High Fall Risk Research Articles

Effect of Balance Exercises with Smart Phone Based Virtual Reality Programme on Balance in Stroke Patients

BACKGROUND AND OBJECTIVES: Stroke is a neurological deficit, caused due to vascular changes. Impaired postural control and balance impairments in post stroke patients, associated with high risk of fall among the stroke patients. The perturbation - based balance training mainly used in older adults and balance impairment. Virtual reality (VR) as a novel technology is rapidly becoming a popular intervention for improving balance. VR can visualize the computer - generated environments with full field of view by Head mounted displays (HMD-VR) .This study was conducted to assess and investigate the effect of balance exercises with smart phone based virtual reality programme on balance in stroke patients. METHOD: This was a randomized single-group pre and post test study design. 30 subjects met the inclusion criteria and were enrolled, assigned and received intervention. Subjects were given perturbation based balance exercise and smart phone based virtual reality along with conventional physiotherapy. Intervention protocol was for 6 days/week for 4 weeks period. RESULTS: Following 4 weeks of intervention showed improvement in postural control and balance which was assessed using BBS, TUG, VR BESS, BESTest, SIS 3.0. Paired t test was used to differentiate the mean significance. The mean pre to post intervention difference is 12.6 with P value < 0.05. TUG score improved from pre to post intervention difference is 1.443 with P value < 0.05. VR BESS score improved from pre to post intervention difference is 10.266 with P value < 0.05. The mean BESTest pre to post intervention difference is 11.467 with P value < 0.05. SIS 3.0 score improved from pre to post intervention difference is 20.33 with P value < 0.05. The result of this study showed highly significant difference in pre and post treatment. CONCLUSION: The study concludes that perturbation based balance exercises with smart phone based virtual reality programme is a useful adjunct on improving balance in stroke patients along with conventional physiotherapy.

A prospective cohort study of the impact of chronic disease on fall injuries in middle-aged and older adults.

This cohort study investigated the impact of chronic diseases on fall risk in middle-aged and older individuals, offering insights for fall prevention strategies. Analysing data from 4,670 participants aged 40+ years, we used a Cox proportional risk model to assess chronic disease types, numbers, and interactions with other factors on fall injury risk across age groups. Results showed that middle-aged adults with respiratory diseases had a 26% increased fall risk (hazard ratio [HR] = 1.26, 95% confidence interval [CI]: 1.05-1.48), and a linear dose-response relationship was observed between chronic disease number and fall risk (p < 0.001). The study also examined interaction effects of chronic diseases with gender, disability, and fall injury history. Female middle-aged and older adults with chronic diseases had a 67% higher fall risk than their male counterparts without chronic diseases (HR = 1.67, 95% CI: 1.36-1.88). In conclusion, chronically ill middle-aged and older adults have a higher fall risk, with high-risk groups including women, those with chronic diseases, and individuals with fall injury history. Fall prevention efforts should target middle-aged adults as well.

Development and Internal Validation of a Prediction Model for Falls Using Electronic Health Records in a Hospital Setting.

Fall prevention is important in many hospitals. Current fall-risk-screening tools have limited predictive accuracy specifically for older inpatients. Their administration can be time-consuming. A reliable and easy-to-administer tool is desirable to identify older inpatients at higher fall risk. We aimed to develop and internally validate a prognostic prediction model for inpatient falls for older patients. Retrospective analysis of a large cohort drawn from hospital electronic health record data. Older patients (≥70years) admitted to a university medical center (2016 until 2021). The outcome was an inpatient fall (≥24hours of admission). Two prediction models were developed using regularized logistic regression in 5 imputed data sets: one model without predictors indicating missing values (Model-without) and one model with these additional predictors indicating missing values (Model-with). We internally validated our whole model development strategy using 10-fold stratified cross-validation. The models were evaluated using discrimination (area under the receiver operating characteristic curve) and calibration (plot assessment). We determined whether the areas under the receiver operating characteristic curves (AUCs) of the models were significantly different using DeLong test. Our data set included 21,286 admissions. In total, 470 (2.2%) had a fall after 24hours of admission. The Model-without had 12 predictors and Model-with 13, of which 4 were indicators of missing values. The AUCs of the Model-without and Model-with were 0.676 (95% CI 0.646-0.707) and 0.695 (95% CI 0.667-0.724). The AUCs between both models were significantly different (P= .013). Calibration was good for both models. Both the Model-with and Model-without indicators of missing values showed good calibration and fair discrimination, where the Model-with performed better. Our models showed competitive performance to well-established fall-risk-screening tools, and they have the advantage of being based on routinely collected data. This may substantially reduce the burden on nurses, compared with nonautomatic fall-risk-screening tools.

Hubungan Status Vitamin D dengan Risiko Jatuh pada Pasien Lansia dengan Penyakit Ginjal Kronik yang Menjalani Hemodialisis Reguler

Introduction. Fall is one of the main causes of hospitalization in the elderly, which is caused by several factors including gait disturbances, balance disorders, visual disturbances, chronic kidney disease (CKD), vitamin D deficiency, and so on. Chronic kidney disease can cause disruption of vitamin D metabolism, especially in the elderly population. This study aimed to assess the relationship between vitamin D status and the risk of falling in elderly patients with CKD who receive regular hemodialysis programs. Methods. We conducted a cross-sectional study by assessing the relationship between vitamin D status and the risk of fall in elderly patients undergoing regular hemodialysis at H. Adam Malik General Hospital and Rasyida Kidney Special Hospital Medan. Fall risk assessment was carried out using the Morse fall scale (MFS) and vitamin D status was examined in the Clinical Pathology Laboratory of H. Adam Malik General Hospital, Medan. The data was analyzed statistically with the chi square test. Results. This study involved 92 subjects with a median vitamin D level of 20.15 (3.9-52.1) mg/dL and a median MFS value of 65 (25-95). As many as 87% of subjects had insufficient vitamin D levels, 11% of subjects had inadequate levels, and 1% of subjects had adequate levels of vitamin D. High fall risk was found in 56% of subjects, 43% had moderate fall risk, and 1% had low fall risk. The chi square test found a significant relationship between vitamin D status and risk of falling with p value = 0.001 and an odds ratio 0.056 (95%CI 0.007-0.454). Conclusion. Reduction of vitamin D level has a significant relationship with the risk of falling in elderly patients with CKD undergoing regular hemodialysis.

Perspectives: How to Apply Motivational Interviewing for Older Adult Fall Prevention

More than one in three adults age ≥65 fall each year, and fall-related deaths are increasing in the United States. Falls risks can be reduced when older adults are able to engage in series of behavior changes to reduce their high fall risk factors. However, older adults perceive their fall risks to be lower than clinically indicated and adherence rates for fall prevention recommendations are suboptimal. Motivational interviewing (MI), a validated patient-centered behavior change communication approach, is ideal for addressing these gaps and facilitating older adults’ engagement in fall prevention. The goal of this paper is to present practical tips to apply MI for fall prevention for clinicians who may not be familiar with MI. We draw on our experience from providing MI sessions to high fall risk older adults within a randomized controlled trial. We describe how we delivered MI sessions and practical lessons learned from this experience. We present how basic MI skills can be used for fall prevention using a case study, how an older adult may move through Stages of Change for fall prevention, and how to address strongly held beliefs about fall prevention.

Comparative study of the accuracy of at-point Clinical Frailty Scale and Morse Fall Scale in identifying high-risk fall patients among hospitalized adults.

Falls are a major concern among hospitalized adults, and it is essential to identify high-risk patients to prevent falls. This retrospective cohort study conducted at the Asan Medical Center, Korea, compared the screening abilities of the at-point Clinical Frailty Scale (CFS) and Morse Fall Scale (MFS) to identify patients at high risk for falls among hospitalized adults. We assessed the records of at-point CFS, MFS, and fall incidence during hospitalization of 2,028 patients aged 18 or older included in this study. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) for each tool. Twenty-five patients (1.23%) experienced falls during hospitalization. The mean at-point CFS score was significantly higher in those with falls than in those without falls. The mean MFS score did not differ significantly between the two groups. The optimal cutoff points for the at-point CFS and MFS scores were 5 and 45, respectively. At these cutoffs, the at-point CFS demonstrated a sensitivity of 76.0%, specificity of 54.0%, PPV of 2.0%, and NPV of 99.4%, whereas the MFS demonstrated a sensitivity of 60.0%, specificity of 68.1%, PPV of 2.2%, and NPV of 99.4%. The AUC values for the at-point CFS and MFS were 0.68 and 0.63, respectively, with no significant difference (p = 0.31). The at-point CFS is a valid screening tool for assessing fall risk in hospitalized adults, as it effectively identifies fall risk with a performance similar to that of the MFS.

Association of social isolation with health status among community-dwelling Chinese older adults living with homecare services: a cross-sectional survey in Hong Kong.

Defined as having few social relationships or infrequent social contact with family, friends, and the community, social isolation is a public health crisis. We aimed to evaluate the prevalence of social isolation and explore the association between social isolation and health status among community-dwelling Chinese Older Adults living with homecare services. This is a cross-sectional survey with a structured questionnaire conducted among older adults aged ≥60 in the Central Kowloon District of Hong Kong during 2017-2018. Social isolation was assessed by the Lubben Social Network Scale-6 and a score less than 12 was defined as socially isolated. Six aspects of health status including fall risk, cognitive function, depression, activities of daily living (ADL), instrumental activities of daily living (IADL), and functional mobility were measured by standardized instruments. Multi-criteria decision analysis (MCDA) was applied to estimate an index to represent the overall health status of the respondents. Multivariate logistic/linear regression models were applied to examine the associations between social isolation and health status after adjusting the sociodemographic characteristics. Among the 1,616 participants included in this analysis, the mean age was 80.9 years, 66.3% were female and 41.4% were identified as socially isolated. Compared with the non-isolated group, the socially isolated group had higher proportions of males, divorced or unmarried, ever smoking and drinking, living alone, and living in public housing without religion. After adjusting for confounders, the odds ratios (OR) comparing the socially isolated vs. non-isolated groups were 2.52 (95%CI: 1.79, 3.56) for high fall risk, 1.51 (1.17, 1.94) for cognitive impairment, and 1.78 (1.31, 2.43) for depression. The socially isolated group increased the odds of abnormal ADL, IADL, and functional mobility by 105-150%, and decreased the overall health score by 5.30 (3.42, 7.18). We demonstrated the association of social isolation with poorer physical function and mental health and overall health status among the community-dwelling Chinese older adults living with homecare services. These findings provided new knowledge about the association of social isolation with both physical and mental function for daily living even for those receiving an integrated homecare service in the community. It implies that an unmet healthcare need existed when comparing the service scope of the current homecare services in the community. It also highlighted the need for targeted prevention and intervention initiatives among community-dwelling old adults to alleviate social isolation for better health and good functioning in the community.

94 A Review of the Utility of the Readmission Risk Scale in Hospitalized Burn Injured Patients

Abstract Introduction The burden of wound care post-hospitalization is often overwhelming, not only for patients and their families but also for home health nurses and intermediate care facilities. Inadequate wound care following hospital discharge can lead to wound deterioration and hospital readmission. These readmissions impact the patient, as well as healthcare institutions, physicians, payor sources, and policy makers. Readmission Risk Scales (RSS) exist but typically focus on those patients with chronic illness. Our hospital’s RRS consists of 16 items: patient without a primary care physician (PCP), active problem list &amp;gt; 2, past medical history &amp;gt; 2, age ≥ 50, lives alone, high fall risk, length of stay &amp;gt; 10 days, mental health disorder, diabetes, heart failure, COPD, alcohol abuse, drug use, uninsured/Medicaid, &amp;gt; 2 ED visits in previous 6 months and prior readmission within 30 days. The purpose of this study was to evaluate the fit of our current RSS for burn patients and identify other variables that may be predictive of readmission in burn patients. Methods This was a retrospective chart review of burn patients admitted over a 1-year period. Primary outcome measures were RSS scores, individual RSS variables, social determinants of health and incidence of readmission within 30 days of discharge. Readmitted patients were compared to those who did not require readmission. Descriptive statistics were calculated, and bivariate and multivariable logistic regressions (forward LR) were used to identify variables that contributed uniquely to readmission. Results A total of 600 burn patients were admitted over the study period of which 449 met inclusion/exclusion criteria. Thirty-two (7%) of these patients were readmitted within 30 days of their initial hospital discharge. In bivariate analyses, only 4 of the current RRS variables were statistically significant predictors of readmission within 30 days, patient without a PCP (p=.019), active problem list &amp;gt; 2 (p&amp;lt; .001), mental health disorder (p=.004) and drug use (p&amp;lt; .00004). However, when these variables were tested simultaneously in one predictive equation, only drug use remained significantly predictive. The total RSS score accounted for only 1.1% of the variance in readmission within 30 days. Conclusions The national readmission rate is 12%, and our overall rate was substantially below this. However, our current Readmission Risk Scale is not predictive in identifying those patients at risk for being readmitted within 30 days of discharge. Further investigation is warranted to identify additional variables to identify at risk patients. Applicability of Research to Practice A valid readmission risk assessment tool, would be beneficial to identify patients who are at risk for readmission and enhancing discharge planning.

Neuropsychiatric Symptoms as Indicators of Fall Risk in Geriatric Inpatients.

Background and Objectives: It is well established that patients with cognitive impairment are at a higher risk of falls. However, the impact of coexisting neuropsychiatric symptoms on the overall risk of falls in hospitalized geriatric individuals with and without dementia has not been extensively studied. This cross-sectional study will assess the association between neuropsychiatric symptoms and fall risk in geriatric individuals analyzed by sex. Materials and Methods: A total of 234 patients, both with and without dementia, admitted to the geriatric ward at Leszek Giec Upper-Silesian Medical Centre of the Silesian Medical University in Katowice, Poland, between January 2019 and January 2020 were included in this study. The Neuropsychiatric Inventory-Questionnaire was used to assess the presence of neuropsychiatric symptoms. Increased fall risk was defined by Berg scores of ≤40. Results: The mean age of the study group was 80.7 ± 6.6, and women accounted for 62.8% of the study population. Apathy was the most common neuropsychiatric symptom, affecting 58.1% of patients, and it was the most common symptom among people with dementia, affecting 67.80% of patients. The receiver operating characteristics curve analysis revealed that a high fall risk was significantly associated with the total number of neuropsychiatric symptoms (≥4) and the total intensity of these symptoms (≥6). For women, high fall risk was associated with three or more neuropsychiatric symptoms and a total neuropsychiatric symptom intensity score of at least 6. For men, the association of high fall risk with the total number of NPS was not significant; a total NPS intensity score of 10 or more was associated with high fall risk. Multivariate logistic regression analysis identified associations with fall risk for hallucinations. Conclusions: Our results suggest that the presence of neuropsychiatric symptoms, particularly hallucinations is associated with an increased risk of falls in geriatric inpatients. In addition, the cumulative total of NPS and their cumulative intensity are both independently associated with an increased risk of falls. These results suggest that fall prevention strategies should include the management of neuropsychiatric symptoms in hospitalized geriatric individuals.

Predictive ability of a self-rated fall risk assessment tool in community-dwelling older women

BackgroundFalls are a substantial health problem among older adults. An accessible and reliable tool for assessing individual fall risk is needed.AimsThe predictive ability of a one-page self-rated fall risk assessment form (KaatumisSeula® [KS]) was evaluated among older women in its current form.MethodsA subsample (n = 384) of community-living older women (aged 72–84 years) participating in the Kuopio Fall Prevention Study (KFPS) completed the KS form. Participants’ falls were prospectively registered for 12 months with SMS messages. Their group status and form-based fall risk category were compared to the verified fall events during the KFPS intervention. Negative binomial regression and multinomial regression analyses were used. Physical performance measurements (single leg stance, leg extension strength and grip strength) were used as covariates.ResultsDuring the follow-up, 43.8% of women fell at least once. Among the fallers, 76.8% had at least one self-determined injurious fall, and 26.2% had falls requiring medical attention. According to KS, 7.6% of the women had low fall risk, 75.0% moderate, 15.4% substantial, and only 2.1% high fall risk. Women in the “moderate fall risk” group had 1.47-fold (95% CI 0.74–2.91; nonsignificant), in “substantial fall risk” 4.00-fold (1.93–8.3; p < 0.001) and in “high fall risk” 3.00-fold (0.97–9.22; nonsignificant) higher risk of falls compared to the “low fall risk” group. Performance in physical tests did not account for future falls.ConclusionsThe KS form proved to be a feasible tool for self-administered fall risk assessment with moderate predictive ability.Trial registrationClinicalTrials.gov identifier: NCT02665169, date of first registration 27/01/2016.

Fall Prevention Care Management: Implementation and Outcomes of a Project to Reduce Fall Risks of Older Adults in Assisted Living Facilities.

Accidental falls are common among older adults and may lead to devastating consequences. One promising approach to reduce falls is to engage older adults in fall risk reduction through care management. This article describes the implementation by undergraduate nursing students of a 6-week interdisciplinary Fall Prevention Care Management (FPCM) intervention to improve the safety of older adults living in assisted living facilities. A secondary qualitative descriptive analysis of narrative visit notes was conducted using the Meyer et al taxonomy to characterize fall prevention interventions with older adults. Individualized fall prevention interventions including motivational interviewing and care management supported clients' engagement with fall prevention by facilitating behavior change related to fall prevention, helping clients identify and reflect on meaning and/or perceptions related to fall prevention. The FPCM project was acceptable, facilitated high fall risk older adults' engagement with fall prevention, and yielded many positive outcomes.

Everyday Experiences of Physical Function and Awareness of Fall Risk in Older Adulthood.

Falls, the leading cause of death and disability among older adults, occur in daily life when the demands of daily activities surpass the ability to maintain balance. An estimated 30% of older adults misestimate their physical function, placing them at greater risk of falling. This study examined how experiences of physical function are linked to awareness of fall risk in daily life. For 30 consecutive days following a fall-risk assessment, 41 older adults (observations = 1,135; 56% women; age: 65-91) self-assessed objective and subjective fall risk using a custom smartphone application. Alignment of objective and subjective fall risk was indexed as awareness of fall risk. Postural sway was measured by the application. Physical and mobility symptoms and fear of falling were reported daily. At baseline, 49% of participants misestimated their fall risk. Awareness of fall risk varied from day to day and fall risk was misestimated on 40% of days. Multilevel multinomial models showed individual differences in the level of daily symptoms to increase the tendency to misestimate fall risk. Daily symptoms and fear of falling increased awareness of high fall risk, but daily symptoms threatened awareness of low fall risk. Findings suggest that misestimation of fall risk is common in older adulthood and informed by appraisals of physical function. Fall prevention strategies could support older adults in understanding their everyday physical function and provide tools to adjust the demands of activities in daily life.

Efficacy on Non-motor and Motor symptoms and Quality of Life using a multidisciplinary telemedicine program in high-risk fall patients with Parkinson’s disease. (S32.003)

<h3>Objective:</h3> This study aims to evaluate the efficacy of a multidisciplinary telemedicine (TM) program to improve lifestyles, the burden of motor and non-motor symptoms (NMS), and quality of life (QoL) in fall patients with Parkinson’s disease (PD) and high risk of fall. <h3>Background:</h3> Falls in PD are very frequent, with devastating consequences, worse QoL, increasing comorbidity, and social isolation. Telerehabilitation has shown promising effects on motor symptoms, but the effectiveness of a multidisciplinary TM intervention in addition to standard clinical care on NMS, QoL and lifestyle remains unclear <h3>Design/Methods:</h3> Longitudinal, randomized study. PD Patients with high risk of falling and restricted access to multidisciplinary care were included (NCT04694443). A multidisciplinary TM program plus standard care was allocated to the study group for 4 months and compared to controls (in-office visits, standard care). TM included occupational therapy, nutrition, and PD clinical management. After discontinuing TM, both groups were compared at 8 months. Gait and PD motor severity were assessed using wearable sensors, MDS-UPDRS, Mini-Best and Freezing of gait questionnaire (FOGQ); quality of life (EuroHis-QoL8) and NMS (NMSS), Apathy Severity (LARS) and Depression/Anxiety Scale (BDI-II). Clinical information at baseline vs. 4 and 8-months visits were compared using parametric/non-parametric tests as needed. <h3>Results:</h3> 51 PD patients, 48.6 % males, median Hoehn Yhar stage 2 (1;3), mean age 68.6 ± 9.7 years were included. At 4 months, compared to controls, patients on TM had an improvement in the MDS-UPDRS II (p=0.01), Mini-Best (p&lt;0.0001) FOGQ (p=0.01); EuroHis-QoL8 (p=0.004); LARS (p&lt;0.0001) and BDI-II scores (p=0.004). After discontinuing TM at 8 months, FOG (p=0.01), and Mini-Best (p=0.001) scores were better in the TM group compared to controls. <h3>Conclusions:</h3> A multidisciplinary TM intervention alongside with standard care improves gait, QoL and NMS in PD patients with a high risk of falling. Long-term benefits on gait were observed more likely attributed to lifestyle modifications <b>Disclosure:</b> Dr. Cubo Delgado has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie. Dr. Cubo Delgado has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Zambon. Dr. Cubo Delgado has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbvie. The institution of Dr. Cubo Delgado has received research support from Spanish health ministry. The institution of Dr. Cubo Delgado has received research support from European union grant. Alvaro Garcia Bustillo has nothing to disclose. Dr. Arnaiz-Gonzalez has nothing to disclose. Florita Valiñas has nothing to disclose. Marta Allende Del Río has nothing to disclose. José Miguel Ramírez Sanz has nothing to disclose. Jose Luis Garrido_Labrador has nothing to disclose. Mrs. Olivares Gil has nothing to disclose. Dr. Diez Pastor has nothing to disclose. Jose Maria Trejo has nothing to disclose. Jeronimo González-Bernal has nothing to disclose. Josefa Gonzalez-Santos has nothing to disclose.

A multifactorial fall risk assessment system for older people utilizing a low-cost, markerless Microsoft Kinect

Falls among older people are a major health concern. This study aims to develop a multifactorial fall risk assessment system for older people using a low-cost, markerless Microsoft Kinect. A Kinect-based test battery was designed to comprehensively assess major fall risk factors. A follow-up experiment was conducted with 102 older participants to assess their fall risks. Participants were divided into high and low fall risk groups based on their prospective falls over a 6-month period. Results showed that the high fall risk group performed significantly worse on the Kinect-based test battery. The developed random forest classification model achieved an average classification accuracy of 84.7%. In addition, the individual’s performance was computed as the percentile value of a normative database to visualise deficiencies and targets for intervention. These findings indicate that the developed system can not only screen out ‘at risk’ older individuals with good accuracy, but also identify potential fall risk factors for effective fall intervention. Practitioner summary: Falls are the leading cause of injuries in older people. We newly developed a multifactorial fall risk assessment system for older people utilising a low-cost, markerless Kinect. Results showed that the developed system can screen out ‘at risk’ individuals and identify potential risk factors for effective fall intervention.

Association of Hearing Status and Cognition With Fall Among the Oldest-Old Chinese: A Nationally Representative Cohort Study.

The oldest-old (aged ≥80 years) are the most rapidly growing population and age is related to hearing impairment (HI) and cognitive decline. We aimed to estimate the association between HI and fall, and the effect of different cognitive states on this association among the oldest-old Chinese population. A total of 6931 Chinese oldest-old were included in the 2018 cross-cohort from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The presence of HI was identified by using a dichotomized metric of self-reported hearing status. Cognitive function was evaluated by using the modified Mini-Mental State Examination (MMSE). Cognitive impairment was defined as the MMSE score below 24 points. Data on fall history were collected by questionnaires survey from the participants or their relatives. We studied the association of hearing status and cognitive function with fall by using multivariable logistic regressions, upon adjustment of sociodemographic characteristics, lifestyles, and health conditions. Our participants were aged 92 (range 80 to 117) on average, with 60.1% being women. In total, 39.1% of the participants had reported HI, 50.1% had cognitive impairment, and 26.2% had a history of falling. Participants with HI had a higher incidence of cognitive impairment (79.4%), as compared with their counterparts without HI (31.3%). Compared with those without HI, HI patients had a higher risk of falling after full adjustment for potential confounders (OR = 1.16 [95% confidence interval, CI, 1.01, 1.32], p = 0.031). In comparison with HI participants without cognitive impairment, HI patients with cognitive impairment had a higher fall risk (OR = 1.45 [95% CI = 1.23, 1.72], p < 0.001). Association of hearing status and cognition with fall was, for the first time, examined on the basis of a nationally-representative oldest-old Chinese population. Poor cognitive performance was common in individuals with HI, and those with HI and cognitive impairment further increased the risk of falling.

Fall Risk in Elderly with Insomnia in Western Romania-A Retrospective Cross-Sectional Study.

Background and Objectives: Falls are frequent among the elderly, imply large social and economic costs, and have serious outcomes. The purpose of this study was to investigate the links between insomnia, comorbidities, multisite pain, physical activity, and fall risk in the elderly. Materials and Methods: This retrospective cross-sectional study included persons recruited from nursing homes for the elderly in Timisoara. We separated the participants into two groups by the absence (group I) or presence of fractures (group II) starting with the age of 65 years. Participants were asked how they feel about their sleep using one item on a 4-point scale from the Assessment of Quality of Life questionnaire. The risk of fall was evaluated using the Falls Risk Assessment Tool. Results: The study enrolled 140 patients with a mean age of 78.4 ± 2.4 years (range 65-98 years), 55 of them being males (39%). By comparing the two groups, we found that the elderly with a history of fractures had a greater number of comorbidities, a higher risk of fall, and more severe sleep disturbances. When using univariate logistic regression, the occurrence of fractures in the elderly was significantly associated with the number of comorbidities, the risk of fall, and the presence of sleep disturbances (p < 0.0001). The multivariate regression analysis selected four independent parameters significantly linked to fractures, and these were the number of comorbidities (p < 0.03), the risk of fall score (p < 0.006), and the sleep disturbances of type 3 (p < 0.003) and 4 (p = 0.001). Conclusions: A fall-risk score over 14 and a number of comorbidities over 2 were notably associated with the occurrence of fractures. We also found strong positive correlations between the type of sleep disturbance and the risk of fall score, the number of comorbidities, and the number of fractures in the elderly.

Predicting future falls in older people using natural language processing of general practitioners' clinical notes.

Falls in older people are common and morbid. Prediction models can help identifying individuals at higher fall risk. Electronic health records (EHR) offer an opportunity to develop automated prediction tools that may help to identify fall-prone individuals and lower clinical workload. However, existing models primarily utilise structured EHR data and neglect information in unstructured data. Using machine learning and natural language processing (NLP), we aimed to examine the predictive performance provided by unstructured clinical notes, and their incremental performance over structured data to predict falls. We used primary care EHR data of people aged 65 or over. We developed three logistic regression models using the least absolute shrinkage and selection operator: one using structured clinical variables (Baseline), one with topics extracted from unstructured clinical notes (Topic-based) and one by adding clinical variables to the extracted topics (Combi). Model performance was assessed in terms of discrimination using the area under the receiver operating characteristic curve (AUC), and calibration by calibration plots. We used 10-fold cross-validation to validate the approach. Data of 35,357 individuals were analysed, of which 4,734 experienced falls. Our NLP topic modelling technique discovered 151 topics from the unstructured clinical notes. AUCs and 95% confidence intervals of the Baseline, Topic-based and Combi models were 0.709 (0.700-0.719), 0.685 (0.676-0.694) and 0.718 (0.708-0.727), respectively. All the models showed good calibration. Unstructured clinical notes are an additional viable data source to develop and improve prediction models for falls compared to traditional prediction models, but the clinical relevance remains limited.

Turning When Using Smartphone in Persons With and Those Without Neurologic Conditions: Observational Study.

Turning during walking is a relevant and common everyday movement and it depends on a correct top-down intersegmental coordination. This could be reduced in several conditions (en bloc turning), and an altered turning kinematics has been linked to increased risk of falls. Smartphone use has been associated with poorer balance and gait; however, its effect on turning-while-walking has not been investigated yet. This study explores turning intersegmental coordination during smartphone use in different age groups and neurologic conditions. This study aims to evaluate the effect of smartphone use on turning behavior in healthy individuals of different ages and those with various neurological diseases. Younger (aged 18-60 years) and older (aged >60 years) healthy individuals and those with Parkinson disease, multiple sclerosis, subacute stroke (<4 weeks), or lower-back pain performed turning-while-walking alone (single task [ST]) and while performing 2 different cognitive tasks of increasing complexity (dual task [DT]). The mobility task consisted of walking up and down a 5-m walkway at self-selected speed, thus including 180° turns. Cognitive tasks consisted of a simple reaction time test (simple DT [SDT]) and a numerical Stroop test (complex DT [CDT]). General (turn duration and the number of steps while turning), segmental (peak angular velocity), and intersegmental turning parameters (intersegmental turning onset latency and maximum intersegmental angle) were extracted for head, sternum, and pelvis using a motion capture system and a turning detection algorithm. In total, 121 participants were enrolled. All participants, irrespective of age and neurologic disease, showed a reduced intersegmental turning onset latency and a reduced maximum intersegmental angle of both pelvis and sternum relative to head, thus indicating an en bloc turning behavior when using a smartphone. With regard to change from the ST to turning when using a smartphone, participants with Parkinson disease reduced their peak angular velocity the most, which was significantly different from lower-back pain relative to the head (P<.01). Participants with stroke showed en bloc turning already without smartphone use. Smartphone use during turning-while-walking may lead to en bloc turning and thus increase fall risk across age and neurologic disease groups. This behavior is probably particularly dangerous for those groups with the most pronounced changes in turning parameters during smartphone use and the highest fall risk, such as individuals with Parkinson disease. Moreover, the experimental paradigm presented here might be useful in differentiating individuals with lower-back pain without and those with early or prodromal Parkinson disease. In individuals with subacute stroke, en bloc turning could represent a compensative strategy to overcome the newly occurring mobility deficit. Considering the ubiquitous smartphone use in daily life, this study should stimulate future studies in the area of fall risk and neurological and orthopedic diseases. German Clinical Trials Register DRKS00022998; https://drks.de/search/en/trial/DRKS00022998.

The effects of optic flow on postural stability: Influence of age and fall risk

BackgroundOptic flow provides dynamic information relating to body position and motion with respect to visual frames of reference. This study investigated the effects of optic flow stimuli presented in four directions on postural stability in young and older adults. MethodsTwenty-five young (20–40 years) and 51 older (≥65 years) people participated in this study, with the older group classified into low fall risk (n = 27), and high fall risk (n = 24) sub-groups. While standing in a dark room, participants viewed static scattered white dots for 30 s, followed by 30 s periods of optic flow consisting of white dots “moving” in one of four flow directions, randomised: radial expansion and contraction, circular anti-clockwise and clockwise. Centre of pressure (CoP) position, postural sway in anteroposterior (AP) and mediolateral (ML) axes, and muscle activity of tibialis anterior (TA), gastrocnemius medialis (GM) and tensor fascia latae (TFL) were recorded. ResultsAcross groups, the four optic flow stimuli induced increased AP sway and three of the four optic flow stimuli induced increased ML sway, with concomitant increases in muscle activity, indicating optic flow stimuli induced a generalised destabilising, rather than a direction-specific, effect. Only one optic flow condition (radial contraction) induced a change in average CoP position, and this may reflect the adoption of a protective stance position to avoid a backward fall. Optic flow destabilised postural control more in older people compared with younger people, and radial expansion stimuli destabilised ML postural control more in the older high fall risk group compared with the older low fall risk group. ConclusionOptic flow stimuli have a generalised destabilising effect on postural control across groups as shown by non-directional specific increases in postural sway and muscular activity. Optic flow stimuli have a greater impact on postural stability in older compared with younger adults and this is more pronounced in the ML plane for older people at increased risk of falls.

Characterization of Postural Sway in Women with Osteoporosis and a Control Group by Means of Linear and Nonlinear Methods.

The mechanisms underlying the altered postural control and risk of falling in patients with osteoporosis are not yet fully understood. The aim of the present study was to investigate postural sway in women with osteoporosis and a control group. The postural sway of 41 women with osteoporosis (17 fallers and 24 non-fallers) and 19 healthy controls was measured in a static standing task with a force plate. The amount of sway was characterized by traditional (linear) center-of-pressure (COP) parameters. Structural (nonlinear) COP methods include spectral analysis by means of a 12-level wavelet transform and a regularity analysis via multiscale entropy (MSE) with determination of the complexity index. Patients showed increased body sway in the medial-lateral (ML) direction (standard deviation in mm: 2.63 ± 1.00 vs. 2.00 ± 0.58, p = 0.021; range of motion in mm: 15.33 ± 5.58 vs. 10.86 ± 3.14, p = 0.002) and more irregular sway in the anterior-posterior (AP) direction (complexity index: 13.75 ± 2.19 vs. 11.18 ± 4.44, p = 0.027) relative to controls. Fallers showed higher-frequency responses than non-fallers in the AP direction. Thus, postural sway is differently affected by osteoporosis in the ML and AP directions. Clinically, effective assessment and rehabilitation of balance disorders can benefit from an extended analysis of postural control with nonlinear methods, which may also contribute to the improvement of risk profiles or a screening tool for the identification of high-risk fallers, thereby prevent fractures in women with osteoporosis.