Fall Prevention Programs Research Articles

The short- and long-term effects of a fall prevention program on the frequency of falls following total knee replacement: A pragmatic single-blinded randomized controlled trial protocol.

Falling following total knee replacement (TKR) is a significant issue, and can result in serious fatal and non-fatal injuries. The proposed study aims to investigate the short and long-term effects of integrating a falls prevention program into conventional physiotherapy versus just conventional physiotherapy on the number of falls, and any subsequent effects on balance, and functional ability among TKR patients. This is a parallel group prospective (52 weeks) randomized single-blinded pragmatic controlled trial conducted at Alrazi Orthopedic Hospital, in Kuwait. Sample size will be 90 pariticpants (45 participants in each group). Particpants will be randomized to intervention or control group. Outcome measures will be collected at baseline, 12 weeks and 52 weeks by investigators who are blinded to treatment allocation. Primary outcome will be fall rate assessed at 52 weeks following the TKR surgery. Secondary outcomes will include knee range of motion, severity of pain, 10-m walk test, Timed Up and Go test, Berg Balance Scale, 30-s sit to stand, patient adherence to home program and patient's satisfaction. Two-way multivariate ANOVA (group × time) will be performed to assess the group (experimental and control group) differences over time (baseline, 12, and 52 weeks). Investigating the physiotherapy programs that could minimize or prevent the risk of falling among TKR patients seems important. The proposed study will be the first step toward determining the exercise program that could be effective in reducing the number of falls among TKR patients. ClinicalTrials.gov, Identifier NCT05642260.

Reactive agility training to prevent frailty in older adults – a randomized controlled trial.

Introduction Alternative approaches to fall prevention programs for older adults have been called for. Agility training, which blends functional movements, stop-and-go actions, direction changes, strength, balance, and cognitive tasks (Donath et al., 2016), appears potentially more effective than traditional strength and balance training methods (Lichtenstein et al., 2020). However, long-term applications often lack considerations of individual progression and reactive decision-making (Lichtenstein et al., 2023). Addressing the need for quick, unforeseen reactions in fall-risk situations, we explored a novel training tailored to individual progress with complex reactive elements. The aim was to enhance neuromuscular and cognitive performance, as well as psychosocial health outcomes in healthy older adults. Methods Forty-six healthy older adults (28 females, mean age 69.5 ± 6.8 years, BMI 25.9 ± 3.4 kg/m²) were randomly assigned to either a control (CON) or agility training (AT) group. The AT program, conducted over a period of 16 weeks (twice per week), involved tasks that progressed in complexity and placed high demands on cognitive skills, strength, balance by applying reactive light systems. Cognitive assessments included the Eriksen-flanker and Go/No-Go tasks, while neuromuscular assessments involved tandem stance, countermovement jump, grip strength, and leg dynamometry. Gait tests were conducted under both single and dual-task conditions. Psychosocial health was evaluated using surveys such as CES-D, WHO-QoL-Bref, ISI, FES-I, and PSS. Data analysis was performed using linear mixed-effects models, examining group×time interactions standardized to baseline standard deviation. Results Compliance was high (85.2 ± 8.3%), and dropouts were low (10.8%). After controlling for age, sex, and BMI, the analysis revealed, on average, at least small effects in favor of the AT group for Go/No-Go task parameters (0.18 < d < 0.47), perceived stress (d = 0.42), psychosocial well-being (d = 0.33), social relationships (d = 0.26), as well as single-task gait speed (d = 0.34). In contrast, effect sizes in favor of the control group were found for reaction time (d = 0.34). Neither strength, explosiveness, and balance parameters, nor physical well-being and fear of falling data showed notable between-group differences (d < 0.2). For effects in favor of the AT group, small negative to moderate positive effects are also compatible with the data. Discussion/Conclusion In this group of very fit and healthy older adults, agility training appears insufficient to markedly improve neuromuscular parameters but may potentially serve to slightly enhance response inhibition and mental health over a 16-week period. The application of the training program in less fit populations should be considered along with potential methods for investigating exercise performance with incorporated cognitive tasks.

Concurrent Validity and Reliability of In-Person and Supervised Remote STEADI Fall Risk Assessment in Community-Dwelling Older Adults.

Physical therapists play a vital role in preventing and managing falls in older adults. With advancements in digital health and technology, community fall prevention programs need to adopt valid and reliable telehealth-based assessments. The purpose of this study was to evaluate the validity and reliability of the telehealth-based timed up and go (TUG) test, 30-second chair stand test (30s-CST), and four-stage (4-stage) balance test as functional components of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall risk assessment. This cross-sectional study was conducted using a convenience sample of community-dwelling older adults. The TUG, 30s-CST, and 4-stage balance test were administered in random order in 1 session in the participant's own environment. Performance was scored concurrently by an in-person and synchronous telehealth rater. The video recordings of the performances were scored by an asynchronous telehealth rater on days 1 and 30 for inter- and intra-rater reliability. Additionally, participants performed the TUG test twice, using the distance measured by the participant and the distance measured by the in-person rater. To establish the validity of telehealth-based STEADI fall risk assessments, the Intraclass Correlation Coefficient (ICC), Pearson correlation coefficient, and 95% limits of agreement were derived. Inter- and intra-rater reliability were established by calculating ICC using a 2-way mixed model. Bland-Altman plots were created for nonsignificant proportional bias tests. Thirty community-dwelling older adults participated. Based on the STEADI algorithm, 13 participants were classified as having a moderate fall risk. A comparison of in-person and synchronous telehealth ratings showed excellent ICCs (0.97-0.99) and relationships (r=0.94-0.98). Bland-Altman plots were created for all tests except for the 30s-CST (t=-2.168, P =.04). All tests had good to excellent inter-rater reliability (ICC=0.84-1.00) and intra-rater reliability (0.77-1.00). No adverse events were reported. This study suggests that telehealth-administered functional tests in the STEADI fall risk assessment are valid and reliable when technology, environment, camera view, and angle are optimally managed.

A Review of Falls And Injuries Of Nursing Home Residents Presenting To The Emergency Department.

Falls are frequently reported within the HSE. The Irish Longitudinal Study on Ageing(TILDA) found that 40% of over 50 s experience a fall in a two year period, with 20% requiring hospital attendance (1). It has been estimated that the cost of injuries related to falls in older people will increase exponentially over the coming years (2). There is no national database in Ireland with statistics for nursing home(NH) residents presenting with falls to our Emergency Departments(ED). To review the prevalence and risk factors for nursing home patients presenting to the Emergency Department with falls. Retrospective chart review. Retrospective review of all NH presentations to the ED of a university hospital over one year. There were 519 ED presentations by NH residents over one year. 48.17% (n = 250), presented with a fall. One third of ED visits presented during conventional working hours. Falls patients were more likely to be admitted when not reviewed by a G.P. prior to presentation. The average length of stay for falls admissions was 10.77 days(n = 132), vs 9.56(n = 153) for admissions with no documented fall. There was no statistical difference in the falls risk medications between groups. Patients presenting with falls were more likely to have bone protection reviewed during their stay(P=.011). Patients with falls were also more likely to use mobility aids(P < 0.001). Rapid referral to falls prevention programmes and the use of standardised care pathways for high falls risk patients are essential for future prevention and management.

Application of machine learning for detecting high fall risk in middle aged workers using video-based analysis of the first three steps.

Falls are among the most prevalent workplace accidents, necessitating thorough screening for susceptibility to falls and customization of individualized fall prevention programs. The aim of this study was to develop and validate a high fall risk prediction model using machine learning (ML) and video-based first three steps in middle-aged workers. Train data (n=190, age 54.5±7.7 years, 48.9% male) and validation data (n=28, age 52.3±6.0 years, 53.6% male) were enrolled in this study. Pose estimation was performed using a marker-free deep pose estimation method called MediaPipe Pose. The first three steps, including the movements of the arms, legs, trunk, and pelvis, were recorded using an RGB camera, and the gait features were identified. Using these gait features and fall histories, a stratified K-fold was used to ensure balanced training and test data, and the area under the curve (AUC) and 95% confidence interval (CI) were calculated. Of 77 gait features in the first three steps, we found 3 gait features in men with an AUC of 0.909 (95% CI, 0.879-0.939) for fall risk, indicating an 'Excellent' (0.9-1.0) classification, while we determined 5 gait features in women with an AUC of 0.670 (95% CI, 0.621-0.719), indicating a 'sufficient' (0.6-0.7) classification. These findings suggest that fall risk prediction can be developed based on ML and the first three steps in men; however, the accuracy was only sufficient in men. Further development of the formula is required for women to improve its accuracy in the middle-aged working population.

Student-Led Falls Prevention Program for Community-Dwelling Older Adults in a Rural Community: A Pilot Study.

A third of community-dwelling adults over the age of 65 years fall each year, making falls a significant concern for the elderly. Older people living in community-dwellings account for 73% of fall-related hospitalisations in older populations. Little is known about identifying, reaching at-risk people, and delivering these interventions in rural communities. Our aim was two-fold. To test the utility of a student-led program in identifying community-dwelling elderly people at high risk for falls in a rural and remote setting. To determine client satisfaction with the falls prevention program. Rural and remote community settings in Queensland, Australia. Forty community-dwelling older adults from the MMM 4 and 6 regions. This pilot study utilised a cross-sectional design and convenience sampling approach. A validated falls risk self-reported checklist and a screening checklist for general practitioners were used to identify older adults at risk of falling. During the home visit, participants were assessed for their cognition, balance and home safety. A client satisfaction survey was completed via telephone 3 months following the home visits. Several risk factors for falls were identified, including unsafe use of equipment, absence of Medi alerts, insufficient supervision, lack of support, inappropriate footwear, behavioural concerns and environmental hazards. Most participants reported that the home assessment was valuable and made their homes safer. An innovative student-led placement model has the potential to provide much-needed access to falls prevention services and minimise falls among community-dwelling older adults in rural and remote locations.

Falls prevention is more than just promoting physical health: evaluation of the group-based, out-patient prevention program ‘Staying safe and active in old age – falls prevention’

ABSTRACT Introduction The aim of this study was to evaluate the German falls prevention program ‘Staying safe and active in old age – falls prevention’, which is already established in practice. Methods The single-arm intervention study consisted of two time points, 6 months apart, to evaluate the multifactorial falls prevention program (n = 125 at Time 2). We observed the groups and their trainers and assessed which behavior change techniques (BCTs) were used. According to our evaluation framework, changes in the following three domains were assessed: (a) fall-related variables (i.e. number of falls, fear of falling), (b) physical functioning (i.e. performance-based gait speed, coordination, self-reported leg strength, balance, as well as habitual execution of the exercises), and (c) psychosocial functioning (i.e. quality of life, activities of daily living, mobility, and loneliness). Linear mixed models were used to determine changes in each variable. Results Demonstration of behavior was the most frequently used BCT. The program showed significant benefits for fear of falling, balance, coordination, habitual execution, and loneliness over time (Cohen’s d between −0.59 and 1.73). Number of falls, gait speed, coordination (dual task), activities of daily living, and quality of life were maintained (Cohen’s d between −0.26 and 0.30), whereas leg strength and mobility decreased significantly at Time 2 (Cohen’s d = −0.55 and −0.36). Discussion Group-based falls prevention programs may facilitate social integration among older adults and may also enhance and maintain physical functioning in old age. Trial registration: German Clinical Trials Register identifier: DRKS00012321.

ENHANCING DEMENTIA CARE PARTNER ENGAGEMENT IN FALL PREVENTION PROGRAMS: A SYSTEMATIC REVIEW

Abstract Community-dwelling older people with cognitive impairment/dementia (CI/D) experience a higher risk of falls than age-matched peers without CI/D. Fall prevention programs for this population often engage their family/friend care partners. Care partner engagement (CPE) has five components: care partners’ recruitment, retention, attendance, active participation, and maintenance of changes. Little is known about the facilitators and barriers that impact CPE in those programs and strategies used to enhance CPE. We conducted a mixed-methods systematic review following PRISMA guidelines (PROSPERO: CRD42023422200). Twenty-nine unique fall prevention programs from 32 studies were included. Most studies described retention (n=19, 60%), attendance (n=12, 38%), and active participation (n=32, 100%) aspects of CPE. Fewer studies illustrated factors related to care partner recruitment (n=6, 19%) and maintenance of change (n=6, 19%). Commonly reported CPE facilitators were older people with CI/D and care partners’ perceived benefits and suitableness of the fall prevention programs and positive relationships between the dyads. The main barriers to CPE are the dyads’ poor health and the burden related to the study logistics of participating in the programs. Program characteristics (e.g., structured/group format, social engagement opportunities, delivery mechanisms, timing) and providers’ characteristics are commonly reported organizational-level factors impacting CPE. Twenty-seven studies mentioned the use of educational (e.g., training, consultation, booklet), relational (e.g., strengthening care relationships, engaging paid caregivers), and behavioral strategies (e.g., action plans, visual reminders, cognitive approach, tracking logs) to promote CPE. Findings proposed a theoretical framework and identified potential strategies to enhance CPE in fall prevention programs for older people with CI/D.

IMPLEMENTATION OF A VIRTUAL FALL PREVENTION PROGRAM IN OLDER VETERANS

Abstract Though virtual platforms have increased in popularity few studies have explored the implementation and benefit of a virtually-based fall prevention program. MOVing FREEly (Multicomponent Otago Virtual Falls Reduction Exercise and Education program) is a VA-based fall prevention program delivered entirely over a virtual care platform. The MOVing FREEly program is six-weeks long and includes both education in fall-risk reduction and evidence-based fall prevention exercises. Process measures captured implementation considerations, feasibility and effectiveness of the program. 27 participants who were older (mean 75 years), mostly male (89.0%), white (85.2%) and moderate or high risk of falling completed the program. 70% were new to the virtual platform. Attendance for education and exercise classes was &amp;gt; 80% with little attrition. There was improvement in the Falls Efficacy Scale-International short form and statistically significant improvement in 30 second sit-to-stand and single leg balance tests. Process measures indicated that 40% of participants needed extra help at the start of each class to sign-on to the virtual visit, which was provided by program facilitators. By the fourth class, all participants were self-sufficient in their ability to navigate the virtual platform. Additional considerations such as electronic health record documentation and coding; clinic setup, referral management and virtual appointment scheduling; patient privacy and health emergency planning were necessary for the start-up and sustainability of the program. Virtual fall prevention programs are feasible and effective but require careful logistical planning and considerations. Implementation considerations from this program can guide future telerehabilitation research and clinical efforts.

The Impact of a Fall Prevention Education Program on Falls-related Knowledge, Prevention Behavior, and Falls Efficacy

Purpose: This study aimed to verify the effectiveness of a fall prevention program for older adult patients hospitalized in an acute general hospital, as well as to provide data for fall prevention among this population.Methods: A total of 29 participants in the experimental group and 29 participants in the control group took part in this survey. After the intervention, the mean difference in fall prevention knowledge was 4.69 for the experimental group and -0.52 for the control group (t=7.761, &lt;i&gt;p&lt;/i&gt;&lt;.001). Fall prevention behavior was 7.52 for the experimental group and 4.24 for the control group (t=3.888, &lt;i&gt;p&lt;/i&gt;&lt;.001), and fall prevention efficacy was 11.90 for the experimental group and -0.28 for the control group (t=8.309, &lt;i&gt;p&lt;/i&gt;&lt;.001).All results showed statistically significant differences, indicating that the fall prevention education program was effective.Results: The homogeneity test of the two groups for each item showed no significant differences. In the experimental group, fall-related knowledge (t=-9.430, &lt;i&gt;p&lt;/i&gt;&lt;.001), fall prevention behavior (t=-12.905, &lt;i&gt;p&lt;/i&gt;&lt;.001), and fall efficacy (t=-7.313, &lt;i&gt;p&lt;/i&gt;&lt;.001) were all significant. In the control group, fall prevention behavior (t=-5.478, &lt;i&gt;p&lt;/i&gt;&lt;.001) was significant, while fallrelated knowledge (t=.653, &lt;i&gt;p&lt;/i&gt;=.517) and fall efficacy (t=.169, &lt;i&gt;p&lt;/i&gt;=.866) were not considered significant. The post-intervention results of the two groups showed that the experimental group had greater fall prevention knowledge (t=6.996, &lt;i&gt;p&lt;/i&gt;&lt;.001), fall prevention behavior (t=-2.762, &lt;i&gt;p&lt;/i&gt;=.008), and fall prevention efficacy (t=7.797, &lt;i&gt;p&lt;/i&gt;&lt;.001) than the control group.Conclusion: Based on these results, it is necessary to develop and implement a fall prevention program for patients at medical institutions to actively participate in which older adult patients at each medical institution can actively participate.

ADVANCING OLDER ADULTS’ QUALITY OF LIFE AND INDEPENDENCE WITH FITNESS: INNOVATIVE APPROACHES AND STRATEGIES

Abstract This symposium by the Fitness, Exercise, and Wellness (FEW) Interest Group showcases diverse approaches to enhancing well-being and quality of life for older adults through innovative exercise interventions and research methodologies. Dr. Sara Pappa’s work outlines the success of the Northern Virginia Falls Prevention Alliance in deploying community-based evidence-based fall prevention programs, highlighting the effectiveness of academic-community partnerships in implementing and scaling such initiatives. Dr. James Dowd delves into the motivations of older runners, revealing that while health benefits play a role, the habit and joy of running are fundamental factors in their persistence, shedding light on the fortitude of this demographic and the new insights that this research is contributing to the field. Dr. Julie Ries and colleagues address research redundancy in meta-analyses evaluating exercise interventions for older adults with cognitive impairments, advocating for more strategic and ethical research practices to optimize resources and knowledge accumulation. Finally, Dr. Patricia C. Heyn and colleagues present a case study of implementing the 4Ms framework in dementia care in Brazil, emphasizing personalized approaches and the role of technology in maintaining family engagement and improving caregiving quality and connectivity from afar. Together, these innovative presentations highlight the importance of interdisciplinary collaborations, personalized care approaches, and technological innovations in promoting older adults’ functional well-being and autonomy, particularly in the realms of fall prevention, physical activity performance, cognitive health, and dementia care.

Effectiveness and cost-effectiveness of a single home-based fall prevention program: a prospective observational study based on questionnaires and claims data

BackgroundFall prevention programmes are essential interventions in societies with aging populations. This study assessed the fall rate and other health outcomes, as well as the cost-effectiveness of a home-based fall prevention programme for community-dwelling older people. In a single home visit, trained physical or occupational therapists performed fall risk assessments, eliminated environmental risk factors, and provided tailored exercises.MethodsA prospective, longitudinal observational study was performed with participants of a fall prevention programme who agreed to be followed-up over one year. Baseline data included self-reported falls one month and one year before the intervention. Participants were monitored through bi-monthly telephone calls, assessing their number of falls, fear of falling (using the Falls Efficacy Scale-International (FES-I), quality of life (using the EuroQuol-5 Dimensions-5 Levels, EQ-5D-5L), and physical activity (in minutes per week). Statistical analysis of the data used a Generalized Estimating Equations (GEE) Poisson-Modell for number of falls and a Linear Mixed Model (LMM) for fear of falling, quality of life and physical activity. In addition, health insurance claims data were used to compare the number of medically treated falls in the year before and after the intervention, as well as the related healthcare spending. Cost-effectiveness of the programme versus usual care was estimated as cost per prevented medically treated fall.ResultsOverall, 639 person-years of observation time were analyzed. Participants had a mean age of 81.8 years (+/- 5.2) and 59% were female. On average, the fall rate decreased from 1.35 to 1.02 per person-year, or -23.9% (95%CI from -35.92 to -9.67), fear of falling decreased by -1.27 points (95%CI from −1.50 to -1.05), quality of life improved by -0.88 points (95%CI from −1.09 to -0.68), and physical activity increased by 9.87 min per day (95%CI from 5.65 to 14.09). Analysis of claims data showed a 48.0% reduction (95%CI from 30.5% to 61.0%) in medically treated falls. The average cost per prevented medically treated fall was estimated at approximately 1,353 USD, with a 50% probability of the intervention being cost saving.ConclusionsThis fall prevention programme with a single home visit was found to be effective and cost effective. Health policies should establish such a model as a reimbursed standard care to assist in combatting the increasing burden of falls on individuals and societies.

Features of effective hospital fall prevention trials: an intervention component analysis

BackgroundFalls in hospitals continue to burden patients, staff, and health systems. Prevention approaches are varied, as well as their success at preventing falls. Intervention component analysis (ICA) is useful in indicating important features associated with successful interventions in sets of trial with high heterogeneity.MethodsWe conducted an ICA of systematically identified randomised controlled trials of interventions for preventing falls in older people in hospitals. Trial characteristics were extracted; inductive thematic analysis of published papers from included trials to seek triallists perspectives on drivers of success or failure of trials was conducted (ICA stage one) followed by a stratified thematic synthesis by trial outcomes, where trials were classified as positive or negative based on their falls rate or falls risk ratios (ICA stage two) and mapped to the presence of the theorised drivers of success or failure of the trials.Results45 trials met the inclusion criteria. Inductive thematic analysis of 50 papers revealed three key drivers (themes), each with subthemes, of effective inpatient hospital fall prevention trials. Theme 1, integration with the local setting, was present in 79% of the positive trials and 67% of the negative trials (79% vs 62% engaging ward staff and 33% vs 43% engaging hospital management). Theme 2, responsive interventions, was present in 83% of the positive trials and 71% of the negative trials (29% vs 38% targeting patient risk assessments and 83% vs 57% tailoring to patient needs and abilities). Theme 3, patient and family involvement, featured in 83% of the positive trials and 52% of the negative trials (50% vs 19% through fall prevention awareness and 58% vs 48% through an active role in fall prevention).ConclusionTailored fall prevention approaches and involving patient and family in fall prevention through increasing awareness, in addition to integration with the local intervention setting, appear to play a role in impacting the effectiveness of fall prevention interventions. These theories should be considered in the design of future fall prevention programs and trials and require further evaluation in high quality trials.

Steps to Avoid Falls in the Elderly – a TECHnology Enhanced Intervention (SAFE-TECH) study: randomized controlled trial protocol for a community-based, multi-component fall prevention program

BackgroundFalls and fall-related injuries among older adults in Singapore are a serious health problem that require early intervention. In previous research, exercise interventions have been effective in improving functional outcomes and reducing falls for a broad group of older adults. However, results from multi-domain, multi-component falls prevention programs for high fall risk older adults in the community remain equivocal. One reason for these results is that there is significant heterogeneity in falls risk factors amongst high falls risk older adults which makes tailoring multicomponent interventions complex. The objective of the trial is to evaluate the effectiveness of an enhanced version of the predecessor program, SAFE. The Steps to Avoid Falls in the Elderly—a TECHnology enhanced intervention (SAFE-TECH) is designed for older adults in the community who are at high risk of falls, with candidate selection and program tailoring based on gait variables derived from wearable sensors and various questionnaire-based features.MethodsSAFE-TECH is a 12-month randomized controlled trial involving 400 older adults at high risk of falling, who are randomly allocated to an intervention or control group in a 1:1 ratio. Participants will be assessed at baseline, 3rd-month and 12th-month for functional status, physical performance, cognitive status, quality of life, and medical history. Monthly phone calls will assess fall status, healthcare utilization, physical activity, and exercise self-efficacy. Participants in the intervention group will undergo a tailored, multi-domain, multi-component falls prevention program. The active intervention phase will last for 12-weeks with exercises focusing on strength, balance, coordination, flexibility, and aerobic endurance; and weekly educational sessions on falls risk with personalized feedback based on participant’s falls risk assessments and environmental checklist.DiscussionsSAFE-TECH seeks to evaluate enhanced existing falls prevention programs by addressing the heterogeneity of falls risk through rapid assessments and personalisation of exercise and education components while maintaining the efficiency of the group setting. Our findings will inform practical efforts to reduce falls and falls-related injuries among community-dwelling older adults.Trial registrationClinicalTrials.gov. Clinical Trial Number: NCT06102954|| 22–10-2023.

The influence of the multifactorial falls prevention programme on mortality.

Multifactorial falls prevention programmes (MFFPs) can prevent falls and fall-related injuries. We aimed to study MFFP patients' mortality compared with their sex-, age- and residence-matched population-based controls. This study is a Finnish single-centre retrospective register-based controlled cohort study of a total of 527 home-dwelling MFFP patients and their 3:1 age-, sex- and residence-matched population-based controls (n = 1581), who had not attended the MFFP. During the follow-up, the cumulative mortality of all patients was 40.4, and of controls 39.1 %. Hazard ratio was 0.82 (95% confidence interval 0.68 to 0.99), p= 0.041. Case patients had a 2.7 times greater risk to die due to accidents, but they had a lower risk to die due to dementia, compared with the control group. The 72-years-old or older participants had a lower mortality rate than the controls during follow-up. The MFFP seems to relate to a lower all-cause mortality when comparing MFFP patients with their age-, sex- and residence-matched controls. However, the MFFP did not seem to relate to a lower injury-related mortality. The relationship between the MFFP and lower all-cause mortality seemed to be strongest in the patients aged 72 years or older. Due to the study setting and population-based control group, it is difficult to draw solid conclusions and further studies are needed. A randomized controlled trial comparing the MFFP with standard care would give better insight on the effectiveness of a MFFP on mortality.

Perioperative inpatient falls for anterior cervical discectomy and fusion patients are on the rise: Risk factors associated with this “never event”

Background ContextPatients undergoing anterior cervical discectomy and fusion (ACDF) often have brief inpatient stays and may be at risk for inpatient falls (IPFs). Such IPFs should be preventable and have been termed a “never event” by the National Quality Forum, an affiliate of The Joint Commission. Despite increasing attention to IPF prevention, no studies have investigated the incidence, trends, and factors associated with IPFs among ACDF patients. PurposeTo characterize the trends in the incidence of ACDF-related IPFs and their risk factors. Study Design/SettingRetrospective cohort study. Patient SampleAdult patients who underwent inpatient ACDF between 2010 – Q3 2022 were abstracted from a large, national, multi-insurance administrative claims database. Outcome MeasuresIncidence, trends, and factors associated with IPFs. MethodsAdult patients who had undergone single or multi-level inpatient ACDF were identified by administrative coding. Exclusion criteria included: patients < 18 years of age, those who underwent outpatient ACDF, concurrent posterior cervical procedures, thoracic or lumbar fusion, and those with trauma, neoplasm, or infection diagnosed within 90-days prior to surgery. The subset of patients who suffered an IPF were subsequently identified. The annual incidence of IPFs was analyzed over the study years and various risk factors were assessed for their correlation with IPFs by multivariable logistic regression. To determine the association between IPF and length of stay (LOS), patients with relative to without IPF were matched 1:4 based on age, sex, and Elixhauser Comorbidity Index (ECI) and compared by multivariable logistic regression. ResultsOf the 294,165 inpatient ACDF patients meeting inclusion criteria, IPFs were identified for 5,548 (1.9%). Between 2010 and Q3 2022, the annual incidence of IPFs increased from 309 (1.1%) to 515 (4.8%) for patients undergoing ACDF (p<0.001). Independent predictors of an IPF were: hospital acquired delirium (odds ratio [OR] 4.50), history of prior falls (OR 3.38), hospital acquired psychosis (OR 3.17), alcohol use disorder (OR 2.68), cervical myelopathy (relative to radiculopathy) (OR 2.66), socioeconomically disadvantaged patients (OR 1.85), history of dementia (OR 1.77), underweight body mass index (BMI <18.5) (OR 1.67), multi-level ACDF (OR 1.43), history of prior cervical surgery (OR 1.41), male sex (OR 1.37), Medicaid insurance (OR 1.34), older age (OR 1.33), patients in the northeast United States (OR 1.15), and obese BMI >30 (OR 1.15) (p<0.001 for all). Relative to patients without IPF, patients who suffered an IPF following ACDF demonstrated incrementally increasing odds of extended LOS (4-5 days [OR 2.63], 6-7 days [OR 3.85], 7+ days [OR 6.78]) (p<0.001 for all). ConclusionIn this robust national sample of patients undergoing inpatient ACDF, IPFs were identified for 1.9%, with an increasing annual incidence over the years. Among these patients, various factors were associated with their occurrence, many of which may be potentially modifiable. These findings have major clinical implications on care pathway optimization regarding early identification of high-risk patients undergoing ACDF and lays a foundation for the refinement of multidisciplinary fall prevention programs.

Analysing programme implementation across districts: a qualitative study of a national falls prevention initiative for older people in New Zealand

BackgroundFalls among older people are a major cause of the global burden of disease. This study investigated the implementation of the Falls and Fracture Prevention Programme, a multicomponent population-based intervention,...

Correlation between fall experience and life functions among community-dwelling older adults in Japan

PurposeThis study investigated the correlation between the risk of falls and life functions, including motor function, cognitive function, and urinary disorders, among older adults residing in small cities in the metropolitan areas of Japan and evaluated the contents of fall prevention instructions. MethodsSixty-nine older adults residing at home participated in this case-control study conducted between September and October 2019. The survey items included questions pertaining to the history of falls; grip strength; the 30-s Chair Stand Test (CS-30), Functional Reach Test (FRT), and Timed Up and Go Test (TUG) scores; mental and cognitive functions [Test Your Memory-Japanese version test (TYM-J)]; living conditions; and urination status [Core Lower Urinary Tract Symptom Score (CLSS)]. ResultsParticipants with a history of falls had significantly lower CS-30 and FRT scores, and significantly higher TUG scores and CLSS than those with no history of falls. Grip strength bore significant correlations with the CS-30 and TUG scores. The CS-30 scores were correlated with the FRT and TUG scores. The FRT scores were correlated with the TUG and French State Activity Index (FAI) scores. The TUG scores were correlated with the TYM-J and FAI scores. The CLSS showed no significant correlations with the remaining items. The FRT scores and CLSS exerted a significant effect on the risk of experiencing falls. ConclusionBoth balancing ability and micturition status affect fall risk and should be considered in treatment strategies for urinary disorders in fall prevention programs for older adults.

Prevalence and Risk Factors of Hip Fracture at Tertiary Hospital in Mogadishu, Somalia.

This study aims to determine the frequency of hip fractures and associated risk factors among patients receiving care at the Somalia Turkish Training and Research Hospital in Mogadishu. A retrospective study of patients treated at the Somalia Turkish Training and Research Hospital in Mogadishu was carried out. 96 of the 108 patients who were admitted met the inclusion criteria. Analyzing the medical records of individuals diagnosed with hip fractures between January and December 2023 allowed for the collection of data on demographics, hip fracture type, and medical history and also conducted follow-ups to identify other potential contributing factors that may not be available in medical records. The main conclusions have been established using descriptive statistical analysis. About 8.67% of all fracture cases were hip fractures, Elderly people (60+) represented the largest group at 64.6%, followed by younger people (17-39) and Middle-aged people (40-59) at 15.6%, and children (3-16) at 4.2%. Females comprised 56.3% of cases, while males made up 43.8%. Most patients (78.1%) had low physical activity. Falls were the primary cause of fractures (83.3%), followed by other traumas (13.5%), and pathological fractures (7.3%). 32.3% of patients had comorbidities, 8.3% had a family history, and 22.9% had prior fractures. The most prevalent hip fractures (81.3%) were those of the femur neck, followed by subtrochanteric and intertrochanteric fractures (10.4% and 8.3%, respectively). This study emphasizes the frequency of hip fractures in Mogadishu, Somalia, as well as the significance of fall prevention, age, gender, and comorbidity treatment. We suggest comprehensive risk assessments, gender-specific bone health programs, fall prevention programs, focused prevention for the elderly, and public education campaigns to reduce the burden of hip fractures and encourage healthier people in our community by putting these measures into practice.

Fall Prevention in Older Adults: Insights from Saudi Arabian Physical Therapists on the Otago Exercise Program.

Falls among older adults are a growing public health concern in Saudi Arabia. The Otago Exercise Program (OEP) is an evidence-based intervention aimed at reducing fall risk in this population. This study assessed the knowledge and attitudes of Saudi Arabian physical therapists toward the OEP and examined potential gender-based differences. A cross-sectional survey was conducted between November 2023 and April 2024, involving 120 licensed physical therapists from Saudi Arabia, recruited via Email and social media. The survey captured sociodemographic data, knowledge, and attitudes regarding the OEP. Responses were analyzed using descriptive statistics, chi-square tests, and Cramér's V to assess the strength of associations, with a significance level set at p < 0.05. Most physical therapists reported knowledge of the OEP's clinical effectiveness (36.7%), cultural compatibility (35.0%), and fall prevention benefits (28.3%). Gender was not significantly associated with knowledge of clinical effectiveness (χ² = 3.84, p = 0.57), contraindications (χ² = 4.44, p = 0.48), cost-effectiveness (χ² = 4.15, p = 0.52), or fall prevention in older adults (χ² = 2.44, p = 0.78), with moderate effect sizes observed (Cramer's V = 0.233 to 0.467). Attitudes toward the OEP were generally positive, with 51.7% supporting its use in regular aging care and 45.0% expressing confidence in delivering the program. There were no significant gender differences in understanding the OEP's recommendations (χ² = 7.45, p = 0.11) or confidence in program delivery (χ² = 7.62, p = 0.10), although strong association effects were noted (Cramer's V = 0.696 and 0.680, respectively). This study highlights the strong knowledge and positive attitudes of Saudi physical therapists toward the OEP, underscoring its potential for integration into national healthcare strategies to improve geriatric care and reduce fall-related risks. The findings emphasize the importance of continuous professional development to address knowledge gaps and optimize the implementation of evidence-based fall prevention programs.