Falls In People Research Articles

Falls in people with Parkinson’s disease: A prospective comparison of community and home-based falls

BackgroundFalls are common and debilitating in people with Parkinson’s disease (PD) and restrict participation in daily activities. Understanding circumstances of falls in the community and at home may assist clinicians to target therapy more effectively. ObjectiveTo compare the characteristics of community and home fallers and the circumstances that contribute to falls in people living with PD. MethodsPeople with mild-moderately severe PD (n = 196) used a daily falls diary and telephone hotline to report prospectively the occurrence, location and circumstances of falls over 14 months. Results62% of people with PD fell, with most falling at least once in the community. Compared to people who fell at home, the community-only fallers had shorter durations of PD (p = 0.012), less severe disease (p = 0.008) and reported fewer falls in the year prior to the study (p = 0.003). Most falls occurred while people were ambulant, during postural transitions and when medication was working well. Community-based falls were frequently attributed to environmental factors such as challenging terrains (p < 0.001), high attention demands (p = 0.029), busy or cluttered areas (p < 0.001) and tasks requiring speed (p = 0.020). Physical loads were more often present in home than community-based falls (p = 0.027). ConclusionFalls that occur in the community typically affect people with earlier PD and less severe disease than home-based falls. Individuals experiencing community-based falls may benefit from physiotherapy to manage challenging environments and high attention demands.

Cohort Randomised Controlled Trial of a Multifaceted Podiatry Intervention for the Prevention of Falls in Older People (The REFORM Trial).

BackgroundFalls are a major cause of morbidity among older people. A multifaceted podiatry intervention may reduce the risk of falling. This study evaluated such an intervention.DesignPragmatic cohort randomised controlled trial in England and Ireland. 1010 participants were randomised (493 to the Intervention group and 517 to Usual Care) to either: a podiatry intervention, including foot and ankle exercises, foot orthoses and, if required, new footwear, and a falls prevention leaflet or usual podiatry treatment plus a falls prevention leaflet. The primary outcome was the incidence rate of self-reported falls per participant in the 12 months following randomisation. Secondary outcomes included: proportion of fallers and those reporting multiple falls, time to first fall, fear of falling, Frenchay Activities Index, Geriatric Depression Scale, foot pain, health related quality of life, and cost-effectiveness.ResultsIn the primary analysis were 484 (98.2%) intervention and 507 (98.1%) control participants. There was a small, non statistically significant reduction in the incidence rate of falls in the intervention group (adjusted incidence rate ratio 0.88, 95% CI 0.73 to 1.05, p = 0.16). The proportion of participants experiencing a fall was lower (49.7 vs 54.9%, adjusted odds ratio 0.78, 95% CI 0.60 to 1.00, p = 0.05) as was the proportion experiencing two or more falls (27.6% vs 34.6%, adjusted odds ratio 0.69, 95% CI 0.52 to 0.90, p = 0.01). There was an increase (p = 0.02) in foot pain for the intervention group. There were no statistically significant differences in other outcomes. The intervention was more costly but marginally more beneficial in terms of health-related quality of life (mean quality adjusted life year (QALY) difference 0.0129, 95% CI -0.0050 to 0.0314) and had a 65% probability of being cost-effective at a threshold of £30,000 per QALY gained.ConclusionThere was a small reduction in falls. The intervention may be cost-effective.Trial RegistrationISRCTN ISRCTN68240461

Risk Factors Associated with the Fear of Falling in Community-Living Elderly People in Korea: Role of Psychological Factors.

Little is known about the risk factors for the fear of falling in elderly Korean individuals. Thus, the present study aimed to investigate the risk factors for fear of falling in a representative elderly population of over 10,000 individuals aged 65 years and older. A multivariate multinomial analysis revealed that the risk factors associated with a severe fear of falling were being female [odds ratio (OR)=4.396], older age (OR=5.550 for those aged ≥85 years), lower level of education (OR=0.719 for those with ≥13 years of schooling), chronic illness (OR=2.788 for those with more than three chronic illnesses), poor subjective health (OR=6.268), functional impairments (OR=2.340), a history of falling (OR=7.062), and depression (OR=1.774). The ORs for each of these risk factors were particularly high in participants with a severe fear of falling. Particularly, a history of falling and/or poor subjective health status had strong independent associations with the fear of falling. The present findings may help health care professionals identify individuals that would benefit from interventions aimed at reducing the fear of falling.

Comparison between Tai Chi and Balance-Strength Training Exercise to Decrease Fear of Fall and Improving Balance and Functional Mobility in Elderly

Background of the study: Falls in older people are a common and important problem that can have devastating consequences for individuals and their support networks. The purpose of this trial is to compare the effect of two types of exercise, Tai Chi versus Balance and strength training (BS Training) to reduce fear of fall and to improve balance and functional mobility in elderly. Method: It was a two-group, single-blind, randomized clinical trial in subjects, and aged 60-80 years old. They were divided in 2 equal groups; Group A was Tai Chi group and Group B was B.S. training group. Exercises were given for both the groups 5 days in a week for 8 weeks, Study outcome include fear of fall (Fall Efficacy Scale- FES), Balance (Berg Balance Scale -BBS) and Function Mobility (Timed up and go test -TUG). Result: There were significant reduction in fear of fall and improvement in balance & functional Mobility in both the groups after 8 weeks of intervention. Tai Chi group had better effect as compare to the Balance-Strength training group in reducing fear of fall & improving Functional Mobility. Conclusion: This study demonstrate that Tai Chi have better beneficial effects in reducing fear of fall and improving balance & functional mobility as compared to Balance-Strength training in elderly after 8 weeks of intervention.

Effect of Dual Tasking on Gait and Balance in Geriatric Population: An Observational Study

Background: Aging is a process of growing old which describes a wide array of physiological changes in the body system. With aging, structural changes of the brain occur, especially in the prefrontal areas, which have been associated with the Executive function and attention systems. Dual tasking demands divided attention which increases chances of fall in Geriatric people. Aim: To evaluate whether Gait or Balance which one is more sensitive for dual task activity in geriatric population and detecting changes in Gait and Balance performance. Materials and methodology: 57 Participants with the age group of 60-84 years (70.51 ± 6.33) took part in the study. Each participant performs 10 meter walk test and berg balance scale. Gait parameters and BBS Score were measured as a baseline data. Then perform 10 MWT and BBS with cognitive and motor task (Dual Task). All gait and balance parameters were documented during dual task activity. Results: The result shows statistical significant (p<0.05) effect of dual task on both Gait and Balance parameters. During dual task activity time and cadence were increased but speed, step length and stride length were reduced. BBS Score were also reduced. Conclusion: Dual tasking affects Gait and Balance both, Where Balance is more affected than Gait in Geriatric population.

Reaction Time and Postural Sway Modify the Effect of Executive Function on Risk of Falls in Older People with Mild to Moderate Cognitive Impairment

To explore the relationship between cognitive performance and falls in older people with mild to moderate cognitive impairment (CI) by investigating the mediational effects of medical, medication, neuropsychological, and physiological factors. Secondary analysis, prospective cohort study. Community and low-level care. 177 older people (aged 82 ± 7 years) with mild to moderate CI (MMSE 11-23; ACE-R < 83). Global cognition and six neuropsychological domains (memory, language, visuospatial, processing speed, executive function [EF], and affect) were assessed. Participants also underwent sensorimotor and balance assessments. Falls were recorded prospectively for 12 months. The EF domain was most strongly associated with multiple falls (relative risk [RR]: 1.50, 95% CI: 1.18-1.91). Global cognition was not associated with falls (RR: 1.09, 95% CI: 0.92-1.30). Additional analyses showed that participants with poorer EF (median cutpoint) were more likely to be taking centrally acting medications and were less physically active. They also had significantly worse vision, reaction time, knee extension strength, balance (postural sway, controlled leaning balance), and higher physiological fall risk scores. Participants with poorer EF were 1.5 times (RR: 1.50, 95% CI: 1.03-2.18) more likely to have multiple falls. Mediational analyses demonstrated that reaction time and postural sway reduced the relative risk of EF on multiple falls by 31% (RR: 1.19, 95% CI: 0.81-1.74). Within this sample of older people with mild to moderate CI, poorer EF increased the risk of multiple falls. This relationship was mediated by reaction time and postural sway,suggesting cognitively impaired older people with poorer EF may benefit from fall prevention programs targeting these mediating factors.

Effects of Functional Training and Calf Stretching on Risk of Falls in Older People: A Pilot Study.

This study aimed to determine the effects of a functional training and ankle stretching program in triceps surae torque, passive stiffness index, and in the risk for fall indicators in older adults. Twenty women (73.4 ± 7.3 years) were allocated into an intervention or control group. The 12-week intervention consisted of functional training and calf stretching exercises performed twice a week. Measurements of peak passive and active torque, passive stiffness, maximum dorsiflexion angle, and indexes of risk for falls (Timed Up and Go, functional reach test, QuickScreen-test) were collected. There were no significant differences for all variables, except the maximum dorsiflexion angle, which increased in the intervention group from 33.78 ± 8.57° to 38.89 ± 7.52°. The exercise program was not sufficient to enhance performance on functional tests and decrease the risk for falls in older adults. The significant increase in the maximum dorsiflexion indicates a positive impact of stretching exercises.

Profile of Falls in Community-Dwelling People with Multiple Sclerosis: Preliminary Results From an Irish Cohort

1.To investigate the context, causes and consequences of falls in people with Multiple Sclerosis (pwMS) 2.To assess the level of concern about falling in this population 3.To investigate the level of reporting of falls and participation in falls prevention programmes.

Effectiveness of Non-Pharmacological Interventions to Prevent Falls in Older People: A Systematic Overview. The SENATOR Project ONTOP Series.

BackgroundFalls are common events in older people, which cause considerable morbidity and mortality. Non-pharmacological interventions are an important approach to prevent falls. There are a large number of systematic reviews of non-pharmacological interventions, whose evidence needs to be synthesized in order to facilitate evidence-based clinical decision making.ObjectivesTo systematically examine reviews and meta-analyses that evaluated non-pharmacological interventions to prevent falls in older adults in the community, care facilities and hospitals.MethodsWe searched the electronic databases Pubmed, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, PsycINFO, PEDRO and TRIP from January 2009 to March 2015, for systematic reviews that included at least one comparative study, evaluating any non-pharmacological intervention, to prevent falls amongst older adults. The quality of the reviews was assessed using AMSTAR and ProFaNE taxonomy was used to organize the interventions.ResultsFifty-nine systematic reviews were identified which consisted of single, multiple and multifactorial non-pharmacological interventions to prevent falls in older people. The most frequent ProFaNE defined interventions were exercises either alone or combined with other interventions, followed by environment/assistive technology interventions comprising environmental modifications, assistive and protective aids, staff education and vision assessment/correction. Knowledge was the third principle class of interventions as patient education. Exercise and multifactorial interventions were the most effective treatments to reduce falls in older adults, although not all types of exercise were equally effective in all subjects and in all settings. Effective exercise programs combined balance and strength training. Reviews with a higher AMSTAR score were more likely to contain more primary studies, to be updated and to perform meta-analysis.ConclusionsThe aim of this overview of reviews of non-pharmacological interventions to prevent falls in older people in different settings, is to support clinicians and other healthcare workers with clinical decision-making by providing a comprehensive perspective of findings.

Daily-Life Gait Quality as Predictor of Falls in Older People: A 1-Year Prospective Cohort Study.

Falls can have devastating consequences for older people. We determined the relationship between the likelihood of fall incidents and daily-life behavior. We used wearable sensors to assess habitual physical activity and daily-life gait quality (in terms of e.g. stability, variability, smoothness and symmetry), and determined their predictive ability for time-to-first-and-second-falls. 319 older people wore a trunk accelerometer (Dynaport MoveMonitor, McRoberts) during one week. Participants further completed questionnaires and performed grip strength and trail making tests to identify risk factors for falls. Their prospective fall incidence was followed up for six to twelve months. We determined interrelations between commonly used gait characteristics to gain insight in their interpretation and determined their association with time-to-falls. For all data -including questionnaires and tests- we determined the corresponding principal components and studied their predictive ability for falls. We showed that gait characteristics of walking speed, stride length, stride frequency, intensity, variability, smoothness, symmetry and complexity were often moderately to highly correlated (r > 0.4). We further showed that these characteristics were predictive of falls. Principal components dominated by history of falls, alcohol consumption, gait quality and muscle strength proved predictive for time-to-fall. The cross-validated prediction models had adequate to high accuracy (time dependent AUC of 0.66–0.72 for time-to-first-fall and 0.69–0.76 for -second-fall). Daily-life gait quality obtained from a single accelerometer on the trunk is predictive for falls. These findings confirm that ambulant measurements of daily behavior contribute substantially to the identification of elderly at (high) risk of falling.

Controlled Whole-body Vibration Training Reduces Risk Of Falls In People With Multiple Sclerosis

Despite the prevalence of falls among people with multiple sclerosis (MS), there are very limited evidence-based treatment approaches for fall prevention among this population. Controlled whole-body vibration (CWBV) training has recently emerged as a new modality to train older adults to reduce their risk of falls primarily because it is portable, safe, easy to use, and effective; and requires less intensive physical activity than traditional exercise-based methods. Nevertheless, there is a lack of evidence about the impact of CWBV training on reducing falls in people with MS. PURPOSE: To examine if an 8-week CWBV training protocol can reduce risk of falls in people with MS. METHODS: Twenty individuals (14 females) with MS (mean ± SD age: 52.0 ± 14.3 y/o, disease duration: 16.1 ± 11.5 y) underwent the vibration training 3 times per week for 8 weeks while standing on a side alternating vibration platform. Each session included 5 repetitions of 1-min vibration exposure followed by a 1-min seated rest. The vibration frequency and amplitude were 20 Hz and 3.2 mm, respectively. Their risk of falls was quantified by the isometric knee extensor muscle strength capacity (normalized to the body mass), the EquiScale balance scale, and Timed-Up-and-Go (TUG) test; and was evaluated pre and post the 8-week training. Paired t-tests were used to examine if the training improves these risk factors of falls. RESULTS: The knee extensor strength capacity on the affected side was significantly increased from 0.92 ± 0.51 Nm/kg for pre-training test to 1.06 ± 52.54 Nm/kg for the post-training test (p < 0.01). Compared to pre-training values, there was a significant improvement at post-training for body balance (11.00 ± 4.16 vs. 12.55 ± 3.31, p < 0.001) and TUG (14.92 ± 6.80 vs. 13.33 ± 5.63 s, p < 0.01). CONCLUSIONS:The findings of this study suggest that an 8-week vibration training program reduced risk of falls among individuals with MS by strengthening muscles, improving body balance, and enhancing functional mobility. The clinical application of CWBV may reduce falls for individuals with MS; however, more systematic studies based on large sample sizes are needed to examine the longitudinal effect of vibration training to reduce the number of real-life falls among persons with MS. Supported by NMSS Grant PP-3385 (to FY).

Gait Speed Cut-Off Point as a Predictor of Fall in Community-Dwelling Older Adults: Three-Year Prospective Finding from Living Profiles of Elderly People Surveys in Korea

BACKGROUND: Gait speed has been reported as a powerful predictor of adverse outcomes in the elderly. Falls in older people are considered significant because they are directly related to quality of life. The purpose of this study was to investigate the relationship between gait speed and falls, and to determine a gait speed cut-off point for identifying elevated risk for falls in elderly Koreans. Methods: Data were gathered from the 2008 and 2011 Living Profiles of Older People Surveys that included 8,009 community-dwelling Korean men and women aged 65 years or older. Gait speed data were extracted from the 2008 survey, and falls data were extracted from the 2008 and 2011 surveys. A receiver operating characteristic curve was plotted, and different gait speed cut-offs were analyzed for sensitivity and specificity to determine a cut-off point for better prediction of subsequent falls. Results: Of all subjects enrolled in the study, 22.2% (1,780 of 8,009) reported falls during the follow-up period. The cut-off point for gait speed was determined to be 0.7 m/s. After adjusting for age and sex, a slower gait speed ( Conclusion: Our findings suggest that a gait speed slower than 0.7 m/s (after adjusting for age and sex) is a reliable predictor of falls in communitydwelling elderly Koreans. Keywords: Gait Speed; Cut-Off Point; Falls; Aging; Aged; Korean Language: en

Prevention of falls in the elderly: a review of new concepts based on the evidence

Who estimates on aging say 2050 will reach 2000 million people over 60 years. It is vital to analyze the attention to this population group and prevent situations that cause increased morbidity and mortality in it. Falls in older people, they have to work in a multidisciplinary way. Clinical impact in falls, social and family factors. Objetive: To analyze the incidence of falls as an etiological factor of bone fractures in patients over 65 years. Establish what other health variables such as comorbidity, polypharmacy, functional dependence, may be related to its etiology. Method: We performed a quasi- experimental design of repeated measures. The final sample consisted of 259 participants. The instruments used were the Barthel Index, the Fototest and MNA. Conclusions: The intervention in the prevention of falls the elderly should be a multidisciplinary work, as it depends on many factors such as health, food, marital status or the conditions of their habitual residence, which must be addressed by various professionals.

Disability is an Independent Predictor of Falls and Recurrent Falls in People with Parkinson’s Disease Without a History of Falls: A One-Year Prospective Study

Predictors of falls in people with Parkinson's disease (PD) who have not previously fallen are yet to be identified. We aimed to identify predictors of all falls and recurrent falls in people with PD who had not fallen in the previous year and to explore the timing of falls in a 12-month follow-up period. Participants with PD (n = 130) were assessed by disease-specific, self-report and balance measures. Falls were recorded prospectively for 12 months. Univariate and multivariate analyses were performed. Kaplan-Meier survival analysis was used to investigate time to falling. Forty participants (31%) had ≥1 fall during follow-up and 21 (16%) had ≥2 falls. Disability, reduced balance confidence and greater concern about falling were associated with ≥1 fall in univariate analyses. Additionally, PD duration and severity, freezing of gait and impaired balance were associated with ≥2 falls (p < 0.05). Disability (Schwab and England scale, Odds Ratio [OR] = 0.56 per 10 points increase; 95% confidence interval [CI] 0.39-0.80; p = 0.002) was associated with ≥1 fall in the final multivariate model (area under the receiver operating characteristic curve [AUC] = 0.65; 95% CI 0.55-0.76; p = 0.005). Disability (Unified Parkinson's Disease Rating Scale activities of daily living, OR = 1.20; 95% CI 1.07-1.34; p = 0.001) and levodopa equivalent dose (OR = 1.11 per 100 mg increase; 95% CI 0.95-1.30; p = 0.19) were associated with ≥2 falls in the final multivariate model (AUC = 0.72; 95% CI 0.60-0.84; p = 0.001). Recurrent fallers experienced their first fall earlier than single fallers (p < 0.05). Self-reported disability was the strongest single predictor of all falls and recurrent falls.

Medications Are Associated with Falls in People with Multiple Sclerosis: A Prospective Cohort Study.

Medication use is associated with falls in many populations, but the relationship between medications and falls in people with multiple sclerosis (MS) is not well understood. The number and types of medications used by 248 ambulatory adults with MS in the United States (n = 53) and Australia (n = 195) were assessed. Participants completed fall diaries for 6 months. Associations between number and type of medications reported and falls, adjusting for age, disease severity, comorbidities, sex, and country, were evaluated using multiple logistic regression. Participants reported taking a median of three medications and two supplements. A total of 143 participants (58%) fell at least once in the 6 months, and 110 (44%) experienced one or more injurious falls. The adjusted relative odds of a fall or an injurious fall increased by 13% (P = .048) and 11% (P = .049), respectively, for each medication and by 43% (P = .015) and 55% (P = .001) for each neurologically active medication. Reported use of MS disease-modifying therapy was associated with 48% decreased odds of falling (P = .035) but not significantly decreased odds of injurious falls. Reporting use of more medications and more neurologically active medications is associated with falls and injurious falls in people with MS. Close evaluation of the need for each medication, with associated minimization of neurologically active medications in patients with MS, may help prevent falls. Use of MS disease-modifying therapies may be associated with fewer falls. This relationship needs further evaluation.

Risk of Falls in People with Diabetes Mellitus

Risk of Falls in People with Diabetes Mellitus

Balance Exercise Program Reduced Falls in People with Multiple Sclerosis: A Single-Group, Pretest-Posttest Trial

Balance Exercise Program Reduced Falls in People with Multiple Sclerosis: A Single-Group, Pretest-Posttest Trial

Occurrence and Predictors of Falls in People With Stroke: Six-Year Prospective Study.

The purpose was to investigate the occurrence of self-reported falls in people with stroke at 3, 6, and 12 months and 6 years post stroke and predictors for falls during 6 years. A prospective study involving 121 people with stroke. Data were obtained through structured interviews and assessments. Generalized estimating equation modeling using proportional odds was used to explore the predictive value of fall history, functioning/disability, and personal factors during 6 years. The proportion of fallers constituted of 35%, 26%, 33%, and 35% of the sample at 3, 6, and 12 months and 6 years of follow-up, respectively. Higher perceived effect of stroke on activities of daily living (odds ratio, 1.37; 95% confidence interval, 1.04-1.80), falls at 3 months (odds ratio, 1.0; 95% confidence interval, 1.01-3.94), and no gait/balance disability at baseline (odds ratio, 7.29; 95% confidence interval, 1.99-26.73) were predictors for future falls. During the 6 years, the odds for a fall decreased for participants with gait/balance disability at baseline but increased for those with no gait/balance disability. Results highlight the importance of performing fall risk evaluations over time among people with stroke, even when gait and balance functioning initially post stroke is good.

Economic Evaluation of a Tai Ji Quan Intervention to Reduce Falls in People With Parkinson Disease, Oregon, 2008-2011.

IntroductionExercise is effective in reducing falls in people with Parkinson disease. However, information on the cost effectiveness of this approach is lacking. We conducted a cost-effectiveness analysis of Tai Ji Quan for reducing falls among patients with mild-to-moderate Parkinson disease.MethodsWe used data from a previous intervention trial to analyze resource use costs related to intervention delivery and number of falls observed during a 9-month study period. Cost effectiveness was estimated via incremental cost-effectiveness ratio (ICER) in which Tai Ji Quan was compared with 2 alternative interventions (Resistance training and Stretching) on the primary outcome of per fall prevented and the secondary outcome of per participant quality-adjusted life years (QALY) gained. We also conducted subgroup and sensitivity analyses.ResultsTai Ji Quan was more effective than either Resistance training or Stretching; it had the lowest cost and was the most effective in improving primary and secondary outcomes. Compared with Stretching, Tai Ji Quan cost an average of $175 less for each additional fall prevented and produced a substantial improvement in QALY gained at a lower cost. Results from subgroup and sensitivity analyses showed no variation in cost-effectiveness estimates. However, sensitivity analyses demonstrated a much lower ICER ($27) when only intervention costs were considered.ConclusionTai Ji Quan represents a cost-effective strategy for optimizing spending to prevent falls and maximize health gains in people with Parkinson disease. While these results are promising, they warrant further validation.

Fear of Falling Is Associated with Recurrent Falls in People with Multiple Sclerosis: A Longitudinal Cohort Study.

People with multiple sclerosis (MS) fall frequently, and there are few clinically valid tools to measure the risk factors for falls. We assessed the unidimensionality of the 7-item Falls Efficacy Scale-International (FES-I), a measure of fear of falling, and determined whether the 7-item FES-I is associated with recurrent falls in people with MS. Falls were counted prospectively for 6 months using fall calendars in 58 people with MS (age, 18-50 years; Expanded Disability Status Scale score, 0-6). The FES-I was administered at baseline, and its unidimensionality was assessed by confirmatory factor analysis. The relationship between FES-I score and future falls, after adjusting for recurrent falls in the past year, was assessed by logistic regression. Fifty-four participants who completed all assessments were included in the analysis. Goodness-of-fit indices confirmed a single-factor solution for the 7-item FES-I (discrepancy χ(2), P = .101; Tucker-Lewis index, 0.953; comparative fit index, 0.969; root mean square error of approximation, 0.098). There was a significant association between fear of falling and falls in the following 3 months, independent of recurrent falls in the past year (odds ratio = 1.22, 95% confidence interval, 1.04-1.43, P = .016). The 7-item FES-I demonstrates good construct validity, allowing the total score to be used as a measure of fear of falling in people with MS. Fear of falling, as measured by the 7-item FES-I, is associated with future recurrent falls independent of past recurrent falls in people with MS.