Recurrent Fallers Research Articles

ASSOCIATION BETWEEN DEPRESSIVE SYMPTOMS, RECURRENT, AND SINGLE FALLS FROM PREVQUEDAS BRAZIL

Introduction: Depressive symptoms are associated with falls in a variety of studies in developed countries. Objectives: 1) To examine the association between abnormal 15-item GDS score, single and recurrent falls in community-dwelling older adults in a developing country. 2) To check if recurrent fallers have greater scores in 15-item GDS, examining if it has any association with age, ethnicity, genre, and numbers of medications used. Methods: Transversal data analyzed was extracted from Prevquedas Brasil, a Multicenter parallel-group randomized controlled trial that evaluates the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people. Statistical Analysis: Pearson Chi-square test used to compare positive screening for depressive symptoms (GDS >5) and fall events (single or recurrent). Sociodemographic variables were analyzed by logistic regression. Stata® software was used. Results: 402 participants (mean age 73.8 ± 7.1years; 88.1% women; 59.8% white). Recurrent falls have association with GDS >5 (92 vs. 28, p=0.008). The mean GDS score is greater for recurrent fallers than to non-recurrent fallers (p<0,001). After logistic regression for sociodemographic variables and medications, elderly with GDS >5 had twice more chance to be a recurrent faller (OR 2.0, 95%IC 1.2–3.3; p=0.007), compared to GDS ≦5. Conclusions: Abnormal 15-item GDS and its greater scores are associated with recurrent fallers in elderly from a developing country.

Falling Direction can Predict the Mechanism of Recurrent Falls in Advanced Parkinson\u2019s Disease

Falls are a common and disabling symptom in patients with Parkinson’s disease (PD). For prevention, it is important to understand the pathophysiology of falls in PD patients, but the predictors for the possible mechanisms underlying such falls have not been clearly elucidated. In this prospective observational study, we investigated the implications of falling direction to predict the mechanisms of recurrent falls in PD patients. We enrolled 62 recurrent fallers with PD and divided them into two groups according to the main falling directions: 45 PD fallers who fell forward (forward fallers), and 17 PD fallers who fell in the other directions (non-forward fallers). Although there was no difference in demographic data, parkinsonism, or frontal lobe function, forward fallers showed more severe falls and tended to fall during walking or turning, while non-forward fallers usually fell during sitting/standing or turning. Additionally, forward fallers revealed higher score on a freezing of gait (FOG) questionnaire. Logistic regression analysis demonstrated that FOG was associated with falling forward, while balance impairment, akinetic-rigid subtype, and neuropsychiatric symptoms were associated with falling into the other directions. Our results indicate that FOG and balance impairment are two major mechanisms for recurrent falling in PD patients, and falling direction is an important predictor for these mechanisms.

Older adult falls prevention behaviors 60 days post-discharge from an urban emergency department after treatment for a fall

BackgroundFalls are a common and debilitating health problem for older adults. Older adults are often treated and discharged home by emergency department (ED)-based providers with the hope they will receive falls prevention resources and referrals from their primary care provider. This descriptive study investigated falls prevention activities, including interactions with primary care providers, among community-dwelling older adults who were discharged home after presenting to an ED with a fall-related injury.MethodsWe enrolled English speaking patients, aged ≥ 65 years, who presented to the ED of an urban level one trauma center with a fall or fall related injury and discharged home. During subjects’ initial visits to the ED, we screened and enrolled patients, gathered patient demographics and provided them with a flyer for a Matter of Balance course. Sixty-days post enrollment, we conducted a phone follow-up interview to collect information on post-fall behaviors including information regarding the efforts to engage family and the primary care provider, enroll in a falls prevention program, assess patients’ attitudes towards falling and experiences with any subsequent falls.ResultsEighty-seven community-dwelling people between the ages of 65 and 90 were recruited, the majority (76%) being women. Seventy-one percent of subjects reported talking to their provider regarding the fall; 37% reported engaging in falls prevention activities. No subjects reported enrolling in a fall prevention program although two reported contacting falls program staff. Fourteen percent of subjects (n=12) reported a recurrent fall and 8% (7) reported returning to the ED after a recurrent fall.ConclusionsFindings indicate a low rate of initiating fall prevention behaviors following an ED visit for a fall-related injury among community-dwelling older adults, and highlight the ED visit as an important, but underutilized, opportunity to mobilize health care resources for people at high risk for subsequent falls.

Predictors of Recurrent Falls in People withParkinson's Disease and Proposal foraPredictive Tool.

Falls are a debilitating problem for people with Parkinson's disease (PD). To compare clinical and functional characteristics of non-fallers, single and recurrent fallers (≥2 falls); to determine predictors of time to second fall; and to develop a predictive tool for identifying people with PD at different categories of falls risk. Participants (n = 229) were assessed by disease-specific, self-report and balance measures and followed up for 12 months. Area under the receiver operating characteristic curves (AUC), Kaplan-Meier curves and log-rank test were performed. Selected predictors with p < 0.10 in univariate analysis were chosen to be entered into the Cox regression model. Eighty-four (37%) participants had ≥2 falls during the follow-up. Recurrent fallers significantly differed from single fallers. The final Cox model included history of ≥2 falls in the past year (Hazard Ratio [HR] = 3.94; 95% confidence interval [CI] 2.26-6.86), motor fluctuations (HR = 1.91; 95% CI 1.12-3.26), UPDRS activities of daily living (ADL) (HR = 1.10 per 1 point increase; 95% CI 1.06-1.14) and levodopa equivalent dose (LED) (HR = 1.09 per 100 mg increase; 95% CI 1.02-1.16). A 3-predictor tool included history of ≥2 falls in the past year, motor fluctuations and UPDRS ADL >12 points (AUC = 0.84; 95% CI 0.78-0.90). By adding LED >700 mg/day and Berg balance scale ≤49 points, a 5-predictor tool was developed (AUC = 0.86; 95% CI 0.81-0.92). Two predictive tools with moderate-to-high accuracy may identify people with PD at low, medium and high risk of falling recurrently within the next year. However, future studies to address external validation are required.

1007 POOR SLEEP IS ASSOCIATED WITH RECURRENT FALLS AMONG OLDER WOMEN IN THE STUDY OF OSTEOPOROTIC FRACTURES

Sleep disturbances and sedative hypnotic medications are risk factors for falls in the elderly. However, little is known about the association of recurrent falls with specific sleep disturbances individually, in aggregate, or with sedative use. We examined the association of two subjective sleep disturbances, poor sleep quality and excessive daytime sleepiness, with recurrent falls among sedative users and non-users. This analysis of the Study of Osteoporotic Fractures used excessive daytime sleepiness (defined as Epworth sleepiness scale score of >10) and poor sleep quality by self-report (Pittsburgh Sleep Quality Index score of >5) collected at visit 8. Self-report of recurrent falls (>1 fall in the preceding year) collected during visit 9 was used for analysis. We used logistic regression models with recurrent falls (yes/no) as the dependent variable; each sleep measure, sedative use (antihistamines, sedative antidepressants, sedative benzodiazepines, benzodiazepine receptor agonists, and supplements- melatonin, valerian) and their interaction effect as independent factors; and age BMI, self-rated health, depression, anxiety, use of assistive device, poor vision, and comorbidities as covariates. Comparisons were stratified by sedative medication use as they affect both sleep and falls. Analysis included 3549 participants (mean age 84 ± 3 years, 19% recurrent fallers). Among sedative non-users, excessive daytime sleepiness and poor sleep quality were significantly associated with recurrent falls (Adjusted Odds Ratio=OR=1.53 [1.20–2.12], p=0.01) and (OR=1.28 [1.02–1.60], p=0.03 respectively). Having both sleep symptoms doubled the odds of recurrent falls in the following year (OR=1.99 [1.38–3.04], p=.001). Among sedative users, magnitudes of ORs indicated elevated risks for those with sleep disturbances, but were not statistically significant. Excessive daytime sleepiness and poor sleep quality are associated with recurrent falls in women, and the association is clearly identifiable in those not using sedatives. Claude D. Pepper Older Americans Independence Center (OAIC- NIA P30 AG024827; PI: Dr. Greenspan)

(245) - Recurrent Falls in Patients with CF-LVAD's Are Associated with Major Morbidity and Mortality

(245) - Recurrent Falls in Patients with CF-LVAD's Are Associated with Major Morbidity and Mortality

Further construct validity of the Timed Up-and-Go Test as a measure of ambulation in multiple sclerosis patients.

The importance of mobility impairments in people with multiple sclerosis (PwMS) denotes a need for valid, reliable, sensitive and feasible clinical measuring tools. The Timed Up-and-Go (TUG) test is a unique mobility measure as it captures other functions apart from walking, i.e., rising out of a chair or turning around an object. To expand the construct validity of the TUG test in PwMS and determine the ability of the TUG score to discriminate between four levels of disability between fallers, recurrent fallers and non-fallers. Cross-sectional. Multiple Sclerosis Center, Sheba Medical Center, Israel. A total of 285 PwMS (176 women) with a mean disease duration of 8.1±8.1 years. We retrospectively evaluated and analyzed computerized data of the TUG test, Four Square Step Test (FSST), posturography measures, 2-minute Walk Test (2mWT), Timed 25-foot Walk Test, fall status, Falls Efficacy Scale - International, Modified Fatigue Impact Scale, instrumented cognitive assessment, and the Multiple Sclerosis Walking Scale self-reported questionnaire. The TUG score of the total sample was 9.3±5.1. In terms of the disability subgroups, significant differences were observed between the four groups with the exception of "very mild" to "mild" groups. In terms of fall status, the MS recurrent fallers demonstrated a significantly slower TUG compared to the MS non-fallers. Strong-modest significant correlation scores were found between the TUG and ambulation tests. The strongest scores were found for the FSST and 2MWT; Pearson's r=0.740, -0.731, respectively. The current study broadens the evidence supporting the usage of the TUG test to assess walking and balance performance in PwMS regardless of the patient's cognitive status. Furthermore, the test can aid in identifying PwMS who are at a high risk of falling. The TUG test is an excellent tool used to assess mobility capabilities in PwMS, monitor disease progression and identify potential MS fallers.

Study Shows No Connection Between Orthostatic Hypotension and Recurrent Falls

Study Shows No Connection Between Orthostatic Hypotension and Recurrent Falls

Effectiveness of Calcifediol in Improving Muscle Function in Post-Menopausal Women: A Prospective Cohort Study.

The role of vitamin D supplementation on muscle function and physical performance is still debated. Calcifediol is an available treatment for hypovitaminosis D, particularly for extra-skeletal effects. Aim of this prospective cohort study was to evaluate the effectiveness of calcifediol on serum levels of 25(OH)D3, appendicular muscle strength, physical performance, and prevention of falls in post-menopausal women. We recruited post-menopausal women aged ≥50years, referring to an outpatient service for the management of osteoporosis over a 18-month period. We included women with a diagnosis of osteoporosis and/or vitamin D deficiency [serum levels of 25(OH)D3 <30ng/ml]. All the participants received calcifediol (20μg, 4 oral drops/day) for a 6-month period. We evaluated at the baseline and after 6months the following outcomes: serum levels of 25(OH)D3, appendicular muscle strength, using the Isometric Hand Grip Strength Test and the Knee Isometric Extension Strength Test, physical performance, using the Short Physical Performance Battery (SPPB) and the 4-m gait speed (4MGS), and the risk of falls (percentage of fallers and recurrent fallers and mean number of falls). A sub-analysis was performed in patients with vitamin D deficiency. We enrolled 113 post-menopausal women, mean aged 68.01±9.13years. After 6months of treatment, there was a significant increase in serum levels of 25(OH)D3 (p<0.001), appendicular muscle strength (p<0.001), and physical performance (p=0.002 at SPPB and p=0.010 at 4MGS, respectively). At 6months, the percentage of fallers was lower, although not significantly (p=0.078), whereas there was a significant reduction both in percentage of recurrent fallers and in the mean number of falls (p<0.001 and p=0.020, respectively). Calcifediol was significantly effective in improving serum levels of 25(OH)D3 and muscle function and in reducing the percentage of recurrent fallers and the mean number of falls in a cohort of post-menopausal women.

Recurrent falls and its risk factors among older men living in the veterans retirement communities: A cross-sectional study

AimTo evaluate the prevalence of recurrent falls and their risk factors among older men living in the Veterans Homes in Taiwan. MethodsThis cross-sectional study enrolled 871 residents and all participants received the comprehensive geriatric assessment, including Barthel Index, Mini-Mental Status Examination (MMSE), Geriatric Depression Scale-5 questions (GDS-5), Mini-Nutrition Assessment Short Form (MNA-SF), the status of urinary incontinence, stool incontinence, polypharmacy, past history of falls, multimorbidity, and medication history. ResultsOverall, 871 subjects (mean age: 85.5±5.2years, all males) participated in this study, whereas 222(25.5%) of them had experienced falls in the past year, and 91 were recurrent fallers. Comparisons between non-fallers, single fallers and recurrent fallers disclosed that they were significantly different in the following characteristics: diabetes mellitus, chronic kidney disease, coronary artery disease, Charlson Comorbidity Index (CCI), Barthel Index, GDS-5, MNA-SF, polypharmacy, use of hypnotics, urinary incontinence, and stool incontinence (P for trend all <0.05). Multiple regression analysis identified that GDS-5 was significantly associated with single falls and recurrent falls (OR 1.256, 95% CI 1.094–1.441, P=0.001 for single fallers; OR 1.480, 95% CI 1.269–1.727, P<0.001 for recurrent fallers). Besides, urinary incontinence was the independently associated with recurrent fallers only (OR 2.369, 95% CI 1.449–3.817, P<0.001), but not single fallers. ConclusionUrinary incontinence and depressive symptoms were independent associated factors for falls among older men living in the retirement communities. However, urinary incontinence was associated with recurrent falls, but not single falls. Intervention study is needed to reduce recurrent falls through management of urinary incontinence.

Exercise Interventions for Preventing Falls Among Older People in Care Facilities: A Meta‐Analysis

Falls in older people are a common problem, often leading to considerable morbidity. However, the overall effect of exercise interventions on fall prevention in care facilities remains controversial. To evaluate the effectiveness of exercise interventions on the rate of falls and number of fallers in care facilities. A meta-analysis was conducted of randomized controlled trials published up to December 2014. Eight databases were searched including Ovid-Medline, Embase, CINAHL, Cochrane Library, KoreaMed, KMbase, KISS, and KisTi. Two investigators independently extracted data and assessed study quality. Twenty-one studies were selected, that included 5,540 participants. Fifteen studies included exercise as a single intervention, whereas the remaining six included exercise combined with two or more fall interventions tailored to each resident's fall risk (i.e., medication review, environmental modification or staff education). Meta-analysis showed that exercise had a preventive effect on the rate of falls (risk ratio [RR] 0.81, 95% CI 0.68-0.97). This effect was stronger when exercise combined with other fall interventions on the rate of falls (RR 0.61, 95% CI 0.52-0.72) and on the number of fallers (RR 0.85, 95% CI 0.77-0.95). Exercise interventions including balance training (i.e., gait, balance, and functional training; or balance and strength) resulted in reduced the rate of falls. Sensitivity analyses indicated that exercise interventions resulted in reduced numbers of recurrent fallers (RR 0.71, 95% CI 0.53-0.97). This review provides an important basis for developing evidence-based exercise intervention protocols for older people living in care facilities. Exercise programs, which are combined with tailored other fall interventions and challenge balance training to improve balance skills, should be applied to frail older people with functional limitations in institutional settings.

Integrated Care Program for the very old adults

Introduction : The University Hospital of Getafe (HUG) is a public reference Hospital belonging to the Servicio Madrileno de Salud (SERMAS). It provides service to patients older than 65 (in most cases over 75), showing the usual features of older frail patients: multiple chronic co-morbid conditions, multi-drug intake and high risk of developing new disability when acutely stressed. Their status must be continuously assessed and they often undergo recurrent hospitalisation. The Geriatrics Service (GS) has implemented an Integrated Care Program (ICP) to fill service gaps, to prevent tasks overlapping and to assure continuum of care. HUG shifted Disease Management Processes (DMP) to new models, engaging different professionals from different units and at different levels both horizontally and vertically. Description of practice : The ICP at HUG and the research described in this paper are aligned with the World Report on Ageing and Health (WHO), which recommends the organisation of services for the older focused in function and not on disease. They also follow the ‘Consensus document on frailty and falls prevention among the elderly’ released by the Spanish Ministry of Health as a part of the ‘Prevention and health promotion strategy of the Spanish NHS’ and approved by the Inter-territorial Council of the NHS in 2014. The ICP promotes the transition from costly inpatient settings to the community. Discharge Criteria from impatient settings were modified and the Acute Care Unit collaborates with the Community Care Unit (CCU) and the General Outpatient Unit (GOC) to devise discharge plans guaranteeing assessment in the community and care delivery until stabilization. These include ICT-supported continuous follow up in the community (CCU) and visits to outpatient settings in the HUG (GOC). Besides, the GS created a Day Hospital to implement training and preventive programs for frail patients (i.e. recurrent fallers accomplish personalized physical training programs to prevent sarcopenia and are educated on action protocols to react if a fall occurs; neuropsychological rehabilitation is conducted for cognitive impaired patients and education ; education on desirable life habits and physical therapy are devised and implemented for diabetic patients). A multidisciplinary team (geriatricians, nurses and occupational therapists) devises personalized programs following a patient centered approach, in which patients are engaged and empowered to self-manage their chronic conditions. The ICP enhances the seamless delivery of care and improves patient outcomes in the GS. However, the implementation of the CGA and the new care processes enlarged the set of data harvested. Before, this information is stored on dedicated data tables that are independent from the General Health Information System (GHIS). This gap constraints information availability within the Service and with other Units and care levels, and hinders integration. An in-depth analysis of the ICP at HUG through case study research identified the barriers for its operation. We designed an innovative information management system to overcome these drawbacks and facilitate full integration, engaging finals users (healthcare professionals). This Integrated Health Information System (IHIS) has the following characteristics: (1) it is an extension of the GHIS, it avoids duplicities; (2) it structures information and make it available; (3) it enables dynamic patient evolution visualization; (4) it is interoperable (following CDA architecture) and scalable. Key findings : The average length of stay in the GS Acute Care Unit is lower than at other departments treating similar patient segments (6.8 vs 9.1 days). Moreover, mortality and re-admissions have not increased and patients’ functional status has improved thanks to the Day Hospital performance. The number of unnecessary hospitalisations has been reduced by around 400 patients/year with a direct impact of €1.5 million. Highlights : Integration must be built over the complete understanding of the environment and its requirements. Otherwise, it may not become a facilitator for integration but a burden for users. The multilevel and multidisciplinary integrated delivery of care services requires the comprehensive knowledge of patient status and care processes. In this sense ICT become an unavoidable tool enhancing information availability. User collaboration led to more effective, efficient and user-friendly system and contributed to the acceptance of the final model. After the modelling stage and validation, the HUG ICT department and the GS are working together to fully develop the IHIS. Conclusion : The GS had already built a successful ICP, but the absence of dedicated information management tools prevents complete integration. We proposed an IHIS devoted to the real requirements at GS. The functional status and frailty determine the outcome of elderly chronic patients. In this sense, IHIS provides Geriatric Teams with a tool to perform CGA, improving the availability of information and allowing the efficient follow-up of older patients.

Stroke and Falls-Clash of the Two Titans in Geriatrics.

Both stroke and falls are common conditions affecting the older adult. Despite stroke being considered a well-established major risk factor for falls, there remains no evidence for effective prevention strategies for falls specifically for stroke survivors. Previous observational studies evaluating falls risk factors in stroke have mainly been uncontrolled and found similar risk factors for stroke populations compared to general older populations. Specific risk factors, however, are likely to play a greater role in stroke survivors including unilateral weakness, hemisensory or visual neglect, impaired coordination, visual field defects, perceptual difficulties and cognitive issues. In addition, individuals with stroke are also more likely to have other associated risk factors for falls including diabetes, falls risk increasing drugs, atrial fibrillation, and other cardiovascular risk factors. While anticoagulation is associated with increased risk of intracranial bleeding after a fall, the risk of suffering a further stroke due to atrial fibrillation outweigh the risk of bleeding from a recurrent fall. Similarly, while blood pressure lowering medications may be linked to orthostatic hypotension which in turn increases the risk of falls, the benefit of good blood pressure control in terms of secondary stroke prevention outweighs the risk of falls. Until better evidence is available, the suggested management approach should then be based on local resources, and published evidence for fall prevention. Multicomponent exercise and individually tailored multifactorial interventions should still be considered as published evidence evaluating the above have included stroke patients in their study population.

A Prospective Study of Back Pain and Risk of Falls Among Older Community-dwelling Men.

Musculoskeletal pain is associated with increased fall risk among older men. However, the association of back pain, the most prevalent type of pain in this population, and fall risk is unknown. We conducted a prospective investigation among 5,568 community-dwelling U.S. men at least 65 years of age from the Osteoporotic Fractures in Men Study (MrOS). Baseline questionnaires inquired about back pain and its location (such as low back), severity, and frequency in the past year. During 1 year of follow-up, falls were summed from self-reports obtained every 4 months. Outcomes were recurrent falls (≥2 falls) and any fall (≥1 fall). Associations of back pain and fall risk were estimated with risk ratios (RRs) and 95% confidence intervals (CIs) from multivariable log-binomial regression models adjusted for age, dizziness, arthritis, knee pain, urinary symptoms, self-rated health, central nervous system medication use, and instrumental activities of daily living. Most (67%) reported any back pain in the past year. During follow-up, 11% had recurrent falls and 25% fell at least once. Compared with no back pain, any back pain was associated with elevated recurrent fall risk (multivariable RR = 1.3, 95% CI: 1.1, 1.5). Multivariable RRs for 1, 2, and 3+ back pain locations were, respectively, 1.2 (95% CI: 1.0, 1.5), 1.4 (1.1, 1.8), and 1.7 (95% CI: 1.3, 2.2). RRs were also elevated for back pain severity and frequency. Back pain was also associated with risk of any fall. Among older men, back pain is independently associated with increased fall risk.

Motion Sensors Estimated Upper Extremity Frailty Score: A Practical Method to Identify 30-Day Recurrent Fall and Hospital Readmission in Elderly Trauma Patients

Motion Sensors Estimated Upper Extremity Frailty Score: A Practical Method to Identify 30-Day Recurrent Fall and Hospital Readmission in Elderly Trauma Patients

Targeting Training on Geriatric Fall Assessment and Prevention Reduces Recurrent Falls

Falls account for the majority of unintentional injury deaths in geriatric patients (Physician's First Watch May 7 2015). While multidisciplinary

The association between serum 25-hydroxyvitamin D level and recurrent falls in the elderly population: a cohort study.

IntroductionSerum vitamin D concentration is a major contributing factor for increasing the risk of fall and fall-related injuries in older adults. However, when prescribed and supplemented for these populations, the outcomes are controversial, and in several cases no improvement has been reported in reducing the risk of recurrent falls. This study aimed to examine the association between serum vitamin D concentration and recurrent falls in Iranian older adults.MethodsThis cohort study was conducted in the emergency departments of two university hospitals. A cohort of 82 elderly participants aged over 60 and suffered from an unintentional episode of falling was evaluated six months after their first ED visit. A structured, self-administered checklist was developed to obtain the participants’ demographic and clinical information. Participants also were asked about any recurrent fall experience during follow-up.ResultsThe mean (SD) age of the study population was 75 (8). Over half of the participants were male (57.3%). The mean (median) serum 25-hydroxyvitamin D (25 (OH)D) concentration was 38 (34) ng/ml. Mean serum 25(OH)D levels varied slightly between gender groups (p=0.450). An inverse but insignificant association was found between the age of participants and their serum 25(OH)D levels (r=−0.03, p=0.7). A small but insignificant association also was found between the mean serum 25(OH)D level and the number of recurrent falls in elderly patients irrespective of their age, gender, or physical activity groups (OR=1.008, p=0.992).ConclusionIn contrast to previous studies, no significant association of serum 25(OH)D concentration was found with recurrent falls in Iranian older adults.

Non-tricyclic and Non-selective Serotonin Reuptake Inhibitor Antidepressants and Recurrent Falls in Frail Older Women

To determine the risk of recurrent falls associated with antidepressants other than tricyclics (TCAs) and selective serotonin reuptake inhibitors (SSRIs) among frail older women. This is a secondary analysis of the Zoledronic acid in frail Elders to STrengthen bone, or ZEST, trial data treated as a longitudinal cohort in 181 frail, osteoporotic women aged ≥65 years in long-term care. The primary exposure was individual non-TCA/non-SSRI antidepressants (i.e., serotonin norepinephrine reuptake inhibitors, mirtazapine, trazodone, and bupropion) at baseline and 6 months. The main outcome was recurrent (at least two) falls within 6 months after antidepressant exposure. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were derived using a generalized estimating equations model. At least 15% of women experienced recurrent falls between 0-6 and 6-12 months. At baseline and 6 months, 18.2% and 6.9% had a non-TCA/non-SSRI antidepressant, respectively. Adjusting for demographics, health status, and other drugs that increase risk of falls, non-TCA/non-SSRI antidepressant exposure significantly increased the risk of recurrent falls (AOR: 2.14; 95% CI: 1.01-4.54). Fall risk further increased after removing bupropion from the non-TCA/non-SSRI antidepressant group in sensitivity analyses (AOR: 2.73; 95% CI: 1.24-6.01). Other antidepressant classes may not be safer than TCAs/SSRIs with respect to recurrent falls in frail older women.

Preoperative Falls and Their Association with Functional Dependence and Quality of Life.

No study has rigorously explored the characteristics of surgical patients with recent preoperative falls. Our objective was to describe the essential features of preoperative falls and determine whether they are associated with preoperative functional dependence and poor quality of life. This was an observational study involving 15,060 surveys from adult patients undergoing elective surgery. The surveys were collected between January 2014 and August 2015, with a response rate of 92%. In the 6 months before surgery, 26% (99% CI, 25 to 27%) of patients fell at least once, and 12% (99% CI, 11 to 13%) fell at least twice. The proportion of patients who fell was highest among patients presenting for neurosurgery (41%; 99% CI, 36 to 45%). At least one fall-related injury occurred in 58% (99% CI, 56 to 60%) of those who fell. Falls were common in all age groups, but surprisingly, they did not increase monotonically with age. Middle-aged patients (45 to 64 yr) had the highest proportion of fallers (28%), recurrent fallers (13%), and severe fall-related injuries (27%) compared to younger (18 to 44 yr) and older (65+ yr) patients (P < 0.001 for each). A fall within 6 months was independently associated with preoperative functional dependence (odds ratio, 1.94; 99% CI, 1.68 to 2.24) and poor physical quality of life (odds ratio, 2.18; 99% CI, 1.88 to 2.52). Preoperative falls might be common and are possibly often injurious in the presurgical population, across all ages. A history of falls could enhance the assessment of preoperative functional dependence and quality of life.

Proposal for a New Predictive Scale for Recurrent Risk of Fall in a Cohort of Community-Dwelling Patients with Stroke

This study aimed to determine risk factors related to the occurrence of falls in stroke patients and to propose a new predictive scale for falls. Demographic and clinical data were collected and the following scales were applied: Barthel Index, Timed Up and Go Test (TUG), and National Institutes of Health Stroke Scale (NIHSS). Subjects were followed prospectively for 2 years for the occurrence of recurrent (≥2) falls. Kaplan-Meier curves were constructed and univariable associations were tested using log-rank test. Two separate multivariable models were then used: the first used Cox proportional hazards regression and the second used Poisson regression. In each model, significant associations were considered present with a P value less than .05. We evaluated 150 individuals and the final analysis included 131 patients; the average age of the patients was 55.8 ± 13 years, 52% were women, and the median NIHSS score was 2 (interquartile range = 1-5). Falls occurred in 17% of patients, with a median of 23 months of follow-up (interquartile range = 16-26 months). In the multivariable Cox regression model, only TUG quartile, female gender, and posterior circulation territory involvement remained significant predictors of recurrent falls. We used the predictors from the Cox regression model to propose a new recurrent fall risk scale. The area under the receiver operating characteristic curve was 73%, 95% confidence interval = 62%-83%, P = .001, with 81.3% sensitivity and 41.8% specificity. The new predictive scale for recurrent risk (including TUG, posterior circulation territory involvement, and female gender) is presented as an instrument for monitoring the risk of recurrent falls.