Address Fall Risk Research Articles

Evidence-Based Strategies for Injury Prevention and Exercise Prescription in Elderly Communities: The Physical Therapist's Perspective

Injury prevention and exercise prescription are critical components of healthcare for older adults. Physical therapists play a critical role in fall risk screening, assessment, and prevention in elderly communities. By incorporating STEADI (Stopping Elderly Accidents, Deaths, and Injuries) and other evidence-based tools and resources, physical therapists can help identify and address fall risk factors, link older adults with community-based programs and resources, and reduce the incidence of falls and related injuries in this population. Evidence-based interventions for fall prevention include exercise interventions that are tailored and include a combination of exercise types, considering individual abilities and preferences. Exercise programs can reduce falls in older people living in residential aged care facilities, but exercise has little or no lasting effect on falls after the end of a program. Physical therapists should consider the patient's fall risk, functional limitations, and comorbidities when prescribing exercises for balance and falls prevention. Physical therapists can help elderly communities implement evidence-based strategies for injury prevention and exercise prescription by adopting a person-centered approach, challenging ageist stereotypes, using sound outcome measures, prioritizing physical activity, and collaborating with other healthcare professionals. By doing so, physical therapists can promote the health, independence, and well-being of older adults, and help them lead active, fulfilling lives. A combination of strength, balance, and functional training exercises, as well as other evidence-based strategies, can significantly reduce the risk of falls in elderly communities. Physical therapists and healthcare providers should consider these interventions when developing fall prevention programs for older adults. Exercise interventions for preventing falls in elderly communities should be implemented regularly, with a frequency of at least three sessions per week, and for a duration of up to 12 months. Keywords: Elderly communities, injury prevention, exercise prescription in elderly, falls prevention, aging

Association between vision impairment and increased prevalence of falls in older US adults.

Vision impairment (VI) is associated with falls in older adults. However, past studies have relied on geographically constrained samples with limited generalizability or self-reports of visual difficulty. To date, there have not been nationally representative studies on the association of objective measures of visual function and falls outcomes. We used cross-sectional data from Round 11 of National Health and Aging Trends Study (NHATS), a nationally representative panel study of age-eligible Medicare beneficiaries (N = 2951). We performed Poisson regression to calculate the prevalence and prevalence ratio (PR) of >1 fall in the past year, any fall in the past month, fear of falling (FoF), and activity limitation due to FoF as a function of distance visual acuity, near visual acuity, and contrast sensitivity. Models were adjusted for demographic and health covariates and were weighted to make nationally representative parameter estimates. The weighted proportion of participants with VI was 27.6% (95% CI, 25.4%-29.9%). Individuals with any VI had a higher prevalence of falls compared with those without VI (18.5% vs. 14.1%, PR = 1.25, 95% CI 1.02-1.53). Specifically, contrast sensitivity impairment was associated with a higher prevalence of recurrent falls (20.8% vs. 14.7%; PR = 1.30, 95% CI 1.01-1.67) and recent falls (17.1% vs. 9.9%; PR = 1.40, 95% CI 1.01-1.94). This relationship existed even independent of near and distance visual acuity. Distance and near visual acuity were not significantly associated with falls. Having any VI was also associated with a higher prevalence of FoF (38.4% vs. 30.5%, PR = 1.17, 95% CI 1.02-1.34). The prevalence of falls is associated with poor contrast sensitivity but not with near or distance visual acuity. Findings suggest greater collaboration between geriatricians and eye care providers may be warranted to assess and address fall risk in older adults with VI.

Landing wise program: feasibility study protocol for Parkinson's disease.

Regardless of the benefits of fall prevention programs, people with Parkinson's disease (PD) will still fall. Therefore, it is crucial to explore novel therapeutic approaches that are well-accepted and effective for addressing fall risk and the fear of falls among this population. The present study aims to assess the feasibility of the Landing Wise program as a therapeutic intervention for reducing the fear of falling in people with PD. A mixed-methods study will be conducted using convenience sampling to recruit 20 people with PD with a moderate concern of falling from a Parkinson's Patients Association. In addition to usual care, participants will attend 2 days per week, 90 min group sessions for 8 weeks. The intervention combines group cognitive behavioral intervention with the training of safe landing strategies. Feasibility will be assessed by six key domains (recruitment strategy and rates, enrollment, retention, acceptability, reasons for decline/withdrawal, and adverse events). Quantitative data will be analyzed using descriptive statistics to characterize the sample, followed by inferential statistics to evaluate differences in the Short Falls Efficacy Scale-International Scale, Movement Disorder Society Unified Parkinson's Disease Rating Scale, Timed Up Go, 6-Minutes Walking Distance, and fall frequency and severity scores between baseline and final assessment. Qualitative data will be analyzed using an inductive thematic analysis process. There is a growing interest in developing new effective therapeutic approaches for people with PD. If proven program feasibility, this study precedes a randomized controlled trial to establish the effectiveness of the Landing Wise program.

Neurological Exam Findings Predictive of Falls in Patient’s with Parkinson’s Disease (P10-11.011)

<h3>Objective:</h3> To investigate the relationship between various neurological exam findings and number of falls in patients with Parkinson’s Disease <h3>Background:</h3> Parkinson’s Disease (PD) has significant effect on patient ability to ambulate. Difficulty in ambulating is often associated with patient falls. Findings of various studies estimate that 38 to 87% of patients with PD experience falls. A history of previous falls, disease duration, and dementia have been identified as independent predictors of falling in PD patients. As patient falls can result in detrimental consequences, such as fractures or head trauma, identifying patients at increased risk of falls is essential. This study sought to examine if components of the neurological exam were associated with an increased number of patient falls. <h3>Design/Methods:</h3> Data regarding neurological exam findings and reported number of patient falls were extracted from the most-recent visit of 242 patients charts at a single treatment center. All neurological exams were completed by one movement disorder specialist. Statistics were calculated using SPSS. <h3>Results:</h3> A higher UPDRS gait score was associated with an increased number of falls (beta=.62, p=.005). A gait score of 0 predicted 2.32 falls/month. A gait score of 4 predicted 8.16 falls/month. A higher UPDRS postural instability score was also associated with a higher number of falls (beta=0.42, p=.003). A instability score of 0 predicted 1.33 falls/month. An instability score of 4 predicted 8.42 falls/month. Utilizing the revised neuropathy disability score, PD patients with a clinical diagnosis of neuropathy did not have more falls than patients without neuropathy (p=0.537). <h3>Conclusions:</h3> Various components of the UPDRS neurological exam can be utilized to discuss fall risk with patients and guide actions to decrease fall risk. Although neuropathy on its own is a predictor of fall risk, it did not result in an additional need to address fall risk in our PD patient population. <b>Disclosure:</b> Miss Valerius has nothing to disclose.

Cancer survivors at greater risk for bone fractures late in life

Cancer survivors at greater risk for bone fractures late in life

STAKEHOLDER ENGAGEMENT IN THE DESIGN OF A FALL RISK PREDICTION SYSTEM FOR SOCIALLY VULNERABLE OLDER ADULTS

Abstract Falls and fall-related injuries are significant public health issues for adults 65 years of age and older. Fall-related injuries are among the most expensive medical conditions. Mild cognitive impairment (MCI) and housing conditions are each independent risk factors for multiple falls among older adults and there is increasing evidence of the adverse effect of MCI on balance, stride, gait speed and increasing fall risk. We developed an innovative technology-supported intervention called Sense4Safety to 1) identify escalating risk for falls through real-time in-home passive sensor monitoring (using depth sensors); 2) employ machine learning to inform individualized alerts for fall risk; and 3) link ‘at risk’ socially vulnerable older adults with a tele-coach who guides them in implementing evidence-based individualized plans to reduce fall-risk. The purpose of this study was a) to examine preferences and attitudes of low-income older adults towards an in-home sensor-based system to inform fall prevention strategies; and b) solicit feedback from and validate the intervention protocols by clinical experts in fall prevention, fall risk assessment and geriatrics. We conducted one hour interview sessions with a total of 10 older adults and 10 clinical experts. Sessions were transcribed and analyzed. Findings included perceived benefits and challenges, recommendations for refinement of the intervention (including educational components and different visualization approaches for sensor data) and the role of family members or trusted others in addressing fall risk. We highlight clinical and ethical implications resulting from the use of passive monitoring for socially vulnerable older adults with MCI.

OUTDOOR FALLS PREVENTION: PROMOTING SAFETY IN URBAN NEIGHBORHOODS

Abstract Outdoor falls present a significant challenge to the well-being of community dwelling older adults. There are a number of existing evidence-based programs that address fall risk, including multifactorial and exercise-based programs. However, despite the difference in risk factors for indoor and outdoor falls, no existing program specifically targets outdoor falls. To fill this gap, the Stroll Safe program was developed and refined based on a prior feasibility study. The 7-week group-based manualized program is focused on promoting safe behavioral strategies to reduce the risk of outdoor falls. In addition to presentations and community mobility coaching by the group leader, an occupational therapist, the program includes group discussion and problem solving, capitalizing on the life experiences of participants. Action planning facilitates implementation of the strategies discussed. Given that the neighborhood environment impacts both risk and fear of falling, a walkability audit (i.e. the SWAN) focused on environmental hazards is included and is used to promote awareness of hazards and as a tool for self-advocacy. Data science and machine learning facilitate the creation of resources for route planning. Vision Zero resources help to identify hotspots for pedestrian injuries, and a map of shadow is used to create a user friendly map of potential hotspots for black ice. In this symposium, we will present 1) Findings from the efficacy trial for Stroll Safe, and 2) Describe data science research that can be used to inform outdoor falls prevention programs.

The effect of obesity on whole-body angular momentum during steady-state walking

BackgroundIndividuals with obesity demonstrate deficits in postural stability, leading to increased fall risks. Controlling whole-body angular momentum is essential for maintaining postural stability during walking and preventing falls. However, it is unknown how obesity impacts whole-body angular momentum during walking. Research purposeTo investigate the change in angular momentum about the body’s COM during walking in individuals with different degrees of obesity. MethodsThirty-eight young adults with different body mass index (BMI) scores walked barefoot at their preferred speed on a treadmill for 2 min. The whole-body angular momentum has been quantified from ground reaction force and moment data to capture the rotational behavior of walking in individuals with obesity without relying solely on placing markers on anatomical landmarks. ResultsWe found that adults with higher BMI scores walked slower with shorter step length, wider step width, and longer double support time (ps<.01). Ranges of the frontal- and transverse-plane angular momentum were greater in adults with higher BMI scores (ps<.01), while no difference was observed between BMI groups in the total sum of changes in whole-body angular momentum in any plane (ps>.05). SignificanceObesity not only decreased walking speed but also limited the ability to control mediolateral stability during walking. Investigating how obesity affects whole-body angular momentum may help better understand why adults with obesity have atypical gait with poor balance, address fall risk factors, and facilitate participation in physical activities.

Mindful and Compassionate Self, Grounded Together: A Qualitative Description of Postmenopausal Women's Perceptions of Balance Flow Yoga.

Yoga has promising benefits for women to reduce fall-injury risk by improving balance, strength, confidence, and other risk factors, although the effect of yoga on reducing injury risk and fall rates is still not clearly established. The objective of the present study was to determine postmenopausal women's perceived changes in overall health and well-being and some of the facilitators and challenges to participating in a 12-week Balance Flow Yoga class, a group-based hatha yoga intervention designed specifically to address fall risk factors. Thirty-six women 50-70 years of age participated in an intervention study consisting of 12 weeks of a control period followed by 12 weeks of twice-weekly hatha Balance Flow Yoga in a community yoga studio. Twenty-three women and four yoga instructors/trainers participated in focus group discussions after the intervention was completed. Discussion was audiotaped, transcribed, and analyzed through inductive thematic analysis by three researchers, a student trainee, and a research assistant. Two overarching themes and four subthemes were revealed. The two overarching themes Mindful and Compassionate Self and Grounded Together represented participants' perceptions of personal growth and their approach to living and the sense of community support and connection. Four interrelated subthemes were Creating a Safe Space; Sense of Community and Commitment; Benefits: Physical and Beyond ; and Balancing Individual Needs. This study demonstrated perceptions of physical, emotional, and social benefits after 12 weeks of Balance Flow Yoga; these benefits could influence women's health, wellness, and future fall risk.

Short-Term Effect of Fesoterodine on Physical Function Relevant to Fall Risk in Older Women With Overactive Bladder.

The aim of this study was to measure the effect of treatment with fesoterodine on physical function relevant to fall risk in older women with overactive bladder. This was a prospective cohort study of women aged 65 years or older with overactive bladder. Urinary symptoms and physical function were measured at baseline and 8 weeks after treatment with fesoterodine. Physical activity and sedentary behavior were measured subjectively using questionnaires and objectively using an accelerometer. Physical function was measured using the Short Physical Performance Battery test. We enrolled 75 women with a median age of 76 years. At baseline, bothersome urgency urinary incontinence and nocturia were reported by 55% and 81%, respectively. At baseline, participants were highly sedentary with a median of 2,118 steps daily. After treatment, urinary symptom severity and health-related quality of life subscale scores of the Overactive Bladder Questionnaire improved significantly (-22.3±24 and 17.5±19.7, respectively; P < 0.0001). The proportion of participants who self-reported a moderate-to-high level of physical activity increased from 27% to 35% after treatment (P = 0.86). However, daily steps decreased significantly (-420.2±949, P < 0.001), whereas daily sedentary time increased by 36.6±88 minutes (P < 0.001). There was no significant change in the Short Physical Performance Battery score (-0.3±2.3, P = 0.6). In older women with overactive bladder, short-term treatment with fesoterodine decreased objectively measured physical activity with no significant change in physical function. Treatment with anticholinergics may need to be supplemented with other therapies to address fall risk in older women with overactive bladder.

Addressing Fall Risk From the Emergency Department: What Are We Missing?

The Research to Practice column focuses on improving the research critique skills of emergency nurses and advanced practice providers to assist with the translation of research into practice. In this issue, we discuss the findings of a secondary data analysis conducted by K. Davenport, M. Alazemi, J. Sri-On, and S. Liu (2020) that examined emergency department provider identification of modifiable risk factors when assessing older adults who present after a fall. The results found that providers frequently miss identifying and intervening in modifiable risk factors that contribute to adverse outcomes and readmissions following discharge. The results suggest future research needs and have implications for emergency nurse practitioner educational preparation.

Staff and Administrator Perceptions of Fall Risk Management in Home- and Community-Based Service Settings

Older adults who receive home- and community-based services (HCBS), such as home-delivered meals and personal care assistance, are at particular risk for falls due to their extremely high prevalence of fall risk factors. HCBS organizations and their staff are well-positioned to implement fall risk screens with HCBS clients and then refer older adults to fall prevention services as needed; however, the extent to which HCBS organizations manage fall risk has yet to be systematically examined. The purpose of this qualitative study was to explore the barriers to and facilitators of implementing fall risk screens and fall prevention service referrals in HCBS organizations. A total of 26 HCBS staff members and administrators participated in semi-structured interviews and focus groups. Qualitative data were examined using directed content analysis guided by the Consolidated Framework for Implementation Research. HCBS staff expressed that strong rapport with clients allowed for them to address fall risk proactively but were concerned that their lack of fall prevention training precluded them from effective fall risk management. HCBS administrators perceived their organization to have reliable internal communication procedures which enhanced fall prevention care coordination but believed their limited connections with fall prevention service providers served as a barrier to referring at-risk clients to appropriate care. Accordingly, HCBS stakeholders are encouraged to develop strategies, such as providing fall prevention coaching and building a network of fall prevention service providers, that account for these barriers and facilitators in future efforts to support effective fall risk management with HCBS clients.

Current and Emerging Trends in the Management of Fall Risk in People with Lower Limb Amputation.

People living with lower limb amputation are at an increased risk of falling compared with the healthy geriatric population. Factors of increased age and increased number of comorbidities could compound the already increased risk. The purpose of this article is to highlight recent research associated with fall risk in amputees and provide the reader with evidence to help guide clinical interventions. Though research on the topic of falls in people with amputation is becoming more common, there is still a dearth of evidence regarding what contributes to increased fall risk and how to address it in this population. There are recent studies that have examined therapy and prosthetic interventions that could mitigate fall risk in people with amputation, yet there is not enough evidence to develop a consensus on the topic. More research is required to determine what contributes to increased fall rates in people with amputation, and what detriments to an amputee's function or psyche may result after incurring a fall. Borrowing from what is known about geriatric fall risk and combining the information with novel and existing approaches to fall mitigation in amputees can offer clinicians the opportunity to develop evidence-based programs to address fall risk in their patients with lower limb amputation.

Implementing Fall Prevention Guidelines with Vulnerable Older Adults: The Social Work Role

ABSTRACTFalls are the leading cause of injury among the older adult population, resulting in costly and devastating aftermaths. National fall prevention guidelines (FPGs) have been established to assist healthcare professionals with addressing fall risk, but little is understood about the extent to which FPGs have been implemented by social workers. Social workers, however, may beuniquely positioned to implement FPGs with older adults due to their expertise in care coordination and home- and community-based service settings. This conceptual paper addresses the timely issue of fall prevention and social workers’ potential role in implementing FPGs to address fall risk.

Feasibility and efficacy of a multi-factorial intervention to prevent falls in older adults with cognitive impairment living in residential care (ProF-Cog). A feasibility and pilot cluster randomised controlled trial

BackgroundFalls are common in people with dementia living in residential care. The ProF-Cog intervention was developed to address fall risk factors specific to this population. The aim of this study was to evaluate the safety, acceptability, and feasibility of the intervention and provide an estimate of its efficacy.MethodsThis was a cluster randomised controlled pilot study undertaken in care homes in London, UK. All permanent residents living in participating homes who were not terminally ill were invited to participate. The intervention included an assessment of falls risk factors followed by a tailored intervention which could include dementia care mapping, comprehensive geriatric assessment, occupational therapy input and twice-weekly exercise for 6 months as required to target identified risk factors. The control group received usual care without a falls risk assessment.Standing balance was the primary outcome. This and other outcome measures were collected at baseline and after 6 months. Falls were recorded for this period using incident reports. Changes were analysed using multi-level modelling. Adherence to the interventions, adverse events and trial feasibility were recorded.ResultsNine care homes enrolled in the study with a total 191 participants (51% of those eligible); five homes allocated to the intervention with 103 participants, and four homes to the usual care control group with 88 participants. The intervention was safe with only one reported fall whilst undertaking exercise. Adherence to agreed recommendations on activity and the environment was modest (21 and 45% respectively) and to exercise was poor (41%). Balance scores (score range 0–49) analysed on 100 participants decreased by a mean of 3.9 in the control and 5.1 in the intervention groups, a non-significant difference (p = 0.9). In other measures, both groups declined equally and there was no difference in falls rates (IRR = 1.59 95%, CI 0.67–3.76).ConclusionThe intervention was safe but not clinically effective. Poor adherence suggests it was not an acceptable or feasible intervention.Trial registrationISRCTN00695885. Registered 26th March 2013.

Older Adult Falls: Effective Approaches to Prevention.

The issue of older adult falls combines a problem with high incidence and high injury susceptibility with an increasing population at risk. A firm understanding of both fall risk factors and effective strategies is required to reduce risk and prevent these injuries. Each year, 28.7% of older adults aged ≥65 sustain a fall. At the national level, this represents 29 million falls resulting in 27,000 deaths and 7 million injuries requiring medical treatment or restricted activity for at least 1 day. There are several strategies that have been shown to effectively reduce the risk or the incidence of falls. More than 90% of older adults see a medical provider at least once a year providing an opportunity to identify and address fall risk factors. Comprehensive fall prevention in the primary care setting is both feasible and practical.

Men's perspectives on fall risk and fall prevention following participation in a group-based programme conducted at Men's Sheds, Australia.

Research on older men's views regarding fall prevention is limited. The purpose of this qualitative study was to explore the experiences and perspectives of older men regarding fall risk and prevention so that fall prevention programmes can better engage older men. Eleven men who had taken part in a group-based fall prevention programme called Stepping On conducted at Men's Sheds in Sydney, Australia, participated in semi-structured interviews during June and July 2015 which were audio-recorded and transcribed. Data were coded and analysed using constant comparative methods. Over-arching theoretical categories were developed into a conceptual framework linking programme context and content with effects of programme participation on men. Men's Sheds facilitated participation in the programme by being inclusive, male-friendly places, where Stepping On was programmed into regular activities and was conducted in an enjoyable, supportive atmosphere. Programme content challenged participants to think differently about themselves and their personal fall risk, and provided practical options to address fall risk. Two major themes were identified: adjusting the mindset where men adopted a more cautious mindset paying greater attention to potential fall risks, being careful, concentrating and slowing down; and changing the ways where men acted purposefully on environmental hazards at home and incorporated fall prevention exercises into their routine schedules. Practitioners can engage and support older men to address falls by better understanding men's perspectives on personal fall risk and motivations for action.

An Introduction to the Centers for Disease Control and Prevention's Efforts to Prevent Older Adult Falls.

An Introduction to the Centers for Disease Control and Prevention's Efforts to Prevent Older Adult Falls.

Fall prevention in our healthiest patients: assessing risk and preventing injury for moms and babies.

Attention is needed in preventing patient falls in newborns and in obstetric units of hospitals. The majority of prenatal, postpartum, and newborn falls are preventable. Little effort has been made to address fall risk during the prenatal period, during labor, and after delivery in the postpartum period for moms and babies. Risk factors for falls in these populations have been identified, and targeted risk assessments and fall prevention interventions have been developed to eliminate these falls. Evidence demonstrates success in reducing falls with a variety of low-cost but high-return initiatives, comprising prenatal education, patient and family engagement, implementation of unique fall risk assessment tools, postpartum mobility assessments, and changes in patient rounding frequency.

Does a fall prevention educational programme improve knowledge and change exercise prescribing behaviour in health and exercise professionals? A study protocol for a randomised controlled trial

IntroductionFalling in older age is a serious and costly problem. At least one in three older people fall annually. Although exercise is recognised as an effective fall prevention intervention, low...