Fall Risk In Adults Research Articles

Estimation of cervicocephalic kinesthetic perception and its correlation with fall risk in adults with diabetes and without diabetes experiencing cervical pain: A comparative study.

This study aimed to evaluate the relationship between cervicocephalic kinesthesia sensation and the incidence of falls in adults with Type 2 Diabetes Mellitus (DM-2) experiencing cervical pain. The research was conducted between January 1, 2022, and August 15, 2022. A total of 60 participants were included, with an average age of 26.03 ± 3.45 years and an average BMI of 21.4 ± 2.05 kg/m². Participants were divided into two groups: an experimental group of adults with DM-2 and cervical pain, and a control group without DM-2 but with cervical pain. Head repositioning errors were significantly higher in the experimental group for right-side and left-side lateral flexion (P = 0.002). Forward flexion also showed a significant difference between groups (P = 0.006). However, no significant differences were observed between the groups in extension (P = 0.589). No considerable differences were noted in the Berg Balance Scale (BBS) and Neck Disability Index (NDI) scores between the groups. Individuals with DM-2 experiencing neck pain exhibited minimal errors in head repositioning tests, yet no substantial alterations were evident in NDI and BBS scores.

The effects of Hyperkyphosis on Balance and Fall Risk in older adults: A Systematic Review.

The effects of Hyperkyphosis on Balance and Fall Risk in older adults: A Systematic Review.

Carpal tunnel syndrome diagnosis as a risk factor for falls.

Subclinical peroneal neuropathy without overt foot drop has been linked to increased fall risk in adults, yet remains underreported due to subtle symptoms and lack of awareness. Patients with carpal tunnel syndrome (CTS) often experience other nerve entrapments, prompting this study to evaluate CTS (a proxy for peroneal nerve entrapment) as a significant predictor of time to first fall. Data from the Merative MarketScan Research Databases (2007-2021) were used to identify adult patients using ICD-9/10 codes. Patients were stratified by CTS diagnosis and fall occurrences, with relevant comorbidities recorded. A survival analysis employing the Cox proportional hazards model assessed relationships between CTS, comorbidities, and future fall risk, accounting for changes in health status over time. Age was the time scale with CTS as a time-varying predictor. This approach isolated CTS-associated risk, while considering the natural increase in fall risk with age. Among 63,187,681 subjects (mean age = 52.82 years ± 7.61), 1,411,695 had a diagnosis of CTS. Of those with CTS, 45,479 patients had a future fall. Univariate analysis showed significant associations between CTS and higher rates of arthritis and diabetes, while heart disease was less prevalent. CTS increased fall risk by 25% (HR 1.25, p < .005). Heart disease was associated with a 10% increase in fall risk (HR 1.10, p < .005), while arthritis and diabetes increased fall risk by 2% (both HR 1.02, p < .005). Kaplan-Meier curve illustrated a steeper decline in survival probability for the CTS group, indicating they experienced falls at younger ages and at a higher rate than those without CTS (χ² = 4386.4, p < .001). Prior diagnosis of CTS is associated with an increased fall risk. Providers should screen CTS patients for fall risk and implement appropriate monitoring strategies. Further investigation on the role of peroneal nerve entrapment in this increased fall risk is warranted. This study identifies a treatable cause of falls, with potential to enhance patient safety and reduce fall-related morbidity.

Influence of regional anesthesia on fall risk in adults over 60 years

Influence of regional anesthesia on fall risk in adults over 60 years

Older Adult Fall Risk Prediction with Deep Learning and Timed Up and Go (TUG) Test Data.

Falls are a major health hazard for older adults; therefore, in the context of an aging population, predicting the risk of a patient suffering falls in the near future is of great impact for health care systems. Currently, the standard prospective fall risk assessment instrument relies on a set of clinical and functional mobility assessment tools, one of them being the Timed Up and Go (TUG) test. Recently, wearable inertial measurement units (IMUs) have been proposed to capture motion data that would allow for the building of estimates of fall risk. The hypothesis of this study is that the data gathered from IMU readings while the patient is performing the TUG test can be used to build a predictive model that would provide an estimate of the probability of suffering a fall in the near future, i.e., assessing prospective fall risk. This study applies deep learning convolutional neural networks (CNN) and recurrent neural networks (RNN) to build such predictive models based on features extracted from IMU data acquired during TUG test realizations. Data were obtained from a cohort of 106 older adults wearing wireless IMU sensors with sampling frequencies of 100 Hz while performing the TUG test. The dependent variable is a binary variable that is true if the patient suffered a fall in the six-month follow-up period. This variable was used as the output variable for the supervised training and validations of the deep learning architectures and competing machine learning approaches. A hold-out validation process using 75 subjects for training and 31 subjects for testing was repeated one hundred times to obtain robust estimations of model performances At each repetition, 5-fold cross-validation was carried out to select the best model over the training subset. Best results were achieved by a bidirectional long short-term memory (BLSTM), obtaining an accuracy of 0.83 and AUC of 0.73 with good sensitivity and specificity values.

Identification of medication-related fall risk in adults and older adults admitted to hospital: A machine learning approach

Identification of medication-related fall risk in adults and older adults admitted to hospital: A machine learning approach

Statin use and fall risk in adults: a cross-sectional survey and mendelian randomization analysis

Background and ObjectiveThe issue of falls poses a significant threat to the health of the elderly population. Although statins can cause myopathy, which implies that they may cause balance problems and increase the risk of falling, this has not been tested. Our objective was to assess whether the use of statins is linked to a higher risk of falls.MethodsA cross-sectional survey study and Mendelian randomization (MR) study were conducted to examine whether the use of statins was associated with an increased risk of falling and balance problems. The cross-sectional study included 2,656 participants from the US population (NHANES) who reported information on balance and falling problems in the past year and their use of statins. Univariate and multivariate logistic regression models were used to investigate the association between statin use and the likelihood of falling or experiencing balance problems. The MR study identified five Single Nucleotide Polymorphisms (SNPs) that predict statin use across five ancestry groups: Admixed African or African, East Asian, European, Hispanic, and South Asian. Additionally, SNPs predicting the risk of falls were acquired from the UK Biobank population. A two-sample MR analysis was performed to examine whether genetically predicted statin use increased the risk of falls.ResultsThe use of statins was found to be associated with an increased likelihood of balance and falling problems (balance problem, OR 1.25, 95%CI 1.02 to 1.55; falling problem, OR 1.27, 95%CI 1.03–1.27). Subgroup analysis revealed that patients under the age of 65 were more susceptible to these issues when taking statins (balance problem, OR 3.42, 95%CI 1.40 to 9.30; falling problem, OR 5.58, 95%CI 2.04–15.40). The MR analysis indicated that the use of statins, as genetically proxied, resulted in an increased risk of falling problems (OR 1.21, 95% CI 1.1–1.33).ConclusionOur study found an association between the use of statins and an increased risk of balance problems and falls in adults over 40 years old, and the MR study result suggested statin use increased risk of falls. The risk was higher in participants under 65 years old compared to those over 65 years old.

Clinical validation of the nursing diagnosis "Fall risk in adults (00303)" in elderly people in the community-dwelling.

To identify the risk factors for the nursing diagnosis of fall risk in adults (00303) in elderly people in the community-dwelling. This is a methodological study, with a quantitative approach, carried out with elderly people living in the city of Ribeirão Preto, SP, Brazil, from February to December 2018. For data collection, the demographic profile, Mini-Mental State Examination, diseases self-reported, functional independence measure, Lawton and Brody scale, geriatric depression scale, and self-perception of gait instruments were used. Tests of accuracy and association of risk factors with p ≤ 0.05 were performed. A total of 262 elderly people, aged over 80 years (55.7%), 71% of which were female and 42.7% were widowed, were included in the sample. A total of 82.1% had vascular diseases, 72.1% had diabetes, and 20.6% had depression. The predominant risk factors were difficulty performing instrumental activities of daily living (58.8%), cognitive dysfunction (43.5%), and depressive symptoms (26.3%). Difficulty performing instrumental activities of daily living had a sensitivity greater than 60%. The positive and negative predictive values were mostly greater than 50%. In the regression analysis, it was found that the elderly have a higher risk of suffering a fall if they present anxiety (p=0.05), impaired physical mobility (p=0.02), and difficulty to perform instrumental activities of daily living as risk factors (p=0.03). It was possible to identify the presence of risk factors for the diagnosis fall risk in adults (00303) in the clinical context of the elderly in home settings and contribute to the clinical validation of the taxonomy, increase the evidence and importance of the diagnosis, and generate new knowledge for gerontological nursing. To help nurses identify risk factors that lead elderly people to suffer falls at home and to implement preventive actions in their community with the support of their families.

Identifying trajectories and predictors of chemotherapy-induced peripheral neuropathy symptoms, physical functioning, and falls across treatment and recovery in adults treated with neurotoxic chemotherapy: the PATTERN observational study protocol (NCT05790538)

BackgroundChemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and dose-limiting side effect of systemic cancer therapy. In many cancer survivors, CIPN persists after treatment ends and is associated with functional impairments, abnormal gait patterns, falls, and diminished quality of life. However, little is known regarding which patients are most likely to develop CIPN symptoms that impair mobility and increase fall risk, when this risk develops, or the optimal timing of early intervention efforts to mitigate the impact of CIPN on functioning and fall risk. This study will address these knowledge gaps by (1) characterizing trajectories of symptoms, functioning, and falls before, during, and after treatment in adults prescribed neurotoxic chemotherapy for cancer; and (2) determining the simplest set of predictors for identifying individuals at risk for CIPN-related functional decline and falls.MethodsWe will enroll 200 participants into a prospective, observational study before initiating chemotherapy and up to 1 year after completing chemotherapy. Eligible participants are aged 40–85 years, diagnosed with stage I-III cancer, and scheduled to receive neurotoxic chemotherapy. We perform objective assessments of vibratory and touch sensation (biothesiometry, tuning fork, monofilament tests), standing and dynamic balance (quiet stance, Timed-Up-and-Go tests), and upper and lower extremity strength (handgrip dynamometry, 5-time repeated chair stand test) in the clinic at baseline, every 4–6 weeks during chemotherapy, and quarterly for 1 year post-chemotherapy. Participants wear devices that passively and continuously measure daily gait quality and physical activity for 1 week after each objective assessment and self-report symptoms (CIPN, insomnia, fatigue, dizziness, pain, cognition, anxiety, and depressive symptoms) and falls via weekly electronic surveys. We will use structural equation modeling, including growth mixture modeling, to examine patterns in trajectories of changes in symptoms, functioning, and falls associated with neurotoxic chemotherapy and then search for distinct risk profiles for CIPN.DiscussionIdentifying simple, early predictors of functional decline and fall risk in adults with cancer receiving neurotoxic chemotherapy will help identify individuals who would benefit from early and targeted interventions to prevent CIPN-related falls and disability.Trial registrationThis study was retrospectively registered with ClinicalTrials.gov (NCT05790538) on 3/30/2023.

O.4.2-8 Gait differences between adults with COPD and healthy controls: systematic review and metaanalyses

PurposeFall risk is increased in adults with COPD. Although gait is an important risk factor for falls, hospitalisations, and mortality, the available literature shows inconsistencies on whether gait differs between adults with COPD and healthy controls. The aim of this study was to identify differences in digitally-measured gait characteristics during laboratory tests between adults with COPD and healthy controls.MethodsAs part of the Mobilise-D project (https://www.mobilise-d.eu), we conducted a systematic review built upon a previous scoping review (Polhemus, A. et al. npj Digit. Med. 2021). The search was updated in July 2021. Teams of two reviewers independently screened articles and extracted data. Meta-analyses were performed in studies not considered at a high risk of bias.ResultsTwenty-five studies were included. Gait speed was studied in 17 studies (68%), step length in 9 (36%), step time in 7 (28%), cadence in 6 (24%) and step width in 5 (20%). Meta-analyses revealed that adults with COPD walked with a lower self-selected speed and top speed than healthy controls. There was a trend towards a lower step length, lower cadence and higher step time at a self-selected walking speed in adults with COPD compared to healthy controls. Step width was similar for both groups.ConclusionAdults with COPD exhibit slower gait than healthy controls. This could contribute to the increased fall risk in adults with COPD.Support/Funding SourceThis work was supported by the Mobilise-D project that has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No. 820820.

Classification of fall risk across the lifespan using gait derived features from a wearable device.

Falls are one of the leading factors of injury and fatality in older adults. Given the importance of early detection of adults at higher risk of falls, we evaluated the ability of machine learning to classify fall risk in adults across the lifespan using wearable sensors embedded in a smartshirt. We evaluated the classification performance of binary and multiclass fall risk classifier models using SciKit Digital Health in adults across the lifespan. Using a k-fold and group k-fold cross-validation strategy, we demonstrate the feasibility of fall risk classification using accelerometer data from 10 second epochs of treadmill walking data from adults across the lifespan. We achieved an 88% accuracy in a binary clasifier of fallers vs. non-fallers, and an 86% accuracy in a multiclass classifier comparing non-fallers, fallers, and recurrent fallers using retrospective fall histories. Comparing group k-fold vs. k-fold cross-validation strategies, we find a 22-27% drop-off in accuracy performance. Furthering the evaluation framework presented in this study would be valuable to the development of more robust and clinically relevant models used in the prediction of fall risk. These models could one day be applied in clinical settings to help better diagnose and monitor fall risk among older adults, improving the care of at-risk individuals and reducing the injury and associated cost of falls.

Understanding the Association of Older Adult Fall Risk Factors by Age and Sex Through Factor Analysis.

Our aim was to identify latent factors underlying multiple observed risk factors for older adult falls and to examine their effects on falls by age and sex. We performed exploratory factor analysis on 13 risk factors in the Behavioral Risk Factor Surveillance System. We used log-linear regression models to measure the association between the identified factors and older adults reporting falls. We identified two underlying factors: physical and mental health limitations. These shared a 50% correlation. Physical health limitations were more strongly associated with falls among men (prevalence ratio = 1.68, 95% CI = 1.65-1.71) than women (prevalence ratio = 1.51, 95% CI = 1.49-1.54). As physical health limitations increased, men aged 65-74 had a greater association with falls compared with other age-sex subgroups. Our findings highlight the composite relationship between age, sex, and physical and mental health limitations in association with older adult falls, and support the evidence for individually tailored, multifactorial interventions.

Combined effect of gender differences and fatiguing task on postural balance, functional mobility and fall risk in adults with multiple sclerosis: A preliminary study

ABSTRACT Aim To investigate the gender difference effect on postural balance, functional mobility, and fall risk after performing a fatiguing task in adults with multiple sclerosis (MS). Methods Eleven women (30.91 ± 8.19 years) and seven men (30.29 ± 7.99 years) with relapsing-remitting MS performed a fatiguing task: three sets of the Five-repetition Sit-To-Stand Test (5-STST) were performed before and after the six-minute WalkTest (6MWT). Bipedal postural balance in eyes open and eyes closed conditions were assessed prefatigue (T0) and postfatigue (T3) using a force platform. Unipedal balance, functional mobility (Timed Up and Go Test), fall risk (Four Square Step Test) and fatigue [Visual Analogue Scale of Fatigue (VASF)] were assessed at T0 and T3. Heart rate (HR) and Rating of Perceived Exertion (RPE) were recorded before (only for HR), during and after the fatiguing task. Results Compared to women, men showed an impairment of posturographic parameters [mean center of pressure (CoP) velocity (CoPVm) in both conditions (p < 0.05); CoP sway area (CoPAr) in both conditions (p < 0.01)], unipedal balance on the dominant leg (p <0.001), mobility (p<0.001) and an increased fall risk (p < 0.05). No gender differences were observed in 6MWT, 5-STST, HR, RPE, and VASF. Conclusion This preliminary study showed that fatiguing task negatively affected postural control, mobility and fall risk only in men. These gender differences were inconclusive but could be taken into account in postural balance rehabilitation programs for MS persons.

Development Of Normative Data of Functional Reach Test in Young Adults of Lahore; A Cross Sectional Survey

Risk of fall is one of the serious health concerns of human beings. Many tests have been developed clinically to measure risk of fall in adults. Objective: To develop preliminary normative data of functional reach test (forward reach) in young adults. Methods: A cross sectional survey was conducted in different geographical areas of Lahore. A sample of 500 healthy young adults was recruited in study through convenience sampling technique. To measure dynamic balance functional reach test (forward) was used. Results: A total sample of 500 young adults were included 22% of participants were females and 78% were males. The mean age of participants was 24± 4 years. The mean score of functional reach test (forward) was 9.87±2.9 inches, the minimum score was 3.20 inches and maximum score was 15.09 inches. There was no statistically significant difference was observed in scores of FRT in across and within the groups of both gender as p-value was &gt; 0.05. There was also weak positive significant correlation between BMI and scores of functional reach test and p&lt;0.05. Conclusion: The study provided the normative value of functional reach test (forward) for young adults.

Backward relative to forward walking speed and falls in older adults with dementia

Backward relative to forward walking speed and falls in older adults with dementia

Step length and fall risk in adults with chronic kidney disease: a pilot study

BackgroundPatients with chronic kidney disease commonly experience gait abnormalities, which predispose to falls and fall-related injuries. An unmet need is the development of improved methods for detecting patients at high risk of these complications, using tools that are feasible to implement in nephrology practice. Our prior work suggested step length could be such a marker. Here we explored the use of step length as a marker of gait impairment and fall risk in adults with chronic kidney disease.MethodsWe performed gait assessments in 2 prospective studies of 82 patients with stage 4 and 5 chronic kidney disease (n = 33) or end-stage renal disease (ESRD) (n = 49). Gait speed and step length were evaluated during the 4-m walk component of the Short Physical Performance Battery (SPPB). Falls within 6 months prior to or following enrollment were identified by questionnaire. Associations of low step length (≤47.2 cm) and slow gait speed (≤0.8 m/s) with falls were examined using logistic regression models adjusted for demographics and diabetes and peripheral vascular disease status.ResultsAssessments of step length were highly reproducible (r = 0.88, p < 0.001 for duplicate measurements at the same visit; r = 0.78, p < 0.001 between baseline and 3-month evaluations). Patients with low step length had poorer physical function, including lower SPPB scores, slower gait speed, and lower handgrip strength. Although step length and gait speed were highly correlated (r = 0.73, p < 0.001), one-third (n = 14/43) of patients with low step length did not have slow gait speed. Low step length and slow gait speed were each independently associated with the likelihood of falls (odds ratio (OR) 3.90 (95% confidence interval (CI) 1.05–14.60) and OR 4.25 (95% CI 1.24–14.58), respectively). Compared with patients who exhibited neither deficit, those with both had a 6.55 (95% CI 1.40–30.71) times higher likelihood of falls, and the number of deficits was associated with a graded association with falls (p trend = 0.02). Effect estimates were similar after further adjustment for ESRD status.ConclusionsStep length and gait speed may contribute additively to the assessment of fall risk in a general adult nephrology population.

Age-Related Vestibular Dysfunction with Motion Sensitive Vertigo and Risk of Fall in Adults

Background: This ageing is physiological process associated with vestibular dysfunction. The incidence of vestibular problems increases with age and can lead to drops, dropping risk, lack of confidence, pain and depression. Vestibular disorder is commonly characterized by vertigo or body discomfort (look and aggravation of postural stability) (a sense of spinning movement). In older adults with a fall history, peripheral vestibular disorders are among the most frequently known and widespread vestibular dysfunctions. Aim: To associate vestibular dysfunction and motion sensitive vertigo and risk of fall in adults. Methodology: Cross sectional study with convenient non- random sampling. For tests has been applied for screening vestibular dysfunction. If a participant shows 2 tests positive have vestibular dysfunction. SPSS 21 is used for data analysis. Results: Highly significant results between association of age with motion sensitive and age with fall efficacy scale P value is less than 5. Results are also significant between MSQ and FES-1. Conclusion: After conducting this research it has been concluded. That age-related vestibular dysfunction significantly associated with motion sensitive vertigo and risk of fall. As with the age people are more concerned about fall Keywords: vestibular dysfunction, vertigo, risk of fall in adults

Static and Dynamic Balance in Adults Undergoing Lumbar Spine Surgery: Screening and Prediction of Postsurgical Outcomes.

Balance and fall risk before and after lumbar surgery was assessed to determine whether balance at baseline predicts long-term postsurgical outcomes. Forty-three patients in the United States and Israel performed the single-leg stance (SLS) test, four square step test (FSST), and 8-foot up-and-go (8FUG) test before and 2 to 4 months after lumbar spine surgery. They completed the Oswestry Disability Index (ODI) and pain rating before and 12 months after lumbar surgery. From baseline to follow-up, the SLS time was 3.74 seconds longer (P = 0.01), the FSST time was 1.94 seconds faster (P < 0.001), and the 8FUG time was 1.55 seconds faster (P = 0.02). Before surgery, 26% of the patients were considered high fall risk according to the FSST and 51% according to the 8FUG. Postsurgery, all patients could complete the physical tests, but 26% remained at high fall risk according to the 8FUG and 7.5% according to the FSST. The three physical measures together explained 30% of the variance in postsurgical ODI scores (P = 0.02). Age was not correlated with performance. Risk of falling is higher than surgeons suspect. Balance tests (ie, SLS, FSST, and 8FUG) are quick and easy to administer. The findings support the importance of screening for balance and fall risk in adults undergoing lumbar spine surgery.

Factors included in adult fall risk assessment tools (FRATs): a systematic review

Abstract Falls often have severe financial and environmental consequences, not only for those who fall, but also for their families and society at large. Identifying fall risk in older adults can be of great use in preventing or reducing falls and fall risk, and preventative measures that are then introduced can help reduce the incidence and severity of falls in older adults. The overall aim of our systematic review was to provide an analysis of existing mechanisms and measures for evaluating fall risk in older adults. The 43 included FRATs produced a total of 493 FRAT items which, when linked to the ICF, resulted in a total of 952 ICF codes. The ICF domain with the most used codes was body function, with 381 of the 952 codes used (40%), followed by activities and participation with 273 codes (28%), body structure with 238 codes (25%) and, lastly, environmental and personal factors with only 60 codes (7%). This review highlights the fact that current FRATs focus on the body, neglecting environmental and personal factors and, to a lesser extent, activities and participation. This over-reliance on the body as the point of failure in fall risk assessment clearly highlights the need for gathering qualitative data, such as from focus group discussions with older adults, to capture the perspectives and views of the older adults themselves about the factors that increase their risk of falling and comparing these perspectives to the data gathered from published FRATs as described in this review.

HOW TO STEADI YOUR PATIENTS WITH THE COORDINATED CARE PLAN TO PREVENT OLDER ADULT FALLS AND EVALUATION GUIDE

Falls are common, costly, and the leading cause of fatal and nonfatal injuries for older Americans. Reports show that fall death rates are increasing. Healthcare providers play an important role in fall prevention but few talk to their patients about falls. This lack of communication demonstrates the need for more physician-initiated fall prevention. The Centers for Disease Control and Prevention (CDC) created the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative to help providers talk to their patients about falls. Specifically, CDC’s new STEADI-based fall prevention program, the Coordinated Care Plan to Prevent Older Adult Falls (CCP) and Evaluation Guide for Older Adult Clinical Fall Prevention Programs can assist healthcare providers in integrating and evaluating new fall prevention programs that screen older adults for fall risk, assess patients’ modifiable fall risk factors, and implement evidenced-based fall prevention interventions (e.g., medication management, physical therapy). The CCP offers guidance for incorporating a STEADI-based fall prevention program including how to engage leadership, integrate with existing clinic workflow and electronic health records, and strategies on how to obtain reimbursement for fall prevention. The Evaluation Plan offers details on how to engage stakeholders, collect data, interpret findings and how to share results for maximum impact. Both documents were based on lessons learned from successful implementation of STEADI-based programs in primary care. A STEADI-based program in New York found fewer fall-related hospitalizations among at-risk patients who received a fall prevention care plan compared to at-risk patients who did not receive a care plan.