Declining age-adjusted incidence of fall-induced injuries among elderly Finns

A review of center of pressure (COP) variables to quantify standing balance in elderly people: Algorithms and open-access code

Postural control is often quantified by recording the trajectory of the center of pressure (COP)-also called stabilogram-during human quiet standing. This quantification has many important applications, such as the early detection of balance degradation to prevent falls, a crucial task whose relevance increases with the aging of the population. Due to the complexity of the quantification process, the analyses of sway patterns have been performed empirically using a number of variables, such as ellipse confidence area or mean velocity. This study reviews and compares a wide range of state-of-the-art variables that are used to assess the risk of fall in elderly from a stabilogram. When appropriate, we discuss the hypothesis and mathematical assumptions that underlie these variables, and we propose a reproducible method to compute each of them. Additionally, we provide a statistical description of their behavior on two datasets recorded in two elderly populations and with different protocols, to hint at typical values of these variables. First, the balance of 133 elderly individuals, including 32 fallers, was measured on a relatively inexpensive, portable force platform (Wii Balance Board, Nintendo) with a 25-s open-eyes protocol. Second, the recordings of 76 elderly individuals, from an open access database commonly used to test static balance analyses, were used to compute the values of the variables on 60-s eyes-open recordings with a research laboratory standard force platform.

Sharp Rise in Fall-Induced Cervical Spine Injuries Among Older Adults Between 1970 and 2017

BACKGROUND

Fall-induced injuries in older adults are a major public health challenge.

METHODS

We determined the current trends in the number and age-adjusted incidence of fall-induced severe cervical spine injuries among older adults in Finland by taking into account all persons 50 years of age or older who were admitted to Finnish hospitals for primary treatment of these injuries between 1970 and 2017. Similar patients aged 20-49 years served as a reference group.

RESULTS

The annual number of fall-induced severe cervical spine injuries among older Finnish adults rose steeply during the follow-up, from 59 in 1970 to 502 in 2017. The age-adjusted incidence of injury (per 100,000 persons) was higher in men than women throughout this period and showed a clear increase from 1970 to 2017: from 8.4 to 25.0 in men, and from 2.8 to 13.9 in women. In both sexes, the increase was most prominent in the oldest age group, persons aged 80 years or older. In the reference group, the injury incidence declined by time.

CONCLUSIONS

The number and incidence of fall-induced severe cervical spine injuries among older Finns showed a sharp rise between 1970 and 2017. An increase in the average risk of serious falls may partly explain the phenomenon. Effective fall and injury prevention measures are urgently needed since further aging of the population is likely to aggravate the problem in the near future.

Does long-term recreational gymnastics prevent injurious falls in older women? A prospective 20-year follow-up

Background

Exercise interventions focusing on balance and strength training have been shown to be effective for falls prevention. The aim of this 20-year register-based follow-up was to examine whether long-term participation in recreational female gymnastics is associated with a lower risk of medically-attended injurious falls.

Methods

Health care register data of 187 women (103 recreational gymnasts and 84 sedentary controls) from the original cohort of 243 women were assessed. The mean age (sd) at baseline was 62.8 (5.4) years and the mean follow-up time was 19.4 (2.7) years (range from 5.6 to 21.0 years).

Injurious falls were scrutinized from medical records. An injurious fall was defined as an event in which falling was mentioned as a reason for making contact with health-care professionals. Negative binomial regression was used to estimate incidence rate ratios (IRR) for injurious falls, and Cox-regression models for calculating hazard ratios (HR) for injured fallers with the control group as reference.

Results

Recreational gymnasts had about 30% less injurious falls compared to controls, the mean IRR (95% CI) being 0.71 (0.51 to 0.96). The HR for injured fallers was 0.73 (0.52 to 1.02) favoring the recreational gymnasts. There were no statistically significant between-group differences for fractures.

Conclusions

Long-term recreational gymnastics appears to reduce the risk of injurious falls in old age.

Physical function tests predict incident falls: A prospective study of 2969 men in the Swedish Osteoporotic Fractures in Men study

Aims: Falls are common in the elderly population, and fall-related injuries are a major health issue. We investigated the ability of simple physical tests to predict incident falls. Methods: The Swedish Osteoporotic Fractures in Men (MrOS) study includes 3014 population-based men aged 69-81 years at the start of the study. These men performed five different physical tests at baseline: right-hand grip strength, left-hand grip strength, timed stand test, 6 m walking test (time and steps) and narrow walking test. During the first study year, we asked participants to fill out questionnaires regarding falls 4, 8 and 12 months after baseline. A total of 2969 men completed at least one questionnaire and were included in this study. We used generalised estimating equations and logarithmic regression models to estimate odds ratios for fallers and recurrent fallers (more than one fall during the one-year examination period) in each quartile of men for each physical test. Results: The proportions of fallers and recurrent fallers were higher in the lowest quartile of the physical tests than in the other three quartiles combined for all physical tests. A reduction of one standard deviation in respective physical test resulted in a 13-21% higher risk of becoming a faller and a 13-31% higher risk of becoming a recurrent faller. Conclusions: Low results on simple physical tests is a risk factor for incident falls in elderly Swedish men and may facilitate identification of high-risk individuals suitable for fall-intervention programs.

Fall-induced wounds and lacerations in older Finns between 1970 and 2014

BACKGROUND

Fall-induced injuries in elderly people are a growing public health issue.

AIM

We aimed to determine the current trends in the fall-induced severe wounds and lacerations among older adults in Finland-an EU country with a well-defined Caucasian population of 5.5 million.

METHODS

The injury trends were assessed by taking into account all persons 80 years of age or older who were admitted to Finnish hospitals for primary treatment of these injuries during 1970-2014.

RESULTS

The number of fall-induced severe wounds and lacerations among 80-year-old or older Finnish adults showed a sharp increase during the 44-year follow-up, from 52 in 1970 to 1393 in 2014. The age-adjusted incidence of injury (per 100,000 persons) also showed a clear rise from 1970 to 2014: from 98.3 to 511.5 in women, and from 92.0 to 395.3 in men. In both sexes, the increase was greatest in the oldest age group (persons 90 years of age or older).

CONCLUSIONS

The number of fall-induced severe wounds and lacerations among older Finnish persons rose in 1970-2014 with a rate that could not be explained merely by demographic changes. Further studies should focus on detailed understanding of the reasons for the rise and assessing possibilities for fall and injury prevention.

Rising incidence of fall-induced maxillofacial injuries among older adults

BACKGROUND

Various fall-induced injuries in older adults are a major public health problem.

AIM

We aimed to assess the current trends in the fall-induced severe maxillofacial injuries among older adults in Finland, an EU country with a well-defined white population of 5.5 million.

METHODS

The injury trends were determined by taking into account all persons 60 years of age or older who were admitted to Finnish hospitals for primary treatment of these injuries between 1999 and 2014.

RESULTS

The number of fall-induced maxillofacial injuries among older Finnish adults doubled during the 16-year follow-up, from 434 in 1999 to 981 in 2014. The age-adjusted incidence of injury (per 100 000 persons) also showed a clear increase from 1999 to 2014: from 47.4 to 71.3 in women, and from 39.2 to 59.6 in men. In both sexes, the increase was most prominent in the oldest age group, persons aged 80 years or older.

CONCLUSIONS

The number of fall-induced severe maxillofacial injuries among older Finns rose considerably between 1999 and 2014-with a rate that could not be explained merely by demographic changes. Further studies are urgently needed to better assess the reasons for the rise and possibilities for injury prevention.

Incidence of fall-related injuries in Iran: A population-based nationwide study

BACKGROUND

Fall-related injuries are considered to be a leading cause of morbidity and disability worldwide. The aim of this study was to investigate the incidence of fall-related injuries and its determinants in Iran.

METHODS

A cross-sectional household survey of a representative sample of 15-64 years old Iranians was carried out in 2011. A three-stage cluster sampling design was used. Total of 1525 clusters were randomly selected. Six households in each cluster were randomly selected, and one member of each household was interviewed. Data on the demographics and history of fall-related injury were obtained using the previously validated and reliability tested Short Form Injury Questionnaire 7 (SFIQ7). In all, 7886 subjects responded to the survey.

RESULTS

The incidence rate of all fall-related injuries was 59 (95%CI: 45-72) per 1000 person-year. The incidence rate of First Aid Fall-Related Injuries (FAFRIs) and Medical Attended Fall-Related Injuries (MAFRIs) were 30±5 and 28±12, respectively. Homes were the most common place of falls (52.5%). For all and MAFRIs, the most common activity leading to fall injury was walking (37.8% and 47.6%, respectively) whereas for FAFRIs was playing (31.9%). For all and FAFRIs, the most common description was as follows: upper limb as the injured organ (52.0% and 61.2%, respectively) and superficial wound as the most prevalent type of injury (39.0% and 61.8%, respectively). However, for MAFRIs, lower limb injuries (52.9%) and fracture (43.6%) were more pronounced. Risk factors for MAFRI were as follows: paid work activity (OR: 3.11; 95%CI: 2.07-4.67), playing (OR: 14.64; 95%CI: 6.34-33.80), walking (OR: 57.09; 95%CI: 28.95-112.59), driving (OR: 2.86; 95%CI: 1.23-6.63), and recreation activities (OR: 44.11; 95%CI: 14.04-138.54). Higher age and education were the other risk factors for MAFRI, as well as residing in rural areas.

CONCLUSION

This study revealed considerable incidence of fall injuries in Iranian population especially in rural regions who need access to protective equipment. People need to be warned about the constant risk of fall even during non-avoidable activities such as walking, playing, driving and paid/unpaid working especially in older ages. Implementation of fall prevention measures, home and behavioural modifications are recommended.

Fall-related injuries among Canadian seniors, 2005-2013: an analysis of the Canadian Community Health Survey

INTRODUCTION

We describe the epidemiology and trends of fall-related injuries among Canadian seniors aged 65 years and older by sex and age, as well as the circumstances and consequences of their injuries.

METHODS

We analyzed nationally representative data from the 2005, 2009/2010 and 2013 samples of the Canadian Community Health Survey to calculate the number and rates of fall-related injuries for each survey year. Where possible, we combined data from two or more samples to estimate the proportion of fall-related injuries by type of injury, part of body injured, type of activity and type of treatment.

RESULTS

The rate of fall-related injuries among seniors increased from 49.4 to 58.8 per 1000 population between 2005 and 2013, during which the number of fall-related injuries increased by 54% overall. Women had consistently higher rates than men across all survey years, while rates increased with advancing age. The upward trend in fall-related injury rates was more prominent among women and younger age groups. The most common type of injury was broken or fractured bones (37%), and the shoulder or upper arm (16%) was the most commonly injured body part. Many fall-related injuries occurred while walking on a surface other than snow or ice (45%). Over 70% of seniors seeking treatment for their injuries visited a hospital emergency department.

CONCLUSION

Given the increase in both the number and rates of fall-related injuries over time, there is a need to continue monitoring trends and injury patterns associated with falls.

Feasibility of whole-body vibration training in nursing home residents with low physical function: a pilot study

BACKGROUND AND AIMS

Whole-body vibration (WBV) training may offer an efficient option to improve physical performance of nursing home residents, but the feasibility of WBV training among frail elderly who require continuous institutional care is still open.

METHODS

Fifteen nursing home residents (mean age 84 years) with low physical performance (mean SPPB score 3.7) participated in this blinded, randomized controlled pilot trial. The intervention was either a 10 week, twice-a-week progressive vibration training with slight exercises done on a side-alternating device or similar sham training without vibration. Physical performance was assessed with Short Physical Performance Battery (SPPB), Timed Up and Go, walk speed and grip strength tests.

RESULTS

Low 12 Hz frequency was well tolerated with mean 95 % compliance in contrast to higher 18 Hz (or 26 Hz) frequency, which was poorly (<30 %) tolerated. While treatment effects were not significant, the mean change in SPPB score was 0.4 (range from -2 to +4) in the WBV group in contrast to -0.1 (from -3 to +3) in the sham group.

DISCUSSION AND CONCLUSION

Frail nursing home residents form not only a potential but also challenging target group for physical rehabilitation with WBV. Side-alternating WBV training performed at low 12 Hz frequency was found generally feasible, whereas higher frequencies appeared formidable. Nevertheless, it is possible that physical performance of some frail elderly without contraindications to WBV can be improved with this type of rapidly executable physical training.

Rapid increase in fall-induced cervical spine injuries among older Finnish adults between 1970 and 2011

BACKGROUND

fall-related injuries in older adults are a major public heath challenge.

METHODS

we determined the current trends in the number and age-adjusted incidence of fall-induced severe cervical spine injuries among older adults in Finland by taking into account all persons in 50 years of age or older who were admitted to Finnish hospitals for primary treatment of these injuries between 1970 and 2011. Similar patients aged 20-49 years served as a reference group.

RESULTS

the number of fall-induced cervical spine injuries among older Finns rose six-fold from 59 in 1970 to 372 in 2011. The age-adjusted incidence of injury (per 100 000 persons) was higher in men than in women throughout this period and showed a clear increase from 1970 to 2011: from 8.5 to 20.3 in men, and from 2.8 to 11.7 in women. In both sexes, the increase was most prominent in the oldest age group, persons aged 70 years or older. In the reference group, the injury incidence did not rise by time.

CONCLUSIONS

the number and incidence of fall-induced severe cervical spine injuries among older Finns increased considerably between 1970 and 2011. An increase in the average risk of serious falls may partly explain the phenomenon. Wide-scale fall and injury prevention measures are urgently needed, because further ageing of the population is likely to worsen the problem in the near future.

Recent advances: osteoporosis in the "oldest old"

Osteoporosis and related fractures disproportionately impact patients with advanced age, those with the frailty phenotype, and those with multiple comorbidities. Recent studies report a changing incidence in fracture type among the oldest old throughout the world, a finding not satisfactorily explained by advances in treatment of lifestyle factors. A growing recognition of the importance of muscle and bone interaction is leading to improved understanding of the underlying biochemical pathways linking them and new therapeutic targets. New models of care for frail older populations, particularly after hip fracture, are being developed but have been challenged to identify appropriate outcomes to target. An appreciation for the relationship between age-related comorbidities, fracture risk, and competing mortality risk is essential for practitioners caring for the oldest-old population.

Fall-induced deaths among older adults: nationwide statistics in Finland between 1971 and 2009 and prediction for the future

BACKGROUND

Fall-related injuries and deaths of elderly people are a major public health concern.

METHODS

Using the Official Cause-of-Death Statistics of Finland we determined the current trends in the number and age-adjusted incidence (per 100,000 persons) of fall-induced deaths among older Finnish men and women by taking into account all persons 50 years of age or older who died because of a fall-induced injury between 1971 and 2009.

RESULTS

Among elderly Finnish men, the number of deaths due to falls increased considerably between the years 1971 and 2009, from 162 to 627 (a 287% increase). The age-adjusted incidence also increased from 43.4 (per 100,000 persons) in 1971 to 57.9 in 2000, but stabilized thereafter (57.3 in 2009). Among elderly Finnish women, the number of fall-induced deaths increased till the beginning of the new millennium (from 279 in 1971 to 499 in 2000) but stabilized thereafter (506 in 2009), and, in sharp contrast to men, women's age-adjusted incidence of fall-induced deaths declined during the entire study period, the incidence being 77.2 in 1971 while only 35.3 in 2009.

CONCLUSIONS

Between 1971 and 2009 the number of fall-induced deaths increased among elderly Finns. The changes were sex-specific so that men surpassed women in both the number and age-adjusted incidence of these fatal falls. Welcome observations were that men's age-adjusted incidence of fall-induced deaths started to stabilize during the new millennium and that in women this incidence continuously declined between 1971 and 2009.

Continuous decline in incidence of hip fracture: nationwide statistics from Finland between 1970 and 2010

We determined the current trend in the number and incidence of hip fracture among persons 50 years of age or older in Finland between 1970 and 2010. After a clear rise until the late 1990s, the incidence of hip fracture has continuously declined.

INTRODUCTION

Hip fractures are a major public health issue associated with excess morbidity and mortality. We determined the current trend in the number and incidence (per 100,000 persons) of hip fracture among older adults in Finland, an EU country with a well-defined Caucasian population of 5.4 million people.

METHODS

We took into account all persons 50 years of age or older who were admitted to hospitals for primary treatment of hip fracture between 1970 and 2010.

RESULTS

The number of hip fractures rose sharply till the end of 1990s (from 1,857 in 1970 to 7,122 in 1997), but since then, the rise has leveled off (7,594 fractures in 2010). Similarly, the age-adjusted incidence of hip fracture increased until 1997 but declined thereafter. The decline was especially clear in women whose age-adjusted incidence was 515.7 (per 100,000 persons) in 1997 but only 382.6 in 2010. In men, the corresponding incidence was 245.3 in 1997 and 210.7 in 2010. The number of hip fractures will increase 1.8-fold by 2030 even with the current 2010 incidence rates because the size of the 50-year-old or older population is likely to increase sharply in the near future.

CONCLUSIONS

The declining trend in the incidence of hip fracture in Finland has continued through the entire first decade of the new millennium. Reasons for this development are uncertain, but possible explanations include increased average body weight, improved functional ability among elderly Finns, and specific measures to prevent bone loss and reduce the risk of falling.