Predictors of falls in elderly people during rehabilitation after hip fracture--who is at risk of a second one?

The usability of rollators as part of the human-centred quality of mobility devices: a systematic narrative literature review

Purpose: The aim of this literature review was to identify and summarize aspects of the usability of rollators from the currently available research literature. Further objectives were the exploration of rollator requirements and the search for possible disciplinary differences in the consideration or elaboration of usability aspects.

Materials and Methods: Following the PRISMA guidelines, the databases CINAHL, Pubmed and Academic Search Elite were examined in the period from April - May 2023. For the synthesis of the quantitative and qualitative data and the identification of prominent themes in this work, a theory driven thematic analysis approach was used.

Results: A total of 45 publications were included (25 quantitative, 14 mixed methods, 6 qualitative) from various disciplines, the majority belonging to physiotherapy 42%, followed by engineering 16% and health sciences 16%. Aspects of usability were extracted using a deductive code catalogue based on QUEST 2.0. The categories "easy to use" (28/126), "comfort" (20/126), and "safety" (14/126) were most frequently assigned. While "repairs & servicing" (5/126), "service delivery" (4/126), and "durability" (3/126) were coded least frequently.

Conclusion: So far, no specific publications on the usability of rollators has been published, which made it necessary to summarize individual usability aspects using a deductive code catalogue. The results obtained, therefore, do not allow any generalized statement about the usability of rollators. However, this initiates discussions about the usability of rollators that should be studied in the future in a participatory and user-centred manner and, placing satisfaction more in the focus of usability engineering and evaluation of rollators.

Imminent fall risk after fracture

RATIONALE

Adults with a recent fracture have a high imminent risk of a subsequent fracture. We hypothesise that, like subsequent fracture risk, fall risk is also highest immediately after a fracture. This study aims to assess if fall risk is time-dependent in subjects with a recent fracture compared to subjects without a fracture.

METHODS

This retrospective matched cohort study used data from the UK Clinical Practice Research Datalink GOLD. All subjects ≥50 years with a fracture between 1993 and 2015 were identified and matched one-to-one to fracture-free controls based on year of birth, sex and practice. The cumulative incidence and relative risk (RR) of a first fall was calculated at various time intervals, with mortality as competing risk. Subsequently, analyses were stratified according to age, sex and type of index fracture.

RESULTS

A total of 624,460 subjects were included; 312,230 subjects with an index fracture, matched to 312,230 fracture-free controls (71% females, mean age 70 ± 12, mean follow-up 6.5 ± 5 years). The RR of falls was highest in the first year after fracture compared to fracture-free controls; males had a 3-fold and females a 2-fold higher risk. This imminent fall risk was present in all age and fracture types and declined over time. A concurrent imminent fracture and mortality risk were confirmed.

CONCLUSION/DISCUSSION

This study demonstrates an imminent fall risk in the first years after a fracture in all age and fracture types. This underlines the need for early fall risk assessment and prevention strategies in 50+ adults with a recent fracture.

Clinical Outcomes of Total Hip Arthroplasty With the Anterolateral Modified Watson-Jones Approach for Displaced Femoral Neck Fractures

Objective

In recent years, many studies have reported good results with total hip arthroplasty (THA) for displaced femoral neck fractures (FNFs). However, no study has reported the clinical outcomes of the anterolateral modified Watson–Jones THA (MWJ-THA) for displaced FNFs. This study aimed to investigate the clinical results of THA for displaced FNFs at our hospital and to discuss the advantages of MWJ-THA over THA with other approaches for displaced FNFs.

Methods

Forty-three patients who underwent MWJ-THA for displaced FNFs were included in this study. Patient characteristics, preinjury walking ability, activities of daily living, implants used, walking ability (at 1, 3, and 6 months after surgery), cup placement angle, clinical hip score, surgical complications, revision surgery, and death within 1 year after surgery were investigated.

Results

The mean age of the 43 patients was 63.3 years, and the mean body mass index (kg/m²) was 21.1. Regarding the heads used, 28-mm heads were used in 4 patients, 32-mm heads were used in 32 patients, and 36-mm heads were used in 7 patients. The cups were placed in the Lewinnek safety zone (93.0%). Four patients had stem sinkage of a few millimeters. 6 months postoperatively, 38 patients walked unaided, and 4 patients walked with a cane. The Harris Hip Score averaged over 90 points at all time points. No postoperative dislocation was observed. Two patients died within 1 year postoperatively.

Conclusion

In this study, MWJ-THA was performed for displaced FNFs and resulted in no postoperative dislocations. Furthermore, more than 90% of the patients regained their preinjury walking ability at 6 months postoperatively. MWJ-THA has great dislocation control and is effective in treating displaced FNFs.

Characteristics of falls occurring during rehabilitation in an acute care hospital in older and non-older patients: A retrospective cohort study

Introduction

Although falls are often reported in hospitals and are common in older individuals, no reports on falls during rehabilitation exist. This study evaluated patients with falls occurring during rehabilitation and identified the characteristics of older and non-older patients.

Materials and methods

Our study retrospectively analyzed reports of falls occurring during rehabilitation at a university hospital from April 1, 2020 to March 31, 2022. The survey items included the number of falls in the hospital as a whole and during rehabilitation, age, gender, modified Rankin Scale (mRS) before admission and at the time of fall, functional independence measure (FIM) at admission, patient communication status at the time of fall, and whether a therapist was near the patient. Patients aged ≥ 65 were considered older; aged ≤ 64, non-older; and those with the same age, gender, and clinical department, randomly selected as non-falling patients.

Results

Thirty-five falls occurred during rehabilitation (14 in the non-older and 21 in the older patients), significantly lower than the 945 for the entire hospital, without any significant difference between non-older and older patients. No significant differences in mRS before admission and FIM at admission were noted for both groups in comparison with the non-falling patient group. Furthermore, gender, mRS, FIM, good communication status, and presence of therapist near the patient were similar between non-older and older patients (non-older 71.4%, older 52.4%). Most falls were minor adverse events that did not require additional treatment.

Conclusion

The rate of falls during rehabilitation was much lower than that during hospitalization, and many falls had minimal impact on the patient. It was also difficult to predict falls in daily life and communication situations, and there was no difference in characteristics between the older and non-older groups. Since more than half of the falls occurred during training with the therapist, it is necessary to reconsider the training content.

Uncemented femoral stem design might have an impact on postoperative periprosthetic femur fracture pattern. A Comparison between flat-wedge and dual-wedge stems

INTRODUCTION

Type I, flat-wedge and type II, dual-wedge stems are currently two common stem types used in primary, uncemented hip arthroplasty. The prevalence of periprosthetic femur fracture is higher in type I stems, possibly because of the different shapes and areas of bone contact. We aimed to compare the fracture pattern, stem stability during the fracture and type of subsequent procedures in periprosthetic femur fractures between type I and II stems.

MATERIALS AND METHODS

This was a retrospective, cross-sectional study conducted in a single tertiary referral hospital of Taipei, Taiwan. We included primary hip arthroplasty procedures using type I or type II stems complicated with postoperative periprosthetic femur fractures. We recorded the age, sex, ASA grade, index procedure, institution of where the index procedure was performed, trauma mechanism, time from index procedure to fracture, procedure for periprosthetic fracture and radiographic parameters including Dorr type, Vancouver classification, stem stability, fracture pattern, type and brand of the stems for analysis.

RESULTS

We included 132 patients who had undergone surgery for periprosthetic femur fracture for type I (N = 46) or type II (N = 86) stems. The mean age was 74.5 years and 52.3% of the patients were female. Type I stems were associated with a higher proportion of a complex fracture pattern (52.2% vs. 8.2%), femoral stem loosening (78.2% vs. 60.4%) and a higher rate of revision stem procedures (69.6% vs. 50.0%) compared with type II stems. Using multivariate analysis, type I stem was the only factor for a complex fracture pattern in the overall population (aOR: 23.60, 95% CI: 6.54-85.16), hemiarthroplasty (aOR: 160.50, 95% CI: 9.77-2635.95) and total hip arthroplasty (aOR: 14.17, 95% CI: 2.92-68.79) subgroups.

CONCLUSION

We observed a difference in fracture patterns between type I and type II stems. Type I stems appear to be an independent risk factor for a complex fracture pattern in patients who had undergone primary hip arthroplasty.

Unplanned Clinic Attendance, Readmission, and Reoperation in the First 12 Months Postoperatively Following Hip Hemiarthroplasty for Acute Hip Fractures: Who Is At Risk?

Introduction Up to 19% of patients who undergo surgery for an acute hip fracture are readmitted to the hospital within three months of the index operation. We aimed to identify risk factors for unplanned clinic attendance, readmission, and mortality within the first 12 months postoperatively and subsequently determine if there is a role for routine follow-up. Method Patients greater than 65 years old who underwent hip hemiarthroplasty using an uncemented Thompson implant for treatment of a traumatic non-pathological hip fracture were identified from a prospectively maintained database at a single institution between August 2007 and February 2011. Patient demographics, comorbidities, place of residence, mobility status, unplanned attendance to an orthopaedic clinic with symptoms relating to the respective limb, readmission, and mortality were recorded. Regression analysis was performed using the IBM Statistical Package for Social Sciences (SPSS), version 24 (IBM SPSS Statistics, Armonk, NY) with P < 0.05 considered significant. Results Five hundred and fifty-four consecutive patients were identified. Unplanned clinic attendance was correlated to age (p = 0.000, B = -0.0159, 95% confidence interval (CI): -0.200 to -0.65), with patients between the ages of 65 - 70 years most likely to require unplanned clinic review postoperatively. The American Society of Anesthesiologists (ASA) grade (p = 0.019, 95% CI: 0.014 to 0.163) and frequency of unplanned outpatient attendance (p = 0.000, 95% CI: 0.120 to 0.284) were significantly associated with increased readmission within 12 months of the index procedure with patients who were regarded as ASA > 2 most likely to require readmission within the first postoperative year. Conclusion To our knowledge, this is the first piece of research that identifies causative factors for unplanned clinic attendance and acute readmission during the first postoperative year in acute hip fracture patients treated by hemiarthroplasty. Routine scheduled follow-up of patients based on risk stratification may be effective in reducing the financial burden of unplanned clinic attendance.

Predictors of Incidence of Fall in Elderly Women; A Six-Month Cohort Study

Objective:

To determine the incidence and predictive factors of the falls in elderly women in Northern Iran.

Methods:

A total of 717 elderly women aged 60 years and above in Amirkola, Northern of Iran participated in this study. Age, history of falls during the 12 months leading to the study, accompanying diseases, status of balance, cognitive status, orthostatic hypotension, state of depressive symptoms, strength of quadriceps muscles and serum vitamin D level were assessed as independent variables during baseline measurement. Incidence of fall (dependent variable) was recorded during a six-month follow-up period.

Results:

Of the participants, 7.8% had experience of fall, out of which 50.0% experienced it once, 25.0% twice, and the rest three times or more. With aging, the incidence of orthostatic hypotension also increased and symptomatic depression became aggravated. In the final model, the variables of the number of accompanying diseases (RR=1.78, 95% CI: 1.00-3.18), severe cognitive impairment (RR=12.70, 95% CI: 3.05-52.86), and depressive symptoms (RR=3.19, 95% CI: 1.48-6.86) remained as strong associated variables for incidence of fall.

Conclusion:

With increasing severity of depressive symptoms and cognitive impairment along with the comorbidities, incidence of fall also increases in the elderly. Thus, psychological aspects of the elderly and comorbidities in this group should be taken care of seriously.

Review of perioperative falls

Falls are a known public health problem, and there is increasing recognition of the importance of perioperative falls for risk prediction and quality assessment. Our objective was to review existing literature regarding the occurrence, injuries, and risk factors of preoperative and postoperative falls. A systematized search of PubMed entries between 1947 and November 2015 produced 24 articles that met inclusion criteria. Most studied orthopaedic surgery patients older than 65 yr. Four were rated 'good' quality. Interrater reliability for the quality assessment was moderate (κ = 0.77). In the 3-12 months before surgery, the proportion of preoperative patients who fell ranged from 24 to 48%. Injuries were common (70%). The rate of postoperative falls ranged from 0.8 to 16.3 per 1000 person-days, with a gradual decline in the months after surgery. Injuries from postoperative falls occurred in 10-70% of fallers, and 5-20% experienced a severe injury. Risk factors were not well studied. Prospective studies reported a higher percentage of falls and fall-related injuries than retrospective studies, suggesting that there may be underdetection of falls and injuries with retrospective studies. Perioperative falls were more common than falls reported in the general community, even up to 12 months after surgery. Surgery-related falls may therefore occur beyond the hospitalization period. Future studies should use a prospective design, validated definitions, and broader populations to study perioperative falls. In particular, investigations of risk factors and follow-up after hospitalization are needed.

REGISTRY NUMBER

PROSPERO registration number CRD42015029971.

[Physical medical aspects of early rehabilitation after proximal femoral fractures]

Proximal femoral fractures in old age are known as fragility fractures. They are the sequelae of osteoporosis and an expression of a general reduced capacity and an increase in sensory and functional deficits against the background of multimorbidity. They are often caused by reduced compensation strategies. Simultaneously, for many older people they represent a life event. Despite modern osteosynthesis techniques and less stressful anesthesia procedures, the occurrence of a proximal femoral fracture shakes the labile equilibrium of those affected. Proximal femoral fractures are associated with a high risk of mortality. Only some 50% of those affected achieve the pretraumatic functional level again. Therefore, a comprehensive, multiprofessional and interdisciplinary management of these patients is required. The rehabilitation has to start at the time of diagnosis and at the latest after the operation with a comprehensive interdisciplinary management. Pain and complaints during the rehabilitation have to be clarified and targeted, mostly multimodal interventions, must be included.

Risk factors for post-operative periprosthetic fractures following primary total hip arthroplasty with a proximally coated double-tapered cementless femoral component

AIMS

The aim of this study was to identify patient- and surgery-related risk factors for sustaining an early periprosthetic fracture following primary total hip arthroplasty (THA) performed using a double-tapered cementless femoral component (Bi-Metric femoral stem; Biomet Inc., Warsaw, Indiana).

PATIENTS AND METHODS

A total of 1598 consecutive hips, in 1441 patients receiving primary THA between January 2010 and June 2015, were retrospectively identified. Level of pre-operative osteoarthritis, femoral Dorr type and cortical index were recorded. Varus/valgus placement of the stem and canal fill ratio were recorded post-operatively. Periprosthetic fractures were identified and classified according to the Vancouver classification. Regression analysis was performed to identify risk factors for early periprosthetic fracture.

RESULTS

The mean follow-up was 713 days (1 to 2058). A total of 48 periprosthetic fractures (3.0%) were identified during the follow-up and median time until fracture was 16 days, (interquartile range 10 to 31.5). Patients with femoral Dorr type C had a 5.2 times increased risk of post-operative periprosthetic fracture compared with type B, while female patients had a near significant two times increased risk over time for post-operative fracture.

CONCLUSION

Dorr type C is an independent risk factor for early periprosthetic fracture, following THA using a double tapered cementless stem such as the Bi-Metric. Surgeons should take bone morphology into consideration when planning for primary THA and consider using cemented femoral components in female patients with poor bone quality. Cite this article: Bone Joint J 2017;99-B:451-7.

Postoperative prevention of falls in older adults with fragility fractures

The postoperative period after correction of a fragility fracture is usually associated with functional deconditioning. This deconditioning is caused by multiple factors associated with a higher risk of falls during the immediate postoperative period and after discharge. Identification of risk and appropriate fall prevention interventions in these patients are pivotal. In this article, an overview is presented of the strategies to identify falls risk in postoperative patients after suffering a fragility fracture. Evidence is presented favoring targeted multicomponent intervention for falls prevention rather than a single intervention in fractured older patients at high risk of new falls and fractures.

Efeitos do exercício na redução do risco de quedas em mulheres idosas com osteoporose

OBJETIVO: Avaliar o efeito de um programa de treinamento de força muscular progressiva e sensório-motor, no equilíbrio e na redução do risco de quedas em mulheres com osteoporose. MÉTODO: Foram selecionadas 82 mulheres sedentárias com idade entre 60 e 75 anos com osteoporose, randomizadas em dois grupos: grupo intervenção, composto por 41 pacientes submetidas a 18 semanas de treinamento de força muscular progressiva do quadríceps (a 50%, 60%, 70% até 80% de 1-RM - uma repetição máxima), e de propriocepção, associado ao tratamento clínico medicamentoso para osteoporose; e grupo controle, também composto por 41 pacientes que receberam apenas o tratamento clínico medicamentoso. O equilíbrio e o risco de quedas foram avaliados por meio da Escala de Equilíbrio de Berg (BBS) e do cálculo do Índice de Quedas (IQ). O número de quedas foi avaliado seis meses antes do início da pesquisa e nos seis meses seguintes. RESULTADOS: 69 pacientes concluíram a pesquisa. O programa promoveu melhora no equilíbrio funcional (p<0,001) demonstrado pela BBS, redução do risco de quedas calculado pelo escore geral do IQ (p<0,004) e ainda uma redução do número total de quedas, que no grupo experimental foram significativamente menores que no grupo controle (p<0,001). CONCLUSÃO: A associação do treinamento de força progressiva para quadríceps e propriocepção é eficaz na prevenção de quedas e redução de seus fatores de risco, e o modelo para previsão quantitativa do risco de quedas pode ser útil na identificação do risco de quedas em pessoas idosas. Registro ensaio clínico: 082213- ANZCTR.

Risk factors for falls in older people in nursing homes and hospitals. A systematic review and meta-analysis

This is a systematic review and meta-analysis aimed at providing a comprehensive and quantitative review of risk factors for falls in older people in nursing homes and hospitals. Using MEDLINE, we searched for prospective studies investigating risk factors for falls in nursing home residents (NHR) and older hospital inpatients (HI). When there were at least 3 studies investigating a factor in a comparable way in a specific setting, we computed the pooled odds ratio (OR) using random effect models. Twenty-four studies met the inclusion criteria. Eighteen risk factors for NHR and six for HI were considered, including socio-demographic, mobility, sensory, medical factors, and medication use. For NHR, the strongest associations were with history of falls (OR=3.06), walking aid use (OR=2.08) and moderate disability (OR=2.08). For HI, the strongest association was found for history of falls (OR=2.85). No association emerged with age in NHR (OR=1.00), while the OR for a 5years increase in age of HI was 1.04. Female sex was, if anything, associated with a decreased risk. A few other medical conditions and medications were also associated with a moderately increased risk. For some important factors (e.g. balance and muscle weakness), a summary estimate was not computed because the measures used in various studies were not comparable. Falls in older people in nursing homes and hospitals have multifactorial etiology. History of falls, use of walking aids and disability are strong predictors of future falls.

"The balancing act"--licensed practical nurse experiences of falls and fall prevention: a qualitative study

BACKGROUND

Falls are common in old age and may have serious consequences. There are many strategies to predict and prevent falls from occurring in long-term care and hospitals. The aim of this study was to describe licensed practical nurse experiences of predicting and preventing further falls when working with patients who had experienced a fall-related fracture. Licensed practical nurses are the main caretakers that work most closely with the patients.

METHODS

A qualitative study of focus groups interviews and field observations was done. 15 licensed practical nurses from a rehabilitation ward and an acute ward in a hospital in northern Sweden were interviewed. Content was analyzed using qualitative content analysis.

RESULTS

The result of the licensed practical nurse thoughts and experiences about risk of falling and fall prevention work is represented in one theme, "the balancing act". The theme includes three categories: "the right to decide", "the constant watch", and "the ongoing negotiation" as well as nine subcategories. The analysis showed similarities and differences between rehabilitation and acute wards. At both wards it was a core strategy in the licensed practical nurse work to always be ready and to pay attention to patients' appearance and behavior. At the rehabilitation ward, it was an explicit working task to judge the patients' risk of falling and to be active to prevent falls. At the acute ward, the words "risk of falling" were not used and fall prevention were not discussed; instead the licensed practical nurses used for example "dizzy and pale". The results also indicated differences in components that facilitate workplace learning and knowledge transfer.

CONCLUSIONS

Differences between the wards are most probably rooted in organizational differences. When it is expected by the leadership, licensed practical nurses can express patient risk of falling, share their observations with others, and take actions to prevent falls. The climate and the structure of the ward are essential if licensed practical nurses are to be encouraged to routinely consider risk of falling and implement risk reduction strategies.

Post-discharge management following hip fracture--get you back to B4: a parallel group, randomized controlled trial study protocol

Background

Fall-related hip fractures result in significant personal and societal consequences; importantly, up to half of older adults with hip fracture never regain their previous level of mobility. Strategies of follow-up care for older adults after fracture have improved investigation for osteoporosis; but managing bone health alone is not enough. Prevention of fractures requires management of both bone health and falls risk factors (including the contributing role of cognition, balance and continence) to improve outcomes.

Methods/Design

This is a parallel group, pragmatic randomized controlled trial to test the effectiveness of a post-fracture clinic compared with usual care on mobility for older adults following their hospitalization for hip fracture. Participants randomized to the intervention will attend a fracture follow-up clinic where a geriatrician and physiotherapist will assess and manage their mobility and other health issues. Depending on needs identified at the clinical assessment, participants may receive individualized and group-based outpatient physiotherapy, and a home exercise program. Our primary objective is to assess the effectiveness of a novel post-discharge fracture management strategy on the mobility of older adults after hip fracture.

We will enrol 130 older adults (65 years+) who have sustained a hip fracture in the previous three months, and were admitted to hospital from home and are expected to be discharged home. We will exclude older adults who prior to the fracture were: unable to walk 10 meters; diagnosed with dementia and/or significant comorbidities that would preclude their participation in the clinical service.

Eligible participants will be randomly assigned to the Intervention or Usual Care groups by remote allocation. Treatment allocation will be concealed; investigators, measurement team and primary data analysts will be blinded to group allocation. Our primary outcome is mobility, operationalized as the Short Physical Performance Battery at 12 months. Secondary outcomes include frailty, rehospitalizations, falls risk factors, quality of life, as well as physical activity and sedentary behaviour. We will conduct an economic evaluation to determine health related costs in the first year, and a process evaluation to ascertain the acceptance of the program by older adults, as well as clinicians and staff within the clinic.

Trial registration number

ClinicalTrials.gov: NCT01254942

Hip fracture management for the hospital-based clinician: a review of the evidence and best practices

Hip fracture is an unfortunate and common health problem in the elderly that is associated with a 1-year mortality of 10% to 35%. Further, only 50% of these patients regain their pre-fracture level of mobility and functional status. Hospital-based clinicians are increasingly asked to comanage these patients. The purpose of this article is to summarize evidence-based clinical management practices that are relevant to hospitalist clinicians who manage hip fracture patients, and to highlight the current evidence for implementing a formal hospitalist and orthopedic comanagement care model.

Development of a urinary incontinence educational program using a competency-based approach and case method

Nurses have limited knowledge about urinary incontinence and find it difficult to care for those who suffer from it, yet there is little training on incontinence designed for nurses. Hence, there is a real need to develop and evaluate an appropriate urinary incontinence educational program. A critical issue is the choice of teaching strategies designed to integrate learning. This article describes the competency-based approach and case method used to develop a urinary incontinence education program.

Evaluation of a fall-prevention program in older people after femoral neck fracture: a one-year follow-up

A randomized, controlled fall-prevention study including 199 patients operated on for femoral neck fracture reduced inpatient falls and injuries. No statistically significant effects of the intervention program could be detected after discharge. It seems that fall-prevention must be part of everyday life in fall-prone old people.

INTRODUCTION

This study evaluates whether a postoperative multidisciplinary, multifactorial fall-prevention program performed by a geriatric team that reduced inpatient falls and injuries had any continuing effect after discharge. The intervention consisted of staff education, systematic assessment and treatment of fall risk factors and vitamin D and calcium supplementation.

METHODS

The randomized, controlled trial with a one-year follow-up at Umeå University Hospital, Sweden, included 199 patients operated on for femoral neck fracture, aged > or = 70 years.

RESULTS

After one year 44 participants had fallen 138 times in the intervention group compared with 55 participants and 191 falls in the control group. The crude postoperative fall incidence was 4.16/1,000 days in the intervention group vs. 6.43/1,000 days in the control group. The incidence rate ratio was 0.64 (95% CI: 0.40-1.02, p = 0.063). Seven new fractures occurred in the intervention group and 11 in the control group.

CONCLUSION

A team applying comprehensive geriatric assessment and rehabilitation, including prevention and treatment of fall-risk factors, reduced inpatient falls and injuries, but no statistically significant effects of the program could be detected after discharge. It seems that fall-prevention must be part of everyday life in fall-prone elderly.

Leg extension power deficit and mobility limitation in women recovering from hip fracture

OBJECTIVE

After hip fracture, muscle strength and power remain persistently poor, especially in the fractured leg. This study explores whether asymmetrical leg extension power (LEP) deficit affects mobility in women after proximal femoral fracture (PFF).

DESIGN

In this observational study, LEP of both legs, 10- and 50-foot walking speed, and stair-climbing speed were measured in 43 women, aged 73-96, at 1 and 13 wks after surgical repair of PFF. Asymmetrical LEP deficit was calculated as (fractured/(sum both legs)) x 100%.

RESULTS

Between weeks 1 and 13 after PFF surgery, LEP increased in the fractured and nonfractured legs by 100% and 30%, respectively. Asymmetrical deficit was reduced from 28.5 +/- 10.2% to 40.4 +/- 8.6%. Linear regression analyses showed that poorer LEP of the nonfractured leg at week 1 correlated significantly with slower walking (beta > 0.525, P < 0.001) and stair-climbing speed (beta > 0.349, P < 0.016) and predicted poorer mobility 12 wks later (beta > 0.354, P < 0.020). Large asymmetrical LEP deficit was cross-sectionally associated with slow stair-climbing speed (beta > 0.343, P < 0.018) at weeks 1 and 13, but not with walking speed.

CONCLUSIONS

Higher LEP of the nonfractured leg predicted better recovery of mobility after PFF. Larger asymmetrical LEP deficit correlated with limitation in climbing stairs-a more challenging mobility task where fluent performance requires unilateral force production.

Risk of falling in patients with a recent fracture

BACKGROUND

Patients with a history of a fracture have an increased risk for future fractures, even in short term. The aim of this study was to assess the number of patients with falls and to identify fall risk factors that predict the risk of falling in the first three months after a clinical fracture.

METHODS

Prospective observational study with 3 months of follow-up in a large European academic and regional hospital. In 277 consenting women and men aged > or = 50 years and with no dementia and not receiving treatment for osteoporosis who presented to hospital with a clinical fracture, fall risk factors were assessed according to the guidelines on fall prevention in the Netherlands. Follow-up information on falls and fractures was collected by monthly telephone interview. Incidence of falls and odds ratio's (OR, with 95% confidence intervals) were calculated.

RESULTS

512 consecutive patients with a fracture were regarded for analysis, 87 were not eligible for inclusion and 137 patients were excluded. No follow-up data were available for 11 patients. Therefore full analysis was possible in 277 patients.A new fall incident was reported by 42 patients (15%), of whom five had a fracture. Of the 42 fallers, 32 had one new fall and 10 had two or more. Multivariate analysis in the total group with sex, age, ADL difficulties, urine incontinence and polypharmacy showed that sex and ADL were significant fall risk factors. Women had an OR of 3.02 (95% CI 1.13-8.06) and patients with ADL-difficulties had an OR of 2.50 (95% CI 1.27-4.93). Multivariate analysis in the female group with age, ADL difficulties, polypharmacy and presence of orthostatic hypotension indicated that polypharmacy was the predominant risk factor (OR 2.51; 95% CI: 1.19 - 5.28). The incidence of falls was 35% in women with low ADL score and polypharmacy compared to 15% in women without these risk factors (OR 3.56: CI 1.47 - 8.67).

CONCLUSION

15% of patients reported a new fall and 5 patients suffered a new fracture within 3 months. Female sex and low ADL score were the major risk factors and, in addition, polypharmacy in women.

A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture

INTRODUCTION

This study evaluates whether a postoperative multidisciplinary, intervention program, including systematic assessment and treatment of fall risk factors, active prevention, detection, and treatment of postoperative complications, could reduce inpatient falls and fall-related injuries after a femoral neck fracture.

METHODS

A randomized, controlled trial at the orthopedic and geriatric departments at Umeå University Hospital, Sweden, included 199 patients with femoral neck fracture, aged >or=70 years.

RESULTS

Twelve patients fell 18 times in the intervention group compared with 26 patients suffering 60 falls in the control group. Only one patient with dementia fell in the intervention group compared with 11 in the control group. The crude postoperative fall incidence rate was 6.29/1,000 days in the intervention group vs 16.28/1,000 days in the control group. The incidence rate ratio was 0.38 [95% confidence interval (CI): 0.20 - 0.76, p=0.006] for the total sample and 0.07 (95% CI: 0.01-0.57, p=0.013) among patients with dementia. There were no new fractures in the intervention group but four in the control group.

CONCLUSION

A team applying comprehensive geriatric assessment and rehabilitation, including prevention, detection, and treatment of fall risk factors, can successfully prevent inpatient falls and injuries, even in patients with dementia.

Hip fracture and its consequences: differences between men and women

This article describes the state of knowledge regarding gender differences with respect to hip fracture and its subsequent outcomes. Most of the work to date investigating hip fracture patients has been done with women, yet some evidence from a few studies with a significant number of male hip fracture patients and from nonfracture samples suggests that women and men may be different at the time of fracture and will have a different course of recovery.

Inpatient falls and injuries in older patients treated for femoral neck fracture

A prospective inpatient study was performed at the Orthopedic and Geriatric Departments at the Umeå University Hospital, Sweden, to study inpatient falls, fall-related injuries, and risk factors for falls following femoral neck fracture surgery. Ninety-seven patients with femoral neck fracture aged 70 years or older were included, background characteristics, falls, injuries, and other postoperative complications were assessed and registered during the hospitalization. There were 60 postoperative falls among 26/97 patients (27%). The postoperative fall event rate was 16.3/1000 Days (95% CI 12.2-20.4). Thirty two percent of the falls resulted in injuries, 25% minor, and 7% serious ones. In multiple regression analyses, delirium after Day 7, HRR 4.62 (95% CI 1.24-16.37), male sex 3.92 (1.58-9.73), and sleeping disturbances 3.49 (1.24-9.86), were associated with inpatient falls. Forty-five percent of the patients were delirious the day they fell. Intervention programs, including prevention and treatment of delirium and sleeping disturbances, as well as better supervision of male patients, could be possible fall prevention strategies. Improvement of the quality of care and rehabilitation, with the focus on fall prevention based on these results, should be implemented in postoperative care of older people.

Falls in outpatients with Parkinson's disease

Falls are one of the most serious complications of gait disturbances in patients with Parkinson's disease (PD). Among previous reports, the percentage of patients with PD who fall varies between 38% to 68%. We sought to determine the frequency of falls and the factors associated with falls in a group of patients with idiopathic PD who attended an outpatient, tertiary movement disorders clinic. 350 ambulatory, non-demented patients (230 males) were studied. Mean age was 69.7+/-10.6 years (range: 43-97 yrs) and mean duration of PD symptoms was 8.6+/- 6.2 years (range: 1-33 yrs). Assessments included characterization of demographics, disease duration, disease severity as measured by the Hoehn and Yahr Scale (H&Y), co-morbidities, the presence of depressive symptoms, the presence of urinary incontinence, use of anti-parkinsonian medications, and two performance-based tests of balance and gait (tandem standing and Timed Up & Go). Fall history was determined during three time periods: previous week, previous month, and previous year. Univariate and multivariate logistic regression models were applied to evaluate the relationship between the above-mentioned factors and falls. 46% of the subjects reported at least one fall in the previous year and 33% reported 2 or more falls and were classified as Fallers. Fallers had significantly more prolonged and advanced PD compared with Non-fallers (p=0.001 and p<0.001, respectively). Urinary incontinence was the factor most closely associated with falls (crude and adjusted OR were 1.95 and 5.89, respectively). Other factors significantly associated with fall status included increased Timed Up & Go times and increased PD duration. These findings confirm that falls are a common problem among patients with advanced PD and suggest easily measurable features that may be used to prospectively identify those PD patients with the greatest risk of falls.