Risk factors for incident falls in older men and women: the English longitudinal study of ageing

Fall Trajectories in Older Men: Trajectories of Change by Age and Predictors for Future Fall Risk

BACKGROUND

Very little is known about specific trajectories or patterns of falls over time. Using the well-characterized cohort of the Osteoporotic Fractures in Men Study (MrOS), we classified individuals by fall trajectories across age and identified predictors of group assignment based on characteristics at baseline.

METHODS

Using an analysis sample of 5 976 MrOS participants and 15 years of follow-up data on incident falls, we used group-based trajectory models (PROC TRAJ in SAS) to identify trajectories of change. We assessed the association of baseline characteristics with group assignment using 1-way analysis of variance and chi-square tests. Multivariable logistic regression was used to analyze the outcome of the high-risk fall trajectory groups compared to the low-risk groups.

RESULTS

Changes in rates of falls were relatively constant or increasing with 5 distinct groups identified. Mean posterior probabilities for all 5 trajectories were similar and consistently above 0.8 indicating a reasonable model fit. Among the 5 fall trajectory groups, 2 were deemed high risk, those with steeply increasing fall risk and persistently high fall risk. Factors associated with fall risk included body mass index, use of central nervous agents, prior history of diabetes and Parkinson's disease, back pain, grip strength, and physical and mental health scores.

CONCLUSIONS

Two distinct groups of high fall risk individuals were identified among 5 trajectory groups, those with steeply increasing fall risk and persistently high fall risk. Statistically significant characteristics for group assignment suggest that future fall risk of older men may be predictable at baseline.

Factors Associated With Incident and Recurrent Falls Among Men Enrolled in Evidence-Based Fall Prevention Programs: An Examination of Race and Ethnicity

We examined factors associated with incident (one) and recurrent (2+) falls among 7207 non-Hispanic White (NHW) (89.7%), non-Hispanic Black (NHB) (5.0%), and Hispanic (5.3%) men ages ≥60 years with ≥1 chronic conditions, enrolled in an evidence-based fall program. Multinomial and binary regression analyses were used to assess factors associated with incident and recurrent falls. Relative to zero falls, NHB and Hispanic men were less likely to report incident (OR = 0.55, p < .001 and OR = 0.70, p = .015, respectively) and recurrent (OR = 0.41, p < .001 and OR = 0.58, p < .001, respectively) falls. Men who reported fear of falling and restricting activities were more likely to report incident (OR = 1.16, p < .001 and OR = 1.32, p < .001, respectively) recurrent and (OR = 1.46, p < .001 and OR = 1.71, p < .001, respectively) falls. Men with more comorbidities were more likely to report recurrent falls (OR = 1.10, p < .001). Compared to those who experienced one fall, men who reported fear of falling (OR = 1.28, p < .001) and restricting activities (OR = 1.31, p < .001) were more likely to report recurrent falls. Findings highlight the importance of multi-component interventions to prevent falls.

Critical gap in practice-lack of attention to falls and possible fall-related post-concussion symptoms in older adults and individuals with neurodegenerative disease

Falls in older adults and those with neurodegenerative disease (ND) are a current public health hazard and the primary cause of sustaining a mild traumatic brain injury (mTBI)/concussion. Little is known regarding how post-concussion symptoms present in older adults and patients with ND, even though they are the demographic at highest risk. A combination of under-reporting of falls and a lack of awareness regarding potential consequences of falls, results in the underdiagnosis of post-fall issues and concussions in this population. Our aim was to conduct a quality assessment survey to assess physician practice regarding falls and their general knowledge of concussion symptoms. We sent surveys through email to 1400 North American physicians, mostly those working at university affiliated hospitals, who specialized in seeing older adults and patients with ND. One hundred forty-one physicians completed the survey. 71.4% of all responding physicians either never inquired or inquired in less than 5% of their patients with ND or older adult patients, about history of falls. Over half of the physicians (51.8%) either never ask or do not consider it necessary to ask about concussion symptoms post-fall. The majority of physicians (92%) recognized that concussions can have lasting effects on patients, particularly on mood and demonstrated good knowledge of post-concussion symptoms by correctly identifying them. Additionally, more than 70% of responding physicians believed that patients with ND or older adults can fully recover from a concussion with the same probability as any other age group if treated. Only 50% of physicians felt confident in managing post-concussion symptoms themselves, 53.9% of physicians did not know of, or did not have nearby concussion clinics to refer patients to. The gaps in practice are clearly reflective of the gaps in the literature regarding falls and concussions in older adults and ND patients. There is a very low rate of physician inquiry about history of falls and concussion symptoms in older patients and those with NDs. Failure to recognize a concussion, can lead to missed opportunities for targeted interventions to address reversible symptoms. Additionally, the misattribution of post-concussion symptoms to disease progression in older patients or those with NDs may delay and hinder appropriate management.

Associations of frailty, self-reported balance problems, hearing abilities, and posturography in a sample of older adults

OBJECTIVE

The aim of this study was to identify risk factors for self-reported balance problems, and to analyse associations between hearing and balance.

DESIGN

A battery of tests was administered to assess hearing and balance performance, as well as additional health-related factors indicative of frailty and fall risk. In a retrospective analysis, logistic regression was used to identify risk factors for self-reported balance problems and linear regression was used to identify associations between hearing ability and functional balance.

STUDY SAMPLE

For the risk factor analysis, 199 volunteers aged 55-81 years (mean:67) were divided into two groups according to their self-reported balance problems. Only participants lacking self-reported balance problems (n = 157) were included in the second analysis.

RESULTS

Female gender, frailty, and fine-motor skills were statistically significant predictors of self-reported balance problems. Functional balance performance was related to hearing impairment for dynamic, but not for static, balance tasks.

CONCLUSION

For a holistic approach to healthcare and regardless of age, individuals with multiple comorbidities and/or phenotypic signs of frailty should be considered at risk for falls. For further research, it was shown that dynamic, rather than static, balance tasks may be needed to gain deeper insights into the relationship between hearing and balance.

Analysis of Hospital Safety and Risk of Falls in the Elderly: A Cross-Sectional Study in Brazil

This study analyzed hospital safety and the risk of falls in elderly people in a university hospital in Brazil. The Morse Falls Scale was used to stratify the risk of falls in 45 hospitalized elderly individuals, and two checklists were used to analyze the hospital environment. The analysis was based on the Chi-square test and multiple regression. The moderate risk of falls was predominant (51.1%). The variable age group (p-value = 0.024) showed statistical evidence of association with the risk of falls. However, the multiple regression analysis showed no difference between the age groups and the risk situation for falls. The hospital wards showed an adequate arrangement of furniture, but some aspects had inadequacies, such as objects in the corridors, non-functional bells in some beds, inadequacy of the toilet bowls in terms of the recommended height, and an absence of non-slip flooring and the support bar in some bathrooms. In conclusion, the moderate risk of falls among the elderly and the adequacy of the hospital environment to technical standards were evident with the exception of failures in the emergency communication system and sanitary installation.

Prevalence and factors associated with falls in older adults in a Middle Eastern population: a retrospective cross-sectional study

OBJECTIVE

The main objective was to determine the prevalence of falls and associated factors in older adults living in Qatar.

STUDY DESIGN

Cross-sectional study.

METHODS

This is a cross-sectional study of older adults aged ≥60 years with at least one encounter with primary health care corporation (PHCC) in Qatar during the period 2017-2022. Data on documented falls, demographic variables, and medical comorbidities were extracted from all PHCCs in Qatar. Descriptive and inferential statistics were used to address the aim of the study.

RESULTS

A total of 68,194 older adults had at least one encounter with PHCC. The median age was 65.0 years, 58.9% were males, and 32.6% were Qatari nationality. A higher percentage of falls was found in individuals with hypertension (80%), diabetes (74.2%), and dyslipidemia (48.9%), which were also the most prevalent comorbidities. The prevalence of falls was 6.7% (95% CI 6.6-6.9). Compared to individuals aged 60-69 years, individuals aged 70-79, 80-89, and 90-99 had increased odds of falls by 1.6 (95% CI 1.5, 1.8), 2.5 (95% CI 2.2, 2.8), and 2.6 (95% CI 2.0, 3.3), respectively. Females and individuals of Qatari nationality had increased odds of fall by 1.5 (95% CI 1.4, 1.6) and 1.2 (95% CI 1.1, 1.3), respectively. Orthostatic hypotension, syncope, Parkinson's disease, and hip arthritis showed the strongest associations with falls.

CONCLUSIONS

Given the growing population of older adults in the Middle East and North African region, falls is a public health concern. The risk factors identified in this study suggest the need for proactive healthcare strategies tailored to the unique needs of older adult populations.

Sex differences in association of joint glycemic, blood pressure and lipid control and two-year risk of falls among older adults with diabetes

AIMS

To characterize the risk of falls among males and females by joint glycemic, blood pressure (BP) and cholesterol control among older adults (≥65 years) with diagnosed diabetes in USA.

METHODS

Using longitudinal data from the Health and Retirement Study (2006-2019), we studied the association of joint glycemic (HbA1c < 7.5 %), BP (systolic <140 and diastolic <90 mmHg) and cholesterol (total < 200 mg/dL) control with two-year risk of falls. We estimated risk ratios (RR) to describe the associations for joint ABC control and independent biomarker control by sex, using modified Poisson regressions after adjusting for known individual and household risk factors.

RESULTS

The analytic sample consisted of 4509 observations from 2829 older adults (54.7 % female) with a mean age of 72.2 (SD: 6.6) years and duration of diabetes of 9.9 years. Joint ABC control was not associated with risk of falls among females but was associated with lower risk among males (0.91 [95%CI: 0.81-1.02]). Furthermore, achievement of glycemic control (0.85 [95%CI: 0.73-0.98]) and BP control (0.89 [95%CI: 0.79-1.01]) were associated with lower risk but cholesterol control (1.15 [95%CI: 0.99, 1.34]) was associated with higher risk of falls among males.

CONCLUSIONS

Joint achievement of glycemic, BP and cholesterol targets may prevent falls among older males. Future studies among people with diabetes should consider biomarker control as a preventive factor for falls.

Females Present Reduced Minimum Toe Clearance During Walking As Compared to Males in Active Older Adults

BACKGROUND

Physical decline due to aging has been associated with the risk of falls. Minimum toe clearance (MTC) is a gait parameter that might play a role in the mechanism of tripping and falling. However, it is unclear if there are any sex-related effects regarding MTC as people age. The present study investigated if there are sex-related differences in MTC in older active adults.

METHODS

Twenty-three females and 23 males (F: 65.5 ± 4.8 years; M: 61.9 ± 5.2 years) walked on a treadmill at a preferred walking speed, while kinematic data were obtained at a sampling frequency of 100 Hz and up-sampled to 120 and 240 Hz. MTC was calculated from the kinematics data and evaluated concerning its magnitude (ie, MTC and MTC/leg length), the time between left/right MTC (ie, T-MTC), amount of variability (ie, coefficient of variation [CV] and coefficient of variation modified [CVm]), and temporal structure of variability, that is, the complexity of the time series (ie, MTC α, T-MTC α).

RESULTS

No sex effects were found for MTC/leg length, for the amount of variability (ie, CV and CVm), and for the complexity of the time series (MTC α, T-MTC α). However, females exhibited significantly lower MTC and T-MTC after adjusting for walking speed, mass, and age as covariates.

CONCLUSIONS

The reduced MTC in females suggests a potential sex-related disparity in the risk of tripping and falling among active older adults.

Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults: A Review

Importance

Falls are reported by more than 14 million US adults aged 65 years or older annually and can result in substantial morbidity, mortality, and health care expenditures.

Observations

Falls result from age-related physiologic changes compounded by multiple intrinsic and extrinsic risk factors. Major modifiable risk factors among community-dwelling older adults include gait and balance disorders, orthostatic hypotension, sensory impairment, medications, and environmental hazards. Guidelines recommend that individuals who report a fall in the prior year, have concerns about falling, or have gait speed less than 0.8 to 1 m/s should receive fall prevention interventions. In a meta-analysis of 59 randomized clinical trials (RCTs) in average-risk to high-risk populations, exercise interventions to reduce falls were associated with 655 falls per 1000 patient-years in intervention groups vs 850 falls per 1000 patient-years in nonexercise control groups (rate ratio [RR] for falls, 0.77; 95% CI, 0.71-0.83; risk ratio for number of people who fall, 0.85; 95% CI, 0.81-0.89; risk difference, 7.2%; 95% CI, 5.2%-9.1%), with most trials assessing balance and functional exercises. In a meta-analysis of 43 RCTs of interventions that systematically assessed and addressed multiple risk factors among individuals at high risk, multifactorial interventions were associated with 1784 falls per 1000 patient-years in intervention groups vs 2317 falls per 1000 patient-years in control groups (RR, 0.77; 95% CI, 0.67-0.87) without a significant difference in the number of individuals who fell. Other interventions associated with decreased falls in meta-analysis of RCTs and quasi-randomized trials include surgery to remove cataracts (8 studies with 1834 patients; risk ratio [RR], 0.68; 95% CI, 0.48-0.96), multicomponent podiatry interventions (3 studies with 1358 patients; RR, 0.77; 95% CI, 0.61-0.99), and environmental modifications for individuals at high risk (12 studies with 5293 patients; RR, 0.74; 95% CI, 0.61-0.91). Meta-analysis of RCTs of programs to stop medications associated with falls have not found a significant reduction, although deprescribing is a component of many successful multifactorial interventions.

Conclusions and Relevance

More than 25% of older adults fall each year, and falls are the leading cause of injury-related death in persons aged 65 years or older. Functional exercises to improve leg strength and balance are recommended for fall prevention in average-risk to high-risk populations. Multifactorial risk reduction based on a systematic clinical assessment for modifiable risk factors may reduce fall rates among those at high risk.

Demographics moderated the association of symptom burden with falls and fall-related outcomes

OBJECTIVES

To examine whether (1) prior-year symptom burden predicted later-year falls and fall-related outcomes and (2) demographics moderated the longitudinal effects of symptom burden on falls and fall-related outcomes among community-dwelling older adults.

METHODS

We used 2011-2018 National Health and Aging Trends Study data that included 9,060 community-dwelling older adults (contributed 34,327 observations). Falls and fall-related outcomes included self-reported falls, multiple falls, fear of falling (FOF), and FOF limiting activity. Symptom burden was defined as the presence of pain, insomnia, breathing difficulty, depressive symptoms, anxiety, and fatigue, and calculated the number of symptoms (range from 0 to 6). Binomial logistic regression was used to examine the associations between symptom burden and falls and fall-related outcomes and the moderation effects of demographic factors.

RESULTS

The majority of the sample were aged between 65 and 79 years old (57.7%), non-Hispanic White (70.5%), and female (58.4%). Each additional symptom was associated with an increased risk of falls (Adjusted Odds Ratio [AOR]: 1.13, 95% CI: 1.10-1.15), multiple falls (AOR: 1.15, 95% CI: 1.12-1.18), FOF (AOR: 1.20, 95% CI: 1.18-1.23), and FOF limiting activity (AOR: 1.24, 95% CI: 1.20-1.28). Age, race/ethnicity, education, and living arrangement statistically significantly moderated the relationships between symptom burden and falls and fall-related outcomes.

CONCLUSIONS

Symptom burden predicted falls, multiple falls, FOF and FOF limiting activity, and demographics may differentially modify this risk. Individually tailored symptom assessment and management plans should be incorporated into fall risk assessment and interventions for community-dwelling older adults living.

Exploring the relationship between falls, fall-related psychological concerns, and personality traits in adults: A scoping review protocol

Background and Aims

Personality traits, such as neuroticism and extraversion, are emerging as important predictors of falls. Despite their significance, existing fall prevention programs often overlook these traits, creating a notable research gap. This study aims to conduct a comprehensive scoping review to explore the existing literature on the relationships among personality traits, falls, and fall-related psychological concerns (FrPCs).

Methods

This scoping review will adhere to the framework established by Arksey and O'Malley, incorporating extensions recommended by the Joanna Briggs Institute and using the PRISMA-ScR checklist. A thorough search strategy will be employed, aligning with the population, concept, and context (PCC) selection criteria. Electronic databases, including MEDLINE, APA PsycINFO, Web of Science, CINAHL, and SPORTDiscus, will be searched from their inception to the present. Additionally, a manual search of the reference lists of identified and relevant full-text articles will be conducted. Two independent reviewers will screen titles and abstracts, perform full-text reviews, and extract data from pertinent articles.

Discussion

Personality traits are increasingly recognized as influential predictors of falls and related psychological concerns. This review aims to make a substantial contribution to the existing literature by being the first to comprehensively explore and provide a descriptive synthesis of the relationship between personality traits and falls, as well as FrPCs in adults. It is hoped that the outcomes of this review will enhance our comprehension of the role of personality traits in falls, potentially informing future research and strategies for this critical area of study.

Scoping Review Registration

This scoping review protocol was registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/KR74X).

Localizing EEG Recordings Associated With a Balance Threat During Unexpected Postural Translations in Young and Elderly Adults

Balance perturbations are accompanied by global cortical activation that increases in magnitude when postural perturbations are unexpected, potentially due to the addition of a startle response. A specific site for best recording the response to unexpected destabilization has not been identified. We hypothesize that a single sensor located near to subcortical brainstem mechanisms could serve as a marker for the response to unpredictable postural events. Twenty healthy young (20.8 ± 2.9 yrs) and 20 healthy elder (71.7 ± 4.2 yrs) adults stood upright on a dynamic platform with eyes open. Platform translations (20 cm at 100 cm/s) were delivered in the posterior (29 trials) and anterior (5 catch trials) directions. Active EEG electrodes were located at Fz and Cz and bilaterally on the mastoids. Following platform acceleration onset, 300 ms of EEG activity from each trial was detrended, baseline-corrected, and normalized to the first trial. Average Root-Mean-Square (RMS) values across "unpredictable" and "predictable" events were computed for each channel. EEG RMS responses were significantly greater with unpredictable than predictable disturbances: Cz ( [Formula: see text]), Fz ( [Formula: see text]), and mastoid ( [Formula: see text]). EEG RMS responses were also significantly greater in elderly than young adults at Cz ( [Formula: see text]) and mastoid ( [Formula: see text]). A significant effect of sex in the responses at the mastoid sensors ( [Formula: see text]) revealed that elderly male adults were principally responsible for the age effect. These results confirm that the cortical activity resulting from an unexpected postural disturbance could be portrayed by a single sensor located over the mastoid bone in both young and elderly adults.

Cross-Lagged Panel Analysis between Physical Frailty, Cognitive Function, and Falls by Sex

OBJECTIVES

This study investigated the reciprocal longitudinal relationships between physical frailty (PF), cognitive function (CF), and falls among community-dwelling older adults, according to sex. The study proposed hypotheses that present PF and CF will affect the occurrence of falls 2 years later.

DESIGN

Secondary data analysis using the first (T1, 2016-2017) and second (T2, 2018-2019) waves of the Korean Frailty and Aging Cohort Study (KFACS).

SETTING AND PARTICIPANTS

A total of 2318 community-dwelling older adults aged 70-84 years in South Korea; mean (SD) age: 75.72 (3.83) years; 47.7% men.

METHODS

PF and CF were measured with the modified version of the Fried Frailty Phenotype and the Korean version of the Mini-Mental State Examination, respectively. The number of falls were assessed. Multigroup cross-lagged panel analysis was used.

RESULTS

The results showed that relationships between PF, CF, and falls were maintained over time through an autoregressive effect. PF at T1 had a statistically significant longitudinal relationship with fall experience at T2 [standardized regression coefficient (β) = 0.087, 95% CI 0.045-0.129; P < .001], and fall experience at T1 had a significant longitudinal relationship with PF at T2 (β = 0.041, 95% CI 0.006-0.076; P = .020). There was no statistically significant relationship between CF and fall experience. PF and CF had statistically significant reciprocal longitudinal relationships (all P < .001). Based on sex, there was a statistically significant longitudinal relationship between fall experience at T1 and PF at T2 for men only (β = 0.063, 95% CI 0.012-0.114; P = .015).

CONCLUSIONS AND IMPLICATIONS

Findings highlight that health care providers should plan fall prevention programs through early intervention for PF improvement along with improvement and maintenance of CF. Specifically, even if older men are currently healthy and have a low risk of falls, it is important to prevent future fatal PF through prior interventions, such as risk activities attention and concerns about falls.

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

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

Clinical study of falls among inpatients with hematological diseases and exploration of risk prediction models

Background

Falls are serious health events that can cause life-threatening injuries, especially among specific populations. This study assessed the risk factors associated with falls among inpatients with hematological diseases and explored the predictive value of fall risk assessment models.

Methods

Clinical data from 275 eligible hematology disease patients who visited Mianyang Central Hospital with or without falls from September 2019 to August 2022 were retrospectively analyzed. Fall risk scores were determined in all included patients. Clinical characteristics were compared between patients with and without falls. Binary logistic regression models were used to screen for potential fall-specific risk factors among hospitalized patients with hematology diseases.

Results

Falls occurred in 79 cases. Patients in the fall group had a higher Charlson Comorbidity Index (CCI), a higher incidence of diabetes mellitus, visual impairment, hematological malignancies, and maintenance of stable disease stage, higher glucose levels, and a greater proportion of dizziness, nocturnal defecation, and receipt of intensive chemotherapy than those in the non-fall group (all P < 0.05). Fall patients were also more likely to have used diuretics, laxatives, sedative-sleeping drugs, analgesics, albumin, and calcium, and to have had catheters placed. The Barthel Index, grade of nursing care, support of chaperones, body temperature, nutrition score, and pain score also differed significantly between the two groups (all P < 0.05). Multivariable logistic regression analysis showed that the maintenance of stable disease stage (OR = 4.40, 95% CI 2.11-9.18, P < 0.001), use of sedative and sleeping drugs (OR = 4.84, 95% CI 1.09-21.49, P = 0.038), use of diuretics (OR = 5.23, 95% CI 2.40-11.41, P < 0.001), and intensive chemotherapy (OR = 10.41, 95% CI 3.11-34.87, P < 0.001) were independent risk factors for falls. A high Barthel Index (OR = 0.95, 95% CI 0.93-0.97, P < 0.001), a high level of nursing care (OR = 0.19, 95% CI 0.04-0.98, P = 0.047), and availability of family accompaniment (OR = 0.15, 95% CI 0.06-0.34, P < 0.001) were protective factors for falls. A ROC curve analysis was used to evaluate the predictive value of different fall-specific risk scales among inpatients with hematological diseases. The Johns Hopkins Fall Risk Rating Scale had high sensibility and specificity with an area under the curve of 0.73 (95% CI 0.66-0.80, P < 0.001).

Conclusion

The Johns Hopkins Fall Risk Scale had a strong predictive value for falls among hospitalized patients with hematology diseases and can be recommended as a valid tool for clinical use.

Rehabilitation after Hip Fracture Surgery Improves Physical and Cognitive Function in Patients with or Without Sarcopenia

Introduction

Sarcopenia is a prevalent risk factor for falls and fractures, and it affects the physical function and mortality of older people. The present study was performed to assess the prevalence of sarcopenia in patients who underwent rehabilitation after hip fracture surgery and to examine the association of sarcopenia with physical and cognitive function outcomes.

Methods

This case-control study involved 132 patients who were admitted to a convalescent rehabilitation ward at a single hospital after surgical treatment of hip fractures from April 2018 to March 2020. The skeletal muscle mass index was examined using whole-body dual-energy X-ray absorptiometry. The Asian Working Group for Sarcopenia 2019 diagnostic criteria were applied on admission. We compared the walking speed, Mini-Mental State Examination (MMSE) score, and Functional Independence Measure (FIM) score between the sarcopenia group and non-sarcopenia group on admission and on discharge.

Results

The prevalence of sarcopenia was 59.8%. In the non-sarcopenia group, the walking speed, MMSE score, FIM total score, FIM motor score, and FIM cognitive score were significantly lower on admission than those on discharge (P < .05). In the sarcopenia group, the walking speed, MMSE score, FIM total score, and FIM motor score were significantly lower on admission than those on discharge (P < .05); there was no significant difference in the FIM cognitive score between admission and discharge. On both admission and discharge, the MMSE score, FIM total score, FIM motor score, and FIM cognitive score were significantly better in the non-sarcopenia group than those in the sarcopenia group.

Conclusions

After postoperative rehabilitation of hip fractures in patients with and without sarcopenia, physical and cognitive function outcomes on discharge were significantly better than those on admission. Patients with sarcopenia had significantly worse physical and cognitive function outcomes than patients without sarcopenia both on admission and on discharge.

Fall Risk in Adult Family Practice Non-Attenders: A Cross-Sectional Study from Slovenia

Introduction

Not much is known about the fall risk among the adult population of those who rarely visit doctors. We wanted to determine the prevalence of increased fall risk in a population of family practice non-attenders and the factors associated with it.

Methods

We included participants from family medicine practices in this cross-sectional study. To be included in the study, the participants had to be adults living in the community (home-dwelling people) who had not visited their chosen family physician in the last five years (non-attenders). The identification of the eligible persons was done through a search of electronic medical records, which yield 2,025 non-attenders. Community nurses collected data in the participants’ homes. The outcome measure was increased fall risk as assessed by the Morse fall scale: increased risk (≥25) vs. no risk.

Results

The sample consisted of 1,945 patients (96.0% response rate) with a mean age of 60.4 years (range 20.5 to 99.7 years). An increased fall risk was determined in 482 or 24.8% (95% CI: [22.9, 26.8]) of the patients. The multivariate model showed a significant association of increased fall risk with higher age (p<0.001), lower systolic blood pressure (p=0.047), poor family function (p=0.016), increased risk of malnutrition (p=0.013), higher number of chronic diseases (p=0.027), higher pain intensity (p<0.001), lower self-assessment of current health (p=0.002), and higher dependence in daily activities (p<0.001).

Conclusion

Non-attenders may have an increased risk of falling which depends on their health status and age. The inclusion of community nurses in primary healthcare teams could be of use not only to identify the non-attenders’ health needs, but also to better manage their health, especially the factors that were identified to be associated with greater fall risk.

Arterial stiffness and augmentation index are associated with balance function in young adults

OBJECTIVE

Arterial stiffness and pulsatile central hemodynamics have been shown to affect various aspects of physical function, such as exercise capacity, gait speed, and motor control. The aim of this study was to examine the potential association between arterial stiffness and balance function in healthy younger men and women.

METHODS

112 participants (age = 21 ± 4 years, n = 78 women) underwent measures of arterial stiffness, pulsatile central hemodynamics, balance function and physical fitness in this cross-sectional study. Postural sway was measured in triplicate while participants stood on a foam surface with their eyes closed for 20 s. The average total center of pressure path length from the three trials was used for analysis. Measures of vascular function were estimated using an oscillometric blood pressure device while at rest and included pulse wave velocity (PWV), augmentation index (AIx), and pulse pressure amplification. Measures of physical fitness used as covariates in statistical models included handgrip strength determined from a handgrip dynamometer, lower-body flexibility assessed using a sit-and-reach test, estimated maximal aerobic capacity (VO₂max) using heart rate and a step test, and body fat percentage measured from air displacement plethysmography.

RESULTS

The results from linear regression indicated that after considering sex, mean arterial pressure, body fat, estimated VO₂max, handgrip strength, and sit-and-reach, PWV (β = 0.44, p < 0.05) and AIx (β = - 0.25, p < 0.01) were significant predictors of postural sway, explaining 10.2% of the variance.

CONCLUSION

Vascular function is associated with balance function in young adults independent of physical fitness. Increased arterial stiffness may negatively influence balance, while wave reflections may be protective for balance.

Cardiovascular disease, muscle function, and long-term falls risk: The Perth Longitudinal Study of Ageing Women

BACKGROUND

A few cross-sectional studies have highlighted inconsistent associations between cardiovascular disease (CVD) and musculoskeletal conditions. We sought to investigate the relationship between clinical CVD including subtypes, compromised muscle function, as well as incident self-reported and injurious falls in older women.

MATERIALS AND METHODS

1431 community-dwelling older women (mean age ± SD; 75.2 ± 2.7 years) were included in over 14.5 years of a prospective study, the Perth Longitudinal Study of Ageing in Women. CVD (up to 18-years prior to the baseline visit) and injurious fall hospitalizations over 14.5 years were obtained from linked health records. Self-reported falls for five years were obtained via a written adverse event diary posted every four months. Timed-Up-and-Go (TUG) test and hand grip strength were used to assess mobility and muscle strength, respectively. Mobility impairment was defined as TUG performance >10.2 sec and muscle weakness characterized as grip strength <22 kg.

RESULTS

Over 5-years, 411 (28.7%) women reported a falls, while 567 (39.6%) were hospitalized due to an injurious fall over 14.5 years. Prior CVD events were associated with 32% (HR 1.32 95%CI, 1.06-1.64) and 29% (HR 1.29 95%CI, 1.07-1.56) increased risk of self-reported and injurious falls, respectively, in multivariable-adjusted models. When considering subtypes of CVD, only cerebrovascular disease was related to self-reported (HR 1.77; 95%CI, 1.15-2.72) and injurious falls requiring hospitalization (HR 1.51; 95%CI, 1.00-2.27). CVD was also associated with cross-sectional and prospective mobility impairments. However, no evidence for such relationships was observed for muscle weakness.

CONCLUSIONS

Prevalent CVD events, particularly cerebrovascular disease, are related to an increased risk of long-term falls. These findings highlight the need to recognize increased falls risk in patients with CVD. Further, there is a need to understand whether incorporating prevalent CVD into falls screening tools improves risk stratification or affects model calibration.

Falls and associated risk factors in a sample of old age population in Egyptian community

Introduction

Falling is a major health problem among old age persons and are the sixth cause of mortality and morbidity among them. Assessing the prevalence of falls among elderly in an Egyptian community and investigating its associated risk factors using the Arabic translation of the SHARE-Questionnaire.

Subjects and methods

This cross-sectional analytic study was a part of the pilot for AL-SEHA project. It included 289 old age people (50+ years age) residing in the study areas. The main project data were collected using the Arabic translation of the SHARE (Survey of Health, Aging, and Retirement in Europe) questionnaire. The original project data were collected by investigators from five universities, then uploaded to the internet server domain of the American University in Cairo (AUC) Social Research Center.

Results

The prevalence of falls was 11.07% (95% CI: 7.95-15.21). Falls were significantly more among 70 years or older (p < 0.001), unemployed or housewives (p = 0.026), have a family caregiver (p = 0.022), and home facilities for disability (p = 0.015). They had significantly higher rates of ischemic heart disease, hypertension, dyslipidemia, stroke, and diabetes mellitus. The most frequently reported problems were the fear of fall and dizziness (62.5%). The multivariate analysis identified the history of stroke and diabetes mellitus, the fear of fall and dizziness, and the total number of health problems and the score of difficulty in performing physical activities as significant independent predictors of fall occurrence. The history of stroke was the strongest risk factor (OR 33.49, CI: 3.45-325.40).

Discussion and recommendations

The prevalence of falls among old age persons in the studied community is not alarmingly high. It is highest among stroke patients. Community interventions and rehabilitation programs are recommended to train and educate old age people, especially those at risk such as stroke and diabetic patients, and those with dizziness to improve their physical fitness and reduce the fear of fall among them.

Association of diabetes mellitus with gait and falls in community-dwelling older adults: Serial mediation of vision and cognition

BACKGROUND/OBJECTIVE

Diabetes mellitus (DM) is associated with walking performance, but potential underlying mechanisms of this association remain unclear. The present study aims to disentangle the pathways linking DM to gait and falls through the serial mediation effect of vision and cognition among the older population.

METHODS

Data were taken from wave 9 (2018-2019) of the English Longitudinal Study of Aging (ELSA), including 5496 participants aged 60 years and older. DM was identified based on medical diagnosis and laboratory tests. Vision and falls were self-reported. Cognition was evaluated using questionnaire. Gait speed was measured by the "timed walking test". Serial mediation analysis was performed using Mplus 8.3.

RESULTS

DM was associated with impaired gait speed (c = 0.085, P < 0.05) and falls (c = 0.061, P < 0.05). The serial mediation model revealed that vision and cognition significantly mediated the association of DM with impaired gait speed, with 17.97% and 23.60% of the total effects explained by vision and cognition respectively, and 3.37% explained by the path through vision and then cognition. Similarly, vision and cognition significantly mediated the association of DM with falls, with 14.99% and 6.67% of the total effects explained by vision and cognition respectively, and 1.67% explained by the path through vision and then cognition.

CONCLUSIONS

These findings contribute to deeper understanding of the mechanism underlying the association of DM with walking performance. Evaluation and intervention targeted at vision and the cognition may be beneficial for improving gait or reducing falls in older adults with DM.

Risky Business: Factors That Increase Risk of Falls Among Older Adult In-Patients

In hospitals, older patients are at increased risk of falling multiple times. This study incorporated an epidemiologic cross-sectional design consisting of 4,348 older patients (≥65-year-old). Eight hundred eighty five (20.4%) in-patients experienced multiple falls while remaining participants had one fall incident. A patient fall event was recorded with age, sex, incident date, type of fall, and location. Logistic regression assessed risk factors found in patients with multiple falls compared to those with one fall. Significant differences were observed in the proportion of multiple falls: in a bed with no rails, standing, walking, and using a wheel/Geri chair (p < .05). Overall, sex, type of fall, and location were significant in predicting multiple falls (p < .05). Male patients were at 16.1% greater risk of multiple falls, when compared to females (p < .05). A fall in complex care, mental health, or respirology were more likely to experience multiple falls (OR = 2.659, 3.620, 1.593 respectively), while season had no impact.

Patterns and predictors of fall injury transitions among Korean older adult fallers: a 2-year longitudinal study

This study was conducted to identify fall injury patterns, the transition from the baseline to follow-up, and the factors associated with the identified fall injury patterns using data obtained from the Korean Frailty and Aging Cohort Study. The participants were 566 community-dwelling older adults with fall experience. Three fall injury patterns were identified as the baseline and follow-up periods. The probability that the participant in the "fracture injury" pattern at Time 1 transitioned to the "fracture injury" pattern at Time 2 was 0.098. The factors associated with the "bruising and/or sprain injury" pattern were education level (relative risk ratio [RRR] = 0.55, p = 0.012), alcohol consumption (RRR = 0.50, p = 0.034), and balancing in tandem position (RRR = 2.77, p < 0.001). In the "fracture injury" pattern, male (RRR = 0.22, p = 0.038), frailty score (RRR = 0.58, p = 0.042), "bruising injury" (RRR = 0.23, p = 0.007), and "sprain injury" (RRR = 0.20, p = 0.007) at the baseline were significant factors. The findings indicate that previous fall experiences, higher alcohol consumption, lower frailty scores, and poor balance levels are associated with fall injury patterns. These patterns should be considered when developing prevention interventions.

Association Between Cancer-Related Fatigue and Falls in Patients With Myeloproliferative Neoplasms: Results of a Multicenter Cross-Sectional Survey From the East German Study Group for Hematology and Oncology (OSHO #97)

OBJECTIVE

This study retrospectively examined the association between cancer-related fatigue (CrF) and the number of falls during the last 12 months in patients with myeloproliferative neoplasms (MPNs).

METHODS

A multicenter, 1-time anonymous survey was conducted using analog and digital questionnaires. Sex-stratified multinomial logistic regression analysis was applied to investigate the association between CrF and number of falls. All analyses were adjusted for age, school education, body mass index, MPN subtype, and quality of life.

RESULTS

The final sample comprised 688 patients (mean age 57.4 ± 13.8, 62.4% women). The fall rate was 16.2% in women and 12.2% in men (P = .153). There were no differences between women and men in terms of CrF between individuals with more than 1 fall, whereas women with 1 fall had a higher CrF compared to those without a fall (RRR = 1.019; 95% CI [1.002-1.039]), respectively.

CONCLUSION

CrF increases the risk of falls in women with MPN. Physicians should evaluate and manage CrF symptoms and implement fall prevention strategies for those who are at increased risk. Further research is needed to better understand the effects of CrF on gait performance and associated fall risk.

Patterns of health service use before and after a statewide fall prevention initiative for older adults at risk of falls

OBJECTIVE

To understand health-care burden from fall-related injury, we investigated patterns of health service use in participants of the Australian statewide Stepping On fall prevention program.

METHODS

Routinely collected ambulance, emergency, hospital and mortality data for 9163 participants across NSW Local Health Districts between 2009 and 2015 were analysed for patterns in fall-related health service use three years before and after the Stepping On program using negative binomial regression analyses.

RESULTS

Overall fall-related health service use increased over the 6-year study period. There was a high period of usage prior to program participation, which decreased postprogram, then appeared to increase again after 12-15 months. Subgroup analysis showed strongest postprogram reductions for women.

CONCLUSIONS

Patterns of service usage suggest initial program benefits that taper off over time. The results of this observational study need to be interpreted with caution. Investment in ongoing fall prevention programs may be needed for lasting impacts.

Association of Pain Phenotypes with Risk of Falls and Incident Fractures

Objective: To compare whether falls risk score and incident fracture over 10.7 years were different among three previously identified pain phenotypes. Methods: Data on 915 participants (mean age 63 years) from a population-based cohort study were studied at baseline and follow-ups at 2.6, 5.1 and 10.7 years. Three pain phenotypes were previously identified using the latent class analysis: Class 1: high prevalence of emotional problems and low prevalence of structural damage; Class 2: high prevalence of structural damage and low prevalence of emotional problems; Class 3: low prevalence of emotional problems and low prevalence of structural damage. Fractures were self-reported and falls risk score was measured using the Physiological Profile Assessment. Generalized estimating equations model and linear mixed-effects model were used to compare differences in incident fractures and falls risk score over 10.7 years between pain phenotypes, respectively. Results: There were 3 new hip, 19 vertebral, and 121 non-vertebral fractures, and 138 any site fractures during 10.7-year follow-up. Compared with Class 3, Class 1 had a higher risk of vertebral (relative risk (RR) = 2.44, 95% CI: 1.22-4.91), non-vertebral fractures (RR = 1.20, 95% CI: 1.01-1.42), and any site fractures (RR = 1.24, 95% CI: 1.04-1.46) after controlling for covariates, bone mineral density and falls risk score. Class 2 had a higher risk of non-vertebral and any site fracture relative to those in Class 3 (non-vertebral: RR = 1.41, 95% CI: 1.17-1.71; any site: RR = 1.44, 95% CI: 1.20-1.73), but not vertebral fracture. Compared with Class 3, Class 1 had a higher falls risk score at baseline (β = 0.16, 95% CI: 0.09-0.23) and over 10.7-year (β = 0.03, 95% CI: 0.01-0.04). Conclusions: Class 1 and/or Class 2 had a higher risk of incident fractures and falls risk score than Class 3, highlighting that targeted preventive strategies for fractures and falls are needed in pain population.

Prevalence of falls in noninstitutionalized people aged 65−80 and associations with sex and functional tests: A multicenter observational study

Falls have a considerable impact on the functional prognosis of older adults. The main focus of this multicenter, retrospective, observational study was to examine the prevalence of falls in Spanish people aged 65−80 years still living at home. The secondary aims included examining the overall sociodemographic and clinical variables associated with a history of falls and then stratifying these findings by sex. We also aimed to determine the differences between sexes with regard to the history and consequences of falls and to evaluate associations between fall history and functional performance tests. The 747 older adults had all participated in the otago exercise program, which is a progressive home program of strength, balance, and endurance exercises. They were recruited by nurses in 21 primary care centers in 10 Spanish provinces between September 2017 to December 2018. The participants' mean age was 72.2 (SD: 4.3) years, and 67% were women. We recorded sociodemographic and clinical variables, functional performance test results, and any falls and/or injuries in the last 12 months. We found that 32% had fallen, 36% of those had fallen more than once, and 48% had sustained injuries when they fell. The bivariate analysis showed that women had more than twice the odds of falling than men and that living alone and being obese or overweight increased the odds of a fall, although living alone was not associated with falls in the multivariable analysis. Our results could guide the development of risk‐specific fall prevention programs to prevent disabilities in older people.

Falls risk screening tools intended to reduce fall risk among independent community‐dwelling older adults: A systematic review

AIMS

The aim of this study is to evaluate an evidence-based fall risk screening tool to predict the risk of falls suitable for independent community-dwelling older adults guided by the World Health Organization's International Classification of Functioning, Disability and Health (WHO-ICF) components, and to examine the reliability and validity of the fall risk screening tool to predict fall risks, and to examine the feasibility of tools among independent community-dwelling older adults.

METHODS

A systematic literature search guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed using the EBSCOHost® platform, ScienceDirect, Scopus and Google Scholar between July and August 2021. Studies from January 2010 to January 2021 were eligible for review. Nine articles were eligible and included in this systematic review. The risk of bias assessment used the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. The WHO-ICF helped to guide the categorization of fall risk factors.

RESULTS

Seven screening tools adequately predicted fall risk among community-dwelling older adults. Six screening tools covered most of the components of the WHO-ICF, and three screening tools omitted the environmental factors. The modified 18-item Stay Independent Brochure demonstrated most of the predictive values in predicting fall risk. All tools are brief and easy to use in community or outpatient settings.

CONCLUSION

The review explores the literature evaluating fall risk screening tools for nurses and other healthcare providers to assess fall risk among independent community-dwelling older adults. A fall risk screening tool consisting of risk factors alone might be able to predict fall risk. However, further refinements and validations of the tools before use are recommended.

Severe low back or lower limb pain is associated with recurrent falls amongst older Australians

Background

Few studies have explored the impact of low back or lower limb pain severity on recurrent (≥2) falls in older adults.

Objectives

Investigate the association between the severity of low back or lower limb pain, and ≥2 falls or falls‐related injuries.

Methods

Community‐dwelling Australian males and females in the ASPREE Longitudinal Study of Older Persons (ALSOP), aged ≥70 years. Self‐reported, cross‐sectional questionnaire data regarding number of falls and falls‐related injuries in the last 12 months; and sites and severity of pain experienced on most days. Adjusted relative risks (RR) were estimated from multivariable Poisson regression models, for males and females separately.

Results

Of 14,892 ALSOP participants, 13% (n = 1983) reported ≥2 falls (‘recurrent fallers’) in the last 12 months. Males and females who reported severe low back, or severe lower limb pain on most days were more likely to report ≥2 falls in the last 12 months compared to those with mild pain (lower back: males RR = 1.70 and females RR = 1.5, p = 0.001; lower limb: males RR = 2.0, p < 0.001 and females RR = 1.4, p = 0.003). Female recurrent fallers who reported severe low back (RR = 1.3, p = 0.029) or lower limb (RR = 1.2, p = 0.024) pain on most days were more likely to report a falls‐related injury in the last 12 months compared to females with mild pain.

Conclusion

Severe low back or lower limb pain was associated with an increased likelihood of recurrent falls (males/females) or falls‐related injuries (females only). Assessment of severe low back and lower limb pain should be considered as a priority when undertaking falls‐risk evaluation.

Significance

Severe low back pain, or severe lower limb pain is associated with an increased likelihood of recurrent falls in older males and females, and an increased likelihood of falls‐related injuries in older female recurrent fallers. Assessment and management of severe low back and lower limb pain should be prioritized when undertaking falls‐risk assessment. Future longitudinal research is required to further interrogate this relationship and its underlying mechanisms.

Experiences and impact of living with incontinence associated stigma: A protocol for a systematic review and narrative synthesis of qualitative studies

Introduction

Incontinence is global health and social issue, with urinary incontinence alone affecting over 400 million people. Incontinence can lead to physical harms such as skin damage, but it also commonly causes social and psychological harms, including those associated with stigma. For many people, treatment to cure incontinence does not work or is not suitable and they live with the long-term consequences of incontinence. At the moment, no stigma reduction interventions (increasingly used with other conditions such as mental health problems and HIV) have been developed for people living with incontinence. As a starting point for developing such an intervention, this review will address the questions 1) What are the incontinence (urinary or faecal) associated experiences of stigma of people living with incontinence? 2) What is the impact of incontinence associated stigma on their lives?

Methods

The reviewers will search Embase, Medline, PsychINFO and the Cumulative Index to Nursing and Allied Health Literature using controlled vocabulary and relevant search terms. Articles assessed to meet inclusion criteria will be included. Once duplicates have been removed, titles and abstracts will be screened and full texts of selected research articles will be reviewed. An adapted Joanna Briggs Institute Data Extraction Form will be used to collect the data and quality will be assessed using the Joanna Briggs Institute checklist for qualitative research appraisal tool. A framework approach (using the Revised Framework for Understanding Non-communicable Disease Related Stigma) will be used to organise, integrate, interpret and summarise findings from included articles. The review will be reported in accordance with the Enhancing Transparency in reporting the synthesis of qualitative research statement. Prospero registration number CRD42021259065.

Discussion

The systematic review described in this protocol will provide the first in-depth, comprehensive understanding of people’s experiences of the stigma associated with incontinence and the impact that it has on their lives. It will identify broader influences of contextual variables such as age, sex, cause and type of incontinence, socio-economic culture and geographical location. The review aims to provide insights to support the development of incontinence associated stigma reduction interventions.

Injuries associated with hypotension after trauma: Is it always haemorrhage?

Introduction

Restricted fluid replacement strategy is one part of damage control resuscitation for patients with trauma haemorrhage. However, not all patients presenting with physiological symptoms suggestive of haemorrhage are bleeding. This descriptive study aims to compare demographics and injuries in adult and older trauma patients presenting to the Emergency Department with hypotension versus normotension.

Methods

This was a retrospective, descriptive data analysis from a UK trauma registry. The records from one major trauma centre were analysed between 2014–2019, and every hypotensive (systolic blood pressure <90 mmHg) trauma patient investigated for injuries associated with hypotension. The hypotensive threshold for older patients was also adjusted to 110 mmHg for sub-cohort analysis.

Results

6245 trauma patients were included, of which 255 (4.1%) arrived hypotensive at the Emergency Department. Significant blood loss was identified in 32.2% of those cases. In 27.1%, multiple potential associations obscured the underlying mechanism for the hypotension but were more commonly associated with hypotension than with normotension. Over a third (37.5%) were ≥65 years old. Neurological injuries occurred more frequently in both older hypotensive groups than younger patients.

Conclusions

This study sought to compare injuries of adult and older trauma patients to aid trauma teams with decision making. In severely injured hypotensive patients, significant blood loss was the principal association with hypotension. However, several factors can mimic bleeding in the hypotensive trauma patient, which should be carefully considered. A prospective study is needed to clarify the characteristics and causes of bleeding mimics.

Epidemiology of Falls in 25 Australian Residential Aged Care Facilities: A Retrospective Longitudinal Cohort Study Using Routinely Collected Data

BACKGROUND

Falls are frequent among older adults and have significant health and economic consequences. There have been few studies on the epidemiology of falls in residential aged care facilities (RACFs). This study aimed to determine the incidence of falls in RACFs using longitudinal routinely collected incident data over five years (Jul 2014-Dec 2019).

METHODS

A retrospective cohort study using fall incident data from 25 RACFs in Sydney, NSW, Australia. Incidents relating to a population of 6,163 aged care residents aged ≥65 years were included. Outcome measures were incidents of all falls; injurious falls, and requiring hospitalisation. Risk-adjusted incidence rate (IR) for each outcome indicator for each of the 25 facilities was calculated.

RESULTS

A total of 27,878 falls were reported over 3,906,772 resident days (a crude rate of 7.14/1000 resident days; 95% confidence interval (CI) 6.81-7.48). Of these, 10,365 (37.2%) were injurious and 2,733 (9.8%) required hospitalisation. The crude IR for injurious falls was 2.65/1000 resident days (95% CI 2.53-2.78) and 0.70 (95% CI 0.66-0.74) for falls requiring hospitalisation. The incidence of falls was significantly higher in respite compared to permanent residents for all falls (adjusted incident rate ratio (aIRR) 1.33; 95% CI 1.18-1.51) and injurious falls (aIRR 1.30; 95% CI 1.14-1.48) and for men compared to women for all outcomes (all falls aIRR 1.69; 95% CI 1.54-1.86; injurious falls aIRR 1.87; 95% CI 1.71-2.04 and falls requiring hospitalisation aIRR 1.29; 95% CI 1.12-1.48). The risk-adjusted IRs per 1000 resident days between facilities varied substantially (all falls 0.57-12.93 falls; injurious falls 0.25-4.47 and falls requiring hospitalisation 0.10-1.70).

CONCLUSION

Falls are frequent in RACFs, often resulting in injury and hospitalisation. The study provides robust and comprehensive information that may help inform future initiatives to minimise the incidence of falls in RACFs.

BASE: Pragmatic Injury Prevention for Practitioners

Unintentional injury remains a leading health problem in developed nations, making injury prevention imperative. Practitioners are primary stakeholders in the injury prevention process but rarely can devote significant time to complicated prevention efforts. Furthermore, theory-based approaches to support injury prevention are less common than atheoretical approaches. We propose a simple method for injury prevention grounded in concepts found in antecedent models. Barriers, attitudes, social context, and environmental factors (or BASE) are suggested as a simple injury prevention model practitioners can follow when working with patients. We present each component of BASE and offer examples of how the approach can be applied to risk factors associated with several types of injury risk behavior.

Are There Sex Differences in Balance Performance after a Short-Term Physical Intervention in Seniors 65+? A Randomized Controlled Trial

A systematic review and meta-analysis of studies demonstrated a relationship between sex and balance determinants in seniors; however, no study has focused on sex-related differences in static and dynamic balance performance after a physical intervention as primary interest. The aim was to investigate sex differences in the static and dynamic balance performance after a 4-week physical intervention based on yoga in seniors 65+ years of age. Five-hundred participants (234 males, 266 females) were assessed with the Tinetti Balance Assessment Tool in pre-and post-testing. The experimental group (122 males, 140 females) underwent the intervention, while the control group (112 males, 126 females) ran their usual daily program. ANCOVA model was used for the statistical evaluation of the results. No sex differences were found in balance performance after a short-term physical intervention in seniors 65+ years of age. At the same time, a significant positive shift was demonstrated in performance in both static and dynamic balance.

Tendência de mortalidade por quedas em idosos, no Brasil, no período de 2000–2019

RESUMO Objetivo: Analisar a tendência da mortalidade por quedas entre idosos, no Brasil, no período de 2000 a 2019. Métodos: Trata-se de um estudo epidemiológico, analítico, com delineamento ecológico de séries temporais. Realizou-se uma análise retrospectiva utilizando dados secundários em saúde, extraídos do Sistema de Informação sobre Mortalidade (SIM) no período específico. Foram calculadas taxas padronizadas de mortalidade geral e específicas por sexo e faixa etária. Para a observação da tendência de mortalidade, utilizou-se o modelo de Prais-Winsten e taxa de incremento anual (TIA). Resultados: No período de 2000 a 2019, foram identificados 135.209 óbitos decorrentes das quedas em idosos. A mortalidade por queda em geral, no período estudado, foi crescente (β=0,023; p<0,001; TIA=5,45%). Observou-se que tanto o sexo masculino (β=0,022; p<0,001; TIA=5,19%) quanto o feminino (β=0,024; p<0,001; TIA=5,72%) apresentaram tendência crescente. Com relação à faixa etária, os resultados apontaram também para tendência de mortalidade crescente em todos os estratos etários, porém maior em idosos com idade ≥80 anos (β=0,027; p<0,001; TIA=6,38%). Conclusão: Observou-se tendência crescente nas taxas de mortalidade no Brasil durante a série histórica estudada. Esses achados sugerem a importância da definição de uma linha de cuidado para esse segmento etário, tendo como foco a promoção da saúde na pessoa idosa e a prevenção dos riscos de quedas, visando a uma redução no número de óbitos por essa causa e favorecendo a qualidade de vida dos idosos.

Mortality trend from falls in Brazilian older adults from 2000 to 2019

ABSTRACT Objective: To analyze the trend of mortality from falls among older adults in Brazil from 2000 to 2019. Methods: This is an epidemiological, analytical study with an ecological time-series design. A retrospective analysis was performed using secondary health data extracted from the Brazilian Mortality Information System in the specific period. Standardized rates of general and sex- and age-specific mortality were calculated. To observe the mortality trend, the Prais-Winsten model and the Annual Increase Rate (AIR) were used. Results: We identified 135,209 deaths resulting from falls in older adults in the period from 2000 to 2019. Mortality from falls in general, during the study period, had an upward trend (β=0.023; p<0.001; AIR=5.45%). We observed that both men (β=0.022; p<0.001; AIR=5.19%) and women (β=0.024; p<0.001; AIR=5.72%) had an upward trend. Regarding age group, the results also pointed to an upward mortality trend in all age strata, although higher in older people aged ≥80 years (β=0.027; p<0.001; AIR=6.38%). Conclusion: There was an upward trend in mortality rates in Brazil during the time series studied. These findings suggest the importance of defining a line of care for this age group, focusing on promoting health in older adults and preventing the risk of falls, aiming at a reduction in the number of deaths from this cause and favoring the quality of life of this population.

The epidemiology of falls in Portugal: An analysis of hospital admission data

BACKGROUND

Falls are a common cause of injury and pose an increased risk of morbidity, mortality, and lifelong disability. Falls encompass a troublesome definition and can pose challenges in epidemiological studies. Data on fall-related hospital admissions in Portugal remain unpublished. This study aimed to examine the epidemiology of fall-related hospital admissions in the Portuguese population between 2010 and 2018. It also aimed to examine annual rates of fall-related hospital admissions using three methodological approaches.

METHODS

The Portuguese Hospital Morbidity Database was used to identify all cases resulting in one or more inpatient admission in public hospitals related to falls from 2010 to 2018. Fall-related hospital admissions were described by age groups, sex, geographical area of residence, and type of fall. Annual rates were computed using three approaches: i) based on the number of inpatient admissions with an ICD code of fall, ii) based on the number of patients admitted to inpatient care with an ICD code of fall, and iii) based on the number of inpatient admissions with a principal diagnosis of injury.

RESULTS

Between 2010 and 2018, 383,016 fall-related admissions occurred in 344,728 patients, corresponding to 2.1% of the total number of hospitalizations during the same period. Higher rates were seen among the younger (20-25) and the oldest age groups (+85), males until the age of 60, females from the age of 60, and areas of residence with a higher aging index. An overall rate of falls per 100,000 population was estimated at 414 (based on number of admissions), 373 (based on number of patients) and 353 (based on number of admissions with a principal diagnosis of injury).

CONCLUSIONS

This study provides an overall picture of the landscape of falls in a scarcely explored setting. The results aim to contribute to identifying appropriate preventive interventions and policies for these populations.

The Bladder at Night during Hospitalisation: Towards optimal care for elderly patients with nocturia

OBJECTIVE

This study aimed to describe the characteristics of nocturia in older hospitalised patients and to explore knowledge, beliefs and experiences associated with night toileting while in hospital in order to identify unmet care needs.

METHODS

A multisite mixed methods cross-sectional study of older hospitalised adults who were admitted for ≥2 days was conducted using a standardised researcher-administered questionnaire. An additional cohort 16 older hospitalised adults with nocturia >twice per night were interviewed to understand the experience and impact of nocturia during hospitalisation.

RESULTS

Nocturia was experienced by 260 out of 308 participants. In-hospital nocturia was significantly correlated with nocturia in the month preceding admission, high diurnal voiding frequency and nocturnal urinary urgency. Bother was attributed to multiple nocturia episodes. Participants had poor knowledge and understanding of nocturia and believed the symptom to be a normal occurrence; only 20% had discussed management with staff. Disrupted sleep and fear of falling were common in older immobile participants with nocturia.

CONCLUSION

Nocturia is highly prevalent in hospitalised older people. Toileting multiple times at night bothers patients, disrupts sleep, heightens a fear of falling yet is rarely addressed in ward management plans. A screening process to identify, assess, provide education and intervene for nocturia has the potential to improve wellbeing, safety at night and to address risk factors.

Associations between meteorological factors and emergency department visits for unintentional falls during Ontario winters

INTRODUCTION

Unintentional falls are a leading cause of injury-related hospital visits among Canadians, especially seniors. While certain meteorological conditions are suspected risk factors for fall-related injuries, few studies have quantified these associations across a wider range of age groups and with population-based datasets.

METHODS

We applied a time-stratified case-crossover study design to characterize associations of highly-spatially-resolved meteorological factors and emergency department (ED) visits for falls, in Ontario, among those aged 5 years and older during the winter months (November to March) between 2011 and 2015. Conditional logistic models were used to estimate the odds ratios (ORs) and their 95% confidence intervals (CIs) for these visits in relation to daily snowfall accumulation, including single-day lags of up to one week before the visit, and daily mean temperature on the day of the visit. Analyses were stratified by age and sex.

RESULTS

We identified 761 853 fall-related ED visits. The odds for these visits was increased for most days up to a week after a snowfall of 0.2 cm or greater (OR = 1.05-1.08) compared to days with no snowfall. This association was strongest among adults aged 30 to 64 years (OR = 1.16-1.19). The OR for fall-related ED visits on cold days (less than -9.4 °C) was reduced by 0.05 relative to days with an average daily temperature of 3.0 °C or higher (OR = 0.95; 95% CI: 0.94, 0.96), and this pattern was evident across all ages. There were no substantive differences in the strength of this association by sex.

CONCLUSION

Snowfall and warmer winter temperatures were associated with an increased risk of fall-related ED visits during Ontario winters. These findings are relevant for developing falls prevention strategies and ensuring timely treatment.

Trend of fall-related mortality among the elderly

OBJECTIVE

To analyze the temporal trend of fall-related mortality in elderly in Brazil from 2008 to 2016.

METHOD

Study of time series of rates of fall-related mortality according to CID-10 from 2008 to 2016. Data from the Mortality Information System on death registers of people ≥ 60 living in Brazil were used. The specific rates of fall-related mortality among the elderly were calculated through the ratio between the number of deaths and the elderly population of that year and region. The populational information was obtained from the 2000 and 2010 censuses. The variation rate and temporal trend were obtained through linear regression (p < 0.05).

RESULTS

The fall-related deaths among the elderly aged ≥ 60 amounted to 72,234 (31.2%). Falls from the same level were the most frequent (53.8%) and death rates in all ages ranged from 29.7 to 44.7 per 100,000 elders. Fall-related deaths increased with age.

CONCLUSION

There was a growing trend of fall-related deaths among elderly in all age groups, an event which is avoidable through the adoption of preventive measures. The high rates and growing trend of fall-related deaths, as well as the aging of the Brazilian population, suggest that public policies for protecting the elderly must be prioritized.

Balance provocation tests identify near falls in healthy community adults aged 40-75 years; an observational study

BACKGROUND

Near falls, such as stumbles or slips without falling to the ground, are more common than falls and often lead to a fall.

PURPOSE

The objective of this study was to investigate which balance tests differentiate near fallers from fallers and non-fallers.

METHODS

This cross-sectional, observational study assessed balance in healthy community dwelling adults aged 40-75 years. Participants reported falls and near falls in the previous 6 months. Balance testing was completed in the local community for static (i.e. feet together and single-leg stance) and dynamic balance (i.e. tandem walk, Functional Movement Screen hurdle step and lunge). Between-group comparative analysis of pass-fail for each balance test was undertaken.

RESULTS

Of 627 participants, there were 99 fallers (15.8%), 121 near fallers (19.3%) and 407 non-fallers (64.9%). Near fallers were twice as likely as non-fallers to fail single-leg stance eyes (OR 2.7, 95% CI 1.5-4.9), five tandem steps (OR 2.5, 95% CI 1.5-5.7), hurdle step (OR 2.9, 95% CI 1.4-5.8), and lunge (OR 2.5. 95% CI 1.5-4.1). The predictive capacity differentiates near fallers with a sensitivity of 73.3%.

DISCUSSION

A new battery of tests assessing static and dynamic balance identifies near fallers in seemingly healthy, community dwelling middle- and young-older-aged adults.

Falls associated with indoor and outdoor environmental hazards among community-dwelling older adults between men and women

BACKGROUND

Hazardous environmental exposures are recognized risk factors for falls among older adults. However, the gender differences in the associations of falls with indoor and outdoor environmental hazards are scarce. This study examined the indoor and outdoor environmental risk factors for falls and compared the data for men and women among U.S. older adults using nationally representative data.

METHODS

We used the 2011 National Health and Aging Trends Study (NHATS) for a cross-sectional analysis of 6680 community-dwelling adults aged ≥65 years in the United States. A series of logistic regressions was used to identify the indoor and outdoor environmental hazards associated with falls stratified by gender after adjusting for sociodemographic, health, and behaviors. We also tested for significant interactions with gender.

RESULTS

Compared to men, women had a higher prevalence of falls. In the model adjusted for sociodemographic, health, and behavioral conditions, there were gender differences in the association of falls with the presence of indoor and outdoor environmental hazards. Gender-specific analyses showed that women with the presence of indoor environmental hazards (OR = 1.37, 95% CI = 1.04.-1.79) had higher odds of falls, whereas for men, the presence of outdoor environmental hazards (OR = 1.34, 95% CI = 1.02-1.75) was associated with falls. We also found a significant interaction term between outdoor environmental hazards and gender (OR = 0.65, 95% CI = 0.47-0.90). The interaction plot indicated that the presence of outdoor environmental hazards increased the risks of falling in men but not in women.

CONCLUSIONS

Significant gender differences exist in the association of falls with indoor and outdoor environmental hazards among older men and women. Our findings suggest that gender-tailored prevention programs to increase awareness of the environmental hazards and gender-specific environmental interventions are needed to help prevent falls.

History of Falls, Dementia, Lower Education Levels, Mobility Limitations, and Aging Are Risk Factors for Falls among the Community-Dwelling Elderly: A Cohort Study

Background: Falling is a serious issue among elderly community dwellers, often resulting in disability. We aimed to investigate the risk factors for falls among elderly community dwellers. Methods: We recruited 232 participants from multiple community learning and care centers, who provided their information through questionnaires. They were divided into two groups, according to their falling events after a 1-year follow-up. Univariate and multivariate logistic regressions were used for statistical analysis. Results: A total of 64 participants reported a fall at the 1-year follow-up. The falling group comprised older and single people with lower education levels, higher rates of dementia, a history of falls, lower scores on the Mini-Mental State Examination, and more disability functions when compared to the non-falling group (all p < 0.05). The regression model showed that a history of falls (OR: 62.011; p < 0.0001), lower education levels (OR: 4.088; p = 0.039), mild dementia (OR: 20.729; p = 0.028), older age (OR: 1.176; p < 0.0001), walking for 300 m (OR: 4.153; p = 0.030), and running for 30 m (OR: 3.402; p = 0.015) were 1-year risk factors for falls. Conclusion: A history of falling, low education levels, aging, mild dementia, and certain mobility limitations were strong risk factors for future falling accidents in elderly Taiwanese community dwellers.

Prevalence of Falls in Patients Presenting to an Ophthalmic Outpatients Department- A Surveillance Study

Introduction:

Approximately 1 in 3 adults aged 65 and over experience a fall each year. Poor vision is an identified risk factor. The aim of this cross-sectional public health surveillance audit was to determine the prevalence of falls experienced in the previous 12 months by adult patients presenting to an ophthalmology department.

Methods:

A short questionnaire was given to consecutive patients attending an ophthalmology department at two trusts in the North West to determine whether they had experienced a fall in the previous 12 months, whether they had suffered a fracture, their eye condition and the type of glasses worn.

Results:

Data was collected for 585 patients (mean age: 69 years, SD: 13.8). Falls in the previous 12 months were reported by 96 (16.4%) patients, and a significant proportion of these were aged 60 years and over (82%, p < 0.0001, one-sample binomial test). Half of the respondents were unaware of their eye health condition for which they were attending the department. Glaucoma was the most prevalent condition in those who had experienced a fall (43%). A significant proportion of the individuals who reported a fall wore single-vision glasses (43%, p < 0.0001, one-sample chi-square test).

Conclusion:

In an ophthalmology outpatient department, the proportion of older adults who experienced a fall in the previous 12 months was lower than the reported prevalence in the general population. There is a need for health literacy to educate patients about their eye condition, the potential effects on their visual function and, consequently, managing falls risk.

Executive-function tasks in patients with mild cognitive impairment and Alzheimer's Disease: Effects of decline and gender

It is exceedingly rare to find studies that analyze the effect of gender differences in executive-function tasks in normal cognitive aging, Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD). The objective of the present study was to analyze the mean differences in performance in four executive-function tasks, the Clock Drawing Test verbal-command, Clock Drawing Test-copy, Phonetic Fluency Test and Trail Making Test-A, according to the gender and impairment group variables. A total of 90 participants (30 patients with Alzheimer's Disease, 30 patients with Mild Cognitive Impairment, and 30 healthy elderly participants; 50% men and 50% women in each group) took part in the study. As expected, the results showed a main effect of the group in most tasks, with a progressively worse performance according to cognitive impairment. Regarding the effect of gender, there were no significant differences in the Mild Cognitive Impairment and healthy elderly groups, but a significantly higher performance of women compared to men was found in the Alzheimer's group. The clinical and theoretical implications of these results are discussed. In particular, the abnormal performance of women with Alzheimer's in the sample may be related to a possible cognitive reserve due to social and educational background in their sociocultural and generational context.

Predictors for functional decline after an injurious fall: a population-based cohort study

Background

The functional consequences of injurious falls are well known. However, studies of the factors that can modify trajectories of disability after an injury from a fall are scarce.

Aims

We aimed to investigate whether sociodemographic and health-related factors may impact this association.

Methods

The study population consisted of 1426 community-dwelling older adults (≥ 60 years) from the SNAC-K cohort study in Stockholm, Sweden. Functional status over 12 years of follow-up was assessed using the number of limitations in basic and instrumental activities of daily living. Sex, cohabitation status, physical activity, and self-rated health were assessed at baseline. Injurious falls were defined as falls requiring healthcare and were assessed over 3 years starting at baseline. Data were analyzed using linear-mixed effects models.

Results

The fastest increase in the number of disabilities was observed in those who had endured an injurious fall and were living alone (β coefficient = 0.408; p < 0.001), been physically inactive (β coefficient = 0.587; p < 0.001), and had poor self-rated health (β coefficient = 0.514; p < 0.001). The negative impact of these factors was more pronounced among fallers compared to non-fallers.

Discussion

Living alone, being physically inactive, and having poor self-rated health magnifies the negative effect of an injurious fall on functional status. Among individuals who endure an injurious fall, the heterogeneity in long-term functional status is substantial, depending on the individuals’ characteristics and behaviors.

Conclusions

These findings emphasize the need for a person-centered approach in care provision and can guide secondary prevention within health care.

Electronic supplementary material

The online version of this article (10.1007/s40520-020-01747-1) contains supplementary material, which is available to authorized users.