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Santana Muñoz D, Lorca Navarro M, Araya Orellana E, Moscoso Aguayo P, Martínez Huenchullán S. [Effect of training with immersive virtual reality on the risk of falling in the elderly: a systematic review]. Rehabilitacion (Madr) 2024; 58:100857. [PMID: 38788265 DOI: 10.1016/j.rh.2024.100857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/16/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024]
Abstract
Aging entails changes in the human body, generating a decrease in physical capabilities, including the risk of falls. New therapies are currently emerging for the risk of falls and immersive virtual reality is one of them, giving the user a realistic feeling of a virtual environment. This systematic review aims to investigate the effects of immersive virtual reality on the risk of falling in older people. Randomized controlled clinical trials were included, with at least one intervention group that used immersive virtual reality, age >60 years and without multiple serious pathologies. Articles published until November 2023 were included, in accordance with the PRISMA guideline and including the PICO strategy, in the electronic databases PubMed, Scielo, Scopus, Semantic Scholar and Science Direct. From a total of 413 articles, 7 studies were selected, which met the pre-established inclusion and exclusion criteria. Of the studies reviewed, the majority found significant improvements in tests that measure risk of falls, only one study did not find improvements in this variable but did find improvements for walking speed and functional reach test. Despite the limited literature, it seems that these interventions can have a positive effect, becoming a good tool to reduce the risk of falling in older people.
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Affiliation(s)
- D Santana Muñoz
- Escuela de Kinesiología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - M Lorca Navarro
- Instituto de Aparato Locomotor y Rehabilitación, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.
| | - E Araya Orellana
- Escuela de Terapia Ocupacional, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Valdivia, Chile
| | - P Moscoso Aguayo
- Instituto de Aparato Locomotor y Rehabilitación, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - S Martínez Huenchullán
- Instituto de Aparato Locomotor y Rehabilitación, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
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Zhou M, Zhang G, Wang N, Zhao T, Liu Y, Geng Y, Zhang J, Wang N, Peng N, Huang L. A novel score for predicting falls in community-dwelling older people: a derivation and validation study. BMC Geriatr 2024; 24:491. [PMID: 38834944 DOI: 10.1186/s12877-024-05064-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/09/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Early detection of patients at risk of falling is crucial. This study was designed to develop and internally validate a novel risk score to classify patients at risk of falls. METHODS A total of 334 older people from a fall clinic in a medical center were selected. Least absolute shrinkage and selection operator (LASSO) regression was used to minimize the potential concatenation of variables measured from the same patient and the overfitting of variables. A logistic regression model for 1-year fall prediction was developed for the entire dataset using newly identified relevant variables. Model performance was evaluated using the bootstrap method, which included measures of overall predictive performance, discrimination, and calibration. To streamline the assessment process, a scoring system for predicting 1-year fall risk was created. RESULTS We developed a new model for predicting 1-year falls, which included the FRQ-Q1, FRQ-Q3, and single-leg standing time (left foot). After internal validation, the model showed good discrimination (C statistic, 0.803 [95% CI 0.749-0.857]) and overall accuracy (Brier score, 0.146). Compared to another model that used the total FRQ score instead, the new model showed better continuous net reclassification improvement (NRI) [0.468 (0.314-0.622), P < 0.01], categorical NRI [0.507 (0.291-0.724), P < 0.01; cutoff: 0.200-0.800], and integrated discrimination [0.205 (0.147-0.262), P < 0.01]. The variables in the new model were subsequently incorporated into a risk score. The discriminatory ability of the scoring system was similar (C statistic, 0.809; 95% CI, 0.756-0.861; optimism-corrected C statistic, 0.808) to that of the logistic regression model at internal bootstrap validation. CONCLUSIONS This study resulted in the development and internal verification of a scoring system to classify 334 patients at risk for falls. The newly developed score demonstrated greater accuracy in predicting falls in elderly people than did the Timed Up and Go test and the 30-Second Chair Sit-Stand test. Additionally, the scale demonstrated superior clinical validity for identifying fall risk.
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Affiliation(s)
- Ming Zhou
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Gongzi Zhang
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Na Wang
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Tianshu Zhao
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Yangxiaoxue Liu
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Yuhan Geng
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Jiali Zhang
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Ning Wang
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Nan Peng
- Department of Rehabilitation Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
| | - Liping Huang
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
- Department of Rehabilitation Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
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Song H, Wei Y, Wang Y, Zhang J. The mediating effect of nutrition on oral frailty and fall risk in community-dwelling elderly people. BMC Geriatr 2024; 24:273. [PMID: 38504156 PMCID: PMC10953286 DOI: 10.1186/s12877-024-04889-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Population aging is accelerating, particularly in Asian countries. Falls are the leading cause of unintentional injuries in the elderly over 60 years old in China. Hence, it is crucial to anticipate the risk factors associated with fall risk. We aimed to explore whether oral frailty and fall risk were reciprocally related and whether nutrition mediated their association. METHODS From October 2022 to March 2023, a total of 409 elderly individuals from the Yangzhou community were selected using the convenience sampling method. Cross-sectional data on older adults' oral frailty, nutrition, and fall risk were collected using questionnaires. Data analysis was performed using SPSS 27.0 and PROCESS macro. RESULTS The fall risk score was 1.0 (ranging from 0 to 4.0), with 107 cases (26.2%) identified as being at risk of falling. Spearman correlation analysis revealed a positive correlation between oral frailty and the risk of falls (rs = 0.430, P < 0.01). Nutrition was found to have a negative correlation with both oral frailty and fall risk (rs=-0.519、-0.457, P < 0.01). When controlling for covariates, it was observed that nutrition mediated the relationship between oral frailty and falls. The mediating effect value accounted for 48.8% of the total effect (P < 0.01). CONCLUSIONS Oral frailty was significantly associated with fall risk, and nutrition might be a mediating factor for adverse effects of oral frailty and fall risk. Enhancing the nutrition of older individuals is a vital approach to mitigating fall risk among those with oral frailty.
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Affiliation(s)
- Huizi Song
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yulian Wei
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, Jiangsu, China
- Taizhou People's Hospital, Jiangsu, Taizhou, China
| | - Yan Wang
- Department of Geriatrics, Northern Jiangsu Peoples Hospital, Yangzhou, Jiangsu Province, China
| | - Jiahui Zhang
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, Jiangsu, China.
- Department of Geriatrics, Northern Jiangsu Peoples Hospital, Yangzhou, Jiangsu Province, China.
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Hu XX, Yang XG, Wang X, Ma X, Geng X. The influence of diabetes and age-related degeneration on body balance control during static standing: a study based on plantar center-of-pressure trajectories and principal component analysis. J Orthop Surg Res 2023; 18:740. [PMID: 37775789 PMCID: PMC10542244 DOI: 10.1186/s13018-023-04129-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/23/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Aging and diabetes can impair the balance function of the elderly and diabetic patients and increase their fall risk. This study aimed to assess the shaking amplitude of the center-of-pressure (CoP) during static standing, to analyze the effects of aging and diabetes on the balance control. MATERIALS AND METHODS This cross-sectional observational study, compared the balance performance of 20 healthy younger adults (27.65 ± 5.60 years), 16 healthy older adults (58.88 ± 3.54 years) and 15 diabetic patients (58.33 ± 5.33 years) in four static standing conditions on a force plate: horizontal, anteroposterior (AP), left and right slope planes (5° angles on AP, left and right directions, respectively). The trajectory coordinates of the CoP over time were recorded and analyzed by principal components analysis to obtain the 95% confidence ellipse and its parameters: angle, major and minor axes lengths, and area. The balance indicators were compared among the three groups using one-way analysis of variance (ANOVA), Brown-Forsythe test or Kruskal-Wallis H test, depending on the normality and homogeneity of variance assumptions. RESULTS The diabetic group had a significantly larger confidence ellipse area than the healthy younger adults on the horizontal plane (P = 0.032) and than the healthy older adults on the horizontal (P = 0.036), AP slope (P = 0.023), and right ML slope (P = 0.037) planes. There were no significant differences in the major axis length of the confidence ellipse among the three groups. The diabetic group had a significantly longer minor axis length than the healthy younger adults on the AP slope (P = 0.039), left ML slope (P = 0.045) and right ML slope (P = 0.016) planes and than the healthy older adults on the AP slope (P = 0.007), left ML slope (P = 0.035) and right ML slope (P = 0.012) planes. CONCLUSIONS The balance control of diabetic patients is decreased compared with healthy younger and older people, and the body swing amplitude increases mainly in the direction of minor axis of confidence ellipse during static standing, while the swing amplitude in the direction of the major axis has no significant change. Evaluating the balance function of diabetic patients can help clinicians identify people with fall risk early and intervene early, thereby reducing the occurrence of fall events in this population.
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Affiliation(s)
- Xing-Xi Hu
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Xiong-Gang Yang
- Department of Orthopaedics, The First People's Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, China
- Yunnan Key Laboratory of Digital Orthopaedics, Kunming, 650032, China
| | - Xu Wang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Xin Ma
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China.
| | - Xiang Geng
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China.
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Akyurek G, Bilgin N, Kocademir FN, Aslan S, Turk AB. Development of the home environment risk rating scale and investigation of the psychometric properties in the elderly and adult individuals. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-10. [PMID: 37361307 PMCID: PMC10030343 DOI: 10.1007/s10389-023-01885-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/03/2023] [Indexed: 03/24/2023]
Abstract
Aim To reduce home accidents, which is one of the critical public health problems, it is necessary to evaluate the home environment first. The aim of this study was to develop the Home Environment Risk Rating Scale (HERRS) and examine its psychometric properties in elderly and adult individuals. Subject and methods This study was conducted on 220 elderly and adult individuals (63.68±10.31 years old, 68.2% female, 31.8% male) living in their homes. The participants completed the Sociodemographic Information Form, Home Environment Conditions Evaluation Form for Falls, and Home and Environment Risk Rating Scale. In addition, psychometric measurement results for horizontal and vertical measurements were analyzed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) methods. Results It was found that the Kaiser-Mayer-Olkin (KMO) value for horizontal and vertical measurements were 0.613 and 0.704, respectively. Results of EFA for horizontal and vertical measurements revealed that five factors together explain 72.033% and three factors together explain 68.368% of the total variance, respectively. The result of CFA for horizontal and vertical measurements demonstrate that the 5-sub-dimension horizontal scale structure and the 3-sub-dimension vertical measurement structure generally fit acceptable in this scale. Cronbach's alpha was satisfactory in all of the measurements (0.73 and 0.80 respectively); the ICCs were good/excellent in all of the measurements (0.99 and 0.90, respectively). Conclusion The results show that HERRS has the potential to examine the risks of the home environment adequately for the home structure of Turkish society in detail and is a valid and reliable test that health professionals can use. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-023-01885-6.
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Affiliation(s)
- Gokcen Akyurek
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Samanpazari/ Altindag, 06100 Ankara, Turkey
| | - Nurten Bilgin
- Department of Physical Therapy and Rehabilitation, Kayseri City Hospital, Kayseri, Turkey
| | | | - Sultan Aslan
- Department of Physical Therapy and Rehabilitation, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Ayşe Betul Turk
- Department of Physical Therapy and Rehabilitation, Ankara City Hospital, Ankara, Turkey
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Pereira CB, Kanashiro AMK. Falls in older adults: a practical approach. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:313-323. [PMID: 35976297 PMCID: PMC9491436 DOI: 10.1590/0004-282x-anp-2022-s107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Falls are a major problem in public health since they are an important cause of morbidity and mortality. To evaluate the risk of fall and prescribe preventive interventions may be a challenging task. OBJECTIVES The objectives of this study are to summarize the most relevant information on the topic "falls in the elderly" and to give a critical view and practical clinical approach on this topic. METHODS In March 2022, a search of Pubmed database was performed, using the terms "fall elderly", fall prevention", "fall risk", with the following parameters: five years, review, systematic review, meta-analysis, practice guidelines. RESULTS There are several risk factors for falls that can be grouped in different areas (psychosocial, demographic, medical, medication, behavioral, environmental). The clinical evaluation of an older adult prone to falls must include identification of risk factors through history and examination and identification of risk of falls through an assessment tool such as gait velocity, functional reach test, timed up and go, Berg balance test, and miniBEST test. Fall prevention strategies can be single or multiple, and physical activity is the most cited. Technology can be used to detect and prevent falls. CONCLUSION A systematic approach to the older patient in risk of falls is feasible and may impact fall prevention.
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Affiliation(s)
- Cristiana Borges Pereira
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil
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Fragility fracture following total hip arthroplasty. J Orthop Sci 2022; 27:402-407. [PMID: 33536142 DOI: 10.1016/j.jos.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 12/03/2020] [Accepted: 12/16/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND While periprosthetic fractures following total hip arthroplasty (THA) are a well-known phenomenon for orthopedic surgeons, fragility fractures following THA are also a significant, though less studied, concern. Furthermore, patients who have undergone THA have several additional risk factors for fragility fractures, including motor weakness, bone atrophy, and limping. The aims of this study were to evaluate the incidence of fragility fractures following THA and to clarify the characteristics of these fractures. METHODS This study included 5678 primary THA procedures in 4589 female patients. This study evaluated body morphology data, disease type leading to THA, Japanese Orthopaedic Association hip score, range of motion of the hip joint, and medical history. Distal radius and patella fractures were defined as fragility fractures. Risk factors for fragility fractures after THA were calculated by comparing the fragility fracture group with the non-fracture group. RESULTS Fifty-three fragility fractures were confirmed in 53 patients (distal radius fracture: 32 fractures in 32 patients, patella fracture: 21 fractures in 21 patients). In the univariate analysis, the following eight risk factors for fragility fractures were significantly different between the groups: height, weight, follow-up period, developmental dysplasia of the hip, primary osteoarthritis, abduction before THA, internal rotation before THA, and external rotation before THA. Medical histories were not significantly different between the groups. There was no difference in any study factor and in the time of occurrence between the radius fractures and patella fractures analyzed as fragility fractures. CONCLUSIONS This study revealed that there are significant preoperative factors of fragility fractures following THA. These factors will serve as useful data for THA treatment strategies, preoperative explanations, and future studies.
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Hong KJ, Kim J. Risk Factors Preventing Immediate Fall Detection: A Study Using Zero-Inflated Negative Binomial Regression. Asian Nurs Res (Korean Soc Nurs Sci) 2021; 15:272-277. [PMID: 34537408 DOI: 10.1016/j.anr.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/09/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Falls are the most common accidents in healthcare facilities, and timely intervention can have a positive effect on the hazards and trauma experienced by patients after a fall. This study determined the factors affecting the time taken to detect a fall. METHODS A total of 3,470 cases of falls reported through the Korea Patient Safety Reporting and Learning System were included in the analysis. A zero-inflated negative binomial regression method was used for this retrospective secondary data analysis study. RESULTS There were 537 patients whose falls were not detected immediately; the count model was used to predict risk factors that delayed fall detection. Women aged 60-69 years-compared to those below 60 years and an evening nursing shift, compared to a day shift-were identified as significant factors. The fall detection time of about 2,933 patients was zero; therefore, the logit model was applied to predict a patient's possibility of belonging to the group whose fall was detected immediately. Comparisons of tertiary hospitals with general hospitals and hospitals, of the evening shift with the day shift, and of the day shift with the night shift indicated significant influencing factors. CONCLUSIONS These findings can assist nurses in recognizing patient and hospital characteristics related to delayed fall detection. Strategies to improve patient safety in healthcare facilities that focus on patient characteristics such as age can be recommended. Furthermore, nurse staffing requires improvement to detect fall incidents immediately.
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Affiliation(s)
- Kyung Jin Hong
- College of Nursing, Kangwon National University, Kangwon, Republic of Korea
| | - Jieun Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea.
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