Fall Prevention In Older Adults Research Articles

Development of STEADI: a fall prevention resource for health care providers.

Falls among people aged ≥65 years are the leading cause of both injury deaths and emergency department visits for trauma. Research shows that many falls are preventable. In the clinical setting, an effective fall intervention involves assessing and addressing an individual's fall risk factors. This individualized approach is recommended in the American and British Geriatrics Societies' (AGS/BGS) practice guideline. This article describes the development of STEADI (Stopping Elderly Accidents, Deaths, and Injuries), a fall prevention tool kit that contains an array of health care provider resources for assessing and addressing fall risk in clinical settings. As researchers at the Centers for Disease Control and Prevention's Injury Center, we reviewed relevant literature and conducted in-depth interviews with health care providers to determine current knowledge and practices related to older adult fall prevention. We developed draft resources based on the AGS/BGS guideline, incorporated provider input, and addressed identified knowledge and practice gaps. Draft resources were reviewed by six focus groups of health care providers and revised. The completed STEADI tool kit, Preventing Falls in Older Patients-A Provider Tool Kit, is designed to help health care providers incorporate fall risk assessment and individualized fall interventions into routine clinical practice and to link clinical care with community-based fall prevention programs.

Serum 25-hydroxyvitamin D and muscle atrophy in the elderly

The objective of this review is to consider the mechanisms by which vitamin D affects muscle and the evidence that vitamin D status is important for muscle performance and fall prevention in older adults. Vitamin D receptors have been identified in human skeletal-muscle cells. Activation of these receptors by 1,25-dihydroxyvitamin D is involved in the action of vitamin D on the myocyte. Several studies have examined the effect of supplemental vitamin D on muscle strength, balance and falls. Among those examining muscle strength, results have been either positive for vitamin D or null. A recent meta-analysis of seventeen such trials revealed no significant effect of vitamin D overall, but a significant improvement in strength was observed in the trials in which the mean starting level of 25-hydroxyvitamin D was 25 nmol/l or below. Evidence for an effect of vitamin D on balance, measured as sway, is less abundant but more consistently positive. Many trials have evaluated the effect of supplemental vitamin D on falls. Overall, there is about a 20% lower risk of falling with supplementation. One meta-analysis considered the vitamin D dose administered and concluded that doses up through 15 μg (600 IU) were ineffective and doses of 17·5-25 μg/d (700-1000 IU/d) significantly lowered fall risk. The minimal 25-hydroxyvitamin D level needed for benefit was 60 nmol/l.

Closing the Gap: A Research Agenda to Accelerate the Adoption and Effective Use of Proven Older Adult Fall Prevention Strategies

Introduction To make an impact on the public's health, evidence-based interventions must be disseminated broadly, supported by training and technical assistance, adopted widely, and implemented as designed. Many effective older adult fall prevention interventions have been identified, but too few have gained wide community acceptance and little is known about the best ways to encourage their broader use. Therefore, as in many other fields, fall prevention suffers from a wide gap between scientific discoveries and their everyday use. Method This article articulates the key activities embedded in Step 4 of the public health model—specifically translation and dissemination to ensure widespread adoption and use—in order to illuminate critical research needs in older adult fall prevention. Conclusions These needs, if addressed, will help close the gap between research and practice.

Early Improvements in Wii Fit Balance Game Scores by Older Adults

The Nintendo Wii Fit gaming system has become increasingly popular for use in balance training and fall prevention in older adults. However, it is unclear how games designed primarily for younger adults transfer to this population. PURPOSE: The goal of this investigation was to examine immediate performance improvement on four games requiring different levels of physical and cognitive challenge. METHODS: Fifteen healthy older adults (8 women: age = 73.1 ± 3.7 yrs, BMI = 28.8 ± 8.1 kg/m2; 7 men: age = 79.1 ± 5.2 yrs, BMI = 25.3 ± 2.1 kg/m2 [mean ± SD]) with neither balance disorders nor video game familiarity visited the laboratory on four separate occasions. Subjects were guided through creating a Wii Fit character and learned how to use the system on the first visit, playing Penguin Slide and Table Tilt briefly. During the remaining three visits subjects played Balance Bubble (BB), Soccer Heading (SH), Obstacle Course (OC), and Tilt City (OC) in randomized 10 min. blocks separated by a rest period. The games required the ankle strategy, hip strategy, foot movement, and dual task performance (upper and lower extremities), respectively. The maximum score obtained within each block was used for analyses. RESULTS: The men were slightly older than the women (p = 0.02). When playing BB, women consistently scored 24% higher than men (p = 0.02), but neither sex improved across visits (p = 0.56). Men did not improve their scores in SH (p = 0.14), though women improved their scores by 78% to match those of the men at the last visit (p < 0.01). There were 83% and 53% increases across visits for both sexes when playing OC (p < 0.01) and TC (p = 0.02), respectively. CONCLUSIONS: Although any major conclusions from this pilot study are limited, there are some cautious conclusions that may be drawn. First, men and women differed in their performance profiles and also in their pattern of improvement across sessions which may partially be explained by age. Second, some improvements occurred across the three sessions that may be relevant for improved balance and postural stability. Third, it appears that not all Wii Fit balance games are suitable for immediate score improvement by older adults. Without early score success, some may become discouraged and discontinue playing, even if long-term use improves balance. Funded by CSU Center on Aging.

Understanding fall meaning and context in marketing balance classes to older adults.

This study explored older, community-dwelling adults' attitudes and values about proposed church-delivered balance classes for fall prevention. Community observation, group interviews with stakeholders, key informant interviews, and focus groups with church members ≥ 60 years of age were analyzed in two ways: first for inductive themes expressing community sentiment about fall prevention for older adults, then for content useful in creating locally tailored social marketing messages. Four themes expressed perceptions of fall-prevention programming: de-emphasizing fall risk and emphasizing strength and independence, moving older adults out of their "comfort zones" to join classes, identifying relationships to support fall-prevention activities, and considering gender-based differences in approaches to fall prevention. A content analysis of the same dataset yielded information about preferred places in the community, promotion through churches, a tolerable price, and the balance class product itself. The qualitative results will inform the social marketing program to increase intervention delivery success.

Dietary protein intake and subsequent falls in older men and women: the Framingham Study.

Poor nutritional status is often present among older adults who experience a fall. However, dietary intake and weight loss are often overlooked as potential factors. The objective of this study was to test the association between dietary protein intake and risk of subsequent falls in a population-based cohort of elderly men and women. Dietary intake and clinic data from 807 men and women (ages 67-93 years) from the Framingham Original Cohort Study were analyzed. Protein intake (total, animal and plant) was assessed as a continuous variable and by tertile of intake. Falls were reported by participants using a validated questionnaire at two time points. Weight was ascertained at each examination to examine the effect of weight loss over follow-up. Higher dietary protein intakes were associated with a reduced odds of falling, although of borderline statistical significance (OR=0.80, 95% CI: 0.60-1.07) and were not associated with the rate of falls over follow-up (RR=0.93, 95%CI: 0.73-1.19). Tertile analyses tended towards a protective association, but most did not achieve statistical significance; there was no dose-response. For those who lost ≥ 5% of their baseline weight, higher intakes of total, animal and plant protein showed a significantly lower rate of subsequent falls. This work highlights the importance of adequate protein intake as a potentially modifiable risk factor for fall prevention in older adults. Further exploration of the interaction of protein intake and weight loss as related to falls is needed.

The utilization of geographic information systems to create a site selection strategy to disseminate an older adult fall prevention program

Public health programmatic interventions are increasingly required to address the prevention needs of aging populations. Falls in adults age 65 and older are the leading cause of injury hospitalization in the U.S., and a leading cause of international fatal injuries in older adults. This project used geographic information systems (GIS) to create a site selection strategy for the dissemination and pilot evaluation of a community-based fall prevention program for older adults in Pierce County, Washington. Potential site addresses ( n = 84), 2000 U.S. census data for adults ≥65 years of age, and local road networks, which were converted into service areas using actual travel time, were entered in a GIS. Potential sites were then ranked by census densities of older adults who lived within 10 min travel time. Nine sites launched the program, with the goal recruiting 20 older adult program participants at each site ( n = 180). At the end of 12 months, participation exceeded program goals ( n = 331). GIS can be used to determine actual travel time, and may facilitate the selection of community-based prevention program sites to maximize accessibility and utilization by targeted populations.

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.

Vitamin D Treatment for the Prevention of Falls in Older Adults: Systematic Review and Meta‐Analysis

To systematically review and quantitatively synthesize the effect of vitamin D therapy on fall prevention in older adults. Systematic review and meta-analysis. MEDLINE, CINAHL, Web of Science, EMBASE, Cochrane Library, LILACS, bibliographies of selected articles, and previous systematic reviews through February 2009 were searched for eligible studies. Older adults (aged > or = 60) who participated in randomized controlled trials that both investigated the effectiveness of vitamin D therapy in the prevention of falls and used an explicit fall definition. Two authors independently extracted data, including study characteristics, quality assessment, and outcomes. The I(2) statistic was used to assess heterogeneity in a random-effects model. Of 1,679 potentially relevant articles, 10 met inclusion criteria. In pooled analysis, vitamin D therapy (200-1,000 IU) resulted in 14% (relative risk (RR)=0.86, 95% confidence interval (CI)=0.79-0.93; I(2)=7%) fewer falls than calcium or placebo (number needed to treat =15). The following subgroups had significantly fewer falls: community-dwelling (aged <80), adjunctive calcium supplementation, no history of fractures or falls, duration longer than 6 months, cholecalciferol, and dose of 800 IU or greater. Meta-regression demonstrated no linear association between vitamin D dose or duration and treatment effect. Post hoc analysis including seven additional studies (17 total) without explicit fall definitions yielded smaller benefit (RR=0.92, 95% CI=0.87-0.98) and more heterogeneity (I(2)=36%) but found significant intergroup differences favoring adjunctive calcium over none (P=.001). Vitamin D treatment effectively reduces the risk of falls in older adults. Future studies should investigate whether particular populations or treatment regimens may have greater benefit.

Older Adult Fall Prevention: Perceptions, Beliefs, and Behaviors

Falls in adults aged 65 years and older are an important health issue associated with excess mortality, functional limitations, loss of independence, and reduced quality of life. Physicians can reduce the likelihood of falls in their older patients by incorporating prevention strategies into their clinical practice. Research has identified effective interventions, notably clinical assessment and risk factor reduction and exercise programs with balance training, that require older adults to adopt new behaviors. However, some older adults believe falls are an inevitable consequence of aging, while others do not see themselves as personally vulnerable. Factors that facilitate adopting fall interventions include social support, low-intensity exercise, and the perception that the programs are relevant. Barriers include fatalism, denial of risk, poor self-efficacy, and no previous history of exercise. To encourage their patients’ participation, physicians need to present fall interventions as lifestyle enhancing and as a way to remain independent. Messages should focus on positive health and social benefits such as improving balance and maintaining independence, rather than emphasizing negative information about falls and fall injuries. Along with the support of family and friends, a personal invitation from a health care provider will encourage older adults to take part in fall prevention programs.

Including Fall Prevention for Older Adults in Your Trauma Injury Prevention Program—Introducing Farewell to Falls

With data showing that more than 50% of visits to our trauma center for older adults 65 years and older are due to falls, injury prevention programs in trauma centers should be paying more attention to the area of fall prevention for older adults. Farewell to Falls, a free, home-based program of Stanford Hospital and Clinic's trauma service, utilizes a multifaceted approach to help reduce falls. In addition to improving the lives of seniors, the program fulfills a community benefit goal and provides strong hospital marketing opportunities. This program is a benefit to hospitals and the older adults they serve.

Fall Prevention for Older Adults

Fall Prevention for Older Adults

Fall prevention in older adults: towards an integrated population-based perspective

Two articles in the 19 January 2008 BMJ 12 highlight tension between the clinical and public health approaches to fracture prevention among older adults. Jarvinen et al 1 review drug...

CDC's research portfolio in older adult fall prevention: A review of progress, 1985-2005, and future research directions

Problem Falls are a leading cause of mortality and morbidity among adults age 65 and older. Population models predict steep increases in the 65 and older population bands in the next 10–15 years and in turn, public health is bracing for increased fall rates and the strain they place on health care systems and society. To assess progress in fall prevention, the Centers for Disease Control and Prevention conducted a research portfolio review to examine the quality, relevance, outcomes and successes of the CDC fall prevention program and its impact on public health. Methods A peer review panel was charged with reviewing 20 years of funded research and conducting a SWOT (strengths, weaknesses, opportunities, and threats) analysis for extramural and intramural research activities. Information was collected from grantees (via a survey instrument), staff were interviewed, and progress reports and products were reviewed and analyzed. Results CDC has invested over $24,900,000 in fall-related research and programs over 20 years. The portfolio has had positive impacts on research, policies and programs, increasing the public health injury prevention workforce, and delivering effective fall prevention programs. Discussion Public health agencies, practitioners, and policy makers recognize that while there are some evidence-based older adult fall prevention interventions available, many remain unused or are infeasible to implement. Specific recommendations across the public health model, include: additional research in gathering robust epidemiologic data on trends and patterns of fall-related injuries at all levels; researching risk factors by setting or sub-population; developing and testing innovative interventions; and engaging in translation and dissemination research on best practices to increase uptake and adoption of fall prevention strategies. CDC has responded to a number of suggestions from the portfolio review including: funding translation research of a proven Tai Chi fall intervention; beginning to address gaps in gender, ethnic, and racial differences in falls; and collaborating with partner organizations who share in CDC's mission to improve public health by preventing falls and reducing fall-related injuries. Impact on Industry Industry has an opportunity to develop more accessible and usable devices to reduce injury from falls (for example, hip protectors and force reducing flooring). By implementing effective, evidence-based interventions to prevent falls and reduce injuries from falls, significant decreases in health care costs can be expected.

Evidence-Based Protocol

Fall Prevention for Older Adults

Exercise for Fall Prevention in Older Adults

Exercise for Fall Prevention in Older Adults

Effects of Sun‐style Tai Chi exercise on physical fitness and fall prevention in fall‐prone older adults

This paper reports a study to determine changes in the physical fitness (knee and ankle muscle strength, balance, flexibility, and mobility), fall avoidance efficacy, and fall episodes of institutionalized older adults after participating in a 12-week Sun-style Tai Chi exercise programme. Fall prevention has a high priority in health promotion for older people because a fall is associated with serious morbidity in this population. Regular exercise is effective in fall prevention for older adults because of improvements in strength and balance. Tai Chi exercise is considered to offer great potential for health promotion and rehabilitation, particularly in the maintenance of good mental and physical condition in older people. A quasi-experimental design with a non-equivalent control group was used. Data were collected from September 2001 to January 2002. A total of 68 fall-prone older adults with a mean age of 77.8 years participated in the study, and 29 people in the Tai Chi group and 30 controls completed the post-test measures. The Tai Chi exercise programme was provided three times a week for 12 weeks in the experimental group. Data were analysed for group differences using t-tests. At post-test, the experimental group showed significantly improved muscle strength in knee and ankle flexors (P < 0.001) and extensors (P < 0.01), and improved flexibility (P < 0.01) and mobility (P < 0.001) compared with the control group. There was no significant group difference in fall episodes, but the relative risk ratio for the Tai Chi exercise group compared with the control group was 0.62. The experimental group reported significantly more confidence in fall avoidance than did the control group. The findings reveal that Tai Chi exercise programmes can safely improve physical strength and reduce fall risk for fall-prone older adults in residential care facilities.

Noise-enhanced balance control in older adults.

Somatosensory information is critical to balance control and fall prevention in older adults. Recently, it has been shown that low-level input noise (electrical or mechanical) can enhance the sensitivity of the human somatosensory system. In this study, we tested the effect of low-level electrical noise, applied at the knee, on balance control in 13 healthy elderly volunteers. Subjects performed multiple single-legged stance trials with imperceptible electrical noise applied at the knee during half of the trials. Balance performance was characterized using a force platform to measure the displacement of the center of pressure (COP) under the subject's stance foot. Seven sway parameters were extracted from the COP time series. Improved balance was defined as a reduction in postural sway as indicated by decreases in the COP measures. Six of the seven sway parameters decreased with electrical noise. Three of these parameters decreased significantly ( < 0.05), and a fourth parameter was borderline significant. Averaged across subjects, the application of electrical noise resulted in a 3.8% reduction in mediolateral COP standard deviation ( = 0.04), a 5.4% decrease in the maximum anteroposterior COP excursion ( = 0.03), a 3.1% reduction in the COP path length ( = 0.04), and a 7.8% decrease in swept area ( = 0.05). The results suggest that imperceptible electrical noise, when applied to the knee, can enhance the balance performance of healthy older adults. These findings suggest that electrical noise-based devices may be effective in improving balance control in elderly people.

Exercise in the prevention of falls in older people: a systematic literature review examining the rationale and the evidence.

Falls are a major source of death and injury in elderly people. For example, they cause 90% of hip fractures and the current cost of hip fractures in the US is estimated to be about 10 billion dollars. Age-related changes in the physiological systems (somatosensory, vestibular and visual) which contribute to the maintenance of balance are well documented in older adults. These changes coupled with age-related changes in muscle and bone are likely to contribute to an increased risk of falls in this population. The integrated rehabilitation-based model of fall risk factors reveals multiple sites for interventions that may reverse fall risk factors. Regular exercise may be one way of preventing falls and fall-related fractures. The evidence for this contention comes from a variety of sources. On the basis of 9 randomised controlled studies conducted since 1996, exercise appears to be a useful tool in fall prevention in older adults, significantly reducing the incidence of falls compared with control groups. However, current limitations such as inconsistencies in the measurement of key dependent and independent variables do not, at present, permit a meta-analysis of intervention trials. Further investigation, using trials designed with the current limitations in mind, is necessary to establish the optimum exercise programme to maximise fall prevention in older adults.

Age Related Changes in Sensory System Dynamics Related to Balance

Maintaining one's balance requires the integration of the somatosensory, visual, and vestibular systems. Age-related decline in one or more of these systems limits the sensory information received, resulting in delayed perception and reaction to a loss of balance. This paper reviews age-related changes in various sensory systems and the integration of the systems in relation to postural control. Suggestions for fall prevention in older adults based on the sensory integration research are provided.