Approach to falls among the elderly in the community

Analysis of fall risk factors and environmental hazards for older adults in Japan: assessing fall situations and locations

[Purpose] This study aimed to examine falls among older adults in Japanese households and determine the risk associated with each fall location. [Participants and Methods] This study included 99 participants (249 fall events) who received daycare rehabilitation at a nursing care facility. Data on fall circumstances were collected from the medical records and accident reports. The analyzed variables included age, medical status, level of care required, fall history, location, and mode of transportation during the falls. [Results] Falls occurred most commonly in bedrooms. Falls at an entrance were associated with no assistive device (OR: 1.76, 95% CI: 1.06-1.80) and 1 history of falls (OR: 1.22, 95% CI: 1.03-3.10). Risk factors for falls in bedrooms included Parkinson's disease (OR: 1.83, 95% CI: 1.11-1.87), orthopedic disease (OR: 1.11, 95% CI: 1.15-3.43), and cane walking (OR: 1.08, 95% CI: 1.33-4.13). Falls in a hallway were associated with no assistive device (OR: 1.75, 95% CI: 1.15-1.91). [Conclusion] Bedrooms and hallways in Japanese households were identified as locations with a high risk of falls. The unique architectural and cultural features of Japanese homes may contribute to this risk. Rehabilitation programs should consider individual fall histories, medical conditions, and differences in mobility.

Association between fear of falling and mortality in middle-aged and older adults: A systematic review and meta-analysis

BACKGROUND

Fear of falling (FOF) has emerged as a significant public health issue, contributing to excess disability among middle-aged and older adults. The association between FOF and mortality remains unclear.

METHODS

Prominent electronic databases (PubMed, Web of Science, the Cochrane Library, Embase, CINHAL, PsycINFO, Scopus, China National Knowledge Infrastructure, China Biology Medicine disc, and Wanfang Database) were searched from inception until October 21, 2023 (data updated on June 9, 2024), for cohort or longitudinal studies investigating the association between FOF and mortality. The heterogeneity between studies was quantitatively assessed using I2. A fixed-effect model calculated the pooled effect size.

RESULTS

A total of seven cohort studies, including 27,714 participants, were analyzed in this systematic review and meta-analysis. The meta-analysis results demonstrated a positive association between FOF and mortality, with a significant increase in the risk of mortality for those with FOF (hazard ratio [HR]:1.29, 95 % confidence interval [CI]: 1.19-1.41, p < 0.05). Subgroup analysis indicated that age, male sex, clinical diagnosis of depression, number of chronic diseases, activity restriction due to FOF, and FOF levels were associated with mortality.

CONCLUSIONS

FOF and mortality have a positive association, which needs to be confirmed by further prospective studies with large samples and long-term follow-up to provide evidence for clinicians to intervene in FOF to reduce mortality in middle-aged and older adults.

Construction of an instrument to enable the assessment of the risk of falls in older outpatients: A quantitative methodological study

OBJECTIVES

To develop an instrument to facilitate the risk assessment of falls in older outpatients.

DESIGN

A quantitative methodological study using the cross-sectional data.

METHODS

This study enrolled 1988 older participants who underwent comprehensive geriatric assessment (CGA) in an outpatient clinic from May 2020 to November 2022. The history of any falls (≥1 falls in a year) and recurrent falls (≥2 falls in a year) were investigated. Potential risk factors of falls were selected by stepwise logistic regression, and a screening tool was constructed based on nomogram. The tool performance was compared with two reference tools (Fried Frailty Phenotype; CGA with 10 items, CGA-10) by using receiver operating curves, sensitivity (Sen), specificity (Spe), and area under the curve (AUC).

RESULTS

Age, unintentional weight loss, depression measured by the Patient Health Questionnaire-2, muscle strength measured by the five times sit-to-stand test, and stand balance measured by semi- and full-tandem standing were the most important risk factors for falls. A fall risk screening tool was constructed with the six measurements (FRST-6). FRST-6 showed the best AUC (Sen, Spe) of 0.75 (Sen = 0.72, Spe = 0.69) for recurrent falls and 0.65 (Sen = 0.74, Spe = 0.48) for any falls. FRST-6 was comparable to CGA-10 and outperformed FFP in performance.

CONCLUSIONS

Age, depression, weight loss, gait, and balance were important risk factors of falls. The FRST-6 tool based on these factors showed acceptable performance in risk stratification.

IMPACT

Performing a multifactorial assessment in primary care clinics is urgent for falls prevention. The FRST-6 provides a simple and practical way for falls risk screening. With this tool, healthcare professionals can efficiently identify patients at risk of falling and make appropriate recommendations in resource-limited settings.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was received, due to our study design.

Exploring the association between activities of daily living ability and injurious falls in older stroke patients with different activity ranges

Injurious falls pose a significant threat to the safety of stroke patients, particularly among older adults. While the influence of activities of daily living (ADL) on falls is acknowledged, the precise connection between ADL ability and fall-related injuries in older stroke patients undergoing rehabilitation, particularly those with varying mobility levels, remains unclear. This multicenter cross-sectional study in China recruited 741 stroke patients aged 65 years and above, categorized into bedridden, domestic, and community groups based on their mobility levels using the Longshi Scale. ADL ability was assessed using the Barthel Index. Logistic regression models, generalized additive models, smoothed curve-fitting, and threshold effect analysis were employed to explore the relationship between ADL ability and injurious falls across the three mobility groups. Results revealed an inverted U-shaped relationship between ADL ability and injurious falls among patients in the domestic group (p = 0.011). Below the inflection point of 35 on the Barthel Index, the likelihood of injurious falls increased by 14% with each unit increase in ADL ability (OR = 1.14, 95% CI 1.010-1.29, p = 0.0331), while above the inflection point, it decreased by 3% per unit increase (OR = 0.97, 95% CI 0.95-0.99, p = 0.0013). However, no significant association between ADL ability and injurious falls was observed in either the bedridden or community groups (p > 0.05). These findings suggest that only older stroke patients capable of engaging in activities at home demonstrate a correlation between ADL ability and injurious falls. The identified inverted U-shaped relationship may aid in identifying fall injury risk in this population.

Multimorbidity patterns and the risk of falls among older adults: a community-based study in China

BACKGROUND

Due to the high prevalence of multimorbidity and realistic health service demands for fall prevention, there is growing interest in the association between multimorbidity and falls. Our study aimed to identify multimorbidity patterns among Chinese older adults and explore the association between multimorbidity patterns and falls.

METHODS

Data from 4,579 Chinese community-dwelling older adults was included in this analysis. Information regarding falls and 10 chronic conditions was collected. An exploratory factor analysis was performed to determine multimorbidity patterns. Regression models were fitted to explore the associations of individual chronic disease or multimorbidity patterns with falls.

RESULTS

Among 4,579 participants, 368 (8.0%) were defined as fallers, including 92 (2.0%) frequent fallers, and multimorbidity affected 2,503 (54.7%) participants. Older adults with multimorbidity were more likely to be fallers [odds ratio (OR) = 1.3, P = 0.02] and frequent fallers (OR = 1.7, P = 0.04). Three multimorbidity patterns were identified (i.e., cardiovascular-metabolic diseases, psycho-cognitive diseases and organic diseases), and the associations between psycho-cognitive diseases/organic diseases and prevalent falls or frequent falls were found to be significant.

CONCLUSIONS

The psycho-cognitive disease pattern and organic disease pattern are significantly associated with falls. Therefore, more attention should be paid to patients with psycho-cognitive diseases and timely, targeted diagnostic and treatment services should be provided in fall prevention.

Global burden of fall and associated factors among individual with low vision: A systematic-review and meta-analysis

INTRODUCTION

Low vision has a significant global health problem that impacts the personal, economical, psychological, and social life of an individual. Each year around 684 000 individuals die from falls, 80% of these deaths occur are in low- and middle-income countries. The risk of falling significantly increases with visual impairment. This review aimed to determine the global pooled prevalence of fall and associated factors among individuals with low vision.

METHODS AND MATERIALS

Systematic search of published studies done on PubMed, EMBASE, MEDLINE, Cochrane, Scopus, Web of Science CINAHL and, Google Scholar. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to report the findings. Quality of studies was assessed using the modified Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using a random-effects method using the STATA™ Version 14 software.

RESULT

Thirty-five (35) studies from different regions involving 175,297 participants included in this meta-analysis. The overall pooled global prevalence fall among individual with low vision was17.7% (95% CI: 16.4-18.9) whereas the highest prevalence was 35.5%; (95% CI: 28.4-42.5) in Australia and the lowest was 19.7%; (95% CI: 7.6-31.8) seen in South America. Fear of falling (OR: 0.16(95%CI 0.09-0.30), and severity of visual impairment (OR: 0.27(95%CI (0.18-0.39) increases the odds of falling.

CONCLUSION

As one cause of accidental death, the prevalence of falls among individuals with low vision is high. Fear of falling and severity of falling increases the odds of falling. Different stakeholders should give due attention and plan effective strategies to reduce the fall among this population.

A study on the falls factors among the older adult with cognitive impairment based on large-sample data

Introduction

This study explored the correlative factors of falls among the older adult with cognitive impairment, to provide distinct evidence for preventing falls in the older adult with cognitive impairment compared with the general older adult population.

Methods

This study was based on a cross-sectional survey, with an older adult population of 124,124 was included. The data was sourced from the Elderly Care Unified Needs Assessment for Long-Term Care Insurance in Shanghai. Binary and multivariable logistic regression analyses were conducted sequentially on the correlative factors of falls. Multivariable logistic regression was performed on variables that were significant, stratified by cognitive function levels.

Results

The incidence of fall in the past 90 days was 17.67% in this study. Specific variables such as gender (male), advanced age (≥80), residence with a elevator (or lift), mild or moderate disability, quality of sleep (acceptable/poor) were negatively correlated with falls, while higher education level, living alone, residence with indoor steps, unclean and untidy living environment, MCI or dementia, chronic diseases, restricted joints, impaired vision, and the use of diaper were positively correlative factors of falls. Comparing with older adult with normal cognitive functions, older adult with dementia faced a higher risk of falling due to accessibility barrier in the residence. For general older adults, less frequency of going outside and poor social interactions were positively correlated with falls, while for older adult with cognitive impairments, going outside moderately (sometimes) was found positively correlated with falls. Older adults with cognitive impairments have increased fall risks associated with chronic diseases, restricted joints, and the use of diaper. The risk of falling escalated with the greater number of chronic diseases.

Discussion

For older adult with cognitive impairments, it is advisable to live with others. Additionally, creating an accessible living environment and maintaining the cleanness and tidiness can effectively reduce the risk of falls, particularly for those with MCI or dementia. Optimal outdoor activity plans should be developed separately based on the cognitive function of older adults. Older adult with dementia who have comorbidities should be paid special attention in fall prevention compared to the general older adult population.

Epidemiology of Cervical Fracture/Cervical Spinal Cord Injury and Changes in Surgical Treatment Modalities in Elderly Individuals During a 10-year Period: A Nationwide Multicenter Study in Japan

STUDY DESIGN

Retrospective multicenter study.

OBJECTIVES

To investigate changes over a 10-years period in the profile of cervical spine and spinal cord injuries among the elderly in Japan.

METHODS

The current multicenter study was a retrospective analysis of inpatients aged ≥65 years, suffering cervical fracture (CF) and/or cervical spinal cord injury (CSCI). We analyzed 1413 patients' epidemiology (from 2010 to 2019). Moreover, 727 patients who underwent surgical treatment were analyzed in 2 groups: the early (2010-2014) and late period (2015-2019).

RESULTS

Both the number of patients and number of surgical patients showed a significant increasing trend (P < .001), while the mean age, the distribution of injury levels and paralysis severity, and the proportion of surgical indications remained the same. The number of surgical patients doubled from 228 to 499 from the early to late periods. Posterior surgery was the most common approach (90.4%), instrumentation surgery with screws increased significantly, and the range of fusion was significantly longer in the late period (2.1 vs 2.7 levels, P = .001). Significantly worsening neurological symptoms were recorded in the late period (1.3% vs 5.8%, P = .006), with C5 palsy being the major one. Otherwise, perioperative, major, and other complications, including mortality, did not differ significantly in incidence.

CONCLUSIONS

Both the number of elderly CF and/or CSCI patients and number of patients undergoing surgery increased dramatically over the decade without any change in profile. Instrumentation surgeries with screws increased, without an increase in systemic complications.

World trends in publication for maxillofacial and dental trauma in the elderly

Aging may increase the risk of maxillofacial and dentoalveolar trauma (MDT). This review assessed global trends in scientific publications on MDT in the elderly. Six databases were searched. Studies about MDT in the elderly (≥60 years old) were included in two text mining stages (S1 and S2). In S1, all studies with elderly subjects were included, while in S2 only studies in which the elderly were assessed in a separate set of data or in a subanalysis by age groups were included. In S1, relevant data were mined using VantagePoint™ software. In S2, data were descriptively analyzed. There were 2265 studies at S1 and 110 at S2. The publication dates spanned from 1963 to 2023. In S1, the most cited keywords and terms were aged (n = 1872), male (n = 1839), female (n = 1777), "mandible fracture" (n = 460), "orbit fracture" (n = 362), and "maxilla fracture" (n = 118). Thirty authors published 10 or more articles with visible collaboration networks. There was a progressive increase in publications, especially in Europe (n = 150). In S2, most studies were case reports/case series (n = 62). The primary etiology was accidental falls (n = 84), the most affected region was the middle third of the face (n = 65), and dental trauma was rarely reported (n = 15). Cone Beam computed tomography was the most used diagnostic tool (n = 67). Of the 81 articles that addressed therapy, 52 opted for surgical treatment. Although there has been an increase in the number of articles on MDT over the years, studies with the elderly population as a specific study group are still needed. Accidental falls were the most reported etiology, while the middle third of the face and the mandible were the anatomic region and bone most affected, respectively. The high number of case reports indicates the need for improvement in the available scientific evidence about MDT in the elderly.

Comparison of falls and risk factors among older adults in urban villages, urban and rural areas of Shantou, China

Objective

To investigate and compare the differences between the incidence of falls, balance and living environment among older persons in urban villages and other types of residential areas.

Methods

We surveyed 580 older adults living in different types of residential areas in Shantou, China, surveying basic information, fall incidence, balance ability testing of older persons, home environment safety assessment.

Results

The incidence of falls among older people in urban villages (19.54 %) was between urban areas(26.63 %) and rural areas(16.91 %). The influencing factors of falls in different residential types were different. Near-fall, abnormal bowel movement, and impaired balance ability were the risk factors of falls among older persons in urban villages. Divorce/single, fair and poor hearing loss and near-fall were the risk factors of falls in urban older adults. Frailty and impaired balance ability were the risk factors of falls in rural older people.

Conclusions

Risk factors for falls in older people vary according to the characteristics of their living areas and relevant interventions should be targeted according to the characteristics of falls occurring in different residential areas.

Combining principal component analysis and logistic regression for multifactorial fall risk prediction among community-dwelling older adults

Falls require comprehensive assessment in older adults due to their diverse risk factors. This study aimed to develop an effective fall risk prediction model for community-dwelling older adults by integrating principal component analysis (PCA) with machine learning. Data were collected for 45 fall-related variables from 1630 older adults in Taiwan, and models were developed using PCA and logistic regression. The optimal model, PCA with stepwise logistic regression, had an area under the receiver operating characteristic curve of 0.78, sensitivity of 74 %, specificity of 70 %, and accuracy of 71 %. While dimensionality reduction via PCA is not essential, it aids practicality. Our framework combines PCA and logistic regression, providing a reliable method for fall risk prediction to support consistent screening and targeted health promotion. The key innovation is using PCA prior to logistic regression, overcoming conventional limitations. This offers an effective community-based fall screening tool for older adults.

Combined effect of falling difficulty and cardiovascular diseases on the risk of all-cause and cardiovascular mortality in older adults: an analysis of the National Health and Nutrition Examination Survey

PURPOSE

Older adults with cardiovascular diseases (CVD) are prone to falls. This study aimed to analyze the combined effect of falling difficulty and CVD on the risk of all-cause- and CVD mortality in older adults.

METHODS

In this retrospective cohort study, people aged ≥60 years with information on falling difficulty and CVD from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) were selected. Multivariable Cox proportional hazards regression model was used to assess the associations of falling difficulty and CVD with all-cause- and CVD mortality.

RESULTS

A total of 1409 participants were included, of whom 868 (58.1%) participants died, and 237 (15.0%) died of CVD. The mean age of participants was 72.1 (0.3) years and 825 (64.7%) were female. Older adults with falling difficulty or CVD were associated with an increased risk of all-cause- and CVD mortality. Older adults in the no falling difficulty & CVD group [hazard ratio (HR) = 1.45, 95% confidence interval (CI) 1.19-1.78], the falling difficulty & no CVD group (HR = 1.45, 95%CI 1.12-1.89), and the falling difficulty & CVD group (HR = 2.13, 95%CI 1.77-2.56) were related to a higher risk of all-cause mortality compared to those in the no falling difficulty & no CVD group. The combined effect of falling difficulty and CVD was positively correlated with the risk of all-cause mortality (HR = 1.26, 95%CI: 1.18-1.34; P-trend <0.001) and CVD mortality (HR = 1.36, 95%CI: 1.18-1.56; P-trend <0.001).

CONCLUSION

The combined effect of falling difficulty and CVD was positively associated with the risk of all-cause- and CVD mortality in older adults.

Reducing falls among residents of retirement homes: A DNP project

ABSTRACT

Falls among older adults (OAs) living in retirement homes (RHs) in Canada are a major public health concern due to high morbidity and mortality as well as significant healthcare expenditures. This quality improvement (QI) initiative, conducted for the author's Doctor of Nursing Practice (DNP) project, aimed to decrease fall rates and ED transfers related to falls among OAs in six RHs across the Greater Toronto Area in Ontario, Canada through a multipart intervention with two primary goals. First, the project aimed to facilitate RH NPs' implementation of a comprehensive fall risk assessment and fall prevention strategy in their practice by incorporating the Stopping Elderly Accidents, Deaths & Injuries (STEADI) toolkit into their armamentarium. Second, it sought to enhance the knowledge of the RHs' registered practical nurses (RPNs), personal support workers (PSWs), and unregulated care providers (UCPs) in assessing fall risk and incorporating fall prevention strategies in their daily practice. By improving NP, RPN, PSW, and UCP knowledge and increasing (by 20%) RPN, PSW, and UCP use of fall prevention strategies, this QI initiative successfully reduced fall rates in the RHs by 40.4%, with no falls requiring transfer to the ED, in the postintervention period. The results of this project highlight the need for an interdisciplinary approach to fall risk reduction in RHs that includes implementation of multifactorial intervention strategies as well as effective organizational policies and procedures for maximum impact.

Effects of a fall prevention exercise regimen on physical and psychosocial outcomes in elderly community dwellers: a randomized comparative study

BACKGROUND

There is a need for comprehensive programs that address both the physical and psychosocial aspects of fall prevention for the elderly.

OBJECTIVE

This study assessed the efficacy of the exercise regimen on various health metrics for elderly community dwellers.

METHODS

Forty-four participants were divided into experimental and control groups. The experimental group adhered to a 9-step core exercise regimen for fall prevention, practicing three times a week for 30 minutes across 10 weeks, while the control group maintained their regular daily activities without any specific exercise program. Before and after the intervention, participants underwent the timed up-and-go t est to evaluate the physical function, the berg balance scale (BBS) and one-legged stance test (OLST) for balance assessment, the activity-specific balance confidence scale for fall-related self-efficacy, and measures for health-related quality of life.

RESULTS

Participants in the experimental group showed significant improvements in physical function (p = .04, Cohen's effect size (d) = 0.2). and balance ability on BBS (p < .01, d = 0.2) and OLST (p < .01, d = 1.3) compared to the control group. Furthermore, there was a notable enhancement in the quality of life indicators for this group, especially in areas such as physical function (p = .04, d = 0.2), physical-role limitation (p = .04, d = 0.2), mental health (p = .01, d = 0.3), vitality (p = .02, d = 0.4), body pain (p = .04, d = 0.5), and general health (p = .04, d = 0.4).

CONCLUSION

These findings highlight the potential of the fall prevention exercise program in improving physical health aspects, but its influence on specific psychosocial elements remains to be determined.

Factors associated with external causes in elderly attended by the mobile emergency care service

OBJECTIVE

To analyze the prevalence and factors associated with external causes in elderly people attended by the mobile emergency care service.

METHOD

Cross-sectional study with 1,972 pre-hospital care records of elderly victims of external causes from 2019 to 2020. A descriptive and bivariate analysis was performed, with a significance level of 5% (p<0.05).

RESULTS

The prevalence of external causes in elderly people attended by the mobile emergency service was 12.2%. Falling was the most frequent occurrence. The associations of the occurrence of falls with age from 90 years old (OR=29.31; p<0.001) and female gender (OR=5.38; p<0.001) stood out, as well as the suspicion of ingestion of alcoholic beverages with occurrence of violence (OR=4.17; p<0.001) and traffic accidents (OR=1.97; p<0.001).

CONCLUSION

The study showed factors associated with injuries due to external causes in theelderly and may support the formulation of coping strategies for this problem.

The primary care NP's guide to prevention and management of falls in older adults

ABSTRACT

Falls are a growing health concern affecting older adults (defined as ages 65 years and older) that can lead to devastating consequences. NPs in primary care settings play an important role in the prevention and management of older adult falls. Methods and resources to screen for fall risk, assess risk factors, and manage falls in older adults are discussed.

Image Findings as Predictors of Fall Risk in Patients with Cerebrovascular Disease

This study examined computed tomography findings in patients with cerebrovascular disease and determined predictors for falls. Images of the head were divided into 13 regions, and the relationships between computed tomography findings and the presence or absence of falls were investigated. A total of 138 patients with cerebrovascular disease (66% men, aged 73.8 ± 9.6 years) were included. A comparison between the fall and non-fall groups revealed a significant difference in the total functional independence measure scores and imaging findings at admission. Logistic regression analysis showed that the thalamus (p < 0.001), periventricular lucency (p < 0.001), lateral hemisphere room enlargement (p < 0.05), and age (p < 0.05) were related to the presence or absence of falls. For the 42 patients with cerebral hemorrhage, the thalamus (p < 0.01), periventricular lucency (p < 0.05), lateral ventricle vicinity (p < 0.05), and posterior limb of the internal capsule (p < 0.05) were extracted as factors related to the presence or absence of falls. For the 96 patients with cerebral infarction, the thalamus (p < 0.001), periventricular lucency (p < 0.01), and anterior limb of the internal capsule (p < 0.05) were extracted as factors related to the presence or absence of falls. This study found a relationship between the thalamus, lateral ventricle enlargement, periventricular lucency, and falls. Fall prognosis can potentially be predicted from computed tomography findings at admission.

Effect of polypharmacy and Fall-Risk-Increasing Drugs (FRIDs) on falls among Brazilian older adults: The SABE cohort study

Polypharmacy, considered as the use of multiple medications, has been one of the factors associated with a higher risk of falls among older adults. However, the association of this factor regardless of the use of Fall-Risk-Increasing Drugs (FRIDs) has not been extensively explored.

OBJECTIVES

This study aimed to evaluate the longitudinal association of polypharmacy with falls and verify whether this association is independent of FRID use.

METHODS

A longitudinal study was conducted with a representative sample of the urban population aged 60 years and over in the city of São Paulo, Brazil, from 2000 to 2006. The analysis of the association among polypharmacy, the use of FRIDs, and the occurrence of falls over the years was performed using Generalized Estimating Equation (GEE) models adjusted for covariates.

RESULTS

The association between polypharmacy and falls was significantly attenuated after the adjustment for covariates and FRIDs. Users of two or more FRIDs had higher odds of falls (OR = 1.51; CI [1.16; 1.96]).

CONCLUSION

FRID use was associated with the occurrence of falls among older adults. The number of medications must be kept to the minimum necessary, and FRIDs should be avoided in approaches to preventing falls among older adults.

Prevalent falls, fall frequencies and health-related quality of life among community-dwelling older Chinese adults

PURPOSE

Fall is a serious health hazard to older adults. The aim of our study was to investigate the relationship between falls and health-related quality of life (HRQOL) in mainland China.

METHODS

Data from 4579 Chinese community-dwelling older adults was analyzed. Data of falls was self-reported by participants, the HRQOL of older adults was measured by the 3-Level EQ-5D (EQ-5D-3L, 3L). Regression models were built to explore the associations of falls (experience and frequency) with the 3L data (index score, EQ-VAS score and health problems). The potential interaction effects between falls and gender on HRQOL were assessed using a likelihood ratio test, sex-stratified analysis was also performed to separately investigate the associations in men and women.

RESULTS

A total of 368 (8.0%) participants had the experience of fall during the last year. Falls (experience and frequency) were significantly related to EQ-5D-3L index and EQ-VAS scores, fall experience contributed to pain/discomfort and anxiety/depression problems, while fall frequency was associated with physical-related problems and pain/discomfort. Significant interactions between falls and sex in several EQ-5D measures were also observed, and men had lager magnitude of associations than women.

CONCLUSION

Falls were negative associated with overall HRQOL as well as separate HRQOL dimensions among older adults. It also appears that the HRQOL influence on older men is more evident than older women.

Fall Prevalence and Associated Risk Factors Among the Elderly Population in Tabuk City, Saudi Arabia: A Cross-Sectional Study 2023

Background Falls are common among older adults, and they constitute a major public health issue with high morbidity and mortality. Aim This study aimed to estimate the prevalence of falls and investigate the contributing risk factors among the elderly population in Tabuk City, Saudi Arabia. Methods This cross-sectional study recruited a random representative sample of the elderly aged ≥ 60 years. We collected data by interviewing the participants using a structured, Arabic-language questionnaire. It included personal information, a history of falls in the past three and 12 months, comorbidities, and environmental factors. The main outcome was a history of falls in the preceding year. Multivariable logistic regression was used to evaluate the association between potential risk factors and falls. Results The study included 296 participants. Most participants were female (66.9%), aged 60-69 years (68.2%), and married (68.9%). The self-reported prevalence of falls over the preceding 12 months was 25.3% (95% confidence interval (CI): 20.6-30.5). Older people with depressive symptoms had significantly increased vulnerability to falls (adjusted odds ratio (AOR): 0.452, 95% CI: 0.239-0.854). Environmental factors were associated with a 1.799 times (95% CI: 1.041-3.109) increased likelihood of fall, and gait impairment was the strongest risk factor (AOR: 2.775, 95% CI: 1.558-4.942). Conclusions Falls are common among the elderly population in Tabuk City, Saudi Arabia. Gait impairment, the presence of depressive symptoms, and environmental hazards were substantially associated with falls, suggesting that most falls are preventable.

Physical strength and mental health mediate the association between pain and falls (recurrent and/or injurious) among community-dwelling older adults in Singapore

OBJECTIVE

This study aims to understand if poor physical strength and depression mediate the association between pain and recurrent and/or injurious falls in a community of older adults.

METHODS

Data was obtained from a nationally representative longitudinal cohort study conducted in Singapore, PHASE (Wave I and II), which collected information from community-dwelling older adults above 60 years old. A hurdle negative binomial regression and binomial logistic regression were used to assess the association between pain and recurrent falls, and pain and injurious falls respectively. A subsequent mediation analysis was conducted.

RESULTS

Almost half of the participants (N = 1144, 39.7%) reported having either mild, moderate, or severe pain at baseline, 166 (5.4%) participants experienced injurious falls and 144 (4.7%) participants experienced recurrent falls at Wave II. After adjusting for covariates, the presence of pain significantly influenced recurrent (OR 2.8; 95% CI: 1.8, 4.4) and injurious falls (OR: 1.8; 95% CI: 1.3, 2.5). Mediation analyses demonstrated that poor physical strength and depression had a significant mediation effect between all pain characteristics on recurrent falls. Poor physical strength partially mediates the effects of pain and injurious falls as well. However, the mediating effect of poor physical strength and depression was not observed between other pain characteristics and injurious falls.

CONCLUSIONS

The findings highlighted differences in the underlying mechanisms between pain characteristics affecting recurrent and injurious falls. These insights will be useful for identifying patients most at risk for recurrent or injurious falls, and for tailoring future community-based fall intervention programmes.

Comparison of gait speed, dynamic balance, and dual-task balance performance according to kinesiophobia level in older adults

PURPOSE

The presence of kinesiophobia was identified in older adults. Studies have examined the effects of kinesiophobia in older adults with chronic pain. Studies examining the effect of kinesiophobia on gait and balance performance in older adults without pain are insufficient. The aim of this study was to compare gait speed, dynamic balance, dual-task balance performance according to kinesiophobia level in community dwelling older adults without pain.

MATERIALS AND METHODS

Seventy-five older adults were included. The socio-demographic data (age, height, weight, fall history, etc.) was recorded. Older adults were divided into two groups based on Tampa Kinesiophobia Scale scores. Scores below 37 were grouped as low level, scores above 37 were grouped as high level. The mini-mental state examination (MMSE), gait speed test, modified Four Square Step Test (mFSST), Five Times Sit-to-Stand Test, dual-mFSSt test (additional cognitive and motor task) were applied for dual-task balance performance.

RESULTS

Thirty-six participants(mean age 70.58 ± 5.59 years) had low kinesiophobia, the other 39 individuals(mean age70.94 ± 7.45 years) had high kinesiophobia. The age, gender, body mass index, cognitive status, and fall history were similar between groups (p > 0.05). The participants with low kinesiophobia were found to have better gait speed, dynamic balance, dual-task balance performance (p < 0.001).

CONCLUSION

This study results showed that the presence of high level of kinesiophobia affects gait speed, dynamic balance, dual-task balance performance, and dual-task cost in older adults. Therefore, a high level of kinesiophobia can lead to falls. It may be important to investigate the effects of kinesiophobia in older adults.

The effect of virtual reality technology on anti-fall ability and bone mineral density of the elderly with osteoporosis in an elderly care institution

OBJECTIVE

To explore the impact of virtual reality (VR) training on anti-fall ability and bone mineral density (BMD) among elderly patients admitted to a healthcare institution.

METHODS

People (aged 50) with osteoporosis in an elderly care institution in Anhui Province June 2020 to October 2021 were selected and randomly divided into VR group (n = 25) and control group (n = 25). In VR group, the virtual reality rehabilitation training system was used for training, while control group was treated with traditional fall prevention exercise intervention. The changes of Berg Balance Scale (BBS), timed up and go test (TUGT), functional gait assessment (FGA), bone mineral density (BMD) and falls during 12 months of training were compared between the two groups.

RESULTS

BBS and FGA were positively correlated with BMD of the lumbar vertebrae and femoral neck, and TUGT was negatively correlated with BMD of the lumbar vertebrae and femoral neck. After 12 months of training, the BBS score, TUGT evaluation and FGA evaluation of the two groups were significantly improved compared with those prior to training (P < 0.05). However, there was no significant difference in the lumbar spine and femoral neck BMD between the two groups 6 months after the intervention. The femoral neck and lumbar spine BMD of the VR group improved, and it was significantly higher than that of the control group 12 months after the intervention. Nevertheless, there was no significant difference in terms of the incidence of adverse events between the two groups.

CONCLUSION

VR training can improve anti-fall ability and increase femoral neck and lumbar spine BMD and can effectively prevent and reduce the risk of injury among elderly people with osteoporosis.

Association between multimorbidity and falls and fear of falling among older adults in eastern China: a cross-sectional study

Background

Growing evidence has reported an association between multimorbidity and falls and fear of falling (FOF) in older adults, however, the results regarding this association from China are limited. Our study aimed to investigate the association between multimorbidity and falls and FOF in older adults in eastern China.

Methods

We conducted a cross-sectional study in Zhejiang Province, Eastern China, which recruited a provincial representative sample of adults aged ≥ 60 years. A structured questionnaire including demographic characteristics, chronic diseases, history of falls in the past 12 months, and FOF, was administered by all participants. The exposure variable was multimorbidity, which was defined as the presence of two or more chronic diseases and medical conditions in the same individual. The outcomes included a history of falls and FOF. Multivariate logistic regression was used to evaluate the association between multimorbidity and falls and FOF in older adults.

Results

In total of 7,774 participants were included in the analysis, among whom 3,898 (50.1%) were female, with a mean ± standard deviation age is 72.9 ± 8.4 years. Multimorbidity was associated with the increased risk of falling in older adults [adjusted odds ratio (OR), 1.99; 95% confidence interval (CI):1.55-2.36]. The ORs for having experienced single fall and repeated falls were 1.85 (95% CI: 1.42-2.42) and 3.45 (95% CI: 1.47-6.97), respectively, with multimorbidity compared with those without chronic diseases. The older adults with multimorbidity were more likely to report FOF compared with those without chronic diseases (adjusted OR, 1.49; 95%CI:1.30-1.70). Moreover, the association between multimorbidity and FOF remained significant in the older adults with a history of fall (OR, 1.57; 95%CI:1.04-2.38).

Conclusion

The association between multimorbidity and falls and FOF is significant in the Chinese population and the effects of multimorbidity on falls and FOF do not vary according to the frequency and history of falls in older adults.

Physical Performance and Falling Risk Are Associated with Five-Year Mortality in Older Adults: An Observational Cohort Study

Background: Falls in older people have a significant impact on public health. The scientific literature has provided evidence about the necessity for older adults to be physically active, since it reduces the incidence of falls, several diseases, and deaths, and can even slow down some effects of aging. The primary aim of our study is to identify if physical performances and risk of falling are related to 1-, 2-, 3-, 4-, and 5-year mortality. Its secondary aim is to establish if people with both severely impaired physical performance and a high risk of falling also present impairment in other geriatric domains. Methods: In this prospective study, we enrolled subjects aged 65 years or more, subjected them to comprehensive assessment (including assessment of risk of falling, physical capacities, comorbidities, autonomies in daily living, cognitive abilities, mood, and nutritional status), and followed them for 5 years. Results: We included 384 subjects, 280 of whom were women (72.7%), with a median age of 81 years. Our results showed that physical performances and risk of falling are highly correlated to each other (rho = 0.828). After divided the sample into three groups (people without augmented risk of falling and able to perform adequate physical activity; people with moderate risk of falling and/or disability; people with severe risk of falling and/or disability), we found that the more severe the disability and risk of falling were, the more compromised the other geriatric domains were. Moreover, the survival probability progressively increased following the same trend, amounting to only 41% in severely compromised people, 51.1% in moderately compromised people, and 62.8% in people without physical compromise nor an augmented falling risk (p = 0.0124). Conclusions: Poor physical performance combined with a high risk of falling, correlated with each other, are associated with higher mortality and impairment in multiple domains in older adults.

Proportion, Pattern, and Predictors of Falls in Older Adults - A Community-based Observational Study in Rural West Bengal

Introduction

In spite of falls being a major public health problem, where most of the falls are preventable, there is a lack of epidemiological investigation among those aged 50 and above, especially in developing countries. Hence, we investigate the proportion, pattern, and predictors of falls in this age group.

Materials and Methods

This cross-sectional community-based study was done in the Uluberia-II block of Howrah district, West Bengal, from February to July 2021. A multistage cluster sampling method was used to meet the sample size. Data were collected with the help of a structured interview schedule. Predictors were estimated by the SPSS version 16 and defined in adjusted odds ratio (AOR) with a 95% confidence interval.

Results

Among 170 study participants, 34.7% (59/170) experienced at least one episode of fall, while 20.6% (35/170) experienced recurrent falls in 12 months. Most (78%; 46/59) falls occurred in the home environment and due to slippage (67.8%; 40/59) on the floor. 84.7% (50/59) sustained any type of injuries, 47.5% (28/59) required either consultation of a physician or medication, and 6.8% (4/59) required hospitalization. Safety Checklist Score measured 75.3% (128/170) had a poor household environment, within that 30.6% (52/170) had a seriously poor household environment, which was an important predictor of falls ([AOR] = 3.59 [1.24-10.38]). Fear of fall (AOR = 6.18 [1.77-21.53]) measured by shortfall efficacy scale and nonformal education (AOR = 5.05 [1.33-19.07]) were also predictors of falls.

Conclusion

Considerable proportion of falls occurred in the past year, which can be preventable by improving modifiable environmental factors and detection of fear of fall in persons at different levels of health-care facilities.

Nurse-Initiated Fall and Osteoporosis Screening for Older Adults in the Emergency Department

Background Many older adults presenting to the emergency department (ED) after a fall are discharged without adequate assessment of their fall risk. A nurse-initiated protocol was introduced for the early screening of older adults with injurious falls. We aimed to promote osteoporosis education and right-site them to appropriate outpatient resources in the community. Methodology In this study, we included ≥65-year-old adults who attended the ED with injurious falls or near falls between December 2019 and December 2020. An ED nurse trained in basic geriatric care performed the cognitive assessment and provided advice on diet, footwear, fall safety, calcium/vitamin D supplementation, and osteoporosis screening. Results A total of 70 (75.7% female) patients aged 65-93 years were included. In total, 34 (48.6%) were started on calcium/vitamin D supplements and 22 (31.4%) went on to receive outpatient bone mineral density scans. Only three patients reattended the ED for recurrent falls/fractures in the six-month follow-up period. Conclusions A nurse-initiated fall and osteoporosis screening protocol is a feasible model of care for targeted screening and education of older adults who present to the ED with injurious falls.

Effect of ukemi practice in judo on fear of falling and mobility skills in healthy older adults

[Purpose] To examine whether fear of falling and mobility skills improved after judo ukemi practice in healthy older adults, and whether a relationship exists between improvements in fear of falling and changes in mobility skills. [Participants and Methods] Ten healthy older adults who participated in exercise classes for middle-aged and elderly people to promote health performed ukemi practice three times in total, increasing the degree of difficulty every week. [Results] No significant differences in fear of falling or 10-m walking times were noted in Steps 1, 2, and 3. A significant reduction in timed up and go test results was observed in Steps 2 and 3. No correlation was found between change in fear of falling and change in mobility skills before and after ukemi practice for all combinations. [Conclusion] The results suggest that judo ukemi practice improves mobility skills in healthy older individuals with relatively high physical ability. These changes may not be due to a reduced fear of falling but rather to quicker physical reactivity and other psychological factors.

Paid caregivers' experiences of falls prevention and care in China's senior care facilities: A phenomenological study

Background

In China, as population aging accelerates, senior care facilities have gradually become a mainstream option. According to the World Health Organization (WHO), the annual rate of falls has increased from 30 to 50% in senior care facilities. A study found that older adults who live in senior care facilities are three times more likely to fall than those who live in the community. The quality of care is highly related to the occurrence of falls. Therefore, exploring paid caregivers' experiences is very important to prevent falls in senior care facilities.

Objective

The aim of this study was to explore paid caregivers' experiences of fall prevention and care in China's senior care facilities. Furthermore, we discussed the situation and provided suggestions.

Design

This is a phenomenological study using face-to-face, in-depth, semi-structured interviews.

Setting

The study was conducted at four senior care facilities in Changsha, Hunan, China.

Participants

Fourteen paid caregivers in four senior care facilities, including nursing assistants and senior nurses, participated in this study.

Methods

A purposive sample method was used to select 14 nursing assistants and senior nurses from four different senior care facilities in Changsha from March to April 2022. Every participant individually completed a face-to-face, in-depth, semi-structured interview. Based on the phenomenological research methodology, the thematic analysis method and the Colaizzi analysis method were used for data analysis and theme extraction.

Results

Based on interview data, a total of seven themes were distilled: (1) paid caregivers' professional requirements; (2) paid caregivers' attitude toward falls; (3) paid caregivers' fall training and education; (4) paid caregivers' knowledge about falls; (5) paid caregivers' fall risk assessment; (6) paid caregivers' fall prevention; and (7) paid caregivers' fall treatment.

Conclusion

In China's senior care facilities, paid caregivers to need to be responsible and pay appropriate attention to older adults. First, senior nurses and nursing assistants need to enhance communication and cooperation. Second, they must learn about deficiencies in fall risk assessment and try their best to improve their capability. Third, they must adopt appropriate education methods to improve fall prevention capability. Finally, the protection of privacy should be taken seriously.

Primary care for people with Parkinson's disease in Brazil: A referral flowchart based on risk of falls

Background

People with Parkinson's disease (PD) need to exercise to have a better quality of life. The risk of falling needs to be considered when choosing and implementing exercise interventions. Flowcharts are used to facilitate referrals in Brazilian primary care network, but there is no specific one for PD.

Aim

To develop a referral flowchart for people with PD in Brazilian primary care based on the risk of falls and scientific evidence in the context of a multidisciplinary approach.

Methods

The development of the referral flowchart was accomplished in three steps; (1) relevant literature was reviewed (2) semi-structured interviews (in focus groups) were conducted with primary health care professionals to investigate the current care for people with Parkinson's disease, and (3) the information obtained from the previous steps were analyzed to inform the development of the referral flowchart.

Results

The fall risk-based flowchart uses the 3-step-fall-prediction tool. The primary health care professional should refer the person with a low risk of falls to activities with minimal supervision and those with a higher risk of falls to specialized neurology services. Neurology services are also the referral target for persons presenting significant mobility restrictions (i.e., restricted to a wheelchair or bed). The referral occurs according to what is available in Brazilian primary care.

Conclusion

This flowchart might be the first step to build a multidisciplinary approach for people with Parkinson's disease in Brazilian primary care. The next stage of this study is the validation and subsequent implementation of the flowchart through the primary care at Unified Health System in Brazil.

Accuracy of Tools to Differentiate Single From Recurrent Fallers Pre-Frail Older Women

Objectives

The objectives of this study were to analyze and compare musculoskeletal and functional performance and present cutoff points to differentiate pre-frail community-dwelling older women regarding their fall history: non fallers (0 falls), fallers (single fall), and recurrent fallers (≥2 falls).

Method

This is a cross-sectional, retrospective study on 90 pre-frail community-dwelling older women (71.2 ± 4.49 years) according to Fried criteria. We assessed peak torque (PT) (isokinetic dynamometer), muscle architecture/mass (ultrasound/dual-energy X-ray absorptometry), and the following functional performance: usual gait speed (UGS), fast gait speed (FGS), walking speed reserve (WSR), cadence and step length, and timed up and go.

Results

The recurrent fallers presented lower UGS (1.12 ± 0.18 vs. 1.29 ± 0.28 m/s; p = 0.05) and isometric PT of knee extensors than the fallers (89.88 ± 20.99 vs. 115.55 ± 23.09 Nm; p = 0.01), and lower FGS than the fallers (1.35 ± 0.26 vs. 1.5 ± 0.29 m/s; p = 0.03) and non-fallers (1.35 ± 0.26 vs. 1.52 ± 0.26 m/s; p = 0.01). The outcomes that differentiated the fallers from the non-fallers were both WSR calculated as a difference (WSRdiff) (≤0.26 m/s) and WSR calculated as a ratio (WSRratio) (≤1.25 m/s), while to differentiate the recurrent fallers from the non-fallers were FGS (≤1.44 m/s) and step length (≤73 cm). The following cutoff points might be used to differentiate recurrent fallers and fallers: UGS (≤1.12 m/s), FGS (≤1.34m/s), step length (≤73 cm), PT knee extension (≤114.2 Nm), PT knee flexion (≤46.3 Nm), and PT ankle dorsiflexion (≤22.1 Nm).

Conclusion

Recurrent fallers community-dwelling pre-frail older women presented a worse musculoskeletal and functional performance when compared to the non-fallers and fallers. Gait speed, step length, PT of both knee extension and flexion, and ankle dorsiflexion can be used to identify both single and recurrent fallers pre-frail older women, contributing to guide interventions and prevent falls and fractures.

Gender differentiated score on the Falls Efficacy Scale International (FES-I Brazil) to assess self-efficacy in falls in community-dwelling older adults

BACKGROUND

Since fear of falling is associated with a history of falls and is more prevalent in women, it is important to define cut-off points differentiated between genders on the Falls Efficacy Scale International Brazil (FES-I Brazil) to implement early prevention and/or rehabilitation strategies.

AIMS

To determine cut-off points on the FES-I Brazil differentiated between genders which discriminate falls and verify their association with the history of falls.

METHODS

This was a cross-sectional study including 306 community-dwelling older adults. Fear of falling score from the FES-I Brazil was the independent variable and the outcome was the history of falls in the last 12 months. The cut-off points differentiated between genders were established according to sensitivity and specificity values evaluated by the Receiver Operating Characteristic Curves (ROC). The multivariable logistic regression was used to verify the association between fear of falling and history of falls.

RESULTS

The cut-off points on the FES-I Brazil to discriminate falls were > 25 points [AUC: 0.67 (95% CI 0.59-0.73)] for women, and > 19 points [AUC: 0.66 (95% CI 0.57-0.74) for men, suggesting that women present a greater fear of falling than men, due to the higher cut-off point found for women. Women and men with fear of falling, respectively, had 2.14 (95% CI 1.11-4.13) and 2.62 (95% CI 1.10-6.85) higher odds of suffering falls compared to those without this condition.

CONCLUSIONS

The FES-I can be used to discriminate falls in the elderly and shows that women have a higher cut-off point than men on the scale.

Association between falls and cognitive performance among community-dwelling older people: a cross-sectional study

BACKGROUND

Falls among older people have a negative impact on health and therefore constitute a public health problem. Cognitive decline can also accompany the aging process, and both conditions lead to significant increases in morbidity and mortality in this population.

OBJECTIVE

To analyze the cognitive performance of older people, classified as non-fallers, sporadic fallers and recurrent fallers, and investigate the relationship between falls and cognition.

DESIGN AND SETTING

Cross-sectional study conducted in the interior of the state of São Paulo, Brazil.

METHODS

Evaluations on 230 older people were conducted. They were divided into three groups: non-fallers, sporadic fallers (one fall) and recurrent fallers (two or more falls). The Mini-Mental State Examination, Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Brief Cognitive Screening Battery (BCSB), Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) similarities subtest and digit span test were applied.

RESULTS

In multinomial logistic regression, being a recurrent faller was significantly associated with lower scores in the CERAD word list (odds ratio, OR = 0.92; 95% confidence interval, CI, 0.86-0.98; P = 0.01), in CERAD constructive praxis (OR = 0.88; 95% CI, 0.79-0.98; P = 0.02), in BCSB figure list memory (OR = 0.94; 95% CI, 0.89-0.99; P = 0.02) and in verbal fluency (OR = 0.89; 95% CI, 0.81-0.97; P = 0.01). Recurrent fallers also had lower scores in these same tests, compared with sporadic fallers.

CONCLUSION

Cognitive impairment, especially in the domains of memory and executive functioning, can influence occurrences of recurrent falls.

Are multimorbidity patterns associated with fear of falling in community-dwelling older adults?

Background

Multimorbidity is defined as the co-occurrence of multiple chronic or acute diseases and medical conditions in the same individual and can be grouped into different patterns based on the type of disease. These patterns are associated with poorer quality of life and premature death. It is believed that these patterns entail functional limitations, which may contribute to the fear of falling; however, this association remains unknown. Identifying this possible association is fundamental for developing individual and collective care approaches aimed at preventing the different patterns of chronic diseases in older adults in order to decrease the fear of falling. The objective of this study was to investigate the association between multimorbidity patterns and fear of falling in older adults.

Methods

This was a cross-sectional study including 308 older adults. The exposure variables were the presence of three multimorbidity patterns (cardiopulmonary, musculoskeletal, and vascular-metabolic) and pattern association assessed by self-report of two or more similar coexisting chronic diseases. The outcome was fear of falling assessed by the Brazilian version of Falls Efficacy Scale-International (cut-off point ≥ 23 points). Multivariable logistic regression was used to analyze the association between variables.

Results

Older adults with cardiopulmonary, musculoskeletal, vascular-metabolic patterns and pattern association had 3.49 (95%CI 1.13; 10.78), 2.03 (95%CI 1.13; 3.64), 2.14 (95%CI 1.20; 3.82), and 4.84 (95%CI 2.19; 10.68), respectively, greater chances of presenting fear of falling when compared to older adults without the patterns.

Conclusions

The presence of multimorbidity patterns is associated with higher chances of reporting fear of falling. It is emphasized that the introduction of public health programs aimed at preventing multimorbidity patterns is essential to reduce possible adverse health outcomes, including fear of falling and its negative consequences for older adult health.

IoT-Based Human Fall Detection System

Human falls are an issue that especially affects elderly people, resulting in permanent disabilities or even in the person’s death. Preventing human falls is a social desire, but it is almost impossible to achieve because it is not possible to ensure full prevention. A possible solution is the detection of human falls in near real-time so that help can quickly be provided. This has the potential to greatly reduce the severity of the fall in long-term health consequences. This work proposes a solution based on the internet of things devices installed in people’s homes. The proposed non-wearable solution is non-intrusive and can be deployed not only in homes but also in hospitals, rehabilitation facilities, and elderly homes. The solution uses a three-layered computation architecture composed of edge, fog, and cloud. A mathematical model using the Morlet wavelet and an artificial intelligence model using artificial neural networks are used for human fall classification; both approaches are compared. The results showed that the combination of both models is possible and brings benefits to the system, achieving an accuracy of 92.5% without false negatives.

Development and testing of the Prev’Quedas game for older adults in the community: a descriptive study

ABSTRACT Objectives: to develop and test a board game for fall prevention in older adults in the community. Methods: a descriptive study, carried out through the use of game design elements (narrative, mechanics, aesthetics and technology), the Health Promotion Model, assessment by experts and testing with older adults. For assessment, the Concordance Index was used, considering it greater than 80%. Results: three prototypes and the final version were developed. The game’s narrative was based on promotion model, comprising individual aspects, benefits and barriers in behavior to prevent falls. The mechanics outlined goals and rules. Aesthetics encompassed layout and illustrations. The technology involved board, cards, pin, roulette and instruction manual. The game was assessed by 36 experts and 31 older women from the community, with a Concordance Index of 93.22% and 99%, respectively. Conclusions: the game developed and tested was considered an adequate educational strategy for fall prevention.

Processo de cuidado para prevenção de quedas em idosos: teoria de intervenção práxica da enfermagem

RESUMO Objetivo analisar o processo de cuidado para prevenção de quedas em idosos na perspectiva teórica e metodológica da Teoria de Intervenção Práxica da Enfermagem em Saúde Coletiva. Métodos estudo transversal descritivo de abordagem qualitativa do tipo pesquisa-cuidado, realizado com participantes de um grupo de convivência de uma Unidade Básica de Saúde em Maringá-PR. Os dados foram coletados a partir de entrevistas semiestruturadas e analisados utilizando a Teoria de Intervenção Práxica da Enfermagem em Saúde Coletiva. Resultados realizou-se a captação e interpretação dos dados nas dimensões estrutural, particular e singular, seguido da avaliação de saúde e identificação dos principais riscos intrínsecos e extrínsecos para quedas dos idosos. Os principais diagnósticos e intervenções de enfermagem foram elencados segundo a CIPE®/CIPESC®. Conclusões e implicações para prática foi possível analisar o processo de cuidado na prevenção de quedas junto aos idosos por meio da perspectiva teórica e metodológica na Teoria de Intervenção Práxica da Enfermagem em Saúde Coletiva, sendo proposto um plano de intervenções de enfermagem.

Desenvolvimento e testagem do jogo Prev’Quedas para pessoas idosas da comunidade: estudo descritivo

RESUMO Objetivos: desenvolver e testar um jogo de tabuleiro para prevenção de quedas em idosos da comunidade. Métodos: estudo descritivo, realizado através da utilização dos elementos do design de jogos (narrativa, mecânica, estética e tecnologia), do Modelo de Promoção da Saúde, da avaliação por especialistas e testagem com pessoas idosas. Para avaliação, utilizou-se o Índice de Concordância, considerando-o maior que 80%. Resultados: desenvolveram-se três protótipos e a versão final. A narrativa do jogo foi embasada no modelo de promoção, compreendendo aspectos individuais, benefícios e barreiras no comportamento para prevenção de quedas. A mecânica delineou objetivos e regras. A estética abrangeu layout e ilustrações. A tecnologia envolveu tabuleiro, cartas, pino, roleta e manual de instrução. O jogo foi avaliado por 36 especialistas e 31 idosas da comunidade, com índice de concordância de 93,22% e 99%, respectivamente. Conclusões: o jogo desenvolvido e testado foi considerado uma estratégia educacional adequada para prevenção de quedas.

Speech therapy´s intervention for falling prevention in aging

PURPOSE

to verify the effectiveness of a Speech Therapy intervention program to decrease the risk of falls in elderly people.

METHODS

Exploratory and intervention study where upon 148 volunteers from community, both genders, with an average of 68.6(± 6.5) years were submitted to the Dynamic Gait Index (DGI)- Brazilian brief and the Timed Up and Go (TUG). Volunteers with or without potential risk for falling were invited to participate in a 50-minutes long intervention program carried out for five consecutive weeks, based on Cawthorne and Cooksey exercises. Seventy-two volunteers 68.1(±6.5) years presented in at least three meeting, were reassessed. The results were analyzed by Wilcoxon, Chi-square, Spearman and Correlation Matrix tests, with p≤5.0%.

RESULTS

Thirty-seven (25.0%) and 106 (71.6%) participants presented, respectively, risks for falls in the DGI-Brazilian brief and TUG. There was negative correlation between the DGI-Brazilian brief (p=0.034) and positive with the TUG (p=0.0071) with age and both instruments (p=0.00000016). Through the comparison the initial and final data a positive correlation was found for the DGI-Brazilian brief and for TUG in the Chi-square test and by Wilcoxon's. Better performance was observed in both tests after the intervention.

CONCLUSION

The intervention was effective in decreasing the risk for falls and improving gait performance, and functional and dynamic balance.

Is the self-perception of the built neighborhood associated with fear of falling in community-dwelling older adults?

INTRODUCTION

Characteristics of a built neighborhood may aggravate agravett to fear of falling in older adults and this knowledge are important to contribute to developing strategies aimed at reducing fear of falling and their consequences.

OBJECTIVE

To verify the association between self-perception of built neighborhood characteristics and fear of falling in community-dwelling older adults.

MATERIALS AND METHODS

This was a cross-sectional study including 308 community-dwelling older adults. The outcome was fear of falling evaluated through Falls Efficacy Scale International. Older adults were classified with high fear of falling when they obtained values ≥ 23 points and classified as low fear of falling with score < 23 point. The built neighborhood variables were evaluated by the adapted Neighborhood Environment Walkability Scale. Multivariable logistic regression was performed to verify associations between the variables.

RESULTS

The prevalence of fear of falling was 48.40%. Significant negative associations were observed between residing near a bus stop, outdoor gyms, safe places to walk during the day, and positive associations between garbage accumulation and/or open sewers and high crime rates and fear of falling.

CONCLUSION

The association between self-perceived characteristics of built neighborhoods and fear of falling points to the need for improvements in urban infrastructure, especially public spaces, in order to reduce fear of falling in community-dwelling older adults.