Falls

A longitudinal analysis of factors associated with age-related cataract among older Australian women: a cohort study of 7851 older Australian women 79-90 years

BACKGROUND

Age-related cataracts are a significant global health issue due to population ageing. More than 70% of older Australians aged 80 or above have clinically significant age-related cataracts.

AIM

The study aimed to identify factors associated with age-related cataracts among older Australian women 79-90 years.

METHOD

A 6-year longitudinal analysis of the Australian Longitudinal Study on Women's Health (ALSWH) was conducted on 7117 women from surveys four to six. The women were asked whether they had been diagnosed or treated for cataracts 3 years before each survey. We used generalised estimating equation (GEE) modelling to identify factors independently associated with age-related cataracts.

RESULTS

At baseline (79-84 years), 44.8% lived in metropolitan Australia, 67.9% had good general health, 26.5% had private health insurance, 30.6% had cataracts, 28.8% had undergone cataract surgery, 12.0% had diabetes, 24.9% had skin cancer, 56.2% had hypertension, 24.0% had a history of falls, 63.0% had visited general practitioner (GP) frequently, and 48.8% were driving themselves as their main means of transport. In the final model, poor general health [adjusted odds ratio (AOR) = 1.23, 95% CI = 1.14, 1.33)], not driving (AOR = 1.09, 95% CI = 1.01, 1.18), having private health insurance (AOR = 1.13, 95% CI = 1.04, 1.23), frequent GP visits (AOR = 1.16, 95% CI = 1.07, 1.25), skin cancer (AOR = 1.26, 95% CI = 1.16, 1.37), hypertension (AOR = 1.13, 95% CI = 1.05, 1.21), and fall (AOR = 1.12, 95% CI = 1.04, 1.22) were significantly associated with the age-related cataracts.

CONCLUSIONS

Systemic diseases, poor quality of life, driving cessation, and health service use were significantly associated with age-related cataracts in older women.

Factors related to the high fall rate in long-term care residents with dementia

BACKGROUND

Falls in long-term care residents with dementia represent a costly but unresolved safety issue. The aim of the present study was to (1) determine the incidence of falls, fall-related injuries and fall circumstances, and (2) identify the relationship between patient characteristics and fall rate in long-term care residents with dementia.

METHODS

Twenty long-term care residents with dementia (80 ± 11 years; 60% male) participated. Falls were recorded on a standardized form, concerning fall injuries, time and place of fall and if the fall was witnessed. Patient characteristics (66 variables) were extracted from medical records and classified into the domains: demographics, activities of daily living, mobility, cognition and behavior, vision and hearing, medical conditions and medication use. We used partial least squares (PLS) regression to determine the relationship between patient characteristics and fall rate.

RESULTS

A total of 115 falls (5.1 ± 6.7 falls/person/year) occurred over 19 months, with 85% of the residents experiencing a fall, 29% of falls had serious consequences and 28% was witnessed. A combination of impaired mobility, indicators of disinhibited behavior, diabetes, and use of analgesics, beta blockers and psycholeptics were associated with higher fall rates. In contrast, immobility, heart failure, and the inability to communicate were associated with lower fall rates.

CONCLUSIONS

Falls are frequent and mostly unwitnessed events in long-term care residents with dementia, highlighting the need for more effective and individualized fall prevention. Our analytical approach determined the relationship between a high fall rate and cognitive impairment, related to disinhibited behavior, in combination with mobility disability and fall-risk-increasing-drugs (FRIDs).

Fatores socioambientais associados à ocorrência de quedas em idosos

O objetivo deste artigo é investigar aspectos socioambientais associados às quedas em idosos residentes no estado do Rio Grande do Sul. Estudo descritivo, transversal, populacional, de base domiciliar, com coleta de dados primários, pertencente a um inquérito epidemiológico realizado no período de 2010 a 2011, com 6751 idosos de 59 cidades do estado do Rio Grande do Sul, Brasil, denominado Perfil dos Idosos do RS. A associação entre o desfecho quedas e as variáveis independentes foram analisadas de forma univariada e múltipla, através de regressão logística, calculando desta forma a chance associada à queda, ajustando por sexo e idade. A frequência de quedas foi de 10,7%. Observamos serem fatores protetores: sexo masculino, maior escolaridade, percepção de insegurança e falta de bancos em locais públicos, participação em atividades sociais e cívicas. Foram considerados fatores de risco: faixa etária mais elevada, uso de órtese e participação em atividades comunitárias. Os resultados mantiveram-se significativos nas análises ajustadas. As quedas são comumente associadas a aspectos físicos e comportamentais, no entanto, as variáveis socioambientais também demonstram ser significativas nesse processo.

Arm movement effect on balance

The background research shows a high incidence of falls and loss of balance related injuries, which cause serious consequences to individual health and quality of life, as well as substantial healthcare impact in services and costs. The literature review emphasizes that arm movements have a potentially significant effect on balance, and indentifies the use of balance boards as a relevant and meaningful tool for dynamic balance evaluation. The primary objective of this initial study was to develop a method to test and evaluate the effect of arm movements on the maintenance of postural stability. Further we investigated the impact of dominant and non-dominant arms, the reaction time of arms, and the amount of activity of arms related to dynamic balance control. The study applied an accelerometer-based balance board test to measure postural stability as related to arm movements. The evaluation consists of accelerometers placed on the two arms and the balance board. Data were acquired from four different subjects and processed accordingly. The finding verified that arms play an important role in the improvement of balance. Our findings suggest that the dominant arm is more active in balance control and that the movement of arms most often occurs just prior to and during loss of balance. The results also suggest that the amount of arm movement activity directly relates to balance control and the use of the dominant arm.

Fall Prevention in Hospitals

This article summarizes research and draws overall conclusions from the body of literature on fall prevention interventions to provide nurse administrators with a basis for developing evidence-based fall prevention programs in the hospital setting. Data are obtained from published studies. Thirteen articles are retrieved that focused on fall interventions in the hospital setting. An analysis is performed based on levels of evidence using an integrative review process. Multifactoral fall prevention intervention programs that included fall-risk assessments, door/bed/patient fall-risk alerts, environmental and equipment modifications, staff and patient safety education, medication management targeted to specific types, and additional assistance with transfer and toileting demonstrate reduction in both falls and fall injuries in hospitalized patients. Hospitals need to reduce falls by using multifactoral fall prevention programs using evidence-based interventions to reduce falls and injuries.

Falls in the community-dwelling elderly with a history of cancer

BACKGROUND

Falls place older adults at risk for injuries, resulting in functional decline, hospitalization, institutionalization, higher healthcare costs, and decreased quality of life.

OBJECTIVE

This study examined community-dwelling elderly to identify if individuals with a history of cancer fall at a higher rate than those without cancer, and if the occurrence of falls was influenced by individual characteristics, symptoms, or function.

METHODS

This was a retrospective, cross-sectional study, in 2007, examining 7,448 community-dwelling elderly 65 years or older in a state in the Midwest. Fallers were identified based on a diagnosis of cancer, age, sex, race and ethnicity, poor vision, reduced activities of daily living (ADLs), instrumental ADLs, cognition, incontinence, pain, or depression.

RESULTS

Findings indicated that 2,125 (28.5%) had at least 1 fall. Of those who fell, 967 (13.0%) had cancer, and 363 (4.9%) with cancer had a fall.

CONCLUSION

Predictors of falls in this population included race, sex, ADLs, incontinence, depression, and pain, all with P <.05. Cancer was not a predictor of falls in this study.

IMPLICATIONS FOR PRACTICE

This study found a high frequency of falls and suggests a predictive model for fall risk in the vulnerable, community-dwelling elderly and will be used to inform future studies.

Primary biliary cirrhosis is associated with falls and significant fall related injury

BACKGROUND

Osteoporosis and autonomic dysfunction are prevalent in the autoimmune liver disease primary biliary cirrhosis (PBC). Postural hypotension is one consequence of autonomic dysfunction and is a recognized risk factor for falls, which, alongside osteoporosis could lead to significant injury and fractures.

AIM

To determine the prevalence and sequelae of falls in PBC and to identify modifiable risk factors.

DESIGN

Cross-sectional, geographical, population census of PBC and two control groups: primary sclerosing cholangitis and a community dwelling population. Multidisciplinary falls assessment of a representative group of PBC.

METHODS

Symptom assessment tools, completed by the three cohorts, determined the prevalence of falls, injuries and associated symptoms. Multidisciplinary assessments, adhering to NICE guidelines, identified modifiable fall associations.

RESULTS

Significantly more of the PBC population had fallen (72% P < 0.001) than both control groups. Fifty-five percent had fallen in the last year (P < 0.001), and 22% more than once in the last year (P < 0.01). Seventy percent of PBC fallers were injured, 27% fractured a bone and 19% were admitted to hospital, all significantly more common than controls. Postural dizziness was significantly worse in fallers (P < 0.001), as were balance (P < 0.001) and lower limb strength (P = 0.002). Lower limb strength was independently associated with number of falls in previous year (beta = 0.184, P < 0.001).

CONCLUSION

Falls and resultant injury are prevalent in PBC and more common than previously recognized. Addressing postural dizziness, poor balance and lower limb weakness using a multidisciplinary approach has the potential to reduce falls, morbidity and mortality and as a result improve quality of life.

Fall risk in community-dwelling elderly cancer survivors: a predictive model for gerontological nurses

The aim of this predictive study was to test a structural model to establish predictors of fall risk in elderly cancer survivors. An aging and nursing model of care was synthesized and used to examine the Minimum Data Set for 6,912 low-income older adult participants in a community setting in the midwestern United States. Data analysis established relationships among fall risk and age, race/ethnicity, history of a previous fall, depression, pain, activities of daily living, instrumental activities of daily living, incontinence, vision, and cognitive status. Factors leading to fall risk can direct nursing activities that have the potential to prevent falls, thus improving older adults' quality of life.