Prior Fall Research Articles

Prevention of Fall-Related Injuries in Long-term Care

Fall-related injuries, a major public health problem in long-term care, may be reduced by interventions that improve safety practices. Previous studies have shown that safety practice interventions can reduce falls; however, in long-term care these have relied heavily on external funding and staff. The aim of this study was to test whether a training program in safety practices for staff could reduce fall-related injuries in long-term care facilities. A cluster randomization clinical trial with 112 qualifying facilities and 10,558 study residents 65 years or older and not bedridden. The intervention was an intensive 2-day safety training program with 12-month follow-up. The training program targeted living space and personal safety; wheelchairs, canes, and walkers; psychotropic medication use; and transferring and ambulation. The main outcome measure was serious fall-related injuries during the follow-up period. There was no difference in injury occurrence between the intervention and control facilities (adjusted rate ratio, 0.98; 95% confidence interval, 0.83-1.16). For residents with a prior fall in facilities with the best program compliance, there was a nonsignificant trend toward fewer injuries in the intervention group (adjusted rate ratio, 0.79; 95% confidence interval, 0.57-1.10). More intensive interventions are required to prevent fall-related injuries in long-term care facilities.

Evaluation of 238 consecutive patients with the extended data set of the Standardised Audit for Hip Fractures in Europe (SAHFE)

Purpose: The aim of this paper is to introduce the extended data set inquiries of the Standardised Audit of Hip Fractures in Europe (SAHFE) and to report our experiences of its use.Method: The extended SAHFE data set was applied to 238 consecutive patients (mean age 78.4 (50 – 102) years, 52 males, 186 females) aged over 50 years with non-pathological fractures of the hip. The extended data set contains 95 questions concerning the patient's abilities prior fall and at follow-up, detailed background factors, concomitant diseases, additional details of the injury, treatment, fracture type and reduction and complications.Results: Thirty-nine percent of the fractures occurred at home and 38% in a hospital. Thirteen percent of the cervical fractures were non-displaced (Garden 1 & 2) and half of the trochanteric fractures intertrochanteric two-part fractures (A11 – A13). The mean Garden alignment index evaluated from antero-posterior roentgenograms changed from the preoperative 144° to the postoperative 168° and that from lateral projections from 144° to 171°, respectively. Most of the patients (89%) had associated diseases, especially cardiovascular conditions. The patients' functioning was significantly impaired at four months compared with the preoperative situation according to the ADL score. The need for social support and assistance had increased, respectively. A total of 63% of the surgeries were delayed for more than 24 hours. Low molecular weight heparin was given to every patient for thromboembolic prophylaxis and 92% received antibiotic prophylaxis. Urinary tract (21%) and chest infections (7%) were the most common complications. The deep infection rate was 2.5%.Conclusion: The extended SAHFE data set is useful and makes it possible to study in more detail the background and outcome factors of hip fractures in a standardized manner.

Untimely Fall Harvest Affects Dry Matter Yield and Root Organic Reserves in Field‐Grown Alfalfa

The regrowth interval between the last summer harvest and the fall harvest is a major determinant of alfalfa (Medicago sativa L.) persistence and spring regrowth. This study assessed the impact of the timing of a fall harvest on persistence, dry matter yield (DMY), and root carbohydrate and N reserves of field‐grown alfalfa. Two cultivars (AC Caribou and WL 225) were harvested either only twice during the summer or three times with the third harvest taken 400, 500, or 600 growing degree days (GDD) after the second summer harvest. Plant density was not affected by a fall harvest across three production years (1997 to 1999). The DMY of the first harvest in the second production year (1998) was significantly reduced by prior fall harvests taken at 400 or 500 GDD. However, the seasonal DMY in 1998 was higher with the 500 or 600 GDD harvest management than with the two harvest system. Root dry weight (DW) was generally reduced by a third harvest in the fall, especially when taken at 400 GDD. Amounts of root carbohydrate reserves (raffinose family oligosaccharides [RFO], sucrose, and starch), as well as the amounts of total amino acids and soluble proteins were significantly reduced by harvesting at 400 or 500 GDD. Untimely fall harvest reduced alfalfa spring regrowth by impeding the accumulation of both carbohydrate and N reserves. Seasonal DMY remained advantageous as long as an interval of 500 or 600 GDD was kept between the last summer and the fall harvests.

Late-Eighteenth-Century Precipitation Reconstructions from James Madison's Montpelier Plantation

Abstract This study presents two independent reconstructions of precipitation from James Madison's Montpelier plantation at the end of the eighteenth century. The first is transcribed directly from meteorological diaries recorded by the Madison family for 17 years and reflects the scientific interests of James Madison and Thomas Jefferson. In his most active period as a scientist, Madison assisted Jefferson by observing the climate and fauna in Virginia to counter the contemporary scientific view that the humid, cold climate of the New World decreased the size and number of its species. The second reconstruction is generated using tree rings from a forest in the Montpelier plantation and connects Madison's era to the modern instrumental precipitation record. These trees provide a significant reconstruction of both early summer and prior fall precipitation. Comparison of the dendroclimatic and diary reconstructions suggests a delay in the seasonality of precipitation from Madison's era to the mid-twentieth...

Soil, Climate, and Atmospheric Deposition Relationships with Elemental Concentrations in Annual Rings of Tuliptree

AbstractThe objectives of this study were to investigate the relationships of contrasting soil properties, climate and atmospheric pollutant (especially S) deposition to elemental concentrations in tree rings. Concentrations of 12 elements were determined in annual rings of tuliptree (Liriodendron tulipifera L.) by proton‐induced x‐ray emission for the 50 even years from 1880 to 1980 within an urbanized‐industrial region in northeastern Ohio. Xylem concentrations of nine elements were consistently and significantly greater on Site 1 where soils were coarse textured and base status was low, than on Site 2 where soils were medium textured and base status was greater. Time series analysis detected high frequencies of elemental pulse interventions during periods of rising S emissions in the 1920s and mid‐1940s. Additionally, step changes in xylem S during these periods, and recently declining xylem S may also reflect changing S emissions. Significant climatic regressions [seasonal mean temperatures and total precipitation, plus annual basal area increment (BAI)] were obtained for 11 elements. Prior fall precipitation was the most consistent and important climate variable associated with xylem chemistry. A significant negative association of BAI with xylem Ca on Site 1, where soil Ca was low, suggested a growth dilution effect and the possibility that soil Ca may be near a critical limit. Soil properties influenced both the absolute concentrations of nearly all elements in xylem and relationships between xylem chemistry and climate. Variations in climate, in addition to soil, are therefore important considerations in spatial and temporal comparisons of xylem chemistry.

Reflex sympathetic augmentation of left-ventricular inotropic state in the conscious dog.

Cardiac reflex responses to a series of partial inferior vena caval occlusions were studied in conscious previously instrumented dogs. Heart rate responses during the fall of systemic arterial pressure were mediated both by increased sympathetic tone and withdrawal of parasympathetic tone. Responses of the left-ventricular inotropic state, estimated from changes in left ventricular pressure rise (LV dP/dt), were studied early after release of a series of partial vena caval occlusions, and a positive linear relation between the prior fall in the systemic arterial pressure and the increase in LV dP/dt was demonstrated. Serial studies showed this effect of persist for at least 12 s beyond the reflex slowing of heart rate early after release of vena caval occlusion. The positive inotropic response was markedly attenuated by beta-adrenergic blockade and also occurred at a constant heart rate. It was present after adrenalectomy. These studies suggest that the integrated baroreceptor responses that are activated by a simultaneous decrease in the venous return and systemic arterial pressure play an important role in the regulation of left-ventricular inotropic state in the conscious dog.