Teach the elderly to prevent falls

The Effectiveness of Injury Prevention Strategies: What Does the Public Believe?

This article is based on a random digit dialed telephone survey in which adults were asked to name effective strategies for preventing deaths due to motor vehicle crashes, falls, drowning, fires/burns, and poisoning. A majority of the 943 respondents could name prevention techniques, although they were least likely to do so for fatal falls. Participants at highest risk for not naming a countermeasure were those with fewer years of education. The strategy cited most often for preventing deaths due to falls, poisoning, and drowning was safety education. These findings suggest that more advantaged members of the public feel they know how to prevent America's leading causes of injury death. They may not fully appreciate, however, the options of creating health-promoting environments and safer products. This work makes it very clear that people with less education also need to be exposed to the breadth of effective injury countermeasures.

A review of the functionalities of smart walkers

There is a need to conceptualize and improve the investigation and developments in assistive devices, focusing on the design and effectiveness of walkers in the user's rehabilitation process and functional compensation. This review surveys the importance of smart walkers in maintaining mobility and discusses their potential in rehabilitation and their demands as assistive devices. It also presents related research in addressing and quantifying the smart walker's efficiency and influence on gait. Besides, it discusses smart walkers focusing on studies related to the concept of autonomous and shared-control and manual guidance, the use of smart walkers as personal helpers to sit-to-stand and diagnostic tools for patients' rehabilitation through the evaluation of their gait.

Risk factors for falls in older Korean adults: the 2011 Community Health Survey

Falls are a major health problem for elderly populations worldwide. We analyzed data from the 2011 Korean Community Health Survey to identify potential risk factors for falls in a representative population-based sample of community-dwelling older Korean adults. Risk factors for falls were assessed by multivariate survey logistic regression models. The prevalence of falls was 16.9% in males and 24.3% in females [Corrected]. Age and female sex were associated with a higher risk of falls. Similarly, living alone, living in an urban area, poor self-rated health, and high stress were associated with a high risk of falls. Subjects with diabetes mellitus, stroke, osteoarthritis, osteoporosis, urinary incontinence, cataracts, or depression had a high risk of falls. However, subjects with hypertension were at low risk for falls. In conclusion, age, female sex, marital status, residence location, self-rated health, stress, and several chronic conditions were significantly associated with the risk for falls in the older Korean adults. Our findings suggest that these risk factors should be addressed in public health policies for preventing falls.

Mobility and functional outcomes after femoral neck fracture surgery in elderly patients: a comparison between hemiarthroplasty and internal fixation

PURPOSE

To find out whether patients with femoral neck fracture treated with hemiarthroplasty differ from those treated with internal fixation regarding functional outcome, walking ability, pain or short-term mortality.

METHOD

Sixty-six patients aged 64 years or more with femoral neck fracture were included in a prospective non-randomised trial with two equal-sized groups recruited consecutively within each group. All patients were treated operatively and encouraged to pursue an active rehabilitation. They were reviewed at admission, before discharge and 3 months after surgery. Assessments included demographic data, length of hospitalisation, post-operative medical complications, activities of daily living, walking ability, pain and mortality.

RESULTS

There were no significant differences between the two groups in terms of age, gender, ability to walk, functional status or at admission. The patients treated with hemiarthroplasty had a longer total hospital stay due to longer waiting time to operation. They started to walk sooner after operation and walked better during hospitalisation. Their walking distance at discharge was longer; their improvement in functional independence, as measured by the Functional Independence Measure, was also higher, but this difference was not statistically significant. Observed mortality in the hemiarthroplasty group was lower.

CONCLUSION

A longer follow-up would be necessary to determine whether the preferable outcomes of hemiarthroplasty persist in the long-term.

Beyond Mortality and Hospitalization Data: Self-Reported Injuries Among Canadian Seniors

This study describes the prevalence and characteristics of self-reported unintentional injuries among Canadians aged 55 years and older. Based on the cross-sectional data from the 1994 National Population Health Survey (NPHS), approximately 10 per cent of older adults experienced unintentional injuries serious enough to limit their normal daily activities. Consistent with hospitalization and mortality data, unintentional falls and motor vehicle crashes were reported as the major causes of injury. However, the other predominant causes of unintentional injuries were environmental incidents and being struck by an object. The most common types of injuries were sprains/strains and broken/fractured bones; the greatest number of injuries was to the lower limbs; and the majority of injuries occurred in the home and surrounding area. Unintentional injuries represent a significant health threat among older adults. Self-reported data serve as a different but complementary source of information on unintentional injuries among older adults.

Head Over Heels: Impact of a Health Promotion Program to Reduce Falls in the Elderly

Le projet FIT – Falls Intervention Trials (étude sur les essais d'intervention après les chutes) – consistait en une étude clinique avec répartition aléatoire des effets d'un programme visant à réduire l'incidence de chutes et leurs séquelles chez les personnes âgées. L'échantillon se composait de 100 personnes de 60 ans et plus, vivant dans la région de la capitale provinciale (Victoria, C.-B.) et ayant fait une chute au cours des trois mois précédant l'étude. L'intervention prenait la forme d'une évaluation détaillée des risques, de commentaires individuels quant aux risques déterminés, ainsi qu'une bande vidéo accompagnée d'une brochure d'information intitulées Head over Heels. La mesure des résultats comprenait l'incidence des chutes, l'auto-efficacité en cas de chutes, la crainte de chuter, le fonctionnement social, l'utilisation des services de santé et la qualité de vie. Bien que les principales variables de l'étude n'aient révélé aucune différence statistique importante entre le groupe expérimental et le groupe témoin, on a pu constater une amélioration au sein des deux groupes entre le début de l'étude et l'évaluation de suivi, six mois après sa conclusion. L'article traite des différentes raisons possibles expliquant ces résultats et leurs conséquences en fonction de recherches plus approfondies.

Risk Factors for Serious Falls Among Community-Based Seniors: Results from the National Population Health Survey

This paper examines factors associated with falling among approximately 3,100 individuals aged 65 and older who were participants in the 1994 National Population Health Survey (NPHS). The intent of the NPHS is to monitor the health of Canadians and risk factors that affect their health. Several factors were identified as increasing the risk of falling, such as advanced age, being female, certain medical conditions, medication use and impaired mobility. The results from this survey, conducted on a national level, confirm the findings of many studies utilizing smaller samples within individual communities. Continuation of the NPHS will aid in offering longitudinal data with respect to falls, and allow for establishing a temporal order prior to the fall event, in order to provide more definitive evidence with respect to risk factors for falls.

Risk factor for accidental injuries within senior citizens' homes: analysis of the Canadian Survey on Ageing and Independence

Using data from the Survey on Ageing and Independence (SAI), risk factors for unintentional injuries occurring within the homes of individuals older than 65 are identified. For the SAI, conducted by Statistics Canada in 1991, data were collected on a representative sample of approximately 20,000 individuals between ages 45 and 102. For each household contacted, one individual older than 45 was interviewed via the telephone. For the present analysis, only individuals older than 65 (n = 10,059) were used. Approximately 5% of senior citizens experienced an injury that limited their activity for at least 1 day. Using logistic regression, the following risk factors for injury were identified: education, alcohol consumption, smoking, rest and sleep patterns, support, and interactions between age and gender, activity limitations and age, and home maintenance and gender. The present findings are important to the body of research concerning injuries among older adults. The results expand current univariate analysis of data identifying risk factors for injuries within the literature and provide comprehensive information pertaining to risk factors for accidental injuries at the multivariate level. Identification of risk factors provides health care professionals, particularly front line nurses, with insight into factors that, if modified, have the potential to decrease accidental injuries and improve or maintain quality of life.

Factors associated with falls in an inpatient palliative care unit: an exploratory study

In one inpatient palliative care unit falls were identified as a frequent and distressing, yet potentially avoidable, concern. The unit had the highest rate of falls in this long-term care setting, exceeding even that of dementia care units. No literature could be identified that examined falls in the palliative care population. The objective of the exploratory study was to examine factors associated with falls through retrospective archival data collection. Detailed information was collected on all 177 falls that occurred in the unit in 1999. Data were also gathered on patients who had not fallen for comparison. Analysis was conducted comparing risk factors of those patients who fell once and those who fell multiple times. It was found that advanced age, longer length of stay and a previous history of falls might be risk factors for future falls. Patients who fell multiple times had less symptom distress than patients who fell once.

Health visitor risk assessment for preventing falls in elderly people

This study was undertaken to look at the feasibility of a health visitor risk assessment for falls at the time of the routine health check for people aged 75 years and above. A total of 162 people were eligible for inclusion in the study. The standard over-75 assessment check was carried out either in the GP surgery or the person's home. A questionnaire was developed to obtain additional information not collected in the routine health check. The results identified two key risk areas: a history of polypharmacy and living in sheltered housing. There were no differences for a range of physical, emotional and environmental factors between people who had fallen and those who had not. A larger study is required to look at the identification of risk factors for falling at the routine over-75 health check, and appropriate referrals that can be put into place to deal with any problems uncovered. Education of health professionals on the risk factors of falls is also required.

Multidimensional correlates of falls in older women

Older women who had fallen within the last year (n = 63) were compared with those who had not fallen (n = 67) on several psychological and motor measures. Both fallers and nonfallers demonstrated high levels of functioning. Discriminant analysis results indicated that a combination of variables, including physical activity and both psychological (general well-being, self-efficacy) and motor (functional reach, mobility) measures differentiated fallers and nonfallers. Results suggest that falling is a multidimensional phenomenon, that small declines on multiple factors may increase risk of falls, and that multifaceted interventions may help maintain high levels of functioning and prevent declines often associated with increased age.

The STEPS Project: participatory action research to reduce falls in public places among seniors and persons with disabilities

Through a process of participatory action research involving a telephone hotline, the STEPS project compiled data over a nine month period on the location and nature of 791 pedestrian slips, trips, falls and potential hazards in the Capital Regional District of British Columbia. Of the 533 people who reported a slip, trip or fall, the majority (80%) were female, and the average age was 65.27 years. Thirty-five percent (n = 186) had some type of physical disability and many (n = 106) reported using a mobility aide at the time of their accident. Most callers (75%) said they had suffered an injury, and of these 55% required medical attention. The most frequently reported fall locations were sidewalks and crosswalks. Major recommendations from the study include the need for municipal priority-setting for repairs with input from key user groups, including the elderly and people with disabilities.

A study of nurses' perceptions of client mobility

This paper is part of a larger study to examine the concept of mobility from the perspectives of clients and nurses. It represents a beginning effort at clarifying, refining, and developing the concept for nursing practice as the current literature concentrates on immobility. The enquiry began with a theoretical phase during which attributes and characteristics of the concept were elicited. This was followed by a fieldwork phase to determine whether there was congruency between the theoretical formulations of the concept and empirical data. Primary nurses and their clients were interviewed and data were analyzed using content analysis. In this article, only data obtained from the nurse population are reported. Themes derived from the nurses' interviews are described and compared with the results of the theoretical phase. Findings revealed that there was a measure of support for the concept as defined in the theoretical phase but pointed to the need for more empirical work with different client populations across settings.

Falls: are rural elders at greater risk?

1. Advocating that elderly clients engage exclusively in behaviors that are free of risks may not always advance the goals of independence, autonomy, and a maximal level of functioning. 2. Falls in the elderly may not be primary events, but indicators of an as yet undetected decline in health, suggesting that the health care provider tailor fall prevention information to the specific lifestyle of the older adult. 3. There may be a range of safe and acceptable risk depending on the lifestyles and the demands of daily living.

Falls in the elderly population: a look at incidence, risks, healthcare costs, and preventive strategies

The number of elderly people in America is growing, and falls among the elderly population are a significant problem. Injuries and their complications can have serious consequences requiring medical attention, hospitalization, and nursing home admission. Seventy percent of the fall-related deaths in the United States occur among elderly people. Risks for falls are categorized as extrinsic factors involving the environment, intrinsic or host factors, those associated with nonbipedal falls, risks related to nonclassified falls, and agent, or iatrogenic, risk factors. Lawsuits related to falls and restraints are increasing. Fall prevention programs, assessment, evaluation, and lobbying for legislation to assist elderly people who fall are some of the responses made by the healthcare system. Rehabilitation nurses must be aware of the incidence and consequences of falls. It is imperative that nurses become involved in coordinating fall prevention and fall reduction programs, monitoring risks for falls, and implementing corrective measures.

A clinical possibility: preventing health problems after the age of 65

1. There are a number of common health problems of the elderly that have the potential to be prevented, postponed, or reversed even after age 65. 2. The nurse's knowledge of the difference between normal aging and a disease process is essential to enable the nurse to detect whether a health problem can be prevented, postponed, or reversed. 3. It is being discovered that there is an alarmingly high number of seniors whose "dementia" is not permanent, but rather is reversible or treatable.

Using research-based interventions to decrease patient falls

The purpose of this study was to decrease patient falls by applying relevant interventions found in the nursing research literature. Clinical nurse specialists assisted staff with the application of selected research-based patient fall program interventions on two adult medical-surgical specialty units in a tertiary care facility. The fall rate on these two units decreased during the study year, while the all-hospital patient fall rate increased. To encourage comparison of fall data among institutions, a standard method for calculating fall rate is presented.