Health and lifestyle risk factors for falls in a large population-based sample of older people in Australia

Bayesian semi-parametric inference for clustered recurrent events with zero inflation and a terminal event

Recurrent events are common in clinical studies and are often subject to terminal events. In pragmatic trials, participants are often nested in clinics and can be susceptible or structurally unsusceptible to the recurrent events. We develop a Bayesian shared random effects model to accommodate this complex data structure. To achieve robustness, we consider the Dirichlet processes to model the residual of the accelerated failure time model for the survival process as well as the cluster-specific shared frailty distribution, along with an efficient sampling algorithm for posterior inference. Our method is applied to a recent cluster randomized trial on fall injury prevention.

Pre-COVID life expectancy, mortality, and burden of diseases for adults 70 years and older in Australia: a systematic analysis for the Global Burden of Disease 2019 Study

Background

The Australian population aged 70 and above is increasing and imposing new challenges for policy makers and providers to deliver accessible, appropriate and affordable health care. We examine pre-COVID patterns of health loss between 1990 and 2019 to inform policies and practices.

Methods

Using the standardised methodology framework and analytical strategies from GBD 2019 methodologies, we estimated mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs), life expectancy at age 70 and above (LE-70), and healthy life expectancy (HALE-70) in Australia comparing them globally and with high socio-demographic index (SDI) groups.

Findings

DALY rates have been improving steadily over the past 30 years among Australians aged 70 and above. Decreases in DALY rates were primarily attributed to a fall in YLLs attributable to cardiovascular diseases (60%) and chronic respiratory disorders (30.2%) and transport injuries (56.9%), while the non-fatal burden remained stable from 1990 to 2019. According to the DALY rates, the top five leading causes are ischemic heart disease, Alzheimer's disease, COPD, stroke, and falls, where falls exhibited the largest increase since 1990.

Interpretation

This study provides an in-depth report on the main causes of mortality and disability in Australia's population aged 70 and above. It sheds light on the shifts in burden over three decades, emphasising the need for the Australian health system to enhance its readiness in addressing the escalating demands of an ageing population. These findings establish pre-COVID baseline estimates for Australia's population aged 70 and above, informing healthcare preparedness.

Funding

Bill & Melinda Gates Foundation.

Factors associated with falls among hospitalized and community-dwelling older adults: the APPCARE study

Background

Falls are a leading cause of disability. Previous studies have identified various risk factors for falls. However, contemporary novel research is needed to explore these and other factors associated with falls among a diverse older adult population. This study aims to identify the factors associated with falls among hospitalized and community-dwelling older adults.

Methods

Cross-sectional data from the 'Appropriate care paths for frail elderly people: a comprehensive model' (APPCARE) study were analyzed. The study sample consisted of hospitalized and community-dwelling older adults. Falling was assessed by asking whether the participant had fallen within the last 12 months. Multivariable logistic regression models were used to evaluate associations between socio-demographic characteristics, potential fall risk factors and falls.

Results

The sample included 113 hospitalized (mean age = 84.2 years; 58% female) and 777 community-dwelling (mean age = 77.8 years; 49% female) older adults. Among hospitalized older adults, loneliness was associated with an increased risk of falls. Associations between female sex, secondary education lever or lower, multimorbidity, a higher score on limitations with activities of daily living (ADL), high risk of malnutrition and falling were found among community-dwelling participants.

Conclusion

The results of this study confirm the multi-factorial nature of falling and the complex interaction of risk factors. Future fall prevention programs could be tailored to the needs of vulnerable subpopulations at high risk for falls.

Associations of Gait Speed, Cadence, Gait Stability Ratio, and Body Balance with Falls in Older Adults

To investigate the association between gait speed (GS), cadence (CAD), gait stability ratio (GSR), and body balance (BB) with falls in a large sample of older adults. The analysis included 619 individuals-305 men and 314 women (69.50 ± 5.62 years)-residing in the Autonomous Region of Madeira, Portugal. Mobility in GS, CAD, and GSR was assessed using the 50-foot walk test and BB by the Fullerton Advanced Balance scale. The frequency of falls was obtained by self-report. Linear regression analysis showed that higher performance in GS and BB was able to reduce the risk of falling by up to 0.34 and 0.44 times, respectively. An increase in the GSR value enhanced the risk of falling by up to 0.10 times. Multinomial analysis indicated that, in relation to the highest tertile (reference), older adults classified with GS and BB performance in the lowest tertile (lowest) had an increased chance (OR) of falling by up to 149.3% and 48.8%, respectively. Moreover, in relation to the highest tertile, the performance of the GSR classified in the lowest and medium tercile showed an increase in the chance of falling by up to 57.4% and 56.4%, respectively.

Handgrip Strength Correlated with Falling Risk in Patients with Degenerative Cervical Myelopathy

Background: Few studies have investigated associations between hand grip strength (HGS) and the surgical outcomes of degenerative cervical myelopathy (DCM). Methods: This study was designed as a prospective observational study of 203 patients who had undergone fusion surgery for DCM. We divided the patients according to sex and HGS differences. Clinical outcome parameters, including HGS, a fall diary and four functional mobility tests (alternative step test, six-meter walk test, timed up and go test, and sit-to-stand test) were measured preoperatively, at 3 months and 1 year after surgery. Results: Mean patient ages were 59.93 years in the male group and 67.33 years in the female group (p = 0.000; independent t-test). The mean HGS of both hands improved significantly at postoperative 3 months and 1 year in all patients (p = 0.000 for both; ANOVA). In male patients, preoperative risk of falls was negatively correlated with HGS (p = 0.000). In female patients, pre- and postoperative risk of falls were correlated negatively with HGS (p = 0.000). The postoperative incidence of falls decreased in both groups (p = 0.000) Conclusions: Postoperative HGS in patients with DCM is correlated with postoperative falls and functional outcome differently, when comparing male and female patients, for predicting favorable outcomes and neurologic deficit recovery after surgery in DCM patients.

Fall-related hospitalization of patients in Iran

PURPOSE

Trauma has been called the neglected disease of modern society. According to WHO, fall is the second major cause of trauma or deaths resulting from unintentional accidents. The aim of this study was to investigate the different types of fall according to International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) in hospitalized patients visiting specialized accident and trauma hospitals of Mashhad, Iran.

METHODS

This was a cross sectional retrospective study performed between March 20, 2013 and March 20, 2014. The research population consisted of all medical records of patients for fall injuries in three specialized accident and trauma hospitals. ICD-10 was adopted to categorize all types of falls (w00-w19). The results obtained were analyzed by SPSS 16.

RESULTS

Altogether 7,448 cases were included. The codes w18 (fall on same level) and w09 (fall involving playground equipment) with the frequencies of 1,856 and 1,303, respectively in both genders had the maximum number of falls. The maximum percentage of mortality has been related to "fall on and from ladder"," fall from cliff "and "fall on same level involving ice and snow".

CONCLUSION

As falls can cause irrecoverable injuries including mortality of people, thus health authorities and policymakers should take preventive measures given the causes of falls and the root of this type of injuries, so that the costs resulting from this cause and its injuries can be reduced.

Prevalence and risk factors associated with falls among community-dwelling and institutionalized older adults in Indonesia

OBJECTIVE

To assess the prevalence and social and health correlates of falls and fall risk in a sample of community-dwelling and institutionalized older Indonesians.

METHODS

This cross-sectional study was conducted July-August 2018 in three regions in Indonesia. Adults aged 60 years and above (n=427) were recruited via random sampling from community clinics and public and private elderly homes. They responded to interview-administered questions and provided measurements on sociodemographics and various health variables, including falls and fall risk. Fall risk was assessed with the STEADI (Stopping Elderly Accidents, Deaths, & Injuries) screen. Multivariable logistic regression was conducted to estimate associations with fall and fall risk.

RESULTS

In the year immediately preceding the study, 29.0% of participants had suffered a fall. Approximately one-third of women (31.1%) and one-fifth of men (20.4%) reported a fall in the past year, and 25.4% of community dwellers and 32.7% of institutionalized older adults had fallen. The overall proportion of fall risk was 45.4%, 49.0% among women, 38.0% among men, 50.5% in the institutionalized setting, and 40.4% in the community setting. In adjusted logistic regression analysis, older age (OR: 1.89, CI: 1.06, 3.37), private elderly home setting (OR:2.04, CI: 1.10, 3.78), and being female (OR: 0.49, CI: 0.30, 0.82) were associated with falls in the preceding 12 months. Older age (80-102 years) (OR: 2.55, CI: 1.46, 4.46), private elderly home residence (OR: 2.24, CI: 1.19, 4.21), lack of education (OR: 0.51, CI: 0.28, 0.93), memory problems (OR: 1.81, CI: 1.09, 2.99), and arthritis (OR: 2.97, CI: 1.26, 7.00) were associated with fall risk by the STEADI screen. In stratified analysis by setting, being female (OR: 0.49, CI: 0.25, 0.95) and living in urban areas (OR: 1.97, CI: 1.03, 3.76) were associated with falls in the institutionalized setting, and having near vision problems (OR: 2.32, CI: 1.09, 4.93) was associated with falls in the community setting. Older age (OR: 2.87, CI: 1.36, 6.07) was associated with fall risk in the institutionalized setting, and rural residence (OR: 0.37, CI: 0.15, 0.93) and having a joint disorder or arthritis (OR: 4.82, CI: 1.28, 16.61) were associated with fall risk in the community setting.

CONCLUSION

A high proportion of older adults in community and institutional care in Indonesia have fallen or were at risk of falling in the preceding 12 months. Health variables for fall and fall risk were identified for the population overall and for specific populations in the home care and community setting that could help in designing fall-prevention strategies.

Understanding Modifiable and Unmodifiable Older Adult Fall Risk Factors to Create Effective Prevention Strategies

Each year, more than 1 in 4 older adults in the United States report a fall and 1 in 10 a fall injury. Using nationally representative data from the 2016 US Behavioral Risk Factor Surveillance System, we evaluated demographic, geographic, functional, and health characteristics associated with falls and fall injuries among adults aged 65 years and older. Analyses included descriptive statistics and multivariable logistic regression to produce crude and adjusted percentages by characteristic. Characteristics most strongly associated with increased fall risk in order of adjusted percentage were depression, difficulty doing errands alone, and difficulty dressing or bathing. Characteristics most strongly associated with fall injury risk in order of adjusted percentage were depression, difficulty dressing or bathing, and being a member of an unmarried couple. The diverse health and functional characteristics associated with increased falls and fall injuries confirm the importance of screening and assessing older adult patients to determine their individual unique risk factors. Health care providers can use tools and resources from the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative to screen their older adult patients for fall risk, assess at-risk patients' modifiable risk factors, and intervene to reduce risk by prescribing evidence-based interventions.

Incidence of falls among community-dwelling older adults in Turkey and its relationship with pain and insomnia

AIM

The aim of this study was to determine the incidence of falls among community-dwelling older adults and the impact of pain and insomnia on falls.

METHODS

This cross-sectional study recruited 659 older adults. Pain was assessed by the Geriatric Pain Measure, and insomnia was assessed by the Insomnia Severity Index. The history of falls was assessed within the last 12 months. Risk factors for falls were determined using logistic regression analysis.

RESULTS

The incidence of falls within the last year was 37.2%. Based on the analyses, pain and insomnia were found to be risk factors for falls.

CONCLUSION

In this study, falls were observed as a common problem among community-dwelling older adults, and pain and insomnia were determined as risk factors for falls. Therefore, pain and insomnia should be addressed when prevention of falls among community-dwelling older adults are planned by health care professionals including nurses.

Effects of Pain and Sleep Quality on Falls Among Nursing Home Residents in Turkey

The current study was conducted to detect the incidence of falls among individuals in nursing homes, as well as the impact of pain and sleep quality on falls. The sample for this cross-sectional study comprised 291 older adults. Pain was assessed using the Geriatric Pain Measure and insomnia was assessed using the Insomnia Severity Index. Incidence of falls within the past 1 year was 40.9%. Risk factors for falling were determined using logistic regression analysis. Based on the analysis, being single (odds ratio [OR] = 2.502, 95% confidence interval [CI] [1.155, 6.195]) and experiencing pain (OR = 2.841, 95% CI [1.195-6.754]) were risk factors for falling. In the current study, falling was seen as a common problem among older adults. Pain in particular should be addressed when planning the prevention of falls in nursing homes. [Res Gerontol Nurs. 2018; 11(5):257-264.].

Prevalence and Risk Factors Associated with Injurious Falls among Community-Dwelling Older Adults in Indonesia

OBJECTIVE

To assess the prevalence and health correlates of fall-related injury in a national population-based community-dwelling sample of older Indonesians.

METHODS

Participants were 6698 older adults, 50 years and older (median age 58.0 years, IQR=11.0, and age range of 50-101 years), who took part in in the Indonesia Family Life Survey (IFLS-5) in 2014-15. They provided information about sociodemographic, various health variables, including a falling down and received treatment history in the last two years.

RESULTS

Overall, 12.8% had one or more fall-related injuries in the past two years, 14.0% among women and 11.5% among men, 7.6% had a single fall, and 5.2% multiple fall-related injuries in the past two years. In multivariable logistic regression models, having two or more chronic conditions, urinary problems, and functional disability was independently associated with multiple fall-related injuries in the past two years in both sexes. Sex-specific risk factors were former tobacco use, having or having had a cataract, sleep disturbance, and sleep impairment in men and poorer economic background, depression symptoms, and low cognitive functioning in women.

CONCLUSION

A significant proportion of older adults in Indonesia have fall-related injury. Several homogenous between the sexes and sex-specific risk factors for fall-related injury were identified that can help in designing fall-prevention strategies.

Medications & Polypharmacy Influence on Recurrent Fallers in Community: a Systematic Review

The purpose of this systematic review is to summarize information about the impact different classes of medications and polypharmacy have on recurrent falls, defined as two or more falls in a 12-month period, in community-dwelling older adults. After adjustment for confounders such as age, gender, weight or depression symptoms, the reviewed studies suggested that older adults who use antidepressants, sedatives or hypnotics and anti-epileptics were more likely to experience recurrent falls than non-users. Polypharmacy (use of four or more prescription medications daily) caused 1.5-2 times higher possibility of recurrent falls in older adults. As a high-risk group, recurrent fallers require meaningful intervention. Medications are believed to be a modifiable risk factor in falls prevention; hence, special consideration should be taken to balance the benefit and harm in initiating, continuing or increasing certain classes of medications in elderly recurrent fallers.

Risk factors and epidemiological profile of hip fractures in Indian population: A case-control study

Objectives

This analytic retrospective case-control study was designed to analyze risk factors and the epidemiological profile of hip fractures among the Indian population with special importance to the mechanism of injuries.

Methods

Patients of hip fractures (n = 41) and age- and sex-matched healthy volunteers (n = 41) were interviewed by a questionnaire regarding the occurrence of the fracture, past history of diseases and long-term medication usage, past and physical activity, supplements, smoking, and alcohol intake. The data were tabulated using descriptive statistics and logistic regression was used to determine significant risk factors.

Results

Age group 60–69 was found to be most affected by hip fractures, though an early onset of fractures was noted in males. Falls due to slipping indoors from standing position was found very commonly. However, an increasing trend of falls was noted from lying down position in the older age groups which was more common during the morning and night hours. Logistic regression analysis for the detection of risk factors was applied to the various variables in the questionnaire. Active status in the past was inversely related (odds ratio [OR], 0.33; P < 0.05) to fracture risk while alternative medication usage in the past 1 year (OR, 4.086; P < 0.05) and significant alcohol consumption were directly associated with fracture risk (OR, 5.484; P < 0.05). A potential inverse relation of use of calcium supplements in the past 3 months and fracture risk (OR, 0.872) was seen, although this was not significant. A potential positive relation of smoking with hip fractures was also seen, but not found significant (OR, 2.204).

Conclusions

Hip fractures in the elderly population are on a rising trend especially in the Indian subcontinent due to a number of factors both hereditary and acquired. Simple measures like routine usage of bedside railing, wall-side railings at an appropriate height, high friction tiles inside rooms and washrooms, and adequate lighting indoors can play a significant role in reducing falls and hip fractures among the elderly.

Fall-related Deterioration of Subjective Symptoms in Patients with Cervical Myelopathy

STUDY DESIGN

Retrospective multi-center study.

OBJECTIVE

This study was conducted to clarify the incidence and neurological outcomes of fall-related deterioration of subjective symptoms in patients undergoing surgical treatment.

SUMMARY OF BACKGROUND DATA

The evidence that minor trauma, including falls, increases the risk of worsening cervical myelopathy is insufficient.

METHODS

A retrospective analysis of patients who had undergone surgery for cervical myelopathy at 12 participating institutes was conducted. Patients who had undergone surgery for symptomatic cervical myelopathy from January 2012 to December 2013 and completed at least 1-year follow-up were included in this study. Data were collected by chart review and a questionnaire that included numbers of recalled falls during the last preoperative year and first postoperative year, circumstances of falls, and whether the patient had experienced fall-related deterioration of subjective symptoms.

RESULTS

A total of 360 eligible patients were recruited into the study. Of these, 177 (49%) reported at least one fall during the last preoperative year, and 105 (29%) experienced fall-related deterioration of subjective symptoms. Forty (11%) reported deterioration of numbness in the arms or legs, and 65 (18%) reported deterioration of motor deficits. Incidences of falls and fall-related deterioration of symptoms decreased significantly after surgery. Patients who experienced fall-related deterioration of motor deficits showed significantly worse surgical outcomes as assessed by Japanese Orthopaedic Association (JOA) score compared with those who did not experience deterioration. The optimal cut-off for preoperative JOA score in predicting an increased risk of fall-related deterioration in motor deficits was 8.

CONCLUSION

Patients with cervical myelopathy commonly experienced preoperative fall-related deterioration of subjective symptoms, associated with significantly worse neurological outcomes. Surgical treatment significantly reduced the incidence of both falls and fall-related deterioration of subjective symptoms.

LEVEL OF EVIDENCE

4.

Older Adults, Falls, and Skin Integrity

GENERAL PURPOSE

To provide an overview of the assessment and management of risk factors for falls in older adults.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant should be better able to:1. Outline the components of an evidence-based falls assessment and identify risk factors for falls.2. Specify strategies to reduce falls in older adults, especially as related to maintaining skin integrity.

ABSTRACT

Older adult patients may present to skin and wound care clinicians with skin injuries as a result of falls. In addition, chronic wounds associated with the patient's conditions may also increase his/her falls risk. Hence, appropriate assessment and management of the risk of falls in older adult patients are key elements of patient-centered care.

Fall-Related Injuries in Community-Dwelling Older Adults in Qom Province, Iran, 2010-2012

Background:

Falls and related injuries are common health problems in the elderly. Fractures, brain and internal organ injuries and death are the common consequences of the falls, which result in dependence, decreased self-efficacy, fear of falling, depression, restricted daily activities, hospitalization and admission to the nursing home and impose costs on the individual and the society.

Objectives:

The purpose of this study was to determine the types of fall-related injuries and the related risk factors in the elderly population of Qom province, Iran.

Patients and Methods:

This retrospective study was performed on 424 elderly people (65 years and over) referred to Shahid Beheshti Hospital, Qom, Iran, due to falls between 2010 and 2012. The ICD-10 codes of external causes of injury from w00 to w19 related to falls were selected from the health information system of the hospital and demographic variables of the patients and external causes of falls were extracted after accessing the files of the patients. Data were analyzed using SPSS version 18 (SPSS Inc., USA). The duration of hospital stay and its relationship with underlying variables were investigated using t test and ANOVA. The level of significance was considered P < 0.05.

Results:

Among 424 elderly people, 180 cases (42.45%) were male and the mean age of the patients was 78.65 ± 7.70 years. Fall on the same level from slipping, tripping, and stumbling was the most common external cause with 291 victims (68.60%), and hip fracture in 121 patients (29.00%), intertrochanteric fracture in 112 patients (26.90%), and traumatic brain injury in 51 patients (12.20%) were the most common causes of hospital stay. The mean hospital stay was 7.33 ± 3.63 days.

Conclusions:

Lower limb fracture and traumatic brain injury were the most common causes of hospitalization, which resulted in the longest hospital stay and highest hospitalization costs in the elderly.

Current and future burden of incident hip fractures in New South Wales, Australia

Population ageing presents significant challenges for many developed nations. Accurately forecasting the likely future burden of age-related medical conditions, such as hip fracture, is critical. In this study, we present estimates of the current and future burden of hip fracture in NSW, Australia, providing crucial information for future health care planning.

PURPOSE

The aims of this study were to investigate the burden of hip fracture in Australia's largest state, New South Wales (NSW), and to build a prediction model to forecast the likely future burden of hip fracture from 2016 to 2036 in persons aged 50 years or more.

METHODS

A retrospective population-based cohort study was conducted using NSW hospitalisation data. Standardised incident hip fracture rates and hip fracture-related acute care length of stay and costs were estimated. Predictive negative binomial regression modelling using age, gender and local health district and year covariates together with projected NSW populations was applied to forecast future hip fractures.

RESULTS

Total incident hip fractures increased 8.8 % over a 12-year period from 2000/2001 to 2011/2012 despite declining age-standardised rates. Estimates of acute care length of stay for the treatment of hip fracture ranged from 10 to 15 days and acute care costs ranged between 21 and 29,000 Australian dollars per fracture. By 2036, incident hip fractures are projected to rise by 35.2 %, assuming a continued decline in the rate of hip fracture or by 107.5 % if the current decline in the rate does not continue. Acute care length of stay and costs are each predicted to rise between 37.1 and 110.4 % by 2036.

CONCLUSION

An ageing population and changing demographics will continue to drive the increasing burden of incident hip fractures in NSW and Australia in the foreseeable future. These anticipated changes provide important information for the planning and management of future hip fracture care.