Falls Efficacy Research Articles

A public data set of walking full-body kinematics and kinetics in individuals with Parkinson's disease.

To our knowledge, there is no Parkinson's disease (PD) gait biomechanics data sets available to the public. This study aimed to create a public data set of 26 idiopathic individuals with PD who walked overground on ON and OFF medication. Their upper extremity, trunk, lower extremity, and pelvis kinematics were measured using a three-dimensional motion-capture system (Raptor-4; Motion Analysis). The external forces were collected using force plates. The results include raw and processed kinematic and kinetic data in c3d and ASCII files in different file formats. In addition, a metadata file containing demographic, anthropometric, and clinical data is provided. The following clinical scales were employed: Unified Parkinson's disease rating scale motor aspects of experiences of daily living and motor score, Hoehn & Yahr, New Freezing of Gait Questionnaire, Montreal Cognitive Assessment, Mini Balance Evaluation Systems Tests, Fall Efficacy Scale-International-FES-I, Stroop test, and Trail Making Test A and B. All data are available at Figshare (https://figshare.com/articles/dataset/A_dataset_of_overground_walking_full-body_kinematics_and_kinetics_in_individuals_with_Parkinson_s_disease/14896881). This is the first public data set containing a three-dimensional full-body gait analysis of individuals with PD under the ON and OFF medication. It is expected to contribute so that different research groups worldwide have access to reference data and a better understanding of the effects of medication on gait.

Validity and Reliability of the Thai Version of the Freezing of Gait Questionnaire in Individuals With Parkinson's disease.

To evaluate the validity and reliability of the Thai version of the Freezing of Gait Questionnaire (FOG-Q) in individuals with Parkinson's disease (PD). The FOG-Q was translated into Thai according to the standard process. Fifty-six individuals with PD participated in the study. The content validity was assessed using the content validity index (CVI). The construct validity was evaluated by correlating Thai FOG-Q with Thai version of the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) items 2.13 and 3.11, Thai version of the Falls Efficacy Scale-International (FES-I), Timed Up and Go test (TUG) and Berg Balance Scale (BBS) using Spearman's correlation coefficient (rS). The correlation between Thai FOG-Q and clinical characteristics, for example, duration of PD and modified Hoehn and Yahr (mH&Y) stage was evaluated. Internal consistency and test-retest reliability were evaluated with Cronbach's alpha (Cα) and intraclass correlation coefficient (ICC), respectively. The Thai FOG-Q had high content validity (CVI=0.96). The mean FOG-Q score was 9.0±4.9. The construct validity showed a strong positive correlation with MDS-UPDRS item 2.13 (rS=0.81), and moderate correlations with MDS-UPDRS item 3.11, FES-I, and TUG (rS=0.42-0.60). A negative correlation with BBS was found (rS=-0.32). It had a moderate correlation with mH&Y stage (rS=0.40). The Thai FOG-Q had good internal consistency (Cα=0.87) with excellent test-retest reliability (ICC=0.91). The Thai FOG-Q has excellent validity and reliability. It is a useful instrument for the evaluation of FOG in individuals with PD.

Lisbon Intensive Falls Trampoline Training (LIFTT) Program for people with Parkinson’s for balance, gait, and falls: study protocol for a randomized controlled trial

BackgroundFalling and gait difficulties in people with Parkinson’s disease (PD) are associated with impaired reactive postural adjustments and impairments in attentional resources. Combined intensive balance motor and cognitive exercise can be beneficial. However, uncertainties persist regarding the true effects and safety when applying such training. Using trampoline beds may be a favorable safe environment for a highly intensive, cognitive, and balancing training approach. The primary goal of this randomized controlled trial is to assess the effects of an intensive cognitive-motor training program in a safe trampoline environment in addition to usual care on balance impairment, gait, physical capacity, fear of falling, falls frequency and severity, cognition, and clinical impairments in people with mild or moderate PD.MethodsSixty participants diagnosed with idiopathic PD, in stage 2–4 Hoehn and Yahr, with a clinical history of gait deficits and a fall history (at least one fall in the last 6 months) will be recruited and randomly allocated to an intervention group receiving cognitive-motor trampoline training or a control group undergoing their usual care. The intervention will consist of 8-week individual training sessions (1-h training, 3 days per week) led by specialized physiotherapists that will provide progressive, challenging training, and guarantee safety. Assessment will be conducted prior to and immediately after the 8-week intervention and at 3 months follow-up after participating in the study. Primary outcome measures will be balance performance (assessed using the Mini-BEST Test and nonlinear analysis) and change in gait parameters (Motor and Cognitive Timed-Up-Go and nonlinear analysis). Secondary outcomes will be change in clinical improvement (Movement Disorder Society Unified Parkinson’s Disease Rating Scale), falls (falls weekly registry), fear of falling (assessed using the Falls Efficacy Scale), physical capacity (6-min walk test), and cognition (Montreal Cognitive Assessment).DiscussionThis study will provide new evidence on the benefits of intensive cognitive-motor balance training on a trampoline for people living with PD. Better guidance on how professionals can apply safer dual-task balance and gait training in rehabilitation is needed.Trial registrationISRCTN Registry ISRCTN13160409. Retrospectively registered on February 23, 2022

Fear of falling, meaningful activity participation and community reintegration among stroke survivors in southwest Nigeria: a cross-sectional study

Background/Aims Community reintegration remains one of the most important goals of rehabilitation. The aim of this study was to investigate the relationships between fear of falling, meaningful activity participation and community reintegration of community-dwelling stroke survivors. Methods The Fall Efficacy Scale-International, Engagement in Meaningful Activities Survey and Reintegration to Normal Living Index were used to assess fear of falling, meaningful activity participation and community reintegration respectively among self-ambulant stroke survivors receiving treatment in physiotherapy outpatient clinics. The study was a cross-sectional survey. Tests of relationships, regression and association were performed with a level of significance set at P<0.05. Results A significant relationship was found between fear of falling and community reintegration (r=−0.27; P=0.01; 95% confidence interval=−0.53 to 0.04); meaningful activity participation and community reintegration (r=0.72; P=0.001; 95% CI=0.48 to 0.89) and fear of falling and meaningful activity participation (r=−0.71; P=0.53; 95% CI=−0.32 to 0.24). Older participants had lower levels of community reintegration and meaningful activity participation. A significant association was found between fear of falling and fall history (P=0.02); increased falls meant higher levels of fear of falling. Sex and duration of stroke had no significant impact on fear of falling, meaningful activity participation and community reintegration. Meaningful activity participation was the strongest predictor of community reintegration (β=1.7; 95% CI=1.30 to 2.11; P=0.001). Conclusions Fear of falling might limit participation in meaningful activity and community integration among stroke survivors. These parameters should be assessed by allied health professionals during stroke rehabilitation.

Reliability and validity of the Arabic version of the modified falls efficacy scale

Purpose The purpose of this study was to adapt Modified Falls Efficacy Scale (MFES) into Arabic and determine the reliability and validity of the instrument. Materials and methods The study was conducted in two phases: (i) translation and adaptation by the systematic approach of the ‘forward-back’ translation method and (ii) psychometric testing of the Arabic version of the Modified Falls Efficacy Scale among 207 community-dwelling older adults (≥ 60 years). Results The Arabic version of the Modified Falls Efficacy Scale demonstrated excellent internal consistency (Cronbach’s alpha = 0.98) and test–retest reliability scores (ICC = 0.96, 95% CI; 0.95–0.97). And also showed strong correlations with both the Falls Efficacy International (r = −0.82) and the activities-specific Balance Confidence Scale (r = 0.87). Sampling adequacy for factor analysis was proven by a Kaiser–Meyer–Olkin value of 0.962. Goodness-of-fit (GFI) statistics for the model were in the acceptable range (Chi-Square/Degree of Freedom (CMIN/DF) = 2.59, Goodness-of-fit index (GFI) = 0.9, Comparative Fit Index (CFI) = 0.97, Root Mean Square Error of Approximation (RMSEA) = 0.79). Conclusion The Arabic version of the Modified Falls Efficacy Scale has demonstrated excellent psychometric qualities to measure the level of fear of falling.

Psychometric Properties of the Falls Efficacy Scale-International, Cut-off Points, and Validating its Short Version Among Iranian Older People.

Older people have a fear of falling, which is far more difficult than falling itself. We measured the extent of this feeling using a short and valid Falls Efficacy Scale-International (FES-I) 7-item questionnaire for the aging community in Iran. The present psychometric work deals with outlining the validation and translation of FES-I (short version) among 9117 Persian-speaking elderly people with a mean age of 70.2±8.3 years (54.1% female and 45.9% male) in July 2021. Investigations were performed on confirmatory factor analysis, exploratory factor analysis, internal consistency, and construct validity along with test-retest reliability, receiver operating characteristic analysis, inter-rater, and convergent validity. 72.4% of the subjects were living alone, 92.9% required support in activities of daily living, and 93.0% experienced falling in the past two years. A one-factor solution was assigned by exploratory factor analysis for FES-I. Thus, this model was proved by the confirmatory factor analysis with valid fit indices. Based on Cronbach's alpha, intra-cluster correlation coefficient, and McDonald's omega (≥ 0.80), internal consistency was confirmed. The exact cut-off value was represented by the receiver operating characteristic analysis for male/female and between with/without fear of falling among older samples with higher measures of specificity and sensitivity. Moreover, a significant effect of age, aging in place, loneliness, hospitalization rate, frailty, and sense of anxiety (effect size ≥ 0.80, p ≤ 0.05) on fear of falls was detected using analysis of variance. The psychometric properties of the original scale were preserved by the Persian version of FES-I seven items as a self-reported measure of fear of falling. It could be assuredly a measure in both community and clinical settings. The possible uses and limitations of the Iranian FES-I were also discussed.

The Five Times Sit-to-Stand Test is associated with both history of falls and fear of falling among community adults aged 50years and older.

Limited evidence has examined the association between balance and mobility measures with risk of fall. To determine the prevalence and balance measures associated with falls and fear of falling among community adults aged 50years and older. This cross-sectional study included community-dwelling adults aged ≥ 50years, living in Saudi Arabia. The participants were asked to report any history of falls in the past 12months and fear of falling using the Falls Efficacy Scale (FES-I). Balance/mobility measures included the Timed Up and Go (TUG) test, Functional Reach Test (FRT), 10-m walk test (10-MWT), 6-min walk test (6-MWT), and Five Times Sit-to-Stand Test (5XSST). Two hundred and six participants, including 96 women, were included. The prevalence of falls was 12.6%, and the 5XSST was the only balance measure significantly associated with falls (OR 1.17, 95% CI [1.03, 1.33], p = 0.019) with a cutoff score of 13.93s or more, a sensitivity of 0.73, and a specificity of 0.58. An increase in 5XSST time was associated with an increase in FES-I score, while a decrease in other balance measures (10-MWT, TUG, FRT, and 6-MWT) was associated with an increase in FES-I scores. Adults living in Saudi Arabia had a low prevalence of falls. The 5XSST was the only significant balance/mobility measure that distinguished fallers from non-fallers.

Investigation of the relationship between trunk control and balance, gait, functional mobility, and fear of falling in people with Alzheimer's disease.

Optimal trunk control relies on adequate musculoskeletal, motor, and somatosensory systems that are often affected in people with Alzheimer's disease (AD). Therefore, the aim of this study was to compare trunk control between people with AD and healthy older adults, and investigate the relationship between trunk control and balance, gait, functional mobility, and fear of falling in people with AD. The study was completed with 35 people with AD and 33 healthy older adults with matching age and gender. Trunk control was evaluated with Trunk Impairment Scale (TIS); balance with Berg Balance Scale (BBS), Functional Reach Test (FRT), One-Leg Standing Test (OLST) and Five-Repeat Sit-and-Stand Test (5STS); gait with Dynamic Gait Index (DGI); functional mobility with Timed Up and Go (TUG) Test; fear of falling with Falls Efficacy Scale-International (FES-I). BBS, FRT, OLST, and DGI scores were lower and 5STS and TUG Test scores were higher in people with AD compared to healthy older adults (p < 0.05). There was no difference in FES-I score between people with AD and healthy older adults (p > 0.05). TIS was associated with BBS, FRT, OLST, 5STS, DGI, TUG Test, and FES-I (r between - 0.341 and 0.738; p < 0.05 for all). Trunk control is affected and related with balance, gait, functional mobility, and fear of falling in people with AD. For this reason, we think that trunk control should be evaluated in the early period, and applications for trunk control should be included in rehabilitation approaches in order to improve balance, gait, functional mobility, and reduce fear of falling.

Telephone-based assessment of the fear of falling in older people and factors associated.

This study aimed to validate the telephone-based application of the Falls Efficacy Scale-International (FES-I) for the assessment of the fear of falling in older people, and to investigate, among personal and environmental factors, which ones can explain this fear in this population. Participants answered the FES-I on two randomized occasions, face-to-face and by telephone. Intraclass correlation coefficient (ICC 3,1 ) was used to investigate the levels of agreement between the two occasions. The possible factors associated were sex, age, previous history of falls, family arrangement, practice of physical activity, presence of orthopedic pathologies, use of walking aids, presence of visual impairment, and presence of stairs in the home environment. Linear regression analysis was applied to investigate which of these factors could explain the fear of falling in older people. One hundred twenty-two individuals were included. There was no significant difference in the mean difference obtained between the two applications of the FES-I (1 point; 95% confidence interval, -4 to 6), with a high level of agreement (ICC = 0.88). Sex and presence of orthopedic pathologies explained 14% of the model. The FES-I showed to be a reliable scale to be applied for telephone assessments of fear of falling in older people. In addition, women with orthopedic pathologies are the profile of older people with most afraid of falling.

Gait Characteristics Associated with Fear of Falling in Hospitalized People with Parkinson's Disease.

Fear of falling (FOF) is common in Parkinson's disease (PD) and associated with distinct gait changes. Here, we aimed to answer, how quantitative gait assessment can improve our understanding of FOF-related gait in hospitalized geriatric patients with PD. In this cross-sectional study of 79 patients with advanced PD, FOF was assessed with the Falls Efficacy Scale International (FES-I), and spatiotemporal gait parameters were recorded with a mobile gait analysis system with inertial measurement units at each foot while normal walking. In addition, demographic parameters, disease-specific motor (MDS-revised version of the Unified Parkinson's Disease Rating Scale, Hoehn & Yahr), and non-motor (Non-motor Symptoms Questionnaire, Montreal Cognitive Assessment) scores were assessed. According to the FES-I, 22.5% reported low, 28.7% moderate, and 47.5% high concerns about falling. Most concerns were reported when walking on a slippery surface, on an uneven surface, or up or down a slope. In the final regression model, previous falls, more depressive symptoms, use of walking aids, presence of freezing of gait, and lower walking speed explained 42% of the FES-I variance. Our study suggests that FOF is closely related to gait changes in hospitalized PD patients. Therefore, FOF needs special attention in the rehabilitation of these patients, and targeting distinct gait parameters under varying walking conditions might be a promising part of a multimodal treatment program in PD patients with FOF. The effect of these targeted interventions should be investigated in future trials.

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.

Investigating Factors Associated with Fear of Falling in Community-Dwelling Older Adults through Structural Equation Modeling Analysis: A Cross-Sectional Study.

The scientific literature mentions the existence of factors associated with fear of falling in older adults. However, the direct and indirect paths of its predictors have not yet been fully explored. This study aimed to analyze the socioeconomic, clinical, and health factors directly and indirectly associated with fear of falling in community-dwelling older adults. This is a cross-sectional study conducted in older adults (n = 410 - 70.11 ± 7.22 years). Clinical and health-condition data were collected, as were data on fear of falling using the Falls Efficacy Scale International-Brazil (FES-I Brazil). It was found that being female and having a higher number of self-reported morbidities, worse physical performance, and a higher number of depressive symptoms were directly associated with greater fear of falling. Regarding indirect associations, physical inactivity, mediated by a greater number of morbidities, worse physical performance, and a greater number of depressive symptoms, was associated with greater fear of falling. In addition, worse self-rated health, mediated by a greater number of depressive symptoms, as well as older age, mediated by worse physical performance, were associated with the outcome. This study provides information on the predictors directly and indirectly associated with fear of falling, expanding current understanding of this relationship.

Effects of Resistance Exercise Using Theraband with Weighted Cuff Resistance on Fall Risk and Balance among the Geriatric Population: A Randomised Controlled Trial

Introduction: Balance impairments and an increased fall risk are common concerns among individuals with various health conditions. Resistance exercise has shown potential in improving balance and reducing fall risk. Aim: To determine the effects of home-based Thera-Band resistance training in reducing the risk of falls among the geriatric population and to compare it with weight-cuff resistance training. Materials and Methods: A Randomised Controlled Trial (RCT) was conducted at the Amity Institute of Health and Applied Science, Noida, India, from November 2022 to April 2023. The intervention period spanned four weeks, and a total of thirtythree subjects were enrolled in the study. The participants were divided into three groups: Group A, Group B, and Group C. Group A performed resistance exercises using weight cuffs combined with standard balance training, Group B performed resistance training with Thera-Band combined with standard balance training, and Group C received standard balance exercises alone. The effects of the interventions on fall risk reduction were assessed using the Berg Balance Scale (BBS), Timed Up and Go (TUG), and Fall Efficacy Scale (FES) among the geriatric population. Paired t-tests were employed to compare pre- and post-intervention data within each group, determining significant changes within each group over the intervention period. Analysis of variance (ANOVA) was utilised to assess between-group effects of the different interventions. Results: The FES scores were assessed pre- and postintervention for each group. Group B (Thera-Band) demonstrated significantly better outcomes in fall efficacy compared to Group A (Weight-cuff) (p&lt;0.01) and Group C (p&lt;0.01). For balance assessment using the BBS, both Group A and Group B showed better results compared to Group C (p&lt;0.01). In terms of mobility assessed through the TUG test, Group B exhibited substantial improvement compared to both Group A and Group C (p&lt;0.05). Improvements in fall efficacy, balance, and mobility were seen in Group B (Thera-Band). Conclusion: Home-based resistance training using TheraBand was found to be the most effective method for reducing the risk of falls in the geriatric population, followed by weightcuff resistance training in combination with conventional balance training. Thera-Band is not only effective but also more convenient, hassle-free, and cost-effective. The geriatric population should be provided with more multi-mode exercises that are easy to perform and have been found to be effective and helpful at their advanced age.

Dual visual impairment and contrast sensitivity among community-dwelling older adults: a cross-sectional study from the PrevQuedas Brazil trial

Objective: To investigate the importance of improving visual assessment for community-dwelling older adult fallers. Methods: This cross-sectional study included eligible community-dwelling older adults (&gt; 60 years of age) from the PrevQuedas Brazil clinical trial who had suffered at least 1 fall in the last 12 months (n = 703). We evaluated visual acuity and contrast sensitivity using the Snellen E chart and low contrast visual acuity tests; those with both impairment types were considered to have dual visual impairment. Results: Visual acuity, low contrast sensitivity, and dual visual impairment were associated with recurrent falls (OR 1.85); visual impairment was more prevalent among the oldest old. Approximately 90.00% of the participants reported using glasses, and 63.80% used multifocal lenses. Dual impairment was identified in 143 (20.30%) participants. In multivariate logistic regression, the predictive variables for recurrent falls were low contrast sensitivity (95%CI 1.15–2.47), dual visual impairment (95%CI 1.16–2.83), and self-perceived fall risk (95%CI 1.16–2.46) which was measured using the Falls Efficacy Scale-International. Conclusion: Older adults with dual visual impairment are more likely to suffer recurrent falls. Low contrast sensitivity is crucial for fall risk assessment. Trial registration: ClinicalTrials.gov (NCT01698580).

THE EFFECT OF FEAR OF FALLING OF OLDER STROKE SURVIVORS ON THEIR SELF-EFFICACY AND QUALITY OF LIFE: A CROSS-SECTIONAL STUDY

Introduction: The study was conducted to examine the effect of fear of falling on self-efficacy and quality of life in older stroke survivors. Methods: A descriptive cross-sectional study design was used. One hundred and twenty-one older adults who had had a stroke and admitted to hospital between March and December 2021 were included. Data were collected using the Sociodemographic Characteristics Form, Stroke Specific Quality of Life Scale, Tinetti Falls Efficacy Scale, Stroke Self-Efficacy Questionnaire, Barthel Activities of Daily Living Index, and Standardized Mini Mental Test. Descriptive statistics, numbers, percentages, means, Pearson correlation analysis, and simple linear regression analysis were used. Results: The mean age of participants was 74.19±6.66 years, Tinetti Falls Efficacy score was 47.67±17.38, Stroke Self Efficacy Questionnaire score was 22.49±7.64, and Stroke Specific Quality of Life Scale score was 3.13 ± 0.68. A statistically significant negative correlation was found between fear of falling and self-efficacy (r:-0.849; p &lt; 0.001) and fear of falling and quality of life (r:-0.846; p &lt; 0.001). The simple linear regression analysis indicates that Tinetti Falls Efficacy Scale had a statistically significant effect on Stroke Self Efficacy Questionnaire (p &lt; 0.001). Tinetti Falls Efficacy Scale had a significant effect on Stroke Specific Quality of Life Scale (p &lt; 0.001). Conclusion: Fear of falling in older stroke survivors significantly affects their self-efficacy and quality of life. It is recommended that fear of falling should be evaluated in detail and comprehensively in older stroke survivors. Keywords: Aged; Fear; Self Efficacy; Stroke; Quality of Life.

Adaptation and Validation of the Falls Efficacy Scale-International (FES-I) in Community-Dwelling Older Mexican Adults.

The objective of this study was to evaluate the reliability and validity of the FES-I scale in community-dwelling older Mexican adults. Participants were 222 older adults, with a mean age of 70 years; 75% were women who completed a sociodemographic data sheet, a Spanish version of the FES-I scale, intended to explore measures of depression, quality of life, and instrumental activities of daily living. Discriminant validity was demonstrated for all items on the FES-I scale and when groups of older adults were compared according to age. Evidence of internal consistency was found in all the items of the FES-I scale (α = .91) and convergent and divergent validity of the FES-I scale with measures of depression and quality of life, except instrumental activities of daily living. The Confirmatory Factor Analysis shows that the FES-I scale partially retains its two-factor measurement properties since five items were removed from the model to fit the data. The FES-I scale is a valid and reliable measure for clinical evaluations of fear of falls in older Mexican adults in the community.

Atividade física e comportamento sedentário como preditores do medo de cair e do risco de sarcopenia em idosos

Abstract Introduction Low-level physical activity and sedentary behavior are factors that can impact the fear of falling and risk of falls in older adults. Objective This study aimed to determine whether the duration and frequency of physical activity and sedentary behavior predict the fear of falling and risk of sarcopenia in older people. Methods This was a cross-sectional study with 116 older individuals from southern and southeastern Brazil. A sociodemographic and health questionnaire, the International Physical Activity Questionnaire (IPAQ – short version), the Falls Efficacy Scale – International (FES-I), and the SARC-f were used. Data were analyzed by bootstrapping procedures, Pearson's correlation, and regression analysis (p &lt; 0.05). Results Walking days (β = -0.38; p &lt; 0.001) and moderate activity days (β = -0.23; p &lt; 0.001) showed a negative prediction of fear of falling. Walking days also had a significant and negative prediction of the risk of sarcopenia (β = -0.34; p &lt; 0.001). Conclusion We conclude that weekly walking and the practice of moderate-intensity physical activity negatively predict the fear of falling in older adults. Weekly walking also negatively predicts the risk of having sarcopenia. Sedentary behavior was not a predictor of fear of falling and risk of sarcopenia.

Establishing a community pharmacy-based fall prevention service - An implementation study.

Community pharmacists are in the position to contribute to fall prevention, but this is not yet common practice. The aim of this study was to evaluate the implementation of a community pharmacy-based fall prevention service. A fall prevention service, consisting of a fall risk screening and assessment including a medication review, was implemented in pharmacies during three months. A preparative online training was provided to the pharmacy team to enhance adoption of the service. Included patients were aged ≥70 years, using ≥5 drugs of which ≥1 fall risk-increasing drug. The implementation process was quantitively assessed by registering medication adaptations, recommendations, and referrals. Changes in patient scores on the Short Fall Efficacy Scale-International (FES-I) and a fall prevention knowledge test were documented at one month follow-up. Implementation was qualitatively evaluated by conducting semi-structured interviews with pharmacists before and after the project, based on the consolidated framework of implementation research. The service was implemented in nine pharmacies and 91 consultations were performed. Medication was adapted of 32 patients. Patients' short FES-I scores were significantly higher at follow-up (p=0.047) and patients' knowledge test scores did not differ (p=0.86). Pharmacists experienced the following barriers: lack of time, absence of staff, and limited multidisciplinary collaboration. Facilitators were training, motivated staff, patient engagement, and project scheduling. The service resulted in a substantial number of medication adaptations and lifestyle recommendations, but many barriers were identified that hamper the sustained implementation of the service.

Characteristics of falls and their fear in older adults requiring long-term care.

[Purpose] Older adults requiring long-term care have a higher rate of falls than older adults who do not. This study aimed to examine the relationship between falls and fear of falling and their characteristics from the perspective of older adults requiring long-term care based on a sub-item in the Modified Falls Efficacy Scale. [Participants and Methods] This study included 51 older adults who were certified as needing long-term care. Fear of falling was measured using the Modified Falls Efficacy Scale. The Modified Falls Efficacy Scale and basic information, such as cognitive function, history of falls, level of care required, and age, were collected and analyzed based on the fall or non-fall groups. [Results] The fall and non-fall groups had 27 and 24 participants, respectively. Comparisons between the groups showed significant differences in the Modified Falls Efficacy Scale scores. Binomial logistic regression analysis results showed that "crossing the street (pedestrian crossing)" was significantly associated with falls (odds ratio=0.75). [Conclusion] In this study, falls were associated with fear of falling; specifically, among the Modified Falls Efficacy Scale items, "crossing the street (pedestrian crossing)" was significantly associated with falls.

Predictors of life-space mobility in patients with fracture 3 months after discharge from convalescent rehabilitation ward: a prospective longitudinal study.

[Purpose] To identify predictors of life-space mobility in patients with fracture three months after discharge from convalescent rehabilitation ward. [Participants and Methods] This is a prospective longitudinal study that included patients aged 65 or older with a fracture who were scheduled for discharge home from the convalescent rehabilitation ward. Baseline measurements included sociodemographic variables (age, gender, and disease), the Falls Efficacy Scale-International, maximum walking speed, the Timed Up & Go test, the Berg Balance Scale, the modified Elderly Mobility Scale, the Functional Independence Measure, the revised version of Hasegawa's Dementia Scale, and the Vitality Index up to two weeks before discharge. As a follow-up, the life-space assessment was measured three months after discharge. In the statistical analysis, multiple linear and logistic regression analyses were performed with the life-space assessment score and the life-space level of "places outside your town" as dependent variables. [Results] The Falls Efficacy Scale-International, the modified Elderly Mobility Scale, age, and gender were selected as predictors in the multiple linear regression analysis, whereas in the multiple logistic regression analysis, the Falls Efficacy Scale-International, age, and gender were selected as predictors. [Conclusion] Our study emphasized the importance of fall-related self-efficacy and motor function for life-space mobility. The findings of this study suggest that when considering post-discharge living, therapists should conduct an appropriate assessment and adequate planning.