Impact of falls on mental health outcomes for older adult mental health patients: An Australian study

The Effect of Motor Imaginary Combined with Transcranial Direct Current Stimulation (tDCS) on Balance in Middle-Aged Women with High Fall Risk: A Double-Blind Randomized Controlled Trial

Introduction. The risk of falling and its subsequent injuries increases with aging. Impaired balance and gait are important contributing factors to the increased risk of falling. A wide range of methods was examined to improve balance, but these interventions might produce small effects or be inapplicable for this population. The current study aimed at investigating the effect of motor imaginary (MI) training combined with transcranial direct current stimulation (tDCS) over the cerebellum on balance in middle-aged women with high fall risk. Methods. Thirty subjects aged 40-65 years old were divided into two groups including intervention ( $n=15$ ) and sham control ( $n=15$ ). The participants completed a 4-week program 3 times per week. The intervention group performed MI training combined with tDCS over the cerebellum, and the control group performed MI training combined with sham tDCS over the cerebellum. Static and dynamic balance were measured at baseline and after completing the 4-week program using balance error scoring system (BESS) and Y balance testing, respectively. Result. A one-way analysis of covariance and paired $t$ -tests were used to analyze the data. Significant improvement was observed in both balance tests in the intervention group after the implementation of the 4-week intervention program compared to the control group. The within-group analysis showed that both static and dynamic balance improved significantly from the baseline values only in the intervention group ( $p<0.05$ ) and not in the control group ( $p>0.05$ ). Conclusion. The results of the study indicate that MI training combined with tDCS over the cerebellum can lead to balance improvement in middle-aged women with high fall risk.

Análise das ocorrências de quedas associadas ao dano em unidade de internação psiquiátrica

Objetivo: analisar as ocorrências de quedas associadas ao dano em pacientes internados em uma unidade psiquiátrica. Método: estudo ecológico retrospectivo de 92 notificações de quedas em unidade de internação psiquiátrica. A coleta dos dados foram pelo sistema eletrônico GEO (Gestão Estratégica Operacional) do hospital estudado e do prontuário, sendo realizada estatística descritiva e testes não-paramétricos. Resultados: quanto ao grau de dano, 39,1% das quedas foram leves e 29,1% moderadas a graves, principalmente, em pacientes com Esquizofrenia e Transtorno Bipolar. As variáveis diagnóstico do paciente, tipo de queda, turno do evento, local da queda e eletroconvulsoterapia não mostraram associação com o grau de dano apresentado pelos pacientes após o evento. Conclusão: com o estudo, foi possível identificar as particularidades que afetam o paciente psiquiátrico e prever as condições mais prevalentes para o evento quedas, de modo a servir de subsídio para a instalação de medidas preventivas durante a internação. 

Toe Support Pattern as a New Predictive Factor Associated with Falls in Older People with Psychiatric Disorders

BACKGROUND

Maintaining autonomy is one of the principal objectives for seniors and people with psychiatric disorders. Podiatric medical care can help them maintain autonomy. This work aimed to characterize and quantify the support of the toes in a psychiatric population by analyzing the influence of psychotropic medications and toe and foot support parameters on the prevalence of falls.

METHODS

We conducted a cross-sectional descriptive study in 67 participants (31 people with psychiatric disorders and 36 without diagnosed disorders [control population]). Toe support pattern was analyzed with a pressure platform. Variables were measured in static and dynamic loading and related to falls and psychotropic medication use.

RESULTS

The psychiatric population fell more than the control population and presented less toe-ground contact in static measurements, although it has more foot-ground contact time. Maximum toe pressure during toe-off is also less intensive in the psychiatric population and is related to people who take psychotropic medications.

CONCLUSIONS

Toe support pattern could be used as a predictive factor for falls and to improve stability in these populations.

Differences in the risk of severe falls between patients aged <65 years and patients aged ≥65 years at a psychiatric hospital based on 12-year incident reports

PURPOSE

This study compared age differences in risk factors for falls requiring treatment in psychiatric patients.

DESIGN AND METHODS

An incident database was used to compare fall incidents in patients aged less than 65 years and those aged greater than or equal to 65 years.

FINDINGS

Approximately 30% of fallers were less than 65 years. Mental status and medication were the main risk factors. Decreased activities of daily living were associated with the most falls in patients greater than or equal to 65 years.

PRACTICE IMPLICATIONS

Fall risk differed between the two age groups. Medication may play a major role in falls among patients less than 65 years.

Validation of Igbo version of the modified falls efficacy scale among community-dwelling older adults: a validation study

Background

Fear of falling (FOF) is a very pervasive problem among older adults. Consequently, many scales have been developed for its assessment. The Modified Falls Efficacy Scale (MFES) is one of the most popular FOF scales. The MFES was originally developed for use in developed countries, and thus may not be entirely suitable for use in developing countries due to cultural and environmental differences between the two country categories. This study was therefore designed to cross-culturally adapt and validate the MFES to Igbo culture and environment among community-dwelling older adults in Nnewi community using established guidelines.

Methods

The original English version of the MFES (E-MFES) was translated, synthesized, back-translated, subjected to expert panel review, and pretested before producing the final Igbo version of the MFES (I-MFES). The I-MFES and the Short Falls Efficacy Scale International were randomly administered to consecutively recruited 109 consenting older adult residents of Nnewi (43.1% males; mean age = 74.45 ± 8.78 years). Convergent and structural validities and internal consistency of the I-MFES were assessed at 0.05 level of significance.

Results

All the 14 items on the E-MFES were retained on the I-MFES. The I-MFES exhibited the same structure as the E-MFES. The correlation between the total scores on the I-MFES and the Short Falls Efficacy Scale International was excellent (rho = − 0.93) indicating evidence of convergent validity of the I-MFES. The Cronbach’s alpha value of the I-MFES was 0.97 showing evidence of excellent internal consistency of the items on the I-MFES.

Conclusion

This study provides evidence of some aspects of validity and reliability of the I-MFES.

[Falls requiring use of health services by the older adults: an analysis of the Brazilian National Health Survey, 2013]

The aim was to analyze the prevalence of falls requiring visits to health services and associated sociodemographic factors in the elderly in the Brazilian National Health Survey (PNS), 2013. This was a cross-sectional population-based study using data on 23,815 elderly Brazilians from the PNS 2013 survey. The outcome variable was falls requiring use of a health service. Crude and adjusted analyses were performed with robust Poisson regression, with prevalence ratio as the measure of effect and the respective 95% confidence interval (95%CI). The stepwise-forward method was used for inclusion of the variables in the multivariate model. The prevalence of falls with the need to seek health services was 7.8% (95%CI: 7.3-8.4). The administrative region with the lowest occurrence of falls was the Southeast (7.3%), and Rondônia was the state with the lowest prevalence (5.3%). In the multivariate analysis, falls were associated with age 75 years or older, female sex, and divorced or separated marital status. The nationally representative data produced by the PNS survey can enhance measures to prevent falls throughout Brazil.

Reducing Falls After Electroconvulsive Therapy: A Quality Improvement Project

Falls after electroconvulsive therapy (ECT) in patients 60 and older have been long recognized as a major clinical care issue across many mental health care settings. The evidence base for fall prevention strategies after receiving ECT is sparse. The risk factors for falls after ECT are vast and complex in nature, especially considering existing comorbid medical conditions. The dearth of research in guiding practitioners on fall reduction interventions for this patient population illuminates a gap in mental health care quality and safety. The purpose of the current nurse-led quality improvement project was to reduce falls in patients undergoing ECT by enhancing safety measures through education and a post-ECT treatment protocol. The project did not prove to be as efficacious as anticipated as measured by fall rate outcomes. Several factors that may account for the project's findings are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 55(7), 20-29.].

Fear of falling in older adults living at home: associated factors

Abstract OBJECTIVE To identify the factors associated with the fear of falling in the older adultliving at home. METHOD Cross-sectional study with probabilistic sampling of older adultenrolled in two Family Health Strategies (FHS). The fear of falling was measured by the Brazilian version of the Falls Efficacy Scale-International and by a household questionnairethat contained the explanatory variables. Multiple Linear Regression using the stepwise selection technique and the Generalized Linear Models were used in the statistical analyses. RESULTS A total of170 older adultsparticipated in the research, 85 from each FHS. The majority (57.1%) aged between 60 and 69; 67.6% were female; 46.1% fell once in the last year. The majority of the older adults(66.5%) had highfear of falling. In the final multiple linear regression model, it was identified that a higher number of previous falls, female gender, older age, and worse health self-assessment explained 37% of the fear of falling among the older adult. CONCLUSION The findings reinforce the need to assess the fear of falling among the older adultliving at home, in conjunction with the development and use ofstrategies based on modifiable factors by professionalsto reduce falls and improve health status, which may contribute to the reduction of the fear of falling among the older adult.