Multiple Fallers Research Articles

Antiretroviral drug use and the risk of falls in people living with HIV: a systematic review and meta-analysis

Objective: The risk of falls in people living with HIV (PLHIVs) on antiretroviral therapy (ART) has received little attention in the literature. The aim of the meta-analysis is to quantify the association between fall risk and various categories of drugs used in ART. Material and Methods: PubMed, Google Scholar, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to January 2023. Any observational study or controlled trial that reported on the relationship of at least one antiretroviral drug with falls in PLHIVs was included. Data on the frequency of single fallers, multiple fallers (≥2 falls), and non-fallers were extracted and studied for each drug and drug category. The pooled results were reported as an odds ratio (OR) with a 95% confidence interval (CI). Results: A total of five observational studies (51 675 participants) were included out of 414 articles obtained through a literature review. Stavudine use was found to be associated with an increased risk of single falls in PLHIVs (OR: 1.69, 95% CI: 1.08–2.66, P=0.02). However, efavirenz (OR: 0.82, 95% CI=0.76–0.89, P<0.001) and zidovudine (OR: 0.82, 95% CI=0.77–0.92, P<0.001) were found protective against the single falls. Didanosine had no significant association with fall risk (OR: 1.23, 95% CI: 0.78–1.93, P=0.37). Likewise, protease inhibitors, integrase inhibitors, nucleoside reverse transcriptase inhibitors, and non-nucleoside reverse transcriptase inhibitors were discovered to have no significant association with fall risk. Conclusion: Most drug categories of ART have no significant association with the risk of falls in PLHIVs. However, certain drugs, such as didanosine and stavudine, which have the inherent effect of causing balance deficits and neuropathy, should be used cautiously.

128 Foot problems in older persons attending a day hospital

Abstract Background Foot problems may contribute to pain and falls in older people. We documented the prevalence of foot problems in older persons attending a Day Hospital for rehabilitation. Methods Symptoms of foot pain and prevalence of foot problems and inappropriate footwear were documented by 2 physiotherapists using a ‘foot problem score’ in consecutive referrals by consultant geriatricians to an offsite day hospital with rehabilitation expertise over a 3-month period. Subjects were categorised into 2 groups depending on whether they had none/only one fall or multiple falls in previous 12 months. Results Sixty-seven patients, age 72–93 years were included in the study. The most common foot problem was hallux valgus in 62 patients (93%) of whom 41(66%) and 4(6.5%) had moderate or severe deviation respectively. Other findings included corn/callus in 37(55%) patients, toenail abnormality in 30(44.7%) whilst only one patient was found to have an ulcer. Seventeen patients (25.4%) complained of painful feet. Twenty-nine patients (43%) were multiple fallers (2 or more falls in previous 12 months) of whom 13(44.8%) complained of foot pain compared to only 4/38(10.5%) of patients with none or only one fall over previous 12 months complaining of foot pain (p = 0.0014). Footwear was deemed inappropriate in 18.8% of patients whilst 56.3% were attending chiropody. Conclusion The higher prevalence of foot problems and foot pain in this survey compared to a similar survey (1) in community dwelling older persons may reflect increased comorbidities in this day hospital population and the adverse effects of foot pain on balance and function. Foot and footwear assessment should be incorporated into comprehensive geriatric assessment.

The relationship of cervicothoracic mobility restrictions to fall risk and fear of falling in ankylosing spondylitis.

The objective of this study is to determine whether restricted cervical mobility in ankylosing spondylitis (AS) is associated with increased fall frequency or fear of falling. A total of 134 AS patients and 199 age- and gender-matched control subjects (CS) with soft-tissue cervicothoracic pain were prospectively evaluated for fall risk. Subjects were divided into non-fallers, single fallers, and multiple fallers. Dynamic cervical rotations and static cervicothoracic axial measurements were compared between the groups. In total, 88 AS patients were reviewed more than once; Kaplan-Meier plots were constructed for fall risk as a function of cervical rotation amplitudes. Falls Efficacy Scale-International (FES-I) questionnaire measured the fear of falling. In total, 34% of AS patients and 29% of CS fell (p = 0.271) in the year prior to evaluation. In AS, static anatomical measurements were unrelated to fall occurrence. The trends of multiple AS fallers to greater flexed forward postures and reduced dynamic cervical rotations were not statistically significant. Cervicothoracic pain (p = 0.0459), BASDAI (p = 0.002), and BASFI (p = 0.003) scores were greater in multiple fallers. FES-I scores were greater in fallers (p = 0.004). Of the 88 AS patients reviewed (or seen) on more than one occasion, 46.5% fell over the 9-year observation period, including all multiple fallers and 71.4% of single fallers. Survival curves showed increased fall risk as cervical rotational amplitudes decreased. In AS, decreased cervical rotations increase fall risk and fear of falling. In multiple fallers, falls were associated with greater disease activity. Cervical muscle stiffness in AS may cause non-veridical proprioceptive inputs and contribute to increased fall frequency similar to individuals with soft-tissue cervicothoracic pain.

Discrepancies in perception of fall risk between patients with subacute stroke and physical therapists in a rehabilitation hospital: a retrospective cohort study.

Objective: Falls are one of the most common complications of a stroke. This study aimed to clarify the discrepancy between the perceived fall risk of hospitalized patients with stroke and the clinical judgment of physical therapists and to examine the changes in discrepancy during hospitalization. Design: Retrospective cohort study. Patients: This study included 426 patients with stroke admitted to a Japanese convalescent rehabilitation hospital between January 2019 and December 2020. Methods: The Falls Efficacy Scale-International was used to assess both patients' and physical therapists' perception of fall risk. The difference in Falls Efficacy Scale-International scores assessed by patients and physical therapists was defined as the discrepancy in fall risk, and its association with the incidence of falls during hospitalization was investigated. Results: Patients had a lower perception of fall risk than physical therapists at admission (p < 0.001), and this trend continued at discharge (p < 0.001). The discrepancy in fall risk perception was reduced at discharge for non-fallers and single fallers (p < 0.001), whereas the difference remained in multiple fallers. Conclusion: Unlike physical therapists, patients underestimated their fall risk, especially patients who experienced multiple falls. These results may be useful for planning measures to prevent falls during hospitalization.

Discriminative Ability of the Four Balance Measures for Previous Fall Experience in Turkish Community-Dwelling Older Adults.

This study aimed to compare the discriminative properties (discriminative effect, sensitivity, specificity, and cutoff values) of four commonly used balance measures for nonfallers, fallers, and multiple fallers among Turkish community-dwelling older adults. Three hundred fifty-one community-dwelling older adults (122 fallers and 229 nonfallers) were evaluated with the timed up and go test, functional reach test, one-leg stance test, and Berg Balance Scale (BBS). Timed up and go test and functional reach test were not sensitive in detecting group differences between fallers and nonfallers, and BBS and one-leg stance test had significant but limited discriminative power with cutoff values of 53.5 points and 7.50s, respectively. In addition, timed up and go test, functional reach test, and one-leg stance test had significant but limited discriminative power, and BBS had acceptable discriminative power for older adults who fell multiple times. These findings suggest that BBS is the most suitable tool for assessing the fall risk of Turkish community-dwelling older adults.

The interdisciplinary fracture liaison service improves health-related outcomes and survival of older adults after hip fracture surgical repair

SummaryDue to the high burden of fragility fractures, we developed an interdisciplinary FLS care pathway for early management and monitoring of older adults discharged from a high-volume trauma center after hip fracture repair. Interdisciplinary FLS effectively improves up to 1-year adherence to treatments for secondary prevention of fragility fractures, reduces health facility admission, and improves long-term survival.PurposeTo compare adherence to secondary fragility fracture prevention, falls, healthcare facility admissions, and mortality between hip fracture older adults who entered the fracture liaison services pathway of care (FLS-CP) and those managed according to the usual traumatologist model of care (U-CP).MethodsProspective observational study enrolling subjects aged ≥ 65 years discharged by high-volume trauma center after hip fracture repair from February 2016 to February 2017, who consecutively entered FLS-CP or U-CP according to their preference and goals.ResultsCompared to U-CP, those in FLS-CP had higher initiation rate and up to 1-year adherence to secondary prevention of fragility fracture, including vitamin D and calcium (87.7% vs 36.9%; p < 0.0001), specific anti-osteoporosis drugs (75.1% vs 8.0%; p < 0.0001), and complete anti-fracture therapy (72.3% vs 5.7%; p < 0.0001). Older adults belonging to FLS-CP showed a lower likelihood of healthcare facility admission (RR 0.597; 95% CI 0.398–0.895; p = 0.0125), with a longer re-hospitalization-free survival (176.4 vs 88.7 days; p = 0.0152) than those in U-CP. One-year incidence of falls and fractures was similar between groups, with a lower tendency of the subjects in the FLS-CP to be multiple fallers (19% vs 34.8%; OR 0.057; 95% CI 0.004–0.876; p = 0.0690). The FLS-CP group experienced a lower 1-year (87.2% vs 74.3%; p = 0.001) and 3-year mortality (67.9% vs 55.6%; p = 0.0245) and a lower adjusted 5-year mortality hazard ratio (50.2% vs 58%; HR = 0.76; 95% CI 0.60; 0.96).ConclusionThe FLS-CP may improve initiation and adherence to secondary prevention of fragility fractures, reduces healthcare facility admission, and improves long-term survival.

The association between fear of falling and occurrence of falls: a one-year cohort study

BackgroundBoth multiple fall experiences and fear of falling (FoF) would make people susceptible to another fall; however, the associations are unknown. This study investigates the association of FoF with fall occurrence among older adults according to their fall history.MethodsIn this study, we adopted a longitudinal observational design. We visited 20 community centers to recruit 1,025 older adults (aged 65 years or older). At baseline, FoF was assessed using a single-item questionnaire. The number of falls in the past year was obtained via a self-questionnaire and participants were classified into three fall history groups (0: non-faller, 1: single faller, 2 or more: multiple faller). After a year of following-up, the number of falls during the year was considered as the main outcome. Poisson regression models clarified the influence of FoF on fall occurrence during the one-year follow-up, according to the participants’ fall history.ResultsThe final sample comprised 530 individuals (follow-up rate: 530/801, 66.4%). Fall history, FoF, and interaction between multiple fallers and FoF were significant in the adjusted statistical model (rate ratio [95% confidence interval]: single faller = 2.81 [1.06, 6.30], multiple faller = 13.60 [8.00, 23.04], FoF = 3.70 [2.48, 5.67], multiple faller*FoF = 0.37 [0.20, 0.68]).ConclusionsWe found that FoF was associated with the occurrence of falls in community-dwelling older adults. However, its association was lower in multiple fallers.

Longitudinal changes in daily patterns of objectively measured physical activity after falls in older adults with varying degrees of glaucoma.

BackgroundVisually impaired older adults have a greater risk of falling, making them particularly susceptible to fall-related health consequences and restricted physical activity. Unclear however, is the relationship between having falls and longitudinal changes in daily patterns of objectively measured physical activity in older adults with visual impairments.MethodsWe created a three-year prospective cohort study (Falls in Glaucoma Study) of older adults with primary or suspected glaucoma at the Johns Hopkins Wilmer Eye Institute from 2013 to 2015. Cumulative incidence of falls was determined through self-reported fall calendars over 12 months. Participants were then classified into one of three groups: multiple fallers (≥2 falls), single fallers (1 fall), and non-fallers (0). Daily physical activity was measured over 1 week using a waist-bound accelerometer during baseline and three-year follow-ups. Activity fragmentation was defined as the reciprocal of the mean activity bout length, with higher fragmentation reflecting shorter, more fractured bouts of continuous activity. Multivariate linear mixed-effects models were used to assess three-year longitudinal changes in: 1) activity fragmentation, and 2) accumulation of activity across six three-hour intervals from 5 AM to 11 PM.FindingsIn adjusted models accounting for visual field damage and other factors, multiple fallers demonstrated greater annual declines (per year) in daily active bouts (-1.79 bouts/day, 95% confidence interval [CI]: -3.35, -0.22), daily active minutes (-17.15 min/day, 95% CI: -26.35, -7.94), and increased fragmentation (1%, 95% CI: 0, 2%) over the three-year follow-up period as compared to non-fallers; no such changes were seen when comparing single fallers and non-fallers. In time-of-day analyses, multiple fallers experienced greater annual declines in average hourly steps over all periods of the day, though the rate of decline was only significant between 5 PM and 8 PM (-27.07 steps/hour, 95% CI: -51.15, -2.99) compared to non-fallers.InterpretationIn an older population with visual impairment, multiple falls over 12 months were associated with more transient and fragmented activity over a subsequent three-year period, and activity declines during evening hours, compared to non-fallers. These findings suggest that multiple fallers with visual impairment may be at high risk for a decline in physical capacity and endurance, warranting clinical interventions.FundingThe research was supported in part by National Institutes of Health Grant EY022976.

Home environmental assessments and modification delivered by occupational therapists to reduce falls in people aged 65 years and over: the OTIS RCT.

Falls and fall-related fractures are highly prevalent among older people and are a major contributor to morbidity and costs to individuals and society. Only one small pilot trial has evaluated the effectiveness of a home hazard assessment and environmental modification in the UK. This trial reported a reduction in falls as a secondary outcome, and no economic evaluation was undertaken. Therefore, the results need to be confirmed and a cost-effectiveness analysis needs to be undertaken. To determine the clinical effectiveness and cost-effectiveness of a home hazard assessment and environmental modification delivered by occupational therapists for preventing falls among community-dwelling people aged ≥ 65 years who are at risk of falling, relative to usual care. This was a pragmatic, multicentre, modified cohort randomised controlled trial with an economic evaluation and a qualitative study. Eight NHS trusts in primary and secondary care in England. In total, 1331 participants were randomised (intervention group, n = 430; usual-care group, n = 901) via a secure, remote service. Blinding was not possible. All participants received a falls prevention leaflet and routine care from their general practitioner. The intervention group were additionally offered one home environmental assessment and modifications recommended or provided to identify and manage personal fall-related hazards, delivered by an occupational therapist. The primary outcome was the number of falls per participant during the 12 months from randomisation. The secondary outcomes were the proportion of fallers and multiple fallers, time to fall, fear of falling, fracture rate, health-related quality of life and cost-effectiveness. The primary analysis included all 1331 randomised participants and indicated weak evidence of a difference in fall rate between the two groups, with an increase in the intervention group relative to usual care (adjusted incidence rate ratio 1.17, 95% confidence interval 0.99 to 1.38; p = 0.07). A similar proportion of participants in the intervention group (57.0%) and the usual-care group (56.2%) reported at least one fall over 12 months. There were no differences in any of the secondary outcomes. The base-case cost-effectiveness analysis from an NHS and Personal Social Services perspective found that, on average per participant, the intervention was associated with additional costs (£18.78, 95% confidence interval £16.33 to £21.24), but was less effective (mean quality-adjusted life-year loss -0.0042, 95% confidence interval -0.0041 to -0.0043). Sensitivity analyses demonstrated uncertainty in these findings. No serious, related adverse events were reported. The intervention was largely delivered as intended, but recommendations were followed to a varying degree. Outcome data were self-reported by participants, which may have led to inaccuracies in the reported falls data. We found no evidence that an occupational therapist-delivered home assessment and modification reduced falls in this population of community-dwelling participants aged ≥ 65 years deemed at risk of falling. The intervention was more expensive and less effective than usual care, and therefore it does not provide a cost-effective alternative to usual care. An evaluation of falls prevention advice in a higher-risk population, perhaps those previously hospitalised for a fall, or given by other professional staff could be justified. Current Controlled Trials ISRCTN22202133. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 46. See the NIHR Journals Library website for further project information.

Home hazard assessment and environmental modification to prevent falls in older people: the OTIS trial

Background: Falls in older people are a major cause of morbidity and mortality. There is some evidence to suggest that home hazard assessment and environmental modification delivered by an occupational therapist may reduce falls. The objective of this study was to evaluate the effectiveness of this intervention, relative to usual care. Methods: A pragmatic, two-arm modified cohort randomised controlled trial in eight NHS trusts in primary and secondary care in England. In total, 1331 community-dwelling adults aged 65 years and over with a history of falls or fear of falling were randomised in a 2:1 allocation to either usual care plus a falls prevention leaflet (n=901) or to receive the home hazard assessment and environmental modification intervention, plus usual care and a falls prevention leaflet (n=430). The primary outcome was the number of falls per participant over the 12 months from randomisation. Secondary outcomes included: proportion of fallers and multiple fallers, time to fall, and fear of falling. Results: All 1331 randomised participants (mean age 80 years, 872 [65.5%] female) were included in the primary analysis. There was a small increase in the rate of falls in the intervention group relative to usual care (adjusted incidence rate ratio 1.17, 95% CI 0.99 to 1.38; p=0.07). A similar proportion of participants in the intervention (57.0%) and usual care group (56.2%) reported at least one fall over 12 months. There were no differences in any of the other secondary outcomes and no serious, related adverse events were reported. Conclusions: Home hazard assessment and environmental modification delivered by an occupational therapist did not reduce falls in community-dwelling older people deemed at higher risk of falling recruited to this trial.

Micro-Doppler Radar Gait Measurement to Detect Age- and Fall Risk-Related Differences in Gait: A Simulation Study on Comparison of Deep Learning and Gait Parameter-Based Approaches

This paper describes the application of micro-Doppler radar (MDR) to gait classification based on fall risk-related differences using deep learning and gait parameter-based approaches. Two classification problems were considered in this study: elderly non-fallers and multiple fallers were classified to investigate the detection of fall risk-related gait differences, and middle-aged (50s) and elderly (70s) adults were classified to detect aging-related gait differences. The MDR signal data of the participants were simulated using an open motion capture gait dataset. The classification results obtained using the deep learning and gait parameter-based approaches showed that the classification accuracy achieved using a support vector machine with the gait parameters extracted from the MDR signals was better than that resulting from the deep learning of spectrogram (time-velocity distribution) images of the MDR signals for both classification problems. The gait parameter-based approach achieved the classification rates of 79 % for faller/non-faller classification and 82 % for 50s/70s classification, whereas the corresponding accuracies were 73 % and 76 %, respectively, using the deep learning approach. These results reveal that the gait parameters extracted via MDR measurements include sufficient information on gait to detect individuals with a high risk of falls and the gait parameter-based approaches are thus effective for both classification problems.

Exercise Effects on Falls, Fractures, Hospitalizations, and Mortality in Older Adults With Dementia: An Individual-Level Patient Data Meta-analysis.

To study the effects of exercise on falls, fractures, hospitalizations, and death in people with dementia. We conducted an individual-level patient data meta-analysis of 7 randomized controlled trials (RCTs). We looked for studies from the reference list of previous systematic reviews and undertook an electronic search for articles published between 2013 and 2019 in Ageline, CENTRAL, PsycINFO, PubMed, and SportsDiscus. Main (binary) outcome measures were the risk of mortality, hospitalization, faller, multiple faller, injurious faller, and fractures. Secondary (count) outcomes were the incident rates of hospitalizations, falls, and injurious falls. From the 1314 participants, 771 were allocated to the exercise group and 543 to the control group. The number of cases regarding the main outcome measures in exercisers and controls were, respectively: 45 (5.8%) and 31 (5.7%) deaths; 102 (14.4%) and 65 (13.4%) participants hospitalized; 221 (34.4%) and 175 (41.3%) had at least 1 fall; 128 (20.2%) and 92 (21.7%) had multiple falls; 78 (24.8%) and 92 (29.3%) had injurious falls; and 19 (2.9%) and 15 (3.5%) had suffered a fracture. Two-step meta-analysis found no effects of exercise on any outcome. One-step meta-analysis found exercise reduced the risk of falls (odds ratio 0.75; 95% CI: 0.57-0.99). Exploratory analysis showed exercise decreased the rate of incident falls in participants with the lowest functional ability (incident rate ratio 0.48; 95% CI: 0.30-0.79). Although the 2-step meta-analysis suggests exercise does not have an effect on the outcomes, 1-step meta-analysis suggested that exercise may reduce fall risk. Data from further high-quality RCTs are still needed.

Tailored Exercise and Home Hazard Reduction Program for Fall Prevention in Older People With Cognitive Impairment: The i-FOCIS Randomized Controlled Trial.

The evidence to support effective fall prevention strategies in older people with cognitive impairment (CI) is limited. The aim of this randomized controlled trial (RCT) was to determine the efficacy of a fall prevention intervention in older people with CI. RCT involving 309 community-dwelling older people with CI. The intervention group (n = 153) received an individually prescribed home hazard reduction and home-based exercise program during the 12-month study period. The control group (n = 156) received usual care. The primary outcome was rate of falls. Secondary outcomes included faller/multiple faller status, physical function, and quality of life. Participants' average age was 82 years (95% CI 82-83) and 49% were female. There was no significant difference in the rate of falls (incidence rate ratio [IRR] 1.05; 95% confidence interval [95% CI] 0.73-1.51). A sensitivity analysis, controlling for baseline differences and capping the number of falls at 12 (4 participants), revealed a nonsignificant reduction in fall rate in the intervention group (IRR 0.78; 95% CI 0.57-1.07). Analyses of secondary outcomes indicated the intervention significantly reduced the number of multiple fallers by 26% (RR 0.74; 95% CI 0.54-0.99) when adjusting for baseline differences. There was a differential impact on falls in relation to physical function (interaction term p-value = .023) with a significant reduction in fall rate in intervention group participants with better baseline physical function (IRR 0.60; 95% CI 0.37-0.98). There were no significant between-group differences for other secondary outcomes. This intervention did not significantly reduce the fall rate in community-dwelling older people with CI. The intervention did reduce the fall rate in participants with better baseline physical function. Australian and New Zealand Trials Registry ACTRN12614000603617.

Cervicothoracic Mechanical Impairment as Part of Complete Neurological Fall Risk Appraisal.

Assessment of individuals at risk for falling entails comprehensive neurological and vestibular examinations. Chronic limitation in cervical mobility reduces gaze accuracy, potentially impairing navigation through complex visual environments. Additionally, humans with scoliosis have altered otolithic vestibular responses, causing imbalance. We sought to determine whether dynamic cervical mobility restrictions or static cervicothoracic impairments are also fall risk factors. We examined 435 patients referred for soft-tissue musculoskeletal complaints; 376 met criteria for inclusion (mean age 52; 266 women). Patients were divided into nonfallers, single fallers, and multiple fallers, less or greater than 65 years old. Subject characteristics, dynamic cervical rotations, and static cervicothoracic axial measurements were compared between groups. Fear of falling was evaluated using the Falls Efficacy Scale-International questionnaire. Long-standing cervicothoracic pain and stiffness conferred increased risk of falling. Neck rotation amplitudes decreased with longer duration musculoskeletal symptoms and were significantly more restricted in fallers, doubling the risk of falling and contributing to increased fear of falling. Mid-thoracic scoliosis amplitudes increased over time, but static axial abnormalities were not greater among fallers, although thoracic kyphoscoliosis heightened fear of falling. In patients at fall risk, thoracic kyphoscoliosis and dynamic neck movements should be assessed, in addition to standard vestibular and neurological evaluations. Additionally, patients with soft tissue cervicothoracic pain and restricted mobility have increased fall frequency and fear of falling, independent of other fall risk factors and should undergo complete fall risk appraisal.

Backward walking sensitively detects fallers in persons with multiple sclerosis

BackgroundIndividuals with multiple sclerosis experience deficits in mobility resulting in injurious falls. Fall detection has proved challenging; the majority of clinical measures rely on forward walking and balance measures, yet these measures have poor sensitivity and predictive value for differentiating between fallers and non-fallers. Backward walking better differentiates fallers from non-fallers in the elderly and other neurodegenerative diseases; therefore, the objective of this study was to examine both forward and backward walking to determine the strongest, unique contributor that differentiates fallers from non-fallers in persons with multiple sclerosis. MethodsIn a single session, spatiotemporal measures of forward and backward walking and fall history were collected. For the subsequent six months, individuals recorded falls in a fall diary. Discriminant function analysis was used to determine what variables most strongly and uniquely differentiate multiple sclerosis fallers from non-fallers. ResultsThirty-eight individuals with multiple sclerosis participated. Forward and backward velocity, stride length, and double support time as well as age, disease severity, and symptom duration were included in the models. Together, the variables differentiated between fallers and non-fallers (Wilk's lambda χ2 (8, N = 36) = 0.497, p<0.001) and in rank order, backward walking velocity was the strongest unique predictor. Repeating the analysis with a stepwise approach yielded that backward walking velocity in the first step (χ2 (1, 34) = 0.68, F = 15.96, p<0.001) and symptom duration in the second step (χ2 = 0.59, F (2, 33) = 11.46; p<0.001) most strongly differentiated retrospective fallers and non-fallers. This stepwise model with backward walking velocity and symptom duration accurately classified 76.3% of cases. Addition of forward walking measures did not significantly improve the models, and indeed the accuracy of classification was reduced to 71.1%. Exploratory analysis showed that backward walking velocity was the best predictor of prospectively reported fallers and non-fallers (χ2 (1, 7) = 0.43, F = 9.20, p = 0.02). ConclusionBackward walking velocity exhibits the highest effect magnitude and specificity in differentiating fallers from non-fallers in individuals with MS and demonstrates potential as clinically feasible and efficient fall detection tool.

Can occupational therapist-led home environmental assessment prevent falls in older people? A modified cohort randomised controlled trial protocol

IntroductionFalls and fall-related injuries are a serious cause of morbidity and cost to society. Environmental hazards are implicated as a major contributor to falls among older people. A recent Cochrane...

Discriminative ability and clinical utility of the Timed Up and Go (TUG) in identifying falls risk in people with multiple sclerosis: a prospective cohort study

Objective: To investigate discriminative ability and clinical utility of the Timed Up and Go under single- and dual-task conditions between fallers and non-fallers in multiple sclerosis (MS). Design: Prospective cohort study. Setting: Neurology service in a tertiary hospital. Subjects: Participants were 101 people with MS and Expanded Disability Status Scale score of 3–6.5. One participant withdrew after the baseline assessment, and hence the data were analysed for 100 participants. Interventions: No specific intervention. Main Measures: Timed Up and Go and Timed Up and Go-Cognitive. Three-month prospective diaries recorded falls. Results: Mean age was 52.6 (SD 10.7) and 66 were female. Majority of the participants had progressive MS (72) and 73 used a walking aid; 56 participants recorded 791 falls. The area under the receiver operating characteristic curve values for Timed Up and Go and Timed Up and Go-Cognitive in distinguishing fallers (person with ⩾1 fall) from non-fallers are 0.60 and 0.57, respectively, and in distinguishing multiple fallers (⩾2 falls) the values are 0.46 and 0.43. A Timed Up and Go score of ⩾9 seconds has a sensitivity of 0.82 and a specificity of 0.34 to identify fallers and a sensitivity of 0.79 and a specificity of 0.27 to identify multiple fallers. A Timed Up and Go-Cognitive score of ⩾11 seconds has a sensitivity of 0.77 and a specificity of 0.30 to identify fallers and a sensitivity of 0.71 and a specificity of 0.26 to identify multiple fallers. Conclusion: The Timed Up and Go and Timed Up and Go-Cognitive do not demonstrate sufficient clinical utility or discriminative ability for assessing falls risk in MS.

The relationship between muscle quality and incidence of falls in older community-dwelling women: An 18-month follow-up study.

Important components that might mediate the relationship between aging and falls are reduced muscle strength and mass. Although muscle-related phenotypes have been linked to falls in older people, the role of muscle quality has yet to be examined. To investigate the relationship between muscle quality and incidence of falls over an 18-month follow-up in older community-dwelling women. A total of 167 women (68.1 ± 6.2 years) underwent quadriceps isometric peak torque and thigh-muscle thickness assessments using isokinetic dynamometer and ultrasound, respectively. Muscle quality was considered as the ratio between maximal strength and muscle thickness. Participants were tracked by phone calls for ascertainment of falls during the follow-up period. Cox proportional regressions and X2 tests were performed, with statistical significance set at P < 0.05. A total of 139 volunteers were successful tracked over the follow-up period. The overall incidence of fall was 23.4% (95% CI: 16.5-31.0). Rate of fallers among individuals with low-muscle quality (57.7%) was higher than in those with normal muscle quality (15.3%) (X2 = 21.132; P < 0.001). The proportion of multiple fallers was also significantly higher (X2 = 11.029; P < 0.001) among volunteers with low-muscle quality when compared to those with normal muscle quality (14.8% and 3.6%, respectively). The presence of low-muscle quality was associated with a significantly greater risk of falls over the follow-up (hazard ratio: 4.619; 95% CI: 2.302-9.269). Low-muscle quality is associated with a higher incidence of falls in older women. These findings provide support for the concept that muscle quality is a clinically meaningful assessment among older people.

Falls in Older Patients with Cancer Undergoing Surgery: Prevalence and Association with Geriatric Syndromes and Levels of Disability Assessed in Preoperative Evaluation.

Falls are common among older adults. However, not much is known about the prevalence of falls among older patients with cancer. In 2015, older patients with cancer referred to Geriatrics service for preoperative evaluation were assessed for fall history, basic and instrumental activities of daily living (ADL and IADL), KPS, and use of assistive device. Of 806 patients, 215 (26.7%) patients reported fall. Incidence of last fall inside and outside home was 54.4% and 45.5%, respectively. Among patients with no falls, 33.6% had KPS ≤ 80 compared to 59.6% with one-time fall and 60.7% with multiple falls (p < 0.001). Among IADL, 8.5% of patients with no falls were unable to do shopping compared with 14.7% in one-time fall and 18.8% in multiple fallers (p < 0.001). In ADL items, the percentage of patients who were limited a lot in walking outside was 10.7% in no falls, 20.2% in one-time fall, and 27.1% in multiple fallers groups (p < 0.001). Only 17.8% of patients with no falls were using canes while 27.7% of patients with one-time fall and 38.8% with multiple falls were using canes (p < 0.001). Falls are prevalent among older patients with cancer. Fall history and number of falls are associated with functional status.

Distinguishing among multiple sclerosis fallers, near-fallers and non-fallers

BackgroundFall rates among adults with multiple sclerosis are consistently greater than 50%, but near-falls (i.e. a trip or stumble) are often undocumented. Furthermore, little is known about the circumstances surrounding fall and near-fall events. The purpose of this study was to examine the similarities and differences among non-fallers, near-fallers and fallers with multiple sclerosis, including the circumstances that surround falls and near-falls. MethodsIn a single visit, 135 multiple sclerosis participants completed the Hopkins Falls Grading Scale, a custom questionnaire investigating circumstances surrounding falls and near-falls, and performed the Timed Up and Go and Timed 25-Foot Walk tests. Mann-Whitney tests were used to examine differences between fallers, near-fallers and non-fallers. Multiple logistic regression with AIC criterion was used to examine associations of circumstances with the odds of falling vs. near-falling. Cumulative odds ordinal logistic regression was used to analyze the association between each of the walking tests and the susceptibility of the individual for falls or near-falls. Results30% of individuals reported falls, while 44% reported near-falls over a 1-year period. Non-fallers completed the walking tests more quickly than near-fallers (p < 0.0045), and fallers (p < 0.0001); near-fallers and fallers demonstrated similar motor profiles. Individuals were more likely to sustain a fall rather than a near-fall under the following circumstances: transferring outside the home (p = 0.015) and tripping over an obstacle (p = 0.025). Performing 1-second slower on the walking tests increased the odds of a history of a fall by 6–20%. ConclusionNear-falls occur commonly in individuals with MS; near-fallers and fallers reported similar circumstances surrounding fall events and demonstrated similar performance on standard timed walking tests. Clinicians monitoring individuals with MS should consider evaluation of the circumstances surrounding falls in combination with quantitative walking measures to improve determination of fall risk and appropriate rehabilitation interventions.