Falls in a community of older adults: findings and implications for practice

Exploring Population Characteristics and Recruitment Challenges in Older People Experiencing Falls at Home without Hospitalization or with an Emergency Department Visit: Insights from the RISING-DOM Experience

Background

An increasing number of falls among community-living older adults are reported in emergency calls. Data on evidence of appropriate fall prevention interventions are limited and challenges in recruiting this population in randomized trials are acknowledged.

Purpose

The main aim of this study was to provide demographic data, circumstance and fall-related outcomes of the population in the RISING-DOM study [Impact d'une évaluation des facteurs de RISque de chute et d'une prise en charge personnalisée, sur la mortalité et l'institutionnalisation, après INtervention du SAMU chez la personne âGée à DOMicile], a multicenter, randomized interventional trial involving community-dwelling older adults who have experienced a fall at home and were not hospitalized. Additionally, the challenges of remote recruitment in this population were discussed.

Patients and Methods

Participants were identified through the Occitania Emergency Observatory database. Participant recruitment and data collection were performed through telephone interviews (October 2019-March 2022). Additionally, a sample survey of Emergency Medical Services calls was carried out.

Results

Out of the 1151 individuals screened, a total of 951 participants were included in the trial follow-up, resulting in an acceptance rate of 82.62%. The screening delay was extended due to the COVID-19 pandemic. Recruiting difficulties were mainly related to identifying potential participants, unavailable contact information and unreachability. Participants' mean age was 84.1 years, 65.8% were women, and 44.3% lived alone. Pain was the most frequent outcome (53%). In the previous year, 73.5% of participants reported experiencing a fall, with 66.7% of those falls requiring assistance from Emergency Medical Services (EMS). Nearly, 40% did not take proactive steps to prevent future falls and walking aids (79.8%) were the most common preventive action.

Conclusion

Indicators of a high-risk group of falls have been identified underscoring the need for appropriate fall interventions in the target population. Challenges of large sampling for randomized fall prevention trials were provided.

Trial Registration

Clinicaltrials.gov identifier: NCT04132544. Registration date: 18/10/2019. https://www.clinicaltrials.gov/ct2/show/NCT04132544?term=rising-dom&draw=2&rank=1.

Prevalence of falls, injury from falls and associations with chronic diseases among community-dwelling older adults in Guangzhou, China: a cross-sectional study

Introduction

As a developing country with the largest older adult population in the world, strengthening the research on falls among the older adults is undoubtedly an urgent item in China. This study aimed to explore the prevalence and risk factors associated with falls and injury from falls among community-dwelling older adults in Guangzhou, China, particularly focusing on their associations with chronic diseases.

Methods

A total of 1,629 participants aged 65 years and above were selected from 11 counties in Guangzhou by the multi-stage stratified random sampling method in 2021. Socio-demographic characteristics, health and lifestyle factors, the status of falls, and injury from falls were measured by structured questionnaires through face-to-face interviews. Chi-square tests and logistic regression analysis were used to identify factors associated with falls and injury from falls. Chord diagrams were used to explore their associations with chronic diseases.

Results

A total of 251 participants (15.41%, 95% CI: 13.98%-17.25%) reported falls, and 162 participants (9.46%, 95% CI:7.72%-11.55%) indicated an injury from falls. Logistic regression analysis showed the results as follows: female patients (adjusted OR = 1.721, 95% CI: 1.681-1.761) aged ≥80 years (1.910, 1.847-1.975), unemployed (1.226, 1.171-1.284), uninsured (1.555, 1.448-1.671), average monthly household income of 2,001-4,000 CNY (1.878, 1.827-1.930), number of services provided by the community health center ≥13 times per year (1.428, 1.383-1.475), illness within 2 weeks (1.633, 1.595-1.672), high-intensity physical activity (2.254, 2.191-2.32), sedentary (1.094, 1.070-1.117), and number of chronic disease illnesses ≥3 (1.930, 1.870-1.993). Meanwhile, those risk factors were also associated with injury from falls. The older adults with medium-intensity physical activity were at lower risk (0.721, 0.705-0.737) of falls and higher risk (1.086, 1.057-1.117) of being injured from falls. Chord diagrams showed the correlations between chronic diseases and falls and injury from falls among community-dwelling older adults in Guangzhou, China.

Conclusion

The high prevalence of falls is found among community-dwelling older adults in Guangzhou, China, which is related to multiple factors such as demographic variables, lifestyle, and health status, especially for chronic diseases. Therefore, targeted interventions should be developed and implemented urgently.

Examining the Effects of an Otago-Based Home Exercise Program on Falls and Fall Risks in an Assisted Living Facility

BACKGROUND AND PURPOSE

The Otago exercise program is a strengthening, balance, and walking program designed to decrease falls among community-dwelling older adults. Few studies have examined the effects of the Otago program in an assisted living environment. The purpose of the current study was to assess the effects of an Otago-based home exercise program in decreasing falls and the risk of falls among older adults living in an assisted living facility.

METHODS

A retrospective chart review of 30 individuals residing at either of 2 assisted living facilities in central Florida was undertaken. Participants had a mean age of 87 years, were at risk for falls as determined by the Tinetti Performance-Oriented Mobility Assessment (POMA), and were provided with an Otago-based intervention by home health physical therapy. The outcome measures were the number of falls in the previous year, the number of falls in the year following the intervention, and Tinetti POMA scores pre- and post-intervention.

RESULTS AND DISCUSSION

The mean (SD) number of falls significantly decreased from 1.4 (0.9) to 0.5 (0.7) fall per person per year after home health physical therapy with the tailored Otago based-exercise intervention. The intervention resulted in a statistically significant improvement in Tinetti POMA scores from 11.8 (2.5) to 17.6 (3.8).

CONCLUSIONS

An Otago-based strengthening, balance, and walking home exercise program can potentially be used to decrease the number of falls and the risk of falling among older adults residing in an assisted living facility.

[Traumatic and psychosocial complications of falls in the elderly in Tunisia]

Introduction

Les chutes chez le sujet âgé constituent un problème de santé majeur de par les complications traumatiques et psychosociales qui peuvent entrainer une perte de l'autonomie et un état de dépendance. L'objectif de notre travail est d'étudier les circonstances et les conséquences traumatiques et psychosociales des chutes chez les sujets âgés.

Méthodes

Nous avons mené une étude rétrospective réalisée entre septembre 2014 et janvier 2016 incluant 40 patients âgés de 65 ans et plus ayant fait au moins une chute l'année précédente recrutés parmi les patients hospitalisés ou suivis à la consultation externe du service de Médecine Interne B de l'hôpital Charles Nicolle. Les circonstances et les conséquences des chutes ont été recueillies par l'interrogatoire rétrospectif des patients et de leur entourage à distance de la chute.

Résultats

L'âge moyen des patients chuteurs était de 75,7 ans avec une prédominance féminine nette (30F/10H). Des facteurs précipitants étaient retrouvés chez 38 patients. Ils étaient de type extrinsèque dans 78,9% des cas et intrinsèques dans 50% des cas. Un séjour prolongé au sol était noté dans 10% des cas. Les fractures étaient plus fréquentes chez les femmes (12F/1H) intéressant surtout les membres supérieurs (61,5%). Les conséquences psychosociales ont été plus fréquentes chez les femmes. Un syndrome post chutes a été noté chez 5 patients.

Conclusion

La correction des facteurs précipitants intrinsèques et extrinsèques des chutes et l'apprentissage du relever du sol en post chutes permettra de prévenir le risque de chute ainsi que ses conséquences graves.

A risk model for the prediction of skin tears in aged care residents: A prospective cohort study

The objective of this study was to construct a predictive model to identify aged care residents at risk of future skin tears. Extensive data about individual characteristics, skin characteristics, and skin properties were gathered from 173 participants at baseline and at 6 months. A predictive model, developed using multivariable logistic regression, identified five variables that significantly predicted the risk of skin tear at 6 months. These included: a history of skin tears in the previous 12 months (OR 3.82 [1.64-8.90], P = 0.002), purpura ≤20 mm in size (OR 3.64 [1.42-9.35], P = 0.007), a history of falls in the previous 3 months (OR 3.37 [1.54-7.41], P = 0.002), clinical manifestations of elastosis (OR 3.19 [1.38-7.38], P = 0.007), and male gender (OR 3.08 [1.22-7.77], P = 0.017). The predictive model yielded an area under the receiver operating characteristic curve of 0.854 with an 81.7% sensitivity and an 81.4% specificity. This predictive model could inform a simple but promising bedside tool for identifying older individuals at risk of skin tears.

Correlates of Falls among Community-Dwelling Elderly in Thailand

Nearly every nation is experiencing rapid population aging. One area of major concern is health; a major health risk for older adults is falling, and there are multiple negative consequences of falling. This is a global concern yet is underresearched in many nations. This study examines demographic, health, and environmental correlates of falling among community-dwelling Thai elderly. Data were collected from a sample of 406 adults aged 60–69. Significant (p < 0.05) fall correlates were urban residence, older age, greater BMI, impaired and uncorrected vision, chronic health conditions, medication use and medication side effects, poor muscle tone, and hazardous indoor and outdoor home environments. Results lead to recommendations for interventions to reduce fall risk that are both evidence-based and culturally acceptable.

Functional ability and health status of community-dwelling late age elderly people with and without a history of falls

Background:

Obvious functional deterioration is demonstrated in elderly people aged 75 years and older. However, there is only little objective evidence relating to falls in these individuals.

Objective:

This cross-sectional study compared functional abilities and health status in the elderly age at least 75 years with no fall, single fall (1 fall), and multiple falls (≥2 falls) during the past 6 months. Furthermore, the study describes fall information of the participants.

Methods:

Ninety participants (30 individuals/group) were interviewed for their health status and fall history within the past 6 months. Then they were objectively assessed in terms of their functional ability to conduct daily activities independently.

Results:

The findings indicated that the functional abilities of participants with multiple falls were significantly poorer, with the number of those requiring a walking device significantly greater than that in the other groups. These individuals reported loss of balance as a major factor for falls, whereas individuals with a single fall reported an environmental hazard as a common cause of falls.

Conclusion:

Although the cross-sectional findings may be unable to clearly confirm the causal relationship of the outcomes, the data support the influence of intrinsic impairments and can be used to promote functional ability and minimise fall risk in these individuals.

Prevalence, circumstances and consequences of falls among community-dwelling older people: results of the 2009 NSW Falls Prevention Baseline Survey

AIM

To describe the prevalence, circumstances and consequences of falls among community-dwelling older people in NSW using data from the 2009 NSW Falls Prevention Baseline Survey.

METHODS

Telephone interviews with a random sample of 5681 NSW residents aged 65 years and over were conducted in 2009.

RESULTS

Of those surveyed, 25.6% reported falling in the last year. Of those who fell, 61.2% fell once, 21.4% fell twice, 7.8% fell three times, and 9.5% fell four or more times in the last year. Sixty-six percent of those who fell in the last year were injured and 20.0% visited a hospital as a result of a fall. The most common injuries were cuts, grazes or bruises (71.0%) and sprains or strains (9.9%).

CONCLUSION

The findings of this survey are consistent with previous findings in the published fall injury prevention literature. The results from the survey will assist in the design of community oriented fall injury prevention strategies and will form the baseline measure for the evaluation of the impact of these strategies in NSW.

Alcohol and the older adult: a comprehensive review

Alcohol consumption in the older adult is of major concern with the advent of baby boomers coming into the over 65-age bracket. Alcohol consumption has been touted as beneficial for health, and while that may be accurate for moderate consumption in younger persons, there is considerable risk associated with increased alcohol intake in older adults. This increase is partially due to age-related physiological changes, existing diagnoses, number of comorbid conditions, and increased use of prescribed and/or over-the-counter medications, coupled with other concerns. This review addresses the current research regarding ethanol consumption in older adults and all-cause mortality as well as several conditions more frequently seen in the geriatric population. These conditions include vascular diseases, hypertension, type 2 diabetes, gastrointestinal disorders, hepatic disorders, dental and oro-facial problems, bone density decline, and falls and fractures. In addition, drug interactions and recent research into select vitamin and mineral considerations with increased alcohol intake in older persons are addressed. While recommendations for alcohol intake have not been specifically established for age ranges within the 65-year-and-older bracket, and practitioners do not routinely assess alcohol intake or ethanol related adverse events in this population, common sense approaches to monitoring will become increasingly important as the generation of "boomers" who believe that alcohol intake improves health comes of age.

Neuronutrition and Alzheimer's disease

Alzheimer's disease (AD) is a complex neurological disorder resulting from both genetic and environmental factors with the latter being particularly important for the sporadic form of the disease. As such, diets rich in saturated fatty acids and alcohol, and deficient in antioxidants and vitamins appear to promote the onset of the disease, while diets rich in unsaturated fatty acids, vitamins, antioxidants, and wine likely suppress its onset. In addition, evidence suggests that diets rich in polyphenols and some spices suppress the onset of AD by scavenging free radicals and preventing oxidative damage. Metal ions are known to catalyze the production of free radicals and induce mental retardation or dementia, and several studies have also identified metals such as Pb, Fe, Al, Cu, and Zn in AD pathogenesis. While specific metal chelators have been tested for therapy, they have not been very successful, probably due to their late administration, i.e., after brain damage has been triggered. Since several dietary polyphenols are known to chelate metals, their routine use may also be protective against the onset of AD. In this review, we summarize beneficial dietary techniques in the fight against AD.

The prevalence, characteristics and correlates of falls in Korean community-dwelling older adults

BACKGROUND

The risk factors for falls that have been reported in Caucasian older adults may not be the same for Korean older adults.

OBJECTIVE

To examine the prevalence, characteristics and correlates of falls among community-dwelling older adults in Korea.

METHODS

A stratified random sampling method was conducted to recruit participants, and 335 were eligible to participate from September 2006 to March 2007. Socio-demographic data, history of disease and medications, activities of daily living (ADL), cognitive status, health behaviour and fall incidents were collected. Descriptive statistics were used to describe the sample. The prevalence of falls was obtained. Univariate analyses for risk factors of falls using chi-square and t-test statistics, and multivariate logistic regression analyses for correlates of falls were performed.

RESULTS

Of the 335 older adults, 48 (15%) elderly had experienced falls. There was a significant difference between older adults who fell and those who did not fall with regard to ADL and exercise behaviour. Non-fallers had higher ADL scores and showed higher levels of adherence to exercise than fallers. The independent risk factor for falls was ADL.

CONCLUSIONS/IMPLICATIONS

In this study, an individual's functional status and exercise engagement were significant factors that differentiated fallers and non-fallers. Therefore, an effective fall prevention programme should be focused on encouraging older adults to participate in regular exercise.

Dietary factors and Alzheimer's disease

Alzheimer's disease (AD) is increasing in prevalence, and environmental risk factors have not been identified with certainty. There is evidence that oxidative stress, homocysteine-related vitamins, fats, and alcohol have a role in the pathogenesis of AD. Few large epidemiological studies have explored the associations between nutrients and AD, and there has been only one trial of vitamin E in the prevention of AD. Some studies suggest that high intake of vitamins C, E, B6, and B12, and folate, unsaturated fatty acids, and fish are related to a low risk of AD, but reports are inconsistent. Modest to moderate alcohol intake, particularly wine, may be related to a low risk of AD. Available data do not permit definitive conclusions regarding diet and AD or specific recommendations on diet modification for the prevention of AD.