Fear of falling assessments in older people with dementia

Fall Risk Screening and Assessment for People Living With Dementia: A Scoping Review

Falls are the leading cause of injury and hospitalization for older adults in Canada and the second leading cause of unintentional injury deaths worldwide. For people living with dementia (PLWD), falls have an even greater impact, but the standard testing methods for fall risk screening and assessment are often not practical for this population. The purpose of this scoping review is to identify and summarize recent research, practice guidelines and gray literature which have considered fall risk screening and assessment for PLWD. Database search results revealed a dearth in the literature that can support researchers and healthcare providers when considering which option/s are the most suitable for PLWD. Further primary studies into the validity of using the various tests with PLWD are needed if researchers and healthcare providers are to be empowered via the literature and clinical practice guidelines to provide the best possible fall risk care for PLWD.

Floor Cleaners as Helper Pets: Projecting Assistive Robots' Agency on Zoomorphic Affordances

Care of ageing adults has become a dominant field of application for assistive robot technologies, promising support for ageing adults residing in care homes and staff, in dealing with practical routine tasks and providing social and emotional relieve. A time consuming and human intensive necessity is the maintenance of high hygiene quality in care homes. Robotic vacuum cleaners have been proven effective for doing the job elsewhere, but-in the context of care homes-are counterproductive for residents' well-being and do not get accepted. This is because people with dementia manifest their agency in more implicit and emotional ways, while making sense of the world around them. Starting from these premises, we explored how a zoomorphic designed vacuum cleaner could better accommodate the sensemaking of people with dementia. Our design reconceptualises robotic vacuum cleaners as a cat-like robot, referring to a playful behaviour and appearance to communicate a non-threatening and familiar role model. Data from an observational study shows that residents responded positively to our prototype, as most of them engaged playfully with it as if it was a pet or a cat-like toy, for example luring it with gestures. Some residents simply ignored the robot, indicating that it was not perceived as frightening or annoying. The level of activity influenced reactions; residents ignored our prototype if busy with other occupations, which proves that it did not cause significant disturbance. We further report results from focus group sessions with formal and informal caregivers who discussed a video prototype of our robot. Caregivers encouraged us to enhance the animal like characteristics (in behaviour and materiality) even further to result in richer interactions and provoke haptic pleasure but also pointed out that residents should not mistake the robot for a real cat.

Two factors that can increase the length of hospital stay of patients with dementia

OBJECTIVES

Patients with dementia are at greater risk of a long hospital stay and this is associated with adverse outcomes. The aim of this service evaluation was to identify variables most predictive of increased length of hospital stay amongst patients with dementia.

METHODS/DESIGN

We conducted a retrospective analysis on a cross-sectional hospital dataset for the period January-December 2016. Excluding length of stay less than 24h and readmissions, the sample comprised of 1133 patients who had a dementia diagnosis on record.

RESULTS

The highest incidence rate ratio for length of stay in the dementia sample was: (a) discharge to a care home (IRR: 2.443, 95% CI 1.778-3.357), (b) falls without harm (IRR: 2.486, 95% CI 2.029-3.045).

CONCLUSIONS

Based on this dataset, we conclude that improvements made to falls prevention strategies in hospitals and discharge planning procedures can help to reduce the length of stay for patients with dementia.

Adult Inpatients’ Perceptions of Their Fall Risk: A Scoping Review

Patient falls in hospitals continue to be a global concern due to the poor health outcomes and costs that can occur. A large number of falls in hospitals are unwitnessed and mostly occur due to patient behaviours and not seeking assistance. Understanding these patient behaviours may help to direct fall prevention strategies, with evidence suggesting the need to integrate patients’ perspectives into fall management. The aim of this scoping review was to explore the extent of the literature about patients’ perceptions and experiences of their fall risk in hospital and/or of falling in hospital. This review was conducted using a five-stage methodological framework recommended by Arksey and O’Malley. A total of nine databases were searched using key search terms such as “fall*”, “perception” and “hospital.” International peer-reviewed and grey literature were searched between the years 2011 and 2021. A total of 41 articles, ranging in study design, met the inclusion criteria. After reporting on the article demographics and fall perception constructs and measures, the qualitative and quantitative findings were organised into five domains: Fall Risk Perception Measures, Patients’ Perceptions of Fall Risk, Patients’ Perceptions of Falling in Hospital, Patients’ Fear of Falling and Barriers to Fall Prevention in Hospital. Approximately two-thirds of study participants did not accurately identify their fall risk compared to that defined by a health professional. This demonstrates the importance of partnering with patients and obtaining their insights on their perceived fall risk, as this may help to inform fall management and care. This review identified further areas for research that may help to inform fall prevention in a hospital setting, including the need for further research into fall risk perception measures.

Differential risk of falls associated with pain medication among community-dwelling older adults by cognitive status

BACKGROUND

Persons living with dementia have an elevated risk of falling and chronic pain. This study investigates the relationship of pain medication use with falls among community-dwelling adults based on their cognitive status.

METHODS

We analysed a nationally representative sample of community-dwelling Medicare beneficiaries (n = 7,491) who completed cognitive assessments used for dementia classification in the 2015 US National Health and Aging Trends Study. We performed survey-weighted logistic regression to investigate differential associations between pain medication use and a recent fall by cognitive status: no dementia, possible dementia and probable dementia, controlling for sociodemographic and health characteristics.

RESULTS

About 16.5% of the analytic sample was classified as possible dementia (8.3%) and probable dementia (8.2%). Pain medication use was associated with a recent fall among those with probable dementia [odds ratio (OR) = 1.86, 95% confidence interval (CI): 1.14, 3.03], controlling for sociodemographic and health characteristics. Taking medication for pain 2 days a week or more (OR = 2.14, 95% CI: 1.20, 3.81) was associated with falls among those with probable dementia. Bothersome pain and worry about falling down were also associated with falls among participants with no dementia and possible dementia, respectively.

CONCLUSION

Differential risk factors for falls by cognitive status imply the need for tailored pain management and fall prevention strategies. The provision of fall prevention programmes stressing balance training and medication use is important regardless of cognitive status in community-dwelling older adults. Future research should explore other modifiable factors associated with the risk of falls among community-dwelling adults.

Sensor-based fall risk assessment in older adults with or without cognitive impairment: a systematic review

BACKGROUND

Higher age and cognitive impairment are associated with a higher risk of falling. Wearable sensor technology may be useful in objectively assessing motor fall risk factors to improve physical exercise interventions for fall prevention. This systematic review aims at providing an updated overview of the current research on wearable sensors for fall risk assessment in older adults with or without cognitive impairment. Therefore, we addressed two specific research questions: 1) Can wearable sensors provide accurate data on motor performance that may be used to assess risk of falling, e.g., by distinguishing between faller and non-faller in a sample of older adults with or without cognitive impairment?; and 2) Which practical recommendations can be given for the application of sensor-based fall risk assessment in individuals with CI? A systematic literature search (July 2019, update July 2020) was conducted using PubMed, Scopus and Web of Science databases. Community-based studies or studies conducted in a geriatric setting that examine fall risk factors in older adults (aged ≥60 years) with or without cognitive impairment were included. Predefined inclusion criteria yielded 16 cross-sectional, 10 prospective and 2 studies with a mixed design.

RESULTS

Overall, sensor-based data was mainly collected during walking tests in a lab setting. The main sensor location was the lower back to provide wearing comfort and avoid disturbance of participants. The most accurate fall risk classification model included data from sit-to-walk and walk-to-sit transitions collected over three days of daily life (mean accuracy = 88.0%). Nine out of 28 included studies revealed information about sensor use in older adults with possible cognitive impairment, but classification models performed slightly worse than those for older adults without cognitive impairment (mean accuracy = 79.0%).

CONCLUSION

Fall risk assessment using wearable sensors is feasible in older adults regardless of their cognitive status. Accuracy may vary depending on sensor location, sensor attachment and type of assessment chosen for the recording of sensor data. More research on the use of sensors for objective fall risk assessment in older adults is needed, particularly in older adults with cognitive impairment.

TRIAL REGISTRATION

This systematic review is registered in PROSPERO ( CRD42020171118 ).