Assessment Of Risk Factors For Falls Research Articles

Assessment of fall-associated risk factors in the Muslim community-dwelling older adults of Peshawar, Khyber Pakhtunkhwa, Pakistan

BackgroundFalls are the third-leading cause of disability among the elderly population worldwide. It is multifactorial, and the occurrence of falls depends on different factors, which can be different from context to context, and individual to individual. Therefore, regular assessment of fall risk factors is required to develop a strategy for fall prevention. The study aimed to identify fall-related risk factors in Pakistani healthy older adults at risk of developing physical disabilities. It also aimed to create a risk-predictive model for fall occurrence, offering evidence for preventive strategies.MethodsData were collected from 140 Muslim older adults from two residential areas of Peshawar, Khyber Pakhtunkhwa, from July 2022 to August 25, 2022, after obtaining permission from the Zhengzhou University Ethical Review Board (ZZUIRB #202,254), and the District Health Department Office (DHO #14,207). Participants were informed, and consent was obtained before data collection. Data were collected using the Time Up and Go Test (TUGT) checklist, the Cognitive Screening Scores (CS-10) checklist, interviews regarding the prayer practice, fall history in the last six months, visual equity questions, and demographic variables.ResultsFactors associated with falls were; age, gender, education, cognitive status, poor walking speed, lack of physical activity, poor vision, and history of falls in the last six months, with a significant P value of (P. < 0.05) in the Pearson correlation coefficient test. Poor cognition, low visual equity, poor walking speed, and lack of exercise increase the risk of falling in the future, with a prediction value of (P < 0.005) in Omnibus, Lemeshow score of (0.77).ConclusionHence, our study provides a road map for future risk assessment of falls by adding the four mentioned risk factors in the proposed model to facilitate timely action to prevent fall-related infirmities in Pakistani healthy older adults.

Effects of Controlled Whole-Body Vibration Training on Functional Performance Among Healthy Older Adults: A 6-Week Pilot Study.

Falling is the second leading cause of injury-related death worldwide and is a leading cause of injury among older adults. Whole-body vibration has been used to improve fall risk factors in older adults. No study has assessed if vibration benefits can be retained over time. The aims of this study were to examine if six-weeks of whole-body vibration could improve fall risk factors and to assess if benefits associated with the training program could be sustained two months following the final training session. Repeated measures randomized controlled design. Twenty-four independent living older adults were recruited and were randomly assigned to the WBV or control group. Participants performed three sessions of whole-body vibration training per week with a vibration frequency of 20Hz or with only an audio recording of the vibration noise. An assessment of fall risk factors was performed prior to, immediately following, and two-months after the completion of the training program. Fall risk factors including functional capacity, mobility, strength, and walking speed were assessed pre-training, post-training, and two-months post-training. Seventeen participants completed the study. No improvements (p<0.05) between groups were found in the measures of physical performance. Findings revealed that six weeks of whole-body vibration is not effective in improving fall risk factors or producing benefits post-training.

The effectiveness of a recurrent fall prevention program applied to elderly people undergoing fracture treatment

BackgroundWorldwide 30–40% of people aged of 65 and over fall each year. It is important to develop preventive interventions for falls in the elderly to prevent injuries leading to mortality and morbidity. ObjectivesThis study evaluated the effectiveness of a recurrent fall prevention program in elderly individuals undergoing fracture treatment. MethodsA pretest-posttest intervention study. A recurrent fall prevention program including assessment of fall risk factors, education on falls and home modifications was developed for elderly people undergoing fracture treatment for 52 patients. ResultsIn the first evaluation before the delivery of the recurrent fall prevention program, the number of risk factors was 17.63 ± 3.40 as mean ± standart deviation. Following implementation of the fall prevention program, the number of risk factors decreased to 15.73 ± 3.19 in the first follow-up and decreased to 14.92 ± 3.06 in the second follow-up. Knowledge scores increased to 6.09 ± 1.65 in the first follow-up and to 6.71 ± 1.53 in the second follow-up, while it was 5.50 ± 1.54 in first evaluation. The differences between follow-ups were statistically significant. During the 3-month study period, 15.4% of participants experienced fall. ConclusionThe recurrent fall prevention program was effective in reducing fall-related risk factors and increase fall knowledge. Health care professionals should assess older people for fall risk factors and increase their awareness for falls.

Adoption of Evidence-Based Fall Prevention Practices in Primary Care for Older Adults with a History of Falls.

A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79 ± 8 years; 68% were female, and 10% were non-white. They averaged six primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall-risk factors varied from 24% (for home safety) to 78% (for vitamin D). An evidence-based intervention was recommended for identified risk factors 73% of the time, on average. Two risk factors were addressed infrequently: medications (21%) and home safety (24%). Use of a structured visit note template independently predicted assessment of fall-risk factors (p = 0.003). Geriatrics specialists were more likely to use a structured note template (p = 0.04) and perform more fall-risk factor assessments (4.6 vs. 3.6, p = 0.007) than general internists. These results suggest opportunities for improving multifactorial fall-risk assessment and management of older adults at high fall risk in primary care. A structured visit note template facilitates assessment. Given that high-risk medications have been found to be independent risk factors for falls, increasing attention to medications should become a key focus of both public health educational efforts and fall prevention in primary care practice.

OS 16-06 RISK FACTORS FOR SERIOUS FALL INJURIES FOLLOWING INITIATION OF ANTIHYPERTENSIVE MEDICATION

Abstract To identify risk factors for serious fall injuries following initiation of antihypertensive medication among older adults. We conducted a retrospective cohort study using a 5% random sample of people with Medicare health insurance, a government program for older US adults. The analysis was restricted to patients with a diagnosis of hypertension who initiated antihypertensive medication between 2007 and 2011. Initiation was defined by the first antihypertensive medication fill in this time period preceded by 365 days with no antihypertensive medication fills. Fall risk factors were determined from claims in the 365 days before antihypertensive medication initiation. Serious fall injuries were defined based on emergency department and inpatient claims with an injury code for nonpathological fractures, brain injury, or dislocation of the hip, knee, shoulder, or jaw, along with a fall-related code; or along with the requirement that there was no motor vehicle accident code in the absence of a fall-related code. The mean (SD) age of patients who initiated antihypertensive medication (n = 65,179) was 76.3 (7.6), 60.5% were women, and 8.8% were black. There were 2,174 serious fall injuries during the year following medication initiation. The incidence rate per 1,000 person-years of serious fall injuries was 45.9 (95% CI, 44.2 - 47.6). Independent risk factors for serious fall injuries included older age, female sex, white race, history of stroke, syncope, osteoporosis, depression or dementia, use of >10 medications, Charlson comorbidity index >0, and serious fall injuries in the year prior to antihypertensive medication initiation (Table). These results suggest that selected demographic and clinical characteristics identify patients at high risk for serious fall injuries following antihypertensive medication initiation. Conducting fall risk factor assessment in older adults initiating antihypertensive medication may be a strategy to improve the recognition of those at risk for serious fall injuries.

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil)

BackgroundFalling in older age is a major public health concern due to its costly and disabling consequences. However very few randomised controlled trials (RCTs) have been conducted in developing countries, in which population ageing is expected to be particularly substantial in coming years. This article describes the design of an RCT to evaluate the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people.Methods/designMulticentre parallel-group RCT involving 612 community-dwelling men and women aged 60 years and over, who have fallen at least once in the previous year. Participants will be recruited in multiple settings in Sao Paulo, Brazil and will be randomly allocated to a control group or an intervention group. The usual care control group will undergo a fall risk factor assessment and be referred to their clinicians with the risk assessment report so that individual modifiable risk factors can be managed without any specific guidance. The intervention group will receive a 12-week Multifactorial Falls Prevention Program consisting of: an individualised medical management of modifiable risk factors, a group-based, supervised balance training exercise program plus an unsupervised home-based exercise program, an educational/behavioral intervention. Both groups will receive a leaflet containing general information about fall prevention strategies. Primary outcome measures will be the rate of falls and the proportion of fallers recorded by monthly falls diaries and telephone calls over a 12 month period. Secondary outcomes measures will include risk of falling, fall-related self-efficacy score, measures of balance, mobility and strength, fall-related health services use and independence with daily tasks. Data will be analysed using the intention-to-treat principle.The incidence of falls in the intervention and control groups will be calculated and compared using negative binomial regression analysis.DiscussionThis study is the first trial to be conducted in Brazil to evaluate the effectiveness of an intervention to prevent falls. If proven to reduce falls this study has the potential to benefit older adults and assist health care practitioners and policy makers to implement and promote effective falls prevention interventions.Trial registrationClinicalTrials.gov (NCT01698580)

The effect of nursing intervention on the prevention of the risk of falls in hospitalized elderly patients

Objective To explore the effect of nursing intervention on the prevention of the risk of falls in hospitalized elderly patients.Methods In the intervention group,350 cases of hospitalized elderly patients were treated with risk intervention.Inpatient fall risk factor assessment scale was used to assess.According to the results of the evaluation nursing measures were carried out,the results were summarized,and the results were compared with control group with 348 patients.Results There were significant differences statistically in mastery of falls prevention knowledge and satisfaction degree of nurses between two groups ( P ＜0.01 ).The incidence rate of falls in intervention group were significant lower than that in control group (P ＜ 0.05).Conclusions Nursing risk intervention on hospitalized elderly patients can promote nurse -patient relationship,improving patient for fall protection,effectively prevent patients'falling. Key words: Risk intervention; Assessment; Elderly patients; Fall

Bone Health and Type 2 Diabetes Mellitus: A Systematic Review

To systematically review the literature related to bone health in older adults with type 2 diabetes mellitus (T2DM). We conducted a systematic review of the literature from January 2005 until February 2010, using keywords related to T2DM and bone-health imaging technology in older adults (aged ≥60 years) to search PubMed, OVID MEDLINE, Ageline, CINAHL, Embase, and PsycINFO. We found a total of 13 studies that met the inclusion criteria for this review. The majority of the studies used dual X-ray absorptiometry (DXA) and showed either higher or similar areal bone mineral density (aBMD) for older adults with T2DM relative to healthy controls. Studies using more advanced imaging suggested that there may be differences in bone geometry between older adults with and without T2DM. Older adults with T2DM have similar or higher aBMD at the hip relative to older adults without T2DM, despite previous literature reporting an increased risk of low-trauma fractures. Recent studies with advanced imaging have suggested that there may be differences in bone geometry between older adults with T2DM and those without. Health professionals, especially physiotherapists, should be aware of the increased risk and include assessment of fall risk factors and exercise prescription for fall prevention for older adults with T2DM.

Older patients presenting to a county hospital ED after a fall: missed opportunities for prevention

Little is known about the characteristics of elderly persons who present to an ED after a fall or about the nature of the care received for the fall itself. We identified elders presenting to a large urban United States ED after a fall, determined risk factors that may have contributed to the fall, and assessed the extent to which falls were addressed in the ED setting. One hundred seventeen fallers were identified. Nearly half were aged 80 years or older. After age, polypharmacy was the most common fall risk factor, followed by more than 1 contributing medical condition and cognitive impairment. Fall risk factors differed significantly for older compared with younger subgroups. More than half (57%) who had fallen were admitted. Of the remainder who fell and were discharged, more than half were scheduled for follow-up of their fall-related injury only, with no follow-up scheduled to address prevention of future falls. In summary, elders who present to an ED after having fallen have a variety of risk factors for falls that can be addressed to reduce their risk of future falls and injury; however, many may not receive such follow-up care. There must be increased awareness among ED providers of the need for a medical evaluation of a fall. Randomized trials evaluating the effect of a focused fall risk factor assessment after presentation to the ED may be warranted.

Changes in Physical Therapy Providers' Use of Fall Prevention Strategies Following a Multicomponent Behavioral Change Intervention

An abundance of evidence suggests that interventions targeting fall risk factors are effective; however, it remains unknown whether, or to what extent, this body of evidence has affected the clinical practice of physical therapy providers. The purposes of this study were: (1) to describe knowledge of, and attitudes toward, fall risk factors and fall reduction strategies; (2) to assess self-reported use of fall reduction strategies with patients; and (3) to identify factors associated with increased use of fall reduction strategies with patients among physical therapy providers exposed to a behavioral change strategy. A cross-sectional survey of physical therapy providers from hospital-based and freestanding outpatient physical therapy facilities throughout north-central Connecticut was conducted between October 2002 and April 2003. The participants were 94 physical therapy providers who had been exposed to the Connecticut Collaboration for Fall Prevention (CCFP) behavioral change effort. The CCFP program uses multicomponent professional behavioral change strategies to embed fall risk factor assessment and management, based on evidence from randomized controlled trials, into the clinical care of older patients. A telephone questionnaire--focusing on fall risk factor knowledge and attitudes and self-reported fall risk factor assessment and management practices before and after exposure to the CCFP efforts--was administered to consenting physical therapy providers. Environmental hazards and gait and balance deficits were named as fall risk factors by 86 (91%) and 73 (78%) participants, respectively. All of the targeted risk factors were mentioned by at least 30% of the participants. Sixty-four participants (68%) reported increased fall reduction practice behaviors. The area of multiple medications was noted most frequently, with 77 participants (82%) noting new practices related to medication use. Only knowledge of fall risk factors and pre-CCFP behaviors were associated with increased fall reduction practices. Physical therapy providers reported an increase in practice behaviors in response to the multicomponent behavioral change strategy. Knowledge of fall risk factors was associated with increased fall reduction practice behaviors, most likely due to the focused nature of the education strategy.

EXPLORING GAIT, BALANCE PERFORMANCE AND FEAR OF FALLING AMONG ELDERLY PEOPLE LIVING IN RURAL AREAS OF THAILAND

Background: Previous evidence indicates that older people allocate more of their attentional resources toward their gait and that the attention-related changes that occur during aging increase the risk of falls. Methods: A cross sectional study was conducted in Banna District and Ongkarak District, Nakornnayok Province, Thailand. One hundred elderly people participated in this study. Gait was assessed by a Time Up and Go Test (TUGT) while the One legged stance test (OLST) assessed balance performance. The Falls Efficacy Scale (FES) measured fear of falling of the elderly people. A WHOQOL-BREF instrument assessed the quality of Life among elderly people. Results: The findings revealed that 58% of the participants were female, aged between 60-74 years (mean = 66.39, SD 3.65). Over a 12 month period, 57% of participants had experienced a fall once, 41% had experienced 2 falls while 2% had experienced 3 or more falls. One-third of the elderly people who participated in the study had a fear of falling. Almost all of the elderly participants (76%) had a moderate fall risk perception score. The mean score of total quality of life was moderate (80.43). Conclusion: Study concluded that the elderly people face a valid risk of falling based on prevalent risk factors that results in a fear of falling. An assessment of fall risk factors are important in establishing a fall prevention program for the elderly faced with fall risk factor from fear of falling and. Assessment fall risk factors are important to provide the suitable falls prevention program for the elderly.