Prevalence of fall, and determinants of repeat incidents of fall in older persons living in old age homes in the National Capital Territory of Delhi, India

Emergency Medical Service Attendances for Adults with Repeat Falls in Western Australia: A State-Wide Retrospective Cohort Study

OBJECTIVES

The risk of falls increases with age and often requires an emergency medical service (EMS) response. We compared the characteristics of patients attended by EMS in response to repeat falls within 30 days and 12 months of their first EMS-attended fall; and explored the number of days between the index fall and the subsequent fall(s).

METHODS

This retrospective cohort study included all adults (> =18 years of age) who experienced their first EMS-attended fall between 1 January 2016 and 31 December 2020, followed up until 31 December 2021. Patients who experienced > =1 subsequent fall, following their first recorded fall, were defined as experiencing repeat falls. Multivariable logistic regression was used to identify the factors associated with repeat falls; and Kaplan-Meier analysis was used to estimate the time (in days) between consecutive EMS-attended falls.

RESULTS

A total of 128,588 EMS-attended fall-related incidents occurred involving 77,087 individual patients. Most patients, 54,554 (71%) were attended only once for a fall-related incident (30,280 females; median age 73 years, inter-quartile range (IQR): 55-84). A total of 22,533 (29%) patients experienced repeat EMS-attended falls (13,248 females; median age 83 years, IQR: 74-89, at first call). These 22,533 patients accounted for 58% (74,034 attendances) of all EMS-attendances to fall-related incidents. Time between EMS-attended falls decreased significantly the more falls a patient sustained. Among the 22,533 patients who experienced repeat falls, 13,363 (59%) of repeat falls occurred within 12 months: 3,103 (14%) of patients sustained their second fall within 30 days of their index fall, and 10,260 (46%) between 31 days to 12 months. Patients who were transported to the hospital, via any urgency, at their first EMS-attended fall, had a reduced odds of sustaining a second EMS-attended fall within both 30 days and 31 days to 12 months, compared to non-transported patients.

CONCLUSION

Nearly 30% of all patients attended by EMS for a fall, sustained repeat falls, which collectively accounted for nearly 60% of all EMS-attendances to fall-related incidents. Further exploration of the role EMS clinicians play in identifying and referring patients who sustain repeat falls into alternative pathways is needed.

Exploring Coping and Religiosity in an Indian Ashram for Older Adults

BACKGROUND AND OBJECTIVES

With the aging of Indians and the cultural context of family care, faith-based ashrams are a possible middle way for older adult care for strained families. Religiosity is multidimensional, but it is unclear how its different dimensions relate to coping. This exploratory study investigates the profile of residents living in a faith-based ashram of Haridwar, a pilgrimage town in Northern India. Additionally, it examines religiosity and coping in this population, and the correlates of positive coping response (PCR).

METHODOLOGY

Preliminary field survey helped zero in on a single consenting ashram. We included 95 older adult participants (≥ 60 years) residing for more than six months. Relevant dimensions were captured with a survey interview form to record sociodemographics, BriefCOPE, and Duke University Religion Index. The sample was representative of the institutionalized older-adult population considering the overlap of sociodemographics (age, gender, and marital status). We conducted linear regression to examine possible predictors of PCR.

RESULTS

Most older adults were Hindus, higher educated, married, and lived with their spouses. The participants were highly religious. Coping through religion was most common, followed by active coping. On linear regression, a significant model emerged [F (13, 63) = 3.411, p < .001), where age, education, and organizational religious activity were significant predictors of PCR. However, other sociodemographic (sex, marital status, economics, family contact) and dimensions of religiosity (non-organizational religious activity and intrinsic religiosity) variables failed to predict PCR.

CONCLUSION

Lesser age, higher education, and involvement in the public practice of religiosity are essential contributors to PCR in older adults. How different aspects of religiosity influence coping and lend meaning to dealing with stress, needs further exploration.

The association between diuretics and falls in older adults: A systematic review and meta-analysis

OBJECTIVE

Diuretic intake increases the risk of falling. However, previous studies have shown inconsistent correlations between diuretics and falls. This meta-analysis aimed to provide a comprehensive overview of the relationship between diuretic use and risk of falls in older adult individuals.

METHODS

Six databases (Cochrane Library, PubMed, Medline, CINAHL, Web of Science, and EMBASE) were searched from their inception to November 9, 2022. The risk of bias was independently evaluated using the Newcastle-Ottawa Quality Assessment Scale. A comprehensive meta-analysis was used to analyze the eligible studies.

RESULTS

Fifteen articles were analyzed. Studies have shown that diuretics can increase the risk of falls in older adult individuals. The probability of falls in older adult individuals who used diuretics was 1.185 times higher than in those who did not take diuretics.

CONCLUSION

Diuretics were significantly associated with an increased risk of falls.

Health Consequences of Falls among Older Adults in India: A Systematic Review and Meta-Analysis

Research has been conducted on the prevalence of health consequences of falls among older adults (aged ≥60 years) in India, and our systematic review and meta-analysis aimed to synthe-size the existing evidence on this topic. The JBI guideline was followed for conducting this review work. Several databases were searched, and eight studies were included. The critical appraisal scores ("yes" responses) for the included studies ranged from 56% to 78%. Among older adults in India who fell, the pooled prevalence of injuries was 65.63% (95% confidence interval [38.89, 87.96]). Similarly, head and/or neck injuries was 7.55% (4.26, 11.62), upper extremity injuries was 19.42% (16.06, 23.02), trunk injuries was 9.98% (2.01, 22.47), lower extremity injuries was 34.36% (24.07, 45.44), cuts, lacerations, abrasions, grazes, bruises and/or contusions was 37.95% (22.15, 55.16), fractures was 12.50% (7.65, 18.30), dislocations and/or sprains was 14.31% (6.03, 25.26), loss of consciousness was 5.96% (0.75, 15.08), disabilities was 10.79% (7.16, 15.02), and hospital admissions was 19.68% (15.54, 24.16). Some of the high figures indicate the need for prioritizing and addressing the problem. Furthermore, high-quality studies on this topic should be conducted, including on psychological health consequences, health-related quality of life, length of hospital stay, and death. PROSPERO registration: CRD42022332903.

Multimorbidity and multi-disability among the elderly in residential care in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES)

We report prevalence and risk factors for multimorbidity and multi-disability among elderly people in residential care in the Hyderabad region in South India. In total, 1182 elderly (aged ≥ 60) participants were examined in 41 homes for the aged centres. Detailed interviews were conducted by trained personnel to collect personal and demographic information. A questionnaire was used to assess the history of non-communicable diseases and Washington Disability Questionnaire (WDQ) was administered to assess disabilities. The mean age of the participants was 75.0 years (SD 8.8 years; range: 60-108 years), 35.4% were men, 20.3% had no formal education, 60.7% had school education and 19% had higher education. The prevalence of multimorbidity was 37.6% (95% CI: 34.8-40.4). Prevalence of multi-disability was 23.6% (95% CI: 21.2-26.3; n = 270). In total, 857 (72.5%) participants reported using at least one medication for NCDs. Over a third of the elderly in residential care had multimorbidity, and a quarter of them had multi-disability. A holistic health care system that comprises health and wellness coupled with rehabilitation to address disabilities is needed to achieve healthy aging in elderly in homes for the aged in India.

Risk factors for falls among older adults in India: A systematic review and meta-analysis

Background and Aim

Falls are common among older adults in India. Several primary studies on its risk factors have been conducted in India. However, no systematic review has been conducted on this topic. Thus, the objective of this systematic review was to synthesize the existing evidence on the risk factors for falls among older adults in India.

Methods

JBI and Preferred Reporting Items for Systematic Reviews and Meta-Analyse guidelines were followed, and two independent reviewers were involved in the process. This review included observational studies conducted among older adults (aged ≥ 60 years) residing in India, reporting any risk factor for falls as exposure and unintentional fall as the outcome. MEDLINE, EMBASE, PsycInfo, CINAHL, and ProQuest Dissertations and Theses were searched until September 24, 2020. Where possible, data were synthesized using random-effects meta-analysis.

Results

The literature search yielded 3445 records. Twenty-two studies met the inclusion criteria of this systematic review, and 19 studies were included in the meta-analysis. Out of the 22 included studies in the systematic review, 12 (out of 18) cross-sectional studies, two case-control studies, and two cohort studies met more than 70% criteria in the respective Joanna Briggs Institute (JBI) checklists. Risk factors for falls among older adults in India included sociodemographic factors, environmental factors, lifestyle factors, physical and/or mental health conditions, and medical interventions.

Conclusions

This systematic review and meta-analysis provided a holistic picture of the problem in India by considering a range of risk factors such as sociodemographic, environmental, lifestyle, physical and/or mental health conditions and medical intervention. These findings could be used to develop falls prevention interventions for older adults in India.

Systematic Review and Meta‐Analysis Registration

The systematic review and meta-analysis protocol was registered with PROSPERO (registration number-CRD42020204818).

Global prevalence of falls in the older adults: a comprehensive systematic review and meta-analysis

BACKGROUND

With increasing life expectancy, declining mortality, and birth rates, the world's geriatric population is increasing. Falls in the older people are one of the most common and serious problems. Injuries from falls can be fatal or non-fatal and physical or psychological, leading to a reduction in the ability to perform activities of daily living. The aim of this study was to determine the prevalence of falls in the older people through systematic review and meta-analysis.

METHODS

In this systematic review and meta-analysis, the data from studies on the prevalence of falls in the older people in the world were extracted in the databases of Scopus, Web of Science (WoS), PubMed and Science Direct, and Google Scholar, Magiran and Scientific Information Database (SID) without any time limit until August 2020. To analyze the eligible studies, the stochastic effects model was used, and the heterogeneity of the studies with the I² index was investigated. Data analysis was conducted with Comprehensive Meta-Analysis software (Version 2).

RESULTS

In the review of 104 studies with a total sample size of 36,740,590, the prevalence of falls in the older people of the world was 26.5% (95% CI 23.4-29.8%). The highest rate of prevalence of falls in the older people was related to Oceania with 34.4% (95% CI 29.2-40%) and America with 27.9% (95% CI 22.4-34.2%). The results of meta-regression indicated a decreasing trend in the prevalence of falls in the older people of the world by increasing the sample size and increasing the research year (P < 0.05).

CONCLUSION

The problem of falls, as a common problem with harmful consequences, needs to be seriously considered by policymakers and health care providers to make appropriate plans for preventive interventions to reduce the rate of falls in the older people.