High Fall Risk Research Articles

Effects of Proprioceptive Neuromuscular Facilitation Technique on Balance Function and Muscle Health in Older Adults With High Fall Risk.

Older adults frequently encounter health challenges, such as impaired balance and muscle health, which increase risk of falls. The current study investigated the effectiveness of the proprioceptive neuromuscular facilitation (PNF) technique in improving balance and muscle health among older adults with high fall risk. A total of 160 older adults with high fall risk were randomized into control and intervention groups. Over 6 months, the control group received standard interventions, while the intervention group received the same interventions and additional PNF training. Both groups demonstrated improvements in balance function over time, with the intervention group exhibiting significant improvements in Berg Balance Scale scores, Timed Up and Go test times, and 30-Second Chair Stand Test counts (p < 0.05). Bone density significantly increased in the intervention group compared to the control group (p < 0.05), although no substantial differences in lower limb muscle mass were observed. Satisfaction rates were higher and fall incidents fewer in the intervention group. The PNF technique is effective in enhancing balance function and muscle health in older adults with high fall risk, demonstrating potential in reducing fall risk and improving quality of life among older adults. [Journal of Gerontological Nursing, 50(8), 37-44.].

Multiple Long-Term Conditions and Disability are Independently Associated with Higher Risk of Fall Among Community Adults: A Cross-Sectional Study [Letter

Multiple Long-Term Conditions and Disability are Independently Associated with Higher Risk of Fall Among Community Adults: A Cross-Sectional Study [Letter

Quantitative gait markers and the TUG time in chronic kidney disease

BackgroundPoor gait performance results in more fall incidents among people with chronic kidney disease (CKD). It is unknown what specific quantitative gait markers contribute to high fall risk in CKD and the size of their mediation effects. MethodsWe included 634 participants from the Taizhou Imaging Study who had complete gait and laboratory data. Quantitative gait assessment was conducted with a wearable insole-like device. Factor analysis was utilized to summarize fifteen highly correlated individual parameters into five independent gait domains. Prevalent CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m2, which was calculated based on cystatin C. Regression models were created to examine the associations of prevalent CKD with quantitative gait markers and the TUG time. Mediation analysis was used to investigate whether poor quantitative gait parameters could be mediators and the proportion of their mediation effects. ResultsParticipants with prevalent CKD had a higher TUG time (odds ratio = 2.02, P = 0.025) and poor gait performance in the phase domain (standardized β = −0.391, FDR = 0.009), including less time in the swing phase (standardized β = −0.365, FDR = 0.027) and greater time in the double-support phase (standardized β = 0.367, FDR = 0.027). These abnormalities mediated the association of prevalent CKD with a high TUG time (for the swing phase: 31.6 %, Pmediation = 0.044; for the double-support phase: 29.6 %, Pmediation = 0.042; for the phase domain: 26.9 %, Pmediation = 0.048). ConclusionPoor phase-related gait abnormalities mediated the relationship between CKD and a high TUG time, suggesting that incorporating quantitative gait markers in specific domains may improve fall prevention programs for individuals with CKD.

Assessing osteoporosis awareness and knowledge levels of Turkish multiple sclerosis patients: an observational study.

To assess the knowledge and awareness of osteoporosis in Turkish multiple sclerosis (MS) patients. Three hundred twenty-five patients were asked to fill out the osteoporosis awareness scale (OAS), which has a scoring range of 31-124, and the revised osteoporosis knowledge test (R-OKT), which has a score range of 0-32. Fall risk assessment for patients was conducted using the timed up-and-go test (high risk: > 30, moderate risk: 29-20, low risk: 14-19, and no risk: < 13 s). An average score of 59.42 ± 19.63(31%) on the OAS and 14.99 ± 5.39 (47%) on the R-OKT was detected. No difference was found in R-OKT scores between genders, education levels, and patients with different fall risks and between genders and education levels in OAS scores. Patients with low, medium, and high fall risks exhibited higher OAS scores compared to those without any fall risk (p = 0.006, p < 0.001, and p < 0.001, respectively). No correlation was found between gender and education level with OAS and R-OKT scores and between the R-OKT scores and the risk of falls. There was a weak correlation between the OAS scores and an increased risk of falls (r = 0.269, p < 0.001). No differences between the age groups regarding OAS and R-OKT scores were observed. Turkish MS patients have inadequate knowledge and low awareness of OP compared to the healthy population. Urgent action is warranted to educate and support individuals with MS, implementing targeted interventions and awareness campaigns to improve early detection and prevent osteoporosis-related complications. ClinicalTrials.gov Identifier: NCT05760651.

Single-belt vs. split-belt treadmill symmetry training: is there a perfect choice for gait rehabilitation post-stroke?

Post-stroke gait asymmetry leads to inefficient gait and a higher fall risk, often causing limited home and community ambulation. Two types of treadmills are typically used for training focused on symmetry: split-belt and single belt treadmills, but there is no consensus on which treadmill is superior to improve gait symmetry in individuals with stroke. To comprehensively determine which intervention is superior, we considered multiple spatial and temporal gait parameters (step length, stride time, swing time, and stance time) and their symmetries. Ten individuals with stroke underwent a single session of split-belt treadmill training and single belt treadmill training on separate days. The changes in step length, stride time, swing time, stance time and their respective symmetries were compared to investigate which training improves both spatiotemporal gait parameters and symmetries immediately after the intervention and after 5min of rest. Both types of treadmill training immediately increased gait velocity (0.08m/s faster) and shorter step length (4.15cm longer). However, split-belt treadmill training was more effective at improving step length symmetry (improved by 27.3%) without sacrificing gait velocity or step length. However, this step length symmetry effect diminished after a 5-min rest period. Split-belt treadmill training may have some advantages over single belt treadmill training, when targeting step length symmetry. Future research should focus on comparing the long-term effects of these two types of training and examining the duration of the observed effects to provide clinically applicable information.

The Impact of Demographics and Comorbidities on Fall Incidence and Prevalence in Older Adults.

Falls among older adults are more than mere accidents; they are a silent epidemic, profoundly impacting the health and well-being of millions of older adults worldwide. This study examines the incidence and prevalence of falls among individuals aged 65 and above, focusing on the influence of demographic factors and comorbid conditions such as hypertension, diabetes mellitus, cancer, and obesity. A retrospective cohort study was conducted using data from the TriNetX network at Virginia Commonwealth University Health System (VCUHS) from 2019 to 2023. The study population included 16,400 individuals aged 65 and above who presented with fall-related trauma. Data on demographics, clinical diagnoses, procedures, and comorbid conditions were analyzed using descriptive statistics to evaluate the incidence and prevalence of falls. The mean age of the study population was 77.3 years, with a higher proportion of females (60.97%) compared to males (39.02%). Despite the larger number of female participants, incidence and prevalence of falls were highest among individuals aged 65-69 years, and fall rates were notably higher among males compared to females. This suggests that while fewer in number, males in our study experienced falls more frequently. Patients with hypertension had the highest incidence proportion (56.67%) and prevalence (75.75%) among comorbid conditions. Falls among older adults are significantly influenced by demographic factors and comorbid conditions. Hypertension, in particular, is associated with the highest fall risk. These findings highlight the need for targeted interventions to manage comorbidities and reduce fall risks among older adult patients.

Evaluation of falling risk and quality of life in the elderly

Aim: The aim of this study is to determine the risk of falling, which is one of the conditions that threaten the health of the elderly, and to evaluate its relationship with quality of life. Methods: A cross-sectional study was conducted in a province located in the west of Türkiye between September and November 2022. The questionnaire was conducted face-to-face in family health centers after obtaining informed consent from the participants. In this study, a questionnaire including sociodemographic characteristics, features related to falls, the fall risk for the older in the community (FROP-Com) screening scale, and the EQ-5D quality of life scale was used. Results: The study was completed with 413 participants. The prevalence of falls within the last year in the study group was 21.1%. According to FROP-Com screen; 8.0% of the participants had a low fall risk and 92.0% had a high fall risk. The median EQ-5D index score was 0.7 (minimum=-0.2; maximum=1.0). FROP-Com fall risk was accepted as the dependent variable, the risk of falling; It was found that it increased 2.5 times in those who did not exercise, 5.1 times in those who did have balance problems, and 3.6 times in those who used assistive devices compared to those who did not. Conclusion: In the Central District of Kütahya, one out of every five people over the age of 65 had a history of falling within the last year. In the study, it is remarkable that there is a relationship between exercise status and the risk of falling. Falls can be prevented or reduced by increasing exercise status.

Fall Risk Screening in Older Adult Patients on Chronic Opioid Therapy: A Quality Improvement Project.

Many older adults prescribed opioid pain medications may be at increased risk of falls. As a quality improvement (QI) initiative, the University of Utah Sugar House clinic initiated a 9-month fall risk screening pilot for older adult patients on chronic opioids. This QI project sought to determine the feasibility of adding screening to a busy clinical practice, examine risk of falls in this patient cohort, and examine whether there were significant clinical and demographic differences between the patients who did or did not receive screening. We observed whether conventionally understood fall risk factors, including higher opioid doses, concurrent benzodiazepine prescription, and age, correlate with high fall risk. After the screening initiative, we determined that it was possible to significantly increase fall risk screening rates with prompts in Electronic Health Record (EHR). This cohort's fall risk screening increased from 18% to 33%. In the patients who were screened, 43% were found to be at high risk of falls. We did not see a correlation with high fall risk and patients taking higher doses of opioids or concurrent benzodiazepine prescriptions. These findings emphasize the need for consistent screening in primary care because review of the medication list alone is not a reliable predictor of fall risk.

Impact of Documented Fall-Risk, Self-Reported Health and Confidence to Prevent Falls on Concern About Falling Among Community-Dwelling Older Adults: Secondary Analysis of a Randomized Clinical Trial.

Individuals identified as high fall risk are expected to have high concern about falling. However, perception and individual factors that influence concern about falling have yet to be thoroughly studied. We aimed to understand factors that influence concern about falling among older adults with increased risk for falling. This was a secondary analysis of a clinical trial among community-dwelling older adults (age ≥65 years old) at high risk for falls (n = 178). Descriptive and regression analyses were used. We analyzed the relationship between participants' baseline concern about falling - categorized into three groups: low (7-8), moderate (9-13), and high (≥14) - and factors that may impact their concern. Exploratory factors included age, sex, self-reported health status and confidence to address fall risks, fall risk scores, and physical performance measures. Among these individuals, 15.2% reported low concern about falling. On average, individuals in higher concern about falling groups had higher fall risk scores (low [5.7], moderate [6.4], and high [8.0]; p < 0.001). Our regression model showed that the odds of being in a higher concern group increased by 21% for every one unit increase in fall risk score and increased by 67% for every one unit increase toward poorer health rating. Conversely, for every one unit increase in self-reported confidence, the odds of being in a higher concern group decreased by 27.5%. Knowledge of older adults' fall risk, health status, and concerns about falling can be used to assist in the personalization of fall prevention interventions for a more holistic approach.

Fall-risk assessment in elderly pilgrims attending large religious congregation: A cross-sectional cohort study

BackgroundFalls are an important geriatric syndrome with tremendous economic burden. The aim of this study was to find the prevalence of fall risk as assessed by digital sensor–based quantitative timed up and go (QTUG) device in elderly pilgrims attending Mahakumbh festival 2019. MethodsAn observational cross-sectional study done in elderly pilgrims attending the Kumbh Festival 2019. Combined fall risk and frailty assessment was estimated objectively using a digital sensor–based QTUG device. Details of age, body mass index (BMI), co-morbidities, and history of falls were also recorded. The association of fall and frailty assessment with gender, age, BMI, co-morbidities, and timed up and go (TUG) time was noted. ResultsIn total, 370 elderly (aged >60 years) individuals were assessed. The mean age was 65.51 ± 5.22 years. The mean BMI was 25.17 ± 4.56 kg/m2. Previous falls history was seen in 40.12%. The mean combined fall risk and combined frailty risk was 51.79 ± 18.11% and 50.12 ± 18.55%, respectively. The mean TUG time was 16.16 ± 7.46 seconds. Age, female gender, and TUG time had significantly increased combined fall-risk percentage and combined frailty estimate (p: <0.0006, <0.0001, and <0.0001, respectively) and combined frailty percentage (p < 0.0001). BMI and age also had a significant correlation with combined frailty risk (p = 0.0018). ConclusionMore than 50% of elderly Indians at Kumbh 2019 had a high combined fall risk and frailty estimate. The mean TUG time of elderly in our study was 16.16 seconds. There was a strong association between increased fall risk and female gender, age, and TUG time.

Characteristic of fall in sarcopenic patients at the National Geriatric Hospital

Objective: to describe the characteristic of falls in sarcopenic patients at National Geriatric Hospital. Method: The study is a cross-sectional descriptive study. Inpatients and outpatients at National Geriatric Hospital excepted for Emergency and Stroke departments, Intensive care unit. The research was conducted from July to October 2022. Results: Mean age 75.68±8.20, 78.2% female. 64 (21.8%) participants reported at least 1 fall in the previous 12 months and 42.9% of participants had a high risk of fall. The majority of falls occurred at home and in the house or bedroom (40%). Conclusion: Patients with sarcopenia have a high prevalence of falls and a high risk of falls. Fall risk assessment and implementation of fall prevention should be carried out in everyday practice.

Relationship Between Unit Characteristics and Fall Incidence: A Cross-Sectional Survey Using Administrative Data in Japan.

Falls are the most frequent accident experienced by inpatients in hospitals. As falls affect patient outcomes, high fall risk factors should be studied to prevent falls and improve patient safety. However, the relationship between hospital unit characteristics and fall risk has never been assessed. This study was designed to identify the unit characteristics significantly related to fall risk. A cross-sectional study was conducted on the medical records of patients hospitalized in a Japanese academic hospital between 2018 and 2019. This study quantified unit activities and utilized Diagnosis Procedure Combination data to examine unit characteristics related to falls based on unit day. Data on 16,307 patients were included in the analysis, and 355 unit days were certified as fall events. Based on patient condition and medical treatment, the results identified antineoplastic injections, radiation therapy, aseptic treatment room, and functional status of partly assisted transfers, meals, and oral care as unit characteristics associated with increased fall events. Decreased nursing time per patient at night (odds ratio [OR] = 0.75, p = .04) and higher numbers of partially assisted transfer patients were also identified as unit characteristics associated with higher fall incidence rates (OR = 5.56, p = .01). The results of this study are expected to assist nurses to predict falls based on unit characteristics; reducing nursing time in the units was found to be a factor associated with higher fall risk. Nurse managers must understand the unit-related fall risk factors, appropriately assign nurse staffing numbers, and demonstrate nursing leadership to prevent falls in their units.

Lower limb strength and associated factors among older patients with dementia

This cross-sectional study was conducted to assess lower limb strength and related factors among older people with dementia examined and treated at the National Geriatric Hospital. Lower limb strength was assessed using the 30-Second Chair Stand Test. The proportion of participants with impaired lower limb strength was 78.2%. There were significant associations between impaired lower limb strength and diabetic patients. There were significant associations between impaired lower limb strength and geriatric syndromes: malnutrition, high risk of falls, and dependence or partial dependence according to the Barthel Index. There was no significant difference between the type of dementia and the level of dementia with impaired lower limb strength. In conclusion: Three-quarters of older dementia patients have impaired lower limb strength. Our results highlighted that diabetes, and geriatric syndromes such as malnutrition, high fall risk, dependence, and partial dependence were significantly associated with lower limb strength in older patients with dementia.

Pencegahan Resiko Jatuh pada Pasien dengan Diagnosis Keperawatan Dypsneu: Studi Kasus

Background: Patient safety is a system used to improve patient care in a relatively safer manner, including risk assessment, patient risk identification and management, case reporting and analysis, the ability to learn from cases, as well as follow-up and implementation of solutions to reduce risk and prevent injury resulting from errors caused by implementation or negligence of action procedures that must be taken. Method: The method used in writing this nurse's scientific work is descriptive qualitative and case study. Results: With the results observed for 3 days, Mrs M is a patient with a high risk of falling. Where a score of more than 45 is a high fall risk category and a score of less than 45 is a mild to moderate fall risk category. Conclusion: The role of professional nurses is as care giver, client advocate, counselor, educator, collaborator, coordinator, change agent, consultant. Application in preventing the risk of falls is by carrying out an initial assessment and re-assessment and intervention - education.

Reframing Communication about Fall Prevention Programs to Increase Older Adults' Intentions to Participate.

Falls and fall-related injuries in community-dwelling older adults are a growing global health concern. Despite effective exercise-based fall prevention programs (FPPs), low enrollment rates persist due to negative connotations associated with falls and aging. This study aimed to investigate whether positive framing in communication leads to a higher intention to participate in an FPP among community-dwelling older adults. We conducted a two-sequence randomized crossover study. We designed two flyers, a standard flyer containing standard terminology regarding FPPs for older adults, and a reframed flyer highlighting fitness and activity by reframing 'fall prevention' as an 'exercise program' and 'old' as 'over 65 years'. With a Mann-Whitney U test, we investigated group differences regarding the intention to participate between the flyers. A sensitivity analysis and subgroup analyses were performed. We conducted qualitative thematic analysis on open-ended answers to gain a deeper understanding of participants' intention to participate. In total, we included 133 participants. Findings indicated a significantly higher intention to participate in the reframed flyer (median = 4; interquartile range = 1-6) compared to the standard flyer (median = 2; interquartile range = 1-4) (p = 0.038). Participants favored more general terms such as 'over 65 years' over 'older adults'. Older adults who were female, not at high fall risk, perceived themselves as not at fall risk, and maintained a positive attitude to aging showed greater receptivity to positively-framed communications in the reframed flyer. Additionally, already being engaged in physical activities and a lack of practical information about the FPP appeared to discourage participation intentions. The results in favor of the reframed flyer provide practical insights for designing and implementing effective (mass-)media campaigns on both (inter)national and local levels, as well as for interacting with this population on an individual basis. Aging-related terminology in promotional materials hinders engagement, underscoring the need for more positive messaging and leaving out terms such as 'older'. Tailored positively framed messages and involving diverse older adults in message development are essential for promoting participation in FPPs across various population subgroups to promote participation in FPPs among community-dwelling older adults.

Incidence and Factors Associated with Falls in Older People in a Long-Term Care Facility: A Prospective Study in Taiwan.

The effectiveness of applying a fall-risk assessment to prevent falls in residents of long-term care facilities has not been investigated. This prospective study enrolled elderly residents in a long-term care facility in Taiwan. Caregivers were provided with a health-status assessment and fall-risk data to enhance their fall-prevention practices. A multivariate analysis was performed to identify the factors associated with falls. A total of 123 subjects, including 68 and 55 for general and nursing-care models, respectively, were assessed. Their health status and risk of falls were provided to the care units to enhance their fall-prevention practices. Subjects in the nursing-care model had more dementia and more prescribed medications, worse physiologic conditions, and higher fall risk. Of them, 28 (23%) had subsequent falls. A univariate analysis showed that those with and without falls were similar in demographic characteristics, prescribed medications, physiologic function, and fall risk. There was a tendency for more falls in the nursing-care model residents (accounting for 61% of those who fell; p = 0.053). A regression analysis showed that gender (beta = 1.359; 95% confidence interval = 0.345-2.374; p = 0.010) and NPI score (beta = 0.101; 95% CI = 0.001-0.200; p = 0.047) were associated with the risk of falls. Residents at the long-term care facility had a significant risk of falls despite knowledge of their fall risk and the implementation of preventive measures. In this context of being aware of the risk, gender, and psychiatric symptoms were significantly associated with falls. Caregivers at long-term care facilities should implement further measures to prevent falls based on behavioral and psychological symptoms.

To assess fall risk in the elderly OPD patients using conventional fall risk tool and Kinesis QTUG device: A comparative study

BackgroundFalls are common among the elderly population and are usually multifactorial. Most of the falls are preventable if the risk factors are identified early and addressed. The primary objective was to assess the agreement between the fall-risk assessment as measured by the digital sensor–based Kinesis Quantitative Timed Up and Go (QTUG) device and conventional Fall Risk Assessment Tool (FRAT) in elderly Indian population. MethodsThe study was conducted in a tertiary care hospital of Western India. Conventional fall-risk assessment was done using the FRAT score and digital sensor–based fall risk was assessed using the Kinesis QTUG device. Agreement between both the fall-risk assessments was done using unweighted kappa. ResultsThe mean age was 68.54 (±2.62) years with females constituting 53.3%. The mean timed-up-and-go test score was 20.33(±7.7) seconds. A total of 253 falls were noted for 147 elderly individuals. Combined fall risk using the Kinesis QTUG device showed that 59.56% (218/366) elderly patients had a high fall risk, whereas the FRAT score showed high fall risk in only 1.36% (5/366) elderly patients. There was a poor agreement between the two tools with unweighted kappa of 0.634. ConclusionsPrevalence of falls in elderly in the last year was 40% in our study. There was a poor agreement in fall-risk estimate using the Kinesis QTUG device and FRAT score with an unweighted kappa value of 0.634.

Fracture Risk Among Stroke Survivors According to Poststroke Disability Status and Stroke Type.

Stroke survivors face physical and cognitive challenges, leading to an increased dependency and a higher fall risk. We aimed to investigate the impact of poststroke disability and stroke type on fracture risk at various sites compared with matched controls. This retrospective cohort study used data from the Korean National Health Insurance System database (2010-2018), including patients with stroke and 1:1 matched controls. Stroke survivors were grouped based on the presence and severity of their poststroke disability and stroke type. The primary outcome was a newly diagnosed fracture, analyzed by Cox proportional hazard regression analyses adjusting for potential confounders. Among 223 358 stroke survivors (mean age, 64.8±10.9 years; 61.2% men), 16 344 fractures occurred during a mean follow-up of 3.7±2.5 years. In matched controls (n=322 161; mean age, 65.4±11.2 years; 61.3% men), 20 398 fractures were identified. Stroke survivors had increased overall fracture risk compared with matched controls (adjusted hazard ratio [aHR], 1.40 [95% CI, 1.37-1.43]). Specifically, hip fracture risk was even greater in stroke survivors (incidence rate per 1000 person-years, 4.7 [95% CI, 4.5-4.8]; aHR, 2.42 [95% CI, 2.30-2.55]) than controls (incidence rate, 2.2 [95% CI, 2.1-2.3]). The risk of vertebral fractures (aHR, 1.29 [95% CI, 1.25-1.34]) and other fractures (aHR, 1.19 [95% CI, 1.15-1.23]) was also higher than that of the control group. Hip fracture risk was the highest among stroke survivors with severe poststroke disability (aHR, 4.82 [95% CI, 4.28-5.42]), although vertebral or other fracture risk was the highest among those with mild poststroke disability. No significant difference in fracture risk was found between hemorrhagic and ischemic stroke survivors when stratified by disability status. Our findings showed increased subsequent fracture risk among stroke survivors, particularly those with poststroke disability and for hip fracture. Bone health assessment and treatment should be emphasized as an essential part of stroke management.

Impaired Standing Balance in Older Adults with Cognitive Impairment after a Severe Fall

Introduction: Fall-related sequelae as well as balance and gait impairments are more pronounced in older adults who are cognitively impaired (OACI) compared to older adults who are cognitively healthy (OACH). Evidence is scarce about differences in standing balance and gait in OACH and OACI after a fall, even though these are major risks for recurrent falls. Thus, the aim of this study was to investigate early impairments in gait and balance, by adding inertial measurement units (IMUs) to a functional performance test in OACH and OACI after a severe fall with a presentation to the emergency department (ED) and immediate discharge. Methods: The study sample was stratified into participants with and without probable cognitive impairment using the result of the Montreal Cognitive Assessment total score (maximum of 30 points). The cutoff for probable cognitive impairment was set at ≤ 24. Standing balance and gait parameters were measured using three IMUs in n = 69 OACH (72.0 ± 8.2 years) and n = 76 OACI (78.7 ± 8.1 years). Data were collected at participants’ homes as part of a comprehensive geriatric assessment in the “SeFallED” study within 4 weeks after presentation to the ED after a severe fall (German Clinical Trials Register ID: 00025949). ANCOVA was used for statistical analysis, adjusted for age. Results: The data indicated significantly more sway for OACI compared to OACH during balance tasks, whereas no differences in gait behavior were found. In detail, differences in standing balance were revealed for mean velocity (m/s) during parallel stance with eyes open (ηp2 = 0.190, p < 0.001) and eyes closed on a balance cushion (ηp2 = 0.059, p = 0.029), as well as during tandem stance (ηp2 = 0.034, p = 0.044) between OACI and OACH. Further differences between the two groups were detected for path length (m/s2) during parallel stance with eyes open (ηp2 = 0.144, p < 0.001) and eyes closed (ηp2 = 0.044, p < 0.027) and for range (m/s2) during tandem (ηp2 = 0.036, p = 0.036) and parallel stance with eyes closed (ηp2 = 0.045, p = 0.032). Conclusion: Even though both groups have experienced a severe fall with presentation to the ED in the preceding 4 weeks, balance control among OACI indicated a higher fall risk than among OACH. Therefore, effective secondary fall prevention efforts have to be established, particularly for OACI.

An emergency department-based system intervention to improve osteoporosis screening for older adults at high-risk of fracture

Abstract Falls and osteoporosis are risk factors for fragility fractures. Bone mineral density (BMD) assessment is associated with better preventative osteoporosis care, but it is underutilized by those at high fracture risk. We created a novel electronic medical record (EMR) alert-driven protocol to screen patients in the emergency department (ED) for fracture risk and tested its feasibility and effectiveness in generating and completing referrals for outpatient BMD testing after discharge. The EMR alert was configured in two tertiary-care EDs and triggered by the term “fall” in the chief complaint, age (≥65 years for women, ≥70 years for men), and high fall risk (Morse score ≥ 45). The alert electronically notified ED study staff of potentially eligible patients. Participants received osteoporosis screening education and had BMD testing ordered. From November 15, 2020 to December 4, 2021, there were 2608 EMR alerts among 2509 patients. We identified 558 patients at high-risk of fracture who were screened for BMD testing referral. Participants were excluded for: serious illness (N = 141), no documented health insurance to cover BMD testing (N = 97), prior BMD testing/recent osteoporosis care (N = 58), research assistant unavailable to enroll (N = 53), concomitant fracture (N = 43), bedridden status (N = 38), chief complaint of fall documented in error (N = 38), long-term care residence (N = 34), participation refusal (N = 32), or hospitalization (N = 3). Of the 16 participants who had BMD testing ordered, 7 scheduled and 5 completed BMD testing. EMR alerts can help identify subpopulations who may benefit from osteoporosis screening, but there are significant barriers to identifying eligible and willing patients for screening in the ED. In our study targeting an innovative venue for osteoporosis care delivery, only about 1% of patients at high-risk of fracture scheduled BMD testing after an ED visit. Adequate resources during and after an ED visit are needed to ensure that older adults participate in preventative osteoporosis care.