Fall Episodes Research Articles

Elderly users of fall-risk-increasing drug perceptions of fall risk and the relation to their drug use – a qualitative study

Objective: The aim of the study was to explore how home-dwelling elderly who use fall-risk-increasing drugs (FRIDs) perceive their fall risk and how they relate this to their drug use.Design, setting and subjects: A qualitative study with 14 home-dwelling elderly FRID users between 65 and 97 years in Central Norway participating in semi-structured individual interviews. The data were analyzed thematically by using systematic text condensation.Results: The main finding was that the informants did not necessarily perceive the use of FRIDs to be a prominent risk factor for falls. Some informants said they did not reflect upon drug use whatsoever and said they fully trusted their physician’s choices. When either experiencing dizziness, fall episodes or by reading the patient information leaflet the informants said to either adjust their drug use or to contact their physician. Some felt rejected due to not getting their point across or their wish to alter the drug was not granted by the physician.Conclusions: Elderly FRID users did not necessarily relate their drug use to fall risk or struggled to present their perceived drug-related problems. Physicians need to regularly inform, monitor and assess the drug treatment when treating elderly with FRIDs.

FALL IN ELDERLY PATIENTS, ASSOCIATED WITH THE USE OF MEDICINES: CLINICAL OBSERVATION

The article presents an analysis of a clinical case of a female patient D., aged of 93 years, hospitalized in the cardiology department of the hospital with multimorbidity and polypragmasy, who had the fall episode due to the prescription of midazolam administered parenterally. The fall was accompanied by the development of trauma - bruising her forehead, followed by suppuration, which demanded surgery in a surgical department. In this clinical case, the fall was a predictor of adverse drug reactions associated with the prescription of the drug preparation.

Frailty Assessment and its Association with Sociodemographic and Health Characteristics in Community Elderly

Background: Frailty assessment in the elderly and its relationship to sociodemographic and health characteristics.
 Method: Quantitative study, descriptive and cross-sectional study, conducted between April to July 2014, at two Family Health Units in Natal, Rio Grande do Norte. The sample consisted of 203 elderly. The data collection procedure occurred through a structured interview, which used two instruments.
 Results: The average age of the participants was 68.59 years; among them, 83 (40.89%) did not show weakness, 45 (22.17%) were apparently vulnerable and 75 (36.94%) were frail. The weakness associated with low education, widowhood, heart disease, diabetes mellitus, osteoporosis, respiratory disease, urinary tract infection, depression, six classes of drugs (antidiabetic, antidepressant, anxiolytic, and antacid against osteoporosis) and fall episode.
 Conclusions: We conclude that assessment of frailty is important to detect the risk and/or embrittlement process already installed in the elderly.

Plant communities and reproductive phenology in mountainous regions of northern Libya

Within the semi-desert landscape of northern Libya, two sub-humid escarpments occur: Al-Akhdar in the east and Nafusa (Jabal Al-Gharbi) in the west. This study compares plant communities in the two regions, which are along an elevation gradient, in terms of species composition and diversity, frequency of different Raunkiaer life forms, and reproductive phenology. The two regions differed in species composition and life-form frequency between regions and between elevation zones within each region. Patterns were associated with the lower rainfall and lower moisture-holding capacity of soils at Nafusa, resulting in more xeric conditions. Only 13% of species were shared between the two regional landscapes. Species diversity, life-form frequency, and duration of the flowering–fruiting phenophase were all affected by elevation above sea level. The duration of flowering and fruiting in spring and fall was associated with environmental conditions, although there were different thresholds in the two regions. There was both a spring and fall episode of flowering at Nafusa, but only spring flowering at Al-Akhdar. It is anticipated that there will be a gradual shift of plant communities to higher elevations and loss of certain sensitive species in response to ongoing climate change.

Development of an algorithm to identify fall-related injuries and costs in Medicare data.

BackgroundIdentifying fall-related injuries and costs using healthcare claims data is cost-effective and easier to implement than using medical records or patient self-report to track falls. We developed a comprehensive four-step algorithm for identifying episodes of care for fall-related injuries and associated costs, using fee-for-service Medicare and Medicare Advantage health plan claims data for 2,011 patients from 5 medical groups between 2005 and 2009.MethodsFirst, as a preparatory step, we identified care received in acute inpatient and skilled nursing facility settings, in addition to emergency department visits. Second, based on diagnosis and procedure codes, we identified all fall-related claim records. Third, with these records, we identified six types of encounters for fall-related injuries, with different levels of injury and care. In the final step, we used these encounters to identify episodes of care for fall-related injuries.ResultsTo illustrate the algorithm, we present a representative example of a fall episode and examine descriptive statistics of injuries and costs for such episodes. Altogether, we found that the results support the use of our algorithm for identifying episodes of care for fall-related injuries. When we decomposed an episode, we found that the details present a realistic and coherent story of fall-related injuries and healthcare services. Variation of episode characteristics across medical groups supported the use of a complex algorithm approach, and descriptive statistics on the proportion, duration, and cost of episodes by healthcare services and injuries verified that our results are consistent with other studies.ConclusionsThis algorithm can be used to identify and analyze various types of fall-related outcomes including episodes of care, injuries, and associated costs. Furthermore, the algorithm can be applied and adopted in other fall-related studies with relative ease.Electronic supplementary materialThe online version of this article (doi:10.1186/s40621-015-0066-z) contains supplementary material, which is available to authorized users.

Fear of falling and associated factors in community elderly with cataracts

Objective: To investigate prevalence of the fear of falling of elderly with cataracts living in the community and the associated factors with high concern with falling occurrences. Methods: A cross-sectional, analytical and observational study. It was composed by 86 elderly diagnosed with bilateral cataracts. To quantify the fear of falling among elderly, the scale Falls Efficacy Scale-International-Brasil (FES-I-BRASIL) was used. Other variables were obtained through application of a structured questionnaire. Results: Between participants, 41.9% reported low concern of falling, while 58.1% reported high concern. From those last ones, 52% fell at least once on the past 12 months and, 30% of them are recurrent fallers. The activities walk in slippery surfaces, walk in irregular surfaces and, walk up and down the stairs represented higher concern for elderly. Conclusion: Cataracts or any other visual issue predispose falls due to difficulty in overcoming obstacles present in the environment. Fear of falling is especially associated with factors acquired after the first fall episode.

Prevalence and factors associated with the risk of falls among the elderly registered in a primary healthcare unit of the city of Natal in the state of Rio Grande do Norte, Brazil

The scope of the study was to analyze the prevalence and factors associated with falls among the elderly registered in a Primary Healthcare Unit (PHU) in Natal, State of Rio Grande do Norte. It involved a cross-sectional study conducted with 280 elderly individuals with data collected at the primary healthcare unit. The association between falls, recurrent falls and independent variables was assessed using bivariate analysis and Poisson regression with calculation of their respective prevalence ratios. It involved predominantly elderly females (68.2%) with mean age of 71.6 years (± 6.7), literate (54.6%), non-retired (73.5%) and sedentary (87.1%). 53.6% of the elderly recorded falls and 27.8% fell twice or more. The predictive model of falls included the female gender (PR= 1.81), osteoarticular diseases (PR = 1.71) and balance impairment (PR = 0.88), while functional mobility (PR = 0.94), fear of falling (PR = 1.21) and balance deficit disorders (PR = 0.80) constituted the definitive model of recurrent falls. A higher prevalence of single fall episodes was found and the associated factors included sociodemographic, health and physical performance variables. On the other hand, the occurrence of two or more falls were only associated with physical performance variables.

Impact of Aspiration Pneumonia on the Clinical Course of Progressive Supranuclear Palsy: A Retrospective Cohort Study.

IntroductionAlthough aspiration pneumonia is the most common complication of progressive supranuclear palsy (PSP), the clinical impact of aspiration pneumonia on disease course and survival has not been fully estimated. Thus, we retrospectively analyzed the prognostic factors and clinical consequences of pneumonia in PSP.MethodsThe clinical course of patients with aspiration pneumonia was surveyed. The association between baseline clinical features (2 years from disease onset) and latency to the initial development of pneumonia was investigated using survival time and Cox regression analyses.ResultsNinety patients with a clinical diagnosis of PSP were observed for 5.1±3.8 years (mean±SD), and 22 had aspiration pneumonia. Subsequently, 20 patients (91%) had to discontinue oral feeding entirely and 13 (59%) died, whereas, of 68 patients without pneumonia, only three patients (4%) died. Time to initial development of pneumonia was strongly correlated with survival time (Spearman R = 0.92, P<0.001), with a mean latency of 2.3 years to death. Among baseline clinical features, early fall episodes and cognitive decline were significant predictors of pneumonia (P = 0.001 and P<0.001, respectively, log rank test). Cox regression analysis demonstrated that early fall episodes (adjusted hazard ratio: 3.9, 95% confidence interval: 1.2–12.5, P = 0.03) and cognitive decline (adjusted hazard ratio: 5.2, 95% confidence interval: 1.4–19.3, P = 0.02) independently predicted pneumonia. By contrast, dysphagia was not associated with pneumonia (P = 0.2, log rank test).ConclusionInitial development of pneumonia indicates an unfavorable clinical course and predicts survival time (mean survival time 2.3 years). Patients with early falls and cognitive decline were at high risk of early development of pneumonia.

Epidemiology of falls among older adults: A cross sectional study from Chandigarh, India

BackgroundFall is an important cause of injury morbidity in older adults. However, epidemiological information on fall is limited in low- and middle-income countries. We investigated the extent, pattern, characteristics, and context of falls in Chandigarh. MethodsA cross sectional survey was carried out among 300 persons (≥60 years), sampled from urban, rural and slums areas of Chandigarh, India from March 2011 to October 2012 using multistage cluster sampling. A pre-tested interview schedule was used and relevant medical examinations were conducted. Multivariable logistic regression was carried out to estimate Odds Ratio (OR) and 95% confidence interval (CI). ResultsIn the past one year, 31% (92/300) respondents reported one or more falls. On an average 0.67 fall episodes occurred/person/year (202/300). Most (68%; 63/92) falls occurred at home; 75% (47/63) occurred while carrying out activities such as toileting, bathing, sleeping and eating etc. Injuries due to falls were reported by 67% (62/92). In these cases, lower extremities, 37% (23/62) were the most common site of injury. Eight percent (5/62) reported fractures. A general physician was consulted by 44% (27/62), and 11% (7/62) utilized emergency services whilst another 11% (7/62) of fall injuries required hospital admission. Risk of fall was higher among females (OR 1.6, 95%CI 1.0–2.8, p 0.068), those taking four or more medicines (OR 2.1, 95%CI 1.2–3.5, p 0.009) and having poor body balance (OR 1.9, 95%CI 1.0–3.4, p 0.037). ConclusionFall injuries were common in older adults of Chandigarh. Large cohort studies are needed to identify risk factors particularly those related to home environment.

Characterization of carbonaceous aerosols over the East China Sea: The impact of the East Asian continental outflow

Seventy-five paired PM2.5 (aerodynamic diameter less than 2.5 μm) and TSP (total suspended particle) samples collected from a pristine island in the East China Sea (ECS) between October 2011 and August 2012 were analyzed for organic carbon (OC), elemental carbon (EC), and n-alkanes. The island lies in the pathway of continental outflow from Mainland China to the northwest Pacific Ocean driven by the East Asian Monsoon. The concentrations of OC, EC (in μg/m3), and n-alkanes (in ng/m3) were highest in winter (means: 4.7, 1.3, 140.1, respectively) and lowest in summer (means: 1.1, 0.3, 17.0, respectively). PM2.5 contained approximately 88% of the OC, 80% of the EC, and 61% of the n-alkanes in TSP. Petroleum residue was the dominant contributor to the n-alkanes. C12–C22n-alkanes with strong even-to-odd predominance observed in winter were attributed to the microbial contribution from sea spray aerosol (SSA) driven by the higher wind speed. There was a higher secondary organic carbon (SOC)/OC ratio in warm seasons (summer and fall) than that in cold seasons (spring and winter). The dominance of primary organic carbon (POC) and EC in cold seasons was possibly mainly due to the influence of the East Asian continental outflow. Three episodes of high concentrations of carbonaceous aerosols were observed, and we focused on the impact of these pollutants from East Asia on the air quality over the ECS. Carbonaceous pollutants were more concentrated in PM2.5 during the fall episode triggered by biomass burning in East China. The winter haze associated with intensive indoor heating in North China brought substantial carbonaceous pollutants, with a minor influence on their size distribution. The dust episode in spring was related to coarse particles (i.e., TSP–PM2.5), yielding a distinctly different size distribution.

Validation of Fall Risk Assessment Scales among Hospitalized Patients in South Korea using Retrospective Data Analysis

Purpose: The purpose of the study was to validate fall risk assessment scales among hospitalized adult patients in South Korea using the electronic medical records by comparing sensitivity, specificity, positive predictive values, and negative predictive values of Morse Fall Scale (MFS), Bobath Memorial Hospital Fall Risk Assessment Scale (BMFRAS), and Johns Hopkins Hospital Fall Risk Assessment tool (JHFRAT). Methods: A total of 120 patients who experienced fall episodes during their hospitalization from June 2010 to December 2013 was categorized into the fall group. Another 120 patients, who didn't experience fall episodes with age, sex, clinical departments, and the type of wards matched with the fall group, were categorized to the comparison group. Data were analyzed for the comparisons of sensitivity, specificity, positive and negative predictive values, and the area under the curve of the three tools. Results: MFS at a cut-off score of 48 had .806 for ROC curves, 76.7% for sensitivity, 77.5% for specificity, 77.3% for positive predictive value, and 76.9% for negative predictive value, which were the highest values among the three fall assessment scales. Conclusion: The MFS with the highest score and the highest discrimination was evaluated to be suitable and reasonable for predicting falls of inpatients in med-surg units of university hospitals.

O4.02: Functioning in elderly women with or without fall episodes

O4.02: Functioning in elderly women with or without fall episodes

Analyzing center of pressure progression during bed exits.

This paper presents a new approach for analyzing center of pressure (COP) progression using pressure data collected from a pressure-sensitive array placed under the bed mattress. Pressure data were collected from a young female participant who was healthy and an older 78 year old female participant who had a history of falls. Information relevant to movement direction, time, path trajectory, magnitude and frequency was presented in three dimensional plots and color differentiated displays. When tested on data collected from an older participant who experienced a fall, this method of analyzing COP was able to illustrate distinct differences in bed exit patterns used pre and post fall episode. This analysis approach shows the potential to detect changes in bed exit patterns indicative of a critical health event. Future applications include home monitoring to assist with early intervention in the event of bed mobility decline.

Frequency and factors associated with falls in patients with advanced cancer presenting to an outpatient supportive care clinic

The aim of this study was to determine the frequency and factors associated with fall episodes in advanced cancer patients. We analyzed data that included demographic characteristics, utilization of assistive devices, cancer diagnosis, metastatic site, performance status, medications including hypnotics and opioids, Edmonton Symptom Assessment Scale (ESAS) score, and Memorial Delirium Assessment Scale (MDAS) score in 384 consecutive patients who were newly referred to the Supportive Care Clinic at the MD Anderson Cancer Center from January 1 to December 31, 2009. All patients completed standardized forms to report falls within the last month. Multivariate backward regression analyses were employed to identify factors predictive of falls in advanced cancer. The mean age of patients was 58 years, and 192 (50%) were male. Mean (SD)/median score for pain was 5 (2.8), 5; fatigue 5.6 (2.6), 6; sleep disturbance 5(2.7), 5; drowsiness 3.7(3), 3; and anorexia 5(3), 5. Some 31 patients (8%) reported fall episodes within the past month, 17 (55%) of whom reported the use of assistive devices. Using assist devices (OR = 5.5, 95% CI: 2.6-11.9, p < 0.0001) and taking zolpidem (OR = 3.39, 95% CI: 1.39-7.7, p = 0.008) were associated with an enhanced chance of falling. Higher MDAS score (4.00 vs. 1.42, p = 0.001) and MDAS positive screening for delirium (21 vs. 3.6%, p < 0.001) were also associated with falls. However, severity on the ESAS at the initial consult was not associated with falls. We conclude that 31 of 384 patients (8%) with advanced cancer receiving outpatient supportive care reported falls in the previous month. Patients with assistive devices, taking zolpidem, and with a higher MDAS score, and a positive delirium screening reported more frequent falls. Further studies are warranted.

Neglected Fracture-Dislocation of the Cervical Spine without Neurological Deficits

Dear Sir, Neglected spinal injuries, either secondary to overlooked diagnosis [1] or due to circumstantial and socio-economic factors [2], are not uncommon but discussed infrequently in the literature [1,2]. A 72-year-old male had history of a slip and fall episode three years ago in a construction field. At that time, he had weakness of all four limbs with bowel and bladder involvement. He was managed conservatively because of financial instruments. He recovered completely over a period of six months. Now, he presented with mild persistent neck pain. On examination, except mild spasticity, there were no motor or sensory deficits. Initial magnetic resonance imaging of the cervical spine showed dislocation of C5 over C6, and the spinal cord was stretched over the dislocated vertebral bodies (Fig. 1). There was no evidence of cord edema or cord contusions. He had one follow up X-ray of the cervical spine at one year after the injury, and it showed a fusion of the C5 and C6 vertebral bodies (Fig. 2A). Recent X-ray of the cervical spine showed increased and complete ossification of the C5 and C6 vertebral bodies (Fig. 2B). In view of the solid fusion and no neurological deficits, the patient continued with conservative management with analgesics. Fig. 1 Initial magnetic resonance imaging of cervical spine showing dislocation of C5 over C6 and the spinal cord was stretched over the dislocated vertebral bodies. Fig. 2 (A) One follow-up X-ray of the cervical spine at one year after the injury showed fusion of C5 and C6 vertebral bodies, and (B) Recent X-ray of the cervical spine showed increased and complete ossification of the C5 and C6 vertebral bodies. Patients with neglected spinal injuries can present with neck pain, restricted neck movements, or clinical features of progressive myelopathy [2-4]. Treatment of neglected spinal injuries needs to be individualized, depending on patient's age, medical condition, severity of myelopathy, and stability spine [5-8]. Aggressive surgical treatment is reserved for younger patients with progressive myelopathy, secondary to dynamic instability [9]. Conservative approach has been suggested for elderly patients with stable, non-progressive deformity [5-8]. In the present case, the reactive new bone formation around the fractured segments might have helped in preventing abnormal movements and development of myelopathy. Neglected spinal injuries are defined as injuries not treated in a timely fashion and found late when options for care are limited [1]. Also, neglected spinal injuries may result when the comprehensive management is not initiated in a timely fashion [2]. These lesions have a much higher incidence of complications, which are more severe and difficult to manage, requiring longer hospitalization, adding to the costs and adversely affecting the functional outcomes [1,2]. In summary, for neglected spinal injuries, either untreated or inadequately treated with progressive deformity, persistent pain and late presentation are more often seen in the developing countries [1]. In rare circumstances (as in present case), neglected complete fracture-dislocations patients can make excellent recovery without neurological deficits [10].

An interdisciplinary momentary confluence of events model to explain, minimize, and prevent pediatric patient falls and fall‐related injuries

This article reviews theoretical, empirical, and clinical evidence to support the hypothesis that pediatric patient fall episodes are rarely predictable; rather, falls and fall-related injuries occur during the momentary convergence of child, parent, and caregiver human factors, and environmental, biomechanical, and system factors. We propose an interdisciplinary pediatric fall and injury prevention model to guide future research toward interventions to prevent or minimize pediatric patient falls and injuries. When falls and near miss falls occur, nurses' detailed descriptions of each model component are critical to discovery of more effective pediatric fall and injury prevention methods.

지역사회거주 여성노인에게 적용한 타이치 낙상예방 프로그램의 효과

Purpose: The study aimed to examine the effects of Tai Chi fall prevention program on risk factors for fall, fear of falling, and quality of life among elderly women living in the community. Methods: A quasi-experimental pretest-posttest design with non-equivalent control group was used. Sixty participants were recruited from 4 senior citizen centers in a city. The 1-hour Tai Chi fall prevention program was provided three times a week for 6 months to the experimental group. Risk factors for fall including fracture risk and bone mineral density, fear of falling, and quality of life were measured at the baseline and at 6 months. Results: Participants were 75 years old in average. At the completion of 6 month program, the experimental group showed lower fracture risks, less fear of falling, and higher scores in several domains of quality of life than the control group, after controlling for the pretest scores, fall experience, and regular exercise habit. Conclusion: The Tai Chi fall prevention program was safely applied to elderly women with improvement in fracture risk, fear of falling, and several domains of quality of life. Future study is necessary to confirm the longer effect of the Tai Chi program for the prevention of fall episodes.

Predictors of a Fall Event in Hospitalized Patients With Cancer

To determine predictors of fall events in hospitalized patients with cancer and develop a scoring system to predict fall events. Retrospective medical record review. A 1,200-bed tertiary care hospital in northeastern Ohio. 145 patients with cancer who did not have a fall event were randomly selected from all oncology admissions from February 2006-January 2007 and compared to 143 hospitalized patients with cancer who had a fall event during the same period. Multivariable logistic regression models predicting falls were fit. Risk score analysis was completed using bootstrap samples to evaluate discrimination between patients who did or did not fall and agreement between predicted and actual fall status. A nomogram of risk scores was created. Fall episodes during hospitalization and patient characteristics that predict falls. While patients were hospitalized for cancer care, their predictors of a fall episode were low pain level, abnormal gait, cancer type, presence of metastasis, antidepressant and antipsychotic medication use, and blood product use (all p < 0.02); risk model c-statistic was 0.89. For hospitalized patients with cancer, predictors reflecting greater fall episode risk can be assessed easily by nursing staff and acted on when the risk is sufficiently high. Understanding specific risk factors of falls in an adult oncology population may lead to interventions that reduce fall risk.

Contribution of arterial Windkessel in low-frequency cerebral hemodynamics during transient changes in blood pressure

The Windkessel properties of the vasculature are known to play a significant role in buffering arterial pulsations, but their potential importance in dampening low-frequency fluctuations in cerebral blood flow has not been clearly examined. In this study, we quantitatively assessed the contribution of arterial Windkessel (peripheral compliance and resistance) in the dynamic cerebral blood flow response to relatively large and acute changes in blood pressure. Middle cerebral artery flow velocity (MCA(V); transcranial Doppler) and arterial blood pressure were recorded from 14 healthy subjects. Low-pass-filtered pressure-flow responses (<0.15 Hz) during transient hypertension (intravenous phenylephrine) and hypotension (intravenous sodium nitroprusside) were fitted to a two-element Windkessel model. The Windkessel model was found to provide a superior goodness of fit to the MCA(V) responses during both hypertension and hypotension (R² = 0.89 ± 0.03 and 0.85 ± 0.05, respectively), with a significant improvement in adjusted coefficients of determination (P < 0.005) compared with the single-resistance model (R² = 0.62 ± 0.06 and 0.61 ± 0.08, respectively). No differences were found between the two interventions in the Windkessel capacitive and resistive gains, suggesting similar vascular properties during pressure rise and fall episodes. The results highlight that low-frequency cerebral hemodynamic responses to transient hypertension and hypotension may include a significant contribution from the mechanical properties of vasculature and, thus, cannot solely be attributed to the active control of vascular tone by cerebral autoregulation. The arterial Windkessel should be regarded as an important element of dynamic cerebral blood flow modulation during large and acute blood pressure perturbation.

Learning on accidents and non-fatal injuries from health-seeking behaviour: a visual account in Nuevo Leon, Mexico

This presentation aims to document the type of accidents and non-fatal injuries for which patients seek help in the informal health network using a visual approach It is based on...