1
|
Leoste J, Strömberg-Järvis K, Robal T, Marmor K, Kangur K, Rebane AM. Testing scenarios for using telepresence robots in healthcare settings. Comput Struct Biotechnol J 2024; 24:105-114. [PMID: 38314026 PMCID: PMC10837455 DOI: 10.1016/j.csbj.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 02/06/2024] Open
Abstract
The ageing global population puts heavy pressure on healthcare systems everywhere. Addressing ageing-related chronic conditions requires employment of novel innovative solutions. Telehealth technologies, including telepresence robots (TPRs), are being rapidly developed to provide healthcare services efficiently wherever needed. This article explores the role of TPRs in addressing the challenges of providing healthcare to an ageing population, emphasizing their potential advantages and drawbacks. Employing an exploratory research approach with qualitative data collection techniques, we tested three TPR usage scenarios in simulated healthcare settings: anamnesis, measurements, and falls and frailty. The study employed a non-random purposive sample comprising 25 participants, and was conducted at a medical facility in June 2023. The findings suggest that TPRs offer promising solutions for healthcare professionals and patients, especially in scenarios when physical presence is impossible or physical isolation is required to prevent contagion. However, the technology is not yet ready to substitute fully human medical workers, potentially causing patient reluctance and emphasizing the need for patient-centered approaches to technology adoption. In addition, more studies are needed to address ethical, privacy, and scalability concerns.
Collapse
Affiliation(s)
- Janika Leoste
- Tallinn University, Narva rd 25, 10120 Tallinn, Estonia
- Tallinn University of Technology, Ehitajate tee 5, 19086 Tallinn, Estonia
| | | | - Tarmo Robal
- Tallinn University of Technology, Ehitajate tee 5, 19086 Tallinn, Estonia
| | - Kristel Marmor
- Tallinn University of Technology, Ehitajate tee 5, 19086 Tallinn, Estonia
| | - Katrin Kangur
- Tallinn University of Technology, Ehitajate tee 5, 19086 Tallinn, Estonia
| | | |
Collapse
|
2
|
Vitamin D and Parkinson's Disease. Nutrients 2022; 14:nu14061220. [PMID: 35334877 PMCID: PMC8953648 DOI: 10.3390/nu14061220] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023] Open
Abstract
Vitamin D is a fat-soluble secosteroid, traditionally considered a key regulator of bone metabolism, calcium and phosphorous homeostasis. Its action is made possible through the binding to the vitamin D receptor (VDR), after which it directly and indirectly modulates the expression of thousands of genes. Vitamin D is important for brain development, mature brain activity and associated with many neurological diseases, including Parkinson’s disease (PD). High frequency of vitamin D deficiency in patients with Parkinson’s disease compared to control population was noted nearly twenty years ago. This finding is of interest given vitamin D’s neuroprotective effect, exerted by the action of neurotrophic factors, regulation of nerve growth or through protection against cytotoxicity. Vitamin D deficiency seems to be related to disease severity and disease progression, evaluated by Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn and Yahr (H&Y) scale, but not with age of PD onset and duration of disease. Additionally, fall risk has been associated with lower vitamin D levels in PD. However, while the association between vitamin D and motor-symptoms seems to be possible, results of studies investigating the association with non-motor symptoms are conflicting. In addition, very little evidence exists regarding the possibility to use vitamin D supplementation to reduce clinical manifestations and disability in patients with PD. However, considering the positive balance between potential benefits against its limited risks, vitamin D supplementation for PD patients will probably be considered in the near future, if further confirmed in clinical studies.
Collapse
|
3
|
Liu X, Zhu X, Song Y. Retrospective analysis and nursing management of inpatient falls: Case series. Medicine (Baltimore) 2021; 100:e27977. [PMID: 34964790 PMCID: PMC8615295 DOI: 10.1097/md.0000000000027977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/30/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Falls are common adverse events: approximately 1 million falls occur in hospitals annually, accounting for approximately 70% of inpatient accidents. OBJECTIVES This study aimed to identify the characteristics of adverse fall events in our hospital from January 2019 to October 2021; it also had the goal of formulating nursing management countermeasures to reduce the occurrence of falls in our hospital. Identify the impact of formulated fall prevention and Group standards. METHODS Details of falls were obtained from the nursing adverse event reporting system of the Affiliated Hospital of Nantong University from January 2019 to December 2020. We analyzed 76 falls reported to the nursing department using a nonpunitive reporting system. We established fall prevention and Group standards. And compared with falls from March to October 2021. RESULTS In the study period, before the intervention, 76 falls occurred in the hospital: 18 in the day shift and 58 in the night shift. Among the falls, 32 (42.1%) occurred at the bedside; that figure was followed by 26 in the toilet (34.2%) and 18 in other places outside the ward (23.7%). The top 3 causes of the falls accounted for 84.2% of the cases: 14 were caused by nurses; 20 were caused by the patients themselves; and 30 cases were caused by concomitant factors. Regarding the consequences of the falls, 18 patients were uninjured, 22 had a mild injury, 12 were moderately injured, and 24 suffered severe injuries. After the intervention, there were fewer falls per patient day and when patients were less likely to be injured in a fall (P < .05). CONCLUSIONS Enhancing awareness of factors that lead to inpatients falls may reduce the risk of concomitant injuries. Group standards should be established to prevent falls. In accordance with standards, it is necessary to consider health education and process supervision; it is also important to encourage inpatients to participate in safety management and to effectively ensure the safety of patients.
Collapse
Affiliation(s)
- Xiaoyan Liu
- Geriatric Department, Affiliated Hospital of Nantong University, Medical School, Nantong University, Nantong, Jiangsu, China
| | - Xiaoling Zhu
- Clinical Medicine Department, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Yan Song
- Medical School, Nantong University, Nantong, Jiangsu, China
| |
Collapse
|
4
|
Lee S, Chung JH, Kim JH. Association Between Sleep Quality and Falls: A Nationwide Population-Based Study from South Korea. Int J Gen Med 2021; 14:7423-7433. [PMID: 34744453 PMCID: PMC8566001 DOI: 10.2147/ijgm.s331103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/05/2021] [Indexed: 01/06/2023] Open
Abstract
Purpose There are few large studies evaluating the association between sleep quality and the risk of falls. We aimed to determine the independent effect of poor sleep quality on an increased risk of falls using a large-sample dataset. Methods We conducted a retrospective, cross-sectional study using population-based data from the 2018 Korean Community Health Survey on 201,700 participants. Sociodemographic, mental health-related, and physical health-related variables as well as sleep quality evaluated by the Pittsburgh Sleep Quality Index (PSQI) were compared between 2499 fallers who have experienced at least one fall during the past 12 months and 199,201 non-fallers. Multivariable logistic regression was performed to identify sleep quality variables significantly associated with an increased risk of falls. Results Fallers had poorer sleep quality (PSQI score >5) and higher scores for global PSQI and individual PSQI components than did non-fallers (all p < 0.001). Multivariable logistic regression adjusted for potential confounders including socioeconomic, physical health-related, and mental health-related variables showed that an increased risk of falls was associated with poor sleep quality (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.19–1.42). Subgroup analyses by age revealed that poor sleep quality was significantly associated with an increased risk of falls in all three adult age groups. Multivariable logistic regression using the seven PSQI components revealed that an increased risk of falls was associated with short sleep duration (OR 1.14, CI 1.09–1.20), increased sleep disturbances (OR 1.30, CI 1.16–1.46), and increased daytime dysfunctions (OR 1.21, CI 1.08–1.13). Conclusion Poor sleep quality caused by short sleep duration may be a principal risk factor of falls in adult populations. Increased sleep disturbances and daytime dysfunctions may also contribute to an increased risk of falls. Our results have clinical and public health perspectives that increasing sleep duration and reducing daytime dysfunctions and sleep disturbances could mitigate unintentional falls.
Collapse
Affiliation(s)
- Sujin Lee
- Department of Neurology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Jae Ho Chung
- Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Ji Hyun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
5
|
Hospital Inpatient Falls across Clinical Departments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158167. [PMID: 34360462 PMCID: PMC8346045 DOI: 10.3390/ijerph18158167] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 12/03/2022]
Abstract
Background: Inpatient falls are common hospital adverse events. We aimed to determine inpatient fall rates in an urban public hospital and analyzed their characteristics across clinical departments. Methods: The study was conducted in a 350-bed urban, multi-specialty public hospital in the 2013–2019 period. Patient data were retrieved from the hospital’s standardized falls reporting system. Descriptive statistics and statistical tests: chi2 and ANOVA tests with multiple comparison tests (post-hoc analysis) were used. For fall incidence estimation a joint-point regression was applied. p-value of 0.05 was considered as statistically significant for all the calculations. Results: The highest prevalence of falls was reported in the rehabilitation and internal medicine wards (1.915% and 1.181%, respectively), the lowest in the orthopedic (0.145%) and rheumatology wards (0.213%) (p < 0.001). The vast majority of falls took place in the late evening and during the night (56.711%) and were classified as bed falls (55.858%). The crude incidence rate (cIR) of falls was 6.484 per one thousand hospitalizations. In the 2013–2017 period, an increase in total cIR was observed, reaching the peak value in 2016; it was followed by a slight decline from 2017 to 2019, however, differences in changes were observed between the wards. Conclusion: Fall rates and trends as well as circumstances of inpatient falls varied significantly among clinical departments, probably due to differences in patient characteristics.
Collapse
|
6
|
Liu J, Wong ZSY, So HY, Tsui KL. Evaluating resampling methods and structured features to improve fall incident report identification by the severity level. J Am Med Inform Assoc 2021; 28:1756-1764. [PMID: 34010385 DOI: 10.1093/jamia/ocab048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/24/2021] [Accepted: 04/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study aims to improve the classification of the fall incident severity level by considering data imbalance issues and structured features through machine learning. MATERIALS AND METHODS We present an incident report classification (IRC) framework to classify the in-hospital fall incident severity level by addressing the imbalanced class problem and incorporating structured attributes. After text preprocessing, bag-of-words features, structured text features, and structured clinical features were extracted from the reports. Next, resampling techniques were incorporated into the training process. Machine learning algorithms were used to build classification models. IRC systems were trained, validated, and tested using a repeated and randomly stratified shuffle-split cross-validation method. Finally, we evaluated the system performance using the F1-measure, precision, and recall over 15 stratified test sets. RESULTS The experimental results demonstrated that the classification system setting considering both data imbalance issues and structured features outperformed the other system settings (with a mean macro-averaged F1-measure of 0.733). Considering the structured features and resampling techniques, this classification system setting significantly improved the mean F1-measure for the rare class by 30.88% (P value < .001) and the mean macro-averaged F1-measure by 8.26% from the baseline system setting (P value < .001). In general, the classification system employing the random forest algorithm and random oversampling method outperformed the others. CONCLUSIONS Structured features provide essential information for categorizing the fall incident severity level. Resampling methods help rebalance the class distribution of the original incident report data, which improves the performance of machine learning models. The IRC framework presented in this study effectively automates the identification of fall incident reports by the severity level.
Collapse
Affiliation(s)
- Jiaxing Liu
- School of Statistics and Mathematics, Zhongnan University of Economics and Law, Wuhan, China.,School of Data Science, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Zoie S Y Wong
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - H Y So
- Alice Ho Miu Ling Nethersole Hospital, New Territories, Hong Kong SAR, China
| | - Kwok Leung Tsui
- School of Data Science, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| |
Collapse
|
7
|
Maitre J, Bouchard K, Gaboury S. Fall Detection With UWB Radars and CNN-LSTM Architecture. IEEE J Biomed Health Inform 2021; 25:1273-1283. [PMID: 33017299 DOI: 10.1109/jbhi.2020.3027967] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fall detection is a major challenge for researchers. Indeed, a fall can cause injuries such as femoral neck fracture, brain hemorrhage, or skin burns, leading to significant pain. However, in some cases, trauma caused by an undetected fall can get worse with the time and conducts to painful end of life or even death. One solution is to detect falls efficiently to alert somebody (e.g., nurses) as quickly as possible. To respond to this need, we propose to detect falls in a real apartment of 40 square meters by exploiting three ultra-wideband radars and a deep neural network model. The deep neural network is composed of a convolutional neural network stacked with a long-short term memory network and a fully connected neural network to identify falls. In other words, the problem addressed in this paper is a binary classification attempting to differentiate fall and non-fall events. As it can be noticed in real cases, the falls can have different forms. Hence, the data to train and test the classification model have been generated with falls (four types) simulated by 10 participants in three locations in the apartment. Finally, the train and test stages have been achieved according to three strategies, including the leave-one-subject-out method. This latter method allows for obtaining the performances of the proposed system in a generalization context. The results are very promising since we reach almost 90% of accuracy.
Collapse
|
8
|
Bartosch PS, Kristensson J, McGuigan FE, Akesson KE. Frailty and prediction of recurrent falls over 10 years in a community cohort of 75-year-old women. Aging Clin Exp Res 2020; 32:2241-2250. [PMID: 31939201 PMCID: PMC7591409 DOI: 10.1007/s40520-019-01467-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/24/2019] [Indexed: 12/20/2022]
Abstract
Background Frailty captures the age-related declines in health leading to increased vulnerability, including falls which are commonplace in older women. The relationship between frailty and falls is complex, with one leading to the other in a vicious cycle. Aims This study addresses the gap in understanding how patterns of frailty and falls propensity interact, particularly in those who have not yet entered the falls-frailty cycle. Methods The Osteoporosis Risk Assessment cohort consists of 1044 community-dwelling women aged 75, with 10 years of follow-up. Investigations were performed and a frailty index constructed at baseline, 5 and 10 years. Falls were self-reported for each previous 12 months. Analysis was two-directional, firstly based on frailty status and second, based on falls status. Recurrent falls was the primary outcome. Results Baseline frailty was a significant predictor of recurrent falls after 5 and 10 years [(OR 2.55 (1.62–3.99); 3.04 (1.63–5.67)]. Among women who had no history of falls at age 75, frailty was a stronger predictor of falls at 5 years [OR 3.06 (1.59–5.89)] than among women who had previously fallen. Discussion Frailty is significantly associated with recurrent falls and most pronounced in those who are frail but have not yet fallen. Conclusions This suggests that frailty should be an integral part of falls-risk assessment to improve identification of those at risk of becoming fallers. Electronic supplementary material The online version of this article (10.1007/s40520-019-01467-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Patrik S Bartosch
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, IM Nilssonsgata 22, 205 02, Malmö, Sweden
| | | | - Fiona E McGuigan
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, IM Nilssonsgata 22, 205 02, Malmö, Sweden
| | - Kristina E Akesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
- Department of Orthopaedics, Skåne University Hospital, IM Nilssonsgata 22, 205 02, Malmö, Sweden.
| |
Collapse
|
9
|
Wogalter MS. Forensic human factors and ergonomics analysis of a trip and fall event in a parking lot. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2020. [DOI: 10.1080/1463922x.2019.1706124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Michael S. Wogalter
- Department of Psychology, North Carolina State University , Raleigh , NC , USA
| |
Collapse
|
10
|
Kobayashi K, Imagama S, Inagaki Y, Suzuki Y, Ando K, Nishida Y, Nagao Y, Ishiguro N. Incidence and characteristics of accidental falls in hospitalizations. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 79:291-298. [PMID: 28878434 PMCID: PMC5577015 DOI: 10.18999/nagjms.79.3.291] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aging of the patient population has led to increased occurrence of accidental falls in acute care settings. The aim of this study is to survey the annual occurrence of falls in a university hospital, and to examine procedures to prevent fall. A total of 49,059 inpatients were admitted to our hospital from April 2015 to March 2016. A fall assessment scale was developed to estimate the risk of fall at admission. Data on falls were obtained from the hospital incident reporting system. There were fall-related incidents in 826 patients (1.7%). Most falls occurred in hospital rooms (67%). Adverse events occurred in 101 patients who fell (12%) and were significantly more frequent in patients aged ≥80 years old and in those wearing slippers. The incidence of falls was also significantly higher in patients in the highest risk group. These results support the validity of the risk assessment scale for predicting accidental falls in an acute treatment setting. The findings also clarify the demographic and environmental factors and consequences associated with fall. These results of the study could provide important information for designing effective interventions to prevent fall in elderly patients.
Collapse
Affiliation(s)
- Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine
| | - Yuko Inagaki
- Department of Quality and Patient Safety, Nagoya University Hospital
| | - Yusuke Suzuki
- Centre for Community Liaison and Patient Consultations, Nagoya University Hospital
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine
| | - Yoshihiro Nishida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine
| | - Yoshimasa Nagao
- Department of Quality and Patient Safety, Nagoya University Hospital
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine
| |
Collapse
|
11
|
Kobayashi K, Ando K, Inagaki Y, Suzuki Y, Nagao Y, Ishiguro N, Imagama S. Characteristics of falls in orthopedic patients during hospitalization. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 80:341-349. [PMID: 30214083 PMCID: PMC6125663 DOI: 10.18999/nagjms.80.3.341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/15/2018] [Indexed: 11/30/2022]
Abstract
Falls are common in elderly patients and comprise 20-30% of all incident reports in hospitals. The current study examined falls in orthopedic patients among 212,617 inpatients admitted to our hospital from April 2012 to March 2017, using a prospective database in the hospital event reporting system. The risk of fall was evaluated using a fall assessment scoresheet at admission and during hospitalization, based on which patients were divided into risk grades 1, 2 and 3. Fall leading to fracture or a life-threatening injury was defined as an adverse event. The number of falls during the study period was 3,925, including 230 in orthopedic patients. Fall cases occurred at all times, but adverse events were significantly more common from 1-7 a.m. (67% vs. 24%, p<0.01). Patients hospitalized for orthopedic surgery had significantly higher fall rates compared to all other patients (3.12% vs. 1.80%, p<0.01), and were older (65.8 vs. 61.4 years, p<0.05) and more frequently >80 years old (23.4% vs. 17.9%, p<0.05). There was a significant difference in fall incidence between risk grades 2 and 3 for patients hospitalized for non-orthopedic surgery, but not for patients hospitalized for orthopedic surgery. We conclude that fall can occur in orthopedic patients with a low predicted risk of fall, and particularly for older patients. This may indicate that frequent specialized fall assessment is desirable after orthopedic surgery.
Collapse
Affiliation(s)
- Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuko Inagaki
- Department of Quality and Patient Safety, Nagoya University Hospital, Nagoya, Japan
| | - Yusuke Suzuki
- Centre for Community Liaison and Patient Consultations, Nagoya University Hospital, Nagoya, Japan
| | - Yoshimasa Nagao
- Department of Quality and Patient Safety, Nagoya University Hospital, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
12
|
Kimura A, Takeshita K, Inoue H, Seichi A, Kawasaki Y, Yoshii T, Inose H, Furuya T, Takeuchi K, Matsunaga S, Seki S, Tsushima M, Imagama S, Koda M, Yamazaki M, Mori K, Nishimura H, Endo K, Yamada K, Sato K, Okawa A. The 25-question Geriatric Locomotive Function Scale predicts the risk of recurrent falls in postoperative patients with cervical myelopathy. J Orthop Sci 2018; 23:185-189. [PMID: 29100824 DOI: 10.1016/j.jos.2017.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Fall-induced injuries represent a major public health concern for older individuals. The relationship between risk of falling and the severity of locomotive syndrome (LS) remains largely unknown. METHODS We conducted a retrospective analysis of patients who had undergone surgery from January 2012 to December 2013 and completed at least 1 year of follow-up at 12 participating institutes. Patients completed a questionnaire survey regarding their fall experience during a routine postoperative follow-up. Questionnaire items included the number of falls during the prior postoperative year and the 25-question Geriatric Locomotive Function Scale (GLFS-25). The severity of cervical myelopathy was assessed using the Japanese Orthopaedic Association (JOA) score. We analyzed the association between the incidence of falling and the severity of LS measured by the GLFS-25. RESULTS Of 360 patients, 61 (16.9%) experienced 1 fall; 31 (8.6%), 2-3 falls; 4 (1.1%), 4-5 falls; and 6 (1.7%), ≥6 falls during the first postoperative year. Thus, 102 (28%) patients experienced at least 1 fall, and 41 (11%) experienced recurrent falls (2 or more falls) during the time period. The mean GLFS-25 score was 30.2 ± 22.7, and 242 (62%) patients had GLFS-25 scores of 16 or higher, which fulfilled the diagnostic criteria for LS. When subjects were categorized into recurrent fallers and non-recurrent fallers, recurrent fallers had a significantly higher GLFS-25 score and a significantly lower extremity motor function score of the JOA score than non-recurrent fallers. The GLFS-25 and lower extremity motor function score of the JOA score yielded the areas under the receiver operating characteristic curves of 0.674 and 0.607, respectively, to differentiate recurrent fallers from non-recurrent fallers. CONCLUSION Postoperative patients with cervical myelopathy had a 62% prevalence of LS. The GLFS-25 may be useful to predict the risk of recurrent falls in patients with cervical myelopathy.
Collapse
Affiliation(s)
- Atsushi Kimura
- Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Katsushi Takeshita
- Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hirokazu Inoue
- Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Atsushi Seichi
- Department of Orthopedic Surgery, Mitsui Memorial Hospital, 1 Izumicho-kanda, Chiyodaku, Tokyo, 101-8643, Japan
| | - Yosuke Kawasaki
- Department of Orthopedic Surgery, Mitsui Memorial Hospital, 1 Izumicho-kanda, Chiyodaku, Tokyo, 101-8643, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hiroyuki Inose
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takeo Furuya
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-0856, Japan
| | - Kazuhiro Takeuchi
- Department of Orthopedic Surgery, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Okayama, Okayama, 701-1154, Japan
| | - Shunji Matsunaga
- Department of Orthopedic Surgery, Imakiire General Hospital, 4-16 Shimotatsuo, Kagoshima, 892-8502, Japan
| | - Shoji Seki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Mikito Tsushima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi, 466-0065, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi, 466-0065, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Kanji Mori
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Kei Yamada
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Asahi-machi 67, Kurume, Japan
| | - Kimiaki Sato
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Asahi-machi 67, Kurume, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| |
Collapse
|
13
|
Kobayashi K, Ando K, Inagaki Y, Suzuki Y, Nagao Y, Ishiguro N, Imagama S. Measures and effects on prevention of fall: the role of a fall working group at a university hospital. NAGOYA JOURNAL OF MEDICAL SCIENCE 2017; 79:497-504. [PMID: 29238106 PMCID: PMC5719209 DOI: 10.18999/nagjms.79.4.497] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/28/2017] [Indexed: 11/30/2022]
Abstract
Fall in hospitalized patients can cause trauma and fractures, which can reduce ADL and QOL, whereas prevention of fall decreases medical expenses. The purpose of this study is to examine prevention of fall due to intervention from a fall working group established in our hospital. The working group focused on three main points. First, colored wrist bands for patients classified as grade 3 risk for fall are used to alert medical staff. Second, information on fall prevention was distributed to patients. Third, standardization of two bed fences and reduced use of slippers for inpatients have been introduced. We investigated falls during hospitalization for 5 years from April 2012 to March 2017. The risk of fall was evaluated as grade 1 (mild) to grade 3 (severe) using an assessment sheet developed by the working group. The incidence of fall decreased over time, with a significant decrease from 2.1% in 2012 to 1.3% in 2016 (p<0.01). Slipper use in fall cases showed a significant decrease from 45.8% in 2012 to 11.0% in 2016 (p<0.01). Among all falls, the percentage of cases with fall risks grade 1 and 2 decreased, while that for grade 3 risk increased from 32.0% in 2012 to 40.3% in 2016 (p<0.05). These results support the efforts of the fall working group have reduced the overall incidence of fall. However, fall in patients with grade 3 risk has not decreased, which suggests that better sharing of information is needed for patients at high risk for fall.
Collapse
Affiliation(s)
- Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuko Inagaki
- Department of Quality and Patient Safety, Nagoya University Hospital, Nagoya, Japan
| | - Yusuke Suzuki
- Centre for Community Liaison and Patient Consultations, Nagoya University Hospital, Nagoya, Japan
| | - Yoshimasa Nagao
- Department of Quality and Patient Safety, Nagoya University Hospital, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
14
|
Kobayashi K, Imagama S, Ando K, Inagaki Y, Suzuki Y, Nishida Y, Nagao Y, Ishiguro N. Analysis of falls that caused serious events in hospitalized patients. Geriatr Gerontol Int 2017; 17:2403-2406. [PMID: 28656702 DOI: 10.1111/ggi.13085] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/29/2017] [Indexed: 11/30/2022]
Abstract
AIM Falls are common adverse events for hospitalized elderly patients that can cause fracture, which decreases activities of daily living, and other injuries that can be fatal. The purpose of the present study was to investigate serious events due to fall, and to consider measures for fall prevention. METHODS Incidents of fall were obtained from a database of 163 558 inpatients at Nagoya University Hospital, Nagoya, Aichi, Japan, from April 2012 to March 2016. The risk of fall was evaluated using a fall assessment score sheet at admission and during hospitalization, based on which patients were divided into risk grades 1, 2 and 3. A fall that led to fracture or a life-threatening injury was defined as a serious event. RESULTS Fall occurred in 3099 patients for 4 years (1.89%). Most patients that fell (45%) were in the highest (grade 3) risk category. Serious events associated with fall occurred in 36 of the 3099 patients (1.2%), and the overall incidence of serious events was 0.22%. These events included fracture in 24 patients, intracranial injury in 10 patients and others in two patients. Finally, one patient died. Serious events occurred significantly more frequently after falls in patients wearing slippers compared with other footwear (P < 0.01). The incidences of serious events and fall were significantly higher in patients with a higher risk of fall (P < 0.05). CONCLUSIONS The present results support the validity of our risk assessment scale for fall, but it should be recognized that fall can also occur in a patient with a low predicted risk of fall. Geriatr Gerontol Int 2017; 17: 2403-2406.
Collapse
Affiliation(s)
- Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuko Inagaki
- Department of Quality and Patient Safety, Nagoya University Hospital, Nagoya, Japan
| | - Yusuke Suzuki
- Center for Community Liaison and Patient Consultations, Nagoya University Hospital, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshimasa Nagao
- Department of Quality and Patient Safety, Nagoya University Hospital, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
15
|
Nilsson M, Eriksson J, Larsson B, Odén A, Johansson H, Lorentzon M. Fall Risk Assessment Predicts Fall-Related Injury, Hip Fracture, and Head Injury in Older Adults. J Am Geriatr Soc 2016; 64:2242-2250. [PMID: 27689675 DOI: 10.1111/jgs.14439] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate the role of a fall risk assessment, using the Downton Fall Risk Index (DFRI), in predicting fall-related injury, fall-related head injury and hip fracture, and death, in a large cohort of older women and men residing in Sweden. DESIGN Cross sectional observational study. SETTING Sweden. PARTICIPANTS Older adults (mean age 82.4 ± 7.8) who had a fall risk assessment using the DFRI at baseline (N = 128,596). MEASUREMENTS Information on all fall-related injuries, all fall-related head injuries and hip fractures, and all-cause mortality was collected from the Swedish Patient Register and Cause of Death Register. The predictive role of DFRI was calculated using Poisson regression models with age, sex, height, weight, and comorbidities as covariates, taking time to outcome or end of study into account. RESULTS During a median follow-up of 253 days (interquartile range 90-402 days) (>80,000 patient-years), 15,299 participants had a fall-related injury, 2,864 a head injury, and 2,557 a hip fracture, and 23,307 died. High fall risk (DFRI ≥3) independently predicted fall-related injury (hazard ratio (HR) = 1.43, 95% confidence interval (CI) = 1.39-1.49), hip fracture (HR = 1.51, 95% CI =1.38-1.66), head injury (HR = 1.12, 95% CI = 1.03-1.22), and all-cause mortality (HR = 1.39, 95% CI = 1.35-1.43). DFRI more strongly predicted head injury (HR = 1.29, 95% CI = 1.21-1.36 vs HR = 1.08, 95% CI = 1.04-1.11) and hip fracture (HR = 1.41, 95% CI = 1.30-1.53 vs HR = 1.08, 95% CI = 1.05-1.11) in 70-year old men than in 90-year old women (P < .001). CONCLUSION Fall risk assessment using DFRI independently predicts fall-related injury, fall-related head injury and hip fracture, and all-cause mortality in older men and women, indicating its clinical usefulness to identify individuals who would benefit from interventions.
Collapse
Affiliation(s)
- Martin Nilsson
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Centre for Bone and Arthritis Research, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Joel Eriksson
- Centre for Bone and Arthritis Research, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Berit Larsson
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anders Odén
- Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Helena Johansson
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Institute for Health and Ageing, Catholic University of Australia, Melbourne, Victoria, Australia
| | - Mattias Lorentzon
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Centre for Bone and Arthritis Research, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
16
|
Abreu N, Hutchins J, Matson J, Polizzi N, Seymour CJ. Effect of Group Versus Home Visit Safety Education and Prevention Strategies for Falling in Community-Dwelling Elderly Persons. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2016. [DOI: 10.1177/089780189801000413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This research study explored the effectiveness of group versus home education in teaching fall prevention to community-dwelling elderly. Twelve elderly volunteered to participate. Group 1 received an inservice instructing them in prevention strategies. Group 2 received individual home visits for the same purpose. All subjects received follow-up home visits to assess modifications and fall occurrence. Statistical analysis showed no significant difference between the two groups at follow-up or within Group 2 initially or at follow-up. Further research is needed to explore more effective teaching strategies to emphasize the importance of prevention and affect modification of the home environment.
Collapse
|
17
|
Taylor K, Reginatto B, Patterson MR, Power D, Komaba Y, Maeda K, Inomata A, Caulfield B. Context focused older adult mobility and gait assessment. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:6943-6. [PMID: 26737889 DOI: 10.1109/embc.2015.7319989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper presents an initial overview of insights gained into how older adults mobilize in the home and community, based on data from inertial sensors which were worn by study participants over a 7-day period. The addition of a wearable camera provided additional contextual information which can be used to assess mobility and understand the factors that influence it in the free living environment. Seven days of data collected from a group of older adults who had experienced one or more falls in the previous six months was compared to that of a control group with no history of falling. Results showed that both groups spent relatively little time walking in challenging environmental conditions, and that the fallers spent significantly less time walking under regular conditions (no effect on gait) and outdoors. Analysis of gait metrics showed that the fallers were slightly slower in general, and more noticeable differences were observed when the participants were regrouped according to mobility levels determined from baseline assessments using traditional methods.
Collapse
|
18
|
Bloch F, Boully C, Bourgoin G. [Falls in the elderly, from the risk factors to prevention]. SOINS. GERONTOLOGIE 2015; 20:10-12. [PMID: 26163408 DOI: 10.1016/j.sger.2015.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There are a number of causes of falls in the elderly. The psychological trauma following a fall can be significant and require early care management. There are multidisciplinary prevention strategies which must be adapted to each case.
Collapse
Affiliation(s)
- Frédéric Bloch
- Pôle de gérontologie, Hôpital Broca, Hôpitaux universitaires Paris centre (AP-HP), 54-56, rue Pascal, 75013 Paris, France.
| | - Clémence Boully
- Pôle de gérontologie, Hôpital Broca, Hôpitaux universitaires Paris centre (AP-HP), 54-56, rue Pascal, 75013 Paris, France
| | - Gaëlle Bourgoin
- Pôle de gérontologie, Hôpital Broca, Hôpitaux universitaires Paris centre (AP-HP), 54-56, rue Pascal, 75013 Paris, France
| |
Collapse
|
19
|
Schwenk M, Jordan ED, Honarvararaghi B, Mohler J, Armstrong DG, Najafi B. Effectiveness of foot and ankle exercise programs on reducing the risk of falling in older adults: a systematic review and meta-analysis of randomized controlled trials. J Am Podiatr Med Assoc 2015; 103:534-47. [PMID: 24297989 DOI: 10.7547/1030534] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Foot and ankle (FA) exercise programs might reduce the risk of falling in older adults. We sought to systematically review the current literature on FA exercise programs targeted at reducing the risk of falling in older adults. METHODS A systematic literature search was performed in the PubMed database, the Physiotherapy Evidence Database, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials. Articles were included based on the following criteria: 1) randomized controlled trial, 2) FA exercise program, and 3) use of fall risk-related motor outcomes (strength, balance, flexibility, and functional ability) or use of falls as an outcome. Weighted effect sizes (d) were calculated across studies for estimating the overall effect of FA exercises on the most frequently reported motor outcome parameters. RESULTS Eight publications met the inclusion criteria. Small to moderate overall effects were found for balance (d = 0.46, P < .001) and ankle flexibility (d = 0.29, P = .006). No significant overall effects were found for ankle plantarflexor strength (d = 0.11, P = .223) and walking performance (d = -0.05, P = .404). Controversial results were reported for other functional measures. Effects varied depending on the type of intervention. Only one study reported improved ankle evertor strength and a significant reduction in falls. CONCLUSIONS Evidence suggests that FA exercise can improve certain fall risk-related motor outcomes and reduce falls. Limited effects on strength and functional ability might be related to insufficient training intensity and lack of adherence. Further studies that include progressive strength and flexibility training are necessary to validate which FA exercise programs are most effective at preventing falls.
Collapse
Affiliation(s)
- Michael Schwenk
- Interdisciplinary Consortium on Advanced Motion Performance College of Medicine, University of Arizona, Tucson, AZ
| | | | | | | | | | | |
Collapse
|
20
|
Gard G. Prevention of Slip and Fall Accidents: Risk Factors, Methods and Suggestions for Prevention. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/ptr.2000.5.3.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
21
|
Glimskär B, Hjalmarson J, Lundberg S, Larsson T. A walker used as a lifting device. Disabil Rehabil Assist Technol 2013; 9:264-9. [PMID: 23937384 DOI: 10.3109/17483107.2013.825820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To develop assistive technology that would help an older person to arise from a kneeling position to a standing one. METHODS Developing a prototype, based on an inclusive design and then testing the prototype to verify the approach. The prototype was subsequently tested by a panel of 20 elderly users. These tests were observed and filmed. Participants' experiences of being lifted with the elevation seat were registered with the VIDAR ergonomic assessment system. RESULT None of the 20 participants used a walker at that time. In response to a question of whether, assuming they might have to use a walker in the future, they thought that a walker with an elevating seat would be helpful, 18 said that it would. Two of the participants did not believe that they would ever have to use a walker. CONCLUSION A simple assistive technology such as a walker equipped with an elevating seat would in many of these cases simplify matters and reduce the distress of people who fall often. In addition, such a device can allow people who fall often to live in their homes longer. For caregivers dealing frequently with people who fall, this assistive device can contribute to decreasing occupational injuries. IMPLICATIONS FOR REHABILITATION Development of a lifting device that can help people raise themselves up entirely on their own, or with minimal assistance, would be a revolutionary step for the individual. Lifting devices in use today requires much more extensive assistance from home helpers or others and due to the risk of injuries it is a great value for the helpers that easy to use devices develops. A walker equipped with an elevating seat could even provide a potential for people to stay in their homes longer.
Collapse
Affiliation(s)
- Bo Glimskär
- Centre for Health and Building, KTH Royal Institute of Technology , Stockholm , Sweden
| | | | | | | |
Collapse
|
22
|
Schwenk M, Lauenroth A, Stock C, Moreno RR, Oster P, McHugh G, Todd C, Hauer K. Definitions and methods of measuring and reporting on injurious falls in randomised controlled fall prevention trials: a systematic review. BMC Med Res Methodol 2012; 12:50. [PMID: 22510239 PMCID: PMC3388463 DOI: 10.1186/1471-2288-12-50] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 04/17/2012] [Indexed: 11/27/2022] Open
Abstract
Background The standardisation of the assessment methodology and case definition represents a major precondition for the comparison of study results and the conduction of meta-analyses. International guidelines provide recommendations for the standardisation of falls methodology; however, injurious falls have not been targeted. The aim of the present article was to review systematically the range of case definitions and methods used to measure and report on injurious falls in randomised controlled trials (RCTs) on fall prevention. Methods An electronic literature search of selected comprehensive databases was performed to identify injurious falls definitions in published trials. Inclusion criteria were: RCTs on falls prevention published in English, study population ≥ 65 years, definition of injurious falls as a study endpoint by using the terms "injuries" and "falls". Results The search yielded 2089 articles, 2048 were excluded according to defined inclusion criteria. Forty-one articles were included. The systematic analysis of the methodology applied in RCTs disclosed substantial variations in the definition and methods used to measure and document injurious falls. The limited standardisation hampered comparability of study results. Our results also highlight that studies which used a similar, standardised definition of injurious falls showed comparable outcomes. Conclusions No standard for defining, measuring, and documenting injurious falls could be identified among published RCTs. A standardised injurious falls definition enhances the comparability of study results as demonstrated by a subgroup of RCTs used a similar definition. Recommendations for standardising the methodology are given in the present review.
Collapse
Affiliation(s)
- Michael Schwenk
- Department of Geriatric Research, AGAPLESION Bethanien-Hospital/Geriatric Center at the University of Heidelberg, Rohrbacherstr.149, Heidelberg 69126, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
MacLaughlin EJ, Sleeper RB, McNatty D, Raehl CL. Management of age-related osteoporosis and prevention of associated fractures. Ther Clin Risk Manag 2011; 2:281-95. [PMID: 18360603 PMCID: PMC1936264 DOI: 10.2147/tcrm.2006.2.3.281] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Osteoporosis and related fractures are a significant concern for the global community. As the population continues to age, morbidity and mortality from fractures due to low bone mineral density (BMD) will likely continue to increase. Efforts should be made to screen those at risk for osteoporosis, identify and address various risk factors for falls and associated fractures, ensure adequate calcium and vitamin D intake, and institute pharmacological therapy to increase BMD when indicated. Agents which increase BMD and have been shown to decrease fractures, particularly at the hip, should be considered preferentially over those for which only BMD data are available. Drugs which have been shown to decrease the risk of age-related osteoporotic fractures include oral bisphosphonates (alendronate, ibandronate, and risedronate), intranasal calcitonin, estrogen receptor stimulators (eg, estrogen, selective estrogen receptor modulators [raloxifene]), parathyroid hormone (teriparatide), sodium fluoride, and strontium ranelate. Data are beginning to emerge supporting various combination therapies (eg, bisphosphonate plus an estrogen receptor stimulator), though more data are needed to identify combinations which are most effective and confer added fracture protection. In addition, further research is needed to identify ideal regimens in special populations such as nursing home patients and men.
Collapse
Affiliation(s)
- Eric J MacLaughlin
- Department of Pharmacy Practice, Texas Tech University Health Sciences Center (TTUHSC) School of PharmacyAmarillo, TX, USA
| | - Rebecca B Sleeper
- Department of Pharmacy Practice, Texas Tech University Health Sciences Center (TTUHSC) School of PharmacyLubbock, TX, USA
| | - Danny McNatty
- Department of Pharmacy Practice, Texas Tech University Health Sciences Center (TTUHSC) School of PharmacyLubbock, TX, USA
| | - Cynthia L Raehl
- Department of Pharmacy Practice, Texas Tech University Health Sciences Center (TTUHSC) School of PharmacyAmarillo, TX, USA
| |
Collapse
|
24
|
Impact of physical activity and sedentary behaviour on fall risks in older people: a systematic review and meta-analysis of observational studies. Eur Rev Aging Phys Act 2011. [DOI: 10.1007/s11556-011-0081-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
The objective of this work was to summarise and evaluate the evidence showing that physical activity is a protector factor as regards falls in older people. Relevant studies were identified through a systematic search in the MEDLINE and Cochrane Library, under the keywords of accidental fall/numerical data and risk factors, and with the bibliographies of retrieved papers. The combined odds ratio (OR) [95% confidence interval] for physical activity was 0.75 [0.64, 0.88] with moderate heterogeneity (I
2 = 33%). For fall injury, it was 0.59 [0.47, 0.74] and, for falls in general, it rose to 0.94 [0.76, 1.17] with nil heterogeneity. The combined OR for sedentary factors was 1.14 [1.10, 1.82] with moderate heterogeneity (I
2 = 36%). Regular physical activity in daily life yields significant reduction in falls in older people, especially falls with injuries.
Collapse
|
25
|
|
26
|
Abou-Raya S, Helmii M, Abou-Raya A. Bone and mineral metabolism in older adults with Parkinson's disease. Age Ageing 2009; 38:675-80. [PMID: 19684354 DOI: 10.1093/ageing/afp137] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Parkinson's disease (PD) and osteoporosis are two common chronic disabling conditions in older adults that adversely affect quality of life. The aim of the present work was to study the relationship between bone changes and PD. METHODS eighty-two patients with established PD aged 65 years or older and 68 age-, sex- and body mass index (BMI)-matched healthy control subjects were recruited. Exclusion criteria included other known causes of osteoporosis. Data including BMI, sunlight exposure, Hoehn and Yahr stage, disease duration and history of previous falls and/or fractures were collected. Bone mineral density was measured using dual energy x-ray absorptiometry. Sera were analysed for ionised calcium, vitamin D, bone alkaline phosphatase (BALP) and urinary N-terminal telopeptide of type I collagen (NTx). Physical and mental performance was also assessed. RESULTS the findings show that the bone mineral density (BMD) of all PD patients was significantly lower compared to controls. PD patients had significantly decreased vitamin D levels, significantly increased BALP and NTx levels, reduced physical and mental performance and more falls and/or fractures in comparison to healthy controls. CONCLUSION PD is associated with an increased incidence of osteoporosis, falls and fractures. PD is thus a risk factor for osteoporosis and appropriate therapeutic interventions should be initiated to slow or prevent disability.
Collapse
Affiliation(s)
- Suzan Abou-Raya
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
| | | | | |
Collapse
|
27
|
Osteoporosis in Parkinson's disease. Parkinsonism Relat Disord 2009; 15:339-46. [DOI: 10.1016/j.parkreldis.2009.02.009] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 02/18/2009] [Accepted: 02/23/2009] [Indexed: 11/20/2022]
|
28
|
Bloch F, Jegou D, Dhainaut JF, Rigaud AS, Coste J, Lundy JE, Claessens YE. Can metabolic abnormalities after a fall predict short term mortality in elderly patients? Eur J Epidemiol 2009; 24:357-62. [DOI: 10.1007/s10654-009-9342-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Accepted: 04/17/2009] [Indexed: 10/20/2022]
|
29
|
Bloch F, Jegou D, Dhainaut JF, Rigaud AS, Coste J, Lundy JE, Claessens YE. Do ED staffs have a role to play in the prevention of repeat falls in elderly patients? Am J Emerg Med 2009; 27:303-7. [PMID: 19328374 DOI: 10.1016/j.ajem.2008.02.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 02/15/2008] [Accepted: 02/22/2008] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Fall-related morbidity is a serious public health issue in older adults referred to emergency departments (EDs). Emergency physicians mostly focus on immediate injuries, whereas the specific assessment of functional consequences and opportunities for prevention remain scarce. The aim of this study was to determine the factors influencing 6-month independence. METHODS We used a prospective observational study at the ED of a tertiary teaching hospital over a 6-month period. Uni- and multivariate assessments of factors related to loss of independence were examined. RESULTS A total of 367 patients survived to 6 months, mean age was 86 years, and 79% were women. The population was initially healthy and independent. Because this independence reassured the medical staff, more than 42% percent were directly discharged home without any improvement of home facilities; only 63% had recovered their independence at the end of the follow-up. There were 111 patients were hospitalized for 30 days or more. Older patients, initial Katz score, and absence of immediate trauma consequences were associated with an increased risk for loss of independence. CONCLUSIONS Because prevention is an emerging role of ED, a multidisciplinary team should evaluate fallers and propose medical and environmental changes as required for those discharged after their ED visit.
Collapse
Affiliation(s)
- Frédéric Bloch
- Department of Gerontology, Hôpital Broca, 54 rue Pascal, Paris, France
| | | | | | | | | | | | | |
Collapse
|
30
|
Bergström U, Björnstig U, Stenlund H, Jonsson H, Svensson O. Fracture mechanisms and fracture pattern in men and women aged 50 years and older: a study of a 12-year population-based injury register, Umeå, Sweden. Osteoporos Int 2008; 19:1267-73. [PMID: 18214568 DOI: 10.1007/s00198-007-0549-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 12/11/2007] [Indexed: 11/26/2022]
Abstract
UNLABELLED In a study of a 12-year population-based injury register, Umeå, Sweden, we analyzed the fracture mechanisms and fracture pattern in men and women 50 years and older. Low-energy trauma was responsible for the major and costliest part of the fracture panorama, but the pattern differs between age groups. INTRODUCTION Osteoporosis-related fracture is a major health problem: the number of hip fractures is expected to double to 2030. While osteoporosis is one of many risk factors, trauma is almost always involved. Therefore, we analyzed injury mechanisms in patients aged over 50. METHODS We registered injury mechanism, cause, diagnosis in all trauma patients at Umeå University hospital, Sweden. This population-based register (1993-2004) comprises a total of 113,668 injuries (29,189 fractures). Patients >or=50 years contributed to 13,279 fractures. RESULTS Low-energy trauma (fall <1 m) caused 53% of all fractures >or=50 years and older. In those over 75 low-energy trauma caused >80%. The seasonal variation of fractures was maximally 25%. With increasing age, proximal fractures became more common, in both upper and lower extremities. Proximal locations predominate in older age groups. CONCLUSIONS Low-energy trauma was responsible for the largest and costliest part of the fracture panorama. In fact, almost all fractures in middle-aged and old people were caused by low-energy mechanisms; thus, most fractures in these patients have a fragility component, and the contribution of osteoporosis-related fractures is more important than previously thought. A better understanding of injury mechanisms also in low-energy trauma is a prerequisite for preventive interventions.
Collapse
Affiliation(s)
- U Bergström
- Department of Orthopaedics, Umeå University Hospital, Umeå, Sweden.
| | | | | | | | | |
Collapse
|
31
|
Peterson EW, Cho CC, von Koch L, Finlayson ML. Injurious falls among middle aged and older adults with multiple sclerosis. Arch Phys Med Rehabil 2008; 89:1031-7. [PMID: 18503796 DOI: 10.1016/j.apmr.2007.10.043] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Revised: 09/28/2007] [Accepted: 10/19/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the prevalence of, and risk factors for, receiving medical attention for a recent injurious fall among middle-aged and older adults who have multiple sclerosis (MS). DESIGN Survey. SETTING United States. PARTICIPANTS Seven hundred people with MS, age 55 years or older and living in the United States, were randomly selected from the North American Research Committee on Multiple Sclerosis Registry and invited by mail to participate in the study. A total of 354 people, aged 55 to 94 years, completed the survey. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participant's self-report regarding receipt of medical care for a fall-related injury (received care within the past 6mo, >6mo ago, or never). RESULTS More than 50% of study participants reported injurious falls; 12%, in the 6 months before the interview. Proportional odds models were used to identify factors associated with increased odds of receiving medical attention for a fall-related injury within the past 6 months. Compared with study participants who reported receiving medical attention for a fall-related injury more than 6 months ago or never, participants who reported receiving medical attention for a fall-related injury within the past 6 months were more likely to report fear of falling (odds ratio [OR]=1.94; 95% confidence interval [CI], 1.27-2.96) and osteoporosis (OR=1.65; 95% CI, 1.03-2.62). CONCLUSIONS Injurious falls were commonly reported by survey participants. Findings suggest that management of fear of falling and osteoporosis are important components of comprehensive fall-injury prevention programs for people aging with MS.
Collapse
Affiliation(s)
- Elizabeth W Peterson
- Department of Occupational Therapy, University of Illinois, Chicago, IL 60612-7250, USA.
| | | | | | | |
Collapse
|
32
|
da Silva Gama Z, Gómez Conesa A. Morbilidad, factores de riesgo y consecuencias de las caídas en ancianos. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s0211-5638(08)72972-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
33
|
Elderly hip fracture patients admitted to the trauma service: does it impact patient outcome? ACTA ACUST UNITED AC 2008; 63:1348-52. [PMID: 18212659 DOI: 10.1097/ta.0b013e31815b838c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hip fractures are primarily a disease of the elderly. Advanced age and associated comorbidities in this patient population can lead to adverse outcomes. We routinely admit our hip fracture patients to the Trauma Service (TS). The goal of this study is to see if this policy has had a positive impact on patient outcome. METHODS The Jacobi Medical Center Trauma and Operating Room registries were used to identify all patients aged 65 and over who presented with a hip fracture during the 5-year period from January 1, 2000 to December 31, 2004. Patient charts were used for data retrieval. Outcome variables were length of hospital stay (LOS), time from admission to surgery, in-hospital complication, and in-hospital mortality rates. RESULTS Complete data were available in 255 patients out of a total of 274 admitted in the study period. The mean age was 81.0 years. The median Injury Severity Score was 10 (range, 9-34). Two hundred forty (94.1%) patients were admitted to the TS. The mean time from admission to surgery was 1.9 days and the mean LOS was 10.5 days. In-hospital complication rate and mortality were 35.8% and 2.1%, respectively. CONCLUSION Our policy of admitting elderly hip fracture patients to the TS has resulted in a mortality and LOS among the lowest reported in the literature. This data suggest that there is a clear benefit to admitting elderly hip fractures to the TS.
Collapse
|
34
|
van der Velde N, Meerding WJ, Looman CW, Pols HAP, van der Cammen TJM. Cost Effectiveness of Withdrawal of Fall-Risk-Increasing Drugs in Geriatric Outpatients. Drugs Aging 2008; 25:521-9. [DOI: 10.2165/00002512-200825060-00005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
35
|
Hartikainen S, Lönnroos E, Louhivuori K. Medication as a risk factor for falls: critical systematic review. J Gerontol A Biol Sci Med Sci 2007; 62:1172-81. [PMID: 17921433 DOI: 10.1093/gerona/62.10.1172] [Citation(s) in RCA: 376] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Falls in older people are associated with poor prognosis. Medication use is a potential cause of falls. Our aim was to systemically review all original articles examining medication use as a risk factor for falls or fall-related fractures in people aged >/=60 years. METHODS We searched English articles in Medline (1996-2004) indexed under "falls" or "accidental falls" and "pharmaceutical preparations" or specific groups of drugs. We excluded studies not meeting the age criterion, not controlled with nonusers of target medicines or nonfallers, or with no clear definition of target medication. RESULTS Twenty-eight observational studies and one randomized controlled trial met the inclusion criteria. The number of participants ranged from 70 to 132,873. The outcome measure was a fall in 22 studies and a fracture in 7 studies. The main group of drugs associated with an increased risk of falling was psychotropics: benzodiazepines, antidepressants, and antipsychotics. Antiepileptics and drugs that lower blood pressure were weakly associated with falls. CONCLUSIONS Central nervous system drugs, especially psychotropics, seem to be associated with an increased risk of falls. The quality of observational studies needs to be improved, for many appear to lack even a clear definition of a fall, target medicines, or prospective follow-up. Many drugs commonly used by older persons are not systematically studied as risk factors for falls.
Collapse
Affiliation(s)
- Sirpa Hartikainen
- School of Public Health and Clinical Nutrition, Department of Geriatrics, University of Kuopio, Finland.
| | | | | |
Collapse
|
36
|
Vanderschot P. Treatment options of pelvic and acetabular fractures in patients with osteoporotic bone. Injury 2007; 38:497-508. [PMID: 17399713 DOI: 10.1016/j.injury.2007.01.021] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Revised: 01/08/2007] [Accepted: 01/16/2007] [Indexed: 02/02/2023]
Abstract
The incidence of pelvic ring and acetabular fractures in the elderly is climbing relentlessly. This increase is attributed to a greater longevity and a decrease in the incidence of alcohol-related trauma in younger adults. Often, the elderly trauma patient has compromised physiological reserve and healing capacity due to concomitant morbidities, resulting in a less favourable clinical outcome. The presence of osteopenic or osteoporotic bone and other treatments for existing comorbidities hamper some treatment alternatives, especially those designed for younger patients. Diverse clinical presentations include minor trauma, major polytrauma and insufficiency fractures. An assessment of the general health and functional status of the patient is of utmost importance to determine the optimal treatment. The different treatment options of pelvic and acetabular fractures in the presence of osteoporosis vary mainly according to the clinical presentation and include: conservative methods, percutaneous or minimally invasive procedures, open reduction and fixation, and primary total hip arthroplasty. Whichever treatment is chosen, even for elderly people, the aim is a rapid mobilisation of the patient in order to reduce complications to some extent inherent to this age group.
Collapse
Affiliation(s)
- P Vanderschot
- Department of Traumatology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
| |
Collapse
|
37
|
Gard G, Berggård G. Assessment of anti-slip devices from healthy individuals in different ages walking on slippery surfaces. APPLIED ERGONOMICS 2006; 37:177-86. [PMID: 16115606 DOI: 10.1016/j.apergo.2005.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2004] [Revised: 04/08/2005] [Accepted: 04/30/2005] [Indexed: 05/04/2023]
Abstract
The interest for effective preventive strategies for slips and falls is growing. Much remains to be done, however, to prevent slips and falls in the traffic environment. Using an appropriate anti-slip device may reduce the risk of slips and falls on different surfaces outdoors during winter. The aim of this study was to evaluate the best anti-slip devices of different designs in the Swedish market on a larger group of healthy individuals in different ages on five different slippery surfaces as a way to develop a standard method to test anti-slip devices. Three different designs of anti-slip devices: heel device, foot-blade device and whole-foot device were evaluated on ice surfaces uncovered or covered with gravel, sand, salt or snow. The evaluations were done according to subject's perceived walking safety and balance, videorecordings of walking postures and movements, time to take on and off each anti-slip device, advantages/disadvantages with each anti-slip device and a list of priorities for own use according to three criteria: safety, balance and appearance. The heel device was perceived to be the most safe on all five surfaces, followed by the toe device and the whole-foot device. The heel device was also perceived to be the one with the best walking balance on uncovered ice and on snow covered ice. There were some significant differences due to gender and age. Most subjects walked with a normal muscle function in the hip and knee when walking with or without an anti-slip device on all surfaces. The heel device was perceived as the most rapid one to take on and the toe device as the most rapid one to take off. All three devices were perceived as having a good foothold. The heel device was perceived to fit the shoe and to be stable at heel-strike. The toe device was easily portable and stable on uncovered ice. The whole-foot device was comfortable to walk with and safe on snow covered ice. The heel device had the highest priority according to walking safety, walking balance and choice for own use.
Collapse
Affiliation(s)
- Gunvor Gard
- Department of Health Sciences, Luleå University of Technology, Hedenbrovägen, SE-961 36 Boden, Sweden.
| | | |
Collapse
|
38
|
Abstract
Parkinson's disease is associated with an increased risk of falls. The risk is greatest in patients with advanced disease. Because Parkinson's disease usually occurs late in life, the risk factors related to the neurological impairments add to those associated with aging. The incidence of fractures is high in patients with Parkinson's disease, with femoral neck fractures in older women being particularly common. Risk factors for fractures include a low body mass index, limited exposure to sunlight, an inadequate vitamin D intake with low 25-OH vitamin D levels, and bone loss. Several studies found decreased bone mineral density values at the femoral neck and lumbar spine in patients with Parkinson's disease. Although this decrease is ascribable in part to factors unrelated with Parkinson's disease, such as older age and female gender, Parkinson's disease itself also plays a role, most notably in patients with severe neurological impairments (Hoehn and Yahr stages III and IV).
Collapse
Affiliation(s)
- Nathalie Vaserman
- Regional Geriatrics Center, 2, rue du Pont-Boeuf, BP 28, 35571 Chantepie cedex, France.
| |
Collapse
|
39
|
Abstract
Injuries resulting from falls in elderly people are a major public-health concern, representing one of the main causes of longstanding pain, functional impairment, disability, and death in this population. The problem is going to worsen, since the rates of such injuries seem to be rising in many areas, as is the number of elderly people in both the developed and developing world. Many methods and programmes to prevent such injuries already exist, including regular exercise, vitamin D and calcium supplementation, withdrawal of psychotropic medication, cataract surgery, professional environment hazard assessment and modification, hip protectors, and multifactorial preventive programmes for simultaneous assessment and reduction of many of the predisposing and situational risk factors. To receive broader-scale effectiveness, these programmes will need systematic implementation. Care must be taken, however, to rigorously select the right actions for those people most likely to benefit, such as vitamin D and calcium supplementation and hip protectors for elderly people living in institutions.
Collapse
Affiliation(s)
- Pekka Kannus
- Accident & Trauma Research Centre, UKK Institute for Health Promotion Research, Tampere, Finland.
| | | | | | | | | |
Collapse
|
40
|
Boufous S, Finch C, Lord S, Close J. The increasing burden of pelvic fractures in older people, New South Wales, Australia. Injury 2005; 36:1323-9. [PMID: 15979626 DOI: 10.1016/j.injury.2005.02.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2004] [Revised: 02/08/2005] [Accepted: 02/08/2005] [Indexed: 02/02/2023]
Abstract
Despite their significant health burden, epidemiological information regarding pelvic fractures is scarce. In this study, we examine trends in admission for pelvic fractures to acute hospitals in New South Wales, Australia, between July 1988 and June 2000, using routinely collected hospital separations statistics. Over this period, the number of admissions for pelvic fractures among those aged 50 years and over increased by 58.4% in men and 110.8% in women. Age-specific rates of admissions per 100,000 population for pelvic fracture also rose significantly, particularly for those aged at least 75 years. The number and proportion of transport related pelvic fractures fell significantly for both men (chi(2)=23.82, d.f.=1, p<0.001) and women (chi(2)=49.26, d.f.=1, p<0.001) while those resulting from falls increased significantly over the 12-year-period. Falls are increasingly becoming the single most important cause of pelvic injuries in older people, suggesting that preventive measures aimed at reducing the risk of falls need to be pursued. Factors contributing to the rise of fall-related pelvic fractures need to be investigated to inform strategies aimed at reversing the observed increase in the number and age-specific rates of pelvic fractures in older people.
Collapse
Affiliation(s)
- Soufiane Boufous
- University of New South Wales, NSW Injury Risk Management Research Centre, Sydney, NSW 2052, Australia.
| | | | | | | |
Collapse
|
41
|
Fisher AA, Davis MW, McLean AJ, Le Couteur DG. Epidemiology of falls in elderly semi-independent residents in residential care. Australas J Ageing 2005. [DOI: 10.1111/j.1741-6612.2005.00081.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
42
|
Aufauvre V, Kemoun G, Carette P, Bergeal E. Évaluation posturale à domicile chez la personne âgée : comparaison chuteurs–non chuteurs. ACTA ACUST UNITED AC 2005; 48:165-71. [PMID: 15848258 DOI: 10.1016/j.annrmp.2004.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Accepted: 12/17/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine the main clinical and posturographic factors correlated with falls in elderly individuals and to specify the role of static posturography in this appraisal. MATERIALS AND METHODS The study involved 38 people living in an residential center who were autonomously ambulatory and had a Mini Mental Test score> or =24. Fallers (N = 15) had fallen within 1 month, and nonfallers (N = 23) had not fallen for at least a year. Assessment consisted of a series of questions, a complete clinical appraisal, specific independently validated tests, and static posturographic analysis different parameters of the stabilogram with the eyes first open and then closed, all carried out in the center. RESULTS From the clinical standpoint, spinal pathologic features and the scores on the Functional Reach Test were significantly different between the fallers and nonfallers. In static posturography, fallers' equilibrium was more precarious than that of nonfallers with eyes are closed: significant differences were observed in surface, X length and overall fast Fourier transform score. The comparison between results with open and closed eyes showed that the fallers had a pronounced tendency to retropulsion in the absence of visual participation: a significant difference as regards overall length, Y length, minimum Y and FFT Y (0.5-2 Hz). CONCLUSIONS To complement a satisfactorily conducted clinical examination, static posturography allows for rapid assessment of equilibrium and posture in elderly patients who fall? Performed at the place where an individual resides, this appraisal constitutes an original and pragmatic element. As an evaluation strategy, it can reveal nonnegligible information within the framework of an appraisal of such, and thereby allows for adjustment of the rehabilitation or compensatory strategy.
Collapse
Affiliation(s)
- V Aufauvre
- Service de médecine physique et de réadaptation, pavillon Maurice-Salles, CHU de Poitiers, France
| | | | | | | |
Collapse
|
43
|
Bergeron E, Lavoie A, Belcaid A, Ratte S, Clas D. Should Patients with Isolated Hip Fractures Be Included in Trauma Registries? ACTA ACUST UNITED AC 2005; 58:793-7. [PMID: 15824658 DOI: 10.1097/01.ta.0000158245.23772.0a] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with isolated hip fractures are frequently excluded from trauma registries. The goal of this study was to show that patients with these injuries have higher resource use and poorer outcomes than the rest of the trauma population. METHODS The Quebec Trauma Registry was used to identify all trauma patients from April 1, 1998, to March 31, 2003. Patients who were dead on arrival at the emergency room were excluded. Isolated hip fracture (HIP) was defined as a diagnosis of a single fracture to the neck of the femur (Abbreviated Injury Scale 1990 codes 851808.3, 851810.3, 851812.3, and 851818.3) secondary to a fall and for which the Injury Severity Score was 9 or 10 (no other Abbreviated Injury Scale code higher than 1). Patients with all other trauma diagnosis (OT) were used for comparison. Outcome variables were length of hospital stay, length of intensive care unit (ICU) stay, in-hospital complications, and status and orientation at discharge. Chi-square and Wilcoxon rank-sum tests were used. RESULTS There were 68,422 patients: 14,426 (21.1%) HIP patients and 53,996 (78.9%) OT patients. The median Injury Severity Score was 9 for HIP (range, 9-10) and 9 for OT (range, 1-75). Mean length of hospital stay was 18.4 days for HIP compared with 11.7 days for OT (p < 0.0001). HIP patients represented 29.5% of the total hospital stay. ICU stay was required for 1,353 HIP patients (9.4%) and for 12,395 (23.0%) OT patients (p < 0.0001). Mean ICU stay was 3.9 days for HIP compared with 5.5 days for OT (p = 0.0006). In-hospital mortality was 8.5% in HIP compared with 3.7% in OT (p < 0.0001). HIP represented 62.7% of patients referred for long-term care and 39.3% of patients referred to a rehabilitation center. CONCLUSION Patients with HIP represented 21.1% of admissions while accounting for 42% of total days of hospitalization and 38% of deaths. Patients with hip fractures have a significantly higher risk of death, prolonged hospital stay, and complication rate, and are more often transferred to a rehabilitation center or to a long-term nursing home than the rest of the trauma population despite lower severity. They require multidisciplinary care typical of the rest of the trauma population and should be included in the trauma registry if the registry is to document the full outcome and resource use of the trauma population.
Collapse
Affiliation(s)
- Eric Bergeron
- Choc-trauma Montérégie, Hôpital Charles-LeMoyne, Greenfield Park, Canada.
| | | | | | | | | |
Collapse
|
44
|
Bruyere O, Wuidart MA, Di Palma E, Gourlay M, Ethgen O, Richy F, Reginster JY. Controlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents. Arch Phys Med Rehabil 2005; 86:303-7. [PMID: 15706558 DOI: 10.1016/j.apmr.2004.05.019] [Citation(s) in RCA: 216] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the effects of whole body vibration in the elderly. DESIGN Randomized controlled trial. SETTING Nursing home. PARTICIPANTS Forty-two elderly volunteers. INTERVENTIONS Six-week vibration intervention plus physical therapy (PT) (n=22) or PT alone (n=20). MAIN OUTCOME MEASURES We assessed gait and body balance using the Tinetti test (maximum scores of 12 for gait, 16 for body balance, 28 for global score), motor capacity using the Timed Up & Go (TUG) test, and health-related quality of life (HRQOL) using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). RESULTS After 6 weeks, the vibration intervention group improved by a mean +/- standard deviation of 2.4+/-2.3 points on the gait score compared with no score change in the control group ( P <.001). The intervention group improved by 3.5+/-2.1 points on the body balance score compared with a decrease of 0.3+/-1.2 points in the control group ( P <.001). TUG test time decreased by 11.0+/-8.6 seconds in the treated group compared with an increase of 2.6+/-8.8 seconds in the control group ( P <.001). The intervention group had significantly greater improvements from baseline on 8 of 9 items on the SF-36 compared with the control group. CONCLUSIONS Controlled whole body vibration can improve elements of fall risk and HRQOL in elderly patients.
Collapse
Affiliation(s)
- Olivier Bruyere
- WHO Collaborating Center for Public Health Aspects of Osteoarticular Disorders, Liège, Belgium.
| | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
Accidents are major health problems leading to deaths and injuries among older people. The present study was performed to investigate the characteristics of the accidents experienced within the last 1 year in people aged 60 years and older living in Antalya City Center. The study was planned as a cross-sectional research. A total of 840 individuals selected from the study population with cluster-sampling method were used in questionnaires. A number of 163 (19.4%) individuals had at least one accident in the last year. A total of 178 accidents were reported within the last 1-year; 124 (69.7%) falls, 22 (12.4%) traffic accidents and 12 (6.7%) dropping of objects to head. The accidents occurred mostly at home (40.4%), at avenue-street etc. (31.5%), and in garden (8.4%). The result of logistic regression analysis revealed that accident frequency was positively related with female gender (odds=1.79, P<0.05), disability of lower extremities (odds=1.63, P<0.05) and hearing impairment (odds=2.01, P<0.05) whereas it was negatively related with living in detached house (odds=0.41, P<0.05). It was found that accidents caused health (82.0%) and financial (38.2%) problems in elderly and also the disabilities in daily activities (66.3%). Average numbers of days with disability in daily activities were 21.1 in 1 year per accident and 5.7 in 1 year per individual. Occurrence of health problems and disability in daily activities were more frequent among women compared to men (P<0.05). Methods like environmental measures or educational programs to prevent accidents and accident-related injuries must be focused on defined risk groups and places where the accidents occur more frequently. Future researches about the effectiveness of prevention in elderly on accident frequency, mortality and morbidity are needed to deal with this current problem.
Collapse
Affiliation(s)
- Levent Donmez
- Akdeniz University Medical Faculty, Department of Public Health, 07070 Campus Antalya, Turkey.
| | | |
Collapse
|
46
|
Abstract
BACKGROUND AND AIMS In the elderly, balance and walking impairments are assumed to play an important role in causing falls. We have assessed prospectively the predictive ability of health, function and balance variables regarding falls and their location. METHODS Falls which occurred during one year in a random sample of 307 women aged 75 years and over (mean 80.8 years, response rate 74.5%) living in the community were recorded and related to baseline registrations of health, medication and tests of walking and balance. RESULTS In all, 155 women (50.5%) reported 308 falls. Outdoor falls were significantly more frequent than indoor falls (57.5 vs 42.5%). The variables having had a fall before the start of the study, osteoporosis, hypertension, feeling depressed, unable to climb 40 cm high steps and walking slowly, all independently predicted a higher number of falls overall. Regarding fall location, having experienced a fall before study start was associated with more falls indoors as well as outdoors. Vision impairment, symptoms of depression, a faster comfortable walking speed, and being able to cope with higher steps were all independent predictors of more outdoor falls also after adjustment for outdoor exposure. A slower comfortable walking speed, a higher amplitude of the center of pressure movements in the frontal plane, a poorer score on the Timed Up & Go test, multimorbidity, poor cognition and hypertension were independent risk factors for indoor falls. Neither number of drugs used nor any specific medication appeared as independent risk factors for falls in this study. CONCLUSIONS The findings of this study suggest that risk factors for indoor and outdoor falls are different. Location of fall may be an important confounder in studies of predictors of falls in the elderly which should encompass this type of information.
Collapse
Affiliation(s)
- Astrid Bergland
- Faculty of Health Sciences, Oslo University College, Oslo, Norway.
| | | | | |
Collapse
|
47
|
Kannus P, Niemi S, Parkkari J, Palvanen M, Heinonen A, Sievänen H, Järvinen T, Khan K, Järvinen M. Why is the age-standardized incidence of low-trauma fractures rising in many elderly populations? J Bone Miner Res 2002; 17:1363-7. [PMID: 12162489 DOI: 10.1359/jbmr.2002.17.8.1363] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Low-trauma fractures of elderly people are a major public health burden worldwide, and as the number and mean age of older adults in the population continue to increase, the number of fractures is also likely to increase. Epidemiologically, however, an additional concern is that, for unknown reasons, the age-standardized incidence (average individual risk) of fracture has also risen in many populations during the recent decades. Possible reasons for this rise include a birth cohort effect, deterioration in the average bone strength by time, and increased average risk of (serious) falls. Literature provides evidence that the rise is not due to a birth cohort effect, whereas no study shows whether bone fragility has increased during this relatively short period of time. This osteoporosis hypothesis could, however, be tested if researchers would now repeat the population measurements of bone mass and density that were made in the late 1980s and the 1990s. If such studies proved that women's and men's age-standardized mean values of bone mass and density have declined over time, the osteoporosis hypothesis would receive scientific support. The third explanation is based on the hypothesis that the number and/or severity of falls has risen in elderly populations during the recent decades. Although no study has directly tested this hypothesis, a great deal of indirect epidemiologic evidence supports this contention. For example, the age-standardized incidence of fall-induced severe head injuries, bruises and contusions, and joint distortions and dislocations has increased among elderly people similarly to the low-trauma fractures. The fall hypothesis could also be tested in the coming years because the 1990s saw many research teams reporting age- and sex-specific incidences of falling for elderly populations, and the same could be done now to provide data comparing the current incidence rates of falls with the earlier ones.
Collapse
Affiliation(s)
- Pekka Kannus
- The Bone Research Group, Accident & Trauma Research Centre, UKK Institute for Health Promotion Research, Tampere, Finland
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
This study retrospectively reviewed all patients aged 75 years and over who were admitted to hospital following an acute head injury. All patients were cared for by general surgeons. The study period lasted for 2 years. Fifty five patients with a mean age of 83.8 years (range 75-97) were admitted. Four patients had a Glasgow Coma Score (GCS) of <13, all had intracranial injuries, only one being fit for neurosurgical intervention. Fifty one patients had a GCS greater than or equal to 13, 25 (49%) were admitted for social reasons, 10 (19.6%) for observation, 9 (17.6%) due to confusion and 7 (13.7%) due to other injuries. Patients spent a total of 366 days in surgical beds. Twenty five patients were discharged or transferred within 24h of admission and 30 patients remained in hospital for a total of 343 days, therefore, 54% of patients occupy 94% of the time spent in hospital. Of these 160 days were spent awaiting transfer to another hospital, 147 days waiting for social services, 24 days waiting for a terminal outcome and 12 days for unspecified reasons. Only 11 (38%) patients who suffered a fall of unknown cause underwent any follow-up investigations. Elderly patients with head injuries rarely require neurosurgical intervention. They often have co-existing medical conditions and complex social needs leading to prolonged hospital admission. The management of these patients might be more appropriately undertaken by physicians specializing in elderly care medicine.
Collapse
Affiliation(s)
- Daniel Lawes
- King George Hospital, Barley Lane, Ilford, Essex, UK.
| |
Collapse
|
49
|
Procter S. Whose evidence? Agenda setting in multi-professional research: Observations from a case study. HEALTH RISK & SOCIETY 2002. [DOI: 10.1080/13698570210293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
50
|
Puisieux F, Pollez B, Deplanque D, Di Pompeo C, Pardessus V, Thevenon A, Dewailly P. Successes and setbacks of the falls consultation: report on the first 150 patients. Am J Phys Med Rehabil 2001; 80:909-15. [PMID: 11821673 DOI: 10.1097/00002060-200112000-00007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We report the results of a Falls Consultation. DESIGN Data concerning the first 150 patients are reported. Each patient was assessed by a geriatrician, a neurologist, and a physiatrist, who visited him or her at home, and was reassessed by the same geriatrician 6 mo later. RESULTS Of the 150 patients, 135 patients completed the initial evaluation. Most of them were frequent fallers. The population was very heterogeneous regarding the health status and the degree of disability. In most cases, falls were the result of several interacting factors. The most frequent recommendations from the staff were physical therapy, environmental changes, and medication changes. Over the following 6 mo, approximately one out of four patients had experienced new falls. However, the risk of falling was significantly reduced (5.3 +/- 7.3 falls in 6 mo before vs. 0.8 +/- 1.6 falls in 6 mo after the intervention). The Activities of Daily Living score was a predictor of recurrent falls, hospitalization, and institutionalization. CONCLUSION Our results show that a multidisciplinary falls consultation can be efficient in reducing the risk of falls in nonselected elderly fallers but suggest that differential strategies are needed to manage adequately the more vigorous and the frail old person as well.
Collapse
Affiliation(s)
- F Puisieux
- Service de Médecine Interne et Gériatrie, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | | | | | | | | | | | | |
Collapse
|