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Cohen C, Bélanger L, Turcotte M, Pereira F. Stressors and coping strategies in older people hospitalised for hip surgery following a fall: a multiple case study. BMC Nurs 2024; 23:653. [PMID: 39272183 PMCID: PMC11401280 DOI: 10.1186/s12912-024-02316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 09/02/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND More than half of older persons admitted to an emergency department after a fall have a hip fracture and require surgery for a total hip replacement. This procedure has a high risk of postoperative complications and consequences for older persons, their informal caregivers, and the healthcare system. This study aimed to explore the perceptions of older persons, their informal caregivers and health professionals about intra-personal, inter-personal and extra-personal stressors arising from hip surgery following the fall of an older person hospitalised in orthopaedics, as well as the coping strategies used and the results obtained. METHODS A qualitative multiple case study. The sample consisted of eight cases. Each case consisted of one older person, their informal caregiver and the professionals involved in their care: a nurse, an orthopaedic surgeon and a physiotherapist. A total of 32 participants were recruited. Data were collected between August 2018 and February 2019 in a public hospital in French-speaking Switzerland. Intra- and inter-case analyses were performed. RESULTS Five topics emerged: two concerning stressors for older persons (the physical and psychological consequences of the fall and hospitalisation; the loss of relational and environmental markers and habits); two relating to the coping strategies used to face the stressors (being resilient and involved in their own care; partially meeting the older person's needs); and one regarding the results of the strategies used (reassurance through consideration of some of their needs). CONCLUSIONS Older persons hospitalised for hip surgery after a fall are confronted with various intra-, inter- and extra-personal stressors and have to explore, together with their informal caregivers, strategies to cope with the consequences of these stressors. Healthcare professionals should possess efficient intervention strategies to help identify and support older persons who experience various types of stressors during hospitalisation for hip surgery following a fall.
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Affiliation(s)
- Christine Cohen
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue Vinet 30, Lausanne, 1004, Switzerland.
| | - Louise Bélanger
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
| | - Mathieu Turcotte
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue Vinet 30, Lausanne, 1004, Switzerland
| | - Filipa Pereira
- School of Health Sciences, HES-SO Valais/Wallis, University of Applied Sciences and Arts, Western Switzerland, Sion, Switzerland
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Arruda MS, Curiati PK, Aliberti MJR, Morinaga CV, Avelino-Silva TJ, Marques APDO, Melo HMDA. The First Step Is the Hardest: Understanding Posthospital Fall Risks in Brazilian Older Adults. J Am Med Dir Assoc 2024; 25:105038. [PMID: 38796170 DOI: 10.1016/j.jamda.2024.105038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/28/2024]
Affiliation(s)
- Marcela S Arruda
- Geriatric Emergency Department Research Group (ProAGE), Hospital Sirio-Libanes, Sao Paulo, Sao Paulo, Brazil; Postgraduate Program in Gerontology (PPGERO), Federal University of Pernambuco, Recife, Brazil.
| | - Pedro K Curiati
- Geriatric Emergency Department Research Group (ProAGE), Hospital Sirio-Libanes, Sao Paulo, Sao Paulo, Brazil; Geriatric Center for Advanced Medicine, Hospital Sirio-Libanes, São Paulo, Sao Paulo, Brazil
| | - Marlon J R Aliberti
- Geriatric Emergency Department Research Group (ProAGE), Hospital Sirio-Libanes, Sao Paulo, Sao Paulo, Brazil; Geriatric Center for Advanced Medicine, Hospital Sirio-Libanes, São Paulo, Sao Paulo, Brazil; Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Christian V Morinaga
- Geriatric Emergency Department Research Group (ProAGE), Hospital Sirio-Libanes, Sao Paulo, Sao Paulo, Brazil
| | - Thiago J Avelino-Silva
- Geriatric Emergency Department Research Group (ProAGE), Hospital Sirio-Libanes, Sao Paulo, Sao Paulo, Brazil; Geriatric Center for Advanced Medicine, Hospital Sirio-Libanes, São Paulo, Sao Paulo, Brazil; Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Ana Paula de O Marques
- Postgraduate Program in Gerontology (PPGERO), Federal University of Pernambuco, Recife, Brazil; Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE)/Ebserh, Recife, Pernambuco, Brazil
| | - Hugo M de A Melo
- Postgraduate Program in Gerontology (PPGERO), Federal University of Pernambuco, Recife, Brazil; Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE)/Ebserh, Recife, Pernambuco, Brazil
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Davey N, Connolly E, Mc Elwaine P, Kennelly SP. A Systematic Review of Falls Risk of Frail Patients with Dementia in Hospital: Progress, Challenges, and Recommendations. Clin Interv Aging 2024; 19:1127-1139. [PMID: 38948169 PMCID: PMC11214555 DOI: 10.2147/cia.s400582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/15/2024] [Indexed: 07/02/2024] Open
Abstract
This review article assesses the effectiveness and limitations of strategies to reduce falls among hospitalized older adults with frailty and dementia. It explores the efficacy of existing fall prevention strategies for a cohort that is acutely susceptible to falls and fall-related consequences. A systematic literature search was conducted across MEDLINE, Embase, CINAHL, and PsycINFO, employing Medical Subject Headings (MeSH) to identify studies on fall prevention strategies in hospitalized older adults with both dementia and frailty published from 2013 to 2023. The initial 643 records were distilled to eight articles, with Structured Interdisciplinary Bedside Rounds (SIBR) emerging as a notable intervention. SIBR demonstrated a reduction in falls by fostering improved interdisciplinary communication and care planning. However, a decline in family engagement during consecutive sessions suggests a need for strategies to sustain familial involvement. The findings advocate for patient-centered interventions that address the cognitive and functional challenges faced by this cohort of older adults. This review advocates for comprehensive and inclusive research in hospital environments to improve fall prevention strategies for frail older adults with dementia.
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Affiliation(s)
- Naomi Davey
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Eimear Connolly
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Paul Mc Elwaine
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sean P Kennelly
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Astolphi Lima C, Alsunaidi S, Lowe S, Hogan DB, Dennett L, Jones CA, Yamamoto S. Exploring the influence of weather variability and climate change on health outcomes in people living with dementia: A scoping review protocol. PLoS One 2024; 19:e0304181. [PMID: 38913693 PMCID: PMC11195938 DOI: 10.1371/journal.pone.0304181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 05/04/2024] [Indexed: 06/26/2024] Open
Abstract
Environmental factors resulting from climate change and air pollution are risk factors for many chronic conditions including dementia. Although research has shown the impacts of air pollution in terms of cognitive status, less is known about the association between climate change and specific health-related outcomes of older people living with dementia. In response, we outline a scoping review protocol to systematically review the published literature regarding the evidence of climate change, including temperature and weather variability, on health-related quality of life, morbidity, mobility, falls, the utilization of health resources, and mortality among older adults living with dementia. This scoping review will be guided by the framework proposed by Arksey and O'Malley. Electronic search (Medline, Embase, PsycINFO, CINAHL, Scopus, Web of Science) using relevant subject headings and synonyms for two concepts (older people with dementia, weather/ climate change). No publication date or other restrictions will be applied to the search strategy. No language restriction will be applied in order to understand the impact of non-English studies in the literature. Eligible studies must include older adults (65+years) with dementia living in the community and investigate the impacts of climate change and/or weather on their health-related quality of life, morbidity, mobility, falls, use of health resources and mortality. Two independent reviewers will screen abstracts and select those for a full-text review, perform these reviews, select articles for retention, and extract data from them in a standardized manner. This data will then be synthesized and interpreted. OSF registration: DOI: 10.17605/OSF.IO/YRFM8.
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Affiliation(s)
- Camila Astolphi Lima
- School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
| | - Sara Alsunaidi
- School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
| | - Samuel Lowe
- School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
| | - David B. Hogan
- Cumming School of Medicine, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Liz Dennett
- Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - C. Allyson Jones
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Shelby Yamamoto
- School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
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Weerasinghe A, Thielman J, Li Y, Doguparty VB, Medeiros A, Keller-Olaman S, Carsley S, Richmond SA. Trends in falls among older adults before and during the COVID-19 pandemic in Ontario, Canada: A retrospective observational study. BMC Geriatr 2024; 24:418. [PMID: 38730402 PMCID: PMC11088052 DOI: 10.1186/s12877-024-05032-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The public health measures associated with the COVID-19 pandemic may have indirectly impacted other health outcomes, such as falls among older adults. The purpose of this study was to examine trends in fall-related hospitalizations and emergency department visits among older adults before and during the COVID-19 pandemic in Ontario, Canada. METHODS We obtained fall-related hospitalizations (N = 301,945) and emergency department visit (N = 1,150,829) data from the Canadian Institute for Health Information databases from 2015 to 2022 for adults ages 65 and older in Ontario. Fall-related injuries were obtained using International Classification of Diseases, 10th edition, Canada codes. An interrupted time series analysis was used to model the change in weekly fall-related hospitalizations and emergency department visits before (January 6, 2015-March 16, 2020) and during (March 17, 2020-December 26, 2022) the pandemic. RESULTS After adjusting for seasonality and population changes, an 8% decrease in fall-related hospitalizations [Relative Rate (RR) = 0.92, 95% Confidence Interval (CI): 0.85, 1.00] and a 23% decrease in fall-related emergency department visits (RR = 0.77, 95%CI: 0.59, 1.00) were observed immediately following the onset of the pandemic, followed by increasing trends during the pandemic for both outcomes. CONCLUSIONS Following an abrupt decrease in hospitalizations and emergency department visits immediately following the onset of the pandemic, fall-related hospitalizations and emergency department visits have been increasing steadily and are approaching pre-pandemic levels. Further research exploring the factors contributing to these trends may inform future policies for public health emergencies that balance limiting the spread of disease among this population while supporting the physical, psychological, and social needs of this vulnerable group.
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Affiliation(s)
- Ashini Weerasinghe
- Public Health Ontario, 661 University Ave, Suite 1701, Toronto, ON , M5G 1M1, Canada.
| | - Justin Thielman
- Public Health Ontario, 661 University Ave, Suite 1701, Toronto, ON , M5G 1M1, Canada
| | - Ye Li
- Public Health Ontario, 661 University Ave, Suite 1701, Toronto, ON , M5G 1M1, Canada
- Dalla School of Public Health, University of Toronto, Toronto, Canada
| | - Varsha B Doguparty
- Public Health Ontario, 661 University Ave, Suite 1701, Toronto, ON , M5G 1M1, Canada
| | - Alexia Medeiros
- Public Health Ontario, 661 University Ave, Suite 1701, Toronto, ON , M5G 1M1, Canada
| | - Sue Keller-Olaman
- Public Health Ontario, 661 University Ave, Suite 1701, Toronto, ON , M5G 1M1, Canada
| | - Sarah Carsley
- Public Health Ontario, 661 University Ave, Suite 1701, Toronto, ON , M5G 1M1, Canada
- Dalla School of Public Health, University of Toronto, Toronto, Canada
| | - Sarah A Richmond
- Public Health Ontario, 661 University Ave, Suite 1701, Toronto, ON , M5G 1M1, Canada
- Dalla School of Public Health, University of Toronto, Toronto, Canada
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Huang L, Chen H, Liang M. The Association Between Habitual Tea Consumption and Frailty Transition in Community-Dwelling Older Adults: A Prospective Cohort Study. J Am Med Dir Assoc 2024; 25:259-265.e3. [PMID: 37454694 DOI: 10.1016/j.jamda.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To investigate the association between habitual tea consumption and transitions between frailty states among older adults in China. DESIGN A prospective cohort study based on the Chinese Longitudinal Healthy Longevity Study. SETTING AND PARTICIPANTS A total of 23,720 older adults aged ≥65 years with complete data regarding frailty status and tea consumption were recruited. METHODS The frequency and consistency of tea consumption were introduced to evaluate levels of tea consumption. The frailty index was used to define frailty status (frail and nonfrail). Frailty transition was classified into remaining nonfrail, improvement, worsening, and remaining frail groups. Logistic regression models were applied. RESULTS The overall frailty prevalence at baseline was 19.1%, being lower among consistent daily tea drinkers (12.5%) and higher among non-tea drinkers (21.9%). Logistic regression analyses showed that the risk of frailty was significantly reduced among consistent daily tea drinkers after adjusting for all confounders [odds ratio (OR), 0.81; 95% CI, 0.67-0.98]. During the 3-year follow-up, improvement in frailty status was more common among consistent daily tea drinkers (50.9%) than non-tea drinkers (40.9%), and this trend was opposite in participants with worsened frailty status (consistent daily tea drinkers: 12.2%) vs non-tea drinkers: 19.2%). Further analysis showed that consistent daily tea drinkers were significantly associated with improvement in frailty status (OR, 3.24; 95% CI, 1.02-10.31) and remaining in a nonfrail state (OR, 1.35; 95% CI, 1.00-1.83). In addition, daily tea consumption was observed to be positively associated with remaining in a nonfrail state and inversely associated with worsened frailty status in men, but not in women. CONCLUSIONS AND IMPLICATIONS Older people consuming tea daily tend to have an improved frailty status in the future. Men with daily tea consumption were less likely to have a worsened frailty status. Advocating for the traditional lifestyle of drinking tea could be a promising way to advance healthy aging for older adults.
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Affiliation(s)
- Lanhui Huang
- Department of Geriatric Endocrinology and Metabolism, The First Affiliated Hospital of Guangxi Medical University, China
| | - Huihe Chen
- Department of Rehabilitation, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
| | - Min Liang
- Department of Geriatric Endocrinology and Metabolism, The First Affiliated Hospital of Guangxi Medical University, China.
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Cheung G, Beyene K, Yan Chan AH, Drayton BA, Jamieson H, Lyndon M, Hikaka J, Ma'u E, Meehan B, Walker X, Rivera-Rodriguez C. Falls Risk in Long-Term Care Residents With Cognitive Impairment: Effects of COVID-19 Pandemic. J Am Med Dir Assoc 2024; 25:177-182. [PMID: 38104633 DOI: 10.1016/j.jamda.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the impact of the COVID-19 pandemic on falls rates in long-term care residents with cognitive impairment. DESIGN An observational study using routinely collected national interRAI data. SETTING AND PARTICIPANTS Participants were from long-term care residents (age ≥60 years) who received an interRAI Long Term Care Facility assessment anywhere in New Zealand between August 17, 2018, and August 16, 2022. METHODS The primary outcome was "At least 1 fall in the last 30 days." Based on the Cognitive Performance Scale (CPS), cognitive impairment was categorized into 3 levels: intact or borderline intact (0-1), mild to moderate impairment (2-3), and moderately to very severe impairment (4-6). The COVID-19 pandemic was divided into 3 periods (First wave: March 21, 2020, to June 8, 2020; Varying level of community outbreaks: June 9, 2020 to August 16, 2021; and Delta-Omicron wave: August 17, 2021, to August 16, 2021) and compared to a pre-COVID-19 period (August 17, 2018, to March 20, 2020). Cox regression modeling was used to study falls and interactions between CPS and COVID-19 pandemic periods, along with other established falls risk factors in the literature. RESULTS A total of 282,518 interRAI-LTCF assessments from 75,132 unique residents were included. Interactions between CPS and COVID-19 pandemic periods found that cognitive impairment was associated with a higher hazard ratio (ranged from 1.22 to 1.37) in each of the 3 COVID-19 pandemic periods. We also found unstable health, unsteady gait, wandering, and moderate to severe ADL dependency were the strongest risk factors for falls. CONCLUSIONS AND IMPLICATIONS Cognitively impaired long-term care residents had an increased risk for falls during the COVID-19 pandemic. This risk was influenced by several factors. In future pandemic or infection control related isolation, residents who are most at risk can be identified for targeted falls prevention programs.
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Affiliation(s)
- Gary Cheung
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.
| | - Kebede Beyene
- Department of Pharmaceutical and Administrative Sciences, University of Health Sciences and Pharmacy, St Louis, MO, USA
| | - Amy Hai Yan Chan
- School of Pharmacy, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Bradley Alan Drayton
- Department of Statistics, Faculty of Science, The University of Auckland, Auckland, New Zealand
| | - Hamish Jamieson
- Department of Medicine, Christchurch Medical School, University of Otago, Christchurch, New Zealand
| | - Mataroria Lyndon
- The Centre for Medical and Health Sciences Education, School of Medicine, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Joanna Hikaka
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Etuini Ma'u
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Brigette Meehan
- interRAI New Zealand, Te Whatu Ora/Health New Zealand, Wellington, New Zealand
| | - Xaviour Walker
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
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Association of Frailty Status with Risk of Fall among Hospitalized Elderly Patients: A Cross-Sectional Study in an Acute Geriatric Unit. MEDICINES (BASEL, SWITZERLAND) 2022; 9:medicines9100048. [PMID: 36286581 PMCID: PMC9609654 DOI: 10.3390/medicines9100048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 11/30/2022]
Abstract
Introduction: The objective was to study the association of frailty status in hospitalized elderly patients with risk of fall in an acute geriatric unit and to characterize elderly “fallers” using a comprehensive gerontological assessment. Patients and Methods: A cross-sectional study was conducted in patients over 65 years of age and hospitalized in an acute geriatric unit. This work was carried out in the Acute Geriatric Medicine Unit, Saint-Julien Hospital, Center Hospitalier Universitaire de Rouen from 1 June 2016 to 15 August 2016. Results: 172 patients were included during the collection period, with a female predominance of 115 patients (66.9%). The average age of the sample was 79.37 years old (65−85). The average CHARLSON score was 6.93 (3−16). Patients came from home in 81.4% of cases (i.e., 140 patients), and from a nursing home in 18.6% of cases (i.e., 32 patients). The risk of falling, as assessed by the Monopodal Support Test, returned as abnormal for 127 patients. In our series, there was a statistically strong link between the risk of falling and the presence of a dementia pathology (p = 0.009), the presence of a vitamin D deficiency (p = 0.03), the presence of frailty, as assessed by the three scales (modified SEGA scale, Fried scale and CFS/7 (<0.001), a high comorbidity score (p = 0.04), and a disturbed autonomy assessment according to IADL (p = 1.02 × 10−5) and according to ADL (p = 6.4 × 10−8). There was a statistically strong link between the risk of falling and the occurrence of death (p = 0.01). Conclusion: The consequences of the fall in terms of morbidity and mortality and the frequency of this event with advancing age and its impact on the quality of life as well as on health expenditure justify a systematic identification of the risk of falling in the elderly population. It is therefore important to have sensitive, specific, and reproducible tools available for identifying elderly people at high risk of falling.
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