Falls In Older Adults Research Articles

Falls in older adults with cancer: an updated systematic review of prevalence, injurious falls, and impact on cancer treatment.

This update of our 2016 systematic review answers the following questions: (1) How often do older adults with cancer fall? (2) What are the predictors for falls? (3) What are the rates and predictors of injurious falls? (4) What are the circumstances and outcomes of falls? (5) How do falls in older patients affect subsequent cancer treatment? and a new research question, (6) Which fall reduction interventions are efficacious in this population? MEDLINE, PubMed, CINAHL, and Embase were searched (September 2015-January 25, 2019). Eligible studies included clinical trials and cohort, case-control, and cross-sectional studies published in English in which the sample (or subgroup) included adults aged ≥ 60, with cancer, in whom falls were examined as an outcome. A total of 2521 titles were reviewed, 67 full-text articles were screened for eligibility, and 30 new studies were identified. The majority involved the outpatient setting (n= 19) utilizing cross-sectional method (n= 18). Sample size ranged from 21 to 17,958. Fall rates ranged from 1.52 to 3.41% per 1000 patient days (inpatient setting) and from 39%/24months to 64%/12months (outpatient setting). One out of the 6 research questions contributed to a new finding: one study reported that 1 in 20 older patients experienced impact on cancer treatment due to falls. No consistent predictors for falls/fall injuries and no studies on fall reduction interventions in the geriatric oncology setting were identified. This updated review highlights a new gap in knowledge pertaining to interventions to prevent falls. Additionally, new knowledge also emerged in terms of impact of falls on cancer treatment; however, further research may increase generalizability. Falls and fall-related injuries are common in older adults with cancer and may affect subsequent cancer treatment. Further studies on predictors of falls, subsequent impacts, and fall reduction in the oncology setting are warranted.

“I Remember the Fall”: Memory of Falls in Older Adults

ABSTRACT Objectives While there is a large body of research on falls and their consequences in older adults, little is known about how older adults remember them. We addressed this gap by inviting older adults to remember falls and control memories. Methods We analyzed specificity of memories and invited participants to rate emotional valence, mental time travel, visual imagery, importance, and rehearsal, as experienced during retrieval. Results Although analysis demonstrated no significant differences between memories of falls and control memories regarding specificity, participants rated memories of falls as more negative than control memories. Furthermore, they rated memories of falls as triggering higher mental time travel, higher visual imagery, higher importance, and higher rehearsal than control memories. Conclusions The negative emotional valence of memories of falls, as well as their ability to trigger significant levels of mental time travel, visual imagery, importance, and rehearsal, demonstrate how these memories are different from other memories in older adults. Clinical implications The findings demonstrate how falls can modulate memory of personal events in older adults.

Effectiveness of Ankle-Foot Orthoses Combined with Physiotherapy on Improving Balance and Reducing Falls in Older Adults

Objective: This study aimed to evaluate the effectiveness of ankle-foot orthoses (AFOs) combined with physiotherapy on improving balance and reducing falls in older adults. Methods: A randomized controlled trial was conducted with 30 older adults aged 65 and above with a history of falls. Participants were randomly assigned to one of three groups: Ankle-Foot Orthoses (AFO), Physiotherapy (PT), and Combined Therapy (AFO + PT). Balance was assessed using the Berg Balance Scale (BBS) and fall incidence was recorded over a 12-week period. Results: The Combined Therapy group showed significant improvements in BBS scores (mean improvement of 16.3 points) and a greater reduction in fall incidence (0 falls) compared to the AFO group (mean improvement of 11.1 points, 2 falls) and the PT group (mean improvement of 11.6 points, 1 fall) with p-values of <0.05. Conclusion: The combination of AFOs and physiotherapy significantly improves balance and reduces fall incidence in older adults more effectively than either intervention alone. These findings support the use of combined therapy in clinical practice to enhance fall prevention strategies in the elderly population.

Estimating Trunk and Neck Stabilization for Avoiding Head Impact during Real-World Falls in Older Adults.

In this work, we quantify the neck's involvement in stabilizing the head during falls in older adults to avoid head impacts. We tracked kinematics of 12 real-world backward falls in long-term care captured on video, where head impact was avoided. We estimated dynamic spring-dashpot parameters of the neck and hip representing active muscle activity and passive tissue structures. Neck stiffness, damping, and target posture averaged 24.00±6.17Nm/rad, 0.38±0.16Nms/rad, and 76.2±14.7° flexion respectively. The stiffness and target posture suggest that residents actively contracted their neck muscles to maintain the head upright. Our results shed light on the importance of neck strength for avoiding head impact during a fall.Clinical Relevance-Falls account for 80% of traumatic brain injuries in adults 65+ years. While upper limb bracing can reduce the risk of head impacts during a fall in young adults, this protective response is less effective in older adults living in longterm care. Understanding how the neck and torso musculature are used to avoid head impact can guide the design of therapeutic exercise programs and assistive or protective devices.

Effect of Preinjury Oral Anticoagulants on Outcomes Following Traumatic Brain Injury from Falls in Older Adults.

Warfarin has been the oral anticoagulant of choice for the treatment of thromboembolic disease. However, upward of 50% of all new anticoagulant prescriptions are now for direct oral anticoagulants (DOAC). Despite this, outcome data evaluating preinjury anticoagulants remain scarce following traumatic brain injury (TBI). Our study objective is to determine the effects of preinjury anticoagulation on outcomes in older adults with TBI. Patient data were obtained from 29 level 1 and 2 trauma centers from 2012 to June 30, 2018. Overall, 8312 patients who were aged 65years or older, suffering a ground level fall, and with an Abbreviated Injury Scale (AIS) head score of ≥3 were identified. Patients were excluded if they presented with no signs of life or a traumatic mechanism besides ground level fall. Statistical comparisons were made using multivariable analyses with anticoagulant/antiplatelet use as the independent variable. Of the total patients with TBI, 3293 were on antiplatelet agents (AP), 669 on warfarin, 414 on warfarin+AP, 188 on DOACs, 116 on DOAC+AP, and 3632 on no anticoagulant. There were 185 (27.7%) patients on warfarin and 43 (22.9%) on a DOAC with a combined outcome of mortality or hospice as compared to 575 (15.8%) in the no anticoagulant group (p<0.001). After adjusting for patient factors, there was an increased risk of mortality or hospice in the warfarin (OR 1.60; 95% CI 1.27-2.01) and DOAC group (OR 1.67; 95% CI 1.07-2.59) as compared to no anticoagulant. Warfarin+AP was associated with an increased risk of mortality or hospice (OR 1.61; 95% CI 1.18-2.21) that was not seen with DOAC+AP (OR 0.93; 95% CI 0.46-1.87) as compared to no anticoagulant. In older adults with TBI, preinjury treatment with warfarin or DOACs resulted in an increased risk of mortality or hospice whereas preinjury AP therapy did not increase risk. Future studies are needed with larger sample sizes to directly compare TBI outcomes associated with preinjury warfarin versus DOAC use.

Falls in Community-Dwelling Older Adults with Lower Back or Knee Pain Are Associated with Cognitive and Emotional Factors.

(1) Background: The present study aimed to examine physical, cognitive and emotional factors affecting falls in community-dwelling older adults with and without pain; (2) Methods: Data from 789 older adults who participated in a community-based health survey were analyzed. Participants completed questionnaires on the presence of pain and previous falls. Muscle weakness (handgrip strength < 26.0 kg for men and < 18.0 kg for women) and low skeletal muscle mass (appendicular skeletal muscle mass index < 7.0 kg/m2 for men and < 5.7 kg/m2 for women) were determined. Mild cognitive impairment (MCI) and depressive symptoms were assessed using the National Center for Geriatrics and Gerontology-Functional Assessment Tool and 15-item geriatric depression scale (GDS-15), respectively; (3) Results: In participants with pain, MCI and GDS-15 were associated with previous falls after adjusting for age, sex, education and medication use. In participants without pain, muscle weakness and low skeletal muscle mass were associated with previous falls when adjusting for the above covariates; (4) Conclusions: Falls in participants with pain were associated with cognitive and emotional factors, whereas falls in those without pain were associated with physical factors. Fall prevention interventions for older adults with pain may require tailored strategies to address cognitive and emotional factors.

When COVID-19 affects muscle: effects of quarantine in older adults

At the beginning of 2020 a respiratory diseased named COVID-19 rapidly spread worldwide. Due to the presence of comorbidities and a greater susceptibility to infections, older adults are the population most affected by this pandemic. An efficient pharmacological treatment for COVID-19 is not ready yet; in the meanwhile, a general quarantine has been initiated as a preventive action against the spread of the disease. If on one side this countermeasure is slowing the spread of the virus, on the other side is also reducing the amount of physical activity. Sedentariness is associated with numerous negative health outcomes and increase risk of fall, fractures and disabilities in older adults. Models of physical inactivity have been widely studied in the past decades, and most studies agreed that is necessary to implement physical exercise (such as walking, low load resistance or in bed exercise) during periods of disuse to protect muscle mass and function from catabolic crisis. Moreover, older adults have a blunted response to physical rehabilitation, and a combination of intense resistance training and nutrition are necessary to overcome the loss of in skeletal muscle due to disuse.

When COVID-19 affects muscle: effects of quarantine in older adults

At the beginning of 2020 a respiratory diseased named COVID-19 rapidly spread worldwide. Due to the presence of comorbidities and a greater susceptibility to infections, older adults are the population most affected by this pandemic. An efficient pharmacological treatment for COVID-19 is not ready yet; in the meanwhile, a general quarantine has been initiated as a preventive action against the spread of the disease. If on one side this countermeasure is slowing the spread of the virus, on the other side is also reducing the amount of physical activity. Sedentariness is associated with numerous negative health outcomes and increase risk of fall, fractures and disabilities in older adults. Models of physical inactivity have been widely studied in the past decades, and most studies agreed that is necessary to implement physical exercise (such as walking, low load resistance or in bed exercise) during periods of disuse to protect muscle mass and function from catabolic crisis. Moreover, older adults have a blunted response to physical rehabilitation, and a combination of intense resistance training and nutrition are necessary to overcome the loss of in skeletal muscle due to disuse.

When COVID-19 affects muscle: effects of quarantine in older adults

At the beginning of 2020 a respiratory diseased named COVID-19 rapidly spread worldwide. Due to the presence of comorbidities and a greater susceptibility to infections, older adults are the population most affected by this pandemic. An efficient pharmacological treatment for COVID-19 is not ready yet; in the meanwhile, a general quarantine has been initiated as a preventive action against the spread of the disease. If on one side this countermeasure is slowing the spread of the virus, on the other side is also reducing the amount of physical activity. Sedentariness is associated with numerous negative health outcomes and increase risk of fall, fractures and disabilities in older adults. Models of physical inactivity have been widely studied in the past decades, and most studies agreed that is necessary to implement physical exercise (such as walking, low load resistance or in bed exercise) during periods of disuse to protect muscle mass and function from catabolic crisis. Moreover, older adults have a blunted response to physical rehabilitation, and a combination of intense resistance training and nutrition are necessary to overcome the loss of in skeletal muscle due to disuse.

Injury Diagnosis and Affected Body Part for Nonfatal Fall-Related Injuries in Community-Dwelling Older Adults Treated in Emergency Departments.

Objective: To estimate frequency and type of older adult fall-related injuries treated in emergency departments (EDs). Methods: We used the 2015 National Electronic Injury Surveillance System: All Injury Program. Patient data were abstracted from the narratives describing the circumstance of injury. Data for community-dwelling older adults (n = 34,336) were analyzed to explore differences in injury diagnosis by demographic characteristics, location of fall, and disposition. Results: 70% of head-related injuries were internal injuries, suggestive of a traumatic brain injury. Most hip injuries were fractures or dislocations (73.3%). Women had higher percentages of fractures/dislocations but lower percentages of internal injuries than men. About a third of fall-related ED visits required hospitalization or transfer. Discussion: Falls in older adults result in array of injuries and pose a burden on the healthcare system. Understanding how fall injuries vary by different characteristics can help inform targeted prevention strategies.

Association between Very Low Dietary Protein Intake and Subsequent Falls in Community-Dwelling Older Adults in the United States

Poor nutrition is linked to frailty and both poor nutrition and frailty are recognized risk factors for falls. This study examined the association between dietary protein intake and subsequent reported falls in community-dwelling older Americans with a history of falls. Other nutritional, functional, and sociodemographic-related variables were also considered in our model. This was a retrospective analysis using data from the U.S. Health and Retirement Study (HRS) and Health Care and Nutrition Study (HCNS), both funded by the U.S. National Institute on Aging. The study population (n=3,859) was community-dwelling older adults, aged >65 years, who reported ever experiencing a fall on the 2012 HRS and had also completed the 2013 HCNS and 2014 HRS. Univariable logistic models were created for all variables of interest; variables approaching statistical significance (p < 0.1) were included in the initial multivariable logistic model. Backwards selection (cut-off of p

Prevalence and Risk Factors for Fall in Older Adults in a Nigerian Urban Community

Prevalence and Risk Factors for Fall in Older Adults in a Nigerian Urban Community

Falls in older aged adults in 22 European countries: incidence, mortality and burden of disease from 1990 to 2017

IntroductionFalls in older aged adults are an important public health problem. Insight into differences in fall-related injury rates between countries can serve as important input for identifying and evaluating prevention...

De-prescribing Program to Evaluate Falls in Older Adults

De-prescribing Program to Evaluate Falls in Older Adults

The Effect of Specific Balance Training Exercises for Preventing Falls among Elderly Women

All European countries are experiencing significant ageing of the population. As the lifespan of the population increases, so does the prevalence of falls. Falls in older adults are a major public health concern and a main cause of morbidity and disability. More than one-third of persons 65 years of age or older fall each year, and in half of such cases the falls are recurrent. It is very important to maintain physical activity and independence in daily activities in elderly persons as well as to apply appropriate preventive means as soon as possible. Various interventions may be used to promote health, enhance quality life and reduce falls in elderly people: exercises, home modifications, appropriate footwear and walking aids. The purpose of this study was to determine the effect of specific balance training exercises for preventing falls among elderly women. Twenty eight women aged 55–75 years participated in the study. The subjects were randomly divided into two groups: exercise (n = 14, mean age 67.9 ± 6.13 years) and control (n = 14, mean age 68.9 ± 5.31). Exercise group women performed specific – Cawthorne-Cooksey balance training exercises for 4 weeks, 5 times a week. Cawthorne-Cooksey exercises consisted of moving head in sitting and standing positions with eyes open or closed, exercises on a balance platform, and walking around. One training session lasted for 30-35 minutes. No exercise was performed in the control group. Static and dynamic balance was assessed using the Berg Balance Scale, Functional Reach Test, and Tinetti Balance Scale, walking speed was assessed using Timed Up and Go Test. Risk for falls was assessed using Desmond Fall Risk Questionnaire [4]. Subjects were evaluated twice: before and after applying exercise program. More than 50% of women have had a fall in the past years, difficulty walking in the dark or on uneven surfaces, they have experienced loss of balance or a light-headed feeling standing up, and they could not walk a straight line. Only 29% of subjects participated in a regular exercise programme. The results of Berg Balance Scale, Functional Reach Test, Tinetti Balance Scale, Timed Up and Go Test did not differ between groups before applying specific exercise program. Specific exercises significantly improved patients’ static and dynamic balance, reach functions and walking speed, while in the control group the results of all performed tests had tendency to decline. Specific Cawthorne-Cooksey balance training exercises are effective (p &lt; 0.05) in improving balance and preventing falls in elderly women.Keywords: falls, elderly age, balance, risk of falls.

Interprofessional Education of Emergency Department Team on Falls in Older Adults.

Interprofessional Education of Emergency Department Team on Falls in Older Adults.

Surface Perturbation Training to Prevent Falls in Older Adults: A Highly Pragmatic, Randomized Controlled Trial.

Falls are the leading cause of injuries among older adults, and trips and slips are major contributors to falls. The authors sought to compare the effectiveness of adding a component of surface perturbation training to usual gait/balance training for reducing falls and fall-related injury in high-risk older adults referred to physical therapy. This was a multi-center, pragmatic, randomized, comparative effectiveness trial. Treatment took place within 8 outpatient physical therapy clinics. This study included 506 patients 65+ years of age at high fall risk referred for gait/balance training. This trial evaluated surface perturbation treadmill training integrated into usual multimodal exercise-based balance training at the therapist's discretion versus usual multimodal exercise-based balance training alone. Falls and injurious falls were assessed with a prospective daily fall diary, which was reviewed via telephone interview every 3months for 1year.A total of 211/253 (83%) patients randomized to perturbation training and 210/253 (83%) randomized to usual treatment provided data at 3-month follow-up. At 3months, the perturbation training group had a significantly reduced chance of fall-related injury (5.7% versus 13.3%; relative risk 0.43) but no significant reduction in the risk of any fall (28% versus 37%, relative risk 0.78) compared with usual treatment. Time to first injurious fall showed reduced hazard in the first 3months but no significant reduction when viewed over the entire first year. The limitations of this trial included lack of blinding and variable application of interventions across patients based on pragmatic study design. The addition of some surface perturbation training to usual physical therapy significantly reduced injurious falls up to 3months posttreatment. Further study is warranted to determine the optimal frequency, dose, progression, and duration of surface perturbation aimed at training postural responses for this population.

Falls in Older Adults: A Systematic Review of Literature on Interior-Scale Elements of the Built Environment

Falls are the leading causes of injury and injury-related deaths in older adults. This review examined the role of interior-scale elements of living environments, including homes, nursing homes, retirement facilities, care facilities, and assisted living facilities, on falls among elderly residents. A comprehensive review of empirical studies, published in peer-reviewed journals, was conducted using the PRISMA process. Results revealed that while several environmental elements are identified as risk factors, a few are fully examined. Flooring is the most examined element in terms of number and robustness of research. Studies that assessed bundled interventions support the notion that environmental attributes affect the incidence and severity of falls. There is a need for more causal and correlational studies to determine the specific impact of each environmental element on falls to inform facility design decisions.

Falls in Older Adults are Serious.

Falls in older adults are a reasonably common occurrence and about 10% of these experience multiple falls annually. These falls may be serious and may cause significant morbidity and mortality. These can also threaten the independence of older people and may be responsible for an individual's loss of independence and socioeconomic consequences. These falls may add extra burden to the health care and to direct and indirect costs. An extensive search of literature was done on the important data bases of PubMed, SCOPUS, and Google Scholar on this topic and all the useful information was derived from the relevant articles for this review. We found that the falls in older individuals are often multi factorial and hence a multidisciplinary approach is required to prevent and manage these falls. The risk factors leading to the falls could be divided into extrinsic, intrinsic and situational factors. The commonest and serious injuries are to the head and fractures, due to fragility of bones. The falls in elderly are on rise and taking the shape of an epidemic. Prevention of these falls is far better than the management. Safe living environment of the elderly people helps in prevention of these falls. The management of the falls should focus on the causative factors, apart from treating the injuries caused by the falls.

Risk Factors for Falls in Older Adults Experiencing Homelessness: Results from the HOPE HOME Cohort Study.

More than half of homeless adults are of age ≥ 50years. Falls are a common cause of morbidity in older adults in the general population. Risk factors for falls in the general population include poor health, alcohol use, and exposure to unsafe environments. Homeless adults aged ≥ 50 have a high prevalence of known risk factors and face additional potential risks. To examine the prevalence of and risk of falling in a cohort of older homeless adults. Longitudinal cohort study with participant interviews every 6months for 3years; data were analyzed using generalized estimating equations (GEEs). Three hundred fifty adults aged ≥ 50, homeless at study entry, recruited via population-based sampling. The dependent variable is any falls in prior 6months; independent variables include individual (i.e., illness, behaviors) and social/environmental (i.e., social support, experiencing violence, living unsheltered) factors. Over three quarters of participants were men (77.1%) and Black (79.7%). The median age was 58 (IQR 54, 61). At baseline, one third (33.7%) reported a fall in the prior 6months. At follow-up visits, 23.1% to 31.2% of participants reported having fallen. In GEE models, individual risk factors (non-Black race, being a women, older age, functional impairment, urinary incontinence, history of stroke, and use of assistive devices, opioid, and marijuana) were associated with increased odds of falls. Environmental and social factors (spending any nights unsheltered (adjusted odds ratio (AOR) = 1.42, CI=1.10-1.83) and experiencing physical assault (AOR = 1.67, CI=1.18-2.37) were also associated. Older homeless adults fall frequently. Likely contributors include having a high prevalence of conditions that increase the risk of falls, compounded by heightened exposure to unsafe environments. Fall prevention in this population should target those at highest risk and address modifiable environmental conditions. Providing shelter or housing and addressing substance use could reduce morbidity from falls in homeless older adults.