Falls In Older Adults Research Articles

Validation of FES-I and Short FES-I Scales in the Polish Setting as the Research Tools of Choice to Identify the Fear of Falling in Older Adults.

Fear of falling is associated with a clear hazard to individual self-reliance, reduced physical activity, as well as a sense of shame and loss of self-confidence. The present study aimed to complete the applicable translation and validation protocol for the Falls Efficacy Scale-International (FES-I) tool, following its prior adaptation to ensure full compatibility with the Polish setting. The FES-I questionnaire, along with its abridged version, was translated in line with the recommended standards of the MAPI Institute, taking into account both the cultural fabric and pertinent language specifics of the country. The survey was attended by 740 individuals (N = 740; 463 women, 277 men), over 60 years old. All respondents were required to complete both the FES-I and FES-I (Short) questionnaires twice, following an intervening period, and subsequently had their responses statistically assessed. The FES-I questionnaire, along with its abridged version, may be recommended as an effective assessment tool for addressing the fear of falling issue among the older adults, consequently allowing the teams of attending physicians, physiotherapists, psychologists, or psychiatrists to complete an unambiguous diagnosis, with a view to helping the patients overcome this particular type of anxiety.

Is fear of falling key to identifying gait and balance abnormalities in community-dwelling older adults? Protocol of a mixed-methods approach

IntroductionThe ageing population poses an increasing burden to public health systems, particularly as a result of falls. Falls have been associated with poor gait and balance, as measured by commonly...

Predicting The Risk of Fall in Community-Dwelling Older Adults in Iran

Background The European Assessment System (EASY) Care Standard is a self-report fall screening tool for the community-dwelling older adults. A study demonstrated that the EASY-Care Standard 2010’s fall subscale (ECSF) is a valid tool for predicting the risk of fall in a nursing home; however, the validity of ECSF in community-dwelling older adults is still not clear. We aimed to evaluate the performance of the instrument as a screening tool to predict the risk of fall among community-dwelling older adults in Iran for a six-month follow-up period. If this tool is useful for the prediction of fall, it can be used for primary health-care services to detect subjects at a higher risk of fall. Method This is a longitudinal validation study that was carried out among 101 community residents ≥60 in Tehran, Iran. The participants were selected using a convenience cluster sampling based on Performance-Oriented Mobility Assessment (POMA) score categorization. The follow-up period of this study was 6 months. The ECFS scores at the baseline of the study were compared between subjects who had fallen and those who had not fallen during the six-month follow-up period. The cutoff was determined using a Receiver Operating Characteristics (ROC) curve analysis. Internal consistency and the sufficient intra-rater reliability were determined. Results The mean age of the participants was 71.87 years. The Spearman’s correlation coefficient between ECSF and POMA scores was equal to 0.829. There was also a correlation coefficient >0.8 between ECFS scores and Timed Up and Go test (TUG) seconds. Two components were detected in the factor analysis of the ECSF. The ECSF cutoff point was four out of eight with the sensitivity and specificity of 76.6 and 87.5%, respectively. The total Kuder-Richardson 20 (KR-20) coefficient was calculated as 0.852. Conclusion It seems that the EASY-Care Standard 2010 is a valid and reliable tool to predict the risk of fall in the next 6 months in the community-dwelling older adults. A valid simple and useful tool that is a good predictor of fall might help the health providers at primary health care level to easily recognize the older adults who are at a high risk of falling. What is already known about this topic? (Including key points and/or knowledge gaps Several tools exist for the predication of fall among older people. The ESAY–Care has been translated into numerous languages. In Iran, there is not a report assessing the validity and reliability of this tool. What this paper adds: (research findings/key new information The Persian version of ESAY-Care tool has a high inter-rater reliability and specificity. The Persian version of ESAY-Care tool could predict the risk of fall for the next six months. The ESAY Care tool is used to identify the risk of fall for the older adults who live in the community. The implications of this paper ESAY-Care can be incorporated into health providers and family caregivers’ measures, especially at primary prevention levels. Falling in older adults can be predicted in every community in the future. ESAY-Care will provide an efficient method to identify older people at the risk of fall during a routine community level assessment.

Associations of Gait Speed, Cadence, Gait Stability Ratio, and Body Balance with Falls in Older Adults.

To investigate the association between gait speed (GS), cadence (CAD), gait stability ratio (GSR), and body balance (BB) with falls in a large sample of older adults. The analysis included 619 individuals-305 men and 314 women (69.50 ± 5.62 years)-residing in the Autonomous Region of Madeira, Portugal. Mobility in GS, CAD, and GSR was assessed using the 50-foot walk test and BB by the Fullerton Advanced Balance scale. The frequency of falls was obtained by self-report. Linear regression analysis showed that higher performance in GS and BB was able to reduce the risk of falling by up to 0.34 and 0.44 times, respectively. An increase in the GSR value enhanced the risk of falling by up to 0.10 times. Multinomial analysis indicated that, in relation to the highest tertile (reference), older adults classified with GS and BB performance in the lowest tertile (lowest) had an increased chance (OR) of falling by up to 149.3% and 48.8%, respectively. Moreover, in relation to the highest tertile, the performance of the GSR classified in the lowest and medium tercile showed an increase in the chance of falling by up to 57.4% and 56.4%, respectively.

Biomechanics of the trochanteric soft tissue during a fall and hip fracture in older adults

Biomechanics of the trochanteric soft tissue during a fall and hip fracture in older adults

Two-year longitudinal relationships between frailty, cognitive function, and fall in community-dwelling older Korean adults

Two-year longitudinal relationships between frailty, cognitive function, and fall in community-dwelling older Korean adults

Cost Analysis of Implementing an Exercise Program for Fall and Fracture Prevention in Older Adults on Proton Pump Inhibitor Therapy.

Falls have significant financial impact. Proton pump inhibitor (PPI) therapy is associated with an increased risk of falls and fractures. Exercise programs have been shown to decrease risk of falls in the elderly population and are recommended by the U.S. Preventive Services Task Force for patients over age 65 to reduce falls. Our study aimed to explore the potential financial benefit of implementing three different Centers for Disease Control and Prevention-recommended exercise-based interventions for fall prevention (Tai Chi, Stepping On, and Otago Exercise Program) in ≥65-year-old patients on PPI therapy. A Markov model was developed to predict the financial implications of fall-related outcomes in the study population. Net cost of the intervention was deducted from the financial savings predicted for fall avoidance relative to the fall reduction conferred by the intervention. Sensitivity analysis was performed on a range of odds ratios between falling and PPI use. Exercise-based interventions were found to offer financial savings when fall reduction rates exceeded 5%, irrespective of variable odds ratios between PPI use and fall rate. Hypothetical implementation of an exercise-based intervention for PPI users ≥65 years of age was estimated to result in annual fall- and fracture-related savings ranging from $10,317.35 to $18,766.28 per individual. Findings suggested an estimated annual reduction in U.S. health care costs of $18 billion to $85 billion. Implementing an exercise-based fall prevention program for elderly PPI users represents a possible strategy to mitigate health care costs in the United States. Future prospective studies are recommended.

The Chinese Short Version of the Activities-Specific Balance Confidence Scale: Its Validity, Reliability, and Predictive Value for Future Falls in Community-Dwelling Older Adults.

PurposeTo examine the reliability and validity of the Chinese short version of the Activities-specific Balance Confidence scale (ABC-6), and its predictive value for prospective falls in community-dwelling older adults.Patients and MethodsA total of 391 community older adults completed the prospective study. Internal consistency reliability, test-retest reliability, structural validity and discriminant validity were analyzed. To determine the accuracy of ABC-6 total score in predicting falls, a receiver operating characteristic curve analysis was performed, and comparisons with the Activities-specific Balance Confidence scale (ABC-16) and Berg Balance Scale (BBS) were made.ResultsExcellent internal consistency (Cronbach’s α = 0.938) and test-retest reliability (ICC=0.964, 95% CI: 0.947–0.977) were found for the ABC-6. Exploratory factor analysis suggested that ABC-6 had a one-factor structure (explained variance, 68.30%). The optimal cutoff value, sensitivity and specificity of ABC-6 to distinguish fallers from non-fallers was ≤ 60.00%, 70.83% and 84.26%, respectively, and there was no significant difference in the predictive value among the ABC-6, ABC-16, and BBS.ConclusionThe Chinese version of the ABC-6 scale was a valid and reliable tool for measuring self-perceived balance confidence in community-dwelling older adults, and can be used as an effective assessment tool to predict future falls.

Validation of the Circular Tandem Walk Test and Optimal Cutoff Score to Determine the Risk of Falls in Active Community-Dwelling Older Adults.

This study was to develop and validate the circular tandem walk test (CTWT) by deriving an optimal cutoff score to indicate the fall risk in 89 active community-dwelling older individuals. The participants aged 65years and older were assessed for their demographic data, fear of fall variables, and history of falls in the past 6months. Subsequently, participants were randomized for the sequence of tests between the tandem walk test and the CTWT. The outcomes of CTWT showed the highest significant correlation with all the fall variables (ranging from .631 to .827, p < .001). Moreover, the time to perform the CTWT ≥ 14.6s and ≥ two error scores had excellent and acceptable diagnostic accuracy to determine the risk of falls in the older individuals, respectively. The CTWT can be used as alternative screening tests for assessing the fall risk in active older adults in community settings.

Foot Anatomical Structural Variations Increase the Risk of Falls in Older Adults

Falls are common among older adults. The purpose of this study was to demonstrate the relationship between foot anatomical structural variations and balance in older adults and quantify foot posture and stabilometry as predictors of fall risk. This case-control study of older adults classified cases or controls according to falls in the last five years. All subjects were healthy women and men &gt; 65 years old (n = 164), who were divided into two groups: 83 individuals who had suffered from a fall in the previous five years (case group) and 81 individuals who had not suffered from a fall (control group). Hallux abductus valgus (HAV) and tailor’s bunion are stability-determining factors. Women have a higher probability of falling. HAV (p = 0.042) and tailor’s bunion (p = 0.069) also increased the fall probability. Morphological foot variations (HAV and tailor’s bunion) linked to gender and age increase fall risk among older adults. In women fallers with HAV, there was a higher possibility of falling (63.9%). According to age, in older adults with HAV, the percentage of falls is high (62%). Fallers with tailor’s bunion (60.7%) are more numerous than fallers without this pathology. Older adults with HAV and tailor´s bunion had twice the probability of suffering a fall than older people without foot anatomical structural. Foot morphology is decisive in falling risk.

Calf Circumference Predicts Falls in Older Adults on Hemodialysis

Older patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis are at a higher risk of falling. However, there is no standard method to screen patients at higher risk. We have evaluated whether calf circumference (CC) measurement would be able to predict falls in this population. This is a prospective study that enrolled patients aged ≥65years on conventional hemodialysis, followed for 6months. The presence of falls was associated with demographical, clinical, and biochemical data. Reduced CC was set at <34cm for men and <33cm for women. We evaluated physical status using Duke activity status index (DASI) and hand grip strength (HGS). Ninety-one patients were included (age 73.7±5.4years, 69.2% men, 56% with diabetes). Mean CC was 32.6±3.7cm, with a high prevalence of reduced CC (61.5%). During the follow-up, 13 falls were identified (1 had a fracture and died). These patients were older and heavier (P=.017 and P=.025, respectively). Most falls occurred in patients with sarcopenic obesity (BMI >27kg/m2 plus reduced HGS or reduced CC). In a logistic regression model, reduced CC (hazard ratio (HR) 7.81, confidence interval (CI): 1.13-53.86, P=.037), higher age (HR 1.19, CI: 1.04-1.36, P=.011), and higher body weight (relative risk (RR) 1.13, CI: 1.04-1.22, P=.003) were independently associated with falls in a fully adjusted model. CC measurement, an easy and nonexpensive tool, was able to predict falls in older patients on HD. Further studies should test the inclusion of CC in a fall risk assessment in older patients on hemodialysis.

Fear of Falling and Balance Confidence in Older Adults with Type 2 Diabetes

Background and Aim: Each year, millions of older people experience falling which can cause serious injuries such as broken bones, head injuries, or even death. Since Diabetes Mellitus can disrupt the balance system and increase falling, and given that fear of falling and balance confidence are critical fall-related psychological concerns that can be the risk factors of falls in the diabetic elderly, this study aimed to compare fear of falling and balance confidence of diabetic and non-diabetic older adults in Iran. Methods: Participants were 63 diabetic older patients and 59 non-diabetic peers aged 60 years and over. Data were collected using the Persian versions of falling efficacy scale-international and activities-specific balance confidence-short form questionnaires. In addition, modified Romberg and timed up and go tests were performed to assess subjective balance performance. Results: The scores of falling efficacy scale-international questionnaire and timed up and go test were significantly higher in diabetic group while the scores of activities-specific balance confidence-short form questionnaire were lower (p&lt;0.001). No significant differences were observed in the modified Romberg test scores between two groups. Conclusion: Fear of falling and low balance confidence are more common in diabetic older adults compared to non-diabetic peers. They have poor performance in timed up and go test and have more falls during the last 12 months. Keywords: Type 2 diabetes mellitus; aging; fear of falling; balance confidence

A Multidimensional Approach for Nurse Practitioners to Screen Fall Risk and Fear of Falling in Community-Dwelling Older Adults

Nurse practitioners are essential in the care of the older adult population. Older adults are at high risk for falls; therefore, nursing assessment should include psychological and physiological measures. Fear of falling is a primary psychological contributor to fall risk. The Falls Efficacy Scale International short; Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths, and Injuries fall risk scale; and Balance Tracking System (BTrackS) balance test are reliable, efficient tools for assessment. Data obtained from these multifactoral tools may inform mobility interventions and education for the patient, further meeting a national safety goal of reducing falls in the older adult population.

Association of falls and fear of falling with objectively-measured driving habits among older drivers: LongROAD study

Objective: Falls in older adults are associated with increased motor vehicle crash risk, possibly mediated by driving behavior. We examined the relationship of falls and fear of falling (FOF) with subsequent objectively measured driving habits. Methods: This multi-site, prospective cohort study enrolled 2990 active drivers aged 65–79 (53% female). At enrollment, we assessed falls in the past year and FOF (Short Falls Efficacy Scale-International). Driving outcomes included exposure, avoidance of difficult conditions, and unsafe driving during one-year follow-up, using in-vehicle Global Positioning System devices. Results: Past-year falls were associated with more hard braking events (HBE). High FOF was associated with driving fewer days, miles, and trips, driving nearer home and more HBE. Differences were attenuated and not significant after accounting for health, function, medications and sociodemographics. Discussion: Differences in objectively measured driving habits according to past-year fall history and FOF were largely accounted for by differences in health and medications. Rather than directly affecting driving, falls and FOF may serve as markers for crash risk and reduced community mobility due to age-related changes and poor health.

Fear of Falling in Older Adults Treated at a Geriatric Day Hospital: Results from a Cross-Sectional Study.

(1) Background: The fear of falling (FOF) is a geriatric syndrome that causes a decrease in daily activities and personal autonomy. Its prevalence is highly variable as are the methodologies used to assess it. This study aimed at estimating the prevalence and describing the main determinants of FOF in older adults attending a geriatric day hospital. (2) Methods: Descriptive, cross-sectional study of individuals aged ≥70 years, who attended an ambulatory functional rehabilitation group in the metropolitan area of Barcelona. FOF was assessed using the Activities-Specific Balance Confidence (ABC) scale. Other recorded outcomes were: sex, age, marital status, living alone, level of education, degree of autonomy, pain, previous falls, visual acuity, and signs of depression. Prevalence was estimated overall and according to the possible determinants. (3) Results: The study included 62 individuals (66.1% women), with a prevalence of fear of falling of 38.7% (95% CI 26.2–51.2%). The identified determinants were pain (OR = 7.4, 95% CI 1.4–39.7), a history of falls (OR = 25.3, 95% CI 2.1–303.4), poor visual acuity (OR = 5.6, 95% CI 1.0–29.8), and signs of depression (OR = 19.3, 95% CI 1.4–264.3). (4) Conclusions: The prevalence and determinants of fear of falling in older adults attending geriatric day hospitals were similar to those described in those dwelling in the community.

The Value of Cognitive and Physical Function Tests in Predicting Falls in Older Adults: A Prospective Study.

IntroductionPrevious studies suggested that physical and cognitive function can be indicators to assess the risk of falls in the elderly. Various tests are widely used in geriatric clinical studies as assessment tools of physical and cognitive function. However, large sample studies comparing the fall predictive value of these tests are still sparse. This study was conducted to investigate the value of cognitive and physical function tests in predicting the risk of subsequent falls in the elderly, with the overarching goal of providing more evidence on fall-risk assessment.MethodsThe current study was based on the data of respondents aged 60 and above from the China Health and Retirement Longitudinal Study (CHARLS). Data from the 2015 CHARLS national survey were used as the baseline data, and the fall data in 2018 were used as the follow-up data. Physical function tests included balance, walking speed, the five times sit-to-stand test (FTSST), and grip strength. The value of cognitive and physical function tests in predicting falls was evaluated by logistic regression analysis and receiver operating characteristic (ROC) curves.ResultsThe incidence of falls among the 4,857 subjects included in this study was 20.86%. Results showed that cognition (OR = 0.83, 95% CI: 0.70–0.98), the FTSST (OR = 3.51, 95% CI: 1.66–7.46), and grip strength (OR = 1.02, 95% CI: 1.01–1.03) were independent predictors of falls in the full sample after adjusting for various confounders. Notably, the above tests showed better predictive value for falls for the oldest-old (≥ 80 years) subjects.ConclusionOverall, results showed that grip strength, the FTSST, and cognition tests are simple and practicable tools for identifying individuals at higher risk of falls in the community. Moreover, the fall predictive performance of physical and cognitive function tests was age-dependent, with a higher predictive value in older adults aged 80 and above.

New Technological Innovations to Improve Balance against Falling in Older Adults: Exergaming, Virtual Reality and Augmented Realty

Older adults fall and live with the fear of falling. Until recently vitamin D to strengthen bones, Tai Chi and other slow deliberate exercises have been prescribed. Recent studies introducing these adults to newer technological innovations such as the Nintendo Wii and Microsoft HoloLens and Oculus from Meta show enjoyment of using the equipment, improvement with balance, reduced fear of falling and stronger feelings of independence. This column reports the troubling statistics of older adults falling, introduces technological innovations and highlights studies using these tools.

The Frequency of Elderly Patients with Diabetes Type II Having Risk of fall and Impaired Balance; A Cross Sectional Survey

Background: Diabetes Mellitus type 2 causes multiple complications like peripheral neuropathy, retinopathy and vestibulopathy. Diabetic neuropathy was one of the very common and long-term complications of DM which worsen throughout time. Postural variability and balance illness were mutual findings in DN due to lessened proprioception. Objective: The objective was to determine the frequency of elderly patients with diabetes type II having risk of Fall and impaired Balance. Methods: It was a cross sectional study. The Sample size was 133 participants surveyed through convenient sampling technique. Total time from May to October 2021 was utilized for study. Berg Balance Scale was used to determine the risk of fall in older adults having diabetes mellitus type 2. Participants were appearing for assessment for once. Data was analyzed on SPS S version 25. Results: The result showed that 76.7% patients were independent in their daily life activities. The results of our study were that total 23.3% patients were at the risk of fall. The means and standard deviation of total score of Berg Balance Scale was found to be 44.49±10.48. Conclusion: Based on findings of study it was concluded about one fourth of patients were at risk of fall and impaired balance. The adverse effects associated with diabetes mellitus like retinopathy, vestibulopathy and diabetic neuropathy may contribute to worsening balance and fall risk. Keywords: Vestibulopathy, Berg Balance Scale, Diabetic Neuropathy, Balance Impairment, Retinopathy

Combined Use of Transcutaneous Electrical Nerve Stimulation and Short Foot Exercise Improves Navicular Height, Muscle Size, Function Mobility, and Risk of Falls in Healthy Older Adults.

Electrical stimulation is an established method that is used to improve muscle strength. The present study compared changes in the navicular drop test (NDT), muscle size, the five times sit to stand (5TSTS) test, the timed up and go (TUG) test, and the risk of falls in response to transcutaneous electrical nerve stimulation (TENS) plus short foot exercise (SFE) and SFE alone in 68 healthy elderly participants aged 65–75 years. Participants were randomly assigned to two groups: TENS plus SFE and SFE alone (with sham TENS). Measurements of NDT, muscle size, 5TSTS, TUG, and risk of falls were made before and after 4 weeks of training. The NDT was significantly improved by a median of 0.31 mm in the TENS plus SFE group and 0.64 mm in the SFE alone group (p < 0.001). Similarly, there was a significant improvement in Falls Efficacy Scale International (FES-I), 5TSTS, and TUG for both groups (p < 0.001). The abductor hallucis muscle size increased by 0.23 cm2 in the TENS plus SFE group and 0.26 cm2 in the SFE alone group (p < 0.001). There were no significant differences between the two groups for any variables (p > 0.05) except TUG, which showed a greater improvement in the TENS plus SFE group (p = 0.008). Our findings demonstrated that TENS plus SFE and SFE alone improved intrinsic foot muscle size. However, TENS plus SFE tended to improve NDT more than SFE alone, particularly in cases of severe muscle weakness. Thus, the combined use of TENS plus SFE could be recommended for muscle strengthening and balance programs for fall prevention in older adults.

Prevention and Management of Falls in Older Adults admitted to Woodlands Hospital, an inpatient Old Age Psychiatric Unit

IntroductionFalls are a significant cause of injury in older adults who are disproportionately at higher risk due to multiple factors such as, mobility issues, co-morbidities and polypharmacy. There are several evidence-based interventions that can be implemented to reduce the risk of – and manage falls.ObjectivesAssess whether Woodlands Hospital has implemented the standards set by NICE guidelines on the management of Falls in Older People.MethodsRetrospective audit of patients admitted to Woodlands Hospital from 1st June to 1st December 2018. 113 patient records were analysed to determine; was an falls risk assessment completed on admission, did patients ’at risk of falls’ have individualized interventions in place, was a falls risk assessment completed weekly at MDT, following a fall, were patients checked for signs of fracture before moved, was a medical examination completed and were neurological observations completed in patients with observed head injury or where it could not be excluded?Results100% of patients had individualised interventions to reduce risk of falls and 97.3% of patients had an assessment of risks completed on admission. 60.3% of patients were checked for signs of fracture. 78.3% of patients had a physical examination within 12 hours. 75% of patients had neurological observations completed.ConclusionsRisk assessment for falls and individualized interventions for patients at risk of falls were completed at a high standard. There remains scope for improvement of review of risk of falls during weekly MDT, documentation of checking for signs of fractures and neurological examination. The outcomes were relayed to the unit and plans to re-audit in September 2021.DisclosureNo significant relationships.