Fall Circumstances Research Articles

Falls and fall-related injuries: prevalence, characteristics, and treatment among participants of the Geelong Osteoporosis Study

BackgroundFalls are a significant public health challenge, especially among older adults. In Australia, falls and related injuries incur an annual cost of $2.3 billion. However, there is a scarcity of prevalence data on falls among population-based groups. This study aimed to report the characteristics, circumstances, and treatment for falls and fall-related injuries in a population-based sample of Australian men and women.MethodsParticipants from the Geelong Osteoporosis Study provided cross-sectional data: baseline for men (2001–2006) and 10-year follow-up for women (2004–2008). Falls over the previous 12 months were self-reported by 2,631 participants aged 20–97 years (1,533 men and 1,098 women). The study described the timing, location, cause, and treatment of falls. Fall prevalence was standardized to the 2006 Australian population. Data collection included self-reported prior fractures, medication, disease conditions, anthropometry, and biochemical tests. Binary logistic regression identified factors linked to fall-related injuries.ResultsFall rates by age group: 20–29 (24.4%), 30–39 (21.5%), 40–49 (18.7%), 50–59 (24.9%), 60–69 (25.0%), 70–79 (34.6%), 80+ (40.5%). The age-standardized prevalence of falls was 25.0% (95% CI: 23.4–26.7%). In adults ≥65 years, the age-standardized prevalence of falls was 32.4% (95% CI: 29.3–35.5%). Fallers were typically older, less mobile, had higher BMI and cholesterol levels, and were more likely to have musculoskeletal conditions, cancer, and polypharmacy. Men had a higher fall risk, but fewer fall-related fractures compared to women. Most falls occurred outdoors (62.1%), were due to extrinsic cause (58.5%), and were on the same level (78.5%). Factors associated with fall-related injuries included being female, elevated falls and falls outside the home. Nearly half (45.7%) of those injured sought medical attention, primarily from general practitioners (25.7%) and emergency departments (12.6%).ConclusionFalls are common, occurring in approximately one quarter of adults in this study, with a greater prevalence among those ≥65 years. Women experienced fewer multiple falls than men. Many participants sought medical attention, primarily from general practitioners. This research identifies fall characteristics and circumstances, informing targeted prevention strategies to reduce occurrences and alleviate burdens on healthcare systems and individuals.

Evaluating fall event definitions relative to lower limb prosthesis users’ lived experiences

Purpose Evaluate specific elements of previously proposed fall and near-fall definitions to determine whether they fully capture lower limb prosthesis (LLP) users’ lived experiences. Methods Semi-structured interviews were conducted with 24 LLP users. Interview transcripts were reviewed, coded, and analyzed using deductive thematic analysis to identify shared experiences and inform revisions to previously reported definitions. Results Four major themes emerged: a fall can be initiated by more than just a loss of balance, loss of balance and losing balance are considered similar, falls are not limited to landing on the ground or floor, and catching yourself and recovering your balance are distinct responses to a loss of balance. Conclusions Two revisions were made to previous definitions to better align with LLP users’ experiences and historically overlooked fall circumstances. A fall is defined as a loss of balance or sudden loss of support where your body lands on the ground, floor, or another object. A near-fall was defined as a loss of balance where you caught yourself or recovered your balance without landing on the ground, floor, or another object. Implementation of these new definitions will aid the collection of accurate, consistent, and meaningful fall data, enhancing aggregation and comparison across studies.

Falls perceived as significant by lower limb prosthesis users are generally associated with fall consequences rather than circumstances

Purpose To determine if falls perceived as significant by lower limb prosthesis (LLP) users were associated with fall circumstances and/or consequences. Materials and methods The circumstances and consequences of LLP users’ most significant fall in the past 12-months were collected using the Lower Limb Prosthesis User Fall Event Survey. Participants rated fall significance from 0 (not significant) to 10 (extremely significant), which was then dichotomized into “low” and “high”. Binary logistic regression was used to assess associations between fall significance and fall circumstances and consequences. Results Ninety-eight participants were included in the analysis. Five fall consequences were associated with greater significance: major injury (OR = 26.7, 95% CI: 1.6–459.6, p = 0.024), need to seek medical treatment (OR = 19.0, 95% CI: 1.1–329.8, p = 0.043), or allied-health treatment (OR = 18.2, 95% CI: 2.3–142.4, p = 0.006), decreased balance confidence (OR = 10.9, 95% CI: 2.4–49.3, p = 0.002), and increased fear of falling (OR = 7.5, 95% CI: 2.4–23.8, p = 0.001), compared to two fall circumstances: impact to the arm (OR = 5.0, 95% CI: 2.0–12.1, p = 0.001), and impact to the face, head, or neck (OR = 9.7, 95% CI: 1.2–77.4, p = 0.032). Conclusions Significant falls were generally more associated with fall consequence than fall circumstances.

Retrospective Analysis of Circumstances of Falls and Related Injuries across Levels of Care in Older Adult Retirement Home Facilities.

Towards developing more effective interventions for fall-related injuries, this study analysed a novel database from six retirement home facilities over a 4-year period comprising 1,877 fallers and 12,445 falls. Falls were characterized based on location, activity, injury site, and type, and the database was stratified across four levels of care: Independent Living, Retirement Care, Assisted Care, and Memory care. Falls most occurred within the bedroom (62.8%), and during unknown (38.1%), walking (20.2%), and transfer tasks (14.6%). Approximately one in three (37%) of all falls resulted in an injury, most commonly involving the upper limb (31.8%), head (26.3%), and lower limb (22.2%), resulting in skin tears (35.3%), aches/pains (29.1%), or bruises (28.0%). While fall location, activity, and injury site were different across levels of care, injury type was not. The data from this study can assist in targeting fall-related injury prevention strategies across levels of care within retirement facilities.

Observational Prospective Study to Determine the Efficacy of 'Non-Slip Socks' vs. 'Adequate Footwear' Regarding the Number of Falls Observed among Admitted Patients.

Fall prevention is an important indicator of the quality of patient care. Prevention includes the use of adequate footwear. Our objective is to determine the differences in the number of falls between patients with "adequate footwear" and "non slip socks", and their associated consequences, to support their use in the prevention of falls among hospitalized patients. This is an observational prospective study on inpatient falls. Patient characteristics, fall circumstances, and injuries were collected through Clinical Report Forms, a review of fall reports, and medical records. Admitted patients over 18 years old were recruited from Geriatric and Internal Medicine Units over a brief period of 3 months. A total of 158 hospitalized patients were recruited. In total, 77 patients (48.73%) were assigned to the non-slip socks group, and 81 (51.27%) were assigned to the adequate footwear group. There were 21 falls during the study period, all of which were experienced by the adequate footwear group (p < 0.0001). The mean age of the patients who fell was 83.14 (range 60-100) years old. The most frequent reasons for admission among the patients who fell were COVID-19 infection (19%) and oncological complications (19%). Overall, 61.9% of patients had a high risk of falling. Most falls (76.1%) occurred in patient rooms, and most of these occurred while wandering around. The most frequent reason for falls was slipping (14/21). For 16 of 21 patients, falls did not have immediate consequences, while 5 had contusions and 1 suffered a wound. Nobody needed to be admitted to the ER or suffered external hemorrhages or loss of consciousness. Non-slip socks represent an adequate alternative to well-fitting rubber-soled footwear. It seems that non-slip socks could prevent falls among hospitalized patients; nevertheless, further studies are necessary to clarify their role in preventing hospital falls and reducing injury rates.

Indoor falls and number of previous falls are independent risk factors for long-term mortality after a hip fracture

BackgroundHip fractures are almost always the result of a fall. Causes and circumstances of falls may differ between frail and vigorous patients.AimTo describe the circumstances of falls causing hip fractures, number of falls during the previous year, and their association with long-term mortality.Patients and methodsThe study is a retrospective review conducted in a tertiary university hospital serving a population of 425,000 inhabitants in Barcelona. All patients admitted with hip fractures with medical records describing the circumstances and number of previous falls were included. The number of falls in the previous 12 months was recorded, including the one causing the fracture. The circumstances of the index fall were dichotomized according to whether it was from the patient’s own height or above; day or night; indoors or outdoors, due to intrinsic or extrinsic causes. Cumulative mortality was recorded for almost 5 years after hip fracture.ResultsIndoor falls were strongly associated with shorter survival. Falling more than once in the previous year was also a risk factor for long-term mortality (hazard ratio 1.461, p < 0.001 and hazard ratio 1.035, p = 0.008 respectively).ConclusionIndoor falls and falling more than once in the previous year are long-term risk factors for mortality after hip fractures. It is always essential to take a careful patient history on admission to determine the number of falls and their circumstances, and special care should be taken to reduce mortality in patients at high risk.

Factors associated with risk of falling among younger inpatients in a mental health setting-A systematic review.

To synthesise evidence related to risk factors of falls among younger mental health inpatients age ≤65 years old. Hospitalised patients with mental illness are at increased risk of falling. Specific risk factors for falls for younger inpatients are poorly understood. Systematic review. Medline, CINAHL, APA PsycINFO, Scopus and Web of Science were searched for studies published in English till December 2022. The review followed the 2020 PRISMA checklist. Odds ratios and P values of significant risk fall factors and the frequency of factors related to circumstances of falls were extracted. Nine studies were included and 95 risk factors, across seven categories were extracted. These categories included socio-demographic, fall-related factors, functional status, health and mental status, psychiatric diagnosis and assessment, medication, and staff related factors. Factors related to medication, health and mental status are most reported. Majority of the patients sustained minor or no injury from the fall and circumstances of fall vary across studies. Factors strongly associated with risk of falls were dizziness, use of psychotropics and antihypertensive drugs. A meta-analysis of risk factors was not possible due to different dependent variables studied, controlled confounding variables and control groups used. Fall prevention is relevant to all patients in mental health settings. Approaches to fall risk assessment and management need to be better tailored to younger mental health patients in the psychiatric setting. Patient or public contribution was not possible because of the study design.

Risk factors for in-hospital patient falls: a retrospective analysis

Background/Aims Falls are a key patient safety concern because of the associated physical injuries, emotional impact and financial burden on patients and the healthcare system. This study aimed to describe the characteristics of falls and assess the potential risk factors among hospitalised patients in a medium-sized acute care hospital in Queensland, Australia. Methods This was a retrospective descriptive study using routinely collected information. The study was conducted in a medium-sized public hospital in Queensland, Australia. Characteristics of patients, their fall risk classification and circumstances of patient falls were extracted from the incident report provided by the hospital. Data were analysed using descriptive statistics. Results A total of 677 patient fall incidents were documented on the hospital's electronic incident system from 2015–17. The majority of falls (98%) occurred in inpatient units and caused no or minimal harm to patients. Older age groups (75–84 years and 85–94 years) made up the greatest proportion of patients who fell. Falls were largely related to toileting activities. The most common locations for inpatient falls were the bed, bedside trolley or treatment chair. Conclusions Intervention studies are needed to develop and evaluate procedures to prevent falls, particularly for activities with a high risk of falls, such as toileting, and for older patients.

Frequency, Characteristics, and Risk Factors for Falls at an Inpatient Cancer Rehabilitation Unit.

Falls in the hospital can lead to adverse events, including injuries. Studies have shown that patients with cancer and those undergoing inpatient rehabilitation (IPR) are at higher risk for falls. Therefore, we measured the frequency, degree of harm, and characteristics of patients who fell in an inpatient cancer rehabilitation unit. A retrospective review was conducted on inpatient cancer rehabilitation patients admitted from January 2012 to February 2016. Fall frequency, degree of harm, fall circumstances, cancer type, patient's fall risk score on the basis of the MD Anderson Cancer Center Adult Inpatient Fall Risk Assessment Tool (MAIFRAT), length of stay, and risk factors were evaluated for patients. There were 72 out of 1,571 unique individual falls (4.6%), with a falls incidence of 3.76 falls per 1,000 patient-days. Most fallers (86%) suffered no harm. Risk factors for falls included presence of patient-controlled analgesia pump (P = .03), pump such as insulin or wound vacuum-assisted closure (P < .01), nasogastric, gastric, or chest tube (P = .05), and higher MAIFRAT score (P < .01). The fallers were younger (62 v 66; P = .04), had a longer IPR stay (13 v 9; P = .03), and had a lower Charlson comorbidity index (6 v 8; P < .01). The frequency and degree of harm for falls in the IPR unit were less than previous studies, which suggests that mobilization for these patients with cancer is safe. The presence of certain medical devices may contribute to fall risk, and more research is needed to better prevent falls in this higher-risk subgroup.

Description and Implications of Falls in Patients Hospitalized Due to COVID-19.

Many hospital quality indicators, including falls, worsened during the COVID-19 pandemic. Patients hospitalized with COVID-19 may be at risk for falling due to the disease itself, patient characteristics, or aspects of care delivery. To describe and explore falls in patients hospitalized with COVID-19. We pooled data from 107 hospitalized adult patients who fell between March 2020 and April 2021. Patients who fell had a current, pending, or recent diagnosis of COVID-19. We analyzed patient characteristics, fall circumstances, and patient and organizational contributing factors using frequencies, the chi-square test, and Fisher's exact test. Patient contributing factors included patients' lack of safety awareness, impaired physical function, and respiratory concerns. Organizational contributing factors related to staff and the isolation environment. Recommendations for managing fall risk in patients hospitalized with COVID-19 include frequent reassessment of risk, consideration of respiratory function as a risk factor, ongoing patient education, assisted mobility, and adequate staff training.

Characterizing Fall Circumstances in Community-Dwelling Older Adults: A Mixed Methods Approach.

Understanding fall circumstances can help researchers better identify causes of falls and develop effective and tailored fall prevention programs. This study aims to describe fall circumstances among older adults from quantitative data using conventional statistical approaches and qualitative analyses using a machine learning approach. The MOBILIZE Boston Study enrolled 765 community-dwelling adults aged 70 years and older in Boston, MA. Occurrence and circumstances of falls (ie, locations, activities, and self-reported causes of falls) were recorded using monthly fall calendar postcards and fall follow-up interviews with open- and close-ended questions during a 4-year period. Descriptive analyses were used to summarize circumstances of falls. Natural language processing was used to analyze narrative responses from open-ended questions. During the 4-year follow-up, 490 participants (64%) had at least 1 fall. Among 1 829 falls, 965 falls occurred indoors and 804 falls occurred outdoors. Commonly reported activities when the fall occurred were walking (915, 50.0%), standing (175, 9.6%), and going down stairs (125, 6.8%). The most commonly reported causes of falls were slip or trip (943, 51.6%) and inappropriate footwear (444, 24.3%). Using qualitative data, we extracted more detailed information on locations and activities, and additional information on obstacles related to falls and commonly reported scenarios such as "lost my balance and fell." Self-reported fall circumstances provide important information on both intrinsic and extrinsic factors contributing to falls. Future studies are warranted to replicate our findings and optimize approaches to analyzing narrative data on fall circumstances in older adults.

1348 A QUALITY IMPROVEMENT PROJECT TO IMPROVE ASSESSMENT AND DOCUMENTATION FOLLOWING INPATIENT FALLS

Abstract Introduction Inpatient falls are a major cause of avoidable harm in patients on elderly care wards. Delays in identification of fall precipitants and recognition of sustained injuries increases morbidity, mortality and length of stay (Cameron et al, Cochrane Database Syst Rev. 2018 Sep; 2018(9)). Patients sustaining falls are often initially assessed by postgraduate year 1 and 2 doctors independently. We aimed to improve patient outcomes following inpatient falls through standardisation of the assessment and documentation following a fall in hospital. Methods Using PDSA methodology, incident reports and documentation of inpatient falls were reviewed retrospectively over three 28-bedded elderly care wards. A post-falls proforma was devised that covered various domains of the post-fall assessment and was distributed to doctors throughout the hospital. Following the intervention, a repeat PDSA cycle was performed prospectively over the same wards and the proportion of assessments fulfilling each domain was compared between the cycles. Results Medical assessment of 27 falls from November 2020 to January 2021 was compared to 31 falls occurring between February and May 2022. Use of the proforma in cycle 2 was limited to 8/31 falls following intervention. Post-intervention, the proportion of assessments fulfilling medication review (19% vs 35%, p=0.14) and anticoagulation status (41% vs 55%, p=0.28) was improved. The proportion fulfilling fall circumstances (89% vs 90%, p=0.85), medical precipitant (70% vs 61%, p=0.46) and ordering of appropriate imaging (93% vs 97%, p=0.47) remained high. Conclusion Standardisation of post-falls assessment and documentation can improve patient safety outcomes through reducing delay in recognition of medical precipitants of falls and identification and management of sustained injuries. Improved integration of a post-falls proforma into electronic systems is needed to maximise its clinical benefit and would be the target of a further PDSA cycle.

PHYSICAL ACTIVITY AND SEDENTARY TIME ASSOCIATIONS WITH NON-FRACTURE FALL INJURY (NFFI) AND FRACTURE

Abstract Understanding fall injury risk factors and circumstances may lead to better prevention. However, many fall injury studies focus on fractures from hospitalizations or emergency events, rather than non-fracture fall injuries (NFFI), which comprise &amp;gt;50% of fall injuries in older adults. We hypothesized that risk factors were differently associated with NFFI vs. fracture fall injuries in a community-based cohort of ambulatory women with fall injuries in the Objective Physical Activity and Cardiovascular Disease Health in Older Women (OPACH) ancillary of the Women’s Health Initiative Long Life Study. Women with daily fall calendars over 1-year follow-up completed telephone interviews regarding fall injury circumstances (Nf662; mean 79.6 + 6.7 years; 73.3% White). Risk factors and fall circumstances were assessed with first reported fall injury (NFFI vs. fracture) using univariate and multivariate logistic regression. Participants with NFFI vs. fracture were more likely to be non-white, less likely to seek clinical treatment or need help up from fall (all p &amp;lt; 0.05). Adjusting for age, race, and BMI, NFFI vs. fracture were more likely to report &amp;gt;=6 hours sitting (OR=1.72, 95% CI=1.07–2.73) and less likely to report weekly moderate exercise (OR=0.61, 95% CI=0.38–0.96), though total accelerometer-measured sedentary time and physical activity (PA) were not significant. Self-reported PA level at the time of fall (OR=1.31, 95% CI=0.82–2.09) and walking outside for &amp;gt;10 minutes &amp;gt;= 1/week (OR=1.24, 95% CI=0.77–1.98) were not different for NFFI vs. fractures. Older women with NFFI vs. fracture had more sedentary time and less moderate exercise, which may have implications for fall injury severity.

CHRONIC PAIN AND CIRCUMSTANCES OF FALLS IN COMMUNITY-LIVING OLDER ADULTS

Abstract Chronic pain is a risk factor contributing to mobility impairment and falls in older adults. Little is known about the patterns of fall circumstances among older adults with pain. This prospective cohort study described frequencies of fall circumstances (i.e., location, activities, and self-reported causes of falls) and examined the relationship between chronic pain and fall circumstances among 765 community-dwelling older adults (mean age=78.1, 63.9% women) in the MOBILIZE Boston Study. Pain severity, fall occurrence, and fall circumstances were recorded using monthly calendar postcards and fall follow-up interviews during a 4-year follow-up. Descriptive analyses summarized frequencies of fall circumstances. Generalized estimating equation (GEE) models examined the relation between monthly pain ratings and circumstances of the first fall in the subsequent month. Among 1,829 falls, 965 (52.8%) falls occurred indoors and 804 (44.0%) falls occurred outdoors, 60 (3.2%) falls with missing location information. Commonly reported activities and causes of falls were walking (915, 50.0%), slips/trips (943, 51.6%), and inappropriate footwear (444, 24.3%). GEE models suggested that compared to fallers without pain, fallers with moderate-to-severe pain had around twice the likelihood of reporting indoor falls (adj.OR=1.93, 95%CI:1.32-2.83), falls in living/dining rooms (adj.OR=2.06, 95%CI:1.27-3.36), and falls due to health problems (adj.OR=2.08, 95%CI:1.16-3.74) or feeling dizzy/faint (adj.OR=2.10, 95%CI:1.08-4.11), but they were less likely to report falls while going down stairs (adj.OR=0.48, 95%CI:0.27-0.87) or falls due to slips/trips (adj.OR=0.67, 95%CI:0.47-0.95) in the subsequent month. Future studies may investigate whether better pain management and tailored fall prevention in elders with chronic pain could lead to fewer falls.

Fall classification, incidence and circumstances in patients undergoing total knee replacement

The objective was to propose a fall-classification framework for patients undergoing total knee replacement (TKR). In addition, we reinforced the available evidence on fall incidence and circumstances and compared the characteristics of fallers versus. nonfallers. Retrospective and prospective data were collected from 253 subjects with severe knee osteoarthritis who were waiting for primary TKR. Falls were classified considering the location of the destabilizing force, source of destabilization and fall precipitating factor. Fall incidence and circumstances were described; the characteristics of fallers and nonfallers in terms of functional and balance performance were compared with F-tests (95% CI). The fall incidence before surgery was 40.3% (95% CI 34.2% to 46.6%). This figure decreased to 13.1% (95% CI 9.2% to 18.0%) and to 23.4% (95% CI 17.8% to 29.6%) at 6 and 12 months after surgery, respectively. Most falls were caused by destabilizations in the base of support (n = 102, 72%) and were due to extrinsic factors (n = 78, 76%) and trip patterns. Significant differences between fallers and nonfallers were found in knee extensor strength and monopodal stability in the surgical limb (p < 0.05). Falls are prevalent in patients with severe knee osteoarthritis. Symptoms and functional performance improve after surgery, and fall incidence is reduced. Most fall events originate from disruptions in the base of support and are precipitated by extrinsic factors, generally trips during walking activities.

Circumstances of Falls During Sit-to-Stand Transfers in Older People: A Cohort Study of Video-Captured Falls in Long-Term Care

ObjectiveTo characterize the circumstances of falls during sit-to-stand transfers in long-term care (LTC), including the frequency, direction, stepping and grasping responses, and injury risk, based on video analysis of real-life falls. DesignCohort study. SettingLTC. ParticipantsWe analyzed video footage of 306 real-life falls by 183 LTC residents that occurred during sit-to-stand transfers, collected from 2007 to 2020. The mean age was 83.7 years (SD=9.0 years), and 93 were female (50.8%). InterventionNot applicable. Main Outcome MeasuresWe used Generalized Estimating Equations to test for differences in the odds that a resident would fall at least once during the rising vs stabilization phases of sit-to-stand and to test the association between the phase of the transfer when the fall occurred (rising vs stabilization) and the following outcomes: (1) the initial fall direction; (2) the occurrence, number, and direction of stepping responses; (3) grasping of environmental supports; and (4) documented injury. ResultsFalls occurred twice as often in the rising phase than in the stabilization phase of the transfer (64.0% and 36.0%, respectively). Falls during rising were more often directed backward, while falls during stabilization were more likely to be sideways (odds ratio [OR]=1.95; 95% confidence interval [CI]=1.07-3.55). Falls during rising were more often accompanied by grasping responses, while falls during stabilization were more likely to elicit stepping responses (grasping: OR=0.30; 95% CI=0.14-0.64; stepping: OR=8.29; 95% CI=4.54-15.11). Injuries were more likely for falls during the stabilization phase than the rising phase of the transfer (OR=1.73; 95% CI=1.04-2.87). ConclusionMost falls during sit-to-stand transfers occurred from imbalance during the rising phase of the transfer. However, falls during the subsequent stabilization phase were more likely to cause injury.

The Prediction of Fall Circumstances Among Patients in Clinical Care - A Retrospective Observational Study.

Standardized fall risk scores have not proven to reliably predict falls in clinical settings. Machine Learning offers the potential to increase the accuracy of such predictions, possibly vastly improving care for patients at high fall risks. We developed a boosting algorithm to predict both recurrent falls and the severity of fall injuries. The model was trained on a dataset including extensive information on fall events of patients who had been admitted to Charité - Universitätsmedizin Berlin between August 2016 and July 2020. The data were recorded according to the German expert standard for fall documentation. Predictive power scores were calculated to define optimal feature sets. With an accuracy of 74% for recurrent falls and 86% for injury severity, boosting demonstrated the best overall predictive performance of all models assessed. Given that our data contain initially rated risk scores, our results demonstrate that well trained ML algorithms possibly provide tools to substantially reduce fall risks in clinical care settings.

Using theoretical frameworks to examine fall history and associated prosthetic mobility in people with nondysvascular lower limb amputation.

Over a million people live with lower limb amputation (LLA) in the United States, and many of them will experience a fall in the next year. The aim of this study was to use existing theoretical frameworks in an attempt to organize the complex interactions of reported fall history and prosthetic mobility in community-ambulating people with LLA. Self-reported fall rate and fall circumstances were recorded in a cross-section of people with unilateral LLA due to nondysvascular causes. Self-report and performance-based standardized outcome measures assessed prosthetic mobility and balance confidence. All variables were considered and appropriately placed within a proposed International Classification of Functioning, Disability, and Health framework while using a fall-type classification framework to classify fall circumstances. Information from 69 participants was analyzed. The reported fall rate was at 46%, with those with transfemoral amputation reporting significantly more falls than those with transtibial amputation ( P = 0.001). Tripping over an object was the most common cause (62.5%), and fallers reported significantly lower perceived prosthetic mobility than nonfallers ( P = 0.001). Despite reporting high levels of balance confidence, results indicate that all groups of fallers and nonfallers are at increased fall risk according to performance-based prosthetic mobility score cutoffs. Community-dwelling people with nondysvascular LLA are at increased fall risk. Classifying fall-related variables using theoretical frameworks provides a means to structure more informative fall risk surveys for people with LLA in an attempt to identify those at greater risk for falling and its potential detrimental effects.

Chronic pain and circumstances of falls in community-living older adults: an exploratory study.

Chronic pain is a risk factor contributing to mobility impairment and falls in older adults. Little is known about the patterns of circumstances of falls among older adults with chronicpain. To examine the relationship between chronic pain and circumstances of falls including location, activities at the time of falls and self-reported causes of falls in older adults. Prospective cohort study. Communities in/around Boston, Massachusetts. The MOBILIZE Boston Study enrolled 765 adults aged ≥70years. Pain severity, fall occurrence and fall circumstances were recorded using monthly calendar postcards and fall follow-up interviews during a 4-year follow-up period. Generalised estimating equation models were performed to examine the relation between monthly pain ratings and circumstances of the first fall in the subsequent month. Compared to fallers without chronic pain, fallers with moderate-to-severe pain had around twice the likelihood of reporting indoor falls (aOR = 1.93, 95%CI: 1.32-2.83), falls in living or dining rooms (aOR = 2.06, 95%CI: 1.27-3.36), and falls due to health problems (aOR = 2.08, 95%CI: 1.16-3.74) or feeling dizzy or faint (aOR = 2.10, 95%CI: 1.08-4.11), but they were less likely to report falls while going down stairs (aOR = 0.48, 95%CI: 0.27-0.87) or falls due to a slip or trip (aOR = 0.67, 95%CI: 0.47-0.95) in the subsequent month. Given the exploratory nature of the study, these findings should be interpreted with caution. Future studies may investigate whether better pain management and tailored fall prevention in older people with chronic pain could lead to fewer falls.

Circumstances and Factors Associated With Falls Among Community-Dwelling Older Adults Diagnosed With Heart Disease Using the International Mobility in Aging Study (IMIAS).

To identify the circumstances of falls and the factors associated with falls among older adults with cardiovascular disease (CVD). Baseline (2012) data from the International Mobility in Aging Study (IMIAS), a cross-sectional study, were used. Falling was measured by the subjective question, "Have you fallen in the last 12 months?" Several subjective questions were asked to obtain information about the circumstances of falls. Potential clinical factors associated with falling were cognitive status, depressive symptoms, physical performance, grip strength, visual acuity, and fear of falling (FOF). These clinical factors were measured respectively with the Leganes Cognitive Test, the Center for Epidemiological Studies Scales Depressive Symptoms, the Short Physical Performance Battery, a Jamar handgrip dynamometer, the Early Treatment Diabetic Retinopathy Study (ETDRS) tumbling E chart placed at 2 m, and the Falls Efficacy Scale-International. A χ 2 test was used to determine whether there were significant differences in fall circumstances among older adults with and without CVD. Two-sample t tests were used to test for any significant differences between older adults with and without CVD. Bonferroni correction was applied to limit type I errors and was corrected to .007. Simple and multiple logistic regressions identified which clinical factors were associated with falling. A total of 429 older adults with CVD (mean age 69.5 ± 2.9) and 431 older adults without CVD (69.2 ± 2.9) participated in the study. Approximately 53% of fallers with CVD had 2 or more falls compared with fallers without CVD (39%). The most common location for falling was at home (43%) for fallers with CVD or in the street (50%) for fallers without CVD. Approximately 9% of fallers with CVD needed to be hospitalized while only 3% of fallers without CVD were admitted to the hospital. Approximately 42% of fallers with CVD had some residual sequelae (eg, being unable to walk around the house or do housework) compared with only 27% of fallers without CVD. Fallers with CVD had significantly ( P value < .007) more depressive symptoms (mean ± SD, 14.7 ± 12.9) and poorer physical performance (8.4 ± 3.0) compared with fallers without CVD (10.1 ± 9.4 and 9.6 ± 2.5, respectively); however FOF was the only significant clinical factor ( P value < .05) associated with falling for older adults with CVD. Incidence of recurrent falls is higher among older adults with CVD than those without CVD. Circumstances of falls among fallers with CVD differ from those identified among fallers without CVD. Fear of falling was the only predictor of fall history among older adults with CVD. The results suggest the merit of considering FOF when designing prevention and intervention programs to reduce falls among older adults with CVD.