Intrinsic Fall Risk Factors Research Articles

Evaluating the Effect of Activity and Environment on Fall Risk in a Paradigm-Depending Laboratory Setting: Protocol for an Experimental Pilot Study

Knowledge about the causal factors leading to falls is still limited, and fall prevention interventions urgently need to be more effective to limit the otherwise increasing burden caused by falls in older people. To identify individual fall risk, it is important to understand the complex interplay of fall-related factors. Although fall events are common, they are seldom observed, and fall reports are often biased. Due to the rapid development of wearable inertial sensors, an objective approach to capture fall events and the corresponding circumstances is provided. The aim of this work is to operationalize a prototypical dynamic fall risk model regarding 4 ecologically valid real-world scenarios (opening a door, slipping, tripping, and usage of public transportation). We hypothesize that individual fall risk is associated with an interplay of intrinsic risk factors, activity, and environmental factors that can be estimated by using data measured within a laboratory simulation setting. We will recruit 30 community-dwelling people aged 60 years or older. To identify several fall-related intrinsic fall risk factors, appropriate clinical assessments will be selected. The experimental setup is adaptable so that the level of fall risk for each activity and each environmental factor is adjustable. By different levels of difficulty, the effect on the risk of falling will be investigated. An 8-camera motion tracking system will be used to record absolute body motions and limits of stability. All laboratory experiments will also be recorded by inertial sensors (L5, dominant leg) and video camera. Logistic regression analyses will be used to model the association between risk factors and falls. Continuous fall risk will be modeled by generalized linear regression models using margin of stability as outcome parameter. The results of this project will prove the concept and establish methods to further use the dynamic fall risk model. Recruitment and measurement initially began in October 2020 but were halted because of the COVID-19 pandemic. Recruitment and measurements recommenced in October 2022, and by February 2023, a total of 25 of the planned 30 subjects have been measured. In the field of fall prevention, a more precise fall risk model will have a significant impact on research leading to more effective prevention approaches. Given the described burden related to falls and the high prevalence, considerable improvements in fall prevention will have a significant impact on individual quality of life and also on society in general by reducing institutionalization and health care costs. The setup will enable the analysis of fall events and their circumstances ecologically valid in a laboratory setting and thereby will provide important information to estimate the individual instantaneous fall risk. DERR1-10.2196/46930.

Development and validation of a continuous fall risk score in community-dwelling older people: an ecological approach

BackgroundFall risk assessment in older people is of major importance for providing adequate preventive measures. Current predictive models are mainly focused on intrinsic risk factors and do not adjust for contextual exposure. The validity and utility of continuous risk scores have already been demonstrated in clinical practice in several diseases. In this study, we aimed to develop and validate an intrinsic-exposure continuous fall risk score (cFRs) for community-dwelling older people through standardized residuals.MethodsSelf-reported falls in the last year were recorded from 504 older persons (391 women: age 73.1 ± 6.5 years; 113 men: age 74.0 ± 6.1 years). Participants were categorized as occasional fallers (falls ≤1) or recurrent fallers (≥ 2 falls). The cFRs was derived for each participant by summing the standardized residuals (Z-scores) of the intrinsic fall risk factors and exposure factors. Receiver operating characteristic (ROC) analysis was used to determine the accuracy of the cFRs for identifying recurrent fallers.ResultsThe cFRs varied according to the number of reported falls; it was lowest in the group with no falls (− 1.66 ± 2.59), higher in the group with one fall (0.05 ± 3.13, p < 0.001), and highest in the group with recurrent fallers (2.82 ± 3.94, p < 0.001). The cFRs cutoff level yielding the maximal sensitivity and specificity for identifying recurrent fallers was 1.14, with an area under the ROC curve of 0.790 (95% confidence interval: 0.746–0.833; p < 0.001).ConclusionsThe cFRs was shown to be a valid dynamic multifactorial fall risk assessment tool for epidemiological analyses and clinical practice. Moreover, the potential for the cFRs to become a widely used approach regarding fall prevention in community-dwelling older people was demonstrated, since it involves a holistic intrinsic-exposure approach to the phenomena. Further investigation is required to validate the cFRs with other samples since it is a sample-specific tool.

Assessment of risk of falls and internal risk factors in elderly patients who need heart pacemarkers

Abstract. The aim is to assess the frequency of falls and intrinsic fall risk factors in patients requiring pacemakers.&#x0D; Methodology. The research was conducted from November 2020 to February 2021. Participated patients were hospitalized at the LUHS hospital Kauno Klinikos Department of Cardiology and required heart pacemaker implantation. Total 82 patients participated in the study. The questionnaire was composed by the authors of the research. The study was obtained by the Bioethics Permit of the Medical Academy of LUHS (No. BEC-SL (B) -42).&#x0D; Results. Almost half of the patients fell (45.1%) at least once a year. Elderly patients (65 years and older) are more likely to experience falls than patients under 65 years of age p=0,006. Elderly patients are more often exposed to various internal risk factors of falls: urination at night (82,9 %), weakness (82,9 %), dizziness (76,8 %). Perceived decreased leg muscle strength was found in both women and men (69.6% and 52.8%, respectively, p = 0.002). Patients older than 65 years and therefore &lt;65 years experienced leg pain (54,9% and 7,2%, respectively, p = 0.002), urination at night (68,4% and 14,6%, respectively, p = 0.009), and experienced fatigue (63,0% and 13,6%, p = 0.028).&#x0D; Conclusions. Almost half of the patients who were in need of heart pacemaker implantation experienced falls. ≥ 65 years old patients experienced falls more than once a year. It has been found that these patients often experience weakness, fatigue, and dizziness. A common intrinsic fall risk factor is urination at night. ≥ 65 years old patients have more internal falls risk factors than patients under 65 years old.

Evaluating Intrinsic Fall Risk Factors After Incomplete Spinal Cord Injury: Distinguishing Fallers From Nonfallers

ObjectiveTo determine whether performance on measures of lower extremity muscle strength, sensory function, postural control, gait speed, and balance self-efficacy could distinguish fallers from nonfallers among ambulatory individuals with spinal cord injury or disease (SCI/D). DesignProspective cohort study. SettingCommunity. ParticipantsIndividuals (N=26; 6 female, aged 58.9±18.2y) with motor incomplete SCI/D (American Spinal Injury Association Impairment Scale rating C [n=5] or D [n=21]) participated. Participants were 7.5±9.1 years post injury. Seventeen participants experienced traumatic causes of spinal cord injury. Main Outcome MeasuresParticipants completed laboratory-based and clinical measures of postural control, gait speed, balance self-efficacy, and lower extremity strength, as well as proprioception and cutaneous pressure sensitivity. Participants were then followed for up to 1 year to track falls using a survey. The survey queried the circumstances and consequences of each fall. If a participant’s number of falls equaled or exceeded the median number of falls experience by all participants, they were classified a faller. ResultsMedian follow-up duration was 362 days and median time to first fall was 60.5 days. Fifteen participants were classified as fallers. Most falls occurred during the morning or afternoon (81%), at home (75%), and while walking (47%). The following laboratory-based and clinical measures distinguished fallers from nonfallers (P<.05): measures of lower extremity strength, cutaneous pressure sensitivity, walking speed, and center of pressure velocity in the mediolateral direction. ConclusionsThere are laboratory-based and clinical measures that can prospectively distinguish fallers from nonfallers among ambulatory individuals with spinal cord injury. These findings may assist clinicians when evaluating their patients’ fall risk.

Validation of the Hendrich II Fall Risk Model: The imperative to reduce modifiable risk factors

AimTo validate the psychometrics of the Hendrich II Fall Risk Model (HIIFRM) and identify the prevalence of intrinsic fall risk factors in a diverse, multisite population. BackgroundInjurious inpatient falls are common events, and hospitals have implemented programs to achieve “zero” inpatient falls. MethodsRetrospective analysis of patient data from electronic health records at nine hospitals that are part of Ascension. Participants were adult inpatients (N = 214,358) consecutively admitted to the study hospitals from January 2016 through December 2018. Fall risk was assessed using the HIIFRM on admission and one time or more per nursing shift. ResultsOverall fall rate was 0.29%. At the standard threshold of HIIFRM score ≥ 5, 492 falls and 76,800 non-falls were identified (fall rate 0.36%; HIIFRM specificity 64.07%, sensitivity 78.72%). Area under the receiver operating characteristic curve was 0.765 (standard error 0.008; 95% confidence interval 0.748, 0.781; p < 0.001), indicating moderate accuracy of the HIIFRM to predict falls. At a lower cut-off score of ≥4, an additional 74 falls could have been identified, with an improvement in sensitivity (90.56%) and reduction in specificity (44.43%). ConclusionAnalysis of this very large inpatient sample confirmed the strong psychometric characteristics of the HIIFRM. The study also identified a large number of inpatients with multiple fall risk factors (n = 77,292), which are typically not actively managed during hospitalization, leaving patients at risk in the hospital and after discharge. This finding represents an opportunity to reduce injurious falls through the active management of modifiable risk factors.

83 Trip Versus Slip: Implication of the Triggers of Falls on Physiological Fall Risk

Abstract Introduction Early identification of fallers with intrinsic fall risk factors could facilitate the delivery of timely and appropriate treatment. This study aims to see if the two most common triggers of falls – trip and slip, have an implication on the physiological profile of older fallers. Methods One thousand one hundred and forty-one community-dwelling older adults aged 60 years or above who had a fall in the past year were recruited in Hong Kong. Details on the falls experienced by the elderly were recorded in an interview. Physiological fall risk of the participants was measured by the short-form Physiological Profile Assessment (PPA). It assesses vision, reaction time, proprioception, balance, and knee extension strength. Mobility was assessed by the 10-meter walk test at comfortable speed. Analysis of Co-variance (ANCOVA) was used to compare the assessment results between those who only experienced trip and falls (n=378; 316 female; mean age=70.4±7.2) and those who only experienced slip and falls (n=204; 159 female; mean age=70.1±7.1) while adjusting for gender proportion. Chi-square test was used to evaluate the difference in the proportion of recurrent fallers across groups. Results Elderly who experienced only trip and falls have a significantly lower knee extension strength (22.9±8.3kg) compare with those who experienced only slip and falls (25.0±9.18 kg; p=0.031). They also tend to take longer to complete the 10-meter walk test (Trip only: 10.17±2.88; Slip only: 9.72±2.63; p=0.085). A higher percentage of those who tripped were recurrent fallers but the difference was insignificant (Trip only: 11.6%; Slip only: 8.3%; p=0.214). No other outcome measure was found to be significantly different across groups (p≥0.418). Conclusion Elderly who tripped and fell have worse physical ability than those who slipped. They are potentially better candidates for fall prevention exercise intervention.

FALL RISK BEHAVIORS AND INTRINSIC RISK FACTORS FOR FALLS IN INDIGENOUS AND NON-INDIGENOUS RURAL OLDER ADULTS

Within California, older adults living in rural counties have reported higher rates of falls than urban dwelling older adults. Although many Indigenous people live in rural areas, it is unclear whether the rate of falls among Indigenous older adults is similar to that of non-indigenous older adults living in rural areas. Thus, the purpose of this study was to examine fall risk behaviors and intrinsic risk factors for falls in rural dwelling Indigenous (N = 89), and non-Indigenous (N = 68) older adults 60-95 years of age living in California. Results showed that both Indigenous and non-Indigenous older adults share similarly high fall rates, but there are a much greater number of Indigenous older adults falling multiple times a year. Moreover, fall risk behaviors and intrinsic fall risk factors were significantly different between Indigenous and non-Indigenous rural-dwelling older adults. Future studies should investigate falls and fall risk factors in different tribes/locations of Indigenous older adults to better understand whether these risk factors differ among tribes. Moreover, it would be beneficial for future studies to assess the effectiveness of fall prevention exercises on fall risk in these communities. Information gained from this study helps to inform clinicians and researchers alike about the prevalence of falls and factors contributing to falls among Indigenous older adults living in rural communities; and helps to influence decisions in the future of programs for reducing fall risk in this often neglected population.

A prospective study on the variation in falling and fall risk among community-dwelling older citizens in 12 European countries

ObjectivesThe rate of falling among older citizens appears to vary across different countries, but the underlying aspects causing this variation are unexplained. We aim to describe between-country variation in falling...

Lower-extremity resistance training on unstable surfaces improves proxies of muscle strength, power and balance in healthy older adults: a randomised control trial.

BackgroundIt is well documented that both balance and resistance training have the potential to mitigate intrinsic fall risk factors in older adults. However, knowledge about the effects of simultaneously executed balance and resistance training (i.e., resistance training conducted on unstable surfaces [URT]) on lower-extremity muscle strength, power and balance in older adults is insufficient. The objective of the present study was to compare the effects of machine-based stable resistance training (M-SRT) and two types of URT, i.e., machine-based (M-URT) and free-weight URT (F-URT), on measures of lower-extremity muscle strength, power and balance in older adults.MethodsSeventy-five healthy community-dwelling older adults aged 65–80 years, were assigned to three intervention groups: M-SRT, M-URT and F-URT. Over a period of ten weeks, all participants exercised two times per week with each session lasting ~60 min. Tests included assessment of leg muscle strength (e.g., maximal isometric leg extension strength), power (e.g., chair rise test) and balance (e.g., functional reach test), carried out before and after the training period. Furthermore, maximal training load of the squat-movement was assessed during the last training week.ResultsMaximal training load of the squat-movement was significantly lower in F-URT in comparison to M-SRT and M-URT. However, lower-extremity resistance training conducted on even and uneven surfaces meaningfully improved proxies of strength, power and balance in all groups. M-URT produced the greatest improvements in leg extension strength and F-URT in the chair rise test and functional reach test.ConclusionAside from two interaction effects, overall improvements in measures of lower-extremity muscle strength, power and balance were similar across training groups. Importantly, F-URT produced similar results with considerably lower training load as compared to M-SRT and M-URT. Concluding, F-URT seems an effective and safe alternative training program to mitigate intrinsic fall risk factors in older adults.Trial registrationThis trial has been registered with clinicaltrials.gov (NCT02555033) on 09/18/2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0366-3) contains supplementary material, which is available to authorized users.

Adaptations in movement performance after plyometric training on mini-trampoline in children.

Deficits in postural control and skill performance are important intrinsic fall risk factors. Thus, the purpose of this study was to investigate the impact of trampoline plyometrics on postural control, and jumping height in prepubertal children. Twenty-two school children were assigned to either a trampoline group (TPLG, N.=12, 7 girls and 5 boys, age =9.30±0.55 years) or a control group (CG, N.=12, 8 girls and 4 boys, age =9.30±0.55 years). The TPLG participated in 4 weeks plyometric training on a mini-trampoline (3 times per week) integrated in their physical education lessons while the CG attended the standard physical education curriculum at school. Pre- and postintervention included the measurements of postural sway and maximum height in countermovement and drop jump. Postural sway decreased significantly (P<0.05) in normal quiet stance (NQS) for the TPLG but not for the CG. Statistically significant decreases in postural sway in the anteroposterior direction during one-leg stance (OLS) were found for the TPLG whereas postural sway was unchanged at both directions for control group. Furthermore, statistically significant improvements in jump height were found only for TPLG after training (P<0.05). Training on elastic surface could be incorporated into children's exercise programs aiming to enhance balance and lower-limb strength to reduce injury rates. For injury prevention during trampoline training, close supervision by experienced personnel is recommended.

Reliability and Validity of Force Platform Measures of Balance Impairment in Individuals With Parkinson Disease.

Complex movement and balance impairments in people with Parkinson disease (PD) contribute to high fall risk. Comprehensive balance assessment is warranted to identify intrinsic fall risk factors and direct interventions. The purpose of this study was to examine the psychometric properties of 3 balance measures of a force platform (FP) system in people with PD. Forty-two community-dwelling individuals with idiopathic PD completed the testing protocol. Test-retest reliability was assessed for the Limits of Stability Test (LOS), Motor Control Test (MCT), and Sensory Organization Test (SOT). Intraclass correlation coefficients (ICC [2,1]) were calculated to determine test-retest reliability and minimal detectable change. Validity was assessed by comparing the FP measures with criterion gait and balance measures using Pearson product moment correlations. Multiple regression analyses examined the contribution of PD characteristics to FP measures. All primary FP variables demonstrated excellent test-retest reliability (ICC=.78-.92). The SOT and LOS demonstrated fair to good correlations with criterion measures, whereas the MCT had fair correlations to balance measures only. Both SOT composite equilibrium and MCT average latency were moderately associated with disease severity. This study's sample had a relatively small number of participants with a positive fall history, which may limit the generalizability of the findings. This study's findings provide support that FP measures are reliable and valid tests of balance impairment in people with PD. Disease severity was significantly associated with SOT and MCT measures, perhaps reflecting that these tests are meaningful indicators of decline in postural control with disease progression. Force platform measures may provide valuable quantitative information about underlying balance impairments in people with PD to guide therapeutic interventions for fall risk reduction.

Leg and trunk muscle coordination and postural sway during increasingly difficult standing balance tasks in young and older adults

Ageing impairs body balance and increases older adults’ fall risk. Balance training can improve intrinsic fall risk factors. However, age comparisons of muscle activity responses during balance tasks are lacking. This study investigated relative muscle activity, muscle coordination and postural sway during various recommended static balance training tasks.Muscle activity (%MVC), amplitude ratios (AR) and co-activity (CAI) were determined during standing tasks for 30s (1: double limb stance on a foam surface, eyes open; 2: double limb stance on firm ground, eyes closed; 3: double limb stance, feet in step position on a foam surface, eyes open; 4: double limb stance, feet in step position on firm ground, eyes closed; 5: single limb stance on firm ground, eyes open) in 20 healthy young adults (24±2 y) and 20 older adults (73±6 y). Surface electromyography (SEMG) was applied (SENIAM guidelines) to ankle (tibialis anterior, soleus, medial gastrocnemius, peroneus longus) and thigh (vastus lateralis, vastus medialis, biceps femoris, semitendinosus) muscles (non-dominant leg). Electrodes over trunk (multifidus and internal oblique) muscles were applied bilaterally.Two- to six-fold higher levels of relative muscle activity were found in older adults for ankle (0.0002<p<0.001), thigh (0.0008<p<0.075) and trunk (0.001<p<0.036) muscles. Co-activation was elevated in young adults for the trunk (0.001<p<0.031) and in older adults for the ankle (0.009<p<0.03). Age-group differences were observed for muscle coordination patterns during all stance conditions at the ankle (0.06<ηp2<0.28) and the trunk (0.14<ηp2<0.23).Older adults had higher electrophysiological costs for all stance conditions. Muscle coordination showed inverse activity patterns at the ankle and trunk. Optimal balance and strength training programs should take into account age-specific alterations in muscle activity.

Effects of a Supervised versus an Unsupervised Combined Balance and Strength Training Program on Balance and Muscle Power in Healthy Older Adults: A Randomized Controlled Trial

Background: Losses in lower extremity muscle strength/power, muscle mass and deficits in static and particularly dynamic balance due to aging are associated with impaired functional performance and an increased fall risk. It has been shown that the combination of balance and strength training (BST) mitigates these age-related deficits. However, it is unresolved whether supervised versus unsupervised BST is equally effective in improving muscle power and balance in older adults. Objective: This study examined the impact of a 12-week BST program followed by 12 weeks of detraining on measures of balance and muscle power in healthy older adults enrolled in supervised (SUP) or unsupervised (UNSUP) training. Methods: Sixty-six older adults (men: 25, women: 41; age 73 ± 4 years) were randomly assigned to a SUP group (2/week supervised training, 1/week unsupervised training; n = 22), an UNSUP group (3/week unsupervised training; n = 22) or a passive control group (CON; n = 22). Static (i.e., Romberg Test) and dynamic (i.e., 10-meter walk test) steady-state, proactive (i.e., Timed Up and Go Test, Functional Reach Test), and reactive balance (e.g., Push and Release Test), as well as lower extremity muscle power (i.e., Chair Stand Test; Stair Ascent and Descent Test) were tested before and after the active training phase as well as after detraining. Results: Adherence rates to training were 92% for SUP and 97% for UNSUP. BST resulted in significant group × time interactions. Post hoc analyses showed, among others, significant training-related improvements for the Romberg Test, stride velocity, Timed Up and Go Test, and Chair Stand Test in favor of the SUP group. Following detraining, significantly enhanced performances (compared to baseline) were still present in 13 variables for the SUP group and in 10 variables for the UNSUP group. Conclusion: Twelve weeks of BST proved to be safe (no training-related injuries) and feasible (high attendance rates of >90%). Deficits of balance and lower extremity muscle power can be mitigated by BST in healthy older adults. Additionally, supervised as compared to unsupervised BST was more effective. Thus, it is recommended to counteract intrinsic fall risk factors by applying supervised BST programs for older adults.

생애전환 초기 노인의 성별에 따른 낙상경험 및 내재적 요인 비교

AbstractPURPOSE: This study compared the elderly falls and the intrinsic fall risk factors according to gender. METHODS: This descriptive cross-sectional study was a secondary analysis of the data collected for medical checkups for the Transitional Periods of Life supported from the National Health Insurance. The subjects examined were 255,505 people aged 66 years in Korea between January and December, 2008. RESULTS: The elderly people aged 66 when in the transitional periods of life experienced 10.6% of their first falls. The first falls of women (12.4%) was greater than that of men (8.5%) in the elderly. The risk factors for falls included dysuria with an odds ratio of 6.2 to 6.6, depression with an odds ratio of 1.5 to 1.8, gait disturbance with an odds ratio of 1.3 to 1.5, and blindness with an odds ratio of 1.3 to 1.4 in both elderly women and men. CONCLUSIONS: Effective fall prevention should focus on dysuria because it is a more important predictor of falls, even though many intrinsic fall risk factors can affect falls in elderly people.

A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: study protocol for a randomized controlled trial

BackgroundWith increasing age neuromuscular deficits (e.g., sarcopenia) may result in impaired physical performance and an increased risk for falls. Prominent intrinsic fall-risk factors are age-related decreases in balance and strength / power performance as well as cognitive decline. Additional studies are needed to develop specifically tailored exercise programs for older adults that can easily be implemented into clinical practice. Thus, the objective of the present trial is to assess the effects of a fall prevention program that was developed by an interdisciplinary expert panel on measures of balance, strength / power, body composition, cognition, psychosocial well-being, and falls self-efficacy in healthy older adults. Additionally, the time-related effects of detraining are tested.Methods/DesignHealthy old people (n = 54) between the age of 65 to 80 years will participate in this trial. The testing protocol comprises tests for the assessment of static / dynamic steady-state balance (i.e., Sharpened Romberg Test, instrumented gait analysis), proactive balance (i.e., Functional Reach Test; Timed Up and Go Test), reactive balance (i.e., perturbation test during bipedal stance; Push and Release Test), strength (i.e., hand grip strength test; Chair Stand Test), and power (i.e., Stair Climb Power Test; countermovement jump). Further, body composition will be analysed using a bioelectrical impedance analysis system. In addition, questionnaires for the assessment of psychosocial (i.e., World Health Organisation Quality of Life Assessment-Bref), cognitive (i.e., Mini Mental State Examination), and fall risk determinants (i.e., Fall Efficacy Scale – International) will be included in the study protocol. Participants will be randomized into two intervention groups or the control / waiting group. After baseline measures, participants in the intervention groups will conduct a 12-week balance and strength / power exercise intervention 3 times per week, with each training session lasting 30 min. (actual training time). One intervention group will complete an extensive supervised training program, while the other intervention group will complete a short version ('3 times 3’) that is home-based and controlled by weekly phone calls. Post-tests will be conducted right after the intervention period. Additionally, detraining effects will be measured 12 weeks after program cessation. The control group / waiting group will not participate in any specific intervention during the experimental period, but will receive the extensive supervised program after the experimental period.DiscussionIt is expected that particularly the supervised combination of balance and strength / power training will improve performance in variables of balance, strength / power, body composition, cognitive function, psychosocial well-being, and falls self-efficacy of older adults. In addition, information regarding fall risk assessment, dose–response-relations, detraining effects, and supervision of training will be provided. Further, training-induced health-relevant changes, such as improved performance in activities of daily living, cognitive function, and quality of life, as well as a reduced risk for falls may help to lower costs in the health care system. Finally, practitioners, therapists, and instructors will be provided with a scientifically evaluated feasible, safe, and easy-to-administer exercise program for fall prevention.Trial registrationClinicalTrials.gov Identifier: NCT01906034

Effects of balance and resistance training in children, adolescents, and seniors

Background and aims Over the last few decades, demographic change has affected the German population in terms of a decreasing proportion of young people and an increasing proportion of elderly people. Both age groups have deficits in motor performance in common, either due to maturation and secular declines (children and adolescents) or due to biologic aging (seniors). As a consequence, deficits in postural control and muscle strength can be observed in children, adolescents, and seniors. Given these functional limitations, it is not surprising that risk of falling and, thus, medical care is particularly high in these age groups. Therefore, the objectives of this work were to investigate whether resistance or balance training have an effect on intrinsic fall risk factors (i.e., deficits in balance and strength) in children, adolescents, and seniors.

Can Balance Training Promote Balance and Strength in Prepubertal Children?

The prevalence of sustaining a fall is particularly high in children. Deficits in postural control and muscle strength are important intrinsic fall risk factors. Thus, the purpose of this study was to investigate the impact of balance training (BT) followed by detraining on postural control, plantar flexor strength, and jumping height in prepubertal children. Thirty grade 1 school children participated in this study and were assigned to either an intervention class (INT, n = 15, age 6.7 ± 0.5 years) or a control class (n = 15, age 6.6 ± 0.5 years). The INT participated in 4 weeks of BT (3 per week) integrated in their physical education lessons. Pre, post, and follow-up tests included the measurements of postural sway on a balance platform, maximal torque and rate of force development of the plantar flexors on an isokinetic device, and jumping height on a force platform. The significance level was set at p < 0.05. Balance training resulted in tendencies in terms of small to medium interaction effects yet not statistically significant improvements in postural sway (f = 0.14; p > 0.05), force production of the plantar flexors (f = 0.18; p> 0.05), and jumping height (f = 0.25; p> 0.05). Immaturity of the postural control system and deficits in attentional focus during practice of balance exercises could be responsible for the nonsignificant findings in this study. Thus, other training regimen (e.g., resistance training) should be applied alone or in combination with BT, which may have the potential to promote balance and strength in children.

Comparison of Traditional and Recent Approaches in the Promotion of Balance and Strength in Older Adults

Demographic change in industrialized countries produced an increase in the proportion of elderly people in our society, resulting in specific healthcare challenges. One such challenge is how to effectively deal with the increased risk of sustaining a fall and fall-related injuries in old age. Deficits in postural control and muscle strength represent important intrinsic fall risk factors. Thus, adequate training regimens need to be designed and applied that have the potential to reduce the rate of falling in older adults by countering these factors. Therefore, the purpose of this review is to compare traditional and recent approaches in the promotion of balance and strength in older adults. Traditionally, balance and resistance training programmes proved to be effective in improving balance and strength, and in reducing the number of falls. Yet, it was argued that these training protocols are not specific enough to induce adaptations in neuromuscular capacities that are specifically needed in actual balance-threatening situations (e.g. abilities to recover balance and to produce force explosively). Recent studies indicated that perturbation-based or multitask balance training and power/high-velocity resistance training have the potential to improve these specific capacities because they comply with the principle of training specificity. In fact, there is evidence that these specifically tailored training programmes are more effective in improving balance recovery mechanisms and muscle power than traditional training protocols. A few pilot studies have even shown that these recently designed training protocols have an impact on the reduction of fall incidence rate in older adults. Further research is needed to confirm these results and to elucidate the underlying mechanisms responsible for the adaptive processes.

Vermijden van valincidenten van ouderen in mondzorgpraktijken

Oral health care practices are ever more frequently visited by frail elderly people. Frail elderly people are at risk for fall accidents due to intrinsic and extrinsic factors. Intrinsic factors are patient-related and extrinsic factors are environment-related. Significant intrinsic fall risk factors for elderly people are orthostatic and postprandial hypotension. The most important effect of hypotension is cerebral hypoperfusion, which can induce syncope and fall. Five to ten per cent of fall accidents of elderly people result in trauma. A serious trauma with possible extreme consequences is hip fracture. One year after a surgical hip fracture treatment of elderly people, 25% are experiencing mobility impairment and 25% have died as a result of co-morbidity or complications. Fall prevention deserves serious attention. Provision of information and strengthening and protecting bones are important prevention measures. In an oral health care practice, general risks of falling must be inventoried on a regular basis, and each (frail) elderly patient should be provided with individual fall-prevention guidance.

The Relationship of Intrinsic Fall Risk Factors to a Recent History of Falling in Older Women With Osteoporosis

Cross-sectional descriptive analysis investigating intrinsic fall risk factors in postmenopausal women with osteoporosis. To examine the relationships between history of recent falls and balance, pain, quality of life, function, posture, strength, and mobility. Women with osteoporosis who fall are at a high risk of fracture due to decreased bone strength. Identifying fall risk factors for older women with osteoporosis is a crucial step in decreasing the incidence of falls and fracture. METHOD AND MEASURES: Seventy-three women over 60 years of age with established osteoporosis participated in comprehensive testing of fall history, physical function, and quality of life. Significant correlations were found between a recent history of falls and degree of kyphosis (r = 0.29), fear of falls/emotional status (r = -0.27), and balance (r = -0.27). Degree of kyphosis and fear of falls/emotional status explained 20% of the variance of recent fall history using binary logistic regression. Women with an increased kyphosis were more likely to have had a recent fall (odds ratio [OR], 1.17; 95% CI, 1.03-1.34) and those with better emotional status and less fear of falling were less likely to have had a recent fall (OR, 0.61; 95% CI, 0.38-0.97). Increased thoracic kyphosis and fear of falling are 2 intrinsic factors associated with recent falls in women with osteoporosis. To design more effective interventions to decrease fall risk in this population, future prospective, longitudinal studies should monitor kyphosis, fear of falling, balance reactions, and other potential risk factors not identified in this study.