Risk factors of falls in elderly patients with visual impairment

Associations between type 2 diabetes mellitus and risk of falls among community-dwelling elderly people in Guangzhou, China: a prospective cohort study

BACKGROUND

Several studies have demonstrated that older adults with type 2 diabetes mellitus (T2DM) have a higher risk of falls compared to those without T2DM, which may lead to disability and a lower quality of life. While, limited prospective studies have quantified the associations in southern China. We conducted a longitudinal cohort study to quantify the associations between T2DM and falls and investigate the risk factors of falls among community-dwelling elderly people in Guangzhou, China.

METHODS

The population-based study included 8800 residents aged 65 and over in 11 counties of Guangzhou at baseline in 2020 and then prospectively followed up through 2022. Of 6169 participants had complete follow-up and were included in the present study. A fall event was identified by self-reported. The Cox regression was applied to quantify the associations between T2DM and falls, and hazard ratios (HRs) were calculated to the factors associated with falls among participants.

RESULTS

The median follow-up time for participants was 2.42 years. During the follow-up period, the incidence of falls among all participants was 21.96%. After adjusting for covariates in Cox regression models, T2DM remained a significant risk factor for falls, with HR of 1.781 (95% CI: 1.600-1.983) in the unadjusted covariates model and 1.757 (1.577-1.957) in the adjusted covariates model. Female (1.286, 1.136-1.457), older age (≥ 80: 1.448, 1.214-1.729), single marital status (1.239, 1.039-1.477), lower education level (primary school and below: 1.619, 1.004-1.361), hypertension (1.149, 1.026-1.286) and stroke (1.619, 1.176-2.228) were associated with a higher risk of falls, whereas everyday physical exercise (0.793, 0.686-0.918) was associated with a lower risk of falls.

CONCLUSION

Falls are common, with risks between T2DM and falls quantified and several factors investigated in the longitudinal cohort study among community-dwelling elderly people in Guangzhou, China. Targeted action on the risk factors may reduce the burden of falls in elderly people with T2DM in the future.

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

INTRODUCTION

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

METHODS AND MATERIALS

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

RESULT

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

CONCLUSION

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

Awareness About Fall Risk and Measures of Fall Prevention Among Older Adults in Buraidah, Saudi Arabia

Background Falls, particularly common among the elderly, pose significant health risks and mortality rates worldwide. Factors such as decline related to old age, gender, medical conditions, and environmental hazards contribute to falls. Prevention strategies focus on environmental modifications, exercise programs, medication reviews, and vitamin D supplementation to reduce fall risks and improve outcomes. This study aims to investigate the awareness of fall risk and measures of fall prevention among older adults in Buraidah, Qassim, Saudi Arabia, and examines the relationship between the level of awareness and various sociodemographic factors. Methodology This cross-sectional study was conducted among elderly patients at primary healthcare centers in Buraidah, Qassim province, Saudi Arabia. Data were collected via an interviewer-administered questionnaire assessing awareness and prevention of falls. Data were cleaned in Excel (Microsoft Corp., Redmond, WA, USA) and analyzed using SPSS version 29 (IBM Corp., Armonk, NY, USA). A linear regression model was used to determine the association. Statistical significance was established at a p-value of 0.05 or lower. Results Our study included 280 elderly participants, of whom 58.2% were female. The mean age was 63.7 years (SD = 4.9), and 34.6% had a bachelor's degree. Regarding fall awareness, 81.4% acknowledged preventability. Notable preventive measures included medication reviews (64.6%), eye examinations (85.7%), physical activity (82.2%), vitamin D supplementation (76.8%), and home safety devices (97.5%). Regarding fall prevention, 61.8% underwent medical examinations annually, and 65.4% had vision checkups. Higher awareness about fall risks was associated with female gender (β = 1.394, 95% confidence interval (CI) = 0.199 to 2.589, p = 0.022), higher education (β = 0.931, 95% CI = 0.549 to 1.314, p < 0.001), and chronic diseases (β = -1.935, 95% CI = -3.313 to -0.556, p = 0.006). Conclusions Our study demonstrates significant awareness among elderly participants regarding fall preventability and measures. Females and those with higher education levels had higher levels of awareness. These findings highlight the importance of targeted interventions to increase awareness and preventive measures among elderly populations.

Prevalence and risk factors for falls among older Chinese adults in the community: findings from the CLHLS study

Older adults have a high prevalence of falls due to a decline in physiological functions and various chronic diseases. This study aimed to investigate the prevalence of and risk factors for falls among older individuals in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We collected information from 9737 older individuals (average age=84.26 years) from the CLHLS and used binary logistic regression analysis to explore the independent risk factors and protective factors for falls. The logistic regression analysis results are reported as adjusted odds ratios (aORs) and 95% confidence intervals (95%CIs). The prevalence of falls among older adults in China was 21.6%, with women (24.6%) having a higher prevalence than men (18.1%). Logistic regression analysis revealed that never (or rarely) eating fresh fruit, difficulty with hearing, cataracts, and arthritis were the common independent risk factors for falls in older Chinese men and women. Among men, age ≥80 years (aOR=1.86), never doing housework (aOR=1.36), and dyslipidemia (aOR=1.47) were risk factors, while eating milk products once a week was a protective factor. Alcohol consumption (aOR=1.40), physical labor (aOR=1.28), and heart disease (aOR=1.21) were risk factors for falls in women, while a daily sleep duration of 6-12 h and garlic consumption once a week were protective factors. The prevalence of falls among older adults in China is 21.6% and is greater in women than in men. These risk and protective factors can be used to formulate reasonable recommendations for living habits, diet, and chronic disease control strategies.

Validating the accuracy of the Hendrich II Fall Risk Model for hospitalized patients using the ROC curve analysis

This retrospective study was conducted at a medical center in southern Taiwan to assess the accuracy of the Hendrich II Fall Risk Model (HIIFRM) in predicting falls. Sensitivity, specificity, accuracy, and optimal cutoff points were analyzed using receiver operating characteristic (ROC) curves. Data analysis was conducted using information from the electronic medical record and patient safety reporting systems, capturing 303 fall events and 47,146 non-fall events. Results revealed that at the standard threshold of HIIFRM score ≥5, the median score in the fall group was significantly higher than in the non-fall group. The top three units with HIIFRM scores exceeding 5 were the internal medicine (50.6%), surgical (26.5%), and oncology wards (14.1%), indicating a higher risk of falls in these areas. ROC analysis showed an HIIFRM sensitivity of 29.5% and specificity of 86.3%. The area under the curve (AUC) was 0.57, indicating limited discriminative ability in predicting falls. At a lower cutoff score (≥2), the AUC was 0.75 (95% confidence interval: 0.666-0.706; p < 0.0001), suggesting acceptable discriminative ability in predicting falls, with an additional identification of 101 fall events. This study emphasizes the importance of selecting an appropriate cutoff score when using the HIIFRM as a fall risk assessment tool. The findings have implications for fall prevention strategies and patient care in clinical settings, potentially leading to improved outcomes and patient safety.

Physical activity and sport practice to improve balance control of visually impaired individuals: a narrative review with future perspectives

Visual disability negatively impacts balance, everyday self-efficacy, and mobility and often leads affected subjects to perceive physical exercise as a burdensome challenge thus discouraging them from practicing. Despite the well-proven benefits of regular physical activity in visually impaired people, especially addressing postural control, there are no specific guidelines and most of the available literature seems to be flawed by critical issues. Given the wide heterogeneity and the multidimensional needs of this population, a more realistic and target-specific perspective is needed in order to properly investigate and promote exercise practice and adherence for balance improvement. On this basis, through a critical overview of the recent literature, the present article aimed to enrich the current knowledge about this topic by providing innovative suggestions, both practical and methodological, and specifically deepening the disability-related deficits and peculiarities of different age ranges. Moreover, since a multidisciplinary approach is advisable when designing and leading exercise protocols tailored to visually impaired individuals, such innovative hints also highlighted the central role of the adapted physical activity specialist, hence contributing to foster its official professional recognition and involvement in this field.

Risk factors for falls among community-dwelling older adults: A systematic review and meta-analysis

Background and objective

The prevalence of falls among older adults living in the community is ~30% each year. The impacts of falls are not only confined to the individual but also affect families and the community. Injury from a fall also imposes a heavy financial burden on patients and their families. Currently, there are different reports on the risk factors for falls among older adults in the community. A retrospective analysis was used in this study to identify risk factors for falls in community-dwelling older adults. This research aimed to collect published studies to find risk factors for falls in community-dwelling older adults.

Methods

We searched for literature from the founding of PubMed, EMBASE, the Cochrane Library, the Web of Science, the China National Knowledge Infrastructure (CNKI), the China Science and Technology Periodicals Database (VIP), and the Wanfang database until September 2022. The studies were selected using inclusion and exclusion criteria. We collected information from relevant studies to compare the impact of potential risk factors such as age, female gender, fear of falling, history of falls, unclear vision, depression, and balance disorder on falls among community-dwelling older adults.

Results

A total of 31 studies were included with 70,868 community seniors. A significant risk factor for falls in the community of older adults was dementia (2.01, 95% CI: 1.41-2.86), age (1.15, 95% CI: 1.09-1.22), female gender (1.52, 95% CI: 1.27-1.81), fear of falling (2.82, 95% CI: 1.68-4.74), history of falls (3.22, 95% CI: 1.98-5.23), vision unclear (1.56, 95% CI: 1.29-1.89), depression (1.23, 95% CI: 1.10-1.37), and balance disorder (3.00, 95% CI: 2.05-4.39).

Conclusion

This study provides preliminary evidence that falls among community-dwelling older adults are associated with factors such as age, female gender, fear of falling, history of falls, unclear vision, depression, and balance disorders. The results of this research may help improve clinician awareness, risk stratification, and fall prevention among community-dwelling older adults.

Systematic review registration

identifier INPLASY2022120080.