Falls In Older Adults Research Articles

A Thematic Analysis of Lived Experiences of Falls in Middle-Aged and Older Adults.

Fall-related injuries occur at a similar prevalence rate in middle-aged and older adults and may increase concerns about falling and future falls. No research to date has examined how experiences of falls and related concerns, differ between middle-aged and older fallers. This study aimed to address this using qualitative interviews. Ten middle-aged (55-64 years) and ten older adults (68-83 years) were interviewed about their experiences of falls and concerns about falling. Guided by a social constructivist epistemology, reflexive thematic analysis was used to categorise themes within the data. Five overarching themes were identified. Four themes showed distinctions between groups (i) perceptions of age-related decline; (ii) ageism: stigma associated with 'fallers'; (iii) concerns about loss of independence; and (iv) unravelling perceived control. The fifth theme (v) perceptions of falls risk: concerns and awareness, demonstrated the most similarities. Whilst middle-aged and older fallers showed similar ratings of concern about falling, the behaviours underlying these were qualitatively different. For older adults, concerns led to protective adaptations to reduce their fall risk. Contrastingly, middle-aged adults showed a lack of personal responsibility over their fall risk. The findings highlight the importance of early educational intervention to reduce future falls and frailty.

Risk Factors for Falls in Community-Dwelling Older Adults During the Novel Coronavirus Pandemic in Japan: A Prospective Cohort Study

This study aimed to test the hypothesis that knowledge derived from indirect assessments can be used to identify fall risk factors during a period of social distancing. A baseline survey of 1953 community-dwelling older adults was conducted in May 2020, with a follow-up survey performed in May 2023 to assess the situation 3 years later. In total, 339 individuals were followed from baseline to follow-up. Baseline age, sex, Questionnaire for Change of Life, Frailty Screening Index, and Questionnaire for Medical Checkup of Old-Old (QMCOO) scores and subscales were used to determine fall predictors. In addition, history of falls in the past year was assessed at follow-up (outcome). The participants were categorized into fall (n = 78) and non-fall (n = 261) groups. Using binary logistic regression analysis, items that showed significant differences in a between-group comparison were analyzed, and age and history of falls, which were sub-items of the QMCOO, were identified as predictors of falls. Although special assessments may be required during periods of social distancing, we believe that it is important for these assessments to continue being performed as they are performed during normal times.

Psychological Resilience and Complex Movement Coordination Predict the Risk of Falls in Older Adults

AbstractThe prevalence of falls in older individuals worldwide is around 26.5%. There is an urgent need to identify factors antagonistic to advanced age-related falls regarding personal safety, family or nursing care time, and healthcare costs. The aim of the study was to examine the relationship between functional fitness, mental health indicators, and the risk of falling (ROF) in older adults. Thirty-eight older adults (60–94 years; 66% female) were tested individually with the Fullerton Functional Fitness Test (FFFT) after completing five instruments gauging resilience, well-being, satisfaction with life, happiness, and perceived stress. We measured the ROF with the Berg Balance Test. All objective and subjective measures correlated significantly with the ROF. Bayesian linear regressions revealed that complex movement coordination accounted for 68.8%, while resilience accounted for 48.5% of the variance in the ROF. Moreover, resilience was also a mediator between complex movement coordination and ROF. These results suggest that complex movement coordination-developing and resilience-enhancing training strategies might be beneficial in reducing the ROF in older adults.

Fear of falling as a psychological consequence of fall in older adults

Abstract Background Falls is one of geriatric syndromes that impact active ageing. It is a major public health problem as falls can lead to irreversible health, social, and psychological consequences, and a large economic burden. Methods Elderly women, aged 65 years and above, who attended the National Osteoporosis Center for diagnostic or treatment purposes, participated in telephone interviews. These interviews aimed to document the outcomes and healthcare measures associated with any falls they experienced in the preceding 12 months. There was used a specially prepared questionnaire for demographic and falls data, fear of falling questionnaire “Falls Efficacy Scale International” (FES-I) and physical activity questionnaire “Physical Activity Scale for the Elderly” (PASE). Results The study population consisted of 339 community-dwelling women (mean age 72.9±5.3 years) all of whom reported experiencing one or more falls. One in three of these women had fallen two or more times. Most of all their fall resulted in an injury, and 79 (23.3%) reported falls led to bone fractures. Fear of falling was reported as a consequence of experienced fall by 251 (74.1%) women. Almost half of fallers restricted their everyday activities. The primary cause for limiting everyday activities was identified as pain. Conclusions Fear of falling was reported by 74.1% of women who fell during the previous 12 months. Every woman who experienced hip or vertebral fractures subsequently restricted their daily activities. Key messages • Fear of falling is common among elderly women who has fallen once or more. • The restriction of everyday activities is usually reported by women who feel pain and are afraid to fall again.

Older Adult Fall Risk Prediction with Deep Learning and Timed Up and Go (TUG) Test Data.

Falls are a major health hazard for older adults; therefore, in the context of an aging population, predicting the risk of a patient suffering falls in the near future is of great impact for health care systems. Currently, the standard prospective fall risk assessment instrument relies on a set of clinical and functional mobility assessment tools, one of them being the Timed Up and Go (TUG) test. Recently, wearable inertial measurement units (IMUs) have been proposed to capture motion data that would allow for the building of estimates of fall risk. The hypothesis of this study is that the data gathered from IMU readings while the patient is performing the TUG test can be used to build a predictive model that would provide an estimate of the probability of suffering a fall in the near future, i.e., assessing prospective fall risk. This study applies deep learning convolutional neural networks (CNN) and recurrent neural networks (RNN) to build such predictive models based on features extracted from IMU data acquired during TUG test realizations. Data were obtained from a cohort of 106 older adults wearing wireless IMU sensors with sampling frequencies of 100 Hz while performing the TUG test. The dependent variable is a binary variable that is true if the patient suffered a fall in the six-month follow-up period. This variable was used as the output variable for the supervised training and validations of the deep learning architectures and competing machine learning approaches. A hold-out validation process using 75 subjects for training and 31 subjects for testing was repeated one hundred times to obtain robust estimations of model performances At each repetition, 5-fold cross-validation was carried out to select the best model over the training subset. Best results were achieved by a bidirectional long short-term memory (BLSTM), obtaining an accuracy of 0.83 and AUC of 0.73 with good sensitivity and specificity values.

Using the Nintendo™ Wii to Improve Physical Function and Reduce the Risk of Falls in Older Adults: A Randomized Controlled Clinical Trial.

(1) Background: Numerous exercise programs that improve physical capacity and the risk of falls in older adults have been proposed with varying degrees of success. A novel approach may be to use a video game system that uses real-time force feedback to train older adults. The aim of this study was to evaluate the effects of a Nintendo™ Wii-based exercise program on physical function and risk of falls in older people. (2) Methods: This 12-week randomized controlled clinical trial involved 73 participants: 36 individuals participating in a control group (CG) and 37 in an experimental group (EG) participating in a combined program. Balance was measured using the Tinetti scale, flexibility was assessed with the back scratch test and the sit-and-reach test, and lower body strength was assessed with the 30 s chair stand-up test. (3) Results: The results of this study show significant improvements in balance, gait, flexibility, and strength of the lower limbs compared to a control group. (4) Conclusions: A Nintendo™ Wii-based exercise program for seniors produces improvements in the physical health of older adults. These improvements highlight the importance of integrating physical exercise through video games as an effective strategy to improve the general health and quality of life of older adults.

Risk of Dementia Diagnosis After Injurious Falls in Older Adults

Emerging evidence suggests that mild cognitive impairment, which is a precursor to Alzheimer disease and related dementias (ADRD), places older adults at increased risk for falls. However, the risk that an older adult develops dementia after experiencing a fall is unknown. To determine the risk of new ADRD diagnosis after a fall in older adults. This retrospective cohort study examined Medicare Fee-for-Service data from 2014 to 2015, with follow-up data available for at least 1 year after the index encounter. Participants included adults aged 66 years and older who experienced a traumatic injury that resulted in an emergency department (ED) or inpatient encounter and did not have a preexisting diagnosis of dementia. Data analysis was performed from August 2023 to July 2024. Experiencing a fall compared with other mechanisms of injury, defined by International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 external cause of injury codes. The hazard of new ADRD diagnosis within 1 year of a fall, assessed by performing a Cox multivariable competing risk model that controlled for potential confounders while accounting for the competing risk of death. The study included 2 453 655 older adult patients who experienced a traumatic injury; 1 522 656 (62.1%) were female; 124 396 (5.1%) were Black and 2 232 102 (91.0%) were White; and the mean (SD) age was 78.1 (8.1) years. The mechanism of injury was a fall in 1 228 847 incidents (50.1%). ADRD was more frequently diagnosed within 1 year of a fall compared with other injury mechanisms (10.6% [129 910 of 1 228 847] vs 6.1% [74 799 of 1 224 808]; P < .001). The unadjusted hazard ratio (HR) of incident dementia diagnosis after a fall was 1.63 (95% CI, 1.61-1.64; P < .001). On multivariable Cox competing risk analysis, falling was independently associated with an increased risk of dementia diagnosis among older adults (HR, 1.21 [95% CI, 1.20-1.21]; P < .001) after controlling for patient demographics, medical comorbidities, and injury characteristics, while accounting for the competing risk of death. Among the subset of older adults without a recent skilled nursing facility admission, the HR was 1.27 (95% CI, 1.26-1.28; P < .001). In this cohort study, new ADRD diagnoses were more common after falls compared with other mechanisms of injury, with 10.6% of older adults being diagnosed with ADRD in the first year after a fall. To improve the early identification of ADRD, this study's findings suggest support for the implementation of cognitive screening in older adults who experience an injurious fall that results in an ED visit or hospital admission.

Association of Polymorphic Cytochrome P450 Enzyme Pathways with Falls in Multimedicated Older Adults

ObjectivesDose exposure is considered relevant for drug-associated falls in older adults, pointing to an importance of drug metabolism. Aim was to analyze individual factors altering drug metabolism such as enzyme saturation by drug exposure and pharmacogenetics in the context of drug-associated falls. DesignProspective population-based study (ActiFE-Ulm study). Setting and ParticipantsCommunity-dwelling older adults. MethodsFocus was laid on the metabolism by polymorphic cytochrome P450 (CYP) enzymes CYP2C19, 2C9, and 2D6. Relevant variants of pharmacogenes were analyzed. Logistic binary regression analysis was used to calculate odds ratios (ORs) and 95% CIs for falls observed prospectively over a 1-year period with drug metabolism characteristics. ResultsIn total, 1377 participants were included in the analysis. Although the phenotype predicted by the genotype was not, the use of drugs metabolized by CYP2C19 was associated with falls. Drugs not known as fall risk–increasing drugs (FRIDs; ie, non-FRIDs), but metabolized by CYP2C19, showed an OR of 1.46 (1.11-1.93) in adjusted analysis. Significant effect modification was observed for a reduced CYP2C19 activity phenotype with non-FRIDs metabolized by CYP2C19. Conclusions and ImplicationsThis study suggests an association between the occurrence of falls in older adults and the metabolic capacity of CYP2C19. Thus, an important step toward prevention of falls might be to personalize dosage and treatment length of the main drug classes known to be CYP2C19 substrates, such as many antidepressants, opioids, and sedatives, but also proton pump inhibitors in particular in poor and intermediate metabolizers.

Examination of the Relationship Between Sensory Processing Skills, Kinesiophobia and Fear of Falling in Older Adults with Hypertension and Normotension

ABSTRACT Objectives The aim of the study was to investigate fear of falling, kinesiophobia, and sensory processing in older adults with hypertension and normotension. Methods Older adults, 62 with hypertension and 62 with normotension, aged 65–84 years were included in the study. The assessment of fear of falling was conducted using the Tinetti Falls Efficacy Scale, kinesiophobia was evaluated with the Tampa Kinesiophobia Scale, and sensory processing skills were analyzed with the Adolescent/Adult Sensory Profile. Results Significant differences were found between the groups in terms of vestibular processing, visual processing and activity level, fear of falling and kinesiophobia (p < .05). No significant differences were found between the groups with respect to taste/smell, tactile, and auditory processing skills. The findings revealed that older adults with hypertension exhibited diminished vestibular and visual processing abilities, reduced activity levels, and heightened concerns about falling and a tendency to experience kinesiophobia. Fear of falling and kinesiophobia were found to increase with decreasing vestibular processing skills and activity levels in both groups (p < .05). Regression analysis revealed that age, kinesiophobia, vestibular processing, and activity levels were significant determinants of fear of falling (p < .05). Conclusion It is recommended that older adults with hypertension be assessed in terms of sensory, functional, and mental health, with the objective of planning appropriate intervention approaches.

Considerations for Developing Patient-centered Clinical Decision Support: Preventing Older Adult Falls after Emergency Department Visits

Considerations for Developing Patient-centered Clinical Decision Support: Preventing Older Adult Falls after Emergency Department Visits

Falls in older adults during treatment for metastatic castration-resistant prostate cancer (mCRPC)

Falls in older adults during treatment for metastatic castration-resistant prostate cancer (mCRPC)

Effect of Coherent Breathing Versus Inspiratory Muscle Training on Risk of Falling and Functional Capacity in Older Adults

Effect of Coherent Breathing Versus Inspiratory Muscle Training on Risk of Falling and Functional Capacity in Older Adults

Association between Falls, Fear of Falling and Depressive Symptoms in Community-Dwelling Older Adults.

Longevity increases pose public health challenges, especially in managing falls and their psychological impacts on older adults. Limited evidence exists on the relationship between a fear of falling (FOF), previous falls, and depressive symptoms among community-dwelling older adults. To evaluate the association between falls, FOF, and depressive symptoms in community-dwelling older adults. This cross-sectional study, conducted in 2018, included 400 older adults from a Basic Health Unit in São Paulo, Brazil. The Geriatric Depression Scale (GDS-15) and the International Falls Efficacy Scale (FES-I) were used, along with self-report questionnaires on fall history. Linear and logistic regression were used to analyze the relationships between variables. The mean age was 75.2 (SD = 8.53) years, with 63.2% being female. Depressive symptoms were observed in 18.3% of the participants, while 90.5% reported a fear of falling (FOF). More than half (63.0%) experienced falls, with 49.5% occurring in the last year. Factors such as the female gender, negative health perceptions, and functional dependence were associated with depressive symptoms. Adjusted analyses indicated that both a fear of falling (FOF) (B = 0.043; p = 0.012) and a history of falls (B = 0.725; p = 0.015) were associated with depressive symptoms. Falls, FOF, and depressive symptoms are interlinked among older adults, underscoring the need for targeted interventions to improve their mental and physical health.

2326 Improving recording and documentation of lying standing blood pressure In patients &amp;gt; 65 admitted with/At high risk of fall(s)

Abstract Introduction The World Falls Guideline 2022 recommends that measurement of lying-standing blood pressure (LSBP) is an integral part of the multifactorial falls assessment (1). Pre-intervention less than half of eligible patients had a LSBP recorded and documented. The aim was to improve the recording and documentation of LSBP for adults aged 65 and over admitted with a fall or at high risk for falls. Method All patients aged 65 and over admitted with fall or identified as at high risk for falls to a care of the elderly ward were included over the period of 15th September 2023-15th November 2023. Royal College of Physicians (RCP) guidance (2017) for standard measurement of LSBP was used2. Data was collected on electronic spreadsheets from electronic observation charts. Two plan do study act (PDSA) cycles were conducted. Firstly, ward posters demonstrated how to record and document LSBP. Secondly ward-based one-to-one teaching interventions using RCP LSBP lanyard flashcards (2) were conducted. Results Following cycle one, 50% of eligible patients had LSBP documented. Following cycle two, 80% of eligible patients had LSBP documented. Following two PDSA cycles, there was a 37.1% increase in the average number of eligible patients who had LSBP correctly recorded and documented. Conclusion(s) Interventions of aide memoirs and education for nursing and medical staff improved the recording and documentation of LSBP. Indications and correct measurement guidance for LSBP should be included in future ward staff induction information and departmental teaching sessions. References 1) Montero-Odasso, M, Van der Velde N, Martin FC et al. The Task Force on Global Guidelines for Falls in Older Adults, World guidelines for falls prevention and management for older adults: a global initiative, Age and Ageing, Volume 51, Issue 9, September 2022. 2) Measurement of lying and standing blood pressure: A brief guide for clinical staff. 2017. https://www.rcplondon.ac.uk/projects/outputs/measurement-lying-and-standing-blood-pressure-brief-guide-clinical-staff.

A Review of the Efficacy and Mechanisms of Blood Flow Restriction Training in Enhancing Somatic Function and Preventing Falls in Older Adults.

Falls have become an important public health problem that seriously affects the quality of survival of older adultsand are a major cause of fractures, death, and reduced quality of life. With the advent of an aging society, the social, economic, and medical burdens of falls in older adults are increasing. Currently, there is a lack of effective means to prevent falls in older adults, and traditional health education and clinical interventions are not effective. It is urgent to find a safe and effective training method that can improve balance function and is suitable for the elderly. Low-intensity blood flow restriction training (BFRT) is an emerging training modality that, by restricting blood flow to the limbs and combining it with low-intensity exercise, can effectively improve muscle mass, aerobic capacity, and bone density, and has been shown to enhance somatic function in older adults. However, the effectiveness and specific mechanisms of BFRT in preventing falls in older adults are unclear. Based on recent research progress, this paper explores the possibility of BFRT in preventing falls in older adults by analyzing its positive effects on muscle mass, balance function, and cognitive function, the risk factors of falling in the elderly are summarized, as well as its potential role in reducing fall risk factors. It aims to provide new thinking for academia and clinical practice and to provide a scientific basis for reducing the risk of falls in the elderly.

Factors influencing older adult community fall prevention exercise implementation: a scoping review.

Exercise that challenges balance is the most effective fall prevention intervention in community-dwelling older adults. Identifying factors influencing implementation of community fall prevention exercise programs is a critical step in developing strategies to support program delivery. To identify implementation facilitators, barriers, and details reported in peer-reviewed publications on community fall prevention exercise for older adults. Scoping review. We searched multiple databases up to July 2023 for English-language publications that reported facilitators and/or barriers to implementing an evidence-based fall prevention exercise program in adults aged 50+ years living independently. At least two reviewers independently identified publications and extracted article, implementation, and exercise program characteristics and coded barriers and facilitators using the Consolidated Framework for Implementation Research (CFIR). We included 22 publications between 2001 and July 2023 that reported factors influencing implementation of 10 exercise programs. 293 factors were reported: 183 facilitators, 91 barriers, 6 described as both a facilitator and barrier, and 13 unspecified factors. Factors represented 33 CFIR constructs across all five CFIR domains: implementation inner setting (n = 95 factors); innovation (exercise program) characteristics (n = 84); individuals involved (n = 54); implementation process (n = 40) and outer setting (n = 20). Eight publications reported implementation strategies used; 6 reported using a conceptual framework; and 13 reported implementation outcomes. The high number of factors reflects the complexity of fall prevention exercise implementation. The low reporting of implementation strategies, frameworks and outcomes highlight the ongoing need for work to implement and sustain community fall prevention exercise programs.

A Virtual Reality-Based Simulation Tool for Assessing the Risk of Falls in Older Adults

A Virtual Reality-Based Simulation Tool for Assessing the Risk of Falls in Older Adults

Emergency Department-Based Physical Function Measures for Falls in Older Adults and Outcomes: A Secondary Analysis of GAPcare.

Falls are the leading reason for injury-related emergency department (ED) visits for older adults. The Geriatric Acute and Post-acute Fall Prevention Intervention (GAPcare), an in-ED intervention combining a medication therapy management session delivered by a pharmacist and a fall risk assessment and plan by a physical therapist, reduced ED revisits at 6 months among older adults presenting after a fall. Our objective was to evaluate the relationship between measures of function obtained in the ED and clinical outcomes. This was a secondary analysis of data from GAPcare, a randomized controlled trial conducted from January 2018 to October 2019 at 2 urban academic EDs. Standardized measures of function (Timed Up and Go [TUG] test, Barthel Activity of Daily Living [ADL], Activity Measure for Post Acute Care [AM-PAC] 6 clicks) were collected at the ED index visit. We performed a descriptive analysis and hypothesis testing (chi square test and analysis of variance) to assess the relationship of functional measures with outcomes (ED disposition, ED revisits for falls, and place of residence at 6 months). Emergency department disposition status refers to discharge location immediately after the ED evaluation is complete (eg, hospital admission, original residence, skilled nursing facility). Among 110 participants, 55 were randomized to the GAPcare intervention and 55 received usual care. Of those randomized to the intervention, 46 received physical therapy consultation. Median age was 81 years; participants were predominantly women (67%) and White (94%). Seventy-three (66%) were discharged to their original residence, 14 (13%) were discharged to a skilled nursing facility and 22 (20%) were admitted. There was no difference in ED disposition status by index visit Barthel ADLs (P = .371); however, TUG times were faster (P = .016), and AM-PAC 6 clicks score was higher among participants discharged to their original residence (P ≤ .001). Participants with slower TUG times at the index ED visit were more likely to reside in nursing homes by six months (P = .002), while Barthel ADL and AM-PAC 6 clicks did not differ between those residing at home and other settings. Measures of function collected at the index ED visit, such as the AM-PAC 6 clicks and TUG time, may be helpful at predicting clinical outcomes for older adults presenting for a fall. Based on our study findings, we suggest a novel workflow to guide the use of these clinical measures for ED patients with falls.

Incidence of Fear of Fall and Stairs Climbing Status in Older Adults After Total Knee Arthroplasty

Background: This research aimed to assess factors influencing the frequency and fear of falls, and the anxiety related to climbing stairs in patients undergoing total knee arthroplasty (TKA). Fall-related injuries are common complications after TKA, affecting daily activities and overall quality of life. Objective: To evaluate the incidence of falls, fear of falling, and stair climbing abilities in patients post-TKA. Methods: The study included 183 patients who had undergone unilateral or bilateral TKA between 6 months to 1 year prior, encompassing both genders. Data were collected using the Fall Efficacy Scale (FES) and the Timed Up and Go (TUG) scale through structured questionnaires. Results: The mean age of participants was 68.78 years (SD=6.828, range 60-89). The mean total FES score was 64.11 (SD=10.712, range 37-91). Approximately 65% of patients had a high fear of falling and poor stair climbing status. Conclusion: The study found that 65% of patients experienced fear of falling and difficulties in stair climbing post-TKA. Continued risk of falls necessitates providing physical therapy and comprehensive discharge training to mitigate fall risk and improve functional outcomes.

Comparison of effects of Otago exercise program vs gaze stability exercise on balance and fear of fall in older adults: A randomized trial.

Fall occurrences and the associated risk of injury are debilitating and major health concerns in the older population. Several interventions have been investigated and implemented to address the needs of balance impairments and to reduce the increased risk of falls. This study aimed to compare the effectiveness of the Otago exercise program (OEP) and gaze stability exercises (GSE) on balance and the risk of falls in older adults residing at an old age home facility. Thirty elderly participants were equally and randomly divided into 2 groups: Group OEP received the OEP, and group GSE received GSE for 8 weeks (thrice a week). In addition, both groups also performed core muscle-strengthening exercises. The outcome measures were the Berg balance scale (BBS) and the Fall efficacy scale-International (FES-I). The interventions resulted in significant improvements (P < .001) in both outcome measures in both groups. The mean pretest BBS scores of groups OEP and GSE increased from 40.4 and 39.2 to the mean post-test scores of 48 and 45.2, respectively. Similarly, the mean pretest FES-I scores of groups OEP and GSE also improved from 39.47 and 40.4 to the mean post-test scores of 32.73 and 36.07. The between-group comparison showed greater improvement (P < .05) in OEP group in both variables. OEP and GSE were found to be beneficial rehabilitation programs in improving balance and fear of falls in healthy older adults. However, the OEP was found to be a more effective intervention and may allow better balance and fall prevention improvements. The study has been registered in clinicaltrials.gov (ID: NCT05781776; on 23/03/2023).