Prevention Of Fall-related Injuries Research Articles

Retrospective Analysis of Circumstances of Falls and Related Injuries across Levels of Care in Older Adult Retirement Home Facilities.

Towards developing more effective interventions for fall-related injuries, this study analysed a novel database from six retirement home facilities over a 4-year period comprising 1,877 fallers and 12,445 falls. Falls were characterized based on location, activity, injury site, and type, and the database was stratified across four levels of care: Independent Living, Retirement Care, Assisted Care, and Memory care. Falls most occurred within the bedroom (62.8%), and during unknown (38.1%), walking (20.2%), and transfer tasks (14.6%). Approximately one in three (37%) of all falls resulted in an injury, most commonly involving the upper limb (31.8%), head (26.3%), and lower limb (22.2%), resulting in skin tears (35.3%), aches/pains (29.1%), or bruises (28.0%). While fall location, activity, and injury site were different across levels of care, injury type was not. The data from this study can assist in targeting fall-related injury prevention strategies across levels of care within retirement facilities.

A SCOPING REVIEW OF SYSTEMS-LEVEL INTERVENTIONS FOR FALL PREVENTION IN LONG-TERM CARE

Abstract Older adults residing in long-term care facilities (LTCFs) are at high risk for falls. In addition to individual resident-level interventions to prevent falls and fall-related injury (FRI), system-focused interventions are also necessary to adequately address fall prevention. Relatively little attention has been given to research involving systems-focused interventions. We aimed to synthesize studies on the effects of system-focused interventions for fall and FRI prevention in LTCFs with the goal of identifying promising strategies and gaps. We searched Medline, CINAHL, and EMBASE databases from 2017 to 2022 following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guideline. We conducted a narrative synthesis to summarize included studies. In the initial review, 301 studies were identified and underwent title and abstract screening resulting in 98 articles were retrieved for full-text review. Fifteen studies were included in data extraction. Fall prevention interventions evaluated in LTCF settings include: (1) multicomponent fall prevention programs, (2) staff education programs, (3) training in safe handling/transfers, (4) environmental adaptations, (5) electronic health record algorithms and prompts, (6) local culture change, (7) video analysis of falls to change local interventions, and (8) facility-level physical activity programs. About half of reported studies reported significant effects of system-focused interventions to reduce fall and FRI in LTCFs. Multicomponent fall prevention programs and physical activity interventions are the most effective systems-level interventions, while electronic health record interventions were the least effective. Overall, little attention has been given in the literature to evaluation of environmental adaptations at the systems level.

ASSOCIATION AND RISK PREDICTION OF PAIN AND FALL-RELATED INJURIES AMONG COMMUNITY-DWELLING OLDER ADULTS IN CHINA

Abstract Background Pain is common in older adults and has also been identified as a fall risk factor, whereas the impact and mechanism of fall-related injuries are still unknown. This study aims to examine the association and risk prediction of pain and fall-related injuries among Chinese older adults. Method This study enrolled 5,721 older adults from the China Health and Retirement Longitudinal Study (wave 2011-2015). Logistic regression was used to analyze the associations between pain characteristics and fall-related injuries. Furthermore, 2022 older adults with pain at baseline were further used to build a fall-related injury prediction model, using five machine learning algorithms (logistic regression, naive bayesian, random forest, adaptive boosting and artificial neural network) with 118 input variables as candidate features, and SHapley Additive exPlanations was used for the prediction model explanation. Results Logistic regression models showed that whether pain (OR=1.35) or pain severity (ORmoderate=1.37, ORsevere =1.48) and multisite pain (OR=1.41) independently predicted fall-related injuries. The Random forest model achieved the best performance among the prediction model with an area under the receiver operating characteristic curve of 0.764. Interpretable results showed that the top 10 significant predictors were: experience of falling, frailty, sex, short physical performance battery, received inpatient care, estimated glomerular filtration rate, lung function, pain quantity, White Blood Cell and Age. Conclusions Pain is associated with fall-related injuries among Chinese older adults. Fall-related injury prevention strategies for older adults with pain should specifically focus on fall history, frailty, and women.

Staff’s insights into fall prevention solutions in long-term care facilities: a cross-sectional study

BackgroundFalls are one of the most common and serious health issues in long-term care facilities (LTCFs), impacting not just residents, but staff and the healthcare system. This study aimed to explore LTCF staff’s current practices around falls prevention, and their suggested solutions for better falls prevention.MethodsIn the southwest of Ireland, a descriptive cross-sectional study was conducted in 13 LTCF sites, across a range of provider types and facility sizes. A survey, measuring staff knowledge, skills and attitudes, was distributed in physical and online formats. Staff suggestions for prioritising fall and fall-related injury prevention activities, and current staff practices regarding fall incidents were also sought. Content analysis was used to analyse responses, mapping categories and subcategories to the refined theoretical domains framework (TDF) and to an existing fall prevention guideline.ResultsThere were 155 respondents (15% response rate), from staff of the LTCFs. Environmental reviews and modifications (aligned to the TDF environmental context and resource domain) were the most common suggestions for preventing both falls and fall-related injuries. Other common suggestions for preventing falls were staff education, monitoring of residents, and using alarm/calling systems, while few staff members, across all roles, reported assessing residents, exercises, reviewing medications, and vitamin D supplements. For preventing fall-related injuries, suggestions included protective equipment, hip protectors and alarm/calling systems. Staff used a standardised approach when responding to a fall incident, with intensive and holistic post-fall control measures. HCAs focussed on transferring residents safely, while nurses of all grades focused more on post-fall assessment. Respondents believed that staff education, communication, increasing staffing levels and enhancing specialist care could support their practice.ConclusionNoting the low response rate, the results suggest an awareness gap regarding some evidence-based, resident-focussed falls prevention solutions, such as pro-active fall-risk assessment, exercise, medication review, and Vitamin D supplements. These aspects should be included in future fall prevention education programmes in LTCFs.

Incidence and clinical characteristics of fall-related injuries among older inpatients at a tertiary grade a hospital in Shandong province from 2018 to 2020

BackgroundFalls are an important cause of injury and death of older people. Hence, analyzing the multifactorial risk of falls from past cases to develop multifactorial intervention programs is clinically significant. However, due to the small sample size, there are few studies on fall risk analysis of clinical characteristics of fallers, especially among older hospitalized patients.MethodsWe collected data on 153 inpatients who fell (age ≥ 60 years) from the hospital nursing adverse event reporting system during hospitalization at Shandong Provincial Hospital Affiliated to Shandong First Medical University, China, from January 2018 to December 2020. Patient characteristics at the time of the fall, surrounding environment, primary nurse, and adverse fall events were assessed. The enumeration data were expressed as frequency and percentage, and the chi-squared was performed between recurrent fallers and single fallers, and non-injurious and injurious fall groups.ResultsCross-sectional data showed 18.3% of the 153 participants experienced an injurious fall. Compared with single fallers, a large proportion of older recurrent fallers more often experienced preexisting conditions such as cerebrovascular disease or taking hypoglycemic drugs. They were exposed to higher risks and could experience at least 3 fall times in 3 months. Besides, the credentials of their responsible nurses were often higher. Factors that increased the risk of a fall-related injury were hypoglycemic drugs (OR 2.751; 95% CI 1.114–6.795), and nursing adverse events (OR 47.571; 95% CI 14.392–157.247). Older inpatients with bed rails (OR 0.437; 95% CI 0.190–1.005) or falling at the edge of the bed (OR 0.365; 95% CI 0.138–0.964) were less likely to be injured than those without bed rails or not falling at the edge of the bed. Fall risks were significantly correlated with more severe fall-related injuries. Older patients with moderate (OR 5.517; CI 0.687–44.306) or high risk (OR 2.196; CI 0.251–19.219) were more likely to experience fall-related injuries than those with low risk.ConclusionsOlder inpatient falls are an ongoing challenge in hospitals in China. Our study found that the incidence of fall-related injuries among inpatients aged ≥ 60 years remained at a minor level. However, complex patient characteristics and circumstances can contribute to fall-related injuries.This study provides new evidence on fall-related injuries of older inpatients in China. Based on the factors found in this study, regular fall-related injury epidemiological surveys that investigate the reasons associated with the injuries were crucial when considering intervention measures that could refine fall-related injuries. More prospective studies should be conducted with improved and updated multidisciplinary fall risk assessment and comprehensive geriatric assessment as part of a fall-related injury prevention protocol.

Risk Factors Associated With Falls and Fall-Related Injuries Among Wheelchair Users With Spinal Cord Injury

ObjectiveTo identify risk factors for falls and fall-related injuries for wheelchair users with spinal cord injury (SCI). DesignCross-sectional study. SettingCommunity setting. ParticipantsFifty-nine community dwelling wheelchair users (N=59), 47.5% male, median age of 52.5 years (IQR, 21 years) with chronic SCI, median time since injury of 16.6 years (IQR, 27.3 years). InterventionsNo intervention. Main Outcome MeasuresOutcomes were incidence of falls and fall-related injuries. Participants reported on falls and fall-related injuries experienced in the previous 6 months. Independent variables were self-reported and performance-based measures. Self-reported measures included demographics, characteristics of SCI, fear of falling, psychological measures, functional independence, wheelchair skills, environmental barriers, quality of life, and community participation. Performance-based measures included transfer quality and sitting balance assessments. Logistic regression analyses were conducted to identify factors influencing falls and fall-related injuries. ResultsIn total, 152 falls and 30 fall-related injuries were reported from a total of 37 fallers. After logistic regression analysis, the model with the greatest levels of clinical utility and discriminative ability for falls (sensitivity 81%; specificity 55%; area under the receiving operating characteristic curve [AUC] statistics=0.73; 95% CI, 0.60-0.86) included the variables of shorter time since SCI, high mobility level, and having received education on fall prevention. The model for fall-related injuries (sensitivity 79%; specificity 75%; AUC statistics=0.77; 95% CI, 0.59-0.96) included the variables of older male individual, lower physical health score, and having received education on fall prevention. ConclusionsThe regression models presented may be used to identify wheelchair users with SCI at greater risk of falls and fall-related injuries. The findings may help to refer those in need to tailored fall and fall-related injury prevention programs. The findings presented in this study were based on a relatively small sample convenience; therefore, further prospective studies with a larger sample size are warranted.

Reliability and objectivity of the susceptibility test of the body injuries during a fall of physiotherapy students

Background and Study Aim. Falling is an increasingly frequent problem. Assessment of the ability to control the body parts that are most susceptible to injury during a fall is the primary goal of prevention of fall-related injuries. The susceptibility test of the body injuries during a fall (STBIDF) is of note. To date, investigations of the STBIDF have been limited to validity assessment. Aim. Verify the reliability and objectivity of the STBIDF test.
 Material and Methods. Thirty-five female physiotherapy students participated in this study voluntarily. The sample was selected from 45 males and females undertaking their first-degree studies during the fifth semester of 2017–2018 at Podhale State College of Applied Sciences (PSCAS) in Nowy Targ, Poland. The STBIDF questionnaire was applied. Each student was recorded during STBIDF test performance. The STBIDF reliability assessment was performed using the test-retest method. The STBIDF objectivity assessment was performed using the Delphi method, with a panel consisting of three experts.
 Results. A significant correlation (rs = 0.865, p < 0.001) between the IndexSBIDF scores for the test and retest was observed. The Wilcoxon signed-rank test result did not reveal any significant differences between the test and retest.
 Conclusions. The STBDIF is characterized by reliability and objectivity; therefore, it is a good tool for analysis of the susceptibility to injury of the body parts most exposed during falls in people from different risk groups. This non-apparatus test is a reliable and easy to use tool, available for experts dealing with falls and their consequences, and preventive approaches. It can also be used in medical, pedagogical, and athletic environments.

The SAFEST review: a mixed methods systematic review of shock-absorbing flooring for fall-related injury prevention

BackgroundShock-absorbing flooring may minimise impact forces incurred from falls to reduce fall-related injuries; however, synthesized evidence is required to inform decision-making in hospitals and care homes.MethodsThis is a Health Technology Assessment mixed methods systematic review of flooring interventions targeting older adults and staff in care settings. Our search incorporated the findings from a previous scoping review, MEDLINE, AgeLine, and Scopus (to September 2019) and other sources. Two independent reviewers selected, assessed, and extracted data from studies. We assessed risk of bias using Cochrane and Joanna Briggs Institute tools, undertook meta-analyses, and meta-aggregation.Results20 of 22 included studies assessed our outcomes (3 Randomised Controlled Trials (RCTs); 7 observational; 5 qualitative; 5 economic), on novel floors (N = 12), sports floors (N = 5), carpet (N = 5), and wooden sub-floors (N = 1). Quantitative data related to 11,857 patient falls (9 studies), and 163 staff injuries (1 study). One care home-based RCT found a novel underlay produced similar injurious falls rates (high-quality evidence) and falls rates (moderate-quality evidence) to a plywood underlay with vinyl overlay and concrete sub-floors. Very low-quality evidence suggested that shock-absorbing flooring may reduce injuries in hospitals (Rate Ratio 0.55, 95% CI 0.36 to 0.84, 2 studies; 27.1% vs. 42.4%; Risk Ratio (RR) = 0.64, 95% CI 0.44 to 0.93, 2 studies) and care homes (26.4% vs. 33.0%; RR 0.80, 95% CI 0.70 to 0.91, 3 studies), without increasing falls. Economic evidence indicated that if injuries are fewer and falls not increased, then shock-absorbing flooring would be a dominant strategy. Fracture outcomes were imprecise; however, hip fractures reduced from 30 in 1000 falls on concrete to 18 in 1000 falls on wooden sub-floors (OR 0.59, 95% CI 0.45 to 0.78; one study; very low-quality evidence). Staff found moving wheeled equipment harder on shock-absorbing floors leading to workplace adaptations. Very low-quality evidence suggests staff injuries were no less frequent on rigid floors.ConclusionEvidence favouring shock-absorbing flooring is uncertain and of very low quality. Robust research following a core outcome set is required, with attention to wider staff workplace implications.Trial registrationPROSPERO CRD42019118834.

Strengthening Resident, Proxy, and Staff Engagement in Injury Prevention in Skilled Nursing Facilities.

Engaging residents, their proxies, and skilled nursing facility (SNF) staff through effective communication has potential for improving fall-related injury prevention. The purpose of this study was to understand how multiple stakeholders develop and communicate fall-related injury prevention plans to enhance sustained implementation. Descriptive qualitative study using framework analysis applied to open-ended semistructured interviews (n = 28) regarding experiences of communication regarding fall-related injury prevention, guided by the Patient and Family Engaged Care framework. Participants included residents at high risk of injury and their proxies, nursing assistants, nurses, and a nurse practitioner from 3 SNFs in the Eastern United States (Massachusetts and North Carolina). Interdisciplinary teams were viewed as essential for injury prevention. However, the roles of the interdisciplinary team members were sometimes unclear. Communication structures were often hierarchical, which reduced engagement of nursing assistants and frustrated proxies. Practices that enhanced engagement included knowing the residents, active listening skills, and use of strategies for respecting autonomy. Engagement was inhibited by time constraints, lack of proactive communication among staff, and by challenges eliciting the perspectives of residents with dementia. Resident barriers included desire for autonomy, strong preferences, and language differences. Strengthening team meeting processes and cultivating open communication and collaboration could facilitate staff, resident, and proxy engagement in injury prevention planning and implementation. Skill building and targeting resources to improve communication can address barriers related to staff practices, resident characteristics, and time constraints.

Fall-Related Injury in Older Adult Home Care Recipients: A Descriptive Population Study

Canada is experiencing a growing aging population leading to an increase in the number of individuals receiving home care. More needs to be known about home care clients who experience fall-related injuries. The purpose of this study was to describe the characteristics of Ontario home care recipients (65 and older) who experienced fall-related injury, and the characteristics of those injuries. We conducted a population-based descriptive study using secondary data from the IC/ES data repository for the period of 2010-2014. Person-level characteristics were extracted from the Resident Assessment Instrument - Home Care and injury characteristics from ICD-10 CA codes for falls (W00-W19) in combination with injuries (S00-S99 or T00-T14), available from the NACRS database. Descriptive statistics and rates were calculated using R. Results show the population (N= 88,731) was primarily female (67.0%), the largest age group was 85-89 years old (25.5%) and hypertension was the most prevalent (83.0%) chronic condition. Clinical Assessment Protocols (CAPs) indicated need for support in management of IADLs (75.4%), falls (72.3%) and pain (70.3%). Most patients (55.8%) used nine or more medications. In 90 days prior to home care assessment, 39.6% experienced no falls, 32.4% fell once, and 26.1% fell two or more times. Injuries primarily took place within the home (38.2%). Factures were the predominant injury type (40.8%), followed by superficial injuries (19.7%). These findings create a foundation for fall-related injury prevention in home care and further research on risk identification, the efficacy of CAPs, and home environment adjustments.

Medication Review in Preventing Older Adults' Fall-Related Injury: a Systematic Review & Meta-Analysis.

BackgroundMedication review is essential in managing adverse drug reactions and improving drug safety in older adults. This systematic review evaluated medication review’s role as a single intervention or combined with other interventions in preventing fall-related injuries in older adults.MethodsElectronic databases search was conducted in PubMed, EMBASE, Scopus, and CINAHL. Two reviewers screened titles and abstracts, reviewed full texts, and performed data extraction and risk of bias assessment. Meta-analyses were conducted on studies with similar participants, interventions, outcomes or settings.ResultsFourteen randomized, controlled studies were included. The pooled results indicated that medication review as a stand-alone intervention was effective in preventing fall-related injuries in community-dwelling older adults (Risk Difference [RD] = −0.06, 95% CI: [−0.11, −0.00], I2 = 61%, p = .04). Medication review also had a positive impact on decreasing the risk of fall-related fractures (RD = −0.02, 95% CI: [−0.04, −0.01], I2 = 0%, p = .01).DiscussionThis systematic review and meta-analysis has demonstrated that medication review is effective in preventing fall-related injuries in general, and fractures specifically, in community-dwelling older adults. Future investigations focusing on the process of performing medication review will further inform fall-related injury prevention for older adults.

A Large-Scale Open Motion Dataset (KFall) and Benchmark Algorithms for Detecting Pre-impact Fall of the Elderly Using Wearable Inertial Sensors.

Research on pre-impact fall detection with wearable inertial sensors (detecting fall accidents prior to body-ground impacts) has grown rapidly in the past decade due to its great potential for developing an on-demand fall-related injury prevention system. However, most researchers use their own datasets to develop fall detection algorithms and rarely make these datasets publicly available, which poses a challenge to fairly evaluate the performance of different algorithms on a common basis. Even though some open datasets have been established recently, most of them are impractical for pre-impact fall detection due to the lack of temporal labels for fall time and limited types of motions. In order to overcome these limitations, in this study, we proposed and publicly provided a large-scale motion dataset called “KFall,” which was developed from 32 Korean participants while wearing an inertial sensor on the low back and performing 21 types of activities of daily living and 15 types of simulated falls. In addition, ready-to-use temporal labels of the fall time based on synchronized motion videos were published along with the dataset. Those enhancements make KFall the first public dataset suitable for pre-impact fall detection, not just for post-fall detection. Importantly, we have also developed three different types of latest algorithms (threshold based, support-vector machine, and deep learning), using the KFall dataset for pre-impact fall detection so that researchers and practitioners can flexibly choose the corresponding algorithm. Deep learning algorithm achieved both high overall accuracy and balanced sensitivity (99.32%) and specificity (99.01%) for pre-impact fall detection. Support vector machine also demonstrated a good performance with a sensitivity of 99.77% and specificity of 94.87%. However, the threshold-based algorithm showed relatively poor results, especially the specificity (83.43%) was much lower than the sensitivity (95.50%). The performance of these algorithms could be regarded as a benchmark for further development of better algorithms with this new dataset. This large-scale motion dataset and benchmark algorithms could provide researchers and practitioners with valuable data and references to develop new technologies and strategies for pre-impact fall detection and proactive injury prevention for the elderly.

Experience-Based Co-Design to Develop an Injury Prevention Intervention in Skilled Nursing Facilities

Experience-based co-design (EBCD) improves clinical effectiveness and safety by incorporating end-user perspectives in the design of clinical interventions. To refine a centralized, multi-component fall-related injury prevention service (IPS) to be tested in skilled nursing facilities (SNFs) in a pragmatic trial, we employed a modified EBCD process. We first conducted in-depth interviews with SNF residents, family members, and staff (n = 28; three facilities in two states) regarding their experiences in falls prevention. We then engaged these and other stakeholders from multiple institutions (n=4) in a day-long co-design workshop with our interdisciplinary research team. Building upon themes drawn from the analysis of interviews, we targeted three intervention components that were refined during the workshop: de-prescribing process, osteoporosis treatment, and educational videoconferences. Key outcomes from the ECBD process included development of strategies to ensure that: (1) residents, families, and SNF staff are involved in communication about residents identified as high risk for fall-related injury, and in related treatment decisions; (2) approaches to monitoring for unintended consequences from the injury prevention plan are clearly understood by direct care staff and are compatible with existing workflow; (3) treatment plan risks and benefits are presented in a manner easily understood by stakeholders; and (4) staff education conferences build trust with the IPS nurse and provide direct care staff with support and advice about challenging cases. EBCD is a feasible approach to strengthen intervention development in SNFs and can lead to testable new ideas for protocol refinement to address diverse stakeholder perspectives.

Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries

Falls represent a leading cause of preventable injury in hospitals and a frequently reported serious adverse event. Hospitalization is associated with an increased risk for falls and serious injuries including hip fractures, subdural hematomas, or even death. Multifactorial strategies have been shown to reduce falls in acute care hospitals, but evidence for fall-related injury prevention in hospitals is lacking. To assess whether a fall-prevention tool kit that engages patients and families in the fall-prevention process throughout hospitalization is associated with reduced falls and injurious falls. This nonrandomized controlled trial using stepped wedge design was conducted between November 1, 2015, and October 31, 2018, in 14 medical units within 3 academic medical centers in Boston and New York City. All adult inpatients hospitalized in participating units were included in the analysis. A nurse-led fall-prevention tool kit linking evidence-based preventive interventions to patient-specific fall risk factors and designed to integrate continuous patient and family engagement in the fall-prevention process. The primary outcome was the rate of patient falls per 1000 patient-days in targeted units during the study period. The secondary outcome was the rate of falls with injury per 1000 patient-days. During the interrupted time series, 37 231 patients were evaluated, including 17 948 before the intervention (mean [SD] age, 60.56 [18.30] years; 9723 [54.17%] women) and 19 283 after the intervention (mean [SD] age, 60.92 [18.10] years; 10 325 [53.54%] women). There was an overall adjusted 15% reduction in falls after implementation of the fall-prevention tool kit compared with before implementation (2.92 vs 2.49 falls per 1000 patient-days [95% CI, 2.06-3.00 falls per 1000 patient-days]; adjusted rate ratio 0.85; 95% CI, 0.75-0.96; P = .01) and an adjusted 34% reduction in injurious falls (0.73 vs 0.48 injurious falls per 1000 patient-days [95% CI, 0.34-0.70 injurious falls per 1000 patient-days]; adjusted rate ratio, 0.66; 95% CI, 0.53-0.88; P = .003). In this nonrandomized controlled trial, implementation of a fall-prevention tool kit was associated with a significant reduction in falls and related injuries. A patient-care team partnership appears to be beneficial for prevention of falls and fall-related injuries. ClinicalTrials.gov Identifier: NCT02969343.

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.

Association Between Arterial Stiffness, Frailty and Fall-Related Injuries in Older Adults.

PurposeThis study was conducted to investigate the relationships between arterial stiffness, frailty and fall-related injuries among community-dwelling older adults.Materials and MethodsA cross-sectional study of a random sample of older adults aged 60 years and older was conducted. Main study parameters: arterial stiffness was measured by the determining the cardio-ankle vascular index (CAVI); Frailty status was defined using a 7-item frailty screening scale, developed in Russia. This questionnaire included question about falls and fall-related injuries. Orthostatic test and anthropometric tests were done. Medical history (comorbidity, medications), the Osteoporosis Self-assessment Tool (OST), nutritional, physical, cognitive and functional status were evaluated.ResultsThe study population included 163 people aged 60–89 years. The average predicted value of CAVI in women aged 60–69 was 9.13 ± 0.13, in men, 9.49 ± 0.05; in women aged 70–79, it was 9.49 ± 0.16, in men, 9.73 ±0.11; in women aged 80 and older it was 10.04 ±0.18, in men, 10.24 ±0.10 units. The CAVI above the predicted value was associated with fall-related injuries even after adjustment for age, sex, use of β-blockers (BBs), history of stroke, and region of residence with the odds ratio 3.52 (95% CI: 1.03 −12.04).ConclusionOur study revealed an independent association between arterial stiffness and fall-related injuries in older adults over 60 years. The findings suggest that clinicians, especially geriatricians, should pay attention to arterial stiffness of patients with fall-related injuries. Similarly, the patients with CAVI above age-predicted value should be evaluated for risk of falls for prevention of fall-related injuries.

Protocol for the SAFEST review: the Shock-Absorbing Flooring Effectiveness SysTematic review including older adults and staff in hospitals and care homes

IntroductionFalls in hospitals and care homes are a major issue of international concern. Inpatient falls are the most commonly reported safety incident in the UK’s National Health Service (NHS), costing...

Recommendations for Fall-Related Injury Prevention: A 1-Year Review of Fall-Related Root Cause Analyses in the Veterans Health Administration.

Injurious falls continue to challenge health care. Causes of serious falls from the largest health care system in the United States can direct future prevention efforts. This article analyzes injurious falls in the Veterans Health Administration and provides generalizable recommended actions to prevent future events. We categorized root cause analysis (RCA) reports and coded injury type, fall type, location, and root causes. We describe interventions during the fall and provide resources for future prevention. There were 154 reported fall RCAs during this time. Most (83%, n = 128) resulted in major injury: hip fractures (43%, n = 66), other fractures (25%, n = 38), and head injury (16%, n = 24). Most falls were unwitnessed (75%, n = 116). Patients who fell were not wearing hip or head protection. Most falls were unwitnessed, and none were on 1:1 observation. Such interventions may help prevent future injurious falls.

The efficacy and safety of exercise for prevention of fall-related injuries in older people with different health conditions, and differing intervention protocols: a meta-analysis of randomized controlled trials

BackgroundWhether exercise prevents fall-related injuries in different health conditions and with different training protocols is still unclear. This study aimed to determine the effect of exercise on fall-related injuries by participant characteristics and divergent exercise protocols. The safety and compliance of exercise were also examined.MethodsElectronic database searches were conducted in PubMed, Web of Science, and EMBASE for randomised controlled trials that evaluated the influence of exercise on fall-induced injuries in older people.ResultsTwenty-five trials met the inclusion criteria. Exercise significantly reduced the risk of fall-related injuries in older adults, risk ratio (RR) 0.879 [95% confidence interval (CI) 0.832–0.928]. Among the injuries, events needing medical care or resulting fractures were also decreased by exercise intervention, with RR 0.681 (0.562–0.825) and 0.561 (0.366–0.860), respectively. When analysis was stratified by participant characteristics and exercise protocols, we found that participants at high risk of falling, or with osteoporosis, were sensitive to exercise intervention. Combined exercise protocols and balance training were the most effective exercise types in reducing fall-related injuries. Exercise-associated beneficial effects were even significant in very old people (≥80 years) and across the duration of interventions (< 6 months, 6 to 12 months and ≥ 12 months). Exercise only generated a very low injury rate per participant year (0.002, 95% CI 0–0.05) and showed relatively good compliance of exercise (as reported in the included papers) (78.5, 95% CI 72.8–84.2%).ConclusionsExercise is effective in preventing fall-induced injuries across a variety of baseline participant characteristics and exercise protocols. Exercise was associated with a low injury rate and had a good compliance, suggesting it is a feasible approach to managing fall-related injuries.

THE SAFEST REVIEW: THE SHOCK-ABSORBING FLOORING EFFECTIVENESS SYSTEMATIC REVIEW IN CARE SETTINGS

Falls in hospitals and care homes are a major issue of international concern. Falls cost the US $34 billion a year, with injurious falls being particularly life-limiting and costly. Shock-absorbing flooring decreases the stiffness of the ground surface to reduce the impact of a fall. There is a growing body of evidence on flooring for fall-related injury prevention, however no systematic review exists to inform practice. We systematically reviewed the evidence on the clinical and cost-effectiveness of shock-absorbing flooring use for fall-related injury prevention in care settings. We searched six databases, clinical trial registries, conference proceedings, theses/dissertations, websites, reference lists, conducted forward citation searches, and liaised with experts in the field. We conducted study selection, data collection, and critical appraisal independently in duplicate. We evaluated the influence of shock-absorbing flooring on fall-related injuries, falls, and staff work-related injuries. We adopted a mixed methods approach considering evidence from randomised, non-randomised, economic, qualitative, and implementation studies. We assessed and reported the quality of outcomes using the GRADE approach and Summary of Findings Tables. This review, conducted over the course of 2019, summarises the certainty of the evidence on whether and which shock-absorbing floors influence injuries from falls, the chance of someone falling over, and work-related injuries in staff (e.g. from manoeuvring equipment across softer floors). Our findings are applicable to health and social care professionals, buildings and facilities managers, carers, older adults, architects, and designers. Funded by National Institute for Health Research, Health Technology Assessment (ref 17/148/11); registered in PROSPERO (CRD42019118834).