Cost of falls in old age: a systematic review

FPGA-based Edge Inferencing for Fall Detection

In the geriatric population, physical injuries sustained by an unintentional or an unpredictable fall on a hard surface is the leading cause of injury related morbidity and sometimes mortality. Each year, close to 30% of adults around the age group of 65 fall down at least once. In the year 2015, close to 2.9 million falls were reported, resulting in 33,000 deaths. As much as 61% of elderly nursing home residents fell at some point during their first year of residence.These falls may aggravate the situation leading to bone fracture, concussion, internal bleeding or traumatic brain injury when immediate medical attention is not offered to the person. Delay in course of the event may sometimes lead to death as well. Recently, many studies have come up with wearable devices. These devices that are now commercially available in the market are small, compact, wireless, battery operated and power efficient. This study discusses the findings that the optimal location for a Fall Detection Sensor on the human body is in front of the Shin bone. This is based on the 183 features collected from Inertial Measurement Unit (IMU) sensors placed on 16 human body locations and trained-tested using Convolutional Neural Networks (CNN) machine learning paradigm. The ultimate goal is to develop a mobile, wireless, wearable, low-power medical device that uses a small Lattice iCE40 Field Programmable Gate Array (FPGA) integrated with gyro and accelerometer sensors which detects whether the device wearer has fallen or not. This FPGA is capable of realizing the Neural Network model implemented in it. This Insitu or Edge inferencing wearable device is capable of providing real-time classifications without any Transmitting or Receiving capabilities over a wireless communication channel.

Genetic basis of falling risk susceptibility in the UK Biobank Study

Both extrinsic and intrinsic factors predispose older people to fall. We performed a genome-wide association analysis to investigate how much of an individual’s fall susceptibility can be attributed to genetics in 89,076 cases and 362,103 controls from the UK Biobank Study. The analysis revealed a small, but significant SNP-based heritability (2.7%) and identified three novel fall-associated loci (P_combined ≤ 5 × 10⁻⁸). Polygenic risk scores in two independent settings showed patterns of polygenic inheritance. Risk of falling had positive genetic correlations with fractures, identifying for the first time a pathway independent of bone mineral density. There were also positive genetic correlations with insomnia, neuroticism, depressive symptoms, and different medications. Negative genetic correlations were identified with muscle strength, intelligence and subjective well-being. Brain, and in particular cerebellum tissue, showed the highest gene expression enrichment for fall-associated variants. Overall, despite the highly heterogenic nature underlying fall risk, a proportion of the susceptibility can be attributed to genetics.

Katerina Trajanoska et al. report a genome-wide association study of self-reported falls in UK Biobank participants. They identify three novel fall-associated loci and find that risk of falling shows patterns of polygenic inheritance and a SNP-based heritability of 2.7%.

Effect of Parkinson's disease and two therapeutic interventions on muscle activity during walking: a systematic review

Gait deficits are a common feature of Parkinson’s disease (PD) and predictors of future motor and cognitive impairment. Understanding how muscle activity contributes to gait impairment and effects of therapeutic interventions on motor behaviour is crucial for identifying potential biomarkers and developing rehabilitation strategies. This article reviews sixteen studies that investigate the electromyographic (EMG) activity of lower limb muscles in people with PD during walking and reports on their quality. The weight of evidence establishing differences in motor activity between people with PD and healthy older adults (HOAs) is considered. Additionally, the effect of dopaminergic medication and deep brain stimulation (DBS) on modifying motor activity is assessed. Results indicated greater proximal and decreased distal activity of lower limb muscles during walking in individuals with PD compared to HOA. Dopaminergic medication was associated with increased distal lower limb muscle activity whereas subthalamic nucleus DBS increased activity of both proximal and distal lower limb muscles. Tibialis anterior was impacted most by the interventions. Quality of the studies was not strong, with a median score of 61%. Most studies investigated only distal muscles, involved small sample sizes, extracted limited EMG features and lacked rigorous signal processing. Few studies related changes in motor activity with functional gait measures. Understanding mechanisms underpinning gait impairment in PD is essential for development of personalised rehabilitative interventions. Recommendations for future studies include greater participant numbers, recording more functionally diverse muscles, applying multi-muscle analyses, and relating EMG to functional gait measures.

A Pilot Study to Detect Balance Impairment in Older Adults Using an Instrumented One-Leg Stance Test

The aim of this study was to investigate whether parameters from an instrumented one-leg stance (OLS) on a force plate could provide relevant information related to fall risk in older people. Forty-two community dwelling older people including 17 fallers and 25 nonfallers, and 25 young subjects performed a OLS while standing on a force plate, with parameters related to transferring weight onto one leg and postural sway in singe-leg stance evaluated. No differences were observed between older fallers and nonfallers and the younger participants for any of the weight transfer parameters. The younger participants were able to reduce their postural sway during the OLS test after the first 0-2 s period, unlike older participants who swayed the same amount throughout the test. The older fallers swayed significantly more than both nonfallers and younger participants throughout the 10-s of OLS evaluated. When the tests were used to classify older participants as fallers, the instrumented OLS achieved 100% accuracy, compared to 69.0% classification accuracy for the five times sit-to-stand test, 61.9% for the standard OLS, and 47.6% for the timed-up-and-go test. These findings suggest that the standard OLS test might not be suitable to detect fall risk. In contrast, an instrumented version of the OLS could provide valuable additional information that could identify older fallers. Future work will include a prospective study of the instrumented OLS in a larger population of older people.

Is power training effective to produce muscle hypertrophy in older adults? A systematic review and meta-analysis

Power training has been suggested to be effective in improving strength, power, and functional capacity in older adults. However, there is still a lack of systematic investigations reporting its effectiveness for muscle hypertrophy. Thus, this study investigated the effect of power training on muscle hypertrophy and compared its magnitude with traditional moderate-velocity resistance training in older adults. A systematic search was conducted to identify clinical trials investigating the effect of power training on muscle hypertrophy (power training vs. control) and/or comparing the effect of power training versus moderate-velocity resistance training for a meta-analytical approach. Ten studies comparing power training to control conditions and 9 studies comparing power training to moderate-velocity resistance training were selected. Three studies were classified as high quality and 2 were preregistered. The meta-analysis showed that power training was superior for muscle hypertrophy compared with control condition (n = 8 studies; standardised mean difference (SMD) = 0.31; 95% confidence interval (CI) = 0.04, 0.58; p = 0.029), and resulted in similar hypertrophy compared with moderate-velocity resistance training (n = 7 studies; SMD = 0.07; 95% CI = –0.18, 0.32; p = 0.50). No significant heterogeneity was observed (p = 0.46 and 0.54, and I2 = 0% and 0%, respectively). Our data suggest that power training is effective for muscle hypertrophy in older adults, with similar effectiveness as moderate-velocity resistance training. (PROSPERO registration no.: CRD42019128951.)

Novelty It is known that power training might be superior to moderate-velocity resistance training for function improvements in older adults, but there was no meta-analysis investigating its effect on muscle hypertrophy. Power training is effective to induce muscle hypertrophy in older adults to a similar extent as moderate-velocity resistance training.

'Believe the positive' aggregation of fall risk assessment methods reduces the detection of risk of falling in older adults

OBJECTIVES

Screening programs for fall prevention in older adults may include several assessment methods. This study investigated the validity of aggregating fall risk assessment methods for stratifying the risk of falling in older adults.

METHODS

This secondary data analysis included 52 community-dwelling residents aged [median (interquartile range)] 74 (69-80) years. Fall occurrences were registered prospectively for six months, with 9 (17%) participants reporting at least one fall during follow-up. The fall risk assessment included the Berg Balance Scale (BBS); polypharmacy (POLY); Falls Risk Assessment Score (FRAS); Fall Risk Assessment Tool (FRAT-up); Falls Efficacy Scale (FES); and posturography with the Wii Balance Board (WBB). Aggregation of methods' results was performed according to the risk classification ('high risk' or 'low risk') assigned by their respective cut-off values under the 'believe the positive' (BP) strategy.

RESULTS

Aggregating 1 (POLY), 2 (+BBS), 3 (+FES), 4 (+FRAT-up), 5 (+FRAS), and 6 (+BBS) methods resulted in a monotonic decrease of several validity indices including (index [95% confidence interval]) diagnostic odds ratio (10.82 [2.38-54.28] to 0.59 [0.12-2.09]) and accuracy (0.67 [0.54-0.78] to 0.20 [0.11-0.31]).

CONCLUSIONS

Aggregating fall risk assessment methods-BBS, POLY, FRAS, FRAT-up, FES, WBB-under the BP strategy does not increase the validity of stratification of the risk of falling in older adults.

Health economic benefits from optimized meal services to older adults-a literature-based synthesis

Malnutrition among older adults causes health problems and economic costs. Prevention of malnutrition through meal service can reduce such costs. This study estimates potential health economic benefits to be generated through meal service to home-dwelling older adults. The study contains three components: (1) systems analysis describing the relationship between meal service, nutritional status, health risk, and health-related costs, focusing on older adults, (2) a series of literature reviews to quantify the identified elements in each stage-subject combination: (i) meal service impact on nutrition status of older adults, (ii) associations between nutrition status and health risks, (iii) health care resource needs associated with these health risks, and (3) a model synthesis of literature findings to estimate the expected economic benefit of improved health status derived from meal service enrollment, using Denmark as an example. Expected economic benefits in terms of saved direct and indirect health care costs and improved quality-of-life was estimated at an amount of €307 per year per individual enrolled, of which direct health care cost savings constituted €75, while value of improved quality-of-life and reduced mortality constituted the rest. The average health economic benefit from enrolling older adults into meal service is likely to decrease with the number of subscribers. Findings like these are important to take into consideration, when making policy decisions regarding size of the meal service capacity, although it should be noted that the presented estimates are based on a number of assumptions of which some are subject to uncertainty.

Effectiveness for introducing nurse practitioners in six long-term care facilities in Québec, Canada: A cost-savings analysis

BACKGROUND

Internationally, most studies have focused on quality and safety in long-term care. However, studies focusing on the economic evaluation of quality and security in long-term care are sparse. Moreover, the economic evaluation of nurse practitioner care in long-term care is lacking, particularly in Québec Canada where roles are new.

PURPOSE

To evaluate the effectiveness of introducing nurse practitioners in six long-term care facilities in Québec using a cost-savings analysis in terms of reduction of nurse practitioner sensitive events (NPSEs).

METHODS

A cost savings analysis was completed using a prospective observational study. All residents (n = 538) under the care of teams that included nurse practitioners who experienced at least one of the following NPSEs: falls, pressure ulcers, short-term transfers, and a change in the time needed to administer the medications consumed were included. Data were collected from September 1st 2015 to August 31st 2016. Descriptive statistics identified numbers of cases for falls, pressure ulcers, short-term transfers, and the number of medications consumed. A literature analysis was used to estimate excess median long-term care facility related costs of these NPSEs. Costs were calculated in 2016 Canadian dollars. The cost savings with the reductions that occurred for falls, pressure ulcers, short term transfers, and the time needed to administer medications after the implementation of a primary healthcare nurse practitioner role in the six long term care facilities were also estimated.

FINDINGS

The median cost of 341 cases of falls, 32 cases of pressure ulcers and 53 cases of short-term transfers in the six long-term facilities would range between CAD 4,516,337.8 and CAD 5,281,824.4. Moreover, the total costs savings from the reduction of adverse events including the reduction of nursing administration time for medications would be between CAD 1,942,533.6 and CAD 3,254,403.4.

DISCUSSION

This is the first study to present the financial consequence of adverse events sensitive to nurse practitioner care in long-term care. Important cost savings were generated from the reduction of adverse events after the implementation of nurse practitioner roles in long-term care. Government should consider these results for prevention and improvements in quality and safety in long-term care.

Haemodialysis patients have worse postural balance with an associated risk of falls

INTRODUCTION

Postural balance is the result of a complex interaction of sensory input which keeps us upright. Haemodialysis patients have alterations which can lead to postural instability and a risk of falls. Our objective was to analyse postural stability and its relationship with the risk of falls in haemodialysis patients using a force platform.

MATERIAL AND METHODS

This was a prospective cross-sectional study. Postural balance was recorded using a force platform in prevalent haemodialysis patients. We collected epidemiological, dialysis, analytical and treatment data. The incidence of falls was recorded over the 6 months following the tests. The postural stability analysis was performed with a portable strain gauge platform (AMTI AccuGait®) and a specific software unit for stabilometry (Balance Trainer® program). We measured 31 balance parameters; the balance variables used were: Area95; AreaEffect; VyMax; Xrange and Yrange. The stabilometry studies were performed in 3 situations: with eyes open; with eyes closed; and with the patient performing a simultaneous task. We performed one study at the start of the dialysis session, and a second study at the end. Stabilometry was measured in a control group under similar conditions.

RESULTS

We studied 32 patients with a mean age of 68 years old; of this group, 20 subjects were male and 12 were female. Their mean weight was 74kg, with a mean BMI of 27.6kg/m². In the controls, there were no significant differences in the stabilometry between the 3 situations studied. Both pre- and post-haemodialysis, patients with closed eyes showed greater imbalance, and there were significant differences with the other situations and controls. We found a significant increase in instability after the haemodialysis session, and greater instability in the 13 patients with diabetes (P<.05). The 4 patients with hyponatraemia (Na<136mmol/l) had worse balance in the simultaneous task situation (P=.038). Various drugs, such as insulin (P=.022), antiplatelet agents (P=.036) and beta-blockers (P=.029), were associated with imbalance. The 10 patients who suffered falls had greater imbalance, Yrange, Xrange, Area95 and AreaEffect, both pre- and post-haemodialysis (P<.05) than those without falls.

CONCLUSIONS

Haemodialysis patients have alterations which can lead to postural instability and a risk of falls. Prevention programmes which include specific exercises to improve balance could be beneficial in reducing the risk of falls in this population.

Trends in Fatal and Nonfatal Injuries Among Older Americans, 2004-2017

INTRODUCTION

This study (1) provides annual population estimates of fatal and nonfatal injury incidence rates for older adults for 2004-2017; (2) determines if trends differ by whether the injury was fatal or nonfatal, a fall or nonfall injury, and for nonfatal injuries, minor or serious; and (3) investigates whether trends vary by age, sex, and race.

METHODS

This study used National Vital Statistics System and National Health Interview Survey data covering the population of adults aged ≥65 years for 2004-2017. Fatal injury incidence rates were estimated using negative binomial models; nonfatal injury incidence rates were estimated using Poisson models. All models compared overall risk and trend differences by year, age, sex, and race, and interactions between year and age, sex, and race. All analyses were conducted in 2019.

RESULTS

Fatal injury incidence was stable over time, but this apparent stability masked a 35% increase in fatal falls and a 17% decrease in fatal nonfall injuries. Increases in fall-related deaths were concentrated among those aged ≥85 years, men, and white older adults. The trend in fatal falls accelerated over time for those aged ≥85 years and white older adults. By contrast, there was a large increase in nonfatal injury incidence, occurring across all injury types. Nonfatal injury risk grew with age and was higher for women and white older adults, but trends did not vary by age, sex, or race.

CONCLUSIONS

Large increases in fatal and nonfatal injuries underscore the urgency of national implementation of fall prevention programs and expanding fall prevention efforts to more general injury prevention.

Incidence and prevalence of falls in adults with intellectual disability living in the community: a systematic review

OBJECTIVE

The objective of the review was too synthesize the best available evidence on the incidence and prevalence of falls among adults with intellectual disability (ID).

INTRODUCTION

Falls among adults with ID frequently cause physical injury and may negatively impact on their quality of life. Studies investigating falls among people with ID have used differing methods and populations, making it difficult to determine the scope and extent of this problem.

INCLUSION CRITERIA

This review considered all studies that included adults with ID aged 18 years and over and which reported percentage/numbers of individuals who fell, and the total number of falls and injurious falls sustained from a fall. Studies were included if they were conducted within community or residential settings. Studies that were conducted in hospitals were excluded. Cohort studies, case-control and cross-sectional studies were included. Studies that used an experimental design, both randomized controlled and quasi experimental design, were also included.

METHODS

A three-step search strategy was undertaken for published and unpublished literature in English from 1990 to 2017. An initial search of MEDLINE and CINAHL was undertaken before a more extensive search was conducted using keywords and index terms across 11 electronic databases. Two independent reviewers assessed the methodological quality of the included studies using the Joanna Briggs Institute standardized critical appraisal instrument for prevalence studies (Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data).Data was extracted using the Joanna Briggs Institute's standardized extraction tool. Data that directly reported or could be used to calculate the incidence and prevalence of falls were extracted. Quantitative data for the number (proportion) of people who fell were pooled in statistical meta-analysis using STATA version 14 (Stata Corp LLC, Texas, USA). Data measuring incidence of falls (rate of falls for the duration of the study) and incidence of injurious falls (rate of falls resulting in one or more injuries for the duration of the study) could not be pooled in meta-analysis, hence results have been presented in a narrative form including tables. Standard GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence assessment of outcomes is also reported.

RESULTS

Nine studies were eligible for inclusion in this review. Eight articles were observational cohort studies which reported on the incidence/prevalence of falls as outcome measures, and one article was a quasi-experimental study design. Overall the methodological quality of the included studies was considered moderate. The pooled proportion of people with ID who fell (four studies, 854 participants) was 39% (95% CI [0.35%-0.43%], very low GRADE evidence). The rate of falls (eight studies, 782 participants) ranged from 0.54 to 6.29 per person year (very low GRADE evidence). The rate of injurious falls (two studies, 352 participants) ranged from 0.33 to 0.68 per person year (very low GRADE evidence).

CONCLUSIONS

Synthesized findings demonstrate that people with ID, who live in community or residential settings, may fall more frequently, and at a younger age, compared to general community populations. Studies should take a consistent approach to measuring and reporting falls outcomes. Further research is recommended to identify the impact of falls on health related outcomes for people with ID and subsequently evaluate falls interventions for their efficacy.

"Study protocol for the ≥65 years NOrthern jutland Cohort of Fall risk Assessment with Objective measurements (the NOCfao study)"

Background

Accidental falls are common among community-dwellers, probably due to the level of physical activity and impaired postural stability. Today, fall risk prediction tools’ discriminative validity are only moderate. In order to increase the accuracy, multiple variables such as highly validated objective field measurements of physical activity and impaired postural stability should be adressed in order to predict falls. The main aim of this paper is to describe the ≥65 years NOrthern jutland Cohort of Fall risk Assessment with Objective measurements (NOCfao) investigating the association between physical activity and impaired postural stability and the risk of fall episodes among community-dwelling older adults.

Methods

The study consists of a baseline session where the participants are asked to respond to three questionnaires, perform physical tests (i.e., measuring strength in the upper and lower extremities, balance, and walking speed), participate in an assessment of pain sensitivity, and to wear an ankle mounted pedometer for measuring physical activity for 5 days. Subsequently, the fall incidences and the circumstances surrounding the falls during the previous 1 to 2 months will be recorded throughout a one-year follow-up period.

Discussion

This study will add to the present-day understanding of the association between physical activity and impaired postural stability and the risk of fall episodes among community-dwelling older adults. These data will provide valid and reliable information on the relationship between these variables and their significance for community-dwelling older adults.

Trial registration

ClinicalTrials.gov identifier: NCT2995317. Registered December 13th, 2016.

Impact of the backward chaining method on physical and psychological outcome measures in older adults at risk of falling: a systematic review

BACKGROUND

Being unable to "get up from the floor" is a risk factor and predictor of serious fall-related injuries in older age; however, floor-rise training (FRT) is not widely used. The backward chaining method (BCM) is a success-oriented, step-by-step form of FRT. This systematic review aimed to evaluate the impact of BCM on physical and psychological outcome measures, and its clinical application.

METHODS

Studies were identified through systematic searching of five databases. Criteria for inclusion were: use of BCM as a treatment method, outcome measures related to falls, and participants aged 60 + years. Study quality was evaluated using the Mixed Methods Appraisal Tool and PEDro scale, if applicable.

RESULTS

Seven studies with a total of 446 participants (mean age 82.4 ± 5.3 years) were identified. Emerging evidence shows that BCM significantly improves the ability to get up unassisted from the floor, as well as mobility with reduced fall incidence in older people. Furthermore, it can potentially reduce fear of falling. Reporting on feasibility and acceptance of BCM was limited. Study quality varied widely.

CONCLUSIONS

BCM provides a promising intervention in fall-related recovery strategies for older adults and is most effective when offered to older adults at risk of falling. Considering the small number of included studies and the varying methodological quality, these findings should be evaluated accordingly. The growing evidence regarding the benefits of BCM, yet the lack of adoption into standard care, highlights the need for further research and clinical application of this intervention approach.

Balance Training in Older Adults Using Exergames: Game Speed and Cognitive Elements Affect How Seniors Play

Falls in older adults are a serious threat to their health and independence, and a prominent reason for institutionalization. Incorrect weight shifts and poor executive functioning have been identified as important causes for falling. Exergames are increasingly used to train both balance and executive functions in older adults, but it is unknown how game characteristics affect the movements of older adults during exergaming. The aim of this study was to investigate how two key game elements, game speed, and the presence of obstacles, influence movement characteristics in older adults playing a balance training exergame. Fifteen older adults (74 ± 4.4 years) played a step-based balance training exergame, designed specifically for seniors to elicit weight shifts and arm stretches. The task consisted of moving sideways to catch falling grapes and avoid obstacles (falling branches), and of raising the arms to catch stationary chickens that appeared above the avatar. No steps in anterior-posterior direction were required in the game. Participants played the game for eight 2 min trials in total, at two speed settings and with or without obstacles, in a counterbalanced order across participants. A 3D motion capture system was used to capture position data of 22 markers fixed to upper and lower body. Calculated variables included step size, step frequency, single leg support, arm lift frequency, and horizontal trunk displacement. Increased game speed resulted in a decrease in mean single support time, step size, and arm lift frequency, and an increase in cadence, game score, and number of error messages. The presence of obstacles resulted in a decrease in single support ratio, step size, cadence, frequency of arm lifts, and game score. In addition, step size increased from the first to the second trial repetition. These results show that both game speed and the presence of obstacles influence players' movement characteristics, but only some of these effects are considered beneficial for balance training whereas others are detrimental. These findings underscore that an informed approach is necessary when designing exergames so that game settings contribute to rather than hinder eliciting the required movements for effective balance training.

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

BACKGROUND AND PURPOSE

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.

METHODS

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.

RESULTS AND DISCUSSION

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).

CONCLUSION

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.

Re-Enactment as a Method to Reproduce Real-World Fall Events Using Inertial Sensor Data: Development and Usability Study

BACKGROUND

Falls are a common health problem, which in the worst cases can lead to death. To develop reliable fall detection algorithms as well as suitable prevention interventions, it is important to understand circumstances and characteristics of real-world fall events. Although falls are common, they are seldom observed, and reports are often biased. Wearable inertial sensors provide an objective approach to capture real-world fall signals. However, it is difficult to directly derive visualization and interpretation of body movements from the fall signals, and corresponding video data is rarely available.

OBJECTIVE

The re-enactment method uses available information from inertial sensors to simulate fall events, replicate the data, validate the simulation, and thereby enable a more precise description of the fall event. The aim of this paper is to describe this method and demonstrate the validity of the re-enactment approach.

METHODS

Real-world fall data, measured by inertial sensors attached to the lower back, were selected from the Fall Repository for the Design of Smart and Self-Adaptive Environments Prolonging Independent Living (FARSEEING) database. We focused on well-described fall events such as stumbling to be re-enacted under safe conditions in a laboratory setting. For the purposes of exemplification, we selected the acceleration signal of one fall event to establish a detailed simulation protocol based on identified postures and trunk movement sequences. The subsequent re-enactment experiments were recorded with comparable inertial sensor configurations as well as synchronized video cameras to analyze the movement behavior in detail. The re-enacted sensor signals were then compared with the real-world signals to adapt the protocol and repeat the re-enactment method if necessary. The similarity between the simulated and the real-world fall signals was analyzed with a dynamic time warping algorithm, which enables the comparison of two temporal sequences varying in speed and timing.

RESULTS

A fall example from the FARSEEING database was used to show the feasibility of producing a similar sensor signal with the re-enactment method. Although fall events were heterogeneous concerning chronological sequence and curve progression, it was possible to reproduce a good approximation of the motion of a person's center of mass during fall events based on the available sensor information.

CONCLUSIONS

Re-enactment is a promising method to understand and visualize the biomechanics of inertial sensor-recorded real-world falls when performed in a suitable setup, especially if video data is not available.

A Multi-Level Analyses of Charges and Cost of Fall-Related Hospitalizations Among Older Adults: Individual, Hospital, and Geospatial Variation

The growing population of older adults has attracted concern from policymakers due in part to the fact that they are at higher risk of costly and potentially injurious falls. Responding to this concern, this study investigated fall-related hospitalizations among those aged 65 and older. Hospitalizations rose from 49,299 to 58,931, with charges and costs (estimated based on charges) increasing from $2.5 billion to $3.6 billion and under $900 million to over $1.1 billion, respectively. The intraclass correlation coefficients from linear mixed-effect models (with charges and costs serving as dependent variables) indicated differences in hospitals accounted for nearly half or more of medical cost variation among older adults suffering a fall-related hospitalization. Nonmetropolitan residence, being aged 65-69 (versus older), and higher risk-of-mortality on admission indicated higher costs. Identifying trends of fall-related hospitalizations over time allows for key stakeholders to not only track the burden of falls among older adults but to also use this information to attract funding for fall prevention strategies from policy makers at various levels (e.g., locally, at the state). Further, identifying characteristics of individuals (e.g., age, race, sex) and places (e.g., rural areas) that carry a higher relative cost can serve to inform the targeted allocation of finite resources including local, state, or federal funding, but also existing evidence-based practices such as community and clinical interventions.

A multi-centre, parallel-group, randomised controlled trial to assess the efficacy and safety of eurythmy therapy and tai chi in comparison with standard care in chronically ill elderly patients with increased risk of falling (ENTAiER): a trial protocol

BACKGROUND

In elderly poeple, multimorbidity and polypharmacy increase while sensory, motor and cognitive functions decrease. Falls occur in 30% of people aged 65 years and older at least once per year, with injuries at 10-20%. Reducing falls and enhancing physical, emotional and cognitive capacities are essential for healthy aging despite chronic disease. Eurythmy therapy (EYT) and Tai Chi train balance, mobility and concentrative and sensory capacities.

METHODS

In eight trial sites (academic or community hospitals), 550 outpatients aged 65 years and older with chronic disease and increased risk of falling (history of imbalance, Berg Balance Scale (BBS) score ≤ 49) will be randomly assigned (1:1:1) to receive either EYT or Tai Chi (each provided in one-hour group sessions, twice, later once per week plus practice at home, for over 24 weeks) added to standard care or standard care alone. Standard care includes a detailed written recommendation on fall prevention and the visit of a primary care doctor. Seniors living a reclusive life or economically disadvantaged elderly will be particularly addressed. A motivation and communication concept supports the trial participants' compliance with trial procedures and practicing. Public and patient representatives are involved in the planning and conduction of the trial. Falls will be documented daily in a diary by the participants. These falls as well as injuries and complications will be ascertained during monthly phone visits. The falls efficacy scale, BBS, cognition (MoCA), Mood (GDS-15), quality of life (SF12), instrumental activities of daily living (IADL), use of medical and non-medical services (FIMA) and adherence will be assessed at months 3, 6, and 12 and inner correspondence with practices (ICPH) at month 6. The trial is funded by the Federal Ministry of Education and Research (BMBF 01GL1805).

DISCUSSION

This study will determine whether EYT and Tai Chi reduce falls, injurious falls, fear of falling and healthcare utilisation and improve mobility, cognition, mood, quality of life and functional independence. A reduction of fall risk and fear of falling and an improvement of mobility, autonomy, quality of life, mood, and cognition are highly relevant for older people to cope with aging and diseases and to reduce healthcare costs. TRAIL REGISTRATION: www.drks.de. DRKS00016609. Registered 30th July 2019.

A hospitalist's role in preventing patient falls

Despite decades of fall prevention efforts, patient falls remain a common cause of harm in hospitalized older adults. While fall prevention strategies have been historically championed by nurses, hospitalist physicians, nurse practitioners, and physician assistants play a vital role in the multidisciplinary care team in ensuring the safety of our patients. Multiple fall risk assessment tools exist, but no one tool has demonstrated excellence in predicting patient falls in the hospital. Any fall risk assessment tool should be complemented by a clinician's individualized evaluation of patient-specific, situational, and environmental risk factors. A particular emphasis on medication review is critical, as numerous medication classes can increase the risk of falls, and medications are a potentially modifiable risk factor. Multiple studies of individual and multicomponent nursing-based interventions have failed to demonstrate success in reducing falls or fall injuries. Promising strategies for fall prevention include tailoring interventions to patient risk factors and individualized patient education. In addition to nursing-based interventions, the hospitalist's role in fall prevention is to (1) identify and address potentially modifiable risk factors, (2) reinforce individualized education to patients, and (3) advise behavior choices that promote safe mobility. If a patient does sustain a fall, the hospitalist should partner with the multidisciplinary care team in post fall care to assess for injury, evaluate underlying causes of the fall, and determine plans for secondary prevention.

Malnutrition risk and hospital-acquired falls in older adults: A cross-sectional, multicenter study

Aim

To assess the relationship of malnutrition risk and in‐hospital falls in a patient group of older hospitalized patients (65–79 and ≥80 years).

Methods

A cross‐sectional, multicenter, point‐prevalence study was conducted in 68 Austrian hospitals with 3702 hospitalized older patients. The relationship between malnutrition risk and falls was analyzed using univariate and multivariate binary logistic regression analyses. Data were analyzed separately for two age groups, patients were aged 65–79 years (n = 2320) and ≥80 years (n = 1382).

Results

Prevalence of hospital‐acquired falls was 5.2%, and prevalence of risk of malnutrition was 24.3% (Malnutrition Universal Screening Tool) and 16.2% (definition using body mass index and weight loss). The univariate analysis showed significant associations of malnutrition risk and in‐hospital falls for patients aged ≥80 years (odds ratio 2.1; 95% confidence interval 1.2–3.6) but not for patients aged 65–79 years. The multivariate logistic regression analysis did not show significant associations between malnutrition risk and hospital‐acquired falls.

Conclusions

The results of this study show that malnutrition risk is a predictor for in‐hospital falls in very old patients (≥80 years). In this patient group, the screening and assessment of nutritional status as well as nutritional interventions for the prevention/treatment of malnutrition risk should be considered as one important factor for successful fall prevention. Studies are necessary to assess the effect of nutritional interventions as part of a multifaceted fall‐prevention program. Geriatr Gerontol Int 2020; 20: 348–353.

The effect of eHealth-based falls prevention programmes on balance in people aged 65 years and over living in the community: protocol for a systematic review of randomised controlled trials

INTRODUCTION

Between 20% and 28% of community-dwelling older people experience a fall each year. Falls can result in significant personal and socioeconomic costs, and are the leading cause of admission to hospital for an older person in Australia. Exercise interventions that target balance are the most effective for preventing falls in community-dwellers; however, greater accessibility of effective programmes is needed. As technology has become more accessible, its use as a tool for supporting and promoting health and well-being of individuals has been explored. Little is known about the effectiveness of eHealth technologies to deliver fall prevention interventions. This protocol describes a systematic review with meta-analysis that aims to evaluate the effect of eHealth fall prevention interventions compared with usual care control on balance in people aged 65 years and older living in the community.

METHODS AND ANALYSIS

We will perform a systematic search of the following electronic databases: MEDLINE, CINAHL Complete, Embase and PsychINFO and citation search of Scopus, Web of Science, PubMed Central, Cochrane Database Central and PEDro for randomised controlled trials that use an eHealth technology to deliver a fall prevention intervention to community-dwellers aged ≥65 years, that are published in English, and include a balance outcome (primary outcome). The screening and selection of articles for review will be undertaken by two independent reviewers. The PEDro scale and Grading of Recommendations, Assessment, Development and Evaluations will be used to assess study quality. The results will be synthesised descriptively, and if sufficient data are available and the studies are not overly heterogeneous, a meta-analysis will be conducted using the random effects model.

ETHICS AND DISSEMINATION

As this will be a systematic review, without involvement of human participants, there will be no requirement for ethical approval. The results of this systematic review will be disseminated through peer-reviewed publications, conference presentations and dissemination to policymakers and consumers to maximise health impact.

PROSPERO REGISTRATION NUMBER

CRD42018115098.

Evaluating the effects of an exercise program (Staying UpRight) for older adults in long-term care on rates of falls: study protocol for a randomised controlled trial

Background

Falls are two to four times more frequent amongst older adults living in long-term care (LTC) than community-dwelling older adults and have deleterious consequences. It is hypothesised that a progressive exercise program targeting balance and strength will reduce fall rates when compared to a seated exercise program and do so cost effectively.

Methods/design

This is a single blind, parallel-group, randomised controlled trial with blinded assessment of outcome and intention-to-treat analysis. LTC residents (age ≥ 65 years) will be recruited from LTC facilities in New Zealand. Participants (n = 528 total, with a 1:1 allocation ratio) will be randomly assigned to either a novel exercise program (Staying UpRight), comprising strength and balance exercises designed specifically for LTC and acceptable to people with dementia (intervention group), or a seated exercise program (control group). The intervention and control group classes will be delivered for 1 h twice weekly over 1 year. The primary outcome is rate of falls (per 1000 person years) within the intervention period.

Secondary outcomes will be risk of falling (the proportion of fallers per group), fall rate relative to activity exposure, hospitalisation for fall-related injury, change in gait variability, volume and patterns of ambulatory activity and change in physical performance assessed at baseline and after 6 and 12 months. Cost-effectiveness will be examined using intervention and health service costs.

The trial commenced recruitment on 30 November 2018.

Discussion

This study evaluates the efficacy and cost-effectiveness of a progressive strength and balance exercise program for aged care residents to reduce falls. The outcomes will aid development of evidenced-based exercise programmes for this vulnerable population.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12618001827224. Registered on 9 November 2018. Universal trial number U1111-1217-7148.

Minimal footwear improves stability and physical function in middle-aged and older people compared to conventional shoes

BACKGROUND

Effects of minimal shoes on stability and physical function in older people are under-researched. No studies have systematically explored effects of a range of minimal footwear features on these factors in older people.

METHODS

A within-participant repeated-measures design was used. Participants were subjected to thirteen footwear conditions: (i) barefoot, (ii) a conventional shoe, (iii) a control minimal shoe, (iv-xiii) minimal shoes differing from the control minimal shoe by one design feature. The outcomes were: (i) postural stability expressed with movement of the center of pressure (CoP) during standing (ii) dynamic stability expressed with the CoP movement during walking, (iv) physical function assessed with the Timed Up and Go test (TUG), and (iv) perceptions of footwear assessed with the Monitor Orthopaedic Shoes questionnaire. Linear Mixed Models were applied for statistical analyses.

FINDINGS

Twenty-two people participated in the study. Compared to the conventional shoe, participants: (i) were more stable during standing and walking in the majority of minimal shoes, and (ii) completed the TUG test faster when wearing the minimal shoe with wider sole. Compared to the control minimal shoe, participants: (i) completed the TUG test faster when wearing the minimal shoe with wider sole; and (ii) perceived features such as a split toe and a higher ankle collar as less fashionable and wearable.

INTERPRETATION

Wearing minimal shoes might be more beneficial for stability and physical function in older adults than wearing conventional shoes. The results will be highly valuable for the design of minimal footwear for older adults.

Multifactorial Assessment of Risk of Falling in 753 Post-Menopausal Women: A Multicenter Cross-Sectional Study by the Italian Group for the Study of Metabolic Bone Diseases

OBJECTIVE

To assess physical performance, number of falls, previous fragility fractures, and ongoing pharmacological therapy in a cohort of post-menopausal women, according to their risk of falling.

METHODS

In this multicenter cross-sectional study, we recruited in a 3-year period (May 2016 to April 2019), women aged >60 years referred to seven Osteoporosis and Bone Metabolism Outpatient Services of the Italian Group for the Study of Metabolic Bone Diseases. The study population was divided into three groups according to the risk of falling, assessed through the Elderly Fall Screening Test (EFST): low risk (EFST score=0-1); moderate risk (EFST=2-3); high risk (EFST=4-5). Outcome measures were: 4-meter gait speed (4MGS); unipedal stance time (UST); number of falls in the previous year; previous fragility fractures; ongoing pharmacological therapy.

RESULTS

We analyzed 753 women (mean aged 70.1±9.2 years): 378 (50.2%) at low risk of falling, 247 (32.8%) at moderate risk, and 128 (17.0%) at high risk. 4MGS and UST resulted as pathological in the 93.9% and 99.2%, respectively, of women at high risk. There were significant differences among groups for both outcomes (p<0.001). There was also a significant difference among groups (p<0.001) in terms of previous falls and fragility fractures. Lastly, there were significant differences (p<0.05) among groups in using antihypertensive drugs, antiplatelet agents, anticoagulants, antidepressants, anti-osteoporotic drugs, and vitamin D, and/or calcium supplementation.

CONCLUSION

Physical performance, prevalence of falls and fragility fractures, and an assessment of pharmacological therapy should be investigated in post-menopausal women because of their significant correlation with risk of falling.

The association between benzodiazepine use and falls, and the impact of sleep quality on this association: data from the TILDA study

BACKGROUND

Benzodiazepines (BZD) are associated with adverse effects, particularly in older adults.

AIM

This study assesses the association between BZD use and falls, and the impact of sleep quality on this association, in community dwelling adults aged over 50.

DESIGN

Cross-sectional analysis of data from wave 1 of The Irish Longitudinal Study on Ageing.

METHODS

Participants were classed as BZD users or non-users and asked if they had fallen in the last year, and whether any falls were unexplained. Sleep quality was assessed via self-reported trouble falling asleep, daytime somnolence and early-rising. Logistic regression assessed for an association between BZD use and falls, and the impact of sleep quality on this association was assessed by categorizing based on BZD use and sleep quality variables.

RESULTS

Of 8175 individuals, 302 (3.69%) reported taking BZDs. BZD use was associated with falls, controlling for confounders [Odds Ratio (OR) 1.40; 1.08, 1.82; P-value 0.012]. There was no significant association between BZDs and unexplained falls, controlling for confounders [OR 1.41; 95% Confidence Interval (CI) 0.95, 2.10; P-value 0.09]. Participants who use BZDs and report daytime somnolence (OR 1.93; 95% CI 1.12, 3.31; P-value 0.017), early-rising (OR 1.93; 95% CI 1.20, 3.11; P-value 0.007) or trouble falling asleep (OR 1.83; 95% CI 1.12, 2.97; P-value 0.015), have an increased odds of unexplained falls.

CONCLUSION

BZD use is associated with falls, with larger effect size in those reporting poor sleep quality in community dwelling older adults. Appropriate prescription of medications such as BZDs is an important public health issue.

Characterizing the limits of human stability during motion: perturbative experiment validates a model-based approach for the Sit-to-Stand task

Falls affect a growing number of the population each year. Clinical methods to assess fall risk usually evaluate the performance of specific motions such as balancing or Sit-to-Stand. Unfortunately, these techniques have been shown to have poor predictive power, and are unable to identify the portions of motion that are most unstable. To this end, it may be useful to identify the set of body configurations that can accomplish a task under a specified control strategy. The resulting strategy-specific boundary between stable and unstable motion could be used to identify individuals at risk of falling. The recently proposed Stability Basin is defined as the set of configurations through time that do not lead to failure for an individual under their chosen control strategy. This paper presents a novel method to compute the Stability Basin and the first experimental validation of the Stability Basin with a perturbative Sit-to-Stand experiment involving forwards or backwards pulls from a motor-driven cable with 11 subjects. The individually-constructed Stability Basins are used to identify when a trial fails, i.e. when an individual must switch from their chosen control strategy (indicated by a step or sit) to recover from a perturbation. The constructed Stability Basins correctly predict the outcome of trials where failure was observed with over 90 % accuracy, and correctly predict the outcome of successful trials with over 95 % accuracy. The Stability Basin was compared to three other methods and was found to estimate the stable region with over 45 % more accuracy in all cases. This study demonstrates that Stability Basins offer a novel model-based approach for quantifying stability during motion, which could be used in physical therapy for individuals at risk of falling.

Enhanced pro-inflammatory response and higher mortality rates in geriatric trauma patients

BACKGROUND

Age has been associated with increased morbidity and mortality after traumatic injury. Disregarding trauma-related factors, this may be caused by the diminished ability to cope with stressors due to limited reserve, the so-called frailty. Inflammation is assumed to promote frailty, and thus, pro-inflammatory markers may constitute as being predictive factors in geriatric trauma patients (TP). Here, we analyzed the influence of age on systemic inflammatory markers and outcome parameters in TP.

PATIENTS AND METHODS

204 TP with injury severity score (ISS) ≥ 16 were included and grouped to younger vs. geriatric, defining an age of 65 as cut-off. ISS, vital signs, physiological parameters, stay at the intensive-care unit (ICU) or in-hospital, and outcome parameters were analyzed. Systemic fibrinogen, interleukin (IL)-6, and IL-10 levels were determined upon admission. A p value < 0.05 was considered statistically significant.

RESULTS

43 geriatric and 161 younger TP were included. ISS (24.19 ± 9.59 vs. 26.93 ± 9.68) was comparable between both groups. Abbreviated Injury Scale (AIS) ≥ 3 of head trauma was more prevalent in geriatric TP (74.42 vs. 64.59%). In both groups, there were significantly more male than female patients; however, this disparity was significantly more distinct in younger TP. Geriatric group showed significantly lower shock indices, higher fibrinogen, and lower IL-10 levels (all p < 0.05). A significant spearman´s rank correlation with age was found for fibrinogen (positive correlation, r = 0.364, p < 0.05), and for IL-10 (negative correlation, r = - 0.168, p < 0.05). In-hospital mortality was significantly increased in geriatric TP.

CONCLUSIONS

An enhanced inflammatory response is associated with higher mortality rates in geriatric trauma patients.

Factors Determining the Increased Risk of Falls in Individuals With Knee Pain in the Malaysian Elders Longitudinal Research (MELoR) Study

Objectives: While the negative impact of falls in older persons has been recognized, the association between knee pains and falls remains inconclusive due to underreporting and undertreatment of knee pain. This study was conducted to evaluate the relationship between knee pain and knee pain severity with falls risk and to further determine factors which influence this potential relationship.

Design: This was cross-sectional study from the Malaysian Elders Longitudinal Research (MELoR) study.

Setting: Urban community dwellers in a middle-income South East Asian country.

Participants: One thousand two hundred twelve of a representative sample of community dwelling older persons aged 55 years and older.

Outcome measures: Falls in the preceding 12 months and knee pain were collected during a home-based computer-assisted interview. Physical and functional performance were measured using the Timed Up and Go test and the Katz and Lawton scales, respectively. Psychological status was determined using the Depression Anxiety and Stress Scale (DASS-21).

Results: Of the 1,212 participants included in this analysis, knee pain was present in 402 (33.17%) individuals (124 (30.85%) mild, 210 (52.24%) moderate, 68 (16.92%) severe). The presence of knee pain was associated with increased risk of falls [odds Ratio, OR(95% confidence interval, CI): 1.81 (1.37–2.38)]. Severe knee pain was an independent predictor for falls after adjustment for functional impairment and psychological status. Mild, moderate, and severe knee pain had a specific indirect effect on falls through reducing functional impairment, which in turn increases their psychological concern.

Conclusion: Future studies should explore this relationship prospectively and evaluate whether interventions which alleviate psychological concerns and improve function will reduce falls risk in those with mild to moderate knee pain.

Development of a lifestyle-integrated physical exercise training and home modification intervention for older people living in a community with a risk of falling (Part 1): the FIT-at-Home fall prevention program

PURPOSE

In this paper, we report on the development and refinement of a progressive physical exercise training and home modification intervention for older people with a risk of falling located in Germany by using the United Kingdom's Medical Research Council framework.

METHODS

The process was iterative and six phases of development emerged: (1) establishing an intervention development group, (2) identifying the evidence on interventions, (3) identifying a theory to underpin the intervention, (4) designing the intervention components, (5) drafting the intervention manual and training course, and (6) piloting and refining of intervention components.

RESULTS

The result was an evidence-based, theory-informed, and user-endorsed intervention: FIT-at-Home. This intervention comprised nine individual sessions over 12 weeks and two follow-up booster sessions delivered by trained occupational therapists. A feasibility study demonstrated the acceptance and feasibility of intervention delivery. Users responses were generally favorable and included recommendations about the intervention manual, mode of delivery of the home hazard assessment, and producing a manual for older people.

CONCLUSIONS

We developed a feasible home-based lifestyle-integrated physical exercise training and home modification intervention for older people with a risk of falling by using a systematic approach. Implications include how this intervention could enrich occupational therapy fall prevention strategy in older people living at home.IMPLICATIONS FOR REHABILITATIONFalls in older people represent a major public health concern and occupational therapists in rehabilitation practice are encouraged to apply evidence-based interventions that reduce the risk of falls in older people living in a community.Many physical and environmental fall risks are modifiable by lifestyle changes such as physical exercise training, home safety assessment, and home modification. We developed a home-based balance and strength exercise training and home modification intervention that aims to improve strength, balance, and home safety.This study indicates that older people, at risk of falling, with functional limitations, and limited mobility, who participated in the FIT-at-Home intervention, felt that exercising at home suited them best.

Meta-analysis and GRADE profiles of exercise interventions for falls prevention in long-term care facilities

AIMS

To provide a comprehensive collection of evidence on the effectiveness of exercise interventions to prevent falls and support clinical decision-making.

DESIGN

A systematic literature review and meta-analysis of randomized controlled trails were performed by combining trials from published systematic reviews and more recent ones from a separate literature search.

DATA SOURCES

The literature search was performed using PubMed, CINAHL, Cochrane Databases, and Google Scholar dating January 2007 - March 2018.

REVIEW METHODS

Comparable studies were pooled using the random-effects model. The GRADE approach was used to judge the evidence.

RESULTS

Exercises with a balance component or with technical devices reduced falls significantly, however, with low confidence in the evidence. The evidence indicated that exercises conducted longer than 6 months were beneficial. In frail residents, exercise interventions seemed to have substantially negative effects on falls.

CONCLUSIONS

Exercise interventions with technical devices, those with a balance component, and those performed longer than 6 months are recommended in long-term care settings. Frail residents need special attention when performing exercises due to their increased risk of falling.

IMPACT

Exercises with a balance component and exercises carried out with technical devices have beneficial effects, whereas exercises performed longer than 6 months are more effective than short-term performances. No significant reduction or decrease in the number of falls was found for exercise in cognitively impaired residents. In frail residents, however, the number of fall events increased substantially as a result of exercise interventions. The results of this review are useful for clinical decision-makers in long-term care facilities with regard to the planning and performance of exercise interventions for residents.

Effectiveness of complex falls prevention interventions in residential aged care settings: a systematic review

OBJECTIVE

The objective of this review was to synthesize the best available evidence for the effectiveness of complex falls prevention interventions delivered at two or more of the following levels: resident, facility or organization, on fall rates in the residential aged care (RAC) population.

INTRODUCTION

Preventing falls in the high risk RAC population is a common global goal with acknowledged complexity. Previous meta-analyses have not specifically addressed complexity, described as falls prevention intervention delivery at multiple levels of a RAC organization, to determine its effect on fall outcomes.

INCLUSION CRITERIA

The current review considered studies that included participants who were aged 65 years and over residing in long-term care settings providing 24-hour supervision and/or care assistance.Studies that evaluated complex falls prevention interventions delivered by single discipline or multidisciplinary teams across at least two or all of the following levels: residents, RAC facility and RAC organization were eligible. Experimental study designs including randomized controlled trials, controlled clinical trials and quasi-experimental trials that reported on measures related to fall incidence were considered, namely, rate of falls (expressed as the number of falls per 1000 occupied bed days), the number of participants who became fallers (expressed as the number of participants who fell once or more) and the rate of injurious falls (expressed as the number of falls with injury per 1000 occupied bed days).

METHODS

A three-step search strategy was undertaken, commencing with an initial scoping search of MEDLINE and CINAHL databases prior to an extensive search of all relevant published literature, clinical trial registries and gray literature. Two independent reviewers assessed selected studies for methodological validity using the standardized critical appraisal instrument from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Data were extracted from the selected studies using the standardized data extraction tool from JBI SUMARI. Quantitative data were pooled in statistical meta-analysis for rate of falls, the number of participants who became fallers and the rate of injurious falls. Meta-analysis was conducted using a random-effect model with heterogeneity assessed using the standard Chi-squared and I index. Where statistical pooling was not possible, study findings were presented in narrative form.

RESULTS

Twelve studies were included in this review with seven being eligible for meta-analysis. Complex falls prevention interventions delivered at multiple levels in RAC populations did not show a significant effect in reducing fall rates (MD = -1.29; 95% CI [-3.01, 0.43]), or the proportion of residents who fell (OR = 0.76; 95% CI [0.42, 1.38]). However, a sensitivity analysis suggested complex falls prevention interventions delivered with additional resources at multiple levels had a significant positive effect in reducing fall rates (MD = -2.26; 95% CI [-3.72, -0.80]).

CONCLUSIONS

Complex falls prevention interventions delivered at multiple levels in the RAC population may reduce fall rates when additional staffing, expertise or resources are provided. Organizations may need to determine how resources can be allocated to best address falls prevention management. Future research should continue to investigate which combinations of multifactorial interventions are effective.

Association of Receiving Multiple, Concurrent Fracture-Associated Drugs With Hip Fracture Risk

IMPORTANCE

Many prescription drugs increase fracture risk, which raises concern for patients receiving 2 or more such drugs concurrently. Logic suggests that risk will increase with each additional drug, but the risk of taking multiple fracture-associated drugs (FADs) is unknown.

OBJECTIVE

To estimate hip fracture risk associated with concurrent exposure to multiple FADs.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used a 20% random sample of Medicare fee-for-service administrative data for age-eligible Medicare beneficiaries from 2004 to 2014. Sex-stratified Cox regression models estimated hip fracture risk associated with current receipt of 1, 2, or 3 or more of 21 FADs and, separately, risk associated with each FAD and 2-way FAD combination vs no FADs. Models included sociodemographic characteristics, comorbidities, and use of non-FAD medications. Analyses began in November 2018 and were completed April 2019.

EXPOSURE

Receipt of prescription FADs.

MAIN OUTCOMES AND MEASURES

Hip fracture hospitalization.

RESULTS

A total of 11.3 million person-years were observed, reflecting 2 646 255 individuals (mean [SD] age, 77.2 [7.3] years, 1 615 613 [61.1%] women, 2 136 585 [80.7%] white, and 219 579 [8.3%] black). Overall, 2 827 284 person-years (25.1%) involved receipt of 1 FAD; 1 322 296 (11.7%), 2 FADs; and 954 506 (8.5%), 3 or more FADs. In fully adjusted, sex-stratified models, an increase in hip fracture risk among women was associated with the receipt of 1, 2, or 3 or more FADs (1 FAD: hazard ratio [HR], 2.04; 95% CI, 1.99-2.11; P < .001; 2 FADs: HR, 2.86; 95% CI, 2.77-2.95; P < .001; ≥3 FADs: HR, 4.50; 95% CI, 4.36-4.65; P < .001). Relative risks for men were slightly higher (1 FAD: HR, 2.23; 95% CI, 2.11-2.36; P < .001; 2 FADs: HR, 3.40; 95% CI, 3.20-3.61; P < .001; ≥3 FADs: HR, 5.18; 95% CI, 4.87-5.52; P < .001). Among women, 2 individual FADs were associated with HRs greater than 3.00; 80 pairs of FADs exceeded this threshold. Common, risky pairs among women included sedative hypnotics plus opioids (HR, 4.90; 95% CI, 3.98-6.02; P < .001), serotonin reuptake inhibitors plus benzodiazepines (HR, 4.50; 95% CI, 3.76-5.38; P < .001), and proton pump inhibitors plus opioids (HR, 4.00; 95% CI, 3.56-4.49; P < .001). Receipt of 1, 2, or 3 or more non-FADs was associated with a small, significant reduction in fracture risk compared with receipt of no non-FADs among women (1 non-FAD: HR, 0.93; 95% CI, 0.90-0.96; P < .001; 2 non-FADs: HR, 0.84; 95% CI, 0.81-0.87; P < .001; ≥3 non-FADs: HR, 0.74; 95% CI, 0.72-0.77; P < .001).

CONCLUSIONS AND RELEVANCE

Among older adults, FADs are commonly used and commonly combined. In this cohort study, the addition of a second and third FAD was associated with a steep increase in fracture risk. Many risky pairs of FADs included potentially avoidable drugs (eg, sedatives and opioids). If confirmed, these findings suggest that fracture risk could be reduced through tighter adherence to long-established prescribing guidelines and recommendations.

The costs of traumatic head injury and associated factors at University of Gondar Specialized Referral Hospital, Northwest Ethiopia

BACKGROUND

Head injuries account for 650,000 annual deaths worldwide. The cost for treating head injury was estimated at US $200 million annually. This contributes to economic impoverishment in low income countries like Ethiopia. Hence, this study was aimed to assess the cost of Traumatic Head Injury (THI) and associated factors in the University of Gondar Specialized Referral Hospital.

METHOD

An institution-based cross-sectional study was conducted from March 01 to May 30, 2017. A total of 387 THI patients were included in the study. An interviewer-administered questionnaire was used for data collection. Direct costs and indirect costs were measured by using the bottom-up approach. Data were entered into Epi-Info version 7 and imported to SPSS version 20 for analysis. Simple and multiple linear regression analysis were done to identify factors associated with cost of THI.

RESULTS

The mean cost of THI per patient was 4673.43 Ethiopian Birr (ETB), 95% CI (4523.6-4823.3), and length of hospital stay averaged 1.73, 95% CI (1.63-1.82). Direct non-medical cost, like transportation fee 1896.19 ETB (±762.56 SD) and medical costs 1101.66 ETB (±534.13 SD) were account for 40.57 and 23.58% of total costs respectively. The indirect cost, loss of income by patient and their attendant due to injury, was 1675.58 ETB (+ 459.26 SD). Patients with moderate and severe levels of injury have 635.167 ETB (Standardized coefficient = 0.173, p < 0.001) and 773.621 ETB (Standardized coefficient = 0. 132, p < 0.001) increased costs, respectively, compared to mild level THI patients. Costs for patients ages 31-45 years were 252.504 ETB (Standardized coefficient = - 0.066, p = 0.046) lower than costs for those 5-14 years old. The cost of THI patients increased by 1022.853 ETB for each additional day of hospital length of stay (Standardized coefficient = 0.648, p < 0.001).

CONCLUSION

Most expenses of the THI were from direct non-medical cost. Prior health service use, length of stay, level of injury, and age were significant predictors of cost of THI.

Validity of the Falls Risk for Older People in the Community (FROP-Com) tool to predict falls and fall injuries for older people presenting to the emergency department after falling

The aims of this study were to (1) externally validate the accuracy of the Falls Risk for Older People in the Community (FROP-Com) falls risk assessment tool in predicting falls and (2) undertake initial validation of the accuracy of the FROP-Com to predict injurious falls (requiring medical attention) in people aged ≥ 60 years presenting to emergency departments (EDs) after falling. Two hundred and thirteen participants (mean age = 72.4 years; 59.2% women) were recruited (control group of a randomised controlled trial). A FROP-Com assessment was completed at a home visit within 2 weeks of ED discharge. Data on falls and injurious falls requiring medical attention were collected via monthly falls calendars for the next 12 months. Predictive accuracy was evaluated using sensitivity and specificity of a high-risk FROP-Com classification (score ≥ 19) in predicting a fall and injurious falls requiring medical attention. Fifty per cent of participants fell, with 60.4% of falls requiring medical attention. Thirty-two per cent were classified as high, 49% as moderate and 19% low falls risk. Low sensitivity was achieved for the FROP-Com high-risk classification for predicting falls (43.4%) and injurious falls (34.4%), although specificity was high (79.4% and 78.6%, respectively). Despite the FROP-Com's low predictive accuracy, the high fall rate and high falls risk of the sample suggest that older people who fall, present to ED and are discharged home are at high risk of future falls. In high-falls-risk populations such as in this study, the FROP-Com is not a valid tool for classifying risk of falls or injurious falls. Its potential value may instead be in identifying risk factors for falling to direct tailoring of falls prevention interventions to reduce future falls.

Educating hospital patients to prevent falls: protocol for a scoping review

INTRODUCTION

Falls prevention in hospitals is an ongoing challenge worldwide. Despite a wide variety of recommended falls mitigation strategies, few have strong evidence for effectiveness in reducing falls and accompanying injuries. Patient education programmes that promote engagement and enable people to understand their heightened falls risk while hospitalised are one approach. The aim of this scoping review is to examine the content, design and outcomes of patient education approaches to hospital falls prevention. As well as critiquing the role of patient education in hospital falls prevention, strategies that can be used in clinical practice shall be recommended.

METHODS AND ANALYSIS

The analysis will apply the methodological framework developed by Arksey and O'Malley and refined by the Joanna Briggs Institute. An initial limited search of Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed will be completed to identify keywords and index terms. A developed search strategy of Medical Subject Headings and text words will be conducted of PubMed, CINAHL, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, PsychINFO, Education Resources Information Center and grey literature databases from January 2008 to current. The reference lists of included articles will be hand searched for additional studies. Two reviewers will screen the titles and abstracts independently and analyse the full text of potential articles based on the inclusion and exclusion criteria. The data will be extracted using a structured data form. Thematic analysis and numerical synthesis of the data will be conducted, and key themes will be identified.

ETHICS AND DISSEMINATION

Results of this scoping review will illuminate the designs and outcomes of patient education research for hospital falls prevention in the current literature. It is anticipated that the findings will highlight best-practice educational design to inform the development of future patient-focused education for falls prevention. Study findings will be presented at relevant conferences and public forums, and published in peer-reviewed journals. Ethics approval is not required.

[Evaluation of a simple screening tool for ambulant fall prevention]

BACKGROUND

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.

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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 resistance training concentric velocity on older adults' functional capacity: A systematic review and meta-analysis of randomised trials

Reduced levels of functional capacity in older adults are related to lower quality of life, frailty, and sarcopenia, and can increase risk of falling, fractures and hospitalisation. Resistance training is an effective method to attenuate age-related functional declines. Based on the findings that muscle power and explosive strength are strongly associated with functional performance in older adults, it has been suggested that fast-intended-velocity resistance training may elicit greater improvements in functional capacity when compared to moderate-velocity resistance training. However, currently, there is no high-quality systematic review and meta-analysis supporting this assertion. The present study compared the magnitude of functional capacity improvements following resistance training performed with fast-intentional velocity versus moderate velocity. Pubmed, Scopus, and Web of Science databases were searched from inception to January 2019. The following eligibility criteria for selecting studies was adopted: Participants aged ≥60 years; resistance training based intervention for lower limbs performed solely with slow to moderate concentric velocity (≥2 s for each concentric phase) or solely with the intention of maximising velocity (i.e., as fast as possible); and at least one functional test for lower limbs, with pre- and post-intervention measurements. When studies employed multiple functional tests, a single (pooled) standardised mean difference was calculated and presented as combined functional capacity. In addition, functional tests were grouped accordingly to their specificity for the sub-groups meta-analyses. Fifteen studies were selected (high quality, n = 3; and pre-registered, n = 2). The results presented heterogeneity and small-studies publication bias, leading to a biased advantage for fast-intended-velocity resistance training (95%CI = 0.18, 0.65; I² = 45%). Short physical performance battery indicated an advantage for fast-intended-velocity resistance training (95%CI = 0.10, 0.94; I² = 0%). There was no difference for timed up and go (95%CI = -0.07, 0.94; I² = 48%), 30-s chair stand (95%CI = -0.24, 1.39; I² = 71%), 5-times chair stand (95%CI = -1.63, 1.27; I² = 57%) stair climb (95%CI = -1.89, 2.81; I² = 0%), short walk (95%CI = -0.99, 0.96; I² = 21%) and long walk (95%CI = -0.59, 1.00; I² = 0%). These results suggest that there is inconclusive evidence to support the superiority of fast-intended-velocity resistance training to improve functional capacity when compared to moderate-velocity resistance training. These results may have been influenced by the lack of high-quality and pre-registered studies, high heterogeneity, and small-studies publication bias. PROSPERO REGISTRATION NUMBER: CRD42019122251.

Balance training using virtual reality improves balance and physical performance in older adults at high risk of falls

Purpose

Exercise programs designed for falls prevention have been proven effective in reducing falls by approximately 21%. Virtual reality may provide a viable alternative intervention for falls prevention. This study compared the effects of virtual reality training using the Balance Rehabilitation Unit (BRU) versus exercise using a modified Otago Exercise Programme (EX) on improving balance and physical performance in the short-term restorative care setting of the Gait and Balance Gym (Gabagym).

Patients and methods

This was a pre- and post-intervention study of 195 participants (median age 78 years, IQR 73–84; 67% female) who presented with a risk and/or history of falls. Participants were assigned to either EX (n=82) or BRU (n=63). Supervised sessions occurred twice a week for 6 weeks. Participants receiving interventions were compared to a separate group (n=50) with similar characteristics who did not receive any intervention. Balance and physical performance were assessed at initial and final attendance and included the 5 Times Sit to Stand (5STS) test, Timed Up and Go (TUG), gait speed and posturography assessment using the BRU. Fear of falling was assessed using the Falls Efficacy Scale. Handgrip strength and adherence were also monitored.

Results

Post-intervention, EX and BRU groups achieved similar improvements and reported similar adherence rates (71% vs 72%, respectively). Both intervention groups improved in balance and physical performance measures. Both interventions showed significantly better improvement than the non-intervention group in TUG (p<0.001), gait speed (p=0.021), limits of stability in posturography assessment (p=0.008), FES-I score (p=0.013) and handgrip strength (p=0.021). Only the BRU group improved control of static posture in the eyes closed (p=0.002) and foam eyes closed (p=0.006) tasks.

Conclusion

This study highlights the potential use of virtual reality as a practical alternative to improve outcomes of balance training for reduction of falls risk in older adults.

Measurement of Fall Injury With Health Care System Data and Assessment of Inclusiveness and Validity of Measurement Models

IMPORTANCE

National injury surveillance systems use administrative data to collect information about severe fall-related trauma and mortality. Measuring milder injuries in ambulatory clinics would improve comprehensive outcomes measurement across the care spectrum.

OBJECTIVES

To assess a flexible set of administrative data-only algorithms for health systems to capture a greater breadth of injuries than traditional fall injury surveillance algorithms and to quantify the algorithm inclusiveness and validity associated with expanding to milder injuries.

DESIGN, SETTING, AND PARTICIPANTS

In this longitudinal diagnostic study of 13 939 older adults (≥65 years) in the nationally representative Health and Retirement Study, a survey was conducted every 2 years and was linked to hospital, emergency department, postacute skilled nursing home, and outpatient Medicare claims (2000-2012). During each 2-year observation period, participants were considered to have sustained a fall-related injury (FRI) based on a composite reference standard of having either an external cause of injury (E-code) or confirmation by the Health and Retirement Study patient interview. A framework involving 3 algorithms with International Classification of Diseases, Ninth Revision codes that extend FRI identification with administrative data beyond the use of fall-related E-codes was developed: an acute care algorithm (head and face or limb, neck, and trunk injury reported at the hospital or emergency department), a balanced algorithm (all acute care algorithm injuries plus severe nonemergency outpatient injuries), and an inclusive algorithm (almost all injuries). Data were collected from January 1, 1998, through December 31, 2012, and statistical analysis was performed from August 1, 2016, to March 1, 2019.

MAIN OUTCOMES AND MEASURES

Validity, measured as the proportion of potential FRI diagnoses confirmed by the reference standard, and inclusiveness, measured as the proportion of reference-standard FRIs captured by the potential FRI diagnoses.

RESULTS

Of 13 939 participants, 1672 (42.4%) were male, with a mean (SD) age of 77.56 (7.63) years. Among 50 310 observation periods, 9270 potential FRI diagnoses (18.4%) were identified; these were tested against 8621 reference-standard FRIs (17.1%). Compared with the commonly used method of E-coded-only FRIs (2-year incidence, 8.8% [95% CI, 8.6%-9.1%]; inclusion of 51.5% [95% CI, 50.4%-52.5%] of the reference-standard FRIs), FRI inclusion was increased with use of the study framework of algorithms. With the acute care algorithm (2-year incidence, 12.6% [95% CI, 12.4%-12.9%]), validity was prioritized (88.6% [95% CI, 87.4%-89.8%]) over inclusiveness (62.1% [95% CI, 61.1%-63.1%]). The balanced algorithm showed a 2-year incidence of 14.6% (95% CI, 14.3%-14.9%), inclusion of 65.3% (95% CI, 64.3%-66.3%), and validity of 83.2% (95% CI, 81.9%-84.6%). With the inclusive algorithm, the number of potential FRIs increased compared with the E-code-only method (2-year incidence, 17.4% [95% CI, 17.1%-17.8%]; inclusion, 68.4% [95% CI, 67.4%-69.3%]; validity, 75.2% [95% CI, 73.7%-76.6%]).

CONCLUSIONS AND RELEVANCE

The findings suggest that use of algorithms with International Classification of Diseases, Ninth Revision codes may increase inclusion of FRIs by health care systems compared with E-codes and that these algorithms may be used by health systems to evaluate interventions and quality improvement efforts.

Service organisation for people with dementia after an injurious fall: challenges and opportunities

Introduction

people with dementia are more likely to fall and less likely to recover well after a fall than cognitively intact older people. Little is known about how best to deliver services to this patient group. This paper explored current service provision to help inform the development of a new intervention.

Methods

qualitative approaches were used to explore the views and experiences of people with dementia, family carers and professionals providing services to people with dementia following an injurious fall. These data were analysed using a thematic, iterative analysis.

Findings

while a wide range of services potentially relevant to people with dementia was identified, there were no dedicated services for people with dementia with fall-related injuries in our three geographical areas. Factors influencing service uptake included a lack of knowledge of local provision amongst professionals and underdeveloped information sharing systems. Some aspects of current service organisation were incompatible with the needs of people with dementia. These include an emphasis on time-limited interventions; lack of longer-term follow-up; and service delivery in environments that could be challenging for people with dementia.

Conclusions

care pathways for people with dementia who fall are fragmented and unclear. This is likely to preclude people with dementia from receiving all appropriate support and contribute to poor recovery following a fall. The findings highlight the need for new approaches to service organisation and delivery which address the specific needs of people with dementia who fall.

EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research

Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.

EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research

Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.

Cost analysis of a brief intervention for the prevention of falls after discharge from an emergency department

RATIONALE, AIMS AND OBJECTIVES

There is considerable uncertainty around the cost-effectiveness of interventions for preventing secondary falls in older people presenting to emergency departments (ED). The objective was to complete an economic evaluation of a brief educational ED intervention aimed at preventing falls in older people post discharge.

METHODS

A net cost analysis was completed from the health system perspective, using data from a controlled clinical trial, where an education intervention was compared to standard care. Patients aged 65 and older presenting to the ED with any diagnosis were enrolled. The costs, using Australian dollars (A$) at 2015 values, included resources required for the intervention and any health care cost incurred in the 6-month follow-up period (time horizon). Cost data were sourced through institutional billing records and liaison with the patient and their general practitioner. Mean costs and differences were analysed through nonparametric bootstrapping.

RESULTS

The total costs in the control group (n = 201) were A$1 576 496 compared to A$1 292 130 in the intervention group (n = 211). The mean net cost per patient was A$7749 and A$6187 (P = 0.68) respectively resulting in a mean difference of A$1580 per patient in the intervention group (95% CI: A$-2806 to A$6150). Patients who presented to the ED with a fall diagnosis were reviewed through subgroup analysis. Total costs for patients who presented with a fall in the control group (n = 69) were A$708 995 compared to A$512 874 in the intervention group (n = 97). The mean net cost per patient was A$10 326 and A$5343 respectively (P = 0.33) with an overall saving of A$4624 per patient in the intervention group (95% CI: A$-2868 to A$15 426).

CONCLUSIONS

A brief intervention had no net cost benefit across the whole study population, but is more cost effective in older people presenting to the ED with a fall.

Perfil psicosocial de adultos mayores mexicanos hospitalizados por fractura de cadera secundaria a caída

Objetivo Definir el perfil psicosocial de adultos mayores de 65 años hospitalizados por fractura de cadera secundaria a caída.Métodos Se realizó un estudio de prevalencia, descriptivo, cuantitativo; reclutándose 55 sujetos mayores de 65 años hospitalizados de marzo 2017 a febrero 2018. Los datos fueron recolectados a través de un cuestionario socioeconómico y el índice de Barthel para Actividades de la Vida Diaria.Resultados El promedio de edad fue de 80,8 años, de los cuales 76,36% eran mujeres. El 58,2% de pacientes eran viudos; 61,8% habían cursado solo la educación primaria y 29,1% no contaban con estudios. El 69,1% de la muestra se encontraba desempleada y 56,36% subsistía con un ingreso mensual menor a US$101,77, dependiendo de programas de apoyo social gubernamental como fuente de ingreso. Los hallazgos en las condiciones de vivienda fueron homogéneos entre la población estudiada. El 67.3% de la muestra presentaba un grado variable de dependencia en las actividades cotidianas.Discusión Los resultados permiten generar la hipótesis de que el riesgo de complicaciones médicas y socioeconómicas durante el periodo de recuperación puede ser mayor en nuestra población debido a las condiciones premórbidas descritas.

Visually Impaired OLder people’s Exercise programme for falls prevenTion (VIOLET): a feasibility study

Background

The visually impaired have a higher risk of falling and are likely to avoid activity.

Objectives

To adapt the existing Falls Management Exercise (FaME) programme, which is delivered in the community, for visually impaired older people (VIOP) and to investigate the feasibility of conducting a definitive randomised controlled trial of this adapted intervention.

Design

Phase I – consultation with stakeholders to adapt the existing programme. Two focus groups were conducted, each with 10 VIOP across the study sites. Phase II – two-centre randomised pilot trial and economic evaluation of the adapted programme for VIOP versus usual care. Phases III and IV – qualitative interviews with VIOP and Postural Stability Instructors regarding their views and experiences of the research process, undertaking the intervention and its acceptability.

Intervention

This was adapted from the group-based FaME programme. A 1-hour exercise programme ran weekly over 12 weeks at the study sites (Newcastle upon Tyne and Glasgow) and was delivered by third-sector organisations. Participants were advised to also exercise at home for 2 hours per week. Those randomised to the usual activities group received no intervention.

Outcome measures

These were completed at baseline, week 12 and week 24. The primary potential outcome measure used was the Short Form Falls Efficacy Scale – International. Secondary outcome assessment measures were activity avoidance, current activity, balance/falls risk, physical activity, loneliness, anxiety and depression, work and social adjustment, quality of life and economic costs. Participants’ compliance was assessed by reviewing attendance records and self-reported compliance with the home exercises. Instructors’ compliance with the course content (fidelity) was assessed by a researcher attending a sample of exercise sessions. Adverse events were collected in a weekly telephone call for all participants in both the intervention and control arm.

Findings

An adapted exercise programme was devised with stakeholders. In the pilot trial, 82 participants drawn from community-living VIOP were screened, 68 met the inclusion criteria and 64 were randomised, with 33 allocated to the intervention and 31 to the usual activities arm. A total of 94% of participants provided data at week 12 and 92% at week 24. Adherence to the study was high. The intervention was found to be both safe and acceptable to participants, with 76% attending nine or more classes. Median time for home exercise was 50 minutes per week. There was little or no evidence that fear of falling, exercise, attitudinal or quality-of-life outcomes differed between trial arms at follow-up. Thematic analysis of the interviews with VIOP participants identified facilitators of and barriers to exercise, including perceived relevance to health, well-being and lifestyle, social interaction, self-perception and practical assistance. Instructors identified issues regarding level of challenge and assistance from a second person.

Limitations

The small sample size and low falls risk of the study sample are study limitations.

Conclusion

Although adaptation, recruitment and delivery were successful, the findings (particularly from qualitative research with instructors and participants) indicated that VIOP with low to moderate falls risk could be integrated into mainstream programmes with some adaptations. A future definitive trial should consider graduated exercises appropriate to ability and falls risk within mainstream provision. Other outcome measures may additionally be considered.

Trial registration

Current Controlled Trials ISRCTN16949845.

Funding

This project was funded by the NIHR Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 4. See the NIHR Journals Library website for further project information.