Fear of Falling among Older Patients Admitted to Hospital after Falls in Vietnam: Prevalence, Associated Factors and Correlation with Impaired Health-Related Quality of Life

The global prevalence of and risk factors for fear of falling among older adults: a systematic review and meta-analysis

BACKGROUND

As a common psychological problem among older adults, fear of falling was found to have a wide range prevalence in different studies. However, the global prevalence of it was unknown and a lack of the large sample confirmed its risk factors.

OBJECTIVES

To report the global prevalence of fear of falling and to explore its risk factors among older adults for further developing precise interventions to systematically manage FOF.

DESIGN

A systematic review and meta-analysis was conducted by PRISMA guidelines.

METHODS

Searches were conducted in PubMed, Web of Science, EMBASE, the Cochrane Library and the manual search in August 20, 2022, updated to September 2, 2023. Observational studies published in English were included and two researchers independently screened and extracted the data. Fixed or random effects mode was used to estimate the pooled prevalence of and risk factors for fear of falling. Heterogeneity resources were analyzed by subgroup and sensitivity analysis. Publication bias was assessed through funnel plots, Egger's test and Begg's test.

RESULTS

A total of the 153 studies with 200,033 participants from 38 countries worldwide were identified. The global prevalence of fear of falling was 49.60%, ranging from 6.96-90.34%. Subgroup analysis found the estimates pooled prevalence of it was higher in developing countries (53.40%) than in developed countries (46.7%), and higher in patients (52.20%) than in community residents (48.40%). In addition, twenty-eight risk factors were found a significant associations with fear of falling, mainly including demographic characteristics, physical function, chronic diseases and mental problems.

CONCLUSION

The global prevalence of FOF was high, especially in developing countries and in patients. Demographic characteristics, Physical function, chronic diseases and mental problems were a significant association with FOF. Policy-makers, health care providers and government officials should comprehensively evaluate these risk factors and formulate precise intervention measures to reduce FOF.

TRIAL REGISTRATION

The study was registered in the International Database of Prospectively Registered Systematic Reviews (PROSPERO): CRD42022358031.

Fear of falling and associated factors among older adults in Southeast Asia: a systematic review

OBJECTIVES

The aim of this study was to provide a comprehensive overview of the prevalence, measurement scales, related factors and interventions for fear of falling (FOF) among older adults in Southeast Asia.

STUDY DESIGN

This was a systematic review.

METHODS

Published research studies on FOF among older adults were searched using the following databases: PubMed, Cochrane Library, Scopus, ASEAN Citation Index, Thai Journal Citation Index, Malaysian Journal Citation Report and Google Scholar. All observational and experimental studies investigating FOF among community-dwelling older adults in Southeast Asia were eligible. A narrative synthesis was used to describe the findings. The Joanna Briggs Institute checklist was used to assess the quality and risk of bias of the included studies.

RESULTS

A total of 15 observational studies and three experimental studies were included after screening 2112 titles and abstracts. These studies, published between 2011 and 2021, were conducted in Malaysia, Singapore, Thailand and Vietnam. The FOF prevalence ranged from 21.6% to 88.2%. The most commonly used FOF assessment tool was the Falls Efficacy Scale-International. Well-reported related factors of FOF were female sex, advanced age, balance impairment and fall history. All experimental studies utilising single- or multi-component interventions comprised an exercise approach. Limited studies have considered environmental factors.

CONCLUSIONS

Various related factors of FOF and the interventions implemented were revealed. Public health researchers and policymakers should consider the factors related to FOF in practical FOF intervention and prevention strategies. Further evidence on FOF issues is required to understand the multidimensional characteristics of FOF, specifically the environmental aspects of older adults in Southeast Asia.

Balance Confidence and Balance Performance, But Not Fall History Are Associated With Quality of Life in Community-Dwelling Older Adults: A Cross Sectional Study

BACKGROUND AND PURPOSE

Fear of falling (FoF) is highly prevalent in community-dwelling older adults and is associated with low health-related quality of life (QoL). Low QoL is associated with increased health care utilization and is a predictor of future falls, but few studies have examined the relationship between high-level balance and dynamic gait performance and QoL in community-dwelling older adults. The purpose of this cross-sectional study was to determine whether there is a relationship between FoF avoidance behaviors, balance confidence, performance on measures of high-level mobility, and QoL in community-dwelling older adults. The secondary purpose was to determine whether older adults who fall have a different QoL than older adults who have not fallen in the past year.

METHODS

Eighty-nine community-dwelling older adults (76.33 ± 6.84 years, 54 female, 34 fallers) completed the World Health Organization Quality of Life-BREF (WHOQOL-BREF), Activities-specific Balance Confidence Scale (ABC), Fear of Falling Avoidance Behavior Questionnaire (FFABQ), Functional Gait Assessment (FGA), and Community Balance and Mobility Scale (CB&M). Correlation and multiple regression analyses were calculated to determine the relationship between the outcome measures and domains on the WHOQOL-BREF.

RESULTS AND DISCUSSION

Significant correlations were observed between the WHOQOL-BREF physical health domain and the ABC, FFABQ, FGA, and CB&M (ρ= 0.524, -0.509, 0.348, and r = 0.423, respectively), the WHOQOL-BREF psychological domain and the ABC (ρ= 0.284) and FFABQ (ρ=-0.384), and the WHOQOL-BREF environment domain and the ABC (ρ= 0.343) and FFABQ (ρ=-0.406). No correlations were found between WHOQOL-BREF domain scores and a history of falls.

CONCLUSIONS

Performance-based outcome measures that measure high-level mobility such as the CB&M and FGA, and patient-reported outcome measures for balance confidence and FoF avoidance behavior such as the ABC and FFABQ, are correlated with the physical health QoL domain on the WHOQOL-BREF. The ABC and FFABQ are correlated with psychological and environment QoL. Fall history was not correlated with QoL. Interventions to decrease FoF or improve high-level mobility may improve QoL in community-dwelling older adults.

Determination of the Fear of COVID-19 and the Quality of Life of Patients With Transcatheter Aortic Valve Implants During the Pandemic

This study aimed to determine the fear of COVID-19 and the quality of life of patients with transcatheter aortic valve implantation (TAVI) during the pandemic. This descriptive cross-sectional study included 132 TAVI patients. Data were collected using a patient information form, the Fear of COVID-19 Scale (FCV-19S), and the EuroQol-5 Dimension (EQ-5D). The mean FCV-19S score of the patients was 17.37 ± 6.12. The mean EQ-5D index score was 0.56 ± 0.37 and the mean VAS score was 65.5 ± 11.5. As per the dimensions of the EQ-5D index, 75% of the patients had mobility problems. According to the logistic regression analysis results, mobility was the most affected parameter, as demonstrated by the worsening in symptoms during the pandemic (odds ratio: 7.370, 95% CI [2.183, 24.881]). The patients with TAVI had a moderate level of fear associated with COVID-19, and the pandemic negatively affected their quality of life.

Adult Inpatients’ Perceptions of Their Fall Risk: A Scoping Review

Patient falls in hospitals continue to be a global concern due to the poor health outcomes and costs that can occur. A large number of falls in hospitals are unwitnessed and mostly occur due to patient behaviours and not seeking assistance. Understanding these patient behaviours may help to direct fall prevention strategies, with evidence suggesting the need to integrate patients’ perspectives into fall management. The aim of this scoping review was to explore the extent of the literature about patients’ perceptions and experiences of their fall risk in hospital and/or of falling in hospital. This review was conducted using a five-stage methodological framework recommended by Arksey and O’Malley. A total of nine databases were searched using key search terms such as “fall*”, “perception” and “hospital.” International peer-reviewed and grey literature were searched between the years 2011 and 2021. A total of 41 articles, ranging in study design, met the inclusion criteria. After reporting on the article demographics and fall perception constructs and measures, the qualitative and quantitative findings were organised into five domains: Fall Risk Perception Measures, Patients’ Perceptions of Fall Risk, Patients’ Perceptions of Falling in Hospital, Patients’ Fear of Falling and Barriers to Fall Prevention in Hospital. Approximately two-thirds of study participants did not accurately identify their fall risk compared to that defined by a health professional. This demonstrates the importance of partnering with patients and obtaining their insights on their perceived fall risk, as this may help to inform fall management and care. This review identified further areas for research that may help to inform fall prevention in a hospital setting, including the need for further research into fall risk perception measures.

Special Issue on "Advances in Socio-Economic Research on Ageing"

This Special Issue provides the readers of the International Journal of Environmental Research and Public Health a multidimensional overview of recent developments in the field of socio-economic gerontological research [...].

An Agile Digital Platform to Support Population Health-A Case Study of a Digital Platform to Support Patients with Delirium Using IoT, NLP, and AI

For an organization to be customer centric and service oriented requires that it use each encounter with a customer to create value, leverage advanced technologies to design digital services to fulfill the value, and assess perceived value-in-use to continue to revise the value as customer expectations evolve. The adaptation of value cycles to address the rapid changes in customer expectations requires agile digital platforms with dynamic software ecosystems interacting with multiple actors. For public health agencies focused on population health, these agile digital platforms should provide tailored care to address the distinct needs of select population groups. Using prior research on aging and dynamic software ecosystems, this paper develops a template for the design of an agile digital platform to support value cycle activities among clinical and non-clinical actors, including population groups. It illustrates the design of an agile digital platform to support clients that suffer from delirium, using digital services that leverage Internet of Things, natural language processing, and AI that uses real-time data for learning and care adaption. We conclude the paper with directions for future research.

Falls risk score removal does not impact inpatient falls: A stepped-wedge, cluster-randomised trial

AIMS AND OBJECTIVES

To investigate the impact of removing a falls risk screening tool from an overall falls risk assessment programme on the rate of falls, injurious falls and completion of falls prevention activities by staff.

BACKGROUND

Falls in older patients are common adverse events in hospital settings. Screening and assessing individual patients for risk of falls are a common, but controversial element of falls prevention strategies in hospitals.

DESIGN

A stepped-wedge, cluster-randomised controlled trial using a disinvestment approach.

METHODS

This trial was carried out according to the Consolidated Standards of Reporting Trials (CONSORT). All patients were admitted to 20 health service wards (9 units) over the 10-month study period. The control condition contained a falls risk screening tool element, a full falls risk factor assessment and intervention provision section. In the intervention condition, only the full falls risk factor assessment and intervention provision section was applied, and the falls risk screening tool element was removed. Fall rates were extracted from hospital level data, files were audited for tool completion, and nurses surveyed about tool use.

RESULTS

There did not appear to be an impact on the falls rate per month when the risk screening tool component was removed (incidence rate ratio (IRR) = 0.84-favours intervention, 95%CI = 0.67 to 1.05, p = .14) nor on the falls rate with serious injury (IRR = 0.90, 95%CI = 0.26 to 3.09, p = .87). There was a thirty-six second reduction of time per patient reported by staff to complete paperwork (p < .001). There was no difference in the proportion of patients for whom the tool was completed, nor the number of falls prevention interventions identified for implementation.

CONCLUSION

Removing the falls risk screening tool section did not negatively impact falls and reduced time spent completing falls prevention paperwork.

RELEVANCE TO CLINICAL PRACTICE

Falls prevention is an important issue in health services. Removal of a screening risk tool is unlikely to impact falls. This has the potential to reduce nursing administration time that may be otherwise redirected to individual approaches to falls prevention.

Impact of Nurses' Intervention in the Prevention of Falls in Hospitalized Patients

Background: Clinical safety is a crucial component of healthcare quality, focused on identifying and avoiding the risks to which patients are exposed. Among the adverse events that occur in a hospital environment, falls have a large impact (1.9–10% of annual income in acute care hospitals); they can cause pain, damage, costs, and mistrust in the health system. Our objective was to assess the effect of an educational intervention aimed at hospital nurses (systematic assessment of the risk of falls) in reducing the incidence of falls. Methods: this was a quasi-experimental study based on a sample of 581 patients in a third level hospital (Comunitat Valenciana, Spain). An educational program was given to the intervention group (n = 303), and a control group was included for comparison (n = 278). In the intervention group, the nurses participated in a training activity on the systematized assessment of the risk of falls. Analysis was undertaken using the Bayesian logistic regression model. Results: a total of 581 patients were studied (50.6% male, 49.4% female), with an average age of 68.3 (DT = 9) years. The overall incidence of falls was 1.2% (0.3% in the intervention group and 2.2% in the control group). Most of the falls occurred in people ≥65 years old (85.7%). The intervention group had a lower probability of falling than the control group (OR: 0.127; IC95%: 0.013–0.821). Neither the length of hospital stay, nor the age of the participants, had any relevant effect. Conclusions: the systematic assessment of the risk of a patient falling during hospital processes is an effective intervention to reduce the incidence of falls.