1
|
Marquez-Doren F, Lucchini-Raies C, Alcayaga C, Bustamante C, González-Agüero M. Acceptability and feasibility of a comprehensive fall prevention model for independent older adults: A qualitative evaluation. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 7:100220. [PMID: 39050690 PMCID: PMC11267027 DOI: 10.1016/j.ijnsa.2024.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/16/2024] [Accepted: 06/20/2024] [Indexed: 07/27/2024] Open
Abstract
Background Falls amongst the elderly represent a global public health challenge because of their potential to cause illness, death, and reduce the autonomy of this group. They also impact the emotional, family, social and economic well-being of those involved. Various strategies to prevent falls have been reported in the literature, focusing mainly on addressing individual risk factors, and on the continuous assessment of the risk of falls in older people. Objective This study evaluated user satisfaction and acceptability of a comprehensive model, implemented in the community, to prevent falls amongst independent older adults aged 65 years and above. It sought to capture both the perceptions of the individuals who received the intervention and of the interventionists who implemented it. The study protocol was registered at ClinicalTrials.gov in November 2020 (ID: NCT04313062). Design Qualitative, exploratory study using a case study design. The evaluation of the intervention followed the recommendations proposed by the Medical Research Council for complex interventions. Methods and participants: In the period between April 2021 to April 2022, 11 semi-structured interviews were conducted with independent older adults between 65 and 80 years of age who participated in the implementation of the comprehensive model in Santiago, Chile. Data were also collected with eight interventionists through: three semi-structured interviews at the beginning of the intervention; and two focus groups with seven interventionists at the end of the implementation of the model. The team members undertook a content analysis of the data collected. Results Three themes emerged to account for the satisfaction and acceptability of the intervention with the model on the part of the participants and interventionists: (1) Previous experience of older persons and interventionists; (2) The older person-interventionist encounter and its context; and (3) Identification of facilitators, strengths and challenges for the implementation of the model. The results show a positive assessment of the model, highlighting the value of the social contact derived from the intervention by both participants and interventionists. Although the model involved an individual intervention, the participants' accounts indicate that it reached out to others, including family members and other elderly acquaintances. Moreover, the interventionists helped identify challenges in implementation and made recommendations to strengthen the model. Conclusion The evaluation of satisfaction and feasibility of implementing the model showed positive results that will nurture the next phase of development of this model, which involves scaling up the intervention.
Collapse
Affiliation(s)
- Francisca Marquez-Doren
- School of Nursing, Pontificia Universidad Católica de Chile. Collaborating Center for the Development of Health and Nursing Services for the Care of Noncommunicable Diseases. PAHO/WHO. Sigma Chapter Alpha Beta Omicron, Santiago, Chile
| | - Camila Lucchini-Raies
- School of Nursing, Pontificia Universidad Católica de Chile. Collaborating Center for the Development of Health and Nursing Services for the Care of Noncommunicable Diseases. PAHO/WHO. Sigma Chapter Alpha Beta Omicron, Santiago, Chile
| | - Claudia Alcayaga
- School of Nursing, Pontificia Universidad Católica de Chile. Collaborating Center for the Development of Health and Nursing Services for the Care of Noncommunicable Diseases. PAHO/WHO. Sigma Chapter Alpha Beta Omicron, Santiago, Chile
| | - Claudia Bustamante
- School of Nursing, Pontificia Universidad Católica de Chile. Collaborating Center for the Development of Health and Nursing Services for the Care of Noncommunicable Diseases. PAHO/WHO. Sigma Chapter Alpha Beta Omicron, Santiago, Chile
| | - Marcela González-Agüero
- School of Nursing, Pontificia Universidad Católica de Chile. Collaborating Center for the Development of Health and Nursing Services for the Care of Noncommunicable Diseases. PAHO/WHO. Sigma Chapter Alpha Beta Omicron, Santiago, Chile
| |
Collapse
|
2
|
Li DD, Yang X, Yang Y, Zhao LH, Zhang TT, Wang YN, Su JB, Wang LH, Shi HY. Association of Questionnaire-Based Physical Activity Analysis and Body Composition Dynamics in Type 2 Diabetes: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2024; 17:2955-2966. [PMID: 39135891 PMCID: PMC11318602 DOI: 10.2147/dmso.s459356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 07/30/2024] [Indexed: 08/15/2024] Open
Abstract
Background Physical activity (PA) exerts an important influence on glycemic control in type 2 diabetes (T2D) patients. Alterations in body composition in patients with T2D may be involved in the overall pathophysiologic process, but PAs and alterations in body composition have been poorly studied. Methods A total of 615 patients with T2D were selected by convenient sampling. The patients were investigated with the International Physical Activity Questionnaire (IPAQ-S). Moreover, biochemical indices were collected, and the progression of the body composition of the subjects was determined via dual-energy X-ray absorptiometry (DXA). The variables included lumbar bone mineral density (LSBMD), femoral neck bone mineral density (FNBMD), hip bone mineral density (HBMD), whole-body bone mineral density (TBMD), limb skeletal muscle mass index (ASMI), whole-body fat percentage (B-FAT) and trunk fat percentage (T-FAT). Moreover, the levels of physical activity (high level of physical activity [H-PA], medium level of physical activity [M-PA] and low level of physical activity [L-PA]) were divided into three groups to analyze the changes in patient body composition with changes in physical activity level. Results One-way analysis of variance showed that β-CTX, TP1NP, HbA1c, B-FAT and T-FAT increased significantly (p<0.05), while 25(OH)D, LSBMD, FNBMD, HBMD, TBMD and ASMI decreased significantly (p<0.001) with the decrease of physical activity. However, there was no significant difference in serum lipids between lnHOMA-ir and lnHOMA-β (p>0.05). Multiple linear regression model was established to gradually adjust for clinical confounding factors. It was found that physical activity level was independently positively correlated with LSBMD, FNBMD, HBMD, TBMD, and ASMI, and was independently negatively correlated with B-FAT and T-FAT in patients with type 2 diabetes. Conclusion A lack of physical activity is an independent risk factor for decreased bone mineral density, decreased skeletal muscle content and increased fat content in patients with T2D.
Collapse
Affiliation(s)
- Dan-Dan Li
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University, and First People’s Hospital of Nantong City, Nantong, 226006, People’s Republic of China
| | - Xue Yang
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University, and First People’s Hospital of Nantong City, Nantong, 226006, People’s Republic of China
| | - Yang Yang
- Department of General Practice, Affiliated Hospital 2 of Nantong University, and First People’s Hospital of Nantong City, Nantong, 226006, People’s Republic of China
| | - Li-Hua Zhao
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University, and First People’s Hospital of Nantong City, Nantong, 226006, People’s Republic of China
| | - Tian-Tian Zhang
- Department of Hepatobiliary Surgery, Affiliated Hospital 2 of Nantong University, and First People’s Hospital of Nantong City, Nantong, 226006, People’s Republic of China
| | - Yi-Nan Wang
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University, and First People’s Hospital of Nantong City, Nantong, 226006, People’s Republic of China
| | - Jian-Bin Su
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University, and First People’s Hospital of Nantong City, Nantong, 226006, People’s Republic of China
| | - Li-Hua Wang
- Department of Nursing, Affiliated Hospital 2 of Nantong University, and First People’s Hospital of Nantong City, Nantong, 226006, People’s Republic of China
| | - Hai-Yan Shi
- Department of Hepatobiliary Surgery, Affiliated Hospital 2 of Nantong University, and First People’s Hospital of Nantong City, Nantong, 226006, People’s Republic of China
| |
Collapse
|
3
|
Gioia A, Libera T, Burks G, Arena S, Hamel RN, Zukowski LA. The effect of virtual reality treadmill training on obstacle crossing parameters in older adults. Hum Mov Sci 2024; 96:103247. [PMID: 38901163 DOI: 10.1016/j.humov.2024.103247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/29/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
With increased age, walking without tripping requires greater cognitive demand. Therefore, it may be beneficial for training interventions to address and incorporate aspects of cognitive load. The purpose of this study was to compare a semi-immersive virtual reality treadmill training (VRTT) and conventional treadmill training (CTT) on obstacle clearance and trip hazard in older adults. Obstacle clearance parameters were measured with foot-mounted inertial measurement units (IMUs) and a Zeno pressure walkway. All data were processed and analyzed through custom Matlab scripts. Obstacle step height mean decreased (p = .003) in the lead limb following both training interventions. Additional significant changes were found in pre- and post-obstacle distance mean following both training interventions. Furthermore, significant correlations were found between demographic, cognitive, and functional mobility assessments and changes in dependent measures. The findings suggest that both the VRTT and CTT interventions may provide a reduction in trip risk in older adults, although through different methods.
Collapse
Affiliation(s)
- Alexander Gioia
- Department of Mechanical Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Theresa Libera
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Garret Burks
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Sara Arena
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Renee N Hamel
- Department of Physical Therapy, High Point University, High Point, NC, USA
| | - Lisa A Zukowski
- Department of Physical Therapy, High Point University, High Point, NC, USA.
| |
Collapse
|
4
|
Ren Y, Li J, Yang J, Hu L, Xu Z, Fu R, Wu K, Guo M, Hu M, Ran L, Li X, Qiu H, Liao L, Zhang M, Luo Y, Zhou S, Ding F. Meteorological parameters and hospital-acquired falls-A multicenter retrospective study based on 10 years of adverse events reporting system data. Heliyon 2024; 10:e34193. [PMID: 39071631 PMCID: PMC11279767 DOI: 10.1016/j.heliyon.2024.e34193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 06/29/2024] [Accepted: 07/04/2024] [Indexed: 07/30/2024] Open
Abstract
Objective and rationale Hospital-acquired falls are common and serious adverse events in medical institutions, with high incidence and injury rates. Studying the occurrence patterns of hospital-acquired falls is important for preventing falls in hospitalized patients. However, the effect of meteorological factors on hospital-acquired falls has not been elucidated. Therefore, this study explored the impact of meteorological parameters on hospital-acquired falls in Chongqing, China, and provided new ideas for the clinical prevention of falls in patients. Methods Correlation analysis and distributed lag nonlinear models were employed to analyze the relationship between 3890 cases of hospital-acquired falls and meteorological data in 13 hospitals in 11 districts and counties in Chongqing from January 2013 to April 2023. Results The number of hospital-acquired falls demonstrated a nonlinear correlation with the daily average relative humidity and negatively correlated with sunshine duration; however, temperature, air pressure, and wind speed were not correlated. Compared to the reference humidity (87 %), the immediate effects of daily average relative humidity (65-68 % and 90-97 %) increased the risk of hospital-acquired falls on the same day (relative risk [RR]:1.027-1.243). When the daily average relative humidity was 95-97 %, lags of 0-1 d and 8-12 d had greater effects on falls (RR:1.073-1.243). The daily average relative humidities of 62-74 % and 91-97 % were statistically significant at cumulative relative risk (CRR)of 4, 7, 10, and 14 d with a cumulative lag (CRR: 1.111-4.277). On sex and age stratification, the lag and cumulative effects of relative humidity more significantly impacted falls in women and patients aged ≥65 years. Conclusion Daily average relative humidity had a nonlinear correlation and lag effect on hospital-acquired falls; therefore, medical institutions should pay attention to the effect of relative humidity on hospital-acquired falls in patients, especially old and female patients.
Collapse
Affiliation(s)
- Yuanyuan Ren
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jinyan Li
- Information Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jun Yang
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lei Hu
- Information Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhihui Xu
- Nursing Department, Hechuan District People's Hospital of Chongqing, Chongqing, 401533, China
| | - Rongjuan Fu
- Nursing Department, Dianjiang People's Hospital of Chongqing, Chongqing, 408300, China
| | - Kaihui Wu
- Nursing Department, Nanchuan District People's Hospital of Chongqing, Chongqing, 408400, China
| | - Min Guo
- Nursing Department, The 13th People's Hospital of Chongqing, Chongqing, 400050, China
| | - Mei Hu
- Nursing Department, Chongqing University Three Gorges Hospital, Chongqing, 404100, China
| | - Liu Ran
- Department of Endocrinology, Changshou District People's Hospital of Chongqing, Chongqing, 401220, China
| | - Xia Li
- Nursing Department, Qijiang District People's Hospital, Chongqing, 401420, China
| | - Huicheng Qiu
- Nursing Department, Liangping District People's Hospital, Chongqing, 405200, China
| | - Lianmei Liao
- Nursing Department, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, 401121, China
| | - Mengmeng Zhang
- Nursing Department, Banan District People's Hospital of Chongqing, Chongqing, 401320, China
| | - Yetao Luo
- Department of Nosocomial Infection Control, Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Sumei Zhou
- Emergency Department, The First Affiliated Hospital of Chongqing Medical University, 400016, China
| | - Fu Ding
- Nursing Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| |
Collapse
|
5
|
Kiyoshi-Teo H, De Lima B, Dieckmann NF, Vincenzo JL, Eckstrom E. Impact of Documented Fall-Risk, Self-Reported Health and Confidence to Prevent Falls on Concern About Falling Among Community-Dwelling Older Adults: Secondary Analysis of a Randomized Clinical Trial. Clin Interv Aging 2024; 19:1273-1280. [PMID: 39011313 PMCID: PMC11249068 DOI: 10.2147/cia.s453789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/27/2024] [Indexed: 07/17/2024] Open
Abstract
Purpose Individuals identified as high fall risk are expected to have high concern about falling. However, perception and individual factors that influence concern about falling have yet to be thoroughly studied. We aimed to understand factors that influence concern about falling among older adults with increased risk for falling. Patients and Methods This was a secondary analysis of a clinical trial among community-dwelling older adults (age ≥65 years old) at high risk for falls (n = 178). Descriptive and regression analyses were used. We analyzed the relationship between participants' baseline concern about falling - categorized into three groups: low (7-8), moderate (9-13), and high (≥14) - and factors that may impact their concern. Exploratory factors included age, sex, self-reported health status and confidence to address fall risks, fall risk scores, and physical performance measures. Results Among these individuals, 15.2% reported low concern about falling. On average, individuals in higher concern about falling groups had higher fall risk scores (low [5.7], moderate [6.4], and high [8.0]; p < 0.001). Our regression model showed that the odds of being in a higher concern group increased by 21% for every one unit increase in fall risk score and increased by 67% for every one unit increase toward poorer health rating. Conversely, for every one unit increase in self-reported confidence, the odds of being in a higher concern group decreased by 27.5%. Conclusion Knowledge of older adults' fall risk, health status, and concerns about falling can be used to assist in the personalization of fall prevention interventions for a more holistic approach.
Collapse
Affiliation(s)
- Hiroko Kiyoshi-Teo
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Bryanna De Lima
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer L Vincenzo
- Department of Physical Therapy, Center for Implementation Research, University of Arkansas for Medical Sciences, Fayetteville, AR, USA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
6
|
Guirguis-Blake JM, Perdue LA, Coppola EL, Bean SI. Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2024; 332:58-69. [PMID: 38833257 DOI: 10.1001/jama.2024.4166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Importance Falls are the most common cause of injury-related morbidity and mortality in older adults. Objective To systematically review evidence on the effectiveness and harms of fall prevention interventions in community-dwelling older adults. Data Sources MEDLINE, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Clinical Trials for relevant English-language literature published between January 1, 2016, and May 8, 2023, with ongoing surveillance through March 22, 2024. Study Selection Randomized clinical trials of interventions to prevent falls in community-dwelling adults 65 years or older. Data Extraction and Synthesis Critical appraisal and data abstraction by 2 independent reviewers. Random-effects meta-analyses with Knapp-Hartung adjustment. Main Outcomes and Measures Falls, injurious falls, fall-related fractures, hospitalizations or emergency department visits, people with 1 or more falls, people with injurious falls, people with fall-related fractures, and harms. Results Eighty-three fair- to good-quality randomized clinical trials (n = 48 839) examined the effectiveness of 6 fall prevention interventions in older adults. This article focuses on the 2 most studied intervention types: multifactorial (28 studies; n = 27 784) and exercise (37 studies; n = 16 117) interventions. Multifactorial interventions were associated with a statistically significant reduction in falls (incidence rate ratio [IRR], 0.84 [95% CI, 0.74-0.95]) but not a statistically significant reduction in individual risk of 1 or more falls (relative risk [RR], 0.96 [95% CI, 0.91-1.02]), injurious falls (IRR, 0.92 [95% CI, 0.84-1.01]), fall-related fractures (IRR, 1.01 [95% CI, 0.81-1.26]), individual risk of injurious falls (RR, 0.92 [95% CI, 0.83-1.02]), or individual risk of fall-related fractures (RR, 0.86 [95% CI, 0.60-1.24]). Exercise interventions were associated with statistically significant reductions in falls (IRR, 0.85 [95% CI, 0.75-0.96]), individual risk of 1 or more falls (RR, 0.92 [95% CI, 0.87-0.98]), and injurious falls (IRR, 0.84 [95% CI, 0.74-0.95]) but not individual risk of injurious falls (RR, 0.90 [95% CI, 0.79-1.02]). Harms associated with multifactorial and exercise interventions were not well reported and were generally rare, minor musculoskeletal symptoms associated with exercise. Conclusions and Relevance Multifactorial and exercise interventions were associated with reduced falls in multiple good-quality trials. Exercise demonstrated the most consistent statistically significant benefit across multiple fall-related outcomes.
Collapse
Affiliation(s)
- Janelle M Guirguis-Blake
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
- Department of Family Medicine, University of Washington, Tacoma
| | - Leslie A Perdue
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Erin L Coppola
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Sarah I Bean
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| |
Collapse
|
7
|
Hutchinson P, Nadeau A, Mercier E, Bouchard J, Beaulieu S, Brousseau AA, Breton É. An Emergency Medical Technician Administered Falls-Assessment Protocol to Safely Identify Elderly Adults with Non-Urgent Conditions that may Avoid Transport to Emergency Department. Can Geriatr J 2024; 27:159-167. [PMID: 38827431 PMCID: PMC11100985 DOI: 10.5770/cgj.27.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
Background Approximately two-thirds of patients transported to emergency departments (ED) for a fall are discharged from the ED without urgent treatment. This pilot study tests the feasibility of implementing a pre-hospital falls-assessment protocol performed by emergency medical technicians (EMTs) to determine whether a patient who fell needs an ED assessment or could be referred safely to a community resource. Methods The protocol was administered by trained EMTs to adults aged ≥ 65 after a fall between October 2019 and March 2020 in Sherbrooke (QC). All patients were transported to ED regardless of protocol outcome (transport recommended/not recommended). The objective was to assess if EMTs could complete the protocol and make the appropriate decision concerning the transport to ED. Secondary objectives aimed to assess the accuracy in identifying patients who do not require transport, and to measure the impact on avoidable ambulance transports. Results A total of 125 EMTs interventions were carried out: 17 patients were in the transport not recommended group, representing 14% of transport to hospital for falls-related EMTs calls that could be possibly avoided. Of these, 110 were transported to ED. Mean duration of on-site EMTs interventions was of 31 minutes. Forty-seven patients were admitted, mostly for infections and fractures, including four in the transport not recommended group. Conclusions This study showed that EMTs can administer a falls-assessment protocol aimed at identifying patients that need an ED evaluation. Results permitted to amend the protocol before the second phase of the project evaluating the safety of the protocol.
Collapse
Affiliation(s)
- Paul Hutchinson
- Institut Universitaire de Gériatrie de Sherbrooke - Centre de Recherche sur le vieillissement, Université de Sherbrooke, Sherbrooke
- Département de gériatrie, Département de médecine, Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke
| | - Alexandra Nadeau
- Centre de recherche du CHU de Québec—Université Laval, Axe santé des populations et pratiques optimales en santé, Québec City
| | - Eric Mercier
- Centre de recherche du CHU de Québec—Université Laval, Axe santé des populations et pratiques optimales en santé, Québec City
- VITAM—Centre de recherche en santé durable de l’Université Laval, Québec City
| | - Jasmin Bouchard
- Département de gériatrie, Département de médecine, Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke
| | - Sarah Beaulieu
- Département de gériatrie, Département de médecine, Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke
| | - Audrey-Anne Brousseau
- Institut Universitaire de Gériatrie de Sherbrooke - Centre de Recherche sur le vieillissement, Université de Sherbrooke, Sherbrooke
| | - Émilie Breton
- Institut Universitaire de Gériatrie de Sherbrooke - Centre de Recherche sur le vieillissement, Université de Sherbrooke, Sherbrooke
- Département de gériatrie, Département de médecine, Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke
| |
Collapse
|
8
|
De Simone B, Chouillard E, Podda M, Pararas N, de Carvalho Duarte G, Fugazzola P, Birindelli A, Coccolini F, Polistena A, Sibilla MG, Kruger V, Fraga GP, Montori G, Russo E, Pintar T, Ansaloni L, Avenia N, Di Saverio S, Leppäniemi A, Lauretta A, Sartelli M, Puzziello A, Carcoforo P, Agnoletti V, Bissoni L, Isik A, Kluger Y, Moore EE, Romeo OM, Abu-Zidan FM, Beka SG, Weber DG, Tan ECTH, Paolillo C, Cui Y, Kim F, Picetti E, Di Carlo I, Toro A, Sganga G, Sganga F, Testini M, Di Meo G, Kirkpatrick AW, Marzi I, déAngelis N, Kelly MD, Wani I, Sakakushev B, Bala M, Bonavina L, Galante JM, Shelat VG, Cobianchi L, Mas FD, Pikoulis M, Damaskos D, Coimbra R, Dhesi J, Hoffman MR, Stahel PF, Maier RV, Litvin A, Latifi R, Biffl WL, Catena F. The 2023 WSES guidelines on the management of trauma in elderly and frail patients. World J Emerg Surg 2024; 19:18. [PMID: 38816766 PMCID: PMC11140935 DOI: 10.1186/s13017-024-00537-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/26/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. METHODS Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. RESULTS The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient's directives, family feelings and representatives' desires, and all decisions should be shared. CONCLUSIONS The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes.
Collapse
Affiliation(s)
- Belinda De Simone
- Department of Emergency Minimally Invasive Surgery, Academic Hospital of Villeneuve St Georges, Villeneuve St Georges, France.
- Department of General Minimally Invasive Surgery, Infermi Hospital, AUSL Romagna, Rimini, Italy.
- General Surgery Department, American Hospital of Paris, Paris, France.
| | - Elie Chouillard
- General Surgery Department, American Hospital of Paris, Paris, France
| | - Mauro Podda
- Department of Surgical Science, Unit of Emergency Surgery, University of Cagliari, Cagliari, Italy
| | - Nikolaos Pararas
- 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | | | - Paola Fugazzola
- Unit of General Surgery I, IRCCS San Matteo Hospital of Pavia, University of Pavia, Pavia, Italy
| | | | | | - Andrea Polistena
- Department of Surgery, Policlinico Umberto I Roma, Sapienza University, Rome, Italy
| | - Maria Grazia Sibilla
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - Vitor Kruger
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Giulia Montori
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | - Emanuele Russo
- Department of Anesthesia, Level I, Trauma Center, Bufalini Hospital, Cesena, Italy
| | - Tadeja Pintar
- UMC Ljubljana and Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - Luca Ansaloni
- New Zealand Blood Service, Christchurch, New Zealand
| | - Nicola Avenia
- Endocrine Surgical Unit - University of Perugia, Terni, Italy
| | - Salomone Di Saverio
- General Surgery Unit, Madonna del Soccorso Hospital, AST Ascoli Piceno, San Benedetto del Tronto, Italy
| | - Ari Leppäniemi
- Division of Emergency Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Andrea Lauretta
- Department of Surgical Oncology, Centro Di Riferimento Oncologico Di Aviano IRCCS, Aviano, Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, Macerata, Italy
| | - Alessandro Puzziello
- Dipartimento di Medicina, Chirurgia e Odontoiatria, Campus Universitario di Baronissi (SA) - Università di Salerno, AOU San Giovanni di Dio e Ruggi di Aragona, Salerno, Italy
| | - Paolo Carcoforo
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - Vanni Agnoletti
- Department of Anesthesia, Level I, Trauma Center, Bufalini Hospital, Cesena, Italy
| | - Luca Bissoni
- Department of Anesthesia, Level I, Trauma Center, Bufalini Hospital, Cesena, Italy
| | - Arda Isik
- Istanbul Medeniyet University, Istanbul, Turkey
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Oreste Marco Romeo
- Bronson Methodist Hospital/Western Michigan University, Kalamazoo, MI, USA
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, United Arab Emirates
| | | | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital and The University of Western Australia, Perth, Australia
| | - Edward C T H Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ciro Paolillo
- Emergency Department, Ospedale Civile Maggiore, Verona, Italy
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Fernando Kim
- University of Colorado Anschutz Medical Campus, Denver, CO, 80246, USA
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Adriana Toro
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Federica Sganga
- Department of Geriatrics, Ospedale Sant'Anna, Ferrara, Italy
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Giovanna Di Meo
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Nicola déAngelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France
| | | | - Imtiaz Wani
- Department of Surgery, Government Gousia Hospital, DHS, Srinagar, India
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Miklosh Bala
- Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Luigi Bonavina
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Novena, Singapore
| | - Lorenzo Cobianchi
- Unit of General Surgery I, IRCCS San Matteo Hospital of Pavia, University of Pavia, Pavia, Italy
- Collegium Medicum, University of Social Sciences, Łodz, Poland
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Venice, Italy
- Collegium Medicum, University of Social Sciences, Łodz, Poland
| | - Manos Pikoulis
- Department of Surgical Science, Unit of Emergency Surgery, University of Cagliari, Cagliari, Italy
| | | | - Raul Coimbra
- Riverside University Health System Medical Center, Riverside, CA, USA
| | - Jugdeep Dhesi
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Melissa Red Hoffman
- Department of Surgery, University of North Carolina, Surgical Palliative Care Society, Asheville, NC, USA
| | - Philip F Stahel
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Ronald V Maier
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, University Clinic, Gomel, Belarus
| | - Rifat Latifi
- University of Arizona, Tucson, AZ, USA
- Abrazo Health West Campus, Goodyear, Tucson, AZ, USA
| | - Walter L Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, AUSL Romagna, Cesena, Italy
| |
Collapse
|
9
|
Colón-Emeric CS, McDermott CL, Lee DS, Berry SD. Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults: A Review. JAMA 2024; 331:1397-1406. [PMID: 38536167 DOI: 10.1001/jama.2024.1416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/24/2024]
Abstract
Importance Falls are reported by more than 14 million US adults aged 65 years or older annually and can result in substantial morbidity, mortality, and health care expenditures. Observations Falls result from age-related physiologic changes compounded by multiple intrinsic and extrinsic risk factors. Major modifiable risk factors among community-dwelling older adults include gait and balance disorders, orthostatic hypotension, sensory impairment, medications, and environmental hazards. Guidelines recommend that individuals who report a fall in the prior year, have concerns about falling, or have gait speed less than 0.8 to 1 m/s should receive fall prevention interventions. In a meta-analysis of 59 randomized clinical trials (RCTs) in average-risk to high-risk populations, exercise interventions to reduce falls were associated with 655 falls per 1000 patient-years in intervention groups vs 850 falls per 1000 patient-years in nonexercise control groups (rate ratio [RR] for falls, 0.77; 95% CI, 0.71-0.83; risk ratio for number of people who fall, 0.85; 95% CI, 0.81-0.89; risk difference, 7.2%; 95% CI, 5.2%-9.1%), with most trials assessing balance and functional exercises. In a meta-analysis of 43 RCTs of interventions that systematically assessed and addressed multiple risk factors among individuals at high risk, multifactorial interventions were associated with 1784 falls per 1000 patient-years in intervention groups vs 2317 falls per 1000 patient-years in control groups (RR, 0.77; 95% CI, 0.67-0.87) without a significant difference in the number of individuals who fell. Other interventions associated with decreased falls in meta-analysis of RCTs and quasi-randomized trials include surgery to remove cataracts (8 studies with 1834 patients; risk ratio [RR], 0.68; 95% CI, 0.48-0.96), multicomponent podiatry interventions (3 studies with 1358 patients; RR, 0.77; 95% CI, 0.61-0.99), and environmental modifications for individuals at high risk (12 studies with 5293 patients; RR, 0.74; 95% CI, 0.61-0.91). Meta-analysis of RCTs of programs to stop medications associated with falls have not found a significant reduction, although deprescribing is a component of many successful multifactorial interventions. Conclusions and Relevance More than 25% of older adults fall each year, and falls are the leading cause of injury-related death in persons aged 65 years or older. Functional exercises to improve leg strength and balance are recommended for fall prevention in average-risk to high-risk populations. Multifactorial risk reduction based on a systematic clinical assessment for modifiable risk factors may reduce fall rates among those at high risk.
Collapse
Affiliation(s)
- Cathleen S Colón-Emeric
- Division of Geriatrics, Duke University, Durham, North Carolina
- Durham VA Geriatric Research Education and Clinical Center, Durham, North Carolina
| | | | - Deborah S Lee
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sarah D Berry
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Marcus Institute for Aging Research & Department of Medicine, Hebrew SeniorLife, Boston, Massachusetts
| |
Collapse
|
10
|
Hopkins RE, Bharat C, Buizen L, Close J, Ivers R, Draper B, Pearson SA, Degenhardt L, Gisev N. Age-Related Risk of Serious Fall Events and Opioid Analgesic Use. JAMA Intern Med 2024; 184:394-401. [PMID: 38373005 PMCID: PMC10877504 DOI: 10.1001/jamainternmed.2023.8154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/10/2023] [Indexed: 02/20/2024]
Abstract
Importance Opioid analgesics may be associated with increased risk of falls, particularly among older adults. Objective To quantify the age-related risk of serious fall events among adults prescribed opioids by opioid exposure, time from initiation, and daily dose. Design, Setting, and Participants This population-based cohort study conducted in New South Wales, Australia, used data linking national pharmaceutical claims to national and state datasets, including information on sociodemographic characteristics, clinical characteristics, medicines use, health services utilization, and mortality (POPPY II study). It included adults (18 years or older) who initiated prescription opioid treatment, which was defined as no prior dispensing during the preceding 365 days, between January 1, 2005, and December 31, 2018. Data were analyzed from February to June 2023. Exposure Time-dependent periods of opioid exposure were evaluated from dispensing records. Main Outcome and Measures Serious fall events identified from emergency department, hospitalization, and mortality records. Negative binomial models were used to assess associations between time-dependent opioid exposure (overall, by time from initiation, and by dose), age, and risk of fall events. Models were adjusted for known fall risk factors, including other fall risk-increasing drugs, frailty risk, and prior serious fall events. Results The cohort comprised 3 212 369 individuals who initiated prescription opioid treatment (1 702 332 women [53%]; median [IQR] age at initiation, 49 [32-65] years). Overall, 506 573 serious fall events were identified, including 5210 fatal falls. During exposure to opioids, the risk of serious fall events was elevated among all age groups; compared with the group aged 18 to 44 years, this risk was highest among those 85 years or older (adjusted incident rate ratio, 6.35; 95% CI, 6.20-6.51). Across all age groups, the first 28 days following opioid initiation was a time of increased serious fall risk; this risk increased with age. Among individuals aged 18 to 84 years, associations were identified between higher daily opioid doses and serious fall events. Conclusions and Relevance The results of this cohort study suggest that prescription opioids were associated with increased risk of serious fall events among adults of all ages, with individuals 85 years or older at greatest risk. These risks should be considered when prescribing opioids, particularly for individuals with preexisting risk factors or when opioids are prescribed at higher doses. Targeted falls prevention efforts may be most effective within the first month following opioid initiation.
Collapse
Affiliation(s)
- Ria E. Hopkins
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Luke Buizen
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jacqueline Close
- Neuroscience Research Australia, UNSW Sydney, Sydney, New South Wales, Australia
| | - Rebecca Ivers
- School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Brian Draper
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
- Menzies Centre for Health Policy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
11
|
Riaz S, Shakil Ur Rehman S, Hafeez S, Hassan D. Effects of kinect-based virtual reality training on bone mineral density and fracture risk in postmenopausal women with osteopenia: a randomized controlled trial. Sci Rep 2024; 14:6650. [PMID: 38503875 PMCID: PMC10950849 DOI: 10.1038/s41598-024-57358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/18/2024] [Indexed: 03/21/2024] Open
Abstract
Osteopenia is a condition characterized by low bone mineral density (BMD) that increases fracture risk, particularly among postmenopausal women (PMW). This study aimed to determine the effects of Kinect-based VRT on BMD and fracture risk in PMW with osteopenia. The study was a prospective, two-arm, parallel-design, randomized controlled trial. The study enrolled 52 participants, 26 randomly assigned to each group. In the experimental group, Kinect-based VRT was provided thrice weekly for 24 weeks for 45 min/session. Both groups were instructed to engage in a daily 30-min walk outdoors. The fracture risk assessment tool (FRAX) was used to calculate fracture risk, and dual-energy X-ray absorptiometry was used to measure lumbar spine and femur neck BMD. Both variables were assessed at baseline and 24 weeks afterwards. After 24 weeks of Kinect-based VRT, the experimental group showed significant BMD increases in the right and left femoral necks and lumbar spine (p value < 0.001). In the control group, the BMD at the right and left femoral necks showed fewer significant changes (p value < 0.022 and 0.004, respectively). In the control group, lumbar spine BMD did not change (p = 0.57). The experimental group showed significantly lower FRAX scores for hip fracture prediction (HFP) and hip prediction of major osteoporotic (HPMO) at both femoral necks (p value < 0.001) than the control group (p = 0.05 and p = 0.01, respectively), but no significant change at the left femoral neck for HFP (p = 0.66) or HPMO (p = 0.26). These findings indicate that a Kinect-based VRT intervention resulted in significantly increased BMD and a reduced fracture risk, as predicted by HFP and HPMO measurements. These improvements were more pronounced in the experimental group than in the control group. Thus, Kinect-based VRT may be utilized as an effective intervention to improve BMD and reduce fracture risk in postmenopausal women with osteopenia.
Collapse
Affiliation(s)
- Saima Riaz
- Department of Physical Therapy, Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Gulberg III, Lahore, 54000, Pakistan.
| | - Syed Shakil Ur Rehman
- Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, 54000, Pakistan
| | - Sana Hafeez
- School of Health Sciences, University of Management and Technology, Lahore, 54000, Pakistan
| | - Danish Hassan
- Department of Physical Therapy, Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Gulberg III, Lahore, 54000, Pakistan
| |
Collapse
|
12
|
Simpkins C, Khalili SM, Yang F. Meta-Analysis-Based Comparison of Annual Fall Risk between Older Adults with Alzheimer's Disease and Mild Cognitive Impairment. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2024; 6:e240002. [PMID: 38725433 PMCID: PMC11081206 DOI: 10.20900/agmr20240002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Background Falls are a primary cause of injuries and hospitalization in older adults. It has been reported that cognitive impairments and dementia can increase fall risk in the older population; however, it remains unknown if fall risk differs among subgroups of dementia. This meta-analysis summarized previous studies reporting the annual fall risk of people with Alzheimer's disease (AD) or mild cognitive impairment (MCI) and compared the fall risk between these two groups of people with dementia. Methods Thirty-five studies enrolling 7844 older adults with AD or MCI were included. The annual fall prevalence and average number of falls of the included studies were meta-analyzed and compared by random-effects models with inverse variance weights. Results The annual fall prevalence in people with AD (43.55%) was significantly higher than MCI (35.26%, p < 0.001). A χ2 test indicated that the pooled fall prevalence is significantly higher in people with AD than MCI χ2 = 158.403, p < 0.001). Additionally, the yearly average number of falls in AD was higher than in MCI (1.30 vs 0.77 falls/person). Conclusions The results showed that older people with AD experience a higher annual fall prevalence with a larger number of falls than older adults with MCI. The results suggested that the fall risk measurements should be reported separately between people with AD and MCI. The findings could provide preliminary guidance for the identification of individuals with dementia who experience a high fall risk.
Collapse
Affiliation(s)
- Caroline Simpkins
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
- These authors contributed equally
| | - Sara Mahmoudzadeh Khalili
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
- These authors contributed equally
| | - Feng Yang
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
| |
Collapse
|
13
|
Hawkins M, Goldhammer T, McClave R, Jenkins-Smith E. Evaluation of a Fall Prevention Program to Reduce Fall Risk and Fear of Falling Among Community-Dwelling Older Adults and Adults with Disabilities. Clin Interv Aging 2024; 19:375-383. [PMID: 38464599 PMCID: PMC10924894 DOI: 10.2147/cia.s448196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/27/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose The overarching goal of the program evaluation was to determine the reach and impact of the District-funded Safe At Home (SAH) modification program in reducing falls, fall injuries, and fear of falls among community-dwelling older adults and adults with disabilities. The SAH program has served over 6000 adults since 2016, the majority of whom are women (79%) and over age 60 (92%). Materials and Methods Letters were mailed in September 2022 to clients (n=492) who had home modifications completed between October 2021-March 2022 inviting them to participate in a brief phone survey about program satisfaction, falls, fall location, and severity. The validated Fall Efficacy Scale (FES) was administered pre (at first visit), post (at last visit), and during the phone survey (within 6 months to 1 year of program completion) to assess fear of falling. The response rate was 55% (n=241). Results Older adults (n=219) and adults with disabilities (n=22) reported high program satisfaction. Most clients, 79%, did not report a fall since the completion of the home modifications. The majority of falls reported, 76%, occurred inside the home. The average evaluation FES score was 32.5 (SD=22.6, range 10-100), indicating relatively low fear of falling. Higher FES scores were associated with a greater likelihood of reporting a fall (r=0.44, p < 0.001, n=51) and older age (r = 0.17, p < 0.01). FES scores were not related to gender. Evaluation FES scores were significantly lower than the pre-FES scores, indicating a reduction in fear of falling and positive impact of the home modifications (T(107) = 5.14, p < 0.001). Conclusion The client-centered SAH program demonstrates significant reductions in falls, fear of falling, and high satisfaction among clients. Recommendations include program expansion to offer other evidence-based components to reduce falls and support safe aging in place.
Collapse
Affiliation(s)
- Melissa Hawkins
- Department of Health Studies, American University, Washington, DC, USA
| | - Tori Goldhammer
- Safe at Home Program, Home Care Partners, Washington, DC, USA
| | - Robin McClave
- Department of Health Studies, American University, Washington, DC, USA
| | - Edwinta Jenkins-Smith
- Department of Aging and Community Living, District of Columbia Department of Health, Washington, DC, USA
| |
Collapse
|
14
|
Vandenput L, Johansson H, McCloskey EV, Liu E, Schini M, Åkesson KE, Anderson FA, Azagra R, Bager CL, Beaudart C, Bischoff-Ferrari HA, Biver E, Bruyère O, Cauley JA, Center JR, Chapurlat R, Christiansen C, Cooper C, Crandall CJ, Cummings SR, da Silva JAP, Dawson-Hughes B, Diez-Perez A, Dufour AB, Eisman JA, Elders PJM, Ferrari S, Fujita Y, Fujiwara S, Glüer CC, Goldshtein I, Goltzman D, Gudnason V, Hall J, Hans D, Hoff M, Hollick RJ, Huisman M, Iki M, Ish-Shalom S, Jones G, Karlsson MK, Khosla S, Kiel DP, Koh WP, Koromani F, Kotowicz MA, Kröger H, Kwok T, Lamy O, Langhammer A, Larijani B, Lippuner K, McGuigan FEA, Mellström D, Merlijn T, Nguyen TV, Nordström A, Nordström P, O'Neill TW, Obermayer-Pietsch B, Ohlsson C, Orwoll ES, Pasco JA, Rivadeneira F, Schott AM, Shiroma EJ, Siggeirsdottir K, Simonsick EM, Sornay-Rendu E, Sund R, Swart KMA, Szulc P, Tamaki J, Torgerson DJ, van Schoor NM, van Staa TP, Vila J, Wareham NJ, Wright NC, Yoshimura N, Zillikens MC, Zwart M, Harvey NC, Lorentzon M, Leslie WD, Kanis JA. A meta-analysis of previous falls and subsequent fracture risk in cohort studies. Osteoporos Int 2024; 35:469-494. [PMID: 38228807 DOI: 10.1007/s00198-023-07012-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/27/2023] [Indexed: 01/18/2024]
Abstract
The relationship between self-reported falls and fracture risk was estimated in an international meta-analysis of individual-level data from 46 prospective cohorts. Previous falls were associated with an increased fracture risk in women and men and should be considered as an additional risk factor in the FRAX® algorithm. INTRODUCTION Previous falls are a well-documented risk factor for subsequent fracture but have not yet been incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between previous falls and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD). METHODS The resource comprised 906,359 women and men (66.9% female) from 46 prospective cohorts. Previous falls were uniformly defined as any fall occurring during the previous year in 43 cohorts; the remaining three cohorts had a different question construct. The association between previous falls and fracture risk (any clinical fracture, osteoporotic fracture, major osteoporotic fracture, and hip fracture) was examined using an extension of the Poisson regression model in each cohort and each sex, followed by random-effects meta-analyses of the weighted beta coefficients. RESULTS Falls in the past year were reported in 21.4% of individuals. During a follow-up of 9,102,207 person-years, 87,352 fractures occurred of which 19,509 were hip fractures. A previous fall was associated with a significantly increased risk of any clinical fracture both in women (hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.33-1.51) and men (HR 1.53, 95% CI 1.41-1.67). The HRs were of similar magnitude for osteoporotic, major osteoporotic fracture, and hip fracture. Sex significantly modified the association between previous fall and fracture risk, with predictive values being higher in men than in women (e.g., for major osteoporotic fracture, HR 1.53 (95% CI 1.27-1.84) in men vs. HR 1.32 (95% CI 1.20-1.45) in women, P for interaction = 0.013). The HRs associated with previous falls decreased with age in women and with duration of follow-up in men and women for most fracture outcomes. There was no evidence of an interaction between falls and BMD for fracture risk. Subsequent risk for a major osteoporotic fracture increased with each additional previous fall in women and men. CONCLUSIONS A previous self-reported fall confers an increased risk of fracture that is largely independent of BMD. Previous falls should be considered as an additional risk factor in future iterations of FRAX to improve fracture risk prediction.
Collapse
Affiliation(s)
- Liesbeth Vandenput
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Helena Johansson
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- MRC and Arthritis Research UK Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - Enwu Liu
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Marian Schini
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Kristina E Åkesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - Fred A Anderson
- GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rafael Azagra
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Health Centre Badia del Valles, Catalan Institute of Health, Barcelona, Spain
- GROIMAP (Research Group), Unitat de Suport a La Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Cerdanyola del Vallès, Barcelona, Spain
- PRECIOSA-Fundación Para La Investigación, Barberà del Vallés, Barcelona, Spain
| | | | - Charlotte Beaudart
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Department of Health Services Research, University of Maastricht, Maastricht, The Netherlands
| | - Heike A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland
- Centre On Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland
| | - Emmanuel Biver
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jacqueline R Center
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Roland Chapurlat
- INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France
| | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Carolyn J Crandall
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - José A P da Silva
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Rheumatology Department, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
| | - Bess Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center On Aging, Tufts University, Boston, MA, USA
| | - Adolfo Diez-Perez
- Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain
| | - Alyssa B Dufour
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - John A Eisman
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Petra J M Elders
- Department of General Practice, Amsterdam UMC, Location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Serge Ferrari
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Yuki Fujita
- Center for Medical Education and Clinical Training, Kindai University Faculty of Medicine, Osaka, Japan
| | - Saeko Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
| | - Claus-Christian Glüer
- Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
| | - Inbal Goldshtein
- Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Goltzman
- Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - Jill Hall
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Didier Hans
- Interdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland
| | - Mari Hoff
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway
| | - Rosemary J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
| | - Martijn Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | - Masayuki Iki
- Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan
| | | | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - Sundeep Khosla
- Robert and Arlene Kogod Center On Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Douglas P Kiel
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
- Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Fjorda Koromani
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mark A Kotowicz
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia
| | - Heikki Kröger
- Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Timothy Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Olivier Lamy
- Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kurt Lippuner
- Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fiona E A McGuigan
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Dan Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden
| | - Thomas Merlijn
- Department of General Practice, Amsterdam UMC, Location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Tuan V Nguyen
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
- School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia
- School of Population Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
| | - Anna Nordström
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Nordström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Terence W O'Neill
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Barbara Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
- Center for Biomarker Research in Medicine, Graz, Austria
| | - Claes Ohlsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Eric S Orwoll
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Julie A Pasco
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anne-Marie Schott
- Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France
| | - Eric J Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, USA
| | | | - Eleanor M Simonsick
- Translational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, USA
| | | | - Reijo Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Karin M A Swart
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Pawel Szulc
- INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France
| | - Junko Tamaki
- Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - David J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Natasja M van Schoor
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Tjeerd P van Staa
- Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Joan Vila
- Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | | | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
| | - MCarola Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marta Zwart
- PRECIOSA-Fundación Para La Investigación, Barberà del Vallés, Barcelona, Spain
- Health Center Can Gibert del Plà, Catalan Institute of Health, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- GROIMAP/GROICAP (Research Groups), Unitat de Suport a La Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Girona, Spain
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Mattias Lorentzon
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - John A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
| |
Collapse
|
15
|
Almeida AS, Paguia A, Neves AP. Nursing Interventions to Empower Family Caregivers to Manage the Risk of Falling in Older Adults: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:246. [PMID: 38541248 PMCID: PMC10970157 DOI: 10.3390/ijerph21030246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 07/23/2024]
Abstract
Falls pose a significant risk to older adults, resulting in injuries and declining quality of life. The psychological impact, particularly the fear of falling, impairs their well-being. This pervasive fear affects daily activities, leading to self-imposed limitations and reduced engagement. This review aimed to identify nursing interventions to empower family caregivers to manage the risk of falling in older adults. A scoping review was developed following the JBI framework. We searched the CINAHL, MEDLINE, Nursing & Allied Health Collection, Cochrane Central Register of Controlled Trials, MedicLatina, and Cochrane Database of Systematic Reviews. The findings of this review revealed that out of 460 initially identified records, nine articles met the eligibility criteria and were retained for further in-depth analysis. These articles provided insights into nine distinct categories of nurse interventions: Therapeutic Relationships, Family Involvement, Personalized Care, Health Education, Multifactorial Falls Risk Assessment, Home Modifications, Referral, Transition Between Healthcare Services, and Health Care Consultants. The findings of this review have significant implications for clinical practice, particularly in emphasizing the crucial role of nurses in empowering family caregivers and older adults to manage the risk of falling at home. Healthcare professionals, policymakers, and researchers can benefit from this informative resource to develop strategies and guidelines.
Collapse
Affiliation(s)
- Ana Silva Almeida
- Setúbal Hospital Center E.P.E., 2910-446 Setúbal, Portugal
- Nursing School of Lisbon, 1900-160 Lisbon, Portugal;
| | - Ana Paguia
- Sado Family Healthcare Unit, 2910-363 Setúbal, Portugal;
| | | |
Collapse
|
16
|
Bourke R, Doody P, Pérez S, Moloney D, Lipsitz LA, Kenny RA. Cardiovascular Disorders and Falls Among Older Adults: A Systematic Review and Meta-Analysis. J Gerontol A Biol Sci Med Sci 2024; 79:glad221. [PMID: 37738307 PMCID: PMC10809055 DOI: 10.1093/gerona/glad221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Falls are a common cause of injury, hospitalization, functional decline, and residential care admission among older adults. Cardiovascular disorders are recognized risk factors for falls. This systematic review assesses the association between cardiovascular disorders and falls in older adults. METHODS Systematic searches were conducted on MEDLINE and Embase, encompassing all literature published prior to December 31, 2022. Included studies addressed persons aged 50 years and older, and assessed the association between cardiovascular disorders and falls or the efficacy of cardiovascular-based interventions to reduce falls. Two reviewers independently extracted data and assessed study quality utilizing a modified Newcastle-Ottawa scale for observational studies, and the Cochrane Risk of Bias 2 tool for interventional studies. A systematic narrative analysis of all cardiovascular outcomes, and meta-analyses of unadjusted odds ratios (ORs) were performed. RESULTS One hundred and eighty-four studies were included: 181 observational and 3 interventional. Several cardiovascular disorders, including stroke, coronary artery disease, valvular heart disease, arterial stiffness, arrhythmia, orthostatic hypotension, and carotid sinus hypersensitivity, were consistently associated with falls. In meta-analysis of unadjusted ORs, the largest positive pooled associations with falls during a 12-month reporting interval were for stroke (OR: 1.90, 95% confidence interval [CI]: 1.70-2.11), peripheral arterial disease (OR: 1.82, 95% CI: 1.12-2.95), atrial fibrillation (OR: 1.52, 95% CI: 1.27-1.82), and orthostatic hypotension (OR: 1.39, 95% CI: 1.18-1.64). CONCLUSIONS Several cardiovascular disorders are associated with falls. These results suggest the need to incorporate cardiovascular assessments for patients with falls. This review informed the cardiovascular recommendations in the new World Guidelines for falls in older adults.Clinical Trials Registration Number: CRD42021272245.
Collapse
Affiliation(s)
- Robbie Bourke
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St. James Hospital, Dublin, Ireland
| | - Paul Doody
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Sergio Pérez
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St. James Hospital, Dublin, Ireland
| | - David Moloney
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St. James Hospital, Dublin, Ireland
| | - Lewis A Lipsitz
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts, USA
| | - Rose Anne Kenny
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St. James Hospital, Dublin, Ireland
| |
Collapse
|
17
|
Greene L, Barber R, Bingham A, Connors J, Conroy S, Elkhafer K, Fox C, Goodwin V, Gordon A, Hall AJ, Harwood RH, Hulme C, Jackson T, Litherland R, Morgan-Trimmer S, Pankiewicz S, Parry SW, Sharma A, Ukoumunne O, Whale B, Allan L. Maintaining independence in individuals with dementia at home after a fall: a protocol for the UK pilot cluster randomised controlled trial MAINTAIN. BMJ Open 2024; 14:e083494. [PMID: 38307534 PMCID: PMC10836345 DOI: 10.1136/bmjopen-2023-083494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/11/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Individuals with dementia face an increased risk of falls. Falls can cause a decline in the individual's overall functionality. All types of falls, including those that do not result in injury, can lead to psychosocial consequences, such as diminished confidence and a fear of falling. Projections indicate a rising trend in dementia diagnoses, implying an increase in fall incidents. Yet, there is a lack of evidence to support interventions for people living with dementia who have fallen. Our objective is to test the feasibility of a falls intervention trial for people with dementia. METHOD AND ANALYSIS This is a UK-based two-arm pilot cluster randomised controlled trial. In this study, six collaborating sites, which form the clusters, will be randomly allocated to either the intervention arm or the control arm (receiving treatment as usual) at a 1:1 ratio. During the 6 month recruitment phase, each cluster will enrol 10 dyads, comprising 10 individuals with dementia and their respective carers, leading to a total sample size of 60 dyads. The primary outcomes are the feasibility parameters for a full trial (ie, percentage consented, follow-up rate and cost framework). Secondary outcomes include activities of daily living, quality of life, fall efficacy, mobility, goal attainment, cognitive status, occurrence of falls, carer burden and healthcare service utilisation. Outcome measures will be collected at baseline and 28 weeks, with an additional assessment scheduled at 12 weeks for the healthcare service utilisation questionnaire. An embedded process evaluation, consisting of interviews and observations with participants and healthcare professionals, will explore how the intervention operates and the fidelity of study processes. ETHICS AND DISSEMINATION The study was approved by the NHS and local authority research governance and research ethics committees (NHS REC reference: 23/WA/0126). The results will be shared at meetings and conferences and will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN16413728.
Collapse
Affiliation(s)
- Leanne Greene
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Robert Barber
- Centre for Health of the Elderly, Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alison Bingham
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - James Connors
- NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, Faculty of Health and Life Sciences University of Exeter, University of Exeter, Exeter, UK
| | - Simon Conroy
- St Pancras Rehabilitation Unit, Central and North West London NHS Foundation Trust, London, UK
| | - Kamr Elkhafer
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Chris Fox
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Victoria Goodwin
- Department of Public Health and Sport Science, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Adam Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS) School of Medicine, University of Nottingham, Nottingham, UK
| | - Abigail J Hall
- Department of Public Health and Sports Science, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Rowan H Harwood
- School of Health Sciences, University of Nottingham School of Health Sciences, Nottingham, UK
| | - Claire Hulme
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - T Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Sarah Morgan-Trimmer
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Sophie Pankiewicz
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Steve W Parry
- Population and Health Sciences Institute Newcastle University, Newcastle University, Newcastle upon Tyne, UK
| | - Ashima Sharma
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Obioha Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, Faculty of Health and Life Sciences University of Exeter, University of Exeter, Exeter, UK
| | - Bethany Whale
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Louise Allan
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| |
Collapse
|
18
|
Mitsutake S, Sa Z, Long J, Braithwaite J, Levesque JF, Watson DE, Close J, Mitchell R. The role of frailty risk for fracture-related hospital readmission and mortality after a hip fracture. Arch Gerontol Geriatr 2024; 117:105264. [PMID: 37979336 DOI: 10.1016/j.archger.2023.105264] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/10/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Frailty risk estimated using hospital administrative data may provide a useful clinical tool to identify older hip fracture patients at-risk of fracture-related readmissions and mortality. This study examined hip fracture hospitalisation temporal trends and explore the role of frailty risk in fracture-related readmission and mortality. METHODS This retrospective cohort study was conducted using linked hospital admission and mortality data in New South Wales, Australia. Patients aged ≥65 years were admitted after a hip fracture between 2014 and 2021 for temporal trends and those admitted and discharged after a hip fracture in 2014-2018 for fracture-related readmission. The Hospital Frailty Risk Score was estimated, and patients were followed for at least 36 months after discharge. A semi-competing risk analysis was used to examine the associations of frailty with fracture-related readmission and/or mortality. RESULTS Hip fracture hospitalisation rate was 472 per 100,000 and declined by 2.9 % (95 % confidence intervals (CI): -3.7 to -2.1) annually. Amongst 28,567 patients, 9.8 % were identified with low frailty risk, 39.4 %, intermediate frailty risk, and 50.6 % with high frailty risk. Patients with intermediate or high frailty risk had a higher chance of fracture-related readmission (Hazard ratios (HR): 1.33, 95 %CI: 1.21-1.47, HR: 1.65, 95 %CI: 1.49-1.83), death (HR: 1.50, 95 %CI: 1.38-1.63, HR: 1.80, 95 %CI: 1.65-1.96) and death post fracture-related readmission (HR: 1.32, 95 %CI: 1.12-1.56, HR: 1.56, 95 %CI: 1.32-1.84) than those with low frailty risk. CONCLUSIONS It appears that frailty risk estimated using hospital administrative data can contribute to identify patients who could benefit from targeted interventions to prevent further fractures.
Collapse
Affiliation(s)
- Seigo Mitsutake
- Australian Institute of Health Innovation, Macquarie University, NSW, Australia; Human care research team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
| | - Zhisheng Sa
- Australian Institute of Health Innovation, Macquarie University, NSW, Australia; NSW Biostatistics Training Program, NSW Ministry of Health, NSW, Australia
| | - Janet Long
- Australian Institute of Health Innovation, Macquarie University, NSW, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, NSW, Australia
| | - Jean-Frederic Levesque
- Agency for Clinical Innovation, NSW, Australia; Centre for Primary Health Care and Equity, University of New South Wales, NSW, Australia
| | | | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Australia; School of Clinical Medicine, University of New South Wales, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, NSW, Australia
| |
Collapse
|
19
|
Meulenbroeks I, Mercado C, Gates P, Nguyen A, Seaman K, Wabe N, Silva SM, Zheng WY, Debono D, Westbrook J. Effectiveness of fall prevention interventions in residential aged care and community settings: an umbrella review. BMC Geriatr 2024; 24:75. [PMID: 38243175 PMCID: PMC10799511 DOI: 10.1186/s12877-023-04624-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024] Open
Abstract
INTRODUCTION Preventing falls is a priority for aged care providers. Research to date has focused on fall prevention strategies in single settings (e.g., residential aged care (RAC) or community settings). However, some aged care providers deliver care, including fall prevention interventions, across RAC and community settings. We conducted an umbrella review to identify what type of fall prevention interventions had the greatest impact on falls outcomes in RAC and community settings. METHODS Five databases were searched for systematic reviews of falls prevention randomised control trials in older adults living in the community or RAC. Data extracted included systematic review methods, population characteristics, intervention characteristics, setting details (RAC or community), and fall-related outcomes (falls, people who have had a fall, fall-related hospitalisations, and fall-related fractures). Review quality was appraised using the Assessment of Multiple Systematic Reviews-2 tool. RESULTS One-hundred and six systematic reviews were included; 63 and 19 of these stratified results by community and RAC settings respectively, the remainder looked at both settings. The most common intervention types discussed in reviews included 'exercise' (61%, n = 65), 'multifactorial' (two or more intervention types delivered together) (26%, n = 28), and 'vitamin D' (18%, n = 19). In RAC and community settings, 'exercise' interventions demonstrated the most consistent reduction in falls and people who have had a fall compared to other intervention types. 'Multifactorial' interventions were also beneficial in both settings however demonstrated more consistent reduction in falls and people who fall in RAC settings compared to community settings. 'Vitamin D' interventions may be beneficial in community-dwelling populations but not in RAC settings. It was not possible to stratify fall-related hospitalisation and fall-related fracture outcomes by setting due to limited number of RAC-specific reviews (n = 3 and 0 respectively). CONCLUSION 'Exercise' interventions may be the most appropriate falls prevention intervention for older adults in RAC and community settings as it is beneficial for multiple fall-related outcomes (falls, fall-related fractures, and people who have had a fall). Augmenting 'exercise' interventions to become 'multifactorial' interventions may also improve the incidence of falls in both settings.
Collapse
Affiliation(s)
- Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia.
| | - Crisostomo Mercado
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Peter Gates
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Amy Nguyen
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
- St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Karla Seaman
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Nasir Wabe
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Sandun M Silva
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Wu Yi Zheng
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Deborah Debono
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| |
Collapse
|
20
|
Llamas-Ramos I, Llamas-Ramos R, Lugones-Sánchez C, González-García S, Tamayo-Morales O, Alvarado-Omenat JJ, Pablos-Hernández C, Gómez-Marcos MA, García-Ortiz L, Rodríguez-Sánchez E. Effect of a lifestyle-integrated functional exercise (LiFE) group intervention (sLiFE) to falls prevention in non-institutionalized older adults. Protocol of a randomised clinical trial. Front Public Health 2024; 11:1304982. [PMID: 38259747 PMCID: PMC10801183 DOI: 10.3389/fpubh.2023.1304982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Personalized programs of integrated strength and balance activities have been shown their effectiveness in falls reduction in the older adults. Objective To measure whether a group intervention with the strength and balance principles of the sLiFE program is more effective than standard health advice in reducing the incidence of falls. Methods The study will comprise 650 participants with more than 65 years who live at home, observing established inclusion and exclusion criteria. Participants will be randomly assigned in two groups: group intervention (n = 325) and standard health advice (n = 325). The intervention group will follow the balance and strength activities described in the LiFE program manual. The group intervention will be carried out in groups of 12-14 and will consist of seven one-hour sessions over 12 weeks in health centres. Incidence of falls and quality of life will be assessed as primary outcome variables. Fear of falling and exercise adherence will be analysed as secondary outcome variables. Discussion Physical activity has been put forward as an effective treatment technique for these patients; however, long-term adherence to these programs remains a challenge. Group interventions could reduce dropout rates. Conclusion Falls represent a major health problem globally due to the disability they cause in older people. Prevention would help reduce not only their incidence but also the health costs derived from their treatment. Group intervention helps clinicians to save resources and time, being able to attend more people with the same quality of care. Clinical trial registration https://clinicaltrials.gov/study/NCT05912088?distance=50&term=NCT05912088&rank=1, identifier NCT05912088.
Collapse
Affiliation(s)
- Inés Llamas-Ramos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
- Department of Nursing and Physiotherapy, Universidad de Salamanca, Salamanca, Spain
- Health Service of Castilla and Leon (SACyL), Salamanca, Spain
- University Hospital of Salamanca, Salamanca, Spain
| | - Rocío Llamas-Ramos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
- Department of Nursing and Physiotherapy, Universidad de Salamanca, Salamanca, Spain
| | - Cristina Lugones-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
| | - Susana González-García
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
| | - Olaya Tamayo-Morales
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
| | | | - Carmen Pablos-Hernández
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
- University Hospital of Salamanca, Salamanca, Spain
| | - Manuel A. Gómez-Marcos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
- Health Service of Castilla and Leon (SACyL), Salamanca, Spain
- Department of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - Luis García-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
- Health Service of Castilla and Leon (SACyL), Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, Universidad de Salamanca, Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
- Health Service of Castilla and Leon (SACyL), Salamanca, Spain
- Department of Medicine, Universidad de Salamanca, Salamanca, Spain
| |
Collapse
|
21
|
Lewis SR, McGarrigle L, Pritchard MW, Bosco A, Yang Y, Gluchowski A, Sremanakova J, Boulton ER, Gittins M, Spinks A, Rapp K, MacIntyre DE, McClure RJ, Todd C. Population-based interventions for preventing falls and fall-related injuries in older people. Cochrane Database Syst Rev 2024; 1:CD013789. [PMID: 38180112 PMCID: PMC10767771 DOI: 10.1002/14651858.cd013789.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Around one-third of older adults aged 65 years or older who live in the community fall each year. Interventions to prevent falls can be designed to target the whole community, rather than selected individuals. These population-level interventions may be facilitated by different healthcare, social care, and community-level agencies. They aim to tackle the determinants that lead to risk of falling in older people, and include components such as community-wide polices for vitamin D supplementation for older adults, reducing fall hazards in the community or people's homes, or providing public health information or implementation of public health programmes that reduce fall risk (e.g. low-cost or free gym membership for older adults to encourage increased physical activity). OBJECTIVES To review and synthesise the current evidence on the effects of population-based interventions for preventing falls and fall-related injuries in older people. We defined population-based interventions as community-wide initiatives to change the underlying societal, cultural, or environmental conditions increasing the risk of falling. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers in December 2020, and conducted a top-up search of CENTRAL, MEDLINE, and Embase in January 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster RCTs, trials with stepped-wedge designs, and controlled non-randomised studies evaluating population-level interventions for preventing falls and fall-related injuries in adults ≥ 60 years of age. Population-based interventions target entire communities. We excluded studies only targeting people at high risk of falling or with specific comorbidities, or residents living in institutionalised settings. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane, and used GRADE to assess the certainty of the evidence. We prioritised seven outcomes: rate of falls, number of fallers, number of people experiencing one or more fall-related injuries, number of people experiencing one or more fall-related fracture, number of people requiring hospital admission for one or more falls, adverse events, and economic analysis of interventions. Other outcomes of interest were: number of people experiencing one or more falls requiring medical attention, health-related quality of life, fall-related mortality, and concerns about falling. MAIN RESULTS We included nine studies: two cluster RCTs and seven non-randomised trials (of which five were controlled before-and-after studies (CBAs), and two were controlled interrupted time series (CITS)). The numbers of older adults in intervention and control regions ranged from 1200 to 137,000 older residents in seven studies. The other two studies reported only total population size rather than numbers of older adults (67,300 and 172,500 residents). Most studies used hospital record systems to collect outcome data, but three only used questionnaire data in a random sample of residents; one study used both methods of data collection. The studies lasted between 14 months and eight years. We used Prevention of Falls Network Europe (ProFaNE) taxonomy to classify the types of interventions. All studies evaluated multicomponent falls prevention interventions. One study (n = 4542) also included a medication and nutrition intervention. We did not pool data owing to lack of consistency in study designs. Medication or nutrition Older people in the intervention area were offered free-of-charge daily supplements of calcium carbonate and vitamin D3. Although female residents exposed to this falls prevention programme had fewer fall-related hospital admissions (with no evidence of a difference for male residents) compared to a control area, we were unsure of this finding because the certainty of evidence was very low. This cluster RCT included high and unclear risks of bias in several domains, and we could not determine levels of imprecision in the effect estimate reported by study authors. Because this evidence is of very low certainty, we have not included quantitative results here. This study reported none of our other review outcomes. Multicomponent interventions Types of interventions included components of exercise, environment modification (home; community; public spaces), staff training, and knowledge and education. Studies included some or all of these components in their programme design. The effectiveness of multicomponent falls prevention interventions for all reported outcomes is uncertain. The two cluster RCTs included high or unclear risk of bias, and we had no reasons to upgrade the certainty of evidence from the non-randomised trial designs (which started as low-certainty evidence). We also noted possible imprecision in some effect estimates and inconsistent findings between studies. Given the very low-certainty evidence for all outcomes, we have not reported quantitative findings here. One cluster RCT reported lower rates of falls in the intervention area than the control area, with fewer people in the intervention area having one or more falls and fall-related injuries, but with little or no difference in the number of people having one or more fall-related fractures. In another cluster RCT (a multi-arm study), study authors reported no evidence of a difference in the number of female or male residents with falls leading to hospital admission after either a multicomponent intervention ("environmental and health programme") or a combination of this programme and the calcium and vitamin D3 programme (above). One CBA reported no difference in rate of falls between intervention and control group areas, and another CBA reported no difference in rate of falls inside or outside the home. Two CBAs found no evidence of a difference in the number of fallers, and another CBA found no evidence of a difference in fall-related injuries. One CITS found no evidence of a difference in the number of people having one or more fall-related fractures. No studies reported adverse events. AUTHORS' CONCLUSIONS Given the very low-certainty evidence, we are unsure whether population-based multicomponent or nutrition and medication interventions are effective at reducing falls and fall-related injuries in older adults. Methodologically robust cluster RCTs with sufficiently large communities and numbers of clusters are needed. Establishing a rate of sampling for population-based studies would help in determining the size of communities to include. Interventions should be described in detail to allow investigation of effectiveness of individual components of multicomponent interventions; using the ProFaNE taxonomy for this would improve consistency between studies.
Collapse
Affiliation(s)
- Sharon R Lewis
- Bone and Joint Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Lisa McGarrigle
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Michael W Pritchard
- Bone and Joint Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alessandro Bosco
- NIHR Applied Research Collaboration Greater Manchester, School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Yang Yang
- NIHR Applied Research Collaboration Greater Manchester, School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Ashley Gluchowski
- NIHR Applied Research Collaboration Greater Manchester, School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
- School of Health & Society, University of Salford, Salford, UK
| | - Jana Sremanakova
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Elisabeth R Boulton
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Matthew Gittins
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Anneliese Spinks
- School of Population Health, University of Queensland, Queensland, Australia
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | | | - Chris Todd
- NIHR Applied Research Collaboration Greater Manchester, School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, and Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
22
|
Kiyoshi-Teo H, McMahon SK, Northup-Snyder K, Cohen DJ. Older People's Descriptions of Their Engagement in Fall Prevention. West J Nurs Res 2024; 46:10-18. [PMID: 37950361 DOI: 10.1177/01939459231211803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Evidence-based strategies to decrease fall rates are well established. However, little is understood about how older people engage in fall prevention strategies. Motivational Interviewing (MI) sessions aimed to facilitate individuals' engagement in fall prevention can be analyzed to learn what it means for older people to engage in fall prevention. Thus, the purpose of this study was to explore how older people describe their engagement in fall prevention. Participants in our parent project, MI for Fall Prevention (MI-FP), who received MI sessions were purposively selected for maximum variation in age, sex, fall risks, and MI specialist assigned. The first (of 8) MI sessions from 16 participants were recorded, transcribed, and analyzed using qualitative content analysis. Three researchers first deductively analyzed fall prevention strategies that participants described using an evidence-based fall prevention guideline as a reference. Then, we inductively analyzed the characteristics of these strategies and how participants engaged in them. Finally, we used the Capability, Opportunity, Motivation, Behavior (COM-B) model to organize our results about factors influencing engagement. We found (1) older adults engage in unique combinations of fall prevention strategies and (2) decisions about engagement in fall prevention strategies were influenced by multiple factors that were personal (e.g., who I am, capability, motivation, and opportunities). This study highlighted how fall prevention can be a life-long lifestyle decision for older people. Understanding older people's perspectives about engaging in fall prevention is essential to develop interventions to promote evidence-based fall prevention strategies in real-world settings.
Collapse
Affiliation(s)
- Hiroko Kiyoshi-Teo
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | | | | | - Deborah J Cohen
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
23
|
Henry A. Older Adult and Healthcare Provider Beliefs About Fall Prevention Strategies. Am J Lifestyle Med 2024; 18:108-117. [PMID: 39184271 PMCID: PMC11339757 DOI: 10.1177/15598276221100431] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
Introduction: Older adults reported about 36 million falls in 2018. Although effective strategies are available to address risk factors and minimize fall risk, little is known about older adults' and healthcare providers' awareness of these strategies. This study describes and compares healthcare providers' and older adults' beliefs about fall prevention and strategies. Methods: Demographic and fall-related data for older adults were obtained from the 2019 fall cohort of Porter Novelli ConsumerStyles. Similar data from primary care practitioners, nurse practitioners, and physician assistants were gathered from the 2019 cohort of DocStyles. Results: Most providers (91.3%) and older adults (85.1%) believed falls can be prevented. Both providers and older adults were most likely to consider strength and balance exercises (90.7% and 82.8%, respectively) and making homes safer (90.5% and 79.9%, respectively) as strategies that help prevent falls. More providers reported that managing medications (84.2%) and tai chi (45.7%) can prevent falls compared to older adults (24.0% and 21.7%, respectively; P < .0001). Conclusion: More healthcare providers than older adults indicated evidence-based strategies exist to reduce falls. Increased patient and provider communication can increase awareness about the benefits of evidence-based strategies such as tai chi, strength and balance exercises, and medication management.
Collapse
Affiliation(s)
- Ankita Henry
- Ankita Henry, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mail-stop S106-9, Chamblee, GA 30341, USA. e-mail:
| |
Collapse
|
24
|
Sturnieks DL, Hicks C, Smith N, Ratanapongleka M, Menant J, Turner J, Lo J, Chaplin C, Garcia J, Valenzuela MJ, Delbaere K, Herbert RD, Sherrington C, Toson B, Lord SR. Exergame and cognitive training for preventing falls in community-dwelling older people: a randomized controlled trial. Nat Med 2024; 30:98-105. [PMID: 38228913 DOI: 10.1038/s41591-023-02739-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 11/27/2023] [Indexed: 01/18/2024]
Abstract
Exergame training, in which video games are used to promote exercise, can be tailored to address cognitive and physical risk factors for falls and is a promising method for fall prevention in older people. Here, we performed a randomized clinical trial using the smart±step gaming system to examine the effectiveness of two home-based computer game interventions, seated cognitive training and step exergame training, for fall prevention in community-dwelling older people, as compared with a minimal-intervention control group. Participants aged 65 years or older (n = 769, 71% female) living independently in the community were randomized to one of three arms: (1) cognitive training using a computerized touchpad while seated, (2) exergame step training on a computerized mat or (3) control (provided with an education booklet on healthy ageing and fall prevention). The rate of falls reported monthly over 12 months-the primary outcome of the trial-was significantly reduced in the exergame training group compared with the control group (incidence rate ratio = 0.74, 95% confidence interval = 0.56-0.98), but was not statistically different between the cognitive training and control groups (incidence rate ratio = 0.86, 95% confidence interval = 0.65-1.12). No beneficial effects of the interventions were found for secondary outcomes of physical and cognitive function, and no serious intervention-related adverse events were reported. The results of this trial support the use of exergame step training for preventing falls in community-dwelling older people. As this intervention can be conducted at home and requires only minimal equipment, it has the potential for scalability as a public health intervention to address the increasing problem of falls and fall-related injuries. Australian and New Zealand Clinical Trial Registry identifier: ACTRN12616001325493 .
Collapse
Affiliation(s)
- Daina L Sturnieks
- Neuroscience Research Australia, Randwick, New South Wales, Australia.
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia.
| | - Cameron Hicks
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Natassia Smith
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | | | - Jasmine Menant
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jessica Turner
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Joanne Lo
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Carly Chaplin
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Jaime Garcia
- UTS Games Studio, Faculty of Engineering and IT, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Michael J Valenzuela
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- Skin2Neuron Pty Ltd, Sydney, New South Wales, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Robert D Herbert
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health, Sydney School of Public Health, Sydney Local Health District, University of Sydney, Sydney, New South Wales, Australia
| | - Barbara Toson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
25
|
Arkkukangas M. Involvement of Older Adults, the Golden Resources, as a Primary Measure for Fall Prevention. Clin Interv Aging 2023; 18:2165-2170. [PMID: 38149083 PMCID: PMC10751217 DOI: 10.2147/cia.s430309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023] Open
Abstract
Falls remain the second leading cause of injury-related deaths worldwide; therefore, longstanding practical fall-prevention efforts are needed. Falls can also lead to a reduction in independence and quality of life among older adults. Fall-prevention research has found that early prevention promotes a prolonged independence. However, it remains unknown which intervention is most beneficial for early prevention and how these interventions should be implemented for long-term effects. In addition, the present and future burden on social and healthcare services contributes to a gap in needs and requires an evidence-based fall prevention. Research suggests that strength, balance, and functional training are effective in reducing falls and fall-related injuries. Such training could greatly impacting independence. Fear of falling and strategies for managing falls are the suggested components to be included when evaluating fall-prevention programs. Thus, the preservation of physical functions is highly relevant for both independence and quality of life. It also contributes to psychological and social well-being, which are important factors for enabling individuals to stay at home for as long as possible. To meet future challenges associated with the expected increase in the older population, older adults should be viewed as a golden resource. With assistance from professionals and researchers, they can learn and gain the ability to institute fall-prevention programs in their own environments. These environments are primarily beyond the responsibilities of the healthcare sector. Therefore, programs comprising current knowledge about fall prevention should be developed, evaluated, and implemented with older adults by using a "train-The-trainer" approach, where a natural collaboration is established between civil society and/or volunteers, healthcare professionals, and researchers. For sustainable and effective fall-prevention programs, a co-design and early collaborative approach should be used in the natural environment, before social and healthcare services are required.
Collapse
Affiliation(s)
- Marina Arkkukangas
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Medicine, Sport and Fitness Science, Dalarna University, Falun, Sweden
- Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Vasteras, Sweden
| |
Collapse
|
26
|
Duc M, Mittaz Hager AG, Zemp D, Roulet G, Bridel A, Hilfiker R. Current practices of physiotherapists in Switzerland regarding fall risk-assessment for community-dwelling older adults: A national cross-sectional survey. F1000Res 2023; 11:513. [PMID: 38131051 PMCID: PMC10733665 DOI: 10.12688/f1000research.73636.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Background Falls can strongly impact older people's quality of life, health, and lifestyle. Multifactorial assessment can determine an individual's risk of falling as the first step for fall prevention intervention. Physiotherapists have an essential role to play in assessing fall risk by older adults living in the community. In the absence of published data on this topic in Switzerland, this study investigated the current practices of physiotherapists to determine whether those are in line with recommendations. Methods An anonymous cross-sectional survey was undertaken among physiotherapists practising in Switzerland between the 21st of November and the 31st of December 2020. A priori and exploratory hypotheses were tested. Responses to open-ended questions were grouped into themes for analysis. Results A total of 938 questionnaires from all three language regions of Switzerland was analysed. Participants worked in different settings, with a higher representation of private practice self-employees (56%). Standardised fall risk assessments or instruments were used by 580 (62%) participants, while 235 (25%) preferred subjective assessment of fall risk only. Differences in fall risk assessment were observed according to the workplace setting (adjusted OR 1.93, 95% CI 1.37 to 2.7) and education level (trend test, p<0.001). The standardised assessments most frequently employed were the Berg Balance Scale (58%), the Timed-Up-and-Go (57%) and the Tinetti Balance Assessment tool (47%). Risk factors for falls were frequently queried, particularly history of falls (88%), home hazards (84%), and functional ability (81%). Technical resources (40%), knowledge (30%), and time (22%) were common barriers to implement a systematic fall risk assessment. Conclusions This study provides an overview of the current practices of physiotherapists in Switzerland in fall risk assessment. There is still room to optimise the standardisation and systematisation of this assessment to implement a best practice strategy and prevent avoidable falls.
Collapse
Affiliation(s)
- Morgane Duc
- Department of Health Professions, Bern University of Applied Sciences, Bern, Bern, 3008, Switzerland
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Leukerbad, Valais, 3954, Switzerland
| | - Anne-Gabrielle Mittaz Hager
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Leukerbad, Valais, 3954, Switzerland
| | - Damiano Zemp
- Geriatric Service, Ospedale Regionale di Mendrisio (EOC), Mendrisio, Ticino, 6850, Switzerland
| | - Guillaume Roulet
- Service of Geriatrics and Geriatric Rehabilitation, Lausanne University Hospital (CHUV), Lausanne, Vaud, 1011, Switzerland
| | - Alice Bridel
- Department of Health Professions, Bern University of Applied Sciences, Bern, Bern, 3008, Switzerland
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Leukerbad, Valais, 3954, Switzerland
| | - Roger Hilfiker
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Leukerbad, Valais, 3954, Switzerland
| |
Collapse
|
27
|
Lytras D, Iakovidis P, Sykaras E, Kottaras A, Kasimis K, Myrogiannis I, Barouxakis A, Tarfali G. Effects of a tailored mat-Pilates exercise program for older adults on pain, functioning, and balance in women with chronic non-specific low back pain: a randomized controlled trial. Aging Clin Exp Res 2023; 35:3059-3071. [PMID: 37934400 DOI: 10.1007/s40520-023-02604-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Mat-Pilates exercise is effective for chronic non-specific low back pain (NSLBP), but its application in older women is understudied. AIM To examine the effects of a 10-week mat-Pilates program on pain, disability, and balance in older women with chronic NSLBP. METHODS Sixty-three women (≥ 65 years) with chronic NSLBP were randomly assigned to intervention (IG) or control (CG) groups. IG received individualized mat-Pilates sessions (45 min, twice weekly), while CG followed a home-based general exercise program. Primary outcomes included visual analog scale (VAS) for pain, Roland-Morris Disability Questionnaire (RMDQ), timed up-and-go (TUG), and Berg Balance Scale (BBS) at baseline, 10 weeks, and 6 months post-intervention. Repeated measures multivariate analysis of covariance (MANCOVA) was used, adjusted for exercise adherence and analgesic use. RESULTS IG significantly improved in VAS and RMDQ scores at 10 weeks and 6 months (p > 0.05). No significant differences were observed in TUG and BBS scores at any measurement point. No between-group differences were found in analgesic use or adherence to exercise during the 6-month follow-up. CONCLUSIONS A 10-week mat-Pilates program reduced pain and improved disability in older women with chronic NSLBP, effects which persisted at 6 months. However, no impact on balance, analgesic use, or exercise adherence was observed. TRIAL REGISTRATION NUMBER/DATE OF REGISTRATION NCT04752579/February 12, 2021.
Collapse
Affiliation(s)
- Dimitrios Lytras
- Department of Physical Education and Sports Sciences, Aristotle University of Thessaloniki, Thermi, 57001, Thessaloniki, Greece.
- Laboratory of Biomechanics and Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University - Alexander Campus, Sindos, P.O. Box 141, 57 400, Thessaloniki, Greece.
| | - Paris Iakovidis
- Laboratory of Biomechanics and Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University - Alexander Campus, Sindos, P.O. Box 141, 57 400, Thessaloniki, Greece
| | - Evaggelos Sykaras
- Department of Physical Education and Sports Sciences, Aristotle University of Thessaloniki, Thermi, 57001, Thessaloniki, Greece
| | - Anastasios Kottaras
- Laboratory of Biomechanics and Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University - Alexander Campus, Sindos, P.O. Box 141, 57 400, Thessaloniki, Greece
| | - Konstantinos Kasimis
- Laboratory of Biomechanics and Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University - Alexander Campus, Sindos, P.O. Box 141, 57 400, Thessaloniki, Greece
| | - Ioannis Myrogiannis
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Aristeidis Barouxakis
- Laboratory of Biomechanics and Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University - Alexander Campus, Sindos, P.O. Box 141, 57 400, Thessaloniki, Greece
| | - Georgia Tarfali
- Biomedical Engineering Department, Faculty of Engineering, Strathclyde University, Glasgow, UK
| |
Collapse
|
28
|
Vincent JI, MacDermid JC, Bassim CW, Santaguida P. Cluster analysis to identify the profiles of individuals with compromised bone health versus unfortunate wrist fractures within the Canadian Longitudinal Study of Aging (CLSA) database. Arch Osteoporos 2023; 18:148. [PMID: 38036802 PMCID: PMC10689536 DOI: 10.1007/s11657-023-01350-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/12/2023] [Indexed: 12/02/2023]
Abstract
We used cluster analysis to determine the profiles of individuals who sustained wrist fractures. We found two groups: (1) young and active and (2) older and less active. This information may be used to identify individuals who require further bone health interventions to optimize healthy aging. INTRODUCTION Distal radial fractures (DRF) are the most common of all fractures, with 6% of males and 33% of females having one at some point in their lifetime. We hypothesize that DRF consists of two subpopulations: one with compromised bone health that is early in the osteoporosis (OP) trajectory and another which are active and healthy and suffer a misfortune fracture due to their high activity levels or risk-taking behaviors. The latter is likely to recover with a minimal disability, while the former may signal a negative health trajectory of disability and early mortality. OBJECTIVE To determine the profiles of individuals who sustained wrist fractures using cluster analysis within the Comprehensive Cohort of the Canadian Longitudinal Study on Aging (CLSA) database considering factors that reflect bone health and activity levels. METHODS We included all the individuals who had a wrist fracture within the CLSA comprehensive cohort of the database (n = 968). The baseline data was used for this analysis. A 2-step cluster analysis was used to identify profiles that were both statistically and clinically meaningful. Variables that were used in the cluster analysis include demographic variables, physical activity status indicators, general health indicators, mobility indicators, bone health indicators, comorbid conditions, and lifestyle factors. RESULTS We were able to identify two distinct profiles that were statistically and clinically meaningful confirming our hypothesis. One cluster included a predominantly younger cohort, who are physically active, with less comorbid conditions, better bone health, and better general health, while the opposite was true of the first cohort. CONCLUSION We were able to identify two clusters-a healthy profile and a bone health compromised profile. This information may be used to identify the subgroup of people who should be targeted in the future for more intensive preventive health services to optimize healthy aging.
Collapse
Affiliation(s)
- Joshua I Vincent
- School of Physical Therapy, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada.
- Roth│McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, 268 Grosvenor St, London, ON, N6A 4V2, Canada.
- School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
| | - Joy C MacDermid
- School of Physical Therapy, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
- Roth│McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, 268 Grosvenor St, London, ON, N6A 4V2, Canada
- School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Carol W Bassim
- Department of Research Methods, Evidence & Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
- Dept. of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Pasqualina Santaguida
- Department of Research Methods, Evidence & Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| |
Collapse
|
29
|
Bouzid W, Tavassoli N, Berbon C, Qassemi S, Vaysset S, Poly M, Bounes V, Shourick J, Nourhashémi F. Exploring Population Characteristics and Recruitment Challenges in Older People Experiencing Falls at Home without Hospitalization or with an Emergency Department Visit: Insights from the RISING-DOM Experience. Clin Interv Aging 2023; 18:1995-2008. [PMID: 38058551 PMCID: PMC10697010 DOI: 10.2147/cia.s421053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/05/2023] [Indexed: 12/08/2023] Open
Abstract
Background An increasing number of falls among community-living older adults are reported in emergency calls. Data on evidence of appropriate fall prevention interventions are limited and challenges in recruiting this population in randomized trials are acknowledged. Purpose The main aim of this study was to provide demographic data, circumstance and fall-related outcomes of the population in the RISING-DOM study [Impact d'une évaluation des facteurs de RISque de chute et d'une prise en charge personnalisée, sur la mortalité et l'institutionnalisation, après INtervention du SAMU chez la personne âGée à DOMicile], a multicenter, randomized interventional trial involving community-dwelling older adults who have experienced a fall at home and were not hospitalized. Additionally, the challenges of remote recruitment in this population were discussed. Patients and Methods Participants were identified through the Occitania Emergency Observatory database. Participant recruitment and data collection were performed through telephone interviews (October 2019-March 2022). Additionally, a sample survey of Emergency Medical Services calls was carried out. Results Out of the 1151 individuals screened, a total of 951 participants were included in the trial follow-up, resulting in an acceptance rate of 82.62%. The screening delay was extended due to the COVID-19 pandemic. Recruiting difficulties were mainly related to identifying potential participants, unavailable contact information and unreachability. Participants' mean age was 84.1 years, 65.8% were women, and 44.3% lived alone. Pain was the most frequent outcome (53%). In the previous year, 73.5% of participants reported experiencing a fall, with 66.7% of those falls requiring assistance from Emergency Medical Services (EMS). Nearly, 40% did not take proactive steps to prevent future falls and walking aids (79.8%) were the most common preventive action. Conclusion Indicators of a high-risk group of falls have been identified underscoring the need for appropriate fall interventions in the target population. Challenges of large sampling for randomized fall prevention trials were provided. Trial Registration Clinicaltrials.gov identifier: NCT04132544. Registration date: 18/10/2019. https://www.clinicaltrials.gov/ct2/show/NCT04132544?term=rising-dom&draw=2&rank=1.
Collapse
Affiliation(s)
- Wafa Bouzid
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
- Regional Health Agency of Occitanie, Toulouse, 31000, France
| | - Neda Tavassoli
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
| | - Caroline Berbon
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
| | - Soraya Qassemi
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
| | - Sandrine Vaysset
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
| | - Magali Poly
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
| | - Vincent Bounes
- Emergency Medicine Unit, University of Toulouse Hospital Center, Toulouse, France
| | - Jason Shourick
- Research Methodology Support Unit (USMR), Clinical Epidemiology and Public Health Department, University of Toulouse Hospital Center, Toulouse, France
- CERPOP, UMR 1295, INSERM – University of Toulouse III, Toulouse, France
| | - Fati Nourhashémi
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
- CERPOP, UMR 1295, INSERM – University of Toulouse III, Toulouse, France
| |
Collapse
|
30
|
Kiyoshi-Teo H, De Lima B, Cohen DJ, Dieckmann N, Winters-Stone K, Eckstrom E. Motivational Interviewing for Fall Prevention (MI-FP) pilot study: Older Adults' readiness to participate in fall prevention. Geriatr Nurs 2023; 54:246-251. [PMID: 37847939 PMCID: PMC10841512 DOI: 10.1016/j.gerinurse.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/19/2023]
Abstract
Older adults' readiness to participate in fall prevention behaviors is largely unknown. We evaluated the feasibility of recruitment for a fall prevention intervention and participants' readiness to participate in fall prevention activities. Patients ≥ 65 years at high fall risk were recruited. Feasibility of recruitment was assessed by reaching the goal sample size (200), and recruitment rate (50%). Surveys assessed participants' readiness to participate in fall prevention activities (confidence to manage fall risks [0-10 scale; 10 most confident] and adherence to fall prevention recommendations). We recruited 200 patients (46.3% of eligible patients), and 185 completed surveys. Participants reported high confidence (range 7.48 to 8.23) in addressing their risks. Their adherence to clinician recommendations was mixed (36.4% to 90.5%). We nearly met our recruitment goals, and found that older adults are confident to address their fall risks, but do not consistently engage in fall prevention recommendations.
Collapse
Affiliation(s)
- Hiroko Kiyoshi-Teo
- Assistant Professor, School of Nursing, Oregon Health & Science University, U.S.A..
| | - Bryanna De Lima
- Data Analyst, Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, U.S.A
| | - Deborah J Cohen
- Professor, Department of Family Medicine, Oregon Health & Science University, U.S.A
| | - Nathan Dieckmann
- Associate Professor, School of Nursing, Oregon Health & Science University, U.S.A
| | | | - Elizabeth Eckstrom
- Professor, School of Medicine, Chief of Geriatrics, Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, U.S.A
| |
Collapse
|
31
|
Bindawas SM. The Changing Incidence and Prevalence of Falls and Its Disability Burden Among the Geriatric Population in Saudi Arabia from 1990 to 2019: A Longitudinal Analysis Using Global Burden of Disease Study Data. Cureus 2023; 15:e49117. [PMID: 38130550 PMCID: PMC10733656 DOI: 10.7759/cureus.49117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Falls represent a significant and growing public health issue among older adults worldwide. This study provides a comprehensive analysis of the trends in the incidence, prevalence, and disability burden of falls among older adults in Saudi Arabia over 29 years, with a focus on gender disparities. METHODS Utilizing the Global Burden of Disease (GBD) Study data, this observational analysis tracked the epidemiology of falls from 1990 to 2019. The study employed ICD-9 and ICD-10 codes to identify falls, analyzing incidence, prevalence, disability-adjusted life years (DALYs), and years lived with disability (YLDs), stratified by gender and reported with 95% uncertainty intervals (UIs). RESULTS The incidence and prevalence of falls increased for both genders from 1990 to 2019, with males showing a higher relative increase in prevalence rates (57% for males vs. 26% for females). The disability burden, indicated by DALYs, increased by 4% for males and decreased by 10% for females, whereas YLDs saw an increase of 38% for males and 8% for females. The analysis highlights a notable rise in both the frequency of falls and their associated disability, with gender-specific variations emphasizing greater impacts on males. CONCLUSIONS The findings illustrate a significant increase in fall-related incidents and associated disabilities among older adults in Saudi Arabia, with distinct gender differences. These trends call for targeted public health interventions and further research into the underlying causes of falls, risk factors, and effective prevention strategies. Such measures are essential to mitigate the impact of falls, improve health outcomes, and enhance the quality of life for the aging population.
Collapse
Affiliation(s)
- Saad M Bindawas
- Rehabilitation Sciences, King Saud University, Riyadh, SAU
- Disability Research, King Salman Center for Disability Research, Riyadh, SAU
| |
Collapse
|
32
|
Olsson Möller U, Zingmark M, Ekstrand J, Haak M. The Content of Physiotherapy and Factors Impacting on Reablement - A National Study. J Multidiscip Healthc 2023; 16:3075-3088. [PMID: 37881528 PMCID: PMC10596052 DOI: 10.2147/jmdh.s415112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/14/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose Reablement is a multidisciplinary intervention aimed at promoting function and independence for people with functional decline. Detailed descriptions of various professions' actions are needed for organization and evaluation of reablement services. This study describes physiotherapy practice in a reablement context in Swedish municipalities, focusing on the content and magnitude of interventions. Methods Physiotherapists (n=108) from 34 municipalities answered a web-based survey covering the target group, content and duration of their actions, and number of contacts initiated over a 3-week period. Data were analyzed with descriptive statistics and multiple logistic regression. Results Overall, 1005 cases were reported, with a mean age of 78.9 years (SD: 11.7); about 91% (n=912) were aged ≥65 and 61% (n=612) were women. About 70% were allocated to home care; 16% (n=160) of these had minor functional limitations (eg, needing safety alarms/help with domestic tasks), and 55% (n=550) had major functional limitations (eg, needing help with personal activities of daily living). The most reported actions were providing technical aids (60.8%, n=576), instructions/counseling (41.5%, n=393), walking/climbing stairs (27.6%, n=262), strength training (27.2%, n=258), and fall prevention (25.5%, n=242). Almost half of the cases included one action (n=494) and about 89% (n=890) targeted primary needs (body functions, walking indoors, self-care, or domestic life), mainly in clients with major functional limitations (odds ratio=2.96; 95% confidence interval: 1.95-4.49). About 50% (n=517) of the cases involved 1-2 contacts; about 55% (n=549) were completed within 3 weeks. Exercise was associated with ≥6 visits over ≥7 weeks. Supervision of home care staff was performed in 19.1% (n=181) of cases. Conclusion Reablement physiotherapy mostly comprises a few actions over a relatively short period. Whether this is a conscious strategy based on the purpose of home-based physiotherapy or clients' needs and wishes, or conversely an expression of limited resources, remains to be investigated.
Collapse
Affiliation(s)
- Ulrika Olsson Möller
- Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Magnus Zingmark
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
- Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden
- Department of Community Medicine and Rehabilitation, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Joakim Ekstrand
- Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| | - Maria Haak
- Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| |
Collapse
|
33
|
Lai WX, Chan AWM, Matchar DB, Ansah JP, Lien CTC, Ismail NH, Wong CH, Xu T, Ho VWT, Tan PJ, Lee JML, Sim RSC, Manap N. Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach. BMC Geriatr 2023; 23:586. [PMID: 37740182 PMCID: PMC10517526 DOI: 10.1186/s12877-023-04294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 09/08/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Falls in older adults are the result of a complex web of interacting causes, that further results in other physical, emotional, and psychological sequelae. A conceptual framework that represents the reciprocal dynamics of these causal factors can enable clinicians, researchers, and policymakers to clarify goals in falls intervention in older adults. METHODS A Group Model Building (GMB) exercise was conducted with researchers and clinicians from academic units and public healthcare institutes in Singapore. The aim of the exercise was to produce a shared visual representation of the causal structure for falls and engage in discussions on how current and future falls intervention programmes can address falls in the older adults, especially in the Asian context. It was conducted in four steps: 1) Outlining and prioritising desirable patient outcomes, 2) Conceptual model building, 3) Identifying key intervention elements of effective falls intervention programmes, 4) Mapping of interventions to outcomes. This causal loop diagram (CLD) was then used to generate insights into the current understanding of falls causal relationships, current efforts in falls intervention in Singapore, and used to identify gaps in falls research that could be further advanced in future intervention studies. RESULTS Four patient outcomes were identified by the group as key in falls intervention: 1) Falls, 2) Injurious falls, 3) Fear of falling, and 4) Restricted mobility and life space. A CLD of the reciprocal relationships between risk factors and these outcomes are represented in four sub-models: 1) Fear of falling, 2) Injuries associated with falls, 3) Caregiver overprotectiveness, 4) Post-traumatic stress disorder and psychological resilience. Through this GMB exercise, the group gained the following insights: (1) Psychological sequelae of falls is an important falls intervention outcome. (2) The effects of family overprotectiveness, psychological resilience, and PTSD in exacerbating the consequences of falls are not well understood. (3) There is a need to develop multi-component falls interventions to address the multitude of falls and falls related sequelae. CONCLUSION This work illustrates the potential of GMB to promote shared understanding of complex healthcare problems and to provide a roadmap for the development of more effective preventive actions.
Collapse
Affiliation(s)
- Wei Xuan Lai
- Duke-NUS Medical School, Programme in Health Services and Systems Research, 8 College Road, Singapore, 169857, Singapore.
| | | | - David Bruce Matchar
- Duke-NUS Medical School, Programme in Health Services and Systems Research, 8 College Road, Singapore, 169857, Singapore
- Department of Medicine, Duke University, Durham, NC, USA
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Tower, Singapore, Singapore
| | - John Pastor Ansah
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
| | | | - Noor Hafizah Ismail
- Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore, Singapore
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chek Hooi Wong
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Tianma Xu
- Health & Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Vanda Wen Teng Ho
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Pey June Tan
- Ageing and Age-Associated Disorders Research Group, Health and Translational Medicine Cluster, University of Malaya, Kuala Lumpur, Malaysia
| | - June May Ling Lee
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Rita Siew Choo Sim
- Duke-NUS Medical School, Programme in Health Services and Systems Research, 8 College Road, Singapore, 169857, Singapore
| | - Normala Manap
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
34
|
Patrick CM, Snowden J, Eckhoff MD, Green CK, Scanaliato JP, Dunn JC, Parnes N. Epidemiology of shoulder dislocations presenting to United States emergency departments: An updated ten-year study. World J Orthop 2023; 14:690-697. [PMID: 37744717 PMCID: PMC10514709 DOI: 10.5312/wjo.v14.i9.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/05/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability. However, there is a paucity of current data available regarding the epidemiological trends of this injury. AIM To provide an updated, comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States. We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events. METHODS Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021. Incidence, age, sex, and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95% confidence intervals (CI). RESULTS In total, an estimated 773039 shoulder dislocations (CI: 640598-905481) presented to emergency rooms across the United States during the study period. The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years. Significantly more male patients sustained dislocations than female patients (537189, 69.5%, vs 235834, 30.5%, P < 0.001). With regard to associated consumer products, sports and recreation equipment were involved in the highest proportion of incidents (44.31%), followed by home structures and construction materials (21.22%), and home furnishings, fixtures, and accessories (21.21%). Regarding product sub-groups, stairs, ramps, landings, floors was cited in the greatest number of cases (131745). CONCLUSION The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons. Male adolescents sustained the highest proportion of dislocations, with a peak incidence in age group 15-20 years, predominantly secondary to participation in sporting and recreational activities. Conversely, women experienced a relatively consistent incidence of dislocation throughout their lifespan. After age 63, the incidence rate of dislocations in females was found to surpass that observed in males.
Collapse
Affiliation(s)
- Cole M Patrick
- Department of Orthopaedics, William Beaumont Army Medical Center, Fort Bliss, TX 79918, United States
| | - Josiah Snowden
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX 76129, United States
| | - Michael D Eckhoff
- Department of Orthopaedics, William Beaumont Army Medical Center, Fort Bliss, TX 79918, United States
| | - Clare K Green
- School of Medicine and Health Sciences, George Washington University, Washington, WA 20052, United States
| | - John P Scanaliato
- Department of Orthopaedics, William Beaumont Army Medical Center, Fort Bliss, TX 79918, United States
| | - John C Dunn
- Department of Orthopaedics, William Beaumont Army Medical Center, Fort Bliss, TX 79918, United States
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, NY 13619, United States
| |
Collapse
|
35
|
Rashidi MM, Saeedi Moghaddam S, Azadnajafabad S, Heidari-Foroozan M, Hashemi SM, Mohammadi E, Esfahani Z, Ebrahimi N, Shobeiri P, Malekpour MR, Abbasi-Kangevari M, Rashedi S, Mohammadi Fateh S, Larijani B, Farzadfar F. Low bone mineral density, a neglected condition in North Africa and Middle East: estimates from the Global Burden of Disease Study, 1990-2019. Osteoporos Int 2023; 34:1577-1589. [PMID: 37217657 DOI: 10.1007/s00198-023-06778-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/25/2023] [Indexed: 05/24/2023]
Abstract
Due to the high prevalence of low bone mineral density in North Africa and Middle East region, estimating its attributable burden would help to a better understanding of this neglected condition for policymakers and health researchers. This study presented the number of attributable deaths has doubled from 1990 to 2019. PURPOSE This study provides the latest estimates of the burden of low bone mineral density (BMD) from 1990 to 2019 in North Africa and Middle East (NAME) region. METHODS The data were extracted from the global burden of disease (GBD) 2019 study to estimate epidemiological indices such as deaths, disability-adjusted life years (DALYs), and summary exposure value (SEV). SEV is a measure of the exposure of the population to a risk factor that considers the amount of exposure by the level of risk. RESULTS Our findings showed that in 1990-2019, the number of deaths and DALYs attributable to low BMD had almost doubled in the region and caused 20,371 (95% uncertainty intervals: 14,848-24,374) deaths and 805,959 (630,238-959,581) DALYs in 2019. However, DALYs and death rates showed a decreasing trend after age standardization. Saudi Arabia had the highest, and Lebanon had the lowest age-standardized DALYs rates in 2019, with rates of 434.2 (329.6-534.3) and 90.3 (70.6-112.1) per 100,000, respectively. The highest burden attributable to low BMD was in the 90-94 and over 95 age groups. Also, there was a decreasing trend in age-standardized SEV to low BMD for both sexes. CONCLUSION Despite the decreasing trend of age-standardized burden indices, considerable amounts of deaths and DALYs were attributable to low BMD, especially in the elderly population, in the region in 2019. As the positive effects of proper interventions will be detectable in the long term, robust strategies and comprehensive stable policies are the ultimate solutions to achieving desired goals.
Collapse
Affiliation(s)
- Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Heidari-Foroozan
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Melika Hashemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zahra Esfahani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Narges Ebrahimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Shobeiri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Abbasi-Kangevari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Rashedi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Rajai Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Mohammadi Fateh
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
36
|
Neziraj M, Axelsson M, Kumlien C, Hellman P, Andersson M. The STAIR OF KNOWLEDGE-a codesigned intervention to prevent pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes in Sweden: development of a complex intervention. BMJ Open 2023; 13:e072453. [PMID: 37562934 PMCID: PMC10423781 DOI: 10.1136/bmjopen-2023-072453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVES To describe the development of a codesigned complex intervention intended to prevent the risks of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes. DESIGN A complex intervention development study. The development of the intervention was conducted in three phases. We established contact with stakeholders in the municipality, updated us of current status of the literature in this area and conducted studies in the local context (1). We codesigned the intervention in workshops together with end users (2). We codesigned the final outline of the intervention in an iterative process with stakeholders (3).Setting: Nursing homes in the municipality in southern Sweden. PARTICIPANTS End users (n=16) in nursing homes (n=4) codesigned the intervention together with the research group in workshops (n=4) in March-April 2022. Additionally, stakeholders (n=17) who were considered to play an important role in developing the intervention participated throughout this process. Data were analysed using reflexive thematic analysis. RESULTS Four workshops were conducted with end users (n=16) and 13 meetings with stakeholders (n=12) were held during the development process. The intervention aims to bridge the evidence-practice gap regarding the preventive care process of the risks of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes. The intervention is aimed at end users, lasts for 3 weeks and is divided into two parts. First, end users obtain knowledge on their own by following written instructions. Second, they meet, interact and discuss the knowledge acquired during part 1. CONCLUSION The intervention is robustly developed and thoroughly described. The study highlights the extensive process that is necessary for developing tailored complex interventions. The description of the entire development process may enhance the replicability of this intervention. The intervention needs to be tested and evaluated in an upcoming feasibility study. TRIAL REGISTRATION NUMBER NCT05308862.
Collapse
Affiliation(s)
- Merita Neziraj
- Department of Care Science, Faculty of Health and Society, Malmo University, Malmo, Sweden
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmo University, Malmo, Sweden
| | - Christine Kumlien
- Department of Care Science, Faculty of Health and Society, Malmo University, Malmo, Sweden
- Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Skanes universitetssjukhus Malmo, Malmo, Sweden
| | - Peter Hellman
- Department of Care Science, Faculty of Health and Society, Malmo University, Malmo, Sweden
| | - Magdalena Andersson
- Health and Social Care, Strategic Development, Unit of Research and Development and Competence Centre, Malmö, Sweden
| |
Collapse
|
37
|
Mitchell A, Elmasry Y, van Poelgeest E, Welsh TJ. Anticoagulant use in older persons at risk for falls: therapeutic dilemmas-a clinical review. Eur Geriatr Med 2023; 14:683-696. [PMID: 37392359 PMCID: PMC10447288 DOI: 10.1007/s41999-023-00811-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/02/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE The aim of this clinical narrative review was to summarise the existing knowledge on the use of anticoagulants and potential adverse events in older people at risk of falls with a history of atrial fibrillation or venous thromboembolism. The review also offers practical steps prescribers can take when (de-)prescribing anticoagulants to maximise safety. METHODS Literature searches were conducted using PubMed, Embase and Scopus. Additional articles were identified by searching reference lists. RESULTS Anticoagulants are often underused in older people due to concerns about the risk of falls and intracranial haemorrhage. However, evidence suggests that the absolute risk is low and outweighed by the reduction in stroke risk. DOACs are now recommended first line for most patients due to their favourable safety profile. Off-label dose reduction of DOACs is not recommended due to reduced efficacy with limited reduction in bleeding risk. Medication review and falls prevention strategies should be implemented before prescribing anticoagulation. Deprescribing should be considered in severe frailty, limited life expectancy and increased bleeding risk (e.g., cerebral microbleeds). CONCLUSION When considering whether to (de-)prescribe anticoagulants, it is important to consider the risks associated with stopping therapy in addition to potential adverse events. Shared decision-making with the patient and their carers is crucial as patient and prescriber views often differ.
Collapse
Affiliation(s)
- Anneka Mitchell
- Research Institute for the Care of Older People (RICE), Bath, UK.
- Pharmacy Department, University Hospitals Plymouth NHS Trust, Plymouth, UK.
- Life Sciences Department, University of Bath, Bath, UK.
| | - Yasmin Elmasry
- Pharmacy Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Tomas J Welsh
- Research Institute for the Care of Older People (RICE), Bath, UK
- Bristol Medical School, University of Bristol, Bristol, UK
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| |
Collapse
|
38
|
Candanedo MJBL, Gramani-Say K, Gerassi RC, Janducci AL, Florido JVB, Alberto SN, Rossi PG, Ansai JH. Effects of case management based on preventing falls in older people: A systematic review. Worldviews Evid Based Nurs 2023; 20:401-414. [PMID: 36999687 DOI: 10.1111/wvn.12643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/23/2023] [Accepted: 03/04/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Falls among older adults can lead to negative consequences with physical, functional, social, and psychological functioning, and a high prevalence of mortality. However, it is still unclear whether case management can reduce the number of falls in this population. AIMS The aims of this review were to analyze the effects of case management on preventing falls and reducing risk factors for falls in older people. METHODS A systematic review was conducted, searching for and synthesizing clinical trials involving case management in older people who had falls or risk for fall outcomes. Two authors extracted data using predefined data fields, and risk of bias was assessed by the Physiotherapy Evidence Database (PEDro) scale. RESULTS Twelve studies were included in the final review. Case management in older people did not significantly reduce the number of falls, falls per person, or severity of falls compared to control groups. Adherence to recommendations in case management ranged from 25% to 88%. LINKING EVIDENCE TO ACTION There is limited evidence of reduced rates of falls and specific risk factors for falls among people who received case management interventions. Randomized trials with good quality are needed.
Collapse
Affiliation(s)
| | - Karina Gramani-Say
- Department of Gerontology, Federal University of São Carlos, São Carlos, Brazil
| | - Renata Carolina Gerassi
- Department of Gerontology, Gerontology Graduate Program, Federal University of São Carlos, São Carlos, Brazil
| | - Ana Luisa Janducci
- Department of Gerontology, Federal University of São Carlos, São Carlos, Brazil
| | | | - Silsam Napolitano Alberto
- Department of Gerontology, Gerontology Graduate Program, Federal University of São Carlos, São Carlos, Brazil
| | - Paulo Giusti Rossi
- Department of Clinical Medicine, Faculty of Medicine of Ribeirão, Preto, University of São Paulo, São Paulo, Brazil
| | - Juliana Hotta Ansai
- Department of Gerontology, Federal University of São Carlos, São Carlos, Brazil
| |
Collapse
|
39
|
Mohr S, Müller C, Hildebrand F, Laubach M. [Fall prevention in old people through occupational therapy home assessment, consultation and modification: a process outline]. Z Gerontol Geriatr 2023; 56:408-414. [PMID: 36070010 PMCID: PMC10406676 DOI: 10.1007/s00391-022-02103-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 10/14/2022]
Abstract
Falls occur frequently in old people and are associated with relevant short-term and long-term trauma sequelae. Particularly in the light of demographic change, preventive measures such as falls prevention are increasingly gaining in importance. Occupational therapy home assessments enable the evaluation of external and behavioral risk factors for falls in the context of environmental prevention. Environmental prevention is an effective measure in preventing morbidity and mortality related to falls in old people and the increase in healthcare costs associated with falls. Occupational therapy home assessments effectively reduce fall risk and fall rate among older people at risk of falling and can be implemented in the context of existing regulatory frameworks. The aim of this overview is to illustrate the optimal process of home assessment and adaptation for patients at risk of falling by general practitioners, orthopedic surgeons and occupational therapists.
Collapse
Affiliation(s)
- Sara Mohr
- Amsterdam University of Applied Sciences, Amsterdam, Niederlande
- Ergo Unterwegs GbR, Bruchsal, Deutschland
| | - Christian Müller
- SHG-Bildung, Fachschule für Ergotherapie, Saarbrücken, Deutschland
| | - Frank Hildebrand
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Markus Laubach
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Aachen, Deutschland.
| |
Collapse
|
40
|
Wittayapun Y, Nawarat J, Lapmanee S, Mackenzie L, Lektip C. Reliability of the 44-question Home Fall Hazard Assessment Tool and personal characteristics associated with home hazards among the Thai elderly. F1000Res 2023; 12:8. [PMID: 37448858 PMCID: PMC10336358 DOI: 10.12688/f1000research.126690.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Background: The 44-question Thai Home Fall Hazard Assessment Tool (Thai-HFHAT) was developed to assist healthcare professionals in identifying the risk of falls among community-dwelling older adults from their home environment. However, the reliability of this tool has not been studied. This study aimed to examine the reliability of the 44-question Thai-HFHAT and determine the demographic characteristics associated with home hazards. Methods: A descriptive cross-sectional study design was used to evaluate inter-rater reliability. The participants in this study were 51 older people from various types of Thai houses: a one-story elevated house, a one-story non-elevated house, and a house with two or more floors, 51 caregivers of older patients, and 5 village health volunteers (VHV). A prospective design was used to evaluate test-retest reliability with older people at different times in their homes. All participants answered 44 Thai-HFHAT questions to determine inter-rater and test-retest reliabilities. The reliabilities were analyzed using an intra-class correlation coefficient (ICC). Demographic characteristics including sex, occupation, and education were used to identify the factors affecting home hazards, and linear regression was used to analyze. Results: The ICC of inter-rater reliability of the 44-question Thai-HFHAT was 0.74 (95% CI: 0.57-0.84) and the test-retest reliability was 0.80 (95% CI: 0.64-0.88) for the older adults, 0.80 (95% CI: 0.65-0.89) for the caregivers and 0.70 (95% CI: 0.477-0.83) for the VHV. In demographic variables, personal business career and education level (grades 1-3) had significant relations with the total number of home hazards in the 44-questions Thai-HFHAT. Conclusions: The 44-question Thai-HFHAT is suitable for home hazard assessment among older adults in Thailand. Further studies are needed to investigate changes in the house environment after using the 44-question Thai-HFHAT to determine which changes can reduce fall risk.
Collapse
Affiliation(s)
- Yuwadee Wittayapun
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, 8016, Thailand
- Movement Science and Exercise Research Center, Walailak University, Nakhon Si Thammarat, 80160, Thailand
| | - Jiraphat Nawarat
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, 8016, Thailand
- Movement Science and Exercise Research Center, Walailak University, Nakhon Si Thammarat, 80160, Thailand
| | - Sarawut Lapmanee
- Department of Basic Medical Sciences, Faculty of Medicine, Siam University, Bangkok, 10160, Thailand
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2141, Australia
| | - Charupa Lektip
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, 8016, Thailand
- Movement Science and Exercise Research Center, Walailak University, Nakhon Si Thammarat, 80160, Thailand
| |
Collapse
|
41
|
Orejel Bustos AS, Tramontano M, Morone G, Ciancarelli I, Panza G, Minnetti A, Picelli A, Smania N, Iosa M, Vannozzi G. Ambient assisted living systems for falls monitoring at home. Expert Rev Med Devices 2023; 20:821-828. [PMID: 37610096 DOI: 10.1080/17434440.2023.2245320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Monitoring systems at home are critical in the event of a fall, and can range from standalone fall detection devices to activity recognition devices that aim to identify behaviors in which the user may be at risk of falling, or to detect falls in real-time and alert emergency personnel. AREAS COVERED This review analyzes the current literature concerning the different devices available for home fall detection. EXPERT OPINION Included studies highlight how fall detection at home is an important challenge both from a clinical-assistance point of view and from a technical-bioengineering point of view. There are wearable, non-wearable and hybrid systems that aim to detect falls that occur in the patient's home. In the near future, a greater probability of predicting falls is expected thanks to an improvement in technologies together with the prediction ability of machine learning algorithms. Fall prevention must involve the clinician with a person-centered approach, low cost and minimally invasive technologies able to evaluate the movement of patients and machine learning algorithms able to make an accurate prediction of the fall event.
Collapse
Affiliation(s)
| | | | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- San Raffaele Institute of Sulmona, Sulmona, Italy
| | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giuseppe Panza
- Dipartimento delle scienze mediche e della lungodegenza, U.O.C. di Medicina Interna A.O.R.N. "San Pio", P.O. "G. Rummo", Benevento, Italy
| | | | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Canadian Advances in Neuro-Orthopaedics for Spasticity Congress (CANOSC), Kingston, Canada
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marco Iosa
- Fondazione Santa Lucia IRCCS, Rome, Italy
- Department of Psychology, Sapienza University, Rome, Italy
| | - Giuseppe Vannozzi
- Fondazione Santa Lucia IRCCS, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Roma, Italy
| |
Collapse
|
42
|
Santamaría A, Pérez S, De Luis B, Orive A, Feijóo R, Etxebarria J. Clinical characteristics and prognostic factors of open globe injuries in a North Spain population: a 10-year review. Eye (Lond) 2023; 37:2101-2108. [PMID: 36371603 PMCID: PMC10333325 DOI: 10.1038/s41433-022-02297-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/27/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To describe the epidemiologic and clinical characteristics of open globe injuries (OGIs) treated in a tertiary hospital and analyse predictors of visual outcome. METHODS This retrospective observational study included all patients with OGIs admitted to Cruces University Hospital between 2010 and 2020. The descriptive analysis included demographic data, type of injury classified as "rupture", "penetration", "perforation", or "intraocular foreign body", trauma mechanism and setting, injury zone, Ocular Trauma Score, delay to surgery, length of hospital stay, antibiotic prophylaxis, initial and final best corrected visual acuity (BCVA), complications and further surgery. Univariate analysis and logistic regression were performed to identify prognostic factors, based on final BCVA. RESULTS Overall, 207 OGI cases were reported. The most common type of injuries were ruptures caused by domestic falls. Notably, 44.4% of eyes developed phthisis bulbi. In the univariate analysis, the following variables were significantly linked to visual outcome: age > 60 years, "rupture", "fall", posterior and/or combined zones of injury, lens damage, retinal/choroidal detachment, initial BCVA of no light perception, and Ocular Trauma Score ≤ 2 (p < 0.001). Delay to surgery, length of stay and further surgery did not have prognostic value. In the logistic regression, initial BCVA of no light perception (p < 0.001) and injury zone III (p = 0.005) remained significant predictors of poor outcome. CONCLUSIONS In the population studied, most OGIs were caused by domestic falls usually affecting elderly patients with comorbidities. Visual outcome depended on patients´ specific characteristics and the nature of the trauma itself, whereas environmental factors failed to show any prognostic value.
Collapse
Affiliation(s)
- Alaitz Santamaría
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, Begiker, Plaza de Cruces s/n, 48903, Barakaldo, Spain.
| | - Silvia Pérez
- Scientific Coordination Facility, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, Plaza de Cruces s/n, 48903, Barakaldo, Spain
| | - Beatriz De Luis
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, Begiker, Plaza de Cruces s/n, 48903, Barakaldo, Spain
| | - Ana Orive
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, Begiker, Plaza de Cruces s/n, 48903, Barakaldo, Spain
| | - Raquel Feijóo
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, Begiker, Plaza de Cruces s/n, 48903, Barakaldo, Spain
| | - Jaime Etxebarria
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, Begiker, Plaza de Cruces s/n, 48903, Barakaldo, Spain
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country (UPV/ EHU), Barrio Sarriena s/n, 48940, Leioa, Spain
| |
Collapse
|
43
|
Ferris H, Merron G, Coughlan T. 1 year mortality after hip fracture in an Irish urban trauma centre. BMC Musculoskelet Disord 2023; 24:487. [PMID: 37312089 DOI: 10.1186/s12891-023-06605-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/05/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Hip fracture accounts for a considerable burden of disease in older adults, yet there is a paucity of data pertaining to longer-term outcomes in the Irish Hip Fracture population. Understanding the factors that influence longer-term survival would allow care pathways to be refined to optimise patient outcomes. In Ireland, there is no linkage to death registration at a national or regional level, nor are longer-term outcomes captured by the Irish Hip Fracture Database. This study aimed to quantify 1-year mortality in an Irish hip fracture cohort and identify factors that influence survival at 1 year. METHODS A retrospective review of hip fracture cases in an Irish urban trauma centre over a 5-year period was conducted. Mortality status was obtained via the Inpatient Management System and correlated with the Irish Death Events Register. A range of routinely collected patient and care process variables were analysed using logistic regression. RESULTS A total of 833 patients were included. Within 1 year of sustaining a hip fracture, 20.5% (171/833) had died. On multivariate analysis, female gender (OR 0.36, p < 0.001, 95% CI 0.23-0.57), independent mobility pre-fracture (OR 0.24, p < 0.001, 95% CI 0.14-0.41) and early mobilisation on the day of or after surgery (OR 0.48, p < 0.001, 95% CI 0.30-0.77) reduced the likelihood of dying within 1 year (AUC 0.78). CONCLUSION Of the variables examined, early postoperative mobilisation was the only modifiable factor identified that conferred a longer-term survival benefit. This underscores the importance of adhering to international best practice standards for early postoperative mobilisation.
Collapse
Affiliation(s)
- Helena Ferris
- Department of Public Health, Health Service Executive - South, Cork, Ireland.
| | - Georgia Merron
- Department of Age-Related Health Care, Tallaght University Hospital, Dublin, Ireland
| | - Tara Coughlan
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
44
|
Areeudomwong P, Duangyod T, Sutalangka C, Buttagat V. Integrated Effects of Thai Essential Oil and Balance Exercise on Parameters associated with Falls in Older Adults at Risk of Falling: A Randomized Controlled Study. Ann Geriatr Med Res 2023; 27:141-150. [PMID: 37403317 DOI: 10.4235/agmr.23.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/07/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Reducing the risk of falling by improving balance and leg strength may be a preventive strategy. This study evaluated the integrated effects of Thai essential oil and balance exercises on parameters associated with Falls in community-dwelling older adults at risk of falling. METHODS Fifty-six participants were randomly allocated to either the intervention group (IG), which performed balance exercises while smelling Thai essential oil scents of Zanthoxylum limonella (Dennst.) Alston, or the control group (CG), which performed balance exercises while receiving a control patch. Balance exercises were practiced for 12, 30-minute sessions over 4 weeks. Static and dynamic balance with eyes open and eyes closed (EC), leg muscle strength, agility, and fear of falling were assessed at baseline, after the 4-week intervention, and at 1 month after the last intervention session. RESULTS Both groups showed significant improvements in static and dynamic balance, ankle plantarflexor strength, and agility after the 4-week intervention (p<0.05), which persisted at the 1-month follow-up (p<0.05). Compared to the CG, the IG demonstrated significantly better static balance in terms of elliptical sway area (p=0.04) and center of pressure (CoP) velocity (p=0.001) during EC, as well as ankle plantarflexor strength (p=0.01). The IG also maintained a significantly greater improvement in CoP velocity during EC (p=0.01). CONCLUSION Integrated Thai essential oil and balance exercises improved static balance and ankle plantarflexor strength compared to the balance exercise with a control patch in older adults at risk of falling.
Collapse
Affiliation(s)
- Pattanasin Areeudomwong
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Thidarat Duangyod
- Department of Applied Thai Traditional Medicine, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Chatchada Sutalangka
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Vitsarut Buttagat
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| |
Collapse
|
45
|
Tan PJ, Ginting ML, Lim ZZB, Balachandar N, Sultana R, Kadir MM, Xu T, Ismail NH, Yap JKY, Wong SF, Yoong J, Matchar DB, Hill K, Wong CH. Pragmatic multicentre stepped-wedge cluster randomised trial to investigate the effectiveness of community-based falls prevention programme for older adults with falls risk in Singapore: a protocol paper. BMJ Open 2023; 13:e072029. [PMID: 37263684 DOI: 10.1136/bmjopen-2023-072029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Falls are an important public health issue with consequences that include injuries, quality of life reduction and high healthcare costs. Studies show that falls prevention strategies are effective in reducing falls rate among community-dwelling older adults. However, the evaluation for effectiveness was usually done in a controlled setting with homogeneous population, and thus may not be generalisable to a wider population. This study aims to evaluate the impact of community falls prevention programmes with group-based strength and balance exercises, on falls risk and health outcomes for older adults with falls risk in Singapore. METHODS AND ANALYSIS This is a pragmatic closed cohort stepped-wedge cluster randomised trial design study, which involves sequential crossover of clusters from the waitlist control condition to the intervention condition, with the sequence of crossover randomly determined. The intervention will be sequentially rolled out to 12 clusters (a minimum of 5 participants/cluster), over 6 time periods with 8-week intervals in Central and North regions of Singapore. The primary analysis will be conducted under the intention-to-treat principle. A general linear mixed model or generalised estimating equation analysis appropriate for a multilevel longitudinal study incorporating an appropriate error distribution and link function will be used. Markov model will be developed to estimate the incremental cost per quality-adjusted life years and incremental cost per fall prevented from the implementation of falls prevention strategies from a societal perspective. Conditional on there being clinically relevant differences in short-term outcomes, we will implement simulation modelling to project the long-term divergence in trajectories for outcomes and costs using the Markov model. ETHICS AND DISSEMINATION Ethics approval has been obtained. Results will be disseminated in publications and other relevant platforms. TRIAL REGISTRATION NUMBER NCT04788251.
Collapse
Affiliation(s)
- Pey June Tan
- Geriatric Education and Research Institute, Singapore
| | | | | | | | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | | | - Tianma Xu
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Noor Hafizah Ismail
- Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore
| | - Joyce Kwee Yong Yap
- Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore
| | - Sweet Fun Wong
- Population Health & Community Transformation, Khoo Teck Puat Hospital, Singapore
| | - Joanne Yoong
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
- Research for Impact, Singapore
| | | | - Keith Hill
- Rehabilitation Aging and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Chek Hooi Wong
- Geriatric Education and Research Institute, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| |
Collapse
|
46
|
Muusse JSC, Zuidema R, van Scherpenseel MC, Velde SJT. Influencing factors of interprofessional collaboration in multifactorial fall prevention interventions: a qualitative systematic review. BMC PRIMARY CARE 2023; 24:116. [PMID: 37193995 DOI: 10.1186/s12875-023-02066-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/27/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND With the ageing population worldwide, falls are becoming a severe and growing health problem. Interprofessional multifactorial fall prevention interventions (FPIs) have effectively prevented falls in community-dwelling older adults. However, the implementation of FPIs often fails due to a lack of interprofessional collaboration. Therefore, gaining insight into the influencing factors of interprofessional collaboration in multifactorial FPI's for older adults living in the community is essential. Consequently, our aim was to provide an overview of factors influencing interprofessional collaboration in multifactorial FPIs for community-dwelling older adults. METHODS This qualitative systematic literature research was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Pubmed, CINAHL, and Embase electronic databases have been systematically searched for eligible articles, with a qualitative design. The quality was appraised using the Checklist for Qualitative Research by the Joann Briggs Institute. The findings were inductively synthesized using a meta-aggregative approach. Confidence in the synthesized findings was established using the ConQual methodology. RESULTS Five articles were included. Analysis of the included studies resulted in 31 influencing factors for interprofessional collaboration, which were labelled as findings. These findings were summarized in ten categories and combined into five synthesized findings. Results showed that communication, role clarity, information sharing, organization, and interprofessional aim influence interprofessional collaboration in multifactorial FPIs. CONCLUSIONS This review provides a comprehensive summary of findings on interprofessional collaboration, specifically in the context of multifactorial FPIs. Knowledge in this area is considerably relevant given the multifactorial nature of falls, which demands an integrated, multidomain approach, including both health and social care. The results can be utilized as a fundament for developing effective implementation strategies aiming to improve interprofessional collaboration between health and social care professionals working in multifactorial FPIs in the community.
Collapse
Affiliation(s)
- J S C Muusse
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - R Zuidema
- Research Centre for Healthy and Sustainable Living, Research Group Proactive Care for Elderly People Living at Home, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - M C van Scherpenseel
- Research Centre for Healthy and Sustainable Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - S J Te Velde
- Research Centre for Healthy and Sustainable Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| |
Collapse
|
47
|
Bogucki S, Siddiqui G, Carter R, McGovern J, Dziura J, Gan G, Li F, Stover G, Cone DC, Brokowski C, Joseph D. Effect of a Home Health and Safety Intervention on Emergency Department Use in the Frail Elderly: A Prospective Observational Study. West J Emerg Med 2023; 24:522-531. [PMID: 37278776 PMCID: PMC10284516 DOI: 10.5811/westjem.58378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 01/24/2023] [Accepted: 02/09/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Geriatric patients are often frail and may lose independence through a variety of mechanisms including cognitive decline, reduced mobility, and falls. Our goal was to measure the effect of a multidisciplinary home health program that assessed frailty and safety and then coordinated ongoing delivery of community resources on short-term, all-cause emergency department (ED) utilization across three study arms that attempted to stratify frailty by fall risk. METHODS Subjects became eligible for this prospective observational study via one of three pathways: 1) by visiting the ED after a fall (2,757 patients); 2) by self-identifying as at risk for falling (2,787); or 3) by calling 9-1-1 for a "lift assist" after falling and being unable to get up (121). The intervention consisted of sequential home visits by a research paramedic who used standardized assessments of frailty and risk of falling (including providing home safety guidance), and a home health nurse who aligned resources to address the conditions found. Outcomes of interest were all-cause ED utilization at 30, 60, and 90 days post-intervention compared with subjects who enrolled via the same study pathway but declined the study intervention (controls). RESULTS Subjects in the fall-related ED visit arm were significantly less likely to have one or more subsequent ED encounters post-intervention than controls at 30 days (18.2% vs 29.2%, P<0.001); 60 days (27.5% vs 39.8%, P<0.001); and 90 days (34.6% vs 46.2%, P<0.001). In contrast, participants in the self-referral arm had no difference in ED encounters post-intervention compared to controls at 30, 60, or 90 days (P=0.30, 0.84, and 0.23, respectively). The size of the 9-1-1 call arm limited statistical power for analysis. CONCLUSION A history of a fall requiring ED evaluation appeared to be a useful marker of frailty. Subjects recruited through this pathway experienced less all-cause ED utilization over subsequent months after a coordinated community intervention than without it. The participants who only self-identified as at risk for falling had lower rates of subsequent ED utilization than those recruited in the ED after a fall and did not significantly benefit from the intervention.
Collapse
Affiliation(s)
- Sandy Bogucki
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Gina Siddiqui
- New York City Health and Hospitals, Elmhurst Hospital Center, Department of Emergency Medicine, Queens, New York
| | - Ryan Carter
- Our Lady of Fatima Hospital, Department of Emergency Medicine, North Providence, Rhode Island
| | - Joanne McGovern
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - James Dziura
- Yale School of Medicine, Yale Center for Analytical Science, Department of Emergency Medicine and of Endocrinology, New Haven, Connecticut
| | - Geliang Gan
- Yale School of Public Health, Yale Center for Analytical Sciences, New Haven, Connecticut
| | - Fangyong Li
- Yale School of Public Health, Yale Center for Analytical Sciences, New Haven, Connecticut
| | - Gina Stover
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | | | - Carolyn Brokowski
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Daniel Joseph
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| |
Collapse
|
48
|
Kwon J, Squires H, Young T. Economic model of community-based falls prevention: seeking methodological solutions in evaluating the efficiency and equity of UK guideline recommendations. BMC Geriatr 2023; 23:187. [PMID: 36997884 PMCID: PMC10061399 DOI: 10.1186/s12877-023-03916-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/21/2023] [Indexed: 04/01/2023] Open
Abstract
Background Falls significantly harm geriatric health and impose substantial costs on care systems and wider society. Decision modelling can inform the commissioning of falls prevention but face methodological challenges, including: (1) capturing non-health outcomes and societal intervention costs; (2) considering heterogeneity and dynamic complexity; (3) considering theories of human behaviour and implementation; and (4) considering issues of equity. This study seeks methodological solutions in developing a credible economic model of community-based falls prevention for older persons (aged 60 +) to inform local falls prevention commissioning as recommended by UK guidelines. Methods A framework for conceptualising public health economic models was followed. Conceptualisation was conducted in Sheffield as a representative local health economy. Model parameterisation used publicly available data including English Longitudinal Study of Ageing and UK-based falls prevention trials. Key methodological developments in operationalising a discrete individual simulation model included: (1) incorporating societal outcomes including productivity, informal caregiving cost, and private care expenditure; (2) parameterising dynamic falls-frailty feedback loop whereby falls influence long-term outcomes via frailty progression; (3) incorporating three parallel prevention pathways with unique eligibility and implementation conditions; and (4) assessing equity impacts through distributional cost-effectiveness analysis (DCEA) and individual-level lifetime outcomes (e.g., number reaching ‘fair innings’). Guideline-recommended strategy (RC) was compared against usual care (UC). Probabilistic sensitivity, subgroup, and scenario analyses were conducted. Results RC had 93.4% probability of being cost-effective versus UC at cost-effectiveness threshold of £20,000 per QALY gained under 40-year societal cost-utility analysis. It increased productivity and reduced private expenditure and informal caregiving cost, but productivity gain and private expenditure reduction were outstripped by increases in intervention time opportunity costs and co-payments, respectively. RC reduced inequality delineated by socioeconomic status quartile. Gains in individual-level lifetime outcomes were small. Younger geriatric age groups can cross-subsidise their older peers for whom RC is cost-ineffective. Removing the falls-frailty feedback made RC no longer efficient or equitable versus UC. Conclusion Methodological advances addressed several key challenges associated with falls prevention modelling. RC appears cost-effective and equitable versus UC. However, further analyses should confirm whether RC is optimal versus other potential strategies and investigate feasibility issues including capacity implications. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-023-03916-z.
Collapse
Affiliation(s)
- Joseph Kwon
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG England
| | - Hazel Squires
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, S1 4DA Sheffield, England
| | - Tracey Young
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, S1 4DA Sheffield, England
| |
Collapse
|
49
|
Clemson L, Stark S, Pighills AC, Fairhall NJ, Lamb SE, Ali J, Sherrington C. Environmental interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2023; 3:CD013258. [PMID: 36893804 PMCID: PMC9998238 DOI: 10.1002/14651858.cd013258.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND Falls and fall-related injuries are common. A third of community-dwelling people aged over 65 years fall each year. Falls can have serious consequences including restricting activity or institutionalisation. This review updates the previous evidence for environmental interventions in fall prevention. OBJECTIVES To assess the effects (benefits and harms) of environmental interventions (such as fall-hazard reduction, assistive technology, home modifications, and education) for preventing falls in older people living in the community. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, other databases, trial registers, and reference lists of systematic reviews to January 2021. We contacted researchers in the field to identify additional studies. SELECTION CRITERIA We included randomised controlled trials evaluating the effects of environmental interventions (such as reduction of fall hazards in the home, assistive devices) on falls in community-residing people aged 60 years and over. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Our primary outcome was rate of falls. MAIN RESULTS We included 22 studies from 10 countries involving 8463 community-residing older people. Participants were on average 78 years old, and 65% were women. For fall outcomes, five studies had high risk of bias and most studies had unclear risk of bias for one or more risk of bias domains. For other outcomes (e.g. fractures), most studies were at high risk of detection bias. We downgraded the certainty of the evidence for high risk of bias, imprecision, and/or inconsistency. Home fall-hazard reduction (14 studies, 5830 participants) These interventions aim to reduce falls by assessing fall hazards and making environmental safety adaptations (e.g. non-slip strips on steps) or behavioural strategies (e.g. avoiding clutter). Home fall-hazard interventions probably reduce the overall rate of falls by 26% (rate ratio (RaR) 0.74, 95% confidence interval (CI) 0.61 to 0.91; 12 studies, 5293 participants; moderate-certainty evidence); based on a control group risk of 1319 falls per 1000 people a year, this is 343 (95% CI 118 to 514) fewer falls. However, these interventions were more effective in people who are selected for higher risk of falling, with a reduction of 38% (RaR 0.62, 95% CI 0.56 to 0.70; 9 studies, 1513 participants; 702 (95% CI 554 to 812) fewer falls based on a control risk of 1847 falls per 1000 people; high-certainty evidence). We found no evidence of a reduction in rate of falls when people were not selected for fall risk (RaR 1.05, 95% CI 0.96 to 1.16; 6 studies, 3780 participants; high-certainty evidence). Findings were similar for the number of people experiencing one or more falls. These interventions probably reduce the overall risk by 11% (risk ratio (RR) 0.89, 95% CI 0.82 to 0.97; 12 studies, 5253 participants; moderate-certainty evidence); based on a risk of 519 per 1000 people per year, this is 57 (95% CI 15 to 93) fewer fallers. However, for people at higher risk of falling, we found a 26% decrease in risk (RR 0.74, 95% CI 0.65 to 0.85; 9 studies, 1473 participants), but no decrease for unselected populations (RR 0.99, 95% CI 0.92 to 1.07; 6 studies, 3780 participants) (high-certainty evidence). These interventions probably make little or no important difference to health-related quality of life (HRQoL) (standardised mean difference 0.09, 95% CI -0.10 to 0.27; 5 studies, 1848 participants; moderate-certainty evidence). They may make little or no difference to the risk of fall-related fractures (RR 1.00, 95% 0.98 to 1.02; 2 studies, 1668 participants), fall-related hospitalisations (RR 0.96, 95% CI 0.87 to 1.06; 3 studies, 325 participants), or in the rate of falls requiring medical attention (RaR 0.91, 95% CI 0.58 to 1.43; 3 studies, 946 participants) (low-certainty evidence). The evidence for number of fallers requiring medical attention was unclear (2 studies, 216 participants; very low-certainty evidence). Two studies reported no adverse events. Assistive technology Vision improvement interventions may make little or no difference to the rate of falls (RaR 1.12, 95% CI 0.84 to 1.50; 3 studies, 1489 participants) or people experiencing one or more falls (RR 1.09, 95% CI 0.79 to 1.50) (low-certainty evidence). We are unsure of the evidence for fall-related fractures (2 studies, 976 participants) and falls requiring medical attention (1 study, 276 participants) because the certainty of the evidence is very low. There may be little or no difference in HRQoL (mean difference 0.40, 95% CI -1.12 to 1.92) or adverse events (falls while switching glasses; RR 1.00, 95% CI 0.98 to 1.02) (1 study, 597 participants; low-certainty evidence). Results for other assistive technology - footwear and foot devices, and self-care and assistive devices (5 studies, 651 participants) - were not pooled due to the diversity of interventions and contexts. Education We are uncertain whether an education intervention to reduce home fall hazards reduces the rate of falls or the number of people experiencing one or more falls (1 study; very low-certainty evidence). These interventions may make little or no difference to the risk of fall-related fractures (RR 1.02, 95% CI 0.96 to 1.08; 1 study, 110 participants; low-certainty evidence). Home modifications We found no trials of home modifications that measured falls as an outcome for task enablement and functional independence. AUTHORS' CONCLUSIONS We found high-certainty evidence that home fall-hazard interventions are effective in reducing the rate of falls and the number of fallers when targeted to people at higher risk of falling, such as having had a fall in the past year and recently hospitalised or needing support with daily activities. There was evidence of no effect when interventions were targeted to people not selected for risk of falling. Further research is needed to examine the impact of intervention components, the effect of awareness raising, and participant-interventionist engagement on decision-making and adherence. Vision improvement interventions may or may not impact the rate of falls. Further research is needed to answer clinical questions such as whether people should be given advice or take additional precautions when changing eye prescriptions, or whether the intervention is more effective when targeting people at higher risk of falls. There was insufficient evidence to determine whether education interventions impact falls.
Collapse
Affiliation(s)
- Lindy Clemson
- Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Susan Stark
- Participation, Environment and Performance Laboratory, Program in Occupational Therapy, Washington University, St Louis, MO, USA
| | - Alison C Pighills
- Mackay Institute of Research and Innovation, Mackay Hospital and Health Service, Mackay, Australia
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Nicola J Fairhall
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sarah E Lamb
- College of Medicine and Health , University of Exeter, Exeter, UK
| | - Jinnat Ali
- Faculty of Health Science, The University of Sydney, Sydney, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
50
|
Buchegger S, Iglseder B, Alzner R, Kogler M, Rose O, Kutschar P, Krutter S, Dückelmann C, Flamm M, Pachmayr J. Patient perspectives on, and effects of, medication management in geriatric fallers (the EMMA study): protocol for a mixed-methods pre-post study. BMJ Open 2023; 13:e066666. [PMID: 36813491 PMCID: PMC9950918 DOI: 10.1136/bmjopen-2022-066666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Pharmacotherapy is critical in geriatric fallers owing to the vulnerability of this population. Comprehensive medication management can be an important strategy to reduce the medication-related risk of falling in this patient group. Patient-specific approaches and patient-related barriers to this intervention have rarely been explored among geriatric fallers. This study will focus on establishing a comprehensive medication management process to provide better insights into patients' individual perceptions regarding their fall-related medication as well as identifying organisational and medical-psychosocial effects and challenges of this intervention. METHODS AND ANALYSIS The study design is a complementary mixed-methods pre-post study which follows the approach of an embedded experimental model. Thirty fallers aged at least 65 years who were on five or more self-managed long-term drugs will be recruited from a geriatric fracture centre. The intervention consists of a five-step (recording, reviewing, discussion, communication, documentation) comprehensive medication management, which focuses on reducing the medication-related risk of falling. The intervention is framed using guided semi-structured pre-post interventional interviews, including a follow-up period of 12 weeks. These interviews will assess patients' perceptions of falls, medication-related risks and gauge the postdischarge acceptability and sustainability of the intervention. Outcomes of the intervention will be measured based on changes in the weighted and summated Medication Appropriateness Index score, number of fall-risk-increasing drugs and potentially inadequate medication according to the Fit fOR The Aged and PRISCUS lists. Qualitative and quantitative findings will be integrated to develop a comprehensive understanding of decision-making needs, the perspective of geriatric fallers and the effects of comprehensive medication management. ETHICS AND DISSEMINATION The study protocol was approved by the local ethics committee of Salzburg County, Austria (ID: 1059/2021). Written informed consent will be obtained from all patients. Study findings will be disseminated through peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER DRKS00026739.
Collapse
Affiliation(s)
- Stephanie Buchegger
- Institute of Pharmacy, Pharmaceutical Biology and Clinical Pharmacy, Paracelsus Medical University Salzburg, Salzburg, Austria
- Center of Public Health and Health Services Research, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, University Hospital Salzburg-Christian Doppler Hospital, Salzburg, Austria
| | - Reinhard Alzner
- Department of Geriatric Medicine, University Hospital Salzburg-Christian Doppler Hospital, Salzburg, Austria
| | - Magdalena Kogler
- Department of Clinical Pharmacy and Drug Information, Hospital Pharmacy, Landesapotheke Salzburg, Salzburg, Austria
| | - Olaf Rose
- Department of Research in Pharmacotherapy, Impac2t, Münster, Germany
| | - Patrick Kutschar
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Simon Krutter
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christina Dückelmann
- Institute of Pharmacy, Pharmaceutical Biology and Clinical Pharmacy, Paracelsus Medical University Salzburg, Salzburg, Austria
- Department of Clinical Pharmacy and Drug Information, Hospital Pharmacy, Landesapotheke Salzburg, Salzburg, Austria
| | - Maria Flamm
- Center of Public Health and Health Services Research, Paracelsus Medical University Salzburg, Salzburg, Austria
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Johanna Pachmayr
- Institute of Pharmacy, Pharmaceutical Biology and Clinical Pharmacy, Paracelsus Medical University Salzburg, Salzburg, Austria
- Center of Public Health and Health Services Research, Paracelsus Medical University Salzburg, Salzburg, Austria
| |
Collapse
|