Fall-related Injuries Research Articles

Needs Assessment for Home Modification and Risk Factors for Home Unintentional Injuries in Post-total Knee Arthroplasty Patients.

Home assessment and modification are crucial to prevent fall and fall-related injuries, especially in vulnerable subjects. This study assessed the need for home modifications and investigated risk factors associated with home injuries in post-total knee arthroplasty (TKA) patients. This study was conducted at the university hospital from July 2022 to July 2023. The patients who had undergone TKA without perioperative complications were recruited. The demographics, clinical data, home environmental factors, needs for home modification, and factors related to home unintentional injury were collected at 2 weeks postoperatively. The analysis was done by using descriptive statistics, and logistic regression. A total of 140 patients were included. The occurrence of falls within 2 weeks after TKA was 33.57%. The location of falls was the home entrance (29.09%), living room (23.64%), and bathroom (18.18%). About 38.5% of the patients explicitly needed home modifications. Falls were associated with inefficient grab bars [adjusted odds ratio=3.26, 95% CI=1.37-7.81, P=0.008] and lighting (adjusted odds ratio=12.83, 95% CI=1.36-121.34, P=0.026). Falls among post-TKA patients were frequently occurred. Preoperative home assessment and home modifications should be done in order to minimize risks of falls, particularly in common locations.

Predicting admission for fall-related injuries in older adults using artificial intelligence: A proof-of-concept study.

Pre-injury frailty has been investigated as a tool to predict outcomes of older trauma patients. Using artificial intelligence principles of machine learning, we aimed to identify a "signature" (combination of clinical variables) that could predict which older adults are at risk of fall-related hospital admission. We hypothesized that frailty, measured using the 5-item modified Frailty Index, could be utilized in combination with other factors as a predictor of admission for fall-related injuries. The National Readmission Database was mined to identify factors associated with admission of older adults for fall-related injuries. Older adults admitted for trauma-related injuries from 2010 to 2014 were included. Age, sex, number of chronic conditions and past fall-related admission, comorbidities, 5-item modified Frailty Index, and medical insurance status were included in the analysis. Two machine learning models were selected among six tested models (logistic regression and random forest). Using a decision tree as a surrogate model for random forest, we extracted high-risk combinations of factors associated with admission for fall-related injury. Our approach yielded 18 models. Being a woman was one of the factors most often associated with admission for fall-related injuries. Frailty appeared in four of the 18 combinations. Being a woman, aged 65-74 years and presenting a 5-item modified Frailty Index score >3 predicted admission for fall-related injuries in 80.3% of this population. Using artificial intelligence principles of machine learning, we were able to develop 18 signatures allowing us to identify older adults at risk of admission for fall-related injuries. Future studies using other databases, such as TQIP, are warranted to validate our high-risk combination models. Geriatr Gerontol Int 2025; ••: ••-••.

Incidence of fall-from-height injuries and predictive factors for severity

Abstract Context The injuries caused by falls-from-height (FFH) are a significant public health concern. FFH is one of the most common causes of polytrauma. The injuries persist to be significant adverse events and a challenge regarding injury severity assessment to identify patients at high risk upon admission. Understanding the incidence and the factors that predict injury severity can help in developing effective intervention strategies. Artificial intelligence (AI) predictive models are emerging to assist in clinical assessment with challenges. Objectives This retrospective study investigated the incidence of FFH injuries utilizing conventional statistics and a predictive AI model to understand the fall-related injury profile and predictive factors. Methods A total of 124 patients who sustained injuries from FFHs were recruited for this retrospective study. These patients fell from a height of 15–30 feet and were admitted into a level II trauma center at the border of US-Mexica region. A chart review was performed to collect demographic information and other factors including Injury Severity Score (ISS), Glasgow Coma Scale (GCS), anatomic injury location, fall type (domestic falls vs. border wall falls), and comorbidities. Multiple variable statistical analyses were analyzed to determine the correlation between variables and injury severity. A machine learning (ML) method, the multilayer perceptron neuron network (MPNN), was utilized to determine the importance of predictive factors leading to in-hospital mortality. The chi-square test or Fisher’s exact test and Spearman correlate analysis were utilized for statistical analysis for categorical variables. A p value smaller than 0.05 was considered to be statistically different. Results Sixty-four (64/124, 51.6 %) patients sustained injuries from FFHs from a border wall or fence, whereas 60 (48.4 %) sustained injuries from FFHs at a domestic region including falls from roofs or scaffolds. Patients suffering from domestic falls had a higher ISS than border fence falls. The height of the falls was not significantly associated with injury severity, but rather the anatomic locations of injuries were associated with severity. Compared with border falls, domestic falls had more injuries to the head and chest and longer intensive care unit (ICU) stay. The MPNN showed that the factors leading to in-hospital mortality were chest injury followed by head injury and low GCS on admission. Conclusions Domestic vs. border FFHs yielded different injury patterns and injury severity. Patients of border falls sustained a lower ISS and more lower-extremity injuries, while domestic falls caused more head or chest injuries and low GCS on admission. MPNN analysis demonstrated that chest and head injuries with low GCS indicated a high risk of mortality from an FFH.

Healthcare spending and factors associated with fall injury in Australia residential aged care: a cohort analysis

BackgroundGiven that fall injury is a critical public health concern in Australia, understanding the economic implications of falls among older adults is crucial to allocating healthcare resources efficiently to reduce...

TRAJECTORIES OF DAYS AT HOME FOLLOWING TRAUMATIC BRAIN INJURY AMONG OLDER ADULTS

Abstract Traumatic brain injury (TBI) is a common fall-related injury among older adults that results in over 123,000 hospitalizations and 485,000 emergency department visits annually. While older adults have poorer recovery following TBI relative to younger adults, most older adults recover well from TBI. Identifying those at increased risk of poor recovery could inform appropriate management pathways, facilitate discussions about palliative care or unmet needs and permit targeted intervention to optimize quality of life or recovery. Time spent at home and not in a hospital or other health care facility each month is a patient-centered measure associated with improved outcomes. We identified unique trajectories of monthly home time following hospitalization for TBI among Medicare beneficiaries aged ≥65 using group-based trajectory modelling and identified characteristics associated with poor recovery. Among 20,350 Medicare beneficiaries who sustained TBI between 2010-2018, four unique trajectories of home time were identified: poor recovery (9.5%), improving recovery (13.7%), good recovery (66.4%), and declining recovery (10.4%). Recovery of monthly home time was complete for most by three months post injury. The strongest predictors of membership in the poor relative to the good recovery trajectory group were diagnosis of ADRD (odd ratio (OR) 2.42; 95% confidence interval (CI) 2.16, 2.72) and dual eligibility for Medicaid, a proxy for socioeconomic vulnerability (OR 5.13; 95% CI 4.59, 5.74). Future studies should seek to further characterize and investigate identified recovery groups to inform management and development of interventions to improve recovery.

Falls in Older Adults: Identifying Predictors and Patterns for Enhanced Monitoring Solutions

This research analyses the patterns and causes of fainting falls by using patient demographics, activities, fall characteristics, and physiological indicators to assist in the development of a preventive monitoring device. The results indicate that individuals aged 60 years and older are at higher risk, and most falls occur while walking. Most falls occur in a forward or backward direction, and most of these are caused by slipping or an episode of fainting. Physiological data also showed that there is a strong relationship between systolic and diastolic blood pressure and a moderate relationship between blood pressure and heart rate, which indicate these metrics as potential early predictors of the risk of fainting. Body temperature has very little association with other clinical factors and contributes little to the prediction of falls. A greater proportion of the research participants had a history of falls and were spread equally in the drug users as well as the non-users, so personal follow-up care was necessary. These findings support the concept of a multi-sensor monitoring device that continuously tracks vital signs, motion, and balance. Such a device, by inclusion of predictive algorithms, should be able to provide timely warnings against fainting episodes, reduce fall-related injuries, and provide individualized interventions based on a person's unique physiological patterns and medical history

Steps to Avoid Falls in the Elderly – a TECHnology Enhanced Intervention (SAFE-TECH) study: randomized controlled trial protocol for a community-based, multi-component fall prevention program

BackgroundFalls and fall-related injuries among older adults in Singapore are a serious health problem that require early intervention. In previous research, exercise interventions have been effective in improving functional outcomes and reducing falls for a broad group of older adults. However, results from multi-domain, multi-component falls prevention programs for high fall risk older adults in the community remain equivocal. One reason for these results is that there is significant heterogeneity in falls risk factors amongst high falls risk older adults which makes tailoring multicomponent interventions complex. The objective of the trial is to evaluate the effectiveness of an enhanced version of the predecessor program, SAFE. The Steps to Avoid Falls in the Elderly—a TECHnology enhanced intervention (SAFE-TECH) is designed for older adults in the community who are at high risk of falls, with candidate selection and program tailoring based on gait variables derived from wearable sensors and various questionnaire-based features.MethodsSAFE-TECH is a 12-month randomized controlled trial involving 400 older adults at high risk of falling, who are randomly allocated to an intervention or control group in a 1:1 ratio. Participants will be assessed at baseline, 3rd-month and 12th-month for functional status, physical performance, cognitive status, quality of life, and medical history. Monthly phone calls will assess fall status, healthcare utilization, physical activity, and exercise self-efficacy. Participants in the intervention group will undergo a tailored, multi-domain, multi-component falls prevention program. The active intervention phase will last for 12-weeks with exercises focusing on strength, balance, coordination, flexibility, and aerobic endurance; and weekly educational sessions on falls risk with personalized feedback based on participant’s falls risk assessments and environmental checklist.DiscussionsSAFE-TECH seeks to evaluate enhanced existing falls prevention programs by addressing the heterogeneity of falls risk through rapid assessments and personalisation of exercise and education components while maintaining the efficiency of the group setting. Our findings will inform practical efforts to reduce falls and falls-related injuries among community-dwelling older adults.Trial registrationClinicalTrials.gov. Clinical Trial Number: NCT06102954|| 22–10-2023.

A Novel Method for Human Fall Detection Using Federated Learning and Interval-Valued Fuzzy Inference Systems

Abstract This study introduces an innovative interval-valued fuzzy inference system (IFIS) integrated with federated learning (FL) to enhance posture detection, with a particular emphasis on fall detection for the elderly. Our methodology significantly advances the accuracy of fall detection systems by addressing key challenges in existing technologies, such as false alarms and data privacy concerns. Through the implementation of FL, our model evolves collaboratively over time while maintaining the confidentiality of individual data, thereby safeguarding user privacy. The application of interval-valued fuzzy sets to manage uncertainty effectively captures the subtle variations in human behavior, leading to a reduction in false positives and an overall increase in system reliability. Furthermore, the rule-based system is thoroughly explained, highlighting its correlation with system performance and the management of data uncertainty, which is crucial in many medical contexts. This research offers a scalable, more accurate, and privacy-preserving solution that holds significant potential for widespread adoption in healthcare and assisted living settings. The impact of our system is substantial, promising to reduce the incidence of fall-related injuries among the elderly, thereby enhancing the standard of care and quality of life. Additionally, our findings pave the way for future advancements in the application of federated learning and fuzzy inference in various fields where privacy and precision in uncertain environments are of paramount importance.

The influence of the multifactorial falls prevention programme on mortality.

Multifactorial falls prevention programmes (MFFPs) can prevent falls and fall-related injuries. We aimed to study MFFP patients' mortality compared with their sex-, age- and residence-matched population-based controls. This study is a Finnish single-centre retrospective register-based controlled cohort study of a total of 527 home-dwelling MFFP patients and their 3:1 age-, sex- and residence-matched population-based controls (n = 1581), who had not attended the MFFP. During the follow-up, the cumulative mortality of all patients was 40.4, and of controls 39.1 %. Hazard ratio was 0.82 (95% confidence interval 0.68 to 0.99), p= 0.041. Case patients had a 2.7 times greater risk to die due to accidents, but they had a lower risk to die due to dementia, compared with the control group. The 72-years-old or older participants had a lower mortality rate than the controls during follow-up. The MFFP seems to relate to a lower all-cause mortality when comparing MFFP patients with their age-, sex- and residence-matched controls. However, the MFFP did not seem to relate to a lower injury-related mortality. The relationship between the MFFP and lower all-cause mortality seemed to be strongest in the patients aged 72 years or older. Due to the study setting and population-based control group, it is difficult to draw solid conclusions and further studies are needed. A randomized controlled trial comparing the MFFP with standard care would give better insight on the effectiveness of a MFFP on mortality.

IoT-Based System for Real-Time Fall Risk Assessment and Health Monitoring

Real-time fall risk assessment and continuous health monitoring are critical components in enhancing elderly care and preventing fall-related injuries. This study presents an IoT-based system designed to provide real-time fall risk assessment and monitor health parameters using wearable sensors. The system integrates the MPU6050 sensor with IoT technology for efficient data collection and analysis. A Random Forest algorithm is employed to process the complex health data, offering precise and reliable fall detection models. The algorithm demonstrates high sensitivity, precision, and accuracy, making it well-suited for processing sensor data to detect falls. The study identifies the waist as the optimal sensor placement, achieving up to 97.9% accuracy, 95.0% precision, and 95.4% sensitivity in detecting mild falls while standing. The wrist sensor performs well in detecting sudden falls, while the leg sensor shows lower accuracy, highlighting challenges in identifying specific fall types. Model validation with Support Vector Machine (SVM) and Random Forest (RF) reveals that the RF model outperforms the SVM, confirming its superiority for fall detection tasks. The system's adaptability and potential for personalized risk assessment promise significant improvements in fall prevention strategies. These findings highlight potential applications that go beyond elderly care, involving at-risk individuals in future research, including those with neurological disorders, sports injuries, or disabilities.

Physical and psychosocial consequences of falls in ambulatory individuals with cerebral palsy by age and gross motor function.

To quantify physical and psychosocial impacts of falls by age and Gross Motor Classification System (GMFCS) level in ambulatory individuals with cerebral palsy (CP). Cross-Sectional Survey. Tertiary specialty hospital and online CP communities. Ambulatory individuals with CP (N=201 adults; 18-76 years old) or the caregivers of minors (N=180; 5-17 years old). Participants completed online surveys to report fall frequency, fall characteristics, injuries, concern about falling (Short Falls Efficacy Scale-International), activity avoidance due to concern about falling (Short Falls Efficacy Scale-International Avoidance Behavior), and psychosocial constructs related to perceived consequences of falling (Consequences of Falling-Damage to Identity subscale). Most participants fell in the past 12 months (86%). Fall frequency in the past 12 months differed by age (P<0.001) and GMFCS level (P=0.021). Individuals 5-12-years-old or GMFCS level II reported the most falls. The percentage of participants who experienced a past serious fall-related injury (e.g., head/face stitches, concussion, fractures) increased with age (P<0.001), affecting 80% of ≥50-year-olds. Falls often occurred in the forward direction, when wearing shoes, and during ambulation. Uneven surfaces and fatigue were notable causes. Concern about falling and associated activity avoidance scores differed by age and GMFCS level (all P<0.01), both which were highest for ≥50-year-olds and GMFCS level III. Although psychosocial consequences of falls (e.g., embarrassment, lost confidence) were elevated across all groups, they did not differ by age or GMFCS level (P=0.130, P=0.083). Nearly everyone (88%) wished they fell less. Falls are common for ambulatory children and adults with CP. Physical and psychosocial consequences of falls were frequent and impacted behavior. Differences observed by age and GMFCS level should be considered in care delivery. Clinically tracking and discussing falls and their repercussions across the lifespan will aid in addressing this under-researched and under-resourced concern of people with CP.

Temporal trends and characteristics of fall-related deaths, hospitalizations and emergency department visits among older adults in Canada.

Falls among older adults (aged 65 years and older) are a public health concern in Canada. Fall-related injuries can cause a reduction in quality of life among older adults, and death. They also entail substantial health care costs. It is essential to monitor fallrelated injuries and deaths among older adults to better understand temporal trends and characteristics and to evaluate fall prevention strategies. We used the most up-to-date data from the Canadian Vital Statistics-Death database, Discharge Abstract Database and National Ambulatory Care Reporting System to analyze the temporal trends of fallrelated mortality, hospitalizations and emergency department (ED) visits among older adults in Canada over more than a decade. Age and sex characteristics were also examined. In 2022, 7189 older adults died due to a fall in Canada (excluding Yukon). From 2010 to 2022, deaths due to falls generally increased in both number and rates. In fiscal year 2023/24, there were 81 599 fall-related hospitalizations in Canada (excluding Quebec) and 212 570 fall-related ED visits in Ontario and Alberta. From fiscal year 2010/11 to 2023/24, even though the overall trend of the rates of fall-related hospitalizations and ED visits did not increase, the numbers generally rose year by year except in 2020/21, the early stage of the COVID-19 pandemic. As for the age and sex characteristics, the rates for deaths, hospitalizations and ED visits rose with advancing age for both men and women. With the aging population, continuous monitoring of the trends is crucial for fall prevention.

A Thematic Analysis of Lived Experiences of Falls in Middle-Aged and Older Adults.

Fall-related injuries occur at a similar prevalence rate in middle-aged and older adults and may increase concerns about falling and future falls. No research to date has examined how experiences of falls and related concerns, differ between middle-aged and older fallers. This study aimed to address this using qualitative interviews. Ten middle-aged (55-64 years) and ten older adults (68-83 years) were interviewed about their experiences of falls and concerns about falling. Guided by a social constructivist epistemology, reflexive thematic analysis was used to categorise themes within the data. Five overarching themes were identified. Four themes showed distinctions between groups (i) perceptions of age-related decline; (ii) ageism: stigma associated with 'fallers'; (iii) concerns about loss of independence; and (iv) unravelling perceived control. The fifth theme (v) perceptions of falls risk: concerns and awareness, demonstrated the most similarities. Whilst middle-aged and older fallers showed similar ratings of concern about falling, the behaviours underlying these were qualitatively different. For older adults, concerns led to protective adaptations to reduce their fall risk. Contrastingly, middle-aged adults showed a lack of personal responsibility over their fall risk. The findings highlight the importance of early educational intervention to reduce future falls and frailty.

The Positive impact of Greenery on the Mental and Physical Health of the Elderly: A Case Study in the Design of a Hospital Garden

Abstract The positive effects of greenery on human health have been studied for centuries. Knowledge and application of these benefits can be used in hospitals and retirement homes. Residents of these facilities are often mentally or physically disabled; hence creating a suitable exterior area in accordance with the scientific findings of the health benefits of greenery could improve the mental and physical states of the elderly and improve overall living conditions. Nature has calming effects and soothes our minds by driving away attention from the stressful problems of everyday life. Green colour, sounds of birds, water, and leaves decrease levels of stress and contribute to mental well-being. Free access to nature or gardens decreases the bad tempers of the elderly and improves memory and the overall state of patients with dementia. It reduces anxiety and stress, which are precursors for cardiovascular diseases. It helps prevent fall-related injuries and improves mobility and cognitive function. Consequently, contact with nature improves the quality of life, decreases the need for taking medicine, and could prolong life expectancy. As a case study, we present a design of the revitalisation of a hospital garden for the elderly in Bratislava city district of Podunajské Biskupice. It puts the knowledge of these benefits and the needs of various types of patients to practice, so that the garden could be used as an effective healing tool and as a calming area for patients as well as the staff and visitors.

FallFitness exercise program provided using the train-the-trainer approach for community-dwelling older adults: a randomized controlled trial

BackgroundFalls and fall-related injuries remain a global challenge and threat to the health of older adults. Specific strength and balance exercises are effective in preventing falls among community-dwelling older adults. Nevertheless, provision of evidence-based fall prevention interventions to a broad population represents a healthcare challenge, indicating that new models for promoting exercise among community-dwelling older adults need to be addressed. Here, we aimed to evaluate the effects of a peer-led group-based exercise intervention provided using the train-the-trainer approach and targeting physical performance, activity level, handgrip strength, quality of life, fall-related self-efficacy, fear of falling, and falling techniques compared with a control group at 8-week follow-up.MethodsThis randomized controlled trial (RCT) included trainers and participants who were recruited from four collaborating regional organizations for retired persons. The intervention was planned to be provided in five municipalities in Sweden, depending on the location of the registered trainers.Eligible participants included adults aged ≥ 60 years who could walk independently and understand written and oral information in Swedish. The FallFitness multicomponent exercise program delivered weekly strength, balance, and falling techniques over eight weeks. It was evaluated using the train-the-trainer approach. Fourteen older adults were eligible for trainer education, and 101 participants were randomly allocated for the FallFitness exercise (n = 50) or a control group (n = 51).ResultsAfter 8 weeks of peer-led training, the short multicomponent exercise program significantly improved the physical activity levels (p = 0.036) and backward and sideways falling techniques (p < 0.001) compared to those in the control group. Fear of falling significantly decreased in the exercise group (p = 0.009). Other outcomes in this study showed to be non-significant.ConclusionsThe multicomponent exercise program provided in eight sessions using the train-the-trainer approach may be effective in promoting physical activity and the learning of motor skills and safe landing strategies. Furthermore, the FallFitness exercise program may reduce the fear of falling and may be both time- and cost-effective.Trial registrationClinicalTrials.gov, NCT06265480 (20240208).

Assessing the feasibility of an integrated collection of education modules for fall and fracture prevention (iCARE) for healthcare providers in long term care: A longitudinal study.

Falls and hip fractures are a major health concern among older adults in long term care (LTC) with almost 50% of residents experiencing a fall annually. Hip fractures are one of the most important and frequent fall-related injuries in LTC. There is moderate to strong certainty evidence that multifactorial interventions may reduce the risk of falls and fractures; however, there is little evidence to support its implementation. The purpose of this study was to determine the feasibility (recruitment rate and adaptations) with a subobjective to understand facilitators to and barriers of implementing the PREVENT (Person-centred Routine Fracture PreEVENTion) model in practice. The model includes a multifactorial intervention on diet, exercise, environmental adaptations, hip protectors, medications (including calcium and vitamin D), and medication reviews to treat residents at high risk of fracture. Our secondary outcomes were to determine if there was a change in knowledge uptake of the guidelines among healthcare providers and in the proportion of fracture prevention prescriptions post-intervention. We conducted a mixed-methods longitudinal cohort study in three LTC homes across southern Ontario. A local champion was selected to help guide the implementation of the model and promote best practices. We reported recruitment rates using descriptive statistics and challenges to implementation using content analysis. We reported changes in knowledge uptake and in the proportion of fracture prevention medications using the McNemar's test. We recruited three LTC homes and identified one local champion for each home. We required two months to identify and train the local champion over three, 1.5-hour train-the-trainer sessions, and the local champion required three months to deliver the intervention to a team of healthcare professionals. We identified several facilitators, barriers, and adaptations to PREVENT. Benefits of the model include easy access to the Fracture Risk Scale (FRS), clear and succinct educational material catered to each healthcare professional, and an accredited Continuing Medical Educational module for physicians and nurses. Challenges included misperceptions between the differences in fall and fracture prevention strategies, fear of perceived side effects associated with fracture prevention medications, and time barriers with completing the audit report. Our study found an increase knowledge uptake of the guidelines and an increase in the proportion of fracture prevention prescriptions post-intervention.

Discontinuation of Cholinesterase Inhibitors Following Initiation of Memantine and Admission to Long-Term Care Among Older Adults.

Discontinuing cholinesterase inhibitors when initiating memantine in patients with dementia may be reasonable to reduce treatment burden, costs, and the risk of adverse drug events. To assess the association of cholinesterase inhibitor discontinuation on long-term care institutionalization among older adults with dementia who initiate memantine. This retrospective propensity score-matched cohort study used Medicare claims data from January 2014 to December 2019. Participants included fee-for-service Medicare beneficiaries with dementia. Data were analyzed from September 2021 to August 2024. Discontinuation vs continuation of cholinesterase inhibitor. The primary outcome was 1-year long-term care institutionalization-free days. Secondary outcomes include all-cause death and adverse drug events over 1 year. We performed subgroup analyses based on age, sex, dementia type (Alzheimer disease vs other), frailty, and dementia severity (mild vs moderate or severe) based on claims-based algorithms. The primary outcome was analyzed using nonparametric restricted mean survival time analysis. Among 16 292 beneficiaries who initiated memantine, 1820 (11.2%) discontinued cholinesterase inhibitors. In the propensity score-matched cohort of 3612 beneficiaries, the mean (SD) age was 80.7 (6.7) years, 2261 (62.6%) were female, and 1989 (55.0%) had a diagnosis of Alzheimer disease. Over 1 year, long-term care institutionalization occurred in 51 of 1806 beneficiaries (2.8%) who discontinued cholinesterase inhibitors (3.4 per 100 person-years) and 62 of 1806 beneficiaries (3.4%) who continued (4.1 per 100 person-years). There was no statistically significant difference in the 1-year mean institutionalization-free days between discontinuation and continuation groups (360.6 [95% CI, 359.3 to 362.0] days vs 359.1 [95% CI, 357.5 to 360.6] days; mean difference, 1.5 [95% CI,-0.5 to 3.6] days). The mean difference in the long-term care institutionalization-free days did not differ by age category, sex, dementia type, frailty, or dementia stage. Individuals who discontinued had a lower rate of fall-related injury (0.9 vs 2.0 per 100 person-years; hazard ratio [HR], 0.47 [95% CI, 0.25 to 0.88]). There was no difference between the discontinuation and continuation groups in all-cause death (10.4 vs 11.6 per 100 person-years; HR, 0.89 [95% CI, 0.72 to 1.10]). In this study, discontinuing cholinesterase inhibitors upon memantine initiation was not associated with an increased risk of long-term care institutionalization but with a lower risk of fall-related injury among older adults with dementia. These findings offer valuable insights for clinicians aiming to reduce treatment burden in this population.

Co-use of cannabis and alcohol among adults and the burden of traumatic brain injury from fall-related events

ABSTRACT Background Co-use of cannabis and alcohol is an emerging trend that can exacerbate injury outcomes. While research has focused on younger age groups, there is a need to examine consequences associated with co-use among adults populations. Falls represent a leading cause of injury among older adults. Coupled with substance use, injuries associated with falls may be more severe. Objectives To examine the burden of fall-related head injury among adults who co-use cannabis and alcohol. Methods Emergency department data from the 2019–2022 National Electronic Injury Surveillance System were analyzed for fall-related head injuries associated with co-use of cannabis and alcohol among middle-aged and older adults aged 55–75. Results An annualized estimate of 545,276 fall-related injuries occurred. Patients who presented with co-use of cannabis and alcohol had the highest prevalence of TBI (PR 1.75; 95% CI 1.25–2.25) and CMF injuries (PR 1.70; 95% CI 1.38–2.03) when contrasted to the alcohol-only or cannabis-only groups. Conclusions Results highlight the burden of co-use of cannabis and alcohol on fall-related head injuries. Healthcare providers, policymakers, patients, and caregivers should be aware of these risks and prioritize targeted interventions to mitigate the impact on the health and safety of older individuals.

Clinical characteristics and influencing factors of serious fall injuries among older inpatients: A secondary analysis of multicenter cross-sectional administrative data

BackgroundInpatient falls are common adverse events in hospitals, particularly among older adults. However, current research on falls in the older population is limited by small sample sizes and reliance on single-center designs without distinguishing the different levels of fall injuries. ObjectiveTo examine the circumstances of falls in older inpatients and investigate the factors influencing serious fall injuries. DesignA secondary analysis of multicenter cross-sectional administrative data from the China National Database of Nursing Quality (CNDNQ). Setting(s)67 hospitals in Hunan, China. Participants5143 fall incidents from 5048 older inpatients were included from January 2019 to December 2022. MethodsDescriptive statistics (means, standard deviations, frequencies, and percentages) were used to describe fall characteristics. Given the multilevel data structure, a Generalized Linear Mixed Model (GLMM) with a Logistic link function was employed, treating hospitals and wards as random effects. Univariate and multivariate analyses were conducted. ResultsThe prevalences of fall-related injuries and serious fall injuries in this study were 63.3 % and 25.0 %, respectively. Nurse-to-patient ratio at the time of fall ≤0.05 (aOR = 1.522, 95 % CI: 1.297–1.785), female gender (aOR = 1.304, 95 % CI: 1.137–1.497), a lengthy hospital stay (aOR = 1.009, 95 % CI: 1.001–1.018) were associated with an increased risk of serious fall injuries. Surgical (aOR = 0.655, 95 % CI: 0.482–0.889) and orthopedic wards (aOR = 0.649, 95 % CI: 0.449–0.939) exhibited lower risks of serious fall injuries than internal medicine wards. The period from 8:00 to 15:59 was associated with a higher risk of serious fall injuries compared to the period from 0:00 to 7:59 (aOR = 1.416, 95 % CI: 1.171–1.713). Compared to lying, standing (aOR = 2.594, 95 % CI: 1.733–3.883), getting in/out of bed (aOR = 1.403, 95 % CI: 1.009–1.951), walking or rehabilitating (aOR = 3.039, 95 % CI: 2.194–4.208), toileting (aOR = 1.411, 95 % CI: 1.038–1.917), and showering (aOR = 2.170, 95 % CI: 1.391–3.385) were associated with an increased risk of serious fall injuries. ConclusionsFall-related injuries and serious fall injuries are highly prevalent among older inpatients. The study provides insights for targeted fall prevention strategies, improving nursing management and patient safety. RegistrationNot registered.

Does Equestrian Helmet Type Affect Head Injury? A Study on Equestrian Helmet Use Among Collegiate Athletes.

To characterize helmet use, head injury risk, and to examine rider-related factors that influence these variables. Cross-sectional study. The University of Alabama at Birmingham Equestrian Sports Medicine Collaborative. In total, 357 equestrians competing at the collegiate level participated in this study. χ2 tests were used to evaluate potential associations between a rider's experience level, riding style, and use of helmet designed with MIPS with number of falls, past head injuries, and helmet use frequency. Data regarding helmet use and equestrian-related injuries were collected. χ2 analysis was used to determine potential associations. More than 50% of athletes reported falling off a horse during the course of 1 year. Head injuries occurred with high frequency. Concussion was the most frequently reported type. More than 50% of athletes with self-reported concussion denied receiving medical treatment. The risk of head injury was similar across helmet brands, and between helmets with Multi-Directional Impact Protection System (MIPS) and those without. Riders with the most experience were less likely to report sustaining a head injury than those with less experience. Contrary to current safety guidelines, 78% of equestrians said that they would not replace their helmet after every fall. Collegiate equestrians have a high risk of fall-related traumatic head injury. Despite this risk, they report helmet use practices that are not in line with current recommendations regarding helmet replacement. This suggests thatmany of the athletes are using protective equipment that does not adequately protect against head injury. Neither helmet brand nor liner type was associated with lower rate of head injury.