Predicting falls: the role of mobility and nonphysical factors

Sociodemographic Factors in Older Adults' Gait Speed Decline: A Gender Disaggregate Growth Curve Analysis of the Ibadan Longitudinal Study of Ageing

BackgroundGait speed is an important predictor of older adults' well-being. We estimated the influence of sociodemographic factors on the gait speed decline of community-dwelling older Nigerians.MethodsUsing the Ibadan Study of Ageing (2007, 2008, and 2009 cycles), we completed a gender disaggregate analysis of sociodemographic influences on participants' gait speed trajectory using mixed-design ANOVA and growth curve analysis.ResultsAt baseline, 53.2% of participants were female, 61.9% were married, with an average age of 75.5 ± 6.8 years and gait speed of 0.96 ± 0.32 m/s. Gender-specific models showed slower gait speed decline in men (β = -0.05, p < .001) compared to women (β = -0.09, p < .001). Widowhood (β = -0.07, p = .001) for women, high socioeconomic status (β = -0.01, p = .009) for men, and chronic disease burden for women (β = -0.02, p = .010) and men (β = -0.03, p = .008) were significant predictors of gait speed decline.ConclusionAddressing culture-related widowhood and women's vulnerabilities, improving health coverage, and promoting lifestyle modifications may mitigate mobility decline among older Nigerians.

A scoping review of safe mobility behaviour in fall prevention: implications for people with Parkinson's disease

PURPOSE

Falls are a major concern for people with Parkinson's disease (PwPD) due to associated motor and non-motor impairments. Promoting safe mobility behaviour may be an effective fall prevention intervention, however this concept is poorly articulated in the literature. The aim of this scoping review was to map out the definition and concepts of safe mobility behaviour to draw implications for PwPD.

MATERIALS AND METHODS

The Joanna Briggs Institute methodology for scoping reviews was followed. Studies involving older adults (aged ≥ 65 years) and/or PwPD that sought to define, describe, and/or explain this concept were included.

RESULTS

Of the 21,936 records retrieved, 124 publications were included. No studies defined safe mobility behaviour. However, its performance was described as a combination of observable actions and cognitive processes. Mobility behaviour was influenced by an interaction between the person, environment, and task performance.

CONCLUSION

We propose a definition for safer mobility behaviour as any protective action and associated functional cognitive process used to reduce the likelihood of a fall during mobility-related activities. It is unique to each person and occurs across a continuum of safer to riskier behaviour. Future research developing and testing interventions targeting safer mobility behaviour for PwPD is warranted.

Age-related decrease in functional mobility score when performing a locomotor task in an immersive environment

In recent years, immersive virtual reality technology has emerged in the field of health. Its use could allow the assessment of the motor behavior of individuals in adaptable and reproducible immersive environments, simulating real situations. This study aimed to assess the effect of an immersive scenario on functional mobility during a simple locomotor task according to age. Sixty young adults and 60 older volunteers, who were autonomous and without cognitive and neurological impairment participated. A locomotor task based on the "Timed Up and Go" task was performed in real and virtual conditions. A functional mobility score was calculated by combining the time and the number of steps used and compared between young and older people. Results showed that correlations between time and the number of steps were the same in VR and real conditions, but the locomotor performance decreased significantly in VR for both populations. Additionally, older people exhibited a more reduced locomotor performance in a virtual environment than young adults, thereby their functional mobility score decreased more to complete the task, reflecting the adoption of a more secure locomotion strategy often related to the fear of falling, with an increase in time and number of steps to support balance. The major difference between reality and VR is the visual immersion with an HMD, and visual information is more important in the sensory integration of older people. Therefore, the reduction in visual field and lack of visual exproprioceptive information about the body segments in the virtual environment could explain these results. Finally, the effect of immersion in a virtual scenario on mobility exists for both populations but is accentuated by the aging process and is therefore age dependent.

Association between Domains of the Clinical-Functional Vulnerability Index and Falls History in Older Adults: A Cross-Sectional Study

Objectives: The study aimed to determine which domains, sets, and isolated or combined questions of the Clinical-Functional Vulnerability Index (CFVI-20) are associated with falls history in older adults. Methods: Instruments used were the CFVI-20 assessment and reported falls during the last year. The receiver operating characteristics (ROC) curves identified the performance of the CFVI-20 domains and questions in identifying older adults with and without falls history, while logistic regression identified relevant questions to identify fall history. Results: This study included 1725 individuals (71.9 ± 7.3 years). The area under the curve (AUC) between the CFVI-20 and fall history was 0.69. The mobility domain presented the largest AUC (0.71; p < 0.01), and most isolated domains showed low AUCs (0.51 to 0.58). Isolated questions were limited to identifying fallers. The regression analysis identified 7 questions of the CFVI-20 with falls. Conclusions: The CFVI-20 general score identified older adults with a fall history. When considered in isolation, most domains were limited to identifying falls, except for the mobility domain. Combining the CFVI-20 questions enabled identification of fallers.

Feasibility of deploying peer coaches to mentor frontline home health aides and promote mobility among individuals recovering from a stroke: pilot test of a randomized controlled trial

BACKGROUND

Each year, approximately 100,000 individuals receive home health services after a stroke. Evidence has shown the benefits of home-based stroke rehabilitation, but little is known about resource-efficient ways to enhance its effectiveness, nor has anyone explored the value of leveraging low-cost home health aides (HHAs) to reinforce repetitive task training, a key component of home-based rehabilitation. We developed and piloted a Stroke Homehealth Aide Recovery Program (SHARP) that deployed specially trained HHAs as "peer coaches" to mentor frontline aides and help individuals recovering from stroke increase their mobility through greater adherence to repetitive exercise regimens. We assessed the feasibility of SHARP and its readiness for a full-scale randomized controlled trial (RCT). Specifically, we examined (1) the practicability of recruitment and randomization procedures, (2) program acceptability, (3) intervention fidelity, and (4) the performance of outcome measures.

METHODS

This was a feasibility study including a pilot RCT. Target enrollment was 60 individuals receiving post-stroke home health services, who were randomized to SHARP + usual home care or usual care only. The protocol specified a 30-day intervention with four planned in-home coach visits, including one joint coach/physical therapist visit. The primary participant outcome was 60-day change in mobility, using the performance-based Timed Up and Go and 4-Meter Walk Gait Speed tests. Interviews with participants, coaches, physical therapists, and frontline aides provided acceptability data. Enrollment figures, visit tracking reports, and audio recordings provided intervention fidelity data. Mixed methods included thematic analysis of qualitative data and quantitative analysis of structured data to examine the intervention feasibility and performance of outcome measures.

RESULTS

Achieving the 60-participant enrollment target required modifying participant eligibility criteria to accommodate a decline in the receipt of HHA services among individuals receiving home care after a stroke. This modification entailed intervention redesign. Acceptability was high among coaches and participants but lower among therapists and frontline aides. Intervention fidelity was mixed: 87% of intervention participants received all four planned coach visits; however, no joint coach/therapist visits occurred. Sixty-day follow-up retention was 78%. However, baseline and follow-up performance-based primary outcome mobility assessments could be completed for only 55% of participants.

CONCLUSIONS

The trial was not feasible in its current form. Before progressing to a definitive trial, significant program redesign would be required to address issues affecting enrollment, coach/HHA/therapist coordination, and implementation of performance-based outcome measures.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04840407 . Retrospectively registered on 9 April 2021.

The Predictive Validity and Clinical Application of Stopping Elderly Accidents, Deaths & Injuries (STEADI) for Fall Risk Screening

Fall prevention is critical for older adults. Stopping Elderly Accidents, Deaths, and Injuries (STEADI) is a fall prevention initiative, promoted by the Center for Disease Control (CDC). The purpose of this review aims to discuss the predictive validity, improve the predictive validity of STEADI, and apply STEADI in clinical settings.

Age-related differences in stair descent balance control: Are women more prone to falls than men?

Stair descent is one of the most common forms of daily locomotion and concurrently one of the most challenging and hazardous daily activities performed by older adults. Thus, sufficient attention should be devoted to this locomotion and to the factors that affect it. This study investigates gender and age-related differences in balance control during and after stair descent on a foam mat. Forty-seven older adults (70% women) and 38 young adults (58% women) performed a descent from one step onto a foam mat. Anteroposterior (AP) and mediolateral (ML) centre of pressure velocity (CoP) and standard deviation of the CoP sway were investigated during stair descent and restabilization. A two-way analysis of variance (ANOVA) revealed the main effects of age for the first 5 s of restabilization. Older women exhibited significantly higher values of CoP sway and velocity in both directions compared to the younger individuals (CoP SD_AP5, 55%; CoP SD_ML5, 30%; CoP V_AP5, 106%; CoP V_ML5, 75%). Men achieved significantly higher values of CoP sway and velocity only in the AP direction compared to their younger counterparts (CoP SD_AP5, 50% and CoP V_AP5, 79%). These findings suggest that with advancing age, men are at higher risk of forward falls, whereas women are at higher risk of forward and sideways falls.

Ankle muscle activation during the limits of stability test in subjects with chronic ankle instability

OBJECTIVE

To study postural control and muscle activity during the limit of stability test (LOS) in subjects with chronic ankle instability.

DESIGN

Observational study.

SETTING

University laboratory.

PARTICIPANTS

10 healthy subjects were included in the control group and 10 subjects in the CAI group (age between 18 and 30 years, with history of the multiple ankle "giving way" episodes in the last six months and score ≤24 in the Cumberland Ankle Instability Tool).

MAIN OUTCOME MEASURES

A computerized dynamic posturography equipment was used for assessing the LOS. The electromyography activity of tibialis anterior (TA), soleus (SOL), medial gastrocnemius (MG) and peroneus longus (PL) was registered.

RESULTS

Subjects with CAI had a greater activation in TA to forward (p < .01), forward affected (p = .001), backward affected (p = .007) and backward directions (p < .01); in PL to forward affected (p < .01) and affected directions (p = .001); in MG to forward (p = .023) and affected directions (p < .01) and in SOL to the affected direction (p = .009). We observed restricted excursions and less directional control in subjects with CAI.

CONCLUSIONS

Subjects with CAI exhibited poorer ability to move their center of gravity within stability limits. In addition, they have an altered ankle muscle activity during LOS test toward the affected ankle joint.

Balance control during stair descent on compliant surface is associated with knee flexor and ankle plantar flexor strength in older adults

Balance and lower limb strength deficits are associated with a high incidence of falls in older adults. This study investigated the association between balance control during and after stair descent onto a compliant surface and lower limb strength. Thirty-five women and 14 men participated in this study. Stair descent time, mean center of pressure velocity in anteroposterior and mediolateral direction during stair descent (CoP V_AP and CoP V_ML), and CoP velocity in the first 5 s of restabilization phase (CoP V₅) were evaluated. Bilateral strength of the knee flexors and extensors, and ankle plantar and dorsal flexors was evaluated. Spearman correlation analysis with Bonferroni correction yielded a significant association between the strength of the knee flexors on the trailing limb and stair descent time in women (r = 0.502, p = 0.002, R² = 0.246). The same analysis in men revealed a significant association between the strength of the knee flexors on the trailing limb and CoP V_AP (r = -0.820, p < 0.001, R² = 0.280) and CoP V_ML (r = -0.697, p = 0.006, R² = 0.359). The strength of the ankle plantar flexors on the trailing limb was significantly associated with stair descent time (r = 0.684, p = 0.007, R² = 0.429) and CoP V_AP (r = -0.723, p = 0.003, R² = 0.408) in men. Stair descent balance control is associated with knee flexion strength on trailing limb in women, and with ankle plantar flexion and knee flexion strength on the same limb in men.

Impact of Social Network on the Risk and Consequences of Injurious Falls in Older Adults

OBJECTIVES

A smaller social network is associated with worse health-related outcomes in older people. We examined the impact of social connections and social support on the risk of injurious fall and on fall-related functional decline and mortality.

DESIGN

Prospective study with 6-year follow-up.

SETTING

Community.

PARTICIPANTS

A total of 2630 participants (aged ≥60 years) from the Swedish National Study on Aging and Care in Kungsholmen.

MEASUREMENTS

Social connections (social network size and contact frequency) and social support (social resource perception and satisfaction) were assessed through validated questionnaires. Data on injurious falls (falls requiring inpatient or outpatient care) and mortality came from official registers. We defined injurious falls as severe if they caused fracture and/or intracranial injury and as multiple if two or more occurred during the 6-year follow-up. Functional decline was defined as the loss of ability to perform one or more activities of daily living during the follow-up.

RESULTS

During the follow-up, 322 participants experienced injurious falls. After adjusting for potential confounders, the hazard ratio of injurious falls was 1.7 (95% confidence interval [CI] = 1.1-2.4) for people with poor social connections and 1.5 (95% CI = 1.1-2.1) for people with moderate social connections (reference: rich social connections). Social support was not associated with fall risk. The odds of functional decline among those with severe/multiple falls and (1) poor social connections (odds ratio [OR] = 5.2 [95% CI = 2.1-12.9]) or (2) poor social support (OR = 4.5 [95% CI = 1.7-12.0]) was up to twice as high as among those with severe/multiple falls and (3) rich social connections (OR = 2.5 [95% CI = .9-6.6]) or (4) rich social support (OR = 2.7 [95% CI = 1.2-6.3]). Similar but more attenuated results emerged for mortality.

CONCLUSIONS

Social network may influence fall risk and fall-related functional decline and mortality. J Am Geriatr Soc 67:1851-1858, 2019.

Ecology of falls

In this chapter, we consider how falls result from interactions between humans and their environment, and the implications of these interactions on the prevention of falls and fall-related injuries. We take a lifespan approach, and examine the human behaviors that create risk for falls and injuries in various environments, and the social and biologic factors that shape those behaviors. While not always stated explicitly, we draw on our experience in collecting and analyzing video footage of hundreds of falls. We consider that most falls do not result in significant injury, and issues of self-autonomy for pursuing a lifestyle that may create risk for falls. To help guide falls management, we propose a mechanism for classifying falls as "acceptable" versus "unacceptable." We also provide an ecology of falls checklist to guide stakeholders in identifying ecologic aspects of falls that may be useful targets for intervention.

Biopsychosocial Predictors of Fall Events Among Older African Americans

This study identifies risk and protective factors for falls among older, community-dwelling African Americans. Drawing upon the biopsychosocial perspective, we conducted a series of sex- and age-adjusted multinomial logistic regression analyses to identify the correlates of fall events among older African Americans. Our sample consisted of 1,442 community-dwelling African Americans aged 65 and older, participating in the 2010-2012 rounds of the Health and Retirement Study. Biophysical characteristics associated with greater relative risk of experiencing single and/or multiple falls included greater functional limitations, poorer self-rated health, poorer self-rated vision, chronic illnesses (high blood pressure, diabetes, cancer, lung disease, heart problems, stroke, and arthritis), greater chronic illness comorbidity, older age, and female sex. Physical activity was negatively associated with recurrent falls. Among the examined psychosocial characteristics, greater depressive symptoms were associated with greater relative risk of experiencing single and multiple fall events. Implications for clinicians and future studies are discussed.

The validity and reliability of the four square step test in different adult populations: a systematic review

BACKGROUND

The four square step test (FSST) was first validated in healthy older adults to provide a measure of dynamic standing balance and mobility. The FSST has since been used in a variety of patient populations. The purpose of this systematic review is to determine the validity and reliability of the FSST in these different adult patient populations.

METHODS

The literature search was conducted to highlight all the studies that measured validity and reliability of the FSST. Six electronic databases were searched including AMED, CINAHL, MEDLINE, PEDro, Web of Science and Google Scholar. Grey literature was also searched for any documents relevant to the review. Two independent reviewers carried out study selection and quality assessment. The methodological quality was assessed using the QUADAS-2 tool, which is a validated tool for the quality assessment of diagnostic accuracy studies, and the COSMIN four-point checklist, which contains standards for evaluating reliability studies on the measurement properties of health instruments.

RESULTS

Fifteen studies were reviewed studying community-dwelling older adults, Parkinson's disease, Huntington's disease, multiple sclerosis, vestibular disorders, post stroke, post unilateral transtibial amputation, knee pain and hip osteoarthritis. Three of the studies were of moderate methodological quality scoring low in risk of bias and applicability for all domains in the QUADAS-2 tool. Three studies scored "fair" on the COSMIN four-point checklist for the reliability components. The concurrent validity of the FSST was measured in nine of the studies with moderate to strong correlations being found. Excellent Intraclass Correlation Coefficients were found between physiotherapists carrying out the tests (ICC = .99) with good to excellent test-retest reliability shown in nine of the studies (ICC = .73-.98).

CONCLUSIONS

The FSST may be an effective and valid tool for measuring dynamic balance and a participants' falls risk. It has been shown to have strong correlations with other measures of balance and mobility with good reliability shown in a number of populations. However, the quality of the papers reviewed was variable with key factors, such as sample size and test set up, needing to be addressed before the tool can be confidently used in these specified populations.

Home Features and Assistive Technology for the Home-Bound Elderly in a Thai Suburban Community by Applying the International Classification of Functioning, Disability, and Health

The ageing population is having an impact worldwide and has created a serious challenge in Thailand's healthcare systems, whereby healthcare practitioners play a major role in promoting independent interaction of their client's abilities, as well as environmental factors. The purpose of this study was to survey features of the home and assistive technology (AT) for the home-bound elderly in the community of Chiang Mai, Thailand. Home evaluation included features inside and outside the home, and AT was based on the International Classification of Functioning, Disability, and Health (ICF) concept. Methods included observation and an interview that were used by the researcher for evaluation. The study found that every home had at least one hazardous home feature such as inappropriate width of the door, high door threshold, tall stair steps, no bedside rail, and inappropriate height of the toilet pan. AT was found in houses as general products and technology for personal use in daily living and for personal indoor and outdoor mobility as well as transportation. Therefore, home features and AT can afford the home-bound elderly independent living within the community. Perspective AT according to the ICF concept could provide a common language for ageing in place benefits.

Neighborhood Environment and Falls among Community-Dwelling Older Adults

Background: Falls present a major challenge to active aging, but the relationship between neighborhood factors and falls is poorly understood. This study examined the relationship between fall events and neighborhood factors, including neighborhood social cohesion (sense of belonging, trust, friendliness, and helpfulness) and physical environment (vandalism/graffiti, rubbish, vacant/deserted houses, and perceived safety walking home at night). Methods: Data were analyzed from 9259 participants over four biennial waves (2006-2012) of the Health and Retirement Study (HRS), a nationally representative sample of adults aged 65 and older in the United States. Results: In models adjusting for demographic and health-related covariates, a one-unit increase in neighborhood social cohesion was associated with 4% lower odds of experiencing a single fall (odds ratio (OR): 0.96, 95% confidence interval (CI): 0.93-0.99) and 6% lower odds of experiencing multiple falls (OR: 0.94, 95% CI: 0.90-0.98). A one-unit increase in the physical environment scale was associated with 4% lower odds of experiencing a single fall (OR: 0.96, 95% CI: 0.93-0.99) and with 5% lower odds of experiencing multiple falls (OR: 0.95, 95% CI: 0.91-1.00) in adjusted models. Conclusions: The physical and social neighborhood environment may affect fall risk among community-dwelling older adults. Findings support the ongoing need for evidence-based fall prevention programming in community and clinical settings.

Simplified Tai Chi Program Training versus Traditional Tai Chi on the Functional Movement Screening in Older Adults

Background. The present study aimed to evaluate and compare the effect of two different types of Tai Chi programs on the Functional Movement Screening (FMS) in older adults. Methods. Ninety older adults (65.5 ± 4.6 years old) who met the eligibility criteria were randomized into three different groups based on a ratio of 1 : 1 : 1: a traditional Tai Chi exercise (TTC), a simplified Tai Chi exercise (TCRT), or a control group (routine activity). The FMS consisted of the deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg rise, trunk stability push-up, and rotatory stability, which was used to measure physical function before the present study and after six months of Tai Chi interventions. Results. Seventy-nine participants completed the present study (control = 27, TTC = 23, and TCRT = 29). Significant improvement on the FMS tests between the baseline and after the six-month intervention was observed in both Tai Chi programs, whereas no significant improvement was observed in the control group. In addition, participants in the TCRT group demonstrated greater improvement than those in the TTC group. Conclusions. The TCRT is more effective in improving the physical function in older adults when compared to the traditional Tai Chi modality, particularly for improving balance.

Types of Hazards in the Homes of Elderly People

This study describes the type and range of hazards found in the homes of elderly persons (n=257) referred to the occupational therapy department of a city teaching hospital. Homes were assessed using an abbreviated version of the Westmead Home Safety Assessment. The most commonly found hazards were in internal traffic ways (48%), the bathroom (40%), and access areas to and from the home (38%). Hazardous mats, pathways, and bathroom and toilet floor surfaces were the most commonly found individual hazards. Mildly cognitively impaired persons were found to have increased exposure to hazards in traffic ways; women were found to have more bed light hazards and people living with others were more likely to have a pet that may pose a risk of the elderly person falling. Otherwise, characteristics of people were generally not found to be associated with increased exposure to any particular type of hazard. We recommend further and more detailed investigation of home hazards, including in the homes of the well elderly.

Education for people with progressive neurological conditions can have negative effects: Evidence from a randomized controlled trial

Objectives: To test the effects of a home-based educational intervention in reducing the incidence and the risk of falls and pressure sores in adults with progressive neurological conditions.

Design: Randomized controlled trial with 12 months follow-up.

Setting: Participants’ homes in the City of Nottingham.

Participants: One hundred and fourteen people with progressive neurological conditions recruited from general practices in Nottingham, including 53 with Parkinson's disease and 45 with multiple sclerosis.

Interventions: In the education group (EG), baseline data were reviewed by an expert panel which advised on actions most likely to promote each individual's physical, social and psychological well-being. An occupational therapist (OT) then visited EG participants to provide education and information and to discuss a personalized 12-month health action plan. The comparison group (CoG) received standardized printed information delivered to their home.

Main measures: Numbers of participants reporting falls and skin sores at two-monthly phone calls during the follow-up period of 12 months.

Results: The EG reported significantly more falls during the follow-up period and at 12 months (adjusted odds ratio 2.83 (95% CI 1.07-7.47), p=0.036) and significantly more skin sores (adjusted odds ratio 12.74 (95% CI 1.14-142.6), p=0.039) than the CoG. There was no difference between CoG and EG in the Nottingham Extended Activities of Daily Living score, but EG patients showed a significant rise in this score over the study period of 1.62 (95% CI 0.69-2.55, p=0.002).

Conclusions: Our findings provide evidence that education for people with progressive neurological conditions can have negative effects.

Personal Functional Goals: A New Approach to Assessing Patient-Centered Outcomes

One dilemma in outcomes research is finding measures that show the impact of an intervention on participants' quality of life, especially in areas most salient to participants. The authors describe the development and testing of a method for eliciting information about personal functional goals from older adults entering an exercise program and assessing progress after completion of the program. The authors' Personal Functional Goals (PFG) Checklist and Interview Protocol is a 45-item checklist of goals for health, daily living, and general well-being. Testing on older adult, community-dwelling participants in controlled exercise intervention studies confirmed the ease of administration and provided preliminary evidence of reliability and validity, including responsiveness to change. Thus, the PFG shows promise for measuring health-related quality of life in terms of individual concerns and is suitable for application in clinical and research settings.

Personalised Prescription of Scalable High Intensity Interval Training to Inactive Female Adults of Different Ages

Stepping is a convenient form of scalable high-intensity interval training (HIIT) that may lead to health benefits. However, the accurate personalised prescription of stepping is hampered by a lack of evidence on optimal stepping cadences and step heights for various populations. This study examined the acute physiological responses to stepping exercise at various heights and cadences in young (n = 14) and middle-aged (n = 14) females in order to develop an equation that facilitates prescription of stepping at targeted intensities. Participants completed a step test protocol consisting of randomised three-minute bouts at different step cadences (80, 90, 100, 110 steps·min^-1) and step heights (17, 25, 30, 34 cm). Aerobic demand and heart rate values were measured throughout. Resting metabolic rate was measured in order to develop female specific metabolic equivalents (METs) for stepping. Results revealed significant differences between age groups for METs and heart rate reserve, and within-group differences for METs, heart rate, and metabolic cost, at different step heights and cadences. At a given step height and cadence, middle-aged females were required to work at an intensity on average 1.9 ± 0.26 METs greater than the younger females. A prescriptive equation was developed to assess energy cost in METs using multilevel regression analysis with factors of step height, step cadence and age. Considering recent evidence supporting accumulated bouts of HIIT exercise for health benefits, this equation, which allows HIIT to be personally prescribed to inactive and sedentary women, has potential impact as a public health exercise prescription tool.

Perturbation training to promote safe independent mobility post-stroke: study protocol for a randomized controlled trial

Background

Falls are one of the most common medical complications post-stroke. Physical exercise, particularly exercise that challenges balance, reduces the risk of falls among healthy and frail older adults. However, exercise has not proven effective for preventing falls post-stroke. Falls ultimately occur when an individual fails to recover from a loss of balance. Thus, training to specifically improve reactive balance control could prevent falls. Perturbation training aims to improve reactive balance control by repeatedly exposing participants to postural perturbations. There is emerging evidence that perturbation training reduces fall rates among individuals with neurological conditions, such as Parkinson disease. The primary aim of this work is to determine if perturbation-based balance training can reduce occurrence of falls in daily life among individuals with chronic stroke. Secondary objectives are to determine the effect of perturbation training on balance confidence and activity restriction, and functional balance and mobility.

Methods/design

Individuals with chronic stroke will be recruited. Participants will be randomly assigned to one of two groups: 1) perturbation training, or 2) ‘traditional’ balance training. Perturbation training will involve both manual perturbations (e.g., a push or pull from a physiotherapist), and rapid voluntary movements to cause a loss of balance. Training will occur twice per week for 6 weeks. Participants will record falls and activity for 12 months following completion of the training program. Standardized clinical tools will be used to assess functional balance and mobility, and balance confidence before and after training.

Discussion

Falls are a significant problem for those with stroke. Despite the large body of work demonstrating effective interventions, such as exercise, for preventing falls in other populations, there is little evidence for interventions that prevent falls post-stroke. The proposed study will investigate a novel and promising intervention: perturbation training. If effective, this training has the potential to not only prevent falls, but to also improve safe independent mobility and engagement in daily activities for those with stroke.

Trial registration

Current Controlled Trials: ISRCTN05434601.

Geospatial distribution of fall-related hospitalization incidence in Texas

INTRODUCTION

With the rapid growth of the aging U.S. population, the incidence of falls and fall-related injuries is expected to rise. We examined incidence and characteristics of fall-related hospitalizations (falls) among Texans aged 50 and older, by geography and across time.

METHOD

We calculated fall-related hospitalization incidence rates (65 and older), identified fall 'hot spots,' and examined availability of fall-prevention programming.

RESULTS

The incidence of fall-related hospitalizations for older adults increased by nearly 20% from 2007 to 2011. There were clusters of 'hot spot' counties throughout the state, many of which lack fall prevention programs.

CONCLUSIONS

Increased efforts are needed to identify older adults at elevated risk for falling and develop referral systems for promoting evidence-based fall prevention programs at multiple levels accounting for geographic settings.

PRACTICAL APPLICATIONS

Geospatial investigations can inform strategic planning efforts to develop clinical-community partnerships to offer fall prevention programming in high risk areas.

[Assessment and training of strength and balance for fall prevention in the elderly: recommendations of an interdisciplinary expert panel]

The proportion of elderly people in societies of western industrialized countries is continuously rising. Biologic aging induces deficits in balance and muscle strength/power in old age, which is responsible for an increased prevalence of falls. Therefore, nationwide and easy-to-administer fall prevention programs have to be developed in order to contribute to the autonomy and quality of life in old age and to help reduce the financial burden on the public health care system due to the treatment of fall-related injuries. This narrative (qualitative) literature review deals with a) the reasons for an increased prevalence of falls in old age, b) important clinical tests for fall-risk assessment, and c) evidence-based intervention/training programs for fall prevention in old age. The findings of this literature review are based on a cost-free practice guide that is available to the public (via the internet) and that was created by an expert panel (i.e., geriatricians, exercise scientists, physiotherapists, geriatric therapists). The present review provides the scientific foundation of the practice guide.

The fall descriptions and health characteristics of older adults with hip fracture: a mixed methods study

BACKGROUND

In light of the multifactorial etiology of fall-related hip fracture, knowledge of fall circumstances may be especially valuable when placed in the context of the health of the person who falls. We aimed to investigate the circumstances surrounding fall-related hip fractures and to describe fall circumstances in relation to participants' health and functional characteristics.

METHODS

The fall circumstances of 125 individuals (age ≥ 50 years) with hip fracture were investigated using semi-structured interviews. Data concerning participants' health (comorbidities and medications) and function (self-reported performance of mobility, balance, personal activities of daily living and physical activity, previous falls and hand grip strength) were collected via medical records, questionnaires and dynamometry. Using a mixed methods design, both data sets were analysed separately and then merged in order to provide a comprehensive description of fall events and identify eventual patterns in the data.

RESULTS

Fall circumstances were described as i) Activity at the time of the fall: Positional change (n = 24, 19%); Standing (n = 16, 13%); Walking (n =71, 57%); Balance challenging (n = 14, 11%) and ii) Nature of the fall: Environmental (n = 32, 26%); Physiological (n = 35, 28%); Activity-related indoor (n = 8, 6%) and outdoor (n = 8, 6%); Trips and slips on snow (n = 20, 16%) and in snow-free conditions (n = 12, 10%) and Unknown (n = 10, 8%). We observed the following patterns regarding fall circumstances and participants' health: those who fell i) during positional change had the poorest functional status; ii) due to environmental reasons (indoors) had moderate physical function, but high levels of comorbidity and fall risk increasing medications; iii) in snow-free environments (outdoors) appeared to have a poorer health and functional status than other outdoor groups.

CONCLUSIONS

Our findings indicate that patterns exist in relation to the falls circumstances and health characteristics of people with hip fracture which build upon that previously reported. These patterns, when verified, can provide useful information as to the ways in which fall prevention strategies can be tailored to individuals of varying levels of health and function who are at risk for falls and hip fracture.

Changing practice in dementia care in the community: developing and testing evidence-based interventions, from timely diagnosis to end of life (EVIDEM)

Background

The needs of people with dementia and their carers are inadequately addressed at all key points in the illness trajectory, from diagnosis through to end-of-life care. The EVIDEM (Evidence-based Interventions in Dementia) research and development programme (2007–12) was designed to help change this situation within real-life settings.

Objectives

The EVIDEM projects were (1) evaluation of an educational package designed to enhance general practitioners’ (GPs’) diagnostic and management skills; (2) evaluation of exercise as therapy for behavioural and psychological symptoms of dementia (BPSD); (3) development of a toolkit for managing incontinence in people with dementia living at home; (4) development of a toolkit for palliative care for people with dementia; and (5) development of practice guidance on the use of the Mental Capacity Act (MCA) 2005.

Design

Mixed quantitative and qualitative methods from case studies to large database analyses, including longitudinal surveys, randomised controlled trials and research register development, with patient and public involvement built into all projects.

Setting

General practices, community services, third-sector organisations and care homes in the area of the North Thames Dementia and Neurodegenerative Diseases Research Network local research network.

Participants

People with dementia, their family and professional carers, GPs and community mental health team members, staff in local authority social services and third-sector bodies, and care home staff.

Main outcome measures

Dementia management reviews and case identification in general practice; changes in behavioural and psychological symptoms measured with the Neuropsychiatric Inventory (NPI); extent and impact of incontinence in community-dwelling people with dementia; mapping of pathways to death of people with dementia in care homes, and testing of a model of collaborative working between primary care and care homes; and understandings of the MCA 2005 among practitioners working with people with dementia.

Results

An educational intervention in general practice did not alter management or case identification. Exercise as a therapy for BPSD did not reduce NPI scores significantly, but had a significant positive effect on carer burden. Incontinence is twice as common in community-dwelling people with dementia than their peers, and is a hidden taboo within a stigma. Distinct trajectories of dying were identified (anticipated, unexpected and uncertain), and collaboration between NHS primary care and care homes was improved, with cost savings. The MCA 2005 legislation provided a useful working framework for practitioners working with people with dementia.

Conclusions

A tailored educational intervention for general practice does not change practice, even when incentives, policy pressure and consumer demand create a favourable environment for change; exercise has potential as a therapy for BPSD and deserves further investigation; incontinence is a common but unrecognised problem for people with dementia in the community; changes in relationships between care homes and general practice can be achieved, with benefits for people with dementia at the end of life and for the UK NHS; application of the MCA 2005 will continue to improve but educational reinforcements will help this. Increased research capacity in dementia in the community was achieved. This study suggests that further work is required to enhance clinical practice around dementia in general practice; investigate the apparent beneficial effect of physical activity on BPSD and carer well-being; develop case-finding methods for incontinence in people with dementia; optimise working relationships between NHS staff and care homes; and reinforce practitioner understanding of the MCA 2005.

Trial registration

EVIDEM: ED-NCT00866099; EVIDEM: E-ISRCTN01423159.

Funding

This project was funded by the Programme Grants for Applied Research programme of the National Institute for Health Research.

Balance impairment in patients with COPD

BACKGROUND/PURPOSE

Chronic obstructive pulmonary disease (COPD) is a respiratory disease that results in progressive airflow limitation and respiratory distress. Physiopathological features of COPD suggest that people who suffer from this disease have many risk factors for falls that have been identified in older individuals. The aim of the study was to compare and quantify functional balance between COPD patients and healthy subjects; to investigate the risk of falls in acute stages of the disease and to identify risk factors that could lead to falls.

METHODS

We studied 46 patients with moderate-severe COPD (29 stable and 17 in acute exacerbation--AECOPD) and 17 healthy subjects (control group) having similar demographic data. We analyzed the difference in Berg Balance Scale (BBS), Single Leg Stance (SLS) and Timed Up and Go test (TUG) between these three groups and the correlation of these scores with a number of incriminatory factors.

RESULTS

The presence of COPD was associated with significant worsening of balance tests: BBS (55 control, vs. 53 COPD, vs. 44 AECOPD points p<0.001), TUG (8.6 control vs. 12.3 COPD vs. 15.9 AECOPD seconds. p<0.001), SLS (31.1 control vs. 17.7 COPD vs. 7.2 AECOPD seconds p<0.001) which may be associated with an increased risk of falls. Anxiety and depression were significantly associated with decreased balance test scores; anxiety (2 control vs. 6 COPD vs. 9 AECOPD points p<0.001) depression (2 control vs. 7 COPD vs. 12 AECOPD points p<0.001).

CONCLUSIONS

According to our results COPD patients in moderate-severe stages and especially those in exacerbation have a high risk of falls.

Acquiring visual information for locomotion by older adults: a systematic review

Developments in technology have facilitated quantitative examination of gaze behavior in relation to locomotion. The objective of this systematic review is to provide a critical evaluation of available evidence and to explore the role of gaze behavior among older adults during different forms of locomotion. Database searches were conducted to identify research papers that met the inclusion criteria of (1) study variables that included direct measurement of gaze and at least one form of locomotion, (2) participants who were older adults aged 60 years and above, and (3) reporting original research. Twenty-five papers related to walking on a straight path and turning (n=4), stair navigation (n=3), target negotiation and obstacle circumvention (n=13) and perturbation-evoked sudden loss of balance (n=5) were identified for the final quality assessment. The reviewed articles were found to have acceptable quality, with scores ranging from 47.06% to 94.12%. Overall, the current literature suggests that differences in gaze behavior during locomotion appear to change in late adulthood, especially with respect to transfer of gaze to and from a target, saccade-step latency, fixation durations on targets and viewing patterns. These changes appear to be particularly pronounced for older adults with high risk of falling and impaired executive functioning.

Falls among adults aging with disability

OBJECTIVE

To investigate the prevalence of and risk factors for falling among individuals aging with multiple sclerosis (MS), muscular dystrophy (MD), postpolio syndrome (PPS), and spinal cord injury (SCI).

DESIGN

Cross-sectional survey data from 2009 to 2010 were analyzed. We used forward logistic regression models to examine whether risk factors such as age, sex, mobility level, years since diagnosis, vision, balance, weakness, number of comorbid conditions, and physical activity could distinguish participants who reported falling from those who did not.

SETTING

Surveys were mailed to community-dwelling individuals who had 1 of 4 diagnoses (MS, MD, PPS, or SCI). The survey response rate was 91%.

PARTICIPANTS

A convenience sample of community-dwelling individuals (N=1862; age, 18-94y) with MS, MD, PPS, or SCI in the United States.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Self-reported fall within the last 6 months.

RESULTS

Fall prevalence for people with MS (54%), MD (70%), PPS (55%), and SCI (40%). Across all 4 groups, fall rates peaked in middle age (45-64y) and among people with moderate mobility limitations. Seven risk factors differentiated participants who fell from those who did not: mobility level, imbalance, age, curvilinear age (age(2)), number of comorbid conditions, duration of diagnosis, and sex. The models differed across diagnostic groups.

CONCLUSIONS

People aging with long-term physical disabilities experience unique challenges that affect their risk of falls. A better understanding of the frequency, severity, and risk factors of falls across diagnostic groups is needed to design and implement customized, effective fall prevention and management programs for these individuals.

The effect of exercise on behavioural and psychological symptoms of dementia: the EVIDEM-E randomised controlled clinical trial

OBJECTIVE

The objective of this study is to evaluate the effectiveness of a simple dyadic (person with dementia and their main carer) exercise regimen as a therapy for the behavioural and psychological symptoms of dementia.

METHOD

A two arm, pragmatic, randomised, controlled, single-blind, parallel-group trial of a dyadic exercise regimen (individually tailored walking regimen designed to become progressively intensive and last between 20-30 min, at least five times per week).Community-dwelling individuals with ICD-10 confirmed dementia with the following: clinically significant behavioural and psychological symptoms, a carer willing and able to co-participate in the exercise regimen, and no physical conditions or symptoms that would preclude exercise participation were invited by mental health or primary care services into the study.

RESULTS

One hundred and thirty-one dyads were recruited to this study. There was no significant difference in Behavioural and Psychological Symptoms as measured by the Neuropsychiatric Inventory at week 12 between the group receiving the dyadic exercise regimen and those that did not (adjusted difference in means (intervention minus control) = -1.53, p = 0.6, 95% CI [-7.37, 4.32]). There was a significant between-group difference in caregiver's burden as measured by the Zarit Caregiver Burden Inventory at week 12 (OR = 0.18, p = 0.01, CI [0.05, 0.69]) favouring the exercise group.

CONCLUSIONS

This study found that regular simple exercise does not appear to improve the behavioural and psychological symptoms of dementia, but did seem to attenuate caregiver burden. Further study to improve exercise uptake are needed.

Racial/Ethnic predictors of falls among older adults: the health and retirement study

OBJECTIVE

The objective of this study was to examine racial/ethnic differences in the probability and frequency of falls among adults aged 65 and older.

METHOD

Using data from the Health and Retirement Study (HRS) from 2000 to 2010, the authors conducted random-intercept logistic and Poisson regression analyses to examine whether race/ethnicity predicted the likelihood of a fall event and the frequency of falls.

RESULTS

The analytic sample included 10,484 older adults. Baseline analyses showed no significant racial/ethnic differences in the probability or number of falls. However, in the longitudinal random-intercept models, African Americans had significantly lower odds (0.65) of experiencing at least one fall compared with non-Hispanic Whites. Among fallers, African Americans had significantly fewer falls (24%) than non-Hispanic Whites, controlling for health and sociodemographic covariates (all ps < .05). Latinos did not differ from non-Hispanic Whites in the likelihood or number of falls.

DISCUSSION

African Americans are less likely to experience initial or recurrent falls than non-Hispanic Whites.

Osteoporosis Assessment Questionnaire-Physical Function (OPAQ-PF): a psychometrically validated osteoporosis-targeted patient reported outcome measure of daily activities of physical function

The purpose of this study was to evaluate the measurement properties of the Osteoporosis Assessment Questionnaire-Physical Functioning (OPAQ-PF). Based on this study, the OPAQ-PF has confirmed unidimensionality and acceptable reliability, construct validity, and sensitivity to change in a recent fracture/no recent fracture osteoporosis sample.

METHODS

Dimensionality was established through exploratory and confirmatory factor analysis. Patients completed three patient reported outcome (PRO) measures and four performance-based measures (PBMs) at baseline to enable an evaluation of construct validity. Patients without a recent fracture completed the OPAQ-PF 2 weeks after baseline to enable an evaluation of test-retest reliability. Ability to detect change and interpretation of change were investigated following completion of the OPAQ-PF 12 and 24 weeks postbaseline by patients with a recent fracture.

RESULTS

A prospective psychometric validation study in 144 postmenopausal women, with moderate to severe osteoporosis, 37 of whom had experienced a recent fragility fracture (<6 weeks). Unidimensionality was established for the OPAQ-PF by factor analysis. The OPAQ-PF had good internal consistency (α = 0.974) and test-retest reliability (mean intraclass correlation coefficient (ICC) 0.993. The OPAQ-PF differentiated between patients with/without recent fracture, and by severity of osteoarthritis; it correlated strongly with hypothesized-related scales and PBMs (r > 0.3, p < 0.001). Ability to detect change was established with high correlations between changes in OPAQ-PF score and changes in global concept scores in recent fracture patients (r ≥ 0.6, 24-week change). Effect size of change on OPAQ-PF score increased by level of global change (p < 0.001). Anchor-based methods identified an OPAQ-PF change of 10 at an individual patient level and 20 at a group level as meaningful to patients.

CONCLUSIONS

The OPAQ-PF has confirmed unidimensionality and acceptable reliability, construct validity, and sensitivity to change in a recent fracture/no recent fracture osteoporosis sample.

Declining cognition and falls: role of risky performance of everyday mobility activities

BACKGROUND

Declining cognition is a risk factor for falls among older adults. The extent to which impaired judgment in performance of daily activities increases fall risk is unclear.

OBJECTIVE

The aim of this study was to determine whether engagement in mobility activities in a risky manner explains the association between declining cognition and rate of falls.

DESIGN

This study was a secondary analysis of baseline and prospective data from older adults enrolled in the intervention arm of a randomized clinical trial.

METHODS

Two hundred forty-five community-dwelling older adults (79% female; mean age=79 years, SD=8.0) who were at risk for falls received physical, cognitive, and functional evaluations. Cognition was assessed with the Short Portable Mental Status Questionnaire (SPMSQ). Using interview and in-home assessment data, physical therapists determined whether participants were at risk for falls when performing mobility-related activities of daily living (ADL) and instrumental ADL (IADL). Falls were measured prospectively for 1 year using monthly falls diaries.

RESULTS

Declining cognition was associated with increased number of mobility activities designated as risky (1.5% of mobility activities performed in a risky manner per SPMSQ point) and with increased rate of falls (rate ratio=1.16 for each unit change in SPMSQ score). Risky performance of mobility activities mediated the relationship between cognition and rate of falls.

LIMITATIONS

Risk assessment was based on the clinical judgment of experienced physical therapists. Cognition was measured with a relatively insensitive instrument, and only selected mobility activities were evaluated.

CONCLUSIONS

Engagement in mobility ADL and IADL tasks in a risky manner emerged as a link between declining cognition and increased number of falls, suggesting a mechanism through which the rate of falls may increase. Specifically, declining cognition is associated with performance of mobility activities in an unsafe manner, thereby increasing the risk for falls.

What is the relation between fear of falling and physical activity in older adults?

OBJECTIVE

To describe the association between fear of falling (FOF) and total daily activity in older adults.

DESIGN

Cross-sectional observational study.

SETTING

Ambulatory clinical research training center.

PARTICIPANTS

Community-dwelling older adults aged ≥64 years (N=78), who were independent in ambulation with or without an assistive device.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

FOF was defined by self-reported fear ratings using the Survey of Activities and Fear of Falling in the Elderly and self-reported fear status determined by response to the following question: Are you afraid of falling? Physical function was assessed using the Late Life Function and Disability Instrument. Physical activity was recorded using an accelerometer worn on the waist for 7 consecutive days, and mean daily counts of activity per minute were averaged over the 7-day period.

RESULTS

Fear ratings were related to total daily activity (r=-.26, P=.02). The relation was not as strong as the relation of function and physical activity (r=.45, P<.001). When stratified by exercise status or functional status, fear was no longer related to total daily activity. Physical function explained 19% of the variance in physical activity, whereas the addition of fear status did not add to the explained variance in physical activity.

CONCLUSIONS

FOF is related to total daily physical activity; however, FOF was not independently associated with physical activity when accounting for physical function. Some FOF may be reported as a limitation in function.

Risk factors for falls in older adults with lower extremity arthritis: a conceptual framework of current knowledge and future directions

PURPOSE

As the numbers of Canadians aged 65 years and over increases over the next 20 years, the prevalence of chronic conditions, including arthritis, will rise as will the number of falls. Although known fall-risk factors are associated with hip and knee osteoarthritis (OA), minimal research has evaluated fall and fracture risk and/or rates in this population. Thus, the purpose was to summarize research on fall and fracture risk in older adults with hip or knee OA and to develop a conceptual framework of fall-risk screening and assessment.

METHOD

The International Classification of Functioning, Disability and Health, clinical practice guidelines for fall-risk screening, and a selected literature review were used.

RESULTS

Gaps exist in our knowledge of fall and fracture risk for this population. Muscle performance, balance, and mobility impairments have been identified, but little is known about whether personal and environmental contextual factors impact fall and fracture risk. Physical activity may help to prevent falls, but non-adherence is a problem.

CONCLUSION

A need exists to assess fall risk in older adults with hip and knee OA. Promoting regular physical activity by focusing on disease- and activity-specific personal contextual factors may help direct treatment planning.

Benefits of a worksite or home-based bench stepping intervention for sedentary middle-aged adults - a pilot study

The aim of this study was to investigate the benefits of a low-volume, vigorous intensity bench stepping programme in sedentary middle-aged adults. Thirty-one healthy but sedentary adults (12 men; 55-64 years) took part in the study. Participants accumulated up to 9 min per day of stepping exercise on three days per week over the 4-week experimental period. Parameters of cardiorespiratory fitness, body composition and lower limb muscle strength were measured on three occasions: TS1 (baseline test), TS2 (following a 4-week control period) and TS3 (following the 4-week intervention). Data were analysed using a repeated-measures ANOVA. Adherence to the programme was excellent (96%). Relative to the insignificant changes following the control period, parameters of cardiorespiratory fitness were significantly improved following training. No alterations in body composition or lower limb muscle strength were detected. These results show that less than 30 min per week of bench step exercise, accumulated in short bouts throughout the day, can improve parameters of cardiorespiratory fitness after only 4 weeks in previously sedentary middle-aged adults. Due to its low-cost, time-efficient and discrete aspects, stepping exercise may have important implications for public health initiatives that promote physical activity in a population who commonly report 'lack of time' as a barrier to physical activity.

Epidemiology of falls and osteoporotic fractures: a systematic review

BACKGROUND AND METHODS

Fractures in elderly populations result from the combination of falls and osteoporosis. We report a systematic review of studies indexed in PubMed reporting annual rates of low-trauma falls and associated osteoporotic fractures among older community-dwelling people (age ≥ 50 years). An osteoporotic fracture was defined as either a fracture resulting from a low-impact fall in subjects with clinical osteoporosis, a fall resulting in an investigator-defined osteoporotic fracture, or a fall resulting in a low-trauma fracture. Rates are presented using descriptive statistics. Meta-analysis was conducted for statistically homogeneous data sets.

RESULTS

The median (range) annual fall prevalence rates (median proportion of people who experienced one or more falls during the past year) for cohorts of women and men (10 determinations), women alone (seven determinations), and men alone (four determinations) were, respectively, 0.334 (0.217-0.625), 0.460 (0.372-0.517), and 0.349 (0.284-0.526). In studies that reported fall prevalence rates for Western men and women separately (four determinations), the pooled risk ratio (95% confidence interval [CI]) for men versus women was 0.805 (95% CI 0.721-0.900). The ranges of fall prevalence rates in East Asian women (two studies) and East Asian men (two studies) were, respectively, 0.163-0.258 and 0.087-0.184. The risk ratio (95% CI) for fall prevalence in East Asian men versus women was 0.634 (0.479-0.838) in studies (two determinations) reporting results for East Asian men and women separately. In cohorts of Western women and men (five determinations), the pooled rate (95% CI) of low-impact falls resulting in fractures was 0.041 (0.031-0.054). The proportion of low-trauma fractures attributable to falls among the Western community-dwelling elderly was within the range of 0.860-0.950 for fractures at all sites or the hip (five determinations). A range of 0.716-0.924 of all fractures were osteoporotic (eight determinations).

CONCLUSION

Fall rates are higher in women than in men in Western community-dwelling populations and lower in East Asian populations. Extrapolated to the US population, the statistics imply that low-impact falls cause approximately 0.53 million osteoporotic fractures annually among the US community-dwelling elderly.

Positive components of mental health provide significant protection against likelihood of falling in older women over a 13-year period

BACKGROUND

In late life, falls are associated with disability, increased health service utilization and mortality. Physical and psychological risk factors of falls include falls history, grip strength, sedative use, stroke, cognitive impairment, and mental ill-health. Less understood is the role of positive psychological well-being components. This study investigated the protective effect of vitality on the likelihood of falls in comparison to mental and physical health.

METHODS

Female participants were drawn from the Dynamic Analyses to Optimise Ageing (DYNOPTA) harmonization project. Participants (n = 11,340) were aged 55-95 years (Mean = 73.68; SD = 4.31) at baseline and observed on up to four occasions for up to 13 years (Mean = 5.30; SD = 2.53).

RESULTS

A series of random intercept logistic regression models consistently identified vitality's protective effects on falls as a stronger effect in the reduction of the likelihood of falls than the effect of mental health. Vitality is a significant predictor of falls likelihood even after adjusting for physical health, although the size of effect is substantially explained by its covariance with mental and physical heath.

CONCLUSIONS

Vitality has significant protective effects on the likelihood of falls. In comparison with mental health, vitality reported much stronger protective effects on the likelihood to fall in comparison with the risk associated with poor mental health in a large sample of older female adults. Both physical health and mental health account for much of the variance in vitality, but vitality still reports a protective effect on the likelihood of falls.

Physical functioning measures and risk of falling in older people living in residential aged care facilities

BACKGROUND

Frail older individuals living in residential aged care facilities (RACFs) have impaired physical function compared with to older people living in the community. In residents of RACFs, we aimed to produce sex-specific means and empirical norms of objective physical function measures to ascertain whether these measures are predictors of falls.

METHODS

Data were extracted from a large cohort study investigating fall and fracture rates in RACFs in the Northern Sydney Health Area, Australia.

RESULTS

Study participants (n = 602, 70.9% female) were recruited from 51 RACFs. Cohort means (±standard deviation) for females were for grip strength (GS) 16.8±5.3 kg, simple reaction time (RT) 384±154 ms, walking speed (WS) 0.56 ±0.20 ms(-1), balance category (B) 3.8±1.1 and sit to stand category (STS) 3.6±0.5. For males, means were for GS 28.8±7.8 kg, RT 335±150 ms, WS 0.62±0.22 ms(-1), B 4.1±1.1 and STS 3.7±0.5. Means of B and STS decreased significantly over the 1-year study period for males and females (p < 0.001). Individual multivariate negative binomial regression models for each functional outcome showed having a WS <0.6 ms(-1) (IRR = 1.37, 95% Cl = 1.03-1.84), a STS score of 3 (IRR = 1.39, 95% Cl = 1.09-1.79) and B category of 3 or 5 (IRR = 1.69, 95% CI = 1.29-2.22) were significantly associated with an increased fall rate.

CONCLUSIONS

This study establishes normative values for physical function tests in mobile residents of RACFs and demonstrates that walking speed, balance and sit to stand impairments are associated with falls in this group.

Predicting falls in elderly receiving home care: the role of malnutrition and impaired mobility

To investigate the role of malnutrition, impaired mobility and care dependency in predicting fallers in older Dutch home care clients.

DESIGN

This study is a secondary analysis of data of the annual independent national prevalence measurement of care problems of Maastricht University. The design involves a cross-sectional, multicentre point prevalence measurement (malnutrition, mobility), and a 30 days incidence measurement (falls).

SETTING

Dutch home care organisations.

PARTICIPANTS

2971 clients (older than 65 years) from 22 home care organizations participated.

MEASUREMENTS

A standardized questionnaire was used to register amongst others data of weight, height, number and type of diseases (like for example neurologic diseases, dementia, CVA, COPD, eye/ear disorders, musculoskeletal disorders), nutritional intake, use of psychopharmaca, undesired weight loss, fall history, mobility, and care dependency.

RESULTS

The study was able to show that fallers are more often malnourished than non-fallers in the univariate analysis. Most importantly the study indicated by multivariate analysis that fallers could be predicted by the risk factors immobility ((OR 2.516 95% CI 1.144-5.532), high care dependency (OR 1.684 95% CI 1.121-2.532) and malnutrition (OR 1.978 95% CI 1.340-2.920).

CONCLUSION

The findings of this study stress that malnutrition, impaired mobility and care dependency are potential reversible factors related to falls. Therefore early identification and management of nutritional status, impaired mobility and care dependency are important aspects for a possible fall prevention strategy.