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Hoedl M, Eglseer D, Bernet N, Everink I, Gordon AL, Lohrmann C, Osmancevic S, Saka B, Schols JMGA, Thomann S, Bauer S. Which factors influence the prevalence of institution-acquired falls? Results from an international, multi-center, cross-sectional survey. J Nurs Scholarsh 2021; 54:462-469. [PMID: 34919335 PMCID: PMC9542022 DOI: 10.1111/jnu.12758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Falls are a highly prevalent problem in hospitals and nursing homes with serious negative consequences such as injuries, increased care dependency, or even death. The aim of this study was to provide a comprehensive insight into institution-acquired fall (IAF) prevalence and risk factors for IAF in a large sample of hospital patients and nursing home residents among five different countries. DESIGN This study reports the outcome of a secondary data analysis of cross-sectional data collected in Austria, Switzerland, the Netherlands, Turkey, and the United Kingdom in 2017 and 2018. These data include 58,319 datapoints from hospital patients and nursing home residents. METHODS Descriptive statistics, statistical tests, logistic regression, and generalized estimating equation (GEE) models were used to analyze the data. FINDINGS IAF prevalence in hospitals and nursing homes differed significantly between the countries. Turkey (7.7%) had the highest IAF prevalence rate for hospitals, and Switzerland (15.8%) had the highest IAF prevalence rate for nursing homes. In hospitals, our model revealed that IAF prevalence was associated with country, age, care dependency, number of medical diagnoses, surgery in the last two weeks, and fall history factors. In nursing homes, care dependency, diseases of the nervous system, and fall history were identified as significant risk factors for IAF prevalence. CONCLUSIONS This large-scale study reveals that the most important IAF risk factor is an existing history of falls, independent of the setting. Whether a previous fall has occurred within the last 12 months is a simple question that should be included on every (nursing) assessment at the time of patient or resident admission. Our results guide the development of tailored prevention programs for persons at risk of falling in hospitals and nursing homes.
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Affiliation(s)
- Manuela Hoedl
- Medical University of Graz, Institute of Nursing Science, Graz, Austria
| | - Doris Eglseer
- Medical University of Graz, Institute of Nursing Science, Graz, Austria
| | - Niklaus Bernet
- Division of Nursing, Department of Health, Bern University of Applied Sciences, Bern, Switzerland
| | - Irma Everink
- Department Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK.,East Midlands Academic Health Sciences Network Patient Safety Collaborative, Nottingham, UK.,NIHR Applied Research Collaboration - East Midlands (ARC-EM), Nottingham, UK
| | - Christa Lohrmann
- Medical University of Graz, Institute of Nursing Science, Graz, Austria
| | | | - Bülent Saka
- Istanbul Faculty of Medicine, Department Internal Medicine, İstanbul Tıp Fakültesi Çapa - Fatih, Istanbul University, LIstanbul, Turkey
| | - Jos M G A Schols
- Department Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Silvia Thomann
- Division of Nursing, Department of Health, Bern University of Applied Sciences, Bern, Switzerland
| | - Silvia Bauer
- Medical University of Graz, Institute of Nursing Science, Graz, Austria
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Zuin M, Brombo G, Capatti E, Romagnoli T, Zuliani G. Orthostatic hypotension and vitamin D deficiency in older adults: systematic review and meta-analysis. Aging Clin Exp Res 2021; 34:951-958. [PMID: 34628636 DOI: 10.1007/s40520-021-01994-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Over the latest years different studies have investigated the possible relationship between D deficiency and occurrence of orthostatic hypotension (OH), often reaching controversial results. We perform an update meta-analysis providing an update overview on the association between hypovitaminosis D and orthostatic hypotension (OH) in older adults. METHODS Data extraction was independently performed by two authors and based upon predefined criteria. The meta-analysis was performed using a random-effects model. Statistical heterogeneity between groups was measured using the Higgins I2 statistic. RESULTS Eight investigations enrolling 16.326 patients (mean age 75.5 years) met the inclusion criteria and were considered for the analysis. Patients with vitamin D deficiency were more likely to have OH compared to those without (OR: 1.36, 95% CI 1.14-1.63, p = 0.0001, I2 = 43.6%). A further sub-analysis, based on three studies, estimating the risk of OH in patients with hypovitaminosis D receiving antihypertensive treatment, did not reach the statistical significance (OR: 1.40, 95% CI 0.61-3.18, p = 0.418, I2 = 53.3%). Meta-regression performed using age (p = 0.12), BMI (p = 0.73) and gender (p = 0.62) as moderators did not reveal any statistical significance in influencing OH. Conversely, physical activity, Vitamin D supplementation and use of radioimmunoassay for the measurement of vitamin D serum levels showed a significant inverse relationship towards the risk of OH (Coeff.-0.09, p = 0.002, Coeff. - 0.12, p < 0.001 and Coeff. - 0.08, p = 0.03, respectively) among patients with hypovitaminosis D. A direct correlation between the administration of antihypertensive treatment and the risk of OH in older patients with low vitamin D level was observed (Coeff. 0.05, p < 0.001). CONCLUSIONS Hypovitaminosis D is significantly associated with OH in older adults and directly influence by the administration of antihypertensive drugs. Conversely, physical activity, vitamin D supplementation and use of radioimmunoassay as analytic method inversely correlated with the risk of OH in older patients.
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Lapierre N, Um Din N, Igout M, Chevrier J, Belmin J. Effects of a Rehabilitation Program Using a Patient-Personalized Exergame on Fear of Falling and Risk of Falls in Vulnerable Older Adults: Protocol for a Randomized Controlled Group Study. JMIR Res Protoc 2021; 10:e24665. [PMID: 34435968 PMCID: PMC8430847 DOI: 10.2196/24665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/16/2020] [Accepted: 03/05/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Older adults often experience physical, sensory, and cognitive decline. Therefore, they have a high risk of falls, which leads to severe health and psychological consequences and can induce fear of falling. Rehabilitation programs using exergames to prevent falls are being increasingly studied. Medimoov is a movement-based patient-personalized exergame for rehabilitation in older adults. A preliminary study showed that its use may influence functional ability and motivation. Most existing studies that evaluate the use of exergames do not involve an appropriate control group and do not focus on patient-personalized exergames. OBJECTIVE This study aims to evaluate the effects of Medimoov on risk of falls and fear of falling in older adults compared with standard psychomotor rehabilitation. METHODS This is a serial, comparative, randomized controlled group study. Both groups (n=25 in each) will receive psychomotor rehabilitation care. However, the methods of delivery will be different; one group will be exposed to the Medimoov exergame platform, and the other only to traditional means of psychomotor rehabilitation. The selection criteria will be (1) age of 65 years or older, (2) ability to answer a questionnaire, (3) ability to stand in a bipedal position for at least 1 minute, (4) score of 13 or greater on the Short Fall Efficacy Scale, and (5) stable medical condition. An evaluation will be made prior to starting the intervention, after 4 weeks of intervention, and at the end of the intervention (after 8 weeks), and it will focus on (1) risk of falls, (2) fear of falling, and (3) cognitive evaluations. Physical activity outside the session will also be assessed by actimetry. The outcome assessment will be performed according to intention-to-treat analysis. RESULTS The protocol (2019-11-22) has been approved by the Comité de Protection des Personnes Nord-Ouest I-Université de Rouen (2019-A00395-52), which is part of the French national ethical committee. The study received funding in February 2020. As of October 2020 (submission date), and due to the context of the COVID-19 pandemic, a total of 10 participants out of 50 had been enrolled in the study. The projected date for the end of the data collection is December 2021. Data analyses have not been started yet, and publication of the results is expected for Spring 2022. CONCLUSIONS The effects of psychomotor rehabilitation using the Medimoov exergame platform on the risk and fear of falls will be evaluated. This pilot study will be the basis for larger trials. TRIAL REGISTRATION ClinicalTrials.gov NCT04134988; https://clinicaltrials.gov/ct2/show/NCT04134988. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/24665.
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Affiliation(s)
- Nolwenn Lapierre
- Hôpital Charles Foix, Assistance Publique-Hôpitaux de Paris, AP-HP.Sorbonne Université, Ivry-Sur-Seine, France.,Centre de Recherches Interdisciplinaires, Université Paris Descartes, Paris, France
| | - Nathavy Um Din
- Hôpital Charles Foix, Assistance Publique-Hôpitaux de Paris, AP-HP.Sorbonne Université, Ivry-Sur-Seine, France
| | - Manuella Igout
- Hôpital Charles Foix, Assistance Publique-Hôpitaux de Paris, AP-HP.Sorbonne Université, Ivry-Sur-Seine, France
| | - Joël Chevrier
- Centre de Recherches Interdisciplinaires, Université Paris Descartes, Paris, France
| | - Joël Belmin
- Hôpital Charles Foix, Assistance Publique-Hôpitaux de Paris, AP-HP.Sorbonne Université, Ivry-Sur-Seine, France.,Faculté de Médecine Sorbonne, Sorbonne Université, Paris, France
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Nascimento MDM, Silva PST. Sensory assessment of balance regulation of physically active women, 60-79 years old. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.53886/gga.e0210037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: To evaluate the performance of sensory regulation of static and dynamic balance in older women, and to verify the sensitivity and specificity levels of the Body Balance Test (Teste de Equilíbrio Corporal, TEC) in relation to its reference standard, determining the best cutoff point for identifying risk of falling. METHODS: 74 women (age 67.59 ± 5.26 years) participated in the study, divided into fallers (n = 18) and non-fallers (n = 56). RESULTS: Comparatively, non-fallers had higher performance scores on static balance exteroceptive regulation (SBER), dynamic balance exteroceptive regulation (DBER), and dynamic balance interoceptive regulation (DBIR). Statistically significant differences were found in DBER (p = ≤0.001) and DBIR (p = 0.031). The area under the ROC curve was 0.73 (95%CI 0.58 – 0.88; p = 0.003), with a sensitivity level of 42.30% and specificity of 84.80%.
CONCLUSIONS: The greatest chance of falling was found for dynamic balance in situations of exteroceptive and interoceptive regulation for older women with and without a history of falls. Deficits in sensory regulation of body balance are common in older women, both fallers and non-fallers.
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Tchouaket É, Kilpatrick K, Jabbour M. Effectiveness for introducing nurse practitioners in six long-term care facilities in Québec, Canada: A cost-savings analysis. Nurs Outlook 2020; 68:611-625. [PMID: 32713732 DOI: 10.1016/j.outlook.2020.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 05/31/2020] [Accepted: 06/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Internationally, most studies have focused on quality and safety in long-term care. However, studies focusing on the economic evaluation of quality and security in long-term care are sparse. Moreover, the economic evaluation of nurse practitioner care in long-term care is lacking, particularly in Québec Canada where roles are new. PURPOSE To evaluate the effectiveness of introducing nurse practitioners in six long-term care facilities in Québec using a cost-savings analysis in terms of reduction of nurse practitioner sensitive events (NPSEs). METHODS A cost savings analysis was completed using a prospective observational study. All residents (n = 538) under the care of teams that included nurse practitioners who experienced at least one of the following NPSEs: falls, pressure ulcers, short-term transfers, and a change in the time needed to administer the medications consumed were included. Data were collected from September 1st 2015 to August 31st 2016. Descriptive statistics identified numbers of cases for falls, pressure ulcers, short-term transfers, and the number of medications consumed. A literature analysis was used to estimate excess median long-term care facility related costs of these NPSEs. Costs were calculated in 2016 Canadian dollars. The cost savings with the reductions that occurred for falls, pressure ulcers, short term transfers, and the time needed to administer medications after the implementation of a primary healthcare nurse practitioner role in the six long term care facilities were also estimated. FINDINGS The median cost of 341 cases of falls, 32 cases of pressure ulcers and 53 cases of short-term transfers in the six long-term facilities would range between CAD 4,516,337.8 and CAD 5,281,824.4. Moreover, the total costs savings from the reduction of adverse events including the reduction of nursing administration time for medications would be between CAD 1,942,533.6 and CAD 3,254,403.4. DISCUSSION This is the first study to present the financial consequence of adverse events sensitive to nurse practitioner care in long-term care. Important cost savings were generated from the reduction of adverse events after the implementation of nurse practitioner roles in long-term care. Government should consider these results for prevention and improvements in quality and safety in long-term care.
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Affiliation(s)
- Éric Tchouaket
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Canada.
| | - Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, McGill University, Montreal, Canada; Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal-Hôpital, Maisonneuve-Rosemont (CIUSSS-EMTL-HMR), Montréal, Canada
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Effects of Whole-Body Vibration on Functional Mobility, Balance, Gait Strength, and Quality of Life in Institutionalized Older People: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Aging Phys Act 2020; 28:219-230. [PMID: 31629362 DOI: 10.1123/japa.2019-0070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/18/2022]
Abstract
The aim of this study was to quantify the effect of whole-body vibration on balance, functional mobility, gait, functional performance, and quality of life in institutionalized older people. Eight databases were systematically reviewed, as recommended by the Cochrane Collaboration. This systematic review was designed to answer the acronym set by the participants, interventions, comparators, and outcomes (PICO)-model. Ten randomized controlled trials were included in the meta-analysis. The analysis of the mean differences (MDs) of the functional mobility assessed with Time Up and Go test was MD = -2.49 s (95% confidence interval, CI, [-4.37, -0.61]; I2 = 68%). In 279 participants from five studies, the overall MD = 0.49 (95% CI [-0.13, 1.11]; I2 = 23%) for gait, and MD = 0.96 (95% CI [-0.45, 2.37]; I2 = 85%) for balance, which represents the total Tinetti score, MD = 1.59 (95% CI [-0.52, 3.70]; I2 = 82%). In summary, whole-body vibration could have benefits on functional mobility in institutionalized older people.
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7
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Kneis S, Wehrle A, Dalin D, Wiesmeier IK, Lambeck J, Gollhofer A, Bertz H, Maurer C. A new approach to characterize postural deficits in chemotherapy-induced peripheral neuropathy and to analyze postural adaptions after an exercise intervention. BMC Neurol 2020; 20:23. [PMID: 31948403 PMCID: PMC6966884 DOI: 10.1186/s12883-019-1589-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/26/2019] [Indexed: 12/05/2022] Open
Abstract
Background Postural instability presents a common and disabling consequence of chemotherapy-induced peripheral neuropathy (CIPN). However, knowledge about postural behavior of CIPN patients is sparse. With this pilot study, we used a new approach to i) characterize postural impairments as compared to healthy subjects, ii) allocate possible abnormalities to a set of parameters describing sensorimotor function, and iii) evaluate the effects of a balance-based exercise intervention. Methods We analyzed spontaneous and externally perturbed postural control in eight CIPN patients before and after a balance-based exercise intervention by using a modification of an established postural control model. These findings were compared to 15 matched healthy subjects. Results Spontaneous sway amplitude and velocity were larger in CIPN patients compared to healthy subjects. CIPN patients’ reactions to external perturbations were smaller compared to healthy subjects, indicating that patients favor vestibular over proprioceptive sensory information. The balance-based exercise intervention up-weighted proprioceptive information in patients. Conclusions CIPN patients’ major postural deficit may relate to underuse of proprioceptive information that results in a less accurate posture control as spontaneous sway results indicate. The balance-based exercise intervention is able to partially correct for this abnormality. Our study contributes to a better understanding of postural impairments in CIPN patients and suggests an effective treatment strategy. Trial registration German Clinical Trials Register: DRKS00004340, retrospectively registered 04 January 2013.
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Affiliation(s)
- Sarah Kneis
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.
| | - Anja Wehrle
- Institute for Exercise- and Occupational Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Daniela Dalin
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Isabella Katharina Wiesmeier
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Johann Lambeck
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Albert Gollhofer
- Department of Sports and Sport Science, University of Freiburg, Freiburg, Germany
| | - Hartmut Bertz
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Christoph Maurer
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
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Guaitolini M, Aprigliano F, Mannini A, Micera S, Monaco V, Sabatini AM. Ambulatory Assessment of the Dynamic Margin of Stability Using an Inertial Sensor Network. SENSORS 2019; 19:s19194117. [PMID: 31547624 PMCID: PMC6806087 DOI: 10.3390/s19194117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 01/10/2023]
Abstract
Loss of stability is a precursor to falling and therefore represents a leading cause of injury, especially in fragile people. Thus, dynamic stability during activities of daily living (ADLs) needs to be considered to assess balance control and fall risk. The dynamic margin of stability (MOS) is often used as an indicator of how the body center of mass is located and moves relative to the base of support. In this work, we propose a magneto-inertial measurement unit (MIMU)-based method to assess the MOS of a gait. Six young healthy subjects were asked to walk on a treadmill at different velocities while wearing MIMUs on their lower limbs and pelvis. We then assessed the MOS by computing the lower body displacement with respect to the leading inverse kinematics approach. The results were compared with those obtained using a camera-based system in terms of root mean square deviation (RMSD) and correlation coefficient (ρ). We obtained a RMSD of ≤1.80 cm and ρ ≥ 0.85 for each walking velocity. The findings revealed that our method is comparable to camera-based systems in terms of accuracy, suggesting that it may represent a strategy to assess stability during ADLs in unstructured environments.
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Affiliation(s)
- Michelangelo Guaitolini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
| | - Federica Aprigliano
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
| | - Andrea Mannini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
| | - Silvestro Micera
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Federale de Lausanne, 1015 Lausanne, Switzerland.
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy.
| | - Angelo Maria Sabatini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
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Aprigliano F, Micera S, Monaco V. Pre-Impact Detection Algorithm to Identify Tripping Events Using Wearable Sensors. SENSORS (BASEL, SWITZERLAND) 2019; 19:E3713. [PMID: 31461908 PMCID: PMC6749342 DOI: 10.3390/s19173713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 02/02/2023]
Abstract
This study aimed to investigate the performance of an updated version of our pre-impact detection algorithm parsing out the output of a set of Inertial Measurement Units (IMUs) placed on lower limbs and designed to recognize signs of lack of balance due to tripping. Eight young subjects were asked to manage tripping events while walking on a treadmill. An adaptive threshold-based algorithm, relying on a pool of adaptive oscillators, was tuned to identify abrupt kinematics modifications during tripping. Inputs of the algorithm were the elevation angles of lower limb segments, as estimated by IMUs located on thighs, shanks and feet. The results showed that the proposed algorithm can identify a lack of balance in about 0.37 ± 0.11 s after the onset of the perturbation, with a low percentage of false alarms (<10%), by using only data related to the perturbed shank. The proposed algorithm can hence be considered a multi-purpose tool to identify different perturbations (i.e., slippage and tripping). In this respect, it can be implemented for different wearable applications (e.g., smart garments or wearable robots) and adopted during daily life activities to enable on-demand injury prevention systems prior to fall impacts.
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Affiliation(s)
| | - Silvestro Micera
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Federale de Lausanne, 1015 Lausanne, Switzerland
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy.
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de Souza AB, Maestri RN, Röhsig V, Lorenzini E, Alves BM, Oliveira D, Gatto DC. In-hospital falls in a large hospital in the south of Brazil: A 6-year retrospective study. Appl Nurs Res 2019; 48:81-87. [DOI: 10.1016/j.apnr.2019.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/08/2019] [Accepted: 05/27/2019] [Indexed: 11/17/2022]
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Singh DKA, Shahar S, Vanoh D, Kamaruzzaman SB, Tan MP. Diabetes, arthritis, urinary incontinence, poor self‐rated health, higher body mass index and lower handgrip strength are associated with falls among community‐dwelling middle‐aged and older adults: Pooled analyses from two cross‐sectional Malaysian datasets. Geriatr Gerontol Int 2019; 19:798-803. [DOI: 10.1111/ggi.13717] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/07/2019] [Accepted: 05/13/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Devinder Kaur Ajit Singh
- Center for Healthy Aging and Wellness, Faculty of Health SciencesUniversiti Kebangsaan Malaysia Kuala Lumpur Malaysia
| | - Suzana Shahar
- Center for Healthy Aging and Wellness, Faculty of Health SciencesUniversiti Kebangsaan Malaysia Kuala Lumpur Malaysia
| | - Divya Vanoh
- Center for Healthy Aging and Wellness, Faculty of Health SciencesUniversiti Kebangsaan Malaysia Kuala Lumpur Malaysia
- Program of Nutrition and Dietetics, School of Health Sciences, Health CampusUniversiti Sains Malaysia Kubang Kerian Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- Department of Medicine, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
- Aging and Age‐Associated Disorders Research Group, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
- Aging and Age‐Associated Disorders Research Group, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
- Center for Innovation in Medical EngineeringUniversity of Malaya Kuala Lumpur Malaysia
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Rejón T, Serra-Prat M, Burdoy E, Cabré M. [Gender differences in the risk factors of falls in the elderly]. Rev Esp Geriatr Gerontol 2019; 54:238-240. [PMID: 30765115 DOI: 10.1016/j.regg.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Tatiana Rejón
- ABS Cirera Molins, Consorci Sanitari del Maresme, Mataró, Barcelona, España
| | - Mateu Serra-Prat
- Unidad de Investigación, Consorci Sanitari del Maresme, Mataró, Barcelona, España.
| | - Emili Burdoy
- ABS Mataró Centre, Consorci Sanitari del Maresme, Mataró, Barcelona, España
| | - Mateu Cabré
- Servicio de Medicina Interna, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, España
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Effects of the Application of a Program of Adapted Utilitarian Judo (JUA) on the Fear of Falling Syndrome (FOF) for the Health Sustainability of the Elderly Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112526. [PMID: 30424492 PMCID: PMC6265678 DOI: 10.3390/ijerph15112526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 10/30/2018] [Accepted: 11/09/2018] [Indexed: 01/23/2023]
Abstract
This research analyzes the fall history of a group of elderly people and studies the effects of an intervention program based on Adapted Utilitarian Judo (JUA) to teach fall control in subjects with fear of falling syndrome (FOF). We adopted a quasi-experimental research design with pre-post measurement of the experimental group, in a healthy, pre-fragile sample of 12 women aged 71.5 ± 8 years, chosen using non-probabilistic-incidental accessibility sampling. The WHO questionnaire was used for the functional assessment of the fall. To evaluate FOF, we applied the 16-item version of the Falls Efficacy Scale-International (FES-I), (pretest and posttest). This intervention program was based on Adapted Utilitarian Judo and conducted over 8 weeks, with two 60-minute sessions each week. After analyzing the scores obtained by the subjects in the pre and post FES-I, we found that the intervention with the JUA program had been significant for the experimental group with p ≤ 0.004, and there was an 11.9% decrease in the fear of falling (FES-I pos = 18.17). The results show that after the application of the JUA program there were significant improvements in subjects’ perception of FOF, with this being greater in those who had the highest levels of fear of falling before the intervention.
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Identification of Fall Risk Factors Through Self-report and Physical Performance. TOPICS IN GERIATRIC REHABILITATION 2018. [DOI: 10.1097/tgr.0000000000000194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bilik O, Damar HT, Karayurt O. Fall behaviors and risk factors among elderly patients with hip fractures. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Duval GT, Paré PY, Gautier J, Walrand S, Dinomais M, Annweiler C. Vitamin D and the Mechanisms, Circumstances and Consequences of Falls in Older Adults: A Case-Control Study. J Nutr Health Aging 2017; 21:1307-1313. [PMID: 29188894 DOI: 10.1007/s12603-016-0857-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine i) whether cases of elderly fallers had lower serum 25-hydroxyvitamin D (25OHD) concentration than controls without history of falls; and ii) whether serum 25OHD concentration was associated with specific mechanisms, circumstances and consequences of falls. DESIGN Case-control study with a 1:2 ratio. SETTING Geriatric ward of the University Hospital of Angers, France, between February 2012 and March 2014. PARTICIPANTS 216 inpatients (72 cases and 144 age- and gender-matched controls). MEASUREMENT Falls were defined as involuntary events causing the person to the ground or other lower level. The main mechanisms, circumstances and consequences of falls were identified using standardized questionnaires. Vitamin D deficiency was defined as serum 25OHD concentration ≤25nmol/L. Age, gender, body mass index, polypharmacy, use antihypertensive drugs, use psychoactive drugs, disability, cognitive performance, serum concentrations of parathyroid hormone, creatinine and albumin, and season of evaluation were used as potential confounders. RESULTS 216 participants (72 cases and 144 controls) were included in the study. There was no between-group difference in the prevalence of vitamin D deficiency (P=0.176). After adjusting for confounding factors, vitamin D deficiency was positively associated with falls (OR=4.03, P=0.014). Finally, the fallers with vitamin D deficiency exhibited more often orthostatic hypotension (68.8% against 33.3%, P=0.039) and a history of recurrent falls (85% against 50%, P=0.002) than those without vitamin D deficiency. CONCLUSION This case-control study reported that vitamin D deficiency was associated with falls in older inpatients. There was a greater prevalence of orthostatic hypotension and of the reccurrence of falls among fallers with vitamin D deficiency, suggesting that vitamin D may influence the conditions predisposing to falls rather than the fall by itself.
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Affiliation(s)
- G T Duval
- Cédric Annweiler, MD, PhD, Division of Geriatric Medicine, Angers University Hospital, F-49933 Angers Cedex 9, France; E-mail: ; Phone: ++33 2 41 35 54 86; Fax: ++33 2 41 35 48 94
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Hou WH, Kang CM, Ho MH, Kuo JMC, Chen HL, Chang WY. Evaluation of an inpatient fall risk screening tool to identify the most critical fall risk factors in inpatients. J Clin Nurs 2016; 26:698-706. [PMID: 27533486 DOI: 10.1111/jocn.13510] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients. BACKGROUND Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high-risk inpatients. DESIGN Secondary data analysis. METHODS A subset of inpatient data for the period from June 2011-June 2014 was extracted from the nursing information system and adverse event reporting system of an 818-bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis. RESULTS During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut-off point of ≥3) had a low sensitivity level (60%), satisfactory specificity (87%), a positive predictive value of 2·0% and a negative predictive value of 99%. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8%; specificity, 78%). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut-off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards. CONCLUSIONS The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions. RELEVANCE TO CLINICAL PRACTICE This study highlights the needs for redefining the cut-off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely monitored by nurses to prevent falling during hospitalisations.
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Affiliation(s)
- Wen-Hsuan Hou
- College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chun-Mei Kang
- Nursing Department, Cathay General Hospital, Taipei, Taiwan.,School of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Mu-Hsing Ho
- College of Nursing, Taipei Medical University, Taipei, Taiwan
| | | | | | - Wen-Yin Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Relationship between the FRAX ® score and falls in community-dwelling middle-aged and elderly people. Osteoporos Sarcopenia 2016; 2:221-227. [PMID: 30775490 PMCID: PMC6372775 DOI: 10.1016/j.afos.2016.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 10/23/2016] [Accepted: 10/25/2016] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Falls is a risk factor for fracture. The FRAX® predicts fractures. Whether the FRAX® is associated with fall in both gender is inconclusive. The aim of our study is to evaluate the association between FRAX scores and falls. METHODS The cross-sectional study set from 2009 to 2010 included 1200 community-dwelling people who were systematically sampled in central Taiwan. The 1200 participants (men: 524; women: 676; ≥40 years old) completed questionnaires about socioeconomic status; lifestyle; medical and fall history were completed. FRAX scores with and without bone mineral density (BMD) were calculated by using the Taiwan calculator. RESULTS A total of 19.8% participants fell down. Binary regression models showed that diabetes mellitus history (OR: 1.61; 95% CI: 1.03-2.52), the FRAX without BMD in a continuous major score (OR: 1.06; 95% CI: 1.03-1.09), continuous hip score (OR: 1.11; 95% CI: 1.05-1.16), categorical major score ≥ 10% (OR: 1.81; 95% CI: 1.25-2.61), and categorical hip score ≥ 3% (OR: 1.80; 95% CI: 1.30-2.50) were independent risk factors for falls. FRAX with BMD in a continuous major score (OR: 1.04; 95% CI: 1.02-1.06), continuous hip score (OR: 1.06; 95% CI: 1.02-1.09), categorical major score ≥ 10% (OR: 1.52; 95% CI: 1.09-2.12), and categorical hip score ≥ 3% (OR: 1.53; 95% CI: 1.13-2.09) were also independent risk factors. CONCLUSIONS We concluded that FRAX® scores with and without BMD were unanimously correlated with falls in community-dwelling middle-aged and elderly males and females.
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Montero-Alía P, Muñoz-Ortiz L, Jiménez-González M, Benedicto-Pañell C, Altimir-Losada S, López-Colomer Y, Prat-Rovira J, Amargant-Rubio JF, Jastes SM, Moreno-Buitrago A, Rodríguez-Pérez MC, Teixidó-Vargas C, Albarrán-Sánchez JL, Candel-Gil A, Serra-Serra D, Martí-Cervantes JJ, Sánchez-Pérez CA, Sañudo-Blanco L, Dolader-Olivé S, Torán-Monserrat P. Study protocol of a randomized clinical trial evaluating the effectiveness of a primary care intervention using the Nintendo™ Wii console to improve balance and decrease falls in the elderly. BMC Geriatr 2016; 16:8. [PMID: 26796956 PMCID: PMC4722618 DOI: 10.1186/s12877-015-0178-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/23/2015] [Indexed: 11/18/2022] Open
Abstract
Background Balance alteration is a risk factor for falls in elderly individuals that has physical, psychological and economic consequences. The objectives of this study are to evaluate the usefulness of an intervention utilizing the Nintendo™ Wii console in order to improve balance, thereby decreasing both the fear of falling as well as the number of falls, and to evaluate the correlation between balance as determined by the console and the value obtained in the Tinetti tests and the one foot stationary test. Methods/Design This is a controlled, randomized clinical trial of individual assignment, carried out on patients over 70 years in age, from five primary care centers in the city of Mataró (Barcelona). 380 patients were necessary for the intervention group that carried out the balance board exercises in 2 sessions per week for a 3 month period, and 380 patients in the control group who carried out their usual habits. Balance was evaluated using the Tinetti test, the one foot stationary test and with the console, at the start of the study, at the end of the intervention (3 months) and one year later. Quarterly telephone follow-up was also conducted to keep track of falls and their consequences. Discussion The study aimed to connect the community with a technology that may be an easy and fun way to assist the elderly in improving their balance without the need to leave home or join rehabilitation groups, offering greater comfort for this population and decreasing healthcare costs since there is no need for specialized personnel. Trial registration Current Control Trial NCT02570178.
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Affiliation(s)
- Pilar Montero-Alía
- Primary Healthcare Research Support Unit Metropolitana Nord, Institute of Primary Care Research (IDIAP) Jordi Gol, Calle Major 49-53, 08921, Santa Coloma de Gramenet, Spain. .,Primary Healthcare Centre Riera (Mataró 1), Catalan Health Institute, Calle Ronda Prim 35, 08302, Mataró, Spain.
| | - Laura Muñoz-Ortiz
- Primary Healthcare Research Support Unit Metropolitana Nord, Institute of Primary Care Research (IDIAP) Jordi Gol, Calle Major 49-53, 08921, Santa Coloma de Gramenet, Spain.
| | - Mercè Jiménez-González
- Primary Healthcare Centre Riera (Mataró 1), Catalan Health Institute, Calle Ronda Prim 35, 08302, Mataró, Spain.
| | - Carla Benedicto-Pañell
- Primary Healthcare Centre Rocafonda (Mataró 3), Catalan Health Institute, Ronda Pintor Rafael Estrany 24, 08320, Mataró, Spain.
| | - Salvador Altimir-Losada
- Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain.
| | - Yolanda López-Colomer
- Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain.
| | - Josep Prat-Rovira
- Residència de Gent Gran del Institut Català d'Assistència i Serveis Socials (ICASS), Gatassa 43, 08303, Mataró, Spain.
| | - Joan Francesc Amargant-Rubio
- Primary Healthcare Centre Gatassa (Radiologia), Catalan Health Institute, Camí del Mig 36, 08303, Mataró, Spain.
| | - Sheila Mendes Jastes
- Primary Healthcare Centre El Masnou, Catalan Health Institute, Calle de Sant Miquel 125, 08320, El Masnou, Spain.
| | - Ana Moreno-Buitrago
- Faculty of Economics and Business, University of Barcelona, Avenida Diagonal 690, 08034, Barcelona, Spain.
| | - M Carmen Rodríguez-Pérez
- Primary Healthcare Centre Riera (Mataró 1), Catalan Health Institute, Calle Ronda Prim 35, 08302, Mataró, Spain.
| | - Cristina Teixidó-Vargas
- Primary Healthcare Centre Ronda Cerdanya (Mataró 5), Catalan Health Institute, Calle del Vallès 37, 08304, Mataró, Spain.
| | - José Luís Albarrán-Sánchez
- Primary Healthcare Centre El Masnou, Catalan Health Institute, Calle de Sant Miquel 125, 08320, El Masnou, Spain.
| | - Anna Candel-Gil
- Primary Healthcare Centre Riera (Mataró 1), Catalan Health Institute, Calle Ronda Prim 35, 08302, Mataró, Spain.
| | - Domènec Serra-Serra
- Primary Healthcare Centre Riera (Mataró 1), Catalan Health Institute, Calle Ronda Prim 35, 08302, Mataró, Spain.
| | - Juan José Martí-Cervantes
- Primary Healthcare Centre Riera (Mataró 1), Catalan Health Institute, Calle Ronda Prim 35, 08302, Mataró, Spain.
| | - Carlos Andrés Sánchez-Pérez
- Primary Healthcare Centre Riera (Mataró 1), Catalan Health Institute, Calle Ronda Prim 35, 08302, Mataró, Spain.
| | - Lidia Sañudo-Blanco
- Primary Healthcare Centre Riera (Mataró 1), Catalan Health Institute, Calle Ronda Prim 35, 08302, Mataró, Spain.
| | - Sònia Dolader-Olivé
- Primary Healthcare Centre Riera (Mataró 1), Catalan Health Institute, Calle Ronda Prim 35, 08302, Mataró, Spain.
| | - Pere Torán-Monserrat
- Primary Healthcare Research Support Unit Metropolitana Nord, Institute of Primary Care Research (IDIAP) Jordi Gol, Calle Major 49-53, 08921, Santa Coloma de Gramenet, Spain.
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