Factors Associated with the Risk of Falls of Nursing Home Residents Aged 80 or Older

Adverse impacts in residential aged care facilities: The resident perspective

OBJECTIVES

Inclusion of consumer perspectives is a key component to person-centred health-care approaches. While current residential aged care systems focus on recording adverse events to meet the requirements of regulatory reporting, little is known about the views of residents. The aim of this research was to explore residents' responses on the types of incidents that have an adverse impact on them and how they are affected by these incidents.

METHODS

The study used a qualitative, inductive approach to derive themes from interviews with 20 permanent residents of aged care facilities in New South Wales and the Australian Capital Territory.

RESULTS

Four main themes surrounding adverse incidents emerged: (i) social relationships and the adverse impacts of lack of meaningful interactions, (ii) adjustment to life in the residential aged care facility and the loss of residents' former life and self-determination, (iii) the impact of COVID-19 lockdowns which meant that residents were not able to go out or interact with others and (iv) acceptance, resignation and resilience in coping with adverse incidents.

CONCLUSIONS

This research highlights the difference between health-care definition, used for incident management reporting and quality indicators, and the way residents respond when asked to describe an incident that has affected them. Resident responses discuss situations having an adverse effect on them in contrast to the way adverse events and incidents are reported and monitored. The findings suggest that within adverse event and incident management systems and resident governance systems, there is scope for incorporating periods of transitions and well-being measures that capture elements that matter to older people.

A Scoping Review of Adverse Incidents Research in Aged Care Homes: Learnings, Gaps, and Challenges

Background: Adverse incidents are well studied within acute care settings, less so within aged care homes. The aim of this scoping review was to define the types of adverse incidents studied in aged care homes and highlight strengths, gaps, and challenges of this research. Methods: An expanded definition of adverse incidents including physical, social, and environmental impacts was used in a scoping review based on the PRISMA Extension for Scoping Reviews Checklist. MEDLINE, CINAHL, and EBSCOhost were searched for English language, peer-reviewed studies conducted in aged care home settings between 2000 and 2020. Forty six articles across 12 countries were identified, charted, and analyzed using descriptive statistics and narrative summary methods. Results: Quantitative studies (n = 42, 91%) dominated adverse incidents literature. The majority of studies focused on physical injuries (n = 29, 63%), with fewer examining personal/interpersonal (15%) and environmental factors (22%). Many studies did not describe the country's aged care system (n = 26, 56%). Only five studies (11%) included residents' voices. Discussion: This review highlights a need for greater focus on resident voices, qualitative research, and interpersonal/environmental perspectives in adverse event research in aged care homes. Addressing these gaps, future research may contribute to better understanding of adverse incidents within this setting.

Situation Analysis of Healthcare Standards and Criteria That Contribute to the Care of Residents in Homes for Older People in Tanzania

Problems experienced in homes for older people in Tanzania highlighted the need for a situation analysis of healthcare standards to identify the baseline of care provided to residents in these homes. This study conducted a situation analysis of structure healthcare standards and associated criteria with the aim of contributing to improved quality of care for residents in homes for older people in Tanzania. Thirty-two homes for older people in Tanzania were audited using an audit instrument that included seven fields, 26 structure standards, and 262 associated criteria. The analysis showed that overall, the homes were non-compliant with healthcare structure standards and associated criteria. The Tanzanian Government should urgently introduce measures to address the missing standards and associated criteria.

Gluteus Maximus Muscle Activation Characteristics During a Chair-Rise in Adults With Chronic Stroke

BACKGROUND AND PURPOSE

A successful chair-rise is an important indicator of functional independence post-stroke. Lower extremity electromyographic analyses provide a basis for muscle activation from which clinical intervention protocols may be derived. Gluteus maximus activation during the chair-rise has not been thoroughly researched in the chronic stroke population. This study investigated the magnitude and onset of gluteus maximus activation during the chair-rise comparing adults post-stroke with healthy controls.

METHODS

In this cross-sectional study, adults with chronic stroke (n = 12) and healthy controls (n = 12) completed 4 natural-speed chair-rise trials. Magnitude and onset of bilateral gluteus maximus activation were measured during the movement with secondary comparative data from biceps femoris and vastus lateralis muscles. Kinetic and kinematic measurements were used to quantify chair-rise phases and movement cycle duration.

RESULTS

Significant decreases in paretic ( P = 0.002), and nonparetic ( P = 0.001) gluteus maximus magnitudes were noted post-stroke compared with ipsilateral extremities of healthy adults. Significant gluteus maximus onset delays were noted in paretic extremities compared with nonparetic extremities post-stroke ( P = 0.009) that were not apparent in comparative muscles. Similar onset times were noted when comparing the paretic extremity post-stroke to the ipsilateral extremity of healthy controls ( P = 0.714) despite prolonged movement cycle durations in those with chronic stroke ( P = 0.001). No onset delays were evident in the biceps femoris ( P = 0.72) or vastus lateralis ( P = 0.338) muscles.

DISCUSSION AND CONCLUSIONS

Despite apparent unilateral muscle weakness post-stroke, bilateral decreases in gluteus maximus activation magnitudes and compounding onset deficits of the paretic extremity were observed during chair-rising. Further research is needed to determine whether interventions maximizing bilateral activation magnitudes and improving temporal activation congruency during chair-rising will carry over to functional gainsVideo Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A387 ).

The Effects of Tai Chi Chuan Exercise Training on the Lower Extremities of Middle-Aged and Elderly

Background: It is known that lower-limb muscle strength is easily maintained in elderly people who practice Tai Chi, although it is necessary to maintain lower-limb muscle strength even as age increases in order to prevent falls. However, the effect of long-term Tai Chi practice and age on lower-limb ability is unclear in middle-aged and elderly people. This research was designed to compare lower-extremity parameters during a countermovement jump between middle-aged and elderly individuals who frequently practice Tai Chi Chuan and individuals in the general population who constituted the healthy group. Methods: There were four groups, and each group included 12 participants. Ten Vicon motion system infrared cameras and two Kistler force plates were used. The data were standardized and analysed using independent-measure two-way ANOVA. Results: The statistical results showed that there was no interaction between the age factor and exercise type factor. The statistics of age factor also showed that age may decrease the jump height (36.36%), peak knee power (24.74%) and peak ankle power (21%) during the take-off phase. In the exercise type factor, long-term Tai Chi training significantly increased the jump height (60%), peak knee moment (19.80%), peak ankle moment (8.06%), peak hip power (29.80%), peak knee power (31.23%) and peak ankle power (16.88%) during the take-off phase. Conclusion: This study shows that long-term Tai Chi training can slow ageing-related functional decline. According to the results of this study, middle-aged and elderly people are encouraged to regularly perform Tai Chi exercises to increase the strength of various muscle groups in the lower limbs and slow the lower-limb muscle changes caused by ageing.

Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review

This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives.

Replacing Sedentary Behavior With Physical Activity of Different Intensities: Implications for Physical Function, Muscle Function, and Disability in Octogenarians Living in Long-Term Care Facilities

BACKGROUND

We investigated the associations of replacing sedentary behavior (SB) with physical activity of different intensities on the physical function of octogenarians living in long-term care facilities.

METHODS

This pooled study recruited 427 older adults aged 80 years and older (69.1% female; body mass index: 27.53). For 345 participants who provided valid data, we assessed device-measured time spent in SB, light-intensity physical activity (LIPA), and moderate to vigorous physical activity (MVPA). We assessed lower limb physical function, strength, mobility, and disability. We used compositional data analysis to investigate the associations of replacing SB with physical activity on the outcomes.

RESULTS

Reallocation of SB to LIPA and MVPA was associated with a higher number of 30-second Chair Stand cycles (LIPA: +0.21, MVPA: +1.81; P < .001), greater peak force (LIPA: +11.96 N, MVPA: +27.68 N; P < .001), peak power (LIPA: +35.82 W, MVPA: +92.73 W; P < .001), peak velocity (LIPA: +0.03 m/s, MVPA: +0.12 m/s; P < .001), higher levels of grip strength (LIPA: +0.68 kg, MVPA: +2.49 kg; P < .001), and less time in the Time Up and Go (LIPA: -7.63 s, MVPA: -12.43 s; P < .001).

CONCLUSIONS

Replacing SB with LIPA or MVPA is associated with physical function and disability of older adults living in long-term care facilities.

Risk Factors Associated with Falls among Nursing Home Residents: A Case-Control Study

Introduction: To identify factors predictive of falls and enable appropriate management of fall risk it is necessary to understand the behaviour and health conditions of older adults living in nursing homes. Objective: This study had two main objectives. The first was to find significant predictors for falls in older adults living in nursing homes. The second main goal was to build a predictive model to find the best predictors for falls. Methods: Out of 56 nursing homes with the same legal statute, 25 agreed to participate. The sample was randomly selected and only the independent or slight/moderately dependent participants were included in the study (n = 325). Results: There was a mean of 1.47 ± 0.99 falls (range from 1 to 7) per resident in nursing homes. By using the t test and odds ratio analysis, ten factors related to falls were identified. Through the binary logistic regression, a model was tested identifying four robust predictors: static balance, resorting to emergency services, polypharmacy, and an independent self-care profile. Conclusions: The present study replicated the main results of contemporary research on the risk factors of falls. More importantly, it suggests that the self-care profile model should be taken into account in future studies and early interventions. It is crucial to implement preventive measures consistent with safer environments and to establish an individual plan for integrated activities according to older adults’ health needs.

Incidence of adverse incidents in residential aged care

ObjectiveAdverse incident research within residential aged care facilities (RACFs) is increasing and there is growing awareness of safety and quality issues. However, large-scale evidence identifying specific areas of need and at-risk residents is lacking. This study used routinely collected incident management system data to quantify the types and rates of adverse incidents experienced by residents of RACFs.MethodsA concurrent mixed-methods design was used to examine 3 years of incident management report data from 72 RACFs in New South Wales and the Australian Capital Territory. Qualitative thematic analysis of free-text incident descriptions was undertaken to group adverse incidents into categories. The rates and types of adverse incidents based on these categories were calculated and then compared using incidence rate ratios (IRRs).ResultsDeidentified records of 11 987 permanent residents (aged ≥65 years; mean (±s.d.) age 84 ± 8 years) from the facilities were included. Of the 60 268 adverse incidents, falls were the most common event (36%), followed by behaviour-related events (33%), other impacts and injuries (22%) and medication errors (9%). The number of adverse incidents per resident ranged from 0 (42%) to 171, with a median of 2. Women (IRR 0.804; P < 0.001) and residents with low care needs (IRR 0.652; P < 0.001) were significantly less likely to adverse incidents compared with men and residents with high care needs respectively.ConclusionThis study demonstrates that data already collected within electronic management systems can provide crucial baseline information about the risk levels that adverse incidents pose to older Australians living in RACFs.What is known about the topic?To date, research into aged care adverse incidents has typically focused on single incident types in small studies involving mitigation strategies. Little has been published quantifying the multiple adverse incidents experienced by residents of aged care facilities or reporting organisation-wide rates of adverse incidents.What does this paper add?This paper adds to the growing breadth of Australian aged care research by providing baseline information on the rates and types of adverse incidents in RACFs across a large and representative provider.What are the implications for practitioners?This research demonstrates that the wealth of data captured by aged care facilities' incident management information systems can be used to provide insight into areas of commonly occurring adverse incidents. Better use of this information could greatly enhance strategic planning of quality improvement activities and the care provided to residents.

Is functional fitness performance a useful predictor of risk of falls among community-dwelling older adults?

Background

Falls among older adults are a serious public health problem. Many studies indicate that positive functional fitness performance decreases the risk of falls. A limited amount of previous study has investigated the association between broad functional fitness and the fall risk. This study examines the associations between functional fitness and the risk of falling among community-dwelling older adults.

Methods

Three waves of cross-sectional data were collected from 2017 to 2019 in Taipei City, Taiwan. Six hundred sixty-five participants aged ≥65 years were randomly recruited from 12 districts of Taipei. Eight functional fitness tests (i.e., back scratch, chair-sit and-reach, 8-ft up-and-go, 30-s sit-to-stand, 30-s arm curl, 30-s single-leg stance, 2-min step, and hand grip strength tests) were performed to record the physical performance of older subjects. A Chinese version of the fall-risk questionnaire (FRQ) was used to calculate the fall risk scores. Linear regression and logistic regression were utilized to estimate the relationships of each functional fitness and fall risk.

Result

The results showed that 37.45% of older adults had a high risk of falling. It was found for each functional fitness that performance was linearly associated with the risk of falling. Moreover, older adults with low-performance levels in all functional fitness except back-scratching were more likely to have a higher risk of falling.

Conclusions

Our study indicated that functional fitness performance appears to provide valid predictive guidance for reducing the risk of falling among the older population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-021-00608-1.

Can cognitive-motor training improve physical functioning and psychosocial wellbeing in nursing home residents? A randomized controlled feasibility study as part of the PROCARE project

BACKGROUND

A multi-component training program holds promises for the elderly, but still has to be tested on its feasibility and effect in nursing homes.

AIMS

The aim of this study was (1) to design a multi-component training program which improves physical functioning and psychosocial wellbeing and (2) to evaluate the feasibility of this intervention in nursing home residents.

METHODS

This study is a two-arm, stratified-randomized controlled feasibility trail. Twenty-four nursing home residents (aged 83.7 ± 6.4, 21 women) were divided into an intervention and a waiting-list control group. The intervention group completed a multi-component training (including dual-task, dynamic balance, endurance and strength exercises) for 16 weeks (twice per week for 45-60 min). Primary outcomes were lower extremity functionality (SPPB), gait performance (GAITRite), health-related quality of life (SF-12) as well as life satisfaction (SWLS).

RESULTS

Life satisfaction (SWLS) and physical functioning (SPPB) increased in the intervention group after training whereas the control group showed a decrease. Gait parameters could only be analyzed for n = 5 participants of the intervention group and n = 2 of the control group and showed no time differences for the intervention group. The mean number of participants was 12.5 ± 1.9 per session (attendance ranged between 66% and 90%).

CONCLUSION

A multi-component training seems (1) to lead to clinically relevant improvements in physical functioning as well as in psychosocial wellbeing and (2) to be feasible and well accepted in nursing home residents. Nevertheless, the complexity and progression of the program as well as the testing protocol have to be adapted. Further research should test the effectiveness of this adapted program in a larger sample size.

Practices of caregivers when evaluating the risk of falls in the admission of older adults to nursing homes

Falls are a complex problem for the older population residing in nursing homes. Despite recommendations, many difficulties remain in the evaluation of and systematic information on fall risk factors.

Sit-to-stand muscle power test: Comparison between estimated and force plate-derived mechanical power and their association with physical function in older adults

OBJECTIVES

This study aimed i) to assess the assumptions made in the sit-to-stand (STS) muscle power test [body mass accelerated during the ascending phase (90% of total body mass), leg length (50% of total body height) and concentric phase (50% of total STS time)], ii) to compare force plate-derived (FPD) STS power values with those derived from the STS muscle power test; and iii) to analyze the relationships of both measurements with physical function.

MATERIAL AND METHODS

Fifty community-dwelling older adults (71.3 ± 4.4 years) participated in the present investigation. FPD STS power was calculated as the product of measured force (force platform) and velocity [difference between leg length (DXA scan) and chair height, divided by time (obtained from FPD data and video analysis)], and compared to estimated STS power using the STS muscle power test. Physical function was assessed by the timed-up-and-go (TUG) velocity, habitual gait speed (HGS) and maximal gait speed (MGS). Paired t-tests, Bland-Altman plots and regressions analyses were conducted.

RESULTS

Body mass accelerated during the STS phase was 85.1 ± 3.8% (p < 0.05; compared to assumed 90%), leg length was 50.7 ± 1.3% of body height (p < 0.05; compared to 50%), and measured concentric time was 50.3 ± 4.6% of one STS repetition (p > 0.05; compared to assumed 50%). There were no significant differences between FPD and estimated STS power values (mean difference [95% CI] = 6.4 W [-68.5 to 81.6 W]; p = 0.251). Both FPD and estimated relative (i.e. normalized to body mass) STS power were significantly related to each other (r = 0.95 and ICC = 0.95; p < 0.05) and to MGS and TUG velocity after adjusting for age and sex (p < 0.05).

CONCLUSIONS

Estimated STS power was not different from FPD STS power and both measures were strongly related to each other and to maximal physical performance.

Comparison of handrail reaction forces between two different handrails during sit-to-stand movement in the elderly

BACKGROUND

The handrail is an effective means of assisting sit-to-stand movements. As some elderly people need force to support their body during sit-to-stand movements because of instability and weakness; however, few handrails are specifically shaped to generate more force and support the body. This study aimed to investigate the effect of a newly designed curved-angled handrail on the reaction force during sit-to-stand movements in the elderly.

METHODS

Twenty-one elderly subjects (age range, 72-84 years) participated in the study. They performed sit-to-stand movements using a conventional vertical handrail and then the curved-angled handrail five times each. For each subject, body coordinate data were acquired and the handrail reaction force was measured using motion analysis and load sensors on the handrail.

FINDINGS

The reaction forces generated in the anterior-posterior and upward-downward directions during sit-to-stand movements using the curved-angled handrail were significantly greater than those generated using the conventional vertical handrail (p < .001).

INTERPRETATION

Compared with using the conventional vertical handrail, using the curved-angled handrail enhances the generated force during sit-to-stand movements.

Center of pressure displacement characteristics differentiate fall risk in older people: A systematic review with meta-analysis

Falling is the second most prevalent cause of accidental death in the world. Currently available clinical tests to assess balance in older people are insufficiently sensitive to screen for fall risk in this population. Laboratory tests that record the center of pressure (COP) trajectory could overcome this problem but despite their widespread use, the choice of COP trajectory features for use as a biomarker of fall risk lacks consensus. This systematic review and meta-analysis aimed at identifying the best COP characteristics to predict risk of falling in older adults. More than 4000 articles were screened; 44 (7176 older adults) were included in this study. Several COP parameters emerged as good indices to discriminate fallers from non-fallers. From sensitivity analysis, Sway area per unit time, anteroposterior mean velocity, and radial mean velocity were the best traditional features. In this study, identification of older people with a high fall risk was demonstrated using quiet-standing recordings. Such screening would also be useful for routine follow-up of balance changes in older fallers in clinical practice.

Reliability, Validity, and Ability to Identity Fall Status of the Berg Balance Scale, Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest in Older Adults Who Live in Nursing Homes

BACKGROUND AND PURPOSE

In any given year, 28% to 35% of older adults experience falls. In nursing home environments, the annual rate of falls increases to 30% to 50%. Our objective was to verify and compare the reliability, validity, and ability to identify falls of the Berg Balance Scale (BBS), Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest for older adults who live in nursing homes.

METHODS

This was a cross-sectional study. Older adults (n = 49; aged 62-90 years; mean = 77.8; standard deviation = 7.2) were recruited from a nonprofit nursing home. All participants were assessed by 2 physiotherapists using the BBS, BESTest, Mini-BESTest, and Brief-BESTest. The interrater and test-retest (7-14 days) reliability were assessed using intraclass correlation coefficients (ICCs [2, 1]). Minimal detectable changes at the 95% confidence level were established. To analyze each test's ability to identify fall status, we used receiver operating characteristic (ROC) curves, whose statistical significance we verified using the area under the ROC curve (AUC) and respective 95% confidence intervals (CIs). The diagnostic likelihood ratios (positive and negative) and 95% CI were used to verify posttest probability. We used Fagan's nomogram to show the posttest probability of each balance test. Validity was assessed using kappa coefficients and the prevalence-adjusted bias-adjusted kappa (PABAK).

RESULTS

Interrater and test-retest reliability for the total scores were good to excellent across all 4 tests (ICC interrater value = 0.992-0.994 and ICC test-retest value = 0.886-0.945). All tests were also able to identify fall status (AUC = 0.712-0.762) and were in good agreement with each other (kappa coefficient for individuals with fall risk = 0.679-0.957 and individuals with no fall risk = 0.135-0.143; PABAK = 83.7%-98%).

CONCLUSION

All balance tests presented similar reliability, reproducibility, and validity. This suggests that any of these tests can be used in clinical practice. However, the Brief-BESTest is the quickest and easiest test to perform.

Effects of shelf bar assistance on kinetic control during sit-to-stand in healthy young and elderly subjects

This study aimed to determine the kinetic effects of using unilateral shelf bar, vertical grab bar (GB), and horizontal GB during sit-to-stand (STS) in young and elderly subjects. Twenty young adults aged 20-40 years and eighteen healthy elderly people aged ≥ 65 years old were recruited. The subjects performed STS with and without using the three types of bars. Bar reaction force (BRF) and maximum power (MP) defined as the maximal product calculated by multiplying the GRF and the velocity of the center of mass in each direction were measured using three-dimensional motion analysis, two load sensors of GB, and four force plates. The use of the shelf bar generated a significantly larger BRF in the vertical direction than the other bars (p < 0.05) and lower MP in the vertical direction than the horizontal bar (p < 0.05) and no bar (p < 0.05). In the younger subjects, only the use of the vertical bar generated a significantly larger BRF (p < 0.05) and negative MP (p < 0.05) in the forward direction than those in elderly subjects. The use of the shelf bar may assist the decreased MP in the vertical direction during STS in elderly people, resulting in decrease of failed STS in daily living. In contrast, the use of the vertical bar in the elderly may not generate sufficient BRF in the forward direction because of lack of eccentric control in the whole body in the forward direction during STS.

Interobserver analysis of safety practices and behaviors adopted by elderly people to prevent falls

Objective:

determine the psychometric properties of the safety practices and behaviors dimension of the Scale of Practices and Behaviors of Institutionalized Elderly People to Prevent Falls in a sample of elderly people with cognitive decline.

Method:

methodological study, with a quantitative approach, to assess the psychometric properties of the mentioned scale in a sample with 102 elderly people with cognitive decline who lived in two long-term care institutions for the public in this age group. Internal consistency evaluation was carried out by calculating the Cronbach’s alpha coefficient; interobserver reliability was expressed by Cohen’s kappa coefficient; and temporal stability, by obtaining Spearman correlation. Compliance with all ethical procedures was observed.

Results:

the dimension of safety practices and behaviors showed α = 0.895 for its 11 items. Seven out of the 11 items reached good to excellent agreement among the experts for interobserver reliability. Kappa index values indicated that the instrument is valid and reliable. Safety practices and behaviors were influenced by institutionalization time, being at least 85 years old, and gait skills.

Conclusion:

the results pointed out that the instrument has good reproducibility and is valid and reliable, which allows its use in clinical practice in elderly people with cognitive decline as well as in research.

Validity of various portable devices to measure sit-to-stand velocity and power in older adults

BACKGROUND

Movement velocity and power in a single STS are related to functional performance in older adults. Identifying accessible tools that provide valid measures of STS velocity/power would allow practitioners to evaluate physical function in clinical settings where time, space and finances are limited.

RESEARCH QUESTION

Does a linear position transducer (LPT), iPhone application (App), and inertial measurement unit (IMU) obtain valid measurements of velocity and power during a single STS compared with 3D motion capture?

METHODS

Twenty-seven community-dwelling older adults aged ≥60 years completed a single STS test with mean velocity and power simultaneously measured with 3D motion capture, an LPT, IMU and App. Acceptable validity was established if the Pearson correlation coefficient (r) was very high (≥0.7) and bias as a standardised effect size (ES) was small (<0.6). The relationship between STS velocity/power and 30s chair STS performance was also evaluated.

RESULTS

Measures of STS velocity obtained by the LPT (r = 0.94, ES = -0.21) and App (r = 0.89, ES = -0.19) were very highly valid when compared to 3D motion capture, and were very strongly related to 30s STS performance (r ≥0.74). The LPT (r = 0.87, ES = 0.13) and App (r = 0.74, ES = -0.12) also showed very high correlations and negligible bias for measuring STS power. Data collected by the IMU failed to meet our pre-determined threshold of acceptable validity for STS velocity (r = 0.72, ES = 1.00) or power (r = 0.61, ES = 0.34).

SIGNIFICANCE

The LPT and iPhone App, but not the IMU, are valid tools for measuring STS velocity and power in community-dwelling older adults. Clinicians can use STS velocity obtained by either the LPT or App as a simple and valid proxy for functional status, which could help identify patients at high-risk of incident disability.

A Review of the Development and Application of Generic Preference-Based Instruments with the Older Population

Older people (aged 65 years and over) are the fastest growing age cohort in the majority of developed countries, and the proportion of individuals defined as the oldest old (aged 80 years and over) living with physical frailty and cognitive impairment is rising. These population changes put increasing pressure on health and aged care services, thus it is important to assess the cost effectiveness of interventions targeted for older people across health and aged care sectors to identify interventions with the strongest capacity to enhance older peoples' quality of life and provide value for money. Cost-utility analysis (CUA) is a form of economic evaluation that typically uses preference-based instruments to measure and value health-related quality of life for the calculation of quality-adjusted life-years (QALYS) to enable comparisons of the cost effectiveness of different interventions. A variety of generic preference-based instruments have been used to measure older people's quality of life, including the Adult Social Care Outcomes Toolkit (ASCOT); Health Utility Index Mark 2 (HUI2); Health Utility Index Mark 3 (HUI3); Short-Form-6 Dimensions (SF-6D); Assessment of Quality of Life-6 dimensions (AQoL-6D); Assessment of Quality of Life-8 dimensions (AQoL-8D); Quality of Wellbeing Scale-Self-Administered (QWB-SA); 15 Dimensions (15D); EuroQol-5 dimensions (EQ-5D); and an older person specific preference-based instrument-the Investigating Choice Experiments Capability Measure for older people (ICECAP-O). This article reviews the development and application of these instruments within the older population and discusses the issues surrounding their use with this population. Areas for further research relating to the development and application of generic preference-based instruments with populations of older people are also highlighted.

Alarming and/or Alerting Device Effectiveness in Reducing Falls in Long-Term Care (LTC) Facilities? A Systematic Review

Perceptions against the use of alarming devices persist in long-term care environments as they are seen as annoying, costly, and a waste of time to the staff involved. Ascertaining whether these perceptions are true or false via the literature was a focus of this study. Proper information to educate staff and to work past these perceptions can be a positive effector for resident safety. Many facilitators for the use of alarming devices were found, as well as many barriers to their use as well. New technology is changing the perceptions regarding these types of devices as time passes. Education is a key component for staff, residents, and families. There are “traditional” issues with the use of alarms such as alarm fatigue by caregivers, high costs of implementation, and issues with proper implementation of alarms. Alarms are perceived as intrusive and the noise from them can be a potential cause of falls. However, alarming devices can be a key intervention in the safety of those residents who are prone to falls. This requires proper implementation and education for all parties involved, and proper oversight surrounding use of the devices.

Cross-cultural adaptation, reliability, and validity of the St. Thomas’s Falls Risk Assessment Tool in Older Adults (STRATIFY)

Abstract Introduction: Falls are an important adverse event among older adults. The St. Thomas’s Falls Risk Assessment Tool in Older Adults (STRATIFY) is a tool to assess the risk of falls; however, it is not translated and adapted to Portuguese. Objective: To translate and perform a cross-cultural adaptation of STRATIFY in Brazilian Portuguese, as well as to test the reliability and validity of the instrument. Method: The cross-cultural adaptation process was carried out in six stages: A) T1 and T2 translations; B) synthesis of translations (T12); C) T12 back translations (RT1 and RT2); D) expert committee review; E) pretesting of the version approved by the committee; F) adapted version of STRATIFY for Brazilian Portuguese. Inter-rater and test-retest reliability were performed using the intraclass correlation coefficient (ICC) and 95% confidence interval (CI). Validity was assessed by the Spearman’s correlation coefficient of the STRATIFY with the Morse Fall Scale (MFS). Data analysis was performed by the Microsoft Office Excel 2016 (translation and adaptation) and by the IBM SPSS Statistics 20.0 (reliability and validity). We used a level of significance of p<0.05. Results: Data were presented about the perception of 33 health professionals on the adapted version of STRATIFY. The following ICC and CI were found for inter-rater and test-retest reliability, respectively: ICC=0.729; CI=0.525-0.845 and ICC=0.876; CI=0.781-0.929. STRATIFY and MFS showed a moderate but significant correlation (ρ=0.50, p<0.001). Conclusion: The translated and adapted version of the STRATIFY presented moderate inter-rater reliability and good test-retest reliability, in addition to a moderate correlation to the MFS.

Validity of a Novel, Clinically Relevant Measure to Differentiate Functional Power and Movement Velocity and Discriminate Fall History Among Older Adults: A Pilot Investigation

Background and Objectives

Lower-body muscular power and movement velocity (MV) are associated with balance and physical function. The Tendo power analyzer (Tendo) is a portable device that calculates functional lower body power (FLBP) and MV. This reliable (Cronbach’s α = .98) method is validated against motion capture analysis of functional lower body sit-to-stand power and velocity (r = .76). However, the Tendo has not been utilized in discrimination or prediction of falls. We determined the discriminant validity of FLBP and MV among older adults based on the history of falls. These results lay the framework for longitudinal research in FLBP and MV in fall prediction/prevention.

Research Design and Methods

Cross-sectional investigation examining differences between FLBP and MV during 5 sit-to-stands of 98 community-dwelling older adults (aged 77.5 years, 61% female) classified by the history of fall (no = 59, yes = 39). Participants completed 5 consecutive sit-to-stands (60-second rest between each) with FLBP and MV measured by the Tendo. Multivariate analysis of variance modeling determined between-group differences in functional lower body sit-to-stand average velocity, peak velocity, relative average power, and relative peak power. Binary and forward conditional logistic regression models determined the ability of each measure to discriminate fall history.

Results

FLBP and MV were significantly lower in older adults with a fall history (p < .05). Relative average power and peak power were 15% and 16% lower and average and peak velocity were 18% and 14% slower, respectively among fallers. Logistic regression indicated average velocity was the best discriminator of fall history (p < .05).

Discussion and Implications

The Tendo detects differences in FLBP and MV during a sit-to-stand while discriminating fall history. Future longitudinal studies should determine efficacy in fall prediction and applicability toward clinically relevant interventions for fall prevention.

Differences Between Moderate to Severely Cognitively Impaired Fallers Versus Nonfallers in Nursing Homes

INTRODUCTION

The purpose of this study was to test differences in psychotropic medication, function, physical activity, agitation, resistiveness to care, comorbidities, and depression among moderate to severely cognitively impaired nursing home residents who were fallers versus nonfallers.

METHODS

This was a secondary data analysis using baseline data from a randomized controlled trial testing the Function and Behavior Focused Care intervention across 12 nursing homes. The sample included 336 older adults, the majority of whom were female and white.

RESULTS

There was a significant difference in the total number of comorbidities, agitation, the total number of psychotropic medications, depressive symptoms, and physical activity between those who fell and those who did not fall (Pillai-Bartlett trace = 4.91; P < .001).

DISCUSSION

Findings support prior work except with regard to medication use, cognition, and function. Due to inconsistent findings, additional research is recommended particularly with regard to the use of specific drug groups and medications.

Quality of life in the institutionalized elderly with dizziness complaint: a cross-sectional study

ABSTRACT Purpose: to evaluate the quality of life in institutionalized elderly people with dizziness complaint and to relate the results to the characteristics of dizziness and functional capacity. Methods: in this cross-sectional study, one-hundred and nineteen elderly residents in three geriatric long-term care institutions in Natal city, Brazil, were evaluated. Those who had presented dizziness in the former year (30/25.2%) were included in this study. The quality of life was measured by the Dizziness Handicap Inventory. Functional capacity was measured by the Berg Balance Scale, the Functional Reach Test, the Unipedal Stance Test with eyes open and closed, and the Falls Efficacy Scale - International. Results: associations were found between physical, functional and emotional aspects and the duration of dizziness (p=0.002, p=0.041 and p=0.004, respectively); the functional aspects with age (p=0.031), the physical aspects with the presence of falls in the previous year (p=0.039); and the physical, functional and emotional aspects of the Dizziness Handicap Inventory with fear of falling (p=0.004, p<0.001 and p=0.016, respectively). Conclusion: institutionalized elderly with dizziness complaints had a low perception of quality of life, and the duration of dizziness, age, falls and fear of falling negatively influenced their quality of life.

Pain, Fear of Falling, and Functional Performance Among Nursing Home Residents: A Longitudinal Study

The aim of this study was to analyze the impact of being pain-affected and fear of falling on functional performance among nursing home residents, longitudinally. We used 6-month follow-up data from a cluster-randomized trial of 12 nursing homes (cluster level) with 239 nursing home residents at baseline (mean age, 95% confidence interval [CI] = 83.04 [81.40, 84.69], 70% women). The longitudinal analysis provided data on pain, fear of falling, functional mobility, and activities of daily living (individual level). The data revealed a trend indicating that pain-relieved nursing home residents showed better functional mobility over time. The results on fear of falling demonstrate obvious differences in the functional performance of nursing home residents cross-sectionally but not longitudinally. Nevertheless, the results underline the importance of an effective pain treatment to prevent decline in functional mobility among nursing home residents. Further longitudinal surveys are needed to verify the findings on functional performance.

Development and evaluation of brochures for fall prevention education created to empower nursing home residents and family members

AIMS AND OBJECTIVES

In this study, we describe the development of evidence- and theory-based fall prevention educational material and its evaluation from the users' perspectives.

BACKGROUND

To reduce risk factors for falling in nursing homes, nursing staff must enact multifactorial fall prevention intervention programmes. A core component of these programmes is to educate residents and their family members, both verbally and in a written form. However, users can only benefit from educational material if it is based on current scientific evidence, easy to understand and process and customised.

DESIGN

We followed a structured procedure during the development process, while considering various aspect of quality. To assess the understandability and usefulness of the resulting educational materials, we conducted a qualitative content analysis study.

METHODS

The educational materials development process incorporated several iterative steps including a systematic literature search and the application of frameworks for designing and writing the materials. To evaluate the material, we performed six focus group discussions separately with residents, family members and nursing staff from two nursing homes (total of 32 participants).

RESULTS

Residents' brochures included clear information on avoiding external risks as well as coping strategies after a fall event. Family members' brochures were more comprehensive, including both concrete tips and outlining the advantages and disadvantages of interventions. Residents and family members had no difficulties understanding the material and tried to apply the content to their individual situations. Nursing staff commented on some ambiguities and incongruities relating to current nursing care practice.

CONCLUSIONS

By involving users in the development of evidence-based educational materials, nursing staff can achieve a high acceptance rate for the materials and motivate users to address the topic.

IMPLICATIONS FOR PRACTICE

The involvement of users is essential for developing educational material that meets users' needs. Educational material should be used as part of an overall strategy to educate residents and family members in nursing homes.

Development and evaluation of low-cost walker with trunk support for senior citizen

OBJECTIVE

Develop and evaluate a low-cost walker with trunk support for senior citizens.

METHOD

Two-stage descriptive study: development of a walker with trunk support and evaluation with fourth age senior citizens.

RESULTS

Twenty-three fourth age senior citizens were selected. The evaluated criteria were the immediate influence of the walker on the static stabilometry with baropodometer and the evaluation of gait with accelerometers monitoring time and amplitude of the hip movement. There was a significant decrease in the body oscillation of senior citizens with the use of the developed walker, and there were changes in the joint amplitudes of the hip, but they were not significant.

CONCLUSION

Using low-cost materials, it was possible to develop and equipment that met resistance and effectiveness requirements. The walker interfered in the balance of the senior citizens, reducing significantly the static body oscillation.

Long-stay institutions for the elderly: physical-structural and organizational aspects

Abstract Objective: To characterize long-stay institutions for the elderly in respect to physical-structural and organizational aspects. Method: This descriptive, cross-sectional, quantitative research was carried out in four long-stay institutions for the elderly in Salvador - Bahia, Brazil, between September and November 2013. Data were collected from the technical officers of the institutions using a questionnaire based on National Health Surveillance Agency standards. Results: This study highlights a partial compliance with current regulations both in respect to the physical-structural and organizational aspects. The elderly are exposed to an environment that is sometimes unhealthy with risk factors for health problems. Conclusion and implications for practice: There is need for adjustments in the institutions to comply with current legislation. This study shows the importance of a multidisciplinary team to provide comprehensive care of institutionalized elderly, with emphasis on the role of nurses in the qualification of institutions and valorization of the elderly.

Patterns of New Physical Problems Emerging in Long-Term Care Residents With Dementia

Individuals receiving skilled nursing care have multiple comorbid conditions that impact comfort and resource use. The current study describes variations in the trajectories of new physical problems emerging over 8 weeks and the predictive value for future health and behavior in a sample of 72 residents with dementia. Residents had two to 37 new physical problems occurring over 8 weeks. Sixty-five percent of the sample had five or more new problems and were identified by three unstable trajectories. Common problems, illnesses, and symptoms accounted for 28.2% of the variance in subsequent new physical problems (p < 0.001) and 25.7% of the variance in subsequent agitation (p < 0.001). This study found more new problems than earlier studies that only examined new acute illness. Findings suggest a higher intensity of need for skilled assessment and treatment than may be available in many long-term care organizations. [Journal of Gerontological Nursing, xx(x), xx-xx.].

Sociotechnical probabilistic risk modeling to predict injurious falls in community living centers

The goal of this study was to apply sociotechnical probabilistic risk assessment to prioritize risks and prevention strategies for serious injurious falls of residents in nursing homes. Risk modeling teams consisted of 26 clinical and nonclinical staff from three Department of Veterans Affairs community living centers and one state Veteran's nursing home. Participants met in groups several times to identify and assign probabilities to provider and resident at-risk behaviors and equipment failures. They identified prevention strategies for the failures that accounted for the highest levels of risk. Six scenarios were modeled: (1) transferring from bed to wheelchair, (2) propelling from bedside to bathroom, (3) transferring from wheelchair to toilet, (4) transferring from toilet to wheelchair, (5) propelling from bathroom to bedside, and (6) transferring from wheelchair to bed. The greatest paths of risk were for residents with impaired mobility and high fragility. A 26% reduction in injurious falls could be achieved by (1) reducing the number of unassisted transfers through a modest improvement in response time to alarms, (2) installing automatic brake locks on 90% of wheelchairs, (3) making the wheelchair maintenance process highly reliable, and (4) decreasing improper transfer techniques by 10%.