1
|
Huang Y, Li C, Lu X, Wang Y. The geographic environment and the frequency of falling: a study of mortality outcomes in elderly people in China. GEOSPATIAL HEALTH 2023; 18. [PMID: 37246537 DOI: 10.4081/gh.2023.1180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/28/2023] [Indexed: 05/30/2023]
Abstract
Falling has become the first and second cause of death due to injury among urban and rural residents in China. This mortality is considerably higher in the southern part of the country than in the North. We collected the rate of mortality due to falling for 2013 and 2017 by province, age structure and population density, taking topography, precipitation and temperature into account. 2013 was used as the first year of the study since this year marks the expansion of the mortality surveillance system from 161 counties to 605 counties making available data more representative. A geographically weighted regression was used to evaluate the relationship between mortality and the geographic risk factors. High levels of precipitation, steep topography and uneven land surfaces as well as a higher quantile of the population aged above 80 years in southern China are believed to have led to the significantly higher number of falling compared with that in the North. Indeed, when evaluated by geographically weighted regression, the factors mentioned found a difference between the South and the North with regard to falling of 81% and 76% for the years 2013 and 2017, respectively. Interaction effects were observed between geographic risk factors and falling that, apart from the age factor, could be explained by topographic and climatic differences. The roads in the South are more difficult to negotiate on foot, particularly when it rains, which increases the probability of falling. In summary, the higher mortality due to falling in southern China emphasizes the need to apply more adaptive and effective measures in rainy and mountainous region to reduce this kind of risk.
Collapse
Affiliation(s)
- Yi Huang
- School of Geographic Sciences, Nantong University, Nantong.
| | - Chen Li
- School of Management, Shanghai University of Engineering Science, Shanghai.
| | - Xianjing Lu
- School of Geographic Sciences, Nantong University, Nantong.
| | - Yue Wang
- School of Geographic Sciences, Nantong University, Nantong.
| |
Collapse
|
2
|
Jo KH, Park J, Ryu SY. The effects of mental health on recurrent falls among elderly adults, based on Korean Community Health Survey data. Epidemiol Health 2020; 42:e2020005. [PMID: 32023776 PMCID: PMC7285425 DOI: 10.4178/epih.e2020005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/02/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES This study aimed to identify the effect of mental health on frequency of falls (single and recurrent falls) among elderly adults. METHODS Data were drawn from the 2015 Korean Community Health Survey. A chi-square test was conducted to compare differences in fall frequency according to health-related behaviors, chronic diseases, and mental health. Subsequently, multinomial logistic regression analysis was used to identify the effects of mental health on single and recurrent falls based on variables found to be significant in the chi-square test. RESULTS Recurrent falls were found to be more risky than single falls. Depression was significantly related to single falls (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.12 to 1.44). Depression (OR, 1.56; 95% CI, 1.38 to 1.76), sleep disorder (5 hours or less: OR, 1.12; 95% CI, 1.02 to 1.23; more than 9 hours: OR, 1.24; 95% CI, 1.07 to 1.44, respectively), and subjective stress (OR, 2.30; 95% CI, 1.90 to 2.78) were significantly related to recurrent falls. CONCLUSIONS The study’s findings suggest that specialized fall prevention programs are needed to address different types of falls in elderly adults. To prevent recurrent falls, systematic treatment strategies and rehabilitation training must improve physical function and mental health.
Collapse
Affiliation(s)
- Kyung Hee Jo
- Department of Public Health, Graduate School of Chosun University, Gwangju, Korea
| | - Jong Park
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
| | - So Yeon Ryu
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
| |
Collapse
|
3
|
Yang Y, Hirdes JP, Dubin JA, Lee J. Fall Risk Classification in Community-Dwelling Older Adults Using a Smart Wrist-Worn Device and the Resident Assessment Instrument-Home Care: Prospective Observational Study. JMIR Aging 2019; 2:e12153. [PMID: 31518278 PMCID: PMC6716444 DOI: 10.2196/12153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 03/23/2019] [Accepted: 05/13/2019] [Indexed: 12/02/2022] Open
Abstract
Background Little is known about whether off-the-shelf wearable sensor data can contribute to fall risk classification or complement clinical assessment tools such as the Resident Assessment Instrument-Home Care (RAI-HC). Objective This study aimed to (1) investigate the similarities and differences in physical activity (PA), heart rate, and night sleep in a sample of community-dwelling older adults with varying fall histories using a smart wrist-worn device and (2) create and evaluate fall risk classification models based on (i) wearable data, (ii) the RAI-HC, and (iii) the combination of wearable and RAI-HC data. Methods A prospective, observational study was conducted among 3 faller groups (G0, G1, G2+) based on the number of previous falls (0, 1, ≥2 falls) in a sample of older community-dwelling adults. Each participant was requested to wear a smart wristband for 7 consecutive days while carrying out day-to-day activities in their normal lives. The wearable and RAI-HC assessment data were analyzed and utilized to create fall risk classification models, with 3 supervised machine learning algorithms: logistic regression, decision tree, and random forest (RF). Results Of 40 participants aged 65 to 93 years, 16 (40%) had no previous falls, whereas 8 (20%) and 16 (40%) had experienced 1 and multiple (≥2) falls, respectively. Level of PA as measured by average daily steps was significantly different between groups (P=.04). In the 3 faller group classification, RF achieved the best accuracy of 83.8% using both wearable and RAI-HC data, which is 13.5% higher than that of using the RAI-HC data only and 18.9% higher than that of using wearable data exclusively. In discriminating between {G0+G1} and G2+, RF achieved the best area under the receiver operating characteristic curve of 0.894 (overall accuracy of 89.2%) based on wearable and RAI-HC data. Discrimination between G0 and {G1+G2+} did not result in better classification performance than that between {G0+G1} and G2+. Conclusions Both wearable data and the RAI-HC assessment can contribute to fall risk classification. All the classification models revealed that RAI-HC outperforms wearable data, and the best performance was achieved with the combination of 2 datasets. Future studies in fall risk assessment should consider using wearable technologies to supplement resident assessment instruments.
Collapse
Affiliation(s)
- Yang Yang
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - John P Hirdes
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Joel A Dubin
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Department of Statistics and Actuarial Science, Faculty of Mathematics, University of Waterloo, Waterloo, ON, Canada
| | - Joon Lee
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
4
|
Yoo JS, Kim CG, Yim JE, Jeon MY. Risk factors of repeated falls in the community dwelling old people. J Exerc Rehabil 2019; 15:275-281. [PMID: 31111013 PMCID: PMC6509467 DOI: 10.12965/jer.1938086.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/23/2019] [Indexed: 11/23/2022] Open
Abstract
This study aimed to provide evidence for the development of an algorithm to identify older adults with a high risk for repeated falls, along with strategies to prevent repeated falls, by analyzing the known physical, psychological, and environmental factors related to falls in older adults. One hundred fifty-seven community-dwelling older adults aged 65 years or older who experienced a fall within the past year were enrolled in this study. Participants' physical, psychological, environmental, and fall prevention-related characteristics were surveyed using structured questionnaires to identify the risk factors for repeated falls. The use of antidepressants, depression score, and compliance with fall prevention behaviors were found to differ significantly between the two groups, and the use of antidepressants and depression were found to be significant predictors of repeated falls. Depression should be considered as a major variable when developing an algorithm to identify the risk of repeated falls among older adults living at home. Also, the practice of fall prevention behaviors was higher in the repeated-falls group, likely due to that group's efforts to prevent additional falls.
Collapse
Affiliation(s)
- Jae Soon Yoo
- Department of Nursing, Chungbuk National University, Cheongju, Korea
| | - Chul Gyu Kim
- Department of Nursing, Chungbuk National University, Cheongju, Korea
| | - Jong Eun Yim
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
| | - Mi Yang Jeon
- College of Nursing, Institute of Health Science, Gyeongsang National University, Jinju, Korea
| |
Collapse
|
5
|
Jeon MY, Jeong H, Petrofsky J, Lee H, Yim J. Effects of a randomized controlled recurrent fall prevention program on risk factors for falls in frail elderly living at home in rural communities. Med Sci Monit 2014; 20:2283-91. [PMID: 25394805 PMCID: PMC4243515 DOI: 10.12659/msm.890611] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Falling can lead to severe health issues in the elderly and importantly contributes to morbidity, death, immobility, hospitalization, and early entry to long-term care facilities. The aim of this study was to devise a recurrent fall prevention program for elderly women in rural areas. Material/Methods This study adopted an assessor-blinded, randomized, controlled trial methodology. Subjects were enrolled in a 12-week recurrent fall prevention program, which comprised strength training, balance training, and patient education. Muscle strength and endurance of the ankles and the lower extremities, static balance, dynamic balance, depression, compliance with preventive behavior related to falls, fear of falling, and fall self-efficacy at baseline and immediately after the program were assessed. Sixty-two subjects (mean age 69.2±4.3 years old) completed the program – 31 subjects in the experimental group and 31 subjects in the control group. Results When the results of the program in the 2 groups were compared, significant differences were found in ankle heel rise test, lower extremity heel rise test, dynamic balance, depression, compliance with fall preventative behavior, fear of falling, and fall self-efficacy (p<0.05), but no significant difference was found in static balance. Conclusions This study shows that the fall prevention program described effectively improves muscle strength and endurance, balance, and psychological aspects in elderly women with a fall history.
Collapse
Affiliation(s)
- Mi Yang Jeon
- Department of Nursing, Gyeongsang National University, Jinju, Korea
| | | | - Jerrold Petrofsky
- Department of Physical Therapy, Loma Linda University, Loma Linda, USA
| | | | - JongEun Yim
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
| |
Collapse
|
6
|
Jung D, Kang Y, Kim MY, Ma RW, Bhandari P. Zero-Inflated Poisson Modeling of Fall Risk Factors in Community-Dwelling Older Adults. West J Nurs Res 2014; 38:231-47. [PMID: 25315901 DOI: 10.1177/0193945914553677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to identify risk factors for falls among community-dwelling older adults. The study used a cross-sectional descriptive design. Self-report questionnaires were used to collect data from 658 community-dwelling older adults and were analyzed using logistic and zero-inflated Poisson (ZIP) regression. Perceived health status was a significant factor in the count model, and fall efficacy emerged as a significant predictor in the logistic models. The findings suggest that fall efficacy is important for predicting not only faller and nonfaller status but also fall counts in older adults who may or may not have experienced a previous fall. The fall predictors identified in this study--perceived health status and fall efficacy--indicate the need for fall-prevention programs tailored to address both the physical and psychological issues unique to older adults.
Collapse
Affiliation(s)
| | | | | | - Rye-Won Ma
- Ewha Womans University, Seoul, South Korea
| | | |
Collapse
|
7
|
Abstract
PURPOSE This study was done to explore factors relating to number of falls among community-dwelling elders, based on gender. METHODS Participants were 403 older community dwellers (male=206, female=197) aged 60 or above. In this study, 8 variables were identified as predictive factors that can result in an elderly person falling and as such, supports previous studies. The 8 variables were categorized as, exogenous variables; perceived health status, somatization, depression, physical performance, and cognitive state, and endogenous variables; fear of falling, ADL & IADL and frequency of falls. RESULTS For men, ability to perform ADL & IADL (β(32)=1.84, p<.001) accounted for 16% of the variance in the number of falls. For women, fear of falling (β(31)=0.14, p<.05) and ability to perform ADL & IADL (β(32)=1.01, p<.001) significantly contributed to the number of falls, accounting for 15% of the variance in the number of falls. CONCLUSION The findings from this study confirm the gender-based fall prediction model as comprehensive in relation to community-dwelling elders. The fall prediction model can effectively contribute to future studies in developing fall prediction and intervention programs.
Collapse
|
8
|
Lim YM, Sung MH. Home environmental and health-related factors among home fallers and recurrent fallers in community dwelling older Korean women. Int J Nurs Pract 2013; 18:481-8. [PMID: 23009377 DOI: 10.1111/j.1440-172x.2012.02060.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of the study was to determine home environmental and health-related factors among home fallers and recurrent fallers in community dwelling older Korean women. The study population included 438 older women aged 65 years and over. Measures included a checklist of home environments and health-related items. Risk indicators for accidental falls and recurrent falling were analysed using logistic regression. Logistic regression analysis revealed that chronic disease (odds ratio (OR) = 2.02, P = 0.007), poor night light (OR = 1.97, P = 0.032) and obstacle of door sill (OR = 1.76, P = 0.021) were predictors of accidental falls, and physical inactivity (OR = 2.34, P = 0.018) and slippery floor in the bathroom (OR = 0.41, P = 0.034) were predictors of recurrent falling. The findings have implications for strategies and suggest the need to modify home environmental context in systematic and consistent ways and the need to maintain physical activities to prevent falls and recurrent falling.
Collapse
Affiliation(s)
- Young Mi Lim
- Department of Nursing, Wonju College of Medicine, Yonsei University, Wonju, Kangwon-do, Korea
| | | |
Collapse
|
9
|
Sefton JM, Yarar C, Berry JW. Massage Therapy Produces Short-term Improvements in Balance, Neurological, and Cardiovascular Measures in Older Persons. Int J Ther Massage Bodywork 2012; 5:16-27. [PMID: 23087775 PMCID: PMC3457719 DOI: 10.3822/ijtmb.v5i3.152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Falls are the primary cause of accidental death in older persons, producing increased morbidity, decreased independence, and billions in medical costs annually. Massage therapy (MT) may produce adaptations that decrease risk of falling. If MT can improve stability in older persons, it may provide a new intervention for this issue. Purpose: Determine the acute effects of a 60-minute MT treatment on static and functional balance, neurological measures, heart rate, and blood pressure in healthy, older individuals. Setting: Laboratory Research Design: A 2 by 4 (treatment by time) mixed factorial experimental design for the cardiovascular and postural control variables; independent variables were treatment with two levels (control, MT) and time with four levels (pretreatment baseline, immediate post-treatment, 20-minute post-treatment, 60-minute post-treatment). Neurological measures utilized a 2 by 2 mixed design, with testing conducted pre- and 60-minutes post-treatment. Participants: Thirty-five healthy, older volunteers (19 male and 16 female; ages 62.9 ± 4.6). Intervention: A 60-minute full-body therapeutic massage. The control group rested quietly in the treatment room. Main Outcome Measures: Static (double-legged) and functional (single-legged) postural control with eyes-open and eyes-closed; Hoffmann-reflex measures; heart rate, and systolic and diastolic blood pressure. Results: MT significantly decreased rectangular displacement area in both the eyes-open and eyes-closed, double-legged stance conditions (p < 0.05); displacement velocity in both eyes-open conditions (p < .05); and systolic and diastolic blood pressure (p < .05), while increasing heart rate (p < .05). MT also significantly lowered Hmax/Mmax ratios compared to controls (p = .002). Decreased Hmax/Mmax measures were correlated to improved stability. Conclusions: A single, 60-minute, full-body massage therapy treatment was shown to have a stabilizing effect on measures of static and dynamic balance and physiological factors related to stability in older adults. MT should be investigated as a potential intervention to decrease falls in older individuals.
Collapse
Affiliation(s)
- Joellen M Sefton
- Neuromechanics Research Laboratory, Department of Kinesiology, Auburn University, Auburn, AL
| | | | | |
Collapse
|