Welcome to the latest key papers and publications focussing mainly on Falls and Falls Prevention in the nursing profession.
The British
Journal of Nursing, Nursing Times, British Journal of Healthcare Assistants,
Journal of Perioperative Practice and the British Journal of Midwifery are all
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Abstract: Older adults do not perceive they are personally at risk of falls or injury. Older adults want more information about falls from healthcare providers. Older adults are interested in fall prevention support from friends and family. Older adults are interested in fall prevention support from insurance companies. Older adults suggest various cues to action for fall prevention engagement. Falls are the leading cause of fatal and nonfatal injuries among older adults. Decreasing falls is highly dependent on engagement in fall prevention activities. The Health Belief Model (HBM) theoretical framework was used to explore older adults' perceptions about falls prevention. An informed grounded theory approach was applied. Four focus groups were conducted using semi-structured interview guides based on the HBM with 27 community-dwelling older adults (average age = 78 years). Deductive content analysis was used to apply constructs of the HBM to the data and explain the findings. Potential reasons for not engaging in falls prevention included lack of self-perceived severity, susceptibility, and self-efficacy with a subtheme of lack of information about falls prevention from medical providers. Potential facilitators included older adults' knowledge and current engagement in falls prevention and socializing while engaging in falls prevention. Participants recommended cues to action to improve engagement in falls prevention from family, friends, physicians, pharmacists, and insurance companies; and using various modes to deliver cues to action, including print, audiovisual, online, and reminders. In this study, the HBM was used to understand older adults' potential barriers, facilitators, and cues to action to support engagement in falls prevention. Engagement in fall prevention behaviors could be improved by addressing barriers such as lack of knowledge, and lack of self-perceived severity and susceptibility to falls. Reinforcing the benefits of fall prevention, and promoting cues to action to engage in falls prevention may also support engagement.
Source: Archives of Gerontology & Geriatrics, 2022; 99: 104610
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A Retrospective Cross-sectional Study on the Risk Factors of Recurrent Falls Among Inpatients
Abstract: Background: Recurrent falls are more likely to cause injuries and disabilities than single falls. Purpose: This study investigated the incidence and risk factors of recurrent falls among inpatients. Methods: We analyzed inpatient fall data from the anomaly event notification database and electronic medical records of a hospital. We collected data regarding 1059 inpatients who had fallen during their hospital stay. Among these inpatients, 390 (36.83%) had fallen within the previous year. Results: Inpatients in the orthopedics and neurology wards were at a higher risk of recurrent falls than those in surgical wards; inpatients who were physically dependent were at a higher risk of recurrent falls than those who were physically independent; inpatients with poor vision were at a lower risk of recurrent falls than those without this issue; and inpatients who were using antidepressants were at a higher risk of recurrent falls than those who were not using antidepressants. Conclusion: The risk of recurrent falls is highly correlated with ward type, physical independence, self-perceived good vision, and use of antidepressants.
Source: Journal of Nursing Care Quality, 2022; 37(2): E31-E37
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Association Between Cognitive Status and Falls With and Without Injury During a Skilled Nursing Facility Short Stay
Abstract: To examine the relationship between cognitive status and falls with and without injury among older adults during the first 18 days of a skilled nursing facility (SNF) and determine if this association is mediated by limitations in activities of daily living (ADL) and impaired balance. Cohort study of Medicare fee-for-service beneficiaries admitted to an SNF between October 1, 2016, and September 31, 2017. 815,927 short-stay nursing home residents admitted to an SNF within 3 days of hospital discharge. Cognitive status at SNF admission was classified as intact, mild, moderate, or severe impairment. Residents were classified as having no falls, a fall without injury, and a fall with a minor or major injury. We used ordinal logistic regression to model the association between cognitive status and falls adjusting for resident and facility characteristics. A causal mediation analysis was used to test for the mediating effects of ADL limitations and impaired balance on the association between cognitive status and falls with an injury. Mild, moderate, and severe cognitive impairment were associated with 1.72 (95% CI: 1.68-1.75), 2.72 (95% CI: 2.66-2.78), and 2.61 (95% CI: 2.48-2.75) higher odds of being in a higher fall severity category, respectively, compared to being cognitively unimpaired. Greater ADL limitations and impaired balance were significantly associated with falls, but each mediated the association between cognitive status and falls by less than 2%. Older adults with cognitive impairment are more likely to experience a fall during an SNF stay. ADL limitations and impaired balance are risk factors for falls but may not contribute to the increased fall risk for SNF residents with cognitive impairment. Continued research is needed to better understand the risk factors for falls among SNF residents with cognitive impairment.
Source: Journal of the American Medical Directors Association, 2022; 23(1): 128-128
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Bibliometrics and Co-Citation Network Analysis of Systematic Reviews of Evidence-Based Nursing Guidelines for Preventing Inpatient Falls
Abstract: Advances in bibliometrics and co-citation analysis provide the opportunity to analyze quantitatively the large amount of nursing research used in evidence-based nursing. Numerous nursing researchers have attempted to obtain evidence that using evidence-based nursing improves the quality of nursing practices. However, little is known about how these efforts comply with the rigorous methods required for a systematic review in a subject area. This study explored the comprehensiveness of systematic reviews in four guidelines for preventing inpatient falls using bibliometrics and a co-citation network technique. Citations (n = 659) and 9417 unique bibliographic records written by 6537 authors were collected from the guidelines in January 2020. The results showed none of the references spanned all four authoring bodies, whereas only 0.1% and 4.7% of the references spanned three and two of the authoring bodies, respectively. The co-citation analysis revealed differences in the scope and primary concerns among the development groups, even in the same setting, with differences in the highly influential articles and authors. These findings imply that although the systematic reviews of guidelines on fall prevention were of good quality, there remain areas for improvement in terms of harmonizing the selection of bibliographic citations comprehensively.
Source: CIN: Computers, Informatics, Nursing, 2022; 40(2): 95-103
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Changes in activity levels, physical functioning, and fall risk during the COVID‐19 pandemic
Abstract: Background: Physical function worsens with older age, particularly for sedentary and socially isolated individuals, and this often leads to injuries. Through reductions in physical activity, the COVID‐19 pandemic may have worsened physical function and led to higher fall‐related risks. Methods: A nationally representative online survey of 2006 U.S. adults aged 50–80 was conducted in January 2021 to assess changes in health behaviors (worsened physical activity and less daily time spent on feet), social isolation (lack of companionship and perceived isolation), physical function (mobility and physical conditioning), and falls (falls and fear of falling) since March 2020. Multivariable logistic regression was used to assess relationships among physical activity, social isolation, physical function, falls, and fear of falling. Results: Among respondents, 740 (36.9%) reported reduced physical activity levels, 704 (35.1%) reported reduced daily time spent on their feet since March 2020, 712 (37.1%) reported lack of companionship, and 914 (45.9%) social isolation. In multivariable models, decreased physical activity (adjusted risk ratio, ARR: 2.92, 95% CI: 2.38, 3.61), less time spent on one's feet (ARR: 1.95, 95% CI: 1.62, 2.34), and social isolation (ARR: 1.51, 95% CI: 1.30, 1.74) were associated with greater risks of worsened physical conditioning. Decreased physical activity, time spent daily on one's feet, and social isolation were similarly associated with worsened mobility. Worsened mobility was associated with both greater risk of falling (ARR: 1.70, 95% CI: 1.35, 2.15) and worsened fear of falling (ARR: 2.02, 95% CI: 1.30, 3.13). Worsened physical conditioning and social isolation were also associated with greater risk of worsened fear of falling. Conclusion: The COVID‐19 pandemic was associated with worsened physical functioning and fall outcomes, with the greatest effect on individuals with reduced physical activity and social isolation. Public health actions to address reduced physical activity and social isolation among older adults are needed.
Source: Journal of the American Geriatrics Society, 2022; 70(1): 49-59
Chronic pain in the frail elderly mediates sleep disorders and influences falls
Abstract: We investigated the mediators of chronic pain and falls in frail elderly people. Mediating factors included previously reported factors as well as sleep disorders and depression. Sleep disorder was a mediator of chronic pain and falls in the frail elderly. It is suggested that interventions for chronic pain and sleep disorders should focus on preventing falls in the frail elderly. Previous studies have highlighted the causation between chronic pain and falls in the elderly, but the mediator variables between chronic pain and falls in the frail elderly have not been identified. The purpose of this study was to identify the mediator variable of chronic pain and falls. This study is a prospective cohort study. Participants were 116 frail elderly individuals living in a community. Chronic pain (pain lasting more than 3 months) was assessed using a questionnaire, and the occurrence of falls was tracked using a falls calendar. Using logistic regression, a model was created with falls as the dependent variable and chronic pain and confounders as independent variables. The mediation analysis was conducted with chronic pain as the independent variable, falls as the dependent variable, and factors that showed significant differences between the chronic pain group and the non-chronic pain group as candidate mediators. Even after adjusting for covariates, chronic pain significantly influenced the occurrence of falls (odds ratio: 3.004, 95% CI [1.226, 7.363], p =0.016). The results of mediation analysis showed a significant direct effect between chronic pain and falls, and a significant indirect effect (partial mediation) of sleep disorders on the relationship between chronic pain and falls. Chronic pain in frail elderly mediates sleep disorders and influences falls. It is suggested that interventions for chronic pain and sleep disorders should focus on preventing falls in the frail elderly.
Source: Archives of Gerontology & Geriatrics, Mar; 99: 104582
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Fall Prevention and Injury Reduction Utilizing Continuous Video Monitoring: A Quality Improvement Initiative
Abstract: Background: Reduction of falls and fall-related injuries in hospital patients remains a priority. Consideration of technology via continuous video monitoring (CVM) is relevant for safe, quality care with favorable cost implications. Local Problem: Although fall rates were in the acceptable national safety standard guidelines, interventions were explored with the aim to further decrease falls using CVM. Methods: The quality improvement project collected descriptive statistics. Run charts portrayed data trends for falls and injuries in 2-week increments over a 6-month period. Interventions: Two-way cameras and a virtual sitter were used to observe fall risk patients. Results: Implementation of CVM with virtual sitters depicted a 14% decline in fall rates and a 6% decrease in fall-related injury rates with positive budget implications. Conclusion: Cost savings, fall rates, and fall injury rates all improved with the inception of video monitoring.
Source: Journal of Nursing Care Quality, 2022; 37(2): 123-129
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Multifactorial falls interventions for people over 65 years in the acute hospital setting: An integrative review
Abstract: Inpatient falls in the elderly are costly health care complications. Multifactorial falls interventions appear to be the most effective in preventing falls, however the majority of studies on multifactorial falls interventions have been conducted in residential aged care settings and rehabilitation units. To evaluate the effectiveness of multifactorial falls interventions for people over 65 years, in the acute hospital setting. A systematic search of literature in four electronic databases, published in the English language from 2015 to 2020 was conducted. Whittemore and Knafl's framework guided the review. The initial search identified 244 papers, nine met the inclusion criteria. Three themes associated with multifactorial falls interventions for people over 65 years in the acute hospital setting emerged from the analysis; (i) Information and education, (ii) Nursing team leadership and the falls team, and (iii) Framework for change. Multifactorial falls interventions are effective in the acute hospital setting, particularly those that include a whole team approach, and are supported by strong nurse leadership at executive and ward level. Several gaps were identified in the literature that may inform future practice, education and research. First, collaboration and co-design with the patient and bedside nurse in the planning, development, and evaluation of falls prevention projects was identified as an important omission. Second, individualised care for the cognitively impaired patient should be the focus of future research.
Source: Collegian, 2022; 29(1): 100-108
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Patient Falls, Nurse Communication, and Nurse Hourly Rounding in Acute Care: Linking Patient Experience and Outcomes
Abstract: Research has consistently found a link between hourly nurse rounding and patient outcomes, including reduced falls, reduced pressure ulcers, reduced call light usage, and improved patient experience; however, little research exists specific to patient falls and nurse rounding in acute care settings. This study adds to the body of knowledge by statistically quantifying and providing linkages between nurse rounding frequency and patient fall rates using data from 31 military treatment facilities comprehensively over a period from fiscal year (FY) 2017 through FY2019. Poisson regression results indicated that hourly nurse rounding was associated with a reduction of more than 21% in fall rates (incidence rate ratio = 0.79, P <.01) relative to infrequent rounding, and poorly rated nurse communication was associated with an 8.6-fold increase in patient fall rates relative to highly rated nurse communication (incidence rate ratio = 8.6, P <.01).
Source: Journal of Public Health Management & Practice, 2022; 28(2): E467-E470
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Using gravitational potential energy to assess the risk of falls from bed
Abstract: In the UK, falls in hospital are the most commonly reported patient safety incident. Risk is multifactorial and increases with age, some medications, and conditions such as delirium and dementia. Falls prevention should include a personalised assessment and discussions with patients, supported by consistent use of numerical data and a mix of word and picture formats. Any decision made to prevent a fall should be in the patient’s best interests and least restrictive of their basic rights and freedoms. Gravitational potential energy is one way of showing the increased risk of harm from falls from a bed with increasing height. This can be combined with popliteal height to determine the best height that is least restrictive for patients and allows them to move safely out of bed.
Source: Nursing Times, 2022; 118(2): 36-39
Using Patient Simulation to Promote Best Practices in Fall Prevention and Postfall Assessment in Nursing Homes
Abstract: Background: Fall-related injuries rise with age and are of particular concern for frail populations living in nursing homes. Local Problem: The Perley and Rideau Veterans' Health Centre is a large nursing home in Ontario, Canada. In 2019, we conducted internal audits of our Falls Prevention Program and identified notable variations in staff's response to a resident fall. Interventions: We developed an in situ patient simulation program of a resident fall. Methods: This was a mixed-methods evaluation of participants' perspectives of a simulation-based interprofessional education program for fall prevention. Results: Participants indicated high-level support for simulation-based learning, with more than 80% of the participants expressing that they will apply these skills in the future when caring for a resident who falls. Conclusions: Our findings indicate that simulation-based training is well received by frontline workers in a nursing home setting and can be conducted as part of a typical shift with minimal disruption to resident care.
Source: Journal of Nursing Care Quality, 2022; 37(2): 117-122
Human Fall Detection Using Passive Infrared Sensors with Low Resolution: A Systematic Review
Abstract: Systems using passive infrared sensors with a low resolution were recently proposed to answer the dilemma effectiveness-ethical considerations for human fall detection by Information and Communication Technologies (ICTs) in older adults. How effective is this type of system? We performed a systematic review to identify studies that investigated the metrological qualities of passive infrared sensors with a maximum resolution of 16x16 pixels to identify falls. The search was conducted on PubMed, ScienceDirect, SpringerLink, IEEE Xplore Digital Library, and MDPI until November 26-28, 2020. We focused on studies testing only these types of sensor. Thirteen articles were "conference papers", five were "original articles" and one was a found in arXiv.org (an open access repository of scientific research). Since four authors "duplicated" their study in two different journals, our review finally analyzed 15 studies. The studies were very heterogeneous with regard to experimental procedures and detection methods, which made it difficult to draw formal conclusions. All studies tested their systems in controlled conditions, mostly in empty rooms. Except for two studies, the overall performance reported for the detection of falls exceeded 85-90% of accuracy, precision, sensitivity or specificity. Systems using two or more sensors and particular detection methods (eg, 3D CNN, CNN with 10-fold cross-validation, LSTM with CNN, LSTM and Voting algorithms) seemed to give the highest levels of performance (> 90%). Future studies should test more this type of system in real-life conditions.
Source: Clinical Interventions In Aging, 2022; 17: 35-53
Effects of Pilates on the risk of falls, gait, balance and functional mobility in healthy older adults: A randomised controlled trial
Abstract: Objective: To investigate the effects of Pilates on falls risk, fear of falling, postural balance, functional mobility, spatiotemporal gait parameters, mobility and physical activity in older adults.
Design(s): Randomized Controlled Trial (RCT).
Method(s): Sixty-one older adults, mean age 70.08 (SD = 5.51) were randomly allocated into a Pilates group (PG, n = 29) or control group (CG, n = 32). Intervention comprised a 12-week Pilates program, with exercises performed twice a week and supplementary exercises at home. The Montreal Cognitive Assessment (MOCA), was used to screen cognition. Primary outcomes: Fear of falling, postural balance (force platform), gait velocity (electronic walkway).
Secondary Outcomes: Functional mobility, mobility, physical activity, and spatiotemporal parameters of gait. Statistical analysis was carried out using Generalized Estimating Equations (GEE). Covariates were adjusted.
Result(s): Positive effects were found for time effects: Time Up and Go (TUG), anteroposterior (AP) and mediolateral (ML) directions of balance, cadence, (stance, step and double support time). The step and double support time showed significant differences between the two groups (p < 0.05). Interaction between time and groups was found for FRT. Age was a significant factor in TUG, FRT, postural balance for AP under open eyes conditions. Health status was significant for ML in eyes open condition. Gait was significant for age, height and health status.
Conclusion(s): Effects of 12 weeks of Pilates intervention on functional mobility, mobility, postural balance and spatiotemporal gait parameters were identified. Further trials of a longer duration are warranted to determine the effectiveness of Pilates on falls prevention.
Source: Journal of Bodywork and Movement Therapies, 2022; 30: 30-41
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Accuracy of the figure of 8 walk test with and without dual-task to predict falls in older adults
Abstract: Background: The figure of eight walk test (F8W) is a measurement tool that examines the ability to walk on a curved path. Adding secondary tasks to the F8W test may increase its ability to predict falls in older adults.
Objective(s): This study aimed to investigate the accuracy of the F8W test and the F8W test with a dual-tasking in predicting future falls in older adults.
Method(s): Eighty older adults between the ages of 60 and 80 were recruited. At the beginning of the study, participants completed the standard F8W test, F8W test with a cognitive task, and F8W test with a motor task. The number of falls was documented during a six-month follow-up. The area under the receiver operating characteristic curve (AUC) was used to compare the accuracy for predicting falls. The cut-off points and the psychometric properties of the tests were computed.
Result(s): The F8W test with a motor task had the highest accuracy for predicting falls in older adults, with an AUC of 0.74 (95%CI = 0.63-0.83). The F8W with a motor task's optimal cut-off score was >12 s, with a sensitivity of 76.5% and a specificity of 65.0%.
Conclusion(s): The F8W with a motor task was a more potent tool for detecting fall risk than the standard F8W or the F8W with a cognitive task. Clinicians may utilize the F8W with a motor task as preliminary guidelines when making clinical judgments concerning older adults who are at risk of falling.
Source: Journal of Bodywork and Movement Therapies, 2022; 30: 69-75
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Linking health service utilisation and mortality data - unravelling what happens after fall-related paramedic care
Abstract: Background: A randomised controlled trial implemented and evaluated a new model of care for non-transported older fallers to prevent future falls and unplanned health service use. This current study uses linked data to evaluate the effects of the intervention beyond the initial 12-month study period.
Method(s): Study data from an established cohort of 221 adults were linked to administrative data from NSW Ambulance, Emergency Department Data Collection, Admitted Patient Data Collection and Registry of Births, Deaths and Marriages evaluating health service use at 12, 24 and 36 months following randomisation including time to event (health service utilisation) and mortality. Negative binomial and Cox's proportional hazard regression were performed to capture the impact of the study between groups and adherence status.
Result(s): At 36 months follow-up, 89% of participants called an ambulance, 87% attended the Emergency Department and 91% were admitted to hospital. There were no significant differences in all-cause health service utilisation between the control and intervention group (IG) at 12, 24 and 36 months follow-up. Fall-related health service use was significantly higher within the IG at 12 (IRR:1.40 (95%CI:1.01-1.94) and 24 months (IRR:1.43 (95%CI:1.05-1.95)). Medication use, impaired balance and previous falls were associated with subsequent health service use. Over 40% of participants died by the follow-up period with risk of death lower in the IG at 36 months (HR:0.64, 95%CI:0.45-0.91).
Conclusion(s): Non-transported fallers have a high risk of future health service use for fall and other medical-related reasons. Interventions which address this risk need to be further explored.
Source: Age and Ageing, 2022; 51(1): afab254
Effects of treadmill slip and trip perturbation-based balance training on falls in community-dwelling older adults (STABILITY): Study protocol for a randomised controlled trial
Abstract: Background: Introduction Falls among older adults are most frequently caused by slips and trips and can have devastating consequences. Perturbation-based balance training (PBT) have recently shown promising fall preventive effects after even small training dosages. However, the fall preventive effects of PBT delivered on a treadmill are still unknown. Therefore, this parallel-group randomised controlled trial aims to quantify the effects of a four-session treadmill-PBT training intervention on falls compared with treadmill walking among community-dwelling older adults aged 65 years or more. Methods and analysis 140 community-dwelling older adults will be recruited and randomised into either the treadmill-PBT or the treadmill walking group. Each group will undergo three initial training sessions within a week and an additional 'booster' session after 26 weeks. Participants in the treadmill-PBT group will receive 40 slip and/or trip perturbations induced by accurately timed treadmill belt accelerations at each training session. The primary outcome of
interest is daily life fall rates collected using fall calendars for a follow-up period of 52 weeks. Secondary outcomes include physical, cognitive and social-psychological fall-related risk factors and will be collected at the pre-training and post-training test and the 26-week and 52-week follow-up tests. All outcomes will be analysed using the intention-to-treat approach by an external statistician. A Poisson's regressions with bootstrapping, to account for overdispersion, will be used to compare group differences in fall rates. Ethics and dissemination The study protocol has been approved by the North Denmark Region Committee on Health Research Ethics (N-20200089). The results will be
disseminated in peer-reviewed journals and at international conferences.
Source: BMJ Open, 2022; 12(2): e052492
Hospital performance comparison of inpatient fall rates; the impact of risk adjusting for patient-related factors: a multicentre cross-sectional survey
Abstract: Background: Comparing inpatient fall rates can serve as a benchmark for quality improvement. To improve the comparability of performance between hospitals, adjustments for patient-related fall risk factors that are not modifiable by care are recommended. Thereafter, the remaining variability in risk-adjusted fall rates can be attributed to differences in quality of care provided by a hospital. Research on risk-adjusted fall rates and their impact on hospital comparisons is currently sparse. Therefore, the aims of this study were to develop an inpatient fall risk adjustment model based on patient-related fall risk factors, and to analyse the impact of applying this model on comparisons of inpatient fall rates in acute care hospitals in Switzerland.
Method(s): Data on inpatient falls in Swiss acute care hospitals were collected on one day in 2017, 2018 and 2019, as part of an annual multicentre cross-sectional survey. After excluding maternity and outpatient wards, all inpatients older than 18 years were included. Two-level logistic regression models were used to construct unadjusted and risk-adjusted caterpillar plots to compare inter-hospital variability in inpatient fall rates.
Result(s): One hundred thirty eight hospitals and 35,998 patients were included in the analysis. Risk adjustment showed that the following factors were associated with a higher risk of falling: increasing care dependency (to a great extent care dependent, odds ratio 3.43, 95% confidence interval 2.78-4.23), a fall in the last 12 months (OR 2.14, CI 1.89-2.42), the intake of sedative and or psychotropic medications (OR 1.74, CI 1.54-1.98), mental and behavioural disorders (OR 1.55, CI 1.36-1.77) and higher age (OR 1.01, CI 1.01-1.02). With odds ratios between 1.26 and 0.67, eight further ICD-10 diagnosis groups were included. Female sex (OR 0.78, CI 0.70-0.88) and postoperative patients (OR 0.83, CI 0.73-0.95) were associated with a lower risk of falling. Unadjusted caterpillar plots identified 20 low- and 3 high-performing hospitals. After risk adjustment, 2 low-performing hospitals remained.
Conclusion(s): Risk adjustment of inpatient fall rates could reduce misclassification of hospital performance and enables a fairer basis for decision-making and quality improvement measures. Patient-related fall risk factors such as care dependency, history of falls and cognitive impairment should be routinely assessed.
Source: BMC Health Services Research, 2022; 22(1): 225
Exploring the impact of experiencing a long lie fall on physical and clinical outcomes in older people requiring an ambulance: A systematic review
Abstract: Background: The long term impacts of experiencing a 'long lie' following a fall in the older person are poorly understood. This systematic review explored the impact of a long lie fall on physical and clinical outcomes in older people requiring an ambulance.
Method(s): PRISMA guidelines were followed.
Result(s): 70 studies were identified. Nine studies were suitable for full review. Four studies meeting the inclusion criteria were included. The Critical Appraisal Skill Programme (CASP) assessed the quality of all included studies. Three studies reported on people aged 65 years and older. One study reported on people aged over 90 years. Personal alarm use was examined in two studies. One study explored patient characteristics of people confirmed to have fallen by paramedics at the scene. One study examined re-contact and characteristics of fallers referred to a falls prevention service.
Discussion(s): Cognitive impairment and long lie were a caveat for falls and repeated falls. Personal alarm use was infrequent, suggesting a need for supporting the older patient in appropriate alarm use and exploration of newer technologies to alleviate their need. Future research should focus on interventions for wearable, smart and e-technology for automatic fall detection and qualitative exploration of the lived experience.
Source: International Emergency Nursing, 2022; 62: 101148
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A Systematic Review and Meta-Analysis of Exercise Interventions and Use of Exercise Principles to Reduce Fear of Falling in Community-Dwelling Older Adults
Abstract: Objective: Fear of falling (FOF) contributes to activity restriction and institutionalization among older adults, and exercise interventions are linked to reduction in FOF. Adhering to exercise principles and adapting optimal exercise parameters are fundamental to optimizing the effectiveness of exercise interventions. The purpose of this review was to describe FOF exercise interventions in community-dwelling older adults, evaluate the extent to which these interventions
followed the exercise principles and reported exercise parameters, and quantify the effect of these interventions on reducing FOF.
Method(s): Randomized controlled trials (RCTs) of FOF exercise interventions in older adults (>=65 years) were identified from 4 databases. The methodological quality of RCTs was assessed using the Physiotherapy Evidence Database scale. A random-effect model was used in the meta-analysis.
Result(s): Seventy-five RCTs were included in this review. With regard to reporting exercise principles, specificity was reported in 92% of trials, progression in 72%, reversibility in 32%, overload in 31%, diminished return in 21%, and initial value in 8%. For exercise parameters, 97% of RCTs reported exercise type; 89%, frequency; and 85%, time. Only 25% reported the intensity. The pooled effect of exercise interventions on FOF among all included studies was a standard mean difference of-0.34 (95% CI =-0.44 to-0.23).
Conclusion(s): This study showed a significant small to moderate effect size of exercise interventions in reducing FOF among community-dwelling older adults. Most exercise principles and intensity of exercises were not adequately reported in included trials. Impact: These inadequate reports could undermine efforts to examine the optimal dosage for exercise prescription. More attention must be given to designing and reporting components of therapeutic exercise programs to facilitate evidence-based practice.
Source: Physical Therapy, 2022; 102(1): pzab236
Perceived neighbourhood environment and falls among community-dwelling adults: cross-sectional and prospective findings from the Survey of Health, Ageing and Retirement in Europe (SHARE)
Abstract: We investigated the association between perceived neighbourhood characteristics and falls in community-dwelling adults, using data from Wave 5 and 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE). We included 25,467 participants aged 50 to 103 years (mean age 66.2 +/- 9.6, 58.5% women), from fourteen European countries (Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Israel, Italy, Luxembourg, Slovenia, Spain, Sweden, Switzerland). At baseline, we recorded individual-level factors (socio-demographic, socio-economic and clinical factors), contextual-level factors (country, urban versus rural area, European region) and perceived neighbourhood characteristics (vandalism or crime, cleanliness, feeling part of neighbourhood, helpful neighbours, accessibility to services) for each participant. We recorded falls in the six months prior to the baseline and 2-year follow-up interviews. The associations between neighbourhood characteristics and falls were analysed by binary logistic regression models; odds ratios (95% confidence intervals) were calculated. Participants reporting-versus not reporting-vandalism or crime had an increased falls risk of 1.16 (1.02-1.31) at follow-up, after full adjustment; lack of cleanliness, feeling part of the neighbourhood, perceiving neighbours as helpful and difficult accessibility to services were not associated with falls. Vandalism or crime was consistently associated with increased falls risks in women, adults without functional impairment and urban areas residents. In conclusion, adverse neighbourhood environments may account for inequality in falls risk among middle-aged and older adults and could be added to fall risk stratification tools.
Source: European Journal of Ageing, 2022; DOI:10.1007/s10433-022-00685-3
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Falls prevention and osteoarthritis: time for awareness and action
Abstract: Osteoarthritis (OA) and falls both commonly affect older people. While high-level evidence exists to prevent falls in older people, falls prevention is rarely considered within contemporary OA management. OA care and falls prevention have for too long been considered as separate clinical constructs. In the context of ageing populations and growing numbers of people with OA, the time to raise awareness and enact appropriate action is now. This Perspectives on Rehabilitation article draws on the findings from a comprehensive mixed-methods falls and OA research program (which uniquely spanned population, clinician, and consumer perspectives) to better understand existing evidence-practice gaps and identify key opportunities for improvements in clinical are. IMPLICATIONS FOR REHABILITATION While high-level evidence exists to prevent falls in older people, falls prevention is rarely considered within contemporary OA management and this represents a concerning knowledge-to-practice gap. Given ageing populations and growth in the number of people with OA, it is time for falls prevention to be incorporated within routine OA care for older people. To achieve this, we need to re-shape current messaging around falls prevention and develop targeted resources to optimise clinician knowledge and skills in this area.
Source: Disability and Rehabilitation, 2022; 1-6. doi: 10.1080/09638288.2022.2040617. Online ahead of print
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TA theoretical framework for addressing fear of falling avoidance behavior in Parkinson's disease
Abstract: Postural instability in Parkinson's disease (PD) is associated with several downstream consequences that ultimately lead to a greater risk of falling. Among the prominent downstream consequences is fear of falling (FOF), which is both common and problematic in PD. It can lead to a vicious cycle of FOF avoidance behavior that results in more sedentary behavior, physical reconditioning, and weakening of already impaired balance systems. This, in turn, may make the person with PD more susceptible to a future fall even with benign daily tasks. While FOF activity avoidance can be adaptive (appropriate), it can also be maladaptive (inappropriate or exaggerated). When this adaptive and maladaptive FOF avoidance behavior is contextualized to gait/balance performance, it provides a theoretical framework that can be used by clinicians to match patterns of behavior to a concordant treatment approach. In the theoretical framework proposed in
this perspective, four different patterns related to FOF avoidance behavior and gait/balance performance are suggested: appropriate avoiders, appropriate non-avoiders, inappropriate avoiders, and inappropriate non-avoiders. For each of the four FOF avoidance behavior patterns, this paper also provides suggested treatment focuses, approaches and recommendations.
Source: Physiotherapy Theory and Practice, 2022; 1-17. doi: 10.1080/09593985.2022.2029655. Online ahead of print
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Concern About Falling, Confidence in Balance, Quality of Life, and Depression Symptoms in Community-Dwelling Older Adults After a 24-week Dual-Task Training With Variable and Fixed Priority: A Randomized Controlled Trial
Abstract: Objective: To evaluate the effect of a 24-week dual-task training with progression from variable to fixed priority on the concern about falling, confidence in balance, quality of life, and depression symptoms in community-dwelling older adults.
Method(s): A total of 60 participants (60-80 y.o.) were randomly allocated into a dual-task training group with progression from variable to fixed priority (experimental group) or into a dual-task training group with variable priority (control group).
Result(s): No between-group difference was observed after the intervention. A significant time effect showed a reduction in concern about falling [mean difference (MD) = -2.91)] and depression symptoms (MD = -1.66), an increase in the physical function (MD = 7.86), overall mental health (MD = 5.82), perception of vitality, energy, and less fatigue (MD = 10.45), general perception of overall health (MD = 6.81), and their health compared to the last year (MD = 11.89).
Conclusion(s): The experimental protocol was not superior to the control one. However, both protocols improved these outcomes.
Source: Research on Aging, 2022; 1640275221073993.
doi: 10.1177/01640275221073993. Online ahead of print
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Risk stratification for early and late falls in acute care settings
Abstract: Background and Aims: Falling generally injures patients, lengthens hospital stays and leads to the wastage of financial and medical resources. Although falls can occur at any stage after hospital admission, there are no studies that characterise falls with length of hospital stay in acute care settings. This study aims to clarify risk stratification of early and late falls in acute care settings.
Method(s): A retrospective cohort study was conducted for participants who were admitted to a teaching hospital in Japan. Patients' falls were divided into two groups based on the median of the fall date (day 10). Considering a 70/30 split, the logistic regression model was used to extract independent predictors for early and late falls for nine risk variables based on exploratory analysis among 26 items selected from the modified Japanese Nursing Association Fall Risk Assessment Tool, and risk models were validated. This study was conducted according to the STROBE guideline.
Result(s): Of the 10,975 patients admitted, 87 and 90 with early and late falls, respectively, were identified. The five significant risk factors extracted for early falls were fall history, muscle weakness, impaired understanding, use of psychotropics and the personality trait of 'doing everything on one's own'; risk factors identified for late falls were being older than 65 years, impaired extremities and unstable gait, in addition to muscle weakness. Using these variables for early and late falls in the validation cohort, the concordance indices of the risk models were both over 0.80.
Conclusion(s): By separately extracting risk factors for early and late falls in an acute care hospital setting, this study shed light on the characteristics of the respective types of falls. Relevant to clinical practice: As the risk factors of falls vary according to the length of hospitalisation, specific preventive care can be implemented to avoid fall incidents.
Source: Journal of Clinical Nursing, 2022; doi: 10.1111/jocn.16267. Online ahead of print
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Muscle power is more important than strength in preventing falls in community-dwelling older adults
Abstract: The primary purpose of this study was to determine whether muscle strength or power is a better predictor of fallers (including both single and recurrent) in everyday living conditions among community-dwelling older adults. Secondly, we identified the optimal threshold of the identified fall predictors to best differentiate fallers from non-fallers. Ninety-four healthy older adults (72.0 +/- 5.5 years) participated in the study. After reporting retrospective falls from the past year, participants were assessed for isometric strength capacities of the knee extensors and flexors. Lower limb power performance was calculated based on the time used to complete the five times sit-to-stand (STS) test. Fifty-six participants (59.6%) reported not falling, and 38 participants (40.4%) reported one or more falls in the past year. No significant differences were found between non-fallers and fallers for knee extensor (p = 0.729) and flexor (p = 0.157) strength capabilities. Non-fallers took significantly less time to complete the STS test (p = 0.010) and demonstrated more leg muscle power (p = 0.016) than fallers. The overall accuracy of classifying fallers and non-fallers was 63.8% and 64.9% for leg muscle power and the STS duration, respectively. The leg power and STS duration optimal cutoff values to discriminate fallers and non-fallers were determined as 1.3 W/(kg x m) and 12 s. Results suggest that STS leg muscle power is more predictive of everyday living falls than strength in community-dwelling older adults. Findings provide valuable information to assist with screening high fall risk older adults and develop muscle power training-based interventions to prevent falls in this population.
Source: Journal of Biomechanics, 2022; 134: 111018
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Association Between Fear of Falling and Frailty in Community-Dwelling Older Adults: A Systematic Review
Abstract: Background/Objective: Fear of falling (FoF) and frailty are common problems in older adults. FoF can lead to self-imposed restriction of activities and then further decline in physical capacities that predispose older adults to frailty. Evaluating the association of these two geriatric syndromes may be the first step for understanding their complex relationship and might ultimately lead to establishing therapeutic goals and guiding treatments for older adults with frailty. This systematic review was conducted to provide evidence regarding the association between FoF and
frailty.
Method(s): All the articles that provided information on the association between FoF and frailty were selected from PubMed, Scopus, CINAHL, and EMBASE in search of relevant papers. Articles reporting information on the association between FoF (exposure) and frailty (outcome), with older adults (age >=60 years) living in the community (ie, living either at home or in places of residence that do not provide nursing care or rehabilitation) were included. Only original articles with observational design (cross-sectional or longitudinal/cohort) were included. The methodological
quality of included articles was evaluated independently by the two assessors through the Newcastle-Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) critical appraisal checklist for longitudinal and crosssectional studies, respectively.
Result(s): The initial searches found 4,342 articles, of which 10 articles were included in this review: 7 cross-sectional and 2 longitudinal studies, and 1 study with cross-sectional and longitudinal analyses. The total sample was composed of 6,294 community-dwelling older adults (61.8% women). Among the longitudinal studies, adjusted odds ratios ranged from 1.18 (95% CI = 1.02; 1.36) to 9.87 (95% CI = 5.22; 18.68), while the adjusted odds ratios of the cross-sectional studies ranged from 1.04 (95% CI = 1.02; 1.07) to 7.16 (95% CI = 2.34; 21.89).
Conclusion(s): FoF increases the risk of frailty in community-dwelling older adults. The knowledge of this association is of utmost importance in clinical practice, since it can help health professionals in the development of rehabilitation, prevention, and health promotion protocols. In addition, these findings can contribute to the development of public health policies and actions aimed at reducing the FoF and consequently the frailty. Prospero: CRD42021276775.
Source: Clinical Interventions in Aging, 2022; 17: 129-140
Anterior load carriage increases the risk of falls in young adults following a slip in gait
Abstract: Most workplace musculoskeletal injuries result from slip-related falls while carrying a load. Although prior studies inspected the effects of front load carriage on spatiotemporal gait parameters, it remains unclear how the anterior load carriage alters the risk of falls after a slip. This study sought to inspect the impact of anterior load carriage on slip-falls. Thirty young adults were evenly randomized into three groups, each assigned a different anterior load (0%, 10%, or 20% of the bodyweight). Under the protection of a safety harness, all participants were exposed to an unexpected and standardized gait-slip perturbation while walking on a treadmill and carrying the assigned load. Their body's responses to the slip were gathered using a motion capture system. The primary (the slip outcome: fall vs. recovery) and secondary measurements (dynamic gait stability, angular momentum, and downward velocity of the body-load system's center of mass or COM) were determined. The results revealed that an increase in the weight carried raises the rate of falls
after a slip. The poor control over the COM's angular momentum and descent, but not dynamic gait stability, were the factors leading to slip-falls during gait for individuals carrying a front load. The findings from this study could shed light on the mechanisms of front load carriage increasing the risk of slip-falls. This can provide preliminary references for designing and assessing safety standards for occupations in which anterior load carriage is necessary to reduce the risk of slip-falls and the resulting injuries.
Source: Safety Science, 2022; 145: 105489
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Differences in walking-to-turning characteristics between older adult fallers and nonfallers: A prospective and observational study using wearable inertial sensors
Abstract: Wearable inertial sensors have gradually been used as an objective technology for biomechanical assessments of both healthy and pathological movement patterns. This paper used foot-worn sensors for characterizing the spatiotemporal characteristics of walking and turning between older fallers and nonfallers. Thirty community-dwelling older fallers and 30 older nonfallers performed 10-m straight walking, turned 180degree around a cone, and then walked 10-m back to the starting point. Specific algorithms were used to measure spatiotemporal gait (double support phase of the gait cycle, swing width, and minimal toe clearance) and turning parameters (turn duration and turn steps) using two foot-worn Physiolog inertial sensor system. The researchers directly exported data as reported by the system. Our findings indicated that older fallers showed 26.58% longer time (P = 0.036) and 13.21% more steps (P = 0.038) compared to nonfallers during turning. However, both groups decreased their walking velocity (both P < 0.001), increased double
support (both P = 0.001), and increased the swing width (both P = 0.001) during the transition from walking to turning. The older nonfallers additionally increased toe clearance (P = 0.001). Compared with the fallers, the older nonfallers showed a larger change in the swing width (P = 0.025) and toe clearance (P = 0.025) in walking to turning. Older fallers may adopt a cautionary strategy while turning to reduce the risk of falls. Wearable sensors can provide the temporospatial characteristics of turning and reveal significant differences by fall status, indicating the potential of turning measures as possible markers for identifying those at fall risk.
Source: International Journal of Rehabilitation Research, 2022; 45(1): 53-57
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Objective(s): The objective of this evidence review was to determine if an exercise program can reduce fall rates and prolong functional independence among older adults living in the community. Data sources: This review included 14 randomized control trials and one quasi-experimental interventional study, all published between 2014 and 2020.
Conclusion(s): The evidence suggests that a home- or community-based exercise program with formal instruction and health care provider involvement can be an effective fall-prevention and harm reduction strategy for community-dwelling older adults. Implications for practice: The evidence suggests that a home- or community-based exercise program may be an effective fall-prevention strategy for older adults living independently in the community. Health care providers should educate these patients about the benefits of exercise as a fall-prevention measure and assist patients in increasing participation in exercise programs by making referrals and promoting engagement in evidence-based exercise programs.
Source: Journal of the American Association of Nurse Practitioners, 2022; 34(2): 247-251
Abstract: Background: Recurrent falls are more likely to cause injuries and disabilities than single falls. Purpose: This study investigated the incidence and risk factors of recurrent falls among inpatients. Methods: We analyzed inpatient fall data from the anomaly event notification database and electronic medical records of a hospital. We collected data regarding 1059 inpatients who had fallen during their hospital stay. Among these inpatients, 390 (36.83%) had fallen within the previous year. Results: Inpatients in the orthopedics and neurology wards were at a higher risk of recurrent falls than those in surgical wards; inpatients who were physically dependent were at a higher risk of recurrent falls than those who were physically independent; inpatients with poor vision were at a lower risk of recurrent falls than those without this issue; and inpatients who were using antidepressants were at a higher risk of recurrent falls than those who were not using antidepressants. Conclusion: The risk of recurrent falls is highly correlated with ward type, physical independence, self-perceived good vision, and use of antidepressants.
Source: Journal of Nursing Care Quality, 2022; 37(2): E31-E37
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Association Between Cognitive Status and Falls With and Without Injury During a Skilled Nursing Facility Short Stay
Abstract: To examine the relationship between cognitive status and falls with and without injury among older adults during the first 18 days of a skilled nursing facility (SNF) and determine if this association is mediated by limitations in activities of daily living (ADL) and impaired balance. Cohort study of Medicare fee-for-service beneficiaries admitted to an SNF between October 1, 2016, and September 31, 2017. 815,927 short-stay nursing home residents admitted to an SNF within 3 days of hospital discharge. Cognitive status at SNF admission was classified as intact, mild, moderate, or severe impairment. Residents were classified as having no falls, a fall without injury, and a fall with a minor or major injury. We used ordinal logistic regression to model the association between cognitive status and falls adjusting for resident and facility characteristics. A causal mediation analysis was used to test for the mediating effects of ADL limitations and impaired balance on the association between cognitive status and falls with an injury. Mild, moderate, and severe cognitive impairment were associated with 1.72 (95% CI: 1.68-1.75), 2.72 (95% CI: 2.66-2.78), and 2.61 (95% CI: 2.48-2.75) higher odds of being in a higher fall severity category, respectively, compared to being cognitively unimpaired. Greater ADL limitations and impaired balance were significantly associated with falls, but each mediated the association between cognitive status and falls by less than 2%. Older adults with cognitive impairment are more likely to experience a fall during an SNF stay. ADL limitations and impaired balance are risk factors for falls but may not contribute to the increased fall risk for SNF residents with cognitive impairment. Continued research is needed to better understand the risk factors for falls among SNF residents with cognitive impairment.
Source: Journal of the American Medical Directors Association, 2022; 23(1): 128-128
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Bibliometrics and Co-Citation Network Analysis of Systematic Reviews of Evidence-Based Nursing Guidelines for Preventing Inpatient Falls
Abstract: Advances in bibliometrics and co-citation analysis provide the opportunity to analyze quantitatively the large amount of nursing research used in evidence-based nursing. Numerous nursing researchers have attempted to obtain evidence that using evidence-based nursing improves the quality of nursing practices. However, little is known about how these efforts comply with the rigorous methods required for a systematic review in a subject area. This study explored the comprehensiveness of systematic reviews in four guidelines for preventing inpatient falls using bibliometrics and a co-citation network technique. Citations (n = 659) and 9417 unique bibliographic records written by 6537 authors were collected from the guidelines in January 2020. The results showed none of the references spanned all four authoring bodies, whereas only 0.1% and 4.7% of the references spanned three and two of the authoring bodies, respectively. The co-citation analysis revealed differences in the scope and primary concerns among the development groups, even in the same setting, with differences in the highly influential articles and authors. These findings imply that although the systematic reviews of guidelines on fall prevention were of good quality, there remain areas for improvement in terms of harmonizing the selection of bibliographic citations comprehensively.
Source: CIN: Computers, Informatics, Nursing, 2022; 40(2): 95-103
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Changes in activity levels, physical functioning, and fall risk during the COVID‐19 pandemic
Abstract: Background: Physical function worsens with older age, particularly for sedentary and socially isolated individuals, and this often leads to injuries. Through reductions in physical activity, the COVID‐19 pandemic may have worsened physical function and led to higher fall‐related risks. Methods: A nationally representative online survey of 2006 U.S. adults aged 50–80 was conducted in January 2021 to assess changes in health behaviors (worsened physical activity and less daily time spent on feet), social isolation (lack of companionship and perceived isolation), physical function (mobility and physical conditioning), and falls (falls and fear of falling) since March 2020. Multivariable logistic regression was used to assess relationships among physical activity, social isolation, physical function, falls, and fear of falling. Results: Among respondents, 740 (36.9%) reported reduced physical activity levels, 704 (35.1%) reported reduced daily time spent on their feet since March 2020, 712 (37.1%) reported lack of companionship, and 914 (45.9%) social isolation. In multivariable models, decreased physical activity (adjusted risk ratio, ARR: 2.92, 95% CI: 2.38, 3.61), less time spent on one's feet (ARR: 1.95, 95% CI: 1.62, 2.34), and social isolation (ARR: 1.51, 95% CI: 1.30, 1.74) were associated with greater risks of worsened physical conditioning. Decreased physical activity, time spent daily on one's feet, and social isolation were similarly associated with worsened mobility. Worsened mobility was associated with both greater risk of falling (ARR: 1.70, 95% CI: 1.35, 2.15) and worsened fear of falling (ARR: 2.02, 95% CI: 1.30, 3.13). Worsened physical conditioning and social isolation were also associated with greater risk of worsened fear of falling. Conclusion: The COVID‐19 pandemic was associated with worsened physical functioning and fall outcomes, with the greatest effect on individuals with reduced physical activity and social isolation. Public health actions to address reduced physical activity and social isolation among older adults are needed.
Source: Journal of the American Geriatrics Society, 2022; 70(1): 49-59
Chronic pain in the frail elderly mediates sleep disorders and influences falls
Abstract: We investigated the mediators of chronic pain and falls in frail elderly people. Mediating factors included previously reported factors as well as sleep disorders and depression. Sleep disorder was a mediator of chronic pain and falls in the frail elderly. It is suggested that interventions for chronic pain and sleep disorders should focus on preventing falls in the frail elderly. Previous studies have highlighted the causation between chronic pain and falls in the elderly, but the mediator variables between chronic pain and falls in the frail elderly have not been identified. The purpose of this study was to identify the mediator variable of chronic pain and falls. This study is a prospective cohort study. Participants were 116 frail elderly individuals living in a community. Chronic pain (pain lasting more than 3 months) was assessed using a questionnaire, and the occurrence of falls was tracked using a falls calendar. Using logistic regression, a model was created with falls as the dependent variable and chronic pain and confounders as independent variables. The mediation analysis was conducted with chronic pain as the independent variable, falls as the dependent variable, and factors that showed significant differences between the chronic pain group and the non-chronic pain group as candidate mediators. Even after adjusting for covariates, chronic pain significantly influenced the occurrence of falls (odds ratio: 3.004, 95% CI [1.226, 7.363], p =0.016). The results of mediation analysis showed a significant direct effect between chronic pain and falls, and a significant indirect effect (partial mediation) of sleep disorders on the relationship between chronic pain and falls. Chronic pain in frail elderly mediates sleep disorders and influences falls. It is suggested that interventions for chronic pain and sleep disorders should focus on preventing falls in the frail elderly.
Source: Archives of Gerontology & Geriatrics, Mar; 99: 104582
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Fall Prevention and Injury Reduction Utilizing Continuous Video Monitoring: A Quality Improvement Initiative
Abstract: Background: Reduction of falls and fall-related injuries in hospital patients remains a priority. Consideration of technology via continuous video monitoring (CVM) is relevant for safe, quality care with favorable cost implications. Local Problem: Although fall rates were in the acceptable national safety standard guidelines, interventions were explored with the aim to further decrease falls using CVM. Methods: The quality improvement project collected descriptive statistics. Run charts portrayed data trends for falls and injuries in 2-week increments over a 6-month period. Interventions: Two-way cameras and a virtual sitter were used to observe fall risk patients. Results: Implementation of CVM with virtual sitters depicted a 14% decline in fall rates and a 6% decrease in fall-related injury rates with positive budget implications. Conclusion: Cost savings, fall rates, and fall injury rates all improved with the inception of video monitoring.
Source: Journal of Nursing Care Quality, 2022; 37(2): 123-129
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Multifactorial falls interventions for people over 65 years in the acute hospital setting: An integrative review
Abstract: Inpatient falls in the elderly are costly health care complications. Multifactorial falls interventions appear to be the most effective in preventing falls, however the majority of studies on multifactorial falls interventions have been conducted in residential aged care settings and rehabilitation units. To evaluate the effectiveness of multifactorial falls interventions for people over 65 years, in the acute hospital setting. A systematic search of literature in four electronic databases, published in the English language from 2015 to 2020 was conducted. Whittemore and Knafl's framework guided the review. The initial search identified 244 papers, nine met the inclusion criteria. Three themes associated with multifactorial falls interventions for people over 65 years in the acute hospital setting emerged from the analysis; (i) Information and education, (ii) Nursing team leadership and the falls team, and (iii) Framework for change. Multifactorial falls interventions are effective in the acute hospital setting, particularly those that include a whole team approach, and are supported by strong nurse leadership at executive and ward level. Several gaps were identified in the literature that may inform future practice, education and research. First, collaboration and co-design with the patient and bedside nurse in the planning, development, and evaluation of falls prevention projects was identified as an important omission. Second, individualised care for the cognitively impaired patient should be the focus of future research.
Source: Collegian, 2022; 29(1): 100-108
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Patient Falls, Nurse Communication, and Nurse Hourly Rounding in Acute Care: Linking Patient Experience and Outcomes
Abstract: Research has consistently found a link between hourly nurse rounding and patient outcomes, including reduced falls, reduced pressure ulcers, reduced call light usage, and improved patient experience; however, little research exists specific to patient falls and nurse rounding in acute care settings. This study adds to the body of knowledge by statistically quantifying and providing linkages between nurse rounding frequency and patient fall rates using data from 31 military treatment facilities comprehensively over a period from fiscal year (FY) 2017 through FY2019. Poisson regression results indicated that hourly nurse rounding was associated with a reduction of more than 21% in fall rates (incidence rate ratio = 0.79, P <.01) relative to infrequent rounding, and poorly rated nurse communication was associated with an 8.6-fold increase in patient fall rates relative to highly rated nurse communication (incidence rate ratio = 8.6, P <.01).
Source: Journal of Public Health Management & Practice, 2022; 28(2): E467-E470
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Using gravitational potential energy to assess the risk of falls from bed
Abstract: In the UK, falls in hospital are the most commonly reported patient safety incident. Risk is multifactorial and increases with age, some medications, and conditions such as delirium and dementia. Falls prevention should include a personalised assessment and discussions with patients, supported by consistent use of numerical data and a mix of word and picture formats. Any decision made to prevent a fall should be in the patient’s best interests and least restrictive of their basic rights and freedoms. Gravitational potential energy is one way of showing the increased risk of harm from falls from a bed with increasing height. This can be combined with popliteal height to determine the best height that is least restrictive for patients and allows them to move safely out of bed.
Source: Nursing Times, 2022; 118(2): 36-39
Using Patient Simulation to Promote Best Practices in Fall Prevention and Postfall Assessment in Nursing Homes
Abstract: Background: Fall-related injuries rise with age and are of particular concern for frail populations living in nursing homes. Local Problem: The Perley and Rideau Veterans' Health Centre is a large nursing home in Ontario, Canada. In 2019, we conducted internal audits of our Falls Prevention Program and identified notable variations in staff's response to a resident fall. Interventions: We developed an in situ patient simulation program of a resident fall. Methods: This was a mixed-methods evaluation of participants' perspectives of a simulation-based interprofessional education program for fall prevention. Results: Participants indicated high-level support for simulation-based learning, with more than 80% of the participants expressing that they will apply these skills in the future when caring for a resident who falls. Conclusions: Our findings indicate that simulation-based training is well received by frontline workers in a nursing home setting and can be conducted as part of a typical shift with minimal disruption to resident care.
Source: Journal of Nursing Care Quality, 2022; 37(2): 117-122
Human Fall Detection Using Passive Infrared Sensors with Low Resolution: A Systematic Review
Abstract: Systems using passive infrared sensors with a low resolution were recently proposed to answer the dilemma effectiveness-ethical considerations for human fall detection by Information and Communication Technologies (ICTs) in older adults. How effective is this type of system? We performed a systematic review to identify studies that investigated the metrological qualities of passive infrared sensors with a maximum resolution of 16x16 pixels to identify falls. The search was conducted on PubMed, ScienceDirect, SpringerLink, IEEE Xplore Digital Library, and MDPI until November 26-28, 2020. We focused on studies testing only these types of sensor. Thirteen articles were "conference papers", five were "original articles" and one was a found in arXiv.org (an open access repository of scientific research). Since four authors "duplicated" their study in two different journals, our review finally analyzed 15 studies. The studies were very heterogeneous with regard to experimental procedures and detection methods, which made it difficult to draw formal conclusions. All studies tested their systems in controlled conditions, mostly in empty rooms. Except for two studies, the overall performance reported for the detection of falls exceeded 85-90% of accuracy, precision, sensitivity or specificity. Systems using two or more sensors and particular detection methods (eg, 3D CNN, CNN with 10-fold cross-validation, LSTM with CNN, LSTM and Voting algorithms) seemed to give the highest levels of performance (> 90%). Future studies should test more this type of system in real-life conditions.
Source: Clinical Interventions In Aging, 2022; 17: 35-53
Effects of Pilates on the risk of falls, gait, balance and functional mobility in healthy older adults: A randomised controlled trial
Abstract: Objective: To investigate the effects of Pilates on falls risk, fear of falling, postural balance, functional mobility, spatiotemporal gait parameters, mobility and physical activity in older adults.
Design(s): Randomized Controlled Trial (RCT).
Method(s): Sixty-one older adults, mean age 70.08 (SD = 5.51) were randomly allocated into a Pilates group (PG, n = 29) or control group (CG, n = 32). Intervention comprised a 12-week Pilates program, with exercises performed twice a week and supplementary exercises at home. The Montreal Cognitive Assessment (MOCA), was used to screen cognition. Primary outcomes: Fear of falling, postural balance (force platform), gait velocity (electronic walkway).
Secondary Outcomes: Functional mobility, mobility, physical activity, and spatiotemporal parameters of gait. Statistical analysis was carried out using Generalized Estimating Equations (GEE). Covariates were adjusted.
Result(s): Positive effects were found for time effects: Time Up and Go (TUG), anteroposterior (AP) and mediolateral (ML) directions of balance, cadence, (stance, step and double support time). The step and double support time showed significant differences between the two groups (p < 0.05). Interaction between time and groups was found for FRT. Age was a significant factor in TUG, FRT, postural balance for AP under open eyes conditions. Health status was significant for ML in eyes open condition. Gait was significant for age, height and health status.
Conclusion(s): Effects of 12 weeks of Pilates intervention on functional mobility, mobility, postural balance and spatiotemporal gait parameters were identified. Further trials of a longer duration are warranted to determine the effectiveness of Pilates on falls prevention.
Source: Journal of Bodywork and Movement Therapies, 2022; 30: 30-41
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Accuracy of the figure of 8 walk test with and without dual-task to predict falls in older adults
Abstract: Background: The figure of eight walk test (F8W) is a measurement tool that examines the ability to walk on a curved path. Adding secondary tasks to the F8W test may increase its ability to predict falls in older adults.
Objective(s): This study aimed to investigate the accuracy of the F8W test and the F8W test with a dual-tasking in predicting future falls in older adults.
Method(s): Eighty older adults between the ages of 60 and 80 were recruited. At the beginning of the study, participants completed the standard F8W test, F8W test with a cognitive task, and F8W test with a motor task. The number of falls was documented during a six-month follow-up. The area under the receiver operating characteristic curve (AUC) was used to compare the accuracy for predicting falls. The cut-off points and the psychometric properties of the tests were computed.
Result(s): The F8W test with a motor task had the highest accuracy for predicting falls in older adults, with an AUC of 0.74 (95%CI = 0.63-0.83). The F8W with a motor task's optimal cut-off score was >12 s, with a sensitivity of 76.5% and a specificity of 65.0%.
Conclusion(s): The F8W with a motor task was a more potent tool for detecting fall risk than the standard F8W or the F8W with a cognitive task. Clinicians may utilize the F8W with a motor task as preliminary guidelines when making clinical judgments concerning older adults who are at risk of falling.
Source: Journal of Bodywork and Movement Therapies, 2022; 30: 69-75
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Linking health service utilisation and mortality data - unravelling what happens after fall-related paramedic care
Abstract: Background: A randomised controlled trial implemented and evaluated a new model of care for non-transported older fallers to prevent future falls and unplanned health service use. This current study uses linked data to evaluate the effects of the intervention beyond the initial 12-month study period.
Method(s): Study data from an established cohort of 221 adults were linked to administrative data from NSW Ambulance, Emergency Department Data Collection, Admitted Patient Data Collection and Registry of Births, Deaths and Marriages evaluating health service use at 12, 24 and 36 months following randomisation including time to event (health service utilisation) and mortality. Negative binomial and Cox's proportional hazard regression were performed to capture the impact of the study between groups and adherence status.
Result(s): At 36 months follow-up, 89% of participants called an ambulance, 87% attended the Emergency Department and 91% were admitted to hospital. There were no significant differences in all-cause health service utilisation between the control and intervention group (IG) at 12, 24 and 36 months follow-up. Fall-related health service use was significantly higher within the IG at 12 (IRR:1.40 (95%CI:1.01-1.94) and 24 months (IRR:1.43 (95%CI:1.05-1.95)). Medication use, impaired balance and previous falls were associated with subsequent health service use. Over 40% of participants died by the follow-up period with risk of death lower in the IG at 36 months (HR:0.64, 95%CI:0.45-0.91).
Conclusion(s): Non-transported fallers have a high risk of future health service use for fall and other medical-related reasons. Interventions which address this risk need to be further explored.
Source: Age and Ageing, 2022; 51(1): afab254
Effects of treadmill slip and trip perturbation-based balance training on falls in community-dwelling older adults (STABILITY): Study protocol for a randomised controlled trial
Abstract: Background: Introduction Falls among older adults are most frequently caused by slips and trips and can have devastating consequences. Perturbation-based balance training (PBT) have recently shown promising fall preventive effects after even small training dosages. However, the fall preventive effects of PBT delivered on a treadmill are still unknown. Therefore, this parallel-group randomised controlled trial aims to quantify the effects of a four-session treadmill-PBT training intervention on falls compared with treadmill walking among community-dwelling older adults aged 65 years or more. Methods and analysis 140 community-dwelling older adults will be recruited and randomised into either the treadmill-PBT or the treadmill walking group. Each group will undergo three initial training sessions within a week and an additional 'booster' session after 26 weeks. Participants in the treadmill-PBT group will receive 40 slip and/or trip perturbations induced by accurately timed treadmill belt accelerations at each training session. The primary outcome of
interest is daily life fall rates collected using fall calendars for a follow-up period of 52 weeks. Secondary outcomes include physical, cognitive and social-psychological fall-related risk factors and will be collected at the pre-training and post-training test and the 26-week and 52-week follow-up tests. All outcomes will be analysed using the intention-to-treat approach by an external statistician. A Poisson's regressions with bootstrapping, to account for overdispersion, will be used to compare group differences in fall rates. Ethics and dissemination The study protocol has been approved by the North Denmark Region Committee on Health Research Ethics (N-20200089). The results will be
disseminated in peer-reviewed journals and at international conferences.
Source: BMJ Open, 2022; 12(2): e052492
Hospital performance comparison of inpatient fall rates; the impact of risk adjusting for patient-related factors: a multicentre cross-sectional survey
Abstract: Background: Comparing inpatient fall rates can serve as a benchmark for quality improvement. To improve the comparability of performance between hospitals, adjustments for patient-related fall risk factors that are not modifiable by care are recommended. Thereafter, the remaining variability in risk-adjusted fall rates can be attributed to differences in quality of care provided by a hospital. Research on risk-adjusted fall rates and their impact on hospital comparisons is currently sparse. Therefore, the aims of this study were to develop an inpatient fall risk adjustment model based on patient-related fall risk factors, and to analyse the impact of applying this model on comparisons of inpatient fall rates in acute care hospitals in Switzerland.
Method(s): Data on inpatient falls in Swiss acute care hospitals were collected on one day in 2017, 2018 and 2019, as part of an annual multicentre cross-sectional survey. After excluding maternity and outpatient wards, all inpatients older than 18 years were included. Two-level logistic regression models were used to construct unadjusted and risk-adjusted caterpillar plots to compare inter-hospital variability in inpatient fall rates.
Result(s): One hundred thirty eight hospitals and 35,998 patients were included in the analysis. Risk adjustment showed that the following factors were associated with a higher risk of falling: increasing care dependency (to a great extent care dependent, odds ratio 3.43, 95% confidence interval 2.78-4.23), a fall in the last 12 months (OR 2.14, CI 1.89-2.42), the intake of sedative and or psychotropic medications (OR 1.74, CI 1.54-1.98), mental and behavioural disorders (OR 1.55, CI 1.36-1.77) and higher age (OR 1.01, CI 1.01-1.02). With odds ratios between 1.26 and 0.67, eight further ICD-10 diagnosis groups were included. Female sex (OR 0.78, CI 0.70-0.88) and postoperative patients (OR 0.83, CI 0.73-0.95) were associated with a lower risk of falling. Unadjusted caterpillar plots identified 20 low- and 3 high-performing hospitals. After risk adjustment, 2 low-performing hospitals remained.
Conclusion(s): Risk adjustment of inpatient fall rates could reduce misclassification of hospital performance and enables a fairer basis for decision-making and quality improvement measures. Patient-related fall risk factors such as care dependency, history of falls and cognitive impairment should be routinely assessed.
Source: BMC Health Services Research, 2022; 22(1): 225
Exploring the impact of experiencing a long lie fall on physical and clinical outcomes in older people requiring an ambulance: A systematic review
Abstract: Background: The long term impacts of experiencing a 'long lie' following a fall in the older person are poorly understood. This systematic review explored the impact of a long lie fall on physical and clinical outcomes in older people requiring an ambulance.
Method(s): PRISMA guidelines were followed.
Result(s): 70 studies were identified. Nine studies were suitable for full review. Four studies meeting the inclusion criteria were included. The Critical Appraisal Skill Programme (CASP) assessed the quality of all included studies. Three studies reported on people aged 65 years and older. One study reported on people aged over 90 years. Personal alarm use was examined in two studies. One study explored patient characteristics of people confirmed to have fallen by paramedics at the scene. One study examined re-contact and characteristics of fallers referred to a falls prevention service.
Discussion(s): Cognitive impairment and long lie were a caveat for falls and repeated falls. Personal alarm use was infrequent, suggesting a need for supporting the older patient in appropriate alarm use and exploration of newer technologies to alleviate their need. Future research should focus on interventions for wearable, smart and e-technology for automatic fall detection and qualitative exploration of the lived experience.
Source: International Emergency Nursing, 2022; 62: 101148
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A Systematic Review and Meta-Analysis of Exercise Interventions and Use of Exercise Principles to Reduce Fear of Falling in Community-Dwelling Older Adults
Abstract: Objective: Fear of falling (FOF) contributes to activity restriction and institutionalization among older adults, and exercise interventions are linked to reduction in FOF. Adhering to exercise principles and adapting optimal exercise parameters are fundamental to optimizing the effectiveness of exercise interventions. The purpose of this review was to describe FOF exercise interventions in community-dwelling older adults, evaluate the extent to which these interventions
followed the exercise principles and reported exercise parameters, and quantify the effect of these interventions on reducing FOF.
Method(s): Randomized controlled trials (RCTs) of FOF exercise interventions in older adults (>=65 years) were identified from 4 databases. The methodological quality of RCTs was assessed using the Physiotherapy Evidence Database scale. A random-effect model was used in the meta-analysis.
Result(s): Seventy-five RCTs were included in this review. With regard to reporting exercise principles, specificity was reported in 92% of trials, progression in 72%, reversibility in 32%, overload in 31%, diminished return in 21%, and initial value in 8%. For exercise parameters, 97% of RCTs reported exercise type; 89%, frequency; and 85%, time. Only 25% reported the intensity. The pooled effect of exercise interventions on FOF among all included studies was a standard mean difference of-0.34 (95% CI =-0.44 to-0.23).
Conclusion(s): This study showed a significant small to moderate effect size of exercise interventions in reducing FOF among community-dwelling older adults. Most exercise principles and intensity of exercises were not adequately reported in included trials. Impact: These inadequate reports could undermine efforts to examine the optimal dosage for exercise prescription. More attention must be given to designing and reporting components of therapeutic exercise programs to facilitate evidence-based practice.
Source: Physical Therapy, 2022; 102(1): pzab236
Perceived neighbourhood environment and falls among community-dwelling adults: cross-sectional and prospective findings from the Survey of Health, Ageing and Retirement in Europe (SHARE)
Abstract: We investigated the association between perceived neighbourhood characteristics and falls in community-dwelling adults, using data from Wave 5 and 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE). We included 25,467 participants aged 50 to 103 years (mean age 66.2 +/- 9.6, 58.5% women), from fourteen European countries (Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Israel, Italy, Luxembourg, Slovenia, Spain, Sweden, Switzerland). At baseline, we recorded individual-level factors (socio-demographic, socio-economic and clinical factors), contextual-level factors (country, urban versus rural area, European region) and perceived neighbourhood characteristics (vandalism or crime, cleanliness, feeling part of neighbourhood, helpful neighbours, accessibility to services) for each participant. We recorded falls in the six months prior to the baseline and 2-year follow-up interviews. The associations between neighbourhood characteristics and falls were analysed by binary logistic regression models; odds ratios (95% confidence intervals) were calculated. Participants reporting-versus not reporting-vandalism or crime had an increased falls risk of 1.16 (1.02-1.31) at follow-up, after full adjustment; lack of cleanliness, feeling part of the neighbourhood, perceiving neighbours as helpful and difficult accessibility to services were not associated with falls. Vandalism or crime was consistently associated with increased falls risks in women, adults without functional impairment and urban areas residents. In conclusion, adverse neighbourhood environments may account for inequality in falls risk among middle-aged and older adults and could be added to fall risk stratification tools.
Source: European Journal of Ageing, 2022; DOI:10.1007/s10433-022-00685-3
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Falls prevention and osteoarthritis: time for awareness and action
Abstract: Osteoarthritis (OA) and falls both commonly affect older people. While high-level evidence exists to prevent falls in older people, falls prevention is rarely considered within contemporary OA management. OA care and falls prevention have for too long been considered as separate clinical constructs. In the context of ageing populations and growing numbers of people with OA, the time to raise awareness and enact appropriate action is now. This Perspectives on Rehabilitation article draws on the findings from a comprehensive mixed-methods falls and OA research program (which uniquely spanned population, clinician, and consumer perspectives) to better understand existing evidence-practice gaps and identify key opportunities for improvements in clinical are. IMPLICATIONS FOR REHABILITATION While high-level evidence exists to prevent falls in older people, falls prevention is rarely considered within contemporary OA management and this represents a concerning knowledge-to-practice gap. Given ageing populations and growth in the number of people with OA, it is time for falls prevention to be incorporated within routine OA care for older people. To achieve this, we need to re-shape current messaging around falls prevention and develop targeted resources to optimise clinician knowledge and skills in this area.
Source: Disability and Rehabilitation, 2022; 1-6. doi: 10.1080/09638288.2022.2040617. Online ahead of print
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TA theoretical framework for addressing fear of falling avoidance behavior in Parkinson's disease
Abstract: Postural instability in Parkinson's disease (PD) is associated with several downstream consequences that ultimately lead to a greater risk of falling. Among the prominent downstream consequences is fear of falling (FOF), which is both common and problematic in PD. It can lead to a vicious cycle of FOF avoidance behavior that results in more sedentary behavior, physical reconditioning, and weakening of already impaired balance systems. This, in turn, may make the person with PD more susceptible to a future fall even with benign daily tasks. While FOF activity avoidance can be adaptive (appropriate), it can also be maladaptive (inappropriate or exaggerated). When this adaptive and maladaptive FOF avoidance behavior is contextualized to gait/balance performance, it provides a theoretical framework that can be used by clinicians to match patterns of behavior to a concordant treatment approach. In the theoretical framework proposed in
this perspective, four different patterns related to FOF avoidance behavior and gait/balance performance are suggested: appropriate avoiders, appropriate non-avoiders, inappropriate avoiders, and inappropriate non-avoiders. For each of the four FOF avoidance behavior patterns, this paper also provides suggested treatment focuses, approaches and recommendations.
Source: Physiotherapy Theory and Practice, 2022; 1-17. doi: 10.1080/09593985.2022.2029655. Online ahead of print
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Concern About Falling, Confidence in Balance, Quality of Life, and Depression Symptoms in Community-Dwelling Older Adults After a 24-week Dual-Task Training With Variable and Fixed Priority: A Randomized Controlled Trial
Abstract: Objective: To evaluate the effect of a 24-week dual-task training with progression from variable to fixed priority on the concern about falling, confidence in balance, quality of life, and depression symptoms in community-dwelling older adults.
Method(s): A total of 60 participants (60-80 y.o.) were randomly allocated into a dual-task training group with progression from variable to fixed priority (experimental group) or into a dual-task training group with variable priority (control group).
Result(s): No between-group difference was observed after the intervention. A significant time effect showed a reduction in concern about falling [mean difference (MD) = -2.91)] and depression symptoms (MD = -1.66), an increase in the physical function (MD = 7.86), overall mental health (MD = 5.82), perception of vitality, energy, and less fatigue (MD = 10.45), general perception of overall health (MD = 6.81), and their health compared to the last year (MD = 11.89).
Conclusion(s): The experimental protocol was not superior to the control one. However, both protocols improved these outcomes.
Source: Research on Aging, 2022; 1640275221073993.
doi: 10.1177/01640275221073993. Online ahead of print
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Risk stratification for early and late falls in acute care settings
Abstract: Background and Aims: Falling generally injures patients, lengthens hospital stays and leads to the wastage of financial and medical resources. Although falls can occur at any stage after hospital admission, there are no studies that characterise falls with length of hospital stay in acute care settings. This study aims to clarify risk stratification of early and late falls in acute care settings.
Method(s): A retrospective cohort study was conducted for participants who were admitted to a teaching hospital in Japan. Patients' falls were divided into two groups based on the median of the fall date (day 10). Considering a 70/30 split, the logistic regression model was used to extract independent predictors for early and late falls for nine risk variables based on exploratory analysis among 26 items selected from the modified Japanese Nursing Association Fall Risk Assessment Tool, and risk models were validated. This study was conducted according to the STROBE guideline.
Result(s): Of the 10,975 patients admitted, 87 and 90 with early and late falls, respectively, were identified. The five significant risk factors extracted for early falls were fall history, muscle weakness, impaired understanding, use of psychotropics and the personality trait of 'doing everything on one's own'; risk factors identified for late falls were being older than 65 years, impaired extremities and unstable gait, in addition to muscle weakness. Using these variables for early and late falls in the validation cohort, the concordance indices of the risk models were both over 0.80.
Conclusion(s): By separately extracting risk factors for early and late falls in an acute care hospital setting, this study shed light on the characteristics of the respective types of falls. Relevant to clinical practice: As the risk factors of falls vary according to the length of hospitalisation, specific preventive care can be implemented to avoid fall incidents.
Source: Journal of Clinical Nursing, 2022; doi: 10.1111/jocn.16267. Online ahead of print
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Muscle power is more important than strength in preventing falls in community-dwelling older adults
Abstract: The primary purpose of this study was to determine whether muscle strength or power is a better predictor of fallers (including both single and recurrent) in everyday living conditions among community-dwelling older adults. Secondly, we identified the optimal threshold of the identified fall predictors to best differentiate fallers from non-fallers. Ninety-four healthy older adults (72.0 +/- 5.5 years) participated in the study. After reporting retrospective falls from the past year, participants were assessed for isometric strength capacities of the knee extensors and flexors. Lower limb power performance was calculated based on the time used to complete the five times sit-to-stand (STS) test. Fifty-six participants (59.6%) reported not falling, and 38 participants (40.4%) reported one or more falls in the past year. No significant differences were found between non-fallers and fallers for knee extensor (p = 0.729) and flexor (p = 0.157) strength capabilities. Non-fallers took significantly less time to complete the STS test (p = 0.010) and demonstrated more leg muscle power (p = 0.016) than fallers. The overall accuracy of classifying fallers and non-fallers was 63.8% and 64.9% for leg muscle power and the STS duration, respectively. The leg power and STS duration optimal cutoff values to discriminate fallers and non-fallers were determined as 1.3 W/(kg x m) and 12 s. Results suggest that STS leg muscle power is more predictive of everyday living falls than strength in community-dwelling older adults. Findings provide valuable information to assist with screening high fall risk older adults and develop muscle power training-based interventions to prevent falls in this population.
Source: Journal of Biomechanics, 2022; 134: 111018
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Association Between Fear of Falling and Frailty in Community-Dwelling Older Adults: A Systematic Review
Abstract: Background/Objective: Fear of falling (FoF) and frailty are common problems in older adults. FoF can lead to self-imposed restriction of activities and then further decline in physical capacities that predispose older adults to frailty. Evaluating the association of these two geriatric syndromes may be the first step for understanding their complex relationship and might ultimately lead to establishing therapeutic goals and guiding treatments for older adults with frailty. This systematic review was conducted to provide evidence regarding the association between FoF and
frailty.
Method(s): All the articles that provided information on the association between FoF and frailty were selected from PubMed, Scopus, CINAHL, and EMBASE in search of relevant papers. Articles reporting information on the association between FoF (exposure) and frailty (outcome), with older adults (age >=60 years) living in the community (ie, living either at home or in places of residence that do not provide nursing care or rehabilitation) were included. Only original articles with observational design (cross-sectional or longitudinal/cohort) were included. The methodological
quality of included articles was evaluated independently by the two assessors through the Newcastle-Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) critical appraisal checklist for longitudinal and crosssectional studies, respectively.
Result(s): The initial searches found 4,342 articles, of which 10 articles were included in this review: 7 cross-sectional and 2 longitudinal studies, and 1 study with cross-sectional and longitudinal analyses. The total sample was composed of 6,294 community-dwelling older adults (61.8% women). Among the longitudinal studies, adjusted odds ratios ranged from 1.18 (95% CI = 1.02; 1.36) to 9.87 (95% CI = 5.22; 18.68), while the adjusted odds ratios of the cross-sectional studies ranged from 1.04 (95% CI = 1.02; 1.07) to 7.16 (95% CI = 2.34; 21.89).
Conclusion(s): FoF increases the risk of frailty in community-dwelling older adults. The knowledge of this association is of utmost importance in clinical practice, since it can help health professionals in the development of rehabilitation, prevention, and health promotion protocols. In addition, these findings can contribute to the development of public health policies and actions aimed at reducing the FoF and consequently the frailty. Prospero: CRD42021276775.
Source: Clinical Interventions in Aging, 2022; 17: 129-140
Anterior load carriage increases the risk of falls in young adults following a slip in gait
Abstract: Most workplace musculoskeletal injuries result from slip-related falls while carrying a load. Although prior studies inspected the effects of front load carriage on spatiotemporal gait parameters, it remains unclear how the anterior load carriage alters the risk of falls after a slip. This study sought to inspect the impact of anterior load carriage on slip-falls. Thirty young adults were evenly randomized into three groups, each assigned a different anterior load (0%, 10%, or 20% of the bodyweight). Under the protection of a safety harness, all participants were exposed to an unexpected and standardized gait-slip perturbation while walking on a treadmill and carrying the assigned load. Their body's responses to the slip were gathered using a motion capture system. The primary (the slip outcome: fall vs. recovery) and secondary measurements (dynamic gait stability, angular momentum, and downward velocity of the body-load system's center of mass or COM) were determined. The results revealed that an increase in the weight carried raises the rate of falls
after a slip. The poor control over the COM's angular momentum and descent, but not dynamic gait stability, were the factors leading to slip-falls during gait for individuals carrying a front load. The findings from this study could shed light on the mechanisms of front load carriage increasing the risk of slip-falls. This can provide preliminary references for designing and assessing safety standards for occupations in which anterior load carriage is necessary to reduce the risk of slip-falls and the resulting injuries.
Source: Safety Science, 2022; 145: 105489
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Differences in walking-to-turning characteristics between older adult fallers and nonfallers: A prospective and observational study using wearable inertial sensors
Abstract: Wearable inertial sensors have gradually been used as an objective technology for biomechanical assessments of both healthy and pathological movement patterns. This paper used foot-worn sensors for characterizing the spatiotemporal characteristics of walking and turning between older fallers and nonfallers. Thirty community-dwelling older fallers and 30 older nonfallers performed 10-m straight walking, turned 180degree around a cone, and then walked 10-m back to the starting point. Specific algorithms were used to measure spatiotemporal gait (double support phase of the gait cycle, swing width, and minimal toe clearance) and turning parameters (turn duration and turn steps) using two foot-worn Physiolog inertial sensor system. The researchers directly exported data as reported by the system. Our findings indicated that older fallers showed 26.58% longer time (P = 0.036) and 13.21% more steps (P = 0.038) compared to nonfallers during turning. However, both groups decreased their walking velocity (both P < 0.001), increased double
support (both P = 0.001), and increased the swing width (both P = 0.001) during the transition from walking to turning. The older nonfallers additionally increased toe clearance (P = 0.001). Compared with the fallers, the older nonfallers showed a larger change in the swing width (P = 0.025) and toe clearance (P = 0.025) in walking to turning. Older fallers may adopt a cautionary strategy while turning to reduce the risk of falls. Wearable sensors can provide the temporospatial characteristics of turning and reveal significant differences by fall status, indicating the potential of turning measures as possible markers for identifying those at fall risk.
Source: International Journal of Rehabilitation Research, 2022; 45(1): 53-57
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A review of the impact of exercise on fall rates
among community-dwelling older adults
Objective(s): The objective of this evidence review was to determine if an exercise program can reduce fall rates and prolong functional independence among older adults living in the community. Data sources: This review included 14 randomized control trials and one quasi-experimental interventional study, all published between 2014 and 2020.
Conclusion(s): The evidence suggests that a home- or community-based exercise program with formal instruction and health care provider involvement can be an effective fall-prevention and harm reduction strategy for community-dwelling older adults. Implications for practice: The evidence suggests that a home- or community-based exercise program may be an effective fall-prevention strategy for older adults living independently in the community. Health care providers should educate these patients about the benefits of exercise as a fall-prevention measure and assist patients in increasing participation in exercise programs by making referrals and promoting engagement in evidence-based exercise programs.
Source: Journal of the American Association of Nurse Practitioners, 2022; 34(2): 247-251
