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Ong MF, Soh KL, Saimon R, Saidi HI, Tiong IK, Myint WW, Mortell M, Japar S. Predictors of fall protection motivation among older adults in rural communities in a middle-income country: A cross-sectional study using the Protection Motivation Theory. J Adv Nurs 2024. [PMID: 38606809 DOI: 10.1111/jan.16190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 03/14/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024]
Abstract
AIMS To evaluate factors associated with fall protection motivation to engage in fall preventive behaviour among rural community-dwelling older adults aged 55 and above using the protection motivation theory scale. DESIGN A cross-sectional study. METHODS The study was conducted in a healthcare clinic in Malaysia, using multistage random sampling from November 2021 to January 2022. Three hundred seventy-five older adults aged 55 and older were included in the final analysis. There were 31 items in the final PMT scale. The analysis was performed within the whole population and grouped into 'faller' and 'non-faller', employing IBM SPSS version 26.0 for descriptive, independent t-test, chi-square, bivariate correlation and linear regressions. RESULTS A total of 375 older participants were included in the study. Fallers (n = 82) and non-fallers (n = 293) show statistically significant differences in the characteristics of ethnicity, assistive device users, self-rating of intention and participation in previous fall prevention programmes. The multiple linear regression model revealed fear, coping appraisal and an interaction effect of fear with coping appraisal predicting fall protection motivation among older adults in rural communities. CONCLUSION Findings from this study demonstrated that coping appraisal and fear predict the protection motivation of older adults in rural communities. Older adults without a history of falls and attaining higher education had better responses in coping appraisal, contributing to a reduction in perceived rewards and improving protection motivation. Conversely, older adults from lower education backgrounds tend to have higher non-preventive behaviours, leading to a decline in fall protection motivation. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE These results contribute important information to nurses working with older adults with inadequate health literacy in rural communities, especially when planning and designing fall prevention interventions. The findings would benefit all nurses, healthcare providers, researchers and academicians who provide care for older adults. PATIENT OR PUBLIC CONTRIBUTION Participants were briefed about the study, and their consent was obtained. They were only required to answer the questionnaire through interviews. Older individuals aged fifty-five and above in rural communities at the healthcare clinic who could read, write or understand Malay or English were included. Those who were suffering from mental health problems and refused to participate in the study were excluded from the study. Their personal information remained classified and not recorded in the database during the data entry or analysis.
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Affiliation(s)
- Mei Fong Ong
- Department of Nursing, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Nursing, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Kim Lam Soh
- Department of Nursing, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rosalia Saimon
- Community Medicine and Public Health, Universiti Malaysia Sarawak, Kuching, Sarawak, Malaysia
| | - Hasni Idayu Saidi
- Department of Biomedical Science, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Ing Khieng Tiong
- Department of Geriatric Medicine, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
| | - Wai Wai Myint
- Medicine and Rehabilitation, Universiti Malaysia Sarawak, Kuching, Sarawak, Malaysia
| | | | - Salimah Japar
- Department of Nursing, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Cooray N, Ho C, Bestman A, Adams S, Nassar N, Keay L, Brown J. Exploring the Potential of a Behavior Theory-Informed Digital Intervention for Infant Fall Prevention: Mixed Methods Longitudinal Study. JMIR Pediatr Parent 2024; 7:e47361. [PMID: 38170580 PMCID: PMC10794959 DOI: 10.2196/47361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Falls are the most common hospitalized injury mechanism in children aged ≤1 years, and currently, there are no targeted prevention interventions. The prevention of falls in children of this age requires changes in the behavior of their caregivers, and theoretically informed digital behavior change interventions (DBCIs) may provide a unique mechanism for achieving effective intervention. However, user acceptance and the ability of DBCIs to effect the required changes in behavior are critical to their likelihood of success. OBJECTIVE This study aims to evaluate a behavior theory-informed digital intervention developed following a user-centered approach for user experience, the potential for this intervention to prevent infant falls, and its impact on behavioral drivers underpinning fall risk in young children. METHODS Parents of infants aged <1 year were recruited and asked to use the intervention for 3 months. A pre-post longitudinal design was used to examine the change in the potential to reduce the risk of falls after a 3-month exposure to the intervention. Postintervention data on behavioral drivers for fall prevention, user acceptability, and engagement with the app were also collected. Interviews were conducted to explore user experiences and identify areas for further improvement of the intervention. RESULTS A total of 62 parents participated in the study. A statistically significant effect on the potential to reduce falls was observed after the intervention. This effect was higher for new parents. Parents agreed that the intervention targeted most of the target behavior drivers. The impact of behavior drivers and intervention on the potential for fall prevention had a positive correlation. The intervention demonstrated good levels of acceptability. Feedback from participants was mostly positive, and the primary area identified for further improvement was widening the scope of the intervention. CONCLUSIONS This study demonstrated the promise of a newly developed digital intervention to reduce the risk of infant falls, particularly among new parents. It also showed a positive influence of the DBCI on the drivers of parental behaviors that are important for fall reduction among infants. The acceptability of the app was high, and important insights were gained from users about how to further improve the app.
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Affiliation(s)
- Nipuna Cooray
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales Sydney, Barangaroo, Australia
| | - Catherine Ho
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales Sydney, Barangaroo, Australia
| | - Amy Bestman
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales Sydney, Barangaroo, Australia
| | - Susan Adams
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales Sydney, Barangaroo, Australia
- Department of Paediatric Surgery, Sydney Children's Hospital, Randwick, Australia
| | - Natasha Nassar
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lisa Keay
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales Sydney, Barangaroo, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia
| | - Julie Brown
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales Sydney, Barangaroo, Australia
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Kwon E, Chang SJ, Kwon M. A Clinical Data Warehouse Analysis of Risk Factors for Inpatient Falls in a Tertiary Hospital: A Case-Control Study. J Patient Saf 2023; 19:501-507. [PMID: 37712829 PMCID: PMC10662580 DOI: 10.1097/pts.0000000000001163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
OBJECTIVES The aims of the study are to identify fall risk factors and to establish automatic risk assessments based on clinical data from electronic medical records of hospitalized patients. METHODS In this retrospective case-control study, we reviewed the electronic medical records of 1454 patients (292 and 1162 patients in the fall and nonfall groups, respectively) who were hospitalized at a 1800-bed tertiary hospital in South Korea between January 1, 2017, and December 31, 2017. Patients' age, sex, and clinical department were matched, and all laboratory reports, clinical flow sheets, and nursing initial assessment records of case from the Clinical Data Warehouse system were analyzed. The collated patient records data were analyzed using SAS (version 9.4) and logistic regression. RESULTS Overall, 65 risk factors, including low body mass index, low blood pressure, low albumin levels, high fasting blood sugar level, low red blood cell counts, and high potassium levels, that significantly increased the incidence of falls were identified. Falls were also associated with 21 items from the clinical flow sheet and nursing initial assessment, including frequent bowel movements, 24-hour urine tests, imaging tests, biopsy, pain, intravenous tubes, unclear consciousness, and taking medication. CONCLUSIONS Fall risk factors identified via the Clinical Data Warehouse can be used to build an automated detection system to detect fall risk in electronic medical records, enabling nurses to assess the fall risk in addition to using the fall scale.
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Affiliation(s)
- Eunok Kwon
- From the Global Planning and Development Department, Seoul National University Hospital, Seoul, Republic of Korea
- Nursing Department, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates
| | | | - Mikyung Kwon
- Department of Pediatric Nursing, Seoul National University Hospital, Seoul, Republic of Korea
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Ahmed N, Kuo Y. Outcomes of Elevated Blood Alcohol Concentrations in Elderly Patients Following a Ground Level Fall: A Matched Analysis from the National Trauma Quality Program. Alcohol 2023:S0741-8329(23)00334-8. [PMID: 37967774 DOI: 10.1016/j.alcohol.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 09/22/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND The rising elderly population and the concomitant increase in alcohol consumption can result in a ground level fall (GLF). The purpose of this study is to evaluate the in-hospital mortality, hospital length of stay, and discharge disposition of elderly patients who sustained a ground level fall (GLF) and tested positive for an elevated blood alcohol concentration (BAC). METHODS The data of patients who were 65 years and older, had an injury after a GLF, and tested for BAC were accessed from the American College of Surgeon -Trauma Quality improvement Program (ACS-TQIP) from the calendar year of 2011-2016. Patients' demography, injury, comorbidities, and outcomes were compared between the groups who tested positive (>0.08g/dl) and negative (0 mg/dl) for BAC. Univariate, followed by matched analyses were performed. All p values are two sided, and a p value <0.05 is considered statistically significant. RESULTS Out of 20,163 patients who satisfied the inclusion criteria, 2,398 (∼12%) patients tested positive for an elevated BAC. There were significant differences found between the two groups, BAC positive vs. BAC negative, in univariate analysis for age and sex with P values <0.001. Propensity score matching balanced demographic characteristics; however, differences remained in certain comorbidities. Exact matching balanced patient demography, injury, and comorbidities. The paired matched analysis showed no significant differences between the two groups for in-hospital mortality (2.1% vs. 2.1%, P=1) and median hospital length of stay (5[4-5] vs. 5[5-5], P=0.307). A higher proportion of patients in BAC group suffered from alcohol withdrawal syndrome (AWS) and deep vein thrombosis (DVT) complications (9.5% vs. 1.4%, P<0.001 and 1.5% vs. 0.5%, P=0.018) compared to BAC negative patients. A slightly higher percentage of patients in the BAC positive group were discharged home without any additional services (39.6% vs. 36.9%, P<0.001). CONCLUSION Of the elderly patients who sustained a GLF and tested for BAC, approximately 12% tested positive for BAC. The overall in-hospital mortality was 2.1%. The BAC-positive group suffered from higher complications of AWS and DVT, and more than 60% of patients required additional services at the time of discharge.
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Affiliation(s)
- Nasim Ahmed
- Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune NJ USA; Hackensack Meridian School of Medicine, Nutley, NJ.
| | - YenHong Kuo
- Department of Research Administration, Hackensack Meridian Health, Edison, NJ; Hackensack Meridian School of Medicine, Nutley, NJ
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Albano GD, Malta G, Alongi A, Rifiorito A, Cannella G, Palmeri M, Malandrino G, Argo A, Zerbo S. A fatal case of paediatric post-traumatic pyomyositis. Med Leg J 2023; 91:159-163. [PMID: 37288539 DOI: 10.1177/00258172231165137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 6-year-old girl was brought to the emergency department with a history of an accidental fall a few days earlier. She presented with a fever, cough and constipation. Sars-CoV-2 infection being suspected, she was transferred to a paediatric facility for Covid-positive patients. During the diagnostic process, the clinical picture suddenly deteriorated with the development of bradycardia, tachypnea and altered sensorium. Despite cardiopulmonary resuscitation attempts, the child died about 16 hours after admission to the emergency department. A judicial forensic autopsy was performed that concluded that her death was due to multiple acute pulmonary, cardiac and renal infarctions secondary to septic thromboembolism in the course of post-traumatic bacterial necrotizing pyomyositis of the right ileo-psoas muscle.
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Affiliation(s)
- Giuseppe D Albano
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Ginevra Malta
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Alberto Alongi
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Arianna Rifiorito
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Giovanni Cannella
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Mattia Palmeri
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Giuliana Malandrino
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Antonina Argo
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Stefania Zerbo
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
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Yuan L, Yibo W, Yuqian D, Haiye R, Jiaxin L, Liping Z. The relationship between fall and loneliness among older people in China: the mediating role of personality trait. Front Psychiatry 2023; 14:1204544. [PMID: 37614652 PMCID: PMC10442840 DOI: 10.3389/fpsyt.2023.1204544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023] Open
Abstract
Aims We aimed to explore the role of personality traits between fall and loneliness. Methods A questionnaire survey was used to investigate falls, the big five personality traits, and loneliness among older people (≥ 60 years old) in China mainland. Results A total of 4,289 older people participated in the survey. There are significant differences in age, marital status, education level, residence, solitariness, and fall in relation to loneliness among older people. Falls, especially when they occurred one time increase the loneliness of older people. Agreeableness, conscientiousness, and neuroticism were significant mediating effects between falls and loneliness. Conclusion This study implied that agreeableness, conscientiousness, and neuroticism were meditating factors between falls and loneliness. In the future, we should consider the big five personality traits more to understand loneliness and offer older people interventions for reducing their loneliness. The study design was cross-sectional, so the temporal precedence of mediators and causality could not be tested. Because the data were collected retrospectively, current loneliness is likely to have confounding effects on retrospective recall.
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Affiliation(s)
- Luo Yuan
- School of Nursing, Capital Medical University, Beijing, China
| | - Wu Yibo
- School of Public Health, Peking University, Beijing, China
| | - Deng Yuqian
- Xiang Ya Nursing School, Central South University, Changsha, Hunan Province, China
| | - Ran Haiye
- Xiang Ya Nursing School, Central South University, Changsha, Hunan Province, China
| | - Liu Jiaxin
- Xiang Ya Nursing School, Central South University, Changsha, Hunan Province, China
| | - Zhao Liping
- Xiang Ya Second Hospital of Central South University, Changsha, Hunan Province, China
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Moreland B, Shakya I, Idaikkadar N. Development and Evaluation of Syndromic Surveillance Definitions for Fall- and Hip Fracture-Related Emergency Department Visits Among Adults Aged 65 Years and Older, United States 2017-2018. J Public Health Manag Pract 2023; 29:297-305. [PMID: 36730978 PMCID: PMC10038877 DOI: 10.1097/phh.0000000000001609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To develop syndromic surveillance definitions for unintentional fall- and hip fracture-related emergency department (ED) visits among older adults (aged ≥65 years) for use in the Centers for Disease Control and Prevention's National Syndromic Surveillance Program (NSSP) data and compare the percentage of ED visits captured using these new syndromes with ED visits from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample (HCUP-NEDS), a nationally representative administrative data set. DESIGN/SETTING Syndromic definitions were developed using chief complaint terms and discharge diagnosis codes in NSSP data. The percentages of ED visits among older adults related to falls and hip fractures in NSSP were compared with the percentages in HCUP-NEDS in 2017 and 2018. MEASURES Prevalence ratios were calculated as the relative difference in the percentage of ED visits related to falls or hip fractures in NSSP compared with HCUP-NEDS. Counts and percentages calculated using HCUP-NEDS were weighted to produce nationally representative estimates. Data were analyzed overall and by sex and age group. RESULTS The percentage of ED visits among older adults related to falls in NSSP was 12% less in 2017 (10.81%) and 7% less in 2018 (11.42%) compared with HCUP-NEDS (2017: 12.30%; 2018: 12.26%). The percentage of ED visits among older adults related to hip fractures in NSSP was 41% less in 2017 (0.65%) and 30% less in 2018 (0.76%) compared with HCUP-NEDS (2017: 1.10%; 2018: 1.09%). In both 2017 and 2018, a higher percentage of ED visits among older women and adults aged 85 years or older were related to falls or hip fractures compared with older men and younger age groups across both data sets. CONCLUSION A smaller percentage of older adults' ED visits met the falls and hip fracture definitions in NSSP compared with HCUP-NEDS in 2017 and 2018. However, demographic trends remained similar across both data sets.
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Affiliation(s)
- Briana Moreland
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia (Mss Moreland and Shakya and Mr Idaikkadar); and Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee (Ms Shakya)
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Rodrigues F, Monteiro AM, Forte P, Morouço P. Effects of Muscle Strength, Agility, and Fear of Falling on Risk of Falling in Older Adults. Int J Environ Res Public Health 2023; 20:4945. [PMID: 36981854 PMCID: PMC10048873 DOI: 10.3390/ijerph20064945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
Falls are a major public health problem among older adults because they lead to premature mortality, loss of autonomy, and increased dependence on others. However, these associations have not been explored using procedures that analyze the sequential effects between risk factors of falling. The present study aimed to examine the effects of muscle strength, agility, and fear of falling on risk of falling using path analysis in community-dwelling older adults. In total, 49 elderly (female = 33, male = 16) participants aged between 65 and 76 years (M = 68.38 years; SD = 6.22) were included for analysis. Muscle strength, agility, fear of falling, and risk of falling were assessed using validated instruments for the older adult population. The proposed model shows that muscle strength was negatively associated with agility. Consequently, agility was negatively associated with fear of falling. The same trend appeared between fear of falling and risk of falling. The effect sizes were between small and medium for agility (R2 = 0.16), fear of falling, (R2 = 0.29), and risk of falling (R2 = 0.03). The main finding of the present study was that muscle strength was significantly correlated with agility, which, in turn, predicted fear of falling. Consequently, lower scores for fear of falling explained lower risk of falling in community-dwelling older adults. While muscle strength is a crucial component of physical fitness, only with adequate levels of agility can older adults possess the efficacy and ability to perform daily tasks.
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Affiliation(s)
- Filipe Rodrigues
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Life Quality Research Center, 2040-413 Leiria, Portugal
| | - António M. Monteiro
- Department of Sport Sciences and Physical Education, Polytechnic of Bragança, 5300-253 Bragança, Portugal
- Research Centre in Sports Sciences, Health, and Human Development, 6201-001 Covilhã, Portugal
| | - Pedro Forte
- Department of Sport Sciences and Physical Education, Polytechnic of Bragança, 5300-253 Bragança, Portugal
- Research Centre in Sports Sciences, Health, and Human Development, 6201-001 Covilhã, Portugal
- ISCE Douro, 4560-708 Penafiel, Portugal
| | - Pedro Morouço
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Center for Innovative Care and Health Technology (CiTechcare), 2410-541 Leiria, Portugal
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Shiri R, Turunen J, Karhula K, Koskinen A, Sallinen M, Ropponen A, Ervasti J, Härmä M. The association between the use of shift schedule evaluation tool with ergonomics recommendations and occupational injuries: A 4-year prospective cohort study among healthcare workers. Scand J Work Environ Health 2023; 49:108-116. [PMID: 36346248 PMCID: PMC10577015 DOI: 10.5271/sjweh.4068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE This study aimed to find out whether utilizing a shift schedule evaluation tool with ergonomics recommendations for working hours has favorable effects on the incidence of occupational injuries. METHODS This 4-year prospective cohort study (2015-2018) consisted of a dynamic cohort of healthcare shift workers (N=29 237) from ten hospital districts and six cities in Finland. Working hour characteristics and occupational injuries were measured with daily registry data. Multilevel generalized linear model was used for the analyses, and the estimates were controlled for hierarchical structure of the data and confounders. RESULTS Ward heads of the cities used the shift schedule evaluation tool 3.2 times more often than ward heads of the hospital districts. Overall incidence of workplace and commuting injuries did not differ between users and non-users of the evaluation tool. The incidence of dislocations, sprains, and strains was lower in the users than non-users [adjusted odds ratio (OR) 0.88, 95% confidence interval (CI) 0.78-0.99]. Approximately 13% of this association was mediated by increase in realized shift wishes and 10% by increase in single days off. In subgroup analyses, the incidence of workplace injury (OR 0.83, 95% CI 0.69-0.99), and among types of injuries, the incidence of dislocations, sprains, and strains (OR 0.69, 95% CI 0.55-0.85) and falling, slipping, tripping, or overturning (OR 0.75, 95% CI 0.58-0.99) were lower in users than non-users among employees of the cities, but no association was found among employees of the hospital districts. CONCLUSION The use of ergonomics recommendations for working hours is associated with a reduced risk of occupational injuries.
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Affiliation(s)
- Rahman Shiri
- Finnish Institute of Occupational Health, P.O. Box 18, FI-00032 Työterveyslaitos, Helsinki.
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Shimizu Y, Taga M, Takahashi Y, Yamamoto Y, Masauji T. Risk assessment of accidental falls in patients taking trazodone, quetiapine, or risperidone for insomnia: A single-center, case-control study. Neuropsychopharmacol Rep 2022; 42:532-537. [PMID: 36321609 PMCID: PMC9773723 DOI: 10.1002/npr2.12297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 12/24/2022] Open
Abstract
AIM No consensus has been reached on the association between the risk of falls and antipsychotic and antidepressant drug use. In this study, we evaluated the risk of falls with trazodone, risperidone, and quetiapine, which are recommended for use at Kanazawa Medical University Hospital. METHODS We reviewed all patients who were admitted to Kanazawa Medical University Hospital between January 1st and December 31st, 2018. We excluded those aged <20 years and those admitted to pediatric, intensive care, and psychiatric wards. Finally, 9273 patients were included. We reviewed the incidence in these patients of accidental falls reported to the medical safety department. We noted whether these patients received trazodone, quetiapine, or risperidone. We also observed whether they were taking a benzodiazepine receptor agonist, which is a known risk factor. We further examined each patient's age, sex, the department they were visiting, and their diseases. Patients were considered to have taken medication if it was administered within 24 hours before an accidental fall. Multiple logistic regression analysis was used to evaluate the risk of accidental fall. RESULTS Multivariate analysis showed that the adjusted odds ratios (OR) for each medication (with 95% confidence intervals) were: trazodone (OR, 0.47 [0.27-0.80]), quetiapine (OR, 1.06 [0.46-2.46]), and risperidone (OR, 0.82 [0.41-1.63]). CONCLUSION The association of risperidone and quetiapine with accidental falls was unclear. Interestingly, however, trazodone may help reduce the risk, which makes it a potential pharmacologic treatment option for insomnia in patients at high risk for accidental falls.
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Affiliation(s)
- Yoshihito Shimizu
- Department of PharmacyKanazawa Medical University HospitalKahokuJapan
| | - Masatoshi Taga
- Department of PharmacyKanazawa Medical University HospitalKahokuJapan
| | | | - Yasuhiko Yamamoto
- Medical Safety DivisionKanazawa Medical University HospitalKahokuJapan
| | - Togen Masauji
- Department of PharmacyKanazawa Medical University HospitalKahokuJapan
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Hopkins J, Hill K, Jacques A, Burton E. Prevalence, risk factors and effectiveness of falls prevention interventions for adults living with Mild Cognitive Impairment in the community: A systematic review and meta-analysis. Clin Rehabil 2022; 37:215-243. [PMID: 36189497 DOI: 10.1177/02692155221129832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify falls prevalence, falls risk factors and evaluate the effectiveness of falls prevention interventions for community-dwelling people with Mild Cognitive Impairment. DATA SOURCES Peer-reviewed articles (inception to 4 August 2022) from PubMed, CINAHL, PsycInfo, EMBASE, Scopus, SportDiscus and the Cochrane library. REVIEW METHODS All types of methodological approaches were considered. Inclusion criteria were community-dwelling; diagnosis of Mild Cognitive Impairment; aged 50+ years. Interventions needed to include falls prevention programs aiming to reduce falls and/or risk of falls. Outcomes of interest included number and/or rate of falls, falls prevalence and falls risk factors. For controlled trials, any control group was included. Quality assessment was completed using Cochrane's Risk of Bias Tool for randomized controlled trials and the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields for all other studies. Where statistical data pooling was not possible, narrative synthesis was used to present data in tables and figures. RESULTS Forty-seven studies were included. Prevalence of falls was 43% when data were gathered prospectively for 12 months. Confirmed falls risk factors included slow gait, dual-tasking, postural control and non-amnesic Mild Cognitive Impairment. Few studies evaluated interventions to reduce falls. Six meta-analyses were conducted, no significant reduction in falls was found. CONCLUSIONS Until further high-quality, adequately powered studies are available to guide practice, best practice guidelines recommend balance training as a core component of falls prevention programs for older people generally, as well as people with Mild Cognitive Impairment.
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Affiliation(s)
- Jane Hopkins
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia
| | - Keith Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Angela Jacques
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia.,Institute for Health Research, 3431University of Notre Dame Australia, Fremantle, WA, Australia
| | - Elissa Burton
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia.,enAble Institute, 1649Curtin University, Perth, WA, Australia
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12
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Saberi N, Darvishpoor Kakhki A, Ilkhani M, Khan HTA. Falls in older ambulatory care patients with cancer in Iran: Implications for clinical practice. J Eval Clin Pract 2022; 28:624-630. [PMID: 34854180 DOI: 10.1111/jep.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
RATIONALE/AIM Falls can have severe consequences particularly for older patients with cancer undergoing ambulatory care. The aim of the study is to identify the predictors of falls in older patients receiving cancer ambulatory care and evaluate the accuracy of the final multivariable model in detecting older patients with falls. METHOD A retrospective study was conducted on 300 older patients aged 60 years and above that were referred for ambulatory care in three oncology clinics based at hospitals in Tehran, Iran. Participants completed a questionnaire comprising demographic, history of falls, and cancer-related factors. Logistic regression was used to determine risk factors associated with falls. RESULTS A total of 35.3% of the older patients with cancer had experienced a fall in the 6 months following the start of their ambulatory care. The most important predictors of falls include the fourth stage of cancer (odds ratio [OR]: 6.47, 95% confidence interval [CI]: 3.20-13.08, p < 0.001), fear of falling (OR: 5.64, 95% CI: 2.58-12.33, p < 0.001), use of hearing (OR: 2.38, 95% CI: 1.07-5.29, p = 0.033) and visual aids (OR: 2.36, 95% CI: 1.12-5.01, p = 0.025), and the number of visits to the doctor (OR: 1.10, 95% CI: 1.01-1.21, p = 0.035). CONCLUSIONS The results indicate that a reduction in falls is possible by introducing strategies to improve care for older patients in the advanced stage of cancer, eliminating the causes of fear of falling, examining and improving vision and hearing, and identifying and addressing the underlying causes of visits to the doctor.
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Affiliation(s)
- Najmeh Saberi
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Darvishpoor Kakhki
- Department of Medical and Surgical Nursing, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahnaz Ilkhani
- Department of Medical and Surgical Nursing, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hafiz T A Khan
- Public Health Group, College of Nursing, Midwifery and Healthcare, University of West London, London, UK
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13
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Jung H, Lee HY, Park HA. Comparisons of Fall Prevention Activities Using Electronic Nursing Records: A Case-Control Study. J Patient Saf 2022; 18:145-151. [PMID: 35344975 PMCID: PMC9359761 DOI: 10.1097/pts.0000000000000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to compare the current fall prevention nursing practices with the evidence-based practices recommended in clinical practice guidelines according to the risk of falling and specific risk factors. METHODS The standardized nursing statements of 12,277 patients were extracted from electronic nursing records and classified into groups according to the risk of falling and individual patients' specific risk factors. The mean frequencies of the fall prevention practices in 10 categories derived from clinical practice guidelines were compared among the groups. We additionally analyzed the differences in the mean frequencies of tailored fall prevention practices according to individual patients' specific risk factors. RESULTS The nurses documented more fall prevention practices for patients at a high risk of falling and nonfallers than for patients at a low risk of falling and fallers. Specifically, the difference in nursing practices related to environmental modifications was largest between patients at a high risk of falling and those at a low risk of falling. There were also large differences in the nursing practices related to mental status, dizziness/vertigo, and mobility limitations between fallers and nonfallers. There was more documentation of tailored fall prevention practices related to mobility limitations for patient with mild lower limb weakness than for those with good power and balance. In contrast, patients with severe lower limb weakness had received fewer fall prevention practices related to mobility limitations. CONCLUSIONS The present findings emphasize that individual risk-specific nursing interventions in addition to universal precautions are crucial for preventing falls among patients.
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Affiliation(s)
- Hyesil Jung
- From the Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam
| | - Ho-Young Lee
- From the Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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14
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Gupta G, Maiya GA, Bhat N S, Hande HM, Dillon L, Keay L. Fear of falling and functional mobility in Elders with Diabetic Peripheral Neuropathy in Coastal Karnataka, India: A Hospital-Based Study. Curr Aging Sci 2022; 15:252-258. [PMID: 35331103 DOI: 10.2174/1874609815666220324153104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/03/2022] [Accepted: 01/13/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Aging with diabetic neuropathy is likely to predispose people to falls. Despite being a high-risk population, estimates of falls and their associated factors are poorly documented in elderly diabetic neuropathy patients living in coastal Karnataka, India. OBJECTIVE To investigate fear of falling and functional mobility, as an approximate measure of clinical fall risk, and explore the associated risk factors in elderly diabetic neuropathy patients living in coastal Karnataka, India. METHOD A hospital-based cross-sectional study on 316 elders aged 60 to 80 with diabetic neuropathy was conducted. A detailed diabetic foot evaluation was done. Self-reported fear of fall and functional mobility was measured using the Falls Efficacy Scale- International and Timed Up and Go test, respectively with published cut-points. Additionally, a recall of 12 months of fall history was recorded. RESULTS Descriptive analysis showed that self-reported fear of fall and below-average functional mobility was present in 39% and 49% of the elders with diabetic neuropathy, respectively. Spearman's correlational analysis revealed that self-reported fall concerns and functional mobility are significantly interdependent. Regression analysis suggested female gender, the severity of neuropathy, and previous falls as significant modifiers for fear of fall and poor functional mobility. CONCLUSION Half of the elders (49%) with diabetic neuropathy have poor functional mobility and 39% have a fear of falling. Improving physical function and addressing fall concerns of elders with diabetic neuropathy can result in greater confidence to participate in everyday activities and contribute to their better health. Hence, early fall risk identification is recommended for providing better health care in these individuals.
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Affiliation(s)
- Garima Gupta
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - G Arun Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Shyamasunder Bhat N
- Department of Orthopaedics, Kasturba Hospital Manipal, Manipal Academy of Higher Education, Manipal, India
| | - H Manjunatha Hande
- Department of Medicine, Kasturba Hospital Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Lisa Dillon
- School of optometry and vision science, UNSW, Sydney
| | - Lisa Keay
- School of optometry and vision science, UNSW, Sydney
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15
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Su Q, Gao Y, Zhang J, Tang J, Song M, Song J, Mao Y, Pi H. Prevalence of Fear of Falling and Its Association With Physical Function and Fall History Among Senior Citizens Living in Rural Areas of China. Front Public Health 2022; 9:766959. [PMID: 35004579 PMCID: PMC8733240 DOI: 10.3389/fpubh.2021.766959] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/29/2021] [Indexed: 10/28/2022] Open
Abstract
Background: Fear of falling (FOF) is as significant as a fall, leading to limited physical activity and poor quality of life among senior citizens. This study aimed to investigate the prevalence of FOF and its association with physical function and fall history among the senior citizens (≥75 years old) living in rural areas of China. Methods: This was a cross-sectional study conducted in eastern China from June to October 2019. All elderly participants were recruited during their attendance for the free health examinations in villages and towns organized by the local healthcare authorities. Data on sociodemographics, fall history, FOF conditions, self-reported comorbidity and regular medications were collected by face-to-face interview, and the physical function status was evaluated through a field test. Univariate and multivariate analyses were performed to compare the differences in physical function and fall history of senior citizens with/without FOF. Results: A total of 753 senior citizens (mean age = 79.04) participated in this study. Of these, 63.5% were aged 75-80. FOF was reported in 22.8% of the participants, while 18.5% had a fall in the past year. Among the senior citizens with and without a fall history, the prevalences of FOF were 38.8 and 19.2%, respectively. On multivariate analyses, FOF was independently associated with the Time Up and Go Test (TUG) duration (OR = 1.080; 95% CI: 1.034-1.128), 4-Stage Balance Test score (OR = 0.746; 95% CI: 0.597-0.931), fall history (OR = 2.633; 95% CI: 1.742-3.980), cerebral apoplexy (OR = 2.478; 95% CI: 1.276-4.813) and comorbidities (≥2) (OR = 1.637; 95% CI: 1.066-2.514), while the correlation between FOF and the 30-s chair stand test was only statistically significant in univariate analysis (Z = -3.528, p < 0.001). Conclusion: High prevalence of FOF is observed among the senior citizens living in rural areas of China. FOF is strongly correlated with physical function performance and fall history. Therefore, the implementation of targeted FOF prevention measures is key to improve the physical activity of the senior citizens, which would ultimately lead to fall prevention and improved quality of life.
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Affiliation(s)
- Qingqing Su
- Medical School of Chinese PLA, Beijing, China
| | - Yuan Gao
- Department of Nursing, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jie Zhang
- Department of Nursing, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jingping Tang
- Department of Rheumatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Mi Song
- Medical School of Chinese PLA, Beijing, China
| | - Jie Song
- Medical School of Chinese PLA, Beijing, China
| | - Yazhan Mao
- Medical School of Chinese PLA, Beijing, China
| | - Hongying Pi
- Medical Service Training Center, Chinese PLA General Hospital, Beijing, China
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Valdés-Badilla P, Ramirez-Campillo R, Herrera-Valenzuela T, Branco BHM, Guzmán-Muñoz E, Mendez-Rebolledo G, Concha-Cisternas Y, Hernandez-Martínez J. Effectiveness of Olympic Combat Sports on Balance, Fall Risk or Falls in Older Adults: A Systematic Review. Biology (Basel) 2022; 11:biology11010074. [PMID: 35053071 PMCID: PMC8773029 DOI: 10.3390/biology11010074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/31/2021] [Accepted: 01/01/2022] [Indexed: 12/11/2022]
Abstract
Simple Summary The regular practice of physical activity has achieved greater diffusion in recent years as a strategy for fall prevention and improving or maintaining the general health status of older adults, which contributes to an active and healthy lifestyle. The strategies to promote active and healthy aging need to be reassessed due to the COVID-19 pandemic to promote the safe practice of physical activity among older adults, considering, among other measures, practicing social distancing or training at home. Such a scenario could provide the opportunity to promote physical activity that requires a limited number of participants in reduced spaces for its practice, such as Olympic combat sports. In this review, an overview of the effects of Olympic combat sports on balance, fall risk, or falls in older adults is presented. From 1496 records, eight studies were included, involving 322 older adults (64% female; mean age = 71.1 years). The available evidence does not allow a definitive recommendation for or against Olympic combat sports interventions as an effective strategy to improve balance and reduce the fall risk or falls in older adults. Therefore, more high-quality studies are required to draw definitive conclusions. Abstract This systematic review and meta-analysis aimed to assess the available body of published peer-reviewed articles related to the effects of Olympic combat sports (OCS), compared with active/passive controls, on balance, fall risk, or falls in older adults. The TESTEX and GRADE scales assessed the methodological quality and certainty of the evidence. The protocol was registered in PROSPERO (code: CRD42020204034). From 1496 records, eight studies were included, involving 322 older adults (64% female; mean age = 71.1 years). The TESTEX scale revealed all studies with a score ≥ 60% (moderate-high quality). The GRADE scale indicated all studies with at least some concerns, up to a high risk of bias (i.e., was rated very low). Meta-analyses were planned, although the reduced number of studies precluded its incorporation in the final manuscript. Only two from six studies that assessed balance found improvements after OCS compared to controls. No differences were found between OCS vs. control groups for fall risk or falls. The available evidence does not allow a definitive recommendation for or against OCS interventions as an effective strategy to improve balance and reduce the fall risk or falls in older adults. Therefore, more high-quality studies are required to draw definitive conclusions.
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Affiliation(s)
- Pablo Valdés-Badilla
- Department of Physical Activity Sciences, Faculty of Education Sciences, Universidad Católica del Maule, Talca 3530000, Chile
- Escuela de Educación, Universidad Viña del Mar, Viña del Mar 2520000, Chile
- Correspondence:
| | - Rodrigo Ramirez-Campillo
- Department of Physical Activity Sciences, Universidad de Los Lagos, Santiago 5290000, Chile;
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 8370035, Chile
| | - Tomás Herrera-Valenzuela
- Department of Physical Activity, Sports and Health Sciences, Faculty of Medical Sciences, Universidad de Santiago de Chile (USACH), Santiago 8370003, Chile;
| | | | - Eduardo Guzmán-Muñoz
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca 110231, Chile; (E.G.-M.); (G.M.-R.); (Y.C.-C.)
| | - Guillermo Mendez-Rebolledo
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca 110231, Chile; (E.G.-M.); (G.M.-R.); (Y.C.-C.)
| | - Yeny Concha-Cisternas
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca 110231, Chile; (E.G.-M.); (G.M.-R.); (Y.C.-C.)
- Pedagogía en Educación Física, Facultad de Educación, Universidad Autónoma de Chile, Talca 3467987, Chile
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17
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Song PYH, Sturnieks DL, Davis MK, Lord SR, Okubo Y. Perturbation-Based Balance Training Using Repeated Trips on a Walkway vs. Belt Accelerations on a Treadmill: A Cross-Over Randomised Controlled Trial in Community-Dwelling Older Adults. Front Sports Act Living 2021; 3:702320. [PMID: 34490425 PMCID: PMC8417700 DOI: 10.3389/fspor.2021.702320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Walkway and treadmill induced trips have contrasting advantages, for instance walkway trips have high-ecological validity whereas belt accelerations on a treadmill have high-clinical feasibility for perturbation-based balance training (PBT). This study aimed to (i) compare adaptations to repeated overground trips with repeated treadmill belt accelerations in older adults and (ii) determine if adaptations to repeated treadmill belt accelerations can transfer to an actual trip on the walkway. Method: Thirty-eight healthy community-dwelling older adults underwent one session each of walkway and treadmill PBT in a randomised crossover design on a single day. For both conditions, 11 trips were induced to either leg in pseudo-random locations interspersed with 20 normal walking trials. Dynamic balance (e.g., margin of stability) and gait (e.g., step length) parameters from 3D motion capture were used to examine adaptations in the walkway and treadmill PBT and transfer of adaptation from treadmill PBT to a walkway trip. Results: No changes were observed in normal (no-trip) gait parameters in both training conditions, except for a small (0.9 cm) increase in minimum toe elevation during walkway walks (P < 0.01). An increase in the margin of stability and recovery step length was observed during walkway PBT (P < 0.05). During treadmill PBT, an increased MoS, step length and decreased trunk sway range were observed (P < 0.05). These adaptations to treadmill PBT did not transfer to a walkway trip. Conclusions: This study demonstrated that older adults could learn to improve dynamic stability by repeated exposure to walkway trips as well as treadmill belt accelerations. However, the adaptations to treadmill belt accelerations did not transfer to an actual trip. To enhance the utility of treadmill PBT for overground trip recovery performance, further development of treadmill PBT protocols is recommended to improve ecological authenticity.
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Affiliation(s)
- Patrick Y H Song
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Daina L Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Michael K Davis
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Yoshiro Okubo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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18
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Abstract
INTRODUCTION Falls during pregnancy occur in 25-27% of women and can cause serious harm to both the mother and the fetus. The objective of this systematic review was to identify intrinsic and extrinsic risk factors for falls during pregnancy by reviewing original studies and addressing possible forms of prevention. METHODS We searched PubMed, Cochrane library, and Web of Science databases for studies assessing risk factors for falling after a fall has occurred or by using posturographic assessment. RESULTS Fourteen studies were included in the review. The identified extrinsic risk factors include slippery floors, cluttered areas, uneven ground, inappropriate shoes, hurrying, walking on stairs, carrying additional loads, poor lighting or obstructed view, sedentary lifestyle and working in physically demanding jobs. The identified intrinsic factors include age less than 30, height more than 160 cm, advanced pregnancy, unintended pregnancy, multiparity, hyperemesis gravidarum, low back pain, gestational diabetes, increase in abdominal circumference, lower ankle stiffness and joint laxity. Physical activity, maternity support belts, and education are possible strategies for fall prevention. CONCLUSION Our systematic review identified 13 intrinsic and 11 extrinsic risk factors for falling during pregnancy. With the knowledge of risk factors and the optimal prevention strategy, healthcare providers could incorporate this information in the treatment of pregnant women and reduce the risk of falling.
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Affiliation(s)
- Ivana Hrvatin
- Faculty of Health Sciences, Biomechanical Laboratory, University of Ljubljana, Ljubljana, Slovenia
| | - Darja Rugelj
- Faculty of Health Sciences, Biomechanical Laboratory, University of Ljubljana, Ljubljana, Slovenia
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19
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Romli MH, Mackenzie L, Lovarini M, Clemson L, Tan MP. Home Hazards With Fear of Falling: Findings From the Baseline Study of the Malaysian Elders Longitudinal Research (MELoR). Front Public Health 2021; 8:612599. [PMID: 33511098 PMCID: PMC7835712 DOI: 10.3389/fpubh.2020.612599] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/09/2020] [Indexed: 01/18/2023] Open
Abstract
Background: Fear of falling (FoF) is a common issue among older people, impacting on psychological health, functional performance and mortality. Many factors associated with fear of falling have been investigated but little is known about the role of home hazards. Home hazards can be due to unsafe environmental and functional features. This study is aims to evaluate the association between home hazards with fear of falling among community-dwelling individuals aged 55 years and over. Methods: Baseline data with 1,489 older individuals from the Malaysian Elders Longitudinal Research (MELoR) study were analyzed. Home visits for interview and observations in the home were conducted with the participants. FoF was established with a single-item question and home hazards with the Home Falls and Accidents Screening Tool (HOME FAST). Results: The majority (76.4%) of older participants experienced FoF. The history of falls was not associated with FoF (p = 0.868), but FoF was associated with participants limiting their daily activities (p < 0.001). Home hazards were less likely (p = 0.023) and functional issues were more likely (p < 0.001) to be associated with a high degree of FoF. However, both home hazards domains were not associated with activity restriction due to FoF. Conclusions: Education about home hazards from the perspective of person-environment interaction may encourage home hazards management and reduce FoF which should be evaluated in future studies.
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Affiliation(s)
- Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.,Malaysian Research Institute on Ageing (MyAgeingTM), Universiti Putra Malaysia, Serdang, Malaysia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Meryl Lovarini
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Lindy Clemson
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Petaling Jaya, Malaysia
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20
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Nyman SR. Tai Chi for the Prevention of Falls Among Older Adults: A Critical Analysis of the Evidence. J Aging Phys Act 2020; 29:343-52. [PMID: 32839351 DOI: 10.1123/japa.2020-0155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/28/2020] [Accepted: 06/28/2020] [Indexed: 11/18/2022]
Abstract
Despite interest as to the benefits of Tai Chi, there remains a controversy over its effectiveness as an exercise intervention for preventing falls among older adults. This review synthesizes the evidence base with a focus on meta-analyses and randomized controlled trials with community-dwelling older adults. It provides a critical lens on the evidence and quality of the trials. High-quality evidence suggests that Tai Chi is an effective intervention for preventing falls in community settings; however, there is unclear evidence for long-term care facilities and an absence of evidence for hospital settings. When compared directly with other exercise interventions, Tai Chi may offer a superior strategy for reducing falls through its benefits on cognitive functioning. Using data from the current Cochrane review, a new synthesis is presented suggesting that 71-81% of community-dwelling older adults are adherent to class-based Tai Chi interventions. The practical opportunities and challenges for practitioners are discussed.
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21
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Ratsimbazafy C, Schwab C, Richebourg N, Fernandez C, Hindlet P. [Elder fallers: A group at risk of readmission?]. Ann Pharm Fr 2020; 79:70-76. [PMID: 32805209 DOI: 10.1016/j.pharma.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/27/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To describe older patients hospitalized for falls, at risk of readmission and priority for interventions to reduce this risk. METHODS We conducted an observational, monocentric, prospective study (from April to June 2019). The inclusion criteria were: patients aged 75 and over, admitted to the Emergency Department for falls, consenting to the study. For patients subsequently hospitalized, the geriatric scores were determined (risk of readmission [ISAR score], state of frailty, degree of autonomy [Katz score]), and when appropriate, medication treatments were listed and compliance of patients was assessed (Girerd score). RESULTS In three months, 154 patients were included (median age 86 years [min 75-max 103], sex ratio 0.44), of which 73 patients were hospitalized. Among these patients, 63% presented a high risk of readmission; 45.2% are likely to become frail; 72.6% were dependent. Finally, 53 of the 73 patients (72.6%) had a treatment in primary care and presented a 71.7% non-compliance or low-compliance rate. Fifty height patients (79.5%) had at least 1 drug associated with fall [min 1-max 7]. CONCLUSIONS Older patients presenting at hospital with a fall were numerous, often likely to become frail and dependent for the majority of them. As the readmission risk is also very high in this population, future studies aiming at reducing the risk of hospital readmission are needed.
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Affiliation(s)
- C Ratsimbazafy
- Hôpital Saint-Antoine, pharmacie, GHU, AP-HP, Sorbonne université, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Université Paris-Saclay, faculté de pharmacie, département de pharmacie clinique, 92296 Chatenay-Malabry, France.
| | - C Schwab
- Université Paris-Saclay, faculté de pharmacie, département de pharmacie clinique, 92296 Chatenay-Malabry, France; Hôpital Saint-Antoine, pharmacie, GHU, AP-HP, Sorbonne Université, INSERM, institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne université, 75012 Paris, France
| | - N Richebourg
- Hôpital Saint-Antoine, pharmacie, GHU, AP-HP, Sorbonne université, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - C Fernandez
- Université Paris-Saclay, faculté de pharmacie, département de pharmacie clinique, 92296 Chatenay-Malabry, France; Hôpital Saint-Antoine, pharmacie, GHU, AP-HP, Sorbonne Université, INSERM, institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne université, 75012 Paris, France
| | - P Hindlet
- Université Paris-Saclay, faculté de pharmacie, département de pharmacie clinique, 92296 Chatenay-Malabry, France; Hôpital Saint-Antoine, pharmacie, GHU, AP-HP, Sorbonne Université, INSERM, institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne université, 75012 Paris, France
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Ratsimbazafy C, Schwab C, Dechartres A, Fernandez C, Hindlet P. Readmissions of Elder Patients Presenting to Hospital for a Fall (RELIEF): A Systematic Review. J Am Med Dir Assoc 2020; 21:1451-1457.e6. [PMID: 32669237 DOI: 10.1016/j.jamda.2020.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/07/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Falls are an important issue in older adults as they are frequent, deleterious, and often lead to repeated consultations at the emergency department (ED) and unplanned hospitalizations. Our principal objective was to provide an inventory of interventions designed to prevent unplanned readmissions or ED visits of older patients presenting to hospital with a fall. DESIGN Systematic review performed on February 11, 2019 in MEDLINE via PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science, without date or language restriction. We manually updated this search in August 1, 2019. Study selection, data extraction and risk of bias assessment were conducted independently by 2 reviewers. SETTING AND PARTICIPANTS We included studies reporting interventions to prevent unplanned readmissions or ED visits of older patients (aged 65 years or over) presenting to hospital because of a fall. RESULTS We identified 475 unique citations after removing duplicates and included 6 studies (2 observational and 4 interventional studies). The studies were published between 2012 and 2019; they evaluated heterogeneous interventions that were frequently multifaceted and multidisciplinary. The interventions were shown effective in reducing readmissions or ED revisits compared with control groups in 3 studies (relative risk reductions between 30% and 65%), all of which were multifaceted and 2/3 multidisciplinary. CONCLUSIONS AND IMPLICATIONS With 6 articles showing inconsistent results, our study highlights the need to adequately design and evaluate interventions to reduce the burden of hospital readmissions among older fallers. Retrieved studies are recent, which underlines that hospital readmissions are a current concern for researchers and public health authorities [PROSPERO registration number: CRD42019131965].
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Affiliation(s)
- Carole Ratsimbazafy
- GHU AP-HP.Sorbonne Université, Hôpital Saint-Antoine, Pharmacie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
| | - Camille Schwab
- GHU AP-HP.Sorbonne Université, Hôpital Saint-Antoine, Pharmacie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Université Paris-Saclay, Faculté de Pharmacie, Département de Pharmacie Clinique, Chatenay Malabry, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GHU AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Biostatistiques santé publique information médicale, Paris, France
| | - Christine Fernandez
- GHU AP-HP.Sorbonne Université, Hôpital Saint-Antoine, Pharmacie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Université Paris-Saclay, Faculté de Pharmacie, Département de Pharmacie Clinique, Chatenay Malabry, France
| | - Patrick Hindlet
- GHU AP-HP.Sorbonne Université, Hôpital Saint-Antoine, Pharmacie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Université Paris-Saclay, Faculté de Pharmacie, Département de Pharmacie Clinique, Chatenay Malabry, France
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Behera C, Krishna K. Fatal positional asphyxia following a fall in bathroom. Med Leg J 2020; 88:169-171. [PMID: 32228375 DOI: 10.1177/0025817219876094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 27-year-old female student was found dead inside the bathroom of her university hostel. The body was in a prone position with her neck over-flexed on to her trunk. The medico-legal autopsy found features of asphyxia. Multiple lacerated wounds were present on the occipital region of scalp. The cause of death was opined as positional asphyxia following an accidental fall and blunt trauma to the head. In this case, concussion due to blunt trauma to the head may have precluded any self-rescue efforts by the victim from the floor leading to positional asphyxia.
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Affiliation(s)
- Chittaranjan Behera
- Department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karthik Krishna
- Department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi, India
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24
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Niempoog S, Sukkarnkosol S, Boontanapibul K. Prevalence of Osteoporosis in Patients with Distal Radius Fracture from Low-Energy Trauma. Malays Orthop J 2019; 13:15-20. [PMID: 31890105 PMCID: PMC6915318 DOI: 10.5704/moj.1911.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 07/17/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction: Osteoporosis is a devastating problem leading to significant morbidity and mortality. Patients with osteoporosis usually present with fractures from low-energy trauma and falls, commonly of the distal radius, which may precede more severe fractures like fracture of the neck of femur, but data from Thailand are limited. The objective of our study was to determine the prevalence of osteoporosis in patients with distal radius fracture from low-energy trauma. Materials and Methods: This was a descriptive retrospective study, performed at Thammasat University Hospital in Thailand, from January 2011 to June 2017. Patients aged more than 50 years with distal radial fractures from low-energy trauma with available bone mineral density (BMD) result were included. Patients with known secondary causes of osteoporosis were excluded. Patients were grouped by age, sex, and BMD status (normal, osteopenic and osteoporotic). Results: One hundred out of 351 patients with distal radial fractures had bone mineral density data but only 79 (73 females) met the inclusion criteria. Most patients were aged 60-69 years old (n=31, 42.5%). 47 (59.5%) patients were osteoporotic, 23 (29.1%) osteopenic, and 9 (11.4%) were normal. Seven (6 osteoporotic) patients suffered a more severe fracture subsequently. No deaths were recorded. Conclusion: Our study found a high rate of osteoporosis mostly in females, consistent with published literature. Assessing BMD is crucial in middle age and elderly patients with fractures to better manage osteoporosis and prevent more severe fractures in the future.
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Affiliation(s)
- S Niempoog
- Department of Orthopaedics, Thammasat University, Pathum Thani, Thailand
- Department of Orthopedics, Chulabhorn International College of Medicine, Pathum Thani, Thailand
| | - S Sukkarnkosol
- Department of Orthopaedics, Thammasat University, Pathum Thani, Thailand
- Department of Orthopedics, Chulabhorn International College of Medicine, Pathum Thani, Thailand
| | - K Boontanapibul
- Department of Orthopedics, Chulabhorn International College of Medicine, Pathum Thani, Thailand
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25
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Correa-Pérez A, Delgado-Silveira E, Martín-Aragón S, Cruz-Jentoft AJ. Fall-risk increasing drugs and recurrent injurious falls association in older patients after hip fracture: a cohort study protocol. Ther Adv Drug Saf 2019; 10:2042098619868640. [PMID: 31632633 PMCID: PMC6767747 DOI: 10.1177/2042098619868640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/18/2019] [Indexed: 12/26/2022] Open
Abstract
Polypharmacy and fall-risk increasing drugs (FRIDS) have been associated with
injurious falls. However, no information is available about the association
between FRIDS and injurious falls after hospital discharge due to hip fracture
in a very old population. We aim to assess the association between the use of
FRIDS at discharge and injurious falls in patients older than 80 years
hospitalized due to a hip fracture. A retrospective cohort study using routinely
collected health data will be conducted at the Orthogeriatric Unit of a teaching
hospital. Patients will be included at hospital discharge (2014), with a 2-year
follow-up. Fall-risk increasing drugs will be recorded at hospital discharge,
and exposure to drugs will be estimated from usage records during the 2-year
follow-up. Injurious falls are defined as falls that lead to any kind of health
care (primary or specialized care, including emergency department visits and
hospital admissions). A sample size of 193 participants was calculated, assuming
that 40% of patients who receive any FRID at discharge, and 20% who do not, will
experience an injurious fall during follow up. This protocol explains the study
methods and the planned analysis. We expect to find a relevant association
between FRIDS at hospital discharge and the incidence of injurious falls in this
very old, high risk population. If confirmed, this would support the need for a
careful pharmacotherapeutic review in patients discharged after a hip fracture.
However, results should be carefully interpreted due to the risk of bias
inherent to the study design.
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Affiliation(s)
- Andrea Correa-Pérez
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Crta. Colmenar Km 9.1, Madrid 28034, Spain
| | - Eva Delgado-Silveira
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Sagrario Martín-Aragón
- Departamento de Farmacología, Facultad de Farmacia, Universidad Complutense, Madrid, Spain
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26
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Castellini G, Gianola S, Stucovitz E, Tramacere I, Banfi G, Moja L. Diagnostic test accuracy of an automated device as a screening tool for fall risk assessment in community-residing elderly: A STARD compliant study. Medicine (Baltimore) 2019; 98:e17105. [PMID: 31574809 PMCID: PMC6775395 DOI: 10.1097/md.0000000000017105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/14/2019] [Accepted: 08/16/2019] [Indexed: 12/04/2022] Open
Abstract
We aimed to determine the accuracy and failure of OAK device, an automated screening, for the assessment of fall risk in a prospective cohort of healthy adults aged over 65 years. The algorithm for fall risk assessment of the centers for disease control and prevention (CDC) was used as reference standard. Of the 183 individuals recruited, the CDC algorithm classified 80 as being at moderate/high risk and 103 at low risk of falling. OAK device failure incidence was 4.9% (confidence interval [CI] upper limit 7.7%), below the preset threshold for futility-early termination of the study (i.e., not above 15%). The OAK device showed a sensitivity of 84% and a specificity of 67% (receiver operating characteristic [ROC] area 82%; 95% confidence interval [CI] 76-88%), not reaching the preplanned target sensitivity (not lower than 85%). Diagnostic accuracy was not far from the sensitivity levels similar to those obtained with other fall risk assessment. However, some limitations can be considered.ClinicalTrials.gov identifier: NCT02655796.
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Affiliation(s)
- Greta Castellini
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology
| | - Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology
| | - Elena Stucovitz
- IRCCS Istituto Ortopedico Galeazzi, Motion Analysis Laboratory
| | - Irene Tramacere
- Scientific Direction, Fondazione IRCCS, Istituto Neurologico Carlo Besta
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Scientific Directorate
- Vita-Salute San Raffaele University
| | - Lorenzo Moja
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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27
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Gaudin AC, Moumneh T, Rivière H, Roy PM, Annweiler C, Brangier A. [Management and orientation of geriatric patients admitted to emergencies for a fall: results of the French prospective OREGoN cohort study]. Geriatr Psychol Neuropsychiatr Vieil 2019; 17:254-60. [PMID: 31328719 DOI: 10.1684/pnv.2019.0809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Falls in older adults are a frequent reason for admission to the emergency department, associated with greater morbidity and mortality risks, and justify specialized geriatric expertise. Our objective was to determine i) the number of older fallers admitted to the emergency department for a serious fall, and ii) the proportion of those who were referred to a geriatrician in the following 12 months. METHODS We included all patients aged 75 and over admitted to the emergency department of the University hospital of Angers, France, for a fall between 1st October and 1st November 2015. The consensual criteria proposed by the French national authority for health (2009) were used to define serious falls. RESULTS Of the 214 older fallers admitted to the emergency department, 213 (99.5%) had at least one severity criterion for the fall. Only 40 older patients (18.7%) were referred to a geriatrician during the following 12 months. They exhibited more frequently a post-fall syndrome (p=0.007), more than 3 fall risk factors (p <0.001), and took more often an anticoagulant (p=0.032) than those who had not been referred to a geriatrician. CONCLUSIONS Although almost all older fallers admitted to the emergency room had experienced a serious fall, only a minority of them received a geriatric assessment in the following year.
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28
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Le Goic M, Wang D, Vidal C, Chiarovano E, Lecompte J, Laporte S, Duysens J, Vidal PP. Corrigendum: An Initial Passive Phase That Limits the Time to Recover and Emphasizes the Role of Proprioceptive Information. Front Neurol 2019; 10:118. [PMID: 30873103 PMCID: PMC6400981 DOI: 10.3389/fneur.2019.00118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/29/2019] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fneur.2018.00986.].
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Affiliation(s)
- Maeva Le Goic
- COGNAC-G (COGNition and ACtion Group), Université Paris Descartes-CNRS UMR-MD-SSA, Paris, France
| | - Danping Wang
- Institute of Information and Control, Hangzhou Dianzi University, Hangzhou, China.,Plateforme d'Etude de la Sensorimotricité, Université Paris Descartes, Paris, France
| | - Catherine Vidal
- COGNAC-G (COGNition and ACtion Group), Université Paris Descartes-CNRS UMR-MD-SSA, Paris, France
| | - Elodie Chiarovano
- COGNAC-G (COGNition and ACtion Group), Université Paris Descartes-CNRS UMR-MD-SSA, Paris, France
| | - Jennyfer Lecompte
- Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - Sebastien Laporte
- Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - Jacques Duysens
- Movement Control and Neuroplasticity Research Group, Department of Kinesiology, KU Leuven, Leuven, Belgium
| | - Pierre-Paul Vidal
- Institute of Information and Control, Hangzhou Dianzi University, Hangzhou, China.,COGNAC-G (COGNition and ACtion Group), Université Paris Descartes-CNRS UMR-MD-SSA, Paris, France
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29
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Teo DB, Wong HC, Yeo AW, Lai YW, Choo EL, Merchant RA. Characteristics of fall-related traumatic brain injury in older adults. Intern Med J 2019; 48:1048-1055. [PMID: 29573078 DOI: 10.1111/imj.13794] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Older adults admitted for falls and its complications, including traumatic brain injury (TBI), is increasing. Recent studies have shown that those with falls who presented to the emergency department (ED) had an increased frequency of ED revisits, especially those with head trauma. AIM To determine the characteristics and predictors of fall-related traumatic brain injury (FRTBI) in older adults. METHODS Retrospective medical chart review of 339 patients aged 65 years and older admitted for TBI in 2014 due to a fall. Characteristics analysed include demographics, fall circumstances, prior ED visits, polypharmacy, readmission, functional status and specialist outpatient clinic utilisation before and after FRTBI. RESULTS A total of 339 (37.4%) patients admitted due to FRTBI was 65 years old and older; 112 (33.0%) for subdural haemorrhage (SDH); 227 (67.0%) for head injury (HI), with a mean age of 80 years. A total of 46 (41.1%) patients with SDH and 107 (47.1%) with HI had a previous ED visit within the last year, while 22 (19.6%) of SDH and 49 (21.6%) of HI had hospitalisation 3 months prior to FRTBI. FRTBI was associated with significant decline in activities of daily living, polypharmacy and increased specialist outpatient clinic appointments (P < 0.001). Mortality was 11 (3.2%). Mild cognitive impairment or dementia was significantly associated with admissions for FRTBI, 3.31 (95% confidence interval 1.68-6.51, P = 0.001) using adjusted logistic regression. CONCLUSION FRTBI is associated with significant functional decline and increased resource utilisation with almost half of the patients having had prior ED visits or hospitalisation. Future studies should focus on falls risk assessment and interventions for high-risk older adults prior to discharge from ED and hospital, and its impact on readmissions due to FRTBI.
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Affiliation(s)
- Desmond B Teo
- Divisions of Advanced Internal Medicine, University Medicine Cluster, National University Hospital, National University Healthcare System, Singapore, Singapore
| | - Hung C Wong
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ai W Yeo
- Department of Nursing, National University Hospital, National University Healthcare System, Singapore, Singapore
| | - Yi W Lai
- Dean's Office, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ee L Choo
- Management Information, Corporate Planning and Development, National University Hospital, National University Healthcare System, Singapore, Singapore
| | - Reshma A Merchant
- Divisions of Geriatric Medicine, University Medicine Cluster, National University Hospital, National University Healthcare System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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30
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Cywka T, Milaszkiewicz A, Teresiński G. Differentiation between suicidal and accidental falls from height using the method proposed by Teh et al. Arch Med Sadowej Kryminol 2019; 69:100-7. [PMID: 32264660 DOI: 10.5114/amsik.2019.94227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
One of the main problems encountered in medico-legal assessment of injuries suffered as a result of falling from a height is the discrimination between the effects of accidental and suicidal falls. The aim of the study was to verify the prevalence of injuries involving different regions of the osteoarticular system in groups of victims of attempted suicide and fatal accidents according to the method proposed by Teh et al. The study material consisted of the findings of extended post-mortem examinations of 114 victims of falls from a height, which were conducted in the Department of Forensic Medicine in Lublin. The post-mortem results were compared with the data found in corresponding prosecutorial case files. The results of the study indicate a higher prevalence of osteoarticular injuries within the pelvis and lower limbs in the group of suicide victims, which correlates with the results reported by Teh et al. An analysis of injuries in different body regions in accordance with the reported method can be useful in determining the circumstances of falling from a height.
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31
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Le Goic M, Wang D, Vidal C, Chiarovano E, Lecompte J, Laporte S, Duysens J, Vidal PP. An Initial Passive Phase That Limits the Time to Recover and Emphasizes the Role of Proprioceptive Information. Front Neurol 2018; 9:986. [PMID: 30524363 PMCID: PMC6262780 DOI: 10.3389/fneur.2018.00986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/01/2018] [Indexed: 12/26/2022] Open
Abstract
In the present experiments, multiple balance perturbations were provided by unpredictable support-surface translations in various directions and velocities. The aim of this study was to distinguish the passive and the active phases during the pre-impact period of a fall. It was hypothesized that it should be feasible if one uses a specific quantitative kinematic analysis to evaluate the dispersion of the body segments trajectories across trials. Moreover, a multi-joint kinematical model was created for each subject, based on a new 3-D minimally invasive stereoradiographic X-ray images to assess subject-specific geometry and inertial parameters. The simulations allowed discriminating between the contributions of the passive (inertia-induced properties) and the active (neuromuscular response) components during falls. Our data show that there is limited time to adjust the way one fall from a standing position. We showed that the pre-impact period is truncated of 200 ms. During the initial part of a fall, the observed trajectory results from the interaction between the destabilizing external force and the body: inertial properties intrinsic to joints, ligaments and musculotendinous system have then a major contribution, as suggested for the regulation of static upright stance. This passive phase is later followed by an active phase, which consists of a corrective response to the postural perturbation. We believe that during a fall from standing height, it takes about 300 ms for postural responses to start correcting the body trajectory, while the impact is expected to occur around 700 ms. It has been argued that this time is sufficient to change the way one falls and that this makes it possible to apply safer ways of falling, for example by using martial arts fall techniques. Also, our results imply visual and vestibular information are not congruent with the beginning of the on-going fall. This consequence is to be noted as subjects prepare to the impact on the basis of sensory information, which would be uniquely mainly of proprioceptive origin at the fall onset. One limitation of the present analysis is that no EMG was included so far but these data are the subject of a future study.
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Affiliation(s)
- Maeva Le Goic
- COGNAC-G (COGNition and ACtion Group), Université Paris Descartes-CNRS UMR-MD-SSA, Paris, France
| | - Danping Wang
- Institute of Information and Control, Hangzhou Dianzi University, Hangzhou, China.,Plateforme d'Etude de la Sensorimotricité, Université Paris Descartes, Paris, France
| | - Catherine Vidal
- COGNAC-G (COGNition and ACtion Group), Université Paris Descartes-CNRS UMR-MD-SSA, Paris, France
| | - Elodie Chiarovano
- COGNAC-G (COGNition and ACtion Group), Université Paris Descartes-CNRS UMR-MD-SSA, Paris, France
| | - Jennyfer Lecompte
- Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - Sebastien Laporte
- Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - Jacques Duysens
- Movement Control and Neuroplasticity Research Group, Department of Kinesiology, KU Leuven, Leuven, Belgium
| | - Pierre-Paul Vidal
- COGNAC-G (COGNition and ACtion Group), Université Paris Descartes-CNRS UMR-MD-SSA, Paris, France.,Institute of Information and Control, Hangzhou Dianzi University, Hangzhou, China
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Tanaka T, Matsumoto H, Son BK, Imaeda S, Uchiyama E, Taniguchi S, Nishino A, Miura T, Tanaka T, Otsuki T, Nishide K, Iijima K, Okata J. Environmental and physical factors predisposing middle-aged and older Japanese adults to falls and fall-related fractures in the home. Geriatr Gerontol Int 2018; 18:1372-1377. [PMID: 30133136 DOI: 10.1111/ggi.13494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/14/2018] [Accepted: 06/15/2018] [Indexed: 11/28/2022]
Abstract
AIM To identify environmental and physical factors that predispose middle-aged and older Japanese adults to falls and fall-related fractures in the home. METHODS A cross-sectional survey was carried out in 2014. Self-administered questionnaires were distributed to 15 000 community-dwelling adults in Japan. The overall crude response rate was 13%. Response data were analyzed from 1561 individuals aged ≥40 years using multiple imputation to analyze missing data. We evaluated falls without fractures and fall-related fractures during the previous 3 years according to demographic, physical and environmental factors, including age, sex, long-term care insurance certification, type of house and barrier-free housing. RESULTS Of the 1561 adults (mean age 68.1 ± 13.0 years), 28% experienced a fall in the home. Among the individuals who experienced a fall, 11% experienced fall-related fractures. These individuals were more likely to be women (OR 2.4, 95.0% CI 1.1-5.1), have LTCI certification (OR 3.9, 95.0% CI 1.6-9.4) and be living in a barrier home (OR 4.0, 95.0% CI 1.6-9.8), after adjustment for covariates. CONCLUSIONS Environmental factors, such as living in a barrier home, are critical for fall-related fractures, in addition to demographic and physical factors. A multidisciplinary approach that considers both physical and environmental factors is necessary for reducing the incidence of fall-related fractures among middle-aged and older Japanese adults. Geriatr Gerontol Int 2018; 18: 1372-1377.
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Affiliation(s)
- Tomoki Tanaka
- Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Bo-Kyung Son
- Institute of Gerontology, Faculty of Engineering, University of Tokyo, Tokyo, Japan
| | - Shujirou Imaeda
- Graduate School of Engineering, University of Tokyo, Tokyo, Japan
| | - Emiko Uchiyama
- Graduate School of Information Science and Technology, University of Tokyo, Tokyo, Japan
| | - Sakiko Taniguchi
- Graduate School of Agricultural and Life Sciences, University of Tokyo, Tokyo, Japan
| | - Akiko Nishino
- Institute of Gerontology, Faculty of Engineering, University of Tokyo, Tokyo, Japan
| | - Takahiro Miura
- Institute of Gerontology, Faculty of Engineering, University of Tokyo, Tokyo, Japan
| | - Toshiaki Tanaka
- Institute of Gerontology, Faculty of Engineering, University of Tokyo, Tokyo, Japan
| | - Toshio Otsuki
- Graduate School of Engineering, University of Tokyo, Tokyo, Japan
| | - Kazuhiko Nishide
- Graduate School of Engineering, University of Tokyo, Tokyo, Japan
| | - Katsuya Iijima
- Institute of Gerontology, Faculty of Engineering, University of Tokyo, Tokyo, Japan
| | - Junichiro Okata
- Institute of Gerontology, Faculty of Engineering, University of Tokyo, Tokyo, Japan.,Graduate School of Engineering, University of Tokyo, Tokyo, Japan
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Abstract
Cumulative data on patient fall risk have been compiled in electronic medical records systems, and it is possible to test the validity of fall-risk assessment tools using these data between the times of admission and occurrence of a fall. The Hendrich II Fall Risk Model scores assessed during three time points of hospital stays were extracted and used for testing the predictive validity: (a) upon admission, (b) when the maximum fall-risk score from admission to falling or discharge, and (c) immediately before falling or discharge. Predictive validity was examined using seven predictive indicators. In addition, logistic regression analysis was used to identify factors that significantly affect the occurrence of a fall. Among the different time points, the maximum fall-risk score assessed between admission and falling or discharge showed the best predictive performance. Confusion or disorientation and having a poor ability to rise from a sitting position were significant risk factors for a fall.
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Affiliation(s)
- Hyesil Jung
- 1 College of Nursing, Seoul National University, South Korea
| | - Hyeoun-Ae Park
- 1 College of Nursing, Seoul National University, South Korea
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Aranda-Gallardo M, Morales-Asencio JM, Enriquez de Luna-Rodriguez M, Vazquez-Blanco MJ, Morilla-Herrera JC, Rivas-Ruiz F, Toribio-Montero JC, Canca-Sanchez JC. Characteristics, consequences and prevention of falls in institutionalised older adults in the province of Malaga (Spain): a prospective, cohort, multicentre study. BMJ Open 2018; 8:e020039. [PMID: 29476031 PMCID: PMC5855255 DOI: 10.1136/bmjopen-2017-020039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Falls are an important adverse event among institutionalised persons. It is in this clinical setting where falls occur more frequently than in any other, despite the measures commonly taken to prevent them. This study aimed to determine the characteristics of a typical institutionalised elderly patient who suffers a fall and to describe the physical harms resulting from this event. We then examined the association between falls and the preventive measures used. METHODS This was a prospective cohort study in 37 nursing homes in Spain. The participants were all the nursing home residents institutionalised in these centres from May 2014 to July 2016. Participants were followed up for 9 months. During this period, two observations were made to evaluate the preventive measures taken and to record the occurrence of falls. RESULTS 896 residents were recruited, of whom 647 completed the study. During this period, 411 falls took place, affecting 213 residents. The injuries caused by the falls were mostly minor or moderate. They took place more frequently among women and provoked 22 fractures (5.35%). The most commonly used fall prevention measure was bed rails (53.53% of cases), followed by physical restraint (16.79%). The latter measure was associated with a higher incidence of injuries not requiring stitches (OR=2.06, 95% CI 1.01 to 4.22, P=0.054) and of injuries that did require stitches (OR=3.51, 95% CI 1.36 to 9.01, P=0.014) as a consequence of falls. Bed rails protected against night-time falls. CONCLUSIONS Falls are a very common adverse event in nursing homes. The prevention of falls is most commonly addressed by methods to restrain movement. The use of physical restraints is associated with a greater occurrence of injuries caused by a fall.
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Affiliation(s)
- Marta Aranda-Gallardo
- Departmentof Nursing, Agencia Sanitaria Costa del Sol, Marbella, Malaga, Spain
- Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC), Madrid, Spain
| | | | | | | | | | - Francisco Rivas-Ruiz
- Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC), Madrid, Spain
- Research Unit, Agencia Sanitaria Costa del Sol, Marbella, Malaga, Spain
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Jeon M, Gu MO, Yim J. Comparison of Walking, Muscle Strength, Balance, and Fear of Falling Between Repeated Fall Group, One-time Fall Group, and Nonfall Group of the Elderly Receiving Home Care Service. Asian Nurs Res (Korean Soc Nurs Sci) 2017; 11:290-6. [PMID: 29290277 DOI: 10.1016/j.anr.2017.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 11/27/2017] [Accepted: 11/27/2017] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to provide information to develop a program to prevent repeated falls by analyzing the difference in gait, muscle strength, balance, and fear of falling according to their fall experience. METHODS The study subjects were 110 elderly individuals aged over 60 years who agreed to their participation in this research. The study participants were categorized into a repeated fall group (n = 40), a one-time fall group (n = 15), and a nonfall group (n = 46) of the elderly. Measurements of gait, muscle strength, balance, and fear of falling were taken in each group. RESULTS With regard to gait, there were significant differences among three groups in gait cycle (F = 3.50, p = .034), speed (F = 13.06, p < .001), and cadence (F = 5.59, p = .005). Regarding muscle strength in the upper and lower limbs, statistically significant differences were shown among three groups in muscle strength of upper (F = 16.98, p < .001) and lower (F = 10.55, p < .001) limbs. With regard to balance, the nonfall group had significantly greater results than the one-time fall group and repeated fall group in dynamic balance (F = 10.80, p < .001) and static balance (F = 8.20, p = .001). In the case of the fear of falling, the repeated fall group had significantly higher score than other two groups (F = 20.62, p < .001). CONCLUSION This study suggests that intervention program should be tailored to fall risk factors to enhance gait and balance and lower body muscle strength and reduce the fear of falling to prevent repeated incidences of falls in this population.
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Beunza-Sola M, Hidalgo-Ovejero ÁM, Martí-Ayerdi J, Sánchez-Hernández JG, Menéndez-García M, García-Mata S. Study of fall risk-increasing drugs in elderly patients before and after a bone fracture. Postgrad Med J 2017; 94:76-80. [PMID: 28916557 DOI: 10.1136/postgradmedj-2017-135129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/26/2017] [Accepted: 08/03/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Accidental falls have a significant economic and human impact. The use of certain drugs is one of the modifiable risk factors associated with these events. OBJECTIVE The aim of this study was to determine the prevalence of use and to explore changes in treatment with fall-related drugs in patients over 65 years of age admitted as a result of a fall-related fracture. METHODS Observational and prospective study performed in a tertiary level hospital. A list of fall risk-increasing drugs (FRIDs) was drawn up. The main study variables were number and type of FRIDs prescribed at admission and 1 month after the fracture and number, type, treating physician and place where changes in FRIDs were implemented. RESULTS In total, 252 patients were included. At admission, 91.3% were receiving at least one FRID, mean daily use was 3.1 FRIDs and the most frequently prescribed FRIDs were diuretics (18%), renin-angiotensin system-acting agents (15.8%) and antidepressants (15%). One month later, mean daily use was 3.4 FRIDs (p=0.099) and a significant increase was detected in the use of hypnotics (p=0.003) and antidepressants (p=0.042). A total of 327 changes in treatment were recorded (1.3 changes/patient). Of the changes, 52.6% were new prescriptions, 72.2% occurred at discharge and 56.6% were ordered by a geriatrician. CONCLUSIONS The use of FRIDs among patients with a fall-related fracture is very high. This use rises 1 month after the fracture, significantly in the case of hypnotics and antidepressants.
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Affiliation(s)
| | - Ángel M Hidalgo-Ovejero
- Department of Orthopaedic Surgery and Traumatology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Jon Martí-Ayerdi
- Department of Orthopaedic Surgery and Traumatology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Miguel Menéndez-García
- Department of Orthopaedic Surgery and Traumatology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Serafín García-Mata
- Department of Orthopaedic Surgery and Traumatology, Complejo Hospitalario de Navarra, Pamplona, Spain
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Erlandson KM, Plankey MW, Springer G, Cohen HS, Cox C, Hoffman HJ, Yin MT, Brown TT. Fall frequency and associated factors among men and women with or at risk for HIV infection. HIV Med 2017; 17:740-748. [PMID: 27028463 DOI: 10.1111/hiv.12378] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Falls and fall-related injuries are a major public health concern. HIV-infected adults have been shown to have a high incidence of falls. Identification of major risk factors for falls that are unique to HIV infection or similar to those in the general population will inform development of future interventions for fall prevention. METHODS HIV-infected and uninfected men and women participating in the Hearing and Balance Substudy of the Multicenter AIDS Cohort Study and Women's Interagency HIV Study were asked about balance symptoms and falls during the prior 12 months. Falls were categorized as 0, 1, or ≥ 2; proportional odds logistic regression models were used to investigate relationships between falls and demographic and clinical variables and multivariable models were created. RESULTS Twenty-four per cent of 303 HIV-infected participants reported at least one fall compared with 18% of 233 HIV-uninfected participants (P = 0.27). HIV-infected participants were demographically different from HIV-uninfected participants, and were more likely to report clinical imbalance symptoms (P ≤ 0.035). In univariate analyses, more falls were associated with hepatitis C, female sex, obesity, smoking, and clinical imbalance symptoms, but not age, HIV serostatus or other comorbidities. In multivariable analyses, female sex and imbalance symptoms were independently associated with more falls. Among HIV-infected participants, smoking, a higher number of medications, and imbalance symptoms remained independent fall predictors, while current protease inhibitor use was protective. CONCLUSIONS Similar rates of falls among HIV-infected and uninfected participants were largely explained by a high prevalence of imbalance symptoms. Routine assessment of falls and dizziness/imbalance symptoms should be considered, with interventions targeted at reducing symptomatology.
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Affiliation(s)
- K M Erlandson
- Department of Medicine, Divisions of Infectious Diseases and Geriatric Medicine, University of Colorado, Aurora, CO, USA.
| | - M W Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - G Springer
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - H S Cohen
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - C Cox
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - H J Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - M T Yin
- Department of Medicine, Division of Infectious Diseases, Columbia University Medical Center, New York, NY, USA
| | - T T Brown
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, Baltimore, MD, USA
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Pasqualetti G, Calsolaro V, Bini G, Dell’Agnello U, Tuccori M, Marino A, Capogrosso-Sansone A, Rafanelli M, Santini M, Orsitto E, Ungar A, Blandizzi C, Monzani F. Clinical differences among the elderly admitted to the emergency department for accidental or unexplained falls and syncope. Clin Interv Aging 2017; 12:687-695. [PMID: 28450779 PMCID: PMC5399985 DOI: 10.2147/cia.s127824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
It is difficult to distinguish unexplained falls (UFs) from accidental falls (AFs) or syncope in older people. This study was designed to compare patients referred to the emergency department (ED) for AFs, UFs or syncope. Data from a longitudinal study on adverse drug events diagnosed at the ED (ANCESTRAL-ED) in older people were analyzed in order to select cases of AF, syncope, or UF. A total of 724 patients (median age: 81.0 [65-105] years, 66.3% female) were consecutively admitted to the ED (403 AF, 210 syncope, and 111 UF). The number of psychotropic drugs was the only significant difference in patients with AF versus those with UF (odds ratio [OR] 1.44; 95% confidence interval 1.17-1.77). When comparing AF with syncope, female gender, musculoskeletal diseases, dementia, and systolic blood pressure >110 mmHg emerged as significantly associated with AF (OR 0.40 [0.27-0.58], 0.40 [0.24-0.68], 0.35 [0.14-0.82], and 0.31 [0.20-0.49], respectively), while valvulopathy and the number of antihypertensive drugs were significantly related to syncope (OR 2.51 [1.07-5.90] and 1.24 [1.07-1.44], respectively). Upon comparison of UF and syncope, the number of central nervous system drugs, female gender, musculoskeletal diseases, and SBP >110 mmHg were associated with UF (OR 0.65 [0.50-0.84], 0.52 [0.30-0.89], 0.40 [0.20-0.77], and 0.26 [0.13-0.55]), respectively. These results indicate specific differences, in terms of demographics, medical/pharmacological history, and vital signs, among older patients admitted to the ED for AF and syncope. UF was associated with higher use of psychotropic drugs than AF. Our findings could be helpful in supporting a proper diagnostic process when evaluating older patients after a fall.
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Affiliation(s)
| | | | | | | | - Marco Tuccori
- Pharmacology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Alessandra Marino
- Pharmacology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | | | - Martina Rafanelli
- Syncope Unit, Geriatric and Intensive Care Medicine, AOU Careggi and University of Florence, Florence
| | - Massimo Santini
- Emergency Department, University Hospital of Pisa, Pisa, Italy
| | - Eugenio Orsitto
- Emergency Department, University Hospital of Pisa, Pisa, Italy
| | - Andrea Ungar
- Syncope Unit, Geriatric and Intensive Care Medicine, AOU Careggi and University of Florence, Florence
| | - Corrado Blandizzi
- Pharmacology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
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Subermaniam K, Welfred R, Subramanian P, Chinna K, Ibrahim F, Mohktar MS, Tan MP. The Effectiveness of a Wireless Modular Bed Absence Sensor Device for Fall Prevention among Older Inpatients. Front Public Health 2017; 4:292. [PMID: 28119908 PMCID: PMC5220104 DOI: 10.3389/fpubh.2016.00292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/21/2016] [Indexed: 11/17/2022] Open
Abstract
Background Falls and fall-related injuries are increasingly serious issues among elderly inpatients due to population aging. The bed-exit alarm has only previously been evaluated in a handful of studies with mixed results. Therefore, we evaluated the effectiveness of a modular bed absence sensor device (M-BAS) in detecting bed exits among older inpatients in a middle income nation in East Asia. Methods Patients aged ≥65 years on an acute geriatric ward who were able to mobilize with or without walking aids and physical assistance were recruited to the study. The total number of alarms and the numbers of true and false alarms were recorded by ward nurses. The M-BAS device is placed across the mattress of all consenting participants. Nurses’ workload was assessed using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) score, while nurses’ perceptions were surveyed. Results The sensitivity of the M-BAS was 100% with a positive predictive value of 68% and a nuisance alarm rate of 31%. There was a significant reduction in total NASA-TLX workload score (mean difference = 14.34 ± 13.96 SD, p < 0.001) at the end of the intervention period. 83% of the nurses found the device useful for falls prevention, 97% found it user friendly, and 87% would use it in future. Conclusion The M-BAS was able to accurately detect bed absence episodes among geriatric inpatients and alert nurses accordingly. The use of the device significantly reduced the total workload score, while the acceptability of the device was high among our nurses. A larger, cluster randomized study to measure actual falls outcome associated with the use of the device is now indicated.
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Affiliation(s)
- Kogilavani Subermaniam
- Anatomy and Physiology Unit, Allied Health Science College, Ministry of Health Malaysia , Sungai Buloh , Malaysia
| | - Ridgwan Welfred
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia; Centre for Innovation in Medical Engineering (CIME), Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Pathmawathi Subramanian
- Department of Nursing Science of Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- Social and Preventive Medicine of Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| | - Fatimah Ibrahim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia; Centre for Innovation in Medical Engineering (CIME), Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Mas S Mohktar
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia; Centre for Innovation in Medical Engineering (CIME), Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Division of Geriatric Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Warren LR, Harley S, Dutschke J, van den Berg A, Dobbins C. Bicycle helmet use to reduce the impact of head injuries in ladder users. ANZ J Surg 2016; 87:1026-1029. [PMID: 26924071 DOI: 10.1111/ans.13447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to determine if wearing a bicycle helmet during ladder use could reduce the incidence and severity of head injury in the event of a fall. METHODS A headform model with inbuilt accelerometers was used to determine the Head Injury Criterion (HIC) score of head impact by dropping 41 helmeted and unhelmeted headforms from eight heights. These results were compared. RESULTS There was a statistically significant difference between averaged HIC scores in helmeted and unhelmeted drops (P < 0.001). Unhelmeted HIC scores ranged from 387 at 0.25 m to 2121 at 0.6 m. Helmeted HIC scores ranged from 29 at 0.25 m to 1199 at 2.5 m. At a height of 0.5 m, the risk of severe brain injury (AIS ≥4) from direct frontal head impact is predicted to reduce from >50% to <5% with helmet use. CONCLUSION There was a significant decrease in the HIC scores when helmets are used and it is likely that the benefits would be seen in the clinical setting. These results provide an argument for the use of a bicycle helmets by all ladder users, in particular those over age 50 who are at increased risk of head injuries. We recommend that bicycle helmet use be incorporated into ladder injury prevention strategies.
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Affiliation(s)
- Leigh R Warren
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Simon Harley
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jeffrey Dutschke
- Centre for Automotive Safety Research, University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew van den Berg
- Centre for Automotive Safety Research, University of Adelaide, Adelaide, South Australia, Australia
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Son HM, Kim SH, Shin SD, Ryoo HW, Ryu HH, Lee JH. Occupational fall injuries presenting to the emergency department. Emerg Med Australas 2015; 26:188-93. [PMID: 24708010 DOI: 10.1111/1742-6723.12166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study was performed to evaluate occupational and fall injuries presenting to the ED, the risk factors associated with falls among all occupational injuries, and factors affecting prognosis. METHODS Data from ED-based Occupational Injury Surveillance System were analysed to investigate the occupational injuries. The 2147 occupational injury subjects were divided into two groups: fall (n = 213, 9.9%) and non-fall (n = 1934, 90.1%). Data including baseline and clinical characteristics were compared between the groups. RESULTS The mean age was older in the fall group (46 vs 42 years old). The rate of construction site-related injury was 32% in the fall group and only 8% in the non-fall group. Injury occurrence during regular working hours (09.00 hours to 18.00 hours) was 70% in the fall group and 57% in the non-fall group. Injury severity using the Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS) was more severe in the fall group than in the non-fall group, and days away from work were longer in the fall group than the non-fall group. Older age, compared with an age <29 years old and presence in a construction area during regular working hours were factors associated with fall injuries. Factors affecting prolonged absence for work were older age, higher EMR-ISS, fall injury and poor workplace environmental conditions. CONCLUSION Risk factors associated with fall-related occupational injuries include older age and being at a construction area during regular working hours. Falls among occupational injuries are more severe than other injuries and result in longer work loss.
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Affiliation(s)
- Hyung Min Son
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
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Baek S, Piao J, Jin Y, Lee SM. Validity of the Morse Fall Scale implemented in an electronic medical record system. J Clin Nurs 2013; 23:2434-40. [PMID: 24112535 DOI: 10.1111/jocn.12359] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the validity of the Morse Fall Scale by analysing the electronic medical records on fall risk during different phases of hospitalisation. BACKGROUND Regular monitoring on fall risk with a reliable and valid assessment tool is a key element in the fall prevention. In Korea, the Morse Fall Scale is currently being used in numerous medical institutions, yet it has not been comprehensively evaluated whether it is suitable and valid. DESIGN The study design was a retrospective case-control study. METHODS The participants included 151 fallers and 694 nonfallers. Data were extracted from a university hospital implementing Morse Fall Scale in the electronic medical records between October 2010 and June 2011. The nonfallers were selected by the stratified random sampling method among the patients who were in the hospital during the same period as the fallers. The Morse Fall Scale scores during three different time periods of hospital stay were used for analysis: the initial assessment score upon admission, the last and the maximum scores recorded from admission to the fall or discharge. RESULTS With the maximum Morse Fall Scale score and the best cut-off point of 51, validity indicators showed the highest performance: 0·72 for sensitivity, 0·91 for specificity, 0·63 for positive predictive value, 0·94 for negative predictive value, 0·63 for Youden Index and 0·77 for the area under the receiver operating characteristic curve. CONCLUSION The Morse Fall Scale showed relatively high predictive performance for the Korean population. RELEVANCE TO CLINICAL PRACTICE The study results recommend practice change in fall prevention. As the validity was highest when the patient was first classified into the high-risk group based on the Morse Fall Scale cut-off score 51, patients classified as high risk should be placed under special nursing interventions until the day of their discharge, regardless of change in the patient state.
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Affiliation(s)
- Seonhyeon Baek
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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