Fall Risk Level Research Articles

ASSOCIATION BETWEEN COGNITION AND FALL RISK BASED ON THE STEADI ALGORITHM: PROJECT VIBE

Falls are a growing concern among older adults with estimates that one in four fall each year. Older adults who experience a fall are at higher risk for poor health outcomes that threaten independence and increase risk of death. Impairment in cognitive function is known to be associated with greater fall occurrence; however, cognitive testing is not an integral part of clinical fall risk assessment. The purpose of this study is to examine cognitive performance in relation to fall risk level and its components determined using the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) algorithm. One hundred eight community dwelling older adults (mean age 79(SD 7.3) years, 76% women, and 56% college or higher education) were included. Cognition was assessed with the Montreal Cognitive Assessment (MoCA; >= 26 normal). The STEADI algorithm was used to assess fall risk (low vs. moderate/high) based on the Stay Independent screening (>= 4), impairment in gait (Timed Up and Go (TUG)), strength (30-second chair stand), and balance (4-stage balance), and number of falls (>= 2). Associations between cognition and fall risk and its components were assessed using logistic regression adjusting for age, gender, and education. Normal cognitive status was marginally associated with lower likelihood of moderate/high compared to low fall risk (OR 0.42, 95% CI 0.17-1.04), and with a lower likelihood of TUG impairment (OR 0.22, 95% CI 0.07-0.66). These results suggest cognitive status may contribute important information about older adults’ fall risk and should be considered an integral part of fall risk assessment.

Outcomes of a Physical Therapist-Led, Statewide, Community-Based Fall Risk Screening.

Falls are the leading cause of morbidity and mortality among US older adults and result in considerable medical and social consequences. Community-based screenings are a type of intervention that provides accessible fall risk screening and education at no cost to the participants. However, little is known about whether or how participants change behavior after screening events. Therefore, the purpose of this study was to quantify and characterize participant risk-reducing behaviors after community-based fall risk screenings. Participants were recruited during 22 community-based fall risk screening events in 2017 led by physical therapists. The screenings were conducted using a modified version of the Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths, and Injuries (CDC STEADI) toolkit. Screenings included risk reduction education via group format and individual recommendations tailored to fall risk classification based on the screening outcomes. For the study, questionnaires were used at baseline to collect demographics and screening results and at 1-month and 5-month follow-up to assess risk reduction behavior change. Descriptive statistics characterized behavior change and assessed outcome differences by baseline fall risk level. Logistic regression analyses examined factors impacting behavior change after screening. At baseline, 123 participants enrolled and 104 (84.6%) responded at 1- and 5-month follow-up. By 1 month, 50.0% of participants had adopted at least 1 fall risk-reducing behavior, which increased to 64.9% by 5 months. Moderate or high fall risk was significantly associated with adopting a new behavior change by 5 months compared with those with low fall risk (P = .04). The odds of adopting a fall risk reduction strategy by 5 months increased with higher education (odds ratio: 2.5, 95% confidence interval: 1.0-6.0) and moderate/high fall risk (odds ratio: 3.0, 95% confidence interval: 1.3-7.2) in a logistic regression model adjusted by age and sex. Screening and education using the STEADI toolkit during community-based screenings result in short- and long-term behavior change to reduce fall risk among older adults, particularly those with moderate to high fall risk. Further research is needed to identify barriers and incentives among participants who do not make fall-related behavioral changes after screening.

Levels of fall risk among Hospitalized elderly

Levels of fall risk among Hospitalized elderly

Smartphone technology can measure postural stability and discriminate fall risk in older adults

BackgroundFalls are the leading cause of injury related death in older adults. Impaired postural stability is a predictor of falls but is seldom objectively assessed in clinical or home settings. Embedded accelerometers within smartphones offer potential to objectively measure postural stability. The purpose of this study was to determine if a smartphone embedded accelerometer can measure static postural stability and distinguish older adults at high levels of fall risk. MethodsThirty older adults (age: 65.9 ± 8.8) underwent seven balance tests while standing on a force plate and holding a smartphone against their chest in a standardized order. Participants also completed the Physiological Profile Assessment to assess their fall risk. Center of pressure (COP) parameters from the force plate including velocity in the anterioposterior (AP) and mediolateral (ML) directions and 95% confidence ellipse were derived. Maximum acceleration and root mean square (RMS) in ML, AP and vertical axes were derived from the smartphone. Spearman rank-order correlations between force plate and smartphone measures were conducted, and receiver operating characteristic (ROC) and the area under the curves (AUC) were constructed to distinguish between low and high fall risk. ResultsThere were moderate to strong significant correlations between measures derived from the force plate and measures derived from the smartphone during challenging balance conditions (ρ = 0.42–0.81; p < 0.01–0.05). The AUC for ROC plots were significant for all COP measures during challenging balance conditions (p < 0.01–0.05). The AUC for ROC plots were significant for RMS vertical and AP during challenging balance conditions (p = 0.01–0.04). SignificanceThis study provides evidence that a smartphone is a valid measure of postural stability and capable of distinguishing fall risk stratification in older adults. There is potential for smartphones to offer objective, fall risk assessments for older adults.

Development of a User-Adaptable Human Fall Detection Based on Fall Risk Levels Using Depth Sensor.

Unintentional falls are a major public health concern for many communities, especially with aging populations. There are various approaches used to classify human activities for fall detection. Related studies have employed wearable, non-invasive sensors, video cameras and depth sensor-based approaches to develop such monitoring systems. The proposed approach in this study uses a depth sensor and employs a unique procedure which identifies the fall risk levels to adapt the algorithm for different people with their physical strength to withstand falls. The inclusion of the fall risk level identification, further enhanced and improved the accuracy of the fall detection. The experimental results showed promising performance in adapting the algorithm for people with different fall risk levels for fall detection.

Effects of different foot progression angles and platform settings on postural stability and fall risk in healthy and medial knee osteoarthritic adults.

This study aims to investigate the effects of varying toe angles at different platform settings on Overall Stability Index of postural stability and fall risk using Biodex Balance System in healthy participants and medial knee osteoarthritis patients. Biodex Balance System was employed to measure postural stability and fall risk at different foot progression angles (ranging from -20° to 40°, with 10° increments) on 20 healthy (control group) and 20 knee osteoarthritis patients (osteoarthritis group) randomly (age: 59.50 ± 7.33 years and 61.50 ± 8.63 years; body mass: 69.95 ± 9.86 kg and 70.45 ± 8.80 kg). Platform settings used were (1) static, (2) postural stability dynamic level 8 (PS8), (3) fall risk levels 12 to 8 (FR12) and (4) fall risk levels 8 to 2 (FR8). Data from the tests were analysed using three-way mixed repeated measures analysis of variance. The participant group, platform settings and toe angles all had a significant main effect on balance ( p ≤ 0.02). Platform settings had a significant interaction effect with participant group F(3, 144) = 6.97, p < 0.01 and toe angles F(21, 798) = 2.83, p < 0.01. Non-significant interactions were found for group × toe angles, F(7, 266) = 0.89, p = 0.50, and for group × toe angles × settings, F(21, 798) = 1.07, p = 0.36. The medial knee osteoarthritis group has a poorer postural stability and increased fall risk as compared to the healthy group. Changing platform settings has a more pronounced effect on balance in knee osteoarthritis group than in healthy participants. Changing toe angles produced similar effects in both the participant groups, with decreased stability and increased fall risk at extreme toe-in and toe-out angles.

The risk of falling among older adults in long-term care: Screening by the Morse Fall Scale

AimTo identify the incidence of key fall risk factors in groups of older adults in long-term care facilities and to find out which factors can be identified by the Morse Fall Scale (MFS) as significant in relation to high fall risks. Fall risk screening is the basis for efficient intervention planning. MFS is often recommended for fall risk detection even in long-term care settings. No tool for the prediction of fall risks has been tested in Slovakia so far. MethodsThe design of this study is descriptive and correlated. Fall risk factors and fall risk screening (according to MFS) were assessed in 89 older adults in two long-term care facilities. The data were collected from July to October 2016. ResultsThe majority of monitored risk factors had a high incidence in the sample. The authors identified that a strong predictor of a fall is mainly the presence of a fall in the patient's clinical history. Statistically significant correlations were found between a history of falling, disorder of the gait and balance, use of ambulatory aids, mental disorder, falling during the study and a high fall risk according to MFS. ConclusionThis tool provides nurses with the information on the level of fall risk and specific risk factors. It also enables targeted planning of preventive and protective interventions. Despite the clinical efficiency of the tool it is still important to continue testing the prediction value of the tool in different areas of nursing practice in Slovakia.

Implementation of the MEDFRAT to Promote Quality Care and Decrease Falls in Community Hospital Emergency Rooms

AbstractPurposeTo identify and implement an evidence-based fall-risk assessment tool for use in emergency departments at Essentia Health, a large, primarily rural health care delivery system with 12 emergency departments. MethodsThe Iowa Model of Evidence-Based Practice to Promote Quality Care was used to guide the process. The Memorial Emergency Department Fall-Risk Assessment Tool (MEDFRAT) was programmed into the electronic medical record, along with interventions that could be selected for 2 fall-risk levels. An education session was developed for emergency nurses about falls and MEDFRAT, with planned time for discussion about any concerns in the implementation of MEDFRAT. MEDFRAT was selected for implementation by nursing leadership because it is evidence based and appeared to be conducive to implementation in the diverse emergency departments across 12 sites in 3 states. ResultsEducation sessions were presented to nurses at 11 of 12 emergency departments. Suggestions to support site-specific implementation were programmed into the electronic health record. Nurses expressed appreciation that they were consulted, and their feedback was incorporated into the tool before it was implemented. Resources needed at each site to implement recommended MEDFRAT interventions in the tool were identified. Needed resources were then provided to the emergency departments before implementation of MEDFRAT. ConclusionsThe Iowa Model was a useful framework to select an evidence-based tool and then engage nurses in the process of implementing evidence-based practice changes in emergency departments across a diverse health care system serving a largely rural population. Ongoing follow-up will determine if this process results in fewer falls.Image 1

Association between the fall risk, age and educational level in active adult and older women

Association between the fall risk, age and educational level in active adult and older women

Managing delirium behaviors with one-to-one sitters.

By implementing a clinical assessment bundle (CAB) stratifying delirium, dementia, and fall risk levels, nurses have been able to make sound clinical judgments to initiate or discontinue one-to-one sitters. Internal benchmarking shows a reduction in sitter hours, costs, and falls in 2015 compared wi

Managing delirium behaviors with one-to-one sitters.

BY IMPLEMENTING a clinical assessment bundle (CAB) stratifying delirium, dementia, and fall risk levels, nurses have been able to make sound clinical judgments to initiate or discontinue one-to-one sitters. Internal benchmarking shows a reduction in sitter hours, costs, and falls in 2015 compared wi

Fall Risk Based on Timed Up and Go Test in Elderly at Nursing Home in West Java, Indonesia

Background : Falls are major cause of morbidity and mortality in elderly patients. Mobility assessment is important in preventing falls in elderly. This study was conducted to determine the level of fall risk in elderly people at Karitas Cimahi Nursing Home, West Java, Indonesia by using ‘timed up and go test’(TUG). Methods :This cross-sectional descriptive study was conducted at Karitas Cimahi Nursing Home from June–November 2013. The risk of falls was categorized into two; high and low risk of falls. High risk of falls indicated when the participants complete the TUG test with time taken >10 seconds, and low risk of falls indicated when the time taken is 10 seconds. Conclusions : The level of fall risk in elderly people at Karitas Cimahi Nursing Home based on the test showed that all participants, both male and female, regardless of using assistive device have high level risk of falls. [AMJ.2017;4(1):83–6] DOI: 10.15850/amj.v4n1.1025

EARTHQUAKE-INDUCED ROCKFALLS IN SANTOMERI VILLAGE, WESTERN GREECE

On the 8th of June 2008 an earthquake of magnitude Ms=6.5 occurred in Western Greece, affecting Achaia and Ilia Prefectures. According to state reports 2 casualties occurred, 214 people were injured and more than 15 villages and towns suffered extensive damages in properties and infrastructures. Among the secondary phenomena that were reported were extensive rockfalls that affected Santomeri village; a small village located on the western slope of the Scolis mountain. Large-sized limestone boulders, some reaching a volume up to 10m3 stroke houses and blocked roads, fortunately without casualties. The village was temporarily evacueated and the Laboratory of Engineering Geology was commissioned to undertake an Engineering Geological appraisal in order to investigate the extent of the rockfall events, assess the rockfall hazard and propose retention and protective measures so the area to be soon re-inhabited. After conducting a detailed engineering geological and geotechnical survey which included large scale engineering geological mapping, rockmass characterization and laboratory tests the inhabited area was initially divided in two zones of different rock fall risk level. By performing rockfall analyses in critical traverses a rock fall retention system, 325m long in total, comprising rock fall barrier was finally proposed.

ISQUA16-1327ESTIMATING THE EFFECTS OF FALL PREVENTION INTERVENTIONS BY ADJUSTING FOR THE RISK OF FALLING WITH A PROPENSITY SCORE

The hospital fall prevention programs that reduced fall rate included fall-risk assessments, multifactorial interventions, post fall follow-up, and integration with electronic records (Spelstra, 2012). However, patients who have received multifactorial interventions and patients who have not have different levels of fall-risk. This hampers comparison of patients who have received interventions and patients who have not and it precludes a determination of the effectiveness of individual interventions. The aim of this study was to examine the effects of fall prevention interventions by adjusting for the fall-risk with a propensity score. This study was conducted at an acute-care hospital with 716 beds. Electronic medical records at this hospital were linked to the Fall Risk …

Fall risk factors analysis based on sample entropy of plantar kinematic signal during stance phase.

Falls are a multi-causal phenomenon with a complex interaction. The aim of our research is to study the effect of multiple variables for potential risk of falls and construct an elderly fall risk assessment model based on demographics data and gait characteristics. A total of 101 subjects, whom belong to Malianwa Street, aged above 50 years old and participated in questionnaire survey. Participants were classified into three groups (high, medium and low risk group) according to the score of elderly fall risk assessment scale. In addition, the data of ground reaction force (GRF) and ground reaction moment (GRM) was record when they performed walking at comfortable state. The demographic variables, sample entropy of GRF and GRM, and impulse difference of bilateral foot were considered as potential explanatory variables of risk assessment model. Firstly, we investigated whether different groups could present difference in every variable. Statistical differences were found for the following variables: age (p=2.28e-05); impulse difference (p=0.02036); sample entropy of GRF in vertical direction (p=0.0144); sample entropy of GRM in anterior-posterior direction (p=0.0387). Finally, the multiple regression analysis results indicated that age, impulse difference and sample entropy of resultant GRM could identify individuals who had different levels of fall risk. Therefore, those results could potentially be useful in the fall risk assessment and monitor the state of physical function in elderly population.

Relationship between dynamical characteristics of sit-to-walk motion and physical functions of elderly humans.

Sit-to-walk (STW) motion is essential for daily activities. Falls frequently occur, when there is impaired ability to perform STW movements. This study investigated the relationships between the dynamical characteristics of STW motion and physical functions of elderly people. 128 elderly (51 males and 77 females, above 65 years) participated in this study. Participants were instructed to perform STW motion at comfortable state and classified into four groups (normal, mild, moderate and severe group) based on physical function, which evaluated with functional reach test and dynamic gait test. The results showed that some relationships were confirmed between the sample entropy characteristics of STW motion. Moreover, a subset of variables was significant different among four groups via Kruskal-Wallis test, which could be potentially used for developing an objective and simple methods to assess balance capacity and fall risk level of elderly people.

Rock fall hazard and risk assessment along Araniko Highway, Central Nepal Himalaya

Rock falls are frequent along the steep slopes of highway cuts in mountainous areas like Nepal. Araniko Highway is a major highway connecting Nepal and China that has suffered from several instability problems. Recent earthquake activity in Nepal has generated many landslides, including rock falls along the highway, mostly between Lamosangu and Liping. These landslides have deposited huge piles of debris along the highway, as well as in the hill slope above, which has increased future risk of rock fall. Here, we have tried to analyze the distribution of rock falls along the highway, their mode of failure, and the associated hazard and risk. The analysis shows that most of the rock falls are concentrated along steep rock cliffs and are mostly rock topples, with some wedge and plane failure type. For the rock fall hazard and risk assessment of the highway, we have slightly modified the original rock fall hazard and risk assessment method to fit the condition of the Araniko Highway. The developed hazard and risk map effectively indicates various levels of rock fall hazard and risk along the highway. Based on the level of hazard and risk, the maintenance and inspection work can be carried out. In addition, the study reveals that this system can be effectively used to prioritize the severity of potential rock falls along other highways with similar geological and morphological settings.

Redesigned Fall and Injury Management of Patients With Stroke.

Falls and fall-related injuries remain a frequent complication of strokes.1 Fall and injury prevention based on fall risk scores and level of fall risk, such as low, moderate, or high, is insufficient, requiring that clinicians redesign fall prevention programs based on patients’ individualized fall and injury risk factors. The purpose of this article is to provide an overview of the selected evidence that supports redesign of fall prevention management of patients with stroke, thereby reducing their actual fall and fall-related injury risks. Clinical expertise is essential for safe fall prevention practices for these patients. Equipment use specifically designed to reduce trauma during a fall can be integrated into patient care. Although 1 in 20 deaths in the United States is attributed to strokes, ≈86% of people who experience a stroke live through the onset, care management, and rehabilitation.2 Each year, ≈23% of the strokes are new-onset ones, indicating that many individuals are living with the residual effects of a stroke and experience a repeat stroke.1 Strokes can occur across age groups with the risk of stroke increases with advanced age.2 The immediate and residual effects of stroke depend on the pathogenesis (anoxic, embolic, and thrombotic), location, and extent of cerebral involvement. Irrespective of the location of the stroke, stroke results in disability and reduces mobility in more than half of stroke survivors ≥65 years of age.3 Patient falls are a major health concern in the care of patients with stroke because falls are one of the most frequent complications among patients with stroke across settings of care, as these patients experience multiple falls. The evidence supports a multifactorial, interdisciplinary fall prevention program for reducing falls and injuries in acute care.4–6 Despite increased research on strategies to reduce both the rate of falls …

Are Virtual Rehabilitation Technologies Feasible Models to Scale an Evidence-Based Fall Prevention Program? A Pilot Study Using the Kinect Camera.

BackgroundFalls in older adults are a significant public health issue. Interventions have been developed and proven effective to reduce falls in older adults, but these programs typically last several months and can be resource intensive. Virtual rehabilitation technologies may offer a solution to bring these programs to scale. Off-the-shelf and custom exergames have demonstrated to be a feasible adjunct to rehabilitation with older adults. However, it is not known if older adults will be able or willing to use a virtual rehabilitation technology to participate in an evidence-based fall prevention program. To have the greatest impact, virtual rehabilitation technologies need to be acceptable to older adults from different backgrounds and level of fall risk. If these technologies prove to be a feasible option, they offer a new distribution channel to disseminate fall prevention programs.ObjectiveStand Tall (ST) is a virtual translation of the Otago Exercise Program (OEP), an evidence-based fall prevention program. Stand Tall was developed using the Virtual Exercise Rehabilitation Assistant (VERA) software, which uses a Kinect camera and a laptop to deliver physical therapy exercise programs. Our purpose in this pilot study was to explore if ST could be a feasible platform to deliver the OEP to older adults from a variety of fall risk levels, education backgrounds, and self-described level of computer expertise.MethodsAdults age 60 and over were recruited to participate in a one-time usability study. The study included orientation to the program, navigation to exercises, and completion of a series of strength and balance exercises. Quantitative analysis described participants and the user experience.ResultsA diverse group of individuals participated in the study. Twenty-one potential participants (14 women, 7 men) met the inclusion criteria. The mean age was 69.2 (± 5.8) years, 38% had a high school education, 24% had a graduate degree, and 66% classified as “at risk for falls”. Eighteen participants agreed they would like to use ST to help improve their balance, and 17 agreed or strongly agreed they would feel confident using the system in either the senior center or the home. Thirteen participants felt confident they could actually set up the system in their home. The mean System Usability Scale (SUS) score was 65.5 ± 21.2 with a range of 32.5 to 97.5. Ten participants scored ST as an above average usability experience compared to other technologies and 5 participants scored a less than optimal experience. Exploratory analysis revealed no significant relationships between user experience, education background, self-described computer experience, and fall risk.ConclusionsResults support the virtual delivery of the OEP by a Kinect camera and an avatar may be acceptable to older adults from a variety of backgrounds. Virtual technologies, like Stand Tall, could offer an efficient and effective approach to bring evidence-based fall prevention programs to scale to address the problem of falls and fall-related injuries. Next steps include determining if similar or better outcomes are achieved by older adults using the virtual OEP, Stand Tall, compared to the standard of care.

An Introduction to the Centers for Disease Control and Prevention's Efforts to Prevent Older Adult Falls.

An Introduction to the Centers for Disease Control and Prevention's Efforts to Prevent Older Adult Falls.