Men's perspectives on fall risk and fall prevention following participation in a group-based programme conducted at Men's Sheds, Australia

Understanding the Association of Older Adult Fall Risk Factors by Age and Sex Through Factor Analysis

Our aim was to identify latent factors underlying multiple observed risk factors for older adult falls and to examine their effects on falls by age and sex. We performed exploratory factor analysis on 13 risk factors in the Behavioral Risk Factor Surveillance System. We used log-linear regression models to measure the association between the identified factors and older adults reporting falls. We identified two underlying factors: physical and mental health limitations. These shared a 50% correlation. Physical health limitations were more strongly associated with falls among men (prevalence ratio = 1.68, 95% CI = 1.65-1.71) than women (prevalence ratio = 1.51, 95% CI = 1.49-1.54). As physical health limitations increased, men aged 65-74 had a greater association with falls compared with other age-sex subgroups. Our findings highlight the composite relationship between age, sex, and physical and mental health limitations in association with older adult falls, and support the evidence for individually tailored, multifactorial interventions.

Ladder Use in Older People: Type, Frequency, Tasks and Predictors of Risk Behaviours

Ladder fall and injury risk increases with age. People who present to a hospital after an injurious ladder fall have been surveyed, but little is known about ladder use in the community. The purpose of this study was to: (1) document salient factors related to ladder safety, and (2) determine physical, executive function, psychological and frequency-of-use factors associated with unsafe ladder use in older people. One hundred and two older people (aged 65+ years) were recruited. Participants completed questionnaires on demographics, health, and ladder use (type, frequency, task, behaviours) and underwent assessments of physical and executive function ability. Results showed both older men and women commonly use step ladders (61% monthly, 96% yearly), mostly inside the home for tasks such as changing a lightbulb (70%) and decorating (43%). Older men also commonly use straight ladders (27% monthly, 75% yearly), mostly outside the home for tasks such as clearing gutters (74%) and pruning trees (40%). Unsafe ladder use was more common in males and individuals with greater ladder use frequency, greater quadriceps strength, better upper limb dexterity, better balance, better stepping ability, greater self-reported everyday risk-taking, a lower fear of falling, and fewer health problems compared to their counterparts (all p < 0.05). These findings document ladder use by older people and provide insight into unsafe ladder behaviours that may be amenable to interventions to reduce ladder falls and associated injuries.

What enables older people to continue with their falls prevention exercises? A qualitative systematic review

OBJECTIVES

To review the qualitative literature that explores the barriers and facilitators to continued participation in falls prevention exercise after completion of a structured exercise programme.

DESIGN

A systematic literature review with thematic synthesis of qualitative studies exploring older adults' experiences of continued participation in falls prevention exercise.

DATA SOURCES

Comprehensive searches were conducted in MEDLINE, PSYCHinfo, AMED, ASSIA, CINAHL and EMBASE from inception until November 2017. Additional studies were identified via searches of reference lists and citation tracking of relevant studies.

ELIGIBILITY CRITERIA

Qualitative or mixed methods studies exploring experiences of community-dwelling older adults (65 years and over) participation in a falls prevention exercise programme including their experience of ongoing participation in exercise after the completion of a structured exercise programme.

DATA EXTRACTION AND SYNTHESIS

Key characteristics including aim, participant characteristics, method of data collection, underpinning qualitative methodology and analytical approach were extracted and independently checked. Thematic synthesis was used to integrate findings.

RESULTS

From 14 studies involving 425 participants, we identified three descriptive themes: identity, motivators/deterrents and nature of the intervention and one overarching analytical theme: agency.

CONCLUSIONS

Older people have their own individual and meaningful rationale for either continuing or stopping exercise after completion of a structured falls prevention exercise programme. Exploring these barriers and facilitators to continued exercise is key during the intervention phase. It is important that health care professionals get to know the older person's rationale and offer the best evidence-based practice and support to individuals, to ensure a smooth transition from their structured intervention towards longer-term exercise-related behaviour.

PROSPERO REGISTRATION NUMBER

CRD42017082637.