Single Fallers Research Articles

Antiretroviral drug use and the risk of falls in people living with HIV: a systematic review and meta-analysis

Objective: The risk of falls in people living with HIV (PLHIVs) on antiretroviral therapy (ART) has received little attention in the literature. The aim of the meta-analysis is to quantify the association between fall risk and various categories of drugs used in ART. Material and Methods: PubMed, Google Scholar, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to January 2023. Any observational study or controlled trial that reported on the relationship of at least one antiretroviral drug with falls in PLHIVs was included. Data on the frequency of single fallers, multiple fallers (≥2 falls), and non-fallers were extracted and studied for each drug and drug category. The pooled results were reported as an odds ratio (OR) with a 95% confidence interval (CI). Results: A total of five observational studies (51 675 participants) were included out of 414 articles obtained through a literature review. Stavudine use was found to be associated with an increased risk of single falls in PLHIVs (OR: 1.69, 95% CI: 1.08–2.66, P=0.02). However, efavirenz (OR: 0.82, 95% CI=0.76–0.89, P<0.001) and zidovudine (OR: 0.82, 95% CI=0.77–0.92, P<0.001) were found protective against the single falls. Didanosine had no significant association with fall risk (OR: 1.23, 95% CI: 0.78–1.93, P=0.37). Likewise, protease inhibitors, integrase inhibitors, nucleoside reverse transcriptase inhibitors, and non-nucleoside reverse transcriptase inhibitors were discovered to have no significant association with fall risk. Conclusion: Most drug categories of ART have no significant association with the risk of falls in PLHIVs. However, certain drugs, such as didanosine and stavudine, which have the inherent effect of causing balance deficits and neuropathy, should be used cautiously.

The relationship of cervicothoracic mobility restrictions to fall risk and fear of falling in ankylosing spondylitis.

The objective of this study is to determine whether restricted cervical mobility in ankylosing spondylitis (AS) is associated with increased fall frequency or fear of falling. A total of 134 AS patients and 199 age- and gender-matched control subjects (CS) with soft-tissue cervicothoracic pain were prospectively evaluated for fall risk. Subjects were divided into non-fallers, single fallers, and multiple fallers. Dynamic cervical rotations and static cervicothoracic axial measurements were compared between the groups. In total, 88 AS patients were reviewed more than once; Kaplan-Meier plots were constructed for fall risk as a function of cervical rotation amplitudes. Falls Efficacy Scale-International (FES-I) questionnaire measured the fear of falling. In total, 34% of AS patients and 29% of CS fell (p = 0.271) in the year prior to evaluation. In AS, static anatomical measurements were unrelated to fall occurrence. The trends of multiple AS fallers to greater flexed forward postures and reduced dynamic cervical rotations were not statistically significant. Cervicothoracic pain (p = 0.0459), BASDAI (p = 0.002), and BASFI (p = 0.003) scores were greater in multiple fallers. FES-I scores were greater in fallers (p = 0.004). Of the 88 AS patients reviewed (or seen) on more than one occasion, 46.5% fell over the 9-year observation period, including all multiple fallers and 71.4% of single fallers. Survival curves showed increased fall risk as cervical rotational amplitudes decreased. In AS, decreased cervical rotations increase fall risk and fear of falling. In multiple fallers, falls were associated with greater disease activity. Cervical muscle stiffness in AS may cause non-veridical proprioceptive inputs and contribute to increased fall frequency similar to individuals with soft-tissue cervicothoracic pain.

Discrepancies in perception of fall risk between patients with subacute stroke and physical therapists in a rehabilitation hospital: a retrospective cohort study.

Objective: Falls are one of the most common complications of a stroke. This study aimed to clarify the discrepancy between the perceived fall risk of hospitalized patients with stroke and the clinical judgment of physical therapists and to examine the changes in discrepancy during hospitalization. Design: Retrospective cohort study. Patients: This study included 426 patients with stroke admitted to a Japanese convalescent rehabilitation hospital between January 2019 and December 2020. Methods: The Falls Efficacy Scale-International was used to assess both patients' and physical therapists' perception of fall risk. The difference in Falls Efficacy Scale-International scores assessed by patients and physical therapists was defined as the discrepancy in fall risk, and its association with the incidence of falls during hospitalization was investigated. Results: Patients had a lower perception of fall risk than physical therapists at admission (p < 0.001), and this trend continued at discharge (p < 0.001). The discrepancy in fall risk perception was reduced at discharge for non-fallers and single fallers (p < 0.001), whereas the difference remained in multiple fallers. Conclusion: Unlike physical therapists, patients underestimated their fall risk, especially patients who experienced multiple falls. These results may be useful for planning measures to prevent falls during hospitalization.

Recurrent Falls over Three Years among Older Adults Age 70+: Associations with Physical and Mental Health Status, Exercise, and Hospital Stay.

We used the 2019-2021 U.S. National Health and Aging Trend Study (N = 3,063, age 70+) and multinomial logistic regression and generalized linear models with Poisson and log link to identify correlates of (1) recurrent falls (2 + falls) over 3years (2019-2021); and (2) any subsequent fall among those who had a fall in 2019. We also examined the associations between falls and hospitalization in 2021. Results show that those with recurrent falls had greater physical/functional and psychological health problems in 2019, while single fallers over the 3years were not significantly different from those without a fall. Exercise was associated with a lower likelihood of a subsequent fall among those who fell in 2019. Both a single fall and recurrent falls over the 3years were associated with a higher risk of hospitalization in 2021. Multifactorial fall preventions including exercise and depression/anxiety treatment are needed to mitigate recurrent fall risks.

Incidence and clinical characteristics of fall-related injuries among older inpatients at a tertiary grade a hospital in Shandong province from 2018 to 2020

BackgroundFalls are an important cause of injury and death of older people. Hence, analyzing the multifactorial risk of falls from past cases to develop multifactorial intervention programs is clinically significant. However, due to the small sample size, there are few studies on fall risk analysis of clinical characteristics of fallers, especially among older hospitalized patients.MethodsWe collected data on 153 inpatients who fell (age ≥ 60 years) from the hospital nursing adverse event reporting system during hospitalization at Shandong Provincial Hospital Affiliated to Shandong First Medical University, China, from January 2018 to December 2020. Patient characteristics at the time of the fall, surrounding environment, primary nurse, and adverse fall events were assessed. The enumeration data were expressed as frequency and percentage, and the chi-squared was performed between recurrent fallers and single fallers, and non-injurious and injurious fall groups.ResultsCross-sectional data showed 18.3% of the 153 participants experienced an injurious fall. Compared with single fallers, a large proportion of older recurrent fallers more often experienced preexisting conditions such as cerebrovascular disease or taking hypoglycemic drugs. They were exposed to higher risks and could experience at least 3 fall times in 3 months. Besides, the credentials of their responsible nurses were often higher. Factors that increased the risk of a fall-related injury were hypoglycemic drugs (OR 2.751; 95% CI 1.114–6.795), and nursing adverse events (OR 47.571; 95% CI 14.392–157.247). Older inpatients with bed rails (OR 0.437; 95% CI 0.190–1.005) or falling at the edge of the bed (OR 0.365; 95% CI 0.138–0.964) were less likely to be injured than those without bed rails or not falling at the edge of the bed. Fall risks were significantly correlated with more severe fall-related injuries. Older patients with moderate (OR 5.517; CI 0.687–44.306) or high risk (OR 2.196; CI 0.251–19.219) were more likely to experience fall-related injuries than those with low risk.ConclusionsOlder inpatient falls are an ongoing challenge in hospitals in China. Our study found that the incidence of fall-related injuries among inpatients aged ≥ 60 years remained at a minor level. However, complex patient characteristics and circumstances can contribute to fall-related injuries.This study provides new evidence on fall-related injuries of older inpatients in China. Based on the factors found in this study, regular fall-related injury epidemiological surveys that investigate the reasons associated with the injuries were crucial when considering intervention measures that could refine fall-related injuries. More prospective studies should be conducted with improved and updated multidisciplinary fall risk assessment and comprehensive geriatric assessment as part of a fall-related injury prevention protocol.

The association between fear of falling and occurrence of falls: a one-year cohort study

BackgroundBoth multiple fall experiences and fear of falling (FoF) would make people susceptible to another fall; however, the associations are unknown. This study investigates the association of FoF with fall occurrence among older adults according to their fall history.MethodsIn this study, we adopted a longitudinal observational design. We visited 20 community centers to recruit 1,025 older adults (aged 65 years or older). At baseline, FoF was assessed using a single-item questionnaire. The number of falls in the past year was obtained via a self-questionnaire and participants were classified into three fall history groups (0: non-faller, 1: single faller, 2 or more: multiple faller). After a year of following-up, the number of falls during the year was considered as the main outcome. Poisson regression models clarified the influence of FoF on fall occurrence during the one-year follow-up, according to the participants’ fall history.ResultsThe final sample comprised 530 individuals (follow-up rate: 530/801, 66.4%). Fall history, FoF, and interaction between multiple fallers and FoF were significant in the adjusted statistical model (rate ratio [95% confidence interval]: single faller = 2.81 [1.06, 6.30], multiple faller = 13.60 [8.00, 23.04], FoF = 3.70 [2.48, 5.67], multiple faller*FoF = 0.37 [0.20, 0.68]).ConclusionsWe found that FoF was associated with the occurrence of falls in community-dwelling older adults. However, its association was lower in multiple fallers.

Group Differences in Fall Risk Assessment among Community-Dwelling Older Adults

Aims This study aims to examine group differences in performance and self-report measures distinguishing non-, single, and recurrent fallers. Methods Fifty-seven community-dwelling older adults completed cognitive and functional assessments and reported number of falls over 12 months. A one-way analysis of variance (ANOVA) examined differences between non-, single, and recurrent fallers. Results Significant group differences were found on fast and comfortable gait speed (p < .01 and p < .01, respectively), Falls Efficacy Scale-International (FES-I) (p = .04), 30-Second Chair Stand (30-SCS) (p < .01), and Mini Mental State Examination (MMSE) (p < .01). An analysis of covariance (ANCOVA) was used to control for MMSE after which the previous outcome measures no longer displayed significance. Conclusions Group differences exist between fallers; further, single fallers may experience a fall differently than other fallers. This sample consisted of healthy older adults yet cognition still played a role, demonstrating that the link between cognition and fall risk is yet to be fully understood.

Longitudinal changes in daily patterns of objectively measured physical activity after falls in older adults with varying degrees of glaucoma.

BackgroundVisually impaired older adults have a greater risk of falling, making them particularly susceptible to fall-related health consequences and restricted physical activity. Unclear however, is the relationship between having falls and longitudinal changes in daily patterns of objectively measured physical activity in older adults with visual impairments.MethodsWe created a three-year prospective cohort study (Falls in Glaucoma Study) of older adults with primary or suspected glaucoma at the Johns Hopkins Wilmer Eye Institute from 2013 to 2015. Cumulative incidence of falls was determined through self-reported fall calendars over 12 months. Participants were then classified into one of three groups: multiple fallers (≥2 falls), single fallers (1 fall), and non-fallers (0). Daily physical activity was measured over 1 week using a waist-bound accelerometer during baseline and three-year follow-ups. Activity fragmentation was defined as the reciprocal of the mean activity bout length, with higher fragmentation reflecting shorter, more fractured bouts of continuous activity. Multivariate linear mixed-effects models were used to assess three-year longitudinal changes in: 1) activity fragmentation, and 2) accumulation of activity across six three-hour intervals from 5 AM to 11 PM.FindingsIn adjusted models accounting for visual field damage and other factors, multiple fallers demonstrated greater annual declines (per year) in daily active bouts (-1.79 bouts/day, 95% confidence interval [CI]: -3.35, -0.22), daily active minutes (-17.15 min/day, 95% CI: -26.35, -7.94), and increased fragmentation (1%, 95% CI: 0, 2%) over the three-year follow-up period as compared to non-fallers; no such changes were seen when comparing single fallers and non-fallers. In time-of-day analyses, multiple fallers experienced greater annual declines in average hourly steps over all periods of the day, though the rate of decline was only significant between 5 PM and 8 PM (-27.07 steps/hour, 95% CI: -51.15, -2.99) compared to non-fallers.InterpretationIn an older population with visual impairment, multiple falls over 12 months were associated with more transient and fragmented activity over a subsequent three-year period, and activity declines during evening hours, compared to non-fallers. These findings suggest that multiple fallers with visual impairment may be at high risk for a decline in physical capacity and endurance, warranting clinical interventions.FundingThe research was supported in part by National Institutes of Health Grant EY022976.

Cervicothoracic Mechanical Impairment as Part of Complete Neurological Fall Risk Appraisal.

Assessment of individuals at risk for falling entails comprehensive neurological and vestibular examinations. Chronic limitation in cervical mobility reduces gaze accuracy, potentially impairing navigation through complex visual environments. Additionally, humans with scoliosis have altered otolithic vestibular responses, causing imbalance. We sought to determine whether dynamic cervical mobility restrictions or static cervicothoracic impairments are also fall risk factors. We examined 435 patients referred for soft-tissue musculoskeletal complaints; 376 met criteria for inclusion (mean age 52; 266 women). Patients were divided into nonfallers, single fallers, and multiple fallers, less or greater than 65 years old. Subject characteristics, dynamic cervical rotations, and static cervicothoracic axial measurements were compared between groups. Fear of falling was evaluated using the Falls Efficacy Scale-International questionnaire. Long-standing cervicothoracic pain and stiffness conferred increased risk of falling. Neck rotation amplitudes decreased with longer duration musculoskeletal symptoms and were significantly more restricted in fallers, doubling the risk of falling and contributing to increased fear of falling. Mid-thoracic scoliosis amplitudes increased over time, but static axial abnormalities were not greater among fallers, although thoracic kyphoscoliosis heightened fear of falling. In patients at fall risk, thoracic kyphoscoliosis and dynamic neck movements should be assessed, in addition to standard vestibular and neurological evaluations. Additionally, patients with soft tissue cervicothoracic pain and restricted mobility have increased fall frequency and fear of falling, independent of other fall risk factors and should undergo complete fall risk appraisal.

Using pharmacy dispensing data to predict falls in older individuals.

AimsAssociations between individual medication use and falling in older individuals are well‐documented. However, a comprehensive risk score that takes into account overall medication use and that can be used in daily pharmacy practice is lacking. We, therefore, aimed to determine whether pharmacy dispensing records can be used to predict falls.MethodsA retrospective cohort study was conducted using pharmacy dispensing data and self‐reported falls among 3454 Dutch individuals aged ≥65 years. Two different methods were used to classify medication exposure for each person: the drug burden index (DBI) for cumulative anticholinergic and sedative medication exposure as well as exposure to fall risk‐increasing drugs (FRIDs). Multinomial regression analyses, adjusted for age and sex, were conducted to investigate the association between medication exposure and falling classified as nonfalling, single falling and recurrent falling. The predictive performances of the DBI and FRIDs exposure were estimated by the polytomous discrimination index (PDI).ResultsThere were 521 single fallers (15%) and 485 recurrent fallers (14%). We found significant associations between a DBI ≥1 and single falling (adjusted odds ratio: 1.30 [95% confidence interval {CI}: 1.02–1.66]) and recurrent falling (adjusted odds ratio: 1.60 [95%CI: 1.25–2.04]). The PDI of the DBI model was 0.41 (95%CI: 0.39–0.42) and the PDI of the FRIDs model was 0.45 (95%CI: 0.43–0.47), indicating poor discrimination between fallers and nonfallers.ConclusionThe study shows significant associations between medication use and falling. However, the medication‐based models were insufficient and other factors should be included to develop a risk score for pharmacy practice.

Comparative Effectiveness of Functional Tests in Fall Prediction After Hip Fracture

ObjectivesTo assess the validity of 4 functional tests in predicting falls within the first year after hip fracture. DesignProspective study of functional tests shortly after hip surgery and incident falls during 12 months' follow-up. Setting and ParticipantsThe sample comprised 173 adults with acute hip fracture, aged 65 years and older (79% women, 77% community dwelling, mean age 84.2 years), who participated in a clinical trial of vitamin D or home exercise. MethodsWe assessed 4 functional tests [Timed Up and Go test (TUG), grip strength, and knee flexor and extensor strength in the nonoperated leg] by trained study physiotherapists at baseline (1-12 days after hip fracture surgery). During 12 months' follow-up, we ascertained all fall events by monthly personal phone calls, a telephone hotline, and a patient diary. Then we compared TUG and strength test performance at baseline between future single fallers, recurrent fallers, and nonfallers over the 12-month follow-up. All analyses adjusted for age, body mass index, gender, 25-hydroxyvitamin D status at baseline, days of follow-up, and treatment allocation (the original trial tested vitamin D treatment and/or a home exercise program). ResultsNinety-two of 173 (53%) participants fell and experienced 212 falls. Participants who became recurrent fallers (n = 54) had significantly longer TUG times at baseline than those who did not fall (n = 81) in the following 12 months (mean TUG for recurrent fallers = 71.6 seconds, SD = 8.2 seconds, vs mean TUG for nonfallers = 51.4 seconds, SD = 6.9 seconds; P = .02). There were no significant differences in TUG times between single fallers and nonfallers. For all 3 strength tests, there were no significant differences between single fallers, recurrent fallers, and nonfallers. Conclusions and ImplicationsIn this population of frail older adults recruited shortly after hip fracture surgery, only the TUG test discriminated between future recurrent fallers and nonfallers over a 12-month follow-up. Because of the high incidence and serious consequences of falls in older adults after a hip fracture, it is very important to identify practical and clinically related tests to predict repeated falls in the first year after a hip fracture, which is of great public health importance.

Heart rate variability and falls in Huntington's disease.

Persons with Huntington's disease (HD) have a high incidence of falls. Autonomic nervous system dysfunction has been reported even in early stages of this disease. To date, there has been no analysis of the relationship between heart rate variability (HRV) and falls in this patient population. The aim of the study reported here was to evaluate the relationship between HRV and falls in persons with HD. Huntington's disease patients enrolled in a prospective study on fear of falling and falls were assessed using short-term HRV analyses and blood pressure measures in both the resting and standing states. Time-frequency domains and nonlinear parameters were calculated. Data on falls, the risk of falling (RoF) and disease-specific scales were collected at baseline and at the end of the 6-month follow-up. Of the 24 HD patients who were invited to participate in the study, 20 completed the baseline analysis and 18 completed the 6-month follow-up. At baseline, seven (35%) HD patients reported at least one fall (single fallers) and 13 (65%) reported ≥ 2 falls (recurrent fallers) in the previous 12 months. At baseline, recurrent fallers had lower RMSSD (root mean square of successive RR interval differences) in the resting state (RMSSD-resting), higher LF/HF (low/high frequency) ratio in both states and higher DFA-α1 parameter (detrended fluctuation analyses over the short term) in both states. This association was similar at the 6-month follow-up for recurrent fallers, who showed lower RMSSD-resting and higher LF/HF ratio in the standing state (LF/HF-standing) than single fallers. Significant correlations were found between the number of falls, RMSSD-resting and LF/HF-standing. No differences were found between recurrent and single fallers for any blood pressure measures. The observed HRV pattern is consistent with a higher sympathetic prevalence associated with a higher RoF. Reduced parasympathetic HRV values in this patient population predict being a recurrent faller at 6 months of follow-up, independently of orthostatic phenomena.

Posturographic measures did not improve the predictive power to identify recurrent falls in community-dwelling elderly fallers

OBJECTIVE:This study aimed to evaluate if posturography can be considered a recurrent fall predictor in elderly individuals.METHODS:This was a cross-sectional study. A total of 124 subjects aged 60 to 88 years were evaluated and divided into two groups—the recurrent fallers (89) and single fallers (35) groups. Patients' sociodemographic characteristics were assessed, and clinical testing was performed. The functional test assessment instruments used were timed up and go test (TUGT), Berg Balance Scale (BBS), five times sit-to-stand test, and Falls Efficacy Scale (to measure fear of falling). Static posturography was performed in a force platform in the following three different situations—eyes open (EO), eyes closed (EC), and EO dual task.RESULTS:There were significant differences between the single and recurrent fallers groups regarding the fear of falling, the Geriatric Depression Scale score, the mean speed calculated from the total displacement of the center point of pressure (COP) in all directions with EO, and the root mean square of the displacement from the COP in the mediolateral axis with EC. Based on the hierarchical logistic regression model, none of the studied posturographic variables was capable of significantly increasing the power of differentiation between the recurrent and single fallers groups. Only TUGT with a cognitive distractor (p<0.05) and the BBS (p<0.01) presented with significant independent predictive power.CONCLUSION:TUGT with a cognitive distractor and the BBS were considered recurrent fall predictors in elderly fallers.

Multisystem Balance Training Reduces Injurious Fall Risk in Parkinson Disease: A Randomized Trial.

Previous studies have shown that balance training could reduce falls in people with Parkinson disease. However, it remains unclear whether exercise can reduce injurious falls. The objective of present study was to determine whether multisystem balance training could reduce injurious falls and modify targeted fall risk factors in Parkinson disease nonfallers and single fallers. Participants were randomly assigned to an 8-wk balance group (experimental, n = 41) or an upper limbs group (control, n = 43). Outcomes examined at posttraining and 12-mo follow-up were: (1) injurious fall risk (ratio of noninjurious fallers to injurious fallers); (2) two potential fall risk factors based on Balance Evaluation Systems Test scores and dual-task timed-up-and-go times. At posttraining, results indicated that there were no injurious falls, and fewer experimental participants were found in high fall risk cohorts based on Balance Evaluation Systems Test scores and dual-task timed-up-and-go times (P < 0.05). At 12-mo follow-up, the number of injurious fallers was lower in experimental group (P < 0.05). There was also a marginally lower percentage of experimental group in the high fall risk cohort based on Balance Evaluation Systems Test scores (P = 0.059). The findings conclude that multisystem balance training potentially reduces injurious fall risk up to 12-mo posttraining and lowers balance-related fall risks in people with Parkinson disease.

130Characteristics of Single and Recurrent Fallers in an Inpatient Cohort and Comparison of Differences in Assessment

130Characteristics of Single and Recurrent Fallers in an Inpatient Cohort and Comparison of Differences in Assessment

Natural history of falls in an incident cohort of Parkinson\u2019s disease: early evolution, risk and protective features

The natural history of falls in early Parkinson’s disease (PD) is poorly understood despite the profound effect of falls on outcome. The primary aim of this study was to describe the natural history of falls, and characterise fallers over 54 months in 99 newly diagnosed people with PD. Seventy-nine (79.7%) participants fell over 54 months and 20 (20.3%) remained falls-naïve. Twenty six (26.2%) reported retrospective falls at baseline. Gait outcomes, disease severity and self-efficacy significantly discriminated across groups. Subjective cognitive complaints emerged as the only significant cognitive predictor. Without exception, outcomes were better for non-fallers compared with fallers at any time point. Between group differences for 54 month fallers and non-fallers were influenced by the inclusion of retrospective fallers and showed a broader range of discriminant characteristics, notably stance time variability and balance self-efficacy. Single fallers (n = 7) were significantly younger than recurrent fallers (n = 58) by almost 15 years (P = 0.013). Baseline performance in early PD discriminates fallers over 54 months, thereby identifying those at risk of falls. Clinical profiles for established and emergent fallers are to some extent distinct. These results reiterate the need for timely interventions to improve postural control and gait.

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.

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.

Fall-related activity avoidance in relation to a history of falls or near falls, fear of falling and disease severity in people with Parkinson's disease.

BackgroundThere is limited knowledge concerning fall-related activity avoidance in people with Parkinson’s disease (PD); such knowledge would be of importance for the development of more efficient PD-care and rehabilitation. This study aimed to examine how fall-related activity avoidance relates to a history of self-reported falls/near falls and fear of falling (FOF) as well as to disease severity in people with PD.MethodsData were collected from 251 (61 % men) participants with PD; their median (min-max) age and PD duration were 70 (45–93) and 8 (1–43) years, respectively. A self-administered postal survey preceded a home visit which included observations, clinical tests and interview-administered questionnaires. Fall-related activity avoidance was assessed using the modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE) as well as by using a dichotomous (Yes/No) question. Further dichotomous questions concerned: the presence of FOF and the history (past 6 months) of falls or near falls, followed by stating the number of incidents. Disease severity was assessed according to the Hoehn and Yahr (HY) stages.ResultsIn the total sample (n = 251), 41 % of the participants reported fall-related activity avoidance; the median mSAFFE score was 22. In relation to a history of fall, the proportions of participants (p < 0.001) that reported fall-related activity avoidance were: non-fallers (30 %), single fallers (50 %) and recurrent fallers, i.e. ≥ 2 falls (57 %). Among those that reported near falls (but no falls), 51 % (26 out of 51) reported fall-related activity avoidance. Of those that reported FOF, 70 % reported fall-related activity avoidance. Fall-related activity avoidance ranged from 24 % in the early PD-stage (HY I) to 74 % in the most severe stages (HY IV-V).ConclusionsResults indicate that fall-related activity avoidance may be related to a history of self-reported falls/near falls, FOF and disease severity in people with PD. Importantly, fall-related activity avoidance is reported among those that do not fall and already in mild PD-stages (HY I-II). Although further studies are needed, our findings indicate that fall-related activity avoidance needs to be addressed early in order to prevent sedentary behavior and participation restrictions.

Falls in people prior to undergoing total hip or total knee replacement surgery: Frequency and associated factors

BackgroundTotal hip/total knee replacement (THR/TKR) surgery is becoming an increasingly common approach for the management of primarily lower limb osteoarthritis. A number of factors such as reducing mobility, structural joint changes, and pain may predispose those awaiting hip and knee surgery to falls, which may impact on pre- and postsurgery functions. The aim of this study was to identify the prevalence of falls in the year preceding THR/TKR surgery, and factors associated with falls. MethodsCross-sectional survey of patients scheduled for THR/TKR, including measures of joint disease severity, falls, falls efficacy, quality of life, pain, and depression. Comparisons across falls status (nonfaller, single faller, or multiple faller) and high/low disease severity for both THR and TKR groups were undertaken. ResultsA total of 282 people (mean age 67.3 years) completed surveys before the surgery (197 TKR). As much as 41% reported one or more falls in the preceding year, and participants reported that the affected joint contributed to the fall in 35% of the cases. TKR multiple fallers (≥ 2 falls) had significantly lower falls efficacy, worse function, greater pain catastrophizing and depression, and poorer 36-Item Short Form Survey Mental Component Scores than nonmultiple fallers. For both THR and TKR groups, several measures were significantly worse for those with greater disease severity, including falls efficacy, depression, pain catastrophizing, self-rated health, and physical activity. ConclusionFalls are common in the 12 months preceding total hip or knee surgery. A number of factors are associated with risk of multiple falls and with joint disease severity. Strategies to reduce falls risk should be a priority in the year preceding lower limb joint surgery to optimize presurgery and postsurgery outcomes.