Common Types of Falls in the Elderly Population, Their Associated Risk Factors and Prevention in a Tertiary Care Center

The prevalence of non-pharmacological interventions in older homecare recipients: an overview from six European countries

PURPOSE

Non-pharmacological interventions (NPIs) play an important role in the management of older people receiving homecare. However, little is known about how often specific NPIs are being used and to what extent usage varies between countries. The aim of the current study was to investigate the prevalence of NPIs in older homecare recipients in six European countries.

METHODS

This is a cross-sectional study of older homecare recipients (65+) using baseline data from the longitudinal cohort study 'Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care' (IBenC). The analyzed NPIs are based on the interRAI Home Care instrument, a comprehensive geriatric assessment instrument. The prevalence of 24 NPIs was analyzed in Belgium, Germany, Finland, Iceland, Italy and the Netherlands. NPIs from seven groups were considered: psychosocial interventions, physical activity, regular care interventions, special therapies, preventive measures, special aids and environmental interventions.

RESULTS

A total of 2884 homecare recipients were included. The mean age at baseline was 82.9 years and of all participants, 66.9% were female. The intervention with the highest prevalence in the study sample was 'emergency assistance available' (74%). Two other highly prevalent interventions were 'physical activity' (69%) and 'home nurse' (62%). Large differences between countries in the use of NPIs were observed and included, for example, 'going outside' (range 7-82%), 'home health aids' (range 12-93%), and 'physician visit' (range 24-94%).

CONCLUSIONS

The use of NPIs varied considerably between homecare users in different European countries. It is important to better understand the barriers and facilitators of use of these potentially beneficial interventions in order to design successful uptake strategies.

Evaluation of falls in older persons in the emergency department during the early Coronavirus-2019 pandemic and pre-pandemic periods

PURPOSE

This study aimed to investigate the clinical characteristics, outcomes and healthcare costs of older patients presented to the emergency department (ED) with falls in the periods before and during the Coronavirus disease-2019 (COVID-19) pandemic.

METHODS

Hospital records one year before and after the onset of the COVID-19 pandemic were retrospectively analyzed through "International Statistical Classification of Diseases-10th Revision" codes. Age, gender, falls, triage classification, length of stay (LOS) in the hospital and the ED, COVID-19 status, Glasgow Coma scale, consultations-comorbidities, injury status, outcomes in the ED, and costs were recorded.

RESULTS

The study comprised of 3187 patients aged ≥ 65 years admitted to the ED of a university hospital between March 2019 and 2021. In terms of pre-pandemic and pandemic periods; older patients presenting with falls to the ED, consultations, Charlson Comorbidity Index, and LOS in the ED were lower in the pandemic period, but costs were higher (p = 0.03, p = 0.01, p = 0.01, p = 0.01 and p = 0.02, respectively). Hospitalization/mortality rates were higher in COVID-19 positive patients (77.2%) than in COVID-19 negative patients (4.6%) within the pandemic period and the patients in the pre-pandemic period (22.8%), and the costs, as well (both p = 0.01).

CONCLUSION

Though the number of fall-related presentations of older persons to the ED, comorbidity burden, consultations, and the LOS in the ED was lower, direct costs were higher during the pandemic period, particularly for COVID-19 positive older patients admitted to ED with falls than the pre-pandemic period, and those patients were with poorer outcomes.

Association between daily activities and fall in older adults: an analysis of longitudinal ageing study in India (2017-18)

Background

Declining functionality affects an individual’s musculoskeletal integrity increasing the risk of fall and disability. Individuals with severe functional limitations are 5 times more likely to experience a fall. Thus, this paper investigated the association between functional decline and falls in older adults.

Methods

This study uses secondary data from the Longitudinal Aging Study in India (2017–18). A total of 31,477 people over the age of 60 are included in the study. Descriptive statistics and bivariate analysis were performed to determine the association between activities of daily living (ADL), instrumental activities of daily living (IADL) and fall. Adjusted odds ratio was used to determine the association of ADL and IADL with fall while controlling for age, gender, balance and gait impairments.

Results

The study reported 6352 fall episodes in 3270 participants aged 60 and above, over a period of 2 years. More than 30% of participants reported difficulty in ADL and IADL. Age and gender adjusted odds of fall were higher in participants with difficulty in more than 4 ADLs (AOR:1.32; CI:1.08 – 1.67) and in more than 2 IADL (AOR: 1.39; CI:1.02 – 1.89). Similarly, the odds of fall were higher for difficulty in ADL (AOR:1.31; CI:1.11 – 1.73) and IADL (AOR of 1.18; CI:1.07 – 1.29) controlling for gait and balance impairment. Difficulty in pushing-pulling objects (AOR: 1.30; CI: 1.15 – 1.46 & AOR: 1.40; CI: 1.21–1.61) and getting up from the chair (AOR: 1.12; CI:1.01–1.26 & AOR: 1.27; CI: 0.99 – 1.26) was significantly associated with fall when adjusted for age, gender and balance and gait parameters.

Conclusions

This study provides the new insights into the association of fall and risk of functional decline, especially difficulty in pushing and pulling objects and getting up from a chair, can be incorporated in the primary screening of fall risk assessment.