Diurnal variation in mortality in older nocturnal fallers

Cost effectiveness of fall prevention programmes for older adults

Falls are associated with a substantial increase in risk of mortality and are the second leading cause of unintentional death worldwide. A single fall can affect all aspects of an older person's life. These broad impacts can lead to worse disability outcomes and a higher likelihood of long-term nursing home admission. There is a need to identify not just effective falls prevention interventions but also cost effectiveness.

Gender Differences in Personal and Situational Risk Factors for Traumatic Brain Injury Among Older Adults

OBJECTIVE

To investigate differences between older men and women in Taiwan in personal and situational risk factors for sustaining a traumatic brain injury (TBI) versus soft-tissue injury (STI) due to a fall.

DESIGN

Matched case-control study.

PARTICIPANTS AND SETTINGS

Cases were defined as patients with a primary diagnosis of TBI due to a fall and were identified from those 60 years or older who visited the emergency department (ED) of 3 university-affiliated hospitals in 2015. Matched by the same hospital ED, gender, and time of falling, 3 controls who had no TBI and who had sustained only soft-tissue injury (STI) due to falling were selected for comparison with each case. Personal factors and situational exposures were compared between the control and case groups. In total, 96 cases and 288 controls in men and 72 cases and 216 controls in women participated in this study.

MAIN MEASURES

Personal factors (sociodemographic and lifestyle factors, medical characteristics, and functional abilities) and situational exposures (location, activities before the fall, center-of-mass change, type of fall, falling direction, protective response, and impact during the fall).

RESULTS

In men, after adjusting for other variables, older age (odds ratio [OR] = 1.04), regular alcohol use (OR = 2.03), an indoor fall (OR = 1.92), activity of getting in/out of bed (OR = 2.56), a fall due to dizziness (OR = 4.09), and falling backward (OR = 2.95) were independently associated with a higher odds of TBI. In women, an older age (OR = 1.03), the presence of Parkinson disease (OR = 10.4), activities of toileting (OR = 2.50), getting in/out of bed (OR = 4.90), and negotiating stairs (OR = 7.13), a fall due to dizziness (OR = 5.05), and falling backward (OR = 2.61) were independently associated with a higher odds of TBI.

CONCLUSIONS

Our results demonstrated similarities and differences in personal and situational risk factors for fall-related TBIs versus STIs between older men and women, and gender differences should be considered when developing intervention strategies.

Falls and fear of falling among Israeli community-dwelling older people: a cross-sectional national survey

BACKGROUND

Falls and fear of falling are a major problem for older people and a leading cause of functional decline and institutionalization. There is limited data on the prevalence of falls in a 12-month period among Israeli older adults. Our main objective was to evaluate the prevalence of falls among Israeli community-dwelling older people aged ≥65 years and to identify factors associated with falls and fear of falling.

METHODS

A national cross-sectional interview survey was conducted between February 2018 and April 2019 by the Israeli Center for Disease Control. The prevalence of falls was assessed by asking participants about falling within the 12 months prior to the survey. Fear of falling was assessed by asking participants about the fear of future falls. Multivariate analysis was used to identify factors associated with falls and with fear of falling.

RESULTS

From 5281 households that were eligible for inclusion in this study, 3242 participants (61.4%) completed the survey. Falling at least once in the past year was reported by 23.8% of the respondents and fear of falling by 48.2%. The majority of the participants (91.1%) reported that they had never received any instruction about fall prevention from their medical care provider. In the multivariate analysis, falls and fear of falling were each a risk factor for the other; and were also significantly associated with female gender, major functional difficulties, the use of walking aids, cardiac disease, diabetes mellitus and psychotropic medications.

CONCLUSION

The prevalence of falls and fear of falling among Israeli community-dwelling older people is comparable to the rates published in other countries. Efforts should be made to increase awareness about falls and their health consequences among older people. The development of specific interventions to target those at higher risk for falls and fear of falling is strongly recommended.

Risk factors for severe injury following indoor and outdoor falls in geriatric patients

INTRODUCTION

This study was performed to examine the characteristics of indoor and outdoor falls in older patients and the factors related to severe injury in the emergency department (ED).

METHODS

In total, 26,515 patients fell indoors and 19,581 outdoors. The general and clinical characteristics were compared between the two groups and factors associated with severe injury following the falls were evaluated.

RESULTS

Younger males fell more frequently outdoors than indoors. The common activities during outdoor falls were sports and leisure activities. Environmental hazards lead to more outdoor falls than indoor falls. Factors associated with severe injury after indoor falls were transport to the ED by public ambulance or from another medical facility rather than individual transportation, fall from stairs rather than fell over, and a head and neck injury rather than a lower extremity injury. Factors related to severe injury after outdoor falls were male sex, transport to the ED by public ambulance or from another medical facility or by another method rather than individual transportation, state employed, fall from stairs rather than fell over, head and neck or thorax or abdomen injury rather than a lower extremity injury.

CONCLUSION

Transport to the ED by public ambulance or from another medical facility, and head and neck injury were risks for severe injury following indoor and outdoor falls in elderly subjects. Efforts to identify the risk factors for severe injury and for falling itself are important to prevent and reduce fall injuries in elderly subjects.

Association of mortality with out-of-hours admission in patients with perforated peptic ulcer

BACKGROUND

Perforated peptic ulcer is a serious emergency surgical condition. The aim of the present nationwide cohort study was to evaluate the association between mortality and out-of-hours admission in patients surgically treated for perforated peptic ulcer.

METHODS

All Danish patients surgically treated for benign gastric or duodenal perforated peptic ulcer in Denmark between September 1, 2011 and August 31, 2013 were included. Patients were identified through The Danish Clinical Register of Emergency Surgery. The association between 90-day mortality and time and day of admission and surgery was assessed by crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

A total of 726 patients were included. Median age was 69.5 years (range 18.2-101.7), and 569 of the 726 patients (78.4%) had at least one coexisting disease. Adjusted ORs and 95% CIs between 90-day mortality and admission in daytime vs. nighttime and weekday vs. weekend were 1.0 (0.7-1.5) and 1.2 (0.8-1.8), respectively. Adjusted ORs with 95% CI between surgery in daytime vs. nighttime and weekday vs. weekend were 0.9 (0.6-1.3) and 1.2 (0.8-1.8), respectively. Sensitivity analysis was consistent with the primary analysis. The overall 90-day mortality rate was 25.6% (186/726).

CONCLUSION

No statistically significant adjusted association between 90-day mortality and out-of-hours admission was found in patients surgically treated for perforated peptic ulcer.

Inappropriate prescribing in older fallers presenting to an Irish emergency department

BACKGROUND

certain medications increase falls risk in older people.

OBJECTIVE

to assess if prescribing modification occurs in older falls presenting to an emergency department (ED).

DESIGN

before-and-after design: presentation to ED with a fall as the index event.

SUBJECTS

over 70's who presented to ED with a fall over a 4-year period.

METHODS

dispensed medication in the 12 months pre- and post-fall was identified using a primary care reimbursement services pharmacy claims database. Screening Tool of Older Person's PIP (STOPP) and Beers prescribing criteria were applied to identify potentially inappropriate prescribing (PIP). Polypharmacy was defined as four or more regular medicines. Psychotropic medication was identified using the WHO Anatomical Therapeutic Chemical classification system. Changes in prescribing were compared using McNemar's test (significance P < 0.05).

RESULTS

One thousand sixteen patients were eligible for analysis; 53.1% had at least one STOPP criteria pre-fall with no change post-fall (53.7%, P = 0.64). Beers criteria were identified in 44.0% pre-fall, with no change post-fall (41.5%, P = 0.125). The most significant individual indicators to change were neuroleptics, which decreased from 17.5 to 14.7% (P = 0.02) and long-acting benzodiazepines decreased from 10.7 to 8.6% (P = 0.005). Polypharmacy was observed in 63% and was strongly predictive of PIP, OR 4.0 (95% CI 3.0, 5.32). A high prevalence of psychotropic medication was identified pre-fall: anxiolytics (15.7%), antidepressants (26%), hypnosedatives (30%). New initiation of anxiolytics and hypnosedatives occurred in 9-15%, respectively, post-fall.

CONCLUSION

a significant prevalence of PIP was observed in older fallers presenting to the ED. No substantial improvements in PIP occurred in the 12 months post-fall, suggesting the need for focused intervention studies to be undertaken in this area.