to assess fall risk, fall risk classification method, and fall risk classification model outcomes. Results Inertial sensors were placed only on the lower back in the majority of papers (65%). One hundred and thirty distinct variables were assessed, which were categorized as position and angle (7.7%), angular velocity (11.5%), linear acceleration (20%), spatial (3.8%), temporal (23.1%), energy (3.8%), frequency (15.4%), and other (14.6%). Fallers were classified using retrospective fall history (30%), prospective fall occurrence (15%), and clinical assessment (32.5%), with 22.5% using a combination of retrospective fall occurrence and clinical assessments. Half of the studies derived models for fall risk prediction, which reached high levels of accuracy (62-100%), specificity (35-100%), and sensitivity (55-99%). Conclusions Inertial sensors are promising sensors for fall risk assessment. Future studies should identify fallers using prospective techniques and focus on determining the most promising sensor sites, in conjunction with determination of optimally predictive variables. Further research should also attempt to link predictive variables to specific fall risk factors and investigate disease populations that are at high risk of falls. PMID:23927446

Increasing fall risk awareness using wearables: A fall risk awareness protocol.

PubMed

Danielsen, Asbjørn; Olofsen, Hans; Bremdal, Bernt Arild

2016-10-01

Each year about a third of elderly aged 65 or older experience a fall. Many of these falls may have been avoided if fall risk assessment and prevention tools where available in a daily living situation. We identify what kind of information is relevant for doing fall risk assessment and prevention using wearable sensors in a daily living environment by investigating current research, distinguishing between prospective and context-aware fall risk assessment and prevention. Based on our findings, we propose a fall risk awareness protocol as a fall prevention tool integrating both wearables and ambient sensing technology into a single platform. Copyright © 2016. Published by Elsevier Inc.

Pro-Active Fall-Risk Management is Mandatory to Sustain in Hospital-Fall Prevention in Older Patients--Validation of the LUCAS Fall-Risk Screening in 2,337 Patients.

PubMed

Hoffmann, V S; Neumann, L; Golgert, S; von Renteln-Kruse, W

2015-12-01

Prevention of in-hospital falls contributes to improvement of patient safety. However, the identification of high-risk patients remains a challenge despite knowledge of fall-risk factors. Hence, objective was to prospectively validate the performance of the LUCAS (Longitudinal Urban Cohort Ageing Study) fall-risk screening, based on routine data (fall history, mobility, mental status) and applied by nurses. Observational study comparing two groups of patients who underwent different fall-risk screenings; the LUCAS screening (2010 - 2011) and the STRATIFY (St. Thomas's Risk Assessment Tool In Falling Elderly Inpatients) (2004 - 2006). Urban teaching hospital. Consecutively hospitalized patients (≥ 65 years old) were screened on admission; LUCAS n = 2,337, STRATIFY n = 4,735. The proportions of fallers were compared between the STRATIFY and the LUCAS time periods. The number of fallers expected was compared to that observed in the LUCAS time period. Standardized fall-incidence recording included case-note checks for unreported falls. Plausibility checks of fall-risk factors and logistic regression analysis for variable fall-risk factors were performed. The proportions of fallers during the two time periods were LUCAS n = 291/2,337 (12.5%) vs. STRATIFY n = 508/4,735 (10.7%). After adjustment for risk-factor prevalence, the proportion of fallers expected was 14.5% (334/2,337), the proportion observed was 12.5% (291/2,337) (p = 0.038). In-hospital fall prevention including systematic use of the LUCAS fall-risk screening reduced the proportion of fallers compared to that expected from the patients' fall-risk profile. Raw proportions of fallers are not suitable to evaluate fall prevention in hospital because of variable prevalence of patients' fall-risk factors over time. Continuous communication, education and training is needed to sustain in-hospital falls prevention.

Multifactorial screening for fall risk in community-dwelling older adults in the primary care office: development of the fall risk assessment & screening tool.

PubMed

Renfro, Mindy Oxman; Fehrer, Steven

2011-01-01

Unintentional falls is an increasing public health problem as incidence of falls rises and the population ages. The Centers for Disease Control and Prevention reports that 1 in 3 adults aged 65 years and older will experience a fall this year; 20% to 30% of those who fall will sustain a moderate to severe injury. Physical therapists caring for older adults are usually engaged with these patients after the first injury fall and may have little opportunity to abate fall risk before the injuries occur. This article describes the content selection and development of a simple-to-administer, multifactorial, Fall Risk Assessment & Screening Tool (FRAST), designed specifically for use in primary care settings to identify those older adults with high fall risk. Fall Risk Assessment & Screening Tool incorporates previously validated measures within a new multifactorial tool and includes targeted recommendations for intervention. Development of the multifactorial FRAST used a 5-part process: identification of significant fall risk factors, review of best evidence, selection of items, creation of the scoring grid, and development of a recommended action plan. Fall Risk Assessment & Screening Tool has been developed to assess fall risk in the target population of older adults (older than 65 years) living and ambulating independently in the community. Many fall risk factors have been considered and 15 items selected for inclusion. Fall Risk Assessment & Screening Tool includes 4 previously validated measures to assess balance, depression, falls efficacy, and home safety. Reliability and validity studies of FRAST are under way. Fall risk for community-dwelling older adults is an urgent, multifactorial, public health problem. Providing primary care practitioners (PCPs) with a very simple screening tool is imperative. Fall Risk Assessment & Screening Tool was created to allow for safe, quick, and low-cost administration by minimally trained office staff with interpretation and follow-up provided by the PCP.

Operationalization and Validation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Fall Risk Algorithm in a Nationally Representative Sample

PubMed Central

Lohman, Matthew C.; Crow, Rebecca S.; DiMilia, Peter R.; Nicklett, Emily J.; Bruce, Martha L.; Batsis, John A.

2017-01-01

Background Preventing falls and fall-related injuries among older adults is a public health priority. The Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool was developed to promote fall risk screening and encourage coordination between clinical and community-based fall prevention resources; however, little is known about the tool’s predictive validity or adaptability to survey data. Methods Data from five annual rounds (2011–2015) of the National Health and Aging Trends Study (NHATS), a representative cohort of adults age 65 and older in the US. Analytic sample respondents (n=7,392) were categorized at baseline as having low, moderate, or high fall risk according to the STEADI algorithm adapted for use with NHATS data. Logistic mixed-effects regression was used to estimate the association between baseline fall risk and subsequent falls and mortality. Analyses incorporated complex sampling and weighting elements to permit inferences at a national level. Results Participants classified as having moderate and high fall risk had 2.62 (95% CI: 2.29, 2.99) and 4.76 (95% CI: 3.51, 6.47) times greater odds of falling during follow-up compared to those with low risk, respectively, controlling for sociodemographic and health related risk factors for falls. High fall risk was also associated with greater likelihood of falling multiple times annually but not with greater risk of mortality. Conclusion The adapted STEADI clinical fall risk screening tool is a valid measure for predicting future fall risk using survey cohort data. Further efforts to standardize screening for fall risk and to coordinate between clinical and community-based fall prevention initiatives are warranted. PMID:28947669

Examining Fall Recurrence Risk of Homebound Hispanic Older Adults Receiving Home Care Services.

PubMed

Solis, Guillermina R; Champion, Jane Dimmitt

2017-03-01

Unintentional falls and injuries is a major problem among older adults and the fourth cause of death in the United States. A previous fall event doubles the risk of recurrence and lessens the person's quality of life. Hispanic older adults have higher rates of disability and lower independent functioning due to poor medical health and risk for fall recurrence. Most fall studies focus on fall risk with few studies on fall recurrence in older adults receiving home health care services unrelated to fall incident. A descriptive pilot study of 30 homebound Hispanic older adults receiving home care services who reported a fall within 3 months was conducted by a multidisciplinary team to evaluate risk of fall recurrence. A heightened risk for fall recurrence was identified with high number of chronic illnesses, high intake of medications, vision problems, and prevalence of urinary incontinence. Findings highlight significant number of intrinsic factors for fall risk recurrence and injuries in a Hispanic older adults population that is homebound and receiving home care services. A multidisciplinary evaluation and culturally appropriate interventions to lessen the risk of fall recurrence are recommended.

Validation of Predictors of Fall Events in Hospitalized Patients With Cancer.

PubMed

Weed-Pfaff, Samantha H; Nutter, Benjamin; Bena, James F; Forney, Jennifer; Field, Rosemary; Szoka, Lynn; Karius, Diana; Akins, Patti; Colvin, Christina M; Albert, Nancy M

2016-10-01

A seven-item cancer-specific fall risk tool (Cleveland Clinic Capone-Albert [CC-CA] Fall Risk Score) was shown to have a strong concordance index for predicting falls; however, validation of the model is needed. The aims of this study were to validate that the CC-CA Fall Risk Score, made up of six factors, predicts falls in patients with cancer and to determine if the CC-CA Fall Risk Score performs better than the Morse Fall Tool. Using a prospective, comparative methodology, data were collected from electronic health records of patients hospitalized for cancer care in four hospitals. Risk factors from each tool were recorded, when applicable. Multivariable models were created to predict the probability of a fall. A concordance index for each fall tool was calculated. The CC-CA Fall Risk Score provided higher discrimination than the Morse Fall Tool in predicting fall events in patients hospitalized for cancer management.

Two-year trajectory of fall risk in people with Parkinson’s disease: a latent class analysis

PubMed Central

Paul, Serene S; Thackeray, Anne; Duncan, Ryan P; Cavanaugh, James T; Ellis, Theresa D; Earhart, Gammon M; Ford, Matthew P; Foreman, K Bo; Dibble, Leland E

2015-01-01

Objective To examine fall risk trajectories occurring naturally in a sample of individuals with early to middle stage Parkinson’s disease (PD). Design Latent class analysis, specifically growth mixture modeling (GMM) of longitudinal fall risk trajectories. Setting Not applicable. Participants 230 community-dwelling PD participants of a longitudinal cohort study who attended at least two of five assessments over a two year period. Interventions Not applicable. Main Outcome Measures Fall risk trajectory (low, medium or high risk) and stability of fall risk trajectory (stable or fluctuating). Fall risk was determined at 6-monthly intervals using a simple clinical tool based on fall history, freezing of gait, and gait speed. Results The GMM optimally grouped participants into three fall risk trajectories that closely mirrored baseline fall risk status (p=.001). The high fall risk trajectory was most common (42.6%) and included participants with longer and more severe disease and with higher postural instability and gait disability (PIGD) scores than the low and medium risk trajectories (p<.001). Fluctuating fall risk (posterior probability <0.8 of belonging to any trajectory) was found in only 22.6% of the sample, most commonly among individuals who were transitioning to PIGD predominance. Conclusions Regardless of their baseline characteristics, most participants had clear and stable fall risk trajectories over two years. Further investigation is required to determine whether interventions to improve gait and balance may improve fall risk trajectories in people with PD. PMID:26606871

Two-Year Trajectory of Fall Risk in People With Parkinson Disease: A Latent Class Analysis.

PubMed

Paul, Serene S; Thackeray, Anne; Duncan, Ryan P; Cavanaugh, James T; Ellis, Theresa D; Earhart, Gammon M; Ford, Matthew P; Foreman, K Bo; Dibble, Leland E

2016-03-01

To examine fall risk trajectories occurring naturally in a sample of individuals with early to middle stage Parkinson disease (PD). Latent class analysis, specifically growth mixture modeling (GMM), of longitudinal fall risk trajectories. Assessments were conducted at 1 of 4 universities. Community-dwelling participants with PD of a longitudinal cohort study who attended at least 2 of 5 assessments over a 2-year follow-up period (N=230). Not applicable. Fall risk trajectory (low, medium, or high risk) and stability of fall risk trajectory (stable or fluctuating). Fall risk was determined at 6 monthly intervals using a simple clinical tool based on fall history, freezing of gait, and gait speed. The GMM optimally grouped participants into 3 fall risk trajectories that closely mirrored baseline fall risk status (P=.001). The high fall risk trajectory was most common (42.6%) and included participants with longer and more severe disease and with higher postural instability and gait disability (PIGD) scores than the low and medium fall risk trajectories (P<.001). Fluctuating fall risk (posterior probability <0.8 of belonging to any trajectory) was found in only 22.6% of the sample, most commonly among individuals who were transitioning to PIGD predominance. Regardless of their baseline characteristics, most participants had clear and stable fall risk trajectories over 2 years. Further investigation is required to determine whether interventions to improve gait and balance may improve fall risk trajectories in people with PD. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A systematic review of risk factors associated with accidental falls, outcome measures and interventions to manage fall risk in non-ambulatory adults.

PubMed

Rice, Laura A; Ousley, Cherita; Sosnoff, Jacob J

2015-01-01

To systematically review peer-reviewed literature pertaining to risk factors, outcome measures and interventions managing fall risk in non-ambulatory adults. Twenty-one papers were selected for inclusion from databases including PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Scopus, Consumer Health Complete and Web of Science. Selected studies involved a description of fall related risk factors, outcomes to assess fall risk and intervention studies describing protocols to manage fall risk in non-ambulatory adults. Studies were selected by two reviewers and consultation provided by a third reviewer. The most frequently cited risk factors/characteristics associated with falls included: wheelchair related characteristics, transfer activities, impaired seated balance and environmental factors. The majority of the outcomes were found to evaluate seated postural control. One intervention study was identified describing a protocol targeting specific problems of individual participants. A global fall prevention program was not identified. Several risk factors associated with falls were identified and must be understood by clinicians to better serve their clients. To improve objective assessment, a comprehensive outcome assessment specific to non-ambulatory adults is needed. Finally, additional research is needed to examine the impact of structured protocols to manage fall risk in non-ambulatory adults. Falls are a common health concern for non-ambulatory adults. Risk factors commonly associated with falls include wheelchair related characteristics, transfer activities, impaired seated balance and environmental factors. Limited outcome measures are available to assess fall risk in non-ambulatory adults. Clinicians must be aware of the known risk factors and provide comprehensive education to their clients on the potential for falls. Additional research is needed to develop and evaluate protocols to clinically manage fall risk.

Fall Risk Assessment in Geriatric-Psychiatric Inpatients to Lower Events (FRAGILE).

PubMed

Nanda, Sudip; Dey, Tanujit; Gulstrand, Rudolph E; Cudnik, Daniel; Haller, Harold S

2011-02-01

The objectives of this retrospective case-control study were to identify risk factors of falls in geriatric-psychiatric inpatients and develop a screening tool to accurately predict falls. The study sample consisted of 225 geriatric-psychiatric inpatients at a Midwestern referral facility. The sample included 136 inpatients who fell and a random stratified sample of 89 inpatients who did not fall. Data collected included age, gender, activities of daily living, and nursing parameters such as bathing assistance, bed height, use of bed rails, one-on-one observation, fall warning system, Conley Scale fall risk assessment, medical diagnosis, and medications. History of falls, impaired judgment, impaired gait, dizziness, delusions, delirium, chronic use of sedative or antipsychotic agents, and anticholinergic urinary bladder medications significantly increased fall risk. Alzheimer's disease, acute use of sedative or anti-psychotic agents, and depression reduced fall risk. A falls risk tool, Fall Risk Assessment in Geriatric-psychiatric Inpatients to Lower Events (FRAGILE), was developed for assessment and risk stratification with new diagnoses or medications. Copyright 2011, SLACK Incorporated.

Understanding Falls Risk and Impacts in Chinese American Older Patients at a Community Health Center.

PubMed

Huang, Susan; Duong, Thomas; Ieong, Liss; Quach, Thu

2017-08-01

While falls are highly prevalent and costly for older adults, little is known about falls for Asian Americans. Using a custom, evidence-based, bilingual fall risk assessment and management tool, our study examined the prevalence of falls among older Chinese-speaking patients at a community health center. We identified the risks for falls and explored an association of fall risk with emergency room (ER) and hospital use in this population. The setting was at a community health center in Oakland, CA. Participants included 839 older Asian American adults (ages 65-80 years) who spoke Cantonese/Mandarin. Primary care clinic staff administered a fall risk assessment and management tool at the time of clinic visits to assess patients' risk factors for falls. Of the total, 173 (20.6%) reported having fallen in the past year, with women comprising a majority (71.7%). 362 patients in the cohort (43.1%) reported fear of falling. For the subset of Medicaid managed care patients (n = 455, 54.3% of total) for whom we were able to obtain ER and hospital utilization data, 31 patients (14.5%) who reported a fall risk had an ER/hospital episode compared to 15 (6.2%) of those who did not self-report fall risks (statistically significant, p < 0.05). A targeted fall risk assessment and management tool designed by community-based primary care practitioners and utilized with linguistic and cultural competence to focus on Asian American older adults, can help establish the prevalence of falls in this understudied population and effectively identify those at higher risk for falls and subsequent ER/hospital utilization. More research is needed to understand the risk and impacts of falls in understudied populations and identify ways to prevent these costly falls.

Probabilistic Risk Assessment for Astronaut Post Flight Bone Fracture

NASA Technical Reports Server (NTRS)

Lewandowski, Beth; Myers, Jerry; Licata, Angelo

2015-01-01

Introduction: Space flight potentially reduces the loading that bone can resist before fracture. This reduction in bone integrity may result from a combination of factors, the most common reported as reduction in astronaut BMD. Although evaluating the condition of bones continues to be a critical aspect of understanding space flight fracture risk, defining the loading regime, whether on earth, in microgravity, or in reduced gravity on a planetary surface, remains a significant component of estimating the fracture risks to astronauts. This presentation summarizes the concepts, development, and application of NASA's Bone Fracture Risk Module (BFxRM) to understanding pre-, post, and in mission astronaut bone fracture risk. The overview includes an assessment of contributing factors utilized in the BFxRM and illustrates how new information, such as biomechanics of space suit design or better understanding of post flight activities may influence astronaut fracture risk. Opportunities for the bone mineral research community to contribute to future model development are also discussed. Methods: To investigate the conditions in which spaceflight induced changes to bone plays a critical role in post-flight fracture probability, we implement a modified version of the NASA Bone Fracture Risk Model (BFxRM). Modifications included incorporation of variations in physiological characteristics, post-flight recovery rate, and variations in lateral fall conditions within the probabilistic simulation parameter space. The modeled fracture probability estimates for different loading scenarios at preflight and at 0 and 365 days post-flight time periods are compared. Results: For simple lateral side falls, mean post-flight fracture probability is elevated over mean preflight fracture probability due to spaceflight induced BMD loss and is not fully recovered at 365 days post-flight. In the case of more energetic falls, such as from elevated heights or with the addition of lateral movement, the contribution of space flight quality changes is much less clear, indicating more granular assessments, such as Finite Element modeling, may be needed to further assess the risks in these scenarios.

Representing and Retrieving Patients' Falls Risk Factors and Risk for Falls among Adults in Acute Care through the Electronic Health Record

ERIC Educational Resources Information Center

Pfaff, Jann

2013-01-01

Defining fall risk factors and predicting fall risk status among patients in acute care has been a topic of research for decades. With increasing pressure on hospitals to provide quality care and prevent hospital-acquired conditions, the search for effective fall prevention interventions continues. Hundreds of risk factors for falls in acute care…

Application of a fall screening algorithm stratified fall risk but missed preventive opportunities in community-dwelling older adults: a prospective study.

PubMed

Muir, Susan W; Berg, Katherine; Chesworth, Bert; Klar, Neil; Speechley, Mark

2010-01-01

Evaluate the ability of the American and British Geriatrics Society fall prevention guideline's screening algorithm to identify and stratify future fall risk in community-dwelling older adults. Prospective cohort of community-dwelling older adults (n = 117) aged 65 to 90 years. Fall history, balance, and gait measured during a comprehensive geriatric assessment at baseline. Falls data were collected monthly for 1 year. The outcomes of any fall and any injurious fall were evaluated. The algorithm stratified participants into 4 hierarchal risk categories. Fall risk was 33% and 68% for the "no intervention" and "comprehensive fall evaluation required" groups respectively. The relative risk estimate for falling comparing participants in the 2 intervention groups was 2.08 (95% CI 1.42-3.05) for any fall and 2.60 (95% Cl 1.53-4.42) for any injurious fall. Prognostic accuracy values were: sensitivity of 0.50 (95% Cl 0.36-0.64) and specificity of 0.82 (95% CI 0.70-0.90) for any fall; and sensitivity of 0.56 (95% CI 0.38-0.72) and specificity of 0.78 (95% Cl 0.67-0.86) for any injurious fall. The algorithm was able to identify and stratify fall risk for each fall outcome, though the values of prognostic accuracy demonstrate moderate clinical utility. The recommendations of fall evaluation for individuals in the highest risk groups appear supported though the recommendation of no intervention in the lowest risk groups may not address their needs for fall prevention interventions. Further evaluation of the algorithm is recommended to refine the identification of fall risk in community-dwelling older adults.

History and mobility exam index to identify community-dwelling elderly persons at risk of falling.

PubMed

Covinsky, K E; Kahana, E; Kahana, B; Kercher, K; Schumacher, J G; Justice, A C

2001-04-01

Falls are common in community-dwelling elderly persons and are a frequent source of morbidity. Simple indices to prospectively stratify people into categories at different fall-risk would be useful to health care practitioners. Our goal was to develop a fall-risk index that discriminated between people at high and low risk of falling. We evaluated the risk of falling over a one-year period in 557 elderly persons (mean age 81.6) living in a retirement community. On the baseline interview, we asked subjects if they had fallen in the previous year and evaluated risk factors in six additional conceptual categories. On the follow-up interview one year later, we again asked subjects if they had fallen in the prior year. We evaluated risk factors in the different conceptual categories and used logistic regression to determine the independent predictors of falling over a one-year period. We used these independent predictors to create a fall-risk index. We compared the ability of a prior falls history with other risk factors and with the combination of a falls history and other risk factors to discriminate fallers from nonfallers. A fall in the previous year (OR = 2.42, 95% CI = 1.49-3.93), a symptom of either balance difficulty or dizziness (OR = 1.83, 95% CI = 1.16-2.89), or an abnormal mobility exam (OR = 2.64, 95% CI = 1.64-4.26) were independent predictors of falling over the subsequent year. These three risk factors together (c statistic =.71) discriminated fallers from nonfallers better than previous history of falls alone (c statistic =.61) or the symptomatic and exam risk factors alone (c statistic =.68). When combined into a risk index, the three independent risk factors stratify people into groups whose risk for falling over the subsequent year ranges from 10% to 51%. A history of falling over the prior year, a risk factor that can be obtained from a clinical history (balance difficulty or dizziness), and a risk factor that can be obtained from a physical exam (mobility difficulty) stratify people into groups at low and high risk of falling over the subsequent year. This risk index may provide a simple method of assessing fall risk in community-dwelling elderly persons. However, it requires validation in other subjects before it can be recommended for widespread use.

The Effects of the A Matter of Balance Program on Falls and Physical Risk of Falls, Tampa, Florida, 2013.

PubMed

Chen, Tuo-Yu; Edwards, Jerri D; Janke, Megan C

2015-09-24

This study investigated the effects of the A Matter of Balance (MOB) program on falls and physical risk factors of falling among community-dwelling older adults living in Tampa, Florida, in 2013. A total of 110 adults (52 MOB, 58 comparison) were enrolled in this prospective cohort study. Data on falls, physical risk of falling, and other known risk factors of falling were collected at baseline and at the end of the program. Multivariate analysis of covariance with repeated measures and logistic regressions were used to investigate the effects of this program. Participants in the MOB group were less likely to have had a fall and had significant improvements in their physical risk of falling compared with adults in the comparison group. No significant effects of the MOB program on recurrent falls or the number of falls reported were found. This study contributes to our understanding of the MOB program and its effectiveness in reducing falls and the physical risk of falling among older adults. The findings support extended use of this program to reduce falls and physical risk of falling among older adults.

Fall risk as a function of time after admission to sub-acute geriatric hospital units.

PubMed

Rapp, Kilian; Ravindren, Johannes; Becker, Clemens; Lindemann, Ulrich; Jaensch, Andrea; Klenk, Jochen

2016-10-07

There is evidence about time-dependent fracture rates in different settings and situations. Lacking are data about underlying time-dependent fall risk patterns. The objective of the study was to analyse fall rates as a function of time after admission to sub-acute hospital units and to evaluate the time-dependent impact of clinical factors at baseline on fall risk. This retrospective cohort study used data of 5,255 patients admitted to sub-acute units in a geriatric rehabilitation clinic in Germany between 2010 and 2014. Falls, personal characteristics and functional status at admission were extracted from the hospital information system. The rehabilitation stay was divided in 3-day time-intervals. The fall rate was calculated for each time-interval in all patients combined and in subgroups of patients. To analyse the influence of covariates on fall risk over time multivariate negative binomial regression models were applied for each of 5 time-intervals. The overall fall rate was 10.2 falls/1,000 person-days with highest fall risks during the first week and decreasing risks within the following weeks. A particularly pronounced risk pattern with high fall risks during the first days and decreasing risks thereafter was observed in men, disoriented people, and people with a low functional status or impaired cognition. In disoriented patients, for example, the fall rate decreased from 24.6 falls/1,000 person-days in day 2-4 to about 13 falls/1,000 person-days 2 weeks later. The incidence rate ratio of baseline characteristics changed also over time. Fall risk differs considerably over time during sub-acute hospitalisation. The strongest association between time and fall risk was observed in functionally limited patients with high risks during the first days after admission and declining risks thereafter. This should be considered in the planning and application of fall prevention measures.

Motor Activity in Aging: An Integrated Approach for Better Quality of Life

PubMed Central

Mastorci, Francesca; Sironi, Annamaria; Gemignani, Angelo

2014-01-01

Old age is normally associated with stereotypical structural and physiological changes in the brain that are caused by deterioration in elementary cognitive, sensory, and sensorimotor functions as well as increased susceptibility to stress. These changes are connected with gait impairment and falls, especially among patients with common neurological diseases. Even in the absence of history of falling or when there is no physical injury after a fall, many older people develop a fear of falling that leads to restricted mobility, reduced activity, depression, social isolation, worsened metabolic disease, and increasing risk of cardiovascular morbidity and mortality. Although links between cognitive decline and age-associated brain changes have been clarified, relationships between gait disorders and psychophysiological alterations in aging are less well understood. This review focuses on two crucial elements of aged individuals with gait disorders: characteristic comorbidities in the elderly and the psychophysiological effects of physical exercise in the elderly with gait disorder. We propose an integrated approach to studying elderly subjects with gait disorder before starting a program of motor rehabilitation with wearable robotic devices, in order to investigate the effectiveness and safety of the ambulatory training. PMID:27351018

Pre-Procedural Patient Education Reduces Fall Risk in an Outpatient Endoscopy Suite.

PubMed

Hilscher, Moira B; Niesen, Cynthia R; Tynsky, Desiree A; Kane, Sunanda V

The purpose of this article was to determine whether scripted pre-procedural fall risk patient education and nurses' intention to assist patients after receiving sedation improves receptiveness of nursing assistance during recovery and decreases fall risk in an outpatient endoscopy suite. We prospectively identified high fall risk patients using the following criteria: (1) use of an assistive device, (2) fallen two or more times within the last year, (3) sustained an injury in a fall within a year, (4) age greater than 85 years, or (5) nursing judgment of high fall risk. Using a scripted dialogue, nurses educated high-risk patients of their fall risk and the nurses' intent to assist them to and in the bathroom. Documentation of patient education, script use, and assistance was monitored. Over 24 weeks, 892 endoscopy patients were identified as high fall risk; 790 (88.5%) accepted post-procedural assistance. Documentation of assistance significantly increased from 33% to 100%. Patients receiving education and postprocedural assistance increased from 27.9% to 100% at week 24. No patient falls occurred 12 months following implementation among patients identified as high fall risk. Scripted pre-procedural fall risk education increases patient awareness and receptiveness to assistance and can lead to decreased fall rates.

Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials

PubMed Central

Chang, John T; Morton, Sally C; Rubenstein, Laurence Z; Mojica, Walter A; Maglione, Margaret; Suttorp, Marika J; Roth, Elizabeth A; Shekelle, Paul G

2004-01-01

Objective To assess the relative effectiveness of interventions to prevent falls in older adults to either a usual care group or control group. Design Systematic review and meta-analyses. Data sources Medline, HealthSTAR, Embase, the Cochrane Library, other health related databases, and the reference lists from review articles and systematic reviews. Data extraction Components of falls intervention: multifactorial falls risk assessment with management programme, exercise, environmental modifications, or education. Results 40 trials were identified. A random effects analysis combining trials with risk ratio data showed a reduction in the risk of falling (risk ratio 0.88, 95% confidence interval 0.82 to 0.95), whereas combining trials with incidence rate data showed a reduction in the monthly rate of falling (incidence rate ratio 0.80, 0.72 to 0.88). The effect of individual components was assessed by meta-regression. A multifactorial falls risk assessment and management programme was the most effective component on risk of falling (0.82, 0.72 to 0.94, number needed to treat 11) and monthly fall rate (0.63, 0.49 to 0.83; 11.8 fewer falls in treatment group per 100 patients per month). Exercise interventions also had a beneficial effect on the risk of falling (0.86, 0.75 to 0.99, number needed to treat 16) and monthly fall rate (0.86, 0.73 to 1.01; 2.7). Conclusions Interventions to prevent falls in older adults are effective in reducing both the risk of falling and the monthly rate of falling. The most effective intervention was a multifactorial falls risk assessment and management programme. Exercise programmes were also effective in reducing the risk of falling. PMID:15031239

Family Socioeconomic Status, Cortisol, and Physical Health in Early Childhood: The Role of Advantageous Neighborhood Characteristics.

PubMed

Roubinov, Danielle S; Hagan, Melissa J; Boyce, W Thomas; Adler, Nancy E; Bush, Nicole R

2018-06-01

Children from families with lower socioeconomic status (SES) evidence greater physiological dysregulation and poorer health. Despite recognition of environmental contributors, little is known about the influence of neighborhood characteristics. The present study examined the moderating role of community-level risks and resources on the relation of family SES to children's daily cortisol output and physical health during the kindergarten year. In fall and spring of kindergarten, children's (N = 338) daily total cortisol was measured and parents and teachers rated children's global physical health. Parents reported family SES. Neighborhood characteristics were assessed using the Child Opportunity Index, a population-level tool that evaluates the quality of multiple domains of neighborhood attributes. In fall, children reared in lower SES family environments had higher cortisol when residing in lower quality (lower opportunity) neighborhoods (b = -.097, p < .001), but there was no relation between family SES and children's cortisol in more advantaged (higher opportunity) neighborhoods (b = -.023, p = .36). Lower family SES was prospectively associated with poorer physical health in spring (controlling for fall health) only among children living in lower opportunity neighborhoods (b = -.250, p = .018) and was unrelated to physical health among children residing in higher opportunity neighborhoods (b = .042, p = .70). Higher opportunity neighborhoods may protect against the negative consequences of low family SES on children's stress physiology and physical health. Public health interventions that bolster neighborhood opportunities may benefit young children reared in socioeconomically disadvantaged family environments.

New methods for fall risk prediction.

PubMed

Ejupi, Andreas; Lord, Stephen R; Delbaere, Kim

2014-09-01

Accidental falls are the leading cause of injury-related death and hospitalization in old age, with over one-third of the older adults experiencing at least one fall or more each year. Because of limited healthcare resources, regular objective fall risk assessments are not possible in the community on a large scale. New methods for fall prediction are necessary to identify and monitor those older people at high risk of falling who would benefit from participating in falls prevention programmes. Technological advances have enabled less expensive ways to quantify physical fall risk in clinical practice and in the homes of older people. Recently, several studies have demonstrated that sensor-based fall risk assessments of postural sway, functional mobility, stepping and walking can discriminate between fallers and nonfallers. Recent research has used low-cost, portable and objective measuring instruments to assess fall risk in older people. Future use of these technologies holds promise for assessing fall risk accurately in an unobtrusive manner in clinical and daily life settings.

The effect of a translating research into practice intervention to promote use of evidence-based fall prevention interventions in hospitalized adults: A prospective pre-post implementation study in the U.S.

PubMed

Titler, Marita G; Conlon, Paul; Reynolds, Margaret A; Ripley, Robert; Tsodikov, Alex; Wilson, Deleise S; Montie, Mary

2016-08-01

Falls are a major public health problem internationally. Many hospitals have implemented fall risk assessment tools, but few have implemented interventions to mitigate patient-specific fall risks. Little research has been done to examine the effect of implementing evidence-based fall prevention interventions to mitigate patient-specific fall risk factors in hospitalized adults. To evaluate the impact of implementing, in 3 U.S. hospitals, evidence-based fall prevention interventions targeted to patient-specific fall risk factors (Targeted Risk Factor Fall Prevention Bundle). Fall rates, fall injury rates, types of fall injuries and adoption of the Targeted Risk Factor Fall Prevention Bundle were compared prior to and following implementation. A prospective pre-post implementation cohort design. Thirteen adult medical-surgical units from three community hospitals in the Midwest region of the U.S. Nurses who were employed at least 20hours/week, provided direct patient care, and licensed as an RN (n=157 pre; 140 post); and medical records of patients 21years of age or older, who received care on the study unit for more than 24hours during the designated data collection period (n=390 pre and post). A multi-faceted Translating Research Into Practice Intervention was used to implement the Targeted Risk Factor Fall Prevention Bundle composed of evidence-based fall prevention interventions designed to mitigate patient-specific fall risks. Dependent variables (fall rates, fall injury rates, fall injury type, use of Targeted Risk Factor Fall Prevention Bundle) were collected at baseline, and following completion of the 15month implementation phase. Nurse questionnaires included the Stage of Adoption Scale, and the Use of Research Findings in Practice Scale to measure adoption of evidence-based fall prevention practices. A Medical Record Abstract Form was used to abstract data about use of targeted risk-specific fall prevention interventions. Number of falls, and number and types of fall injuries were collected for each study unit for 3months pre- and post-implementation. Data were analyzed using multivariate analysis. Fall rates declined 22% (p=0.09). Types of fall injuries changed from major and moderate to minor injuries. Fall injury rates did not decline. Use of fall prevention interventions improved significantly (p<0.001) for mobility, toileting, cognition, and risk reduction for injury, but did not change for those targeting medications. Using the Translating Research Into Practice intervention promoted use of many evidence-based fall prevention interventions to mitigate patient-specific fall risk factors in hospitalized adults. Copyright © 2015. Published by Elsevier Inc.

Operationalisation and validation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall risk algorithm in a nationally representative sample.

PubMed

Lohman, Matthew C; Crow, Rebecca S; DiMilia, Peter R; Nicklett, Emily J; Bruce, Martha L; Batsis, John A

2017-12-01

Preventing falls and fall-related injuries among older adults is a public health priority. The Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool was developed to promote fall risk screening and encourage coordination between clinical and community-based fall prevention resources; however, little is known about the tool's predictive validity or adaptability to survey data. Data from five annual rounds (2011-2015) of the National Health and Aging Trends Study (NHATS), a representative cohort of adults age 65 years and older in the USA. Analytic sample respondents (n=7392) were categorised at baseline as having low, moderate or high fall risk according to the STEADI algorithm adapted for use with NHATS data. Logistic mixed-effects regression was used to estimate the association between baseline fall risk and subsequent falls and mortality. Analyses incorporated complex sampling and weighting elements to permit inferences at a national level. Participants classified as having moderate and high fall risk had 2.62 (95% CI 2.29 to 2.99) and 4.76 (95% CI 3.51 to 6.47) times greater odds of falling during follow-up compared with those with low risk, respectively, controlling for sociodemographic and health-related risk factors for falls. High fall risk was also associated with greater likelihood of falling multiple times annually but not with greater risk of mortality. The adapted STEADI clinical fall risk screening tool is a valid measure for predicting future fall risk using survey cohort data. Further efforts to standardise screening for fall risk and to coordinate between clinical and community-based fall prevention initiatives are warranted. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Official Positions for FRAX® clinical regarding falls and frailty: can falls and frailty be used in FRAX®? From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.

PubMed

Masud, Tahir; Binkley, Neil; Boonen, Steven; Hannan, Marian T

2011-01-01

Risk factors for fracture can be purely skeletal, e.g., bone mass, microarchitecture or geometry, or a combination of bone and falls risk related factors such as age and functional status. The remit of this Task Force was to review the evidence and consider if falls should be incorporated into the FRAX® model or, alternatively, to provide guidance to assist clinicians in clinical decision-making for patients with a falls history. It is clear that falls are a risk factor for fracture. Fracture probability may be underestimated by FRAX® in individuals with a history of frequent falls. The substantial evidence that various interventions are effective in reducing falls risk was reviewed. Targeting falls risk reduction strategies towards frail older people at high risk for indoor falls is appropriate. This Task Force believes that further fracture reduction requires measures to reduce falls risk in addition to bone directed therapy. Clinicians should recognize that patients with frequent falls are at higher fracture risk than currently estimated by FRAX® and include this in decision-making. However, quantitative adjustment of the FRAX® estimated risk based on falls history is not currently possible. In the long term, incorporation of falls as a risk factor in the FRAX® model would be ideal. Copyright © 2011 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Nurses' Perceptions of Implementing Fall Prevention Interventions to Mitigate Patient-Specific Fall Risk Factors.

PubMed

Wilson, Deleise S; Montie, Mary; Conlon, Paul; Reynolds, Margaret; Ripley, Robert; Titler, Marita G

2016-08-01

Evidence-based (EB) fall prevention interventions to mitigate patient-specific fall risk factors are readily available but not routinely used in practice. Few studies have examined nurses' perceptions about both the use of these EB interventions and implementation strategies designed to promote their adoption. This article reports qualitative findings of nurses' perceptions about use of EB fall prevention interventions to mitigate patient-specific fall risks, and implementation strategies to promote use of these interventions. The findings revealed five major themes: before-study fall prevention practices, use of EB fall prevention interventions tailored to patient-specific fall risk factors, beneficial implementation strategies, overall impact on approach to fall prevention, and challenges These findings are useful to guide nurses' engagement and use of EB fall prevention practices tailored to patient-specific fall risk factors. © The Author(s) 2016.

A Successful ED Fall Risk Program Using the KINDER 1 Fall RiskAssessment Tool.

PubMed

Townsend, Ann B; Valle-Ortiz, Marisol; Sansweet, Tracy

2016-11-01

Emergency nurses did not perform falls risk assessments routinely on our ED patients; the instrument used was aimed at inpatients. We identified a need to revise fall assessment practices specific to our emergency department. The purpose of the performance improvement project was to reduce ED falls and evaluate the use of an ED-specific fall risk tool, the KINDER 1 Fall Risk Assessment. The plan was to establish fall risk assessment practices at point of ED entry and to decrease total falls. We retrospectively reviewed ED fall data for each quarter of 2013, which included risk assessments scores, the total number of falls, and the circumstances of each fall. Using Kotter's framework to guide a successful change process, we implemented the KINDER 1 to assess fall risk. During the first 4 weeks of the project, 937 patients (27%) were identified as high risk for falls using the KINDER 1. During the subsequent 3 quarters, the total number of falls decreased; reported falls without injuries dropped from 0.21 to 0.07 per 1000 patients, and falls with injuries were reduced from 0.21 to 0.0 per 1000 patients. The results of this project represented a valuable step toward achieving our goal to keep ED patients safe from injuries as a result of falls. The findings add to the body of nursing knowledge on the application of clinical-based performance improvement projects to improve patient outcomes and to provide data on the use of the KINDER 1 tool, which has not been extensively tested. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Examining the relationship between specific cognitive processes and falls risk in older adults: a systematic review

PubMed Central

Hsu, Chun Liang; Nagamatsu, Lindsay S.; Davis, Jennifer C.; Liu-Ambrose, Teresa

2015-01-01

Purpose Recent evidence suggests that impaired cognition increases seniors’ risk of falling. The purpose of this review was to identify the cognitive domains that are significantly associated with falls or falls risk in older adults. Methods We conducted a systematic review of peer-reviewed journal articles published from 1948 to present, focusing on studies investigating different domains of cognitive function and their association with falls or falls risk in adults aged 60 years or older. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we completed a comprehensive search of MEDLINE, Pubmed, and EMBASE databases to identify studies examining the association between cognitive function and falls or falls risk. With an expert in the field, we developed a quality assessment questionnaire to rate the quality of the studies included in this systematic review. Results Twenty-five studies were included in the review. We categorized studies based on two related but distinct cognitive domains: 1) executive functions, or 2) dual-task ability. Twelve studies reported a significant association between executive functions and falls risk. Thirteen studies reported that dual-task performance is a predictor of falls or falls risk in older adults. Three studies did not report an association between cognition and falls risk. Conclusion Consistent evidence demonstrated that executive functions and dual-task performance were highly associated with falls or falls risk. The results from this review will aid healthcare professionals and researchers in developing innovative screening and treatment strategies for mitigating falls risk by targeting specific cognitive domains. PMID:22638707

Identifying nursing home residents at risk for falling.

PubMed

Kiely, D K; Kiel, D P; Burrows, A B; Lipsitz, L A

1998-05-01

To develop a fall risk model that can be used to identify prospectively nursing home residents at risk for falling. The secondary objective was to determine whether the nursing home environment independently influenced the development of falls. A prospective study involving 1 year of follow-up. Two hundred seventy-two nursing homes in the state of Washington. A total of 18,855 residents who had a baseline assessment in 1991 and a follow-up assessment within the subsequent year. Baseline Minimum Data Set items that could be potential risk factors for falling were considered as independent variables. The dependent variable was whether the resident fell as reported at the follow-up assessment. We estimated the extrinsic risk attributable to particular nursing home environments by calculating the annual fall rate in each nursing home and grouping them into tertiles of fall risk according to these rates. Factors associated independently with falling were fall history, wandering behavior, use of a cane or walker, deterioration of activities of daily living performance, age greater than 87 years, unsteady gait, transfer independence, wheelchair independence, and male gender. Nursing home residents with a fall history were more than three times as likely to fall during the follow-up period than residents without a fall history. Residents in homes with the highest tertile of fall rates were more than twice as likely to fall compared with residents of homes in the lowest tertile, independent of resident-specific risk factors. Fall history was identified as the strongest risk factor associated with subsequent falls and accounted for the vast majority of the predictive strength of the model. We recommend that fall history be used as an initial screener for determining eligibility for fall intervention efforts. Studies are needed to determine the facility characteristics that contribute to fall risk, independent of resident-specific risk factors.

[Excessive daytime sleepiness].

PubMed

Bittencourt, Lia Rita Azeredo; Silva, Rogério Santos; Santos, Ruth Ferreira; Pires, Maria Laura Nogueira; Mello, Marco Túlio de

2005-05-01

Sleepiness is a physiological function, and can be defined as increased propension to fall asleep. However, excessive sleepiness (ES) or hypersomnia refer to an abnormal increase in the probability to fall asleep, to take involuntary naps, or to have sleep atacks, when sleep is not desired. The main causes of excessive sleepiness is chronic sleep deprivation, sleep apnea syndrome, narcolepsy, movement disorders during sleep, circadian sleep disorders, use of drugs and medications, or idiopathic hypersomnia. Social, familial, work, and cognitive impairment are among the consequences of hypersomnia. Moreover, it has also been reported increased risk of accidents. The treatment of excessive sleepiness includes treating the primary cause, whenever identified. Sleep hygiene for sleep deprivation, positive pressure (CPAP) for sleep apnea, dopaminergic agents and exercises for sleep-related movement disorders, phototherapy and/or melatonin for circadian disorders, and use of stimulants are the treatment modalities of first choice.

Relationship Between Perceived Risk of Falling and Adoption of Precautions to Reduce Fall Risk.

PubMed

Blalock, Susan J; Gildner, Paula L; Jones, Jennifer L; Bowling, James M; Casteel, Carri H

2016-06-01

To better understand the relationship between perceived risk of falling and awareness and adoption of four specific precautions that older adults have taken to reduce this risk. Cross-sectional. Data were collected in in-person interviews conducted in the homes of study participants. Interviews conducted between March 2011 and September 2013 and lasted an average of 60-90 minutes. A stratified sampling strategy designed to enroll an equal number of homebound and nonhomebound participants was used. All participants (N = 164) were recruited from central North Carolina. Participants were asked about 1-year fall history, perceived risk of falling, restriction of activities because of fear of falling, awareness of four recommended fall prevention behaviors (exercise, annual medication review, bathroom grab bars, safe footwear), and current practice of these behaviors. In bivariate analyses, individuals who were aware of two behaviors recommended to reduce the risk of falling (exercise, use of safe footwear) and had adopted these behaviors perceived their risk of falling as lower than individuals who were aware of the recommended behaviors but had not adopted them. Moreover, in multivariate analyses, individuals who did not know that exercise is recommended to reduce the risk of falling perceived their risk of falling as lower than those who were aware of this recommendation and had adopted it. Individuals were least likely to be aware that medication reviews and exercise are recommended to reduce fall risk. Awareness of behaviors recommended to reduce fall risk appears necessary for adoption of these behaviors to reduce perceived risk. Fall-prevention campaigns should emphasize behaviors where awareness is low. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Physiology in Medicine: neuromuscular consequences of diabetic neuropathy.

PubMed

Allen, Matti D; Doherty, Timothy J; Rice, Charles L; Kimpinski, Kurt

2016-07-01

Diabetic polyneuropathy (DPN) refers to peripheral nerve dysfunction as a complication of diabetes mellitus. This condition is relatively common and is likely a result of vascular and/or metabolic disturbances related to diabetes. In the early or less severe stages of DPN it typically results in sensory impairments but can eventually lead to major dysfunction of the neuromuscular system. Some of these impairments may include muscle atrophy and weakness, slowing of muscle contraction, and loss of power and endurance. Combined with sensory deficits these changes in the motor system can contribute to decreased functional capacity, impaired mobility, altered gait, and increased fall risk. There is no pharmacological disease-modifying therapy available for DPN and the mainstay of treatment is linked to treating the diabetes itself and revolves around strict glycemic control. Exercise therapy (including aerobic, strength, or balance training-based exercise) appears to be a promising preventative and treatment strategy for patients with DPN and those at risk. The goal of this Physiology in Medicine article is to highlight important and overlooked dysfunction of the neuromuscular system as a result of DPN with an emphasis on the physiologic basis for that dysfunction. Additionally, we sought to provide information that clinicians can use when following patients with diabetes or DPN including support for the inclusion of exercise-based therapy as an effective, accessible, and inexpensive form of treatment. Copyright © 2016 the American Physiological Society.

Falls in elderly people: a multifactorial analysis of risk markers using data from the Swedish general population study 'Good ageing in Skåne'.

PubMed

Stenhagen, Magnus; Nordell, Eva; Elmståhl, Sölve

2013-04-01

The aim of this study was to describe the prevalence of falls in a general older population, especially among the most elderly, and the risk markers associated with falls. This is a cross-sectional study in which 38 fall risk markers were analysed in non-, occasional- and frequent-fallers. The population was 2,865 individuals (aged 60-93), randomly selected from the general population register. The risk of falling was calculated as age-adjusted odds ratios. The relation between the number of risk markers for an individual and falls was also analysed. About one in ten reported falling during the past 6 months, 35% of which were over 90 years old. Twenty-one risk markers were significantly related to falls confirming falling as a multifactorial problem. These included a variety of diseases, symptoms, medical and physical functions, life-style factors and the taking of certain drugs. The five risk markers with the highest odds ratio in frequent fallers were 'tendency to fall' (37.9), 'low walking speed' (12.8), consumption of 'neuroleptics' (10.9), 'impaired mobility' (10.0) and 'dementia' (5.4). Subjects with more than four and seven risk markers showed a 9- respectively 28-fold increase in the risk of falling, especially among frequent fallers and those aged over 90 years. Falls are common in the elderly population and the risk is multifactorial. The results imply that there is an overrepresentation of fallers in a distinct subgroup of the very elderly and those with multiple risk markers. The self-perceived clinical sign 'tendency to fall' seems highly sensitive as indicator of individuals at risk. Several risk markers may be treatable. Fall risk seems to increase in a non-linear, almost exponential way with increasing number of risk markers.

Exercise for Fall Risk Reduction in Community-Dwelling Older Adults: A Systematic Review

PubMed Central

Arnold, Catherine M.; Sran, Meena M.; Harrison, Elizabeth L.

2008-01-01

Purpose: To evaluate the influence of exercise on falls and fall risk reduction in community-dwelling older adults and to present an updated synthesis of outcome measures for the assessment of fall risk in community-dwelling older adults. Method: A systematic review was performed, considering English-language articles published from 2000 to 2006 and accessible through MEDLINE, CINAHL, PEDro, EMBASE, and/or AMED. Included were randomized controlled clinical trials (RCTs) that used an exercise or physical activity intervention and involved participants over age 50. Screening and methodological quality for internal validity were conducted by two independent reviewers. Results: The search retrieved 156 abstracts; 22 articles met the internal validity criteria. Both individualized and group exercise programmes were found to be effective in reducing falls and fall risk. The optimal type, frequency, and dose of exercise to achieve a positive effect have not been determined. A variety of outcome measures have been used to measure fall risk, especially for balance. Conclusions: Falls and fall risk can be reduced with exercise interventions in the community-dwelling elderly, although the most effective exercise variables are unknown. Future studies in populations with comorbidities known to increase fall risk will help determine optimal, condition-specific fall-prevention programmes. Poor balance is a key risk factor for falls; therefore, the best measure of this variable should be selected when evaluating patients at risk of falling. PMID:20145768

Falls risk assessment outcomes and factors associated with falls for older Indigenous Australians.

PubMed

Hill, Keith D; Flicker, Leon; LoGiudice, Dina; Smith, Kate; Atkinson, David; Hyde, Zoë; Fenner, Stephen; Skeaf, Linda; Malay, Roslyn; Boyle, Eileen

2016-12-01

To describe the prevalence of falls and associated risk factors in older Indigenous Australians, and compare the accuracy of validated falls risk screening and assessment tools in this population in classifying fall status. Cross-sectional study of 289 Indigenous Australians aged ≥45 years from the Kimberley region of Western Australia who had a detailed assessment including self-reported falls in the past year (n=289), the adapted Elderly Falls Screening Tool (EFST; n=255), and the Falls Risk for Older People-Community (FROP-Com) screening tool (3 items, n=74) and FROP-Com falls assessment tool (n=74). 32% of participants had ≥1 fall in the preceding year, and 37.3% were classified high falls risk using the EFST (cut-off ≥2). In contrast, for the 74 participants assessed with the FROP-Com, only 14.9% were rated high risk, 35.8% moderate risk, and 49.3% low risk. The FROP-Com screen and assessment tools had the highest classification accuracy for identifying fallers in the preceding year (area under curve >0.85), with sensitivity/specificity highest for the FROP-Com assessment (cut-off ≥12), sensitivity=0.84 and specificity=0.73. Falls are common in older Indigenous Australians. The FROP-Com falls risk assessment tool appears useful in this population, and this research suggests changes that may improve its utility further. © 2016 Public Health Association of Australia.

Risk factors for falling in home-dwelling older women with stroke: the Women's Health and Aging Study.

PubMed

Lamb, S E; Ferrucci, L; Volapto, S; Fried, L P; Guralnik, J M

2003-02-01

Much of our knowledge of risk factors for falls comes from studies of the general population. The aim of this study was to estimate the risk of falling associated with commonly accepted and stroke-specific factors in a home-dwelling stroke population. This study included an analysis of prospective fall reports in 124 women with confirmed stroke over 1 year. Variables relating to physical and mental health, history of falls, stroke symptoms, self-reported difficulties in activities of daily living, and physical performance tests were collected during home assessments. Risk factors for falling commonly reported in the general population, including performance tests of balance, incontinence, previous falls, and sedative/hypnotic medications, did not predict falls in multivariate analyses. Frequent balance problems while dressing were the strongest risk factor for falls (odds ratio, 7.0). Residual balance, dizziness, or spinning stroke symptoms were also a strong risk factor for falling (odds ratio, 5.2). Residual motor symptoms were not associated with an increased risk of falling. Interventions to reduce the frequency of balance problems during complex tasks may play a significant role in reducing falls in stroke. Clinicians should be aware of the increased risk of falling in women with residual balance, dizziness, or spinning stroke symptoms and recognize that risk assessments developed for use in the general population may not be appropriate for stroke patients.

Mitigating fall risk: A community fall reduction program.

PubMed

Reinoso, Humberto; McCaffrey, Ruth G; Taylor, David W M

One fourth of all American's over 65 years of age fall each year. Falls are a common and often devastating event that can pose a serious health risk for older adults. Healthcare providers are often unable to spend the time required to assist older adults with fall risk issues. Without a team approach to fall prevention the system remains focused on fragmented levels of health promotion and risk prevention. The specific aim of this project was to engage older adults from the community in a fall risk assessment program, using the Stopping Elderly Accidents, Deaths & Injuries (STEADI) program, and provide feedback on individual participants' risks that participants could share with their primary care physician. Older adults who attended the risk screening were taking medications that are known to increase falls. They mentioned that their health care providers do not screen for falls and appreciated a community based screening. Copyright © 2017 Elsevier Inc. All rights reserved.

Fall Risk Assessment Through Automatic Combination of Clinical Fall Risk Factors and Body-Worn Sensor Data.

PubMed

Greene, Barry R; Redmond, Stephen J; Caulfield, Brian

2017-05-01

Falls are the leading global cause of accidental death and disability in older adults and are the most common cause of injury and hospitalization. Accurate, early identification of patients at risk of falling, could lead to timely intervention and a reduction in the incidence of fall-related injury and associated costs. We report a statistical method for fall risk assessment using standard clinical fall risk factors (N = 748). We also report a means of improving this method by automatically combining it, with a fall risk assessment algorithm based on inertial sensor data and the timed-up-and-go test. Furthermore, we provide validation data on the sensor-based fall risk assessment method using a statistically independent dataset. Results obtained using cross-validation on a sample of 292 community dwelling older adults suggest that a combined clinical and sensor-based approach yields a classification accuracy of 76.0%, compared to either 73.6% for sensor-based assessment alone, or 68.8% for clinical risk factors alone. Increasing the cohort size by adding an additional 130 subjects from a separate recruitment wave (N = 422), and applying the same model building and validation method, resulted in a decrease in classification performance (68.5% for combined classifier, 66.8% for sensor data alone, and 58.5% for clinical data alone). This suggests that heterogeneity between cohorts may be a major challenge when attempting to develop fall risk assessment algorithms which generalize well. Independent validation of the sensor-based fall risk assessment algorithm on an independent cohort of 22 community dwelling older adults yielded a classification accuracy of 72.7%. Results suggest that the present method compares well to previously reported sensor-based fall risk assessment methods in assessing falls risk. Implementation of objective fall risk assessment methods on a large scale has the potential to improve quality of care and lead to a reduction in associated hospital costs, due to fewer admissions and reduced injuries due to falling.

In-hospital fall-risk screening in 4,735 geriatric patients from the LUCAS project.

PubMed

Neumann, L; Hoffmann, V S; Golgert, S; Hasford, J; Von Renteln-Kruse, W

2013-03-01

In-hospital falls in older patients are frequent, but the identification of patients at risk of falling is challenging. Aim of this study was to improve the identification of high-risk patients. Therefore, a simplified screening-tool was developed, validated, and compared to the STRATIFY predictive accuracy. Retrospective analysis of 4,735 patients; evaluation of predictive accuracy of STRATIFY and its single risk factors, as well as age, gender and psychotropic medication; splitting the dataset into a learning and a validation sample for modelling fall-risk screening and independent, temporal validation. Geriatric clinic at an academic teaching hospital in Hamburg, Germany. 4,735 hospitalised patients ≥65 years. Sensitivity, specificity, positive and negative predictive value, Odds Ratios, Youden-Index and the rates of falls and fallers were calculated. There were 10.7% fallers, and the fall rate was 7.9/1,000 hospital days. In the learning sample, mental alteration (OR 2.9), fall history (OR 2.1), and insecure mobility (Barthel-Index items 'transfer' + 'walking' score = 5, 10 or 15) (OR 2.3) had the most strongest association to falls. The LUCAS Fall-Risk Screening uses these risk factors, and patients with ≥2 risk factors contributed to the high-risk group (30.9%). In the validation sample, STRATIFY SENS was 56.8, SPEC 59.6, PPV 13.5 and NPV 92.6 vs. LUCAS Fall-Risk Screening was SENS 46.0, SPEC 71.1, PPV 14.9 and NPV 92.3. Both the STRATIFY and the LUCAS Fall-Risk Screening showed comparable results in defining a high-risk group. Impaired mobility and cognitive status were closely associated to falls. The results do underscore the importance of functional status as essential fall-risk factor in older hospitalised patients.

Tools for assessing fall risk in the elderly: a systematic review and meta-analysis.

PubMed

Park, Seong-Hi

2018-01-01

The prevention of falls among the elderly is arguably one of the most important public health issues in today's aging society. The aim of this study was to assess which tools best predict the risk of falls in the elderly. Electronic searches were performed using Medline, EMBASE, the Cochrane Library, CINAHL, etc., using the following keywords: "fall risk assessment", "elderly fall screening", and "elderly mobility scale". The QUADAS-2 was applied to assess the internal validity of the diagnostic studies. Selected studies were meta-analyzed with MetaDisc 1.4. A total of 33 studies were eligible out of the 2,321 studies retrieved from selected databases. Twenty-six assessment tools for fall risk were used in the selected articles, and they tended to vary based on the setting. The fall risk assessment tools currently used for the elderly did not show sufficiently high predictive validity for differentiating high and low fall risks. The Berg Balance scale and Mobility Interaction Fall chart showed stable and high specificity, while the Downton Fall Risk Index, Hendrich II Fall Risk Model, St. Thomas's Risk Assessment Tool in Falling elderly inpatients, Timed Up and Go test, and Tinetti Balance scale showed the opposite results. We concluded that rather than a single measure, two assessment tools used together would better evaluate the characteristics of falls by the elderly that can occur due to a multitude of factors and maximize the advantages of each for predicting the occurrence of falls.

Above, Beyond, and Over the Side rails: Evaluating the New Memorial Emergency Department Fall-Risk-Assessment Tool.

PubMed

Scott, Robin A; Oman, Kathleen S; Flarity, Kathleen; Comer, Jennifer L

2018-03-06

Patient falls are a significant issue in hospitalized patients and financially costly to hospitals. The Joint Commission requires that patients be assessed for fall risk and interventions in place to mitigate the risk of falls. It is imperative to have a patient population/setting specific fall risk assessment tool to identify patients at risk for falling. The purpose of this study was to evaluate the reliability and validity of the 2013 Memorial ED Fall Risk Assessment tool (MEDFRAT) specifically designed for the ED population. A two-phase prospective design was used for this study. Phase one determined the interrater reliability of the MEDFRAT. Phase two assessed the validity of the MEDFRAT in an emergency department (ED) within a 600-bed academic/teaching institution; Level II Trauma Center with >100,000 annual patient visits. The Memorial ED Fall Risk Assessment Tool was validated in this ED setting. The tool demonstrated positive interrater reliability (k=0.701) and when implemented with a falls prevention strategy and staff education demonstrated a 48% decrease in ED fall rate (0.57 falls/1000 patient visits) post implementation during the study period. The MEDFRAT, an evidenced based ED-specific fall risk tool was implemented on the basis of the risk factors consistently identified in the literature: prior fall history, impaired mobility, altered mental status, altered elimination, and the use of sedative medication. The Memorial ED Fall Risk Assessment Tool demonstrated to be a valid tool for this hospital system. Copyright © 2018 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Evidence-Based Practice Guideline: Fall Prevention for Older Adults.

PubMed

Kruschke, Cheryl; Butcher, Howard K

2017-11-01

Falls are a major cause of injury and death annually for millions of individuals 65 and older. Older adults are at risk for falls for a variety of reasons regardless of where they live. Falls are defined as any sudden drop from one surface to a lower surface. The purpose of this fall prevention evidence-based practice guideline is to describe strategies that can identify individuals at risk for falls. A 10-step protocol including screening for falls, comprehensive fall assessment, gait and balance screening when necessary, and an individualized fall intervention program addressing specific fall risks is presented. Reassessing fall risk and fall prevention programs will ensure a proactive approach to reducing falls in the aging population. [Journal of Gerontological Nursing, 43(11), 15-21.]. Copyright 2017, SLACK Incorporated.

Preoperative and postoperative serial assessments of postural balance and fall risk in patients with arthroscopic anterior cruciate ligament reconstruction.

PubMed

Gokalp, Oguzhan; Akkaya, Semih; Akkaya, Nuray; Buker, Nihal; Gungor, Harun R; Ok, Nusret; Yorukoglu, Cagdas

2016-04-27

Impaired postural balance due to somatosensory data loss with mechanical instability has been shown in patients with ACL deficiency. To assess postural balance in patients with ACL insufficiency prior to surgery and following reconstruction with serial evaluations. Thirty patients (mean age of 27.7 ± 6.7 years) who underwent arthroscopic reconstruction of ACL with bone-patellar tendon-bone autograft were examined for clinical and functional variables at preoperative day and postoperative 12th week. Posturographic analysis were performed by using Tetrax Interactive Balance System (Sunlight Medical Ltd, Israel) at preoperative day, at 4th, 8th, and 12th weeks following reconstruction. Data computed by posturographic software by the considerations of the oscillation velocities of body sways is fall risk as a numeric value (0-100, lower values indicate better condition). All of the patients (mean age of 27.7 ± 6.7 years) had significant improvements for clinical, functional evaluations and fall risk (p< 0.05). Mean fall risk was within high-risk category (59.9 ± 22.8) preoperatively. The highest fall risk was detected at postoperative 4th week. Patients had high fall risk at 8th week similar to preoperative value. Mean fall risk decreased to low level risk at 12th week. Preoperative symptom duration had relationships with preoperative fall risk and postoperative improvement of fall risk (p= 0.001, r= -0.632, p= 0.001, r= -0.870, respectively). The improvement of fall risk was higher in patients with symptoms shorter than 6 months (p= 0.001). According to these results, mean fall risk of patients with ACL insufficiency was within high risk category preoperatively, and fall risk improves after surgical reconstruction, but as the duration of complaints lengthens especially longer than 6 months, the improvement of fall risk decreases following reconstruction.

A risk-factor analysis of medical litigation judgments related to fall injuries in Korea.

PubMed

Kim, Insook; Won, Seonae; Lee, Mijin; Lee, Won

2018-01-01

The aim of this study was to find out the risk factors through analysis of seven medical malpractice judgments related to fall injuries. The risk factors were analysed by using the framework that approaches falls from a systems perspective and comprised people, organisational or environmental factors, with each factor being comprised of subfactors. The risk factors found in each of the seven judgments were aggregated into one framework. The risk factors related to patients (i.e. the people factor) were age, pain, related disease, activities and functional status, urination state, cognitive function impairment, past history of fall, blood transfusion, sleep endoscopy state and uncooperative attitude. The risk factors related to the medical staff and caregivers (i.e. people factor) were observation negligence, no fall prevention activities and negligence in managing high-risk group for fall. Organisational risk factors were a lack of workforce, a lack of training, neglecting the management of the high-risk group, neglecting the management of caregivers and the absence of a fall prevention procedure. Regarding the environment, the risk factors were found to be the emergency room, chairs without a backrest and the examination table. Identifying risk factors is essential for preventing fall accidents, since falls are preventable patient-safety incidents. Falls do not happen as a result of a single risk factor. Therefore, a systems approach is effective to identify risk factors, especially organisational and environmental factors.

Effects of AlcoholEdu for College on Alcohol-Related Problems Among Freshmen: A Randomized Multicampus Trial*

PubMed Central

Paschall, Mallie J.; Antin, Tamar; Ringwalt, Christopher L.; Saltz, Robert F.

2011-01-01

Objective: AlcoholEdu for College is a 2- to 3-hour online course for incoming college freshmen. This study was the first multicampus trial to examine effects of AlcoholEdu for College on alcohol-related problems among freshmen. Method: Thirty universi participated in the study. Fifteen were randomly assigned to receive AlcoholEdu, and the other 15 were assigned to the control condition. AlcoholEdu was implemented by intervention schools during the summer and/or fall semester. Cross-sectional surveys of freshmen were conducted at each university beginning before the intervention in spring 2008/2009; post-intervention surveys were administered in fall 2008/2009 and spring 2009/2010. The surveys included questions about the past-30-day frequency of 28 alcohol-related problems, from which we created indices for the total number of problems and problems in seven domains: physiological, academic, social, driving under the influence/riding with drinking drivers, aggression, sexual risk taking, and victimization. Multilevel Poisson regression analyses were conducted to examine intent-to-treat and dosage effects of AlcoholEdu for College on these outcomes. Results: Multilevel intent-to-treat analyses indicated significant reductions in the risk for past-30-day alcohol problems in general and problems in the physiological, social, and victimization domains during the fall semester immediately after completion of the course. However, these effects did not persist in the spring semester. Additional analyses suggested stronger AlcoholEdu effects on these outcomes at colleges with higher rates of student course completion. No AlcoholEdu effects were observed for alcohol-related problems in the other four domains. Conclusions: AlcoholEdu for College appears to have beneficial short-term effects on victimization and the most common types of alcohol-related problems among freshmen. Universities may benefit the most by mandating AlcoholEdu for College for all incoming freshmen and by implementing this online course along with environmental prevention strategies. PMID:21683046

Falls and Fall Prevention in Older Adults With Early-Stage Dementia: An Integrative Review.

PubMed

Lach, Helen W; Harrison, Barbara E; Phongphanngam, Sutthida

2017-05-01

Older adults with mild cognitive impairment (MCI) and early-stage dementia have an increased risk of falling, with risks to their health and quality of life. The purpose of the current integrative review was to evaluate evidence on fall risk and fall prevention in this population. Studies were included if they examined falls or fall risk factors in older adults with MCI or early-stage dementia, or reported interventions in this population; 40 studies met criteria. Evidence supports the increased risk of falls in individuals even in the early stages of dementia or MCI, and changes in gait, balance, and fear of falling that may be related to this increased fall risk. Interventions included exercise and multifactorial interventions that demonstrated some potential to reduce falls in this population. Few studies had strong designs to provide evidence for recommendations. Further study in this area is warranted. [Res Gerontol Nurs. 2017; 10(03):139-148.]. Copyright 2016, SLACK Incorporated.

Risk factors for recurrent injurious falls that require hospitalization for older adults with dementia: a population based study.

PubMed

Meuleners, Lynn B; Fraser, Michelle L; Bulsara, Max K; Chow, Kyle; Ng, Jonathon Q

2016-09-29

Older adults with dementia are at an increased risk of falls, however, little is known about risk factors for recurrent injurious falls (a subsequent fall after the first fall has occurred) among this group. This study aimed to identify risk factors for recurrent injurious falls requiring hospitalization among adults aged 60+ years with dementia. This retrospective, whole-population cohort study was conducted using the Western Australian Hospital Morbidity Data System and Western Australian Death Registrations from 2001 to 2013. Survival analysis using a stratified conditional Cox model (type 1) was undertaken to identify risk factors for recurrent injurious falls requiring hospitalization. There were 32,519 participants with an index hospital admission with dementia during the study period. Over 27 % (n = 8970) of the cohort experienced a total of 11,073 injurious falls requiring hospitalization during follow up with 7297 individuals experiencing a single fall, 1330 experiencing two falls and 343 experiencing three or more falls. The median follow-up time for each individual was 2.49 years. Females were at a significantly increased risk of 7 % for recurrent injurious falls resulting in hospitalization (adjusted hazard ratio 1.07, 95 % CI 1.01-1.12), compared to males. Increasing age, living in rural areas, and having an injurious fall in the year prior to the index hospital admission with dementia also increased the risk of recurrent injurious falls resulting in hospitalization. Screening those with dementia for injurious falls history could help to identify those most at risk of recurrent injurious falls. Improvement of heath care and falls prevention services for those with dementia who live in rural areas may also reduce recurrent injurious falls.

Prevalence of fall injuries and risk factors for fall among hospitalized children in a specialized childrens hospital in Saudi Arabia.

PubMed

AlSowailmi, Banan Abdullah; AlAkeely, Maha Heshaam; AlJutaily, Hayat Ibrahim; Alhasoon, Mohammad Abdulaziz; Omair, Amir; AlKhalaf, Hamad Abdullah

2018-01-01

Fall injuries among children during hospital stay is a major patient safety issue. Inpatient pediatric falls can lead to numerous negative consequences. In contrast to adults, there is a paucity of information on the prevalence and risk factors associated with children's falls during hospitalization. Identify the prevalence of fall injuries among hospital.ized children and describe the demographic and environmental factors that could predict a higher risk of severe outcomes of fall. Descriptive, cross-sectional prevalence study. Specialized children's hospital. Data was obtained through the electronic Safety Reporting System (SRS). All reported fall events during hospitalization in children less than or equal 14 years of age for the period from 1 April 2015 to 30 April 2016 were included. Fall events that occurred in the day care unit and the outpatient clinic were excluded. Prevalence and possible risk factors for fall events. 48. The prevalence of falls among the 4860 admitted children was 9.9 (95% CI=7.5, 13.1) per 1000 patients (48/4860). A majority of the falls were among boys (n=26, 54%), in the age group from 1-5 years old (n=22, 46%), in children at high risk of falling (n=35, 73%), with normal mobility status (n=21, 44%), and with no history of previ.ous falls (n=33, 69%). Severe injuries accounted for 25% of falls (n=12). However, falls among the moderate risk category (n=9, 69%) were more often severe than falls among the high risk category of children (n=12, 34%) (P=.03). Risk factor identification is required to prevent falls and their severe outcomes. Underreporting and single-centered study. None.

Relationship between subjective fall risk assessment and falls and fall-related fractures in frail elderly people

PubMed Central

2011-01-01

Background Objective measurements can be used to identify people with risks of falls, but many frail elderly adults cannot complete physical performance tests. The study examined the relationship between a subjective risk rating of specific tasks (SRRST) to screen for fall risks and falls and fall-related fractures in frail elderly people. Methods The SRRST was investigated in 5,062 individuals aged 65 years or older who were utilized day-care services. The SRRST comprised 7 dichotomous questions to screen for fall risks during movements and behaviours such as walking, transferring, and wandering. The history of falls and fall-related fractures during the previous year was reported by participants or determined from an interview with the participant's family and care staff. Results All SRRST items showed significant differences between the participants with and without falls and fall-related fractures. In multiple logistic regression analysis adjusted for age, sex, diseases, and behavioural variables, the SRRST score was independently associated with history of falls and fractures. Odds ratios for those in the high-risk SRRST group (≥ 5 points) compared with the no risk SRRST group (0 point) were 6.15 (p < 0.01) for a single fall, 15.04 (p < 0.01) for recurrent falls, and 5.05 (p < 0.01) for fall-related fractures. The results remained essentially unchanged in subgroup analysis accounting for locomotion status. Conclusion These results suggest that subjective ratings by care staff can be utilized to determine the risks of falls and fall-related fractures in the frail elderly, however, these preliminary results require confirmation in further prospective research. PMID:21838891

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

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

2007-01-01

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. PMID:17605771

Risk Factors for Falls in Older Adults with Lower Extremity Arthritis: A Conceptual Framework of Current Knowledge and Future Directions

PubMed Central

Gyurcsik, Nancy C.

2012-01-01

ABSTRACT Purpose: As the numbers of Canadians aged 65 years and over increases over the next 20 years, the prevalence of chronic conditions, including arthritis, will rise as will the number of falls. Although known fall-risk factors are associated with hip and knee osteoarthritis (OA), minimal research has evaluated fall and fracture risk and/or rates in this population. Thus, the purpose was to summarize research on fall and fracture risk in older adults with hip or knee OA and to develop a conceptual framework of fall-risk screening and assessment. Method: The International Classification of Functioning, Disability and Health, clinical practice guidelines for fall-risk screening, and a selected literature review were used. Results: Gaps exist in our knowledge of fall and fracture risk for this population. Muscle performance, balance, and mobility impairments have been identified, but little is known about whether personal and environmental contextual factors impact fall and fracture risk. Physical activity may help to prevent falls, but non-adherence is a problem. Conclusion: A need exists to assess fall risk in older adults with hip and knee OA. Promoting regular physical activity by focusing on disease- and activity-specific personal contextual factors may help direct treatment planning. PMID:23729967

Evaluation of an inpatient fall risk screening tool to identify the most critical fall risk factors in inpatients.

PubMed

Hou, Wen-Hsuan; Kang, Chun-Mei; Ho, Mu-Hsing; Kuo, Jessie Ming-Chuan; Chen, Hsiao-Lien; Chang, Wen-Yin

2017-03-01

To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients. Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high-risk inpatients. Secondary data analysis. A subset of inpatient data for the period from June 2011-June 2014 was extracted from the nursing information system and adverse event reporting system of an 818-bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis. During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut-off point of ≥3) had a low sensitivity level (60%), satisfactory specificity (87%), a positive predictive value of 2·0% and a negative predictive value of 99%. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8%; specificity, 78%). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut-off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards. The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions. This study highlights the needs for redefining the cut-off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely monitored by nurses to prevent falling during hospitalisations. © 2016 John Wiley & Sons Ltd.

The development of a multidisciplinary fall risk evaluation tool for demented nursing home patients in the Netherlands.

PubMed

Neyens, Jacques C L; Dijcks, Béatrice P J; van Haastregt, Jolanda C M; de Witte, Luc P; van den Heuvel, Wim J A; Crebolder, Harry F J M; Schols, Jos M G A

2006-03-21

Demented nursing home patients are at high risk for falls. Falls and associated injuries can have a considerable influence on the autonomy and quality of life of patients. The prevention of falls among demented patients is therefore an important issue. In order to intervene in an efficient way in this group of patients, it is important to systematically evaluate the fall risk profile of each individual patient so that for each patient tailor-made preventive measures can be taken. Therefore, the objective of the present study is to develop a feasible and evidence based multidisciplinary fall risk evaluation tool to be used for tailoring preventive interventions to the needs of individual demented patients. To develop this multidisciplinary fall risk evaluation tool we have chosen to combine scientific evidence on the one hand and experts' opinions on the other hand. Firstly, relevant risk factors for falling in elderly persons were gathered from the literature. Secondly, a group of Dutch experts in the field of falls and fall prevention in the elderly were consulted to judge the suitability of these risk factors for use in a multidisciplinary fall risk evaluation tool for demented nursing home patients. Thirdly, in order to generate a compact list of the most relevant risk factors for falling in demented elderly, all risk factors had to fulfill a set of criteria indicating their relevance for this specific target population. Lastly the final list of risk factors resulting from the above mentioned procedure was presented to the expert group. The members were also asked to give their opinion about the practical use of the tool. The multidisciplinary fall risk evaluation tool we developed includes the following items: previous falls, use of medication, locomotor functions, and (correct) choice and use of assistive and protective devices. The tool is developed for the multidisciplinary teams of the nursing homes. This evidence and practice based multidisciplinary fall risk evaluation tool targets the preventive interventions aimed to prevent falls and their negative consequences in demented nursing home patients.

Falling and fall risk in adult patients with severe haemophilia.

PubMed

Rehm, Hanna; Schmolders, Jan; Koob, Sebastian; Bornemann, Rahel; Goldmann, Georg; Oldenburg, Johannes; Pennekamp, Peter; Strauss, Andreas C

2017-05-10

The objective of this study was to define fall rates and to identify possible fall risk factors in adult patients with severe haemophilia. 147 patients with severe haemophilia A and B were evaluated using a standardized test battery consisting of demographic, medical and clinical variables and fall evaluation. 41 (27.9 %) patients reported a fall in the past 12 months, 22 (53.7 %) of them more than once. Young age, subjective gait insecurity and a higher number of artificial joints seem to be risk factors for falling. Falls seem to be a common phenomenon in patients with severe haemophilia. Fall risk screening and fall prevention should be implemented into daily practice.

The Association Between Fall Frequency, Injury Risk, and Characteristics of Falls in Older Residents of Long-Term Care: Do Recurrent Fallers Fall More Safely?

PubMed

van Schooten, Kimberley S; Yang, Yijian; Feldman, Fabio; Leung, Ming; McKay, Heather; Sims-Gould, Joanie; Robinovitch, Stephen N

2018-05-09

Although a fall is a necessary prerequisite to a fall-related injury, previous studies suggest that frequent fallers are at lower injury risk for a given fall. We tested the hypotheses that differences in protective responses or the circumstances of falls underlie differences in injury risk with fall frequency. We analyzed video footage of 897 falls experienced by 220 long-term care residents (mean age 82 ± 9 years) to identify the cause of imbalance, activity leading to falling, direction of fall initiation, balance recovery and fall protective responses, and occurrence of impact to the head or hip. We further obtained injury information from the facilities' fall registration. We used generalized estimating equation models to examine the association between quartiles of fall frequency, injury risk, and fall characteristics. Residents with the highest fall frequency group (Q4; ≥5.6 falls/year) were less likely to sustain an injury per fall. They were less likely to fall during walking and more likely to fall during stand-to-sit transfers. Residents in the lowest fall frequency group (Q1; <1.15 falls/year) were more likely to fall during walking, and walking was associated with an increased risk for injury. When compared to less frequent fallers, more frequent fallers had a lower risk for injury per fall. This appeared to be explained by differences in the circumstances of falls, and not by protective responses. Injury prevention strategies in long-term care should target both frequent and infrequent fallers, as the latter are more mobile and apt to sustain injury.

A measure of fall risk behaviors and perceptions among community-dwelling older adults.

PubMed

Yuen, Hon Keung; Carter, Rickey E

2006-01-01

Relatively little is known about the interaction between behavioral and environmental circumstances associated with falls among community-dwelling older adults. This study is designed to develop an instrument that measures community-dwelling older adults' participation in and perceptions of fall risk behaviors. Eighty-seven community-dwelling older adults aged 60 or above (mean +/- SD = 76 +/- 7.9), who had experienced at least one fall in the past 12 months, completed a questionnaire dealing with frequency of their participation in fall risk behaviors, their perceptions of these behaviors, and their fall history. Data were subjected to exploratory factor analysis. A 20-item instrument consisting of three constructs was presented as the Fall Risk Behaviors and Perceptions Scale (FRB&PS). Two of the three constructs of the instrument were de-stabilizers and non-supports, both of which measure participation in fall risk behaviors; the third was perceptions of fall risk behaviors. Internal consistency coefficient of the FRB&PS is 0.733 with a root mean square error of approximation (RMSEA) score of 0.075, which indicates an adequate model fit. Results from the stepwise regression analyses indicated that adults aged 75 and above (the old-old) participated less frequently in fall risk activities (p = 0.025), and had more knowledge about fall risks as measured by a higher perception score (p = 0.025) than those aged 60 to 75 (the young-old). Older men tended to participate more frequently in fall risk activities (p = 0.020) than older women; in addition, those older adults who are more mobile (p = 0.002) also participated more frequently in fall risk behaviors than those who are less mobile. Preliminary findings indicate that the pilot FRB&PS is a reliable and valid instrument to measure community-dwelling older adults' participation in and perceptions of fall risk behaviors. Additional psychometric validation of the FRB&PS on predicting the likelihood of falls is warranted.

Primary Care Fall Risk Assessment for Elderly West Virginians.

PubMed

Minkemeyer, Vivian M; Meriweather, Matt; Shuler, Franklin D; Mehta, Saurabh P; Qazi, Zain N

2015-01-01

West Virginia is ranked second nationally for the percent of its population 65 years of age. The elderly are especially susceptible to falls with fall risk increasing as age increases. Because falls are the number one cause of injury-related morbidity and mortality in the West Virginia elderly, evaluation of fall risk is a critical component of the patient evaluation in the primary care setting. We therefore highlight fall risk assessments that require no specialized equipment or training and can easily be completed at an established office visit. High quality clinical practice guidelines supported by the American Geriatric Society recommend yearly fall risk evaluation in the elderly. Those seniors at greatest risk of falls will benefit from the standardized therapy protocols outlined and referral to a balance treatment center. Patients with low-to-moderate fall risk attributed to muscle weakness or fatigue should be prescribed lower extremity strengthening exercises, such as kitchen counter exercises, to improve strength and balance.

Risk Factors for Falls and Fall-Related Injuries in Adults 85 Years of Age and Older

PubMed Central

Grundstrom, Anna C.; Guse, Clare E.; Layde, Peter M.

2011-01-01

Background Falls are a leading cause of morbidity and mortality in older adults. No previous studies on risk factors for falls have focused on adults 85 years and older, the most rapidly growing segment of adults. Methods We examined demographic, health, and behavioral risk factors for falls and fall-related injuries in adults 65 years and older, with a particular focus on adults 85 years and older. We analyzed self-reported information from the Behavioral Risk Factor Surveillance System (BRFSS) for 2008. Results Data was available for 120,923 people aged 65 or older and 12,684 people aged 85 or older. Of those aged 85 or older, 21.3% reported at least one fall in the past 3 months and 7.2% reported at least one fall related injury requiring medical care or limiting activity for a day or longer. Below average general health, male sex, perceived insufficient sleep, health problems requiring assistive devices, alcohol consumption, increasing body mass index and history of stroke were all independently associated with a greater risk of falls or fall related injuries. The greater risk of falling in those 85 years and older appeared to be due to the deterioration of overall health status with age; among those with excellent overall health status, there was no greater risk of falling in adults 85 years and older compared to those 65–84 years of age. Conclusions Our results suggest that those with risk factors for falls and fall-related injuries may be appropriate targets for evidence-based fall prevention programs. PMID:21862143

Risk factors for falls and fall-related injuries in adults 85 years of age and older.

PubMed

Grundstrom, Anna C; Guse, Clare E; Layde, Peter M

2012-01-01

Falls are a leading cause of morbidity and mortality in older adults. No previous studies on risk factors for falls have focused on adults 85 years and older, the most rapidly growing segment of adults. We examined demographic, health, and behavioral risk factors for falls and fall-related injuries in adults 65 years and older, with a particular focus on adults 85 years and older. We analyzed self-reported information from the Behavioral Risk Factor Surveillance System (BRFSS) for 2008. Data was available for 120,923 people aged 65 or older and 12,684 people aged 85 or older. Of those aged 85 or older, 21.3% reported at least one fall in the past 3 months and 7.2% reported at least one fall related injury requiring medical care or limiting activity for a day or longer. Below average general health, male sex, perceived insufficient sleep, health problems requiring assistive devices, alcohol consumption, increasing body mass index and history of stroke were all independently associated with a greater risk of falls or fall related injuries. The greater risk of falling in those 85 years and older appeared to be due to the deterioration of overall health status with age; among those with excellent overall health status, there was no greater risk of falling in adults 85 years and older compared to those 65-84 years of age. Our results suggest that those with risk factors for falls and fall-related injuries may be appropriate targets for evidence-based fall prevention programs. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

A modified fall risk assessment tool that is specific to physical function predicts falls in community-dwelling elderly people.

PubMed

Hirase, Tatsuya; Inokuchi, Shigeru; Matsusaka, Nobuou; Nakahara, Kazumi; Okita, Minoru

2014-01-01

Developing a practical fall risk assessment tool to predict the occurrence of falls in the primary care setting is important because investigators have reported deterioration of physical function associated with falls. Researchers have used many performance tests to predict the occurrence of falls. These performance tests predict falls and also assess physical function and determine exercise interventions. However, the need for such specialists as physical therapists to accurately conduct these tests limits their use in the primary care setting. Questionnaires for fall prediction offer an easy way to identify high-risk fallers without requiring specialists. Using an existing fall assessment questionnaire, this study aimed to identify items specific to physical function and determine whether those items were able to predict falls and estimate physical function of high-risk fallers. The analysis consisted of both retrospective and prospective studies and used 2 different samples (retrospective, n = 1871; prospective, n = 292). The retrospective study and 3-month prospective study comprised community-dwelling individuals aged 65 years or older and older adults using community day centers. The number of falls, risk factors for falls (15 risk factors on the questionnaire), and physical function determined by chair standing test (CST) and Timed Up and Go Test (TUGT) were assessed. The retrospective study selected fall risk factors related to physical function. The prospective study investigated whether the number of selected risk factors could predict falls. The predictive power was determined using the area under the receiver operating characteristic curve. Seven of the 15 risk factors were related to physical function. The area under the receiver operating characteristic curve for the sum of the selected risk factors of previous falls plus the other risk factors was 0.82 (P = .00). The best cutoff point was 4 risk factors, with sensitivity and specificity of 84% and 68%, respectively. The mean values for the CST and TUGT at the best cutoff point were 12.9 and 12.5 seconds, respectively. In the retrospective study, the values for the CST and TUGT corresponding to the best cutoff point from the prospective study were 13.2 and 11.4 seconds, respectively. This study confirms that a screening tool comprising 7 fall risk factors can be used to predict falls. The values for the CST and TUGT corresponding to the best cutoff point for the selected 7 risk factors determined in our prospective study were similar to the cutoff points for the CST and TUGT in previous studies for fall prediction. We propose that the sum of the selected risk factors of previous falls plus the other risk factors may be identified as the estimated value for physical function. These findings may contribute to earlier identification of high-risk fallers and intervention for fall prevention.

Conceptualizing a Dynamic Fall Risk Model Including Intrinsic Risks and Exposures.

PubMed

Klenk, Jochen; Becker, Clemens; Palumbo, Pierpaolo; Schwickert, Lars; Rapp, Kilan; Helbostad, Jorunn L; Todd, Chris; Lord, Stephen R; Kerse, Ngaire

2017-11-01

Falls are a major cause of injury and disability in older people, leading to serious health and social consequences including fractures, poor quality of life, loss of independence, and institutionalization. To design and provide adequate prevention measures, accurate understanding and identification of person's individual fall risk is important. However, to date, the performance of fall risk models is weak compared with models estimating, for example, cardiovascular risk. This deficiency may result from 2 factors. First, current models consider risk factors to be stable for each person and not change over time, an assumption that does not reflect real-life experience. Second, current models do not consider the interplay of individual exposure including type of activity (eg, walking, undertaking transfers) and environmental risks (eg, lighting, floor conditions) in which activity is performed. Therefore, we posit a dynamic fall risk model consisting of intrinsic risk factors that vary over time and exposure (activity in context). eHealth sensor technology (eg, smartphones) begins to enable the continuous measurement of both the above factors. We illustrate our model with examples of real-world falls from the FARSEEING database. This dynamic framework for fall risk adds important aspects that may improve understanding of fall mechanisms, fall risk models, and the development of fall prevention interventions. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Describing Older Adults' Awareness of Fall Risk Using Situation Awareness Research Techniques: A Pilot Study.

PubMed

Azzarello, Jo; Hall, Beth

2016-07-01

The purpose of the current study was to evaluate efficacy of techniques adapted from situation awareness research for describing how older adults perceive and understand fall risk factors in the context of daily routine. Eleven older adults watched a video of an older woman performing daily activities. Thirteen intrinsic, extrinsic, and behavioral fall risks were embedded throughout the scenario. The video was periodically frozen/blanked from view while participants answered questions about their understanding of the situation and associated story elements. Participants perceived a variety of fall risk factors but did not necessarily interpret them as indicating fall risk. Many fall risks held non-fall meaning for participants (e.g., newspapers on the floor meant the woman liked to read). Although four participants readily identified a fall risk situation, seven did not until they were explicitly asked to consider safety. Study techniques were effective for describing situation awareness of fall risk and several suggestions for improvement are described. [Res Gerontol Nurs. 2016; 9(4):161-166.]. Copyright 2016, SLACK Incorporated.

Psychometric validation of the Chinese version of the Johns Hopkins Fall Risk Assessment Tool for older Chinese inpatients.

PubMed

Zhang, Junhong; Wang, Min; Liu, Yu

2016-10-01

To culturally adapt and evaluate the reliability and validity of the Chinese version of the Johns Hopkins Fall Risk Assessment Tool among older inpatients in the mainland of China. Patient falls are an important safety consideration within hospitals among older inpatients. Nurses need specific risk assessment tools for older inpatients to reliably identify at-risk populations and guide interventions that highlight fixable risk factors for falls and consequent injuries. In China, a few tools have been developed to measure fall risk. However, they lack the solid psychometric development necessary to establish their validity and reliability, and they are not widely used for elderly inpatients. A cross-sectional study. A convenient sampling was used to recruit 201 older inpatients from two tertiary-level hospitals in Beijing and Xiamen, China. The Johns Hopkins Fall Risk Assessment Tool was translated using forward and backward translation procedures and was administered to these 201 older inpatients. Reliability of the tool was calculated by inter-rater reliability and Cronbach's alpha. Validity was analysed through content validity index and construct validity. The Inter-rater reliability of Chinese version of Johns Hopkins Fall Risk Assessment Tool was 97·14% agreement with Cohen's Kappa of 0·903. Cronbach's α was 0·703. Content of Validity Index was 0·833. Two factors represented intrinsic and extrinsic risk factors were explored that together explained 58·89% of the variance. This study provided evidence that Johns Hopkins Fall Risk Assessment Tool is an acceptable, valid and reliable tool to identify older inpatients at risk of falls and falls with injury. Further psychometric testing on criterion validity and evaluation of its advanced utility in geriatric clinical settings are warranted. The Chinese version of Johns Hopkins Fall Risk Assessment Tool may be useful for health care personnel to identify older Chinese inpatients at risk of falls and falls with injury. © 2016 John Wiley & Sons Ltd.

Physical activity level and fall risk among community-dwelling older adults.

PubMed

Low, Sok Teng; Balaraman, Thirumalaya

2017-07-01

[Purpose] To find the physical activity level and fall risk among the community-dwelling Malaysian older adults and determine the correlation between them. [Subjects and Methods] A cross-sectional study was conducted in which, the physical activity level was evaluated using the Rapid Assessment of Physical Activity questionnaire and fall risk with Fall Risk Assessment Tool. Subjects recruited were 132 community-dwelling Malaysian older adults using the convenience sampling method. [Results] The majority of the participants were under the category of under-active regular light-activities and most of them reported low fall risk. The statistical analysis using Fisher's exact test did not show a significant correlation between physical activity level and fall risk. [Conclusion] The majority of community-dwelling Malaysian older adults are performing some form of physical activity and in low fall risk category. But this study did not find any significant correlation between physical activity level and fall risk among community-dwelling older adults in Malaysia.

Validation of the Saskatoon Falls Prevention Consortium's Falls Screening and Referral Algorithm

PubMed Central

Lawson, Sara Nicole; Zaluski, Neal; Petrie, Amanda; Arnold, Cathy; Basran, Jenny

2013-01-01

ABSTRACT Purpose: To investigate the concurrent validity of the Saskatoon Falls Prevention Consortium's Falls Screening and Referral Algorithm (FSRA). Method: A total of 29 older adults (mean age 77.7 [SD 4.0] y) residing in an independent-living senior's complex who met inclusion criteria completed a demographic questionnaire and the components of the FSRA and Berg Balance Scale (BBS). The FSRA consists of the Elderly Fall Screening Test (EFST) and the Multi-factor Falls Questionnaire (MFQ); it is designed to categorize individuals into low, moderate, or high fall-risk categories to determine appropriate management pathways. A predictive model for probability of fall risk, based on previous research, was used to determine concurrent validity of the FSRI. Results: The FSRA placed 79% of participants into the low-risk category, whereas the predictive model found the probability of fall risk to range from 0.04 to 0.74, with a mean of 0.35 (SD 0.25). No statistically significant correlation was found between the FSRA and the predictive model for probability of fall risk (Spearman's ρ=0.35, p=0.06). Conclusion: The FSRA lacks concurrent validity relative to to a previously established model of fall risk and appears to over-categorize individuals into the low-risk group. Further research on the FSRA as an adequate tool to screen community-dwelling older adults for fall risk is recommended. PMID:24381379

FRAT-up, a Web-based fall-risk assessment tool for elderly people living in the community.

PubMed

Cattelani, Luca; Palumbo, Pierpaolo; Palmerini, Luca; Bandinelli, Stefania; Becker, Clemens; Chesani, Federico; Chiari, Lorenzo

2015-02-18

About 30% of people over 65 are subject to at least one unintentional fall a year. Fall prevention protocols and interventions can decrease the number of falls. To be effective, a prevention strategy requires a prior step to evaluate the fall risk of the subjects. Despite extensive research, existing assessment tools for fall risk have been insufficient for predicting falls. The goal of this study is to present a novel web-based fall-risk assessment tool (FRAT-up) and to evaluate its accuracy in predicting falls, within a context of community-dwelling persons aged 65 and up. FRAT-up is based on the assumption that a subject's fall risk is given by the contribution of their exposure to each of the known fall-risk factors. Many scientific studies have investigated the relationship between falls and risk factors. The majority of these studies adopted statistical approaches, usually providing quantitative information such as odds ratios. FRAT-up exploits these numerical results to compute how each single factor contributes to the overall fall risk. FRAT-up is based on a formal ontology that enlists a number of known risk factors, together with quantitative findings in terms of odds ratios. From such information, an automatic algorithm generates a rule-based probabilistic logic program, that is, a set of rules for each risk factor. The rule-based program takes the health profile of the subject (in terms of exposure to the risk factors) and computes the fall risk. A Web-based interface allows users to input health profiles and to visualize the risk assessment for the given subject. FRAT-up has been evaluated on the InCHIANTI Study dataset, a representative population-based study of older persons living in the Chianti area (Tuscany, Italy). We compared reported falls with predicted ones and computed performance indicators. The obtained area under curve of the receiver operating characteristic was 0.642 (95% CI 0.614-0.669), while the Brier score was 0.174. The Hosmer-Lemeshow test indicated statistical significance of miscalibration. FRAT-up is a web-based tool for evaluating the fall risk of people aged 65 or up living in the community. Validation results of fall risks computed by FRAT-up show that its performance is comparable to externally validated state-of-the-art tools. A prototype is freely available through a web-based interface. ClinicalTrials.gov NCT01331512 (The InChianti Follow-Up Study); http://clinicaltrials.gov/show/NCT01331512 (Archived by WebCite at http://www.webcitation.org/6UDrrRuaR).

Concordance of Motion Sensor and Clinician-Rated Fall Risk Scores in Older Adults.

PubMed

Elledge, Julie

2017-12-01

As the older adult population in the United States continues to grow, developing reliable, valid, and practical methods for identifying fall risk is a high priority. Falls are prevalent in older adults and contribute significantly to morbidity and mortality rates and rising health costs. Identifying at-risk older adults and intervening in a timely manner can reduce falls. Conventional fall risk assessment tools require a health professional trained in the use of each tool for administration and interpretation. Motion sensor technology, which uses three-dimensional cameras to measure patient movements, is promising for assessing older adults' fall risk because it could eliminate or reduce the need for provider oversight. The purpose of this study was to assess the concordance of fall risk scores as measured by a motion sensor device, the OmniVR Virtual Rehabilitation System, with clinician-rated fall risk scores in older adult outpatients undergoing physical rehabilitation. Three standardized fall risk assessments were administered by the OmniVR and by a clinician. Validity of the OmniVR was assessed by measuring the concordance between the two assessment methods. Stability of the OmniVR fall risk ratings was assessed by measuring test-retest reliability. The OmniVR scores showed high concordance with the clinician-rated scores and high stability over time, demonstrating comparability with provider measurements.

Risk factors of falls in inpatients and their practical use in identifying high-risk persons at admission: Fukushima Medical University Hospital cohort study.

PubMed

Hayakawa, Takehito; Hashimoto, Shigeatsu; Kanda, Hideyuki; Hirano, Noriko; Kurihara, Yumi; Kawashima, Takako; Fukushima, Tetsuhito

2014-01-01

To clarify the risk factors for falls in hospital settings and to propose the use of such factors to identify high-risk persons at admission. Prospective cohort study. Fukushima Medical University Hospital, Japan, from August 2008 and September 2009. 9957 adult consecutive inpatients admitted to our hospital. Information was collected at admission from clinical records obtained from a structured questionnaire conducted in face-to-face interviews with subjects by nurses and doctors and fall events were collected from clinical records. The proportion of patients who fell during follow-up was 2.5% and the incidence of falls was 3.28 per 100 person-days. There were significant differences in age, history of falling, cognitive dysfunction, planned surgery, wheelchair use, need for help to move, use of a remote caring system, rehabilitation, use of laxative, hypnotic or psychotropic medications and need for help with activities of daily living (ADL) between patients who did and did not fall. Multivariable adjusted ORs for falls showed that age, history of falls and need for help with ADL were common risk factors in both men and women. Using psychotropic medication also increased the risk of falling in men while cognitive dysfunction and use of hypnotic medication increased the risk of falling in women. Planned surgery was associated with a low risk of falls in women. To prevent falls in inpatients it is important to identify high-risk persons. Age, history of falling and the need for help with ADL are the most important pieces of information to be obtained at admission. Care plans for patients including fall prevention should be clear and considered.

Perceived Fall Risk and Functional Decline: Gender Differences in Patient's Willingness to Discuss Fall Risk, Fall History, or to Have a Home Safety Evaluation.

PubMed

Greenberg, Marna Rayl; Moore, Elizabeth C; Nguyen, Michael C; Stello, Brian; Goldberg, Arnold; Barraco, Robert D; Porter, Bernadette G; Kurt, Anita; Dusza, Stephen W; Kane, Bryan G

2016-06-01

The CDC reports that among older adults, falls are the leading cause of injury-related death and rates of fall-related fractures among older women are twice those of men. We set out to 1) determine patient perceptions (analyzed by gender) about their perceived fall risk compared to their actual risk for functional decline and death and 2) to report their comfort level in discussing their fall history or a home safety plan with their provider. Elders who presented to the Emergency Department (ED†) were surveyed. The survey included demographics, the Falls Efficacy Scale (FES) and the Vulnerable Elders Survey (VES); both validated surveys measuring fall concern and functional decline. Females had higher FES scores (mean 12.3, SD 5.9) than males (mean 9.7, SD 5.9 p = .007) in the 146 surveys analyzed. Females were more likely to report an increased fear of falling, and almost three times more likely to have a VES score of 3 or greater than males (OR = 2.86, 95% CI: 1.17-7.00, p = .02). A strong correlation was observed between FES and VES scores (r = 0.80, p < .001). No difference in correlation was observed between males and females, p = .26. Participants (77 percent) reported they would be comfortable discussing their fall risk with a provider; there was no difference between genders (p = .57). In this study, irrespective of gender, there appears to be a high association between subjects' perceived fall risk and risk for functional decline and death. The majority of patients are likely willing to discuss their fall risk with their provider. These findings may suggest a meaningful opportunity for fall risk mitigation in this setting.

Risk factors of falls in inpatients and their practical use in identifying high-risk persons at admission: Fukushima Medical University Hospital cohort study

PubMed Central

Hayakawa, Takehito; Hashimoto, Shigeatsu; Kanda, Hideyuki; Hirano, Noriko; Kurihara, Yumi; Kawashima, Takako; Fukushima, Tetsuhito

2014-01-01

Objectives To clarify the risk factors for falls in hospital settings and to propose the use of such factors to identify high-risk persons at admission. Design Prospective cohort study. Setting Fukushima Medical University Hospital, Japan, from August 2008 and September 2009. Participants 9957 adult consecutive inpatients admitted to our hospital. Methods Information was collected at admission from clinical records obtained from a structured questionnaire conducted in face-to-face interviews with subjects by nurses and doctors and fall events were collected from clinical records. Results The proportion of patients who fell during follow-up was 2.5% and the incidence of falls was 3.28 per 100 person-days. There were significant differences in age, history of falling, cognitive dysfunction, planned surgery, wheelchair use, need for help to move, use of a remote caring system, rehabilitation, use of laxative, hypnotic or psychotropic medications and need for help with activities of daily living (ADL) between patients who did and did not fall. Multivariable adjusted ORs for falls showed that age, history of falls and need for help with ADL were common risk factors in both men and women. Using psychotropic medication also increased the risk of falling in men while cognitive dysfunction and use of hypnotic medication increased the risk of falling in women. Planned surgery was associated with a low risk of falls in women. Conclusions To prevent falls in inpatients it is important to identify high-risk persons. Age, history of falling and the need for help with ADL are the most important pieces of information to be obtained at admission. Care plans for patients including fall prevention should be clear and considered. PMID:25232563

Fall prevention: is the STRATIFY tool the right instrument in Italian Hospital inpatient? A retrospective observational study.

PubMed

Castellini, Greta; Demarchi, Antonia; Lanzoni, Monica; Castaldi, Silvana

2017-09-15

Although several risk assessment tools are in use, uncertainties on their accuracy in detecting fall risk already exist. Choosing the most accurate tool for hospital inpatient is still a challenge for the organizations. We aimed to retrospectively assess the appropriateness of a fall risk prevention program with the STRATIFY assessment tool in detecting acute-care inpatient fall risk. Number of falls and near falls, occurred from January 2014 to March 2015, was collected through the incident reporting web-system implemented in the hospital's intranet. We reported whether the fall risk was assessed with the STRATIFY assessment tool and, if so, which was the judgement. Primary outcome was the proportion of inpatients identified as high risk of fall among inpatients who fell (True Positive Rate), and the proportion of inpatients identified as low-risk that experienced a fall howsoever (False Negative Rate). Characteristics of population and fall events were described among subgroups of low risk and high risk inpatients. We collected 365 incident reports from 40 hospital units, 349 (95.6%) were real falls and 16 (4.4%) were near falls. The fall risk assessment score at patient's admission had been reported in 289 (79%) of the overall incident reports. Thus, 74 (20.3%) fallers were actually not assessed with the STRATIFY, even though the majority of them presented risk recommended to be assessed. The True Positive Rate was 35.6% (n = 101, 95% CI 30% - 41.1%). The False Negative Rate was 64.4% (n = 183, 95% CI 58.9%-70%) of fallers, nevertheless they incurred in a fall. The STRATIFY mean score was 1.3 ± 1.4; the median was 1 (IQQ 0-2). The prevention program using only the STRATIFY tool was found to be not adequate to screen our inpatients population. The incorrect identification of patients' needs leads to allocate resources to erroneous priorities and to untargeted interventions, decreasing healthcare performance and quality.

Post-fall reporting in aged acute inpatient mental health units: an 18-month observational cohort study.

PubMed

Furness, Trentham; Mnatzaganian, George; Garlick, Robyn; Ireland, Susan; McKenna, Brian; Hill, Keith D

2017-12-01

Despite the high risk of falling for people with severe mental illness, there is limited falls research in mental health settings. Therefore, the objective of this observational cohort study was to conduct a focused post-fall review of fall episodes within aged acute inpatient mental health units at one of Australia's largest publicly funded mental health organizations. A post-fall reporting tool was developed to collect intrinsic and extrinsic fall risk factors among three aged acute mental health inpatient units over an 18-month period. Descriptive and inferential analyses were conducted to describe fall risk factors and predictors of fall risk. There were a total of 115 falls, of which the tool was used for 93 (80.9%) episodes. Falls occurred most often in consumer's bedroom/bathroom and were unwitnessed. Intrinsic risk factors were most often attributed to postural drop and losing balance during walking. However, that was in contrast to consumer's who self-reported feeling dizzy as the reason of the fall. Based on the cohort, future falls could be reduced by targeting those aged above 82 years, or with a diagnosis of dementia. Recurrent falls during admission could be reduced by targeting those with psychotic illness and males with a diagnosis of dementia. A clearer dialogue among consumers and clinical staff reporting about fall episodes may support future remedial interventions and inform programs to reduce fall risk and assist the challenge of describing unwitnessed falls in aged acute inpatient mental health settings.

Development of a Risk Assessment Tool to Predict Fall-Related Severe Injuries Occurring in a Hospital

PubMed Central

Toyabe, Shin-ichi

2014-01-01

Inpatient falls are the most common adverse events that occur in a hospital, and about 3 to 10% of falls result in serious injuries such as bone fractures and intracranial haemorrhages. We previously reported that bone fractures and intracranial haemorrhages were two major fall-related injuries and that risk assessment score for osteoporotic bone fracture was significantly associated not only with bone fractures after falls but also with intracranial haemorrhage after falls. Based on the results, we tried to establish a risk assessment tool for predicting fall-related severe injuries in a hospital. Possible risk factors related to fall-related serious injuries were extracted from data on inpatients that were admitted to a tertiary-care university hospital by using multivariate Cox’ s regression analysis and multiple logistic regression analysis. We found that fall risk score and fracture risk score were the two significant factors, and we constructed models to predict fall-related severe injuries incorporating these factors. When the prediction model was applied to another independent dataset, the constructed model could detect patients with fall-related severe injuries efficiently. The new assessment system could identify patients prone to severe injuries after falls in a reproducible fashion. PMID:25168984

The 34th Annual Fall Meeting of the American Physiological Society and the International Conference on Hydrogen Ion Transport in Epithelia.

ERIC Educational Resources Information Center

Physiologist, 1983

1983-01-01

Provided are abstracts of papers presented at the annual American Physiological Society meeting and International Conference on Hydrogen Ion Transport in Epithelia. Papers are grouped by such topic areas as lung fluid balance, renal cardiovascular integration, smooth muscle physiology, neuroendocrines (pituitary), exercise physiology, mechanics of…

The design of a purpose-built exergame for fall prediction and prevention for older people.

PubMed

Marston, Hannah R; Woodbury, Ashley; Gschwind, Yves J; Kroll, Michael; Fink, Denis; Eichberg, Sabine; Kreiner, Karl; Ejupi, Andreas; Annegarn, Janneke; de Rosario, Helios; Wienholtz, Arno; Wieching, Rainer; Delbaere, Kim

2015-01-01

Falls in older people represent a major age-related health challenge facing our society. Novel methods for delivery of falls prevention programs are required to increase effectiveness and adherence to these programs while containing costs. The primary aim of the Information and Communications Technology-based System to Predict and Prevent Falls (iStoppFalls) project was to develop innovative home-based technologies for continuous monitoring and exercise-based prevention of falls in community-dwelling older people. The aim of this paper is to describe the components of the iStoppFalls system. The system comprised of 1) a TV, 2) a PC, 3) the Microsoft Kinect, 4) a wearable sensor and 5) an assessment and training software as the main components. The iStoppFalls system implements existing technologies to deliver a tailored home-based exercise and education program aimed at reducing fall risk in older people. A risk assessment tool was designed to identify fall risk factors. The content and progression rules of the iStoppFalls exergames were developed from evidence-based fall prevention interventions targeting muscle strength and balance in older people. The iStoppFalls fall prevention program, used in conjunction with the multifactorial fall risk assessment tool, aims to provide a comprehensive and individualised, yet novel fall risk assessment and prevention program that is feasible for widespread use to prevent falls and fall-related injuries. This work provides a new approach to engage older people in home-based exercise programs to complement or provide a potentially motivational alternative to traditional exercise to reduce the risk of falling.

The relationship of intrinsic fall risk factors to a recent history of falling in older women with osteoporosis.

PubMed

Arnold, Cathy M; Busch, Angela J; Schachter, Candice L; Harrison, Liz; Olszynski, Wojciech

2005-07-01

Cross-sectional descriptive analysis investigating intrinsic fall risk factors in postmenopausal women with osteoporosis. To examine the relationships between history of recent falls and balance, pain, quality of life, function, posture, strength, and mobility. Women with osteoporosis who fall are at a high risk of fracture due to decreased bone strength. Identifying fall risk factors for older women with osteoporosis is a crucial step in decreasing the incidence of falls and fracture. METHOD AND MEASURES: Seventy-three women over 60 years of age with established osteoporosis participated in comprehensive testing of fall history, physical function, and quality of life. Significant correlations were found between a recent history of falls and degree of kyphosis (r = 0.29), fear of falls/emotional status (r = -0.27), and balance (r = -0.27). Degree of kyphosis and fear of falls/emotional status explained 20% of the variance of recent fall history using binary logistic regression. Women with an increased kyphosis were more likely to have had a recent fall (odds ratio [OR], 1.17; 95% CI, 1.03-1.34) and those with better emotional status and less fear of falling were less likely to have had a recent fall (OR, 0.61; 95% CI, 0.38-0.97). Increased thoracic kyphosis and fear of falling are 2 intrinsic factors associated with recent falls in women with osteoporosis. To design more effective interventions to decrease fall risk in this population, future prospective, longitudinal studies should monitor kyphosis, fear of falling, balance reactions, and other potential risk factors not identified in this study.

Are triage questions sufficient to assign fall risk precautions in the ED?

PubMed

Southerland, Lauren T; Slattery, Lauren; Rosenthal, Joseph A; Kegelmeyer, Deborah; Kloos, Anne

2017-02-01

The American College of Emergency Physicians Geriatric Emergency Department (ED) Guidelines and the Center for Disease Control recommend that older adults be assessed for risk of falls. The standard ED assessment is a verbal query of fall risk factors, which may be inadequate. We hypothesized that the addition of a functional balance test endorsed by the Center for Disease Control Stop Elderly Accidents, Deaths, and Injuries Falls Prevention Guidelines, the 4-Stage Balance Test (4SBT), would improve the detection of patients at risk for falls. Prospective pilot study of a convenience sample of ambulatory adults 65 years and older in the ED. All participants received the standard nursing triage fall risk assessment. After patients were stabilized in their ED room, the 4SBT was administered. The 58 participants had an average age of 74.1 years (range, 65-94), 40.0% were women, and 98% were community dwelling. Five (8.6%) presented to the ED for a fall-related chief complaint. The nursing triage screen identified 39.7% (n=23) as at risk for falls, whereas the 4SBT identified 43% (n=25). Combining triage questions with the 4SBT identified 60.3% (n=35) as at high risk for falls, as compared with 39.7% (n=23) with triage questions alone (P<.01). Ten (17%) of the patients at high risk by 4SBT and missed by triage questions were inpatients unaware that they were at risk for falls (new diagnoses). Incorporating a quick functional test of balance into the ED assessment for fall risk is feasible and significantly increases the detection of older adults at risk for falls. Copyright © 2016 Elsevier Inc. All rights reserved.

Improving Fall Risk Factor Identification and Documentation of Risk Reduction Strategies by Rehabilitation Therapists through Continuing Education

ERIC Educational Resources Information Center

Karnes, Michele J.

2011-01-01

This static group comparison study determined that an educational intervention was effective in increasing fall risk factor assessment, documentation of fall risk factors, and strategies devised to reduce fall risk factors by rehabilitation therapists for their older adult outpatients in clinics. Results showed that experimental group identified…

[Impact of fall risk and fear of falling on mobility of independently living senior citizens transitioning to frailty: screening results concerning fall prevention in the community].

PubMed

Anders, J; Dapp, U; Laub, S; von Renteln-Kruse, W

2007-08-01

There is a strong relation between mobility, walking safety and living independently in old age. People with walking problems suffer from fear of falling and tend to restrict their mobility and performance level in the community environment--even before falls occur. This study was planned to test the validity and prognostic value of a fall risk screening instrument ("Sturz-Risiko-Check") that has already shown its feasibility, acceptance and reliability, targeting independently living senior citizens. The study sample was recruited from a sheltered housing complex in Hamburg (with written consent). Persons with need of professional care ("Pflegestufe" in Germany) were excluded. The residents were asked to fill in the multidimensional questionnaire ("Sturz-Risiko- Check"). In a second step, a trained nurse asked the participants in a phone call about their competence in the instrumental activities of daily living (I-ADL mod. from Lawton, Brody 1969) and about their usual mobility performance level (e.g. frequency and distance of daily walks, use of public transport). According to the number and weight of self-reported risk factors for falling, three groups: "low fall risk", "medium fall risk" and "high fall risk" were classified. Finally, this classification was re-tested after one year, asking for falls and fall related injuries. A total of 112 senior citizens without need of personal care, living in a sheltered housing facility were asked to participate. Acceptance was high (76.1%). Self-reported data from 79 participants concerning falls, fall-risk, mobility and instrumental activities of daily living were included in the statistical analyses. Mean age was 78 (64 to 93) years and associated by a high percentage of women (75.9%) in this sample. The older participants reported 0 to 13 different factors (mean 5) related to a high risk of future falls. Most participants (78.5%) quit cycling because of fear of falling. There was a high incidence in the study sample and over the three risk groups of chronic disorders like cardiac failure (75.9%) and disturbed vision or hearing (64.6%). According to the rising risk of falling over the three risk groups (low, medium and high), there were symptoms of fast functional decline or frailty like diminished walking speed (6.3 vs 36.8 vs 72.0%), sarcopenia (failed chairrise test: 0 vs 18.4 vs 28%) or already perceived fall events (0 vs 5.3 vs 56.0%) and ongoing restriction in basic activities. Those results were proven by the data on fall frequencies after one year (follow-up). We found an increase in falls over all three risk groups (12.5 vs 31.6 vs 28%) with fall-related severe injuries (fractures) in two persons classified in the high fall-risk group. The results of the fall-risk screening were useful to classify groups with different probability to fall in the near future. Fear-offalling and symptoms of frailty were related to an increasing risk of falling and loss of mobility and autonomy in still independently living senior citizens. The fall-risk screening instrument ("Sturz-Risiko-Check" questionnaire) was useful and valid to predict risk of falling and functional decline in independently living senior citizens transitioning to frailty. This screening will be part of a prevention approach in the City of Hamburg to offer primary and secondary prevention interventions adapted to special target groups of community- dwelling elder people (robust in contrast to frail elderly). The implementation should be accompanied by training sessions for physicians in the primary care sector and health improvement programmes for elder citizens.

Falls risk assessment begins with hello: lessons learned from the use of one home health agency's fall risk tool.

PubMed

Flemming, Patricia J; Ramsay, Katherine

2012-10-01

Identifying older adults at risk for falls is a challenge all home healthcare agencies (HHAs) face. The process of assessing for falls risk begins with the initial home visit. One HHA affiliated with an academic medical center describes its experience in development and use of a Falls Risk Assessment (FRA) tool over a 10-year period. The FRA tool has been modified since initial development to clarify elements of the tool based on research and to reflect changes in the Outcome and Assessment Information Set (OASIS) document. The primary purpose of this article is to share a validated falls risk assessment tool to facilitate identification of fall-related risk factors in the homebound population. A secondary purpose is to share lessons learned by the HHA during the 10 years using the FRA.

Height effects in real and virtual environments.

PubMed

Simeonov, Peter I; Hsiao, Hongwei; Dotson, Brian W; Ammons, Douglas E

2005-01-01

The study compared human perceptions of height, danger, and anxiety, as well as skin conductance and heart rate responses and postural instability effects, in real and virtual height environments. The 24 participants (12 men, 12 women), whose average age was 23.6 years, performed "lean-over-the-railing" and standing tasks on real and comparable virtual balconies, using a surround-screen virtual reality (SSVR) system. The results indicate that the virtual display of elevation provided realistic perceptual experience and induced some physiological responses and postural instability effects comparable to those found in a real environment. It appears that a simulation of elevated work environment in a SSVR system, although with reduced visual fidelity, is a valid tool for safety research. Potential applications of this study include the design of virtual environments that will help in safe evaluation of human performance at elevation, identification of risk factors leading to fall incidents, and assessment of new fall prevention strategies.

Medication fall risk in old hospitalized patients: a retrospective study.

PubMed

Costa-Dias, Maria José; Oliveira, Alexandre Santos; Martins, Teresa; Araújo, Fátima; Santos, Ana Sofia; Moreira, Cristina Nogueira; José, Helena

2014-02-01

While the causes of falls in old hospitalized patients are multifactorial, medication has been considered as one of the most significant factors. Given the large impact that this phenomenon has on the lives of the elderly and organizations, it is important to explore such phenomenon in greater depth. The objective of this study was to explore the association between medication and falls and the recurrent falls (n≥2), and identify medication related risk for fall in hospitalized patients, in a large acute hospital. Retrospective and quantitative study from June 2008 to December 2010. The study was conducted in a private hospital for acute patients in Lisbon, Portugal. The study included a sample of 214 episodes of fall event notifications which occurred in 193 patients. The current study was conducted through the "face to face consensus" technique which emerged the treatment groups to investigate. Regarding the data analysis we used Student's t test, ANOVA and Odds Ratio. In the violation of the premises for the use of parametric statistics we used the Kruskal-Wallis test. To assess the fall risk, and the medication-related fall risk, we used the Morse Fall Risk Scale, and the Medication Fall Risk Score. Patients who received drugs from the therapy group of "Central Nervous System", are 10 times more likely to have fall risk (OR 9. 90, 95% CI 1.6-60.63). Association was found between falls (OR 6.09, 95% CI 1.30-28.54) and its recurrence (OR 3.32, 95% CI 1.61-6.85), among patients receiving haloperidol and receiving tramadol for recurrent falls (OR 3.10, 95% CI 1.59-6.07). In 34% of the patients the medication fall risk score was 6 or higher. This current study allowed identifying medication-related risk factors for falls, that nurses should consider when prescribing interventions to prevent falls and its recurrence, when patients are admitted to acute care hospitals. Copyright © 2014 Elsevier Ltd. All rights reserved.

Medication use and associated risk of falling in a geriatric outpatient population.

PubMed

Freeland, Kathryn N; Thompson, Amy N; Zhao, Yumin; Leal, Julie E; Mauldin, Patrick D; Moran, William P

2012-09-01

Studies have shown that approximately one third of community-dwelling people aged 65 years and older will experience a fall each year. Many studies indicate that use of multiple medications may put patients at an increased risk of falling, but few studies have been conducted to correlate the number of medications with the risk of falls. To determine the medications most frequently used in patients aged 65 years or older who have experienced a fall within the past year, with particular attention to type or number of medications most commonly associated with multiple falls or a fall with injury. We conducted a chart review in an outpatient internal medicine clinic over a 13-month period. A total of 118 patients 65 years of age or older who were taking 4 or more medications and had experienced at least 1 fall in the previous 12 months were included. Data relating to sex, age, race, diagnoses, medications, and number and type of falls were obtained during the chart review. The primary end point of the study was number and type of medications most commonly used in patients experiencing a fall. A total of 116 patients were examined for trends in fall risk. A logistic regression model and receiver operating characteristic curve demonstrated significant fall risk with the addition of medications, with patients experiencing a 14% increase in fall risk with the addition of each medication beyond a 4-medication regimen (OR 1.14; 95% CI 1.02 to 1.27; p = 0.027). The addition of medications is associated with a significant increase in risk of falls in elderly patients, regardless of drug class. Further studies are needed to assess the possible increased risk of falls with increasing number of medications.

Development and evaluation of an automated fall risk assessment system.

PubMed

Lee, Ju Young; Jin, Yinji; Piao, Jinshi; Lee, Sun-Mi

2016-04-01

Fall risk assessment is the first step toward prevention, and a risk assessment tool with high validity should be used. This study aimed to develop and validate an automated fall risk assessment system (Auto-FallRAS) to assess fall risks based on electronic medical records (EMRs) without additional data collected or entered by nurses. This study was conducted in a 1335-bed university hospital in Seoul, South Korea. The Auto-FallRAS was developed using 4211 fall-related clinical data extracted from EMRs. Participants included fall patients and non-fall patients (868 and 3472 for the development study; 752 and 3008 for the validation study; and 58 and 232 for validation after clinical application, respectively). The system was evaluated for predictive validity and concurrent validity. The final 10 predictors were included in the logistic regression model for the risk-scoring algorithm. The results of the Auto-FallRAS were shown as high/moderate/low risk on the EMR screen. The predictive validity analyzed after clinical application of the Auto-FallRAS was as follows: sensitivity = 0.95, NPV = 0.97 and Youden index = 0.44. The validity of the Morse Fall Scale assessed by nurses was as follows: sensitivity = 0.68, NPV = 0.88 and Youden index = 0.28. This study found that the Auto-FallRAS results were better than were the nurses' predictions. The advantage of the Auto-FallRAS is that it automatically analyzes information and shows patients' fall risk assessment results without requiring additional time from nurses. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Fall risk assessment and prevention.

PubMed

Kline, Nancy E; Davis, Mary Elizabeth; Thom, Bridgette

2011-02-01

Patient falls are a common cause of morbidity and are the leading cause of injury deaths in adults age 65 years and older. Injuries sustained as result of falls in a cancer hospital are often severe, regardless of patient age, due to the nature of the underlying cancer. Falls are a nursing-sensitive indicator and nurses are in a unique position to assess, design, implement, and evaluate programs for fall risk reduction. We analyzed our nursing processes related to falls and fall prevention in conjunction with an evidence-based review, a research study to improve our fall risk-assessment process, and development of a comprehensive fall-reduction program. This article outlines how our institution developed a fall risk assessment for the oncology patient population, and utilized this assessment in a comprehensive nursing approach to fall prevention in both inpatient and outpatient settings.

Nutritional strategies to reduce falls risk in older people.

PubMed

Nash, Louise; Bergin, Nick

2018-03-23

A literature review found an association between increased falls risk and malnutrition, sarcopenia, vitamin D deficiency and dehydration. Strategies to identify, prevent and treat these conditions can help to reduce falls risk in at-risk groups such as frail, older people. Nurses can reduce falls risk in older people by raising awareness of risk factors and embedding nutritional strategies in local falls reduction strategies. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Falls efficacy, postural balance, and risk for falls in older adults with falls-related emergency department visits: prospective cohort study.

PubMed

Pua, Yong-Hao; Ong, Peck-Hoon; Clark, Ross Allan; Matcher, David B; Lim, Edwin Choon-Wyn

2017-12-21

Risk for falls in older adults has been associated with falls efficacy (self-perceived confidence in performing daily physical activities) and postural balance, but available evidence is limited and mixed. We examined the interaction between falls efficacy and postural balance and its association with future falls. We also investigated the association between falls efficacy and gait decline. Falls efficacy, measured by the Modified Falls Efficacy Scale (MFES), and standing postural balance, measured using computerized posturography on a balance board, were obtained from 247 older adults with a falls-related emergency department visit. Six-month prospective fall rate and habitual gait speed at 6 months post baseline assessment were also measured. In multivariable proportional odds analyses adjusted for potential confounders, falls efficacy modified the association between postural balance and fall risk (interaction P = 0.014): increasing falls efficacy accentuated the increased fall risk related to poor postural balance. Low baseline falls efficacy was strongly predictive of worse gait speed (0.11 m/s [0.06 to 0.16] slower gait speed per IQR decrease in MFES; P < 0.001). Older adults with high falls efficacy but poor postural balance were at greater risk for falls than those with low falls efficacy; however, low baseline falls efficacy was strongly associated with worse gait function at follow-up. Further research into these subgroups of older adults is warranted. ClinicalTrials.gov identifier: NCT01713543 .

Disease state fingerprint for fall risk assessment.

PubMed

Similä, Heidi; Immonen, Milla

2014-01-01

Fall prevention is an important and complex multifactorial challenge, since one third of people over 65 years old fall at least once every year. A novel application of Disease State Fingerprint (DSF) algorithm is presented for holistic visualization of fall risk factors and identifying persons with falls history or decreased level of physical functioning based on fall risk assessment data. The algorithm is tested with data from 42 older adults, that went through a comprehensive fall risk assessment. Within the study population the Activities-specific Balance Confidence (ABC) scale score, Berg Balance Scale (BBS) score and the number of drugs in use were the three most relevant variables, that differed between the fallers and non-fallers. This study showed that the DSF visualization is beneficial in inspection of an individual's significant fall risk factors, since people have problems in different areas and one single assessment scale is not enough to expose all the people at risk.

Measures and effects on prevention of fall: the role of a fall working group at a university hospital.

PubMed

Kobayashi, Kazuyoshi; Ando, Kei; Inagaki, Yuko; Suzuki, Yusuke; Nagao, Yoshimasa; Ishiguro, Naoki; Imagama, Shiro

2017-11-01

Fall in hospitalized patients can cause trauma and fractures, which can reduce ADL and QOL, whereas prevention of fall decreases medical expenses. The purpose of this study is to examine prevention of fall due to intervention from a fall working group established in our hospital. The working group focused on three main points. First, colored wrist bands for patients classified as grade 3 risk for fall are used to alert medical staff. Second, information on fall prevention was distributed to patients. Third, standardization of two bed fences and reduced use of slippers for inpatients have been introduced. We investigated falls during hospitalization for 5 years from April 2012 to March 2017. The risk of fall was evaluated as grade 1 (mild) to grade 3 (severe) using an assessment sheet developed by the working group. The incidence of fall decreased over time, with a significant decrease from 2.1% in 2012 to 1.3% in 2016 (p<0.01). Slipper use in fall cases showed a significant decrease from 45.8% in 2012 to 11.0% in 2016 (p<0.01). Among all falls, the percentage of cases with fall risks grade 1 and 2 decreased, while that for grade 3 risk increased from 32.0% in 2012 to 40.3% in 2016 (p<0.05). These results support the efforts of the fall working group have reduced the overall incidence of fall. However, fall in patients with grade 3 risk has not decreased, which suggests that better sharing of information is needed for patients at high risk for fall.

Effects of a multifactorial falls prevention program for people with stroke returning home after rehabilitation: a randomized controlled trial.

PubMed

Batchelor, Frances A; Hill, Keith D; Mackintosh, Shylie F; Said, Catherine M; Whitehead, Craig H

2012-09-01

To determine whether a multifactorial falls prevention program reduces falls in people with stroke at risk of recurrent falls and whether this program leads to improvements in gait, balance, strength, and fall-related efficacy. A single blind, multicenter, randomized controlled trial with 12-month follow-up. Participants were recruited after discharge from rehabilitation and followed up in the community. Participants (N=156) were people with stroke at risk of recurrent falls being discharged home from rehabilitation. Tailored multifactorial falls prevention program and usual care (n=71) or control (usual care, n=85). Primary outcomes were rate of falls and proportion of fallers. Secondary outcomes included injurious falls, falls risk, participation, activity, leg strength, gait speed, balance, and falls efficacy. There was no significant difference in fall rate (intervention: 1.89 falls/person-year, control: 1.76 falls/person-year, incidence rate ratio=1.10, P=.74) or the proportion of fallers between the groups (risk ratio=.83, 95% confidence interval=.60-1.14). There was no significant difference in injurious fall rate (intervention: .74 injurious falls/person-year, control: .49 injurious falls/person-year, incidence rate ratio=1.57, P=.25), and there were no significant differences between groups on any other secondary outcome. This multifactorial falls prevention program was not effective in reducing falls in people with stroke who are at risk of falls nor was it more effective than usual care in improving gait, balance, and strength in people with stroke. Further research is required to identify effective interventions for this high-risk group. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A prospective study on the variation in falling and fall risk among community-dwelling older citizens in 12 European countries

PubMed Central

Franse, Carmen B; Rietjens, Judith AC; Burdorf, Alex; van Grieken, Amy; Korfage, Ida J; van der Heide, Agnes; Mattace Raso, Francesco; van Beeck, Ed; Raat, Hein

2017-01-01

Objectives The rate of falling among older citizens appears to vary across different countries, but the underlying aspects causing this variation are unexplained. We aim to describe between-country variation in falling and explore whether intrinsic fall risk factors can explain possible variation. Design Prospective study on data from the cross-national Survey of Health, Ageing and Retirement in Europe (SHARE). Setting Twelve European countries (Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Italy, The Netherlands, Spain, Sweden, Switzerland). Participants Community-dwelling persons aged ≥65 years (n=18 596). Measurements Socio-demographic factors (age, gender, education level and living situation) and intrinsic fall risk factors (less than good self-rated health (SRH), mobility limitations, limitations with activities of daily living (ADL), dizziness, impaired vision, depression and impaired cognition) were assessed in a baseline interview. Falling was assessed 2 years later by asking whether the participant had fallen within the 6 months prior to the follow-up interview. Results There was significant between-country variation in the rate of falling (varying from 7.9% in Switzerland to 16.2% in the Czech Republic). The prevalence of intrinsic fall risk factors varied twofold to fourfold between countries. Associations between factors age ≥80 years, less than good SRH, mobility limitations, ADL limitations, dizziness and depression, and falling were different between countries (p<0.05). Between-country differences in falling largely persisted after adjusting for socio-demographic differences but strongly attenuated after adjusting for differences in intrinsic fall risk factors. Conclusion There is considerable variation in the rate of falling between European countries, which can largely be explained by between-country variation in the prevalence of intrinsic fall risk factors. There are also country-specific variations in the association between these intrinsic risk factors and falling. These findings emphasise the importance of addressing intrinsic fall risk in (inter)national fall-prevention strategies, while highlighting country-specific priorities. PMID:28667220

The "Aachen fall prevention App" - a Smartphone application app for the self-assessment of elderly patients at risk for ground level falls.

PubMed

Rasche, Peter; Mertens, Alexander; Bröhl, Christina; Theis, Sabine; Seinsch, Tobias; Wille, Matthias; Pape, Hans-Christoph; Knobe, Matthias

2017-01-01

Fall incidents are a major problem for patients and healthcare. The "Aachen Fall Prevention App" (AFPA) represents the first mobile Health (mHealth) application (app) empowering older patients (persons 50+ years) to self-assess and monitor their individual fall risk. Self-assessment is based on the "Aachen Fall Prevention Scale," which consists of three steps. First, patients answer ten standardized yes-no questions (positive criterion ≥ 5 "Yes" responses). Second, a ten-second test of free standing without compensatory movement is performed (positive criterion: compensatory movement). Finally, during the third step, patients rate their subjective fall risk on a 10-point Likert scale, based on the results of steps one and two. The purpose of this app is (1) to offer a low-threshold service through which individuals can independently monitor their individual fall risk and (2) to collect data about how a patient-centered mHealth app for fall risk assessment is used in the field. The results represent the first year of an ongoing field study. From December 2015 to December 2016, 197 persons downloaded the AFPA (iOS ™ and Android ™ ; free of charge). N  = 111 of these persons voluntarily shared their data and thereby participated in the field study. Data from a final number of n  = 79 persons were analyzed due to exclusion criteria (age, missing objective fall risk, missing self-assessment). The objective fall risk and the self-assessed subjective risk measured by the AFPA showed a significant positive relationship. The "Aachen Fall Prevention App" (AFPA) is an mHealth app released for iOS and Android. This field study revealed the AFPA as a promising tool to raise older adults' awareness of their individual fall risk by means of a low-threshold patient-driven fall risk assessment tool.

Systematic Review of Falls in Older Adults with Cancer

PubMed Central

Wildes, Tanya M; Dua, Priya; Fowler, Susan A.; Miller, J. Philip; Carpenter, Christopher R.; Avidan, Michael S.; Stark, Susan

2014-01-01

Objectives lder adults frequently experience falls, at great cost to themselves and society. Older adults with cancer may be at greater risk for falls and have unique risk factors. Materials and Methods We undertook a systematic review of the available medical literature to examine the current evidence regarding factors associated with falls in older adults with cancer. PubMed, Embase, CINAHL, CENTRAL, DARE, Cochrane Database of Systematic Reviews and clinical trials.gov were searched using standardized terms for concepts of oncology/cancer, people 60 and older, screening, falls and diagnosis. Eligible studies included cohort or case-control studies or clinical trials in which all patients, or a subgroup of patients, had a diagnosis of cancer and in which falls were either the primary or secondary outcome. Results We identified 31 studies that met our inclusion criteria. Several studies suggest that falls are more common in older adults with a diagnosis of cancer than those without. Among the 11 studies that explored factors associated with outpatient falls, some risk factors for falls established in the general population were also associated with falls in older adults with cancer, including dependence in activities of daily living and prior falls. Other factors associated with falls in a general population, such as age, polypharmacy and opioid use, were not predictive of falls among oncology populations. Falls among older adults with cancer in the inpatient setting were associated with established risk factors for falls in people without cancer, but also with factors unique to an oncology population, such as brain metastases. Conclusions Falls in older adults with cancer are more common than in the general population, and are associated with risk factors unique to people with cancer. Further study is needed to establish methods of screening older adults with cancer for fall risk and ultimately implement interventions to reduce their risk of falls. Identifying which older adults with cancer are at greater risk for falls is a requisite step to ultimately intervene and prevent falls in this vulnerable population. PMID:25454770

Falls-Related Drug Use and Risk of Falls Among Older Adults: A Study in a US Medicare Population.

PubMed

Musich, Shirley; Wang, Shaohung S; Ruiz, Joann; Hawkins, Kevin; Wicker, Ellen

2017-07-01

Approximately one-third of community-dwelling older adults fall each year, and approximately 10% have falls requiring medical services. Among other factors, research studies have linked certain medications with an increased risk of falls. The aim of this study was to examine the risk of falls relative to use patterns among new and continuing falls-related drug (FRD) users. A 10% random sample, insured in AARP ® Medicare Supplement and AARP Medicare Part D Rx plans, was utilized to define new and continuing FRD users. New users had a 12-month pre-period without FRD use, whereas continuing users had at least one FRD in the pre-period. Both groups had 12-month follow-up after initiating or continuing FRD use. Characteristics associated with the risk of falls for new and continuing users were determined using multivariate logistic regression models. Among insureds, 44% used at least one of the FRD classes. Of these, 29% were new users (N = 35,340) and 71% were continuing users (N = 121,488). Fall rates for the two subgroups were similar at 7 and 8%, respectively. Characteristics associated with the risk of falls were previous injurious fall, use of two or more classes of FRDs, older age, poorer health, and being female. New users were at higher risk than continuing users. New users of FRDs were at highest risk of falls, and continuing users were at increased risk, especially with higher numbers of FRD classes. Both groups could benefit from falls awareness and prevention programs.

Improving nursing students' assessment of fall risk in community-dwelling older adults.

PubMed

Patton, Susan K

2016-12-09

Nationally, approximately one third of older adults fall each year. Falls and resulting injury result in decreased mobility, functional impairment, loss of independence, and increased mortality. Utilization of evidence-based protocols by health care providers to identify older adults at risk of falling is limited, and rates of participation by older adults in prevention activities is low. Because of nursing's increasing role in caring for older adults, development of fall prevention education for nursing students would result in increased awareness of the need for fall prevention in community-dwelling older adults and increased access of older adults to falls risk assessment. There is a need to extend research to inform teaching and learning strategies for fall prevention. After pretesting, a convenience sample of 52 undergraduate nursing students and 22 graduate nursing students completed an online education program and performed a falls risk assessment on an older adult. After completing the clinical assignment, students completed a posttest and self-efficacy survey. Data were analyzed using multivariate statistical tests. Results revealed an increase in knowledge and student self-reporting of efficacy of fall risk assessment skills for the older adult population. This study suggests that nursing students acquired the necessary knowledge and self-efficacy for assessing fall risk of older adults through the combination of an online learning module and participating in actual fall risk assessment of an older adult.

Adoption of Evidence-Based Fall Prevention Practices in Primary Care for Older Adults with a History of Falls.

PubMed

Phelan, Elizabeth A; Aerts, Sally; Dowler, David; Eckstrom, Elizabeth; Casey, Colleen M

2016-01-01

A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79 ± 8 years; 68% were female, and 10% were non-white. They averaged six primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall-risk factors varied from 24% (for home safety) to 78% (for vitamin D). An evidence-based intervention was recommended for identified risk factors 73% of the time, on average. Two risk factors were addressed infrequently: medications (21%) and home safety (24%). Use of a structured visit note template independently predicted assessment of fall-risk factors (p = 0.003). Geriatrics specialists were more likely to use a structured note template (p = 0.04) and perform more fall-risk factor assessments (4.6 vs. 3.6, p = 0.007) than general internists. These results suggest opportunities for improving multifactorial fall-risk assessment and management of older adults at high fall risk in primary care. A structured visit note template facilitates assessment. Given that high-risk medications have been found to be independent risk factors for falls, increasing attention to medications should become a key focus of both public health educational efforts and fall prevention in primary care practice.

Adoption of Evidence-Based Fall Prevention Practices in Primary Care for Older Adults with a History of Falls

PubMed Central

Phelan, Elizabeth A.; Aerts, Sally; Dowler, David; Eckstrom, Elizabeth; Casey, Colleen M.

2016-01-01

A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79 ± 8 years; 68% were female, and 10% were non-white. They averaged six primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall-risk factors varied from 24% (for home safety) to 78% (for vitamin D). An evidence-based intervention was recommended for identified risk factors 73% of the time, on average. Two risk factors were addressed infrequently: medications (21%) and home safety (24%). Use of a structured visit note template independently predicted assessment of fall-risk factors (p = 0.003). Geriatrics specialists were more likely to use a structured note template (p = 0.04) and perform more fall-risk factor assessments (4.6 vs. 3.6, p = 0.007) than general internists. These results suggest opportunities for improving multifactorial fall-risk assessment and management of older adults at high fall risk in primary care. A structured visit note template facilitates assessment. Given that high-risk medications have been found to be independent risk factors for falls, increasing attention to medications should become a key focus of both public health educational efforts and fall prevention in primary care practice. PMID:27660753

Falls screening and assessment tools used in acute mental health settings: a review of policies in England and Wales

PubMed Central

Narayanan, V.; Dickinson, A.; Victor, C.; Griffiths, C.; Humphrey, D.

2016-01-01

Objectives There is an urgent need to improve the care of older people at risk of falls or who experience falls in mental health settings. The aims of this study were to evaluate the individual falls risk assessment tools adopted by National Health Service (NHS) mental health trusts in England and healthcare boards in Wales, to evaluate the comprehensiveness of these tools and to review their predictive validity. Methods All NHS mental health trusts in England (n = 56) and healthcare boards in Wales (n = 6) were invited to supply their falls policies and other relevant documentation (e.g. local falls audits). In order to check the comprehensiveness of tools listed in policy documents, the risk variables of the tools adopted by the mental health trusts’ policies were compared with the 2004 National Institute for Health and Care Excellence (NICE) falls prevention guidelines. A comprehensive analytical literature review was undertaken to evaluate the predictive validity of the tools used in these settings. Results Falls policies were obtained from 46 mental health trusts. Thirty-five policies met the study inclusion criteria and were included in the analysis. The main falls assessment tools used were the St. Thomas’ Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY), Falls Risk Assessment Scale for the Elderly, Morse Falls Scale (MFS) and Falls Risk Assessment Tool (FRAT). On detailed examination, a number of different versions of the FRAT were evident; validated tools had inconsistent predictive validity and none of them had been validated in mental health settings. Conclusions Falls risk assessment is the most commonly used component of risk prevention strategies, but most policies included unvalidated tools and even well validated tool such as the STRATIFY and the MFS that are reported to have inconsistent predictive accuracy. This raises questions about operational usefulness, as none of these tools have been tested in acute mental health settings. The falls risk assessment tools from only four mental health trusts met all the recommendations of the NICE falls guidelines on multifactorial assessment for prevention of falls. The recent NICE (2013) guidance states that tools predicting risk using numeric scales should no longer be used; however, multifactorial risk assessment and interventions tailored to patient needs is recommended. Trusts will need to update their policies in response to this guidance. PMID:26395210

The Association Between Body Adiposity Measures, Postural Balance, Fear of Falling, and Fall Risk in Older Community-Dwelling Women.

PubMed

Neri, Silvia Gonçalves Ricci; Gadelha, André Bonadias; de David, Ana Cristina; Ferreira, Aparecido Pimentel; Safons, Marisete Peralta; Tiedemann, Anne; Lima, Ricardo M

2017-12-07

Recent investigations demonstrate an association between obesity and the propensity of older adults to fall. The aim of this study was to investigate the association between body adiposity measures, postural balance, fear of falling, and risk of falls in older women. One hundred forty-seven volunteers took part in this cross-sectional study. Participants underwent body composition assessment using dual-energy x-ray absorptiometry and had body mass index, waist circumference (WC), and body adiposity index measured. Postural balance was assessed using a force platform, while fear of falling and risk of falls were, respectively, evaluated by the Falls Efficacy Scale-International and the QuickScreen Clinical Falls Risk Assessment. All adiposity measures were correlated to at least 1 postural stability parameter and to fear of falling (ρ= 0.163, P < .05 to r = 0.337, P < .001); however, WC was the index most strongly correlated to risk of falls (ρ= 0.325; P < .001). When obesity was classified using WC, it was observed that compared with nonobese individuals (n = 51), obese individuals (n = 96) exhibited greater center of pressure displacement in the anteroposterior and mediolateral axes, especially during conditions with feet apart (P < .05). The obese group also exhibited an increased fear of falling (28.04 vs 24.59; P = .002) and had a higher proportion of individuals with increased fall risk (72% vs 35%; P < .001). In summary, adiposity measures are associated with risk of falls in older women, which might be mediated by reduced postural balance and increased fear of falling. Among these indices, WC, an easy and low-cost assessment, demonstrated the strongest association with falls-related outcomes.

Dance! Don't Fall - preventing falls and promoting exercise at home.

PubMed

Kerwin, Maureen; Nunes, Francisco; Silva, Paula Alexandra

2012-01-01

Falling is a serious danger to older adults that is usually only addressed after a person has fallen, when doctors administer clinical tests to determine the patient's risk of falling again. Having the technological capability of performing fall risk assessment tests with a smartphone, the authors set out to design a mobile application that would enable users to monitor their risk themselves and consequently prevent falls from occurring. The authors conducted a literature review and two observation sessions before beginning the iterative design process that resulted in the Dance! Don't Fall (DDF) game, a mobile application that enables users to both monitor their fall risk and actively reduce it through fun and easy exercise.

Use of fall risk increasing drugs in residents of retirement villages: a pilot study of long term care and retirement home residents in Ontario, Canada.

PubMed

Rojas-Fernandez, Carlos; Dadfar, Farzan; Wong, Andrea; Brown, Susan G

2015-10-14

Falls continue to be a problem for older people in long-term care (LTC) and retirement home (RH) settings and are associated with significant morbidity and health care use. Fall-risk increasing drugs (FRIDs) are known to increase fall risk and represent modifiable risk factors. There are limited data regarding the use of FRIDs in contemporary LTC and RH settings, and it has not been well documented to what extent medication regimens are reviewed and modified for those who have sustained falls. The objective of this study is to characterize medication related fall risk factors in LTC and RH residents and on-going use of medications known to increase fall risk. Retrospective chart review of residents aged >65 who sustained one or more falls living in LTC or RH settings. 105 residents who fell one or more times during 2009-2010 were identified with a mean age of 89 years, a mean of nine scheduled medications and seven diagnoses, and 83% were women. Residents in LTC were ostensibly at higher risk for falls relative to those in RH settings as suggested by higher proportion of residents with multiple falls, multiple comorbidities, comorbidities that increase fall risk and visual impairment. Post fall injuries were sustained by 42% of residents, and residents in RH sustained more injuries relative to LTC residents (47 vs 34%). Use of FRIDs such as benzodiazepines, antipsychotic, antidepressant and various antihypertensive drugs was common in the present sample. No medication regimen changes were noted in the 6-month post fall period. The present study documented common use FRIDs by LTC and RH residents with multiple falls. These potentially modifiable falls risk factors are not being adequately addressed in contemporary practice, demonstrating that there is much room for improvement with regards to the safe and appropriate use of medications in LTC and RH residents.

Executive function and falls in older adults: new findings from a five-year prospective study link fall risk to cognition.

PubMed

Mirelman, Anat; Herman, Talia; Brozgol, Marina; Dorfman, Moran; Sprecher, Elliot; Schweiger, Avraham; Giladi, Nir; Hausdorff, Jeffrey M

2012-01-01

Recent findings suggest that executive function (EF) plays a critical role in the regulation of gait in older adults, especially under complex and challenging conditions, and that EF deficits may, therefore, contribute to fall risk. The objective of this study was to evaluate if reduced EF is a risk factor for future falls over the course of 5 years of follow-up. Secondary objectives were to assess whether single and dual task walking abilities, an alternative window into EF, were associated with fall risk. We longitudinally followed 256 community-living older adults (age: 76.4±4.5 yrs; 61% women) who were dementia free and had good mobility upon entrance into the study. At baseline, a computerized cognitive battery generated an index of EF, attention, a closely related construct, and other cognitive domains. Gait was assessed during single and dual task conditions. Falls data were collected prospectively using monthly calendars. Negative binomial regression quantified risk ratios (RR). After adjusting for age, gender and the number of falls in the year prior to the study, only the EF index (RR: .85; CI: .74-.98, p = .021), the attention index (RR: .84; CI: .75-.94, p = .002) and dual tasking gait variability (RR: 1.11; CI: 1.01-1.23; p = .027) were associated with future fall risk. Other cognitive function measures were not related to falls. Survival analyses indicated that subjects with the lowest EF scores were more likely to fall sooner and more likely to experience multiple falls during the 66 months of follow-up (p<0.02). These findings demonstrate that among community-living older adults, the risk of future falls was predicted by performance on EF and attention tests conducted 5 years earlier. The present results link falls among older adults to cognition, indicating that screening EF will likely enhance fall risk assessment, and that treatment of EF may reduce fall risk.

Fall risk assessment: retrospective analysis of Morse Fall Scale scores in Portuguese hospitalized adult patients.

PubMed

Sardo, Pedro Miguel Garcez; Simões, Cláudia Sofia Oliveira; Alvarelhão, José Joaquim Marques; Simões, João Filipe Fernandes Lindo; Melo, Elsa Maria de Oliveira Pinheiro de

2016-08-01

The Morse Fall Scale is used in several care settings for fall risk assessment and supports the implementation of preventive nursing interventions. Our work aims to analyze the Morse Fall Scale scores of Portuguese hospitalized adult patients in association with their characteristics, diagnoses and length of stay. Retrospective cohort analysis of Morse Fall Scale scores of 8356 patients hospitalized during 2012. Data were associated to age, gender, type of admission, specialty units, length of stay, patient discharge, and ICD-9 diagnosis. Elderly patients, female, with emergency service admission, at medical units and/or with longer length of stays were more frequently included in the risk group for falls. ICD-9 diagnosis may also be an important risk factor. More than a half of hospitalized patients had "medium" to "high" risk of falling during the length of stay, which determines the implementation and maintenance of protocoled preventive nursing interventions throughout hospitalization. There are several fall risk factors not assessed by Morse Fall Scale. There were no statistical differences in Morse Fall Scale score between the first and the last assessment. Copyright © 2015 Elsevier Inc. All rights reserved.

Falls in patients with chronic obstructive pulmonary disease: a call for further research

PubMed Central

Roig, M; Eng, JJ; MacIntyre, DL; Road, JD; Reid, WD.

2012-01-01

Summary Chronic obstructive pulmonary disease (COPD) is a respiratory disease that results in airflow limitation and respiratory distress. The effects of COPD, however, are not exclusively limited to respiratory function and people with COPD face many non-respiratory manifestations that affect both function and mobility. Deficits in function and mobility have been associated with an increased risk for falling in older adults. The purpose of this study was to provide a theoretical framework to identify risks factors for falls in people with COPD. We have analyzed the literature to identify possible relationships between pathophysiological changes observed in COPD and common risk factors for falls. Well-established fall risk factors in people with COPD include lower limb muscle weakness and impaired activities of daily living. Other intrinsic risk factors such as gait and balance deficits, nutritional depletion, malnutrition, depression, cognitive impairments and medications are possible risk factors that need to be confirmed with more studies. There is no evidence that visual deficits are common in COPD. The role that precipitating factors such as syncope and postural hypotension may have on fall risk is unclear. Exacerbations and dyspnea do not have a precipitating effect on fall risk but they contribute to the progressive physical deterioration that may theoretically increase the risk for falls. While these results suggest that people with COPD might have an increased susceptibility to fall compared to their healthy peers, further research is needed to determine the prevalence of falls and specific risk factors for falls in people living with COPD. PMID:19419852

The Relationship between Falls Efficacy and Improvement in Fall Risk Factors Following an Exercise Plus Educational Intervention for Older Adults with Hip Osteoarthritis.

PubMed

Arnold, C M; Faulkner, R A; Gyurcsik, N C

2011-01-01

Older adults with decreased confidence in their ability to prevent a fall may benefit from an exercise programme that includes self-efficacy-enhancing education. The objectives of this study were to explore differences in fall-risk outcomes in older adults with higher vs. lower levels of falls efficacy and to evaluate the relationship between baseline falls-efficacy status and changes in fall risk factors following two interventions. Fifty-four older adults with hip osteoarthritis and at least one risk factor for falls received aquatic exercise twice weekly plus education once weekly (EE) or aquatic exercise only, twice weekly (EO), for 11 weeks. EE participants with low baseline falls efficacy demonstrated significantly (p<0.05) greater improvement in balance and falls efficacy compared to EE participants with high baseline falls efficacy. In the EE group only, baseline falls-efficacy status (low vs. high median split on the Activities-specific Balance Confidence Scale) was significantly (p<0.05) correlated with positive balance and falls-efficacy change scores (Spearman rank r=0.45 and 0.63 respectively). Individuals with one or more fall-risk factors and low falls efficacy may benefit from receiving an intervention that combines exercise with self-efficacy-enhancing education. Falls-efficacy screening may be important for decisions regarding referral to fall-prevention programmes.

The Relationship between Falls Efficacy and Improvement in Fall Risk Factors Following an Exercise Plus Educational Intervention for Older Adults with Hip Osteoarthritis

PubMed Central

Faulkner, R.A.; Gyurcsik, N.C.

2011-01-01

ABSTRACT Purpose: Older adults with decreased confidence in their ability to prevent a fall may benefit from an exercise programme that includes self-efficacy-enhancing education. The objectives of this study were to explore differences in fall-risk outcomes in older adults with higher vs. lower levels of falls efficacy and to evaluate the relationship between baseline falls-efficacy status and changes in fall risk factors following two interventions. Method: Fifty-four older adults with hip osteoarthritis and at least one risk factor for falls received aquatic exercise twice weekly plus education once weekly (EE) or aquatic exercise only, twice weekly (EO), for 11 weeks. Results: EE participants with low baseline falls efficacy demonstrated significantly (p<0.05) greater improvement in balance and falls efficacy compared to EE participants with high baseline falls efficacy. In the EE group only, baseline falls-efficacy status (low vs. high median split on the Activities-specific Balance Confidence Scale) was significantly (p<0.05) correlated with positive balance and falls-efficacy change scores (Spearman rank r=0.45 and 0.63 respectively). Conclusions: Individuals with one or more fall-risk factors and low falls efficacy may benefit from receiving an intervention that combines exercise with self-efficacy-enhancing education. Falls-efficacy screening may be important for decisions regarding referral to fall-prevention programmes. PMID:22942514

Falls in Patients With Heart Failure: A Systematic Review.

PubMed

Lee, Kayoung; Pressler, Susan J; Titler, Marita

Many heart failure patients show fall-related signs/symptoms including postural hypotension, cerebellar injury, and cognitive impairments. Falls contribute to injuries, increased healthcare use, and death, but falls have been understudied in this population. The purpose of this review is to identify fall rates, fall injuries, and risk factors for falls in heart failure patients. A systematic literature review was conducted using MEDLINE, CINAHL, PubMed, PsycINFO, and Cochrane Library to identify publications from August 1973 to June 2013. Keywords were accidental falls, heart failure, fall rates, fall injuries, and fall risk. Inclusion criteria were publications that were primary data based, included heart failure sample, had falls/fall risk as study variables, and were written in English language. Exclusion criteria were quality improvement/evaluation, case reports/studies, news, opinions, narrative reviews, meeting reports, reflections, and letters to editors. Data were abstracted using a standardized data collection form. Four publications met the inclusion criteria. In the first study, fall rate was 43%, which is higher than the fall rates among community-dwelling older adults. Fall-related injuries were not examined in any of studies. Benzodiazepines and digoxin were identified as medications that increased risk of falls in 1 case-control study. Loop diuretics were not significantly associated with falls in 1 cohort study. In the fourth study, patients who had poor gait and balance were at greater risk of falling. Future studies are needed to determine factors associated with falls, characterize injuries resulting from falls, and most importantly design testable interventions to prevent falls in heart failure patients.

FRAT-up, a Web-based Fall-Risk Assessment Tool for Elderly People Living in the Community

PubMed Central

Cattelani, Luca; Palumbo, Pierpaolo; Palmerini, Luca; Bandinelli, Stefania; Becker, Clemens; Chiari, Lorenzo

2015-01-01

Background About 30% of people over 65 are subject to at least one unintentional fall a year. Fall prevention protocols and interventions can decrease the number of falls. To be effective, a prevention strategy requires a prior step to evaluate the fall risk of the subjects. Despite extensive research, existing assessment tools for fall risk have been insufficient for predicting falls. Objective The goal of this study is to present a novel web-based fall-risk assessment tool (FRAT-up) and to evaluate its accuracy in predicting falls, within a context of community-dwelling persons aged 65 and up. Methods FRAT-up is based on the assumption that a subject’s fall risk is given by the contribution of their exposure to each of the known fall-risk factors. Many scientific studies have investigated the relationship between falls and risk factors. The majority of these studies adopted statistical approaches, usually providing quantitative information such as odds ratios. FRAT-up exploits these numerical results to compute how each single factor contributes to the overall fall risk. FRAT-up is based on a formal ontology that enlists a number of known risk factors, together with quantitative findings in terms of odds ratios. From such information, an automatic algorithm generates a rule-based probabilistic logic program, that is, a set of rules for each risk factor. The rule-based program takes the health profile of the subject (in terms of exposure to the risk factors) and computes the fall risk. A Web-based interface allows users to input health profiles and to visualize the risk assessment for the given subject. FRAT-up has been evaluated on the InCHIANTI Study dataset, a representative population-based study of older persons living in the Chianti area (Tuscany, Italy). We compared reported falls with predicted ones and computed performance indicators. Results The obtained area under curve of the receiver operating characteristic was 0.642 (95% CI 0.614-0.669), while the Brier score was 0.174. The Hosmer-Lemeshow test indicated statistical significance of miscalibration. Conclusions FRAT-up is a web-based tool for evaluating the fall risk of people aged 65 or up living in the community. Validation results of fall risks computed by FRAT-up show that its performance is comparable to externally validated state-of-the-art tools. A prototype is freely available through a web-based interface. Trial Registration ClinicalTrials.gov NCT01331512 (The InChianti Follow-Up Study); http://clinicaltrials.gov/show/NCT01331512 (Archived by WebCite at http://www.webcitation.org/6UDrrRuaR). PMID:25693419

[Fall prevention counselling for patients with hearing and balance disorders].

PubMed

Ptok, M; Ptok, A; Jungheim, M; Kühn, D; Miller, S

2014-09-01

Otolaryngologists caring for patients with hearing and balance disorders are also responsible for advising patients about their increased risk of falling and informing them of fall prevention measures. This review will give a brief overview of appropriate programs. This systematic review is based on a selective literature search. Intrinsic and extrinsic fall risk factors can be distinguished. The former include not only hearing and balance disorders, but also increasing age, nocturia, dementia, limited mobility and poor nutritional status. Extrinsic factors include, for example, unfixed carpet edges, poor lighting and poor footwear. Fall prevention can be achieved through appropriate counselling about risk factors and fall prevention courses. The frequency of falls--with potentially very adverse consequences--increases continuously beyond the age of 60 years. Furthermore, the risk of falling is significantly increased in patients with hearing and balance disorders. Otolaryngologists caring for this patient group should inform them about their fall risk and advise appropriate countermeasures during counselling. A basal knowledge of fall prevention measures is therefore helpful.

Falls: Epidemiology, Pathophysiology, and Relationship to Fracture

PubMed Central

Berry, Sarah D.; Miller, Ram

2009-01-01

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. PMID:19032925

The Stroke Assessment of Fall Risk (SAFR): predictive validity in inpatient stroke rehabilitation.

PubMed

Breisinger, Terry P; Skidmore, Elizabeth R; Niyonkuru, Christian; Terhorst, Lauren; Campbell, Grace B

2014-12-01

To evaluate relative accuracy of a newly developed Stroke Assessment of Fall Risk (SAFR) for classifying fallers and non-fallers, compared with a health system fall risk screening tool, the Fall Harm Risk Screen. Prospective quality improvement study conducted at an inpatient stroke rehabilitation unit at a large urban university hospital. Patients admitted for inpatient stroke rehabilitation (N = 419) with imaging or clinical evidence of ischemic or hemorrhagic stroke, between 1 August 2009 and 31 July 2010. Not applicable. Sensitivity, specificity, and area under the curve for Receiver Operating Characteristic Curves of both scales' classifications, based on fall risk score completed upon admission to inpatient stroke rehabilitation. A total of 68 (16%) participants fell at least once. The SAFR was significantly more accurate than the Fall Harm Risk Screen (p < 0.001), with area under the curve of 0.73, positive predictive value of 0.29, and negative predictive value of 0.94. For the Fall Harm Risk Screen, area under the curve was 0.56, positive predictive value was 0.19, and negative predictive value was 0.86. Sensitivity and specificity of the SAFR (0.78 and 0.63, respectively) was higher than the Fall Harm Risk Screen (0.57 and 0.48, respectively). An evidence-derived, population-specific fall risk assessment may more accurately predict fallers than a general fall risk screen for stroke rehabilitation patients. While the SAFR improves upon the accuracy of a general assessment tool, additional refinement may be warranted. © The Author(s) 2014.

Metric properties of the "timed get up and go- modified version" test, in risk assessment of falls in active women

PubMed Central

2017-01-01

Abstract Objective: To analyse the metric properties of the Timed Get up and Go-Modified Version Test (TGUGM), in risk assessment of falls in a group of physically active women. Methods: A sample was constituted by 202 women over 55 years of age, were assessed through a crosssectional study. The TGUGM was applied to assess their fall risk. The test was analysed by comparison of the qualitative and quantitative information and by factor analysis. The development of a logistic regression model explained the risk of falls according to the test components. Results: The TGUGM was useful for assessing the risk of falls in the studied group. The test revealed two factors: the Get Up and the Gait with dual task. Less than twelve points in the evaluation or runtimes higher than 35 seconds was associated with high risk of falling. More than 35 seconds in the test indicated a risk fall probability greater than 0.50. Also, scores less than 12 points were associated with a delay of 7 seconds more in the execution of the test (p= 0.0016). Conclusions: Factor analysis of TGUGM revealed two dimensions that can be independent predictors of risk of falling: The Get up that explains between 64% and 87% of the risk of falling, and the Gait with dual task, that explains between 77% and 95% of risk of falling. PMID:28559642

Dementia as a risk factor for falls and fall injuries among nursing home residents.

PubMed

van Doorn, Carol; Gruber-Baldini, Ann L; Zimmerman, Sheryl; Hebel, J Richard; Port, Cynthia L; Baumgarten, Mona; Quinn, Charlene C; Taler, George; May, Conrad; Magaziner, Jay

2003-09-01

To compare rates of falling between nursing home residents with and without dementia and to examine dementia as an independent risk factor for falls and fall injuries. Prospective cohort study with 2 years of follow-up. Fifty-nine randomly selected nursing homes in Maryland, stratified by geographic region and facility size. Two thousand fifteen newly admitted residents aged 65 and older. During 2 years after nursing home admission, fall data were collected from nursing home charts and hospital discharge summaries. The unadjusted fall rate for residents in the nursing home with dementia was 4.05 per year, compared with 2.33 falls per year for residents without dementia (P<.0001). The effect of dementia on the rate of falling persisted when known risk factors were taken into account. Among fall events, those occurring to residents with dementia were no more likely to result in injury than falls of residents without dementia, but, given the markedly higher rates of falling by residents with dementia, their rate of injurious falls was higher than for residents without dementia. Dementia is an independent risk factor for falling. Although most falls do not result in injury, the fact that residents with dementia fall more often than their counterparts without dementia leaves them with a higher overall risk of sustaining injurious falls over time. Nursing home residents with dementia should be considered important candidates for fall-prevention and fall-injury-prevention strategies.

Risk Profiles for Injurious Falls in People Over 60: A Population-Based Cohort Study

PubMed Central

Ek, Stina; Rizzuto, Debora; Fratiglioni, Laura; Johnell, Kristina; Xu, Weili

2018-01-01

Abstract Background Although falls in older adults are related to multiple risk factors, these factors have commonly been studied individually. We aimed to identify risk profiles for injurious falls in older adults by detecting clusters of established risk factors and quantifying their impact on fall risk. Methods Participants were 2,566 people, aged 60 years and older, from the population-based Swedish National Study on Aging and Care in Kungsholmen. Injurious falls was defined as hospitalization for or receipt of outpatient care because a fall. Cluster analysis was used to identify aggregation of possible risk factors including chronic diseases, fall-risk increasing drugs (FRIDs), physical and cognitive impairments, and lifestyle-related factors. Associations between the clusters and injurious falls over 3, 5, and 10 years were estimated using flexible parametric survival models. Results Five clusters were identified including: a “healthy”, a “well-functioning with multimorbidity”, a “well-functioning, with multimorbidity and high FRID consumption”, a “physically and cognitively impaired”, and a “disabled” cluster. The risk of injurious falls for all groups was significantly higher than for the first cluster of healthy individuals in the reference category. Hazard ratios (95% confidence intervals) ranged from 1.71 (1.02–2.66) for the second cluster to 12.67 (7.38–21.75) for the last cluster over 3 years of follow-up. The highest risk was observed in the last two clusters with high burden of physical and cognitive impairments. Conclusion Risk factors for injurious fall tend to aggregate, representing different levels of risk for falls. Our findings can be useful to tailor and prioritize clinical and public health interventions. PMID:28605455

Frailty Versus Stopping Elderly Accidents, Deaths and Injuries Initiative Fall Risk Score: Ability to Predict Future Falls.

PubMed

Crow, Rebecca S; Lohman, Matthew C; Pidgeon, Dawna; Bruce, Martha L; Bartels, Stephen J; Batsis, John A

2018-03-01

To compare the ability of frailty status to predict fall risk with that of community fall risk screening tools. Analysis of cross-sectional and longitudinal data from NHATS. National Health and Aging Trend Study (NHATS) 2011-2015. Individuals aged 65 and older (N = 7,392). Fall risk was defined according to the Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative. Frailty was defined as exhaustion, weight loss, low activity, slow gait speed, and weak grip strength. Robust was defined as meeting 0 criteria, prefrailty as 1 or 2 criteria, and frailty as 3 or more criteria. Falls were self-reported and ascertained using NHATS subsequent rounds (2012-2015). We compared the ability of frailty to predict future falls with that of STEADI score, adjusting for age, race, sex, education, comorbidities, hearing and vision impairment, and disability. Of the 7,392 participants (58.5% female), there 3,545 (48.0%) were classified as being at low risk of falling, 2,966 (40.1%) as being at moderate risk, and 881 (11.9%) as being at high risk. The adjusted risk of falling over the 4 subsequent years was 2.5 times as great for the moderate-risk group (hazard ratio (HR) = 2.50, 95% confidence interval (CI) = 2.16-2.89) and almost 4 times as great (HR = 3.79, 95% CI = 2.76-5.21) for the high-risk group as for the low-risk group. Risk of falling was greater for those who were prefrail (HR = 1.34, 95% CI 1.16-1.55) and frail (HR = 1.20, 95% CI = 0.94-1.54) than for those who were robust. STEADI score is a strong predictor of future falls. Addition of frailty status does not improve the ability of the STEADI measure to predict future falls. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Quantitative rock-fall hazard and risk assessment for Yosemite Valley, Yosemite National Park, California

USGS Publications Warehouse

Stock, Greg M.; Luco, Nicolas; Collins, Brian D.; Harp, Edwin L.; Reichenbach, Paola; Frankel, Kurt L.

2014-01-01

Rock falls are common in Yosemite Valley, California, posing substantial hazard and risk to the approximately four million annual visitors to Yosemite National Park. Rock falls in Yosemite Valley over the past few decades have damaged structures and caused injuries within developed regions located on or adjacent to talus slopes highlighting the need for additional investigations into rock-fall hazard and risk. This assessment builds upon previous investigations of rock-fall hazard and risk in Yosemite Valley and focuses on hazard and risk to structures posed by relatively frequent fragmental-type rock falls as large as approximately 100,000 (cubic meters) in volume.

Falling and fall risk factors in adults with haemophilia: an exploratory study.

PubMed

Sammels, M; Vandesande, J; Vlaeyen, E; Peerlinck, K; Milisen, K

2014-11-01

Falls are a particular risk in persons with haemophilia (PWH) because of damaged joints, high risk of bleeding, possible impact on the musculoskeletal system and functioning and costs associated with treatment for these fall-related injuries. In addition, fall risk increases with age and PWH are increasingly entering the over 65 age group. The aim of this study was to determine the occurrence of falls during the past year and to explore which fall risk factors are present in community-dwelling PWH. Dutch speaking community-dwelling adults were included from the age of 40 years with severe or moderate haemophilia A or B, independent in their mobility and registered at the University Hospitals Leuven. They were asked to come to the haemophilia centre; otherwise a telephone survey was conducted. Demographic and social variables, medical variables, fall evaluation and clinical variables were queried. From the 89 PWH, 74 (83.1%) participated in the study. Twenty-four (32.4%) fell in the past year, and 10 of them (41.7%) more than once with an average of four falls. Living conditions, physical activity, avoidance of winter sports due to fear of falling, orthopaedic status, urinary incontinence and mobility impairments are potential fall risk factors in adult PWH. This exploratory study indicates that PWH are attentive to falling since they are at higher risk for falls and because of the serious consequences it might have. Screening and fall prevention should be stimulated in the daily practice of haemophilia care. © 2014 John Wiley & Sons Ltd.

Medication-related fall incidents in an older, ambulant population: the B-PROOF study.

PubMed

Ham, Annelies C; Swart, Karin M A; Enneman, Anke W; van Dijk, Suzanne C; Oliai Araghi, Sadaf; van Wijngaarden, Janneke P; van der Zwaluw, Nikita L; Brouwer-Brolsma, Elske M; Dhonukshe-Rutten, Rosalie A M; van Schoor, Natasja M; van der Cammen, Tischa J M; Lips, Paul; de Groot, Lisette C P G M; Uitterlinden, André G; Witkamp, Renger F; Stricker, Bruno H; van der Velde, Nathalie

2014-12-01

Medication use is a potentially modifiable risk factor for falling; psychotropic and cardiovascular drugs have been indicated as main drug groups that increase fall risk. However, evidence is mainly based on studies that recorded falls retrospectively and/or did not determine medication use at the time of the fall. Therefore, we investigated the associations indicated in the literature between medication use and falls, using prospectively recorded falls and medication use determined at the time of the fall. Data from the B-PROOF (B-vitamins for the prevention of osteoporotic fractures) study were used, concerning community-dwelling elderly aged ≥65 years. We included 2,407 participants with pharmacy dispensing records. During the 2- to 3-year follow-up, participants recorded falls using a fall calendar. Cox proportional hazard models were applied, adjusting for potential confounders including age, sex, health status variables and concomitant medication use. During follow-up, 1,147 participants experienced at least one fall. Users of anti-arrhythmic medication had an increased fall risk (hazard ratio [HR] 1.61; 95% confidence interval [CI] 1.12-2.32) compared with non-users. Similarly, non-selective beta-blocker use was associated with an increased fall risk (HR 1.41 [95% CI 1.12-1.78]), while statin use was associated with a lower risk (HR 0.81 [95% CI 0.71-0.94]). Benzodiazepine use (HR 1.32 [95% CI 1.02-1.71]), and antidepressant use (HR 1.40 [95% CI 1.07-1.82]) were associated with an increased fall risk. Use of other cardiovascular and psychotropic medication was not associated with fall risk. Our results strengthen the evidence for an increased fall risk in community-dwelling elderly during the use of anti-arrhythmics, non-selective beta-blockers, benzodiazepines, and antidepressant medication. Clinicians should prescribe these drugs cautiously and if possible choose safer alternatives for older patients.

Use of Risk Assessment Tool for Inpatient Traumatic Intracranial Hemorrhage after Falls in Acute Care Hospital Setting

PubMed Central

Toyabe, Shin-ichi

2012-01-01

Severe injuries such as intracranial hemorrhage (ICH) are the most serious problem after falls in hospital, but they have not been considered in risk assessment scores for falls. We tried to determine the risk factors for ICH after falls in 20,320 inpatients (696,364 patient-days) aged from 40 to 90 years who were admitted to a tertiary-care university hospital. Possible risk factors including STRATIFY risk score for falls and FRAX™ risk score for fractures were analyzed by univariate and multivariate analyses. Fallers accounted for 3.2% of the patients, and 5.0% of the fallers suffered major injuries, including peripheral bone fracture (59.6%) and ICH (23.4%). In addition to STRATIFY, FRAX™ was significantly associated not only with bone fractures but also ICH. Concomitant use of risk score for falls and risk score for fractures might be useful for the prediction of major injuries such as ICH after falls. PMID:22980233

Fall Risk, Supports and Services, and Falls Following a Nursing Home Discharge.

PubMed

Noureldin, Marwa; Hass, Zachary; Abrahamson, Kathleen; Arling, Greg

2017-09-04

Falls are a major source of morbidity and mortality among older adults; however, little is known regarding fall occurrence during a nursing home (NH) to community transition. This study sought to examine whether the presence of supports and services impacts the relationship between fall-related risk factors and fall occurrence post NH discharge. Participants in the Minnesota Return to Community Initiative who were assisted in achieving a community discharge (N = 1459) comprised the study sample. The main outcome was fall occurrence within 30 days of discharge. Factor analyses were used to estimate latent models from variables of interest. A structural equation model (SEM) was estimated to determine the relationship between the emerging latent variables and falls. Fifteen percent of participants fell within 30 days of NH discharge. Factor analysis of fall-related risk factors produced three latent variables: fall concerns/history; activities of daily living impairments; and use of high-risk medications. A supports/services latent variable also emerged that included caregiver support frequency, medication management assistance, durable medical equipment use, discharge location, and receipt of home health or skilled nursing services. In the SEM model, high-risk medications use and fall concerns/history had direct positive effects on falling. Receiving supports/services did not affect falling directly; however, it reduced the effect of high-risk medication use on falling (p < .05). Within the context of a state-implemented transition program, findings highlight the importance of supports/services in mitigating against medication-related risk of falling post NH discharge. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Falls prevention focused medication review by a pharmacist in an acute hospital: implications for future practice.

PubMed

Browne, Claire; Kingston, Claire; Keane, Claire

2014-10-01

Patients at risk of falling are regularly prescribed medicines which increase falls risk. Medication review is a widely advocated risk reduction strategy. The objectives of this descriptive study were to determine the number and types of falls risk medicines suitable for intervention, and to develop guidance to optimise the effectiveness of future medication related falls prevention initiatives. An Irish acute teaching hospital and tertiary referral centre. 50 hospital in-patients at risk of falls underwent medication review focused on falls prevention by a pharmacist. Falls risk medicines were identified, and reviewed. If scope to discontinue, dose reduce or switch to a safer alternative was identified by the pharmacist, the suggested medication changes were communicated to the patient's care team. Identification of the classes of falls risk medicines and types of prescriptions with greatest potential for intervention. Results The mean number of falls risk medicines prescribed to each patient was 4.8 (± 2.8) and the total number prescribed to the 50 patients was 238. Following medication review, the pharmacist identified 48 (20 %) as suitable for intervention. Consequently, 34 medication changes (70.8 %) were implemented. Four medication classes accounted for over 80 % of medication changes. These were anti-emetics, opioid analgesics, anti-cholinergic agents acting on the bladder and benzodiazepines/hypnotics. Intervention was statistically significantly more likely to be possible in the case of p.r.n. medicines compared to regular medicines (p < 0.001, Chi square test). Medication reviews focused on falls prevention took an average of 23.5 min per patient to complete. Medication reviews focused on falls prevention involve striking a balance between minimising medicines associated with falls and effectively treating medical conditions. We found only 20 % of falls risk medicines were suitable for change, and reviews were time consuming and resource intensive. However, targeting four medication classes, and being particularly alert to the potential to discontinue 'as required' medicines, has the potential to achieve most of the benefits of more comprehensive reviews. This information will guide the development of future falls risk medicine review initiatives in our hospital, increasing their feasibility in the acute hospital setting.

Fall Risk Awareness and Safety Precautions Taken by Older Community-Dwelling Women and Men—A Qualitative Study Using Focus Group Discussions

PubMed Central

Pohl, Petra; Sandlund, Marlene; Ahlgren, Christina; Bergvall-Kåreborn, Birgitta; Lundin-Olsson, Lillemor; Wikman, Anita Melander

2015-01-01

Introduction Daily life requires frequent estimations of the risk of falling and the ability to avoid a fall. The objective of this study was to explore older women’s and men’s understanding of fall risk and their experiences with safety precautions taken to prevent falls. Methods A qualitative study with focus group discussions was conducted. Eighteen community-dwelling people [10 women and 8 men] with and without a history of falls were purposively recruited. Participants were divided into two groups, and each group met four times. A participatory and appreciative action and reflection approach was used to guide the discussions. All discussions were audio recorded and transcribed verbatim. Data were analysed by qualitative content analysis, and categories were determined inductively. Findings Three categories describing the process of becoming aware of fall risks in everyday life were identified: 1] Facing various feelings, 2] Recognizing one’s fall risk, and 3] Taking precautions. Each category comprised several subcategories. The comprehensive theme derived from the categories was “Safety precautions through fall risk awareness”. Three strategies of ignoring [continuing a risky activity], gaining insight [realizing the danger in a certain situation], and anticipating [thinking ahead and acting in advance] were related to all choices of actions and could fluctuate in the same person in different contexts. Conclusions The fall risk awareness process might be initiated for various reasons and can involve different feelings and precautions as well as different strategies. This finding highlights that there are many possible channels to reach older people with information about fall risk and fall prevention, including the media and their peers. The findings offer a deeper understanding of older peoples’ conceptualizations about fall risk awareness and make an important contribution to the development and implementation of fall prevention programmes. PMID:25781181

Interventions for preventing falls in older people living in the community.

PubMed

Gillespie, Lesley D; Robertson, M Clare; Gillespie, William J; Sherrington, Catherine; Gates, Simon; Clemson, Lindy M; Lamb, Sarah E

2012-09-12

Approximately 30% of people over 65 years of age living in the community fall each year. This is an update of a Cochrane review first published in 2009. To assess the effects of interventions designed to reduce the incidence of falls in older people living in the community. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (February 2012), CENTRAL (The Cochrane Library 2012, Issue 3), MEDLINE (1946 to March 2012), EMBASE (1947 to March 2012), CINAHL (1982 to February 2012), and online trial registers. Randomised trials of interventions to reduce falls in community-dwelling older people. Two review authors independently assessed risk of bias and extracted data. We used a rate ratio (RaR) and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person year) between intervention and control groups. For risk of falling, we used a risk ratio (RR) and 95% CI based on the number of people falling (fallers) in each group. We pooled data where appropriate. We included 159 trials with 79,193 participants. Most trials compared a fall prevention intervention with no intervention or an intervention not expected to reduce falls. The most common interventions tested were exercise as a single intervention (59 trials) and multifactorial programmes (40 trials). Sixty-two per cent (99/159) of trials were at low risk of bias for sequence generation, 60% for attrition bias for falls (66/110), 73% for attrition bias for fallers (96/131), and only 38% (60/159) for allocation concealment.Multiple-component group exercise significantly reduced rate of falls (RaR 0.71, 95% CI 0.63 to 0.82; 16 trials; 3622 participants) and risk of falling (RR 0.85, 95% CI 0.76 to 0.96; 22 trials; 5333 participants), as did multiple-component home-based exercise (RaR 0.68, 95% CI 0.58 to 0.80; seven trials; 951 participants and RR 0.78, 95% CI 0.64 to 0.94; six trials; 714 participants). For Tai Chi, the reduction in rate of falls bordered on statistical significance (RaR 0.72, 95% CI 0.52 to 1.00; five trials; 1563 participants) but Tai Chi did significantly reduce risk of falling (RR 0.71, 95% CI 0.57 to 0.87; six trials; 1625 participants).Multifactorial interventions, which include individual risk assessment, reduced rate of falls (RaR 0.76, 95% CI 0.67 to 0.86; 19 trials; 9503 participants), but not risk of falling (RR 0.93, 95% CI 0.86 to 1.02; 34 trials; 13,617 participants).Overall, vitamin D did not reduce rate of falls (RaR 1.00, 95% CI 0.90 to 1.11; seven trials; 9324 participants) or risk of falling (RR 0.96, 95% CI 0.89 to 1.03; 13 trials; 26,747 participants), but may do so in people with lower vitamin D levels before treatment.Home safety assessment and modification interventions were effective in reducing rate of falls (RR 0.81, 95% CI 0.68 to 0.97; six trials; 4208 participants) and risk of falling (RR 0.88, 95% CI 0.80 to 0.96; seven trials; 4051 participants). These interventions were more effective in people at higher risk of falling, including those with severe visual impairment. Home safety interventions appear to be more effective when delivered by an occupational therapist.An intervention to treat vision problems (616 participants) resulted in a significant increase in the rate of falls (RaR 1.57, 95% CI 1.19 to 2.06) and risk of falling (RR 1.54, 95% CI 1.24 to 1.91). When regular wearers of multifocal glasses (597 participants) were given single lens glasses, all falls and outside falls were significantly reduced in the subgroup that regularly took part in outside activities. Conversely, there was a significant increase in outside falls in intervention group participants who took part in little outside activity.Pacemakers reduced rate of falls in people with carotid sinus hypersensitivity (RaR 0.73, 95% CI 0.57 to 0.93; three trials; 349 participants) but not risk of falling. First eye cataract surgery in women reduced rate of falls (RaR 0.66, 95% CI 0.45 to 0.95; one trial; 306 participants), but second eye cataract surgery did not.Gradual withdrawal of psychotropic medication reduced rate of falls (RaR 0.34, 95% CI 0.16 to 0.73; one trial; 93 participants), but not risk of falling. A prescribing modification programme for primary care physicians significantly reduced risk of falling (RR 0.61, 95% CI 0.41 to 0.91; one trial; 659 participants).An anti-slip shoe device reduced rate of falls in icy conditions (RaR 0.42, 95% CI 0.22 to 0.78; one trial; 109 participants). One trial (305 participants) comparing multifaceted podiatry including foot and ankle exercises with standard podiatry in people with disabling foot pain significantly reduced the rate of falls (RaR 0.64, 95% CI 0.45 to 0.91) but not the risk of falling.There is no evidence of effect for cognitive behavioural interventions on rate of falls (RaR 1.00, 95% CI 0.37 to 2.72; one trial; 120 participants) or risk of falling (RR 1.11, 95% CI 0.80 to 1.54; two trials; 350 participants).Trials testing interventions to increase knowledge/educate about fall prevention alone did not significantly reduce the rate of falls (RaR 0.33, 95% CI 0.09 to 1.20; one trial; 45 participants) or risk of falling (RR 0.88, 95% CI 0.75 to 1.03; four trials; 2555 participants).No conclusions can be drawn from the 47 trials reporting fall-related fractures.Thirteen trials provided a comprehensive economic evaluation. Three of these indicated cost savings for their interventions during the trial period: home-based exercise in over 80-year-olds, home safety assessment and modification in those with a previous fall, and one multifactorial programme targeting eight specific risk factors. Group and home-based exercise programmes, and home safety interventions reduce rate of falls and risk of falling.Multifactorial assessment and intervention programmes reduce rate of falls but not risk of falling; Tai Chi reduces risk of falling.Overall, vitamin D supplementation does not appear to reduce falls but may be effective in people who have lower vitamin D levels before treatment.

Falls and Fall-Prevention in Older Persons: Geriatrics Meets Spaceflight!

PubMed Central

Goswami, Nandu

2017-01-01

This paper provides a general overview of key physiological consequences of microgravity experienced during spaceflight and of important parallels and connections to the physiology of aging. Microgravity during spaceflight influences cardiovascular function, cerebral autoregulation, musculoskeletal, and sensorimotor system performance. A great deal of research has been carried out to understand these influences and to provide countermeasures to reduce the observed negative consequences of microgravity on physiological function. Such research can inform and be informed by research related to physiological changes and the deterioration of physiological function due to aging. For example, head-down bedrest is used as a model to study effects of spaceflight deconditioning due to reduced gravity. As hospitalized older persons spend up to 80% of their time in bed, the deconditioning effects of bedrest confinement on physiological functions and parallels with spaceflight deconditioning can be exploited to understand and combat both variations of deconditioning. Deconditioning due to bed confinement in older persons can contribute to a downward spiral of increasing frailty, orthostatic intolerance, falls, and fall-related injury. As astronauts in space spend substantial amounts of time carrying out exercise training to counteract the microgravity-induced deconditioning and to counteract orthostatic intolerance on return to Earth, it is logical to suggest some of these interventions for bed-confined older persons. Synthesizing knowledge regarding deconditioning due to reduced gravitational stress in space and deconditioning during bed confinement allows for a more comprehensive approach that can incorporate aspects such as (mal-) nutrition, muscle strength and function, cardiovascular (de-) conditioning, and cardio-postural interactions. The impact of such integration can provide new insights and lead to methods of value for both space medicine and geriatrics (Geriatrics meets spaceflight!). In particular, such integration can lead to procedures that address the morbidity and the mortality associated with bedrest immobilization and in the rising health care costs associated with an aging population demographic. PMID:29075195

Falls and Fall-Prevention in Older Persons: Geriatrics Meets Spaceflight!

PubMed

Goswami, Nandu

2017-01-01

This paper provides a general overview of key physiological consequences of microgravity experienced during spaceflight and of important parallels and connections to the physiology of aging. Microgravity during spaceflight influences cardiovascular function, cerebral autoregulation, musculoskeletal, and sensorimotor system performance. A great deal of research has been carried out to understand these influences and to provide countermeasures to reduce the observed negative consequences of microgravity on physiological function. Such research can inform and be informed by research related to physiological changes and the deterioration of physiological function due to aging. For example, head-down bedrest is used as a model to study effects of spaceflight deconditioning due to reduced gravity. As hospitalized older persons spend up to 80% of their time in bed, the deconditioning effects of bedrest confinement on physiological functions and parallels with spaceflight deconditioning can be exploited to understand and combat both variations of deconditioning. Deconditioning due to bed confinement in older persons can contribute to a downward spiral of increasing frailty, orthostatic intolerance, falls, and fall-related injury. As astronauts in space spend substantial amounts of time carrying out exercise training to counteract the microgravity-induced deconditioning and to counteract orthostatic intolerance on return to Earth, it is logical to suggest some of these interventions for bed-confined older persons. Synthesizing knowledge regarding deconditioning due to reduced gravitational stress in space and deconditioning during bed confinement allows for a more comprehensive approach that can incorporate aspects such as (mal-) nutrition, muscle strength and function, cardiovascular (de-) conditioning, and cardio-postural interactions. The impact of such integration can provide new insights and lead to methods of value for both space medicine and geriatrics (Geriatrics meets spaceflight!). In particular, such integration can lead to procedures that address the morbidity and the mortality associated with bedrest immobilization and in the rising health care costs associated with an aging population demographic.

Neurological Gait Abnormalities And Risk Of Falls In Older Adults

PubMed Central

Verghese, Joe; Ambrose, Anne F; Lipton, Richard B; Wang, Cuiling

2009-01-01

Objective To estimate the validity of neurological gait evaluations in predicting falls in older adults. Methods We studied 632 adults age 70 and over (mean age 80.6 years, 62% women) enrolled in the Einstein Aging Study whose walking patterns were evaluated by study clinicians using a clinical gait rating scale. Association of neurological gaits and six subtypes (hemiparetic, frontal, Parkinsonian, unsteady, neuropathic, and spastic) with incident falls was studied using generalized estimation equation procedures adjusted for potential confounders, and reported as risk ratio with 95% confidence intervals (CI). Results Over a mean follow-up of 21 months, 244 (39%) subjects fell. Mean fall rate was 0.47 falls per person year. At baseline, 120 subjects were diagnosed with neurological gaits. Subjects with neurological gaits were at increased risk of falls (risk ratio 1.49, 95% CI 1.11 – 2.00). Unsteady (risk ratio 1.52, 95% CI 1.04 – 2.22), and neuropathic gait (risk ratio 1.94, 95% CI 1.07 – 3.11) were the two gait subtypes that predicted risk of falls. The results remained significant after accounting for disability and cognitive status, and also with injurious falls as the outcome. Conclusions Neurological gaits and subtypes are independent predictors of falls in older adults. Neurological gait assessments will help clinicians identify and institute preventive measures in older adults at high risk for falls. PMID:19784714

The correlation between white matter hyperintensity and balance disorder and fall risk: An observational, prospective cohort study.

PubMed

Shen, Dong-Chao; Wu, Shuo-Lin; Shi, Yu-Zhi; Wang, Shuo; Zhang, Yu-Mei; Wang, Chun-Xue

2016-09-01

The presence of an association between white matter hyperintensity (WMH) and the risk of falls in older people is uncertain, with little supporting prospective evidence available at present. We aimed to determine whether WMH was associated with dysfunctions of balance and gait, and other sensorimotor factors leading to falls, and the independent factors related to falls in older Chinese people. The protective effect of exercise against falls was also addressed. In a representative sample of hospital-based individuals aged 50 years and older in China, the patients' history of falls, magnetic resonance imaging data, scores on the 9-item Berg Balance Scale (BBS-9) test and timed up-and-go test (TUGT), and sensorimotor measures of computerized dynamic posturography (CDP) were analyzed. Incident falls were recorded prospectively over a 12-month period. Using regression modeling, the association between the risk of falls and baseline WMH was estimated. Only individuals with severe WMH were at an increased risk of falls, and CDP was more sensitive than BBS-9 in detecting WMH-related balance and gait dysfunction. However, WMH was not an independent predictor of falls. Taller height and overweight or obese body habitus were identified as novel protective factors for falls. Female, fall history, and increased TUGT score were identified as independent risk factors for falls in older Chinese people. Although WMH was associated with an increased risk of falls, it was not an independent predictor.

Association of polypharmacy with fall risk among geriatric outpatients.

PubMed

Kojima, Taro; Akishita, Masahiro; Nakamura, Tetsuro; Nomura, Kazushi; Ogawa, Sumito; Iijima, Katsuya; Eto, Masato; Ouchi, Yasuyoshi

2011-10-01

To investigate the association of fall risk with comorbidities and medications in geriatric outpatients in a cross-sectional design.   A total of 262 outpatients (84 men and 178 women, mean age 76.2±6.8years) were evaluated. Physical examination, clinical histories and medication profile were obtained from each patient. History of falls in the past year, 22-item fall risk index, 13-point simple screening test for fall, and time interval of one-leg standing test were examined as markers of fall risk. On univariate analysis, older age, female sex, hypertension, osteoporosis, history of stroke, number of comorbidities, use of antihypertensives, aspirin, bisphosphonates, hypnotics and number of prescribed drugs were significantly associated with either of four indices. On multiple regression analysis, the number of drugs was associated with all of the four indices, independent of other factors associated in the univariate analysis. The association of number of drugs with fall risk indices was stepwise. In geriatric outpatients, polypharmacy rather than number of comorbidities was associated with fall risk. Prospective and intervention studies are needed to clarify the causal relationship between polypharmacy, comorbidities and fall risk. © 2011 Japan Geriatrics Society.

Improving prediction of fall risk among nursing home residents using electronic medical records.

PubMed

Marier, Allison; Olsho, Lauren E W; Rhodes, William; Spector, William D

2016-03-01

Falls are physically and financially costly, but may be preventable with targeted intervention. The Minimum Data Set (MDS) is one potential source of information on fall risk factors among nursing home residents, but its limited breadth and relatively infrequent updates may limit its practical utility. Richer, more frequently updated data from electronic medical records (EMRs) may improve ability to identify individuals at highest risk for falls. The authors applied a repeated events survival model to analyze MDS 3.0 and EMR data for 5129 residents in 13 nursing homes within a single large California chain that uses a centralized EMR system from a leading vendor. Estimated regression parameters were used to project resident fall probability. The authors examined the proportion of observed falls within each projected fall risk decile to assess improvements in predictive power from including EMR data. In a model incorporating fall risk factors from the MDS only, 28.6% of observed falls occurred among residents in the highest projected risk decile. In an alternative specification incorporating more frequently updated measures for the same risk factors from the EMR data, 32.3% of observed falls occurred among residents in the highest projected risk decile, a 13% increase over the base MDS-only specification. Incorporating EMR data improves ability to identify those at highest risk for falls relative to prediction using MDS data alone. These improvements stem chiefly from the greater frequency with which EMR data are updated, with minimal additional gains from availability of additional risk factor variables. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[Influence of skeletal muscles on the risk of falling in old age].

PubMed

Schöne, D; Freiberger, E; Sieber, C C

2017-04-01

Falls in older adults are a major public health problem, affecting 1 in 3 persons aged 65 and over at least once a year. Consequences of falling include death, injuries, fear of falling, and subsequent loss of independence. The age-related loss of muscle mass and function (sarcopenia) as well as muscle strength are markers of the frailty syndrome. In addition, they are associated with physical function and are a risk factor for falling. Older adults should be screened for falls at least annually. If evaluated as at-risk, a comprehensive falls assessment should be conducted to determine an individual's risk profile. Physical exercise with balance and strength training play a key role in the prevention and management of functional decline and fall risk. Multifactorial interventions are indicated in at-risk individuals. In sarcopenic individuals, sufficient intake of protein must be taken into account and supplementation in combination with exercise appears to be useful.

Feasibility of interdisciplinary community-based fall risk screening.

PubMed

Elliott, Sharon J; Ivanescu, Andrada; Leland, Natalie E; Fogo, Jennifer; Painter, Jane A; Trujillo, Leonard G

2012-01-01

This pilot study examined the feasibility of (1) conducting interdisciplinary fall risk screens at a communitywide adult fall prevention event and (2) collecting preliminary follow-up data from people screened at the event about balance confidence and home and activity modifications made after receiving educational information at the event. We conducted a pilot study with pre- and posttesting (4-mo follow-up) with 35 community-dwelling adults ≥55 yr old. Approximately half the participants were at risk for falls. Most participants who anticipated making environmental or activity changes to reduce fall risk initiated changes (n = 8/11; 72.7%) during the 4-mo follow-up period. We found no significant difference in participants' balance confidence between baseline (median = 62.81) and follow-up (median = 64.06) as measured by the Activities-specific Balance Confidence scale. Conducting interdisciplinary fall risk screens at an adult fall prevention event is feasible and can facilitate environmental and behavior changes to reduce fall risk. Copyright © 2012 by the American Occupational Therapy Association, Inc.

The effects of sleep quality, physical activity, and environmental quality on the risk of falls in dementia.

PubMed

Eshkoor, Sima Ataollahi; Hamid, Tengku Aizan; Nudin, Siti Sa'adiah Hassan; Mun, Chan Yoke

2013-06-01

This study aimed to identify the effects of sleep quality, physical activity, environmental quality, age, ethnicity, sex differences, marital status, and educational level on the risk of falls in the elderly individuals with dementia. Data were derived from a group of 1210 Malaysian elderly individuals who were noninstitutionalized and demented. The multiple logistic regression model was applied to estimate the risk of falls in respondents. Approximately the prevalence of falls was 17% among the individuals. The results of multiple logistic regression analysis revealed that age (odds ratio [OR] = 1.03), ethnicity (OR = 1.76), sleep quality (OR = 1.46), and environmental quality (OR = 0.62) significantly affected the risk of falls in individuals (P < .05). Furthermore, sex differences, marital status, educational level, and physical activity were not significant predictors of falls in samples (P > .05). It was found that age, ethnic non-Malay, and sleep disruption increased the risk of falls in respondents, but high environmental quality reduced the risk of falls.

Mobility measures differentiate falls risk status in persons with multiple sclerosis: An exploratory study.

PubMed

Sebastião, Emerson; Learmonth, Yvonne C; Motl, Robert W

2017-01-01

Falls are of great concern among persons with multiple sclerosis (MS). To examine differences in metrics of mobility, postural control, and cognition in persons with MS with distinct fall risk status; and to investigate predictors of fall risk group membership using discriminant analysis. Forty-seven persons with MS completed the Activities-Balance Confidence (ABC) Scale and underwent a battery of assessments of mobility, balance, and cognition. Participants further wore an accelerometer for 7 days as an assessment of steps/day. Participants were allocated into fall risk groups based on ABC scale scores (increased fall risk (IFR); and normal fall risk (NFR)). We examined univariate differences between groups using ANOVA, and discriminant function analysis (DFA) identified the significant multivariate predictors of FR status. After controlling for disability level, the IFR group had significantly (p < 0.05) worse scores on measures of mobility (i.e., MSWS-12, 6 MW, and steps/day) compared to the NFR group. DFA identified MSWS-12 and 6 MW scores as significant (p < 0.05) predictors of fall risk group membership. Those two variables collectively explained 55% of variance in fall risk grouping. The findings suggest that mobility should be the focus of rehabilitation programs in persons with MS, especially for those at IFR.

Older Adult Falls: Effective Approaches to Prevention

PubMed Central

Dellinger, Ann

2017-01-01

Purpose The issue of older adult falls combines a problem with high incidence and high injury susceptibility with an increasing population at risk. A firm understanding of both fall risk factors and effective strategies is required to reduce risk and prevent these injuries. Recent Findings Each year, 28.7% of older adults aged ≥65 sustain a fall. At the national level, this represents 29 million falls resulting in 27,000 deaths and 7 million injuries requiring medical treatment or restricted activity for at least 1 day. There are several strategies that have been shown to effectively reduce the risk or the incidence of falls. Summary More than 90% of older adults see a medical provider at least once a year providing an opportunity to identify and address fall risk factors. Comprehensive fall prevention in the primary care setting is both feasible and practical. PMID:28845383

The interplay between gait, falls and cognition: can cognitive therapy reduce fall risk?

PubMed Central

Segev-Jacubovski, Orit; Herman, Talia; Yogev-Seligmann, Galit; Mirelman, Anat; Giladi, Nir; Hausdorff, Jeffrey M

2011-01-01

In this article, we briefly summarize the incidence and significant consequences of falls among older adults, the insufficient effectiveness of commonly used multifactorial interventions and the evidence linking falls and cognitive function. Recent pharmacologic and nonpharmacologic studies that evaluated the effects of cognitive therapy on fall risk are reviewed. The results of this article illustrate the potential utility of multiple, diverse forms of cognitive therapy for reducing fall risk. The article also indicates that large-scale, randomized controlled trials are warranted and that additional research is needed to better understand the pathophysiologic mechanisms underlying the interplay between human mobility, fall risk and cognitive function. Nonetheless, we suggest that multimodality interventions that combine motor and cognitive therapy should, eventually, be incorporated into clinical practice to enable older adults and patients to move safer and with a reduced fall risk. PMID:21721921

Falls and fall-related injuries in older dialysis patients.

PubMed

Cook, Wendy L; Tomlinson, George; Donaldson, Meghan; Markowitz, Samuel N; Naglie, Gary; Sobolev, Boris; Jassal, Sarbjit V

2006-11-01

Dialysis patients are increasingly older and more disabled. In community-dwelling seniors without kidney disease, falls commonly predict hospitalization, the onset of frailty, and the need for institutional care. Effective fall prevention strategies are available. On the basis of retrospective data, it was hypothesized that the fall rates of older (> or =65 yr) chronic outpatient hemodialysis (HD) patients would be higher than published rates for community-dwelling seniors (0.6 to 0.8 falls/patient-year). It also was hypothesized that risk factors for falls in dialysis outpatients would include polypharmacy, dialysis-related hypotension, cognitive impairment, and decreased functional status. Using a prospective cohort study design, HD patients who were > or =65 yr of age at a large academic dialysis unit were recruited. All study participants underwent baseline screening for fall risk factors. Patients were followed prospectively for a minimum of 1 yr. Falls were identified through biweekly patient interviews in the HD unit. A total of 162 patients (mean age 74.7 yr) were recruited; 57% were male. A total of 305 falls occurred in 76 (47%) patients over 190.5 person-years of follow-up (fall-incidence 1.60 falls/person-year). Injuries occurred in 19% of falls; 41 patients had multiple falls. Associated risk factors included age, comorbidity, mean predialysis systolic BP, and a history of falls. In the HD population, the fall risk is higher than in the general community, and fall-related morbidity is high. Better identification of HD patients who are at risk for falls and targeted fall intervention strategies are required.

Cost effectiveness of withdrawal of fall-risk-increasing drugs in geriatric outpatients.

PubMed

van der Velde, Nathalie; Meerding, Willen Jan; Looman, Caspar W; Pols, Huibert A P; van der Cammen, Tischa J M

2008-01-01

Withdrawal of fall-risk-increasing drugs has been proven to be effective in older persons. However, given the enormous rise in healthcare costs in recent decades, the effect of such withdrawals on healthcare costs also needs to be considered. Within a common geriatric outpatient population, patients with a history of falls were assessed for falls risk (n = 139). Fall-risk-increasing drugs were withdrawn when appropriate (n = 75). All participants had a 2-month follow-up for fall incidents. The number of prevented falls was calculated using a loglinear regression model. The savings on health expenditures as a result of prevented injuries (estimated from a literature review) and reduced consumption of pharmaceuticals were compared with the intervention costs. After adjustment for confounders, drug withdrawal resulted in a falls risk reduction of 0.89 (95% CI 0.33, 0.98) per patient compared with the non-withdrawal group. Net cost savings were euro1691 (95% CI 662, 2181) per patient in the cohort. This resulted in a cost saving of euro491 (95% CI 465, 497) per prevented fall. Withdrawal of fall-risk-increasing drugs generates significant cost savings. Extrapolation of these findings to a national scale results in an estimated reduction of euro60 million in healthcare expenditures, that is, 15% of fall-related health costs.

The Neighborhood Environment: Perceived Fall Risk, Resources, and Strategies for Fall Prevention.

PubMed

Chippendale, Tracy; Boltz, Marie

2015-08-01

To explore the experience of older adults in their neighborhood in relation to perceived fall risk, fear of falling (FOF), and resources/strategies for fall prevention. Fourteen older adults, 65 years of age and older from 3 urban senior centers, participated in this qualitative study. The semistructured interview guidelines and background questionnaire were developed by the researchers based on the literature and an existing measure of walkability. Both tools were refined based on pilot interviews with seniors. Collaizzi's phenomenological method was used for data analysis. Five themes emerged from the data: (a) The built environment contributes to perceived fall risk and FOF, (b) personal strategies used to adapt to perceived neighborhood fall risks-behavioral approaches, (c) resources for physical activity and safety, (d) barriers to physical activity and exercise, and (e) neighborhood features as a motivator. Urban-dwelling seniors perceive that neighborhood features contribute to or mitigate fall risk and FOF. Behavioral strategies are used by seniors to prevent outdoor falls. The findings can help clinicians develop targeted fall prevention interventions for well elders and help urban planners to design and retrofit urban environments to reduce fall risk. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A comparison of the burden and resultant risk associated with occupational falls from a height and on the same level in Australia.

PubMed

Mangharam, Jean; Moorin, Rachael; Straker, Leon

2016-12-01

Occupational falls are one of the leading causes of occupational injury and death internationally. This study described the nature of occupational falls following an analysis of workers compensation data in Western Australia. Frequencies, proportions and incidence rates were calculated following mechanism, gender, age and industry stratification. The natures of injury and bodily locations affected were compared between mechanisms of fall. Industry incidence rates were ranked and their corresponding proportions reported. Cost and lost time were described and risk scores for each burden type (incapacity, cost and lost time) were calculated and compared between fall mechanisms. Of all occupational falls, the proportion, incidence rates and risk scores of falls on same level were consistently greater compared to falls from a height. Gender, age and industry groups that appear to be at highest risk vary with the measure used and mechanism of incident. This study translates epidemiological information into a risk score that can aid in prioritisation. Practitioner Summary: This paper presents an in-depth analysis of Worker's Compensation claims for falls in Western Australia. Calculated proportion, incidence rates and formulated risk scores for falls on the level were consistently greater compared to falls from a height. Limitations associated with the analysis of large-scale data-sets are described.

Feasibility of using the International Classification of Functioning, Disability and Health Core Set for evaluation of fall-related risk factors in acute rehabilitation settings.

PubMed

Huang, Shih W; Lin, Li F; Chou, Lin C; Wu, Mei J; Liao, Chun D; Liou, Tsan H

2016-04-01

Previously, we reported the use of an International Classification of Functioning (ICF) core set that can provide a holistic framework for evaluating the risk factors of falls; however, data on the feasibility of applying this core set are lacking. To investigate the feasibility of applying the fall-related ICF risk-factor core set in the case of patients in an acute-rehabilitation setting. A cross-sectional and descriptive correlational design. Acute-rehabilitation ward. A total of 273 patients who experienced fall at acute-rehabilitation ward. The data on falls were collected from the hospital's Nursing Information System (NIS) and the fall-reporting system (Adverse Event Reporting System, AERS) between 2010 and 2013. The relationship of both systems to the fall-related ICF core set was analyzed to assess the feasibility of their clinical application. We evaluated the feasibility of using the fall-related ICF risk-factor core set by using the frequency and the percentage of the fall patients in of the listed categories. The fall-related ICF risk-factor core set category b735 (muscle tone functions) exhibited a high feasibility (85.95%) for clinical application, and the category b730 (muscle power functions) covered 77.11% of the patients. The feasibility of application of the category d410 (change basic body position) was also high in the case of all fall patients (81.69%). In the acute-rehabilitation setting, the feasibility of application of the fall-related ICF risk-factor core set is high. The fall-related ICF risk-factor core set can help multidisciplinary teams develop fall-prevention strategies in acute rehabilitation wards.

Predictive validity of the Hendrich fall risk model II in an acute geriatric unit.

PubMed

Ivziku, Dhurata; Matarese, Maria; Pedone, Claudio

2011-04-01

Falls are the most common adverse events reported in acute care hospitals, and older patients are the most likely to fall. The risk of falling cannot be completely eliminated, but it can be reduced through the implementation of a fall prevention program. A major evidence-based intervention to prevent falls has been the use of fall-risk assessment tools. Many tools have been increasingly developed in recent years, but most instruments have not been investigated regarding reliability, validity and clinical usefulness. This study intends to evaluate the predictive validity and inter-rater reliability of Hendrich fall risk model II (HFRM II) in order to identify older patients at risk of falling in geriatric units and recommend its use in clinical practice. A prospective descriptive design was used. The study was carried out in a geriatric acute care unit of an Italian University hospital. All over 65 years old patients consecutively admitted to a geriatric acute care unit of an Italian University hospital over 8-month period were enrolled. The patients enrolled were screened for the falls risk by nurses with the HFRM II within 24h of admission. The falls occurring during the patient's hospital stay were registered. Inter-rater reliability, area under the ROC curve, sensitivity, specificity, positive and negative predictive values and time for the administration were evaluated. 179 elderly patients were included. The inter-rater reliability was 0.87 (95% CI 0.71-1.00). The administration time was about 1min. The most frequently reported risk factors were depression, incontinence, vertigo. Sensitivity and specificity were respectively 86% and 43%. The optimal cut-off score for screening at risk patients was 5 with an area under the ROC curve of 0.72. The risk factors more strongly associated with falls were confusion and depression. As falls of older patients are a common problem in acute care settings it is necessary that the nurses use specific validate and reliable fall risk assessment tools in order to implement the most effective prevention measures. Our findings provided supporting evidence to the choice of the HFRM II to screen older patients at risk of falling in acute care settings. Copyright © 2010 Elsevier Ltd. All rights reserved.

A prospective study on the variation in falling and fall risk among community-dwelling older citizens in 12 European countries.

PubMed

Franse, Carmen B; Rietjens, Judith Ac; Burdorf, Alex; van Grieken, Amy; Korfage, Ida J; van der Heide, Agnes; Mattace Raso, Francesco; van Beeck, Ed; Raat, Hein

2017-06-30

The rate of falling among older citizens appears to vary across different countries, but the underlying aspects causing this variation are unexplained. We aim to describe between-country variation in falling and explore whether intrinsic fall risk factors can explain possible variation. Prospective study on data from the cross-national Survey of Health, Ageing and Retirement in Europe (SHARE). Twelve European countries (Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Italy, The Netherlands, Spain, Sweden, Switzerland). Community-dwelling persons aged ≥65 years (n=18 596). Socio-demographic factors (age, gender, education level and living situation) and intrinsic fall risk factors (less than good self-rated health (SRH), mobility limitations, limitations with activities of daily living (ADL), dizziness, impaired vision, depression and impaired cognition) were assessed in a baseline interview. Falling was assessed 2 years later by asking whether the participant had fallen within the 6 months prior to the follow-up interview. There was significant between-country variation in the rate of falling (varying from 7.9% in Switzerland to 16.2% in the Czech Republic). The prevalence of intrinsic fall risk factors varied twofold to fourfold between countries. Associations between factors age ≥80 years, less than good SRH, mobility limitations, ADL limitations, dizziness and depression, and falling were different between countries (p<0.05). Between-country differences in falling largely persisted after adjusting for socio-demographic differences but strongly attenuated after adjusting for differences in intrinsic fall risk factors. There is considerable variation in the rate of falling between European countries, which can largely be explained by between-country variation in the prevalence of intrinsic fall risk factors. There are also country-specific variations in the association between these intrinsic risk factors and falling. These findings emphasise the importance of addressing intrinsic fall risk in (inter)national fall-prevention strategies, while highlighting country-specific priorities. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Fall risk factors and sex differences among community-dwelling elderly individuals in Japan. A Kameoka study].

PubMed

Masumoto, Taeko; Yamada, Yosuke; Yamada, Minoru; Nakaya, Tomoki; Miyake, Motoko; Watanabe, Yuya; Yoshida, Tsukasa; Yokoyama, Keiichi; Yamagata, Emi; Date, Heiwa; Nanri, Hinako; Komatsu, Mitsuyo; Yoshinaka, Yasuko; Fujiwara, Yoshinori; Okayama, Yasuko; Kimura, Misaka

2015-01-01

Although factors associated with falls might differ between men and women, no large-scale studies were conducted to examine the sex difference of risk factors for falls in Japanese elderly. The purpose of this study was to examine fall risk factors and sex differences among community-dwelling elderly individuals using a complete survey of the geriatric population in Kameoka city. A self-administered questionnaire survey was conducted with 18,231 community-dwelling elderly individuals aged 65 years or over in Kameoka city, Kyoto Prefecture, between July and August 2011, excluding people who were publicly certified with a long-term care need of grade 3 or higher. The questionnaire was individually distributed and collected via mail. Out of 12,159 responders (recovery rate of 72.2%), we analyzed the data of 12,054 elderly individuals who were not certified as having long-term care needs. The questionnaire was composed of basic attributes, a simple screening test for fall risk, the Kihon Check List with 25 items, and the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence with 13 items. These items were grouped into nine factors: motor function, malnutrition, oral function, houseboundness, forgetfulness, depression, Instrumental Activity of Daily Living (IADL), intellectual activities, and social role. Of all the respondents, 20.8% experienced falls within the last year, and 26.6% were classified as having high fall risk. Fall risk increased with age in both sexes, and risk in all age groups was higher for women than for men. All factors were significantly associated with fall risk in both sexes. After controlling for these factors, a significant relationship was found between fall risk and motor function, malnutrition, oral function, forgetfulness, depression, and IADL in men and motor function, oral function, forgetfulness, depression, and IADL in women. The deterioration of motor function was associated with three-times-higher risk than non-deterioration of motor function. In addition, significant interaction was found in sex×malnutrition, oral function, IADL, and intellectual activities; malnutrition and low oral function were stronger factors in men than in women; and IADL and intellectual activities were stronger factors in women than in men. One in five community-dwelling independent elderly individuals experienced falls in the last year, and one in four had high fall risk. We found a significant relationship between fall risk and the nine factors, particularly deterioration of motor function in both sexes. Sex difference was observed for fall risk factors; therefore, a sex-specific support policy for fall prevention is necessary.

Falls risk among a very old home-dwelling population

PubMed Central

Iinattiniemi, Sari; Jokelainen, Jari; Luukinen, Heikki

2009-01-01

Objective The aim of this prospective study was to examine risk factors of falling in a very old home-dwelling population. Design A prospective study of home-dwelling elderly people. Methods Baseline data were collected by home-nursing staff through postal questionnaires and clinical tests. Data on falls were recorded in telephone interviews every other month during a follow-up of 11 months constituting 494 person years (PY). Negative binomial modeling was used to assess fall risk. Setting General community. Subjects A population sample of home-dwelling subjects aged 85 years or older (n = 555). Main outcome measures Fall rate and risk factors of falls. Results Altogether 512 falls occurred in 273 (49%) subjects, incidence rate 1.03/PY. According to a multivariate model, history of recurrent falling, trouble with vision when moving, use of antipsychotic drug, and feelings of anxiety, nervousness, or fear were independent risk factors for subsequent falls. Conclusion Appropriate care of poor vision and feelings of anxiety, nervousness, or fear, and avoidance of use of antipsychotic drugs might be useful in the prevention of falls among the most elderly home-dwellers. PMID:19065453

Fall risk and prevention agreement: engaging patients and families with a partnership for patient safety.

PubMed

Vonnes, Cassandra; Wolf, Darcy

2017-01-01

Falls are multifactorial in medical oncology units and are potentiated by an older adult's response to anxiolytics, opiates and chemotherapy protocols. In addition, the oncology patient is at an increased risk for injury from a fall due to coagulopathy, thrombocytopenia and advanced age. At our National Cancer Institute-designated inpatient cancer treatment centre located in the southeastern USA, 40% of the total discharges are over the age of 65. As part of a comprehensive fall prevention programme, bimonthly individual fall reports have been presented with the Chief Nursing Officer (CNO), nursing directors, nurse managers, physical therapists and front-line providers in attendance. As a result of these case discussions, in some cases, safety recommendations have not been followed by patients and families and identified as an implication in individual falls. Impulsive behaviour was acknowledged only after a fall occurred. A medical oncology unit was targeted for this initiative due to a prolonged length of stay. This patient population receives chemotherapeutic interventions, management of oncological treatment consequences and cancer progression care. The aim of this project was to explore if initiation of a Fall Prevention Agreement between the nursing team and older adults being admitted to medical oncology units would reduce the incidence of falls and the incidence of falls with injury. In order to promote patient and family participation in the fall reduction and safety plan, the Fall Risk and Prevention Agreement was introduced upon admission. Using the Morse Fall Scoring system, patient's risk for fall was communicated on the Fall Risk and Prevention Agreement. Besides admission, patients were reassessed based on change of status, transfer or after a fall occurs. Fall and fall injuries rates were compared two-quarters prior to implementation of the fall agreement and eight-quarters post implementation. Falls and fall injuries on the medical oncology unit had an overall reduction of 37% and 58.6%, respectively. A robust fall prevention standard does not ensure care team participation in all elements to reduce fall occurrence. Historically, the Fall Risk and Prevention Agreement had not been initiated on admission. Incorporating patients and families in discussions related to fall risk and prevention is consistent with collaborative communication. The Joint Commission and the Centers for Medicare and Medicaid Services in 2002 encouraged patients and family participation in the acute care experience to promote safety. The medical oncology patient in many cases on admission is identified as 'moderate' risk for fall. It is during the course of treatment and an extended length of stay that deconditioning and treatment side effects result in a fall. This patient population often overestimates their abilities and functional status.Engagement with patients and families during the admission process will hopefully communicate the need for a collaborative effort for fall prevention during the hospitalisation. Although this project is limited in data, integrating patients and families into care planning may have a significant impact in reducing falls in the 'moderate' risk patient. Additional studies including a multivariate analysis are needed to determine whether supporting evidence links fall reduction to the presence and use of a patient and family agreement.

Risks, consequences, and prevention of falls of older people in oral healthcare centers.

PubMed

de Baat, Cees; de Baat, Paul; Gerritsen, Anneloes E; Flohil, Karien A; van der Putten, Gert-Jan; van der Maarel-Wierink, Claar D

2017-03-01

One-third of community-dwelling people older than 65 years of age fall each year, and half of them fall at least twice a year. Older care home residents are approximately three times more likely to fall when compared to community-dwelling older people. Risk indicators for falls are related to the older people's body, environment, behavior, and activities. An important health risk indicator is (orthostatic or postprandial) hypotension, which may induce cerebral hypoperfusion. Although the majority of falls remain without major consequences, 10% to 25% of falls in care homes result in bodily trauma. Prevalent fall-related injuries are brain injury, lower extremity fracture including hip fracture and forearm/wrist fracture, facial fracture, humeral fracture, and rib/scapular fracture. As fall accidents by older people can have severe consequences, prevention of falls is of paramount importance. Healthcare providers, including oral healthcare providers, should inform older people on risks of falling and draw attention to potentially hazardous arrangements. © 2016 Special Care Dentistry Association and Wiley Periodicals, Inc.

Predicting Geriatric Falls Following an Episode of Emergency Department Care: A Systematic Review

PubMed Central

Carpenter, Christopher R.; Avidan, Michael S.; Wildes, Tanya; Stark, Susan; Fowler, Susan A.; Lo, Alexander X.

2015-01-01

Background Falls are the leading cause of traumatic mortality in geriatric adults. Despite recent multispecialty guideline recommendations that advocate for proactive fall prevention protocols in the emergency department (ED), the ability of risk factors or risk stratification instruments to identify subsets of geriatric patients at increased risk for short-term falls is largely unexplored. Objectives This was a systematic review and meta-analysis of ED-based history, physical examination, and fall risk stratification instruments with the primary objective of providing a quantitative estimate for each risk factor’s accuracy to predict future falls. A secondary objective was to quantify ED fall risk assessment test and treatment thresholds using derived estimates of sensitivity and specificity. Methods A medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED, EMBASE, CINAHL, CENTRAL, DARE, the Cochrane Registry, and Clinical Trials. Unpublished research was located by a hand search of emergency medicine (EM) research abstracts from national meetings. Inclusion criteria for original studies included ED-based assessment of pre-ED or post-ED fall risk in patients 65 years and older with sufficient detail to reproduce contingency tables for meta-analysis. Original study authors were contacted for additional details when necessary. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) was used to assess individual study quality for those studies that met inclusion criteria. When more than one qualitatively similar study assessed the same risk factor for falls at the same interval following an ED evaluation, then meta-analysis was performed using Meta-DiSc software. The primary outcomes were sensitivity, specificity, and likelihood ratios for fall risk factors or risk stratification instruments. Secondary outcomes included estimates of test and treatment thresholds using the Pauker method based on accuracy, screening risk, and the projected benefits or harms of fall prevention interventions in the ED. Results A total of 608 unique and potentially relevant studies were identified, but only three met our inclusion criteria. Two studies that included 660 patients assessed 29 risk factors and two risk stratification instruments for falls in geriatric patients in the 6 months following an ED evaluation, while one study of 107 patients assessed the risk of falls in the preceding 12 months. A self-report of depression was associated with the highest positive likelihood ratio (LR) of 6.55 (95% confidence interval [CI] = 1.41 to 30.48). Six fall predictors were identified in more than one study (past falls, living alone, use of walking aid, depression, cognitive deficit, and more than six medications) and meta-analysis was performed for these risk factors. One screening instrument was sufficiently accurate to identify a subset of geriatric ED patients at low risk for falls with a negative LR of 0.11 (95% CI = 0.06 to 0.20). The test threshold was 6.6% and the treatment threshold was 27.5%. Conclusions This study demonstrates the paucity of evidence in the literature regarding ED-based screening for risk of future falls among older adults. The screening tools and individual characteristics identified in this study provide an evidentiary basis on which to develop screening protocols for geriatrics adults in the ED to reduce fall risk PMID:25293956

Predicting geriatric falls following an episode of emergency department care: a systematic review.

PubMed

Carpenter, Christopher R; Avidan, Michael S; Wildes, Tanya; Stark, Susan; Fowler, Susan A; Lo, Alexander X

2014-10-01

Falls are the leading cause of traumatic mortality in geriatric adults. Despite recent multispecialty guideline recommendations that advocate for proactive fall prevention protocols in the emergency department (ED), the ability of risk factors or risk stratification instruments to identify subsets of geriatric patients at increased risk for short-term falls is largely unexplored. This was a systematic review and meta-analysis of ED-based history, physical examination, and fall risk stratification instruments with the primary objective of providing a quantitative estimate for each risk factor's accuracy to predict future falls. A secondary objective was to quantify ED fall risk assessment test and treatment thresholds using derived estimates of sensitivity and specificity. A medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED, EMBASE, CINAHL, CENTRAL, DARE, the Cochrane Registry, and Clinical Trials. Unpublished research was located by a hand search of emergency medicine (EM) research abstracts from national meetings. Inclusion criteria for original studies included ED-based assessment of pre-ED or post-ED fall risk in patients 65 years and older with sufficient detail to reproduce contingency tables for meta-analysis. Original study authors were contacted for additional details when necessary. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) was used to assess individual study quality for those studies that met inclusion criteria. When more than one qualitatively similar study assessed the same risk factor for falls at the same interval following an ED evaluation, then meta-analysis was performed using Meta-DiSc software. The primary outcomes were sensitivity, specificity, and likelihood ratios for fall risk factors or risk stratification instruments. Secondary outcomes included estimates of test and treatment thresholds using the Pauker method based on accuracy, screening risk, and the projected benefits or harms of fall prevention interventions in the ED. A total of 608 unique and potentially relevant studies were identified, but only three met our inclusion criteria. Two studies that included 660 patients assessed 29 risk factors and two risk stratification instruments for falls in geriatric patients in the 6 months following an ED evaluation, while one study of 107 patients assessed the risk of falls in the preceding 12 months. A self-report of depression was associated with the highest positive likelihood ratio (LR) of 6.55 (95% confidence interval [CI] = 1.41 to 30.48). Six fall predictors were identified in more than one study (past falls, living alone, use of walking aid, depression, cognitive deficit, and more than six medications) and meta-analysis was performed for these risk factors. One screening instrument was sufficiently accurate to identify a subset of geriatric ED patients at low risk for falls with a negative LR of 0.11 (95% CI = 0.06 to 0.20). The test threshold was 6.6% and the treatment threshold was 27.5%. This study demonstrates the paucity of evidence in the literature regarding ED-based screening for risk of future falls among older adults. The screening tools and individual characteristics identified in this study provide an evidentiary basis on which to develop screening protocols for geriatrics adults in the ED to reduce fall risk. © 2014 by the Society for Academic Emergency Medicine.

The impact of fall risk assessment on nurse fears, patient falls, and functional ability in long-term care.

PubMed

Dever Fitzgerald, Theresa; Hadjistavropoulos, Thomas; Williams, Jaime; Lix, Lisa; Zahir, Sharmeen; Alfano, Dennis; Scudds, Rhonda

2016-01-01

The purpose of this study was to determine whether providing fall risk information to long-term care (LTC) nurses affects restraint use, activities of daily living (ADL), falls, and nurse fears about patient falls. One-hundred and fifty LTC residents were randomized to a fall risk assessment intervention or care-as-usual group. Hypotheses were tested using analyses of variance and path analyses. Restraint use was associated with lower ADL scores. In the intervention group, there ceased to be significant relationships between nurse fears about falls and patient falls (after controlling for actual patient risk; post-intervention, nurse fears about falls were based on realistic appraisals), and between fears and restraints (i.e. unjustified nurse fears became less likely to lead to unjustified restraint use). No group differences in falls were identified. Despite a lack of group differences in falls, results show initial promise in potentially impacting resident care. Increasing intervention intensity may lead to fall reductions in future research. Given the high prevalence rates of falls in LTC and associated injuries, prevention programs are important. Nurse fears about patient falls may impact upon restraint use which, when excessive, can interfere with the patient's ability to perform ADL. Excessive restraint use, due to unjustified nurse fears, could also lead to falls. Providing accurate, concise information to nursing staff about patient fall risk may aid in reducing the association between unjustified nurse fears and the resulting restraint use that can have potential negative consequences.

Risk factors for incident falls in older men and women: the English longitudinal study of ageing.

PubMed

Gale, Catharine R; Westbury, Leo D; Cooper, Cyrus; Dennison, Elaine M

2018-05-16

Falls are a major cause of disability and death in older people, particularly women. Cross-sectional surveys suggest that some risk factors associated with a history of falls may be sex-specific, but whether risk factors for incident falls differ between the sexes is unclear. We investigated whether risk factors for incident falls differ between men and women. Participants were 3298 people aged ≥60 who took part in the Waves 4-6 surveys of the English Longitudinal Study of Ageing. At Wave 4, they provided information about sociodemographic, lifestyle, behavioural and medical factors and had their physical and cognitive function assessed. Data on incident falls during the four-year follow-up period was collected from them at Waves 5 and 6. Poisson regression with robust variance estimation was used to derive relative risks (RR) for the association between baseline characteristics and incident falls. In multivariable-adjusted models that also controlled for history of falls, older age was the only factor associated with increased risk of incident falls in both sexes. Some factors were only predictive of falls in one sex, namely more depressive symptoms (RR (95% CI) 1.03 (1.01,1.06)), incontinence (1.12 (1.00,1.24)) and never having married in women (1.26 (1.03,1.53)), and greater comorbidity (1.04 (1.00,1.08)), higher levels of pain (1.10 (1.04,1.17) and poorer balance, as indicated by inability to attempt a full-tandem stand, (1.23 (1.04,1.47)) in men. Of these, only the relationships between pain, balance and comorbidity and falls risk differed significantly by sex. There were some differences between the sexes in risk factors for incident falls. Our observation that associations between pain, balance and comorbidity and incident falls risk varied by sex needs further investigation in other cohorts.

A Greater Extent of Insomnia Symptoms and Physician-Recommended Sleep Medication Use Predict Fall Risk in Community-Dwelling Older Adults.

PubMed

Chen, Tuo-Yu; Lee, Soomi; Buxton, Orfeu M

2017-11-01

Cross-sectional studies suggest that insomnia symptoms are associated with falls in later life. This longitudinal study examines the independent and interactive effects of the extent of insomnia symptoms (i.e., multiple co-existing insomnia symptoms) and sleep medications on fall risk over a 2-year follow-up among community-dwelling older adults. Using data from the Health and Retirement Study (2006-2014, N = 6882, Mage = 74.5 years ± 6.6 years), we calculated the extent of insomnia symptoms (range = 0-4) participants reported (i.e., trouble falling asleep, waking up during the night, waking up too early, and not feeling rested). At each wave, participants reported recent sleep medications use and falls since the last wave, and were evaluated for balance and walking speed. A greater burden of insomnia symptoms and using physician-recommended sleep medications at baseline independently predicted falling after adjusting for known risk factors of falling. The effects of insomnia symptoms on fall risk differed by sleep medications use. The extent of insomnia symptoms exhibited a positive, dose-response relation with risk of falling among those not using sleep medications. Older adults using physician-recommended sleep medications exhibited a consistently higher fall risk irrespective of the extent of insomnia symptoms. The number of insomnia symptoms predicts 2-year fall risk in older adults. Taking physician-recommended sleep medications increases the risks for falling in older adults, irrespective of the presence of insomnia symptoms. Future efforts should be directed toward treating insomnia symptoms, and managing and selecting sleep medications effectively to decrease the risk of falling in older adults. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Executive Function and Falls in Older Adults: New Findings from a Five-Year Prospective Study Link Fall Risk to Cognition

PubMed Central

Mirelman, Anat; Herman, Talia; Brozgol, Marina; Dorfman, Moran; Sprecher, Elliot; Schweiger, Avraham; Giladi, Nir; Hausdorff, Jeffrey M.

2012-01-01

Background Recent findings suggest that executive function (EF) plays a critical role in the regulation of gait in older adults, especially under complex and challenging conditions, and that EF deficits may, therefore, contribute to fall risk. The objective of this study was to evaluate if reduced EF is a risk factor for future falls over the course of 5 years of follow-up. Secondary objectives were to assess whether single and dual task walking abilities, an alternative window into EF, were associated with fall risk. Methodology/Main Results We longitudinally followed 256 community-living older adults (age: 76.4±4.5 yrs; 61% women) who were dementia free and had good mobility upon entrance into the study. At baseline, a computerized cognitive battery generated an index of EF, attention, a closely related construct, and other cognitive domains. Gait was assessed during single and dual task conditions. Falls data were collected prospectively using monthly calendars. Negative binomial regression quantified risk ratios (RR). After adjusting for age, gender and the number of falls in the year prior to the study, only the EF index (RR: .85; CI: .74–.98, p = .021), the attention index (RR: .84; CI: .75–.94, p = .002) and dual tasking gait variability (RR: 1.11; CI: 1.01–1.23; p = .027) were associated with future fall risk. Other cognitive function measures were not related to falls. Survival analyses indicated that subjects with the lowest EF scores were more likely to fall sooner and more likely to experience multiple falls during the 66 months of follow-up (p<0.02). Conclusions/Significance These findings demonstrate that among community-living older adults, the risk of future falls was predicted by performance on EF and attention tests conducted 5 years earlier. The present results link falls among older adults to cognition, indicating that screening EF will likely enhance fall risk assessment, and that treatment of EF may reduce fall risk. PMID:22768271

Lower-Limb Joint Coordination Pattern in Obese Subjects

PubMed Central

Ranavolo, Alberto; Donini, Lorenzo M.; Mari, Silvia; Serrao, Mariano; Silvetti, Alessio; Iavicoli, Sergio; Cava, Edda; Asprino, Rosa; Pinto, Alessandro; Draicchio, Francesco

2013-01-01

The coordinative pattern is an important feature of locomotion that has been studied in a number of pathologies. It has been observed that adaptive changes in coordination patterns are due to both external and internal constraints. Obesity is characterized by the presence of excess mass at pelvis and lower-limb areas, causing mechanical constraints that central nervous system could manage modifying the physiological interjoint coupling relationships. Since an altered coordination pattern may induce joint diseases and falls risk, the aim of this study was to analyze whether and how coordination during walking is affected by obesity. We evaluated interjoint coordination during walking in 25 obese subjects as well as in a control group. The time-distance parameters and joint kinematics were also measured. When compared with the control group, obese people displayed a substantial similarity in joint kinematic parameters and some differences in the time-distance and in the coupling parameters. Obese subjects revealed higher values in stride-to-stride intrasubjects variability in interjoint coupling parameters, whereas the coordinative mean pattern was unaltered. The increased variability in the coupling parameters is associated with an increased risk of falls and thus should be taken into account when designing treatments aimed at restoring a normal locomotion pattern. PMID:23484078

Cross Time-Frequency Analysis of Gastrocnemius Electromyographic Signals in Hypertensive and Nonhypertensive Subjects

NASA Astrophysics Data System (ADS)

Mitchell, Patrick; Krotish, Debra; Shin, Yong-June; Hirth, Victor

2010-12-01

The effects of hypertension are chronic and continuous; it affects gait, balance, and fall risk. Therefore, it is desirable to assess gait health across hypertensive and nonhypertensive subjects in order to prevent or reduce the risk of falls. Analysis of electromyography (EMG) signals can identify age related changes of neuromuscular activation due to various neuropathies and myopathies, but it is difficult to translate these medical changes to clinical diagnosis. To examine and compare geriatrics patients with these gait-altering diseases, we acquire EMG muscle activation signals, and by use of a timesynchronized mat capable of recording pressure information, we localize the EMG data to the gait cycle, ensuring identical comparison across subjects. Using time-frequency analysis on the EMG signal, in conjunction with several parameters obtained from the time-frequency analyses, we can determine the statistical discrepancy between diseases. We base these parameters on physiological manifestations caused by hypertension, as well as other comorbities that affect the geriatrics community. Using these metrics in a small population, we identify a statistical discrepancy between a control group and subjects with hypertension, neuropathy, diabetes, osteoporosis, arthritis, and several other common diseases which severely affect the geriatrics community.

Opinions of Nurses About the Evaluation of Risk of Falling Among Inpatients.

PubMed

Atay, Selma; Vurur, Sevda; Erdugan, Necla

Patient falls and fall-related injuries are an important problem for patients, relatives, caregivers, and the health system at large. This study aims to identify opinions of nurses about the risk of falling among patients staying in hospitals. This study uses a qualitative descriptive design and employs a semistructured interview method to identify the opinions and experiences of nurses about patient falls. This study evaluated the opinions of a total of 12 staff nurses. It was found that nurses consider patients in the postoperative period to be most prone to falls. They think that most falls take place during transfers and that the medical diagnosis of the patient plays a crucial role in fall incidents. The most important problem associated with patient falls was symptoms of traumatic brain injury. According to the participating nurses, the risk of fall for every patient should be evaluated upon admission. Measures that the nurses take against patient falls include raising the bed's side rails and securing the bed brakes. The findings of this research suggest that in-service training programs about the evaluation of the risk of falling should be organized for nurses. Guidelines should be developed for patients with different levels of risk of falling. It is suggested that nurses should be in charge of training patients who are conscious, their relatives, and caregiver personnel. The training of nurses and caregivers helps to prevent the falls of inpatients.

Novel sensing technology in fall risk assessment in older adults: a systematic review.

PubMed

Sun, Ruopeng; Sosnoff, Jacob J

2018-01-16

Falls are a major health problem for older adults with significant physical and psychological consequences. A first step of successful fall prevention is to identify those at risk of falling. Recent advancement in sensing technology offers the possibility of objective, low-cost and easy-to-implement fall risk assessment. The objective of this systematic review is to assess the current state of sensing technology on providing objective fall risk assessment in older adults. A systematic review was conducted in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA). Twenty-two studies out of 855 articles were systematically identified and included in this review. Pertinent methodological features (sensing technique, assessment activities, outcome variables, and fall discrimination/prediction models) were extracted from each article. Four major sensing technologies (inertial sensors, video/depth camera, pressure sensing platform and laser sensing) were reported to provide accurate fall risk diagnostic in older adults. Steady state walking, static/dynamic balance, and functional mobility were used as the assessment activity. A diverse range of diagnostic accuracy across studies (47.9% - 100%) were reported, due to variation in measured kinematic/kinetic parameters and modelling techniques. A wide range of sensor technologies have been utilized in fall risk assessment in older adults. Overall, these devices have the potential to provide an accurate, inexpensive, and easy-to-implement fall risk assessment. However, the variation in measured parameters, assessment tools, sensor sites, movement tasks, and modelling techniques, precludes a firm conclusion on their ability to predict future falls. Future work is needed to determine a clinical meaningful and easy to interpret fall risk diagnosis utilizing sensing technology. Additionally, the gap between functional evaluation and user experience to technology should be addressed.

Effects of vertical and side-alternating vibration training on fall risk factors and bone turnover in older people at risk of falls.

PubMed

Corrie, Heather; Brooke-Wavell, Katherine; Mansfield, Neil J; Cowley, Alison; Morris, Robert; Masud, Tahir

2015-01-01

whole-body vibration training may improve neuromuscular function, falls risk and bone density, but previous studies have had conflicting findings. this study aimed to evaluate the influence of vertical vibration (VV) and side-alternating vibration (SV) on musculoskeletal health in older people at risk of falls. single-blind, randomised, controlled trial comparing vibration training to sham vibration (Sham) in addition to usual care. participants were 61 older people (37 women and 24 men), aged 80.2 + 6.5 years, referred to an outpatient falls prevention service. participants were randomly assigned to VV, SV or Sham in addition to the usual falls prevention programme. Participants were requested to attend three vibration sessions per week for 12 weeks, with sessions increasing to six, 1 min bouts of vibration. Falls risk factors and neuromuscular tests were assessed, and blood samples collected for determination of bone turnover, at baseline and following the intervention. chair stand time, timed-up-and-go time, fear of falling, NEADL index and postural sway with eyes open improved in the Sham group. There were significantly greater gains in leg power in the VV than in the Sham group and in bone formation in SV and VV compared with the Sham group. Conversely, body sway improved less in the VV than in the Sham group. Changes in falls risk factors did not differ between the groups. whole-body vibration increased leg power and bone formation, but it did not provide any additional benefits to balance or fall risk factors beyond a falls prevention programme in older people at risk of falls. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[Characteristics of falls producing hip fracture in an elderly population. Differences according to age and gender].

PubMed

Formiga, F; Ruiz, D; López-Soto, A; Duaso, E; Chivite, D; Pérez-Castejón, J M

2006-01-01

The majority of hip fractures are produced because of a fall. We examined the characteristics associated with falls causing hip fracture in elderly patients. Characteristics of falls owing to hip fracture were analyzed in 410 consecutive patients admitted in 6 hospitals during the 2004. We evaluated the location, time and the possible cause of fall: intrinsic risk factor, extrinsic or combined. We evaluated 316 women (77%) and 94 men, mean age 81.9 years. Previous to the hip fracture, the mean BI was 77.5. The mean value of falls during the last year was 1.9. Previously to the fall that caused hip fracture, we found that 24% of the patients had fallen repeatedly (more than two falls). Usually falls were at home (68%) and during daytime (80%). In 45% of patients an intrinsic risk factor was considered the most likely cause, in 33% an extrinsic risk factor and in 22% a combination. The majority of falls owing to hip fracture in elderly people happen in daytime, at home and due to intrinsic risk factors. Efforts to identify elderly people at risk of fall should be stressed in order to establish preventive measures.

Identification of fall risk factors in older adult emergency department patients.

PubMed

Carpenter, Christopher R; Scheatzle, Mark D; D'Antonio, Joyce A; Ricci, Paul T; Coben, Jeffrey H

2009-03-01

Falls represent an increasingly frequent source of injury among older adults. Identification of fall risk factors in geriatric patients may permit the effective utilization of scarce preventative resources. The objective of this study was to identify independent risk factors associated with an increased 6-month fall risk in community-dwelling older adults discharged from the emergency department (ED). This was a prospective observational study with a convenience sampling of noninstitutionalized elders presenting to an urban teaching hospital ED who did not require hospital admission. Interviews were conducted to determine the presence of fall risk factors previously described in non-ED populations. Subjects were followed monthly for 6 months through postcard or telephone contact to identify subsequent falls. Univariate and Cox regression analysis were used to determine the association of risk factors with 6-month fall incidence. A total of 263 patients completed the survey, and 161 (61%) completed the entire 6 months of follow-up. Among the 263 enrolled, 39% reported a fall in the preceding year, including 15% with more than one fall and 22% with injurious falls. Among those completing the 6 months of follow-up, 14% reported at least one fall. Cox regression analysis identified four factors associated with falls during the 6-month follow-up: nonhealing foot sores (hazard ratio [HR] = 3.71, 95% confidence interval [CI] = 1.73 to 7.95), a prior fall history (HR = 2.62, 95% CI = 1.32 to 5.18), inability to cut one's own toenails (HR = 2.04, 95% CI = 1.04 to 4.01), and self-reported depression (HR = 1.72, 95% CI = 0.83 to 3.55). Falls, recurrent falls, and injurious falls in community-dwelling elder ED patients being evaluated for non-fall-related complaints occur at least as frequently as in previously described outpatient cohorts. Nonhealing foot sores, self-reported depression, not clipping one's own toenails, and previous falls are all associated with falls after ED discharge.

Mechanical falls: are patients willing to discuss their risk with a health care provider?

PubMed

Greenberg, Marna Rayl; Nguyen, Michael C; Stello, Brian; Goldberg, Arnold R; Barraco, Robert D; Porter, Bernadette G; Kurt, Anita; Dusza, Stephen W; Kane, Bryan G

2015-01-01

Falls in the elderly cause serious injury. We aimed to determine subjects' comfort in discussing fall risk and home safety evaluations. This prospective study surveyed a convenience sample of subjects (≥50 years old) in an emergency department (ED), health fair (HF), and family practice (FP). The survey included the Falls Efficacy Scale and Vulnerable Elders Survey-validated surveys measuring fall concern and functional decline. Other data-environmental living conditions, participant behaviors, fall frequency-were collected. The associations between perceived fall risk and participant characteristics were assessed using descriptive statistics and random-effects logistic regression. Participants (n = 416, 38% males, 62% females) had a mean age of 67.6 years; 35% were high fall risk. Previous year falls (p = 0.002), use of assistive device (p < 0.001), having at least one alcoholic drink/week (p = 0.043), and poor or fair perceived health status (p < 0.001) were associated with perceived fall risk. HF respondents were more willing than FP respondents to discuss falls (84.9% vs. 73.1%, p = 0.025). The difference was not significant between the HF and ED respondents (84.9% vs. 76.9, p = 0.11). HF subjects were more willing than FP to have a home safety inspection (68.9% vs. 45.9%, p < 0.001). The difference was not significant between the HF and ED respondents (68.9% vs 58.5, p = 0.09). Perceived and actual fall risks are highly associated. Most participants are willing to discuss their fall risk and a home safety evaluation. HF subjects were most willing to have these discussions; ED subjects were less willing than HF, but not significantly different from health fair participants. FP participants were significantly less willing to have these discussions than HF participants. This may suggest a meaningful opportunity for fall risk prevention in outpatient settings such as health fairs and the ED. Copyright © 2015 Elsevier Inc. All rights reserved.

United States Air Force Training Extract AFSC 4M0X1 Aerospace Physiology (Active Duty)

DTIC Science & Technology

2002-05-01

Training Emphasis Rating ABOVE AVG = "ABOVE AVERAGE" in Training Emphasis; Tasks that fall between the Mean and 1 SD HIGH...34HIGH" in Training Emphasis; Tasks that fall between 1 SD and 2 SD VERY HIGH = "VERY HIGH" in Training Emphasis; Tasks that fall above...3.97 17 4 28 7 23 28 33 21 5.61 11 fall (PLF) platforms F0209 Instruct or evaluate students during descent

Effectiveness of an automatic manual wheelchair braking system in the prevention of falls.

PubMed

Martorello, Laura; Swanson, Edward

2006-01-01

The purpose of this study was to evaluate the effectiveness of an automatic manual wheelchair braking system in the reduction of falls for patients at high risk of falls while transferring to and from a manual wheelchair. The study design was a normative survey carried out through the use of a written questionnaire sent to 60 skilled nursing facilities to collect data from the medical charts, which identified patients at high risk for falls who used an automatic wheelchair braking system. The facilities participating in the study identified a frequency of falls of high-risk patients while transferring to and from the wheelchair ranging from 2 to 10 per year, with a median fall rate per facility of 4 falls. One year after the installation of the automatic wheelchair braking system, participating facilities demonstrated a reduction of zero to three falls during transfers by high-risk patients, with a median fall rate of zero falls. This represents a statistically significant reduction of 78% in the fall rate of high-risk patients while transferring to and from the wheelchair, t (18) = 6.39, p < .0001. Incident reports of falls to and from manual wheelchairs were reviewed retrospectively for a 1-year period. This study suggests that high-risk fallers transferring to or from manual wheelchairs sustained significantly fewer falls when the Steddy Mate automatic braking system for manual wheelchairs was installed. The application of the automatic braking system allows clients, families/caregivers, and facility personnel an increased safety factor for the reduction of falls from the wheelchair.

Fall risk profile and quality-of-life status of older chiropractic patients.

PubMed

Holt, Kelly R; Noone, Paul L; Short, Krystal; Elley, C Raina; Haavik, Heidi

2011-02-01

The primary aim of this study was to estimate the prevalence of fall risk factors in older chiropractic patients. The secondary aim was to investigate the quality-of-life status of older chiropractic patients and to see whether a history of falling was related to quality-of-life status. A cross-sectional study was conducted at 12 chiropractic practices throughout Auckland, New Zealand, and Melbourne, Australia. The study involved gaining a profile of health status, fall history, and fall risk from active chiropractic patients who were 65 years or older. One hundred ten older chiropractic patients were approached, and 101 agreed to participate in this study (response rate, 91.8%). Thirty-five percent of participants had experienced at least 1 fall in the previous 12 months. Of those that had fallen, 80% had at least a minor injury, with 37% of fallers requiring medical attention and 6% suffering a serious injury. The prevalence of most fall risk factors was consistent with published data for community-dwelling older adults. Quality of life of older chiropractic patients appeared to be good, but fallers reported a lower physical component summary score compared with nonfallers (P = .04). A portion of the older chiropractic patients sampled in this study had a substantial risk of falling. This risk could be assessed on a regular basis for the presence of modifiable fall risk factors, and appropriate advice, given when fall risks are identified. Copyright © 2011 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Exploring Older Adult ED Fall Patients' Understanding of Their Fall: A Qualitative Study.

PubMed

Shankar, Kalpana N; Taylor, Devon; Rizzo, Caroline T; Liu, Shan W

2017-12-01

We sought to understand older patients' perspectives about their fall, fall risk factors, and attitude toward emergency department (ED) fall-prevention interventions. We conducted semistructured interviews between July 2015 and January 2016 of community-dwelling, nondemented patients in the ED, who presented with a fall to an urban, teaching hospital. Interviews were halted once we achieve thematic saturation with the data coded and categorized into themes. Of the 63 patients interviewed, patients blamed falls on the environment, accidents, a medical condition, or themselves. Three major themes were generated: (1) patients blamed falls on a multitude of things but never acknowledged a possible multifactorial rationale, (2) patients have variable level of concerns regarding their current fall and future fall risk, and (3) patients demonstrated a range of receptiveness to ED interventions aimed at preventing falls but provided little input as to what those interventions should be. Many older patients who fall do not understand their fall risk. However, based on the responses provided, older adults tend to be more receptive to intervention and more concerned about their future fall risk, making the ED an appropriate setting for intervention.

Blood pressure and falls in community-dwelling people aged 60 years and older in the VHM&PP cohort.

PubMed

Klein, Diana; Nagel, Gabriele; Kleiner, Andrea; Ulmer, Hanno; Rehberger, Barbara; Concin, Hans; Rapp, Kilian

2013-05-21

Falls are one of the major health problems in old people. Different risk factors were identified but only few epidemiological studies analysed the influence of conventionally measured blood pressure on falls. The objective of our study was to investigate the relationship between systolic and diastolic blood pressure and falls. In 3,544 community-dwelling Austrian women and men aged 60 years and older, data on falls within the previous three months were collected by questionnaire. Blood pressure was measured by general practitioners within the Vorarlberg Health Monitoring and Prevention Programme (VHM&PP) 90 to 1095 days before the fall assessment. A multiple logistic regression analysis was conducted. The models were stratified by gender and adjusted by age, number of medical conditions and subjective feeling of illness. In total, 257 falls in 3,544 persons were reported. In women, high systolic and diastolic blood pressure was associated with a decreased risk of falls. An increase of systolic blood pressure by 10 mmHg and of diastolic blood pressure by 5 mmHg reduced the risk of falling by 9% (OR 0.91, 95% Cl 0.84-0.98) and 8% (OR 0.92, 95% Cl 0.85-0.99), respectively. In men, an increased risk of falls was observed in participants with low systolic or low diastolic blood pressure. Blood pressure was associated with the risk of falls. Hypertensive values decreased the risk in women and low blood pressure increased the risk in men.

Occupational and environmental risk factors for falls among workers in the healthcare sector.

PubMed

Drebit, Sharla; Shajari, Salomeh; Alamgir, Hasanat; Yu, Shicheng; Keen, Dave

2010-04-01

Falls are a leading cause of occupational injury for workers in healthcare, yet the risk factors of falls in this sector are understudied. Falls resulting in workers' compensation for time-loss from work from 2004-2007 for healthcare workers in British Columbia (BC) were extracted from a standardised incident-reporting database. Productive hours were derived from payroll data for the denominator to produce injury rates; relative risks were derived through Poisson regression modelling. A total of 411 falls were accepted for time-loss compensation. Compared to registered nurses, facility support workers (risk ratio (95% CI) = 6.29 (4.56-8.69)) and community health workers (6.58 (3.76-11.50)) were at high risk for falls. Falls predominantly occurred outdoors, in patients' rooms and kitchens depending on occupation and sub-sector. Slippery surfaces due to icy conditions or liquid contaminants were a leading contributing factor. Falls were more frequent in the colder months (January-March). The risk of falls varies by nature of work, location and worker demographics. The findings of this research will be useful for developing evidence-based interventions. STATEMENT OF RELEVANCE: Falls are a major cause of occupational injury for healthcare workers. This study examined risk factors including occupation type, workplace design, work setting, work organisation and environmental conditions in a large healthcare worker population in BC, Canada. The findings of this research should contribute towards developing evidence-based interventions.

Identifying Risk Factors for Elder Falls in Geriatric Rehabilitation in Israel.

PubMed

Ben Natan, Merav; Heyman, Neomi; Ben Israel, Joshua

2016-01-01

To identify risk factors for elder falls in a geriatric rehabilitation center in Israel. Retrospective chart review study. Four hundred and twelve medical records of inpatients in geriatric rehabilitation were retrospectively analyzed to compare between elders who sustained falls and those who did not. Of elders hospitalized during this year, 14% sustained falls. Fallers included a high proportion of males, with little comorbidity, not obese, and cardiovascular patients. Falls occurred frequently during patients' first week at the facility, mostly during the daytime. The falls occurred frequently in patients' rooms, and a common scenario was a fall during transition. The research findings single out patients who are allegedly at a lower risk of falls than more complex patients. Caregivers in geriatric rehabilitation settings should pay attention to patients who are allegedly at a lower risk of falls than more complex patients, and to cardiovascular patients in particular. © 2014 Association of Rehabilitation Nurses.

Loss of Consciousness During Single Sling Helicopter Hoist Rescue Resulting in a Fatal Fall.

PubMed

Biles, Jessie; Garner, Alan A

2016-09-01

Although harness suspension trauma has been documented since the 1960s, especially in the mountaineering setting, there is little robust medical research into the area. Helicopter hoist rescue shares similar risks and is reserved for those cases that cannot be accessed safely by other routes, where extrication may be hazardous or will take an unreasonable amount of time. The single sling or chest harness used for hoist rescue is a single harness around the upper torso and is easier and quicker to apply than a stretcher. However, the risks of a chest harness need to be balanced against the patient's condition, the environment, aircraft performance, and the urgency of the rescue. We report an adult male falling 80 ft to his death while being hoisted into a rescue helicopter for a likely fractured ankle. A single rescue sling harness technique was used, but the patient became unconscious, slipped out of the harness, and fell. He had significant comorbidities, including cardiomyopathy, obstructive sleep apnea, morbid obesity, and diabetes. A decrease in cardiac output secondary to thoracic compression was the presumed cause for his loss of consciousness and the potential physiological mechanisms and modifying factors are discussed. Further research into harness suspension trauma is required. Stretcher, double point harnesses, or rescue baskets are likely safer methods of hoisting, especially in a medically compromised patient. Biles J, Garner AA. Loss of consciousness during single sling helicopter hoist rescue resulting in a fatal fall. Aerosp Med Hum Perform. 2016; 87(9):821-824.

Fall Risk Assessment Tools for Elderly Living in the Community: Can We Do Better?

PubMed

Palumbo, Pierpaolo; Palmerini, Luca; Bandinelli, Stefania; Chiari, Lorenzo

2015-01-01

Falls are a common, serious threat to the health and self-confidence of the elderly. Assessment of fall risk is an important aspect of effective fall prevention programs. In order to test whether it is possible to outperform current prognostic tools for falls, we analyzed 1010 variables pertaining to mobility collected from 976 elderly subjects (InCHIANTI study). We trained and validated a data-driven model that issues probabilistic predictions about future falls. We benchmarked the model against other fall risk indicators: history of falls, gait speed, Short Physical Performance Battery (Guralnik et al. 1994), and the literature-based fall risk assessment tool FRAT-up (Cattelani et al. 2015). Parsimony in the number of variables included in a tool is often considered a proxy for ease of administration. We studied how constraints on the number of variables affect predictive accuracy. The proposed model and FRAT-up both attained the same discriminative ability; the area under the Receiver Operating Characteristic (ROC) curve (AUC) for multiple falls was 0.71. They outperformed the other risk scores, which reported AUCs for multiple falls between 0.64 and 0.65. Thus, it appears that both data-driven and literature-based approaches are better at estimating fall risk than commonly used fall risk indicators. The accuracy-parsimony analysis revealed that tools with a small number of predictors (~1-5) were suboptimal. Increasing the number of variables improved the predictive accuracy, reaching a plateau at ~20-30, which we can consider as the best trade-off between accuracy and parsimony. Obtaining the values of these ~20-30 variables does not compromise usability, since they are usually available in comprehensive geriatric assessments.

Zolpidem is independently associated with increased risk of inpatient falls.

PubMed

Kolla, Bhanu Prakash; Lovely, Jenna K; Mansukhani, Meghna P; Morgenthaler, Timothy I

2013-01-01

Inpatient falls are associated with significant morbidity and increased healthcare costs. Zolpidem has been reported to decrease balance and is associated with falls. Yet, it is a commonly used hypnotic agent in the inpatient setting. Zolpidem use in hospitalized patients may be a significant and potentially modifiable risk factor for falling. To determine whether inpatients administered zolpidem are at greater risk of falling. Retrospective cohort study. Adult non-intensive care unit (non-ICU) inpatients at a tertiary care center. Adult inpatients who were prescribed zolpidem were identified. Electronic medical records were reviewed to capture demographics and other risk factors for falls. The fall rate was compared in those administered zolpidem versus those only prescribed zolpidem. Multivariate analyses were performed to determine whether zolpidem was independently associated with falls. The fall rate among patients who were prescribed and received zolpidem (n = 4962) was significantly greater than among patients who were prescribed but did not receive zolpidem (n = 11,358) (3.04% vs 0.71%; P < 0.001). Zolpidem use continued to remain significantly associated with increased fall risk after accounting for age, gender, insomnia, delirium status, dose of zolpidem, Charlson comorbidity index, Hendrich's fall risk score, length of hospital stay, presence of visual impairment, gait abnormalities, and dementia/cognitive impairment (adjusted odds ratio [OR] 4.37, 95% confidence interval [CI] = 3.34-5.76; P < 0.001). Additionally, patients taking zolpidem who experienced a fall did not differ from other hospitalized adult patients who fell in terms of age, opioids, antidepressants, sedative-antidepressants, antipsychotics, benzodiazepine, or antihistamine use. Zolpidem use was a strong, independent, and potentially modifiable risk factor for inpatient falls. Copyright © 2012 Society of Hospital Medicine.

The FIM instrument to identify patients at risk of falling in geriatric wards: a 10-year retrospective study.

PubMed

Petitpierre, Nicolas Julien; Trombetti, Andrea; Carroll, Iain; Michel, Jean-Pierre; Herrmann, François Richard

2010-05-01

the main objective was to evaluate if the admission functional independence measure (FIM) score could be used to predict the risk of falls in geriatric inpatients. a 10-year retrospective study was performed. the study was conducted in a 298-bed geriatric teaching hospital in Geneva, Switzerland. all patients discharged from the hospital from 1 January 1997 to 31 December 2006 were selected. measures used were FIM scores at admission using the FIM instrument and number of falls extracted from the institution's fall report forms. during the study period, there were 23,966 hospital stays. A total of 8,254 falls occurred. Of these, 7,995 falls were linked to 4,651 stays. Falls were recorded in 19.4% of hospital stays, with a mean incidence of 7.84 falls per 1,000 patients-days. Although there was a statistically significant relationship between total FIM score, its subscales, and the risk of falling, the sensitivity, specificity, positive predictive value and negative predictive value obtained with receiver operating characteristic curves were insufficient to permit fall prediction. This might be due in part to a non-linear relationship between FIM score and fall risk. in this study, the FIM instrument was found to be unable to predict risk of falls in general geriatric wards.

A longitudinal study of change in falls risk and balance and mobility in healthy older people and people with Alzheimer disease.

PubMed

Suttanon, Plaiwan; Hill, Keith D; Said, Catherine M; Dodd, Karen J

2013-08-01

The aim of this study was to determine the rate of change in falls risk and balance and mobility performance in people with Alzheimer disease (AD) compared with those of healthy older people over a 1-yr period. A 1-yr follow-up study of change in levels of falls risk, balance, and mobility performance in 15 community-dwelling older people with mild to moderate AD and 15 healthy age-matched older people was conducted. Each participant completed a comprehensive assessment of balance and mobility, falls and falls risk, and level of physical activity at baseline and 1 yr later. The rate of increase in the number of falls and risk of falling was greater in people with AD. The rate of deterioration on a number of balance and mobility measures was also significantly greater in people with AD compared with the healthy older people. People with mild to moderate AD have an increased rate of decline in falls risk, balance, and mobility over a 12-mo period compared with age-matched healthy older people. Given this increased rate of decline, intermittent review of falls, balance and mobility, and interventions to address identified contributory risk factors should be considered by health practitioners.

Then we all fall down: fall mortality by trauma center level.

PubMed

Roubik, Daniel; Cook, Alan D; Ward, Jeanette G; Chapple, Kristina M; Teperman, Sheldon; Stone, Melvin E; Gross, Brian; Moore, Forrest O

2017-09-01

Ground-level falls (GLFs) are the predominant mechanism of injury in US trauma centers and accompany a spectrum of comorbidities, injury severity, and physiologic derangement. Trauma center levels define tiers of capability to treat injured patients. We hypothesized that risk-adjusted observed-to-expected mortality (O:E) by trauma center level would evaluate the degree to which need for care was met by provision of care. This retrospective cohort study used National Trauma Data Bank files for 2007-2014. Trauma center level was defined as American College of Surgeons (ACS) level I/II, ACS III/IV, State I/II, and State III/IV for within-group homogeneity. Risk-adjusted expected mortality was estimated using hierarchical, multivariable regression techniques. Analysis of 812,053 patients' data revealed the proportion of GLF in the National Trauma Data Bank increased 8.7% (14.1%-22.8%) over the 8 y studied. Mortality was 4.21% overall with a three-fold increase for those aged 60 y and older versus younger than 60 y (4.93% versus 1.46%, P < 0.001). O:E was lowest for ACS III/IV, (0.973, 95% CI: 0.971-0.975) and highest for State III/IV (1.043, 95% CI: 1.041-1.044). Risk-adjusted outcomes can be measured and meaningfully compared among groups of trauma centers. Differential O:E for ACS III/IV and State III/IV centers suggests that factors beyond case mix alone influence outcomes for GLF patients. More work is needed to optimize trauma care for GLF patients across the spectrum of trauma center capability. Copyright © 2017 Elsevier Inc. All rights reserved.

[Development of a portable fall risk index for elderly people living in the community].

PubMed

Toba, Kenji; Okochi, Jiro; Takahashi, Tai; Matsubayashi, Kozo; Nishinaga, Masanori; Yamada, Shizuru; Takahashi, Ryutaro; Nishijima, Reiko; Kobayashi, Yoshio; Machida, Ayako; Akishita, Masahiro; Sasaki, Hidetada

2005-05-01

To develop a portable risk index for falls. Risk factors were chosen from previously established factors then we added several environmental factors to the risk index; previous falls in the last 12 month, trippig or stumbling, inability to ascend or descend stairs without help, decreased walking speed, inability to cross a road within the green signal interval, inability to walk 1km without a break, inability to stand on one leg for 5 seconds (eyes open), using a cane, inability to wring out a towel, dizziness or faintness, stooped or rounded back, knee joint pain, visual disturbance, hearing disturbance, cognitive decline, fear of falling, receiving 5 or more prescribed drugs, sensation of darkness at home, obstacles inside, barrier on the carpet or floor, using steps daily at home, steep slopes around home. The questionnaire sheet was completed by 2,439 community-dwelling elderly subjects (76.3 +/- 7.4 years old). The frequency of each items of fall risk index was compared between fallers (history of fall within one year) and non-fallers. Multiple regression analysis was performed to identify independent risk factors for previous falls. Except barrier, step use and steep slope around home, all items in the fall risk index were more frequent in fallers. Multivariate analysis revealed that tripping or stumbling, inability to cross a road within the green signal interval, dizziness or faintness, obstacles inside, inability to wring out a towel, cane use and knee joint pain were independent risk factors for previous falls. These 7 selected items were further analyzed as predictors. The maximum sum of sensitivity and specificity was reached at the cut-off point of 2/3 (sensitivity 0.65, specificity 0.72) by receiver operating curve. Portable fall risk index is useful for clinical settings to identify high-risk subjects.

High incidence of falls and fall-related injuries in wheelchair users with spinal cord injury: A prospective study of risk indicators.

PubMed

Forslund, Emelie Butler; Jørgensen, Vivien; Franzén, Erika; Opheim, Arve; Seiger, Åke; Ståhle, Agneta; Hultling, Claes; Stanghelle, Johan K; Roaldsen, Kirsti Skavberg; Wahman, Kerstin

2017-01-31

To identify risk indicators for, and incidence of, recurrent falls and fall-related injuries in wheelchair users with traumatic spinal cord injury. Prospective multi-centre study. One hundred and forty-nine wheelchair users with spinal cord injury attending follow-up in Sweden and Norway. Inclusion criteria: wheelchair users ≥ 18 years old with traumatic spinal cord injury ≥ 1 year post-injury. individuals with motor complete injuries above C5. Falls were prospectively reported by text message every second week for one year and were followed-up by telephone interviews. Outcomes were: fall incidence, risk indicators for recurrent (> 2) falls and fall-related injuries. Independent variables were: demographic data, quality of life, risk willingness, functional independence, and exercise habits. Of the total sample (n = 149), 96 (64%) participants fell, 45 (32%) fell recurrently, 50 (34%) were injured, and 7 (5%) severely injured. Multivariate logistic regression analysis showed that reporting recurrent falls the previous year increased the odds ratio (OR) of recurrent falls (OR 10.2, p < 0.001). Higher quality of life reduced the OR of fall-related injuries (OR 0.86, p = 0.037). Previous recurrent falls was a strong predictor of future falls. The incidence of falls, recurrent falls and fall-related injuries was high. Hence, prevention of falls and fall-related injuries is important.

Utilizing a Meals on Wheels program to teach falls risk assessment to medical students.

PubMed

Demons, Jamehl L; Chenna, Swapna; Callahan, Kathryn E; Davis, Brooke L; Kearsley, Linda; Sink, Kaycee M; Watkins, Franklin S; Williamson, Jeff D; Atkinson, Hal H

2014-01-01

Falls are a critical public health issue for older adults, and falls risk assessment is an expected competency for medical students. The aim of this study was to design an innovative method to teach falls risk assessment using community-based resources and limited geriatrics faculty. The authors developed a Fall Prevention Program through a partnership with Meals-on-Wheels (MOW). A 3rd-year medical student accompanies a MOW client services associate to a client's home and performs a falls risk assessment including history of falls, fear of falling, medication review, visual acuity, a Get Up and Go test, a Mini-Cog, and a home safety evaluation, reviewed in a small group session with a faculty member. During the 2010 academic year, 110 students completed the in-home falls risk assessment, rating it highly. One year later, 63 students voluntarily completed a retrospective pre/postsurvey, and the proportion of students reporting moderate to very high confidence in performing falls risk assessments increased from 30.6% to 87.3% (p < .001). Students also reported using most of the skills learned in subsequent clerkships. A single educational intervention in the MOW program effectively addressed geriatrics competencies with minimal faculty effort and could be adopted by many medical schools.

Automated Technology for In-home Fall Risk Assessment and Detection Sensor System

PubMed Central

Rantz, Marilyn J.; Skubic, Marjorie; Abbott, Carmen; Galambos, Colleen; Pak, Youngju; Ho, Dominic K.C.; Stone, Erik E.; Rui, Liyang; Back, Jessica; Miller, Steven J.

2013-01-01

Falls are a major problem for older adults. A continuous, unobtrusive, environmentally mounted in-home monitoring system that automatically detects when falls have occurred or when the risk of falling is increasing could alert health care providers and family members so they could intervene to improve physical function or mange illnesses that are precipitating falls. Researchers at the University of Missouri (MU)Center for Eldercare and Rehabilitation Technology are testing such sensor systems for fall risk assessment and detection in older adults’ apartments in a senior living community. Initial results comparing ground truth fall risk assessment data and GAITRite gait parameters with gait parameters captured from Mircosoft Kinect and Pulse-Dopplar radar are reported. PMID:23675644

Increased Risk for Falling Associated with Subtle Cognitive Impairment: Secondary Analysis of a Randomized Clinical Trial

PubMed Central

Gleason, Carey E.; Gangnon, Ronald E.; Fischer, Barbara L.; Mahoney, Jane E.

2009-01-01

Background/Aims Having dementia increases patients’ risk for accidental falls. However, it is unknown if having mild cognitive deficits also elevates a person's risk for falls. This study sought to clarify the relationship between subtle cognitive impairment, measured with a widely-used, clinic-based assessment, the Mini Mental State Exam (MMSE), and risk for falls. Methods In a secondary analysis of the Kenosha County Falls Prevention Study, a randomized controlled trial targeting older adults at risk for falls, we examined the association between baseline MMSE and prospective rate of falls over 12 months in 172 subjects randomized to control group. Results Using univariate analysis, the rate of falls increased with each unit decrease in MMSE score down to at least 22 (rate ratio 1.25, 95% confidence interval (CI) 1.09–1.45, p = 0.0026). Using stepwise multivariate regression, controlling for ability to perform activities of daily living, use of assistive device, current exercise, and arthritis, the association between MMSE score and falls rate persisted (rate ratio 1.20, 95% CI 1.03–1.40, p = 0.021). Conclusion Minimal decrements on the MMSE were associated with elevations in rate of falls, suggesting that subtle cognitive deficits reflected in MMSE scores above a cut-off consistent with a diagnosis of dementia, can influence risk for falls. PMID:19602883

Activity Monitoring and Heart Rate Variability as Indicators of Fall Risk: Proof-of-Concept for Application of Wearable Sensors in the Acute Care Setting.

PubMed

Razjouyan, Javad; Grewal, Gurtej Singh; Rishel, Cindy; Parthasarathy, Sairam; Mohler, Jane; Najafi, Bijan

2017-07-01

Growing concern for falls in acute care settings could be addressed with objective evaluation of fall risk. The current proof-of-concept study evaluated the feasibility of using a chest-worn sensor during hospitalization to determine fall risk. Physical activity and heart rate variability (HRV) of 31 volunteers admitted to a 29-bed adult inpatient unit were recorded using a single chest-worn sensor. Sensor data during the first 24-hour recording were analyzed. Participants were stratified using the Hendrich II fall risk assessment into high and low fall risk groups. Univariate analysis revealed age, daytime activity, nighttime side lying posture, and HRV were significantly different between groups. Results suggest feasibility of wearable technology to consciously monitor physical activity, sleep postures, and HRV as potential markers of fall risk in the acute care setting. Further study is warranted to confirm the results and examine the efficacy of the proposed wearable technology to manage falls in hospitals. [Journal of Gerontological Nursing, 43(7), 53-62.]. Copyright 2017, SLACK Incorporated.

In-hospital paediatric accidents: an integrative review of the literature.

PubMed

Da Rin Della Mora, R; Bagnasco, A; Sasso, L

2012-12-01

Paediatric hospitals can be perceived by children, parents, health professionals as 'safe' places, but accidents do occur. To review publications relating to in-hospital paediatric accidents and highlight the state-of-the-science concerning this issue especially in relation to falls, and the evolution of research addressing this issue. Integrative review of papers published before March 2011 on accidents and falls occurred in hospitalized children. Electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature and Cochrane Library databases) and further hand searching through references were searched. The inclusion criteria were articles involving observational, quasi-experimental or experimental studies in English or Italian. Exclusion criteria were articles addressing the outcomes of falls caused by suspect violence on children. Thirteen studies in English were included. Of the 13 studies conducted between 1963 and 2010, 10 had been conducted in the last 5 years; 10 in the USA. The studies were divided into two categories: contextualization and prevention of the 'accident' or 'fall' phenomenon (10 studies), and fall risk assessment (three studies). The most frequent type of design was observational explorative/descriptive. Several areas of investigation were explored (hazardous environment, children's characteristics correlated to accidents/falls, characteristics of the accidents/falls and their outcomes, paediatric fall risk factors and risk assessment tools, fall risk prevention programmes, parents' perceptions of accident/fall risks, etc.). No comparable methods were used to investigate the contextualization and prevention of the 'accident' and 'fall' phenomena; proposed fall risk assessment tools were not evaluated for their reliability and validity. Consensus would be needed around the approach to accidents in terms of: the definition of 'accident' and 'fall'; 'fall-related injury' and respective classifications; the frequency and rate calculation methods; the tools used to assess the risk of falls; and evidence-based practice aimed at preventing them. © 2012 The Authors. International Nursing Review © 2012 International Council of Nurses.

Risk of Falls in Parkinson's Disease: A Cross-Sectional Study of 160 Patients

PubMed Central

Contreras, Ana; Grandas, Francisco

2012-01-01

Falls are a major source of disability in Parkinson's disease. Risk factors for falling in Parkinson's disease remain unclear. To determine the relevant risk factors for falling in Parkinson's disease, we screened 160 consecutive patients with Parkinson's disease for falls and assessed 40 variables. A comparison between fallers and nonfallers was performed using statistical univariate analyses, followed by bivariate and multivariate logistic regression, receiver-operating characteristics analysis, and Kaplan-Meier curves. 38.8% of patients experienced falls since the onset of Parkinson's disease (recurrent in 67%). Tinetti Balance score and Hoehn and Yahr staging were the best independent variables associated with falls. The Tinetti Balance test predicted falls with 71% sensitivity and 79% specificity and Hoehn and Yahr staging with 77% sensitivity and 71% specificity. The risk of falls increased exponentially with age, especially from 70 years onward. Patients aged >70 years at the onset of Parkinson's disease experienced falls significantly earlier than younger patients. PMID:22292126

Men's perspectives on fall risk and fall prevention following participation in a group-based programme conducted at Men's Sheds, Australia.

PubMed

Liddle, Jeannine L M; Lovarini, Meryl; Clemson, Lindy M; Jang, Haeyoung; Willis, Karen; Lord, Stephen R; Sherrington, Catherine

2017-05-01

Research on older men's views regarding fall prevention is limited. The purpose of this qualitative study was to explore the experiences and perspectives of older men regarding fall risk and prevention so that fall prevention programmes can better engage older men. Eleven men who had taken part in a group-based fall prevention programme called Stepping On conducted at Men's Sheds in Sydney, Australia, participated in semi-structured interviews during June and July 2015 which were audio-recorded and transcribed. Data were coded and analysed using constant comparative methods. Over-arching theoretical categories were developed into a conceptual framework linking programme context and content with effects of programme participation on men. Men's Sheds facilitated participation in the programme by being inclusive, male-friendly places, where Stepping On was programmed into regular activities and was conducted in an enjoyable, supportive atmosphere. Programme content challenged participants to think differently about themselves and their personal fall risk, and provided practical options to address fall risk. Two major themes were identified: adjusting the mindset where men adopted a more cautious mindset paying greater attention to potential fall risks, being careful, concentrating and slowing down; and changing the ways where men acted purposefully on environmental hazards at home and incorporated fall prevention exercises into their routine schedules. Practitioners can engage and support older men to address falls by better understanding men's perspectives on personal fall risk and motivations for action. © 2016 John Wiley & Sons Ltd.

Fall determinants and home modifications by occupational therapists to prevent falls: Facteurs déterminants des chutes et modifications du domicile effectuées par les ergothérapeutes pour prévenir les chutes.

PubMed

Maggi, Patrick; de Almeida Mello, Johanna; Delye, Sam; Cès, Sophie; Macq, Jean; Gosset, Christiane; Declercq, Anja

2018-02-01

Approximately one third of older people over 65 years fall each year. Home modifications may decrease occurrence of falls. This study aims to determine the risk factors of falls for frail older persons and to evaluate the impact of home modifications by an occupational therapist on the occurrence of falls. We conducted a longitudinal study using a quasiexperimental design to examine occurrence of falls. All participants 65 years of age and older and were assessed at baseline and 6 months after the intervention. Bivariate analysis and logistic regression models were used to study the risk factors of falls and the effect of home modifications on the incidence of falls. The main predictors of falls were vision problems, distress of informal caregiver, and insufficient informal support. Home modifications provided by an occupational therapist showed a significant reduction of falls. Informal caregivers and their health status had an impact on the fall risk of frail older persons. Home modifications by an occupational therapist reduced the fall risk of frail older persons at 6-months follow-up.

Fall TIPS: strategies to promote adoption and use of a fall prevention toolkit.

PubMed

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

2009-11-14

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.

A feasibility study and pilot randomised trial of a tailored prevention program to reduce falls in older people with mild dementia.

PubMed

Wesson, Jacqueline; Clemson, Lindy; Brodaty, Henry; Lord, Stephen; Taylor, Morag; Gitlin, Laura; Close, Jacqueline

2013-09-03

People with dementia have a disproportionately high rate of falls and fractures and poorer outcomes, yet there is currently no evidence to guide falls prevention in this population. A randomised trial design was used to test feasibility of study components and acceptability of a home hazard reduction and balance and strength exercise fall prevention program. The program was tailored to participant's individual cognitive levels and implemented as a carer-supported intervention. Feasibility of recruitment, retention and implementation of intervention were recorded through observation and documented in field notes. Adherence, carer burden and use of task simplification strategies were also monitored. Outcome measures, collected at 12 weeks included physiological, fear of falling, cognitive and functional measures. Recruitment was achievable but may be more challenging in a multisite trial. Twenty two dyads of persons with mild dementia and their carers were randomised to intervention or usual care control group. Of 38 dyads referred to the study, there was a high rate of willingness to participate, with 6 (16%) declining and 10 (26%) not meeting inclusion criteria. The intervention was well received by participants and carers and adherence to both program components was very good. All participants implemented some home safety recommendations (range 19-80%) with half implementing 50% or more. At the end of 12 weeks, 72% of the intervention group were exercising. Both the rate of falling and the risk of a fall were lower in the intervention group but these findings were not significant (RR= 0.50 (95% CI 0.11-2.19). There were no differences in physiological outcome measures between the control and intervention groups. However results were influenced by the small study size and incomplete data primarily in the intervention group at follow up. The pilot study was feasible and acceptable to people with mild dementia and their carers. The lessons learnt included: recruitment for a larger trial will require multiple approaches; home safety recommendations should provide a greater emphasis on environmental use compared with behavioural change; strategies to ensure an adequate dosage of exercise should be further explored. We recommend that intervention delivery incorporate an integrated occupational therapy and physiotherapy approach and that carers be provided with an individualised session to enhance dementia-specific skills in management and communication. A refined intervention should be tested in a randomised trial with an adequately powered sample size. Australia and New Zealand Clinical Trials Registry 126100001049066.

A feasibility study and pilot randomised trial of a tailored prevention program to reduce falls in older people with mild dementia

PubMed Central

2013-01-01

Background People with dementia have a disproportionately high rate of falls and fractures and poorer outcomes, yet there is currently no evidence to guide falls prevention in this population. Methods A randomised trial design was used to test feasibility of study components and acceptability of a home hazard reduction and balance and strength exercise fall prevention program. The program was tailored to participant’s individual cognitive levels and implemented as a carer-supported intervention. Feasibility of recruitment, retention and implementation of intervention were recorded through observation and documented in field notes. Adherence, carer burden and use of task simplification strategies were also monitored. Outcome measures, collected at 12 weeks included physiological, fear of falling, cognitive and functional measures. Results Recruitment was achievable but may be more challenging in a multisite trial. Twenty two dyads of persons with mild dementia and their carers were randomised to intervention or usual care control group. Of 38 dyads referred to the study, there was a high rate of willingness to participate, with 6 (16%) declining and 10 (26%) not meeting inclusion criteria. The intervention was well received by participants and carers and adherence to both program components was very good. All participants implemented some home safety recommendations (range 19-80%) with half implementing 50% or more. At the end of 12 weeks, 72% of the intervention group were exercising. Both the rate of falling and the risk of a fall were lower in the intervention group but these findings were not significant (RR= 0.50 (95% CI 0.11-2.19). There were no differences in physiological outcome measures between the control and intervention groups. However results were influenced by the small study size and incomplete data primarily in the intervention group at follow up. Conclusions The pilot study was feasible and acceptable to people with mild dementia and their carers. The lessons learnt included: recruitment for a larger trial will require multiple approaches; home safety recommendations should provide a greater emphasis on environmental use compared with behavioural change; strategies to ensure an adequate dosage of exercise should be further explored. We recommend that intervention delivery incorporate an integrated occupational therapy and physiotherapy approach and that carers be provided with an individualised session to enhance dementia-specific skills in management and communication. A refined intervention should be tested in a randomised trial with an adequately powered sample size. Trial registration Australia and New Zealand Clinical Trials Registry 126100001049066 PMID:24004682

Risk of falls in patients with ankylosing spondylitis.

PubMed

Dursun, Nigar; Sarkaya, Selda; Ozdolap, Senay; Dursun, Erbil; Zateri, Coskun; Altan, Lale; Birtane, Murat; Akgun, Kenan; Revzani, Aylin; Aktas, İlknur; Tastekin, Nurettin; Celiker, Reyhan

2015-03-01

Risk of vertebral fractures is increased in patients with ankylosing spondylitis (AS). The underlying mechanisms for the elevated fracture risk might be associated with bone and fall-related risks. The aims of this study were to evaluate the risk of falls and to determine the factors that increase the risk of falls in AS patients. Eighty-nine women, 217 men, a total of 306 AS patients with a mean age of 40.1 ± 11.5 years from 9 different centers in Turkey were included in the study. Patients were questioned regarding history of falls within the last 1 year. Their demographics, disease characteristics including Bath AS Disease Activity Index, Bath AS Metrology Index (BASMI), Bath AS Functional Index (BASFI), and risk factors for falls were recorded. The Short Physical Performance Battery (SPPB) test was used for evaluation of static and dynamic balance. Erythrocyte sedimentation rate, C-reactive protein, and 25-hydroxyvitamin D levels were measured. Forty of 306 patients reported at least 1 fall in the recent 1 year. The patients with history of falls had higher mean age and longer disease duration than did nonfallers (P = 0.001). In addition, these patients' BASMI and BASFI values were higher than those of nonfallers (P = 0.002; P = 0.000, respectively). We found that the patients with history of falls had lower SPPB scores (P = 0.000). We also found that the number of falls increased with longer disease duration and older age (R = 0.117 [P = 0.041] and R = 0.160 [P = 0.005]). Our results show that decreased SPPB scores were associated with increased number of falls (R = 0.183, P = 0.006). Statistically significant correlations were found between number of falls and AS-related lost job (R = 0.140, P = 0.014), fear of falling (R = 0.316, P = 0.000), hip involvement (R = 0.112, P = 0.05), BASMI (R =0.234, P = 0.000), and BASFI (R = 0.244, P = 0.000). Assessment of pain, stiffness, fatigue, and lower-extremity involvement as well as asking for a history of falls will highlight those at high risk for further falls. In addition to the general exercise program adopted for all patients, we suggest that a balance rehabilitation program should be valuable for the patients with risk factors for fall. Exercise may improve fear of falling and BASFI and BASMI scores. However, further study is needed to investigate these hypotheses. We believe that clinicians should train and support the patients via reducing fear of falls and maintaining good posture and functional capacity.

Increased gait variability may not imply impaired stride-to-stride control of walking in healthy older adults: Winner: 2013 Gait and Clinical Movement Analysis Society Best Paper Award.

PubMed

Dingwell, Jonathan B; Salinas, Mandy M; Cusumano, Joseph P

2017-06-01

Older adults exhibit increased gait variability that is associated with fall history and predicts future falls. It is not known to what extent this increased variability results from increased physiological noise versus a decreased ability to regulate walking movements. To "walk", a person must move a finite distance in finite time, making stride length (L n ) and time (T n ) the fundamental stride variables to define forward walking. Multiple age-related physiological changes increase neuromotor noise, increasing gait variability. If older adults also alter how they regulate their stride variables, this could further exacerbate that variability. We previously developed a Goal Equivalent Manifold (GEM) computational framework specifically to separate these causes of variability. Here, we apply this framework to identify how both young and high-functioning healthy older adults regulate stepping from each stride to the next. Healthy older adults exhibited increased gait variability, independent of walking speed. However, despite this, these healthy older adults also concurrently exhibited no differences (all p>0.50) from young adults either in how their stride variability was distributed relative to the GEM or in how they regulated, from stride to stride, either their basic stepping variables or deviations relative to the GEM. Using a validated computational model, we found these experimental findings were consistent with increased gait variability arising solely from increased neuromotor noise, and not from changes in stride-to-stride control. Thus, age-related increased gait variability likely precedes impaired stepping control. This suggests these changes may in turn precede increased fall risk. Copyright © 2017 Elsevier B.V. All rights reserved.

A two-question tool to assess the risk of repeated falls in the elderly

PubMed Central

Gálvez-Barrón, César; Narvaiza, Leire; Miñarro, Antonio; Ruiz, Jorge; Valldosera, Esther; Gonzalo, Natalia; Ng, Thalia; Sanguino, María Jesús; Yuste, Antonio

2017-01-01

Introduction Older adults’ perception of their own risk of fall has never been included into screening tools. The goal of this study was to evaluate the predictive validity of questions on subjects’ self-perception of their own risk of fall. Methods This prospective study was conducted on a probabilistic sample of 772 Spanish community-dwelling older adults, who were followed-up for a one year period. At a baseline visit, subjects were asked about their recent history of falls (question 1: “Have you fallen in the last 6 months?”), as well as on their perception of their own risk of fall by using two questions (question 2: “Do you think you may fall in the next few months?” possible answers: yes/no; question 3: “What is the probability that you fall in the next few months?” possible answers: low/intermediate/high). The follow-up consisted of quarterly telephone calls, where the number of falls occurred in that period was recorded. Results A short questionnaire built with questions 1 and 3 showed 70% sensitivity (95% CI: 56%-84%), 72% specificity (95% CI: 68%-76%) and 0.74 area under the ROC curve (95% CI: 0.66–0.82) for prediction of repeated falls in the subsequent year. Conclusions The estimation of one’s own risk of fall has predictive validity for the occurrence of repeated falls in older adults. A short questionnaire including a question on perception of one’s own risk of fall and a question on the recent history of falls had good predictive validity. PMID:28489888

The consumption of two or more fall risk-increasing drugs rather than polypharmacy is associated with falls.

PubMed

Zia, Anam; Kamaruzzaman, Shahrul B; Tan, Maw P

2017-03-01

The presemt study aimed to determine the association between the risk of recurrent and injurious falls with polypharmacy, fall risk-increasing drugs (FRID) and FRID count among community-dwelling older adults. Participants (n = 202) were aged ≥65 years with two or more falls or one injurious fall in the past year, whereas controls (n = 156) included volunteers aged ≥65 years with no falls in the past year. A detailed medication history was obtained alongside demographic data. Polypharmacy was defined as "regular use of five or more prescription drugs." FRID were identified as cardiovascular agents, central nervous system drugs, analgesics and endocrine drugs; multiple FRID were defined as two or more FRID. Multiple logistic regression analyses were used to adjust for confounders. The use of non-steroidal anti-inflammatory drugs was independently associated with an increased risk of falls. Univariate analyses showed both polypharmacy (OR 2.23, 95% CI 1.39-3.56; P = 0.001) and the use of two or more FRID (OR 2.9, 95% CI 1.9-4.5; P = 0.0001) were significantly more likely amongst fallers. After adjustment for age, sex and comorbidities, blood pressure, and physical performance scores, polypharmacy was no longer associated with falls (OR 1.6, 95% CI 0.9-2.9; P = 0.102), whereas the consumption of two or more FRID remained a significant predictor for falls (OR 2.8, 95% CI 1.4-5.3; P = 0.001). Among high risk fallers, the use of two or more FRID was an independent risk factor for falls instead of polypharmacy. Our findings will inform clinical practice in terms of medication reviews among older adults at higher risk of falls. Future intervention studies will seek to confirm whether avoidance or withdrawal of multiple FRID reduces the risk of future falls. Geriatr Gerontol Int 2017; 17: 463-470. © 2016 Japan Geriatrics Society.

The effect of aquatic exercise and education on lowering fall risk in older adults with hip osteoarthritis.

PubMed

Arnold, Cathy M; Faulkner, Robert A

2010-07-01

To evaluate the effect of aquatic exercise and education on fall risk factors in older adults with hip osteoarthritis (OA). Seventy-nine adults, 65 years of age or older with hip OA and at least 1 fall risk factor, were randomly assigned to 1 of 3 groups: aquatics and education (AE; aquatic exercise twice a wk with once-a-wk group education), aquatics only (A; 2 wk aquatic exercise) and control (C; usual activity). Balance, falls efficacy, dual-task function, functional performance (chair stands), and walking performance were measured pre- and postintervention or control period. There was a significant improvement in fall risk factors (full-factorial MANCOVA, baseline values as covariates; p = .038); AE improved in falls efficacy compared with C and in functional performance compared with A and C. The combination of aquatic exercise and education was effective in improving fall risk factors in older adults with arthritis.

Sessions and Abstracts by Day for Satellite Meeting: Comparative Physiology of Respiration with Emphasis on Avian Respiratory Control, October 11 and 12, 1981.

ERIC Educational Resources Information Center

Physiologist, 1981

1981-01-01

Provides abstracts of contributed and invited papers presented at a satellite meeting on "Comparative Physiology of Respiration," October 11 and 12, 1981, at Ohio State University, as part of the 32nd Annual Fall Meeting of the American Physiological Society. (CS)

Physiology in Medicine: neuromuscular consequences of diabetic neuropathy

PubMed Central

Doherty, Timothy J.; Rice, Charles L.; Kimpinski, Kurt

2016-01-01

Diabetic polyneuropathy (DPN) refers to peripheral nerve dysfunction as a complication of diabetes mellitus. This condition is relatively common and is likely a result of vascular and/or metabolic disturbances related to diabetes. In the early or less severe stages of DPN it typically results in sensory impairments but can eventually lead to major dysfunction of the neuromuscular system. Some of these impairments may include muscle atrophy and weakness, slowing of muscle contraction, and loss of power and endurance. Combined with sensory deficits these changes in the motor system can contribute to decreased functional capacity, impaired mobility, altered gait, and increased fall risk. There is no pharmacological disease-modifying therapy available for DPN and the mainstay of treatment is linked to treating the diabetes itself and revolves around strict glycemic control. Exercise therapy (including aerobic, strength, or balance training-based exercise) appears to be a promising preventative and treatment strategy for patients with DPN and those at risk. The goal of this Physiology in Medicine article is to highlight important and overlooked dysfunction of the neuromuscular system as a result of DPN with an emphasis on the physiologic basis for that dysfunction. Additionally, we sought to provide information that clinicians can use when following patients with diabetes or DPN including support for the inclusion of exercise-based therapy as an effective, accessible, and inexpensive form of treatment. PMID:26989220

Body mass index, falls, and injurious falls among U.S. adults: Findings from the 2014 Behavioral Risk Factor Surveillance System.

PubMed

Ylitalo, Kelly R; Karvonen-Gutierrez, Carrie A

2016-10-01

Falls are an important health concern because they are associated with loss of independence and disability, particularly among women. We determined the age- and sex-specific prevalence of injurious falls among adults in the United States and examined the impact of obesity on fall risk. Self-reported falls, injurious falls, and health histories were obtained from 280,035 adults aged 45-79years in the 2014 Behavioral Risk Factor Surveillance System. Body mass index was categorized as underweight (<18.5kg/m 2 ), normal weight (18.5-24.9kg/m 2 ), overweight 25-29.9kg/m 2 ), class I obesity (30.0-34.9kg/m 2 ), or class II/III obesity (≥35.0kg/m 2 ) based on self-reported height and weight. Data were analyzed using weighted age- and sex-specific prevalence rates and Poisson regression. Overall, 11.0% reported ≥1 injurious fall in the previous 12months. Mid-life women 55-59years reported the highest prevalence of injurious falls (15.4%). Among mid-life women, overweight was associated with injurious falls (RR=1.17; 95% CI: 1.08, 1.28), but overweight was not associated with falling among other age-sex groups. Class II/III obesity was associated with injurious falls among all age-sex groups. After considering the mediators like health conditions (depression, cardiovascular disease, diabetes, arthritis) and behaviors (physical activity, sleep), the association of class II/III obesity and injurious fall risk persisted only among mid-life women (RR=1.23; 95% CI: 1.12, 1.36). Not only are mid-life women at high risk for falls, but the class II/III obesity is a risk factor for injurious falls. Targeting mid-life women for fall and injury prevention is an important aim for practitioners, particularly given unique correlates of falling for this group. Copyright © 2016 Elsevier Inc. All rights reserved.

Association between Antidepressants and Fall-Related Injuries among Long-Term Care Residents.

PubMed

Macri, Jennifer C; Iaboni, Andrea; Kirkham, Julia G; Maxwell, Colleen; Gill, Sudeep S; Vasudev, Akshya; Whitehead, Marlo; Seitz, Dallas P

2017-12-01

Antidepressants are associated with an increased risk of falls although little is known of the comparative risks of different types of antidepressants or individuals who are at greatest risk for falls. We examined the association between new use of antidepressants and fall-related injuries among older adults in long-term care (LTC). This was a matched, retrospective cohort study involving LTC residents in Ontario, Canada, from 2008 to 2014. New users of antidepressants were matched to non-users of antidepressants. The primary outcome was any fall resulting in an emergency department (ED) visit or hospitalization within 90 days after exposure. Secondary outcomes included hip fractures, wrist fractures, and falls reported in LTC. Multivariate logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval associated with antidepressants and outcomes. New users of any antidepressant had an increased risk of ED visits or hospitalization for falls within 90 days when compared with individuals not receiving antidepressants (5.2% versus 2.8%; adjusted OR: 1.9, 95% CI: 1.7-2.2). Antidepressants were also associated with an increased risk of all secondary outcomes. The increased risk of fall-related injuries was evident among selective-serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, trazodone, and across multiple patient subgroups. New use of antidepressants is associated with significantly increased risk of falls and fall-related injuries among LTC residents across different patient subgroups and antidepressant classes. The potential risk of fall-related outcomes should be carefully considered when initiating antidepressants among older adults in LTC. Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Risk factors of falls among elderly living in Urban Suez - Egypt

PubMed Central

Kamel, Mohammed Hany; Abdulmajeed, Abdulmajeed Ahmed; Ismail, Sally El-Sayed

2013-01-01

Introduction Falling is one of the most common geriatric syndromes threatening the independence of older persons. Falls result from a complex and interactive mix of biological or medical, behavioral and environmental factors, many of which are preventable. Studying these diverse risk factors would aid early detection and management of them at the primary care level. Methods This is a cross sectional study about risk factors of falls was conducted to 340 elders in Urban Suez. Those are all patients over 60 who attended two family practice centers in Urban Suez. Results When asked about falling during the past 12 months, 205 elders recalled at least one incident of falling. Of them, 36% had their falls outdoors and 24% mentioned that stairs was the most prevalent site for indoor falls. Falls were also reported more among dependant than independent elderly. Using univariate regression analysis, almost all tested risk factors were significantly associated with falls in the studied population. These risk factors include: living alone, having chronic diseases, using medications, having a physical deficit, being in active, and having a high nutritional risk. However, the multivariate regression analysis proved that the strongest risk factors are low level of physical activity with OR 0.6 and P value 0.03, using a cane or walker (OR 1.69 and P value 0.001) and Impairment of daily living activities (OR 1.7 and P value 0.001). Conclusion Although falls is a serious problem among elderly with many consequences, it has many preventable risk factors. Health care providers should advice people to remain active and more research is needed in such an important area of Family Practice. PMID:23504298

Risk factors of falls among elderly living in urban Suez--Egypt.

PubMed

Kamel, Mohammed Hany; Abdulmajeed, Abdulmajeed Ahmed; Ismail, Sally El-Sayed

2013-01-01

Falling is one of the most common geriatric syndromes threatening the independence of older persons. Falls result from a complex and interactive mix of biological or medical, behavioral and environmental factors, many of which are preventable. Studying these diverse risk factors would aid early detection and management of them at the primary care level. This is a cross sectional study about risk factors of falls was conducted to 340 elders in Urban Suez. Those are all patients over 60 who attended two family practice centers in Urban Suez. When asked about falling during the past 12 months, 205 elders recalled at least one incident of falling. Of them, 36% had their falls outdoors and 24% mentioned that stairs was the most prevalent site for indoor falls. Falls were also reported more among dependant than independent elderly. Using univariate regression analysis, almost all tested risk factors were significantly associated with falls in the studied population. These risk factors include: living alone, having chronic diseases, using medications, having a physical deficit, being in active, and having a high nutritional risk. However, the multivariate regression analysis proved that the strongest risk factors are low level of physical activity with OR 0.6 and P value 0.03, using a cane or walker (OR 1.69 and P value 0.001) and Impairment of daily living activities (OR 1.7 and P value 0.001). Although falls is a serious problem among elderly with many consequences, it has many preventable risk factors. Health care providers should advice people to remain active and more research is needed in such an important area of Family Practice.

Falls from height during the floor slab formwork of buildings: current situation in Spain.

PubMed

Adam, Jose M; Pallarés, Francisco J; Calderón, Pedro A

2009-01-01

One of the phases with the highest risk of falls from a height in the construction of a building is during the floor slab formwork stage. This paper analyzes this particular risk, as well as the most frequently used fall-protection systems. A survey was carried out to define the current situation in Spain with regard to falls from a height during floor slab formwork and the fall-protection systems used to prevent such a risk. The results of the survey clarified the current situation in Spain with regard to this risk, and made it clear that there is considerable risk of falling from a height during the floor slab formwork stage. All the safety systems analyzed presented a series of weak points that should be studied in detail before they can be used on building sites. The risk of falling associated with floor slab formwork and the most frequently used protection systems are analyzed. As no research had been carried out to date on this type of risk, we consider the research presented in this article to be a pioneer in the field.

Using single leg standing time to predict the fall risk in elderly.

PubMed

Chang, Chun-Ju; Chang, Yu-Shin; Yang, Sai-Wei

2013-01-01

In clinical evaluation, we used to evaluate the fall risk according to elderly falling experience or the balance assessment tool. Because of the tool limitation, sometimes we could not predict accurately. In this study, we first analyzed 15 healthy elderly (without falling experience) and 15 falling elderly (1~3 time falling experience) balance performance in previous research. After 1 year follow up, there was only 1 elderly fall down during this period. It seemed like that falling experience had a ceiling effect on the falling prediction. But we also found out that using single leg standing time could be more accurately to help predicting the fall risk, especially for the falling elderly who could not stand over 10 seconds by single leg, and with a significant correlation between the falling experience and single leg standing time (r = -0.474, p = 0.026). The results also showed that there was significant body sway just before they falling down, and the COP may be an important characteristic in the falling elderly group.

Associations between obesity and overweight and fall risk, health status and quality of life in older people.

PubMed

Mitchell, Rebecca J; Lord, Stephen R; Harvey, Lara A; Close, Jacqueline C T

2014-02-01

To determine whether overweight and obese individuals have higher reported fall and fall injury risk than individuals of healthy weight, and to examine the influence of BMI on health, quality of life and lifestyle characteristics of fallers. A representative sample of community-based individuals aged 65 years and older in New South Wales was surveyed regarding their history of falls, height, weight, lifestyle and general health within a 12-month period. Obese individuals had a 31% higher risk of having fallen, but no higher risk of a fall-related injury compared to healthy-weight individuals. Obese fallers also had a 57% higher risk of believing nothing could be done to prevent falls; a 41% higher risk of using four or more medications; a 30% higher risk of experiencing moderate or extreme pain or discomfort; were 26% less likely have walked for two or more hours in the last week; and were less likely to think they were doing enough physical activity. Older obese individuals have an increased risk of falls and obese fallers have a higher prevalence of pain and inactivity than fallers of a healthy weight. A decrease in sedentary lifestyle and regular weight-bearing exercise may reduce fall risk in older obese individuals. © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia.

Fall risk and prevention needs assessment in an older adult Latino population: a model community global health partnership.

PubMed

Hanlin, Erin R; Delgado-Rendón, Angélica; Lerner, E Brooke; Hargarten, Stephen; Farías, René

2013-01-01

The impact of falls in older adults presents a significant public health burden. Fall risk is not well-described in Latino populations nor have fall prevention programs considered the needs of this population. The objectives of this study were to develop a needs assessment of falls in older adult Latinos at a community center (CC), determine fall prevention barriers and strengths in this population, determine the level of interest in various fall prevention methods, and provide medical students an opportunity for participation in a culturally diverse community project. A cross-sectional survey was conducted with a convenience sample of older adult program participants. The survey was developed in collaboration with both partners. CC participants were approached by the interviewer and asked to participate. They were read the survey in their preferred language and their answers were recorded. Data were analyzed using descriptive statistics. We conducted 103 interviews. We found that 54% of participants had fallen in the last year, and of those 21% required medical care, 81% were afraid of falling again, and 66% considered themselves at risk for falling again. Of all respondents, 52% had 5 or more of the 10 surveyed risk factors for falling; 4% had no risk factors. Of all respondents, 75% were afraid of falling. Talking with health care providers and participating in an exercise class were the preferred methods of health information delivery (78% and 65%, respectively). Older adult Latinos in this selected population frequently fall and are worried about falling. Risk factors are prevalent. A fall prevention program is warranted and should include exercise classes and a connection with local primary care providers. A partnership between an academic organization and a CC is an ideal collaboration for the future development of prevention program.

Usual Alcohol Consumption and Risks for Nonfatal Fall Injuries in the United States: Results From the 2004-2013 National Health Interview Survey.

PubMed

Chen, Chiung M; Yoon, Young-Hee

2017-07-29

Acute alcohol consumption is known to be a risk factor for fall injuries. The study sought to determine whether usual alcohol consumption increases the risk for nonfatal fall injuries. Data from 289,187 sample adults in the 2004-2013 U.S. National Health Interview Surveys were analyzed. Of these, 3,368 (∼1%) reported a total of 3,579 fall-injury episodes requiring medical consultation in the past 3 months. Latent class analysis based on four contextual indicators identified four ecological subtypes of fall injury within two age groups (18-49 and 50+). Five drinking patterns (i.e., lifetime abstainer, former drinker, low-risk drinker, increased-risk drinker, and highest-risk drinker) were categorized according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) low-risk drinking guidelines. Controlling for potential confounders, negative binomial regression estimated the adjusted rates of any type and subtypes of fall injury, by gender, for each drinking pattern relative to lifetime abstainer. Compared with lifetime abstainers, the adjusted rate of any fall injury for adults ages 18-49 was significantly higher among highest-risk drinkers (men: incidence rate ratio [IRR] = 2.59, 95% confidence interval [CI] [1.60, 4.20]; women: IRR = 1.90, 95% CI [1.24, 2.91]) and increased-risk drinkers (men: IRR = 1.94, 95% CI [1.25, 3.00]; women: IRR = 1.51, 95% CI [1.11, 2.07]). Furthermore, highest-risk drinkers had higher adjusted rates of either leisure- or sports-related fall injuries than lifetime abstainers. Alcohol consumption exceeding NIAAA's low-risk drinking guidelines is associated with elevated rates of nonfatal fall injuries. Findings underscore the importance of adhering to these recommendations.

Receipt of Caregiving and Fall Risk in US Community-dwelling Older Adults.

PubMed

Hoffman, Geoffrey J; Hays, Ron D; Wallace, Steven P; Shapiro, Martin F; Yakusheva, Olga; Ettner, Susan L

2017-04-01

Falls and fall-related injuries (FRI) are common and costly occurrences among older adults living in the community, with increased risk for those with physical and cognitive limitations. Caregivers provide support for older adults with physical functioning limitations, which are associated with fall risk. Using the 2004-2012 waves of the Health and Retirement Study, we examined whether receipt of low (0-13 weekly hours) and high levels (≥14 weekly hours) of informal care or any formal care is associated with lower risk of falls and FRIs among community-dwelling older adults. We additionally tested whether serious physical functioning (≥3 activities of daily living) or cognitive limitations moderated this relationship. Caregiving receipt categories were jointly significant in predicting noninjurious falls (P=0.03) but not FRIs (P=0.30). High levels of informal care category (P=0.001) and formal care (P<0.001) had stronger associations with reduced fall risk relative to low levels of informal care. Among individuals with ≥3 activities of daily living, fall risks were reduced by 21% for those receiving high levels of informal care; additionally, FRIs were reduced by 42% and 58% for those receiving high levels of informal care and any formal care. High levels of informal care receipt were also associated with a 54% FRI risk reduction among the cognitively impaired. Fall risk reductions among older adults occurred predominantly among those with significant physical and cognitive limitations. Accordingly, policy efforts involving fall prevention should target populations with increased physical functioning and cognitive limitations. They should also reduce financial barriers to informal and formal caregiving.

Neighborhood walkability, fear and risk of falling and response to walking promotion: The Easy Steps to Health 12-month randomized controlled trial.

PubMed

Merom, D; Gebel, K; Fahey, P; Astell-Burt, T; Voukelatos, A; Rissel, C; Sherrington, C

2015-01-01

In older adults the relationships between health, fall-related risk factors, perceived neighborhood walkability, walking behavior and intervention impacts are poorly understood. To determine whether: i) health and fall-related risk factors were associated with perceptions of neighborhood walkability; ii) perceived environmental attributes, and fall-related risk factors predicted change in walking behavior at 12 months; and iii) perceived environmental attributes and fall-related risk factors moderated the effect of a self-paced walking program on walking behavior. Randomized trial on walking and falls conducted between 2009 and 2012 involving 315 community-dwelling inactive adults ≥ 65 years living in Sydney, Australia. Measures were: mobility status, fall history, injurious fall and fear of falling (i.e., fall-related risk factors), health status, walking self-efficacy and 11 items from the neighborhood walkability scale and planned walking ≥ 150 min/week at 12 months. Participants with poorer mobility, fear of falling, and poor health perceived their surroundings as less walkable. Walking at 12 months was significantly greater in "less greenery" (AOR = 3.3, 95% CI: 1.11-9.98) and "high traffic" (AOR = 1.98, 95% CI: 1.00-3.91) neighborhoods. The intervention had greater effects in neighborhoods perceived to have poorer pedestrian infrastructure (p for interaction = 0.036). Low perceived walkability was shaped by health status and did not appear to be a barrier to walking behavior. There appears to be a greater impact of, and thus, need for, interventions to encourage walking in environments perceived not to have supportive walking infrastructure. Future studies on built environments and walking should gather information on fall-related risk factors to better understand how these characteristics interact.

Race and fall risk: data from the National Health and Aging Trends Study (NHATS).

PubMed

Sun, Daniel Q; Huang, Jin; Varadhan, Ravi; Agrawal, Yuri

2016-01-01

the objective of this study was to explore whether race-based difference in fall risk may be mediated by environmental and physical performance risk factors. using data from a nationally representative longitudinal survey of 7,609 community-dwelling participants in the National Health and Aging Trends Study (NHATS), we evaluated whether racial differences in fall risk may be explained by physical performance level (measured by the Short Physical Performance Battery), mobility disability, physical activity level and likelihood of living alone. Multivariate Poisson regression and mediation models were used in analyses. in whites and blacks, the annual incidence of 'any fall' was 33.8 and 27.1%, respectively, and the annual incidence of 'recurrent falls' was 15.5 and 12.3%, respectively. Compared with whites, blacks had relative risks of 0.7 (95% confidence interval 0.6-0.8) and 0.6 (0.5-0.8) for sustaining any fall and recurrent falls, respectively, in adjusted analyses. Blacks had poorer performance on the SPPB (P < 0.001), higher levels of mobility disability (P < 0.001), similar levels of physical activity (P = 0.19) and were equally likely to live alone relative to whites (P = 0.77). Mediation analysis revealed that these risk factors collectively acted as suppressors and none of these factors accounted for the racial differences in fall risk observed. relative to whites, blacks were at 30 and 40% decreased risk of sustaining any fall and recurrent falls, respectively. This difference in risk remains unexplained. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Orthostatic Hypotension in Middle-Age and Risk of Falls.

PubMed

Juraschek, Stephen P; Daya, Natalie; Appel, Lawrence J; Miller, Edgar R; Windham, Beverly Gwen; Pompeii, Lisa; Griswold, Michael E; Kucharska-Newton, Anna; Selvin, Elizabeth

2017-02-01

One-third of older adults fall each year. Orthostatic hypotension (OH) has been hypothesized as an important risk factor for falls, but findings from prior studies have been inconsistent. We conducted a prospective study of the association between baseline OH (1987-1989) and risk of falls in the Atherosclerosis Risk in Communities (ARIC) Study. Falls were ascertained during follow-up via ICD-9 hospital discharge codes or Centers for Medicare & Medicaid Services claims data. OH was defined as a drop in systolic blood pressure (SBP) ≥20mm Hg or diastolic blood pressure (DBP) ≥10mm Hg within 2 minutes of moving from the supine to standing position. Changes in SBP or DBP during OH assessments were also examined as continuous variables. During a median follow-up of 23 years, there were 2,384 falls among 12,661 participants (mean age 54 years, 55% women, 26% black). OH was associated with risk of falls even after adjustment for demographic characteristics and other risk factors (hazard ratio (HR): 1.30; 95% confidence interval (CI): 1.10, 1.54; P = 0.002). Postural change in DBP was more significantly associated with risk of falls (HR 1.09 per -5mm Hg change in DBP; 95% CI: 1.05, 1.13; P < 0.001) than postural change in SBP (HR 1.03 per -5mm Hg change in SBP; 95% CI: 1.01, 1.05; P = 0.002). In a community-based, middle-aged population, OH, and in particular, postural change in DBP, were independent risk factors for falls over 2 decades of follow-up. Future studies are needed to examine OH thresholds associated with increased risk of falls. © American Journal of Hypertension, Ltd 2016. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Orthostatic Hypotension in Middle-Age and Risk of Falls

PubMed Central

Juraschek, Stephen P.; Daya, Natalie; Appel, Lawrence J.; Miller, Edgar R.; Windham, Beverly Gwen; Pompeii, Lisa; Griswold, Michael E.; Kucharska-Newton, Anna

2017-01-01

BACKGROUND One-third of older adults fall each year. Orthostatic hypotension (OH) has been hypothesized as an important risk factor for falls, but findings from prior studies have been inconsistent. METHODS We conducted a prospective study of the association between baseline OH (1987–1989) and risk of falls in the Atherosclerosis Risk in Communities (ARIC) Study. Falls were ascertained during follow-up via ICD-9 hospital discharge codes or Centers for Medicare & Medicaid Services claims data. OH was defined as a drop in systolic blood pressure (SBP) ≥20mm Hg or diastolic blood pressure (DBP) ≥10mm Hg within 2 minutes of moving from the supine to standing position. Changes in SBP or DBP during OH assessments were also examined as continuous variables. RESULTS During a median follow-up of 23 years, there were 2,384 falls among 12,661 participants (mean age 54 years, 55% women, 26% black). OH was associated with risk of falls even after adjustment for demographic characteristics and other risk factors (hazard ratio (HR): 1.30; 95% confidence interval (CI): 1.10, 1.54; P = 0.002). Postural change in DBP was more significantly associated with risk of falls (HR 1.09 per −5mm Hg change in DBP; 95% CI: 1.05, 1.13; P < 0.001) than postural change in SBP (HR 1.03 per −5mm Hg change in SBP; 95% CI: 1.01, 1.05; P = 0.002). CONCLUSIONS In a community-based, middle-aged population, OH, and in particular, postural change in DBP, were independent risk factors for falls over 2 decades of follow-up. Future studies are needed to examine OH thresholds associated with increased risk of falls. PMID:27638848

The impact of combined use of fall-risk medications and antithrombotics on injury severity and intracranial hemorrhage among older trauma patients.

PubMed

Hohmann, Natalie; Hohmann, Lindsey; Kruse, Michael

2014-01-01

Use of fall-risk medications (medications that increase risk of falling in the elderly as defined by Beers criteria, STOPP/START criteria, and other literature) or antithrombotics is common in the elderly, and the impact of their concomitant use should be assessed in regards to fall injuries. The primary objective of this study is to assess the simultaneous outpatient use of fall-risk medications and antithrombotics in elderly fall-patients, and secondarily to analyze the injury severity score and occurrence of intracranial hemorrhage. Consecutive chart review at a level 2 trauma center in California, USA from August 01, 2009 to October 31, 2010. Records included 112 patients at least 65 years of age admitted with an outpatient fall. Fisher's exact and Student's t-tests were used (alpha 0.05, two-tailed) to examine prescribing patterns, intracranial hemorrhage occurrence, and injury severity score. Regression adjusted for antithrombotic and fall-risk medication type and number, opiate use, co-morbidities, age, and gender. Thirty-nine percent (44/112) of outpatients were prescribed antithrombotics plus fall-risk medications. The mean injury severity score (ISS) was 13.3 (range 1-26, standard deviation 7.2) for patients taking both medication classes versus 9.7 (range 1-25, standard deviation 7.5) for patients taking antithrombotics alone (p = 0.027). Additionally, in patients over 80 years of age, intracranial hemorrhage occurred more frequently with the use of antithrombotics plus fall-risk medications versus antithrombotics alone (18/29 = 62.1% versus 7/24 = 29.2%, p = 0.027, odds ratio = 3.974, 95% confidence interval = 1.094-15.010). Multivariate analyses showed an independent relationship between intracranial hemorrhage occurrence and type of therapy, as well as injury severity score and simultaneous therapy with fall-risk medications and antithrombotics. Simultaneous prescribing of antithrombotics and fall-risk medications is common. For outpatients over 80 years of age, the odds of experiencing a post-fall intracranial hemorrhage are 4 times higher when prescribed antithrombotics plus fall-risk medications compared to antithrombotics alone, and injury severity is higher with combined use of these medication classes. Copyright © 2014 Mosby, Inc. All rights reserved.

Whip use and race progress are associated with horse falls in hurdle and steeplechase racing in the UK.

PubMed

Pinchbeck, G L; Clegg, P D; Proudman, C J; Morgan, K L; French, N R

2004-07-01

Falls during racing present a risk of injury to both horse and jockey and a risk of fatality to horses. To use video recordings of races to describe the circumstances surrounding horse falls at hurdle and steeplechase fences and to identify and quantify within-race risk factors for horse falls in National Hunt racing in the UK. A retrospective, matched, nested case-control study using video recordings of races was conducted on 6 UK racecourses. Cases and controls were matched on both race type and jump number at which the fall occurred. Conditional logistic regression analysis was used to examine the univariable and multivariable relationship between predictor variables and the risk of falling. The risk of falling was significantly associated with whip use and race progress. Horses which were being whipped and progressing through the race were at greater than 7 times the risk of falling compared to horses which were not being whipped and which had no change in position or lost position through the field. This study has identified whip use and the position of the horse with respect to others in the field as potential risk factors for horse falls. If these findings are confirmed by the use of intervention trials (e.g. with whip-free or restricted whip use races), modifications could be introduced which would reduce the frequency of horse falls, leading to improved equine welfare.

Changes in step-width during dual-task walking predicts falls.

PubMed

Nordin, E; Moe-Nilssen, R; Ramnemark, A; Lundin-Olsson, L

2010-05-01

The aim was to evaluate whether gait pattern changes between single- and dual-task conditions were associated with risk of falling in older people. Dual-task cost (DTC) of 230 community living, physically independent people, 75 years or older, was determined with an electronic walkway. Participants were followed up each month for 1 year to record falls. Mean and variability measures of gait characteristics for 5 dual-task conditions were compared to single-task walking for each participant. Almost half (48%) of the participants fell at least once during follow-up. Risk of falling increased in individuals where DTC for performing a subtraction task demonstrated change in mean step-width compared to single-task walking. Risk of falling decreased in individuals where DTC for carrying a cup and saucer demonstrated change compared to single-task walking in mean step-width, mean step-time, and step-length variability. Degree of change in gait characteristics related to a change in risk of falling differed between measures. Prognostic guidance for fall risk was found for the above DTCs in mean step-width with a negative likelihood ratio of 0.5 and a positive likelihood ratio of 2.3, respectively. Findings suggest that changes in step-width, step-time, and step-length with dual tasking may be related to future risk of falling. Depending on the nature of the second task, DTC may indicate either an increased risk of falling, or a protective strategy to avoid falling. Copyright 2010. Published by Elsevier B.V.

Timed up and go test combined with self-rated multifactorial questionnaire on falls risk and sociodemographic factors predicts falls among community-dwelling older adults better than the timed up and go test on its own

PubMed Central

Ibrahim, Azianah; Singh, Devinder Kaur Ajit; Shahar, Suzana; Omar, Mohd Azahadi

2017-01-01

Background Early detection of falls risk among older adults using simple tools may assist in fall prevention strategies. The aim of this study was to identify the best parameters associated with previous falls, either the timed up and go (TUG) test combined with sociodemographic factors and a self-rated multifactorial questionnaire (SRMQ) on falls risk or the TUG on its own. Falls risk was determined based on parameters associated with previous falls. Design This was a retrospective cohort study. Setting The study was conducted in a community setting. Participants The participants were 1,086 community-dwelling older adults, with mean age of 69.6±5.6 years. Participants were categorized into fallers and nonfallers based on their history of falls in the past 12 months. Method Participants’ sociodemographic data was taken, and SRMQ consisting of five falls-related questions was administered. Participants performed the TUG test twice, and the mean was taken as the result. Results A total of 161 participants were categorized as fallers (14.8%). Multivariate logistic regression analysis showed that the model (χ2(6)=61.0, p<0.001, Nagelkerke R2=0.10) consisting of the TUG test, sociodemographic factors (gender, cataract/glaucoma and joint pain), as well as the SRMQ items “previous falls history” (Q1) and “worried of falls” (Q5), was more robust in terms of falls risk association compared to that with TUG on its own (χ2(1)=10.3, p<0.001, Nagelkerke R2=0.02). Conclusion Combination of sociodemographic factors and SRMQ with TUG is more favorable as an initial falls risk screening tool among community-dwelling older adults. Subsequently, further comprehensive falls risk assessment may be performed in clinical settings to identify the specific impairments for effective management. PMID:29138571

Risk factors for geriatric patient falls in rehabilitation hospital settings: a systematic review.

PubMed

Vieira, Edgar Ramos; Freund-Heritage, Rosalie; da Costa, Bruno R

2011-09-01

To review the literature to identify and synthesize the evidence on risk factors for patient falls in geriatric rehabilitation hospital settings. Eligible studies were systematically searched on 16 databases from inception to December 2010. The search strategies used a combination of terms for rehabilitation hospital patients, falls, risk factors and older adults. Cross-sectional, cohort, case-control studies and randomized clinical trials (RCTs) published in English that investigated risks for falls among patients ≥65 years of age in rehabilitation hospital settings were included. Studies that investigated fall risk assessment tools, but did not investigate risk factors themselves or did not report a measure of risk (e.g. odds ratio, relative risk) were excluded. A total of 2,824 references were identified; only eight articles concerning six studies met the inclusion criteria. In these, 1,924 geriatric rehabilitation patients were followed. The average age of the patients ranged from 77 to 83 years, the percentage of women ranged from 56% to 81%, and the percentage of fallers ranged from 15% to 54%. Two were case-control studies, two were RCTs and four were prospective cohort studies. Several intrinsic and extrinsic risk factors for falls were identified. Carpet flooring, vertigo, being an amputee, confusion, cognitive impairment, stroke, sleep disturbance, anticonvulsants, tranquilizers and antihypertensive medications, age between 71 and 80, previous falls, and need for transfer assistance are risk factors for geriatric patient falls in rehabilitation hospital settings.

Firefighting to Innovation: Using Human Factors and Ergonomics to Tackle Slip, Trip, and Fall Risks in Hospitals.

PubMed

Hignett, Sue; Wolf, Laurie; Taylor, Ellen; Griffiths, Paula

2015-11-01

The aim of this study was to use a theoretical model (bench) for human factors and ergonomics (HFE) and a comparison with occupational slips, trips, and falls (STFs) risk management to discuss patient STF interventions (bedside). Risk factors for patient STFs have been identified and reported since the 1950s and are mostly unchanged in the 2010s. The prevailing clinical view has been that STF events indicate underlying frailty or illness, and so many of the interventions over the past 60 years have focused on assessing and treating physiological factors (dizziness, illness, vision/hearing, medicines) rather than designing interventions to reduce risk factors at the time of the STF. Three case studies are used to discuss how HFE has been, or could be, applied to STF risk management as (a) a design-based (building) approach to embed safety into the built environment, (b) a staff- (and organization-) based approach, and (c) a patient behavior-based approach to explore and understand patient perspectives of STF events. The results from the case studies suggest taking a similar HFE integration approach to other industries, that is, a sustainable design intervention for the person who experiences the STF event-the patient. This paper offers a proactive problem-solving approach to reduce STFs by patients in acute hospitals. Authors of the three case studies use HFE principles (bench/book) to understand the complex systems for facility and equipment design and include the perspective of all stakeholders (bedside). © 2015, Human Factors and Ergonomics Society.

Fall-related injuries in a nursing home setting: is polypharmacy a risk factor?

PubMed

Baranzini, Federico; Diurni, Marcello; Ceccon, Francesca; Poloni, Nicola; Cazzamalli, Sara; Costantini, Chiara; Colli, Cristiano; Greco, Laura; Callegari, Camilla

2009-12-11

Polypharmacy is regarded as an important risk factor for fallingand several studies and meta-analyses have shown an increased fall risk in users of diuretics, type 1a antiarrhythmics, digoxin and psychotropic agents. In particular, recent evidence has shown that fall risk is associated with the use of polypharmacy regimens that include at least one established fall risk-increasing drug, rather than with polypharmacy per se. We studied the role of polypharmacy and the role of well-known fall risk-increasing drugs on the incidence of injurious falls. A retrospective observational study was carried out in a population of elderly nursing home residents. An unmatched, post-stratification design for age class, gender and length of stay was adopted. In all, 695 falls were recorded in 293 residents. 221 residents (75.4%) were female and 72 (24.6%) male, and 133 (45.4%) were recurrent fallers. 152 residents sustained no injuries when they fell, whereas injuries were sustained by 141: minor in 95 (67.4%) and major in 46 (32.6%). Only fall dynamics (p = 0.013) and drugs interaction between antiarrhythmic or antiparkinson class and polypharmacy regimen (> or =7 medications) seem to represent a risk association for injuries (p = 0.024; OR = 4.4; CI 95% 1.21 - 15.36). This work reinforces the importance of routine medication reviews, especially in residents exposed to polypharmacy regimens that include antiarrhythmics or antiparkinson drugs, in order to reduce the risk of fall-related injuries during nursing home stays.

Self-Awareness of Falls Risk Among Elderly Patients: Characterizing Awareness Deficits and Exploring Associated Factors.

PubMed

Mihaljcic, Tijana; Haines, Terry P; Ponsford, Jennie L; Stolwyk, Renerus J

2015-12-01

To characterize self-awareness in older adults undergoing inpatient rehabilitation and explore factors associated with reduced awareness of falls risk. Prospective, cross-sectional design. Older adult inpatient rehabilitation setting. Rehabilitation inpatients (N=91; mean age, 77.97±8.04y) and their treating physiotherapist. None. Three aspects of self-awareness (intellectual, emergent, anticipatory) were measured using the Self-Awareness of Falls Risk Measure. Demographic, medical, and cognitive (Mini-Mental State Examination) information were collected. Current ability was measured using the FIM and timed Up and Go test. Of the patients in the sample, 31% to 63% underestimated falls risk and 3% to 10% overestimated falls risk depending on the aspect of awareness measured. Different aspects of reduced self-awareness were correlated with being a man, higher educational attainment, neurologic history, lower cognitive ability, and lower functional ability. Regression analysis indicated that sex (β=-.33, P=.004), education (β=-.30, P=.006), and neurologic history (β=-.22, P=.038) were independently associated with overall self-awareness. The results suggest that a proportion of older adults undergoing inpatient rehabilitation underestimate personal falls risk. Further research is required to investigate the contributors to and effects of reduced self-awareness of falls risk. Greater understanding of these factors will facilitate the development of strategies to increase awareness of falls risk and increase engagement in falls prevention. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Fall-related experiences of stroke survivors: a meta-ethnography.

PubMed

Walsh, Mary; Galvin, Rose; Horgan, N Frances

2017-04-01

Health professionals view falls after stroke as common adverse events with both physical and psychological consequences. Stroke survivors' experiences are less well understood. The aim of this systematic review was to explore the perception of falls-risk within the stroke recovery experience from the perspective of people with stroke. A systematic literature search was conducted. Papers that used qualitative methods to explore the experiences of individuals with stroke around falls, falls-risk and fear of falling were included. Two reviewers independently assessed the methodological quality of papers. Meta-ethnography was conducted. Concepts from each study were translated into each other to form theories that were combined through a "lines-of-argument" synthesis. Four themes emerged from the six included qualitative studies: (i) Fall circumstances, (ii) perception of fall consequences, (iii) barriers to community participation and (iv) coping strategies. The synthesis revealed that stroke survivors' perceived consequences of falls exist on a continuum. Cognitive and emotional adjustment may be required in the successful adoption of coping strategies to overcome fall-related barriers to participation. Stroke survivors' fall-related experiences appear to exist within the context of activity and community participation. Further research is warranted due to the small number of substantive studies available for synthesis. Implications for Rehabilitation Health care professionals should recognize that cognitive and emotional adjustment may berequired for stroke survivors to accept strategies for overcoming falls-risk, including dependenceon carers and assistive devices. Several factors in addition to physical interventions may be needed to minimize falls-risk whileincreasing activity participation. These factors could include increasing public awareness about the effects of stroke and falls-risk,and ensuring access to psychological services for stroke survivors. Rehabilitation professionals should reflect on whether they perceive there to be an appropriatelevel of fear of falling post-stroke. They should understand that stroke survivors might not conceptualize falls-risk in this way.

Risk factors for unintentional injuries due to falls in children aged 0–6 years: a systematic review

PubMed Central

Khambalia, A; Joshi, P; Brussoni, M; Raina, P; Morrongiello, B; Macarthur, C

2006-01-01

Objective To identify risk factors for unintentional injuries due to falls in children aged 0–6 years. Design A systematic review of the literature. Methods Electronic databases from 1966 to March 2005 were comprehensively searched to identify empirical research that evaluated risk factors for unintentional injuries due to falls in children aged 0–6 years and included a comparison group. Results 14 studies met the inclusion criteria. Studies varied by the type of fall injury that was considered (ie, bunk bed, stairway, playground or infant walker) and with respect to the quality of evidence. In general, major risk factors for the incidence or severity of injuries due to falls in children included age of the child, sex, height of the fall, type of surface, mechanism (dropped, stairway or using a walker), setting (day care v home care) and socioeconomic status. Conclusion Despite a high burden, few controlled studies have examined the risk and protective factors for injuries due to falls in children aged 0–6 years. The only study to examine falls from a population health perspective suggests that age, sex and poverty are independent risk factors for injuries due to falls in children. PMID:17170185

Vision and falls in older people: risk factors and intervention strategies.

PubMed

Lord, Stephen R; Smith, Stuart T; Menant, Jasmine C

2010-11-01

Poor vision impairs balance and increases the risk of falls and fractures in older people. Multifocal glasses can add to this risk by impairing contrast sensitivity, depth perception, and ability to negotiate obstacles. Vision assessment and provision of new spectacles may not reduce, and may even increase, the risk of falls. Restriction of the use of multifocal glasses may reduce falls in active older people. Other effective fall prevention strategies include maximizing vision through cataract surgery and occupational therapy interventions in visually impaired older people. Copyright © 2010 Elsevier Inc. All rights reserved.

Domestic Environmental Risk Factors Associated with Falling in Elderly

PubMed Central

LÖK, Neslihan; AKIN, Belgin

2013-01-01

Background: This is a cross-sectional study aiming at analyzing the relation between falling and domestic environmental –risk factors in community-dwelling elderly. Methods: The study consisted of 243 randomly chosen community-dwelling elderly over 65 years of age living around a health care center in Central Selcuklu, Konya. Data were collected with a questionnaire form including socio-demographic and other characteristics, with the Rivermead Mobility Index for evaluating mobility condition and an Evaluation Form of Domestic Environmental Risk Factors of Falling (EFDERF), which is developed by the researcher to assess domestic environmental risk factors of falling. Results: Based on (EFDERF) high number of problems lived in bathroom/restroom, kitchen, bedroom, sitting room/saloon and in all other areas was a risk factor in terms of domestic falling characteristics while the number of problems lived in hall and stairs was not a significant risk factor. Conclusion: EFDERF may be used by the nurses and health professionals to evaluate risk of falling and collecting data after visits in primary-care of elderly. PMID:23515204

Falls among union carpenters.

PubMed

Lipscomb, Hester J; Li, Leiming; Dement, John M

2003-08-01

Falls are a leading cause of morbidity and mortality in the construction trades. We identified a cohort of 16,215 active union carpenters, hours worked, and their workers' compensation claims for a 10-year period. The data on this well-defined cohort were used to describe their work-related falls; to define rates of injury and the associated costs; and to identify high-risk groups. Same level falls occurred at a rate of 1.8/200,000 hours worked; falls from elevations at a rate of 2.3/200,000 hours worked. These injuries resulted in direct payments of 0.30 dollars per hour of work or 2.40 dollars per 8-hr day. Mean costs per fall increased with increasing age. Age was not associated with risk of falls from elevations; younger carpenters had modestly reduced rates of falls from the same level. Rates of falls decreased with increasing time in the union. Carpenters whose usual work involved drywall installation or residential work were at highest risk. Falls are a significant public health risk for carpenters and they are responsible for a significant burden of work-related injury costs. While there is a need for prevention of falls from elevations--through training, enforcement of fall protection regulations, improved safety climate, or engineering changes--there is also the need to prevent falls from lower elevations. Differences in risk likely reflect varying exposures and safety practices in different areas of carpentry, as well as training, experience, and job assignments based on longevity in the union. Copyright 2003 Wiley-Liss, Inc.

Home ownership and fall-related outcomes among older adults in South Korea.

PubMed

Do, Young Kyung; Kim, Cheong-Seok

2013-10-01

Many of the previously identified environmental risk factors for fall-related outcomes (e.g. flooring, stairs and steps, kitchen, and bathrooms) are amenable to change, but the extent of the changes on these home-related risk factors are conditional on home ownership of the elderly. This study aims to test whether lack of home ownership is associated with a higher risk of falls, and a higher likelihood of reporting fear of falling and activity limitations due to fear of falling among older adults in South Korea. Using data from the first two waves (2006 and 2008) of the Korean Longitudinal Study of Aging, the associations between home ownership variables and three fall-related outcomes were examined in two regression models. A logistic regression model of any falls in the past 2 years was estimated to examine whether older adults living in short-term rental homes based on monthly rent have an increased risk of falls. A probit model accounting for sample selection was estimated to examine whether the two related outcomes, fear of falling and limiting activities due to fear of falling, are associated with home ownership status. Compared with owned home, short-term rental home predicted a higher likelihood of incident of falls and activity limitation due to fear of falling. The study findings suggest that the lack of home ownership with unstable housing tenure is an important risk factor for fall-related outcomes among older adults in South Korea. © 2012 Japan Geriatrics Society.

Exploring the relationship between fall risk-increasing drugs and fall-related fractures.

PubMed

De Winter, Sabrina; Vanwynsberghe, Sarah; Foulon, Veerle; Dejaeger, Eddy; Flamaing, Johan; Sermon, An; Van der Linden, Lorenz; Spriet, Isabel

2016-04-01

Hospital admissions due to fall-related fractures are a major problem in the aging population. Several risk factors have been identified, including drug use. Most studies often retrieved prescription-only drugs from national databases. These are associated with some limitations as they do not always reliably reproduce the complete patient's active drug list. To evaluate the association between the number of FRIDs intake identified by a standardised medication reconciliation process and a fall-related fracture leading to a hospital admission in older adults. The first cohort has been recruited from one traumatology ward of a tertiary teaching hospital in Belgium and the second cohort has been recruited from 11 community pharmacies in Belgium. A prospective study with two individually matched cohorts was performed. Adult patients (≥75 years) admitted with an injury due to a fall were included in the first cohort (faller group). The second cohort consisted of patients who did not suffer from a fall within the last 6 months (non-faller group). Matching was performed for age, gender, place of residence and use of a walking aid. In both groups, clinical pharmacists and undergraduate pharmacy students obtained the medication history, using a standardised approach. A list of drugs considered to increase the risk of falling was created. It included cardiovascular drugs and drugs acting on the nervous system. A linear mixed model was used to compare the number of fall risk-increasing drugs between fallers and non-fallers. The number of fall risk-increasing drugs in a faller versus a non-faller group. Sixty-one patients were matched with 121 non-fallers. Patients received on average 3.1 ± 2.1 and 3.2 ± 1.8 fall risk-increasing drugs in the faller and in the non-faller group, respectively. The mean number of fall risk-increasing drugs was comparable in both groups (p = 0.844), even after adjusting for alcohol consumption, fear of falling, vision and foot problems (p = 0.721). In a sample of hospitalised patients admitted for a fall-related injury, no significant difference in the number of fall risk-increasing drugs versus that of an outpatient group of non-fallers was found.

Risk Factors Associated with Falls in Older Adults with Dementia: A Systematic Review

PubMed Central

Fernando, Eresha; Fraser, Michelle; Hendriksen, Jane; Kim, Corey H.

2017-01-01

Purpose: People with dementia fall more often than cognitively healthy older adults, but their risk factors are not well understood. A review is needed to determine a fall risk profile for this population. The objective was to critically evaluate the literature and identify the factors associated with fall risk in older adults with dementia. Methods: Articles published between January 1988 and October 2014 in EMBASE, PubMed, PsycINFO, and CINAHL were searched. Inclusion criteria were participants aged 55 years or older with dementia or cognitive impairment, prospective cohort design, detailed fall definition, falls as the primary outcome, and multi-variable regression analysis. Two authors independently reviewed and extracted data on study characteristics, quality assessment, and outcomes. Adjusted risk estimates were extracted from the articles. Results: A total of 17 studies met the inclusion criteria. Risk factors were categorized into demographic, balance, gait, vision, functional status, medications, psychosocial, severity of dementia, and other. Risk factors varied with living setting and were not consistent across all studies within a setting. Conclusion: Falls in older adults with dementia are associated with multiple intrinsic and extrinsic risk factors, some shared with older adults in general and others unique to the disease. Risk factors vary between community- and institution-dwelling samples of adults with dementia or cognitive impairment. PMID:28539696

Physiological responses of ponderosa pine in western Montana to thinning, prescribed fire and burning season.

PubMed

Sala, Anna; Peters, Gregory D; McIntyre, Lorna R; Harrington, Michael G

2005-03-01

Low-elevation ponderosa pine (Pinus ponderosa Dougl. ex. Laws.) forests of the northern Rocky Mountains historically experienced frequent low-intensity fires that maintained open uneven-aged stands. A century of fire exclusion has contributed to denser ponderosa pine forests with greater competition for resources, higher tree stress and greater risk of insect attack and stand-destroying fire. Active management intended to restore a semblance of the more sustainable historic stand structure and composition includes selective thinning and prescribed fire. However, little is known about the relative effects of these management practices on the physiological performance of ponderosa pine. We measured soil water and nitrogen availability, physiological performance and wood radial increment of second growth ponderosa pine trees at the Lick Creek Experimental Site in the Bitterroot National Forest, Montana, 8 and 9 years after the application of four treatments: thinning only; thinning followed by prescribed fire in the spring; thinning followed by prescribed fire in the fall; and untreated controls. Volumetric soil water content and resin capsule ammonium did not differ among treatments. Resin capsule nitrate in the control treatment was similar to that in all other treatments, although burned treatments had lower nitrate relative to the thinned-only treatment. Trees of similar size and canopy condition in the three thinned treatments (with and without fire) displayed higher leaf-area-based photosynthetic rate, stomatal conductance and mid-morning leaf water potential in June and July, and higher wood radial increment relative to trees in control units. Specific leaf area, mass-based leaf nitrogen content and carbon isotope discrimination did not vary among treatments. Our results suggest that, despite minimal differences in soil resource availability, trees in managed units where basal area was reduced had improved gas exchange and growth compared with trees in unmanaged units. Prescribed fire (either in the spring or in the fall) in addition to thinning, had no measurable effect on the mid-term physiological performance and wood growth of second growth ponderosa pine.

A longitudinal comparative study of falls in persons with knee arthroplasty and persons with or at high risk for knee osteoarthritis.

PubMed

L Riddle, Daniel; J Golladay, Gregory

2016-11-01

we determined the yearly prevalence of single and multiple falls in persons with or at risk of knee osteoarthritis (OA) and persons undergoing knee arthroplasty over an 8-year period. We also compared annual fall rates among persons with and without knee arthroplasty to determine if fall rates are associated with knee arthroplasty. we studied 4,200 persons from the Osteoarthritis Imitative (OAI), a National Institutes of Health funded prospective study of persons 45-79 years and conducted from 2004 to 2012. All either had knee OA or were at risk of developing knee OA but did not have knee arthroplasty. The surgical group comprised 413 persons who underwent knee arthroplasty. Key fall risk factors were assessed at yearly study visits. Graphical depictions illustrated single and multiple fall trajectories. Multinomial regression adjusted for potential confounders compared fall rates for those with and without knee arthroplasty. fall rate trajectories for the two samples were generally flat and fall rates were similar. For the arthroplasty sample, fall rates did not increase in the immediate perioperative period relative to earlier and later periods. No differences in fall rates were found among the arthroplasty and non-arthroplasty samples after adjustment for potential confounding (P > 0.05). fall rates were generally stable and similar over an 8-year period among persons with and without knee arthroplasty. Clinicians should not assume that persons undergoing knee arthroplasty are at greater risk for falls either before or after surgery as compared to persons with or at risk for knee OA. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Correlation between nutritional status and comprehensive physical performance measures among older adults with undernourishment in residential institutions.

PubMed

Singh, Devinder K A; Manaf, Zahara A; Yusoff, Noor Aini M; Muhammad, Nur A; Phan, Mei Fang; Shahar, Suzana

2014-01-01

The consequences of combined undernourishment and decreased physical performance in older adults are debilitating and increases cost of care. To date, the information regarding the association between nutritional status and physical performance does not provide a complete picture. Most studies used limited or self-reported measures to evaluate physical performance. The objective of this study was to examine the correlation between nutritional status and comprehensive physical performance measures among undernourished older adults who reside in residential institutions. Forty-seven older adults (26 males, 21 females) aged ≥ 60 (69.23 ± 8.63) years who were identified as undernourished from two residential institutions participated in this study. A battery of physical performance tests (10 m gait speed test, dominant hand grip strength test, timed five-repetition sit-to-stand test, ten step test, arm curl test, scratch test, and respiratory muscle strength test), biochemical profiles (serum albumin, hemoglobin, serum ferritin, and prealbumin levels), and falls risk using the short-form Physiological Profile Approach were performed. The Functional Ability Questionnaire and Geriatric Depression Scale were also administered. The results demonstrated that generally older adults with undernourishment scored poorly on the physical performance tests, had depression, and a high risk of falls. Biochemical results demonstrated that 10.9% of the participants were anemic, 63% had hypoalbuminemia (<3.5 g/dL), and 21.7% were at risk of protein energy malnutrition with prealbumin level (100-170 mg/L). A significant correlation (P<0.05) was demonstrated between hand grip strength and ferritin, between self-reported mobility dependence and prealbumin levels, and between self-reported mobility tiredness and body mass index. These results confirm that older adults with undernutrition have poor physical function, higher falls risk, and depression. Clinically, overall health that includes nutritional status, physical function, and depression level should be taken into consideration in the assessment and treatment of older adults residing at residential institutions.

Beta-blocker use and fall risk in older individuals: Original results from two studies with meta-analysis.

PubMed

Ham, Annelies C; van Dijk, Suzanne C; Swart, Karin M A; Enneman, Anke W; van der Zwaluw, Nikita L; Brouwer-Brolsma, Elske M; van Schoor, Natasja M; Zillikens, M Carola; Lips, Paul; de Groot, Lisette C P G M; Hofman, Albert; Witkamp, Renger F; Uitterlinden, André G; Stricker, Bruno H; van der Velde, Nathalie

2017-10-01

To investigate the association between use of β-blockers and β-blocker characteristics - selectivity, lipid solubility, intrinsic sympathetic activity (ISA) and CYP2D6 enzyme metabolism - and fall risk. Data from two prospective studies were used, including community-dwelling individuals, n = 7662 (the Rotterdam Study) and 2407 (B-PROOF), all aged ≥55 years. Fall incidents were recorded prospectively. Time-varying β-blocker use was determined using pharmacy dispensing records. Cox proportional hazard models adjusted for age and sex were applied to determine the association between β-blocker use, their characteristics - selectivity, lipid solubility, ISA and CYP2D6 enzyme metabolism - and fall risk. The results of the studies were combined using meta-analyses. In total 2917 participants encountered a fall during a total follow-up time of 89 529 years. Meta-analysis indicated no association between use of any β-blocker, compared to nonuse, and fall risk, hazard ratio (HR) = 0.97 [95% confidence interval (CI) 0.88-1.06]. Use of a selective β-blocker was also not associated with fall risk, HR = 0.92 (95%CI 0.83-1.01). Use of a nonselective β-blocker was associated with an increased fall risk, HR = 1.22 (95%CI 1.01-1.48). Other β-blocker characteristics including lipid solubility and CYP2D6 enzyme metabolism were not associated with fall risk. Our study suggests that use of a nonselective β-blocker, contrary to selective β-blockers, is associated with an increased fall risk in an older population. In clinical practice, β-blockers have been shown effective for a variety of cardiovascular indications. However, fall risk should be considered when prescribing a β-blocker in this age group, and the pros and cons for β-blocker classes should be taken into consideration. © 2017 The British Pharmacological Society.

Dizziness, but not falls rate, improves after routine cataract surgery: the role of refractive and spectacle changes.

PubMed

Supuk, Elvira; Alderson, Alison; Davey, Christopher J; Green, Clare; Litvin, Norman; Scally, Andrew J; Elliott, David B

2016-03-01

To determine whether dizziness and falls rates change due to routine cataract surgery and to determine the influence of spectacle type and refractive factors. Self-reported dizziness and falls were determined in 287 patients (mean age of 76.5 ± 6.3 years, 55% females) before and after routine cataract surgery for the first (81, 28%), second (109, 38%) and both eyes (97, 34%). Dizziness was determined using the short-form of the Dizziness Handicap Inventory. Six-month falls rates were determined using self-reported retrospective data. The number of patients with dizziness reduced significantly after cataract surgery (52% vs 38%; χ(2) = 19.14(,) p < 0.001), but the reduction in the number of patients who fell in the 6-months post surgery was not significant (23% vs 20%; χ(2) = 0.87, p = 0.35). Dizziness improved after first eye surgery (49% vs 33%, p = 0.01) and surgery on both eyes (58% vs 35%, p < 0.001), but not after second eye surgery (52% vs 45%, p = 0.68). Multivariate logistic regression analyses found significant links between post-operative falls and change in spectacle type (increased risk if switched into multifocal spectacles). Post-operative dizziness was associated with changes in best eye visual acuity and changes in oblique astigmatic correction. Dizziness is significantly reduced by first (or both) eye cataract surgery and this is linked with improvements in best eye visual acuity, although changes in oblique astigmatic correction increased dizziness. The lack of improvement in falls rate may be associated with switching into multifocal spectacle wear after surgery. © 2015 The Authors Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.

The Little Schmidy Pediatric Hospital Fall Risk Assessment Index: A diagnostic accuracy study.

PubMed

Franck, Linda S; Gay, Caryl L; Cooper, Bruce; Ezrre, Suzanne; Murphy, Barbette; Chan, June Shu-Ling; Buick, Maureen; Meer, Carrie R

2017-03-01

Falls are among the most common potentially preventable adverse events. Current pediatric falls risk assessment methods have poor precision and accuracy. To evaluate an inpatient pediatric fall risk assessment index, known as the Little Schmidy, and describe characteristics of pediatric falls. Retrospective case control and descriptive study. The dataset included 114 reported falls and 151,678 Little Schmidy scores documented in medical records during the 5-year study period (2007-2011). Pediatric medical and surgical inpatient units of an academic medical center in the western United States. Pediatric hospital inpatients <25 years of age. Nurses used the 5-item, 7-point Little Schmidy to assess fall risk each day and night shift throughout the patient's hospitalization. Conditional fixed-effects logistic regressions were used to examine predictive relationships between Little Schmidy scores (at admission, highest prior to fall, and just prior to fall) and the patient's fall status (fell or not). The sensitivity and specificity of different cut-off scores were explored. Associations between Little Schmidy scores and patient and hospitalization factors were examined using multilevel mixed-effects logistic regression and multilevel mixed-effects ordinal logistic regression. Little Schmidy scores were significantly associated with pediatric falls (p<0.005). Maximal performance was achieved with a 4-item, 4-point, Little Schmidy index (LS4) using a cut-off score of 1 to indicate fall risk with sensitivity of 79% and specificity of 49%. Patients with an LS4 score ≥1 were 4 times more likely to fall before the next assessment than patients with a score of 0. LS4 scores indicative of fall risk were associated with age ≥5 years, neurological diagnosis, multiple hospitalizations, and night shift, but not with sex, length of hospital stay, or hospital unit. Of the 114 reported falls, 64% involved a male patient, nearly one third (32%) involved adolescents (13-17 years), most resulted in no (59%) or mild (36%) injury, and most (54%) were related to diagnosis or clinical characteristics. For 60% of the falls, fall precautions had been implemented prior to the fall. The revised 4-item Little Schmidy, the LS4, predicts pediatric falls when administered every day and night shift, but identifies most patients (65%) as being at risk for fall. Strategies for improving the accuracy and efficiency of the assessments are proposed. Further research is needed to develop more effective pediatric fall prevention strategies tailored to patient's age, diagnosis, and time of day. Copyright © 2017 Elsevier Ltd. All rights reserved.

Social Dancing and Incidence of Falls in Older Adults: A Cluster Randomised Controlled Trial

PubMed Central

Merom, Dafna; Mathieu, Erin; Cerin, Ester; Morton, Rachael L.; Simpson, Judy M.; Anstey, Kaarin J.; Sherrington, Catherine; Lord, Stephen R.; Cumming, Robert G.

2016-01-01

Background The prevention of falls among older people is a major public health challenge. Exercises that challenge balance are recognized as an efficacious fall prevention strategy. Given that small-scale trials have indicated that diverse dance styles can improve balance and gait of older adults, two of the strongest risk factors for falls in older people, this study aimed to determine whether social dance is effective in i) reducing the number of falls and ii) improving physical and cognitive fall-related risk factors. Methods and Findings A parallel two-arm cluster randomized controlled trial was undertaken in 23 self-care retirement villages (clusters) around Sydney, Australia. Eligible villages had to have an appropriate hall for dancing, house at least 60 residents, and not be currently offering dance as a village activity. Retirement villages were randomised using a computer generated randomisation method, constrained using minimisation. Eligible participants had to be a resident of the village, be able to walk at least 50 m, and agree to undergo physical and cognitive testing without cognitive impairment. Residents of intervention villages (12 clusters) were offered twice weekly one-hour social dancing classes (folk or ballroom dancing) over 12 mo (80 h in total). Programs were standardized across villages and were delivered by eight dance teachers. Participants in the control villages (11 clusters) were advised to continue with their regular activities. Main outcomes: falls during the 12 mo trial and Trail Making Tests. Secondary outcomes: The Physiological Performance Assessment (i.e., postural sway, proprioception, reaction time, leg strength) and the Short Physical Performance Battery; health-related physical and mental quality of life from the Short-Form 12 (SF-12) Survey. Data on falls were obtained from 522 of 530 (98%) randomised participants (mean age 78 y, 85% women) and 424 (80%) attended the 12-mo reassessment, which was lower among folk dance participants (71%) than ballroom dancing (82%) or control participants (82%, p = 0.04). Mean attendance at dance classes was 51%. During the period, 444 falls were recorded; there was no significant difference in fall rates between the control group (0.80 per person-year) and the dance group (1.03 per person-year). Using negative binomial regression with robust standard errors the adjusted Incidence Rate Ratio (IRR) was 1.19 (95% CI: 95% CI = 0.83, 1.71). In exploratory post hoc subgroup analysis, the rate of falls was higher among dance participants with a history of multiple falls (IRR = 2.02, 95% CI: 1.15, 3.54, p = 0.23 for interaction) and with the folk dance intervention (IRR = 1.68, 95% CI: 1.03, 2.73). There were no significant between-group differences in executive function test (TMT-B = 2.8 s, 95% CI: −6.2, 11.8). Intention to treat (ITT) analysis revealed no between-group differences at 12-mo follow-up in the secondary outcome measures, with the exception of postural sway, favouring the control group. Exploratory post hoc analysis by study completers and style indicated that ballroom dancing participants apparently improved their gait speed by 0.07 m/s relative to control participants (95% CI: 0.00, 0.14, p = 0.05). Study limitations included allocation to style based on logistical considerations rather than at random; insufficient power to detect differential impacts of different dance styles and smaller overall effects; variation of measurement conditions across villages; and no assessment of more complex balance tasks, which may be more sensitive to changes brought about by dancing. Conclusions Social dancing did not prevent falls or their associated risk factors among these retirement villages' residents. Modified dance programmes that contain "training elements" to better approximate structured exercise programs, targeted at low and high-risk participants, warrant investigation. Trial Registration The Australian New Zealand Clinical Trials Registry ACTRN12612000889853 PMID:27575534

Social Dancing and Incidence of Falls in Older Adults: A Cluster Randomised Controlled Trial.

PubMed

Merom, Dafna; Mathieu, Erin; Cerin, Ester; Morton, Rachael L; Simpson, Judy M; Rissel, Chris; Anstey, Kaarin J; Sherrington, Catherine; Lord, Stephen R; Cumming, Robert G

2016-08-01

The prevention of falls among older people is a major public health challenge. Exercises that challenge balance are recognized as an efficacious fall prevention strategy. Given that small-scale trials have indicated that diverse dance styles can improve balance and gait of older adults, two of the strongest risk factors for falls in older people, this study aimed to determine whether social dance is effective in i) reducing the number of falls and ii) improving physical and cognitive fall-related risk factors. A parallel two-arm cluster randomized controlled trial was undertaken in 23 self-care retirement villages (clusters) around Sydney, Australia. Eligible villages had to have an appropriate hall for dancing, house at least 60 residents, and not be currently offering dance as a village activity. Retirement villages were randomised using a computer generated randomisation method, constrained using minimisation. Eligible participants had to be a resident of the village, be able to walk at least 50 m, and agree to undergo physical and cognitive testing without cognitive impairment. Residents of intervention villages (12 clusters) were offered twice weekly one-hour social dancing classes (folk or ballroom dancing) over 12 mo (80 h in total). Programs were standardized across villages and were delivered by eight dance teachers. Participants in the control villages (11 clusters) were advised to continue with their regular activities. falls during the 12 mo trial and Trail Making Tests. The Physiological Performance Assessment (i.e., postural sway, proprioception, reaction time, leg strength) and the Short Physical Performance Battery; health-related physical and mental quality of life from the Short-Form 12 (SF-12) Survey. Data on falls were obtained from 522 of 530 (98%) randomised participants (mean age 78 y, 85% women) and 424 (80%) attended the 12-mo reassessment, which was lower among folk dance participants (71%) than ballroom dancing (82%) or control participants (82%, p = 0.04). Mean attendance at dance classes was 51%. During the period, 444 falls were recorded; there was no significant difference in fall rates between the control group (0.80 per person-year) and the dance group (1.03 per person-year). Using negative binomial regression with robust standard errors the adjusted Incidence Rate Ratio (IRR) was 1.19 (95% CI: 95% CI = 0.83, 1.71). In exploratory post hoc subgroup analysis, the rate of falls was higher among dance participants with a history of multiple falls (IRR = 2.02, 95% CI: 1.15, 3.54, p = 0.23 for interaction) and with the folk dance intervention (IRR = 1.68, 95% CI: 1.03, 2.73). There were no significant between-group differences in executive function test (TMT-B = 2.8 s, 95% CI: -6.2, 11.8). Intention to treat (ITT) analysis revealed no between-group differences at 12-mo follow-up in the secondary outcome measures, with the exception of postural sway, favouring the control group. Exploratory post hoc analysis by study completers and style indicated that ballroom dancing participants apparently improved their gait speed by 0.07 m/s relative to control participants (95% CI: 0.00, 0.14, p = 0.05). Study limitations included allocation to style based on logistical considerations rather than at random; insufficient power to detect differential impacts of different dance styles and smaller overall effects; variation of measurement conditions across villages; and no assessment of more complex balance tasks, which may be more sensitive to changes brought about by dancing. Social dancing did not prevent falls or their associated risk factors among these retirement villages' residents. Modified dance programmes that contain "training elements" to better approximate structured exercise programs, targeted at low and high-risk participants, warrant investigation. The Australian New Zealand Clinical Trials Registry ACTRN12612000889853.

Optimism, Cynical Hostility, Falls, and Fractures: The Women's Health Initiative Observational Study (WHI-OS).

PubMed

Cauley, Jane A; Smagula, Stephen F; Hovey, Kathleen M; Wactawski-Wende, Jean; Andrews, Christopher A; Crandall, Carolyn J; LeBoff, Meryl S; Li, Wenjun; Coday, Mace; Sattari, Maryam; Tindle, Hilary A

2017-02-01

Traits of optimism and cynical hostility are features of personality that could influence the risk of falls and fractures by influencing risk-taking behaviors, health behaviors, or inflammation. To test the hypothesis that personality influences falls and fracture risk, we studied 87,342 women enrolled in WHI-OS. Optimism was assessed by the Life Orientation Test-Revised and cynical hostility, the cynicism subscale of the Cook-Medley questionnaire. Higher scores indicate greater optimism and hostility. Optimism and hostility were correlated at r = -0. 31, p < 0.001. Annual self-report of falling ≥2 times in the past year was modeled using repeated measures logistic regression. Cox proportional hazards models were used for the fracture outcomes. We examined the risk of falls and fractures across the quartiles (Q) of optimism and hostility with tests for trends; Q1 formed the referent group. The average follow-up for fractures was 11.4 years and for falls was 7.6 years. In multivariable (MV)-adjusted models, women with the highest optimism scores (Q4) were 11% less likely to report ≥2 falls in the past year (odds ratio [OR] = 0.89; 95% confidence intervals [CI] 0.85-0.90). Women in Q4 for hostility had a 12% higher risk of ≥2 falls (OR = 1.12; 95% CI 1.07-1.17). Higher optimism scores were also associated with a 10% lower risk of fractures, but this association was attenuated in MV models. Women with the greatest hostility (Q4) had a modest increased risk of any fracture (MV-adjusted hazard ratio = 1. 05; 95% CI 1.01-1.09), but there was no association with specific fracture sites. In conclusion, optimism was independently associated with a decreased risk of ≥2 falls, and hostility with an increased risk of ≥2 falls, independent of traditional risk factors. The magnitude of the association was similar to aging 5 years. Whether interventions aimed at attitudes could reduce fall risks remains to be determined. © 2016 American Society for Bone and Mineral Research. © 2016 American Society for Bone and Mineral Research.

Cross-Sectional and Longitudinal Risk Factors for Falls, Fear of Falling, and Falls Efficacy in a Cohort of Middle-Aged African Americans

ERIC Educational Resources Information Center

Anderson, Elena M.; Wolinsky, Fredric D.; Miller, J. Phillip; Wilson, Margaret-Mary G.; Malmstrom, Theodore K.; Miller, Douglas K.

2006-01-01

Purpose: The purpose of this study is to cross-sectionally and longitudinally identify risk factors for falls, fear of falling, and falls efficacy in late-middle-aged African Americans. Design and Methods: We performed in-home assessments on a probability sample of 998 African Americans and conducted two annual follow-up interviews. Multiple…

Fall Prevention for Older Adults Receiving Home Healthcare.

PubMed

Bamgbade, Sarah; Dearmon, Valorie

2016-02-01

Falls pose a significant risk for community-dwelling older adults. Fall-related injuries increase healthcare costs related to hospitalization, diagnostic procedures, and/or surgeries. This article describes a quality improvement project to reduce falls in older adults receiving home healthcare services. The fall prevention program incorporated best practices for fall reduction, including fall risk assessment, medication review/management, home hazard and safety assessment, staff and patient fall prevention education, and an individualized home-based exercise program. The program was implemented and evaluated during a 6-month time frame. Fewer falls occurred post implementation of the falls prevention program with no major injuries.

Teaching Materials and Methods.

ERIC Educational Resources Information Center

Physiologist, 1982

1982-01-01

Twelve abstracts of papers presented at the 33rd Annual Fall Meeting of the American Physiological Society are listed, focusing on teaching materials/methods. Topics, among others, include trends in physiology laboratory programs, cardiovascular system model, cardiovascular computer simulation with didactic feedback, and computer generated figures…

Sarcopenia and sarcopenic obesity in Spanish community-dwelling middle-aged and older women: Association with balance confidence, fear of falling and fall risk.

PubMed

Aibar-Almazán, Agustín; Martínez-Amat, Antonio; Cruz-Díaz, David; Jiménez-García, José D; Achalandabaso, Alexander; Sánchez-Montesinos, Indalecio; de la Torre-Cruz, Manuel; Hita-Contreras, Fidel

2018-01-01

To analyze the association of sarcopenia, obesity, and sarcopenic obesity (SO) with fear of falling (FoF) and balance confidence in a Spanish sample of middle-aged and older community-dwelling women. A total of 235 women (69.21±7.56 years) participated in this study. Body composition (bioelectrical impedance analysis), hand-grip strength, and physical performance (gait speed) were evaluated for the diagnosis of sarcopenia, obesity, and SO. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale. The Activities-Specific Balance Confidence Scale (ABC) and the Falls Efficacy Scale-International (FES-I) were employed to assess FoF and balance confidence, respectively. Scores of >26 on the FES-I and <67% on the ABC were used to identify women at risk of falling. The independent associations of sarcopenia, obesity and SO with FoF, balance confidence, and fall risk were evaluated by multivariate linear and logistic regressions, adjusting for potential confounding variables. 27.23% and 18.72% of women presented with sarcopenia and SO, respectively. Gait speed, body mass index (BMI), and fall history were independently associated with ABC score (adjusted-R 2 =0.152) and fall risk (ABC) (adjusted-R 2 =0.115). FES-I score was independently associated (adjusted-R 2 =0.193) with fall history, gait speed, BMI, and depression, which, together with obesity (BMI) and SO, remained independent factors for fall risk measured as FES-I score (adjusted-R 2 =0.243). In community-dwelling middle-aged and older Spanish women, BMI, gait speed, and fall history were independently associated with FoF, balance confidence, and fall risk. Depression was related only to FoF, and, together with obesity (BMI) and SO, was an independent predictor of fall risk as assessed by the FES-I. Copyright © 2017 Elsevier B.V. All rights reserved.

Semmes-Weinstein Monofilament Examination for Predicting Physical Performance and the Risk of Falls in Older People: Results of the Pro.V.A. Longitudinal Study.

PubMed

Carrer, Pamela; Trevisan, Caterina; Curreri, Chiara; Giantin, Valter; Maggi, Stefania; Crepaldi, Gaetano; Manzato, Enzo; Sergi, Giuseppe

2018-01-01

To investigate whether the Semmes-Weinstein monofilament examination (SWME) was associated with, and could predict, measures of physical performance and the risk of fall in older people. Prospective study. Community. Older participants (N=2826) enrolled in the Progetto Veneto Anziani (Pro.V.A.) study and a subsample of persons (n=1885) who did not report falls at baseline for longitudinal analyses. Not applicable. Falls reported in the year preceding the assessment and Short Physical Performance Battery (SPPB) were recorded at baseline and again after 4.4 years. At baseline, 830 participants (29.4%) had experienced falls in the previous year, with a higher prevalence of falls in those positive at SWME than in those negative at SWME (35.8% vs 28.0%; P=.001). Using logistic regression, participants positive at SWME had a (significant) 66% higher risk of presenting worse SPPB score (95% confidence interval, 1.51-1.83) and between 25% and 32% higher risks of having experienced ≥1 fall or recurrent falls than did those negative at SWME. The incidence of falls at follow-up was higher in the positive SWME group than in the negative SWME group (42.2% vs 30.7%; P=.001), and multinomial logistic regression showed that the former had a 13% higher risk of decline in SPPB scores (95% confidence interval, 1.03-1.25), particularly for gait and balance; 48% higher risk of having had 1 fall; and 77% higher risk of recurrent falls. At both baseline and follow-up, the larger the extension of neuropathy (negative SWME vs unilateral impairment in positive SWME vs bilateral impairment in positive SWME), the greater its negative effect on falls and physical performance. SMWE was associated with, and could predict, lower extremity physical performance and falls in older people. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Falls Prevention: Unique to Older Adults

MedlinePlus

... medications can be adjusted to reduce your falling risk. Falls and Medication Management : Reduce Medication Whenever Possible Older people are much more likely than younger people to use many prescription and ... medicines increase the risk of a fall, and interactions between drugs may ...

Effect of music-based multitask training on gait, balance, and fall risk in elderly people: a randomized controlled trial.

PubMed

Trombetti, Andrea; Hars, Mélany; Herrmann, François R; Kressig, Reto W; Ferrari, Serge; Rizzoli, René

2011-03-28

Falls occur mainly while walking or performing concurrent tasks. We determined whether a music-based multitask exercise program improves gait and balance and reduces fall risk in elderly individuals. We conducted a 12-month randomized controlled trial involving 134 community-dwelling individuals older than 65 years, who are at increased risk of falling. They were randomly assigned to an intervention group (n = 66) or a delayed intervention control group scheduled to start the program 6 months later (n = 68). The intervention was a 6-month multitask exercise program performed to the rhythm of piano music. Change in gait variability under dual-task condition from baseline to 6 months was the primary end point. Secondary outcomes included changes in balance, functional performances, and fall risk. At 6 months, there was a reduction in stride length variability (adjusted mean difference, -1.4%; P < .002) under dual-task condition in the intervention group, compared with the delayed intervention control group. Balance and functional tests improved compared with the control group. There were fewer falls in the intervention group (incidence rate ratio, 0.46; 95% confidence interval, 0.27-0.79) and a lower risk of falling (relative risk, 0.61; 95% confidence interval, 0.39-0.96). Similar changes occurred in the delayed intervention control group during the second 6-month period with intervention. The benefit of the intervention on gait variability persisted 6 months later. In community-dwelling older people at increased risk of falling, a 6-month music-based multitask exercise program improved gait under dual-task condition, improved balance, and reduced both the rate of falls and the risk of falling. Trial Registration clinicaltrials.gov Identifier: NCT01107288.

Reduced oxygen utilization in septic shock: disorder or adaptation?

PubMed

Steiner, Alexandre A

2015-01-01

A fall in oxygen utilization during septic or endotoxic shock is thought to reflect circulatory hypoxia or mitochondrial dysfunction, but these pathology-oriented hypotheses do not explain all clinical observations. Here we discuss an alternative hypothesis of how oxygen utilization could fall as the result of a physiological thermometabolic adaptation.

Risk of Fall for Individuals with Intellectual Disability

ERIC Educational Resources Information Center

Chiba, Yoichi; Shimada, Atsuyoshi; Yoshida, Futoshi; Keino, Hiromi; Hasegawa, Mariko; Ikari, Hiroyuki; Miyake, Shikako; Hosokawa, Masanori

2009-01-01

Our aim was to identify risk factors for falling and establish a method to assess risk for falls in adults with intellectual disabilities. In a cross-sectional survey of 144 Japanese adults, we found that age, presence of epilepsy, and presence of paretic conditions were independent risk factors. The Tinetti balance and gait instrument was…

[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

2011-01-01

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) PMID:21854643

Identifying protective and risk factors for injurious falls in patients hospitalized for acute care: a retrospective case-control study.

PubMed

Aryee, Emmanuel; James, Spencer L; Hunt, Guenola M; Ryder, Hilary F

2017-11-07

Admitted patients who fall and injure themselves during an acute hospitalization incur increased costs, morbidity, and mortality, but little research has been conducted on identifying inpatients at high risk to injure themselves in a fall. Falls risk assessment tools have been unsuccessful due to their low positive predictive value when applied broadly to entire hospital populations. We aimed to identify variables associated with the risk of or protection against injurious fall in the inpatient setting. We also aimed to test the variables in the ABCs mnemonic (Age > 85, Bones-orthopedic conditions, anti-Coagulation and recent surgery) for correlation with injurious fall. We performed a retrospective case-control study at an academic tertiary care center comparing admitted patients with injurious fall to admitted patients without fall. We collected data on the demographics, medical and fall history, outcomes, and discharge disposition of injured fallers and control patients. We performed multivariate analysis of potential risk factors for injurious fall with logistic regression to calculate adjusted odds ratios. We identified 117 injured fallers and 320 controls. There were no differences in age, anti-coagulation use or fragility fractures between cases and controls. In multivariate analysis, recent surgery (OR 0.46, p = 0.003) was protective; joint replacement (OR 5.58, P = 0.002), psychotropic agents (OR 2.23, p = 0.001), the male sex (OR 2.08, p = 0.003) and history of fall (OR 2.08, p = 0.02) were significantly associated with injurious fall. In this study, the variables in the ABCs parameters were among the variables not useful for identifying inpatients at risk of injuring themselves in a fall, while other non-ABCs variables demonstrated a significant association with injurious fall. Recent surgery was a protective factor, and practices around the care of surgical patients could be extrapolated to reduce the in-hospital fall rates.

An Electronic Health Record Data-driven Model for Identifying Older Adults at Risk of Unintentional Falls

PubMed Central

Baus, Adam; Coben, Jeffrey; Zullig, Keith; Pollard, Cecil; Mullett, Charles; Taylor, Henry; Cochran, Jill; Jarrett, Traci; Long, Dustin

2017-01-01

Screening for risk of unintentional falls remains low in the primary care setting because of the time constraints of brief office visits. National studies suggest that physicians caring for older adults provide recommended fall risk screening only 30 to 37 percent of the time. Given prior success in developing methods for repurposing electronic health record data for the identification of fall risk, this study involves building a model in which electronic health record data could be applied for use in clinical decision support to bolster screening by proactively identifying patients for whom screening would be beneficial and targeting efforts specifically to those patients. The final model, consisting of priority and extended measures, demonstrates moderate discriminatory power, indicating that it could prove useful in a clinical setting for identifying patients at risk of falls. Focus group discussions reveal important contextual issues involving the use of fall-related data and provide direction for the development of health systems–level innovations for the use of electronic health record data for fall risk identification. PMID:29118679

Hypothermia-induced acute kidney injury in a diabetic patient with nephropathy and neuropathy.

PubMed

Yamada, Shunsuke; Shimomura, Yukiko; Ohsaki, Masato; Fujisaki, Akiko; Tsuruya, Kazuhiko; Iida, Mitsuo

2010-01-01

Hypothermia is a life-threatening medical condition defined as an unintentional fall in body temperature below 35 degrees C. Exposure to cold environment stimulates the thermoregulatory system to maintain the body temperature within the physiological range. Patients with malnutrition and/or diabetes mellitus are at high risk for accidental hypothermia, and acute kidney injury, which is mainly caused by pre-renal factors, occurs in relation to hypothermia. However, acute exacerbation of pre-existing chronic kidney disease has been rarely reported. Here, we present a patient with diabetes mellitus and malnutrition who developed two separate episodes of hypothermia followed by acute exacerbation of chronic kidney disease.

A real time study of the human equilibrium using an instrumented insole with 3 pressure sensors.

PubMed

Abou Ghaida, Hussein; Mottet, Serge; Goujon, Jean-Marc

2014-01-01

The present work deals with the study of the human equilibrium using an ambulatory e-health system. One of the point on which we focus is the fall risk, when losing equilibrium control. A specific postural learning model is presented, and an ambulatory instrumented insole is developed using 3 pressures sensors per foot, in order to determine the real-time displacement and the velocity of the centre of pressure (CoP). The increase of these parameters signals a loss of physiological sensation, usually of vision or of the inner ear. The results are compared to those obtained from classical more complex systems.

"Staying safe" - a narrative review of falls prevention in people with Parkinson's - "PDSAFE".

PubMed

Hulbert, Sophia; Rochester, Lynn; Nieuwboer, Alice; Goodwin, Vicki; Fitton, Carolyn; Chivers-Seymour, Kim; Ashburn, Ann

2018-05-18

Parkinson's disease demonstrates a spectrum of motor and non-motor symptoms. Falling is common and disabling. Current medical management shows minimal impact to reduce falls or fall-related risk factors, such as deficits in gait, strength, and postural instability. Despite evidence supporting rehabilitation in reducing fall risk factors, the most appropriate intervention to reduce overall fall rate remains inconclusive. This article aims to 1) synthesise current evidence and conceptual models of falls rehabilitation in Parkinson's in a narrative review; and based on this evidence, 2) introduce the treatment protocol used in the falls prevention and multi-centre clinical trial "PDSAFE". Search of four bibliographic databases using the terms "Parkinson*" and "Fall*" combined with each of the following; "Rehab*, Balanc*, Strength*, Strateg*and Exercis*" and a framework for narrative review was followed. A total of 3557 papers were identified, 416 were selected for review. The majority report the impact of rehabilitation on isolated fall risk factors. Twelve directly measure the impact on overall fall rate. Results were used to construct a narrative review with conceptual discussion based on the "International Classification of Functioning", leading to presentation of the "PDSAFE" intervention protocol. Evidence suggests training single, fall risk factors may not affect overall fall rate. Combining with behavioural and strategy training in a functional, personalised multi-dimensional model, addressing all components of the "International Classification of Functioning" is likely to provide a greater influence on falls reduction. "PDSAFE" is a multi-dimensional, physiotherapist delivered, individually tailored, progressive, home-based programme. It is designed with a strong evidence-based approach and illustrates a model for the clinical delivery of the conceptual theory discussed. Implications for Rehabilitation Parkinson's disease demonstrates a spectrum of motor and non-motor symptoms, where falling is common and disabling. Current medical and surgical management have minimal impact on falls, rehabilitation of falls risk factors has strong evidence but the most appropriate intervention to reduce overall fall rate remains inconclusive. Addressing all components of the International Classification of Function in a multifactorial model when designing falls rehabilitation interventions may be more effective at reducing fall rates in people with Parkinson's than treating isolated risk factors. The clinical model for falls rehabilitation in people with Parkinson's should be multi-dimensional.

Fall incidence and associated risk factors among people with a lower limb amputation during various stages of recovery - a systematic review.

PubMed

Steinberg, Noam; Gottlieb, Amihai; Siev-Ner, Itzhak; Plotnik, Meir

2018-03-14

The objective of this study was to estimate fall incidence and describe associated risk factors among people with a lower limb amputation (LLA) during various stages of recovery: the surgical ward, in-patient rehabilitation and return to community life. A systematic search of relevant English language articles was performed using PubMed and EMBASE. Out of 310 initial "hits," six retrospective cohort studies, one prospective cohort study and eleven cross-sectional studies from which fall incidence and risk factors could be extracted, were selected for critical review. Fall incidence and associated risk factors were extracted and analyzed in the context of various clinical stages of recovery after amputation. The studies were evaluated for quality using the "Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies." Results showed that during all stages of recovery, people with a LLA are at increased risk of falling compared with able-bodied individuals, as well as other clinical populations. Each stage of recovery is associated with different fall risk factors. The current review is limited mainly by the paucity of studies on the topic. Specialised care focusing on the most relevant risk factors for each stage of recovery may enhance fall prevention during post-fall recovery. Implications for rehabilitation •  People with a lower limb amputation are at a high risk of falling in all stages of their clinical course.      •  Health professionals should be aware that people with a lower limb amputation in the first 4 years ofamputation or with four or more health-related problems are at an increased risk.      •  Health professionals should also be aware that increased gait variability, excess confidence in balance andwalking abilities and less cautious stair walking, impose an elevated risk of falling and should focus theirefforts in reducing these factors.

Diabetes mellitus and risk of falls in older adults: a systematic review and meta-analysis.

PubMed

Yang, Yu; Hu, Xinhua; Zhang, Qiang; Zou, Rui

2016-11-01

intensive or very loose glycemic control may contribute to the risk of falls in diabetic patients. However, studies on diabetes mellitus and the risk of falls have yielded conflicting results. Our objective was to investigate the effect of diabetes mellitus on the risk of falls in older adults by conducting a systematic review and meta-analysis. the PubMed and Embase databases were searched for relevant studies published until November 2015. Only prospective cohort studies reporting at least age-adjusted risk estimate of falls compared diabetic to non-diabetic individuals were selected. Diabetes mellitus was ascertained by a combination of medical history and laboratory tests or use of anti-diabetic drugs. a total of six studies involving 14,685 participants were identified. The number of falls in diabetic and non-diabetic individuals was 423 of 1,692 (25.0%) and 2,368 of 13,011 (18.2%), respectively. Diabetes mellitus was associated with an increased risk of falls (risk ratio [RR] = 1.64; 95% confidence intervals [CI] 1.27-2.11) in a random-effects model. Subgroup analyses showed that the risk of falls seemed more pronounced among both gender groups (RR = 1.81; 95% CI 1.19-2.76) than among women (RR = 1.52; 95% CI 1.04-2.21). Diabetes increased 94% (RR = 1.94; 95% CI 1.42-2.63) and 27% (RR = 1.27; 95% CI 1.06-1.52) risk of falls in insulin-treated and no-insulin-treated patients, respectively. this meta-analysis reveals that older adults with diabetes mellitus are associated with greater risk of falls, and this association is more pronounced in insulin-treated patients. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A regression tree for identifying combinations of fall risk factors associated to recurrent falling: a cross-sectional elderly population-based study.

PubMed

Kabeshova, A; Annweiler, C; Fantino, B; Philip, T; Gromov, V A; Launay, C P; Beauchet, O

2014-06-01

Regression tree (RT) analyses are particularly adapted to explore the risk of recurrent falling according to various combinations of fall risk factors compared to logistic regression models. The aims of this study were (1) to determine which combinations of fall risk factors were associated with the occurrence of recurrent falls in older community-dwellers, and (2) to compare the efficacy of RT and multiple logistic regression model for the identification of recurrent falls. A total of 1,760 community-dwelling volunteers (mean age ± standard deviation, 71.0 ± 5.1 years; 49.4 % female) were recruited prospectively in this cross-sectional study. Age, gender, polypharmacy, use of psychoactive drugs, fear of falling (FOF), cognitive disorders and sad mood were recorded. In addition, the history of falls within the past year was recorded using a standardized questionnaire. Among 1,760 participants, 19.7 % (n = 346) were recurrent fallers. The RT identified 14 nodes groups and 8 end nodes with FOF as the first major split. Among participants with FOF, those who had sad mood and polypharmacy formed the end node with the greatest OR for recurrent falls (OR = 6.06 with p < 0.001). Among participants without FOF, those who were male and not sad had the lowest OR for recurrent falls (OR = 0.25 with p < 0.001). The RT correctly classified 1,356 from 1,414 non-recurrent fallers (specificity = 95.6 %), and 65 from 346 recurrent fallers (sensitivity = 18.8 %). The overall classification accuracy was 81.0 %. The multiple logistic regression correctly classified 1,372 from 1,414 non-recurrent fallers (specificity = 97.0 %), and 61 from 346 recurrent fallers (sensitivity = 17.6 %). The overall classification accuracy was 81.4 %. Our results show that RT may identify specific combinations of risk factors for recurrent falls, the combination most associated with recurrent falls involving FOF, sad mood and polypharmacy. The FOF emerged as the risk factor strongly associated with recurrent falls. In addition, RT and multiple logistic regression were not sensitive enough to identify the majority of recurrent fallers but appeared efficient in detecting individuals not at risk of recurrent falls.

Concurrent validation of an index to estimate fall risk in community dwelling seniors through a wireless sensor insole system: A pilot study.

PubMed

Di Rosa, Mirko; Hausdorff, Jeff M; Stara, Vera; Rossi, Lorena; Glynn, Liam; Casey, Monica; Burkard, Stefan; Cherubini, Antonio

2017-06-01

Falls are a major health problem for older adults with immediate effects, such as fractures and head injuries, and longer term effects including fear of falling, loss of independence, and disability. The goals of the WIISEL project were to develop an unobtrusive, self-learning and wearable system aimed at assessing gait impairments and fall risk of older adults in the home setting; assessing activity and mobility in daily living conditions; identifying decline in mobility performance and detecting falls in the home setting. The WIISEL system was based on a pair of electronic insoles, able to transfer data to a commercially available smartphone, which was used to wirelessly collect data in real time from the insoles and transfer it to a backend computer server via mobile internet connection and then onwards to a gait analysis tool. Risk of falls was calculated by the system using a novel Fall Risk Index (FRI) based on multiple gait parameters and gait pattern recognition. The system was tested by twenty-nine older users and data collected by the insoles were compared with standardized functional tests with a concurrent validity approach. The results showed that the FRI captures the risk of falls with accuracy that is similar to that of conventional performance-based tests of fall risk. These preliminary findings support the idea that theWIISEL system can be a useful research tool and may have clinical utility for long-term monitoring of fall risk at home and in the community setting. Copyright © 2017 Elsevier B.V. All rights reserved.

Influence of cognitive impairment on fall risk among elderly nursing home residents.

PubMed

Seijo-Martinez, M; Cancela, J M; Ayán, C; Varela, S; Vila, H

2016-12-01

Information relating the severity of cognitive decline to the fall risk in institutionalized older adults is still scarce. This study aims to identify potential fall risk factors (medications, behavior, motor function, and neuropsychological disturbances) depending on the severity of cognitive impairment in nursing home residents. A total of 1,167 nursing home residents (mean age 81.44 ± 8.26 years; 66.4% women) participated in the study. According to the MEC, (the Spanish version of the Mini-Mental State Examination) three levels of cognitive impairment were established: mild (20-24) "MCI", moderate (14-19) "MOCI", and severe (≤14) "SCI". Scores above 24 points indicated the absence cognitive impairment (NCI). Information regarding fall history and fall risk during the previous year was collected using standardized questionnaires and tests. Sixty falls (34%) were registered among NCI participants and 417 (43%) among people with cognitive impairment (MCI: 35%; MOCI: 40%; SCI: 50%). A different fall risk model was observed for MCI, MOCI, SCI, and NCI patients. The results imply that the higher the level of cognitive impairment, the greater the number of falls (F1,481 = 113.852; Sig = 0.015), although the level of significance was not maintained when MOCI and SCI participants were compared. Depression, neuropsychiatric disturbances, autonomy constraints in daily life activity performance, and low functional mobility were factors closely associated with fall risk. This study provides evidence indicating that fall risk factors do not hold a direct correlation with the level of cognitive impairment among elderly nursing home care residents.

The efficacy of fall-risk-increasing drug (FRID) withdrawal for the prevention of falls and fall-related complications: protocol for a systematic review and meta-analysis.

PubMed

Lee, Justin Yusen; Holbrook, Anne

2017-02-20

Despite limited evidence of effectiveness, withdrawal (discontinuation or dose reduction) of high risk medications known as "fall-risk increasing drugs" (FRIDs) is typically conducted as a fall prevention strategy based on presumptive benefit. Our objective is to determine the efficacy of fall-risk increasing drugs (FRIDs) withdrawal on the prevention of falls and fall-related complications. We will search for all published and unpublished randomized controlled trials evaluating the effect of FRID withdrawal compared to usual care on the rate of falls, incidence of falls, fall-related injuries, fall-related fractures, fall-related hospitalizations, or adverse effects related to the intervention in adults aged 65 years or older. Electronic database searches will be conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL. A grey literature search will be conducted including clinical trial registries and conference proceedings and abstracts. Two reviewers will independently perform in duplicate citation screening, full-text review, data abstraction, and risk of bias assessment. Conflicts will be resolved through team discussion or by a third reviewer if no consensus can be reached. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criteria will be used to independently rate overall confidence in effect estimates for each outcome. Results will be synthesized descriptively, and a random effects meta-analysis will be conducted for each outcome if studies are deemed similar methodologically, clinically, and statistically. We will attempt to determine whether a FRID withdrawal strategy alone is effective at preventing falls in older adults. Our results will be used to optimize and focus fall prevention strategies and initiatives internationally with a goal of improving the health of older adults. PROSPERO CRD42016040203.

A Prospective Study of Back Pain and Risk of Falls Among Older Community-dwelling Women

PubMed Central

Litwack-Harrison, Stephanie; Cawthon, Peggy M.; Kado, Deborah M.; Deyo, Richard A.; Makris, Una E.; Carlson, Hans L.; Nevitt, Michael C.

2016-01-01

Background. Back pain and falls are common health conditions among older U.S. women. The extent to which back pain is an independent risk factor for falls has not been established. Methods. We conducted a prospective study among 6,841 community-dwelling U.S. women at least 65 years of age from the Study of Osteoporotic Fractures (SOF). Baseline questionnaires inquired about any back pain, pain severity, and frequency in the past year. During 1 year of follow-up, falls were summed from self-reports obtained every 4 months. Two outcomes were studied: recurrent falls (≥2 falls) and any fall (≥1 fall). Associations of back pain and each fall outcome were estimated with risk ratios (RRs) and 95% confidence intervals (CIs) from multivariable log-binomial regression. Adjustments were made for age, education, smoking status, fainting history, hip pain, stroke history, vertebral fracture, and Geriatric Depression Scale. Results. Most (61%) women reported any back pain. During follow-up, 10% had recurrent falls and 26% fell at least once. Any back pain relative to no back pain was associated with a 50% increased risk of recurrent falls (multivariable RR = 1.5, 95% CI: 1.3, 1.8). Multivariable RRs for recurrent falls were significantly elevated for all back pain symptoms, ranging from 1.4 (95% CI: 1.1, 1.8) for mild back pain to 1.8 (95% CI: 1.4, 2.3) for activity-limiting back pain. RRs of any fall were also significantly increased albeit smaller than those for recurrent falls. Conclusions. Older community-dwelling women with a recent history of back pain are at increased risk for falls. PMID:26757988

Medication use and fall-risk assessment for falls in an acute care hospital.

PubMed

Chiu, Ming-Huang; Lee, Hsin-Dai; Hwang, Hei-Fen; Wang, Shih-Chieh; Lin, Mau-Roung

2015-07-01

A nested case-control study was carried out to examine relationships of a fall-risk score and the use of single medications and polypharmacy with falls among hospitalized patients aged 50 years and older in Taiwan. There were 83 patients who experienced a fall during hospitalization in an acute-care hospital. Matched by age and sex, five control patients for each case were randomly selected from all other inpatients who had not experienced any fall at the time of the index fall. Patients who took tricyclic antidepressants, diuretics, and narcotics were 3.36-, 1.83- and 2.09-fold, respectively, more likely to experience a fall than their counterparts. Conversely, patients who took beta-blockers were 0.34-fold more likely than those who did not take them to experience a fall. Patients taking ≥6 medications were 3.08-fold more likely than those taking fewer medications to experience a fall, whereas those with anxiety were 4.72-fold more likely to experience a fall than those without. A high fall-risk score was not significantly associated with the occurrence of falls. Among older hospitalized patients, tricyclic antidepressants, diuretics, narcotics, and polypharmacy should be mindfully prescribed and reviewed on a regular basis. A fall-risk scale developed from community-dwelling older people might not accurately predict falls in hospitalized patients. Further research to validate the negative effect of beta-blocker use on falls is required. © 2014 Japan Geriatrics Society.

Causes and risk factors of falls in patients with Parkinson's disease.

PubMed

Rudzińska, Monika; Bukowczan, Sylwia; Banaszkiewicz, Krzysztof; Stozek, Joanna; Zajdel, Katarzyna; Szczudlik, Andrzej

2008-01-01

Falls are a common and serious problem among Parkinson's disease (PD) patients. However, knowledge about the causes and risk factors of falls is limited. There have been a few attempts to classify the causes of falls. The classification suggested by Olanow seems to be the most comprehensive one. The aim of this study was to analyze retrospectively the causes of falls and risk factors of falls in PD patients. One hundred and four patients with moderately advanced PD were included in the study. The patients were asked to describe the circumstances and consequences of falls which occurred during 12 months preceding the examination. The falls were classified according to the Olanow classification of causes of falls. Fifty-two patients (50%) reported at least one fall during the previous year with a mean number of 1.5 falls per year. The most common causes of falls were environmental factors, sudden falls and postural instability. There were no falls caused by severe dyskinesia, drugs or cardiovascular disorders. The only independent risk factors of the recurrent falls identified in this study were UPDRS part II score (OR 1.17, 95% CI: 1.02-1.37) and Mini Mental State Examination score (OR 0.85, 95% CI: 0.72-0.99). Considering these results we may be able to prevent most falls by means of the education of patients about environmental factors and using adequate rehabilitation techniques concentrating on postural stability and gait.

Quantitative rock-fall hazard and risk assessment for Yosemite Valley, Yosemite National Park, California

USGS Publications Warehouse

Stock, Greg M.; Luco, Nicolas; Collins, Brian D.; Harp, Edwin L.; Reichenbach, Paola; Frankel, Kurt L.

2012-01-01

caused injuries within developed regions located on or adjacent to talus slopes, highlighting the need for additional investigations into rock-fall hazard and risk. This assessment builds upon previous investigations of rock fall hazard and risk in Yosemite Valley (Wieczorek et al., 1998, 1999; Guzzetti et al., 2003; Wieczorek et al., 2008), and focuses on hazard and risk to structures posed by relatively frequent fragmental-type rock falls (Evans and Hungr, 1999), up to approximately 100,000 m3 in volume.

Dual-task testing to predict falls in community-dwelling older adults: a systematic review.

PubMed

Muir-Hunter, S W; Wittwer, J E

2016-03-01

Cognitive impairment increases fall risk in older adults. Dual-task testing is an accepted way to assess the interaction between cognition and mobility; however, there is a lack of evidence-based recommendations for dual-task testing to evaluate fall risk in clinical practice. To evaluate the association between dual-task testing protocols and future fall risk, and to identify the specific dual-task test protocols associated with elevated risk. MEDLINE, Pubmed and EMBASE electronic databases were searched from January 1988 to September 2013. Two independent raters identified prospective cohort studies (duration of at least 1 year) of dual-task assessment in community-dwelling participants aged ≥60 years, with 'falls' as the primary outcome. Methodological quality was scored independently by two raters using a published checklist of criteria for evaluating threats to the validity of observational studies. Deterioration in gait during dual-task testing compared with single-task performance was associated with increased fall risk. Shortcomings within the literature significantly limit knowledge translation of dual-task gait protocols into clinical practice. There is a paucity of prospective studies on the association of dual-task gait assessment with fall risk. Changes in gait under dual-task testing are associated with future fall risk, and this association is stronger than that for single-task conditions. Limitations in the available literature preclude development of detailed recommendations for dual-task gait testing procedures in clinical practice to identify and stratify fall risk in older adults. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

CYP2C9 Genotypes Modify Benzodiazepine-Related Fall Risk: Original Results From Three Studies With Meta-Analysis.

PubMed

Ham, Annelies C; Ziere, Gijsbertus; Broer, Linda; Swart, Karin M A; Enneman, Anke W; van Dijk, Suzanne C; van Wijngaarden, Janneke P; van der Zwaluw, Nikita L; Brouwer-Brolsma, Elske M; Dhonukshe-Rutten, Rosalie A M; van Schoor, Natasja M; Zillikens, M Carola; van Gelder, Teun; de Vries, Oscar J; Lips, Paul; Deeg, Dorly J H; de Groot, Lisette C P G M; Hofman, Albert; Witkamp, Renger F; Uitterlinden, André G; Stricker, Bruno H; van der Velde, Nathalie

2017-01-01

To investigate whether the CYP2C9*2 and *3 variants modify benzodiazepine-related fall risk. Three prospective studies; the Rotterdam Study, B-PROOF, and LASA. Community-dwelling individuals living in or near five Dutch cities. There were 11,485 participants aged ≥55 years. Fall incidents were recorded prospectively. Benzodiazepine use was determined using pharmacy dispensing records or interviews. Cox proportional hazard models adjusted for age and sex were applied to determine the association between benzodiazepine use and fall risk stratified for CYP2C9 genotype and comparing benzodiazepine users to nonusers. The results of the three studies were combined applying meta-analysis. Within benzodiazepine users, the association between genotypes and fall risk was also assessed. Three thousand seven hundred five participants (32%) encountered a fall during 91,996 follow-up years, and 4% to 15% (depending on the study population) used benzodiazepines. CYP2C9 variants had frequencies of 13% for the *2 allele and 6% for the *3 allele. Compared to nonusers, current benzodiazepine use was associated with an 18% to 36% increased fall risk across studies with a combined hazard ratio (HR) = 1.26 (95% confidence interval [CI], 1.13; 1.40). CYP2C9*2 or *3 allele variants modified benzodiazepine-related fall risk. Compared to nonusers, those carrying a CYP2C9*2 or *3 allele and using benzodiazepines had a 45% increased fall risk (HR, 1.45 95% CI, 1.21; 1.73), whereas CYP2C9*1 homozygotes using benzodiazepines had no increased fall risk (HR, 1.14; 95% CI, 0.90; 1.45). Within benzodiazepine users, having a CYP2C9*2 or *3 allele was associated with an increased fall risk (HR, 1.35; 95% CI, 1.06; 1.72). Additionally, we observed an allele dose effect; heterozygous allele carriers had a fall risk of (HR = 1.30; 95% CI, 1.05; 1.61), and homozygous allele carriers of (HR = 1.91 95% CI, 1.23; 2.96). CYP2C9*2 and *3 allele variants modify benzodiazepine-related fall risk. Those using benzodiazepines and having reduced CYP2C9 enzyme activity based on their genotype are at increased fall risk. In clinical practice, genotyping might be considered for elderly patients with an indication for benzodiazepine use. However, because the exact role of CYP2C9 in benzodiazepine metabolism is still unclear, additional research is warranted. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Objective Assessment of Fall Risk in Parkinson's Disease Using a Body-Fixed Sensor Worn for 3 Days

PubMed Central

Weiss, Aner; Herman, Talia; Giladi, Nir; Hausdorff, Jeffrey M.

2014-01-01

Background Patients with Parkinson's disease (PD) suffer from a high fall risk. Previous approaches for evaluating fall risk are based on self-report or testing at a given time point and may, therefore, be insufficient to optimally capture fall risk. We tested, for the first time, whether metrics derived from 3 day continuous recordings are associated with fall risk in PD. Methods and Materials 107 patients (Hoehn & Yahr Stage: 2.6±0.7) wore a small, body-fixed sensor (3D accelerometer) on lower back for 3 days. Walking quantity (e.g., steps per 3-days) and quality (e.g., frequency-derived measures of gait variability) were determined. Subjects were classified as fallers or non-fallers based on fall history. Subjects were also followed for one year to evaluate predictors of the transition from non-faller to faller. Results The 3 day acceleration derived measures were significantly different in fallers and non-fallers and were significantly correlated with previously validated measures of fall risk. Walking quantity was similar in the two groups. In contrast, the fallers walked with higher step-to-step variability, e.g., anterior-posterior width of the dominant frequency was larger (p = 0.012) in the fallers (0.78±0.17 Hz) compared to the non-fallers (0.71±0.07 Hz). Among subjects who reported no falls in the year prior to testing, sensor-derived measures predicted the time to first fall (p = 0.0034), whereas many traditional measures did not. Cox regression analysis showed that anterior-posterior width was significantly (p = 0.0039) associated with time to fall during the follow-up period, even after adjusting for traditional measures. Conclusions/Significance These findings indicate that a body-fixed sensor worn continuously can evaluate fall risk in PD. This sensor-based approach was able to identify transition from non-faller to faller, whereas many traditional metrics were not successful. This approach may facilitate earlier detection of fall risk and may in the future, help reduce high costs associated with falls. PMID:24801889

Validation of Fall Risk Assessment Specific to the Inpatient Rehabilitation Facility Setting.

PubMed

Thomas, Dan; Pavic, Andrea; Bisaccia, Erin; Grotts, Jonathan

2016-09-01

To evaluate and compare the Morse Fall Scale (MFS) and the Casa Colina Fall Risk Assessment Scale (CCFRA) for identification of patients at risk for falling in an acute inpatient rehabilitation facility. The primary objective of this study was to perform a retrospective validation study of the CCFRAS, specifically for use in the inpatient rehabilitation facility (IRF) setting. Retrospective validation study. The study was approved under expedited review by the local Institutional Review Board. Data were collected on all patients admitted to Cottage Rehabiliation Hospital (CRH), a 38-bed acute inpatient rehabilitation hospital, from March 2012 to August 2013. Patients were excluded from the study if they had a length of stay less than 3 days or age less than 18. The area under the receiver operating characteristic curve (AUC) and the diagnostic odds ratio were used to examine the differences between the MFS and CCFRAS. AUC between fall scales was compared using the DeLong Test. There were 931 patients included in the study with 62 (6.7%) patient falls. The average age of the population was 68.8 with 503 males (51.2%). The AUC was 0.595 and 0.713 for the MFS and CCFRAS, respectively (0.006). The diagnostic odds ratio of the MFS was 2.0 and 3.6 for the CCFRAS using the recommended cutoffs of 45 for the MFS and 80 for the CCFRAS. The CCFRAS appears to be a better tool in detecting fallers vs. nonfallers specific to the IRF setting. The assessment and identification of patients at high risk for falling is important to implement specific precautions and care for these patients to reduce their risk of falling. The CCFRAS is more clinically relevant in identifying patients at high risk for falling in the IRF setting compared to other fall risk assessments. Implementation of this scale may lead to a reduction in fall rate and injuries from falls as it more appropriately identifies patients at high risk for falling. © 2015 Association of Rehabilitation Nurses.

Testing the reliability of the Fall Risk Screening Tool in an elderly ambulatory population.

PubMed

Fielding, Susan J; McKay, Michael; Hyrkas, Kristiina

2013-11-01

To identify and test the reliability of a fall risk screening tool in an ambulatory outpatient clinic. The Fall Risk Screening Tool (Albert Lea Medical Center, MN, USA) was scripted for an interview format. Two interviewers separately screened a convenience sample of 111 patients (age ≥ 65 years) in an ambulatory outpatient clinic in a northeastern US city. The interviewers' scoring of fall risk categories was similar. There was good internal consistency (Cronbach's α = 0.834-0.889) and inter-rater reliability [intra-class correlation coefficients (ICC) = 0.824-0.881] for total, Risk Factor and Client's Health Status subscales. The Physical Environment scores indicated acceptable internal consistency (Cronbach's α = 0.742) and adequate reliability (ICC = 0.688). Two Physical Environment items (furniture and medical equipment condition) had low reliabilities [Kappa (K) = 0.323, P = 0.08; K = -0.078, P = 0.648), respectively. The scripted Fall Risk Screening Tool demonstrated good reliability in this sample. Rewording two Physical Environment items will be considered. A reliable instrument such as the scripted Fall Risk Screening Tool provides a standardised assessment for identifying high fall risk patients. This tool is especially useful because it assesses personal, behavioural and environmental factors specific to community-dwelling patients; the interview format also facilitates patient-provider interaction. © 2013 John Wiley & Sons Ltd.

Deep Learning to Predict Falls in Older Adults Based on Daily-Life Trunk Accelerometry.

PubMed

Nait Aicha, Ahmed; Englebienne, Gwenn; van Schooten, Kimberley S; Pijnappels, Mirjam; Kröse, Ben

2018-05-22

Early detection of high fall risk is an essential component of fall prevention in older adults. Wearable sensors can provide valuable insight into daily-life activities; biomechanical features extracted from such inertial data have been shown to be of added value for the assessment of fall risk. Body-worn sensors such as accelerometers can provide valuable insight into fall risk. Currently, biomechanical features derived from accelerometer data are used for the assessment of fall risk. Here, we studied whether deep learning methods from machine learning are suited to automatically derive features from raw accelerometer data that assess fall risk. We used an existing dataset of 296 older adults. We compared the performance of three deep learning model architectures (convolutional neural network (CNN), long short-term memory (LSTM) and a combination of these two (ConvLSTM)) to each other and to a baseline model with biomechanical features on the same dataset. The results show that the deep learning models in a single-task learning mode are strong in recognition of identity of the subject, but that these models only slightly outperform the baseline method on fall risk assessment. When using multi-task learning, with gender and age as auxiliary tasks, deep learning models perform better. We also found that preprocessing of the data resulted in the best performance (AUC = 0.75). We conclude that deep learning models, and in particular multi-task learning, effectively assess fall risk on the basis of wearable sensor data.

Influences of a Church-Based Intervention on Falls Risk Among Seniors.

PubMed

Briggs, Morgan; Morzinski, Jeffrey A; Ellis, Julie

2017-08-01

Prior studies illustrate that community-based programs effectively decrease falls risk in older adults and that faith-based programs improve health behaviors. The literature is unclear whether faith-based initiatives reduce seniors' fall risks. To tackle this gap, a long-term partnership led by 10 urban churches, a nearby nursing school, and a medical school developed a study with 3 objectives: determine baseline health concerns associated with falls (eg, depression, polypharmacy), implement a nurse-led, faith-based health education initiative for community-dwelling African American seniors at-risk of hospitalization, and assess pre- to post -program fall frequency. The 100 Healthy, At-Risk Families study team implemented 8 monthly educational health sessions promoting self-care and social support. Community nurses led the 60- to 90-minute sessions at each of 10 churches. To collect study data, nurses interviewed enrolled seniors pre- and post-intervention. Descriptive and comparison statistics were analyzed in Excel and Statistical Package for Social Sciences. Senior data at baseline found high rates of polypharmacy and physical imbalance, and no significant depression or gaps in social support. There was not a statistically significant change pre- to post-program in fall frequency "in prior year." Study findings reveal insights about African American senior health and fall risks. Church settings may provide a protective, psychosocial buffer for seniors, while polypharmacy and mobility/balance concerns indicate need for continued attention to fall risks. No increase in pre- to post-program falls was encouraging.

Deep Learning to Predict Falls in Older Adults Based on Daily-Life Trunk Accelerometry

PubMed Central

Englebienne, Gwenn; Pijnappels, Mirjam

2018-01-01

Early detection of high fall risk is an essential component of fall prevention in older adults. Wearable sensors can provide valuable insight into daily-life activities; biomechanical features extracted from such inertial data have been shown to be of added value for the assessment of fall risk. Body-worn sensors such as accelerometers can provide valuable insight into fall risk. Currently, biomechanical features derived from accelerometer data are used for the assessment of fall risk. Here, we studied whether deep learning methods from machine learning are suited to automatically derive features from raw accelerometer data that assess fall risk. We used an existing dataset of 296 older adults. We compared the performance of three deep learning model architectures (convolutional neural network (CNN), long short-term memory (LSTM) and a combination of these two (ConvLSTM)) to each other and to a baseline model with biomechanical features on the same dataset. The results show that the deep learning models in a single-task learning mode are strong in recognition of identity of the subject, but that these models only slightly outperform the baseline method on fall risk assessment. When using multi-task learning, with gender and age as auxiliary tasks, deep learning models perform better. We also found that preprocessing of the data resulted in the best performance (AUC = 0.75). We conclude that deep learning models, and in particular multi-task learning, effectively assess fall risk on the basis of wearable sensor data. PMID:29786659

Testing a fall risk model for injection drug users.

PubMed

Pieper, Barbara; Templin, Thomas N; Goldberg, Allon

2012-01-01

Fall risk is a critical component of clinical assessment and has not been examined for persons who have injected illicit drugs and are aging. The aim of this study was to test and develop the Fall Risk Model for Injection Drug Users by examining the relationships among injection drug use, chronic venous insufficiency, lower extremity impairments (i.e., decreased ankle range of motion, reduced calf muscle endurance, and leg pain), age and other covariates, and the Tinetti balance and gait total score as a measure of fall risk. A cross-sectional comparative design was used with four crossed factors. Standardized instruments were used to assess the variables. Moderated multiple regression with linear and quadratic trends in age was used to examine the nature of the relationship between the Tinetti balance and gait total and age and the potential moderating role of injection drug use. A prespecified series of models was tested. Participants (n = 713) were men (46.9%) and women with a mean age of 46.26 years and primarily African American (61.7%) in methadone treatment centers. The fall risk of a 48-year-old leg injector was comparable with the fall risk of a 69-year-old who had not injected drugs. Variables were added to the model sequentially, resulting in some lost significance of some when they were explained by subsequent variables. Final significant variables in the model were employment status, number of comorbidities, ankle range of motion, leg pain, and calf muscle endurance. Fall risk was associated with route of drug use. Lower extremity impairments accounted for the effects of injection drug use and chronic venous insufficiency on risk for falls. Further understanding of fall risk in injection users is necessary as they age, attempt to work, and participate in activities.

NOCTURNAL ENURESIS AS A RISK FACTOR FOR FALLS IN OLDER COMMUNITY-DWELLING WOMEN WITH URINARY INCONTINENCE

PubMed Central

Pahwa, Avita K.; Andy, Uduak U.; Newman, Diane K.; Stambakio, Hanna; Schmitz, Kathryn H.; Arya, Lily A.

2016-01-01

Purpose To determine the association between urinary symptoms, fall risk and physical limitations in older community-dwelling women with urinary incontinence (UI). Materials and Methods In-depth assessment of day and nighttime urinary symptoms, fall risk, physical function, physical performance tests and mental function in older community-dwelling women with UI and who had not sought care for their urinary symptoms. All assessments were performed in the participants’ homes. We used univariable and multivariable linear regression to examine the relationship of urinary symptoms with fall risk, physical function, and physical performance. Results In 37 women with UI (mean age 74 ± 8.4 years), 48% were at high risk for falls. Nocturnal enuresis was reported by 50%. Increased fall risk was associated with increasing frequency of nocturnal enuresis (p=0.04), worse lower limb (p<0.001) and worse upper limb (p<0.0001) function and worse performance on a composite physical performance test of strength, gait and balance (p=0.02). Women with nocturnal enuresis had significantly lower median physical performance test scores (7, range 0, 11) than women without nocturnal enuresis (median 9, range 1, 12, p=0.04). In a multivariable regression model that included age, nocturnal enuresis episodes and physical function, only physical function was associated with increased fall risk (p<0.0001). Conclusion Nocturnal enuresis is common in older community-dwelling women with UI and may serve as a marker for fall risk even in women not seeking care for their urinary symptoms. Interventions targeting upper and lower body physical function could potentially reduce risk of falls in older women with UI. PMID:26626218

Lower Limb Osteoarthritis and the Risk of Falls in a Community-Based Longitudinal Study of Adults with and without Osteoarthritis

PubMed Central

Doré, Adam L.; Golightly, Yvonne M.; Mercer, Vicki S.; Shi, Xiaoyan A.; Renner, Jordan B.; Jordan, Joanne M.; Nelson, Amanda E.

2014-01-01

Objective Knee and hip osteoarthritis (OA) are known risk factors for falls, but whether they together additionally contribute to falls risk is unknown. This study utilizes a biracial cohort of men and women to examine the influence of lower limb OA burden on the risk for future falls. Methods A longitudinal analysis was performed using data from 2 time points of a large cohort. The outcome of interest was falls at follow up. Covariates included age, sex, race, body mass index, a history of prior falls, symptomatic OA of the hip and/or knee, a history of neurologic or pulmonary diseases, and current use of narcotic medications. Symptomatic OA was defined as patient reported symptoms and radiographic evidence of OA in the same joint. Logistic regression analyses were used to determine associations between covariates and falls at follow-up. Results The odds of falling increased with an increasing number of lower limb symptomatic OA joints: those with 1 joint had 53% higher odds, those with 2 joints had 74% higher odds, those with 3–4 OA joints had 85% higher odds. When controlling for covariates, patients who had symptomatic knee or hip OA had an increased likelihood of falling (aOR 1.39 95% CI [1.02, 1.88]; aOR 1.60 95% CI [1.14, 2.24], respectively). Conclusions This study reveals the risk for falls increases with additional symptomatic OA lower limb joints and confirms that symptomatic hip and knee OA are important risk factors for falls. PMID:25331686

Subclinical Peroneal Neuropathy: A Common, Unrecognized, and Preventable Finding Associated With a Recent History of Falling in Hospitalized Patients.

PubMed

Poppler, Louis H; Groves, Andrew P; Sacks, Gina; Bansal, Anchal; Davidge, Kristen M; Sledge, Jenifer A; Tymkew, Heidi; Yan, Yan; Hasak, Jessica M; Potter, Patricia; Mackinnon, Susan E

2016-11-01

Identification of modifiable risk factors for falling is paramount in reducing the incidence and morbidity of falling. Peroneal neuropathy with an overt foot drop is a known risk factor for falling, but research into subclinical peroneal neuropathy (SCPN) resulting from compression at the fibular head is lacking. The purpose of our study was to determine the prevalence of SCPN in hospitalized patients and establish whether it is associated with a recent history of falling. We conducted a cross-sectional study of 100 medical inpatients at a large academic tertiary care hospital in St Louis, Missouri. General medical inpatients deemed at moderate to high risk for falling were enrolled in the summer of 2013. Patients were examined for findings that suggest peroneal neuropathy, fall risk, and a history of falling. Multivariate logistic regression was used to correlate SCPN with fall risk and a history of falls in the past year. The mean patient age was 53 years (SD = 13 years), and 59 patients (59%) were female. Thirty-one patients had examination findings consistent with SCPN. After accounting for various confounding variables within a multivariate logistic regression model, patients with SCPN were 4.7 times (95% CI, 1.4-15.9) more likely to report having fallen 1 or more times in the past year. Subclinical peroneal neuropathy is common in medical inpatients and is associated with a recent history of falling. Preventing or identifying SCPN in hospitalized patients provides an opportunity to modify activity and therapy, potentially reducing risk. © 2016 Annals of Family Medicine, Inc.

Fall prevention in the young old using an exoskeleton human body posturizer: a randomized controlled trial.

PubMed

Verrusio, W; Gianturco, V; Cacciafesta, M; Marigliano, V; Troisi, G; Ripani, M

2017-04-01

Fall risk in elderly has been related with physical decline, low quality of life and reduced survival. To evaluate the impact of exoskeleton human body posturizer (HBP) on the fall risk in the elderly. 150 subjects (mean age 64.85; 79 M/71 F) with mild fall risk were randomized into two groups: 75 for group treated with human body posturizer (HBP group) and 75 for physical training without HBP group (exercise group). The effects of interventions were assessed by differences in tests related to balance and falls. Medically eligible patients were screened with Tinetti balance and Gait evaluation scale, short physical performance battery and numeric pain rating scale to determine fall risk in elderly people. In the HBP group there was a significant improvement in short physical performance battery, Tinetti scale and Pain Numeric rating scale with a significant reduction in fall risk (p < 0.05). In the exercise group we observed only minimal variations in the test scores. The results at the sixth and twelfth months show a twofold positive effect in the HBP group reducing fall risk and improving quality of life by reducing pain. The use of exoskeleton human body posturizer seems to be a new significant device for prevention of fall in elderly patients. Further research should be carried out to obtain more evidence on effects of robotic technology for fall prevention in the elderly.

Fall-related injuries among initially 75- and 80-year old people during a 10-year follow-up.

PubMed

Saari, Päivi; Heikkinen, Eino; Sakari-Rantala, Ritva; Rantanen, Taina

2007-01-01

The aim of this study was to investigate the occurrence, type, scene and seasonal variation of fall related injuries, and the impact of socio-economic factors, mobility limitation, and the most common diseases on the risk of injurious falls over a 10-year follow-up. Elderly residents of Jyväskylä, Finland, aged initially 75 and 80 years, took part in the study in 1989-1990. The health and functional capacity assessments were carried out at the baseline. Injurious falls were monitored over a 10-year period. The rate of injurious falls per thousand person-years was 188 among women and 78 among men. Of all fall-related diagnoses, head injuries comprised 32%, upper limb injuries 27% and hip injuries 19%. Majority of injurious falls took place indoors and no seasonal variation in fall occurrence was observed. Recurring falls were more likely to take place in institutions. Osteoarthritis increased the risk of injurious falls but no effect was observed for coronary heart diseases or mobility limitation. All in all, intrinsic factors, such as chronic diseases and mobility limitation had only minor effect on risk of injurious falls among older people. The current results suggest that preventive interventions for injurious falls among older people should pay attention to the risk factors present indoors.

Falls in Cognitively Impaired Older Adults: Implications for Risk Assessment And Prevention.

PubMed

Montero-Odasso, Manuel; Speechley, Mark

2018-02-01

To provide an overview of the role of cognition in falls, with potential implications for managing and preventing falls in older adults. Review. Observational and interventional studies addressing the role of cognition on falls. Community-dwelling older adults (65 years and older). The relationship between gait and cognition in aging and neurodegeneration was reviewed in the medical literature to highlight the role of brain motor control deficits in fall risk. The benefits of dual-task gait assessments as a marker of fall risk were reviewed. Therapeutic approaches for reducing falls by improving certain aspects of cognition were appraised. Low performance in attention and executive function are associated with gait slowing, instability, and future falls. Drug-enhancement of cognition may reduce falls in Parkinson's disease, and cognitive training, dual-task training, and virtual reality modalities are promising to improve mobility in sedentary older adults and in those with cognitive impairment and dementia. Falls remain common in older people, with higher prevalence and morbidity in those who are cognitively impaired. Disentangling the mechanism and contribution of cognitive deficits in fall risk may open new treatment approaches. Mounting evidence supports that cognitive therapies help reduce falls. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Predicting Falls and When to Intervene in Older People: A Multilevel Logistical Regression Model and Cost Analysis

PubMed Central

Smith, Matthew I.; de Lusignan, Simon; Mullett, David; Correa, Ana; Tickner, Jermaine; Jones, Simon

2016-01-01

Introduction Falls are the leading cause of injury in older people. Reducing falls could reduce financial pressures on health services. We carried out this research to develop a falls risk model, using routine primary care and hospital data to identify those at risk of falls, and apply a cost analysis to enable commissioners of health services to identify those in whom savings can be made through referral to a falls prevention service. Methods Multilevel logistical regression was performed on routinely collected general practice and hospital data from 74751 over 65’s, to produce a risk model for falls. Validation measures were carried out. A cost-analysis was performed to identify at which level of risk it would be cost-effective to refer patients to a falls prevention service. 95% confidence intervals were calculated using a Monte Carlo Model (MCM), allowing us to adjust for uncertainty in the estimates of these variables. Results A risk model for falls was produced with an area under the curve of the receiver operating characteristics curve of 0.87. The risk cut-off with the highest combination of sensitivity and specificity was at p = 0.07 (sensitivity of 81% and specificity of 78%). The risk cut-off at which savings outweigh costs was p = 0.27 and the risk cut-off with the maximum savings was p = 0.53, which would result in referral of 1.8% and 0.45% of the over 65’s population respectively. Above a risk cut-off of p = 0.27, costs do not exceed savings. Conclusions This model is the best performing falls predictive tool developed to date; it has been developed on a large UK city population; can be readily run from routine data; and can be implemented in a way that optimises the use of health service resources. Commissioners of health services should use this model to flag and refer patients at risk to their falls service and save resources. PMID:27448280

Depression, Antidepressants, and Falls Among Community-Dwelling Elderly People: The MOBILIZE Boston Study

PubMed Central

2013-01-01

Background. The mechanisms linking falls and depression are still unknown. The aim of the study is to examine the association between depression and antidepressants, with indoor and outdoor falls, and to investigate how antidepressants mediate this relationship. Methods. The study included 763 men and women aged 70 and older with baseline measures for depression and antidepressant use are captured with prospective data on falls from the “Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly” (MOBILIZE) Boston study, which is a population-based longitudinal study (from 2005 to 2009). Results. Overall, the rate of falls was 26 falls/100 person-years. Seventeen percent of participants had clinically significant depressive symptoms (CSDS), and 12% used antidepressants. CSDS increased the risk of indoor and outdoor falls (incidence rate ratio [IRR] = 1.6, 95% confidence interval [CI] = 1.2–2.3, p < .01; IRR = 1.6, 95% CI = 1.2–2.2, p < .01). Antidepressant use increased the risk of outdoor falls by 70% and partially mediated the association between CSDS and outdoor falls (IRR = 1.7, 95% CI = 1.2–2.5, p < .05). There was no relationship between antidepressant use and indoor falls. Similar results were observed when depression was considered as a continuous variable. Conclusions. Depression increased the risk of indoor and outdoor falls. Antidepressant use among older adults with CSDS increased the risk of outdoor, but not indoor falls. Clinicians should carefully consider the role of antidepressants among older adults with CSDS and their potential increase for the risk of outdoor falls. PMID:23817088

The effect of hemodialysis on balance measurements and risk of fall.

PubMed

Erken, Ertugrul; Ozelsancak, Ruya; Sahin, Safak; Yılmaz, Emine Ece; Torun, Dilek; Leblebici, Berrin; Kuyucu, Yunus Emre; Sezer, Siren

2016-10-01

Patients with end-stage renal disease (ESRD) have increased risk of falls and fall-related complications. Other than aging and factors related to chronic kidney disease, treatment of hemodialysis may also contribute to this increased risk. The aim of this study was to demonstrate the impairment of balance after a session of hemodialysis with a quantitative assessment and reveal an increased fall risk that would possibly be related to treatment of hemodialysis for patients on maintenance hemodialysis. Fifty-six patients with ESRD on chronic hemodialysis program and 53 healthy individuals were involved in this study. Fall Index percentages were calculated, and fall risk categories were determined for all patients and healthy controls using Tetrax posturography device (Sunlight Medical Ltd Israel). The patient group was evaluated twice for balance, before and after a routine session of hemodialysis. Fall Index scores of healthy controls were lower than that of ESRD patients (p = 0.001). In the patient group, we found the mean Fall Index to be significantly higher at the post-dialysis assessment compared to the pre-dialysis assessment (p = 0.003). The number of patients with high risk of falling also increased at the post-dialysis assessment yet the difference did not reach significance. Fall Index was correlated with the increase in age only at the pre-dialysis balance measurement (p = 0.038). Patients with better dialysis adequacy had significantly lower Fall Index scores than the others at the pre-dialysis balance measurement (p = 0.004). The difference was not significant at the post-dialysis measurement. In the current study, we evaluated the balance of ESRD patients before and after a routine session of hemodialysis treatment. This is the first study to investigate the effect of hemodialysis on balance, using an electronic posturographic balance system. We found the Fall Index score to be significantly higher after hemodialysis, indicating a negative effect of hemodialysis on postural stability. As expected, our data showed an increased Fall Index score correlated with the increase in age both in ESRD patients and in healthy controls. However, the correlation with age was not observed for the patient group at the post-dialysis balance measurement. We might conceive that young patients with ESRD are also prone to fall risk after a session of hemodialysis. Methods that provide quantitative assessment for fall risk could be rather beneficial for high-risk populations such as patients on maintenance hemodialysis.

Fall prevention in central coast community pharmacies.

PubMed

Stuart, Gina M; Kale, Helen L

2018-04-19

Fall injuries among people aged 65 years and over (older people) cause substantial health decline and cost to the health system. In 2009 in New South Wales, 25.6% of older people fell in the previous year, and 10.7% (32 000) were hospitalised. Pharmacists are trusted professionals, who interact extensively with older people and have potential to augment fall prevention in pharmacies. This brief report describes how professional development improved pharmacist's knowledge and confidence in fall prevention, encouraged implementation of fall prevention plans and facilitated the provision of brief fall prevention interventions for older clients, after identification of fall risk. In 2014, pharmacists from all Central Coast pharmacies (n = 76) were invited to free, continuing professional development (CPD) in fall prevention. It provided education and resources to identify clients' fall risk, conduct brief fall prevention interventions and implement fall prevention health promotion plans (FPHPP). Pharmacists completed written: Baseline and post-workshop questionnaires to assess changes in pharmacist's knowledge and confidence, and existing fall prevention in pharmacies. Logs of client fall risk and brief fall prevention interventions offered to clients. Four-month follow-up questionnaires to assess implementation of FPHPPs and pharmacy practice changes. Pharmacists representing 36% of pharmacies participated. At four-month follow-up, 67% had implemented FPHPPs, and 62% delivered brief interventions determined by client fall risk. Fall prevention in pharmacies can be augmented through locally provided CPD tailored for pharmacists. SO WHAT?: This model could increase fall prevention reach. It is transferable to settings where health professionals provide services to older adults and require reregistration through professional development. © 2018 Australian Health Promotion Association.

Changes in bone mineral density may predict the risk of fracture differently in older adults according to fall history.

PubMed

Berry, Sarah D; McLean, Robert R; Hannan, Marian T; Cupples, L Adrienne; Kiel, Douglas P

2014-12-01

To determine whether the association between change in bone mass density (BMD) over 4 years and risk of hip and nonvertebral fracture differs according to an individual's history of falls. Population-based cohort study. Framingham, Massachusetts. Individuals with two measures of BMD at the femoral neck (mean age 78.8; 310 male, 492 female). Cox proportional hazards models were used to estimate hazard ratios (HRs) for the association between percentage change in BMD (per sex-specific standard deviation) and risk of incident hip and nonvertebral fracture. Models were stratified based on history of falls (≥1 falls in the past year) and recurrent falls (≥2 falls) ascertained at the time of the second BMD test. Interactions were tested by including the term "fall history * change in BMD" in the models. Mean change in BMD was -0.6%/year; 27.8% of participants reported falls, and 10.8% reported recurrent falls. Seventy-six incident hip and 175 incident nonvertebral fractures occurred over a median follow-up of 9.0 years. There was no difference in the association between change in BMD and hip fracture according to history of falls (P for interaction = .57). The HR associated with change in BMD and nonvertebral fracture was 1.31 (95% confidence interval (CI) = 1.10-1.56) in participants without a history of falls and 0.95 (95% CI 0.70-1.28) in those with a fall (interaction P = .07). Results for recurrent fallers were similar. The effect of BMD loss on risk of nonvertebral fracture may be greater in persons without a history of falls. It is possible that change in BMD contributes less to fracture risk when a strong risk factor for fracture, such as falls, is present. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Impact of Fall Prevention on Nurses and Care of Fall Risk Patients.

PubMed

King, Barbara; Pecanac, Kristen; Krupp, Anna; Liebzeit, Daniel; Mahoney, Jane

2018-03-19

Falls are common events for hospitalized older adults, resulting in negative outcomes both for patients and hospitals. The Center for Medicare and Medicaid (CMS) has placed pressure on hospital administrators by identifying falls as a "never event", resulting in a zero falls goal for many hospitals. Staff nurses are responsible for providing direct care to patients and for meeting the hospital no falls goal. Little is known about the impact of "zero falls" on nurses, patients and the organization. A qualitative study, using Grounded Dimensional Analysis (GDA) was conducted to explore nurses' experiences with fall prevention in hospital settings and the impact of those experiences on how nurses provide care to fall risk patients. Twenty-seven registered nurses and certified nursing assistants participated in in-depth interviews. Open, axial and selective coding was used to analyze data. A conceptual model which illustrates the impact of intense messaging from nursing administration to prevent patient falls on nurses, actions nurses take to address the message and the consequences to nurses, older adult patients and to the organization was developed. Intense messaging from hospital administration to achieve zero falls resulted in nurses developing a fear of falls, protecting self and unit, and restricting fall risk patients as a way to stop messages and meet the hospital goal. Results of this study identify unintended consequences of fall prevention message on nurses and older adult patients. Further research is needed understand how nurse care for fall risk patients.

Temporal Trends in Fall Rates with the Implementation of a Multifaceted Fall Prevention Program: Persistence Pays Off.

PubMed

Walsh, Catherine M; Liang, Li-Jung; Grogan, Tristan; Coles, Courtney; McNair, Norma; Nuckols, Teryl K

2018-02-01

Most fall prevention programs are only modestly effective, and their sustainability is unknown. An academic medical center implemented a series of fall prevention interventions from 2001 to 2014. The medical center's series of fall prevention interventions were as follows: reorganized the Falls Committee (2001), started flagging high-risk patients (2001), improved fall reporting (2002), increased scrutiny of falls (2005), instituted hourly nursing rounds (2006), reorganized leadership systems (2007), standardized fall prevention equipment (2008), adapted to a move to a new hospital building (2008), routinely investigated root causes (2009), mitigated fall risk during hourly nursing rounds (2009), educated patients about falls (2011), and taught nurses to think critically about risk (2012). To evaluate temporal trends in falls and injury falls, piecewise negative binomial regression with study unit-level random effects was used to analyze structured validated data sets available since 2003. From July 2003 through December 2014, the crude fall rate declined from 3.07 to 2.22 per 1,000 patient days, and injury falls declined from 0.77 to 0.65 per 1,000 patient days. Nonsignificant increases in falls occurred after nurses started rounding hourly and after the move to the new hospital. On the basis of regression models, significant declines occurred after nurses began to mitigate fall risk during hourly rounds (p = 0.009). Instituting incremental changes for more than a decade was associated with a meaningful (about 28%) and sustained decline in falls, although the rate of decline varied over time. Hospitals interested in reducing falls but concerned about competing clinical and financial priorities may find an incremental approach to be effective. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Assessment, prevention and management of skin tears.

PubMed

Benbow, Maureen

2017-04-28

Skin tears are common in older people. They are acute wounds that are at high risk of becoming complex, chronic wounds due to the interplay between the physiological changes in the skin and trauma from the external environment. Skin tears have been reported to have prevalence rates equal to, or greater than, those for pressure ulcers. A comprehensive risk assessment should include assessment of the individual's general health (chronic/critical disease, polypharmacy and cognitive, sensory and nutritional status); mobility (history of falls, impaired mobility, dependent activities of daily living, and mechanical trauma); and skin (extremes of age, fragile skin and previous skin tears). A recognised classification system should be used to identify and document skin tears and guide treatment decisions in line with local wound management protocols. Nurses and carers are in a prime position to prevent, assess and manage skin tears.

Epidemiology of falls in older adults in Texas.

PubMed

Alamgir, Hasanat; Wong, Nicole J; Hu, Yueha; Yu, Mo; Marshall, Amanda; Yu, Shicheng

2015-02-01

The expected increase in the US older adult population implies an increased risk of fall-related injury among these individuals. We describe the epidemiology of fall morbidity among older adults in Texas, a large US state with a diverse population base. Texas Behavioral Risk Factor Surveillance System 2010 data were analyzed. The falls outcome was defined as falling: any fall in the past 3 months and a serious fall: a fall resulting in limited activities for at least 1 day or requiring medical attention. A total of 5996 subjects were included in this analysis; 17.6% (n = 1055) reported falling 1 to 5 times in the previous 3 months, and 361 (6%) experienced serious falls. Risk of falling had a significant positive association among respondents who rated their general health as fair to poor (relative risk [RR] 2.39, 95% confidence interval [CI] 1.55-3.68) and a negative association for those who reported regular physical activity (RR 0.59, 95% CI 0.42-0.82). A similar model examined the risk of serious falls and found statistically positive associations in respondents who reported fair or poor general health (RR 3.29, 95% CI 2.00-5.43). Negative associations were found for those who reported regular physical activity (RR 0.56, 95% CI 0.38-0.83) and for men (RR 0.62, 95% CI 0.39-0.98). No statistically significant correlations for either of the fall outcomes were found with residence, obesity, education, income, age, ethnicity, employment, marital status, diabetes mellitus, or cardiovascular disease. Interventions aimed at the prevention of falls should focus on maintaining and improving general health and promoting physical activity among older adults.

Assessment of head injury risk associated with feet-first free falls in 12-month-old children using an anthropomorphic test device.

PubMed

Thompson, Angela K; Bertocci, Gina; Pierce, Mary Clyde

2009-04-01

Short distance falls are a common false history provided in cases of child abuse. Falls are also a common occurrence in ambulating young children. The purpose of this study was to determine the risk of head injury in short distance feet-first free falls for a 12-month-old child. Feet-first free falls were simulated using an anthropomorphic test device. Three fall heights and five surfaces were tested to determine whether changing fall environment characteristics leads to differences in head injury risk outcomes. Linear head accelerations were measured and angular head accelerations in the anterior-posterior direction were determined. Head injury criteria values and impact durations were also determined for each fall. The mean peak linear head acceleration across all trials was 52.2g. HIC15 values were all below the injury assessment reference value. The mean peak angular head acceleration across all trials was 4,246 rad/s2. Impact durations ranged from 12.1 milliseconds to 27.8 milliseconds. In general, head accelerations were greater and impact durations were lower for surfaces with lower coefficients of restitution (a measure of resiliency). In falls onto wood and linoleum over concrete, the ground-based fall was associated with greater accelerations than the two higher fall heights. Results show that fall dynamics play an important role in head injury outcome measures. Different fall heights and impact surfaces led to differences in head injury risk, but the risk of severe head injury across all tested scenarios was low for a 12-month-old child in feet-first free falls.

Psychoactive Medications Increase the Risk of Falls and Fall-related Injuries in Hospitalized Patients With Cirrhosis.

PubMed

Tapper, Elliot B; Risech-Neyman, Yesenia; Sengupta, Neil

2015-09-01

Reducing or eliminating falls is a focus of patient safety programs as well as health policy. Falls are tied to hospital reimbursement. However, little is known about the risk of falls among hospitalized patients with cirrhosis or factors that affect risk of falling. We conducted a retrospective cohort study of inpatients with cirrhosis from 2010 to 2013 at a liver transplant center. Our primary aim was to determine the clinical factors associated with falls and fall-related injuries for patients with cirrhosis. Our secondary aim was to describe the rate ratio of falls and fall-related injuries among patients with cirrhosis compared with general medical inpatients. During the study period, there were 1749 admissions to the liver service; 55 (3.1%) resulted in falls. Patients who fell were more likely to have received benzodiazepines (50.9% vs 16.7%, P < .0001) and antipsychotic agents (30.9% vs 7.3%, P < .0001). After adjusting for hepatic encephalopathy, the respective odds of a fall after benzodiazepine or antipsychotic exposure were 6.59 (95% confidence interval [CI], 3.76-11.59) and 3.72 (95% CI, 1.90-7.06). The adjusted risk of a fall-related injury was also significantly associated with benzodiazepine and antipsychotic agents, with respective odds ratios of 3.45 (95% CI, 1.39-8.23) and 3.42 (95% CI, 1.09-8.99). Fall-related injuries occurred at a rate of 1.70/1000 patient-days for patients with cirrhosis vs 0.5/1000 patient-days for patients in the general medical service. Accordingly, the rate ratio for a fall-related injury among patients with cirrhosis was 3.37 (95% CI, 1.99-5.72; P < .0001). Psychoactive medications are associated with an increased adjusted risk of falls and fall-related injuries in hospitalized patients with cirrhosis. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

Risk factors for falls with severe fracture in elderly people living in a middle-income country: a case control study.

PubMed

Coutinho, Evandro S F; Fletcher, Astrid; Bloch, Katia V; Rodrigues, Laura C

2008-08-26

Fracture after falling has been identified as an important problem in public health. Most studies of risk factors for fractures due to falls have been carried out in developed countries, although the size of the elderly population is increasing fast in middle income countries. The objective of this paper is to identify risk factors for fall related to severe fractures in those aged 60 or more in a middle-income country. A case-control study was carried out in Rio de Janeiro-Brazil based general hospitals between 2002-2003. Two hundred-fifty hospitalised cases of fracture were matched with 250 community controls by sex, age group and living area. Data were collected for socio-demographic variables, health status and drugs used before the fall. A conditional logistic regression model was fitted to identify variables associated with the risk of fall related severe fracture. Low body mass index, cognitive impairment, stroke and lack of urine control were associated with increased risk of severe fall related fractures. Benzodiazepines and muscle relaxants were also related to an increased risk of severe fractures while moderate use of alcohol was associated with reduced risk. Although the association between benzodiazepines and fractures due to fall has been consistently demonstrated for old people, this has not been the case for muscle relaxant drugs. The decision to prescribe muscle relaxants for elderly people should take into account the risk of severe fracture associated with these drugs.

Fall-risk prediction in older adults with cancer: an unmet need.

PubMed

Wildes, Tanya M; Depp, Brittany; Colditz, Graham; Stark, Susan

2016-09-01

Falls in older adults with cancer are more common than in noncancer controls, yet no fall-risk screening tool has been validated in this population. We undertook a cross-sectional pilot study of the Falls Risk Questionnaire (FRQ) in 21 adults aged ≥65 receiving systemic cancer therapy. Participants completed the FRQ, geriatric assessment measures, and a measure of fear-of-falling. The recruitment rate was 87.5 %, with 95.2 % completion of the FRQ and additional geriatric assessment and quality of life measures. The FRQ correlated significantly with the Timed Up and Go test (Pearson r 0.479, p = 0.028). In addition, the FRQ score correlated directly with fear-of-falling and inversely with QOL, particularly physical health and neurotoxicity subscales. In conclusion, the FRQ was feasible in older adults receiving cancer therapy and correlates with measures of physical performance, functional status, and fear-of-falling. The FRQ may prove to be a valuable fall-risk screening tool to implement fall-prevention interventions in this vulnerable population of older adults with cancer.

Negotiating identity and self-image: perceptions of falls in ambulatory individuals with spinal cord injury - a qualitative study.

PubMed

Jørgensen, Vivien; Roaldsen, Kirsti Skavberg

2017-04-01

Explore and describe experiences and perceptions of falls, risk of falling, and fall-related consequences in individuals with incomplete spinal cord injury (SCI) who are still walking. A qualitative interview study applying interpretive content analysis with an inductive approach. Specialized rehabilitation hospital. A purposeful sample of 15 individuals (10 men), 23 to 78 years old, 2-34 years post injury with chronic incomplete traumatic SCI, and walking ⩾75% of time for mobility needs. Individual, semi-structured face-to-face interviews were recorded, condensed, and coded to find themes and subthemes. One overarching theme was revealed: "Falling challenges identity and self-image as normal" which comprised two main themes "Walking with incomplete SCI involves minimizing fall risk and fall-related concerns without compromising identity as normal" and "Walking with incomplete SCI implies willingness to increase fall risk in order to maintain identity as normal". Informants were aware of their increased fall risk and took precautions, but willingly exposed themselves to risky situations when important to self-identity. All informants expressed some conditional fall-related concerns, and a few experienced concerns limiting activity and participation. Ambulatory individuals with incomplete SCI considered falls to be a part of life. However, falls interfered with the informants' identities and self-images as normal, healthy, and well-functioning. A few expressed dysfunctional concerns about falling, and interventions should target these.

Race and fall risk: data from the National Health and Aging Trends Study (NHATS)

PubMed Central

Sun, Daniel Q.; Huang, Jin; Varadhan, Ravi; Agrawal, Yuri

2016-01-01

Objectives: the objective of this study was to explore whether race-based difference in fall risk may be mediated by environmental and physical performance risk factors. Methods: using data from a nationally representative longitudinal survey of 7,609 community-dwelling participants in the National Health and Aging Trends Study (NHATS), we evaluated whether racial differences in fall risk may be explained by physical performance level (measured by the Short Physical Performance Battery), mobility disability, physical activity level and likelihood of living alone. Multivariate Poisson regression and mediation models were used in analyses. Results: in whites and blacks, the annual incidence of ‘any fall’ was 33.8 and 27.1%, respectively, and the annual incidence of ‘recurrent falls’ was 15.5 and 12.3%, respectively. Compared with whites, blacks had relative risks of 0.7 (95% confidence interval 0.6–0.8) and 0.6 (0.5–0.8) for sustaining any fall and recurrent falls, respectively, in adjusted analyses. Blacks had poorer performance on the SPPB (P < 0.001), higher levels of mobility disability (P < 0.001), similar levels of physical activity (P = 0.19) and were equally likely to live alone relative to whites (P = 0.77). Mediation analysis revealed that these risk factors collectively acted as suppressors and none of these factors accounted for the racial differences in fall risk observed. Conclusions: relative to whites, blacks were at 30 and 40% decreased risk of sustaining any fall and recurrent falls, respectively. This difference in risk remains unexplained. PMID:26764401

Comparison of the Validity of Four Fall-Related Psychological Measures in a Community-Based Falls Risk Screening

ERIC Educational Resources Information Center

Moore, Delilah S.; Ellis, Rebecca; Kosma, Maria; Fabre, Jennifer M.; McCarter, Kevin S.; Wood, Robert H.

2011-01-01

We examined the measurement properties of fall-related psychological instruments with a sample of 133 older adults (M age = 74.4 years, SD = 9.4). Measures included the Comprehensive Falls Risk Screening Instrument, Falls-efficacy Scale-International (FES-I), Activities-specific Balance Confidence (ABC), modified Survey of Activities and Fear of…

Slipping through the cracks: A cross-sectional study examining older adult emergency department patient fall history, post-fall treatment and prevention.

PubMed

Goldberg, Elizabeth M; McCreedy, Ellen M; Gettel, Cameron J; Merchant, Roland C

2017-12-01

Falls are the leading cause of emergency department (ED) visits for fatal and non-fatal injuries among adults 65 years old and older. We aimed to better understand the fall history, risk for further falls, and actions taken to prevent further falls among this higher fall risk population. This cross-sectional study included older adults without cognitive impairment presenting to the Rhode Island Hospital ED from February to May 2017. Of the 76 participants, 35 self-reported no prior falls, and 41 self-reported at least one prior fall, of whom 20 fell on the day of ED presentation. Participants with vs. without self-reported prior falls were similar in age, gender, race, and substance use. Participants with prior falls scored lower on cognitive testing and had more comorbidities associated with falls. Only one quarter of those with prior falls reported making changes and few were evaluated by professionals to prevent future falls. This study highlights that older adult ED patients who sustain a fall are at higher risk for subsequent falls, and that greater fall prevention efforts are needed to protect this vulnerable group. [Full article available at http://rimed.org/rimedicaljournal-2017-12.asp].

The role of exercise in fall prevention for older adults.

PubMed

Rose, Debra J; Hernandez, Danielle

2010-11-01

This article reviews the evidence for the effectiveness of stand-alone exercise interventions and multifactorial intervention strategies that include exercise in lowering fall incidence rates and/or fall risk among older adults residing in the community, acute, subacute, and long-term care settings. Stand-alone exercise programs that emphasize multiple exercise categories are effective in reducing fall rates and fall risk in community-residing older adults, and may also be effective when conducted for a sufficient duration with older adult patients in subacute settings. In contrast, multifactorial fall risk reduction programs that include exercise as a component and are delivered by a multidisciplinary team are more effective in lowering fall rates in long-term care settings. Copyright © 2010 Elsevier Inc. All rights reserved.

Endogenous hormones, muscle strength, and risk of fall-related fractures in older women.

PubMed

Sipilä, Sarianna; Heikkinen, Eino; Cheng, Sulin; Suominen, Harri; Saari, Päivi; Kovanen, Vuokko; Alén, Markku; Rantanen, Taina

2006-01-01

Among older people, fracture-causing fall often leads to health deterioration. The role of endogenous hormone status and muscle strength on fall-related fracture risk is unclear. This study investigates if, after adjustment for bone density, endogenous hormones and muscle strength would predict fall-related limb fracture incidence in older community-dwelling women followed-up over 10 years. As a part of a prospective population-based study, 187 75-year-old women were investigated. Serum estradiol, testosterone, sex hormone binding globulin, and dehydroepiandrosterone sulfate concentrations were analyzed, and isometric muscle strength and bone mineral density were assessed. Fall-related limb fractures were gathered from patient records. Serum estradiol concentration was a significant predictor of fall-related limb fractures. Women with serum estradiol concentrations less than 0.022 nmol/L had a 3-fold risk (relative risk 3.05; 95% confidence interval, 1.26-7.36), and women with estradiol concentrations between 0.022 and 0.066 nmol/L doubled the risk (relative risk 2.24; 95% confidence interval, 0.97-5.19) of fall-related limb fracture compared to the women with estradiol concentrations ()above 0.066 nmol/L. Adjustment for muscle strength and bone mineral density did not materially change the risk estimates. High muscle strength was associated with a low incidence of fall-related limb fractures. This study showed that in 75-year-old women higher serum estradiol concentration and greater muscle strength were independently associated with a low incidence of fall-related limb fractures even after adjustment for bone density. Our results suggest that hormonal status and muscle strength have their own separate mechanisms protecting from fall-related fractures. This finding is of importance in developing preventive strategies, but calls for further study.

Factors Associated with the Risk of Falls of Nursing Home Residents Aged 80 or Older.

PubMed

Álvarez Barbosa, Francisco; Del Pozo-Cruz, Borja; Del Pozo-Cruz, Jesús; Alfonso-Rosa, Rosa M; Sañudo Corrales, Borja; Rogers, Michael E

2016-01-01

Falls are the leading cause of mortality and morbidity in older and represents one of the major and most costly public health problems worldwide. Evaluate the influences of lower limb muscle performance, static balance, functional independence and quality of life on fall risk as assessed with the timed up and go (TUG) test. Cross-sectional study. Fifty-two residents aged 80 or older were assessed and distributed in one of the two study groups (no risk of falls; risk of falls) according to the time to complete the TUG test. A Kistler force platform and linear transducer was used to determinate lower limb muscle performance. Postural Stability (static balance) was measured by recording the center of pressure. The EuroQol-5 dimension was used to assess Health-related quality of life and the Barthel index was used to examine functional status. Student's t-test was performed to evaluate the differences between groups. Correlations between variables were analyzed using Spearman or Pearson coefficient. ROC (receiver operating charasteristic) analysis was used to determine the cut-off points related to a decrease in the risk of a fall. Participants of no-fall risk group showed better lower limb performance, quality of life, and functional status. Cut-off points were determined for each outcome. Risk of falls in nursing home residents over the age of 80 is associated with lower limb muscle performance, functional status, and quality of Life. Cut-off points can be used by clinicians when working toward fall prevention and could help in determining the optimal lower limb muscle performance level for preventing falls. © 2015 Association of Rehabilitation Nurses.

Wearable technology and ECG processing for fall risk assessment, prevention and detection.

PubMed

Melillo, Paolo; Castaldo, Rossana; Sannino, Giovanna; Orrico, Ada; de Pietro, Giuseppe; Pecchia, Leandro

2015-01-01

Falls represent one of the most common causes of injury-related morbidity and mortality in later life. Subjects with cardiovascular disorders (e.g., related to autonomic dysfunctions and postural hypotension) are at higher risk of falling. Autonomic dysfunctions increasing the risk of falling in the short and mid-term could be assessed by Heart Rate Variability (HRV) extracted by electrocardiograph (ECG). We developed three trials for assessing the usefulness of ECG monitoring using wearable devices for: risk assessment of falling in the next few weeks; prevention of imminent falls due to standing hypotension; and fall detection. Statistical and data-mining methods are adopted to develop classification and regression models, validated with the cross-validation approach. The first classifier based on HRV features enabled to identify future fallers among hypertensive patients with an accuracy of 72% (sensitivity: 51.1%, specificity: 80.2%). The regression model to predict falls due to orthostatic dropdown from HRV recorded before standing achieved an overall accuracy of 80% (sensitivity: 92%, specificity: 90%). Finally, the classifier to detect simulated falls using ECG achieved an accuracy of 77.3% (sensitivity: 81.8%, specificity: 72.7%). The evidence from these three studies showed that ECG monitoring and processing could achieve satisfactory performances compared to other system for risk assessment, fall prevention and detection. This is interesting as differently from other technologies actually employed to prevent falls, ECG is recommended for many other pathologies of later life and is more accepted by senior citizens.

American Physiological Society Fall Meeting, August 15-20, 1976, University of Pennsylvania, Philadelphia, Pennsylvania. Abstracts of Papers

ERIC Educational Resources Information Center

Physiologist, 1976

1976-01-01

Presented are abstracts of papers arranged in alphabetical order by first-named author. The proceedings of the American Physiological Society were held jointly with the American Society of Zoologists (ASZ) and the Biomedical Engineering Society (BMES). (EB)

Comparison of ISS, NISS, and RTS score as predictor of mortality in pediatric fall.

PubMed

Soni, Kapil Dev; Mahindrakar, Santosh; Gupta, Amit; Kumar, Subodh; Sagar, Sushma; Jhakal, Ashish

2017-01-01

Studies to identify an ideal trauma score tool representing prediction of outcomes of the pediatric fall patient remains elusive. Our study was undertaken to identify better predictor of mortality in the pediatric fall patients. Data was retrieved from prospectively maintained trauma registry project at level 1 trauma center developed as part of Multicentric Project-Towards Improving Trauma Care Outcomes (TITCO) in India. Single center data retrieved from a prospectively maintained trauma registry at a level 1 trauma center, New Delhi, for a period ranging from 1 October 2013 to 17 February 2015 was evaluated. Standard anatomic scores Injury Severity Score (ISS) and New Injury Severity Score (NISS) were compared with physiologic score Revised Trauma Score (RTS) using receiver operating curve (ROC). Heart rate and RTS had a statistical difference among the survivors to nonsurvivors. ISS, NISS, and RTS were having 50, 50, and 86% of area under the curve on ROCs, and RTS was statistically significant among them. Physiologically based trauma score systems (RTS) are much better predictors of inhospital mortality in comparison to anatomical based scoring systems (ISS and NISS) for unintentional pediatric falls.

Chair rise transfer detection and analysis using a pendant sensor: an algorithm for fall risk assessment in older people.

PubMed

Zhang, Wei; Regterschot, G Ruben H; Wahle, Fabian; Geraedts, Hilde; Baldus, Heribert; Zijlstra, Wiebren

2014-01-01

Falls result in substantial disability, morbidity, and mortality among older people. Early detection of fall risks and timely intervention can prevent falls and injuries due to falls. Simple field tests, such as repeated chair rise, are used in clinical assessment of fall risks in older people. Development of on-body sensors introduces potential beneficial alternatives for traditional clinical methods. In this article, we present a pendant sensor based chair rise detection and analysis algorithm for fall risk assessment in older people. The recall and the precision of the transfer detection were 85% and 87% in standard protocol, and 61% and 89% in daily life activities. Estimation errors of chair rise performance indicators: duration, maximum acceleration, peak power and maximum jerk were tested in over 800 transfers. Median estimation error in transfer peak power ranged from 1.9% to 4.6% in various tests. Among all the performance indicators, maximum acceleration had the lowest median estimation error of 0% and duration had the highest median estimation error of 24% over all tests. The developed algorithm might be feasible for continuous fall risk assessment in older people.

Older Persons’ Perception of Risk of Falling: Implications for Fall-Prevention Campaigns

PubMed Central

Hughes, Karen; van Beurden, Eric; Eakin, Elizabeth G.; Barnett, Lisa M.; Patterson, Elizabeth; Backhouse, Jan; Jones, Sue; Hauser, Darren; Beard, John R.; Newman, Beth

2008-01-01

Objectives. We examined older people’s attitudes about falls and implications for the design of fall-prevention awareness campaigns. Methods. We assessed data from (1) computer-assisted telephone surveys conducted in 2002 with Australians 60 years and older in Northern Rivers, New South Wales (site of a previous fall-prevention program; n=1601), and Wide Bay, Queensland (comparison community; n=1601), and (2) 8 focus groups (n=73). Results. Participants from the previous intervention site were less likely than were comparison participants to agree that falls are not preventable (odds ratio [OR]=0.76; 95% confidence interval [CI]=0.65, 0.90) and more likely to rate the prevention of falls a high priority (OR=1.31; 95% CI=1.09, 1.57). There was no difference between the groups for self-perceived risk of falls; more than 60% rated their risk as low. Those with a low perceived risk were more likely to be men, younger, partnered, and privately insured, and to report better health and no history of falls. Focus group data indicated that older people preferred messages that emphasized health and independence rather than falls. Conclusions. Although older people accepted traditional fall-prevention messages, most viewed them as not personally relevant. Messages that promote health and independence may be more effective. PMID:18172132

Voluntary sway and rapid orthogonal transitions of voluntary sway in young adults, and low and high fall-risk older adults.

PubMed

Tucker, Murray G; Kavanagh, Justin J; Morrison, Steven; Barrett, Rod S

2009-10-01

Falls amongst older people have been linked to reduced postural stability and slowed movement responses. The objective of this study was to examine differences in postural stability and the speed of response between young adults, low fall-risk older adults, and high fall-risk older adults during voluntary postural sway movements. Twenty-five young adults (25+/-4 years), and 32 low fall-risk (74+/-5 years), and 16 high fall-risk (79+/-7 years) older adults performed voluntary sway and rapid orthogonal transitions of voluntary sway between the anterior-posterior and medial-lateral directions. Measures included reaction and movement time and the amplitudes of the centre of pressure, centre of mass, and the separation distance between the centre of pressure and centre of mass. Both fall-risk groups compared to the young had slower reaction and movement time, greater centre of pressure and/or centre of mass amplitude in the orthogonal (non-target) direction during voluntary sway, and reduced anterior-posterior and medial-lateral separation between the centre of pressure and centre of mass during voluntary sway and orthogonal transitions. High compared to low fall-risk individuals had slower reaction and movement time, increased non-target centre of mass amplitude during voluntary sway, and reduced medial-lateral centre of pressure and centre of mass separation during voluntary sway and orthogonal transitions. Age-related deterioration of postural control resulted in slower reactive responses and reduced control of the direction of body movement during voluntary sway and orthogonal transitions. Slower postural reaction and movement time and reduced medial-lateral control of the centre of mass during voluntary sway movements are associated with increased fall-risk in community-living older people.

Implementation of evidence-based falls prevention in clinical services for high-risk clients.

PubMed

Day, Lesley; Trotter, Margaret J; Hill, Keith D; Haines, Terry P; Thompson, Catherine

2014-06-01

The extent to which best practice for falls prevention is being routinely delivered by health care providers for community-dwelling older adults is unclear. We investigated falls prevention practice among Hospital Admission Risk Programs (HARP) that provide and coordinate specialized health care for people at high risk of hospitalization. Cross-sectional survey of all HARP services in Victoria, excluding one paediatric programme (n = 34). The questionnaire focused upon medication review and exercise prescription, as these are the evidence-based falls interventions with a good fit with HARP services. Completed questionnaires were received from 24 programmes (70.6%) that service 15,250 older clients (60+ years). All except one programme screened for medicine use; however, a lower proportion (65% of those that screen) target falls risk medications. Among the 17 programmes responding to the exercise prescription question, all routinely include strengthening exercises, and almost all (n = 15) include flexibility, endurance training and movement of the centre of gravity. A lesser proportion (71%) includes reducing the need for upper limb support. The majority of services (88%) undertake falls risk assessments, and all of these either make referral appointments for clients or refer to other services that make referral appointments for clients. Follow-up of appointments and the resulting recommendations was high. Screening for falls risk medications could be improved and staff training in exercise prescription for balance challenge in this high-risk group may be needed. Although evidence-based falls prevention practice within Victorian HARP services appears strong, the effect on falls risk may not be as high as that achieved in randomized trials. © 2014 John Wiley & Sons, Ltd.

Telephone Care Management of Fall Risk:: A Feasibility Study.

PubMed

Phelan, Elizabeth A; Pence, Maureen; Williams, Barbara; MacCornack, Frederick A

2017-03-01

Care management has been found to be more effective than usual care for some chronic conditions, but few studies have tested care management for prevention of elder falls. This study aimed to assess the feasibility and preliminary efficacy of telephone care management of older adults presenting for medical attention due to a fall. The setting was an independent practice association in western Washington serving 1,300 Medicare Advantage-insured patients. Patients aged ≥65 years treated for a fall in an emergency department or their primary care provider's office were contacted via telephone by a care manager within 48 hours of their fall-related visit and invited to participate in a telephone-administered interview to identify modifiable fall risk factors and receive recommendations and follow-up to address identified risk factors. Data from care manager records, patient medical records, and healthcare claims for the first 6 months (November 2009-April 2010) of program implementation were analyzed in 2011. The feasibility of screening and management of fall risk factors over the telephone and the effect on medically attended falls were assessed. Twenty-two patients eligible for fall care management were reached and administered the protocol. Administration took 15-20 minutes and integrated easily with the care manager's other responsibilities. Follow-through on recommendations varied, from 45% for those for whom exercise participation was recommended to 100% for other recommendations. No medically attended falls occurred over 6 months of follow-up. Telephone care management of fall risk appears feasible and may reduce falls requiring medical attention. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Bone mineral density changes during pregnancy in actively exercising women as measured by quantitative ultrasound.

PubMed

To, William W K; Wong, Margaret W N

2012-08-01

To evaluate whether bone mineral density (BMD) changes in women engaged in active exercises during pregnancy would be different from non-exercising women. Consecutive patients with singleton pregnancies who were engaged in active exercise training during pregnancy were prospectively recruited over a period of 6 months. Quantitative USG measurements of the os calcis BMD were performed at 14-20 weeks and at 36-38 weeks. These patients were compared to a control cohort of non-exercising low-risk women. A total of 24 physically active women undergoing active physical training of over 10 h per week at 20 weeks gestation and beyond (mean 13.1 h, SD 3.3) were compared to 94 non-exercising low-risk women. A marginal fall in BMD of 0.015 g/cm(2) (SD 0.034) was demonstrable from early to late gestation in the exercising women, which was significantly lower than that of non-exercising women (0.041 g/cm(2); SD 0.042; p = 0.005). Logistic regression models confirmed that active exercises in pregnancy were significantly associated with the absence of or less BMD loss in pregnancy. In women actively engaged in physical training during pregnancy, the physiological fall in BMD during pregnancy was apparently less compared to those who did not regularly exercise.

Implementation of a fall screening program in a high risk of fracture population.

PubMed

Ritchey, Katherine; Olney, Amanda; Shofer, Jane; Phelan, Elizabeth A; Matsumoto, Alvin M

2017-10-31

Fall prevention is an important way to prevent fractures in person with osteoporosis. We developed and implemented a fall screening program in the context of routine osteoporosis care. This program was found to be feasible and showed that a significant proportion of persons with osteoporosis are at risk of falling. Falls are the most common cause of fracture in persons with osteoporosis. However, osteoporosis care rarely includes assessment and prevention of falling. We thus sought to assess the feasibility of a fall screening and management program integrated into routine osteoporosis care. The program was developed and offered to patients with osteoporosis or osteopenia seen at an outpatient clinic between May 2015 and May 2016. Feasibility was measured by physical therapist time required to conduct screening and ease of integrating the screening program into the usual clinic workflow. Self-report responses and mobility testing were conducted to describe the fall and fracture risk profile of osteoporosis patients screened. Effects on fall-related care processes were assessed via chart abstraction of patient participation in fall prevention exercise. Of the 154 clinic patients who presented for a clinic visit, 68% met screening criteria and completed in two thirds of persons. Screening was completed in a third of the time typically allotted for traditional PT evaluations and did not interfere with clinic workflow. Forty percent of those screened reported falling in the last year, and over half had two or more falls in the past year. Over half reported a balance or lower extremity impairment, and over 40% were below norms on one or more performance tests. Most patients who selected a group exercise fall prevention program completed all sessions while only a quarter completed either supervised or independent home-based programs. Implementation of a fall risk screening program in an outpatient osteoporosis clinic appears feasible. A substantial proportion of people with osteoporosis screened positive for being at risk of falling, justifying integration of fall prevention into routine osteoporosis care.

Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: I. Cardiovascular Drugs.

PubMed

de Vries, Max; Seppala, Lotta J; Daams, Joost G; van de Glind, Esther M M; Masud, Tahir; van der Velde, Nathalie

2018-04-01

Use of certain medications is recognized as a major and modifiable risk factor for falls. Although the literature on psychotropic drugs is compelling, the literature on cardiovascular drugs as potential fall-risk-increasing drugs is conflicting. The aim of this systematic review and meta-analysis is to provide a comprehensive overview of the associations between cardiovascular medications and fall risk in older adults. Design: A systematic review and meta-analysis. Medline, Embase, and PsycINFO. Key search concepts were "fall," "aged," "causality," and "medication." Studies that investigated cardiovascular medications as risk factors for falls in participants ≥60 years old or participants with a mean age of 70 or older were included. A meta-analysis was performed using the generic inverse variance method, pooling unadjusted and adjusted odds ratios (ORs) separately. In total, 131 studies were included in the qualitative synthesis. Meta-analysis using adjusted ORs showed significant results (pooled OR [95% confidence interval]) for loop diuretics, OR 1.36 (1.17, 1.57), and beta-blocking agents, OR 0.88 (0.80, 0.97). Meta-analysis using unadjusted ORs showed significant results for digitalis, OR 1.60 (1.08, 2.36); digoxin, OR 2.06 (1.56, 2.74); and statins, OR 0.80 (0.65, 0.98). Most of the meta-analyses resulted in substantial heterogeneity that mostly did not disappear after stratification for population and setting. In a descriptive synthesis, consistent associations were not observed. Loop diuretics were significantly associated with increased fall risk, whereas beta-blockers were significantly associated with decreased fall risk. Digitalis and digoxin may increase the risk of falling, and statins may reduce it. For the majority of cardiovascular medication groups, outcomes were inconsistent. Furthermore, recent studies indicate that specific drug properties, such as selectivity of beta-blockers, may affect fall risk, and drug-disease interaction also may play a role. Thus, studies addressing these issues are warranted to obtain a better understanding of drug-related falls. Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Effects of acute thermal stress on the survival, predator avoidance, and physiology of juvenile fall Chinook salmon

USGS Publications Warehouse

Mesa, M.G.; Weiland, L.K.; Wagner, P.

2002-01-01

We subjected juvenile fall chinook salmon from the Hanford Reach of the Columbia River to acute thermal stressors in the laboratory that were derived from field data. We assessed the effects of thermal stress on: (1) the extent of direct mortality; (2) the vulnerability of fish to predation by smallmouth bass; and (3) some general physiological stress responses and synthesis of heat shock protein 70 (hsp70). Thermally-stressed fish showed little direct mortality and no increases in vulnerability to predation. However, these fish showed transient increases in plasma concentrations of cortisol, glucose, and lactate, and a dramatic (25-fold higher than controls) and persistent (lasting 2 wk) increase in levels of liver hsp70. Our results indicate that exposure of Hanford Reach juvenile fall chinook salmon to such stressors did not lead to significant increases in direct mortality or vulnerability to predation, but did alter physiological homeostasis, which should be of concern to those managing this resource. Because our fish received only a single exposure to one of the stressors we examined, we are also concerned about the consequences of exposing fish to multiple, cumulative stressors - a likely scenario for fish in the wild.

Fall prevention and monitoring of assisted living patients: an exploratory study of physician perspectives.

PubMed

Nyrop, Kirsten A; Zimmerman, Sheryl; Sloane, Philip D; Bangdiwala, Srikant

2012-06-01

Explore physician perspectives on their involvement in fall prevention and monitoring for residential care/assisted living (RC/AL) residents. Exploratory cross-sectional study; mailed questionnaire. Four RC/AL communities, North Carolina. Primary physicians for RC/AL residents. Past Behavior and future Intentions of physicians with regard to (1) fall risk assessment and (2) collaboration with RC/AL staff to reduce falls and fall risks among RC/AL residents were explored using Theory of Planned Behavior (TPB) constructs. Predictor variables examined (1) physicians' views on their own responsibilities (Attitude), (2) their views of expectations from important referent groups (Subjective Norms), and (3) perceived constraints on engaging in fall prevention and monitoring (Perceived Behavioral Control). Physicians reported conducting fall risk assessments of 47% of RC/AL patients and collaborating with RC/AL staff to reduce fall risks for 36% of RC/AL patients (Behavior). These proportions increased to 75% and 62%, respectively, for future Intentions. TPB-based models explained approximately 60% of the variance in self-reported Behavior and Intentions. Physician's involvement in fall prevention and monitoring was significantly associated (P < .05) with their perceptions of barriers and facilitators-ease, time, reimbursement, and expertise. This study provides first data on physician beliefs regarding their involvement in fall risk assessment of RC/AL patients and collaboration with RC/AL staff to reduce fall risks of individual patients. Challenges to physician involvement identified in our study are not unique or specific to the RC/AL setting, and instead relate to clinical practice and reimbursement constraints in general. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Blood Pressure, Antihypertensive Polypharmacy, Frailty, and Risk for Serious Fall Injuries Among Older Treated Adults With Hypertension.

PubMed

Bromfield, Samantha G; Ngameni, Cedric-Anthony; Colantonio, Lisandro D; Bowling, C Barrett; Shimbo, Daichi; Reynolds, Kristi; Safford, Monika M; Banach, Maciej; Toth, Peter P; Muntner, Paul

2017-08-01

Antihypertensive medication and low systolic blood pressure (BP) and diastolic BP have been associated with an increased falls risk in some studies. Many older adults have indicators of frailty, which may increase their risk for falls. We contrasted the association of systolic BP, diastolic BP, number of antihypertensive medication classes taken, and indicators of frailty with risk for serious fall injuries among 5236 REGARDS study (Reasons for Geographic and Racial Difference in Stroke) participants ≥65 years taking antihypertensive medication at baseline with Medicare fee-for-service coverage. Systolic BP and diastolic BP were measured, and antihypertensive medication classes being taken assessed through a pill bottle review during a study visit. Indicators of frailty included low body mass index, cognitive impairment, depressive symptoms, exhaustion, impaired mobility, and history of falls. Serious fall injuries were defined as fall-related fractures, brain injuries, or joint dislocations using Medicare claims through December 31, 2014. Over a median of 6.4 years, 802 (15.3%) participants had a serious fall injury. The multivariable-adjusted hazard ratio for a serious fall injury among participants with 1, 2, or ≥3 indicators of frailty versus no frailty indicators was 1.18 (95% confidence interval, 0.99-1.40), 1.49 (95% confidence interval, 1.19-1.87), and 2.04 (95% confidence interval, 1.56-2.67), respectively. Systolic BP, diastolic BP, and number of antihypertensive medication classes being taken at baseline were not associated with risk for serious fall injuries after multivariable adjustment. In conclusion, indicators of frailty, but not BP or number of antihypertensive medication classes, were associated with increased risk for serious fall injuries among older adults taking antihypertensive medication. © 2017 American Heart Association, Inc.

Understanding the Relationship between Type 2 Diabetes Mellitus and Falls in Older Adults: A Prospective Cohort Study

PubMed Central

Roman de Mettelinge, Tine; Cambier, Dirk; Calders, Patrick; Van Den Noortgate, Nele; Delbaere, Kim

2013-01-01

Background Older adults with type 2 Diabetes Mellitus are at increased risk of falling. The current study aims to identify risk factors that mediate the relationship between diabetes and falls. Methods 199 older adults (104 with diabetes and 95 healthy controls) underwent a medical screening. Gait (GAITRite®), balance (AccuGait® force plate), grip strength (Jamar®), and cognitive status (Mini-Mental State Examination and Clock Drawing Test) were assessed. Falls were prospectively recorded during a 12-month follow-up period using monthly calendars. Results Compared to controls, diabetes participants scored worse on all physical and cognitive measures. Sixty-four participants (42 diabetes vs. 22 controls) reported at least one injurious fall or two non-injurious falls (“fallers”). Univariate logistic regression identified diabetes as a risk factor for future falls (Odds Ratio 2.25, 95%CI 1.21–4.15, p = 0.010). Stepwise multiple regressions defined diabetes and poor balance as independent risk factors for falling. Taking more medications, slower walking speed, shorter stride length and poor cognitive performance were mediators that reduced the Odds Ratio of the relationship between diabetes and faller status relationship the most followed by reduced grip strength and increased stride length variability. Conclusions Diabetes is a major risk factor for falling, even after controlling for poor balance. Taking more medications, poorer walking performance and reduced cognitive functioning were mediators of the relationship between diabetes and falls. Tailored preventive programs including systematic medication reviews, specific balance exercises and cognitive training might be beneficial in reducing fall risk in older adults suffering from diabetes. PMID:23825617

Falls in the general elderly population: a 3- and 6- year prospective study of risk factors using data from the longitudinal population study ‘Good ageing in Skane’

PubMed Central

2013-01-01

Background Accidental falls in the elderly are a major health problem, despite extensive research on risk factors and prevention. Only a limited number of multifactorial, long-term prospective studies have been performed on risk factors for falls in the general elderly population. The aim of this study was to identify risk factors predicting falls in a general elderly population after three and six years, using a prospective design. Methods The prevalence of 38 risk factors was recorded at a baseline assessment of 1763 subjects (aged 60–93 years). The incidence of one or more falls was recorded after three and six years. The predicted risk of falling, after exposure to the various risk factors, was analysed in a multiple logistic regression model, adjusted for age and sex, and presented as odds ratios (OR). A principal component analysis (PCA), including the statistical significant factors, was also performed to identify thematic, uncorrelated components associated with falls. Results The use of neuroleptics (OR 3.30, 95% CI: 1.15–9.43), heart failure with symptoms (OR 1.88, 95% CI: 1.17–3.04) and low walking speed (OR 1.77, 95% CI: 1.28–2.46) were prominent individual risk factors for falls. In the PCA, three main components predicting falls were identified: reduced mobility, OR 2.12 (95% CI 1.54–2.91), heart dysfunction, OR 1.66 (95% CI 1.26–2.20) and functional impairment including nocturia, OR 1.38 (95% CI 1.01-1.88). Conclusions Three main components predicting falls were identified in a general elderly population after three and six years: reduced mobility, heart dysfunction and functional impairment including nocturia. The use of neuroleptic drugs was also a prominent individual risk factor, although the prevalence was low. Heart failure with symptoms was a significant risk factor for falls and may be of clinical importance as the prevalence of this condition in the elderly is increasing worldwide. There is need for further research on the relation between heart failure and falls in the elderly, as the treatment for this condition is poorly documented in this demographic. The findings of this study may be valuable in the development of intervention programmes aimed at sustainable, long-term reduction of falls in the elderly. PMID:23919320

High fall incidence and fracture rate in elderly dialysis patients.

PubMed

Polinder-Bos, H A; Emmelot-Vonk, M H; Gansevoort, R T; Diepenbroek, A; Gaillard, C A J M

2014-12-01

Although it is recognised that the dialysis population is ageing rapidly, geriatric complications such as falls are poorly appreciated, despite the many risk factors for falls in this population. The objective of this study was to determine the incidence, complications and risk factors for falls in an elderly dialysis population. A one-year observational study of chronic dialysis patients aged ≥ 70 years. At baseline, patient characteristics were noted and during follow-up the vital parameters and laboratory values were recorded. Patients were questioned weekly about falls, fall circumstances and consequences by trained nurses. 49 patients were included with a median age of 79.3 years (70-89 years). During follow-up 40 fall accidents occurred in 27 (55%) patients. Falls resulted in fractures in 15% of cases and in hospital admissions in 15%. In haemodialysis (HD) patients, the mean systolic blood pressure (SBP) before HD was lower in fallers compared with non-fallers (130 vs. 143 mmHg). Several patients in the lower blood pressure category received antihypertensive medication. For every 5 mmHg lower SBP (before HD) the fall risk increased by 30% (hazard ratio (HR) 1.30, 95% CI 1.03-1.65, p = 0.03). Furthermore, fall risk increased by 22% for every 10 pmol/l rise of parathyroid hormone (HR 1.22, 95% CI 1.06-1.39, p = 0.004). Elderly dialysis patients have a high incidence of falls accompanied by a high fracture rate. Given the high complication rate, elderly patients at risk of falling should be identified and managed. Reduction of blood pressure-lowering medication might be a treatment strategy to reduce falls.

A simple test of choice stepping reaction time for assessing fall risk in people with multiple sclerosis.

PubMed

Tijsma, Mylou; Vister, Eva; Hoang, Phu; Lord, Stephen R

2017-03-01

Purpose To determine (a) the discriminant validity for established fall risk factors and (b) the predictive validity for falls of a simple test of choice stepping reaction time (CSRT) in people with multiple sclerosis (MS). Method People with MS (n = 210, 21-74y) performed the CSRT, sensorimotor, balance and neuropsychological tests in a single session. They were then followed up for falls using monthly fall diaries for 6 months. Results The CSRT test had excellent discriminant validity with respect to established fall risk factors. Frequent fallers (≥3 falls) performed significantly worse in the CSRT test than non-frequent fallers (0-2 falls). With the odds of suffering frequent falls increasing 69% with each SD increase in CSRT (OR = 1.69, 95% CI: 1.27-2.26, p = <0.001). In regression analysis, CSRT was best explained by sway, time to complete the 9-Hole Peg test, knee extension strength of the weaker leg, proprioception and the time to complete the Trails B test (multiple R 2   =   0.449, p < 0.001). Conclusions A simple low tech CSRT test has excellent discriminative and predictive validity in relation to falls in people with MS. This test may prove useful in documenting longitudinal changes in fall risk in relation to MS disease progression and effects of interventions. Implications for rehabilitation Good choice stepping reaction time (CSRT) is required for maintaining balance. A simple low-tech CSRT test has excellent discriminative and predictive validity in relation to falls in people with MS. This test may prove useful documenting longitudinal changes in fall risk in relation to MS disease progression and effects of interventions.

Clinical use of Nintendo Wii bowling simulation to decrease fall risk in an elderly resident of a nursing home: a case report.

PubMed

Clark, Robert; Kraemer, Theresa

2009-01-01

Of the estimated 1.7 million residents of nursing homes in the United States, approximately half fall annually; and 11% of these sustain injury. This is twice the rate for persons dwelling in the community. By addressing fall risk, physical therapists have an opportunity to reduce falls which are the leading cause of injury deaths, as well as the most common cause of nonfatal injuries for older adults in the United States. This case report examines the effect of a novel interactive video game intervention to address balance dysfunction in an elderly resident of a nursing home who was at risk for falls. The patient is an 89-year-old resident diagnosed with an unspecified balance disorder and a history of multiple falls. Self reports of gait abnormalities, scores on several clinical measures, and her fall history classified her as having substantial risk for future falls. A nontraditional approach to balance training, employing the Nintendo Wii bowling simulation, was used as intervention for this patient's balance disorder. After 6 one-hour treatment sessions, the patient's Berg Balance Score improved from 48 to 53. On the Dynamic Gait Index, the patient improved her score from 19 to 21. The patient's Timed Up and Go Test improved from 14.9 to 10.5 seconds, all suggesting a reduced risk of falling. The patient's ABC Score improved from 88 to 90%. Physical therapy intervention, using the Nintendo Wii bowling simulation, may have decreased fall risk for this individual.

Comparison of fall prediction by the Hessisch Oldendorf Fall Risk Scale and the Fall Risk Scale by Huhn in neurological rehabilitation: an observational study.

PubMed

Hermann, Olena; Schmidt, Simone B; Boltzmann, Melanie; Rollnik, Jens D

2018-05-01

To calculate scale performance of the newly developed Hessisch Oldendorf Fall Risk Scale (HOSS) for classifying fallers and non-fallers in comparison with the Risk of Falling Scale by Huhn (FSH), a frequently used assessment tool. A prospective observational trail was conducted. The study was performed in a large specialized neurological rehabilitation facility. The study population ( n = 690) included neurological and neurosurgery patients during neurological rehabilitation with varying levels of disability. Around the half of the study patients were independent and dependent in the activities of daily living (ADL), respectively. Fall risk of each patient was assessed by HOSS and FSH within the first seven days after admission. Event of fall during rehabilitation was compared with HOSS and FSH scores as well as the according fall risk. Scale performance including sensitivity and specificity was calculated for both scales. A total of 107 (15.5%) patients experienced at least one fall. In general, fallers were characterized by an older age, a prolonged length of stay, and a lower Barthel Index (higher dependence in the ADL) on admission than non-fallers. The verification of fall prediction for both scales showed a sensitivity of 83% and a specificity of 64% for the HOSS scale, and a sensitivity of 98% with a specificity of 12% for the FSH scale, respectively. The HOSS shows an adequate sensitivity, a higher specificity and therefore a better scale performance than the FSH. Thus, the HOSS might be superior to existing assessments.

The Strategies to Reduce Injuries and Develop Confidence in Elders Intervention: Falls Risk Factor Assessment and Management, Patient Engagement, and Nurse Co-management.

PubMed

Reuben, David B; Gazarian, Priscilla; Alexander, Neil; Araujo, Katy; Baker, Dorothy; Bean, Jonathan F; Boult, Chad; Charpentier, Peter; Duncan, Pamela; Latham, Nancy; Leipzig, Rosanne M; Quintiliani, Lisa M; Storer, Thomas; McMahon, Siobhan

2017-12-01

In response to the epidemic of falls and serious falls-related injuries in older persons, in 2014, the Patient Centered Outcomes Research Institute (PCORI) and the National Institute on Aging funded a pragmatic trial, Strategies to Reduce Injuries and Develop confidence in Elders (STRIDE) to compare the effects of a multifactorial intervention with those of an enhanced usual care intervention. The STRIDE multifactorial intervention consists of five major components that registered nurses deliver in the role of falls care managers, co-managing fall risk in partnership with patients and their primary care providers (PCPs). The components include a standardized assessment of eight modifiable risk factors (medications; postural hypotension; feet and footwear; vision; vitamin D; osteoporosis; home safety; strength, gait, and balance impairment) and the use of protocols and algorithms to generate recommended management of risk factors; explanation of assessment results to the patient (and caregiver when appropriate) using basic motivational interviewing techniques to elicit patient priorities, preferences, and readiness to participate in treatments; co-creation of individualized falls care plans that patients' PCPs review, modify, and approve; implementation of the falls care plan; and ongoing monitoring of response, regularly scheduled re-assessments of fall risk, and revisions of the falls care plan. Custom-designed falls care management software facilitates risk factor assessment, the identification of recommended interventions, clinic note generation, and longitudinal care management. The trial testing the effectiveness of the STRIDE intervention is in progress, with results expected in late 2019. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Clinical and neurophysiological risk factors for falls in patients with bilateral vestibulopathy.

PubMed

Schniepp, Roman; Schlick, Cornelia; Schenkel, Fabian; Pradhan, Cauchy; Jahn, Klaus; Brandt, Thomas; Wuehr, Max

2017-02-01

Patients with bilateral vestibular failure (BVF) exhibit imbalance when standing and walking that is linked to a higher fall risk. The purpose of this study was to identify risk factors for falls in BVF. We therefore systematically investigated the interrelationship of clinical and demographic characteristics, gait impairments, and the fall frequency of these patients. Clinical and demographic characteristics as well as quantitative measures of gait performance on a pressure-sensitive gait carpet were collected from 55 patients with different etiologies of BVF. Clinical and demographic data as well as spatiotemporal gait characteristics were used for ANOVA testing and a logistic regression model with categorized fall events as dependent variables. The impairment of peripheral vestibular function, duration of disease, and the overall gait status were not associated with the history of falls in patients with BVF. In contrast, the most predictive factors for falls in BVF were an increase in temporal gait variability, especially at slow walking speeds (p < 0.001; OR = 1.3), and the presence of a concomitant peripheral neuropathy (p < 0.045; OR = 3.6). BVF patients with a high risk of falling exhibit specific gait alterations in a speed-dependent manner. In particular, increased gait fluctuations during slow walking are most predictive for an increased fall risk. The presence of a concomitant peripheral neuropathy further critically impairs postural stability in these patients. Clinical assessment of both these aspects is therefore important to identify those patients at a particularly high fall risk and to initiate preventive procedures early.

Preventing falls in assisted living: Results of a quality improvement pilot study.

PubMed

Zimmerman, Sheryl; Greene, Angela; Sloane, Philip D; Mitchell, Madeline; Giuliani, Carol; Nyrop, Kirsten; Walsh, Edith

Residents of assisted living (AL) communities are at high risk for falls, which result in negative outcomes and high health care costs. Adapting effective falls prevention programs for AL quality improvement (QI) has the potential to reduce falls, improve resident quality of life, and reduce costs. This project tested the feasibility and outcomes of an evidence-based multi-component QI program, the Assisted Living Falls Prevention and Monitoring Program (AL-FPMP). Resident posture and gait improved, likely due to exercise and/or physical therapy. Effective falls prevention QI programs can be implemented in AL, and are advised to (1) establish and maintain a falls team to create a culture focused on the reduction of falls risk; (2) teach staff to assess residents using the Morse Falls Scale to increase their awareness of residents' falls risk and improvement; and (3) modify existing exercise programs to address balance and lower body strength. Copyright © 2016 Elsevier Inc. All rights reserved.

Factors associated with falling in early, treated Parkinson's disease: The NET-PD LS1 cohort.

PubMed

Chou, Kelvin L; Elm, Jordan J; Wielinski, Catherine L; Simon, David K; Aminoff, Michael J; Christine, Chadwick W; Liang, Grace S; Hauser, Robert A; Sudarsky, Lewis; Umeh, Chizoba C; Voss, Tiffini; Juncos, Jorge; Fang, John Y; Boyd, James T; Bodis-Wollner, Ivan; Mari, Zoltan; Morgan, John C; Wills, Anne-Marie; Lee, Stephen L; Parashos, Sotirios A

2017-06-15

Recognizing the factors associated with falling in Parkinson's disease (PD) would improve identification of at-risk individuals. To examine frequency of falling and baseline characteristics associated with falling in PD using the National Institute of Neurological Disorders and Stroke (NINDS) Exploratory Trials in PD Long-term Study-1 (NET-PD LS-1) dataset. The LS-1 database included 1741 early treated PD subjects (median 4year follow-up). Baseline characteristics were tested for a univariate association with post-baseline falling during the trial. Significant variables were included in a multivariable logistic regression model. A separate analysis using a negative binomial model investigated baseline factors on fall rate. 728 subjects (42%) fell during the trial, including at baseline. A baseline history of falls was the factor most associated with post-baseline falling. Men had lower odds of post-baseline falling compared to women, but for men, the probability of a post-baseline fall increased with age such that after age 70, men and women had similar odds of falling. Other baseline factors associated with a post-baseline fall and increased fall rate included the Unified PD Rating Scale (UPDRS) Activities of Daily Living (ADL) score, total functional capacity (TFC), baseline ambulatory capacity score and dopamine agonist monotherapy. Falls are common in early treated PD. The biggest risk factor for falls in PD remains a history of falling. Measures of functional ability (UPDRS ADL, TFC) and ambulatory capacity are novel clinical risk factors needing further study. A significant age by sex interaction may help to explain why age has been an inconsistent risk factor for falls in PD. Copyright © 2017 Elsevier B.V. All rights reserved.

Identifying Balance Measures Most Likely to Identify Recent Falls.

PubMed

Criter, Robin E; Honaker, Julie A

2016-01-01

Falls sustained by older adults are an increasing health care issue. Early identification of those at risk for falling can lead to successful prevention of falls. Balance complaints are common among individuals who fall or are at risk for falling. The purpose of this study was to evaluate the clinical utility of a multifaceted balance protocol used for fall risk screening, with the hypothesis that this protocol would successfully identify individuals who had a recent fall (within the previous 12 months). This is a retrospective review of 30 individuals who self-referred for a free fall risk screening. Measures included case history, Activities-Specific Balance Confidence Scale, modified Clinical Test of Sensory Interaction on Balance, Timed Up and Go test, and Dynamic Visual Acuity. Statistical analyses were focused on the ability of the test protocol to identify a fall within the past 12 months and included descriptive statistics, clinical utility indices, logistic regression, receiver operating characteristic curve, area under the curve analysis, effect size (Cohen d), and Spearman correlation coefficients. All individuals who self-referred for this free screening had current imbalance complaints, and were typically women (70%), had a mean age of 77.2 years, and had a fear of falling (70%). Almost half (46.7%) reported at least 1 lifetime fall and 40.0% within the past 12 months. Regression analysis suggested that the Timed Up and Go test was the most important indicator of a recent fall. A cutoff score of 12 or more seconds was optimal (sensitivity: 83.3%; specificity: 61.1%). Older adults with current complaints of imbalance have a higher rate of falls, fall-related injury, and fear of falling than the general community-dwelling public. The Timed Up and Go test is useful for determining recent fall history in individuals with imbalance.

Fall risk assessment among older adults with mild Alzheimer disease.

PubMed

Ryan, John J; McCloy, Constance; Rundquist, Peter; Srinivasan, Visalakshi; Laird, Rosemary

2011-01-01

Older adults with Alzheimer disease (AD) fall more than twice as often as those without dementia, yet few studies have assessed fall risk in this population. The purpose of the study was to determine whether a fall assessment, the Physical Performance Test 7-item (PPT 7-item), could accurately identify subjects with history of falls in a group of community-dwelling elders with mild AD. An additional purpose was to determine whether the PPT 7-item, a cognitive screen, and/or nonperformance data could predict falling in this population. Forty-three community-dwelling elders diagnosed with mild AD completed the fall risk assessment. In addition, the following data were collected: Mini-Mental State Examination (MMSE) score, age, gender, education, gait aid use, number of falls in the past 6 months, and history of fall-related injury. There was a significant difference in the PPT 7-item total score between subjects with history of falls and subjects without history of falls (z = -2.04, P = .042), with items related to turning (z = -2.56, P = .01) and walking (z = -2.89, P = .004) accounting for most of the difference. However, only gait aid usage predicted falling (45.8% of the variance). While the PPT 7-item was able to detect differences in mobility between subjects with history of falls and subjects without history of falls in subjects with mild AD, total PPT 7-item score did not predict falling. Gait aid usage was more strongly related to falling in these subjects. Early detection of fall risk in individuals with mild AD is important to prevent injuries and moderate costs of care.

Risk Factors for Falls in Older Adults With Mild Cognitive Impairment and Mild Alzheimer Disease.

PubMed

Ansai, Juliana Hotta; de Andrade, Larissa Pires; Masse, Fernando Arturo Arriagada; Gonçalves, Jessica; de Medeiros Takahashi, Anielle Cristhine; Vale, Francisco Assis Carvalho; Rebelatto, José Rubens

2017-03-03

Understanding fall risk factors in people with mild cognitive impairment (MCI) and Alzheimer disease (AD) can help to establish specific plans for prevention of falls. The purpose of this study was to identify fall risk factors in older adults with MCI and mild AD. A prospective study was conducted with community-dwelling older adults (40 MCI; 38 mild AD). The assessments consisted of sociodemographic and health variables, caloric expenditure, functional status, functional mobility (10-m walk test, dual-task test, and transition Timed Up and Go phases), cognitive domains, and depressive symptoms. Falls were recorded for 6 months by a falls calendar and monthly telephone calls. Falls were reported in 52.6% and 51.4% of people with MCI and mild AD, respectively. Among people with MCI, lower functional status, higher time spent on walk and dual task tests, and higher depressive symptom scores were associated with falls. Higher time spent on the dual-task test was independently associated with falls. Among people with mild AD, falls were associated with lower time spent on the walk test and turn-to-sit phase, and a higher visuospatial domain score. Lower time spent on the turn-to-sit phase was identified as an independent predictor of falls. Careful attention should be given to dual-task and turn-to-sit activities when detecting risk of falls among older people with MCI and mild AD.

A poor performance in comprehensive geriatric assessment is associated with increased fall risk in elders with hypertension: a cross-sectional study.

PubMed

Chu, Jiao-Jiao; Chen, Xu-Jiao; Shen, Shan-Shan; Zhang, Xue-Feng; Chen, Ling-Yan; Zhang, Jing-Mei; He, Jing; Zhao, Jun-Feng

2015-03-01

Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose of this study was to determine if age related systemic functional decline related with increased fall risks in elderly patients with hypertension. A total of 342 elderly hypertension patients (age 79.5 ± 6.7 years, male 63.8%) were recruited to the study. Comprehensive geriatric assessment (CGA), including measurements about activity of daily living (ADL), nutrition, cognition, depression, numbers of prescription medication and number of clinical diagnosis, was conducted to evaluate the physical and mental status of each participants. Fall risk was evaluated by Morse fall scale, Tinetti performance oriented mobility assessment (POMA) and history of fall in the recent year. Participants were grouped into tertiles according to CGA score. Correlation between CGA and fall risk was analyzed through SPSS 18.0. Participants with higher CGA score were likely to be older, had a lower body mass index (BMI), and a higher prevalence of cardiovascular disease, chronic obstructive pulmonary disease (COPD), cerebrovascular disease and osteoarthropathia. Participants in higher tertile of CGA score got increased prevalence of fall risk than those in lower tertile (P < 0.01 T3 vs. T1, P < 0.01 T3 vs. T2). Correlation analysis and regression analysis showed significant association between CGA and Morse fall scale (P < 0.001), as well as CGA and POMA (P < 0.001). Meanwhile, CGA components also showed co-relationships with increase fall risks. After adjusting age, BMI, benzodiazepine use, cardiovascular disease, cerebrovascular disease, COPD and osteoarthropathia, both history of fall in the recent year and rising Morse fall scale were significantly associated with ADL impairment (OR: 2.748, 95%CI: 1.598-4.725), (OR: 3.310, 95%CI: 1.893-5.788). Decreased Tinetti POMA score was associated with Mini-Mental State Examination (MMSE) (OR: 4.035, 95%CI: 2.100-7.751), ADL (OR: 2.380, 95%CI: 1.357-4.175) and shortened MNA form (MNA-SF) impairment (OR: 2.692, 95%CI: 1.147-6.319). In elderly adults with hypertension, impaired physical and mental function is associated with increased fall risk. Further study is required to investigate possible mediators for the association and effective interventions.

Fall Risk Assessment Predicts Fall-Related Injury, Hip Fracture, and Head Injury in Older Adults.

PubMed

Nilsson, Martin; Eriksson, Joel; Larsson, Berit; Odén, Anders; Johansson, Helena; Lorentzon, Mattias

2016-11-01

To investigate the role of a fall risk assessment, using the Downton Fall Risk Index (DFRI), in predicting fall-related injury, fall-related head injury and hip fracture, and death, in a large cohort of older women and men residing in Sweden. Cross sectional observational study. Sweden. Older adults (mean age 82.4 ± 7.8) who had a fall risk assessment using the DFRI at baseline (N = 128,596). Information on all fall-related injuries, all fall-related head injuries and hip fractures, and all-cause mortality was collected from the Swedish Patient Register and Cause of Death Register. The predictive role of DFRI was calculated using Poisson regression models with age, sex, height, weight, and comorbidities as covariates, taking time to outcome or end of study into account. During a median follow-up of 253 days (interquartile range 90-402 days) (>80,000 patient-years), 15,299 participants had a fall-related injury, 2,864 a head injury, and 2,557 a hip fracture, and 23,307 died. High fall risk (DFRI ≥3) independently predicted fall-related injury (hazard ratio (HR) = 1.43, 95% confidence interval (CI) = 1.39-1.49), hip fracture (HR = 1.51, 95% CI =1.38-1.66), head injury (HR = 1.12, 95% CI = 1.03-1.22), and all-cause mortality (HR = 1.39, 95% CI = 1.35-1.43). DFRI more strongly predicted head injury (HR = 1.29, 95% CI = 1.21-1.36 vs HR = 1.08, 95% CI = 1.04-1.11) and hip fracture (HR = 1.41, 95% CI = 1.30-1.53 vs HR = 1.08, 95% CI = 1.05-1.11) in 70-year old men than in 90-year old women (P < .001). Fall risk assessment using DFRI independently predicts fall-related injury, fall-related head injury and hip fracture, and all-cause mortality in older men and women, indicating its clinical usefulness to identify individuals who would benefit from interventions. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

Temporal association between hospitalization and rate of falls after discharge.

PubMed

Mahoney, J E; Palta, M; Johnson, J; Jalaluddin, M; Gray, S; Park, S; Sager, M

2000-10-09

Evidence suggests that acute illness and hospitalization may increase the risk for falls. To evaluate the rate of falls, and associated risk factors, for 90 days following hospital discharge. We consecutively enrolled 311 patients, aged 65 years and older, discharged from the hospital after an acute medical illness and receiving home-nursing services. Patients were assessed within 5 days of discharge for prehospital and current functioning by self-report, and balance, vision, cognition, and delirium by objective measures. Patients were followed up weekly for 13 weeks for falls, injuries, and health care use. The rate of falls was significantly higher in the first 2 weeks after hospitalization (8.0 per 1000 person-days) compared with 3 months later (1.7 per 1000 person-days) (P =.002). Fall-related injuries accounted for 15% of all hospitalizations in the first month after discharge. Independent prehospital risk factors significantly associated with falls included dependency in activities of daily living, use of a standard walker, 2 or more falls, and more hospitalizations in the year prior. Posthospital risk factors included use of a tertiary amine tricyclic antidepressant, probable delirium, and poorer balance, while use of a cane was protective. The rate of falls is substantially increased in the first month after medical hospitalization, and is an important cause of injury and morbidity. Posthospital risk factors may be potentially modifiable. Efforts to assess and modify risk factors should be integral to the hospital and posthospital care of older adults (those aged >/=65 years).

Strength and balance training for adults with peripheral neuropathy and high risk of fall: current evidence and implications for future research.

PubMed

Tofthagen, Cindy; Visovsky, Constance; Berry, Donna L

2012-09-01

To evaluate the evidence for strength- and balance-training programs in patients at high risk for falls, discuss how results of existing studies might guide clinical practice, and discuss directions for additional research. A search of PubMed and CINAHL® databases was conducted in June 2011 using the terms strength, balance training, falls, elderly, and neuropathy. Only clinical trials conducted using specific strength- or balance-training exercises that included community-dwelling adults and examined falls, fall risk, balance, and/or strength as outcome measures were included in this review. One matched case-control study and two randomized, controlled studies evaluating strength and balance training in patients with diabetes-related peripheral neuropathy were identified. Eleven studies evaluating strength and balance programs in community-dwelling adults at high risk for falls were identified. The findings from the reviewed studies provide substantial evidence to support the use of strength and balance training for older adults at risk for falls, and detail early evidence to support strength and balance training for individuals with peripheral neuropathy. The evidence demonstrates that strength and balance training is safe and effective at reducing falls and improving lower extremity strength and balance in adults aged 50 years and older at high risk for falls, including patients with diabetic peripheral neuropathy. Future studies should evaluate the effects of strength and balance training in patients with cancer, particularly individuals with chemotherapy-induced peripheral neuropathy.

Trait impulsivity is associated with the risk of falls in Parkinson's disease.

PubMed

Smulders, Katrijn; Esselink, Rianne A; Cools, Roshan; Bloem, Bastiaan R

2014-01-01

Impulsivity is a "tendency to act prematurely without foresight." Clinical experience suggests that such impulsive behavior can impact on the fall risk in Parkinson's disease (PD), but this has never been tested. We investigated whether trait impulsivity is related to fall risk in a large cohort of PD patients. We also investigated whether trait impulsivity affects the fall risk differently for patients with more or less postural instability and gait disability (PIGD). 388 patients with PD (H&Y ≤ 3) completed the Barratt Impulsiveness Scale (BIS-11, higher scores indicating greater impulsivity) to assess trait impulsivity, including three subscales: motor impulsivity (e.g. "I do things without thinking"), attentional impulsivity (e.g. "I concentrate easily") and non-planning (e.g. "I plan tasks carefully"). Falls were registered prospectively for 6 months. Patients classified as non-fallers (0 falls, n = 237) were compared to recurrent PD fallers (>1 fall, n = 78). Total impulsivity scores were higher for recurrent fallers (59.5) compared to non-fallers (56.8; p = .012). This effect was predominantly driven by higher scores on the subscale for attentional impulsivity (p = .003). The difference in attentional impulsivity was independent of gender, disease severity, dopaminergic medication, and cognitive function. Motor and non-planning impulsivity did not differ between recurrent fallers and non-fallers. There was no evidence that impulsivity modulated the association between PIGD and fall risk. This is the first evidence that impulsivity, in particular in the attentional domain, is related to fall risk in PD.

Prevention of patient falls in hospitals in the Czech Republic.

PubMed

Brabcová, Iva; Bártlová, Sylva; Hajduchová, Hana; Tóthová, Valérie

2015-01-01

The prevention of patient falls is one of the safety goals set forth by the Ministry of Health of the Czech Republic. A sociological survey was carried out to (1) determine to what extent nurses identify the risk of patient falls at admission, (2) if the risk is reassessed and at what intervals, (3) what preventive measures were taken, and (4) in what way are patient falls reported. A representative sample consisting of general nurses working shifts on inpatient wards at hospitals in the Czech Republic was surveyed. Altogether 772 nurses took part in the study. The survey showed that at admission, most nurses assessed the risk of falls (91.6%). Nonetheless, it should stand as a stark warning that nearly one fifth of the respondents (16.2%) did not reassess the risk of falls after admission! On the other hand, it can be perceived as a positive that most nurses (70.1%) use a multifaceted program of preventive measures for at risk patients and immediately reported fall events to the doctor in charge (71.4%). During statistical testing, the predication that a working atmosphere supporting a culture of patient safety would significantly decrease the probability of patient falls and increases the willingness of nurses to use preventive programs in daily practice. Results from the survey showed that a system to minimalize fall risks has been successfully introduced into the hospitals of the Czech Republic. The system is based on the recommendations of the Ministry of Health of the Czech Republic.

Falling Down on the Job: Evaluation and Treatment of Fall Risk Among Older Adults With Upper Extremity Fragility Fractures.

PubMed

McDonough, Christine M; Colla, Carrie H; Carmichael, Donald; Tosteson, Anna N A; Tosteson, Tor D; Bell, John-Erik; Cantu, Robert V; Lurie, Jonathan D; Bynum, Julie P W

2017-03-01

Clinical practice guidelines recommend fall risk assessment and intervention for older adults who sustain a fall-related injury to prevent future injury and mobility decline. The aim of this study was to describe how often Medicare beneficiaries with upper extremity fracture receive evaluation and treatment for fall risk. Observational cohort. Participants were fee-for-service beneficiaries age 66 to 99 treated as outpatients for proximal humerus or distal radius/ulna ("wrist") fragility fractures. -Participants were studied using Carrier and Outpatient Hospital files. The proportion of patients evaluated or treated for fall risk up to 6 months after proximal humerus or wrist fracture from 2007-2009 was examined based on evaluation, treatment, and diagnosis codes. Time to evaluation and number of treatment sessions were calculated. Logistic regression was used to analyze patient characteristics that predicted receiving evaluation or treatment. Narrow (gait training) and broad (gait training or therapeutic exercise) definitions of service were used. There were 309,947 beneficiaries who sustained proximal humerus (32%) or wrist fracture (68%); 10.7% received evaluation or treatment for fall risk or gait issues (humerus: 14.2%; wrist: 9.0%). Using the broader definition, the percentage increased to 18.5% (humerus: 23.4%; wrist: 16.3%). Factors associated with higher likelihood of services after fracture were: evaluation or treatment for falls or gait prior to fracture, more comorbidities, prior nursing home stay, older age, humerus fracture (vs wrist), female sex, and white race. Claims analysis may underestimate physician and physical therapist fall assessments, but it is not likely to qualitatively change the results. A small proportion of older adults with upper extremity fracture received fall risk assessment and treatment. Providers and health systems must advance efforts to provide timely evidence-based management of fall risk in this population. © 2017 American Physical Therapy Association

Falling Down on the Job: Evaluation and Treatment of Fall Risk Among Older Adults With Upper Extremity Fragility Fractures

PubMed Central

Colla, Carrie H.; Carmichael, Donald; Tosteson, Anna N. A.; Tosteson, Tor D.; Bell, John-Erik; Cantu, Robert V.; Lurie, Jonathan D.; Bynum, Julie P. W.

2017-01-01

Abstract Background: Clinical practice guidelines recommend fall risk assessment and intervention for older adults who sustain a fall-related injury to prevent future injury and mobility decline. Objective: The aim of this study was to describe how often Medicare beneficiaries with upper extremity fracture receive evaluation and treatment for fall risk. Design: Observational cohort. Methods: Participants were fee-for-service beneficiaries age 66 to 99 treated as outpatients for proximal humerus or distal radius/ulna (“wrist”) fragility fractures. -Participants were studied using Carrier and Outpatient Hospital files. The proportion of patients evaluated or treated for fall risk up to 6 months after proximal humerus or wrist fracture from 2007–2009 was examined based on evaluation, treatment, and diagnosis codes. Time to evaluation and number of treatment sessions were calculated. Logistic regression was used to analyze patient characteristics that predicted receiving evaluation or treatment. Narrow (gait training) and broad (gait training or therapeutic exercise) definitions of service were used. Results: There were 309,947 beneficiaries who sustained proximal humerus (32%) or wrist fracture (68%); 10.7% received evaluation or treatment for fall risk or gait issues (humerus: 14.2%; wrist: 9.0%). Using the broader definition, the percentage increased to 18.5% (humerus: 23.4%; wrist: 16.3%). Factors associated with higher likelihood of services after fracture were: evaluation or treatment for falls or gait prior to fracture, more comorbidities, prior nursing home stay, older age, humerus fracture (vs wrist), female sex, and white race. Limitations: Claims analysis may underestimate physician and physical therapist fall assessments, but it is not likely to qualitatively change the results. Conclusions: A small proportion of older adults with upper extremity fracture received fall risk assessment and treatment. Providers and health systems must advance efforts to provide timely evidence-based management of fall risk in this population. PMID:28340130

Diagnostic Accuracy of Fall Risk Assessment Tools in People With Diabetic Peripheral Neuropathy

PubMed Central

Pohl, Patricia S.; Mahnken, Jonathan D.; Kluding, Patricia M.

2012-01-01

Background Diabetic peripheral neuropathy affects nearly half of individuals with diabetes and leads to increased fall risk. Evidence addressing fall risk assessment for these individuals is lacking. Objective The purpose of this study was to identify which of 4 functional mobility fall risk assessment tools best discriminates, in people with diabetic peripheral neuropathy, between recurrent “fallers” and those who are not recurrent fallers. Design A cross-sectional study was conducted. Setting The study was conducted in a medical research university setting. Participants The participants were a convenience sample of 36 individuals between 40 and 65 years of age with diabetic peripheral neuropathy. Measurements Fall history was assessed retrospectively and was the criterion standard. Fall risk was assessed using the Functional Reach Test, the Timed “Up & Go” Test, the Berg Balance Scale, and the Dynamic Gait Index. Sensitivity, specificity, positive and negative likelihood ratios, and overall diagnostic accuracy were calculated for each fall risk assessment tool. Receiver operating characteristic curves were used to estimate modified cutoff scores for each fall risk assessment tool; indexes then were recalculated. Results Ten of the 36 participants were classified as recurrent fallers. When traditional cutoff scores were used, the Dynamic Gait Index and Functional Reach Test demonstrated the highest sensitivity at only 30%; the Dynamic Gait Index also demonstrated the highest overall diagnostic accuracy. When modified cutoff scores were used, all tools demonstrated improved sensitivity (80% or 90%). Overall diagnostic accuracy improved for all tests except the Functional Reach Test; the Timed “Up & Go” Test demonstrated the highest diagnostic accuracy at 88.9%. Limitations The small sample size and retrospective fall history assessment were limitations of the study. Conclusions Modified cutoff scores improved diagnostic accuracy for 3 of 4 fall risk assessment tools when testing people with diabetic peripheral neuropathy. PMID:22836004

Incidence and characteristics of accidental falls in hospitalizations

PubMed Central

Kobayashi, Kazuyoshi; Imagama, Shiro; Inagaki, Yuko; Suzuki, Yusuke; Ando, Kei; Nishida, Yoshihiro; Nagao, Yoshimasa; Ishiguro, Naoki

2017-01-01

ABSTRACT Aging of the patient population has led to increased occurrence of accidental falls in acute care settings. The aim of this study is to survey the annual occurrence of falls in a university hospital, and to examine procedures to prevent fall. A total of 49,059 inpatients were admitted to our hospital from April 2015 to March 2016. A fall assessment scale was developed to estimate the risk of fall at admission. Data on falls were obtained from the hospital incident reporting system. There were fall-related incidents in 826 patients (1.7%). Most falls occurred in hospital rooms (67%). Adverse events occurred in 101 patients who fell (12%) and were significantly more frequent in patients aged ≥80 years old and in those wearing slippers. The incidence of falls was also significantly higher in patients in the highest risk group. These results support the validity of the risk assessment scale for predicting accidental falls in an acute treatment setting. The findings also clarify the demographic and environmental factors and consequences associated with fall. These results of the study could provide important information for designing effective interventions to prevent fall in elderly patients. PMID:28878434

Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors.

PubMed

Mazur, Katarzyna; Wilczyński, Krzysztof; Szewieczek, Jan

2016-01-01

Inpatient geriatric falls are a frequent complication of hospital care that results in significant morbidity and mortality. Evaluate factors associated with falls in geriatric inpatients after implementation of the fall prevention program. Prospective observational study comprised of 788 consecutive patients aged 79.5±7.6 years ( [Formula: see text] ± standard deviation) (66% women and 34% men) admitted to the subacute geriatric ward. Comprehensive geriatric assessment (including Mini-Mental State Examination, Barthel Index of Activities of Daily Living, and modified Get-up and Go Test) was performed. Confusion Assessment Method was used for diagnosis of delirium. Patients were categorized into low, moderate, or high fall risk groups after clinical and functional assessment. About 15.9%, 21.1%, and 63.1% of participants were classified into low, moderate, and high fall risk groups, respectively. Twenty-seven falls were recorded in 26 patients. Increased fall probability was associated with age ≥76 years ( P <0.001), body mass index (BMI) <23.5 ( P =0.007), Mini-Mental State Examination <20 ( P =0.004), Barthel Index <65 ( P =0.002), hemoglobin <7.69 mmol/L ( P =0.017), serum protein <70 g/L ( P =0.008), albumin <32 g/L ( P =0.001), and calcium level <2.27 mmol/L. Four independent factors associated with fall risk were included in the multivariate logistic regression model: delirium (odds ratio [OR] =7.33; 95% confidence interval [95% CI] =2.76-19.49; P <0.001), history of falls (OR =2.55; 95% CI =1.05-6.19; P =0.039), age (OR =1.14; 95% CI =1.05-1.23; P =0.001), and BMI (OR =0.91; 95% CI =0.83-0.99; P =0.034). Delirium, history of falls, and advanced age seem to be the primary risk factors for geriatric falls in the context of a hospital fall prevention program. Higher BMI appears to be associated with protection against inpatient geriatric falls.

Negotiating identity and self-image: perceptions of falls in ambulatory individuals with spinal cord injury – a qualitative study

PubMed Central

Jørgensen, Vivien; Roaldsen, Kirsti Skavberg

2016-01-01

Objective: Explore and describe experiences and perceptions of falls, risk of falling, and fall-related consequences in individuals with incomplete spinal cord injury (SCI) who are still walking. Design: A qualitative interview study applying interpretive content analysis with an inductive approach. Setting: Specialized rehabilitation hospital. Subjects: A purposeful sample of 15 individuals (10 men), 23 to 78 years old, 2-34 years post injury with chronic incomplete traumatic SCI, and walking ⩾75% of time for mobility needs. Methods: Individual, semi-structured face-to-face interviews were recorded, condensed, and coded to find themes and subthemes. Results: One overarching theme was revealed: “Falling challenges identity and self-image as normal” which comprised two main themes “Walking with incomplete SCI involves minimizing fall risk and fall-related concerns without compromising identity as normal” and “Walking with incomplete SCI implies willingness to increase fall risk in order to maintain identity as normal”. Informants were aware of their increased fall risk and took precautions, but willingly exposed themselves to risky situations when important to self-identity. All informants expressed some conditional fall-related concerns, and a few experienced concerns limiting activity and participation. Conclusion: Ambulatory individuals with incomplete SCI considered falls to be a part of life. However, falls interfered with the informants’ identities and self-images as normal, healthy, and well-functioning. A few expressed dysfunctional concerns about falling, and interventions should target these. PMID:27170274

Can cognitive enhancers reduce the risk of falls in older people with Mild Cognitive Impairment? A protocol for a randomised controlled double blind trial

PubMed Central

2009-01-01

Background Older adults with cognitive problems have a higher risk of falls, at least twice that of cognitively normal older adults. The consequences of falls in this population are very serious: fallers with cognitive problems suffer more injuries due to falls and are approximately five times more likely to be admitted to institutional care. Although the mechanisms of increased fall risk in cognitively impaired people are not completely understood, it is known that impaired cognitive abilities can reduce attentional resource allocation while walking. Since cognitive enhancers, such as cholinesterase inhibitors, improve attention and executive function, we hypothesise that cognitive enhancers may reduce fall risk in elderly people in the early stages of cognitive decline by improving their gait and balance performance due to an enhancement in attention and executive function. Method/Design Double blinded randomized controlled trial with 6 months follow-up in 140 older individuals with Mild Cognitive Impairment (MCI). Participants will be randomized to the intervention group, receiving donepezil, and to the control group, receiving placebo. A block randomization by four and stratification based on fall history will be performed. Primary outcomes are improvements in gait velocity and reduction in gait variability. Secondary outcomes are changes in the balance confidence, balance sway, attention, executive function, and number of falls. Discussion By characterizing and understanding the effects of cognitive enhancers on fall risk in older adults with cognitive impairments, we will be able to pave the way for a new approach to fall prevention in this population. This RCT study will provide, for the first time, information regarding the effect of a medication designed to augment cognitive functioning have on the risk of falls in older adults with Mild Cognitive Impairment. We expect a significant reduction in the risk of falls in this vulnerable population as a function of the reduced gait variability achieved by treatment with cognitive enhancers. This study may contribute to a new approach to prevent and treat fall risk in seniors in early stages of dementia. Trial Registration The protocol for this study is registered with the Clinical Trials Registry, identifier number: NCT00934531 http://www.clinicaltrials.gov PMID:19674471

Psychological distress and the increased risk of falling into poverty: a longitudinal study of Australian adults.

PubMed

Callander, Emily J; Schofield, Deborah J

2015-10-01

To identify whether psychological distress is associated with an increased risk of falling into poverty, giving a more complete picture of how psychological distress affects living standards. Longitudinal analysis of the nationally representative Household Income and Labour Dynamics in Australian (HILDA) survey using Poisson regression models to estimate relative risk of falling into income poverty and multidimensional poverty between 2007 and 2012. The sample was limited to those who were not already in income poverty in 2007. Psychological distress was identified using the Kessler-10 (K10) scale. After adjusting for confounding factors, having moderate psychological distress increased the risk of falling into income poverty by 1.62 (95% CI 1.31-2.01, p < 0.0001) and the risk of falling into multidimensional poverty by 1.85 (95% CI 1.37-2.48, p < 0.0001); having very high psychological distress increased the risk of falling into income poverty by 2.40 (95% CI 1.80-3.20, p < 0.0001) and the risk of falling into multidimensional poverty by 3.68 (95% CI 2.63-5.15, p < 0.0001), compared to those with low psychological distress. Those who did experience income poverty (RR: 1.29, 95% CI 1.04-1.61, p = 0.0210) and those who experienced multidimensional poverty (RR: 1.69, 95% CI 1.32-2.17, p < 0.0001) had an increased risk of having their level of psychological distress increase further compared to those who did not experience poverty. To date, the increased risk of falling into poverty that is associated with elevated levels of psychological distress has been an overlooked burden of the condition.

Clinical prediction of fall risk and white matter abnormalities: a diffusion tensor imaging study

USDA-ARS?s Scientific Manuscript database

The Tinetti scale is a simple clinical tool designed to predict risk of falling by focusing on gait and stance impairment in elderly persons. Gait impairment is also associated with white matter (WM) abnormalities. Objective: To test the hypothesis that elderly subjects at risk for falling, as deter...

Postural Control in Young People with Visual Impairments and Various Risks of Falls

ERIC Educational Resources Information Center

Sadowska, Dorota; Stemplewski, Rafal; Szeklicki, Robert

2017-01-01

Introduction: Early diagnosis of postural control deficiencies facilitates implementation of an individual rehabilitation plan to prevent falls. The aim of the study was to assess the risk of falling in individuals with visual impairments, and to compare performance-based and theoretical limits of stability in subjects with various risks of…

Development and Evaluation of an Online Fall-Risk Questionnaire for Nonfrail Community-Dwelling Elderly Persons: A Pilot Study

PubMed Central

Obrist, Seraina; Rogan, Slavko; Hilfiker, Roger

2016-01-01

Introduction. Falls are frequent in older adults and may have serious consequences but awareness of fall-risk is often low. A questionnaire might raise awareness of fall-risk; therefore we set out to construct and test such a questionnaire. Methods. Fall-risk factors and their odds ratios were extracted from meta-analyses and a questionnaire was devised to cover these risk factors. A formula to estimate the probability of future falls was set up using the extracted odds ratios. The understandability of the questionnaire and discrimination and calibration of the prediction formula were tested in a cohort study with a six-month follow-up. Community-dwelling persons over 60 years were recruited by an e-mail snowball-sampling method. Results and Discussion. We included 134 persons. Response rates for the monthly fall-related follow-up varied between the months and ranged from low 38% to high 90%. The proportion of present risk factors was low. Twenty-five participants reported falls. Discrimination was moderate (AUC: 0.67, 95% CI 0.54 to 0.81). The understandability, with the exception of five questions, was good. The wording of the questions needs to be improved and measures to increase the monthly response rates are needed before test-retest reliability and final predictive value can be assessed. PMID:27247571

Fall prevention in high-risk patients.

PubMed

Shuey, Kathleen M; Balch, Christine

2014-12-01

In the oncology population, disease process and treatment factors place patients at risk for falls. Fall bundles provide a framework for developing comprehensive fall programs in oncology. Small sample size of interventional studies and focus on ambulatory and geriatric populations limit the applicability of results. Additional research is needed. Copyright © 2014 Elsevier Inc. All rights reserved.

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

ERIC Educational Resources Information Center

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

2006-01-01

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…

The effect of Pilates based exercise on mobility, postural stability, and balance in order to decrease fall risk in older adults.

PubMed

Pata, Rachel W; Lord, Katrina; Lamb, Jamie

2014-07-01

Falls are a common problem in older adults. Impaired balance, mobility and postural stability are risk factors for falling. Limited research has been performed on Pilates exercise and the ability to decrease fall risk. In this quasi-experimental study, 35 adults (61-87 years old) participated in an 8-week Pilates based exercise program. Blind examiners conducted the Timed Up and Go (TUG), Forward Reach Test, and Turn 180 Test before and after the intervention. Number of falls, perception of Pilates, and fear of falling was also recorded. Thirty-two (91.4%) participants completed post-test measures. Significant improvements were seen in the TUG (p <0.001) and Turn 180 Test (p = 0.002). Improvements were also demonstrated in the Forward Reach Test (p = 0.049). A positive perception of the Pilates program and decreased fear of falling was shown. Results suggest a Pilates based exercise program may be effective in improving balance, mobility and postural stability to decrease fall risk. Copyright © 2013 Elsevier Ltd. All rights reserved.

Gait and balance in the aging population: Fall prevention using innovation and technology.

PubMed

Khanuja, Kavisha; Joki, Jaclyn; Bachmann, Gloria; Cuccurullo, Sara

2018-04-01

On a global basis, adults 65 years of age and older experience falls more frequently than younger individuals, and these often result in severe injuries as well as increased healthcare costs. Gait and balance disorders in this population are among the most common causes of falls and negatively influence quality of life and survivorship. Although falls are a major public health problem and guidelines/recommendations are available to physicians, many are fully aware of different assessments, tools, and resources available for intervention. Given the risk for potentially devastating outcomes if severe injuries occur secondary to a fall, fall prevention strategies in clinical offices is a timely consideration in today's health care landscape. This paper presents a three-tier model, comprising assessment, prevention, and intervention, to highlight methods, proactive programs, and innovative tools and technology that have been developed for fall prevention. Awareness of these resources will enhance the clinician's ability to accurately assess balance and gait, which can improve physical function, and decrease the risk of falls for both average-risk and high-risk older adults. Copyright © 2018 Elsevier B.V. All rights reserved.

Visual risk factors for falls in older people.

PubMed

Lord, Stephen R

2006-09-01

Poor vision reduces postural stability and significantly increases the risk of falls and fractures in older people. Most studies have found that poor visual acuity increases the risk of falls. However, studies that have included multiple visual measures have found that reduced contrast sensitivity and depth perception are the most important visual risk factors for falls. Multifocal glasses may add to this risk because their near-vision lenses impair distance contrast sensitivity and depth perception in the lower visual field. This reduces the ability of an older person to detect environmental hazards. There is now evidence that maximising vision through cataract surgery is an effective strategy for preventing falls. Further randomised controlled trials are required to determine whether individual strategies (such as restriction of use of multifocal glasses) or multi-strategy visual improvement interventions can significantly reduce falls in older people. Public health initiatives are required to raise awareness in older people and their carers of the importance of regular eye examinations and use of appropriate prescription glasses.

Targeting a high-risk group for fall prevention: strategies for health plans.

PubMed

Jennings, Lee A; Reuben, David B; Kim, Sung-Bou; Keeler, Emmett; Roth, Carol P; Zingmond, David S; Wenger, Neil S; Ganz, David A

2015-09-01

Although Medicare has implemented incentives for health plans to reduce fall risk, the best way to identify older people at high risk of falling and to use screening results to target fall prevention services remains unknown. We evaluated 4 different strategies using a combination of administrative data and patient-reported information that health plans could easily obtain. Observational study. We used data from 1776 patients 75 years or older in 4 community-based primary care practices who screened positive for a fear of falling and/or a history of falls. For these patients, we predicted fall-related injuries in the 24 months after the date of screening using claims/encounter data. After controlling for age and gender, we predicted the number of fall-related injuries by adding Elixhauser comorbidity count, any claim for a fall-related injury during the 12 months prior to screening, and falls screening question responses in a sequential fashion using negative binomial regression models. Basic patient characteristics, including age and Elixhauser comorbidity count, were strong predictors of fall-related injury. Among falls screening questions, a positive response to, "Have you fallen 2 or more times in the past year?" was the most predictive of a fall-related injury (incidence rate ratio [IRR], 1.56; 95% CI, 1.25-1.94). Prior claim for a fall-related injury also independently predicted this type of injury (IRR, 1.41; 95% CI, 1.05-1.89). The best model for predicting fall-related injuries combined all of these approaches. The combination of administrative data and a simple screening item can be used by health plans to target patients at high risk for future fall-related injuries.

Biodex Fall Risk Assessment in the Elderly With Ataxia: A New Age-Dependent Derived Index in Rehabilitation: An Observational Study.

PubMed

Prometti, Paola; Olivares, Adriana; Gaia, Giuseppina; Bonometti, Giampietro; Comini, Laura; Scalvini, Simonetta

2016-03-01

The aim of this study was to evaluate if the Biodex Fall Risk Assessment could provide an age-adjusted index useful for classifying patients at "risk of fall."This was a cohort study conducted on 61 chronic patients, in stable conditions, having a history of ataxia, difficulty in walking or loss of balance, and aged >64 years. These patients were coming from home to our Institute undergoing a period of in-hospital standard rehabilitation. Assessment of clinical parameters was performed at entry. Functional scales (Functional Independence Measure [FIM] for motor and cognitive function, Barthel G, Tinetti POMA), and the Biodex Fall Risk Index (FRI) were performed at entry and discharge. The Normalized FRI, obtained adjusting FRI to the reported maximum predictive FRI for the relevant age, identified 2 types of patients: those with a greater risk of fall than expected for that age, labeled Case 1 (Normalized FRI>1); and those with an equal or even lesser risk of fall than expected for that age, labeled Case 0 (Normalized FRI≤1).FRI, Normalized FRI as well as independent variables as age, sex, pathology group, FIM, BarthelG, were considered in a multiple regression analysis to predict the functional improvement (i.e., delta Tinetti Total score) after rehabilitation.Normalized FRI is useful in assessing patients at risk of falls both before and after rehabilitation. At admission, the Normalized FRI evidenced high fall risk in 46% of patients (Case 1) which decreased to 12% after rehabilitation, being greater than age-predicted in 7 patients (Case 1-1) despite the functional improvement observed after the rehabilitation treatment. Normalized FRI evidenced Case 1-1 patients as neurological, "very old" (86% in age-group 75-84 years), and with serious events at 18 to 24 months' follow-up. Normalized FRI, but not FRI, at admission was a predictor of improvement in Tinetti Total scores.The normalized FRI effectively indicated patients at higher risk of fall, in whom health deterioration, falls, or cognitive decline was later documented at follow-up. The normalized FRI could be a standardized measure for identifying frailer patients becoming a further criterium of discharge home and marker of fall risk at home.

The functional assessment Berg Balance Scale is better capable of estimating fall risk in the elderly than the posturographic Balance Stability System.

PubMed

Pereira, Vanessa Vieira; Maia, Roberto Alcantara; Silva, Sonia Maria Cesar de Azevedo

2013-01-01

The purpose of this study was to verify which instrument better identifies recurrent falls in the elderly. Ninety-eight old people, with an average age of 80 ± 4 years, were submitted to an assessment of balance and fall risk by means of the Berg Balance Scale (BBS) and the posturographic Balance Stability System (BSS). The BBS was correlated with the BSS (r=-0.27; p=0.008), age (r=-0.38; p<0.001) and number of falls (r=-0.25; p=0.013) and the analysis of logistical regression showed that the elderly classified with fall risk on the BBS presented 2.5 (95%CI 1.08-5.78) more chance of identifying who had two falls or more over the last year. The BBS identified that the greater the age the worse the functional balance and demonstrated a greater capacity to identify falls risk suffered over the last year when compared with the BSS.

Classification of older adults with/without a fall history using machine learning methods.

PubMed

Lin Zhang; Ou Ma; Fabre, Jennifer M; Wood, Robert H; Garcia, Stephanie U; Ivey, Kayla M; McCann, Evan D

2015-01-01

Falling is a serious problem in an aged society such that assessment of the risk of falls for individuals is imperative for the research and practice of falls prevention. This paper introduces an application of several machine learning methods for training a classifier which is capable of classifying individual older adults into a high risk group and a low risk group (distinguished by whether or not the members of the group have a recent history of falls). Using a 3D motion capture system, significant gait features related to falls risk are extracted. By training these features, classification hypotheses are obtained based on machine learning techniques (K Nearest-neighbour, Naive Bayes, Logistic Regression, Neural Network, and Support Vector Machine). Training and test accuracies with sensitivity and specificity of each of these techniques are assessed. The feature adjustment and tuning of the machine learning algorithms are discussed. The outcome of the study will benefit the prediction and prevention of falls.

Gait dynamics to optimize fall risk assessment in geriatric patients admitted to an outpatient diagnostic clinic

PubMed Central

de Groot, Maartje H.; van Campen, Jos P.; Beijnen, Jos H.; Hortobágyi, Tibor; Vuillerme, Nicolas; Lamoth, Claudine C. J.

2017-01-01

Fall prediction in geriatric patients remains challenging because the increased fall risk involves multiple, interrelated factors caused by natural aging and/or pathology. Therefore, we used a multi-factorial statistical approach to model categories of modifiable fall risk factors among geriatric patients to identify fallers with highest sensitivity and specificity with a focus on gait performance. Patients (n = 61, age = 79; 41% fallers) underwent extensive screening in three categories: (1) patient characteristics (e.g., handgrip strength, medication use, osteoporosis-related factors) (2) cognitive function (global cognition, memory, executive function), and (3) gait performance (speed-related and dynamic outcomes assessed by tri-axial trunk accelerometry). Falls were registered prospectively (mean follow-up 8.6 months) and one year retrospectively. Principal Component Analysis (PCA) on 11 gait variables was performed to determine underlying gait properties. Three fall-classification models were then built using Partial Least Squares–Discriminant Analysis (PLS-DA), with separate and combined analyses of the fall risk factors. PCA identified ‘pace’, ‘variability’, and ‘coordination’ as key properties of gait. The best PLS-DA model produced a fall classification accuracy of AUC = 0.93. The specificity of the model using patient characteristics was 60% but reached 80% when cognitive and gait outcomes were added. The inclusion of cognition and gait dynamics in fall classification models reduced misclassification. We therefore recommend assessing geriatric patients’ fall risk using a multi-factorial approach that incorporates patient characteristics, cognition, and gait dynamics. PMID:28575126

Gait dynamics to optimize fall risk assessment in geriatric patients admitted to an outpatient diagnostic clinic.

PubMed

Kikkert, Lisette H J; de Groot, Maartje H; van Campen, Jos P; Beijnen, Jos H; Hortobágyi, Tibor; Vuillerme, Nicolas; Lamoth, Claudine C J

2017-01-01

Fall prediction in geriatric patients remains challenging because the increased fall risk involves multiple, interrelated factors caused by natural aging and/or pathology. Therefore, we used a multi-factorial statistical approach to model categories of modifiable fall risk factors among geriatric patients to identify fallers with highest sensitivity and specificity with a focus on gait performance. Patients (n = 61, age = 79; 41% fallers) underwent extensive screening in three categories: (1) patient characteristics (e.g., handgrip strength, medication use, osteoporosis-related factors) (2) cognitive function (global cognition, memory, executive function), and (3) gait performance (speed-related and dynamic outcomes assessed by tri-axial trunk accelerometry). Falls were registered prospectively (mean follow-up 8.6 months) and one year retrospectively. Principal Component Analysis (PCA) on 11 gait variables was performed to determine underlying gait properties. Three fall-classification models were then built using Partial Least Squares-Discriminant Analysis (PLS-DA), with separate and combined analyses of the fall risk factors. PCA identified 'pace', 'variability', and 'coordination' as key properties of gait. The best PLS-DA model produced a fall classification accuracy of AUC = 0.93. The specificity of the model using patient characteristics was 60% but reached 80% when cognitive and gait outcomes were added. The inclusion of cognition and gait dynamics in fall classification models reduced misclassification. We therefore recommend assessing geriatric patients' fall risk using a multi-factorial approach that incorporates patient characteristics, cognition, and gait dynamics.

The effect of vacuum assisted socket suspension on prospective, community-based falls by users of lower limb prostheses.

PubMed

Rosenblatt, Noah J; Ehrhardt, Tess

2017-06-01

Individuals with lower limb amputation are at increased risk of falling compared to age-matched peers. The purpose of this study was to quantify the effect of socket suspension on the risk of falling, by comparing prospectively tracked falls between a group of participants that used vacuum assisted socket suspension (VASS) and a group that did not use this system. Fifteen current users of VASS and 12 non-VASS users received an email every two weeks for one year, with a link to an online survey that asked whether they fell (i.e., "unintentionally came to rest on a lower surface") or stumbled (i.e., lost balance but did not fall) in the prior two weeks. A Chi-squared test was used to compare fall and stumble risk between groups, after stratifying by level of amputation, and the phi coefficient (φ) was used to quantify effect size. While the use of VASS did not affect the rate of falling (i.e., falls per person year) for either persons with transtibial amputation (TTA) or those with transfemoral amputation (TFA), the absolute risk of having multiple falls was reduced by nearly 75% in the former (φ=0.83), which is particularly important given that recurrent falls are associated with more severe injuries. There was no effect of VASS on the risk of falls in TFA. Further work is warranted to demonstrate the persistence of these effects in larger, more controlled samples. Copyright © 2017 Elsevier B.V. All rights reserved.

The relative contribution of physical and cognitive fall risk factors in people with Parkinson's disease: a large prospective cohort study.

PubMed

Paul, Serene S; Sherrington, Catherine; Canning, Colleen G; Fung, Victor S C; Close, Jacqueline C T; Lord, Stephen R

2014-01-01

In order to develop multifaceted fall prevention strategies for people with Parkinson's disease (PD), greater understanding of the impact of physical and cognitive performance on falls is required. We aimed to identify the relative contribution of a comprehensive range of physical and cognitive risk factors to prospectively-measured falls in a large sample of people with PD and develop an explanatory multivariate fall risk model in this group. METHODS MEASURES: of PD signs and symptoms, freezing of gait, balance, mobility, proprioception, leg muscle strength, and cognition were collected on 205 community-dwelling people with PD. Falls were monitored prospectively for 6 months using falls diaries. A total of 120 participants (59%) fell during follow-up. Freezing of gait (P < .001), dyskinesia (P = .02), impaired anticipatory and reactive balance (P < .001), impaired cognition (P = .002), reduced leg muscle strength (P = .006), and reduced proprioception (P = .04) were significantly associated with future falls in univariate analyses. Freezing of gait (risk ratio [RR] = 1.03, 95% confidence interval [CI] = 1.00-1.05, P = .02), impaired anticipatory (RR = 1.01, 95% CI = 1.00-1.02, P = .03) and reactive (RR = 1.26, 95% CI = 1.01-1.58, P = .04) balance, and impaired orientation (RR = 1.28, 95% CI = 1.01-1.62, P = .04) maintained significant associations with falls in multivariate analysis. The study findings elucidate important physical and cognitive determinants of falls in people with PD and may assist in developing efficacious fall prevention strategies for this high-risk group.

[Study on incidence and risk factors of fall in the elderly in a rural community in Beijing].

PubMed

Zhang, D; He, Y; Liu, M; Yang, H B; Wu, L; Wang, J H; Yang, S S; Chen, J; Wang, Y Y; Zeng, J; Yao, Y; Guo, M L

2016-05-01

To investigate the incidence of fall in the old farmers of Miyun county in Beijing. The old farmers who lived in Jugezhuang and Fengjiayu townships of Miyun county were selected for a questionnaire survey to collect the information about the incidence of fall and their health status. A total of 2 397 old farmers, including 967 males and 1 430 females, were surveyed. Fall occurred in 347 old farmers(14.5%). The difference in the incidence of fall was significant between males(9.6%)and females(17.8%). A total of 282 falls occurred in courtyards, 45 falls occurred in field/hilly areas. Among the falls occurred, 216(27.2%)led to injuries. The most common site of injuries was hip(45 falls). Logistic regression analysis showed that physical exercise and high income were protective factors, but difficult standing up and walking, visual problem and stroke were the risk factors. In the males, the special risk factor was mid cognitive impairment, and in the females, the special risk factor was urinary incontinence, but afternoon nap was a protective factor. The incidence of fall in the rural community was relatively high with distinct area distribution, which has caused serious influence on the mental and physical health of the elderly.

Are falls prevention programs effective at reducing the risk factors for falls in people with type-2 diabetes mellitus and peripheral neuropathy: A systematic review with narrative synthesis.

PubMed

Gu, Yu; Dennis, Sarah M

2017-02-01

Diabetic peripheral neuropathy (DPN) is a common complication of type-2 diabetes mellitus (T2DM) that predisposes the elderly to a higher falls risk. Falls prevention programs with a component of weight-bearing exercises are effective in decreasing future falls in the elderly. However, weight-bearing exercise was only recently recommended in guidelines for exercise for people with T2DM and DPN. Since then, there have been an increasing number of studies to evaluate the effectiveness of falls prevention programs on this targeted population. A systematic literature review was undertaken to determine the effectiveness of falls prevention programs for people with T2DM and DPN. Nine published studies that investigated the effect of exercise training on falls risk among people with T2DM and DPN were included in the review. Interventions included lower limb strengthening, balance practice, aerobic exercise, walking programs, and Tai Chi. The preliminary evidence presented in this review suggests that people with T2DM and DPN can improve their balance and walking after a targeted multicomponent program without risk of serious adverse events. There is insufficient long-term follow-up data to determine whether the improvements in balance or strength resulted in a decrease falls risk in the community setting. Copyright © 2016 Elsevier Inc. All rights reserved.

Executive function predicts risk of falls in older adults without balance impairment

PubMed Central

2011-01-01

Background Executive dysfunction has previously been found to be a risk factor for falls. The aim of this study is to investigate the association between executive dysfunction and risk of falling and to determine if this association is independent of balance. Methods Participants were 188 community-dwelling individuals aged 65 and older. All participants underwent baseline and annual evaluations with review of health history, standardized neurologic examination, neuropsychological testing, and qualitative and quantitative assessment of motor function. Falls were recorded prospectively using weekly online health forms. Results During 13 months of follow-up, there were 65 of 188 participants (34.6%) who reported at least one fall. Univariate analysis showed that fallers were more likely to have lower baseline scores in executive function than non-fallers (p = 0.03). Among participants without balance impairment we found that higher executive function z-scores were associated with lower fall counts (p = 0.03) after adjustment for age, sex, health status and prior history of falls using negative binomial regression models. This relationship was not present among participants with poor balance. Conclusions Lower scores on executive function tests are a risk factor for falls in participants with minimal balance impairment. However, this effect is attenuated in individuals with poor balance where physical or more direct motor systems factors may play a greater role in fall risk. PMID:22070602

Individual housing-based socioeconomic status predicts risk of accidental falls among adults.

PubMed

Ryu, Euijung; Juhn, Young J; Wheeler, Philip H; Hathcock, Matthew A; Wi, Chung-Il; Olson, Janet E; Cerhan, James R; Takahashi, Paul Y

2017-07-01

Accidental falls are a major public health concern among people of all ages. Little is known about whether an individual-level housing-based socioeconomic status measure is associated with the risk of accidental falls. Among 12,286 Mayo Clinic Biobank participants residing in Olmsted County, Minnesota, subjects who experienced accidental falls between the biobank enrollment and September 2014 were identified using ICD-9 codes evaluated at emergency departments. HOUSES (HOUsing-based Index of SocioEconomic Status), a socioeconomic status measure based on individual housing features, was also calculated. Cox regression models were utilized to assess the association of the HOUSES (in quartiles) with accidental fall risk. Seven hundred eleven (5.8%) participants had at least one emergency room visit due to an accidental fall during the study period. Subjects with higher HOUSES were less likely to experience falls in a dose-response manner (hazard ratio: 0.58; 95% confidence interval: 0.44-0.76 for comparing the highest to the lowest quartile). In addition, the HOUSES was positively associated with better health behaviors, social support, and functional status. The HOUSES is inversely associated with accidental fall risk requiring emergency care in a dose-response manner. The HOUSES may capture falls-related risk factors through housing features and socioeconomic status-related psychosocial factors. Copyright © 2017 Elsevier Inc. All rights reserved.

Use of the Dynamic Visual Acuity Test as a screener for community-dwelling older adults who fall.

PubMed

Honaker, Julie A; Shepard, Neil T

2011-01-01

Adequate function of the peripheral vestibular system, specifically the vestibulo-ocular reflex (VOR; a network of neural connections between the peripheral vestibular system and the extraocular muscles) is essential for maintaining stable vision during head movements. Decreased visual acuity resulting from an impaired peripheral vestibular system may impede balance and postural control and place an individual at risk of falling. Therefore, sensitive measures of the vestibular system are warranted to screen for the tendency to fall, alerting clinicians to recommend further risk of falling assessment and referral to a falling risk reduction program. Dynamic Visual Acuity (DVA) testing is a computerized VOR assessment method to evaluate the peripheral vestibular system during head movements; reduced visual acuity as documented with DVA testing may be sensitive to screen for falling risk. This study examined the sensitivity and specificity of the computerized DVA test with yaw plane head movements for identifying community-dwelling adults (58-78 years) who are prone to falling. A total of 16 older adults with a history of two or more unexplained falls in the previous twelve months and 16 age and gender matched controls without a history of falls in the previous twelve months participated. Computerized DVA with horizontal head movements at a fixed velocity of 120 deg/sec was measured and compared with the Dynamic Gait Index (DGI) a gold standard gait assessment measurement for identifying falling risk. Receiver operating characteristics (ROC) curve analysis and area under the ROC curve (AUC) were used to assess the sensitivity and specificity of the computerized DVA as a screening measure for falling risk as determined by the DGI. Results suggested a link between computerized DVA and the propensity to fall; DVA in the yaw plane was found to be a sensitive (92%) and accurate screening measure when using a cutoff logMAR value of >0.25.

Evaluation with stabilometric platform of balance disorders in osteoporosis patients. A proposal for a diagnostic protocol.

PubMed

Cultrera, Pina; Pratelli, Elisa; Petrai, Veronica; Postiglione, Marco; Zambelan, Giulia; Pasquetti, Pietro

2010-05-01

Osteoporosis is a systemic disease with reduced bone mass and qualitative alterations of the bone, associated to increased risk of fracture. Pathogenesis of osteoporosis fractures is multifactorial. Main risk factor is falls (except for vertebral fragility fractures which occurs often in absence of trauma). Aging by itself produces physiological changes: muscular hypotrophy with asthenia, deficit of visus and hearing together with associated pathologies and multi-drug therapies. In osteoporosis patients with vertebral fractures posture change occurs which reduces balance. After clinical postural evaluation it is possible to carry out instrumental evaluation of posture with computerized methods such as stabilometry, baropodometry, dynanometry and gait analysis. Examination carried out with use of stabilometric computerized platform allows stabilometric (body sway assessment) as well as posturometric examination (center of pressure assessment during quiet standing). Fundamental parameters obtained are: position of the body center of gravity, area and shape of sway density curve and velocity variables. Protocol of evaluation includes assessment of examination in standard condition and in condition of temporary sensorial deprivation (to investigate the influence of various afferent systems on the maintenance of posture and balance). Accurate evaluation of postural control in osteoporosis patients constitutes a fundamental tool in fracture risk evaluation due to fall and in identification and correction of modifiable factors responsible for balance defect. This approach, together with adequate drug therapy, may lead to significant reduction of fractures in osteoporosis patients with subsequent reduction of hospitalization and residual consequent disabilities.

Factors associated with recognition and prioritization for falling, and the effect on fall incidence in community dwelling older adults.

PubMed

Jansen, Sofie; Schoe, Jolanda; van Rijn, Marjon; Abu-Hanna, Ameen; Moll van Charante, Eric P; van der Velde, Nathalie; de Rooij, Sophia E

2015-12-17

Recent trials have shown that multifactorial fall interventions vary in effectiveness, possibly due to lack of adherence to the interventions. The aim of this study was to examine what proportion of older adults recognize their falls risk and prioritize for fall-preventive care, and which factors are associated with this prioritization. Observational study within the intervention arm of a cluster randomized controlled trial (RCT) on the effect of preventive interventions for geriatric problems in older community-dwellers at risk of functional decline.  general practices in the Netherlands. Participants were community dwellers (70+) in whom falling was identified as a condition. A comprehensive geriatric assessment (CGA) was performed by a registered community care nurse. Participants were asked which of the identified conditions they recognized and prioritized for in a preventive care plan, and subsequent interventions were started. Multivariable logistic regression was performed to identify which factors were associated with this prioritization. Fall-incidence was measured during one-year follow-up. The RCT included 6668 participants, 3430 were in the intervention arm. Of those, 1209 were at risk of functional decline, of whom 936 underwent CGA. In 380 participants (41 %), falling was identified as a condition; 62 (16 %) recognized this and 37 (10 %) prioritized for it. Factors associated with prioritization for falls-prevention were: recurrent falls in the past year (OR 2.2 [95 % CI 1.1-4.4]), severe fear-of-falling (OR 2.7 [1.2-6.0]) and use of a walking aid (2.3 [1.1-5.0]). Sixty participants received a preventive intervention for falling; 29 had prioritized for falling. Incidence of falls was higher in the priority group than the non-priority group (67 % vs. 37 % respectively) during first six months of follow-up, but similar between groups after 12 months (40.7 % vs. 44.4 %). The proportion of community-dwellers at risk of falls that recognizes this risk and prioritizes for preventive care is small. Recurrent falls in the past year, severe fear-of-falling and use of a walking aid were associated with prioritization. Prioritization was associated with a greater fall-risk during first six months, which appeared to level out at one-year follow-up. These results could aid in the identification of community-dwellings likely to benefit from fall-preventive interventions. NTR2653 , 17 December 2010.

Psychotropic drug initiation or increased dosage and the acute risk of falls: a prospective cohort study of nursing home residents

PubMed Central

2013-01-01

Background Previous studies suggest that psychotropic drug changes may signal an acute period of time whereby a person is highly vulnerable to fall. It is unknown whether certain classes of psychotropic agents are less safe with respect to the acute risk of falls. Our purpose was to compare fall rates in the 7 days following a change of an antidepressant, antipsychotic, or benzodiazepine. We also identified specific times when residents are at high risk for falls with respect to a psychotropic drug change. Methods Residents in our one-year study included 851 long term care residents from two nursing home facilities in Boston, MA, U.S.A. (May 2010 - May 2011). Drug changes (i.e., new prescriptions or increased dose of a previously used drug) were ascertained using the computerized provider order entry system, whereas falls were ascertained by incident reports. Negative binomial regression was used to compare the rate of falls following a drug change between medication classes. Further, we calculated the rate of falls for each of the 7 days before and 7 days after a psychotropic drug change. Results Forty-eight percent of residents were prescribed a new prescription or increased dose of a psychotropic drug during the study. The rate of falls was similar in the 7 days following a change to a SSRI versus non-SSRI antidepressant (11.9 versus 14.4 falls/1,000 person years; p = 0.58), a typical versus an atypical antipsychotic (25.4 versus 17.1 falls/1,000 person years; p = 0.10), or a short versus long acting benzodiazepine (15.2 versus 13.9 falls/1,000 person years; p = 0.23). Fall risk was highest on day 4 before the drug change (19.0 falls/1,000 person days), on the day of the drug change through 2 days after the drug change (17.6-20.3 falls/1,000 person days), and 5-6 days after the drug change (17.6-19.0 falls/1,000 person days). Conclusions In the nursing home, risk of falls was similar following a psychotropic drug change of any class. We observed higher fall risk in the days before, but mostly after the drug change. We recommend that nursing home residents be closely monitored following a psychotropic drug change in an effort to reduce falls. PMID:23432790

Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients

PubMed Central

Chen, Ying; Zhu, Ling-Ling; Zhou, Quan

2014-01-01

Background Falls among the elderly are an issue internationally and a public health problem that brings substantial economic and quality-of-life burdens to individuals and society. Falls prevention is an important measure of nursing quality and patient safety. Numerous studies have evaluated the association of medication use with fall risk in elderly patients. However, an up-to-date review has not been available to summarize the multifaceted pharmaceutical concerns in the prevention of medication-related falls. Materials and methods Relevant literature was identified by performing searches in PubMed, Web of Science, and the Cochrane Library, covering the period until February 2014. We included studies that described an association between medications and falls, and effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and pharmacological interventions on fall risk in elderly patients. The full text of each included article was critically reviewed, and data interpretation was performed. Results Fall-risk-increasing drugs (FRIDs) include central nervous system-acting agents, cough preparations, nonsteroidal anti-inflammatory drugs, anti-Alzheimer’s agents, antiplatelet agents, calcium antagonists, diuretics, α-blockers, digoxin, hypoglycemic drugs, neurotoxic chemotherapeutic agents, nasal preparations, and antiglaucoma ophthalmic preparations. The degree of medication-related fall risk was dependent on one or some of the following factors: drug pharmacokinetic/pharmacodynamic properties (eg, elimination half-life, metabolic pathway, genetic polymorphism, risk rating of medications despite belonging to the same therapeutic class) and/or characteristics of medication use (eg, number of medications and drug–drug interactions, dose strength, duration of medication use and time since stopping, medication change, prescribing appropriateness, and medication adherence). Pharmacological interventions, including withdrawal of FRIDs, pharmacist-conducted clinical medication review, and computerized drug alerts, were effective in reducing fall risk. Conclusion Based on the literature review, clear practical recommendations for clinicians to prevent falls in the elderly included making a list of FRIDs, establishing a computerized alert system for when to e-prescribe FRIDs, seeking an alternative drug with lower fall risk, withdrawing FRIDs if clinically indicated, taking pertinent cautions when the use of FRIDs cannot be avoidable, paying attention to prescribing appropriateness, simplifying the medication regimen, strengthening pharmacist-conducted clinical medication review, ensuring the label of each FRID dispensed contains a corresponding warning sign, being careful when medication change occurs, enhancing medication adherence, and mandating for periodic reassessment of potential risk associated with the patient’s medication regimen. Further studies should be conducted in this area, such as investigating whether medication reconciliation and improving medication adherence could decrease the rate of falls. PMID:24966681

[Evaluation of a simple screening tool for ambulant fall prevention].

PubMed

Knobe, M; Rasche, P; Rentemeister, L; Bliemel, C; Bücking, B; Bollheimer, L C; Pape, H-C

2018-02-02

An individual's risk of falling is generally difficult to detect and it is likely to be underestimated. Thus, preventive measures are challenging and they demand sufficient integration and implementation into aftercare and outpatient management. The Aachen Falls Prevention Scale (AFPS) is a quick and easy tool for patient-driven fall risk assessment. Older adults' risk of falling is identified in a suitable manner and they then have the opportunity to independently assess and monitor their risk of falling. The aim of the current study was to evaluate the AFPS as a simple screening tool in geriatric trauma patients via the identification of influencing factors, e.g. objective or subjective fall risk, fear of falling (FOF) and demographic data. In this context, we investigated older adults' willingness to take part in special activities concerning fall prevention. Retrospectively, all patients over 70 years of age who received in-hospital fracture treatment between July 2014 and April 2016 were analyzed at a level I trauma center. After identification of 884 patients, participants completed a short questionnaire (47 questions, yes/no, Likert scale) comprising the AFPS. A history of falls in the past year was considered an indicator of a balance disorder. In addition, ambulant patients were invited to participate between July and August 2016. In total, 201 patients (mean 80.4 years, range 63-97 years) performed a self-assessment based on the AFPS. After steps 1 and 2 of the AFPS had been completed, 95 (47%) participants rated their subjective risk of falling as high (more than 5 points). Of the participants 84 (42%) were objectively classified as "fallers" with significant effects on their AFPS evaluation and rating of their subjective risk of falling. Furthermore, 67% of the participants identified a general practitioner as their main contact person, and 43% of the respondents viewed the AFPS as a beneficial screening tool in fall risk evaluation (8% negative attitudes). Only 12% of the participants could imagine using the AFPS app version as a feasible option. It would be advantageous to pretest at-risk individuals in their environment using a simple self-assessment approach, with the main purpose of identifying potential balance problems. With this approach, cost savings in the healthcare system are possible, combined with a higher health-related quality of life in the geriatric population.

Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients.

PubMed

Chen, Ying; Zhu, Ling-Ling; Zhou, Quan

2014-01-01

Falls among the elderly are an issue internationally and a public health problem that brings substantial economic and quality-of-life burdens to individuals and society. Falls prevention is an important measure of nursing quality and patient safety. Numerous studies have evaluated the association of medication use with fall risk in elderly patients. However, an up-to-date review has not been available to summarize the multifaceted pharmaceutical concerns in the prevention of medication-related falls. Relevant literature was identified by performing searches in PubMed, Web of Science, and the Cochrane Library, covering the period until February 2014. We included studies that described an association between medications and falls, and effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and pharmacological interventions on fall risk in elderly patients. The full text of each included article was critically reviewed, and data interpretation was performed. Fall-risk-increasing drugs (FRIDs) include central nervous system-acting agents, cough preparations, nonsteroidal anti-inflammatory drugs, anti-Alzheimer's agents, antiplatelet agents, calcium antagonists, diuretics, α-blockers, digoxin, hypoglycemic drugs, neurotoxic chemotherapeutic agents, nasal preparations, and antiglaucoma ophthalmic preparations. The degree of medication-related fall risk was dependent on one or some of the following factors: drug pharmacokinetic/pharmacodynamic properties (eg, elimination half-life, metabolic pathway, genetic polymorphism, risk rating of medications despite belonging to the same therapeutic class) and/or characteristics of medication use (eg, number of medications and drug-drug interactions, dose strength, duration of medication use and time since stopping, medication change, prescribing appropriateness, and medication adherence). Pharmacological interventions, including withdrawal of FRIDs, pharmacist-conducted clinical medication review, and computerized drug alerts, were effective in reducing fall risk. Based on the literature review, clear practical recommendations for clinicians to prevent falls in the elderly included making a list of FRIDs, establishing a computerized alert system for when to e-prescribe FRIDs, seeking an alternative drug with lower fall risk, withdrawing FRIDs if clinically indicated, taking pertinent cautions when the use of FRIDs cannot be avoidable, paying attention to prescribing appropriateness, simplifying the medication regimen, strengthening pharmacist-conducted clinical medication review, ensuring the label of each FRID dispensed contains a corresponding warning sign, being careful when medication change occurs, enhancing medication adherence, and mandating for periodic reassessment of potential risk associated with the patient's medication regimen. Further studies should be conducted in this area, such as investigating whether medication reconciliation and improving medication adherence could decrease the rate of falls.

Sleep disturbances and risk of falls in an old Chinese population-Rugao Longevity and Ageing Study.

PubMed

Ma, Teng; Shi, Guoping; Zhu, Yinsheng; Wang, Yong; Chu, Xuefeng; Jiang, Xiaoyan; Liu, Zuyun; Cai, Jian; Wang, Hongfei; Jin, Li; Wang, Zhendong; Wang, Xiaofeng

2017-11-01

To explore the relationship between sleep disturbances and falls in an elderly Chinese population. Data from 1726 individuals aged 70-87 years from the Rugao Longevity and Ageing Study were used. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep variables. Outcomes were falls ≥1 time per year and falls ≥2 times per year. A total of 22.7% of the participants experienced ≥1 fall, and 9.8% experienced ≥2 falls per year. Poor sleep quality was associated with ≥1 fall (OR 1.08, 95% CI 1.05-1.12; OR 1.27, 95% CI 1.14-1.41) and ≥2 falls (OR 1.08, 95% CI 1.03-1.14; OR 1.28, 95% CI 1.10-1.48), with an increase per PSQI score and SD PSQI score, respectively. In addition, sleep quality, sleep latency, sleep efficiency, and sleep disturbance subcomponents were associated with an increased risk of ≥1 fall with ORs of 1.44 (95% CI, 1.21-1.72), 1.23 (95%CI,1.09-1.40), 1.12 (95%CI, 1.01-1.23) and 1.70 (95% CI,1.35-2.14), respectively, and were associated with an increased risk of ≥2 falls with ORs 1.54 (95%CI, 1.22-1.96), 1.21(95%CI, 1.02-1.44), 1.17 (95% CI 1.02-1.33), and 1.78 (95%CI, 1.31-2.44), respectively. Further, participants slept ≤5h per night had an increased risk of ≥1 fall (OR 2.34; 95%CI, 1.59-3.46) and ≥2 falls (OR 2.19; 95%CI, 1.30-3.69). Poor sleep quality and several subcomponent sleep symptoms were consistently associated with increased risk of falls ≥1 time and ≥2 times in Chinese elderly. The identification of sleep disturbances may help identify high-risk Chinese elders who may benefit from fall prevention education. Copyright © 2017 Elsevier B.V. All rights reserved.

Fall-Risk-Increasing Drugs: A Systematic Review and Meta-analysis: III. Others.

PubMed

Seppala, Lotta J; van de Glind, Esther M M; Daams, Joost G; Ploegmakers, Kimberley J; de Vries, Max; Wermelink, Anne M A T; van der Velde, Nathalie

2018-04-01

The use of psychotropic medication and cardiovascular medication has been associated with an increased risk of falling. However, other frequently prescribed medication classes are still under debate as potential risk factors for falls in the older population. The aim of this systematic review and meta-analysis is to evaluate the associations between fall risk and nonpsychotropic and noncardiovascular medications. A systematic review and meta-analysis. A search was conducted in Medline, PsycINFO, and Embase. Key search concepts were "falls," "aged," "medication," and "causality." Studies were included that investigated nonpsychotropic and noncardiovascular medications as risk factors for falls in participants ≥60 years or participants with a mean age ≥70 years. A meta-analysis was performed using the generic inverse variance method, pooling unadjusted and adjusted odds ratio (OR) estimates separately. In a qualitative synthesis, 281 studies were included. The results of meta-analysis using adjusted data were as follows (a pooled OR [95% confidence interval]): analgesics, 1.42 (0.91-2.23); nonsteroidal anti-inflammatory drugs (NSAIDs), 1.09 (0.96-1.23); opioids, 1.60 (1.35-1.91); anti-Parkinson drugs, 1.54 (0.99-2.39); antiepileptics, 1.55 (1.25-1.92); and polypharmacy, 1.75 (1.27-2.41). Most of the meta-analyses resulted in substantial heterogeneity that did not disappear after stratification for population and setting in most cases. In a descriptive synthesis, consistent associations with falls were observed for long-term proton pump inhibitor use and opioid initiation. Laxatives showed inconsistent associations with falls (7/20 studies showing a positive association). Opioid and antiepileptic use and polypharmacy were significantly associated with increased risk of falling in the meta-analyses. Long-term use of proton pump inhibitors and opioid initiation might increase the fall risk. Future research is necessary because the causal role of some medication classes as fall-risk-increasing drugs remains unclear, and the existing literature contains significant limitations. Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Satisfying Product Features of a Fall Prevention Smartphone App and Potential Users' Willingness to Pay: Web-Based Survey Among Older Adults.

PubMed

Rasche, Peter; Mertens, Alexander; Brandl, Christopher; Liu, Shan; Buecking, Benjamin; Bliemel, Christopher; Horst, Klemens; Weber, Christian David; Lichte, Philipp; Knobe, Matthias

2018-03-27

Prohibiting falls and fall-related injuries is a major challenge for health care systems worldwide, as a substantial proportion of falls occur in older adults who are previously known to be either frail or at high risk for falls. Hence, preventive measures are needed to educate and minimize the risk for falls rather than just minimize older adults' fall risk. Health apps have the potential to address this problem, as they enable users to self-assess their individual fall risk. The objective of this study was to identify product features of a fall prevention smartphone app, which increase or decrease users' satisfaction. In addition, willingness to pay (WTP) was assessed to explore how much revenue such an app could generate. A total of 96 participants completed an open self-selected Web-based survey. Participants answered various questions regarding health status, subjective and objective fall risk, and technical readiness. Seventeen predefined product features of a fall prevention smartphone app were evaluated twice: first, according to a functional (product feature is implemented in the app), and subsequently by a dysfunctional (product feature is not implemented in the app) question. On the basis of the combination of answers from these 2 questions, the product feature was assigned to a certain category (must-be, attractive, one-dimensional, indifferent, or questionable product feature). This method is widely used in user-oriented product development and captures users' expectations of a product and how their satisfaction is influenced by the availability of individual product features. Five product features were identified to increase users' acceptance, including (1) a checklist of typical tripping hazards, (2) an emergency guideline in case of a fall, (3) description of exercises and integrated workout plans that decrease the risk of falling, (4) inclusion of a continuous workout program, and (5) cost coverage by health insurer. Participants' WTP was assessed after all 17 product features were rated and revealed a median monthly payment WTP rate of €5.00 (interquartile range 10.00). The results show various motivating product features that should be incorporated into a fall prevention smartphone app. Results reveal aspects that fall prevention and intervention designers should keep in mind to encourage individuals to start joining their program and facilitate long-term user engagement, resulting in a greater interest in fall risk prevention. ©Peter Rasche, Alexander Mertens, Christopher Brandl, Shan Liu, Benjamin Buecking, Christopher Bliemel, Klemens Horst, Christian David Weber, Philipp Lichte, Matthias Knobe. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 27.03.2018.

Satisfying Product Features of a Fall Prevention Smartphone App and Potential Users’ Willingness to Pay: Web-Based Survey Among Older Adults

PubMed Central

Mertens, Alexander; Brandl, Christopher; Liu, Shan; Buecking, Benjamin; Bliemel, Christopher; Horst, Klemens; Weber, Christian David; Lichte, Philipp; Knobe, Matthias

2018-01-01

Background Prohibiting falls and fall-related injuries is a major challenge for health care systems worldwide, as a substantial proportion of falls occur in older adults who are previously known to be either frail or at high risk for falls. Hence, preventive measures are needed to educate and minimize the risk for falls rather than just minimize older adults’ fall risk. Health apps have the potential to address this problem, as they enable users to self-assess their individual fall risk. Objective The objective of this study was to identify product features of a fall prevention smartphone app, which increase or decrease users’ satisfaction. In addition, willingness to pay (WTP) was assessed to explore how much revenue such an app could generate. Methods A total of 96 participants completed an open self-selected Web-based survey. Participants answered various questions regarding health status, subjective and objective fall risk, and technical readiness. Seventeen predefined product features of a fall prevention smartphone app were evaluated twice: first, according to a functional (product feature is implemented in the app), and subsequently by a dysfunctional (product feature is not implemented in the app) question. On the basis of the combination of answers from these 2 questions, the product feature was assigned to a certain category (must-be, attractive, one-dimensional, indifferent, or questionable product feature). This method is widely used in user-oriented product development and captures users’ expectations of a product and how their satisfaction is influenced by the availability of individual product features. Results Five product features were identified to increase users’ acceptance, including (1) a checklist of typical tripping hazards, (2) an emergency guideline in case of a fall, (3) description of exercises and integrated workout plans that decrease the risk of falling, (4) inclusion of a continuous workout program, and (5) cost coverage by health insurer. Participants’ WTP was assessed after all 17 product features were rated and revealed a median monthly payment WTP rate of €5.00 (interquartile range 10.00). Conclusions The results show various motivating product features that should be incorporated into a fall prevention smartphone app. Results reveal aspects that fall prevention and intervention designers should keep in mind to encourage individuals to start joining their program and facilitate long-term user engagement, resulting in a greater interest in fall risk prevention. PMID:29588268

Is independence of older adults safe considering the risk of falls?

PubMed

Talarska, Dorota; Strugała, Magdalena; Szewczyczak, Marlena; Tobis, Sławomir; Michalak, Michał; Wróblewska, Izabela; Wieczorowska-Tobis, Katarzyna

2017-03-14

Falls affect approx. 30% of elderly population per year. They cause major injuries and reduce independence of the older adults' functioning. The main objective of the study was to evaluate the degree of independence and find the fall risk factors in the study group. The study included 506 - older adults. The study group included patients from GP clinics and members of two senior centers. The study duration was 12 months. Our study tools included EASY- Care Standard 2010 questionnaire, Abbreviated Mental Test Score (AMTS), Index Barthel, Instrumental Activities of Daily Living Scale (IADL), Geriatric Depression Scale (GDS), Timed Up and Go (TUG). The study included 357 (70.6%) female and 149 (29.4%) male subjects. The mean age of the study group patients was 75.7 years ± 8.0. Most of the older adult subjects were independent in both basic (Index Barthel) and instrumental (IADL) activities. Gait fluency evaluated in TUG scale found slow and unsteady gait in 33.7% of the subjects. 27.5% of the subjects used mobility aids when walking. In the Risk of falls scale, 131 subjects (25.89%) were at risk of falls. According to logistic regression the main risk of fall determinants (p <0.05) in the study group were: age, previous falls, feet problems, lack of regular care, impaired vision, urinary incontinence, pain, sleeping disorders, and lowered mood. Risk of falls increases in people less independent in terms of basic and complex life activities and in people with depression. Most of the risk factors can be modified. It is necessary to develop a standard procedure aimed at preventing falls in the elderly.

The influence of mechanical vibration on local and central balance control.

PubMed

Ehsani, Hossein; Mohler, Jane; Marlinski, Vladimir; Rashedi, Ehsan; Toosizadeh, Nima

2018-04-11

Fall prevention has an indispensable role in enhancing life expectancy and quality of life among older adults. The first step to prevent falls is to devise reliable methods to identify individuals at high fall risk. The purpose of the current study was to assess alterations in local postural muscle and central sensory balance control mechanisms due to low-frequency externally applied vibration among elders at high fall risk, in comparison with healthy controls, as a potential tool for assessing fall risk. Three groups of participants were recruited: healthy young (n = 10; age = 23 ± 2 years), healthy elders (n = 10; age = 73 ± 3 years), and elders at high fall risk (n = 10; age = 84 ± 9 years). Eyes-open and eyes-closed upright standing balance performance was measured with no vibration, 30 Hz, and 40 Hz vibration of Gastrocnemius muscles. When vibratory stimulation was applied, changes in local-control performance manifested significant differences among the groups (p < 0.01). On average between conditions, we observed 97% and 92% less change among high fall risk participants when compared to healthy young and older adults, respectively. On the other hand, vibration-induced changes in the central-control performance were not significant between groups (p ≥ 0.19). Results suggest that local-control deficits are responsible for balance behavior alterations among elders at high fall risk and healthy individuals. This observation may be attributable to deterioration of short-latency reflexive loop in elders at high fall risk. On the other hand, we could not ascribe the balance alterations to problems related to central nervous system performance or long-latency responses. Copyright © 2018 Elsevier Ltd. All rights reserved.

Short Berg Balance Scale, BBS-9, as a predictor of fall risk among the aged: a prospective 12-month follow-up study.

PubMed

Hohtari-Kivimäki, Ulla; Salminen, Marika; Vahlberg, Tero; Kivelä, Sirkka-Liisa

2013-12-01

The aim of this study was to assess the adequacy of the short, 9-item Berg Balance Scale (BBS-9) to predict fall risk among the community-dwelling aged. The subjects (n = 519) were derived from the participants in a multifactorial fall prevention intervention conducted in Pori, Finland. Receiver operating characteristic (ROC) analysis was used to determine the cut-off score for BBS-9 (range 0-36) to classify aged people with a fall risk during a 12-month follow-up. Logistic regression was used to analyse the relationship of potential confounders with fall risk. The association between the cut-off score for BBS-9 and fall risk was tested using the Chi-square test. In determining the cut-off score of BBS-9 to classify fall risk, the highest sensitivity (0.51) and specificity (0.57) (when both presumed to be above 0.50) sum score was within the limit range 32 scores or below. The area under curve (AUC) was significantly better in the model adjusted for significant confounders (vision and the number of regularly used drugs) (AUC = 0.64) than in the unadjusted model (AUC = 0.57) (p = 0.045). Among patients who scored 32 or below in BBS-9 the incidence of multiple falls was 20.0 %, whereas among those who scored 33-36 it was 15.7 %. BBS-9 with the cut-off score of 32/33 together with data on vision and the number of regularly used drugs predicted moderately the risk of falling among the community-dwelling aged.

Risk of fall-related injury in people with lower limb amputations: A prospective cohort study.

PubMed

Wong, Christopher Kevin; Chihuri, Stanford T; Li, Guohua

2016-01-01

To assess fall-related injury risk and risk factors in people with lower limb amputation. Prospective longitudinal cohort with follow-up every 6 months for up to 41 months. Community-dwelling adults with lower limb amputations of any etiology and level recruited from support groups and prosthetic clinics. Demographic and clinical characteristics were obtained by self-reported questionnaire and telephone or in-person follow-up. Fall-related injury incidence requiring medical care per person-month and adjusted hazard ratio of fall-related injury were calculated using multivariable proportional hazards regression modeling. A total of 41 subjects, with 782 follow-up person-months in total, had 11 fall-related injury incidents (14.1/1,000 person-months). During follow-up, 56.1% of subjects reported falling and 26.8% reported fall-related injury. Multivariable proportional hazard modeling showed that women were nearly 6 times more likely as men to experience fall-related injury and people of non-white race were 13 times more likely than people of white race to experience fall-related injury. The final predictive model also included vascular amputation and age. Risk of fall-related injury requiring medical care in people with lower limb amputation appears to be higher than in older adult inpatients. Intervention programs to prevent fall-related injury in people with lower limb amputation should target women and racial minorities.

Assessment of the quality of fall detection and management in primary care in the Netherlands based on the ACOVE quality indicators.

PubMed

Askari, M; Eslami, S; van Rijn, M; Medlock, S; Moll van Charante, E P; van der Velde, N; de Rooij, S E; Abu-Hanna, A

2016-02-01

We determined adherence to nine fall-related ACOVE quality indicators to investigate the quality of management of falls in the elderly population by general practitioners in the Netherlands. Our findings demonstrate overall low adherence to these indicators, possibly indicating insufficiency in the quality of fall management. Most indicators showed a positive association between increased risk for functional decline and adherence, four of which with statistical significance. This study aims to investigate the quality of detection and management of falls in the elderly population by general practitioners in the Netherlands, using the Assessing Care of Vulnerable Elders (ACOVE) quality indicators. Community-dwelling persons aged 70 years or above, registered in participating general practices, were asked to fill in a questionnaire designed to determine general practitioner (GP) adherence to fall-related indicators. We used logistic regression to estimate the association between increased risk for functional decline-quantified by the Identification of Seniors At Risk for Primary Care score-and adherence. We then cross-validated the self-reported falls with medical records. Of the 950 elders responding to our questionnaire, only 10.6 % reported that their GP proactively asked them about falls. Of the 160 patients who reported two or more falls, or one fall for which they visited the GP, only 23.1 % had fall documentation in their records. Adherence ranged between 13.6 and 48.6 %. There was a significant positive association between the ISAR-PC scores and adherence in four QIs. Documentation of falls was highest (36.7 %) in patients whom the GP had proactively asked about falls. Based on patient self-reports, adherence to the ACOVE fall-related indicators was poor, suggesting that the quality of evaluation and management of falls in community-dwelling older persons in the Netherlands is poor. The documentation of falls and fall-related risk factors was also poor. However, for most QIs, adherence to them increased with the increase in the risk of functional decline.

Risk factors, incidence, consequences and prevention strategies for falls and fall-injury within older indigenous populations: a systematic review.

PubMed

Lukaszyk, Caroline; Harvey, Lara; Sherrington, Cathie; Keay, Lisa; Tiedemann, Anne; Coombes, Julieann; Clemson, Lindy; Ivers, Rebecca

2016-12-01

To examine the risk factors, incidence, consequences and existing prevention strategies for falls and fall-related injury in older indigenous people. Relevant literature was identified through searching 14 electronic databases, a range of institutional websites, online search engines and government databases, using search terms pertaining to indigenous status, injury and ageing. Thirteen studies from Australia, the United States, Central America and Canada were identified. Few studies reported on fall rates but two reported that around 30% of indigenous people aged 45 years and above experienced at least one fall during the past year. The most common hospitalised fall injuries among older indigenous people were hip fracture and head injury. Risk factors significantly associated with falls within indigenous populations included poor mobility, a history of stroke, epilepsy, head injury, poor hearing and urinary incontinence. No formally evaluated, indigenous-specific fall prevention interventions were identified. Falls are a significant and growing health issue for older indigenous people worldwide that can lead to severe health consequences and even death. No fully-evaluated, indigenous-specific fall prevention programs were identified. Implications for Public Health: Research into fall patterns and fall-related injury among indigenous people is necessary for the development of appropriate fall prevention interventions. © 2016 Public Health Association of Australia.

The Association between Generalized Anxiety Disorder, Subthreshold Anxiety Symptoms and Fear of Falling among Older Adults: Preliminary Results from a Pilot Study.

PubMed

Payette, Marie-Christine; Bélanger, Claude; Benyebdri, Fethia; Filiatrault, Johanne; Bherer, Louis; Bertrand, Josie-Anne; Nadeau, Alexandra; Bruneau, Marie-Andrée; Clerc, Doris; Saint-Martin, Monique; Cruz-Santiago, Diana; Ménard, Caroline; Nguyen, Philippe; Vu, T T Minh; Comte, Francis; Bobeuf, Florian; Grenier, Sébastien

2017-01-01

A relationship between generalized anxiety disorder (GAD) and fear of falling (FOF) has long been proposed but never specifically studied. This study aimed at analyzing the relationship between FOF and GAD or anxiety symptoms, while controlling for major depressive episodes (MDE), depressive symptoms, fall risk, and sociodemographic variables. Twenty-five older adults participated in this pilot study. Assessments included the following: Anxiety Disorder Interview Schedule, Geriatric Anxiety Inventory, Geriatric Depression Scale, Falls-Efficacy Scale-International. A multidisciplinary team evaluated fall risk. FOF was significantly correlated with GAD, MDE, anxiety and depressive symptoms, and fall risk, but not with sociodemographic variables. Multiple regression analyses indicated that GAD and anxiety symptoms were significantly and independently associated with FOF. Although the results of this pilot study should be replicated with larger samples, they suggest that FOF is associated with GAD and anxiety symptoms even when considering physical factors that increase the risk of falling. Treatment of FOF in patients with GAD may present a particular challenge because of the central role of intolerance of uncertainty, which may prevent patients from regaining confidence despite the reduction of fall risk. Clinicians should screen for GAD and anxiety symptoms in patients with FOF to improve detection and treatment.

Biomechanical evaluation of injury severity associated with patient falls from bed.

PubMed

Bowers, Bonnie; Lloyd, John; Lee, W; Powell-Cope, G; Baptiste, A

2008-01-01

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 of 97.5 cm onto a tiled surface. Risk of injury increased to 40% when extrapolated for the height added by bedrails. Using a floor mat decreased this risk to less than 1% for bedrail height for feet-first falls. Calculated impact forces indicated a risk of skull fracture when hitting the tiled surface. Floor mats and height-adjustable beds positioned to the lowest height should be used to decrease the risk of injury associated with falling from bed.

The reliability of the Hendrich Fall Risk Model in a geriatric hospital.

PubMed

Heinze, Cornelia; Halfens, Ruud; Dassen, Theo

2008-12-01

Aims and objectives.  The purpose of this study was to test the interrater reliability of the Hendrich Fall Risk Model, an instrument to identify patients in a hospital setting with a high risk of falling. Background.  Falls are a serious problem in older patients. Valid and reliable fall risk assessment tools are required to identify high-risk patients and to take adequate preventive measures. Methods.  Seventy older patients were independently and simultaneously assessed by six pairs of raters made up of nursing staff members. Consensus estimates were calculated using simple percentage agreement and consistency estimates using Spearman's rho and intra class coefficient. Results.  Percentage agreement ranged from 0.70 to 0.92 between the six pairs of raters. Spearman's rho coefficients were between 0.54 and 0.80 and the intra class coefficients were between 0.46 and 0.92. Conclusions.  Whereas some pairs of raters obtained considerable interobserver agreement and internal consistency, the others did not. Therefore, it is concluded that the Hendrich Fall Risk Model is not a reliable instrument. The use of more unambiguous operationalized items is preferred. Relevance to clinical practice.  In practice, well operationalized fall risk assessment tools are necessary. Observer agreement should always be investigated after introducing a standardized measurement tool. © 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd.

A manual physical therapy intervention for symptoms of knee osteoarthritis and associated fall risk: A case series of four patients.

PubMed

Allen, Chris; Sheehan, Riley; Deyle, Gail; Wilken, Jason; Gill, Norman

2018-02-26

Patients with knee osteoarthritis (OA) are at an increased risk of falling. Further, the symptoms associated with knee OA are correlated with fall risk. A manual physical therapy (MPT) approach consisting of mobilizing techniques and reinforcing exercise improves the symptoms and functional limitations associated with knee OA. The purpose of this case series is to evaluate an MPT intervention of mobilization techniques and exercise for knee OA on improving symptoms and quantify the secondary benefit of improving stumble recovery. Four patients with symptomatic knee OA and four matched controls completed a fall risk assessment. Following 4 weeks of intervention, patients were reevaluated. Initial Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores indicated notable symptoms and functional limitations in all patients. In addition, all patients displayed elevated fall risk and/or impaired stumble responses. Following 4 weeks of intervention, all patients reported meaningful reductions in all three WOMAC subscales and demonstrated improvements in at least two of the three fall risk measures. We identified potential connections between symptom relief in patients with knee OA, stumble response, and ultimately fall risk. The results suggest that MPT intervention designed to improve the signs and symptoms of knee OA may lead to a secondary benefit of improved gait stability and stumble response.

Evaluation of hip fracture risk in relation to fall direction.

PubMed

Nankaku, Manabu; Kanzaki, Hideto; Tsuboyama, Tadao; Nakamura, Takashi

2005-11-01

The purpose of this study is to evaluate hip fracture risk in relation to fall direction, and to elucidate factors that influence the impact force in falls on the hip. Eight healthy volunteers performed deliberate falls in three directions (lateral, posterolateral and posterior) on a force platform covered by a mattress of 13 cm thickness. Fall descent motions and impact postures were examined by a three-dimensional analyzer. The maximum ground force reaction, velocity of the greater trochanter at impact, and activity of quadriceps and gluteus medius were measured. In all trials of lateral and posterolateral falls, but not of posterior falls, the subjects hit their greater trochanter directly on the mattress. The impact forces were between 2,000 N and 4,000 N. Posterolateral falls showed significantly higher velocity at impact than did posterior falls. The height and the lower limb length exhibited positive correlations with the impact force in all directions of fall. In the lateral fall, there was a positive correlation between the activity of quadriceps and the impact force. In view of the impact point, force, and velocity, the posterolateral fall seemed to carry the highest risk of hip fracture.

Factors associated with fall-related fractures in Parkinson's disease.

PubMed

Cheng, Kuei-Yueh; Lin, Wei-Che; Chang, Wen-Neng; Lin, Tzu-Kong; Tsai, Nai-Wen; Huang, Chih-Cheng; Wang, Hung-Chen; Huang, Yung-Cheng; Chang, Hsueh-Wen; Lin, Yu-Jun; Lee, Lian-Hui; Cheng, Ben-Chung; Kung, Chia-Te; Chang, Ya-Ting; Su, Chih-Min; Chiang, Yi-Fang; Su, Yu-Jih; Lu, Cheng-Hsien

2014-01-01

Fall-related fracture is one of the most disabling features of idiopathic Parkinson's disease (PD). A better understanding of the associated factors is needed to predict PD patients who will require treatment. This prospective study enrolled 100 adult idiopathic PD patients. Stepwise logistic regressions were used to evaluate the relationships between clinical factors and fall-related fracture. Falls occurred in 56 PD patients, including 32 with fall-related fractures. The rate of falls in the study period was 2.2 ± 1.4 per 18 months. The percentage of osteoporosis was 34% (19/56) and 11% in PD patients with and without falls, respectively. Risk factors associated with fall-related fracture were sex, underlying knee osteoarthritis, mean Unified Parkinson's Disease Rating Scale score, mean Morse fall scale, mean Hoehn and Yahr stage, and exercise habit. By stepwise logistic regression, sex and mean Morse fall scale were independently associated with fall-related fracture. Females had an odds ratio of 3.8 compared to males and the cut-off value of the Morse fall scale for predicting fall-related fracture was 72.5 (sensitivity 72% and specificity 70%). Higher mean Morse fall scales (>72.5) and female sex are associated with higher risk of fall-related fractures. Preventing falls in the high-risk PD group is an important safety issue and highly relevant for their quality of life. Copyright © 2013 Elsevier Ltd. All rights reserved.

Bayesian networks: a new method for the modeling of bibliographic knowledge: application to fall risk assessment in geriatric patients.

PubMed

Lalande, Laure; Bourguignon, Laurent; Carlier, Chloé; Ducher, Michel

2013-06-01

Falls in geriatry are associated with important morbidity, mortality and high healthcare costs. Because of the large number of variables related to the risk of falling, determining patients at risk is a difficult challenge. The aim of this work was to validate a tool to detect patients with high risk of fall using only bibliographic knowledge. Thirty articles corresponding to 160 studies were used to modelize fall risk. A retrospective case-control cohort including 288 patients (88 ± 7 years) and a prospective cohort including 106 patients (89 ± 6 years) from two geriatric hospitals were used to validate the performances of our model. We identified 26 variables associated with an increased risk of fall. These variables were split into illnesses, medications, and environment. The combination of the three associated scores gives a global fall score. The sensitivity and the specificity were 31.4, 81.6, 38.5, and 90 %, respectively, for the retrospective and the prospective cohort. The performances of the model are similar to results observed with already existing prediction tools using model adjustment to data from numerous cohort studies. This work demonstrates that knowledge from the literature can be synthesized with Bayesian networks.

Elderly users of fall-risk-increasing drug perceptions of fall risk and the relation to their drug use - a qualitative study.

PubMed

Bell, Hege Therese; Steinsbekk, Aslak; Granas, Anne Gerd

2017-09-01

The aim of the study was to explore how home-dwelling elderly who use fall-risk-increasing drugs (FRIDs) perceive their fall risk and how they relate this to their drug use. A qualitative study with 14 home-dwelling elderly FRID users between 65 and 97 years in Central Norway participating in semi-structured individual interviews. The data were analyzed thematically by using systematic text condensation. The main finding was that the informants did not necessarily perceive the use of FRIDs to be a prominent risk factor for falls. Some informants said they did not reflect upon drug use whatsoever and said they fully trusted their physician's choices. When either experiencing dizziness, fall episodes or by reading the patient information leaflet the informants said to either adjust their drug use or to contact their physician. Some felt rejected due to not getting their point across or their wish to alter the drug was not granted by the physician. Elderly FRID users did not necessarily relate their drug use to fall risk or struggled to present their perceived drug-related problems. Physicians need to regularly inform, monitor and assess the drug treatment when treating elderly with FRIDs.

Using the Centers for Disease Control and Prevention's Stay Independent Checklist to Engage a Community of American Indians and Raise Awareness About Risk of Falls, 2016.

PubMed

Popp, Janet; Waters, Debra L; Leekity, Karen; Ghahate, Donica; Bobelu, Jeanette; Tsikewa, Ross; Herman, Carla J; Shah, Vallabh

2017-01-19

The unintentional death rate from falls is higher among American Indians from the US Southwest than from other regions in the country. The Zuni Pueblo is a geographically isolated, rural American Indian community located in western New Mexico. Education and screening for falls risk is lacking in this community and may be needed to reduce falls and falls-related illness and death. Building on a 17-year relationship with the Zuni Health Initiative, meetings were held with Zuni tribal leadership, staff from the Zuni Senior Center and Zuni Home Health Services, members of the Zuni Comprehensive Community Health Center, Indian Health Service, and Zuni community health representatives (CHRs) to discuss elder falls in the community. Existing infrastructure, including CHRs who were already trained and certified in diabetes education and prevention, provided support for the study. Tribal leadership agreed that CHRs would be trained to administer the Centers for Disease Control and Prevention's (CDC's) Stay Independent checklist to assess falls risk. They administered the checklist during one-on-one interviews in Shiwi (Zuni native language), English, or both to a convenience sample of 50 Zuni elders. Mean age of participants was 72 (standard deviation, 7.4) years, and 78% were women. Fifty-two percent reported at least 1 fall during the past year; 66% scored 4 or more on the CDC Stay Independent checklist, indicating elevated risk for falls. CHRs reported that the checklist was easy to administer and culturally accepted by the elder participants. This study broadened the Zuni Health Initiative to include falls risk screening. Self-reported falls were common in this small sample, and the incidence was significantly higher than the national rate. These results highlight the need for community engagement, using culturally acceptable falls screening, to promote falls education and implement falls prevention programs.

Using the Hendrich II Inpatient Fall Risk Screen to Predict Outpatient Falls After Emergency Department Visits.

PubMed

Patterson, Brian W; Repplinger, Michael D; Pulia, Michael S; Batt, Robert J; Svenson, James E; Trinh, Alex; Mendonça, Eneida A; Smith, Maureen A; Hamedani, Azita G; Shah, Manish N

2018-04-01

To evaluate the utility of routinely collected Hendrich II fall scores in predicting returns to the emergency department (ED) for falls within 6 months. Retrospective electronic record review. Academic medical center ED. Individuals aged 65 and older seen in the ED from January 1, 2013, through September 30, 2015. We evaluated the utility of routinely collected Hendrich II fall risk scores in predicting ED visits for a fall within 6 months of an all-cause index ED visit. For in-network patient visits resulting in discharge with a completed Hendrich II score (N = 4,366), the return rate for a fall within 6 months was 8.3%. When applying the score alone to predict revisit for falls among the study population the resultant receiver operating characteristic (ROC) plot had an area under the curve (AUC) of 0.64. In a univariate model, the odds of returning to the ED for a fall in 6 months were 1.23 times as high for every 1-point increase in Hendrich II score (odds ratio (OR)=1.23 (95% confidence interval (CI)=1.19-1.28). When included in a model with other potential confounders or predictors of falls, the Hendrich II score is a significant predictor of a return ED visit for fall (adjusted OR=1.15, 95% CI=1.10-1.20, AUC=0.75). Routinely collected Hendrich II scores were correlated with outpatient falls, but it is likely that they would have little utility as a stand-alone fall risk screen. When combined with easily extractable covariates, the screen performs much better. These results highlight the potential for secondary use of electronic health record data for risk stratification of individuals in the ED. Using data already routinely collected, individuals at high risk of falls after discharge could be identified for referral without requiring additional screening resources. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Equivalent Fall Risk in Elderly Patients on Hemodialysis and Peritoneal Dialysis.

PubMed

Farragher, Janine; Rajan, Tasleem; Chiu, Ernest; Ulutas, Ozkan; Tomlinson, George; Cook, Wendy L; Jassal, Sarbjit V

2016-01-01

♦ Accidental falls are common in the hemodialysis (HD) population. The high fall rate has been attributed to a combination of aging, kidney disease-related morbidity, and HD treatment-related hazards. We hypothesized that patients maintained on peritoneal dialysis (PD) would have fewer falls than those on chronic HD. The objective of this study was to compare the falls risk between cohorts of elderly patients maintained on HD and PD, using prospective data from a large academic dialysis facility. ♦ Patients aged 65 years or over on chronic in-hospital HD and PD at the University Health Network were recruited. Patients were followed biweekly, and falls occurring within the first year recorded. Fall risk between the 2 groups was compared using both crude and adjusted Poisson lognormal random effects modeling. ♦ Out of 258 potential patients, 236 were recruited, assessed at baseline, and followed biweekly for falls. Of 74 PD patients, 40 (54%) experienced 86 falls while 76 out of 162 (47%) HD patients experienced a total of 305 falls (crude fall rate 1.25 vs 1.60 respectively, odds ratio [OR] falls in PD patients 0.78, 95% confidence interval [CI] 0.61 - 0.92, p = 0.04). After adjustment for differences in comorbidity, number of medications, and other demographic differences, PD patients were no less likely to experience accidental falls than HD patients (OR 1.63, 95% CI 0.88 - 3.04, p = 0.1). ♦ We conclude that accidental falls are equally common in the PD population and the HD population. These data argue against post-HD hypotension as the sole contributor to the high fall risk in the dialysis population. Copyright © 2016 International Society for Peritoneal Dialysis.

A long-recommended but seldom-used method of analysis for fall injuries found a unique pattern of risk factors in the youngest-old.

PubMed

Legrand, Helen; Pihlsgård, Mats; Nordell, Eva; Elmståhl, Sölve

2015-08-01

Few studies on fall risk factors use long-recommended methods for analysis of recurrent events. Previous falls are the biggest risk factor for future falls, but few fall studies focus on the youngest-old. This study's objective was to apply Cox regression for recurrent events to identify factors associated with injurious falls in the youngest-old. Participants were community-dwelling residents of southern Sweden (n = 1,133), aged 59-67 at baseline (median 61.2), from the youngest cohorts of the larger Good Aging in Skåne (GÅS) study. Exposure variable data were collected from baseline study visits and medical records. Injurious falls, defined as emergency, inpatient, or specialist visits associated with ICD-10 fall codes during the follow-up period (2001-2011), were gathered from national and regional registries. Analysis was conducted using time to event Cox Regression for recurrent events. A majority (77.1 %) of injurious falls caused serious injuries such as fractures and open wounds. Exposure to nervous system medications [hazard ratio (HR) 1.40, 95 % confidence interval (CI) 1.03-1.89], central nervous system disease (HR 1.79, CI 1.18-2.70), and previous injurious fall(s) (HR 2.00, CI 1.50-2.68) were associated with increased hazard of injurious fall. Regression for recurrent events is feasible with typical falls' study data. The association of certain exposures with increased hazard of injurious falls begins earlier than previously studied. Different patterns of risk factors by age can provide insight into the progression of frailty. Tailored fall prevention screening and intervention may be of value in populations younger than those traditionally screened.

Predicting falls using two instruments (the Hendrich Fall Risk Model and the Morse Fall Scale) in an acute care setting in Lebanon.

PubMed

Nassar, Nada; Helou, Nancy; Madi, Chantal

2014-06-01

To assess the predictive value of two instruments (the Morse Fall Scale (MFS) and the Heindrich II Fall Risk Model (HFRM)] in a Middle Eastern country (Lebanon) and to evaluate the factors that are related to falls. A prospective observational cross-sectional design was used. Falls and fall-related injuries in the acute care settings contribute a substantial health and economic burden on patients and organisations. Preventing falls is a priority for most healthcare organisations. While the risk of falling cannot be eliminated, it can be significantly reduced through accurate assessment of patients' risk of falling. Data from 1815 inpatients at the American University of Beirut Medical Center (AUBMC) in Lebanon were evaluated using two instruments to predict falls: the MFS and the HFRM. The incidence of falls was 2·7% in one year. The results indicate that while the instruments were significantly correlated, the HFRM was more sensitive in predicting falls than the MFS. The internal consistency of both scales was moderate, but inter-rater reliability was high. Patients using antiepileptic drugs and assistance devises had higher odds of falling. Although both instruments were easy to use in a Middle Eastern country, the HFRM rather than the MFS is recommended for inpatients in an acute care setting as it had higher sensitivity and specificity. It is recommended that while the HFRM had adequate sensitivity, it is not seamless, and as such, nurses should not rely entirely on it. Rather, nurses should use their expert clinical judgement, their ethical obligations and cultural considerations to implement a safer environment of care for the patient. © 2013 John Wiley & Sons Ltd.

Fall risk factors analysis based on sample entropy of plantar kinematic signal during stance phase.

PubMed

Shengyun Liang; Huiyu Jia; Zilong Li; Huiqi Li; Xing Gao; Zuchang Ma; Yingnan Ma; Guoru Zhao

2016-08-01

Falls are a multi-causal phenomenon with a complex interaction. The aim of our research is to study the effect of multiple variables for potential risk of falls and construct an elderly fall risk assessment model based on demographics data and gait characteristics. A total of 101 subjects, whom belong to Malianwa Street, aged above 50 years old and participated in questionnaire survey. Participants were classified into three groups (high, medium and low risk group) according to the score of elderly fall risk assessment scale. In addition, the data of ground reaction force (GRF) and ground reaction moment (GRM) was record when they performed walking at comfortable state. The demographic variables, sample entropy of GRF and GRM, and impulse difference of bilateral foot were considered as potential explanatory variables of risk assessment model. Firstly, we investigated whether different groups could present difference in every variable. Statistical differences were found for the following variables: age (p=2.28e-05); impulse difference (p=0.02036); sample entropy of GRF in vertical direction (p=0.0144); sample entropy of GRM in anterior-posterior direction (p=0.0387). Finally, the multiple regression analysis results indicated that age, impulse difference and sample entropy of resultant GRM could identify individuals who had different levels of fall risk. Therefore, those results could potentially be useful in the fall risk assessment and monitor the state of physical function in elderly population.

A qualitative understanding of patient falls in inpatient mental health units.

PubMed

Powell-Cope, Gail; Quigley, Patricia; Besterman-Dahan, Karen; Smith, Maureen; Stewart, Jonathan; Melillo, Christine; Haun, Jolie; Friedman, Yvonne

2014-01-01

Falls are the leading cause of injury-related deaths among people age 65 and older, and fractures are the major category of serious injuries produced by falls. Determine market segment-specific recommendations for "selling" falls prevention in acute inpatient psychiatry. Descriptive using focus groups. One inpatient unit at a Veterans' hospital in the Southeastern United States and one national conference of psychiatric and mental health nurses. A convenience sample of 22 registered nurses and advanced practice nurses, one physical therapist and two physicians participated in one of six focus groups. None. Focus groups were conducted by expert facilitators using a semistructured interview guide. Focus groups were recorded and transcribed. Content analysis was used to organize findings. Findings were grouped into fall risk assessment, clinical fall risk precautions, programmatic fall prevention, and "selling" fall prevention in psychiatry. Participants focused on falls prevention instead of fall injury prevention, were committed to reducing risk, and were receptive to learning how to improve safety. Participants recognized unique features of their patients and care settings that defined risk, and were highly motivated to work with other disciplines to keep patients safe. Selling fall injury prevention to staff in psychiatric settings is similar to selling fall injury prevention to staff in other health care settings. Appealing to the larger construct of patient safety will motivate staff in psychiatric settings to implement best practices and customize these to account for unique population needs characteristics. © The Author(s) 2014.

Revisit, Subsequent Hospitalization, Recurrent Fall, and Death Within 6 Months After a Fall Among Elderly Emergency Department Patients.

PubMed

Sri-On, Jiraporn; Tirrell, Gregory P; Bean, Jonathan F; Lipsitz, Lewis A; Liu, Shan W

2017-10-01

We seek to describe the risk during 6 months and specific risk factors for recurrent falls, emergency department (ED) revisits, subsequent hospitalizations, and death within 6 months after a fall-related ED presentation. This was a secondary analysis of a retrospective cohort of elderly fall patients who presented to the ED from one urban teaching hospital. We included patients aged 65 years and older who had an ED fall visit in 2012. We examined the frequency and risk factors of adverse events (composite of recurrent falls, ED revisits, subsequent hospitalization, and death, selected a priori) at 6 months. Our study included 350 older adults. Adverse events steadily increased, from 7.7% at 7 days, 21.4% at 30 days, and 50.3% at 6 months. Within 6 months, 22.6% of patients had at least one recurrent fall, 42.6% revisited the ED, 31.1% had subsequent hospitalizations, and 2.6% died. In multivariable logistic regression analysis, psychological or sedative drug use predicted recurrent falls, ED revisits, subsequent hospitalizations, and adverse events. More than half of fall patients had an adverse event within 6 months of presenting to the ED after a fall. The risk during 6 months of these adverse events increased with psychological or sedative drug use. Larger future studies should confirm this association and investigate methods to minimize recurrent falls through management of such medications. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

It Takes a Village to Prevent Falls: Reconceptualizing Fall Prevention and Management for Older Adults

PubMed Central

Ganz, David A.; Alkema, Gretchen E.; Wu, Shinyi

2013-01-01

Systematic evidence reviews support the efficacy of physical activity programs and multifactorial strategies for fall prevention. However, community settings where 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. We highlight examples of innovative programs and policies that provide fall prevention strategies consistent with the ICCC framework, and provide evidence where available on the effects of these strategies on processes and outcomes of care. We close by proposing a “no wrong door” approach to fall prevention and management, in which older adults who are found to be at risk for 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

Falls and Fractures: A systematic approach to screening and prevention.

PubMed

Ambrose, Anne Felicia; Cruz, Lisanne; Paul, Geet

2015-09-01

Falls are one of the major causes of mortality and morbidity in older adults. Every year, an estimated 30-40% of patients over the age of 65 will fall at least once. Falls lead to moderate to severe injuries, fear of falling, loss of independence and death in a third of those patients. Falls account for 87 % of all fractures in the elderly. These fractures are almost always due to low impact injuries in osteoporotic bones. Several organizations have recommended screening older patients to identify those with a high risk of falling and, or fractures. The present review provides a brief summary and update of the relevant literature, summarizing screening tools and interventions to prevent falls and fractures. The major risk factors identified are impaired balance and gait, polypharmacy, and history of previous falls. Other risk factors include advancing age, female gender, visual impairments, cognitive decline especially attention and executive dysfunction, and environmental factors. Recommendations for the clinician to screen and prevent falls in older patients are also summarized. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A small-area study of environmental risk assessment of outdoor falls.

PubMed

Lai, Poh-Chin; Wong, Wing-Cheung; Low, Chien-Tat; Wong, Martin; Chan, Ming-Houng

2011-12-01

Falls in public places are an issue of great health concern especially for the elderly. Falls among the elderly is also a major health burden in many countries. This study describes a spatial approach to assess environmental causes of outdoor falls using a small urban community in Hong Kong as an example. The method involves collecting data on fall occurrences and mapping their geographic positions to examine circumstances and environmental evidence that contribute to falls. High risk locations or hot spots of falls are identified on the bases of spatial proximity and concentration of falls within a threshold distance by means of kernel smoothing and standard deviational ellipses. This method of geographic aggregation of individual fall incidents for a small-area study yields hot spots of manageable sizes. The spatial clustering approach is effective in two ways. Firstly, it allows visualisation and isolation of fall hot spots to draw focus. Secondly and especially under conditions of resource decline, policy makers are able to target specific locations to examine the underlying causal mechanisms and strategise effective response and preventive measures based on the types of environmental risk factors identified.

Association of stressful life events with incident falls and fractures in older men: the Osteoporotic Fractures in Men (MrOS) Study

PubMed Central

Fink, Howard A.; Kuskowski, Michael A.; Marshall, Lynn M.

2014-01-01

Background: small, retrospective studies suggest that major life events and/or sudden emotional stress may increase fall and fracture risk. The current study examines these associations prospectively. Methods: a total of 5,152 men aged ≥65 years in the Osteoporotic Fractures in Men study self-reported data on stressful life events for 1 year prior to study Visit 2. Incident falls and fractures were ascertained for 1 year after Visit 2. Fractures were centrally confirmed. Results: a total of 2,932 (56.9%) men reported ≥1 type of stressful life event. In men with complete stressful life event, fall and covariate data (n = 3,949), any stressful life event was associated with a 33% increased risk of incident fall [relative risk (RR) 1.33, 95% confidence interval (CI) 1.19–1.49] and 68% increased risk of multiple falls (RR = 1.68, 95% CI = 1.40–2.01) in the year following Visit 2 after adjustment for age, education, Parkinson's disease, diabetes, stroke, instrumental activities of daily living (IADL) impairment, chair stand time, walk speed, multiple past falls, depressive symptoms and antidepressant use. Risk increased with the number of types of stressful life events. Though any stressful life event was associated with a 58% increased age-adjusted risk for incident fracture, this association was attenuated and no longer statistically significant after additional adjustment for total hip bone mineral density, fracture after age 50, Parkinson's disease, stroke and IADL impairment. Conclusions: in this cohort of older men, stressful life events significantly increased risk of incident falls independent of other explanatory variables, but did not independently increase incident fracture risk. PMID:24002237

Fall predictors in older cancer patients: a multicenter prospective study.

PubMed

Vande Walle, Nathalie; Kenis, Cindy; Heeren, Pieter; Van Puyvelde, Katrien; Decoster, Lore; Beyer, Ingo; Conings, Godelieve; Flamaing, Johan; Lobelle, Jean-Pierre; Wildiers, Hans; Milisen, Koen

2014-12-15

In the older population falls are a common problem and a major cause of morbidity, mortality and functional decline. The etiology is often multifactorial making the identification of fall predictors essential for preventive measures. Despite this knowledge, data on falls within the older cancer population are limited. The objective of this study was to evaluate the occurrence of falls within 2 to 3 months after cancer treatment decision and to identify predictors of falls (≥1 fall) during follow-up. Older patients (70 years or more) with a cancer treatment decision were included. At baseline, all patients underwent geriatric screening (G8 and Flemish Triage Risk Screening Tool), followed by a geriatric assessment including living situation, activities of daily living (ADL), instrumental activities of daily living (IADL), fall history in the past 12 months, fatigue, cognition, depression, nutrition, comorbidities and polypharmacy. Questionnaires were used to collect follow-up (2-3 months) data. Univariate and multivariate analyses were performed to identify predictors for falls (≥1 fall) during follow-up. At baseline, 295 (31.5%) of 937 included patients reported at least one fall in the past 12 months with 88 patients (29.5%) sustaining a major injury. During follow-up (2-3 months), 142 (17.6%) patients fell, of whom 51.4% fell recurrently and 17.6% reported a major injury. Baseline fall history in the past 12 months (OR = 3.926), fatigue (OR = 0.380), ADL dependency (OR = 0.492), geriatric risk profile by G8 (OR = 0.471) and living alone (OR = 1.631) were independent predictors of falls (≥1 fall) within 2-3 months after cancer treatment decision. Falls are a serious problem among older cancer patients. Geriatric screening and assessment data can identify patients at risk for a fall. A patient with risk factors associated with falls should undergo further evaluation and intervention to prevent potentially injurious fall incidents.

Fall prevention in acute care hospitals: a randomized trial.

PubMed

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

2010-11-03

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. To investigate whether a fall prevention tool kit (FPTK) using health information technology (HIT) decreases patient falls in hospitals. 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). 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. The primary outcome was patient falls per 1000 patient-days adjusted for site and patient care unit. A secondary outcome was fall-related injuries. 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. The use of a fall prevention tool kit in hospital units compared with usual care significantly reduced rate of falls. clinicaltrials.gov Identifier: NCT00675935.

Fall Prevention in Acute Care Hospitals

PubMed Central

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

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. PMID:21045097

Differences in Functional Fitness Among Older Adults With and Without Risk of Falling.

PubMed

Zhao, Yanan; Chung, Pak-Kwong

2016-03-01

This study aimed to identify the differences in functional fitness between older adults who were at risk of falling and those who were not. A total of 104 older adults aged 65-74 years were recruited from a local community senior center. They were independent older adults without a history of falls in the preceding 12 months. Falling risk status was assessed using the Fall Risk Test. Five dimensions of functional fitness with seven testing parameters (i.e., 30-second chair stand test, 30-second arm curl test, 2-minute step test, chair sit and reach test, back scratch test, 8-foot up and go test, and body mass index) were evaluated by the Senior Fitness Test. Only 78 participants completed all the tests, of which 48 participants were identified with risk of falling, and 30 participants were free from risk of falling. Results from multivariate analysis of variance found significant differences on the combined outcome variables, especially in the 8-foot up and go test, 2-minute step test, and 30-second arm curl test. Results from discriminant analysis found a significant discriminant function among all the seven testing parameters, where the 8-foot up and go test, and the 2-minute step test contributed most. Older adults who are at the early stage of risk of falling tend to have lower functional fitness capacities, especially in agility and dynamic balance, aerobic endurance as well as in a combined relationship among all the testing parameters. Copyright © 2016. Published by Elsevier B.V.

Effectiveness of individualized fall prevention program in geriatric rehabilitation hospital setting: a cluster randomized trial.

PubMed

Aizen, Efraim; Lutsyk, Galina; Wainer, Lea; Carmeli, Sarit

2015-10-01

There is no conclusive evidence that hospital fall prevention programs can reduce the number of falls. We aimed to investigate the effect of a targeted individualized falls prevention program in a geriatric rehabilitation hospital. This was a two-stage cluster-controlled trial carried out in five geriatric rehabilitation wards. Participants were 752 patients with mean age 83.2 years. The intervention was a two-phase targeted intervention falls prevention program. The intervention included an assessment of patient's risk by a risk assessment tool and an individual management that includes medical, behavioral, cognitive and environmental modifications. Patients with moderate risk received additionally orientation guidance, and mobility restriction. Patients determined as high risk were additionally placed under permanent personal supervision. Outcome measures were falls during hospital stay. In both stages of the trial, intervention and control wards were almost similar at baseline for individual patient characteristics. Overall, 37 falls occurred during the study. No significant difference was found in fall rates during follow-up between intervention and control wards: 1.306 falls per 1000 bed days in the intervention groups and 1.763-1.826 falls per 1000 bed days in the control groups. The adjusted hazard ratio for falls in the intervention groups was 1.36 (95 % confidence interval 0.89-1.77) (P = 0.08) in the first stage and 1.27 (95 % confidence interval 0.92-1.67) (P = 0.12) in the second stage. These results suggest that in a geriatric rehabilitation hospital a targeted individualized intervention falls prevention program is not effective in reducing falls.

Relationship of Prescribed Drugs with the Risk of Fall in Inpatients.

PubMed

Kozono, Aki; Isami, Keisuke; Shiota, Kimiko; Tsumagari, Kyouichi; Nagano, Masahisa; Inoue, Daisuke; Adachi, Rui; Hiraki, Yoichi; Nakagawa, Yoshihiro; Kamimura, Hidetoshi; Yamamichi, Ken

2016-01-01

Falls are common in elderly patients and are often serious. Several drugs have been associated with an increased risk of fall. Older adults often take multiple drugs for chronic diseases, and thus may be at increased risk from drugs associated with fall. We investigated the association between drug use and falling in hospitalized older people, with the goal of identifying medications that may increase the risk of a fall. A retrospective case control study was performed at the National Hospital Organization Kumamoto Saishunso Hospital in Japan. Medications taken by patients who fell (n=57) were compared with those taken by patients who did not fall (n=63). The median age (interquartile range; IQR) of the fall and non-fall groups were 75.0 (67.0-83.0) and 80.0 (70.3-84.5) years, respectively. The characteristics of the two groups were similar, with no significant differences in age, sex, or body weight. The probability of falling increased when the patients used zolpidem [odds ratio (OR)=2.47; 95%CI: 1.09-5.63; p<0.05] and calcium channel antagonists (OR=0.299; 95%CI: 0.13-0.68; p<0.01), and was also related to physical factors (OR=2.27; 95%CI: 1.01-5.09; p<0.05). Elderly patients taking zolpidem may fall due to sleepiness, and blood pressure control may be important to prevent orthostatic high blood pressure. In the treatment of elderly people, medical staff should try to choose drugs that prevent fall or are not associated with falling.

Insights about Fall Prevention of Older Adults in the State of Hawai'i.

PubMed

Yamazaki, Yuka; Hayashida, Cullen T; Yontz, Valerie

2017-01-01

The senior population in Hawai'i is growing at a dramatic pace. In the older population, falls and fall-related injuries are leading causes of morbidity and mortality. Moreover, the health care costs for falls are very high. The State of Hawai'i has taken measures to prevent falls through the promotion of medication reviews, vision checks, home assessments, and exercise. However, current published examinations of fall preventive measures have been insufficient, and more research is needed to confirm risk factors, effectiveness of preventive measures, and to explore future objectives. This paper examined the validity of fall risk factors and fall preventive measures for Hawai'i's seniors by conducting mail questionnaire surveys to a sample of seniors using medical alert services from one company in Hawai'i. The results of chi-square analysis suggest that having reduced ability to perform Activities of Daily Living (ADL) and reduced Instrumental Activities of Daily Living (IADL) were associated with a greater risk of falls ( P < .01). In addition, those who fell were more likely to talk about fall preventions with their family members or friends and health providers compared with those who did not ( P = .048 and .003, respectively). Evidence-based exercise programs for strengthening muscles and controlling physical balance may be needed to improve ADL and IADL. Furthermore, the results suggest that seniors do not accept that they are at risk of falling before they actually fall. Public health providers should consider how they approach seniors, and how they inform them of the importance of fall prevention across the life span.

The Association between Hearing Loss, Postural Control, and Mobility in Older Adults: A Systematic Review.

PubMed

Agmon, Maayan; Lavie, Limor; Doumas, Michail

2017-06-01

Degraded hearing in older adults has been associated with reduced postural control and higher risk of falls. Both hearing loss (HL) and falls have dramatic effects on older persons' quality of life (QoL). A large body of research explored the comorbidity between the two domains. The aim of the current review is to describe the comorbidity between HL and objective measures of postural control, to offer potential mechanisms underlying this relationship, and to discuss the clinical implications of this comorbidity. PubMed and Google Scholar were systematically searched for articles published in English up until October 15, 2015, using combinations of the following strings and search words: for hearing: Hearing loss, "Hearing loss," hearing, presbycusis; for postural control: postural control, gait, postural balance, fall, walking; and for age: elderly, older adults. Of 211 screened articles, 7 were included in the systematic review. A significant, positive association between HL and several objective measures of postural control was found in all seven studies, even after controlling for major covariates. Severity of hearing impairment was connected to higher prevalence of difficulties in walking and falls. Physiological, cognitive, and behavioral processes that may influence auditory system and postural control were suggested as potential explanations for the association between HL and postural control. There is evidence for the independent relationship between HL and objective measures of postural control in the elderly. However, a more comprehensive understanding of the mechanisms underlying this relationship is yet to be elucidated. Concurrent diagnosis, treatment, and rehabilitation of these two modalities may reduce falls and increase QoL in older adults. American Academy of Audiology

A High-yield Fall Risk and Adverse Events Screening Questions From the Stopping Elderly Accidents, Death, and Injuries (STEADI) Guideline for Older Emergency Department Fall Patients.

PubMed

Sri-On, Jiraporn; Tirrell, Gregory Philip; Kamsom, Anucha; Marill, Keith A; Shankar, Kalpana Narayan; Liu, Shan W

2018-03-25

The objectives were to examine whether responses to the Stopping Elderly Accidents, Death, and Injuries (STEADI) questions responses predicted adverse events after an older adult emergency department (ED) fall visits and to identify factors associated with such recurrent fall. We conducted a prospective study at two urban, teaching hospitals. We included patients aged ≥ 65 years who presented to the ED for an accidental fall. Data were gathered for fall-relevant comorbidities, high-risk medications for falls, and the responses to 12 questions from the STEADI guideline recommendation. Our outcomes were the number of 6-month adverse events that were defined as mortality, ED revisit, subsequent hospitalization, recurrent falls, and a composite outcome. There were 548 (86.3%) patients who completed follow-up and 243 (44.3%) patients experienced an adverse event after a fall within 6 months. In multivariate analysis, seven questions from the STEADI guideline predicted various outcomes. The question "Had previous fall" predicted recurrent falls (odds ratio [OR] = 2.45, 95% confidence interval [CI] = 1.52 to 3.97), the question "Feels unsteady when walking sometimes" (OR = 2.34, 95% CI = 1.44 to 3.81), and "Lost some feeling in their feet" predicted recurrent falls. In addition to recurrent falls risk, the supplemental questions "Use or have been advised to use a cane or walker," "Take medication that sometimes makes them feel light-headed or more tired than usual," "Take medication to help sleep or improve mood," and "Have to rush to a toilet" predicted other outcomes. A STEADI score of ≥4 did not predict adverse outcomes although seven individual questions from the STEADI guidelines were associated with increased adverse outcomes within 6 months. These may be organized into three categories (previous falls, physical activity, and high-risk medications) and may assist emergency physicians to evaluate and refer high-risk fall patients for a comprehensive falls evaluation. © 2018 by the Society for Academic Emergency Medicine.

One-leg balance is an important predictor of injurious falls in older persons.

PubMed

Vellas, B J; Wayne, S J; Romero, L; Baumgartner, R N; Rubenstein, L Z; Garry, P J

1997-06-01

To test the hypothesis that one-leg balance is a significant predictor of falls and injurious falls. Analysis of data from a longitudinal cohort study. Healthy, community-living volunteers older than age 60 enrolled in the Albuquerque Falls Study and followed for 3 years (N = 316; mean age 73 years). Falls and injurious falls detected via reports every other month. Baseline measures of demographics, history, physical examination, Iowa Self Assessment Inventory, balance and gait assessment, and one-leg balance (ability to stand unassisted for 5 seconds on one leg). At baseline, 84.5% of subjects could perform one-leg balance. (Impairment was associated with older age and gait abnormalities.) Over the 3-year follow-up, 71% experienced a fall and 22% an injurious fall. The only independent significant predictor of all falls using logistic regression was age greater than 73. However, impaired one-leg balance was the only significant independent predictor of injurious falls (relative risk: 2.13; 95% CI: 1.04, 4.34; P = .03). One-leg balance appears to be a significant and easy-to-administer predictor of injurious falls, but not of all falls. In our study, it was the strongest individual predictor. However, no single factor seems to be accurate enough to be relied on as a sole predictor of fall risk or fall injury risk because so many diverse factors are involved in falling.

How Do Community-Dwelling Persons with Alzheimer Disease Fall? Falls in the FINALEX Study.

PubMed

Perttila, Niko M; Öhman, Hannareeta; Strandberg, Timo E; Kautiainen, Hannu; Raivio, Minna; Laakkonen, Marja-Liisa; Savikko, Niina; Tilvis, Reijo S; Pitkala, Kaisu H

2017-01-01

People with dementia are at high risk for falls. However, little is known of the features causing falls in Alzheimer disease (AD). Our aim was to investigate how participants with AD fall. In the FINALEX (Finnish Alzheimer Disease Exercise Trial) study, participants' ( n = 194) falls were followed up for 1 year by diaries kept by their spouses. The most common reason for falls ( n = 355) was stumbling ( n = 61). Of the falls, 123 led to injuries, 50 to emergency department visits, and 13 to fractures. The participants without falls ( n = 103) were younger and had milder dementia than those with 1 ( n = 34) or ≥2 falls ( n = 57). Participants with a Mini Mental State Examination score of around 10 points were most prone to fall. In adjusted regression models, good nutritional status, good physical functioning, and use of antihypertensive medication (incident rate ratio [IRR] 0.68, 95% confidence interval [CI] 0.54-0.85) protected against falls, whereas fall history (IRR 2.71, 95% CI 2.13-3.44), osteoarthritis, diabetes mellitus, chronic obstructive pulmonary disease, higher number of drugs, drugs with anticholinergic properties, psychotropics, and opioids (IRR 4.27, 95% CI 2.92-6.24) were risk factors for falls. Our study provides a detailed account on how and why people with AD fall, suggesting several risk and protective factors.

How Do Community-Dwelling Persons with Alzheimer Disease Fall? Falls in the FINALEX Study

PubMed Central

Perttila, Niko M.; Öhman, Hannareeta; Strandberg, Timo E.; Kautiainen, Hannu; Raivio, Minna; Laakkonen, Marja-Liisa; Savikko, Niina; Tilvis, Reijo S.; Pitkala, Kaisu H.

2017-01-01

Background People with dementia are at high risk for falls. However, little is known of the features causing falls in Alzheimer disease (AD). Our aim was to investigate how participants with AD fall. Methods In the FINALEX (Finnish Alzheimer Disease Exercise Trial) study, participants' (n = 194) falls were followed up for 1 year by diaries kept by their spouses. Results The most common reason for falls (n = 355) was stumbling (n = 61). Of the falls, 123 led to injuries, 50 to emergency department visits, and 13 to fractures. The participants without falls (n = 103) were younger and had milder dementia than those with 1 (n = 34) or ≥2 falls (n = 57). Participants with a Mini Mental State Examination score of around 10 points were most prone to fall. In adjusted regression models, good nutritional status, good physical functioning, and use of antihypertensive medication (incident rate ratio [IRR] 0.68, 95% confidence interval [CI] 0.54–0.85) protected against falls, whereas fall history (IRR 2.71, 95% CI 2.13–3.44), osteoarthritis, diabetes mellitus, chronic obstructive pulmonary disease, higher number of drugs, drugs with anticholinergic properties, psychotropics, and opioids (IRR 4.27, 95% CI 2.92–6.24) were risk factors for falls. Conclusions Our study provides a detailed account on how and why people with AD fall, suggesting several risk and protective factors. PMID:28690633

A poor performance in comprehensive geriatric assessment is associated with increased fall risk in elders with hypertension: a cross-sectional study

PubMed Central

Chu, Jiao-Jiao; Chen, Xu-Jiao; Shen, Shan-Shan; Zhang, Xue-Feng; Chen, Ling-Yan; Zhang, Jing-Mei; He, Jing; Zhao, Jun-Feng

2015-01-01

Background Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose of this study was to determine if age related systemic functional decline related with increased fall risks in elderly patients with hypertension. Methods A total of 342 elderly hypertension patients (age 79.5 ± 6.7 years, male 63.8%) were recruited to the study. Comprehensive geriatric assessment (CGA), including measurements about activity of daily living (ADL), nutrition, cognition, depression, numbers of prescription medication and number of clinical diagnosis, was conducted to evaluate the physical and mental status of each participants. Fall risk was evaluated by Morse fall scale, Tinetti performance oriented mobility assessment (POMA) and history of fall in the recent year. Participants were grouped into tertiles according to CGA score. Correlation between CGA and fall risk was analyzed through SPSS 18.0. Results Participants with higher CGA score were likely to be older, had a lower body mass index (BMI), and a higher prevalence of cardiovascular disease, chronic obstructive pulmonary disease (COPD), cerebrovascular disease and osteoarthropathia. Participants in higher tertile of CGA score got increased prevalence of fall risk than those in lower tertile (P < 0.01 T3 vs. T1, P < 0.01 T3 vs. T2). Correlation analysis and regression analysis showed significant association between CGA and Morse fall scale (P < 0.001), as well as CGA and POMA (P < 0.001). Meanwhile, CGA components also showed co-relationships with increase fall risks. After adjusting age, BMI, benzodiazepine use, cardiovascular disease, cerebrovascular disease, COPD and osteoarthropathia, both history of fall in the recent year and rising Morse fall scale were significantly associated with ADL impairment (OR: 2.748, 95%CI: 1.598–4.725), (OR: 3.310, 95%CI: 1.893–5.788). Decreased Tinetti POMA score was associated with Mini-Mental State Examination (MMSE) (OR: 4.035, 95%CI: 2.100–7.751), ADL (OR: 2.380, 95%CI: 1.357−4.175) and shortened MNA form (MNA-SF) impairment (OR: 2.692, 95%CI: 1.147−6.319). Conclusions In elderly adults with hypertension, impaired physical and mental function is associated with increased fall risk. Further study is required to investigate possible mediators for the association and effective interventions. PMID:25870613

Dialysis Facility Safety: Processes and Opportunities.

PubMed

Garrick, Renee; Morey, Rishikesh

2015-01-01

Unintentional human errors are the source of most safety breaches in complex, high-risk environments. The environment of dialysis care is extremely complex. Dialysis patients have unique and changing physiology, and the processes required for their routine care involve numerous open-ended interfaces between providers and an assortment of technologically advanced equipment. Communication errors, both within the dialysis facility and during care transitions, and lapses in compliance with policies and procedures are frequent areas of safety risk. Some events, such as air emboli and needle dislodgments occur infrequently, but are serious risks. Other adverse events include medication errors, patient falls, catheter and access-related infections, access infiltrations and prolonged bleeding. A robust safety system should evaluate how multiple, sequential errors might align to cause harm. Systems of care can be improved by sharing the results of root cause analyses, and "good catches." Failure mode effects and analyses can be used to proactively identify and mitigate areas of highest risk, and methods drawn from cognitive psychology, simulation training, and human factor engineering can be used to advance facility safety. © 2015 Wiley Periodicals, Inc.

Impact of fear of falling and fall history on disability incidence among older adults: Prospective cohort study.

PubMed

Makino, Keitaro; Makizako, Hyuma; Doi, Takehiko; Tsutsumimoto, Kota; Hotta, Ryo; Nakakubo, Sho; Suzuki, Takao; Shimada, Hiroyuki

2018-04-01

Fear of falling (FOF) is a major health problem for older adults, present not just in fallers, but also nonfallers. This study examined the impact of FOF and fall history on disability incidence among community-dwelling older adults from a prospective cohort study. A total of 5104 older adults living in community settings participated in baseline assessment and were followed up for about 4 years (median 52 mo, range 49-55 mo). At baseline, participants were assessed the presence of FOF and their fall history, and divided into 4 groups: Fall (-) FOF (-), Fall (+) FOF (-), Fall (-) FOF (+), and Fall (+) FOF (+). Disability incidence was defined as national long-term care insurance certification for personal support or care. During the follow-up period, 429 participants (9.9%) were newly certified as having a disability and needing personal support for long-term care insurance. Fall (-) FOF (+) group and Fall (+) FOF (+) group showed a significantly higher risk of disability incidence than Fall (-) FOF (-) group even after adjusting for covariates (Fall (-) FOF (+): hazard ratio 1.28, 95% confidence interval, 1.01-1.62, Fall (+) FOF (+): hazard ratio 1.44, 95% confidence interval, 1.05-1.98). Fear of falling could be a simple and useful predictor of disability incidence in community-dwelling older adults. Identifying and decreasing fall risk factors may prevent fall-related injuries, but excessive FOF may be associated with increased risk of disability incidence. Copyright © 2017 John Wiley & Sons, Ltd.

The association between whole body sagittal balance and risk of falls among elderly patients seeking treatment for back pain.

PubMed

Kim, J; Hwang, J Y; Oh, J K; Park, M S; Kim, S W; Chang, H; Kim, T-H

2017-05-01

The objective of this study was to assess the association between whole body sagittal balance and risk of falls in elderly patients who have sought treatment for back pain. Balanced spinal sagittal alignment is known to be important for the prevention of falls. However, spinal sagittal imbalance can be markedly compensated by the lower extremities, and whole body sagittal balance including the lower extremities should be assessed to evaluate actual imbalances related to falls. Patients over 70 years old who visited an outpatient clinic for back pain treatment and underwent a standing whole-body radiograph were enrolled. Falls were prospectively assessed for 12 months using a monthly fall diary, and patients were divided into fallers and non-fallers according to the history of falls. Radiological parameters from whole-body radiographs and clinical data were compared between the two groups. A total of 144 patients (120 female patients and 24 male patients) completed a 12-month follow-up for assessing falls. A total of 31 patients (21.5%) reported at least one fall within the 12-month follow-up. In univariate logistic regression analysis, the risk of falls was significantly increased in older patients and those with more medical comorbidities, decreased lumbar lordosis, increased sagittal vertical axis, and increased horizontal distance between the C7 plumb line and the centre of the ankle (C7A). Increased C7A was significantly associated with increased risk of falls even after multivariate adjustment. Whole body sagittal balance, measured by the horizontal distance between the C7 plumb line and the centre of the ankle, was significantly associated with risk of falls among elderly patients with back pain. Cite this article : J. Kim, J. Y. Hwang, J. K. Oh, M. S. Park, S. W. Kim, H. Chang, T-H. Kim. The association between whole body sagittal balance and risk of falls among elderly patients seeking treatment for back pain. Bone Joint Res 2017;6:-344. DOI: 10.1302/2046-3758.65.BJR-2016-0271.R2. © 2017 Kim et al.

Cost Effectiveness of Falls and Injury Prevention Strategies for Older Adults Living in Residential Aged Care Facilities.

PubMed

Church, Jody L; Haas, Marion R; Goodall, Stephen

2015-12-01

To evaluate the cost effectiveness of interventions designed to prevent falls and fall-related injuries among older people living in residential aged care facilities (RACFs) from an Australian health care perspective. A decision analytic Markov model was developed that stratified individuals according to their risk of falling and accounted for the risk of injury following a fall. The effectiveness of the interventions was derived from two Cochrane reviews of randomized controlled trials for falls/fall-related injury prevention in RACFs. Interventions were considered effective if they reduced the risk of falling or reduced the risk of injury following a fall. The interventions that were modelled included vitamin D supplementation, annual medication review, multifactorial intervention (a combination of risk assessment, medication review, vision assessment and exercise) and hip protectors. The cost effectiveness was calculated as the incremental cost relative to the incremental benefit, in which the benefit was estimated using quality-adjusted life-years (QALYs). Uncertainty was explored using univariate and probabilistic sensitivity analysis. Vitamin D supplementation and medication review both dominated 'no intervention', as these interventions were both more effective and cost saving (because of healthcare costs avoided). Hip protectors are dominated (less effective and more costly) by vitamin D and medication review. The incremental cost-effectiveness ratio (ICER) for medication review relative to vitamin D supplementation is AU$2442 per QALY gained, and the ICER for multifactorial intervention relative to medication review is AU$1,112,500 per QALY gained. The model is most sensitive to the fear of falling and the cost of the interventions. The model suggests that vitamin D supplementation and medication review are cost-effective interventions that reduce falls, provide health benefits and reduce health care costs in older adults living in RACFs.

Vibration perception threshold in relation to postural control and fall risk assessment in elderly.

PubMed

de Mettelinge, Tine Roman; Calders, Patrick; Palmans, Tanneke; Vanden Bossche, Luc; Van Den Noortgate, Nele; Cambier, Dirk

2013-09-01

This study investigates (i) the potential discriminative role of a clinical measure of peripheral neuropathy (PN) in assessing postural performance and fall risk and (ii) whether the integration of a simple screening vibration perception threshold (VPT) for PN in any physical (fall risk) assessment among elderly should be recommended, even if they do not suffer from DM. One hundred and ninety-five elderly were entered in a four-group model: DM with PN (D+; n = 75), DM without PN (D-; n = 28), non-diabetic elderly with idiopathic PN (C+; n = 31) and non-diabetic elderly without PN (C-; n = 61). Posturographic sway parameters were captured during different static balance conditions (AMTI AccuGait, Watertown, MA). VPT, fall data, Mini-Mental State Examination and Clock Drawing Test were registered. Two-factor repeated-measures ANOVA was used to compare between groups and across balance conditions. The groups with PN demonstrated a strikingly comparable, though bigger sway, and a higher prospective fall incidence than their peers without PN. The indication of PN, irrespective of its cause, interferes with postural control and fall incidence. The integration of a simple screening for PN (like bio-thesiometry) in any fall risk assessment among elderly is highly recommended. Implications for Rehabilitation The indication of peripheral neuropathy (PN), irrespective of its cause, interferes with postural control and fall incidence. Therefore, the integration of a simple screening for PN (like bio-thesiometry) in any fall risk assessment among elderly is highly recommended. It might be useful to integrate somatosensory stimulation in rehabilitation programs designed for fall prevention.