Fall Prevention Programs Research Articles

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.

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.

Cost-effectiveness of falls prevention strategies for older adults: protocol for a living systematic review

IntroductionOne-third of adults aged 65+ fall annually. Injuries from falls can be devastating for individuals and account for 1.5% of annual healthcare spending. With the growing ageing population, falls place...

Assessing the Effectiveness of a Non-Punitive Fall Prevention Program.

Our single-center, quality improvement project evaluated the impact of a fall reduction plan while using a Just Culture Algorithm that included weekly fall reviews involving front line staff using a non-punitive structure. The project has shown successful results. Prior to starting the program, data at this institution indicated falls were higher than the national fall rate of 3-5 per 1000 patient days. To achieve the goal of reducing the fall rate to below 3.1, an interdisciplinary fall committee was formed, consisting of nurses, nursing leaders, patient care technicians, pharmacists, and physical therapists. The committee operated in a non-punitive format and included all staff members directly involved in fall-related incidents. Protocols for implementing an evidence-based prevention program were developed to (1) address environmental concerns, (2) educate clinical workers and patients' families, (3) enforce interventions, (4) conduct weekly non-punitive, round table discussions, and (5) provide leadership support. Measures were implemented to proactively prevent falls. Data was collected and reported to all departments monthly. Following implementation of the program, results showed a statistically significant decrease in average fall rates per 1000 patient days from pre-intervention (4.05) to post-intervention (2.54) (P = .0001). Results showed improvement below the national average (3-5 falls per 1000 patient days), resulting in cost savings for the institution due to fewer falls. Inpatient medical-surgical and progressive care units had a noteworthy decline in the total number of falls, with notable estimated cost savings. Preventative interventions have shown effective results with compassionate, non-punitive leadership, an interdisciplinary team, and continuous follow-up education. Heeding to the Just Culture Algorithm as the foundation of weekly reviews, staff were empowered to engage in fall reduction strategies. A comprehensive weekly fall review program with ongoing staff education and transparent data reporting yielded a significant, sustained reduction in patient falls, with a substantial cost savings in excess of $1.6 million dollars over the life of the program.

Engaging wheelchair and scooter users in the co-design of an mHealth application for fall prevention and management: thematic analysis of focus group research

This study aimed to explore the potential of a mobile health (mHealth) application (app) to support the delivery of a fall prevention and management program, Individualized Reduction of FaLLs (iROLL), for people with spinal cord injury (SCI) and multiple sclerosis (MS) who use wheelchairs and scooters (WC/S) full-time by seeking end-users’ input into the functioning and ongoing design of the iROLL-O + mobile app. Two focus group discussions included nine adults with SCI or MS who used a WC/S for at least 75% of mobility, who experienced at least one fall in the past three years and have internet and access to an internet-capable device. One group had prior iROLL experience (n = 4); while the other had none (n = 5). The focus groups examined the app’s usefulness, accessibility, appearance, and ease of use. The participants with prior iROLL experience also discussed how the app would enhance their experience with the program. Thematic analysis revealed five app-related themes: perceived usefulness, perceived usability, accessibility, appearance, and enhancement of the iROLL experience, with participants providing actionable suggestions for improvement. Participants with previous exposure to the iROLL program emphasized the app’s potential to facilitate flexible access to the program and expand its reach to a wider audience. The iROLL-O + app was perceived positively, especially with respect to the enhancement of users’ access and experience with the program. Focus group findings will inform ongoing app development for optimized usability and reduced likelihood of technology abandonment. IMPLICATIONS FOR REHABILITATION End-users’ impressions of the Individual Reduction of faLLs Online application (iROLL-O + app) highlight the potential for integrating mHealth apps in fall prevention and management education efforts, offering a promising and accessible avenue to support the delivery of tailored programs. The study notes that the app facilitates flexible access and wider reach to the program, indicating the importance of incorporating features that enhance accessibility and accommodate the diverse needs of individuals who use wheelchairs and scooters. Actionable suggestions provided by participants underscore the importance of a user-centered design approach in developing rehabilitation-related mobile apps.

Characteristics of falls in Japanese community-dwelling older adults.

Understanding the characteristics of falls among older adults is necessary to prevent them. These characteristics include questions such as when (month and time), where (places), who (age), what (injury), why (trigger), and how (direction) the falls occur. The objective of this study was to identify the characteristics of falls in individuals aged 65-74 years (young-old), 75-84 years (old-old), and ≥85 years (oldest-old). We conducted an observational mail survey among community-dwelling older adults in Japan and collected detailed information on the incidence of falls over the past 3 years. The month, time, location, trigger, direction, and resulting trauma of each fall were analyzed and compared across the different age groups (young-old, old-old, and oldest-old). A total of 1695 falls among 1074 community-dwelling older adults were analyzed in this study. Falls were frequent during May and October as well as during the winter season from December to February, especially between 10:00 a.m. and 11:00 a.m. These fall characteristics were consistent across all the age groups. There was a higher incidence of outdoor falls among relatively young older adults, which were typically caused by tripping or slipping. However, as one progresses with age, there is a higher incidence of falls indoors, typically due to loss of balance or leg entrapment. Approximately 60% of older fallers experience some form of injury due to falls, with fractures considered the most serious, occurring in ≈10% of all falls. We clarified the characteristics of falls including the "when, where, who, what, why, and how" of the fall. A future challenge is to use this valuable information to develop effective fall prevention programs for older populations worldwide. Geriatr Gerontol Int 2024; 24: 1181-1188.

Effect of structured nurse-patient conversation on preventing falls among patients in an acute care hospital: A mixed study

ObjectivesInpatient falls are a major patient safety issue in acute care hospitals. Multifactorial in-hospital fall prevention programs have shown reductions in falls and related risks. One common element of successful programs is active patient involvement. This study objective was to explore patients’ and nurses’ experiences with a structured intervention to foster patient involvement. MethodsThis study was conducted between September 2020 and April 2021 in a university hospital neurological ward. The studied intervention consisted of a falls information leaflet, and a structured nurse-patient conversation about fall risk-reduction activities. Nurses were trained to deliver the intervention and supported throughout the study. Nurses’ and patients’ experiences regarding personal involvement, satisfaction, and confidence were surveyed and analyzed quantitatively and qualitatively. ResultsFifty-six patients recruited by ward nurses received the intervention. After receiving the intervention, patients reported high levels of satisfaction with the in-hospital fall prevention conversation. Twenty-one nurses indicated that they would use the leaflet and communication aid. Twenty-one nurses commented on intervention facilitators and barriers. More specific facilitators included their shared perception that “handing out the leaflet to patients was not problematic” and that the leaflet was seen as “applicable in many patient situations.” Their comments indicated two particularly prominent barriers to conducting the intervention in clinical practice: 1) “finding the time for the implementation in the daily clinical routine and workload” and 2) “environmental factors like a noisy and busy atmosphere on the ward.” ConclusionsThis study provides insights into a patient involvement intervention featuring a structured nurse-patient discussion about fall risks. The accompanying information leaflet and communication guide require adaptations to facilitate sustainable implementation into the hospital’s fall prevention program, but proved useful.

Analysis of the Effectiveness of a Fall Prevention Program Incorporating an Interprofessional Team Collaboration Model on Reducing Fall Risk in Elderly Living in Long-term Care Facilities

Concurrent with population ageing, falls have become a significantly more challenging public health issue among older adults. Three years of data collected recently from a nursing home in northern Taiwan reveals an increasing trend in fall density that is primarily associated with aging, physiological decline, chronic diseases, polypharmacy, osteoporosis, and lack of exercise. The percentage of nursing home residents at high risk of falls is currently at 12.6%, and the fall rate has been reported as reaching as high as 30% annually. A fall prevention program was implemented to reduce the fall incidence rate to 18%, with secondary goals of improving fall prevention awareness, behavior, self-efficacy, lower limb muscle strength, balance, and gait by 10% on average, respectively, between pre-test and post-test. From September 30, 2023 to February 29, 2024, a health promotion activity and fall prevention exercise course were implemented using an interdisciplinary team collaboration model over a six-week period, providing individualized exercise for the participants. The study included 20 older adults with an average age of 88 years. Most (90%; n = 18) had chronic diseases, 25% (n = 5) were on more than nine medications, 70% (n = 14) had reduced bone mass, and 40% (n = 8) were at high risk of falls, with a fall incidence rate of 30% during the immediately preceding year. Post-intervention, the fall incidence rate dropped to 5%, fall prevention awareness, behavior, and self-efficacy increased by 18.3%, and lower limb muscle strength, balance, and gait improved by 11.7%. The post-test results in fall prevention awareness, behavioral changes, self-efficacy, and lower limb strength, balance, and gait were all significantly better than pre-test results, with all results achieving statistical significance. The project results support the positive effects of the developed intervention effectively on elderly physical fitness and fall risk, providing valuable insights for the implementation of fall prevention strategies in nursing homes.

Considerations across multiple stakeholder groups when implementing fall prevention programs in the acute hospital setting: a qualitative study.

Falls in hospital remain a common and costly patient safety issue internationally. There is evidence that falls in hospitals can be prevented by multifactorial programs and by education for patients and staff, but these are often not routinely or effectively implemented in practice. Perspectives of multiple key stakeholder groups could inform implementation of fall prevention strategies. Clinicians of different disciplines, patients and their families were recruited from wards at two acute public hospitals. Semi-structured interviews and focus groups were conducted to gain a broad understanding of participants' perspectives about implementing fall prevention programs. Data were analysed using an inductive thematic approach. Data from 50 participants revealed three key themes across the stakeholder groups shaping implementation of acute hospital fall prevention programs: (i) 'Fall prevention is a priority, but whose?' where participants agreed falls in hospital should be addressed but did not necessarily see themselves as responsible for this; (ii) 'Disempowered stakeholders' where participants expressed feeling frustrated and powerless with fall prevention in acute hospital settings; and (iii) 'Shared responsibility may be a solution' where participants were optimistic about the positive impact of collective action on effectively implementing fall prevention strategies. Key stakeholder groups agree that hospital fall prevention is a priority, however, challenges related to role perception, competing priorities, workforce pressure and disempowerment mean fall prevention may often be neglected in practice. Improving shared responsibility for fall prevention implementation across disciplines, organisational levels and patients, family and staff may help overcome this.

The presence of risk factors in the home environment that influences the fall of people of the third age

Introduction: Aging is a natural, irreversible physiological process that depends on genetic, environmental, and lifestyle factors. Many physiological, biological, psychological, and other factors play a major role. According to the World Health Organization, falls are the second leading cause of unintentional injury death in the world and represent a major global public health problem. Falls are most commonly caused by intrinsic and extrinsic risk factors. A comprehensive assessment of fall risk is critical to the development of effective fall prevention programs. The screening protocol is brief, easy to use, and multifactorial and allows the identification of risk factors for falls. The aim of this study is to investigate the importance of the presence of risk factors in the home environment and the impact on increasing the risk of falls in people in the third age. Methods: The study was conducted in the municipality of Podgorica. 109 elderly people from urban and rural areas were included in the study using the snowball method. The instruments used in our study are a standardized checklist for assessing risk factors in the home environment, inside and outside the home (HASSAT), and a self-assessment scale of one’s own concern about a possible falls efficacy scale international. The survey was conducted from the end of October to the end of November 2023. Results: There is a statistically significant difference in social and physical activities of daily living in the area of concern about falling. When analyzing the overall result of the fear of falling scale in relation to gender, a significant statistical difference is found. The analysis of the individual rooms in relation to the age of the respondents shows that there is a significant statistical difference. Conclusion: The results obtained show that the high risk of falling is present in all rooms of the home environment for people in their 3rd year of life and that fear of falling increases with age.

Study protocol: process and outcome evaluation of the Walk with Ease program for fall prevention

BackgroundFalls are the leading cause of injury related morbidity and mortality in older adults. Primary and secondary prevention strategies that address modifiable risk factors are critically important to reduce the number of falls and fall related injuries. A number of evidence-based fall prevention programs are available, but few offer potential for broad dissemination and public health impact due to implementation barriers, such as a need for trained program leaders and clinicians.MethodsThe study will use a randomized controlled trial design to evaluate incorporating physical therapy exercises (primary prevention strategy) within an existing intervention called Walk with Ease. While Walk with Ease has an established evidence-base related to the management of arthritis pain and symptoms, the present study will determine the potential to also reduce falls and fall risk in community-dwelling older adults. The integrated process and outcome evaluation will determine the relative effectiveness of individually-prescribed exercises (compared to standardized exercises) as well as the potential of ‘habit training’ resources (relative to generic behavior prompts) to improve compliance with exercises in this population.DiscussionThe study, conducted through a local clinical-community partnership will advance both the science and practice of community-based fall prevention programming, while also informing implementation strategies needed to promote broader dissemination.Trial registrationClinicalTrials.gov, NCT05693025, Registered January 20, 2023, Updated March 1, 2023.

Adoption, Implementation, and Maintenance of Evidence-Based Falls Prevention Programs.

We evaluate the implementation of evidence-based falls prevention programs (EBFPPs) of the Administration for Community Living (ACL) Grantees by (1) describing adoption; (2) evaluating implementation through participant adherence; and (3) describing program maintenance. Secondary data analysis of a national data repository included forty-four ACL grantees spanning 31 states who were funded between September 2014 and December 2019 and provided information on over 80,000 older adult participants. Descriptive statistics including frequencies, percentages, and means were used to describe adoption, implementation (adherence), and maintenance of EBFPPs. Senior centers were the most common organizations to adopt EBFPPs. Most programs were maintained at their respective organizational site through repeat offerings, with several programs (60%) being offered greater than 10 times. Information regarding adoption, implementation, and maintenance of EBFPPs is valuable in identifying the best programs suited for different organizations and their clientele, which can inform policy for scaling and sustaining EBFPPs across the nation.

Translation, extension, and evaluation of usability, usefulness, and safety of a fall prevention and management program for people living with spinal cord injury and multiple sclerosis who use wheelchairs or scooters full time.

Falls are prevalent among people living with Multiple Sclerosis (PwMS) and Spinal Cord Injury (PwSCI) who use wheelchairs or scooters (WC/S) full time, however, there is a scarcity of evidence-based fall prevention and management programs. To describe the systematic translation of an in-person fall prevention and management program (Individualized Reduction Of FaLLs - iROLL) for PwMS to an online platform, extending its scope to include PwSCI, and to evaluate the preliminary useability, usefulness, and safety of the intervention. iROLL was systematically translated to an online platform (iROLL-O). PwMS and PwSCI who use a WC/S full time, experienced at least one fall within the past 36 months, and could transfer independently or with minimal to moderate assistance, enrolled in iROLL-O. Usability, usefulness, and safety were evaluated through 1:1 semi-structured interviews, gathering feedback on: perceived impact of the intervention on falls and functional mobility, program experiences, adverse events, and recommendations for improvement. Five participants successfully completed the iROLL-O program. No safety concerns were raised by participants. Themes emerging from the semi-structured interviews included: (1) barriers and facilitators to program access, (2) motivation for participation, (3) program outcomes, and (4) program content and structure. Participants reported reduced concerns about falling, enhanced functional mobility skills, and highlighted the supportive nature of synchronous group meetings for learning. No adverse events occurred during the implementation of iROLL-O and participants found the program to be useable and useful. Further testing is needed to examine efficacy among a large and diverse population.

Exercise for fall prevention in older adults

Background: Global population aging has significantly increased fall-related incidents among older adults, which is associated with major health risks and challenges for healthcare systems. Falls are a leading cause of injury, disability, and mortality in South Korea, which has shown rapid expansion of the elderly population. Development of effective fall-prevention strategies, including exercise-based interventions is important to address this issue.Current Concepts: Exercise-based fall prevention programs include several key types such as strength and functional movement training and balance exercises. Strength training includes resistance exercises and weightbearing activities to enhance muscle strength, which is essential for stability and fall prevention. Balance exercises improve stability and coordination, including standing on one leg and heel-to-toe walking. Functional movement training includes exercises that simulate daily activities and help individuals to improve their ability to safely perform routine tasks. Programs such as the Otago Exercise Program integrate these elements and offer a comprehensive approach to fall prevention. Such regimens combined with training in safe falling techniques are important to reduce fall risk and improve outcomes. Assessment tools, including the timed up-and-go and senior fitness tests, are useful to identify at-risk individuals and tailor interventions accordingly.Discussion and Conclusion: An effective fall prevention exercise program requires a multifaceted approach that combines various exercise types and focuses on improving muscle strength, balance, flexibility, and functional skills, as well as safe falling and floor recovery techniques. Tailoring these interventions to individual needs and regular risk assessments can enhance their usefulness.

Systematic review of adherence to technology-based falls prevention programs for community-dwelling older adults: Reimagining future interventions.

Prevention programs, and specifically exercise, can reduce falls among community-dwelling older adults, but low adherence limits the benefits of effective interventions. Technology may overcome some barriers to improve uptake and engagement in prevention programs, although less is known on adherence for providing them via this delivery mode. We aimed to synthesize evidence for adherence to technology-based falls prevention programs in community-dwelling older adults 60 years and older. We conducted a systematic review following standard guidelines to identify randomized controlled trials for remote delivered (i.e., no or limited in-person sessions) technology-based falls prevention programs for community-dwelling older adults. We searched nine sources using Medical Subject Headings (MeSH) terms and keywords (2007-present). The initial search was conducted in June 2023 and updated in December 2023. We also conducted a forward and backward citation search of included studies. Two reviewers independently conducted screening and study assessment; one author extracted data and a second author confirmed findings. We conducted a random effects meta-analysis for adherence, operationalized as participants' completion of program components, and aimed to conduct meta-regressions to examine factors related to program adherence and the association between adherence and functional mobility. We included 11 studies with 569 intervention participants (average mean age 74.5 years). Studies used a variety of technology, such as apps, exergames, or virtual synchronous classes. Risk of bias was low for eight studies. Five interventions automatically collected data for monitoring and completion of exercise sessions, two studies collected participants' online attendance, and four studies used self-reported diaries or attendance sheets. Studies included some behavior change techniques or strategies alongside the technology. There was substantial variability in the way adherence data were reported. The mean (range) percent of participants who did not complete planned sessions (i.e., dropped out or lost to follow-up) was 14% (0-32%). The pooled estimate of the proportion of participants who were adherent to a technology-based falls prevention program was 0.82 (95% CI 0.68, 0.93) for studies that reported the mean number of completed exercise sessions. Many studies needed to provide access to the internet, training, and/or resources (e.g., tablets) to support participants to take part in the intervention. We were unable to conduct the meta-regression for adherence and functional mobility due to an insufficient number of studies. There were no serious adverse events for studies reporting this information (n = 8). The use of technology may confer some benefits for program delivery and data collection. But better reporting of adherence data is needed, as well as routine integration and measurement of training and skill development to use technology, and behavior change strategies within interventions. There may be an opportunity to rethink or reimagine how technology can be used to support people's adoption and integration of physical activity into daily life routines.

Qualitative Comparative Analysis of exercise interventions for fall prevention in residential aged care facilities

BackgroundExercise interventions are highly effective at preventing falls in older people living in the community. In residential aged care facilities (RACFs), however, the evidence for effectiveness is highly variable, warranting exploration of drivers of successful trials. This study aims to identify the conditions of randomised controlled trials (RCTs) that are associated with reducing falls in RACFs and test whether it can explain the variability.MethodsRCTs testing exercise interventions in RACFs compared to usual care, reporting rate or risk of falls from the 2018 Cochrane Collaboration review and a search update to December 2022 were included. Two authors independently extracted and coded trial conditions and outcomes according to a theory developed from prior Intervention Component Analysis. Trial outcomes were coded as successful or unsuccessful based on point estimates for the rate or risk ratio for falls, or p value. Qualitative Comparative Analysis (QCA), utilising Boolean minimisation theory, was conducted to determine the key conditions driving trial success. A subgroup meta-analysis and the GRADE approach was applied to the final theory.ResultsEighteen trials undertaken in 11 countries with 2,287 residents were included. Participants were predominately ambulant females aged 70 to 80 with cognitive impairment. Most interventions were fully supervised or supervised at the start of the intervention. QCA identified two configurations as drivers of successful exercise falls prevention programs: (i) group exercise that is moderate or low intensity, or (ii) for independent ambulatory residents, exercise for more than 1 h per week. The combination of configuration (i) and (ii) had consistency and total coverage scores of 1, indicating all trials were explained. This combination was associated with a reduction in falls (rate ratio 0.45, 95%CI 0.34 to 0.59; risk ratio 0.66, 95%CI 0.53 to 0.82; low certainty evidence).ConclusionTo successfully reduce falls in RACFs, exercise programs should provide continuous supervised moderate-intensity group exercise. For programs that mostly include independent ambulatory residents, exercise for at least 80 min per week should be provided. As many current residents are frail, tailored exercise is likely necessary and an individualised dose may be required. Future trials should test exercise interventions for less mobile residents.

Identifying opportunities for community EMS fall prevention

BackgroundFalls are a leading cause of morbidity and mortality among older adults in the United States. Current fall prevention interventions rely on provider referral or enrollment during inpatient admissions and require engagement and independence of the patient. Community emergency medical services (CEMS) are a unique opportunity to rapidly identify older adults at risk for falls and provide proactive fall prevention interventions in the home. We describe the demographics and treatment characteristics of the older adult population most likely to benefit from these interventions. Materials and methodsWe linked 2019 Healthcare Cost and Utilization Project Massachusetts State Emergency Department (ED) and State Inpatient Databases with American Hospital Association survey data to query ED encounters and inpatient admissions for adults age ≥55 with ED encounters for fall-related injury between July 1, 2019 and December 31, 2019. Univariable descriptive statistics assessed participant characteristics and bivariable tests of significance compared diagnoses, disposition, and hospital characteristics between older adults with and without an EMS encounter in the six months prior to the presenting fall. ResultsOf 66,027 older adults who presented with a fall to a Massachusetts ED in July-December 2019, 7,942 (11%) had a prior encounter with EMS in the preceding six months, most of which included an injury diagnosis (99%). Compared to older adults without previous EMS encounters, those with previous EMS encounters were more often in poorer health (17% vs. 10% with multiple or complex comorbidities, p < 0.001) and of lower socioeconomic status (12% vs. 8% in lowest neighborhood income quartile, p < 0.001; 10% vs. 6% enrolled in Medicaid, p < 0.001) compared to those without a prior EMS encounter. ConclusionsA significant proportion of older adults presenting to the ED with fall related injury have encounters with EMS in the preceding months. These participants are predisposed to poorer health and economic outcomes worsened by their fall and thus demonstrate a population that would benefit from CEMS fall prevention programs.

Hip Strength, Change of Direction, and Falls in Recreational Pickleball Players.

While a high incidence of pickleball-related falls is reported, little is known regarding factors differentiating persons with and without a fall history during play. This study aimed to determine differences between recreational pickleball players who fell while playing and those who did not. Additional aims were to determine reasons for falling and to investigate associations among assessed factors. Cross-sectional study. Participants completed a survey reporting age, fall history, and reasons for falling during play. Hip abduction strength, single leg squat form, ankle dorsiflexion, and change of direction time using a modified T-test on a pickleball court (i.e.pickleball T-test) were assessed. Among the 92 individuals participating in the study, 42% reported a fall while playing and 30% reported falling more than once. Leading reasons for reported falls were lunging and moving backward. Participants who reported falling were significantly older (z = -2.60, p = 0.009) and slower on the pickleball T-test (z = -2.10, p = 0.036) than those who did not report falling. Hip abduction strength was not associated with fall history but was associated with faster time on the pickleball T-test (left rs = -.41, p < 0.001, right rs = -.48, p < 0.001). Single leg squat form and dorsiflexion were not related to fall history. Falls are common among recreational pickleball players, particularly older players. Fall prevention programs for pickleball players should be considered including multi-directional lunging, lower extremity strength and power development, and change of direction training that includes moving backward. 2.