Fall-related Factors Research Articles

Sensitivity of Fall Risk Perception and Associated Factors in Hospitalized Patients with Mental Disorders

PurposeTo reduce falls in hospitalized patients with mental disorders, the patients should be sensitive to fall risk perception. This study identified the sensitivity to fall risk perceptions and associated factors, including demographic, clinical, and fall-related factors, among inpatients with mental disorders. MethodsWe used a descriptive, cross-sectional design, recruiting 170 inpatients with mental disorders from two psychiatric hospitals in South Korea. Sensitivity to fall risk perception was classified using fall occurrence and the Fall Risk Perception Questionnaire. ResultsThe prevalence of falls was 16.5%. Approximately 47% of falls occurred within 10 days of hospitalization, 67.9% within 1 month, and 85.7% within 2 months. Among the 28 participants who fell, 60.7% had inadequate-low sensitivity to fall risk perception. Among the 142 participants who did not fall, 11.3% had inadequate-high sensitivity to fall risk perception. Low sensitivity to fall risk perception was related to diagnosis, psychiatric symptoms, and fall history due to the mental disorder. High sensitivity to fall risk perception was related to age at onset of the mental disorder, urinary or bowel problems, and fear of falling. The multiple logistic regression found that the diagnosis and fall history due to the mental disorder were associated with inadequate-low sensitivity, and age at onset and fear of falling were associated with inadequate-high sensitivity to fall risk perception. ConclusionsOver 60% of patients who fell had low sensitivity to fall risk perception. Inadequate-low and high sensitivity to fall risk perception are related to the demographic, clinical, and fall-related characteristics among inpatients with mental disorders. Therefore, nurses should assess fall risk perception, consider these factors together during this assessment, and manage them appropriately in hospitalized patients with mental disorders.

BACKWARD WALKING SPEED: A NOVEL MOBILITY MEASURE FOR YOUNGER AND OLDER ADULTS

Abstract Mobility is fundamental to healthy aging. Forward walking speed (FWS) is a well-established measure of mobility, physical functioning, and fall risk but fewer studies have assessed backward walking speed (BWS). This study explored the relationship between FWS, BWS, and fall-related factors. Independently ambulatory, community-dwelling young adults (n=20; age: 22.9 years ±1.6) and older adults (n=19; age: 70.2 years ±6.2) completed forward and backward walking assessments on a 3.9 meter long instrumented pressure mat. Paper surveys assessed sociodemographic characteristics, fall history, and fear of falling using the Falls Efficacy Scale – International (FES). FWS, BWS, and directional difference percent change ((FWS-BWS/FWS)*100) were compared using independent sample t-tests, and simple linear regression was used to model the relationship between mobility measures and fear of falling. In the total sample (n=39), 23% of adults reported a fall in the previous 12 months. Compared to older adults, young adults exhibited significantly faster FWS (138.3 cm/sec ± 16.5 vs. 119.3 cm/sec ±23.4; p=0.006) and BWS (82.6 cm/sec ±18.2 vs. 63.8 cm/sec ±20.7; p=0.005). Males displayed a significantly lower mean directional difference percent change (39.4 ±11.4 vs. 47.4 ±11.1; p=0.034), than females. Among older adults, BWS was strongly and negatively correlated with FES scores (r=-0.58; p=0.009). BWS explained a greater proportion of variance in fear of falling compared to FWS (33.93% vs. 24.84%). BWS and directional difference in walking speed may be novel measures of physical functioning. Prospective studies should consider assessing BWS with future fall risk among older adults.

Inpatient Falls and Orthopaedic Injuries in Elderly Patients: A Retrospective Cohort Analysis From a Falls Register.

Background Hospital inpatient falls have been a major area of concern in the healthcare setting. This poses a multifaceted challenge to healthcare systems, as elderly patients are at increased risk of harm and significant morbidity secondary to inpatient falls. In addition, hospital admission increases the risk of falls in acutely unwell elderly patients. There remains little consensus on best practices in reducing inpatient falls. With this, lies the risk to life or quality of life to this cohort of patients. Moreover, it is not evident whether orthopaedic injuries sustained by elderly patients in hospital and their management, including rehabilitation, has evolved with time. Methodology This was a retrospective cohort analysis of all inpatient falls over a three-year period in a single UK District General Hospital. A total of 101,183 acute admissions were analysed. All falls were identified and categorised into harm categories according to National Patient Safety Alerts. Patients sustaining moderate harm or more were assessed to determine injuries sustained, patient-associated factors, factors surrounding the fall, management incurred, length of stay, and financial burden incurred. Results A total of 101,183 admissions were analysed revealing a total of 2,453 in-patient falls. The rate of inpatient falls was 2.42%. Of these, 49 (1.98%) patients sustained moderate harm or more. Patient-related factors included age and comorbidities; 82% of patients were above the age of 75, and 78% of patients had three or more medical comorbidities. Fall-related factors leading to moderate harm or more included time of fall and ward. Most falls occurred out of hours (80%) and in acute medical wards (69%). The average length of stay following fall was 2.4 weeks per patient and a combined 110 weeks in the three-year period. In non-deceased patients, increased dependency and reduced mobility at discharge were noted. The total hospital annual financial burden due to moderate harm or more following an inpatient fall was approximately £123,490.00. Length of stay was the major contributor to this (£90,090.00 annually). Conclusions Inpatient falls remain a considerable patient safety issue, with orthopaedic injuries playing a central role in harm to patients following these falls. These also pose considerable service and financial costs to healthcare organisations. Further work is needed to identify best practices in in-hospital fall prevention and streamlining post-fall management and rehabilitation.

Fall-portent detection for construction sites based on computer vision and machine learning

PurposeFall accidents can cause casualties and economic losses in the construction industry. Fall portents, such as loss of balance (LOB) and sudden sways, can result in fatal, nonfatal or attempted fall accidents. All of them are worthy of studying to take measures to prevent future accidents. Detecting fall portents can proactively and comprehensively help managers assess the risk to workers as well as in the construction environment and further prevent fall accidents.Design/methodology/approachThis study focused on the postures of workers and aimed to directly detect fall portents using a computer vision (CV)-based noncontact approach. Firstly, a joint coordinate matrix generated from a three-dimensional pose estimation model is employed, and then the matrix is preprocessed by principal component analysis, K-means and pre-experiments. Finally, a modified fusion K-nearest neighbor-based machine learning model is built to fuse information from the x, y and z axes and output the worker's pose status into three stages.FindingsThe proposed model can output the worker's pose status into three stages (steady–unsteady–fallen) and provide corresponding confidence probabilities for each category. Experiments conducted to evaluate the approach show that the model accuracy reaches 85.02% with threshold-based postprocessing. The proposed fall-portent detection approach can extract the fall risk of workers in the both pre- and post-event phases based on noncontact approach.Research limitations/implicationsFirst, three-dimensional (3D) pose estimation needs sufficient information, which means it may not perform well when applied in complicated environments or when the shooting distance is extremely large. Second, solely focusing on fall-related factors may not be comprehensive enough. Future studies can incorporate the results of this research as an indicator into the risk assessment system to achieve a more comprehensive and accurate evaluation of worker and site risk.Practical implicationsThe proposed machine learning model determines whether the worker is in a status of steady, unsteady or fallen using a CV-based approach. From the perspective of construction management, when detecting fall-related actions on construction sites, the noncontact approach based on CV has irreplaceable advantages of no interruption to workers and low cost. It can make use of the surveillance cameras on construction sites to recognize both preceding events and happened accidents. The detection of fall portents can help worker risk assessment and safety management.Originality/valueExisting studies using sensor-based approaches are high-cost and invasive for construction workers, and others using CV-based approaches either oversimplify by binary classification of the non-entire fall process or indirectly achieve fall-portent detection. Instead, this study aims to detect fall portents directly by worker's posture and divide the entire fall process into three stages using a CV-based noncontact approach. It can help managers carry out more comprehensive risk assessment and develop preventive measures.

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

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

Falls, fear of falling, and related factors in patients with diabetic foot disease

BackgroundFalls and fear of falling (FOF) are common in patients with diabetic foot disease (DFD). PurposeTo understand the relationship between falls, FOF, and related factors in patients with DFD. MethodWe recruited 70 patients being treated for DFD at two hospitals in Korea. A structured questionnaire was used in investigating fall experience, FOF, and related factors. ResultsAmong the participants, 42.8 % fell in the past year, and FOF was reported in 57.1 %. Rates of “no caregiver,” “DFD duration (>1 year),” and “burning pain” were higher in fallers than non-fallers. The rates of “older adults (≥65 years of age),” “unemployed,” “not using assistive devices,” “visual impairment,” and “hearing impairment” were higher in patients with FOF than in those without FOF. However, the level of balance confidence was lower in patients with FOF. ConclusionsThe fall experience of patients with DFD was associated with the presence of their caregiver, disease-related factors, and foot pain symptoms, while FOF was related to age and fall-related factors.

Evaluating the Effect of Activity and Environment on Fall Risk in a Paradigm-Depending Laboratory Setting: Protocol for an Experimental Pilot Study

Knowledge about the causal factors leading to falls is still limited, and fall prevention interventions urgently need to be more effective to limit the otherwise increasing burden caused by falls in older people. To identify individual fall risk, it is important to understand the complex interplay of fall-related factors. Although fall events are common, they are seldom observed, and fall reports are often biased. Due to the rapid development of wearable inertial sensors, an objective approach to capture fall events and the corresponding circumstances is provided. The aim of this work is to operationalize a prototypical dynamic fall risk model regarding 4 ecologically valid real-world scenarios (opening a door, slipping, tripping, and usage of public transportation). We hypothesize that individual fall risk is associated with an interplay of intrinsic risk factors, activity, and environmental factors that can be estimated by using data measured within a laboratory simulation setting. We will recruit 30 community-dwelling people aged 60 years or older. To identify several fall-related intrinsic fall risk factors, appropriate clinical assessments will be selected. The experimental setup is adaptable so that the level of fall risk for each activity and each environmental factor is adjustable. By different levels of difficulty, the effect on the risk of falling will be investigated. An 8-camera motion tracking system will be used to record absolute body motions and limits of stability. All laboratory experiments will also be recorded by inertial sensors (L5, dominant leg) and video camera. Logistic regression analyses will be used to model the association between risk factors and falls. Continuous fall risk will be modeled by generalized linear regression models using margin of stability as outcome parameter. The results of this project will prove the concept and establish methods to further use the dynamic fall risk model. Recruitment and measurement initially began in October 2020 but were halted because of the COVID-19 pandemic. Recruitment and measurements recommenced in October 2022, and by February 2023, a total of 25 of the planned 30 subjects have been measured. In the field of fall prevention, a more precise fall risk model will have a significant impact on research leading to more effective prevention approaches. Given the described burden related to falls and the high prevalence, considerable improvements in fall prevention will have a significant impact on individual quality of life and also on society in general by reducing institutionalization and health care costs. The setup will enable the analysis of fall events and their circumstances ecologically valid in a laboratory setting and thereby will provide important information to estimate the individual instantaneous fall risk. DERR1-10.2196/46930.

Age and Gender Differences in Fall-Related Factors Affecting Community-Dwelling Older Adults.

Falls are one of the major adverse events affecting older adults that can result in serious injuries. Hospitalizations and deaths because of fall-related injuries have been increasing. Nevertheless, there is a dearth of studies examining the physical condition and current exercise habits of older adults. Moreover, studies analyzing the role of factors related to fall risk by age and gender in large populations are also scarce. This study was designed to investigate the prevalence of falls among community-dwelling older adults and elucidate the effects of age and gender on the related factors using a biopsychosocial model. This cross-sectional study utilized data from the 2017 National Survey of Older Koreans. On the basis of the biopsychosocial model, the biological factors related to falls included chronic diseases, number of medications, visual difficulties, activity of daily living (ADL) dependence, lower-limb muscle strength, and physical performance; psychological factors included depression, cognitive ability, regular smoking, alcohol consumption, nutritional status, and exercise; and the social factors included educational level, annual income, living conditions, and instrumental ADL dependence. Of the 10,073 older adults surveyed, 57.5% were women and approximately 15.7% had experienced falls. The results of the logistic regression showed that, in men, falls were significantly associated with taking more medications and being able to climb 10 stair steps; in women, falls were significantly associated with poor nutritional status and instrumental ADL dependence; and in both genders, falls were significantly associated with greater depression, ADL dependence, and the presence of more chronic diseases and negatively associated with physical performance. The results suggest that practicing kneeling and squatting is the most effective strategy for reducing fall risk in older adult men and that improving nutritional status and strengthening physical ability is the most effective strategy for reducing fall risk in older adult women.

Cross-Sectional Analysis of Fall-Related Factors with a Focus on Fall Prevention Self-Efficacy and Self-Cognition of Physical Performance among Community-Dwelling Older Adults

This study aimed to determine how fall prevention self-efficacy and degree of deviation in self-cognition of physical performance, which have recently received attention for their potential to explain falls in combination with a wide variety of fall-related factors, as well as affect falls. Older adults using day-care services (n = 27 with six men, mean age: 81.41 ± 7.43 years) were included in this study. Fall history in the past year, the modified fall efficacy scale (MFES), and physical performance and cognition errors were examined by evaluating the functional reach test (FRT), the stepping over test, and the timed up and go test (TUG), along with a questionnaire. In the fall (n = 14) and non-fall (n = 13) groups, logistic regression analysis using Bayesian statistical methods was used to identify factors associated with falls. The odds ratios for the MFES ranged from 0.97 to 1.0, while those of cognition-error items ranged from 3.1 to 170.72. These findings suggested that deviation in self-cognition of physical performance, particularly overestimation of timed cognitive ability, was a factor with more explanatory power for fall history. Future studies should analyze differences by disease and age group, which were not clarified in this study, to identify more detailed fall risk factors.

Injurious falls before, during and after dementia diagnosis: a population-based study

the timing of incident injurious falls at different stages of dementia diagnosis is unclear. to identify when the occurrence of injurious falls begins to increase among individuals who are going to develop dementia, to explore the time point at which people living with dementia are at highest risk of injurious falls and to ascertain differences in fall-related factors pre- and post-dementia diagnosis. this study included 2,707 participants with incident dementia and 2,707 1:1 matched (i.e. same birth year and sex) controls without dementia. dementia diagnosis and date of onset were identified from the National Patient Registry (NPR) and the Swedish Cause of Death Register following international criteria. Information on injurious falls and history of chronic disease was obtained from the NPR. Data were analysed using conditional Poisson regression and generalized estimating equation models. compared with controls, the incidence of injurious falls among participants with dementia started to increase beginning 4years pre-diagnosis (incidence rate ratio [IRR] 1.70, 95% confidence interval [CI] 1.30-2.22), reaching a peak (IRR 3.73, 95% CI 3.16-4.41) in the year of dementia diagnosis. Heavy drinking, physically active and cardiometabolic diseases (CMDs) were associated with incident falls among those with dementia. people with dementia have a higher incidence of injurious falls beginning 4years leading up to diagnosis and peaking during the year of diagnosis. Older age, female, heavy drinking, physically active and CMDs may predict injurious falls among people with dementia.

Co-occurrences of fall-related factors in adults aged 60 to 85 years in the United States National Health and Nutrition Examination Survey.

A broad set of factors are associated with falling (e.g., age, sex, physical activity, vision, health), but their co-occurrence is understudied. Our objectives were to quantify the number and pattern of co-occurring fall-related factors. Data were obtained from the U.S. National Health and Nutrition Examination Survey (N = 1,957, 60-85 years). Twenty fall-related factors were included (based on previous research), covering a wide range including cognitive, motor, sensory, health, and physical activity measures. The number and pattern of co-occurring fall-related factors were quantified with logistic regression and cluster analyses, respectively. Most participants (59%) had ≥4 fall-risk factors, and each additional risk factor increased the odds of reporting difficulty with falling by 1.28. The identified clusters included: (1) healthy, (2) cognitive and sensory impaired, and (3) health impaired. The mean number of co-occurring fall-related factors was 3.7, 3.8, and 7.2, for clusters 1, 2, and 3, respectively (p<0.001). These observations indicate that co-occurrence of multiple fall-risk factors was common in this national sample of U.S. older adults and the factors tended to aggregate into distinct clusters. The findings support the protective effect of physical activity on fall-risk, the association between gait speed and falls, and the detrimental effect of health-related factors on difficulty with falls (e.g., arthritis, prescription medications). Cluster analyses revealed a complex interplay between sex and BMI that may alter the role of BMI in the etiology of falls. Cluster analyses also revealed a large detrimental effect of health-related factors in cluster 3; it is important to extend current fall interventions (typically focused on balance, flexibility, strength, cognitive, fear factors) to include health-related interventions that target factors such as BMI and arthritis.

Changes in Physical Functioning and Fall-Related Factors in Older Adults Due to COVID-19 Social Isolation.

BackgroundSocial isolation has been one of the main measures for the prevention of COVID-19. It’s possible that, in addition to the natural aging-related deficits, social isolation has accelerated the decline of the different components of physical and mental capacity in older adults. This study aimed to compare the functional capacity and concern about falling in older adults before and during COVID-19 social isolation.MethodThis observational longitudinal study was carried out with 45 community dwelling older adults (mean age 65.6 ± 4.6 years, 88.8% women). Functional capacity and concerns about falling assessments were carried out before the COVID-19 pandemic, and between the 16th and 18th week of social isolation. All testes were face-to-face, except the second FES-I assessment, which took place via telephone call in order to minimize a prolonged person-to-person contact. Muscle strength, muscle power, functional mobility, functional muscle fitness, upper and lower body flexibility, dynamic balance, and Efficacy Scale were assessments.ResultsRegarding functional capacity, there was 14% decline in muscle strength (p<.001), 7% in power (p=.001), 11% in functional mobility (p=.001), 20% in functional muscle fitness (p=.001), and 60% in upper body flexibility (p=.001) and 33% lower body flexibility (p=.003). The dynamic balance and the concern about falling showed no statistically significant differences.ConclusionThus, it can be concluded that there was a decline in older adults’ functional capacity during COVID-19 social isolation.

The Effects of Combined Physical and Cognitive Interventions on Direct and Indirect Fall Outcomes for the Elderly with Mild Cognitive Impairment: A Systematic Review

This review was intended to determine the effectiveness of physical and cognitive training (PCT) on falls and fall-related factors and cognitive function among community-dwelling elderly people with mild cognitive impairment (MCI). A systematic literature search was performed of the MEDLINE, CINAHL, Web of Sciences, Scopus, ProQuest, Embase, and Google Scholar databases for articles published from 2010 to 2020. The studies that combined PCT to assess their impacts on fall outcomes both directly and indirectly were included. Study quality was assessed using the standardized JBI Critical Appraisal Tool for RCTs. The standardized data extraction tool from JBI-MAStARI was used to extract data of included studies. Seven RCTs involving 740 participants were included. The overall fall incidence did not significantly decrease after the interventions. However, PCT significantly impacted the cognitive function and physical activities of elderly people with MCI, particularly improving their balancing ability, gait speed, muscular strength, and executive functions. This study indicated that combining PCT improves balance ability, gait speed, and executive functioning in the elderly with MCI, which may help to minimize fall occurrence.

Role of physical therapists and aromatherapy for fall prevention in older people: A narrative review.

Falls among older people are usually the result of several causes combined. Identifying all the fall-related factors that apply to a particular individual and providing comprehensive multifactorial intervention is recommended for the prevention of falls among older people. However, the overall net benefit of multifactorial intervention in preventing falls is small, and it does not appear to improve fall-related outcomes, such as the number of fall-related injuries. Therefore, we might require new perspectives to overcome this situation. Here, we raise two novel strategies for fall prevention among older people. One is using physical therapists more actively. The other is using aromatherapy for stabilization of older people. Physical therapists should carry out detailed gait assessment and caregiver education. Aromatherapy is effective in improving balance and mental stability in older people. To overcome refractory geriatric syndrome, there is no choice but to eliminate all preconceived ideas before choosing the best fall prevention strategies. Geriatr Gerontol Int 2021; 21: 445-450.

Association of fall risk factors and non-motor symptoms in patients with early Parkinson\u2019s disease

The association of non-motor symptoms (NMSs) with fall-related factors in patients with Parkinson’s disease (PD) remains to be further elucidated in the early stages of the disease. Eighty-six patients with less than 5 years of the onset of PD were retrospectively enrolled in the study. We assessed potential fall-related risk factors including (1) a history of falls during the past year (faller versus non-faller), (2) the fear of falling (FoF), and (3) the freezing of gait (FoG). Different types of NMSs were measured using the Montreal Cognitive Assessment (MoCA), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Parkinson’s disease Fatigue Scale (PFS), and the Scales for Outcomes in Parkinson’s disease—Autonomic dysfunction (SCOPA-AUT). The faller group (37.2%) showed higher scores for BDI, BAI, PFS, and SCOPA-AUT, compared to the non-faller group. From logistic regression analyses, the prior history of falls was related to the gastrointestinal domain of SCOPA-AUT, FoF was associated with BAI, and gastrointestinal and urinary domains of SCOPA-AUT, and FoG was linked to BAI and gastrointestinal domain of SCOPA-AUT. In conclusion, we found that fall-related risk factors in patients with early PD were highly connected with gastrointestinal dysautonomia.

Factors associated with falls in community-dwelling older adults: an analysis based on subscales of the frailty screening index.

[Purpose] We aimed to obtain new findings by investigating the relationship between the presence or absence of falls and the results from the Frailty Screening Index (FSI), which can be easily carried out. [Participants and Methods] A total of 780 community-dwelling older adults (age ≥65 years) were classified based on whether they had fallen in the past year as those who had fallen at least once (fall group), and those who had not (non-fall group). We compared the study groups using sub-items of the FSI to extract more specific fall-related factors. The FSI is a questionnaire that comprises five items with simple ‘yes/no’ responses. [Results] The following three out of five sub-items of the FSI were extracted as fall-related factors: 1) “no” to the question, “Do you do physical exercise, like walking, at least once a week?”; 2) “yes” to the question, “Do you think you walk slower than before?”; and 3) “yes” to the question, “Have you felt tired for no reason (in the past two weeks)?” [Conclusion] The study results suggest the significance of paying attention to participant responses to the sub-items on the FSI, instead of merely determining their frailty risk based on their total score.

Relationship between Fall History and Self-Perceived Motor Fitness in Community-Dwelling People: A Cross-Sectional Study.

History of falling is an important fall risk factor. If a relationship between fall history and self-perceived motor fitness could be established, then treating it as a correctable risk of re-fall due to falls may be possible. We conducted a cross-sectional study of the relationship between fall history and self-perceived motor fitness in daily life among 670 community-dwelling people (mean age 62.0 ± 9.6 years, 277 men and 393 women) who had participated in health examinations. They completed a self-administered questionnaire that asked about their history of single or multiple falls and included a 14-item motor fitness scale. The responses were analyzed using multivariate logistic regression analysis. The results showed that in both younger and older (<65 years) subjects, a history of single or multiple falls was associated with a negative response to “being able to put on socks, pants or a skirt while standing without support”. For subjects ≥65 years, an association was also observed with “shortness of breath when climbing stairs”. Self-perceived motor fitness related to fall history can easily be noticed by an individual and may help them become aware of fall-related factors earlier in everyday life.

Longitudinal Associations Between Gait, Falls, and Disability in Community-Dwelling Older Adults With Type II Diabetes Mellitus: Findings From The Irish Longitudinal Study on Ageing (TILDA).

Diabetes is associated with gait deficits, future falls, and disability; however, it is unclear if associations remain after controlling for relevant confounders. This study investigated (i) the effects of type II diabetes on spatiotemporal gait parameters in community-dwelling older adults and (ii) if diabetes status was independently associated with future falls and disability, after controlling for gait and other confounders. Baseline data were obtained from 2608 community-dwelling adults (≥60 years) participating in The Irish Longitudinal Study on Ageing (TILDA). Diabetes was identified from self-reported doctors' diagnosis, medications, and glycated hemoglobin levels. Gait characteristics were obtained during single- and dual-task walking using a GAITRite mat (n = 2560). Incident falls and disability were collected over 4 years follow-up (n = 2473). Associations between diabetes status and gait (cross-sectional) and falls and disability (longitudinal) were investigated using regression analysis, adjusting for medications, cardiovascular health, neuropsychological function, and fall-related factors. Diabetes (prevalence = 9.1%) was cross-sectionally associated with shorter dual-task step length after adjusting for covariates (β = -1.59, 95% CI: -3.10, -0.08, p < .05). Diabetes was independently associated with increased risk of future instrumental activity of daily living (IADL) difficulty in those with no prior difficulty (incidence rate ratio [IRR] = 1.51, 95% CI: 1.08, 2.11, p < .05) although dual-task step length was an important confounder in all disability models. No independent associations between diabetes and falls were observed. Diabetes was independently associated with shorter dual-task step length and increased risk of future IADL difficulty. Multidimensional interventions addressing poor health and function in those with diabetes may help reduce the risk of gait deficits and future disability.

Impact of Trunk Resistance and Stretching Exercise on Fall-Related Factors in Patients with Parkinson's Disease: A Randomized Controlled Pilot Study.

Background: This study aimed to examine the effect of a 12-week progressive trunk resistance and stretching exercise program on fall-related factors in patients with Parkinson’s disease (PD). Methods: A randomized study assessed a progressive trunk resistance and stretching exercise program over a 12-week period. A total of 17 patients with PD participated and were randomly allocated into an exercise group (n = 10) or a control group (n = 7). Participants in the exercise group completed the exercise program in 60- to 90-min sessions for three days per week. Primary and secondary outcome measures included the trunk mobility scale, functional fitness test, standing balance, and sit-to-walk test. Results: The exercise group showed improvements in functional fitness, trunk mobility, standing balance, and dynamic stability compared with the control group (all p < 0.05). The 2.44 m timed up and go test (odds ratio (OR): 0.125) and the 2 min step test (OR: 10.584) of the functional fitness test, and the first-step length (OR: 3.558) and first-toe clearance height (OR: 4.777) of the sit-to-walk test, were different between the groups following the exercise program. Conclusion: This 12-week exercise program improved fall-related factors in patients with PD and may lead to prevention of fall-related injuries.

92 Development and Validity of a Fall-Risk Score for Older People who Receive Nursing-Care-Service

Abstract Introduction Older people who receive nursing-care-service have multiple fall-risk than well-functioning older people. To our knowledge, there is no appropriate fall-risk assessment for them. Most of the fall-risk assessments in previous researches were subjective. Thus, we aimed to develop a new fall-risk score included major fall-related factors such as objective motor-functions for older who receive nursing-care-service, and to verify the validity of the score. Method We recruited 264 older people who receive nursing-care-service. They were randomly allocated to the fall-risk score development group (Development group) and the score validity group (Validity group). All assessment items were major fall-risk related factors. As motor-function tests, Short-Physical-Performance-Battery (SPPB) including single-task-walking (STW), and dual-task-walking (DTW) were performed. Dual-task-cost (DTC) was computed. The DTC score was made with 0 = lower than 20%, 1 = more than 20%, 2 = incomplete DTW. As a cognitive-function test, Mini-Mental-State-Examinations was examined. Basic-health-related-information and past one-year fall-history were obtained via patient care records. Information of fear of falling was obtained via interview. In the Development group, the association between fall-history and the major fall-related factors were analyzed using multiple-logistic-regression analysis. Based on these results, we developed the 4-point fall-risk score consisted of DTC score and SPPB score (0=more than 10-point, 1=7 to 9 point, 2=less than 6-point). Finally, in the Validity group, the association between fall-history and the fall-risk score was investigated using logistic-regression analysis, and we computed area-under-the-curve (AUC). Results In the Development group, the fall-history was associated with SPPB (Odds ratio[95%CI] = 0.73[0.61-0.87]), and DTC score (Odds ratio[95%CI] = 2.50[1.14-5.79]). In the Validity group, our fall-risk score was significantly associated with fall-history [ AUC=73%, sensitivity=67%, specificity=71% ]. Conclusion In the fall-risk assessment for older people who receive nursing-care-service, our fall-risk score included SPPB and DTC are useful. The validity of our fall-risk score was confirmed.