Characteristics of outdoor falls among older people: a qualitative study

Falls prevention in older people and the role of nursing

Falls among older individuals pose a significant public health challenge globally, impacting both individual wellbeing and healthcare systems. This article examines the importance of falls prevention in older people and the pivotal role of nursing in this domain. It presents statistics indicating the high prevalence of falls among older adults, highlighting their substantial impact on morbidity, mortality and healthcare costs. Furthermore, it discusses the multifactorial nature of fall risk factors, including age-related changes, chronic health conditions, medication use, impaired mobility, sensory deficits and environmental hazards. Nursing interventions encompass comprehensive assessments, personalised care plans, patient education and advocacy efforts aimed at reducing fall risks and enhancing safety. By addressing intrinsic and extrinsic factors contributing to falls, nurses contribute significantly to improving the quality of life for older adults and reducing the economic burden associated with fall-related injuries.

The Impact of Dual-Tasks and Disease Severity on Posture, Gait, and Functional Mobility among People Living with Dementia in Residential Care Facilities: A Pilot Study

Gait speed and timed-up-and-go (TUG) predict cognitive decline, falls, and mortality. Dual-tasks may be useful in cognitive screening among people living with dementia (PWD), but more evidence is needed. This cross-sectional study aimed to compare single- and dual-task performance and determine the influence of dementia severity on dual-task performance and interference. Thirty PWD in two residential care facilities (Age: 81.3 ± 7.1 years; Montreal Cognitive Assessment: 10.4 ± 6.0 points) completed two trials of single- (feet apart) and dual-task posture (feet apart while counting backward), single- (walk 4 m) and dual-task gait (walk 4m while naming words), and single- (timed-up-and-go (TUG)), and dual-task functional mobility (TUG while completing a category task) with APDM inertial sensors. Dual-tasks resulted in greater sway frequency, jerk, and sway area; slower gait speed; greater double limb support; shorter stride length; reduced mid-swing elevation; longer TUG duration; reduced turn angle; and slower turn velocity than single-tasks (ps < 0.05). Dual-task performance was impacted (reduced double limb support, greater mid-swing elevation), and dual-task interference (greater jerk, faster gait speed) was related to moderate-to-severe compared to mild PWD. Moderate-to-severe PWD had poorer dynamic stability and a reduced ability to appropriately select a cautious gait during dual-tasks than those with mild PWD, indicating the usefulness of dual-tasks for cognitive screening.

The effects of plantarflexor weakness and reduced tendon stiffness with aging on gait stability

Falls among older adults are a costly public health concern. Such falls can be precipitated by balance disturbances, after which a recovery strategy requiring rapid, high force outputs is necessary. Sarcopenia among older adults likely diminishes their ability to produce the forces necessary to arrest gait instability. Age-related changes to tendon stiffness may also delay muscle stretch and afferent feedback and decrease force transmission, worsening fall outcomes. However, the association between muscle strength, tendon stiffness, and gait instability is not well established. Given the ankle's proximity to the onset of many walking balance disturbances, we examined the relation between both plantarflexor strength and Achilles tendon stiffness with walking-related instability during perturbed gait in older and younger adults-the latter quantified herein using margins of stability and whole-body angular momentum including the application of treadmill-induced slip perturbations. Older and younger adults did not differ in plantarflexor strength, but Achilles tendon stiffness was lower in older adults. Among older adults, plantarflexor weakness associated with greater whole-body angular momentum following treadmill-induced slip perturbations. Weaker older adults also appeared to walk and recover from treadmill-induced slip perturbations with more caution. This study highlights the role of plantarflexor strength and Achilles tendon stiffness in regulating lateral gait stability in older adults, which may be targets for training protocols seeking to minimize fall risk and injury severity.

Efficacy of the Stroll Safe Outdoor Fall Prevention Program: A Randomized Controlled Trial

BACKGROUND AND OBJECTIVES

Outdoor falls can negatively affect the independence and well-being of community-dwelling older adults. Although there is some overlap, there are also differences in risk factors for indoor and outdoor falls. There are no existing community-based fall prevention programs that specifically target outdoor fall prevention. To fill this gap, the Stroll Safe program was developed.

RESEARCH DESIGN AND METHODS

A cluster-randomized controlled trial design was used with randomization at the site level. Participants (N = 86) were aged 60 and older, with a history of an outdoor fall or who had a fear of falling outdoors. Eight naturally occurring retirement community program sites were randomly assigned to the treatment or wait list control group. Outcome measures included the Outdoor Falls Questionnaire, the Falls Behavioral Scale for the Older Person, and the Falls Efficacy Scale-International to examine knowledge of risks, safe strategy use, protective behaviors, and fear of falling. An Analysis of Covariance (ANCOVA) was used to compare change scores between groups with covariates included for any initial differences between groups. A linear mixed model was also conducted to account for any clustering effects.

RESULTS

Significant differences (ps < .05) were found between groups for knowledge of outdoor fall risks and safe strategy use. Effect sizes were large (Cohen's d = 1.2-1.9). Results were retained at 6-week follow-up.

DISCUSSION AND IMPLICATIONS

Stroll Safe is effective in improving knowledge of outdoor fall risks and increasing safe strategy use for community mobility. Stroll Safe fills a gap in outdoor fall prevention programs. Clinical Trials Registration Number: NCT03624777.

Experiences of Older Adults With Mild Balance Dysfunction Who Participated in a Supervised Seniors Exercise Park Program Progressing to Independent Practice

Older adults with mild balance dysfunction can benefit from early intervention. This research explored the experiences of older adults with mild balance dysfunction participating in an 18-week supervised outdoors Seniors Exercise Park program and 6 weeks of unsupervised independent practice. Factors influencing attendance and independent practice were also explored. Semistructured face-to-face interviews were conducted with 24 participants (mean age = 77.4 years, SD = 5.4) and 22 participants (mean age = 77.5 years, SD = 5.6) after 18 and 24 weeks, respectively. The data were analyzed using reflexive thematic analysis. Many participants perceived improvements in health and responded positively to the supervised Seniors Exercise Park program. Factors supporting attendance included building social connections and positive instructor personality. Barriers to training included competing time demands and poor health. These insights suggest that a group-based Seniors Exercise Park supervised program was well accepted and can be an option to improve the health of older adults with mild balance dysfunction.

Neighborhood Socioeconomic Status, Green Space, and Walkability and Risk for Falls Among Postmenopausal Women: The Women's Health Initiative

PURPOSE

This study estimated associations between neighborhood socioeconomic status (NSES), walkability, green space, and incident falls among postmenopausal women and evaluated modifiers of these associations, including study arm, race and ethnicity, baseline household income, baseline walking, age at enrollment, baseline low physical functioning, baseline fall history, climate region, and urban-rural residence.

METHODS

The Women's Health Initiative recruited a national sample of postmenopausal women (50-79 years) across 40 U.S. clinical centers and conducted yearly assessments from 1993 to 2005 (n = 161,808). Women reporting a history of hip fracture or walking limitations were excluded, yielding a final sample of 157,583 participants. Falling was reported annually. NSES (income/wealth, education, occupation), walkability (population density, diversity of land cover, nearby high-traffic roadways), and green space (exposure to vegetation) were calculated annually and categorized into tertiles (low, intermediate, high). Generalized estimating equations assessed longitudinal relationships.

RESULTS

NSES was associated with falling before adjustment (high vs. low, odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Walkability was significantly associated with falls after adjustment (high vs. low, odds ratio, 0.99; 95% confidence interval, 0.98-0.99). Green space was not associated with falling before or after adjustment. Study arm, race and ethnicity, household income, age, low physical functioning, fall history, and climate region modified the relationship between NSES and falling. Race and ethnicity, age, fall history, and climate region modified relationships between walkability and green space and falling.

CONCLUSIONS

Our results did not show strong associations of NSES, walkability, or green space with falling. Future research should incorporate granular environmental measures that may directly relate to physical activity and outdoor engagement.

The Stroll Safe outdoor falls prevention program: Participant experiences in eight community sites

BACKGROUND AND OBJECTIVES

Outdoor falls can negatively impact the quality of life of community-dwelling older adults. Although there are differences in risk factors for indoor and outdoor falls, none of the existing evidence-based fall prevention programs specifically targets outdoors falls. To fill this gap, the Stroll Safe program was developed. The purpose of this study was to explore participant's experiences in the Stroll Safe program RESEARCH DESIGN AND METHODS: In this qualitative study, we conducted focus groups at eight community program sites with Stroll Safe program participants. Thematic analysis, with both deductive and inductive coding were used. Researcher triangulation was employed to increase trustworthiness of the findings RESULTS: Four major themes emerged from the data, including (1) Precipitants of behavioral change, (2) Behavioral change, (3) Program design, and 4) Enjoyment of program experience. Several sub-themes were also uncovered DISCUSSION AND IMPLICATIONS: Although the qualitative findings are consistent with the quantitative findings from the efficacy trial, the results also reveal benefits that were not captured by the quantitative analysis. In addition, the findings related to the influence of the group leader and program design can be used to guide future implementation science studies.

Making Chile More Pedestrian-Friendly for Older Persons: Expert Perspectives

Walking provides numerous benefits to older persons, but its practice is hindered by social factors and the built environment. This article aims to understand the factors that encourage or discourage older people's walking behaviors, as well as the policies influencing those factors in Chile. It does so by reporting the analysis of twenty-five semi-structured interviews with Chilean policymakers and local leaders. The experts consistently represented walking as a beneficial activity for older persons that, nonetheless, occurs in adverse built environments. They asserted that the absence of older people in the public discussion and a top-down policy-making structure hamper its promotion.

Circumstances and Factors Associated With Falls Among Community-Dwelling Older Adults Diagnosed With Heart Disease Using the International Mobility in Aging Study (IMIAS)

BACKGROUND AND PURPOSE

To identify the circumstances of falls and the factors associated with falls among older adults with cardiovascular disease (CVD).

METHODS

Baseline (2012) data from the International Mobility in Aging Study (IMIAS), a cross-sectional study, were used. Falling was measured by the subjective question, "Have you fallen in the last 12 months?" Several subjective questions were asked to obtain information about the circumstances of falls. Potential clinical factors associated with falling were cognitive status, depressive symptoms, physical performance, grip strength, visual acuity, and fear of falling (FOF). These clinical factors were measured respectively with the Leganes Cognitive Test, the Center for Epidemiological Studies Scales Depressive Symptoms, the Short Physical Performance Battery, a Jamar handgrip dynamometer, the Early Treatment Diabetic Retinopathy Study (ETDRS) tumbling E chart placed at 2 m, and the Falls Efficacy Scale-International. A χ 2 test was used to determine whether there were significant differences in fall circumstances among older adults with and without CVD. Two-sample t tests were used to test for any significant differences between older adults with and without CVD. Bonferroni correction was applied to limit type I errors and was corrected to .007. Simple and multiple logistic regressions identified which clinical factors were associated with falling.

RESULTS

A total of 429 older adults with CVD (mean age 69.5 ± 2.9) and 431 older adults without CVD (69.2 ± 2.9) participated in the study. Approximately 53% of fallers with CVD had 2 or more falls compared with fallers without CVD (39%). The most common location for falling was at home (43%) for fallers with CVD or in the street (50%) for fallers without CVD. Approximately 9% of fallers with CVD needed to be hospitalized while only 3% of fallers without CVD were admitted to the hospital. Approximately 42% of fallers with CVD had some residual sequelae (eg, being unable to walk around the house or do housework) compared with only 27% of fallers without CVD. Fallers with CVD had significantly ( P value < .007) more depressive symptoms (mean ± SD, 14.7 ± 12.9) and poorer physical performance (8.4 ± 3.0) compared with fallers without CVD (10.1 ± 9.4 and 9.6 ± 2.5, respectively); however FOF was the only significant clinical factor ( P value < .05) associated with falling for older adults with CVD.

CONCLUSIONS

Incidence of recurrent falls is higher among older adults with CVD than those without CVD. Circumstances of falls among fallers with CVD differ from those identified among fallers without CVD. Fear of falling was the only predictor of fall history among older adults with CVD. The results suggest the merit of considering FOF when designing prevention and intervention programs to reduce falls among older adults with CVD.

Global trends and hotspots in research on osteoporosis rehabilitation: A bibliometric study and visualization analysis

Background

The field of rehabilitation medicine plays an essential role in the comprehensive management of osteoporosis and its consequences. The benefits of therapeutic exercise are increasingly being recognized in this area, which receives an increasing number of publications. this study was designed to comprehensively identify collaborative networks, parse and track research trends, spotlight present hotspots, and accurately predict frontiers and focus on the health topics related to osteoporosis rehabilitation.

Methods

This research adopted computer retrieval of osteoporosis rehabilitation-related research published in the Web of Science Core Collection (WoSCC) from inception to June 14, 2022. The bibliometric visualization and comparative analysis involving countries, institutions, journals, authors, references, and keywords were performed using the CiteSpace and VOSviewer software.

Results

A total of 3,268 articles were included, and the number of articles published each year has demonstrated a steady increase. The United States and the University of Melbourne were the highest productive country and institution, with 1,325 and 87 articles, respectively. The journal of osteoporosis international has published the greatest number of articles, with 221 publications, and the journal of bone and mineral research ranked first in the co-citation counts (cited by 11,792 times). The most productive and highly-cited authors were Heinonen A and Cummings S, with 35 publications and 680 citations.

Conclusions

At present, "physical activity," "weight bearing exercise," "muscle strength," "whole body vibration," "postmenopausal women," "older women," children, men are the noteworthy research hot topics. Future research that focus on the major modes and parameters of physical activity/exercise for osteoporosis (including whole body vibration, weight bearing exercises, resistance training), targeted multicomponent training regimens, rehabilitation therapy for postmenopausal women, older women, children and men, osteoporosis related-sarcopenia and fractures, and mesenchymal stem cells are becoming frontiers and focus on the health topics related to osteoporosis rehabilitation in the upcoming years, which are worthy of further exploration.

Health Emergencies, Falls, and Use of Communication Technologies by Older People with Functional and Social Frailty: Ageing in Place in Deprived Areas of Italy

Frail older people ageing alone in place need help to perform daily living activities, especially when functional limitations are increasing and formal/informal supports are lacking. This context represents a risk of experiencing health emergencies, in particular falls. It is thus important to understand how seniors manage these potential difficulties and who helps them. The present study aimed to explore these dimensions in Italy, where 120 qualitative interviews were carried out in 2019 within the "Inclusive ageing in place" (IN-AGE) research project, involving frail older people living alone at home. A content analysis was conducted. Results showed that seniors need to manage health emergencies regarding heart and breathing problems but mainly episodes of falls are reported, with consequent fractures and fear of falling again. In several cases, the use of a mobile phone was crucial in order to seek for help, and the first to intervene were children, in addition to some neighbors. Some seniors also referred their ability to call independently the General Practitioner (GP) or the emergency room, in order to not disturb family members. These findings highlight new useful insights for policy makers, regarding health emergencies prevention and management measures to put in place, especially concerning falls, and the support provided by communication technologies.

A qualitative investigation exploring neighbourhood environment, risks and fear of falling, and fall prevention strategies among urban-dwelling older adults in a high-density city

Falls in older adulthood can have serious consequences. It is therefore important to identify ways to prevent falls, particularly from the voice of older adults. Bottom-up qualitative exploration of the perspectives of older adults can provide rich insights that can help inform the development of effective fall prevention programmes. However, currently there is a dearth of such empirical data, especially among urban-dwelling older adults in high-density cities where fall rates are high. The current study aimed to examine qualitatively perceptions of neighbourhood physical environment in relation to falls, perceived risks and fear of falling, and strategies and behaviours for fall prevention in a sample of urban-dwelling older adults in the high-density city of Hong Kong. Face-to-face semi-structured in-depth interviews were conducted with 50 community-dwelling older adults. Interviews were transcribed verbatim and analysed using thematic analysis techniques. Five general themes were revealed: risks and circumstances of falls, consequences of falls, fear of falling and its consequences, neighbourhood environment, and strategies and behaviours of fall prevention. While older adults discussed the risks of falling and held a fear of falling, these beliefs were mixed. In addition to fall prevention strategies (e.g. keep balance), current findings highlighted the importance of establishing protective factors (e.g. flat and even walking paths) and reducing risk factors (e.g. neighbourhood clutter) in neighbourhood environments. For urban-dwelling older adults in high-density cities, current findings highlight the importance of focusing efforts at the built environment level in addition to strategies and behaviours of fall prevention at the individual level.

The effectiveness of exergames on fear of falling in community-dwelling older adults: a systematic review

ObjectivesFear of falling is common among older adults and can increase fall-risk through premature activity restriction. Exergames, an emerging tool in fall prevention, combine exercise with interactive and adaptive game elements. This review examines the extent to which exergame interventions reduce fear of falling among community-dwelling older adults. Method: Guided by the PRISMA methodology, we reviewed peer-reviewed studies that were published in English between 2006 and 2019 and employed a comparative design to test the effect of exergames on fear of falling in community-dwelling older adults. Two reviewers screened the literature and extracted data on the exergame platform, participants, study design, and results. A modified PEDro scale was used to assess study quality. Disagreements were resolved through discussion with the third reviewer. Results: Our literature search resulted in 23 eligible studies on exergame interventions where fear of falling was the primary or secondary outcome. Most interventions (35%) occurred within hospitals and were delivered via a Wii-based system (61%). Fear of falling was most commonly measured using the Falls Efficacy Scale, the Activities-specific Balance Scale and their modified versions. A total of 15 of the 23 studies reported statistically significant changes in fear of falling. Quality assessment showed 10 studies to be rated as 'good.' Conclusion: This review showed that exergame may have a positive effect in reducing fear of falling in community-dwelling older adults. The finding provides a direction for clinical practice in the research area of intervention on fear of falling in older adults.

Associations between community participation and types of places visited among persons living with and without dementia: risks perception and socio-demographic aspects

Introduction

Increasingly, literature has focused on community participation in places visited by persons living with and without dementia. Earlier research indicates that multiple factors, including socio-demographic aspects and risk perception may influence community participation.

Aim and methods

This cross-sectional, explorative study aims to inquire into how places visited, socio-demographic aspects and risks perception are associated with self-rated community participation for persons living with and without dementia (n = 70) in Switzerland. Data was collected through face-to-face interviews with questionnaires (ACT-OUT, MoCA, sociodemographic). First, we investigated whether the number of places visited was correlated with self-rated participation; then we added socio-demographic and risks perception factors with a bivariate analysis; and searched for a model using multinomial logistic regressions.

Results

For the group of participants living with dementia, risks of falling (p = .014) and of getting lost (p = .037) were significantly associated with self-rated participation. For the group of participants living without dementia, visiting places outside the home was significantly associated with self-rated participation, especially visiting places in domain D/places for recreational and physical activities (p = .005).

Discussion and conclusions

The results of exploring multiple factors and searching for a model highlights the complexity of community participation as a construct. Risks and visiting places for recreational and physical activities seem to play a role in self-rated participation. Mobile interviews might be better suited to gain in-depth understanding on community participation for persons living with dementia.

Perceived neighborhood and fall history among community-dwelling older adults living in a large Brazilian urban area: a multilevel approach

Few studies have examined the neighborhood features related to falls in the older population in low-and-middle-income countries, including Brazil. This study aimed to evaluate if perceived neighborhood features are related to falls among older Brazilian adults living in a large urban area. This cross-sectional study was conducted using data from 834 participants (≥60 years) from a multistage household survey in Belo Horizonte, Brazil. The association between fall history in the previous year and perceived neighborhood features (quality of services, physical and social disorder, and safety) was examined using multilevel logistic regression. The fall prevalence was 13.6%. Older adults living in neighborhoods with a higher physical disorder were more likely to report fall in the previous year, even after controlling for demographic, clinical and social variables (OR = 2.59; 95% CI = 1.14-5.87). The other neighborhood features investigated were not associated with a fall history. Our findings suggest that improving the physical environment represents an important strategy to prevent falls in the Brazilian urban older population.

Associations of neuroticism with falls in older adults: do psychological factors mediate the association?

OBJECTIVES

Neuroticism predicts falls in older people. In addition, concern about falling and depressive symptoms are associated with fall risk. This study examined whether concern about falling and depressive symptoms mediate the association between neuroticism and falls.

METHOD

Cross-sectional data on 314 community-dwelling people aged 70-85 years were utilized. Neuroticism was assessed with a short modified form of the Eysenck Personality Inventory. Indoor and outdoor falls during the past year were self-reported. Concern about falling was assessed with the Falls Efficacy Scale-International and depressive symptoms with the Geriatric Depression Scale-15. Path modeling was used to examine the associations between variables.

RESULTS

Mediating pathways linking neuroticism and falls were found: neuroticism was positively associated with concern about falling, which was subsequently linked to indoor falls (indirect effect β = 0.34, p = 0.002) and recurrent outdoor falls (β = 0.19, p = 0.045). Moreover, a pathway from neuroticism to indoor falls through depressive symptoms was also found (β = 0.21, p = 0.054). In other words, higher neuroticism was associated with higher concern about falling and depressive symptoms, both of which were linked to falls. The associations were independent of age, sex, use of psychotropic, chronic diseases, persistent pain, physical performance, physical activity, and executive functioning that are known risk factors for falls.

DISCUSSION

The results indicate that concern about falling and depressive symptoms mediate the association between neuroticism and falling. Longitudinal studies are needed to confirm the causality of the findings and to examine the potential to reduce falls by targeting concern about falling and depressive symptoms among older adults higher in neuroticism.

Fall-related events in people who are lower limb prosthesis users: the lived experience

PURPOSE

To explore lived experiences, and identify common themes as well as vocabulary associated with fall-related events in lower limb prosthesis (LLP) users.

MATERIALS AND METHODS

Five focus groups of LLP users from across the United States were conducted remotely via video or tele-conferencing. Focus group transcripts were coded and analyzed using methods adapted from a grounded theory approach to identify themes.

RESULTS

Focus group participants (n = 25) described experiences associated with fall-related events that resulted in the identification of six themes: (1) memories of fall-related events are shaped by time and context, (2) location and ground conditions influence whether falls occur, (3) some activities come with more risk, (4) fall-related situations are multi-faceted, and often involve the prosthesis, (5) how LLP users land, but not the way they go down, tends to vary, and (6) not all falls affect LLP users, but some near-falls do.

CONCLUSION

Consideration for where LLP users fall, what they are doing when they fall, how they fall, what occurs as a result of a fall, and how well memory of a fall persists may enhance recording and reporting of falls, contribute to development of improved fall risk assessment tools, and inspire the design and function of prosthetic componentry for patient safety.Implications for rehabilitationFalls are a common problem in lower limb prosthesis (LLP) users that can lead to adverse health outcomes.Concerns over near falls, not just falls, may merit greater attention from rehabilitation professionals.Elements of the lived experience that appear unique to LLP users include the role of prosthetic fit, function, and comfort in losing and/or recovering balance; as well as the tendency of LLP users to modify rather than stop or avoid activities associated with falls.

Knowledge, skills and attitudes of older people and staff about getting up from the floor following a fall: a qualitative investigation

Background

Falls are the most common reason for ambulance callouts resulting in non-conveyance. Even in the absence of injury, only half of those who fall can get themselves up off the floor, often remaining there over an hour, increasing risk of complications.

There are recognized techniques for older people to learn how to get up after a fall, but these are rarely taught. The aim of this study was to develop an understanding of attitudes of older people, carers and health professionals on getting up following a fall.

Methods

A qualitative focus group and semi-structured interviews were conducted with 28 participants, including community-dwelling older people with experience of a non-injurious fall, carers, physiotherapists, occupational therapists, paramedics and first responders. Data were transcribed and analysed systematically using the Framework approach. A stakeholder group of falls experts and service users advised during analysis.

Results

The data highlighted three areas contributing to an individual’s capability to get-up following a fall: the environment (physical and social); physical ability; and degree of self-efficacy (attitude and beliefs about their own ability). These factors fell within the wider context of making a decision about needing help, which included what training and knowledge each person already had to manage their fall response.

Staff described how they balance their responsibilities, prioritising the individual’s immediate needs; this leaves limited time to address capability in the aforementioned three areas. Paramedics, routinely responding to falls, only receive training on getting-up techniques from within their peer-group. Therapists are aware of the skillset to breakdown the getting-up process, but, with limited time, select who to teach these techniques to.

Conclusion

Neither therapists nor ambulance service staff routinely teach strategies on how to get up, meaning that healthcare professionals largely have a reactive role in managing falls. Interventions that address the environment, physical ability and self-efficacy could positively impact on peoples’ capability to get up following a fall. Therefore, a more proactive approach would be to teach people techniques to manage these aspects of future falls and to provide them easily accessible information.

A scoping review of fall hazards in the homes of older adults and development of a framework for assessment and intervention

INTRODUCTION

Comprehensive evaluation and intervention provided by occupational therapists is effective in reducing the presence of fall hazards in the homes of older adults. The purpose of this study was to document known environmental hazards and to update a previous content analysis. A secondary goal reviewed a framework for evaluation and practice.

METHODS

A comprehensive scoping review of published academic articles was performed from 1996 to 2019 to answer: What environmental hazards have been associated with falls in the homes of community-dwelling older adults? Data was extracted in a standardised critical appraisal worksheet and content analysis was conducted. A review of a conceptual framework for assessment and intervention was conducted by international experts (n = 6) in face-to-face interviews.

RESULTS

Fourteen studies met the inclusion criteria for the scoping study. The studies reported 17 in-home environmental hazards: throw rugs/carpets, clutter, cords/wires, poorly placed light switches, items placed too low, items placed too high, no grab bars, toilet seats too low, uneven floor surfaces, slippery/wet surfaces, snowy/icy surfaces, backless/unsupportive shoes, unsteady stairs, inadequate lighting, inadequate heating/cooling, step stools without railings, and pets.

CONCLUSION

A comprehensive list of specific fall hazards in and around the homes of older adults and a guiding framework offers occupational therapists an evidence-based foundation for fall prevention efforts.

Perceived risks, concession travel pass access and everyday technology use for out-of-home participation: cross-sectional interviews among older people in the UK

Background

The health-promoting qualities of participation as an opportunity for social and cognitive engagement are well known. Use of Everyday Technology such as Smartphones or ATMs, as enabling or disabling factors for out-of-home participation is however under-researched, particularly among older people with and without dementia. Out-of-home participation involves participation in places and activities outside of a person’s home, in public space. Situated within the context of an increasingly technological society, the study investigated factors such as perceived risks, access to a concession travel pass and use of Everyday Technologies, and their relationship with out-of-home participation, among older people in the UK.

Methods

One hundred twenty-eight older people with and without dementia in urban and rural environments in the UK, were interviewed using the Participation in ACTivities and Places OUTside Home (ACT-OUT) Questionnaire and the Everyday Technology Use Questionnaire (ETUQ). Associations between Everyday Technology use, perceived risk of falling, functional impairment, access to a concession travel pass and out-of-home participation were investigated using ordinal regression.

Results

A higher probability of Everyday Technology use (Odds Ratio [OR] = 1.492; 95% Confidence Interval [CI] = 1.041–1.127), perceived risk of falling outside home (OR = 2.499; 95% CI = 1.235–5.053) and, access to a concession travel pass (OR = 3.943; 95% CI = 1.970–7.893) were associated with a higher level of out-of-home participation. However, other types of risk (getting lost; feeling stressed or embarrassed) were not associated with out-of-home participation. Having a functional impairment was associated with a low probability of a higher level of out-of-home participation (OR = .470; 95% CI = .181–1.223). Across the sample, ‘outside home’ Everyday Technologies were used to a higher degree than ‘portable’ Everyday Technologies which can be used both in and outside home.

Conclusions

The study provides insights into perceived risks, access to a concession travel pass and use of Everyday Technologies, and their relationship with out-of-home participation, among older people in the UK. Increased knowledge about factors associated with out-of-home participation may help to guide targeted health and social care planning.

Look out: an exploratory study assessing how gaze (eye angle and head angle) and gait speed are influenced by surface complexity

Background

Most research investigating the connection between walking and visual behaviour has assessed only eye movements (not head orientation) in respect to locomotion over smooth surfaces in a laboratory. This is unlikely to reflect gaze changes found over the complex surfaces experienced in the real world, especially given that eye and head movements have rarely been assessed simultaneously.

Research question

How does gaze (eye and head) angle and gait speed change when walking over surfaces of different complexity?

Methods

In this exploratory study, we used a mobile eye tracker to monitor eye movements and inertia measurement unit sensors (IMUs) to measure head angle whilst subjects (n = 11) walked over surfaces with different complexities both indoors and outdoors. Gait speed was recorded from ankle IMUs.

Results

Overall, mean gaze angle was lowest over the most complex surface and this surface also elicited the slowest mean gait speed. The head contributed increasingly to the lowering of gaze with increased surface complexity. Less complex surfaces showed no significant difference between gaze and gait behaviour.

Significance

This study supports previous research showing that increased surface complexity is an important factor in determining gaze and gait behaviour. Moreover, it provides the novel finding that head movements provide important contributions to gaze location. Our future research aims are to further assess the role of the head in determining gaze location during locomotion across a greater range of complex surfaces to determine the key surface characteristics that influence gaze during gait.

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Osteoporosis-related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fractureamong people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, andsubcutaneous pharmacotherapies are efficaciousandcanreduce risk of future fracture.Patientsneededucation,however, about thebenefitsandrisks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first-line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive butmay be beneficial for selected patients at high risk.Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the earlypost-fractureperiod,prompt treatment is recommended.Adequate dietary or supplemental vitaminDand calciumintake shouldbe assured. Individuals beingtreatedfor osteoporosis shouldbe reevaluated for fracture risk routinely, includingvia patienteducationabout osteoporosisandfracturesandmonitoringfor adverse treatment effects.Patients shouldbestronglyencouraged to avoid tobacco, consume alcohol inmoderation atmost, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease).

Physical and perceptual measures of walking surface complexity strongly predict gait and gaze behaviour

BACKGROUND

Walking surfaces vary in complexity and are known to affect stability and fall risk whilst walking. However, existing studies define surfaces through descriptions only.

OBJECTIVE

This study used a multimethod approach to measure surface complexity in order to try to characterise surfaces with respect to locomotor stability.

METHODS

We assessed how physical measurements of walking surface complexity compared to participant's perceptual ratings of the effect of complexity on stability. Physical measurements included local slope measures from the surfaces themselves and shape complexity measured using generated surface models. Perceptual measurements assessed participants' perceived stability and surface roughness using Likert scales. We then determined whether these measurements were indicative of changes to stability as assessed by behavioural changes including eye angle, head pitch angle, muscle coactivation, walking speed and walking smoothness.

RESULTS

Physical and perceptual measures were highly correlated, with more complex surfaces being perceived as more challenging to stability. Furthermore, complex surfaces, as defined from both these measurements, were associated with lowered head pitch, increased muscle coactivation and reduced walking smoothness.

SIGNIFICANCE

Our findings show that walking surfaces defined as complex, based on physical measurements, are perceived as more challenging to our stability. Furthermore, certain behavioural measures relate better to these perceptual and physical measures than others. Crucially, for the first time this study defined walking surfaces objectively rather than just based on subjective descriptions. This approach could enable future researchers to compare results across walking surface studies. Moreover, perceptual measurements, which can be collected easily and efficiently, could be used as a proxy for estimating behavioural responses to different surfaces. This could be particularly valuable when determining risk of instability when walking for individuals with compromised stability.

Experiences of the Built Environment, Falls and Fear of Falling Outdoors among Older Adults: An Exploratory Study and Future Directions

Falls can have serious impacts on the health, wellbeing and daily mobilities of older adults. Falls are a leading cause of injury and death amongst older adults and outdoor falls comprise a substantial proportion of pedestrian injuries. As well as physical injuries, the psychological impacts of experiencing a fall can result in older adults getting out of the house less often, resulting in lower levels of physical activity and social connection. Despite the known consequences of falls, relatively little research considers the impact of the urban built environment on falls among older adults. This research aimed to explore the experiences of older adults in the urban environment, falling and the fear of falling outdoors. We conducted an online survey with adults aged 50+ using a participatory mapping survey tool and a convenience sample. The study area was Greater Christchurch, New Zealand. Results suggest that both perceived accessibility and neighbourhood conditions are independently associated with fear of falling, after controlling for frequency of falling, gender and activities of daily living. Our findings demonstrate the need for much better understandings of the relationships between the urban environment, outdoor mobility, fear of falling and falling among older adults and we propose suggestions for future research.

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Osteoporosis-related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first-line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive but may be beneficial for selected patients at high risk. Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the early post-fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease). © 2019 American Society for Bone and Mineral Research.

Association between Recent Falls and Changes in Outdoor Environments near Community-Dwelling Older Adults' Homes over Time: Findings from the NHATS Study

Neighborhood environments have been increasingly associated with incidents of falling and the fear of falling. However, little is known about the causal impact of neighborhood environments on falling. This study identifies whether changes in outdoor environmental attributes over a one-year period are associated with the occurrence of recent falls among community-dwelling older adults aged 65 and older in the United States. Data were obtained from 4802 adults aged 65 years or older from the National Health and Aging Trends Study (NHATS). Logistic regression analyses were performed to identify neighborhood risk factors linked to the odds of experiencing recent falls at the one-year follow-up. Almost one in ten subjects (9.7% of 4802 subjects) who had not fallen before reported experiencing recent falls after one year. After adjusting for sociodemographic, health, and walking-related behavioral covariates, these subjects were more likely to reside in areas with higher environmental barriers on sidewalks/streets and uneven walking surfaces or broken steps, compared to non-fallers. Our findings suggest that safe and well-maintained outdoor environments may help prevent falls among community-dwelling older adults who engage in outdoor activities. Clinical and environmental interventions for promoting both safe walking and safe environments are warranted.

Feasibility of the Stroll Safe Outdoor Fall Prevention Program

OBJECTIVE

Although half of falls occur outdoors, existing prevention programs focus primarily on risk factors for indoor falls. The purpose of this study was to evaluate the feasibility of the Stroll Safe outdoor fall prevention program and to obtain feedback to refine the program and research methods to plan a larger scale study.

METHOD

A quasi-experimental design (N = 24) was used. A fidelity checklist, attendance records, a focus group, and a reflective log were used to conduct a process, resource, and project management assessment. Preliminary outcomes were examined using fall calendars and standardized measures of fall prevention strategy use.

RESULTS

Needed modifications were determined. Preliminary outcomes reveal increased use of fall prevention strategies and decreased stumbles, trips, slips, and falls outdoors among program participants.

CONCLUSION

The Stroll Safe program is an innovative new program that is feasible to implement among community-dwelling older adults. Further study is warranted.

Relationship between the occurrence of falls by season and physical functions of community-dwelling old-old people living in cold, snowy areas

AIM

To investigate the functional characteristics of older adults who experienced a fall in the winter season and other seasons.

METHODS

Participants were 403 older adults enrolled in the project "Population-Based and Inspiring Potential Activity for Old-old Inhabitants," and were living in cold, snowy regions in Japan. They were aged ≥75 years, and 41.9% (n = 169) were men. Sociodemographic characteristics, and physical, psycho-cognitive and social factors were surveyed. By experiences of falls, they were divided into three groups: the non-fall group, the fall in non-winter group and the fall in winter group. Each factor was compared with a χ² -test, Student's t-test and Mann-Whitney U-test. Logistic regression analysis was carried out. spss version 25 was used for the statistical analysis. The level of significance was set at 5%.

RESULTS

No differences were confirmed between the non-fall and fall in winter groups. In contrast, the maximum walking speed in the fall in non-winter group was significantly slower than the non-fall group, even with adjustment by variables, such as age, sex and self-efficacy.

CONCLUSIONS

When considering intervention methods for health promotion, it is necessary to consider not only the presence or absence of falls, but also the seasons of falls. Geriatr Gerontol Int 2019; 19: 124-129.

Pharmacological and Non-pharmacological Means for Prevention of Fractures among Elderly

Fractures are major cause of morbidity, mortality, and healthcare and social services expenditure in elderly. Fractures often have multifactorial etiologies and the condition emerges due to the interaction between the different predisposing and precipitating factors. One of the most common causes leading to fractures after minimal trauma in older people is osteoporosis. The objective of this article is to describe the clinical concept and summarize the evidence and to explain the future directions for research, focusing on specific issues related to prevent fracture in the elderly. This study reviewed the scientific literature addressing strategies for primary and secondaryprevention of fractures among elderly in the context of pharmacological and non-pharmacological means. A growing body of scientific evidence supports the use of both non-pharmacological and pharmacological interventions for the prevention of fracture. Research on these interventions has yielded positive outcomes in fracture rates. The bisphosphonates and vitamin D and calcium suppliments are the preferred therapy for prevention of osteoporotic fractures. Weight-bearing exercise and reducing home hazards have beneficial effects in reducing the incidence of falls and consequently reduce fractures. Prevention of fractures in elderly consists of therapy and prevention of osteoporosis, fall prevention, and using injury-site protection by high-risk elderly patients. Special consideration needs to be taken to reduce home hazard, and falls prevention education can be recommended to the elderly with history of fall or mobility limitations. Future research to prevent fractures in elderly population should not only concentrate on improving bone density and strength but also need to be focused on falls reduction strategies.

Locations, Circumstances, and Outcomes of Falls in Patients With Glaucoma

PURPOSE

To characterize the locations, circumstances, and outcomes of falls in patients with varying degrees of glaucoma.

DESIGN

Prospective cohort study.

METHODS

Patients with suspected or diagnosed glaucoma completed monthly calendars reporting falls. After each fall, a 30-item questionnaire was administered to determine fall location, circumstances, and injury. Mean deviation on visual field (VF) testing was used to categorize glaucoma severity. Main outcome measures were fall locations, circumstances, and outcomes.

RESULTS

One-hundred forty-two patients experienced 330 falls. Falls were most likely to occur in/around the home (71%), and this likelihood did not vary significantly with severity of VF damage (P > .2). The most commonly cited fall circumstances were tripping (43.6%), slipping (31.3%), uneven flooring (23.5%), and poor vision (15.9%). The circumstances related to falls did not vary by severity of VF damage (P > .2), except for poor vision, which was more frequently cited in individuals with more advanced VF damage (P = .001). Forty-three percent of falls resulted in some injury; and the likelihood of injury did not vary by severity of VF loss (P = .60) or any other factor except floor type and number of comorbidities (P < .05 for all). Falls in persons with more severe glaucoma were more likely to result in a fracture (9.4%) or an emergency room visit (18.8%), though these associations did not persist in multivariable models (P > .5 for all).

CONCLUSIONS

Glaucoma patients fall mostly in/around the home and demonstrate similar fall circumstances across the spectrum of disease severity, suggesting that current fall prevention interventions, particularly those emphasizing home modification, may be an adequate starting point to prevent falls in this high-risk-group.

Record of the circumstances of falls in the community: perspective in the Iberian Peninsula

Objective:

to determine the diagnosis of the situation regarding documentation of falls and risk of falls in people older than 75 years in basic health units in Spain and Portugal.

Method:

mixed exploratory study in two stages: (i) quantitative descriptive of randomly selected fall records produced in one year (597 records; 197 Spanish and 400 Portuguese); and (ii) qualitative, with the purpose of knowing the perception of health professionals employing semi-structured interviews (72 professionals, 16 Spanish and 56 Portuguese). The study areas were two basic health units in southern Spain and northern Portugal.

Results:

in the fall records, the number of women was higher. The presence of fall was associated with the variables age, presence of dementia, osteoarticular disease, previous falls and consumption of antivertiginous medication. Health professionals perceived an absence of risk assessment instruments, as well as lack of prevention programs and lack of awareness of this event.

Conclusion:

falls are perceived as an area of ​​priority attention for health professionals. Nonetheless, there is a lack of adherence to the registration of falls and risk assessment, due to organizational, logistical and motivational problems.

Characteristics of falls in elderly persons residing in the community: a population-based study

Abstract Object: to examine the characteristics to the last fall of Brazilian elderly persons who experienced falls in 2008 and 2009, and to identify if there is a relationship with sociodemographic characteristics, physical health, comorbidities, clinical conditions and the circumstances of the falls. Methods: a cross-sectional, population based study was carried out with participants aged 65 and older from Barueri in the state of São Paulo and Cuiabá in the state of Mato Grosso, Brazil. Households were enrolled within each census region according to population density and the number of elderly persons living in each region. A multidimensional questionnaire composed of sociodemographic factors and data regarding falls was used. Associations were analyzed using contingency tables, and Fisher's Exact or Pearson's Chi-square test was used. Results: 774 elderly people were included in the study, 299 of whom reported falling in the previous year. Of these, 176 (58.9%) had fallen once and 123 (41.1%) reported having fallen twice or more. Among fallers the mean age was 72.53 (±6.12) years and 214 (71.6%) were female. About 107 (35.8%) of the elderly reported having fallen forwards, 79 (26.4%) fell to the side and 42(14%) fell backwards. Regarding the circumstances of the falls, 107 (35.8%) reported having lost their balance, 79 (26.4%) said they had stumbled and 42 (14%) said they had slipped. There was an association between the mechanism and circumstances of the falls and having fallen once or twice or more. There was an association between the circumstances of falls and the number of medications taken. Conclusion: The characteristics of falls were different among elderly persons who had fallen once or twice or more, which may guide health professionals, the elderly and their families in relation to specific fall prevention strategies.

Pedestrian falls: A review of the literature and future research directions

INTRODUCTION

Pedestrian falls (PFs) - falls in public spaces without collisions with other road users - are a significant cause of serious transport-related injuries, amounting to three-quarters of all pedestrians admitted to hospital.

METHODS

This scoping review examined peer-reviewed research on PFs published between 1995 and 2015. Electronic databases (Scopus, SafetyLit, and PubMed) were used to find studies identifying PFs or outdoor falls (the latter also including falls in gardens).

RESULTS

We identified only 28 studies reporting relevant information on PFs (i.e., 15 prospective, 10 retrospective, and 3 intervention studies). The results show that more walking is related to a lower risk of PFs. Older people, especially older women, have a higher risk of (injurious) PFs. Outdoor fall victims have equally good or better health characteristics and scores on balance tests compared to those who have not experienced such falls. Road factors such as uneven surfaces, busy junctions, stairs, and slippery surfaces seem to play an important role in PFs, but much of the research on these factors is of a qualitative nature.

CONCLUSIONS

PF victims are generally in good health (apart from normal age-related problems) but at risk due to road factors.

PRACTICAL APPLICATIONS

We recommend to adopt a human factors approach. The road system should be adapted to human capabilities and limitations including those of pedestrians. Measures such as preventing uneven surfaces and good winter maintenance seem to be effective. However, we advise more quantitative research on road factors to inform design guidelines and standards for public space authorities given the qualitative nature of current research on road factors.

Falls, risk factors and fear of falling among persons older than 65 years of age

AIM

Falling represents a major public health problem among older persons because it leads to premature mortality, loss of independence, and placement in assisted-living facilities. The purpose of this study was to assess the main features and risks for falls among persons older than 65 years of age as well as to quantify their fear of falling.

METHODS

A total of 354 persons older than 65 years of age were recruited at a community health centre. Characteristics of the most recent fall were obtained through detailed interviews with study participants. The Falls Efficacy Scale was used to quantify fear of falling.

RESULTS

Frequency of falling was 15.8%. Falls occurred most often while walking (49%). One-half of fallers (49.1%) sustained an injury. Head haematomas and soft tissues contusions were the most common consequences of falls. The average Falls Efficacy Scale score was significantly higher in fallers ( P = 0.001). Multiple logistic regression analysis showed that having a fear of falling (odds ratio = 4.14, 95% confidence interval: 1.22-14.08, P = 0.02) and being a woman (odds ratio = 2.10, 95% confidence interval: 0.97-4.53, P = 0.05) were independent risk factors for falling among older persons.

CONCLUSION

The frequency of falls among older people was similar to those in other populations. These results could be used to help select older persons who should be enrolled in fall prevention programmes.

Knowledge, behavioral practices, and experiences of outdoor fallers: Implications for prevention programs

OBJECTIVE

Although the epidemiology and prevention of falls has been well studied, the focus has been on indoor rather than outdoor falls. Older adults' knowledge of outdoor risk factors and their outdoor fall prevention practices have not been examined. To fill this gap, and to inform the development of a prevention program, we sought to explore the experiences and fall prevention knowledge and practices of older adults who had sustained an outdoor fall.

METHODS

A cross-sectional study using random digit telephone dialing was used to survey community dwelling seniors (N=120) across the five boroughs of New York City. We used the Outdoor Falls Questionnaire (OFQ), a valid and reliable tool as the survey instrument. Perceived outdoor fall risks, strategies used for prevention, and outdoor fall experiences were examined. SPSS version 21 was used for descriptive analysis of participant characteristics and to determine frequencies of perceived outdoor fall risks and strategies used for prevention. Phenomenological analysis was used with the qualitative data. Qualitative and quantitative data were analyzed separately and a mixed methods matrix was used to interpret and integrate the findings.

RESULTS

Analysis revealed diverse unmet education and training needs including the importance of using single vision glasses, understanding the fall risks associated with recreational areas and parking lots, safe outdoor walking strategies, safe carrying of items on level and uneven surfaces, as well as when walking up and down stairs, and safety in opening/closing doors.

CONCLUSIONS

Study findings are informative for outdoor fall prevention programs as well as practice.

The role of the environment in falls among stroke survivors

BACKGROUND

Stroke survivors' risk of falls may be particularly sensitive to the environment due to deficits such as visuospatial neglect or homonymous hemianopia. We sought to identify the prevalence of falls among stroke survivors and investigate the possible role of the environment in falling.

MATERIALS AND METHODS

Data from the National Health and Aging Trends Study (NHATS), a nationally representative population of community-dwelling adults over 65, were used. We compared the prevalence of falling in the past month between stroke survivors and demographic and comorbidity matched controls using sequential Poisson regression models.

RESULTS

The proportion of stroke survivors reporting a fall in the previous month was 18.8% compared to 10.8% among matched controls (PR: 1.74; 95% CI: 1.36-2.25). These differences were attenuated after adjusting for known confounders, mediators and aspects of the environment (PR: 1.17; 95% CI: 0.86-1.60). Indoor tripping hazards were associated with falls (PR: 1.24; 95% CI: 1.01-1.53). The association between stroke and falls was modified by neighborhood social disorder, such that in areas of low social disorder, falls in the previous month were more common in stroke survivors compared to non-stroke controls.

CONCLUSIONS

The difference in falls among stroke survivors and matched controls is largely explained by known risk factors and physical capacity. Indoor tripping hazards were associated with falls among stroke survivors and matched controls. Explanations of why the association between stroke and falls was protective in areas of high social disorder are unclear, but may warrant additional research.

Is independence of older adults safe considering the risk of falls?

BACKGROUND

Falls affect approx. 30% of elderly population per year. They cause major injuries and reduce independence of the older adults' functioning. The main objective of the study was to evaluate the degree of independence and find the fall risk factors in the study group.

METHODS

The study included 506 - older adults. The study group included patients from GP clinics and members of two senior centers. The study duration was 12 months. Our study tools included EASY- Care Standard 2010 questionnaire, Abbreviated Mental Test Score (AMTS), Index Barthel, Instrumental Activities of Daily Living Scale (IADL), Geriatric Depression Scale (GDS), Timed Up and Go (TUG).

RESULTS

The study included 357 (70.6%) female and 149 (29.4%) male subjects. The mean age of the study group patients was 75.7 years ± 8.0. Most of the older adult subjects were independent in both basic (Index Barthel) and instrumental (IADL) activities. Gait fluency evaluated in TUG scale found slow and unsteady gait in 33.7% of the subjects. 27.5% of the subjects used mobility aids when walking. In the Risk of falls scale, 131 subjects (25.89%) were at risk of falls. According to logistic regression the main risk of fall determinants (p <0.05) in the study group were: age, previous falls, feet problems, lack of regular care, impaired vision, urinary incontinence, pain, sleeping disorders, and lowered mood.

CONCLUSIONS

Risk of falls increases in people less independent in terms of basic and complex life activities and in people with depression. Most of the risk factors can be modified. It is necessary to develop a standard procedure aimed at preventing falls in the elderly.

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.

Falls are unintentional: Studying simulations is a waste of faking time

Researchers tend to agree that falls are, by definition, unintentional and that sensor algorithms (the processes that allows a computer program to identify a fall among data from sensors) perform poorly when attempting to detect falls 'in the wild' (a phrase some scientists use to mean 'in reality'). Algorithm development has been reliant on simulation, i.e. asking actors to throw themselves intentionally to the ground. This is unusual (no one studies faked coughs or headaches) and uninformative (no one can intend the unintentional). Researchers would increase their chances of detecting 'real' falls in 'the real world' by studying the behaviour of fallers, however, vulnerable, before, during and after the event: the literature on the circumstances of falling is more informative than any number of faked approximations. A complimentary knowledge base (in falls, sensors and/or signals) enables multidisciplinary teams of clinicians, engineers and computer scientists to tackle fall detection and aim for fall prevention. Throughout this paper, I discuss differences between falls, 'intentional falling' and simulations, and the balance between simulation and reality in falls research, finally suggesting ways in which researchers can access examples of falls without resorting to fakery.

Individual and contextual characteristics of indoor and outdoor falls in older residents of São Paulo, Brazil

PURPOSE OF THE STUDY

To analyze a representative sample of older individuals of São Paulo, Brazil, according to outdoor fallers, indoor fallers and non-fallers, and to identify biological and socioeconomic (individual and contextual) factors associated with the occurrence and place of falls.

MATERIALS AND METHODS

A cross-sectional study was conducted using data (n = 1345) from the 2010 wave of the Health, Wellbeing and Aging (SABE) Study, a representative sample of older residents (60 years and older) of São Paulo, Brazil. Multinomial logistic analysis was performed to identify individual factors associated with the occurrence and place of falls, and multilevel multinomial analysis to identify contextual effects (green areas, violence, presence of slums and income inequality).

RESULTS

29% had a fall in the last 12 months, with 59% occurring in indoor spaces. Individuals who had outdoor falls were overall not statistically different from non-fallers; on the other hand, those who had the last fall indoor had worse health status. Moderate homicide rate was a factor associated with increased presence of indoor falls, compared with non-fallers.

IMPLICATIONS

Our results describe the importance of falls, a common problem in active and community-dwelling older adults of São Paulo, Brazil. Transforming outdoor spaces into walk-friendly areas is essential to allow socialization and autonomy with safety. Creating strategies that take into account the most vulnerable populations, as those who live in violent areas and the oldest older adults, will be a growing challenge among developing countries.

Patterns of perspectives on fall-prevention beliefs by community-dwelling older adults: a Q method investigation

Background

Falling has high incidence and reoccurrence rates and is an essential factor contributing to accidental injury or death for older adults. Enhancing the participation of community-dwelling older adults in fall-prevention programs is crucial. Understanding fall-prevention beliefs will be beneficial for developing a community-based fall-prevention program. The aim of the present study was to identify the distinct types of subjective views on the fall-prevention beliefs of community-dwelling older adults aged 80 years and older by applying the Q method.

Methods

The Q method was adopted to investigate the pattern of perception on fall-prevention beliefs. Forty-two older adults aged 80 − 92 years from a community care center in Northern Taiwan were recruited and requested to complete a Q-sorting. A series of Q-sorts was performed by the participants to rank 30 statements into a normal distribution Q-sort grid. The Q-sorts were subjected to principal component analysis by using PQMethod software Version 2.35.

Results

Four statistically independent perspectives were derived from the analysis and reflected distinct viewpoints on beliefs related to fall prevention. Participants in the Considerate perspective believed that health problems caused by falling were serious and fall prevention could decrease the burden they place on their family. Participants in the Promising perspective believed that existing health problems could cause a fall and that fall prevention contributed to their well-being. Participants in the Adaptable perspective perceived low barriers to execute fall prevention and displayed self-confidence and independence in preventing falls. Participants in the Ignorance perspective believed that they could not prevent falls and perceived barriers to fall prevention.

Conclusions

By combining theoretical constructs and the Q methodology approach, this study identified four distinct perspectives on fall prevention among community-dwelling older adults. Critical reflection on older adult personal perspectives and interpretations of the required responsive approach is a key element for appropriating fall-prevention support.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0307-1) contains supplementary material, which is available to authorized users.

Developing an audit checklist to assess outdoor falls risk

Falls by older people (aged 65+) are linked to disability and a decrease in mobility, presenting a challenge to active ageing. As such, older fallers represent a vulnerable road user group. Despite this there is little research into the causes and prevention of outdoor falls. This paper develops an understanding of environmental factors causing falls or fear of falling using a walk-along interview approach with recent fallers to explore how older people navigate the outdoor environment and which aspects of it they perceived facilitate or hinder their ability to go outdoors and fear of falling. While there are a number of audit checklists focused on assessing the indoor environment for risk or fear of falls, nothing exists for the outdoor environment. Many existing street audit tools are focused on general environmental qualities and have not been designed with an older population in mind. We present a checklist that assesses aspects of the environment most likely to encourage or hinder those who are at risk of falling outdoors, developed through accounting for the experiences and navigational strategies of elderly individuals. The audit checklist can assist occupational therapists and urban planners, designers and managers in working to reduce the occurrence of outdoor falls among this vulnerable user group.

Indoor and outdoor falls among older adult trauma patients: A comparison of patient characteristics, associated factors and outcomes

AIM

The aim of the present study was to examine significant differences in patient characteristics, associated factors and outcomes for indoor versus outdoor falls among trauma patients.

METHODS

A retrospective cross-sectional study using data from the trauma registry and electronic medical records at a level 1 trauma center in the USA was carried out. People aged 55 years or older, for whom fall location could be identified (n = 712), were included in the study. Demographic information, functional status before admission, comorbid conditions, activation level, Injury Severity Score, discharge disposition and injury type were included in the comparative analyses. Associated factors for falls and fractures in each location were also examined using logistic regression.

RESULTS

Significant differences were found in patient characteristics between indoor and outdoor fallers. Significant differences in outcomes were found related to discharge disposition and injury type. Open wounds were more common among outdoor fallers (26.5%) as compared with indoor fallers (16.3%, P = 0.002). Although disorders of joints with difficulty walking were associated with fractures among both indoor (OR 7.20, CI 2.19-23.66) and outdoor fallers (OR 5.65, CI 1.27-25.06), sex was only associated with fractures among those who fell indoors (OR 1.69 CI 1.12-2.56).

CONCLUSIONS

Significant differences exist in characteristics of indoor and outdoor fallers, and for discharge disposition and injury type for each fall location among patients admitted for trauma care. Factors associated with fractures differ between indoor and outdoor fallers. Results can help to inform targeted primary and secondary prevention initiatives. Geriatr Gerontol Int 2017; 17: 905-912.

Years of life lost due to lower extremity injury in association with dementia, and care need: a 6-year follow-up population-based study using a multi-state approach among German elderly

BACKGROUND

Dementia and care need are challenging aging populations worldwide. Lower extremity injury (LEI) in the elderly makes matters worse. Using a multi-state approach, we express the effect of LEI on dementia, care need, and mortality in terms of remaining life expectancy at age 75 (rLE) and years of life lost (YLL).

METHODS

A population-based random sample of beneficiaries aged 75-95 years was drawn from the largest public health insurer in Germany in 2004 and followed until 2010 (N 62,103; Mean Age ± SD 81.5 ± 4.8 years; Female 71.2%). We defined a five-state model (Healthy, Dementia, Care, Dementia & Care, Dead), and calculated transition-specific hazard ratios of LEI using Cox regression. The transition probabilities as well as the YLL due to LEI were estimated.

RESULTS

LEI significantly increased the risk for each transition, with a maximum risk for the transition from Healthy to Care (HR: 1.70, 95% CI: 1.63-1.77) and a minimum risk for the transition from Care to Dead (HR: 1.16, 95% CI: 1.10-1.22). If the elderly had LEI-history, their age-specific mortality was generally higher and their probabilities of transient states peaked at younger ages. At age 75, initially dementia-free and care-independent elderly experiencing LEI lost about 2 years of life, of which more than 90% were life years free of dementia or care need. Dementia patients lost about one and a half year, more than 60% were free of long-term care need.

CONCLUSIONS

LEI not only casts a large health burden on care need, but is also associated with cognitive decline and shortened rLE. LEI plus dementia extend the relative life time in need of care, despite generally shortening rLE. Using the composite measure YLL may help to better convey these results to the elderly, families, and health professionals. This may strengthen preventive measures as well as improve timely and rehabilitative treatment of LEI, not only in cognitive and physically intact elderly.

Gait Speed and Variability for Usual Pace and Pedestrian Crossing Conditions in Older Adults Using the GAITRite Walkway

Objectives: To determine gait characteristics of community-dwelling older adults at different speeds and during a crosswalk simulation. Methods: Twenty-two older adults completed walking trials at self-selected slow, usual, and fast paces, and at a crosswalk simulation, using the GAITRite walkway. These objective measures were complemented by self-report health and mobility questionnaires. Results: Gait speeds at self-selected slow, usual, and fast paces were 98.7 (18.1) cm/s, 140.9 (20.4) cm/s, and 174.0 (20.6) cm/s, respectively, and at simulated crosswalk conditions was 144.2 (22.3) cm/s. For usual pace, right step length variability was 2.0 (1.4) cm and step time variability was 13.6 (7.2) ms, compared with 2.4 (1.3) cm and 17.3 (9.7) ms, respectively, for crosswalk conditions. Discussion: Our sample of healthy older adults walked at a speed exceeding standards for crossing urban streets; however, in response to a crosswalk signal, participants adopted a significantly faster and more variable gait.

PREVALENCE OF FALLS AND ASSOCIATED RISK FACTORS AMONG AGED POPULATION: COMMUNITY BASED CROSS-SECTIONAL STUDY FROM TURKEY

AIM

The aim of the study was to examine the prevalence and risk factors of falls among persons aged 65 years and older in Qanakkale, Turkey.

METHODS

A community based cross-sectional study was conducted between May-September 2013. A total of 1,001 elderly living in Çanakkale city centre were included into our study. The research was carried out with face-to-face interviews and survey forms. The survey form consists of seven sections: demographic characteristics, significance of ageing, daily activities, quality of life and social network in old age, use of health services and health problems, bad habits, and the European Health Impact Scale. Data analysis was performed using the SPSS software version 19.0. For data investigation the chi-square and logistic regression analyses were used.

RESULTS

The prevalence of falls at home or outside was 32.1% among elderly in the last six months period. The prevalence of falling for women at home as well as outside was statistically significantly higher than for men (p < 0.05). According to multivariate analysis results the risk of falling at home or outside was increased by 2.7 times in women (95% CI: 1.90-3.75), by. 2.1 times in those who cannot take care of themselves (95% Cl: 1.33-3.29), and by 1.7 times in those who have low quality of life (95% Cl: 1.24-2.43).

CONCLUSIONS

This community based cross-sectional study showed that prevalence of falling was high in aged persons living in centre of Çanakkale located in the western part of Turkey. Moreover, the risk was increased in women, those who cannot take care for themselves, and those with low standard of living.

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.

Fatores ambientais e risco de quedas em idosos: revisão sistemática

A queda em idosos é resultado de uma interação complexa entre fatores intrínsecos e extrínsecos. Embora seja difícil separar esses fatores, estudos apontam que fatores de risco ambientais estão presentes em aproximadamente 40% das quedas. O objetivo deste estudo foi realizar uma revisão sistemática da literatura sobre o envolvimento de fatores ambientais nas quedas em idosos vivendo na comunidade. Para tanto, foram selecionados estudos publicados no período de janeiro de 2000 a maio de 2014 nas bases de dados eletrônicas MEDLINE, LILACS e SciELO. Apenas artigos disponíveis na íntegra e em inglês, português e espanhol foram considerados para esta revisão. Após a análise do título, do resumo e do texto na íntegra, dez artigos foram incluídos na revisão. Nos estudos analisados, aproximadamente metade das quedas ocorreu durante a locomoção e envolveu tropeços e escorregões. Os fatores de risco ambientais estão muito presentes nas quedas (20-58%), sendo que superfícies irregulares, superfícies molhadas/escorregadias, objetos/tapetes soltos e desníveis no chão/problemas com degraus foram os mais prevalentes. Observou-se tendência de aumento na ocorrência de quedas em ambientes externos, as quais são frequentemente precipitadas por fatores extrínsecos. Mais estudos são necessários na caracterização e no desenvolvimento de estratégias de prevenção de quedas em ambientes externos.