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Migliorini F, Giorgino R, Hildebrand F, Spiezia F, Peretti GM, Alessandri-Bonetti M, Eschweiler J, Maffulli N. Fragility Fractures: Risk Factors and Management in the Elderly. MEDICINA-LITHUANIA 2021; 57:medicina57101119. [PMID: 34684156 PMCID: PMC8538459 DOI: 10.3390/medicina57101119] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 02/08/2023]
Abstract
Given the progressive ageing of Western populations, the fragility fractures market has a growing socioeconomic impact. Fragility fractures are common in the elderly, negatively impacting their quality of life, limiting autonomy, increasing disability, and decreasing life expectancy. Different causes contribute to the development of a fractures in frail individuals. Among all, targeting fragile patients before the development of a fracture may represent the greatest challenge, and current diagnostic tools suffer from limitations. This study summarizes the current evidence on the management of fragility fractures, discussing risk factors, prevention, diagnosis, and actual limitations of the clinical therapeutic options, putting forward new ideas for further scientific investigation.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University, 52074 Aachen, Germany; (F.M.); (F.H.); (J.E.)
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, 20122 Milan, Italy;
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University, 52074 Aachen, Germany; (F.M.); (F.H.); (J.E.)
| | - Filippo Spiezia
- Department of Orthopaedic and Trauma Surgery, Ospedale San Carlo Potenza, Via Potito Petrone, 85100 Potenza, Italy;
| | - Giuseppe Maria Peretti
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy;
- IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
| | | | - Jörg Eschweiler
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University, 52074 Aachen, Germany; (F.M.); (F.H.); (J.E.)
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke-on-Trent ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London E1 4DG, UK
- Correspondence:
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Fear of Falling, Recurrence of Falls, and Quality of Life in Patients with a Low Energy Fracture-Part II of an Observational Study. ACTA ACUST UNITED AC 2021; 57:medicina57060584. [PMID: 34200303 PMCID: PMC8226509 DOI: 10.3390/medicina57060584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/17/2022]
Abstract
Background and objective: Falls in elderly cause injury, mortality, and loss of independence, making Fear of Falling (FoF) a common health problem. FoF relates to activity restriction and increased fall risk. A voluntary intervention including fall risk assessment and prevention strategies was implemented to reduce falls in elderly patients with low energy fractures (LEF). The primary purpose of this study was to evaluate FoF and the number of subsequent falls in trauma patients one year after a LEF. The secondary aim was to examine how FoF affects patients' lives in terms of Quality of Life (QoL), mobility, and activity levels. Finally, participation in the voluntary fall prevention program (FPP) was evaluated. Materials and Methods: Observational cohort study in one Swiss trauma center. LEF patients, treated between 2012 and 2015, were analyzed one year after injury. Primary outcomes were Falls-Efficacy Score-International (FES-I) and number of subsequent falls. Secondary outcomes were EuroQoL-5-Dimensions-3-Levels (EQ5D-3L), mobility, activity levels, and participation in the FPP. Subgroup analysis was performed for different age categories. Results: 411 patients were included for analysis. Mean age was 72 ± 9.3, mean FES-I was 21.1 ± 7.7. Forty percent experienced FoF. A significant negative correlation between FoF and QoL (R = 0.64; p < 0.001) was found. High FoF correlated with lower activity levels (R= -0.288; p < 0.001). Six percent visited the FPP. Conclusions: At follow-up, 40% suffered from FoF which seems to negatively affect patients' QoL. Nevertheless, participation in the FPP was low. Simply informing patients about their susceptibility to falls and recommending participation in FPPs seems insufficient to motivate and recruit patients into FPPs. We suggest implementing repeated fall risk- and FoF screenings as standard procedures in the follow-up of LEF, especially in patients aged over 75 years.
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Rasche P, Nitsch V, Rentemeister L, Coburn M, Buecking B, Bliemel C, Bollheimer LC, Pape HC, Knobe M. The Aachen Falls Prevention Scale: Multi-Study Evaluation and Comparison. JMIR Aging 2019; 2:e12114. [PMID: 31518273 PMCID: PMC6715018 DOI: 10.2196/12114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/16/2018] [Accepted: 01/23/2019] [Indexed: 01/13/2023] Open
Abstract
Background Fall risk assessment is a time-consuming and resource-intensive activity. Patient-driven self-assessment as a preventive measure might be a solution to reduce the number of patients undergoing a full clinical fall risk assessment. Objective The aim of this study was (1) to analyze test accuracy of the Aachen Falls Prevention Scale (AFPS) and (2) to compare these results with established fall risk assessment measures identified by a review of systematic reviews. Methods Sensitivity, specificity, and receiver operating curves (ROC) of the AFPS were calculated based on data retrieved from 2 independent studies using the AFPS. Comparison with established fall risk assessment measures was made by conducting a review of systematic reviews and corresponding meta-analysis. Electronic databases PubMed, Web of Science, and EMBASE were searched for systematic reviews and meta-analyses that reviewed fall risk assessment measures between the years 2000 and 2018. The review of systematic reviews was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was used to assess the methodological quality of reviews. Sensitivity, specificity, and ROC were extracted from each review and compared with the calculated values of the AFPS. Results Sensitivity, specificity, and ROC of the AFPS were evaluated based on 2 studies including a total of 259 older adults. Regarding the primary outcome of the AFPS subjective risk of falling, pooled sensitivity is 57.0% (95% CI 0.467-0.669) and specificity is 76.7% (95% CI 0.694-0.831). If 1 out of the 3 subscales of the AFPS is used to predict a fall risk, pooled sensitivity could be increased up to 90.0% (95% CI 0.824-0.951), whereas mean specificity thereby decreases to 50.0% (95% CI 0.42-0.58). A systematic review for fall risk assessment measures produced 1478 articles during the study period, with 771 coming from PubMed, 530 from Web of Science, and 177 from EMBASE. After eliminating doublets and assessing full text, 8 reviews met the inclusion criteria. All were of sufficient methodological quality (R-AMSTAR score ≥22). A total number of 9 functional or multifactorial fall risk assessment measures were extracted from identified reviews, including Timed Up and Go test, Berg Balance Scale, Performance-Oriented Mobility Assessment, St Thomas’s Risk Assessment Tool in Falling Elderly, and Hendrich II Fall Risk Model. Comparison of these measures with pooled sensitivity and specificity of the AFPS revealed a sufficient quality of the AFPS in terms of a patient-driven self-assessment tool. Conclusions It could be shown that the AFPS reaches a test accuracy comparable with that of the established methods in this initial investigation. However, it offers the advantage that the users can perform the self-assessment independently at home without involving trained health care professionals.
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Affiliation(s)
- Peter Rasche
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Verena Nitsch
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Lars Rentemeister
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Mark Coburn
- Klinik für Anästhesiologie, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Benjamin Buecking
- Center for Orthopaedics and Trauma Surgery, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Christopher Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Leo Cornelius Bollheimer
- Department of Geriatrics, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Orthopaedic Trauma, University of Zurich Medical Center, University of Zurich, Zurich, Switzerland
| | - Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
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Rasche P, Mertens A, Brandl C, Liu S, Buecking B, Bliemel C, Horst K, Weber CD, Lichte P, Knobe M. Satisfying Product Features of a Fall Prevention Smartphone App and Potential Users' Willingness to Pay: Web-Based Survey Among Older Adults. JMIR Mhealth Uhealth 2018; 6:e75. [PMID: 29588268 PMCID: PMC5893889 DOI: 10.2196/mhealth.9467] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/16/2018] [Accepted: 02/23/2018] [Indexed: 01/15/2023] Open
Abstract
Background Prohibiting falls and fall-related injuries is a major challenge for health care systems worldwide, as a substantial proportion of falls occur in older adults who are previously known to be either frail or at high risk for falls. Hence, preventive measures are needed to educate and minimize the risk for falls rather than just minimize older adults’ fall risk. Health apps have the potential to address this problem, as they enable users to self-assess their individual fall risk. Objective The objective of this study was to identify product features of a fall prevention smartphone app, which increase or decrease users’ satisfaction. In addition, willingness to pay (WTP) was assessed to explore how much revenue such an app could generate. Methods A total of 96 participants completed an open self-selected Web-based survey. Participants answered various questions regarding health status, subjective and objective fall risk, and technical readiness. Seventeen predefined product features of a fall prevention smartphone app were evaluated twice: first, according to a functional (product feature is implemented in the app), and subsequently by a dysfunctional (product feature is not implemented in the app) question. On the basis of the combination of answers from these 2 questions, the product feature was assigned to a certain category (must-be, attractive, one-dimensional, indifferent, or questionable product feature). This method is widely used in user-oriented product development and captures users’ expectations of a product and how their satisfaction is influenced by the availability of individual product features. Results Five product features were identified to increase users’ acceptance, including (1) a checklist of typical tripping hazards, (2) an emergency guideline in case of a fall, (3) description of exercises and integrated workout plans that decrease the risk of falling, (4) inclusion of a continuous workout program, and (5) cost coverage by health insurer. Participants’ WTP was assessed after all 17 product features were rated and revealed a median monthly payment WTP rate of €5.00 (interquartile range 10.00). Conclusions The results show various motivating product features that should be incorporated into a fall prevention smartphone app. Results reveal aspects that fall prevention and intervention designers should keep in mind to encourage individuals to start joining their program and facilitate long-term user engagement, resulting in a greater interest in fall risk prevention.
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Affiliation(s)
- Peter Rasche
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Alexander Mertens
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Christopher Brandl
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Shan Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Benjamin Buecking
- Hand and Reconstructive Surgery, Department of Trauma, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Christopher Bliemel
- Hand and Reconstructive Surgery, Department of Trauma, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Klemens Horst
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Christian David Weber
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Philipp Lichte
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
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