Please see http://www.cec.health.nsw.gov.au/programs/falls-prevention
ACSQHC 2009 Falls Prevention Best Practice Guidelines for Australian Hospitals, Residential Aged Care and Community Care.TheCECstillhaslimitednumberoffreecopies(forNSWHealthstaffonly)oftheACSQHCFalls
Prevention Best Practice Guidelines remaining. These are available in hard copies or on CD including
a Guideline, Guidebook and CD (contains the complete set of guidelines, guidebooks, implementation
guide and fact sheets.
Please contact Ingrid Hutchinson at the CEC on 02 9269 5516
The resources for the STEADI program developed by Dr Judy Stevens from the US Centre for Disease Control and Prevenion, including all toolkit materials are now available and can be downloaded at website link above.
Mind Health Connect Programhttp://www.mindhealthconnect.org.au/about-me/health-professional
Mind Health Connect program is supported by the Australian Government and is part of the National E-Mental Health Strategy and includes information and on line screening for mental health issues for people in the community as well as educational programs and modules for professionals.
www.activeandhealthy.nsw.gov.auFind a falls prevention exercise program in your local community.
Search by suburb To find a falls prevention exercise program in your local area. Exercise programs Have been approved for registration on this website. Programs include: Tai Chi, Stepping On, Gentle Exercise and more. Other highlights • The Staying Active and On Your Feet booklet with exercises to do at home, and lifestyle and home safety checklists. • Information for health professionals - falls prevention best-practice.
View the website at: www.activeandhealthy.nsw.gov.au Please promote this website and provide feedback at: www.activeandhealthy.nsw.gov.au/feedback
Background: Screening of depressive symptoms is recommended in recurrent fallers. Compared to the 30-item and 15-item Geriatric Depression Scales (GDS), the 4-item GDS is easier to administer and quicker to perform. Theassociationbetweenabnormal4-itemGDSscoreandrecurrentfallshasnotyetbeenexamined.Inaddition,while depressive symptoms-related gait instability is well known, the association with recurrent falls has been few studied.
Objective:1)Toexaminetheassociationbetweenabnormal4-itemGDSscoreandrecurrentfallsincommunity-dwellingolderadultsusingoriginaldatafromhealthexaminationcenters(HEC)ofFrenchhealthinsuranceofLyon,and2)toperformasystematicreviewofstudiesthatexaminedtheassociationofdepressivesymptomswithrecurrent falls among older adults.
Methods: Firstly, based on a cross-sectional design, 2,594 community-dwellers (mean age 72.1±5.4years; 49.8% women)wererecruitedinHECofLyon,France.The4-itemGDSscore(abnormalifscore≥1)andrecurrentfalls(i.e.,2 or more falls in the past year) were used as main outcomes. Secondly, a systematic English and French Medline literature search was conducted on May 28, 2012 with no limit of date using the following Medical Subject Heading (MeSH) terms “Aged OR aged, 80 and over”, “Accidental falls”, “Depressive disorder” and “Reccurence”. The search also included the reference lists of the retrieved articles.
Results: A total of 19.0% (n=494) participants were recurrent fallers in the cross-sectional study. Abnormal 4-item GDS score was more prevalent among recurrent fallers compared to non-recurrent fallers (44.7% versus 25.0%, withP<0.001),andwassignificantlyassociatedwithrecurrentfalls(Oddratio(OR)=1.82withP<0.001forfullmodel; OR=1.86 with P<0.001 for stepwise backward model). In addition to the current study, the systematic reviewfoundonlyfourotherstudiesonthistopic,threeofthemexaminingtheassociationofdepressivesymptomswithrecurrentfallsusing30-itemor15-itemGDS.Allstudiesshowedasignificantassociationofdepressive symptoms with recurrent falls.
Conclusions: The current cross-sectional study shows an association between abnormal 4-item GDS score and recurrentfalls.Thisassociationofdepressivesymptomswithrecurrentfallswasconfirmedbythesystematicreview. Based on these results, we suggest that recurrent falls risk assessment should involve a systematic screening of depressive symptoms using the 4-item GDS.
Discriminative ability and predictive validity of the timed up and go test in identifying older people who fall: systematic review and meta-analysis
Schoene D, Wu SM, Mikolaizak AS, Menant JC, Smith ST, Delbaere K, Lord SR.
J. Am. Geriatr. Soc. 2013; ePub(ePub): ePub.
Affiliation:FallsandBalanceResearchGroup,NeuroscienceResearchAustralia,Sydney,NewSouthWales,Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
OBJECTIVES: To investigate the discriminative ability and diagnostic accuracy of the Timed Up and Go Test (TUG) as a clinical screening instrument for identifying older people at risk of falling.
AbstractsRecent abstracts from the research literature
DESIGN: Systematic literature review and meta-analysis.
SETTING AND PARTICIPANTS: People aged 60 and older living independently or in institutional settings.
MEASUREMENTS:StudieswereidentifiedwithsearchesofthePubMed,EMBASE,CINAHL,andCochraneCENTRALdata bases. Retrospective and prospective cohort studies comparing times to complete any version of the TUG of fallers and non-fallers were included.
RESULTS:Fifty-threestudieswith12,832participantsmettheinclusioncriteria.Thepooledmeandifferencebetween fallers and non-fallers depended on the functional status of the cohort investigated: 0.63 seconds (95% confidence(CI)=0.14-1.12seconds)forhigh-functioningto3.59seconds(95%CI=2.18-4.99seconds)forthosein institutional settings. The majority of studies did not retain TUG scores in multivariate analysis. Derived cut-pointsvariedgreatlybetweenstudies,andwiththeexceptionofafewsmallstudies,diagnosticaccuracywaspoorto moderate.
CONCLUSION:ThefindingssuggestthattheTUGisnotusefulfordiscriminatingfallersfromnon-fallersinhealthy,high-functioning older people but is of more value in less-healthy, lower-functioning older people. Overall, the predictive ability and diagnostic accuracy of the TUG are at best moderate. No cut-point can be recommended. Quick,multifactorialfallriskscreensshouldbeconsideredtoprovideadditionalinformationforidentifyingolderpeople at risk of falls.
Epidemiology of falls and osteoporotic fractures: a systematic review
BACKGROUND AND METHODS: Fractures in elderly populations result from the combination of falls and osteoporosis.WereportasystematicreviewofstudiesindexedinPubMedreportingannualratesoflow-traumafallsandassociatedosteoporoticfracturesamongoldercommunity-dwellingpeople(age≥50years).Anosteoporoticfracturewasdefinedaseitherafractureresultingfromalow-impactfallinsubjectswithclinicalosteoporosis,afallresultinginaninvestigator-definedosteoporoticfracture,orafallresultinginalow-trauma fracture. Rates are presented using descriptive statistics. Meta-analysis was conducted for statistically homogeneous data sets.
RESULTS:Themedian(range)annualfallprevalencerates(medianproportionofpeoplewhoexperiencedoneor more falls during the past year) for cohorts of women and men (10 determinations), women alone (seven determinations), and men alone (four determinations) were, respectively, 0.334 (0.217-0.625), 0.460 (0.372-0.517), and 0.349 (0.284-0.526). In studies that reported fall prevalence rates for Western men and women separately(fourdeterminations),thepooledriskratio(95%confidenceinterval[CI])formenversuswomenwas0.805 (95% CI 0.721-0.900). The ranges of fall prevalence rates in East Asian women (two studies) and East Asian men (two studies) were, respectively, 0.163-0.258 and 0.087-0.184. The risk ratio (95% CI) for fall prevalence in East Asian men versus women was 0.634 (0.479-0.838) in studies (two determinations) reporting results for EastAsianmenandwomenseparately.IncohortsofWesternwomenandmen(fivedeterminations),thepooledrate (95% CI) of low-impact falls resulting in fractures was 0.041 (0.031-0.054). The proportion of low-trauma fractures attributable to falls among the Western community-dwelling elderly was within the range of 0.860-0.950forfracturesatallsitesorthehip(fivedeterminations).Arangeof0.716-0.924ofallfractureswereosteoporotic (eight determinations).
CONCLUSION: Fall rates are higher in women than in men in Western community-dwelling populations and lower inEastAsianpopulations.ExtrapolatedtotheUSpopulation,thestatisticsimplythatlow-impactfallscauseapproximately0.53millionosteoporoticfracturesannuallyamongtheUScommunity-dwellingelderly.
Inthismeta-analysis,weevaluatedtheeffectofexerciseonfracturereductionintheelderly.Ourresultsdeterminedasignificantlypositiveeffectonoverallfractures,whereasthepossibilityofapublicationbiasindicates the need for well-designed (multi-center) trials that generate enough power to focus on osteoporotic fractures.
INTRODUCTION:Thepreventiveeffectofexerciseonfractureincidencehasnotbeenclearlydeterminedyet.Thus,thepurposeofthisstudyistoevaluatetheeffectivenessofexerciseinpreventingoverallandvertebralfracturesin older adults by meta-analyses technique.
METHODS: This study followed the PRISMA recommendations for systematic reviews and meta-analyses. A systematicreviewofEnglisharticlesbetween1980andMarch2012wasperformed.Termsusedwere:“exercise”,“fractures”, “bone”, “falls”, “osteoporosis”, “BMD”, “BMC”, “bone turnover”, while the search was limited to “clinicaltrial”and“humans”.Controlledexercisetrialsthatreportedfracturenumberasendpointorobservationin subjects 45 years and older were included.
RESULTS:Tencontrolledexercisetrialsthatreportedoverallfracturesandthreeexercisetrialsthatreportedvertebralfracturesmetourinclusioncriteria.Overallfracturenumberintheexercisegroupwas36(n=754)comparedwith73fracturesintheCG(n=670)(relativerisk[RR]=0.49;95%confidenceinterval[CI],0.31-0.76).Nosignificantheterogeneityoftrialresults(p=0.28;I(2)=17)wasdetermined;however,therewassomeevidence to suggest a publication bias. The overall RR for vertebral fracture number (0.56; 95 % CI, 0.30-1.04) (EG:19fractures/103subjectsvs.CG:31fractures/102subjects)wasborderlinenon-significantwhiletheheterogeneity of trial results also cannot be ruled out.
CONCLUSION:Althoughthereisevidencethatexercisereducesoveralland,toalesserdegree,vertebralfracturesin the elderly, the possibility of publication bias weakens our result and demonstrates the imperative for large exercisestudieswithdedicatedexerciseprotocolsthatfocusonfracturesasaprimaryendpoint.
Effects of different exercise interventions on risk of falls, gait ability and balance in physically frail older adults. A systematic review
Cadore EL, Rodríguez-Mañas L, Sinclair A, Izquierdo M.
INTRODUCTION: The aim of this review was to recommend training strategies, which improve the functional capacityinphysicallyfrailolderadultsbasedonscientificliterature,focusingspeciallyinsupervisedexerciseprograms that improved muscle strength, fall risk, balance and gait ability.
METHODS:Scielo,ScienceCitationIndex,MEDLINE,Scopus,SportDiscusandScienceDirectdatabasesweresearchedfrom1990to2012.Studiesmusthavementionedtheeffectsofexercisetrainingonatleastoneofthefollowing four parameters: incidence of falls, gait, balance and lower-body strength.
RESULTS:Twentystudieswhichinvestigatedtheeffectsofmulti-componentexercisetraining(10),resistancetraining (6), endurance training (1) and balance training (3) were included in the present revision. Ten trials investigatedtheeffectsofexerciseontheincidenceoffallsinelderlywithphysicalfrailty.Sevenofthemhave found a fewer falls incidence after physical training when compared with the control group. Eleven trials investigatedtheeffectsofexerciseinterventiononthegaitability.Sixofthemshowedenhancementsinthegaitability.Tentrialsinvestigatedtheeffectsofexerciseinterventiononthebalanceperformanceandsevenofthem
Abstracts ContinuedRecent abstracts from the research literature
demonstratedenhancedbalance.Thirteentrialsinvestigatedtheeffectsofexerciseinterventiononthemusclestrength and nine of them showed increases in the muscle strength.
CONCLUSION:Themulti-componentexerciseinterventioncomposedbystrength,enduranceandbalancetrainingseems to be the best strategy to improve rate of falls, gait ability, balance and strength performance in physically frail older adults.
Epidemiology and risk factorsFall-related hip fracture hospitalisations and the prevalence of dementia within older people in New South Wales, Australia: An analysis of linked data
Scandol JP, Toson B, Close JC.
Injury 2012; ePub(ePub): ePub.
Affiliation:CentreforEpidemiologyandEvidence,NSWMinistryofHealth,LockedMailBag961,NorthSydney,NSW 2059, Australia; Falls and Injury Prevention Group, Neuroscience Research Australia, NSW, Australia.
INTRODUCTION:Dementiaandfall-relatedhipfracturesbothcontributesignificantlytotheburdenofillnesswithin elderly populations in Australia and elsewhere. The research presented here uses a large probabilistically linked dataset from NSW, Australia to estimate the prevalence of dementia within hip fracture patients and investigate the impact of dementia on hospitalisation length of stay (LOS) and survival.
METHOD:ThecasesconsideredwereNSWresidentsaged65yearsandabovewhoexperiencedafallrelatedhipfracture between 1 July 2000 and 30 June 2009. The prevalence of dementia was calculated for the incident hip fractureusingtwomethodstoinferdementiastatus.Coxproportionalhazardsregressionmodellingwasusedto estimate the relative rate of discharge from a hospitalisation episode, and the relative mortality rate of hip fracturepatientssufferingdementiaversusthosewhowerecognitivelyintact.Additionalcovariatesusedinthemodelsincludedsex,agegroupatadmission,theCharlsonComorbidityIndexandseparationmode.
RESULTS: Of the 44,143 fall-related incident hip fracture cases considered, between 24% (observed diagnosis) to 29% (inferred diagnosis) of these people had dementia. The median LOS for patients with dementia was shorter than those without dementia, but there was a strong interaction with age. The rate of discharge from the fracture-related hospitalisation episode of the cases with dementia was 40% greater (95% CI 1.4-1.5) than the non-demented group. Similarly, the relative mortality rate of those with dementia was greater (2.4, 95% CI 2.3-2.6)thanthenon-dementedgroup.BothCoxanalysesindicatedevidenceformaineffectsofageatadmissionandcomorbidity,aswellasinteractioneffectsbetweenagegroupanddementiastatus.
CONCLUSION: The use of linked datasets with tens of thousands of cases enables the calculation of precise estimatesofvariousparameters.Peoplewithdementiaconstituteasignificantproportionofthetotalpopulationof elderly hip fracture patients in hospitals (up to 29%). Their mortality rate is greater than those without a diagnosis of dementia and their hospital length of stay is shorter, particularly if they are discharged to a residential aged care facility.
Falls in older persons with intellectual disabilities: fall rate, circumstances and consequences
Smulders E, Enkelaar L, Weerdesteyn V, Geurts AC, van Schrojenstein Lantman-de Valk H.
J. Intellect. Disabil. Res. 2012; ePub(ePub): ePub.
Affiliation:DepartmentofRehabilitation,RadboudUniversityMedicalCentre,NijmegenCentreforEvidenceBasedPractice, Nijmegen, the Netherlands.
BACKGROUND: Falling is a common cause of injuries and reduced quality of life. Persons with intellectual disabilities (ID) are at increased risk for falls and related injuries. As the number of elderly persons with ID is
growing rapidly, it is imperative to gain insight into the quantity of the problem of falling, the circumstances that precipitatefallsandtobetterunderstandtheiraetiologyinpersonswithID.Thisisthefirststudytoprospectivelyinvestigate fall rate, circumstances and fall consequences in older adults with mild to moderate ID.
METHOD:Eighty-twoindividualswithmildtomoderateID,50yearsandover[meanage62.3(SD=7.6),34male],participated in this study, which was conducted at three service providers for persons with ID in the Netherlands. Falls were registered for 1 year with monthly fall registration calendars to determine the fall rate (mean number of falls per person per year). Information on fall circumstances and consequences was obtained from questionnaires completed by caregivers and study participants after each fall.
RESULTS: We determined that the fall rate in this sample was 1.00 fall per person per year. Thirty-seven participantsreportedatleastonefall(range1-6).Sexandagewerenotrelatedtofalls.Mostfallsoccurredwhilewalking (63.3%), outside (61.7%) and in familiar environments (88.9%). Importantly, 11.5% of falls resulted in severeinjuries,approximatelyhalfofwhichwerefractures.
CONCLUSION: The circumstances and consequences of falls in persons with ID are comparable to those of the general elderly population, but the rate is substantially higher. As such, appropriate fall prevention strategies must be developed for individuals with ID.
Factors associated with falls among older adults living in institutions
Damián J, Pastor-Barriuso R, Valderrama-Gama E, de Pedro-Cuesta J.
BACKGROUND:Fallshaveenormousimpactinolderadults.Yet,thereisinsufficientevidenceregardingtheeffectivenessofpreventiveinterventionsinthissetting.Theobjectivesweretomeasurethefrequencyoffallsand associated factors among older people living institutions. METHODS: Data were obtained from a survey on a probabilistic sample of residents aged >=65 years, drawn in 1998-99 from institutions of Madrid (Spain). Residents, their caregivers, and facility physicians were interviewed. Fall rates were computed based on the number of physician-reported falls in the preceding 30 days. Adjusted rate ratios were computed using negative binomialregressionmodels,includingage,sex,cognitivestatus,functionaldependence,numberofdiseases,andpolypharmacy.
RESULTS:Thefinalsamplecomprised733residents.Thefallratewas2.4fallsperperson-year(95%confidenceinterval[CI],2.04-2.82).Thestrongestriskfactorwasnumberofdiseases,withanadjustedrateratio(RR)of1.32(95% CI, 1.17-1.50) for each additional diagnosis. Other variables associated with falls were: urinary incontinence (RR=2.56[95%CI,1.32-4.94]);antidepressantuse(RR=2.32[95%CI,1.22-4.40]);arrhythmias(RR=2.00[95%CI,1.05-3.81]);andpolypharmacy(RR=1.07[95%CI,0.95-1.21],foreachadditionalmedication).Theattributablefraction for number of diseases (with reference to those with <= 1 condition) was 84% (95% CI, 45-95%).
CONCLUSIONS: Number of diseases was the main risk factor for falls in this population of institutionalized older adults. Other variables associated with falls, probably more amenable to preventive action, were urinary incontinence, antidepressants, arrhythmias, and polypharmacy. Virtual slides: The virtual slide(s) for this article can be found here http://www.diagnosticpathology.diagnomx.eu/vs/3916151157277337.
Pain and anxiety mediate the relationship between dizziness and falls in older people
Menant JC, Wong A, Sturnieks DL, Close JC, Delbaere K, Sachdev PS, Brodaty H, Lord SR.
J. Am. Geriatr. Soc. 2013; ePub(ePub): ePub.
Affiliation:FallsandBalanceResearchGroup,NeuroscienceResearchAustralia,Randwick,NewSouthWales,Australia; School of Public Health and Community Medicine, University of New South Wales, New South Wales, Australia.
MEASUREMENTS: Participants completed questionnaires related to health and psychological well-being and underwentatilttablebloodpressuretest,thePhysiologicalProfileAssessment(PPA;vision,reactiontime,proprioception, postural sway, and quadriceps strength), and leaning balance tests. Prospective falls data were collected using monthly calendars for 12 months. Participants were categorized into dizzy and nondizzy groups based on self-report of dizziness, vertigo, and light-headedness.
RESULTS: Two hundred seventeen (42%) participants reported vertigo or dizziness (10%), light-headedness (16%),orboth(16%).Thedizzyparticipantsweresignificantlymorelikelytoreportneckandbackpain,pasttransient ischemic attacks, and feeling dizzy upon upright tilting. They also had poorer balance and less strength andscoredhigheronmeasuresofdepressionandanxiety(P<.05).Therewerenobloodpressuremeasurement-relateddifferencesbetweenthegroups.Dizzinessincreasedtheriskofmultiplefallsinanunadjustedanalysis(relativerisk(RR)=1.55,95%confidenceinterval=1.08-2.23).AftercontrollingforPPAscores,neckandbackpainandanxietyweremediatorsthatreducedtheRRoftherelationshipbetweendizzinessandfallerstatusthemost(14%)inamodifiedPoissonregressionmodel.
CONCLUSION:Sufferingfromneckandbackpainandanxietyweremediatorsoftherelationshipbetweendizziness and falls after controlling for poor sensorimotor function and balance. Older people with dizziness might benefitfrominterventionstargetingthesemediatorssuchaspainmanagementandcognitivebehavioraltherapy.
Fear of FallingFactors associated with fear of falling among community-dwelling elderly adults without reduced performance in instrumental activities of daily living
Oya T, Uchiyama Y, Shimada H, Makizako H, Doi T, Yoshida D, Uemura K, Suzuki T.
Nippon Ronen Igakkai Zasshi 2012; 49(4): 457-462.
Affiliation:DepartmentofPhysicalTherapyPrograminPhysicalandOccupationalTherapy,NagoyaUniversityGraduate School of Health Science.
AIM:Thepurposeofthisstudywastoexaminefactorsrelatedtofearoffalling(FOF)inelderlyadultswhoshowedno reduced performance regarding independent instrumental activities of daily living (IADL).
METHODS: A total of 119 elderly adults participated in the study (mean age, 75.7±7.2 years, women, n=60). We investigated the prevalence of FOF, anamnesis, medications, body pain, and history of falls, the Geriatric DepressionScale,InternationalPhysicalActivityQuestionnaire,Life-SpaceAssessment(LSA).TheTimedUpandGo test (TUG) and one-legged standing time were measured to evaluate physical performance. Participants were divided into elderly adults with FOF (FOF group) and those without FOF (non-FOF group). The unpaired t-test or chi-square test was used for group comparisons. Multiple logistic regression analysis was then performed to examinethefactorsassociatedwithFOF.
RESULTS: The prevalence of FOF was 51.3% overall. The FOF group had a higher prevalence of anamnesis, body pain, and history of falls than the non-FOF group. The FOF group had lower LSA scores, longer durations on the TUG, and shorter durations on the one-legged standing test than the non-FOF group. On multiple logistic regressionanalysis,LSA(totalscore,120points)wassignificantlyassociatedwithFOF(oddsratio:0.96,95%confidenceinterval=0.93-0.99).
CONCLUSION: Fearoffallingwassignificantlyassociatedwithlifespaceincommunity-dwellingelderlyadultswho showed no reduced performance regarding IADL. In future, it will be necessary to clarify any possible causal relationship by longitudinal investigations.
Intensive exercise reduces the fear of additional falls in elderly people: findings from the Korea falls prevention study
Oh DH, Park JE, Lee ES, Oh SW, Cho SI, Jang SN, Baik HW.
BACKGROUND/AIMS: Falls among older people are a major public health problem and may result in fracture, medical complications that require hospitalization, and fear of additional falls. Given the prevalence and impact of the fear of falling again, reducing the incidence of falls is important to prevent additional falls. This study analyzed whetherexerciseprogramsdecreasethefearoffuturefallsinelderlypatientswhohavefallenpreviously.
METHODS: A randomized controlled study was performed that included 65 elderly community-dwelling subjects whohadfalleninthepreviousyear.Subjectswererandomizedintotwogroups:anexercisegroup(EG,n=36)andacontrolgroup(CG,n=29).TheEGparticipatedinthreeexercisesessionsperweekfor12weeks.Musclestrength,balance,agility,flexibility,andmuscularenduranceweremeasuredatbaselineandafter12weeks.
RESULTS:Afterthe12-weekexerciseprogram,thesubjectsintheEGdemonstratedremarkableimprovementintheirwalkingspeed,balance(p=0.003),backstrength(p=0.08),lowerextremitystrength(p=0.004),andflexibility(p<0.001).Whenaskedwhethertheywereafraidoffalling,moreparticipantsintheEGthanintheCGresponded “not at all” or “a little.”
CONCLUSIONS:The12-weekexerciseprogramdescribedherereducedthefearoffalling(p=0.02).Italsoimprovedthebalance,flexibility,andmusclestrengthoftheparticipantsandwasassociatedwithimprovedquality of life.
The Falls Efficacy Scale International: a cross-sectional validation in people with multiple sclerosis
van Vliet R, Hoang P, Lord S, Gandevia S, Delbaere K.
Arch. Phys. Med. Rehabil. 2012; ePub(ePub): ePub.
Affiliation:NeuroscienceResearchAustraliaandUniversityofNewSouthWales,SydneyAustralia;RadboudUniversity Nijmegen Medical Centre, the Netherlands.
OBJECTIVE:Toevaluatepsychometricpropertiesof16-itemand7-itemFallsEfficacyScaleInternational(FES-I)inpeople with multiple sclerosis (MS). DESIGN: validation and prospective cohort study
SETTING: People with multiple sclerosis living in metropolitan Sydney, Australia
PARTICIPANTS:Onehundredandsixtyninecommunity-dwellingpeoplewithMS(aged21-73years)whowerereferred to Multiple Sclerosis Australia for physiotherapy assessment.
INTERVENTIONS: Not applicable
MAIN OUTCOME MEASURES: FES-I scores and a range of socio-demographic, physical and neuropsychological measures.
RESULTS: The mean score for the 16-item FES-I was 34.9 (SD = 11.2) and the mean score for 7-item FES-I was 14.7 (SD = 4.7). FES-I total scores were normally distributed: skewness of 0.35 (SEM 0.19) for the 16-item and 0.47 (SEM0.19)forthe7-itemFES-I,indicatingtheabsenceoffloorandceilingeffects.InternalreliabilitywasexcellentwithCronbach’sαvaluesof0.94(16-item)and0.86(7-item).Raschanalysesindicatedthatthestructureand
Abstracts ContinuedRecent abstracts from the research literature
measurement properties were better for the 7-item FES-I compared to the 16-item FES-I. Construct validity of bothscaleswassupportedbysensitivitytogroupdifferencesrelatingtodemographiccharacteristicsandfallriskfactors.
CONCLUSION:Thefindingsindicatethatboth16-itemand7-itemversionsoftheFES-Iprovidevaluableinformation about fear of falling in people with MS. However, the 7-item version of FES-I has better psychometric properties in people with MS.
Activity restriction vs. self-direction: hospitalised older adults’ response to fear of falling
Boltz M, Resnick B, Capezuti E, Shuluk J.
Int. J. Older People Nurs. 2013; ePub(ePub): ePub.
AIM: To describe fear of falling in hospitalised older adults and its relationship with patient characteristics and physicalfunctionandexplorepatientviewsofassociatedfactors.
BACKGROUND: Functional decline is a common complication in hospitalised older adults, associated with low mobility and physical activity. Fear of falling may contribute to limited mobility and physical activity, and loss of physical function. An understanding of this relationship, as well as contributing factors, may inform the development of safe, function-promoting interventions.
METHODS: (i) correlations and analysis of variance methods; (ii) content and thematic analysis; and (iii) evaluation of convergence, complementarity and dissonance of quantitative and qualitative data.
RESULTS: Depressed older persons were more likely to describe fear of falling (r = 0.47, P = 0.002). Fear of falling was associated with the loss of physical function from admission to discharge (F = 7.6, P = 0.009). The participant response to fear of falling was activity restriction vs. self-direction. Participants described the following factors, organised by social-ecological framework, to be considered when developing alternatives to activity restriction: intrapersonal, interpersonal, environmental and policy.
CONCLUSION:Fearoffallingplaysasignificantroleinrestrictingphysicalactivityandfunction.Amultifactorialapproach may provide a viable alternative to activity restriction, by facilitating self-direction and functional recovery.
IMPLICATIONS FOR PRACTICE: Interventions to prevent falls and activities to promote functional mobility are ideally developed in tandem, with attention paid to the physical and social environment. Preventing hospital-acquired disability may require a shift in organisational values around safety, from a solely protective approach toonethatreflectsanenablingphilosophyemphasisingindependenceandself-direction.Suchaparadigmshiftwould demonstrate a valuing not only of the absence of falls but also the preservation and restoration of function.
Risk AssessmentAssessment of the elderly: it’s worth covering the risks
BACKGROUND: Comprehensive assessments provide an invaluable opportunity to identify those at risk of adverse health events, enabling timely access to appropriate health care.
AIMS:Thisstudyaimedtoevaluatetheeffectivenessofacomprehensiveassessmenttool,theAdultPatientAssessmentTool(APAT),particularlyinrelationtoearlyidentificationofolderpeopleatriskoffalls,pressureareas, cognitive impairment or delirium, or patients with mental illness or substance abuse.
RESULTS: With the introduction of the APAT, assessment of falls risk and mental illness increased. The number of nursing actions relating to pressure areas and falls also increased, indicating a greater awareness of patients’ individual needs. Non-clinical information gathered through the APAT enabled a more holistic approach to patient care.
CONCLUSION: The use of electronic medical records would alleviate pressures on nurses’ time, providing an opportunitytostoreandretrievecomprehensivenursingassessmentandbenefitpatienthealthcare.Implicationsfor nursing management Early assessment results in an increased number of nursing activities related to patient care. Further education relating to mental health and substance abuse screening and cognitive assessment may enhance the completion of these tools.
Intervention StudiesEffects of interactive video-game based system exercise on the balance of the elderly
Affiliation:DepartmentofPhysicalMedicineandRehabilitation,SchoolofMedicine,CollegeofMedicine,TaipeiMedical University, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taiwan.
Thisstudyevaluatedtheeffectsofinteractivevideo-gamebased(IVGB)trainingonthebalanceofolderadults.The participants of the study included 30 community-living persons over the age of 65. The participants were divided into 2 groups. Group A underwent IVGB training for 6 weeks and received no intervention in the following 6weeks.GroupBreceivednointerventionduringthefirst6weeksandthenparticipatedintraininginthefollowing 6 weeks. After IVGB intervention, both groups showed improved balance based on the results from the followingtests:theBergBalanceScale(BBS),ModifiedFallsEfficacyScale(MFES),TimedUpandGo(TUG)test,andthe Sway Velocity (SV) test (assessing bipedal stance center pressure with eyes open and closed). Results from the SwayArea(SA)test(assessingbipedalstancecenterpressurewitheyesopenandclosed)revealedasignificantimprovementinGroupBafterIVGBtraining.GroupAretainedsometrainingeffectsafter6weekswithoutIVGBintervention.Additionally,amoderateassociationemergedbetweentheXavixmeasuredstepsystemsteppingtests and BBS, MFES, Unipedal Stance test, and TUG test measurements. In conclusion, IVGB training improves balanceafter6weeksofimplementation,andthebeneficialeffectspartiallyremainaftertrainingiscomplete.Further investigation is required to determine if this training is superior to traditional physical therapy.
Efficacy of supervised Tai Chi exercises versus conventional physical therapy exercises in fall prevention for frail older adults: a randomized controlled trial
Tousignant M, Corriveau H, Roy PM, Desrosiers J, Dubuc N, Hébert R.
METHOD: The participants were frail older adults living in the community, admitted to the day hospital program inSherbrooke,Quebec,Canada(n=152).Theywererandomizedtoreceivea15-weekintervention,eitherbysupervisedTaiChiexercises(n=76)orconventionalphysicaltherapy(n=76).Fallincidenceandseveritywereassessed using both the calendar technique and phone interviews once a month during 12 months following the end of the intervention. Other variables were collected at baseline to compare the two groups: age, comorbidity, balance, sensory interaction on balance, and self-rated health.
Health care providers are challenged to replicate evidence-based programs in their communities. These programs maybeadaptedtofitnewcommunities,butthekeycomponentsmustbedeliveredwithfidelity.Thisarticledescribesafour-stepfidelityassuranceprotocoldevelopedbytheHawai’i’sHealthyAgingPartnershipasitadapted and replicated evidence-based health promotion programs for Hawai’i’s older adults.
The four steps are the following: (a) deconstruct the program into its components and prepare a step-by-step planforprogramreplication;(b)identifyagenciesreadytoreplicatetheprogram,andsponsorexcellenttrainingtolocalstaffwhowilldeliverandcoordinateit;(c)monitorthefidelityofprogramdeliveryusingstandardizedchecklists;and(d)trackparticipantoutcomestoassureachievementofexpectedoutcomes.TheprotocolisillustratedwithexamplesfromHawai’i’sHealthyAgingPartnership’sexperiencereplicatingEnhanceFitness,aseniorexerciseprogram.Thisprotocolistransferrabletoothercommunitieswantingtoadaptandreplicateevidence-based, public health program.
An exercise intervention to prevent falls in Parkinson’s: an economic evaluation
Fletcher E, Goodwin VA, Richards SH, Campbell JL, Taylor RS.
METHODS: One hundred and thirty participants were recruited through specialist clinics, primary care and Parkinson’ssupportgroupsandrandomisedtoeitheranexerciseinterventionorusualcare.Healthandsocialcareutilisationandhealth-relatedqualityoflife(EQ-5D)wereassessedoverthe20weeksofthestudy(ten-week intervention period and ten-week follow up period), and these data were complete for 93 participants. Incrementalcostperqualityadjustedlifeyear(QALY)wasestimated.TheuncertaintyaroundcostsandQALYswasrepresentedusingcost-effectivenessacceptabilitycurves.
Thisstudyexploredolder,community-dwellingadults’attitudesandvaluesaboutproposedchurch-deliveredbalance classes for fall prevention. Community observation, group interviews with stakeholders, key informant interviews,andfocusgroupswithchurchmembers≥60yearsofagewereanalyzedintwoways:firstforinductivethemesexpressingcommunitysentimentaboutfallpreventionforolderadults,thenforcontentusefulincreatinglocallytailoredsocialmarketingmessages.Fourthemesexpressedperceptionsoffall-preventionprogramming:de-emphasizing fall risk and emphasizing strength and independence, moving older adults out of their “comfort zones” to join classes, identifying relationships to support fall-prevention activities, and considering gender-baseddifferencesinapproachestofallprevention.Acontentanalysisofthesamedatasetyieldedinformationabout preferred places in the community, promotion through churches, a tolerable price, and the balance class product itself. The qualitative results will inform the social marketing program to increase intervention delivery success.
Characteristics of patients who stop falling after a risk-based multidisciplinary intervention initiated in a geriatric day hospital
Flabeau O, Laurendeau G, Laksir H, Castaings-Pelet S, Harston S, Bourdel-Marchasson I.
BACKGROUND:Multidisciplinaryinterventionsforfallershaveprovidedconflictingresultsinpartduetothediversityoffallers’profiles.Objectives:todeterminethecharacteristicsofthesubgroupofpatientswithapositive response to a multidisciplinary fall prevention program initiated in a geriatric day hospital.
DESIGN: Prospective observational study in day hospital.
METHODS:Patients>75yearsreferredforfallsduringthelast3monthsbenefitedfromamultidisciplinaryassessment to record their characteristics at baseline and to tailor a risk-based multidisciplinary intervention for fall prevention. Patients free from falls at the 3rd or 6th month were compared to persistent fallers for baseline characteristics.
RESULTS:Sixty-ninepatientswereassessedatbaseline(meanage85.2y(SD=0.6)),44atthe3rdmonthand21at the 6th month. Baseline characteristics of the patients free from falls at the 3rd month were the lower number of previous non-serious falls (p=0.013), living in nursing home (p=0.045), a higher Berg balance score (p=0.02) andabettermentalhealth-relatedqualityoflife(MHQol,p=0.045).Onmultivariateanalysisrestrictedtohome-dwellingpatients,thepositivepredictivefactorswerelessisolationathome(OR=0.028,95%CI[0-0.813],p=0.037),alowernumberofnon-seriouspreviousfalls(OR=0.526[0.309-0.894],p=0.018),abetterMHQol(OR=1.205[1.000-1.452],p=0.050)andatrendforyoungerage(OR=0.662,[0.426-1.027],p=0.066).
CONCLUSION: Being able to call upon a support person (familial or institutional) to apply advice and a less serious risk of falling may be preliminary conditions for success in a multidisciplinary intervention initiated in a day hospital.
Abstracts ContinuedRecent abstracts from the research literature
PURPOSE OF THE STUDY: This study evaluates a nursing home Fall Management program to see if residents’ mobility increased and injurious falls decreased.
DESIGN AND METHODS: Administrative health care use and fall occurrence report data were analyzed from 2 ruralhealthregionsinManitoba,Canada,fromJune1,2003toMarch31,2008.Aquasiexperimental,pre-post,comparison group design was used to compare rates of three outcomes, falls, injurious falls, and falls resulting in hospitalization, by RHA (program vs nonprogram nursing homes) and period (preprogram vs postprogram). Data collectors entered occurrence report information into spreadsheets. This was supplemented with administrative health care use data.
RESULTS:Theprogramappearstohavebenefittedresidents-fallstrendedupward,injuriousfallsremainedstable,andhospitalizedfallsdecreasedsignificantly(0.036-0.021perperson-year[ppy];p=.043).Comparedwith nonprogram residents in the postperiod, both groups had the same fall rate, but program residents had significantlyfewerinjuriousfalls(0.596-0.746ppy;p=.02)andhospitalizedfalls(0.02-0.041ppy;p=.023).
IMPLICATIONS: These results are among a small body of literature showing that Fall Management was associated with improved outcomes in program nursing homes from pre- to postperiod and compared with nonprogram nursinghomes.Thisresearchprovidessomesupportforthebenefitsofbeingproactiveandimplementinginjuryprevention strategies universally and pre-emptively before a resident falls, helping to minimize injuries while keepingresidentsmobileandactive.LargerscaleresearchisneededtoidentifythetrueeffectivenessoftheFallManagement program and generalizability of results.
Towards falls prevention: A wearable wireless and battery-less sensing and automatic identification tag for real time monitoring of human movements
Ranasinghe DC, Shinmoto Torres RL, Sample AP, Smith JR, Hill K, Visvanathan R.
Conf. Proc. IEEE Eng. Med. Biol. Soc. 2012; 2012: 6402-6405.
Fallsrelatedinjuriesamongelderlypatientsinhospitalsorresidentsinresidentialcarefacilitiesisasignificantproblem that causes emotional and physical trauma to those involved while presenting a rising healthcare expenseincountriessuchasAustraliawherethepopulationisageing.NovelapproachesusinglowcostandprivacypreservingsensorenabledRadioFrequencyIdentification(RFID)technologymayhavethepotentialtoprovidealowcostandeffectivetechnologicalinterventiontopreventfallsinhospitals.Weoutlinethedetailsofa wearable sensor enabled RFID tag that is battery free, low cost, lightweight, maintenance free and can be worn continuously for automatic and unsupervised remote monitoring of activities of frail patients at acute hospitals or residents in residential care. The technological developments outlined in the paper forms part of an overall technological intervention developed to reduce falls at acute hospitals or in residential care facilities. This paper outlines the details of the technology, underlying algorithms and the results (where an accuracy of 94-100% was achieved) of a successful pilot trial.
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NSW Falls Prevention Network BackgroundThe NSW Falls Prevention Network was established in 1993. The role of this network has grown since its inception and now includes:
•Meetings for discussion of falls related issues;• Disseminationofresearchfindingsbothlocaland
