Incident falls impair ability to function in hip-fracture survivors: A prospective study of 95 elderly women

Concomitant upper limb fractures and short-term functional recovery in hip fracture patients: does the site of upper limb injury matter?

OBJECTIVE

The aim of this study was to evaluate functional recovery in a subgroup of hip fracture patients who sustained a simultaneous fracture at the upper limb, taking into account the site of upper limb injury.

DESIGN

Of 760 patients admitted consecutively to the authors' rehabilitation hospital because of a fall-related hip fracture, 700 were retrospectively investigated. Functional outcome was assessed using Barthel Index scores.

RESULTS

In 49 of the 700 patients, a single fall resulted in both a hip fracture and a fracture of either wrist (n = 34) or proximal humerus (n = 15). The patients with concomitant shoulder fractures had lower median Barthel Index scores after rehabilitation (70 vs. 90, P = 0.003), lower median Barthel Index effectiveness (57.1 vs. 76.9, P = 0.018), and prolonged median length of stay (42 vs. 36 days, P = 0.011) than did the patients with isolated hip fractures. Significant differences persisted after adjustment for six potential confounders. The adjusted odds ratio for achieving a Barthel Index score lower than 85 was 6.71 (95% confidence interval, 1.68-26.81; P = 0.007) for the patients with concomitant shoulder fractures. Conversely, no prognostic disadvantages were associated with concomitant wrist fractures.

CONCLUSIONS

Data show a worse functional recovery and a prolonged length of stay in the subgroup of hip fracture patients who sustained a concomitant fracture at the proximal humerus, but not at the wrist.

Ocorrência de quedas em idosos não institucionalizados: revisão sistemática da literatura

Revisão sistemática da literatura com o objetivo de identificar a ocorrência de quedas de idosos residentes na comunidade. Utilizando o portal CAPES, realizou-se busca nas bases de dados Academic Search (EBSCO), SciELO e Science Direct (ELSEVIER); e uma busca adicional na base de dados Lecturas Educación Física y Deportes, do site EFDEPORTES. Foram encontrados, com os descritores utilizados, 247 artigos publicados no período de 2000 a 2011. Foram excluídos 230 que não atenderam a um ou mais dos critérios de inclusão. Incluíram-se no estudo 17 artigos, sendo 12 transversais, dois de coorte prospectiva, dois de pesquisa de base populacional e um de coorte retrospectiva. A amostra total envolvida nos estudos foi de 114.911 sujeitos, com média de idade de aproximadamente 70 anos, distribuídos em sete países: Brasil, Estados Unidos, Espanha, Itália, Nigéria, Turquia e China. A ocorrência de quedas variou de 15,9 a 56,3%, com mediana de 28,50%. Embora apresente variação, a ocorrência de quedas na população idosa que reside na comunidade é alta.

Effectiveness of a community-based multifaceted fall-prevention intervention in active and independent older Chinese adults

Objective:

To evaluate the effectiveness of an 18-month multifaceted intervention designed to reduce the incidence of falls in community-living older adults in China.

Methods:

A population-based community trial evaluated by before-and-after cross-sectional surveys. Four residential communities were randomised to either a multifaceted intervention or a control condition. Baseline information was collected from a sample of older adults in each community. A 1-year annual fall rate was calculated after an 18-month comprehensive intervention.

Results:

After intervention, 7.19% of the intervention community sample reported falls, compared with 17.86% of the control community sample (p<0.000). The annual fall rate decreased by 10.52% in the intervention communities, whereas the difference in control communities was not statistically significant.

Conclusions:

Multifaceted interventions in community settings may be useful in preventing falls among older people, and can be applied in similar settings in China.