falls links - neurafallsnetwork.neura.edu.au/wp-content/uploads/2014/... · so safety must be...

Southern NSW LHD Rural Falls Forum 2

Falls, dementia & unintended

consequences 4

New Resources and Conference 7 New resources, websites and upcoming meetings.

Abstacts 8 Recent abstracts from the research literature.

Network Information 19 How to join and communicate through the network.

Inside this Issue

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FALLS LINKSVolume 8, Issue 5, 2013 Newsletter of the NSW Falls Prevention Network

This year the NSW Falls Prevention Network celebrates 20 years as a network promoting falls prevention and injury minimising harm from falls to a wide network of health professionals, community service and residential aged care providers.

This issue includes articles on:

• Southern NSW LHD Rural Falls Forum Report

• Falls, dementia and unintended consequences by Professor Richard Fleming

fallsnetwork.neura.edu.au

Welcome

“Falls Prevention is Everyone’s Business®”

Southern NSW LHD Falls Forum Batemans Bay participants listening to the presentation by Ms Anthea Temple from the

Aged Health Network, Agency For Clinical Innovation

http://fallsnetwork.neura.edu.au

Falls Links Vol 8, Issue 5 , 2013 NSW Falls Prevention Network

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Southern NSW Local Health District Falls Prevention ForumKey falls prevention experts provided presentations at a forum held in Batemans Bay on Thursday 24th October which was attended by 98 participants on the day (110 had registered). Participants travelled from 16 locations within the Local Health District (LHD) to attend this forum and came from a range of work settings including hospital, community, residential aged care as well as community service providers from both the public and private sector.

The forum was opened by Ms Tania Dufty, Director of Nursing and Midwifery, Southern NSW LHD.

The presenters and presentations on the day included:

Ms Lorraine Lovitt, Leader, NSW Falls Prevention Program, Clinical Excellence Commission, CEC – Driving Change

Ms Niccola Follett, Falls Coordinator, Health Promotion Unit, Southern NSW LHD who launched the new procedure Falls prevention & Injury Management for admitted patients, residents and subacute clients in Southern NSW LHD settings

DrJasmineMenant,ResearchOfficer,FallsandBalanceResearchGroup,NeuroscienceResearchAustralia (NeuRA), Falls prevention research update

Dr Esther Vance, Falls Prevention Network, NeuRA, Falls Prevention resources

MsMoragTaylor,PhysiotherapistandPhDcandidate,FallsandBalanceResearchGroup(NeuRA)and Prince of Wales Hospital, Managing falls in older people with cognitive impairment

MsAntheaTemple,ProjectOfficer,AgedHealthNetwork,AgencyforClinicalInnovation(ACI),Care of the Confused Hospitalised Older Persons Study (CHOPS)

There was an opportunity for participants to discuss issues or raise questions around the presentations they had heard and on implementing falls prevention strategies in the discussion groups for each of the care settings and the CHOPS project.

The PDFs of the presentations are available on the NSW Falls Prevention Network website at:

http://fallsnetwork.neura.edu.au/events/index.php#past

Evaluations were completed by 64% of the participants. Over95%ofrespondentsratedtheoverallforumas≥4(1 is poor and 5 is excellent) and over 80% of respondents ratedthepresentationsbythepresentersas≥4.Themain expectations participants had of the forum were; an update on the research evidence on falls prevention and evidence based best-practice strategies for falls prevention as well as an opportunity to network with other participants. Most participants indicated that their expectations were met or exceeded.

Participants wanted to be kept regularly informed on the evidence based research particularly on strategies that work and their implementation for their care settings especially residential aged care and also for community service providers. The main mechanisms suggested by participants for delivery of this information was through further face to face sessions or email updates.

Themainissuesandbarriersthatparticipantsidentifiedas prevented them from implementing falls prevention strategies were a lack of resources and workforce as wellasaneedforfurtherstaffeducationandtimetoimplement strategies especially with dementia clients.

Comments on the forums by participants:

‘Fantastic, learnt so much, did not even know about the new policy’

‘Greatday,goodsharingofinformationandnetworking’

Well run interesting day, good to hear about the differentprograms’

‘Privilege to have speakers of the highest calibre and expertise’

‘Goodpresentations,avarietyoftopicsandresources’

‘Food for thought on how we manage falls in aged care’

Ms Tania Dufty

Ms Morag Taylor

Dr Jasmine Menant

http://fallsnetwork.neura.edu.au/events/index.php#past

NSW Falls Prevention Network Falls Links Vol 8, Issue 5, 2013

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Toassistinimplementingfallspreventionstrategiesparticipantssuggestedimprovedprovisionofongoingstaffeducation with a choice of delivery mechanisms (online modules or face to face) as well as education for clients and their families and more resources and volunteers would also improve implementation.

The main overall comments on the forum were that it was very informative and well presented and the information was found to be very useful to those who attended.

ThisforumwasanimportantinitiativetosupportstaffinSouthernNSWLHDandwascosteffective($40perparticipant).

Esther Vance, Morag Taylor, Jasmine Menant, Lorraine Lovitt and Niccola Follett

TheHospitalGroup

withNiccolaFollet

t TheCommunityGroupwithEstherVance

TheCHOPSGroupwithAntheaTempleTheResidential

CareGroupwit

hElizabethHup

patz


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Falls, dementia and unintended consequencesProfessor Richard Fleming, Director,NSW/ACT Dementia Training Study Centre, University of Wollongong.

In general terms people with dementia are three times more likely to fall than others of a similar age andgender.Wecanbemoreprecisethanthisthoughbylookingatthedifferenttypesofdementia.TheextensiveworkofBallardandhisteaminNewcastle-on-TynehasshownthatpeoplewithAlzheimer’sdisease are approximately 2.5 times more likely to fall than similar people without dementia, those with vascular dementia about three times more likely, those with Lewy Bodies about nine times more likely and those with Parkinson’s disease dementia a huge 19 times more likely (Allan, Ballard et al. 2009).

The result of a fall can be extremely traumatic. The experience of the fall itself can be very unsettling, particularly if it occurs when the person is alone or unsupervised and leads to a period of helplessness waiting for assistance. A surprising 80% of falls occur in this situation. The results of the fall, apart from the physical damage, can be disturbing. A transfer to the unfamiliar surroundings of a hospital is almost guaranteed to increase the confusion and discomfort of a person with dementia. Falling has been shown to be the leading cause of admission to a hospital for community dwelling people with dementia (Rudolph, Zaninetal.2010).Inthecaseofaseriousfallresultinginafractureorbreakagetheeffectsofageneralanaesthetic and surgical treatment on a person with dementia can be profoundly traumatic. It is bad enough that dementia is associated with a 3 to 4 fold increase in the risk of hip fractures but there is also a 3 fold increase in the 6 month post fracture mortality rate compared with older people without dementia to contend with (Vidán, Serra et al. 2005; Kurrle, Brodaty et al. 2012).

Thesearchforthecausesoffallshasoccupiedsubstantialeffort(Eriksson,Gustafsonetal.2008)butperhaps the most interesting research has been aimed at identifying those causes that we can do something about.ThishasbeenledbytheBallardteammentionedaboveandhasresultedintheidentificationofhypotension, particularly the hypotension that occurs when a person rises from lying or sitting to a standing position, the use of cardioactive medications and depression as being the medical features of the problem thatmightlendthemselvestomodificationthroughmedicalmeans(Allan,Ballardetal.2009).

There are other aspects of the situation that might also provide opportunities for intervention. As well as identifying medical issues associated with falling the research described above also highlighted the protectiveeffectsofphysicalexercise.Thisaddstotheincreasingbodyofevidenceontheimportanceofphysicalexerciseincombattingdementia(Liu-AmbroseandDonaldson2009;Ahlskog,Gedaetal.2011)andtheevidenceofthebeneficialeffectsofphysicalexerciseondepression(Cooney,Dwanetal.2013).Soit is clear that one of the steps that needs to be taken, not only to reduce falls but to help protect against depression and dementia, is the establishment and maintenance of as high a level of physical activity as the person can safely manage.

Thepotentialforreducingfallsbymodifyingthephysicalenvironmenthasbeenidentified(Kurrle,Brodatyetal.2012).Perhapsthefirstconsiderationhereshouldbethesafetyprovidedbytheenvironment.Howeverthisisnotquiteasstraightforwardasitmightfirstappearaspeoplewithdementiadonotalwaysreact well to environments that are obviously safe (Torrington 2006). If doors are obviously locked or the garden surrounded by a prison like fence then it should be no surprise that frustration occurs. Unfortunately frustration can quickly become agitation, then aggression, resulting in sedation and then, the unintended and paradoxical consequence, falling becomes more likely.

Similarly,thepursuitofsafetythroughtheuseofphysicalrestraintsismisguided.Capezutihasshownthatnursing homes that had the least restraint reduction had a 50% higher rate of falls (p < .01) and more than twice the rate of fall-related minor injuries (p < .001) when compared to the homes that reduced the use of restraintsby23%and56%(Capezuti,Strumpfetal.1998).

So safety must be pursued in less obtrusive ways than locking people in or securing them to furniture or wheelchairs. Perhaps this can be achieved by using hip protectors (Kurrle, Brodaty et al. 2012) or selecting afloorsurfacethatreducesthelikelihoodofitcausingafractureshouldapersonfallonit.Thereissomeevidencetoshowthatacarpeted,woodenfloorisassociatedwithfewerhipfractures(Simpson,Lambetal.2004).

There are some features which are well understood to contribute to falls (Lowery, Buri et al. 2000) and should be avoided in all environments where falls are likely. These include avoiding loose rugs, providing grab rails by the toilet and, whenever possible, avoiding a low toilet.


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Somewhatlessobviousistheneedtobeawareoftheeffectsofsharpcontrastsonthefloor.Itisquitecommontoseeasharpcontrastbetweenthefloorcoveringsinacorridorandabedroom.Thisisoftenperceivedasachangein level by a person with dementia and results in them trying to step up, or down, as they walk over the junction. Thiscanleadtoafall.Asimilarriskoccurswhentherearesharpshadowscastonthefloororwhenthepatterninacarpetinvolvescontrastingshapes(Mendez,Cherrieretal.1996;Bakker2003).

There are two ways to get an idea of how much contrast an environment presents to an older person. The better oneistolookatitthroughayellowfilter,perhapsjustapieceofyellowcellophane,tomimictheeffectoftheyellowing of the lens of the ageing eye. The other is to take a photograph of it and print it in black and white.

Ifwalkingishazardousforapersonwithdementiathenconfusedwanderingmustbeanevengreaterrisk.Providinggoodsignageandlandmarkstohelpwayfindingmaybeofassistance.Goodsignsarealittlebeloweyelevel and use a combination of texts and graphics that contrast strongly with the background. A good landmark is a distinctive feature that will guide the person with dementia in the right direction, e.g. a large and bold picture of a meal time scene that will attract the person to a point from which they can see the dining room.

Helpingpeoplefindwhattheywant,e.g.thetoilet,atnightbyprovidinganightlighthasbeenfoundtoreducefalls (Lowery, Buri et al. 2000).

Familiarityisimportanttopeoplewithdementiaastheyfinditdifficulttolearnhowtousenewthingsorfindtheir way around new environments. The importance of familiarity in the context of falls can be seen in the findingthatfallsinhospitaloccurmostoftenshortlyafteradmissionorshortlyaftertransfertoanewward(vanDijk, Meulenberg et al. 1993). There is little that can be done in terms of environmental changes to reduce this problembutraisingawarenessofstaffofthisriskmayhelp.

There is a tendency in many aged care homes to reduce the opportunities people with dementia have to get outside. This is often understandable because the design of the outside spaces is such that they cannot be supervisedfromwherethestaffspendmostoftheirtimeandtheyhavetriphazards.Itisverysaddeningtoseethedoorstoagardenthathasbeenbuiltbyfundsraisedbywellintentionedvolunteerslockedbecausestaffareconcerned about the safety issues. Paradoxically this may well increase the likelihood of falling. Not only because of the frustration and agitation that can build up in people who are locked up but also because the lack of sunlight will lead to the depletion of Vitamin D and make their bones more brittle.

Sometimes in these circumstances it is possible to identify a small part of the garden that can be supervised and madetriphazardfree.Ifthiscanbeseparatedfromtherestofthegardensothatpeoplewithdementiadon’twanderintounsupervised,dangerousareas,thenthestaffmaybepreparedtoallowpeoplewithdementiaaccessto that space. Ideally this space should provide a clearly visible path (contrasting against the background), with few, if any, decision points; that leads the person past a variety of opportunities to engage in activities or with objects, e.g. feeding birds in a cage, looking at memorabilia or sitting in the shade and watching passers-by. An excellent source of information on outside spaces for people with dementia is to be found at the Dementia Enabling Environments Project (DEEP) web-site www.enablingenvironments.com.au/ (see page 7 for more information on this website).

The role of the physical environment in promoting a good quality of life for people with dementia has been recognised bytheAustralianGovernmentwhichhasgiventheNSW/ACT Dementia Training Study Centre the task of providing education and advice on environmental design.

This has resulted in the establishment of an education and consultancy service available free of charge to aged care and health care providers across Australia. The service is available to those who are in the process of planning a new facility (aged care or hospital based) or refurbishing an old one. Information on it can be obtained from the DTSC web site www.dtsc.com.au/ or by contacting me directly at [email protected]

There is no doubt that people with dementia are at risk of falling and that this risk must be recognised and minimised.

Unfortunately risk minimisation often seems to morph into risk avoidance and the result is the severe curtailment of activity. As has been outlined above this can have unintended negative consequences.

http://www.enablingenvironments.com.au/

http://www.dtsc.com.au/

mailto:rfleming%40uow.edu.au?subject=


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Perhaps there would be an advantage in abandoning the ideas of risk minimisation and risk avoidance and replacing them with the idea of risk selection. When all is said and done that is all we can do. Risk avoidance, at best, results in the reduction of a certain set of risks, e.g. falling, but replaces them with a new set of risks; the risks of creating frustration, agitation and anger as described above. There are other risks, such as apathy and depression that could easily be added to the list. In choosing a particular strategy we do not avoid all risks, we simply select a sub-set of risks that we deem to be important and focus on them without giving due consideration to the others.

All of the strategies for avoiding, or minimising, falls discussed above need to be placed into the context of a philosophy of care if they are to be anything more than an ad hoc collection of hints. It would be refreshing to see them put into a philosophy of care that recognises that life involves risk taking and provides people with the choice of the risks that they wish to take.

References

Ahlskog,J.E.,Y.E.Geda,etal.(2011).“Physicalexerciseasapreventiveordisease-modifyingtreatmentofdementia and brain aging.” Mayo Clinic Proceedings. Mayo Clinic 86(9): 876-884.

Allan,L.M.,C.G.Ballard,etal.(2009).“Incidenceandpredictionoffallsindementia:aprospectivestudyinolderpeople.” Plos One 4(5): e5521-e5521.

Bakker,R.(2003).“Sensoryloss,dementia,andenvironments.”Generations27(1):46.

Capezuti,E.,N.E.Strumpf,etal.(1998).“Therelationshipbetweenphysicalrestraintremovalandfallsandinjuriesamongnursinghomeresidents.”JournalsofGerontologySeriesA-BiologicalSciences&MedicalSciences53(1):M47-52.

Cooney,G.M.,K.Dwan,etal.(2013).“Exercisefordepression.”TheCochraneDatabaseOfSystematicReviews9:CD004366.

Eriksson,S.,Y.Gustafson,etal.(2008).“Riskfactorsforfallsinpeoplewithandwithoutadiagnoseofdementialivinginresidentialcarefacilities:Aprospectivestudy.”ArchivesOfGerontologyAndGeriatrics46(3):293-306.

Kurrle, S. E., H. Brodaty, et al. (2012). Physical comorbidities of dementia. Cambridge, Cambridge University Press.

Liu-Ambrose,T.andM.G.Donaldson(2009).“Exerciseandcognitioninolderadults:istherearoleforresistancetraining programmes?” British Journal Of Sports Medicine 43(1): 25-27.

Lowery,K.,H.Buri,etal.(2000).“Whatistheprevalenceofenvironmentalhazardsinthehomesofdementiasufferersandaretheyassociatedwithfalls.”InternationalJournalofGeriatricPsychiatry15(10):883-886.

Mendez,M.F.,M.M.Cherrier,etal.(1996).“DepthperceptioninAlzheimer’sdisease.”PerceptualAndMotorSkills83(3 Pt 1): 987-995.

Rudolph,J.L.,N.M.Zanin,etal.(2010).“HospitalizationinCommunity-DwellingPersonswithAlzheimer’sDisease:FrequencyandCauses.”JournaloftheAmericanGeriatricsSociety58(8):1542-1548.

Simpson,A.H.R.W.,S.Lamb,etal.(2004).“Doesthetypeofflooringaffecttheriskofhipfracture?10.1093/ageing/afh071.” Age and Ageing 33(3): 242-246.

Torrington,J.(2006).“Whathasarchitecturegottodowithdementiacare?Explorationsoftherelationshipbetween quality of life and building design in two EQUAL projects.” Quality in Ageing 7(1): 34.

vanDijk,P.T.M.,O.G.R.M.Meulenberg,etal.(1993).“Fallsindementiapatients.”TheGerontologist33(2):200.

Vidán,M.,J.A.Serra,etal.(2005).“Efficacyofacomprehensivegeriatricinterventioninolderpatientshospitalizedforhipfracture:arandomized,controlledtrial.”JournaloftheAmericanGeriatricsSociety53(9):1476-1482.


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New Resources, Websites and ConferencesDementia Enabling Environments


Alzheimer’sAustraliaWA,inpartnershipwith the NSW Dementia Training Study Centre at the University of Wollongong, have been funded by the National Quality Dementia Care Initiative to develop a national project focusing on translating research into practice in the area of enabling environments for people with dementia.

This website using the latest research and a set of good evidence based practice principles which are the foundation for the initiatives and provides aged care providers and families with very practical information and advice on how to improve the environment.

Exercise as Medicine®

http://exerciseismedicine.org.au

This website provides a range or resources for the general public, health care providers and encouraging active workplaces and working with industry partners. There are fact sheets, tools and forms and a monthly subscription newsletter for each of the target groups.

A national education package subsidised under the Chronic Disease Prevention and Service Improvement Fund provides free education sessions forGPs,PrimaryCareNursesandAlliedHealth Providers, further information on online modules and workshop dates are available at:

http://exerciseismedicine.org.au/health-care-providers/eim-education

The Australian Association for Gerontology (AAG) National Conference 27-29 November 2013

http://www.aag.asn.au/national-conference/2013-conference

TheconferencethemeisGreyExpectations:‘Ageinginthe 21st Century’ and includes a wide range of sessions including a Concurrent Session on Falls Prevention on the Friday 29th November. The program can be accessed at:

http://www.aag.asn.au/national-conference/conference-program


http://exerciseismedicine.org.au

http://exerciseismedicine.org.au/health-care-providers/eim-education

http://www.aag.asn.au/national-conference/2013-conference




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EpidemiologyOlder adults with acquired brain injury: A population based study

Chan V, Zagorski B, Parsons D, Colantonio A.

BMC Geriatr. 2013; 13(1): 97.

(Copyright © 2013, BioMed Central) DOI 10.1186/1471-2318-13-97 PMID 24060144

Abstract

BACKGROUND:Acquiredbraininjury(ABI),whichincludestraumatic(TBI)andnon-traumaticbraininjury(nTBI),is a leading cause of death and disability worldwide. The objective of this study was to examine the trends, characteristics,causeofbraininjury,anddischargedestinationofhospitalizedolderadultsaged65yearsandolderwithanABIdiagnosisinapopulationwithuniversalaccesstohospitalcare.Theprofileofcharacteristicsofpatients with TBI and nTBI causes of injury was also compared.

METHODS: A population based retrospective cohort study design with healthcare administrative databases was used. Data on acute care admissions were obtained from the Discharge Abstract Database and patients were identifiedusingtheInternationalClassificationofDiseases--Version10codesforOntario,CanadafromApril1,2003 to March 31, 2010. Older adults were examined in three age groups -- 65 to 74, 75 to 84, and 85+ years.

RESULTS: From 2003/04 to 2009/10, there were 14,518 episodes of acute care associated with a TBI code and 51, 233episodeswithanTBIcode.Overall,therateofhospitalizedTBIandnTBIepisodesincreasedwitholderagegroups. From 2007/08 to 2009/10, the percentage of patients that stayed in acute care for 12 days or more and the percentage of patients with delayed discharge from acute care increased with age. The most common cause of TBI was falls while the most common type of nTBI was brain tumours. The percentage of patients discharged to long term care and complex continuing care increased with age and the percentage discharged home decreased withage.In-hospitalmortalityalsoincreasedwithage.OlderadultswithTBIandnTBIdifferedsignificantlyindemographic and clinical characteristics and discharge destination from acute care.

CONCLUSIONS: This study showed an increased rate of acute care admissions for both TBI and nTBI with age. It also provided additional support for falls prevention strategies to prevent injury leading to cognitive disability with costly human and economic consequences. Implications for increased numbers of people with ABI are discussed.

Association of executive function impairment, history of falls and physical performance in older adults: A cross-sectional population-based study in eastern France

Muir SW, Beauchet O, Montero-Odasso M, Annweiler C, Fantino B, Speechley M.

J. Nutr. Health Aging 2013; 17(8): 661-665.

Affiliation:SusanWMuirPTPhD,ParkwoodHospital,DivisionofGeriatricsRoomA-350,801CommissionersRdE.London,Ontario,CanadaN6A5A5,Tel:519-685-4292ext.42577,Email:[email protected].

(Copyright © 2013, Springer Science+Business Media) DOI 10.1007/s12603-013-0045-4 PMID 24097019

Abstract

OBJECTIVE: To estimate: 1) the association between executive function (EF) impairment and falls; and 2) the association of EF impairment on tests of physical function used in the evaluation of fall risk. Design: Cross-sectional study. Setting: Thirteen health examination centres in Eastern France. Participants: Four thousand four hundred and eighty one community-dwelling older adults without dementia aged 65 to 97 years (mean age 71.8±5.4, women 47.6%).

MEASUREMENTS: Participants underwent a comprehensive medical assessment that included evaluations of EF usingtheClockDrawingTestandofphysicalperformanceusingtheTimedUpandGoTest(TUG).AnalysisusedmultivariablemodifiedPoissonregressiontoevaluatetheassociationbetweenimpairedEFandeachofthefalloutcomes (any fall, recurrent falls, fall-related injuries). Multivariable linear regression was used to evaluate the associationbetweenEFimpairmentandperformanceontheTUGandgripstrength.

RESULTS: EF impairment, assessed using the clock drawing test, was present in 24.9% of participants. EF impairment was independently associated with an increased risk of any fall (RR=1.13, 95% CI (1.03, 1.25)) and major soft tissue fall-related injury (RR= 2.42, 95% CI (1.47, 4.00)). Additionally, EF impairment was associated

AbstractsRecent abstracts from the research literature


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withworseperformanceontheTUG(p<0.0001).

CONCLUSIONS: EF impairment among older adults without dementia was highly prevalent and was independently associated with an increased risk for falls, fall-related injuries and with decreased physical function. The use of the Clock Drawing Test is an easy to administer measure of EF that can be used routinely in comprehensive fall risk evaluations.

Falls in Parkinson disease: Analysis of a large cross-sectional cohort

ParashosSA,WielinskiCL,GiladiN,GurevichT.

J. Parkinsons Dis. 2013; ePub(ePub): ePub.

Affiliation:StruthersParkinson’sCenter,GoldenValley,MN,USA.

(Copyright © 2013, IOS Press) DOI 10.3233/JPD-130249 PMID 24113557

Abstract

BACKGROUND:FallsremainasignificantcauseofmorbidityinPD.Riskfactorsarenotwellunderstood.

OBJECTIVE:InthisstudyweexploreriskfactorsforfallsinPDutilizingthecross-sectional,baselinedataintheNational Parkinson Foundation Quality Improvement Initiative (NPF-QII) database. Subjects are being followed prospectively, and this study will provide the basis for subsequent longitudinal analyses.

METHODS: A cross-sectional analysis of data from 2,876 ambulatory patients with Parkinson disease enrolled in the NPF-QII at 18 sites. Main outcome measure was falling history in the 3 months preceding assessment. The following were considered as possible predictor variables: age, sex, height, weight, body mass index, disease duration,ageatdiseaseonset,investigator’sconfidenceinthediagnosis,HoehnandYahrstage,resttremor,ability to stand unassisted, coexistent pathologies (cardiovascular, respiratory, diabetes, cancer, neurological, osteoarthritis,and“other”comorbidities),anticholinergics,antidepressants,antipsychotics,cognitiveenhancers,deepbrainstimulationsurgery,timed-up-and-go,semanticfluency,and5wordrecall.Variableswithassociationstotheoutcomemeasureinunivariateanalyseswereanalyzedinmultivariablemodelsusinglogisticregression.

RESULTS: 37.2% of subjects experienced falls. In the multivariable regression model the following variables were found to be independently associated with falls: disease duration; Hoehn and Yahr stage; absence of rest tremor; cardiovascular,arthritis,or“other”comorbidity;antidepressants;deepbrainstimulationsurgery;timed-up-and-go;and,semanticfluency.

CONCLUSION: Disease duration but not age is independently associated with falls in Parkinson disease. Timed-up-and-goaccuratelyreflectsfallsrisk.Impairedsemanticfluencyisindependentlyassociatedwithfalls,whileverbalmemory is not. Comorbidities, antidepressants, and deep brain stimulation also contribute to falls risk.

Risk AssessmentDevelopment and validation of a fall-related impulsive behaviour scale for residential care

Whitney J, Jackson SH, Close JC, Lord SR.

Age Ageing 2013; ePub(ePub): ePub.

Affiliation:ClinicalAgeResearchUnit,ClinicalGerontology,KingsCollegeHospitalNHSFoundationTrust,London,UK.

(Copyright © 2013, Oxford University Press) DOI 10.1093/ageing/aft130 PMID 24136339

Abstract

INTRODUCTION: impulsivity in older people with cognitive impairment has yet to be examined rigorously as a risk factor for falls. The objective of this study was to evaluate the psychometric properties of a new fall-related impulsive behaviour scale (FIBS) for a cognitively impaired population living in residential care.

METHODS: one hundred and nine care home residents (84.5 ± 8.3 years) were assessed on the FIBS and a range of behavioural, physical and neuropsychological measures. Participants were then prospectively followed up for falls for 6 months.


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RESULTS:theinternalreliability(Cronbach’sα=0.77)andtest-retestreliability(intra-classcorrelationcoefficient=0.93)oftheFIBSwerebothgood.ConstructvaliditywassupportedbysignificantcorrelationsbetweentheFIBSand the neuropsychiatric inventory (r = 0.43, P < 0.001), wandering (r = 0.33, P = 0.001) and global cognition (r = -0.2,P=0.04).ComparedwithresidentswithFIBSscores<1,thosewithFIBSscoresof≥1werenearlythreetimesmore likely to fall in the following 6 months, AOR = 2.92 (95% CI: 1.03-8.29).

CONCLUSION: the FIBS is a simple, valid and reliable scale for assessing fall-related impulsivity in care home residents and can be recommended for use in this group for both research and clinical purposes.

Severity of fall-based injuries, fear of falling, and activity restriction: Sex differences in a population-based sample of older Canadian adults

LebouthillierDM,ThibodeauMA,AsmundsonGJ.

J. Aging Health 2013; ePub(ePub): ePub.

Affiliation:UniversityofRegina,Saskatchewan,Canada.

(Copyright © 2013, Sage Publications) DOI 10.1177/0898264313507317 PMID 24150063

Abstract

OBJECTIVES:Littleisknownabouthowdifferentfall-basedinjuriesrelatetofearoffallingandactivityrestriction,andiftheserelationshipsdifferbetweensexes.Weexploredfearoffallingandactivityrestrictioninindividualswho have experienced fall-based injuries.

METHODS: A total of 16,369 older adults from the Canadian Community Health Survey reported their worst fall-based injury, whether they experience fear of falling, and whether they restrict activities from fear of falling.

RESULTS: Females had greater odds of fear of falling than males. Only females who experienced a fracture or head injury had increased odds of fear of falling and only females who experienced a head injury had increased odds of restricting activities compared with females who fell without injury.

DISCUSSION: Only severe fall-based injuries are associated with fear of falling and activity restriction, and this relationshipisuniquetofemales.Sexdifferenceswarrantfurtherinvestigationandsuggestaneedfortargetedinterventions.

Risk FactorsNeuropsychological, physical, and functional mobility measures associated with falls in cognitively impaired older adults

TaylorME,DelbaereK,LordSR,MikolaizakAS,BrodatyH,CloseJC.

J. Gerontol. A Biol. Sci. Med. Sci. 2013; ePub(ePub): ePub.

Affiliation:NeuroscienceResearchAustralia,BarkerStreet,Randwick,Sydney,NSW2031,[email protected].

(Copyright©2013,GerontologicalSocietyofAmerica)DOI10.1093/gerona/glt166PMID24149433

Abstract

BACKGROUND:Olderpeoplewithcognitiveimpairmenthaveanelevatedfallrisk,with60%fallingannually.There is a lack of evidence for fall prevention in this population, in part due to limited understanding of risk factors. This study examined fall risk in older people with cognitive impairment with an emphasis on identifying explanatoryandmodifiableriskfactors.

METHODS: One hundred and seventy-seven community-dwelling older people with mild-moderate cognitive impairment (Mini-Mental State Examination 11-23/Addenbrooke’s Cognitive Examination-Revised <83) underwent neuropsychological, physical, and functional assessments. Falls were recorded prospectively for 12 months with the assistance of carers.

RESULTS: Of the 174 participants available to follow-up, 111 (64%) fell at least once and 71 (41%) at least twice.Higherfallrateswereassociatedwithslowerreactiontime,impairedbalance(swayonfloorandfoam,semitandem, near-tandem, tandem stance), and reduced functional mobility (co-ordinated stability, timed up-and-go, steps needed to turn 180°, sit-to-stand, gait velocity). Higher fall rates were also associated with increased

Abstracts ContinuedRecent abstracts from the research literature


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medication use (central nervous system, total number) and poorer performances in cognitive (Addenbrooke’s Cognitive Examination-Revised: visuospatial domain, cube drawing; Trail-Making Test) and psychological (GeriatricDepressionScale,GoldbergAnxietyScale,FallsEfficacyScale-International)tests.Multivariateanalysisidentifiedincreasedswayonfoam,co-ordinatedstabilityscore,anddepressivesymptomstobesignificantlyandindependently associated with falls while controlling for age, years of education, and Addenbrooke’s Cognitive Examination-Revised score.

CONCLUSIONS:Thisstudyidentifiedseveralriskfactorsoffallsinolderpeoplewithcognitiveimpairment,anumberofwhicharepotentiallymodifiable.Futureresearchinvolvingtargetedinterventionsaddressingmedication use, balance, mood, and functional performance may prove useful for fall prevention in this population.

Different risk-increasing drugs in recurrent versus single fallers: Are recurrent fallers a distinct population?

AskariM,EslamiS,SchefferAC,MedlockS,deRooijSE,vanderVeldeN,Abu-HannaA.

Drugs Aging 2013; ePub(ePub): ePub.

Affiliation:DepartmentofMedicalInformatics,AcademicMedicalCenter,UniversityofAmsterdam,Meibergdreef9,1105AZ,Amsterdam,TheNetherlands,[email protected].

(Copyright©2013,AdisInternational)DOI10.1007/s40266-013-0110-zPMID23959914

Abstract

BACKGROUND:Polypharmacy,andspecificallytheuseofmultiplefall-risk-increasingdrugs(FRID),havebeenassociated with increased risk of falling in older age. However, it is not yet clear whether the known set of FRIDs can be extrapolated to recurrent fallers, since they form a distinct group of more vulnerable older persons with differentcharacteristics.

OBJECTIVES: We aim to investigate which classes of medications are associated with recurrent falls in elderly patients visiting the Emergency Department (ED) after a fall.

METHODS: This study had a cross-sectional design and was conducted in the ED of an academic medical center. Patients who sustained a fall, 65 years or older, and who visited the ED between 2004 and 2010 were invited to fillinavalidatedfallquestionnairedesignedtoassesspatientandfallcharacteristics(CAREFALLTriageInstrument[CTI]). We translated self-reported medications to anatomical therapeutic chemical (ATC) codes (at the second level). Univariate logistic regression analysis was performed to explore the association between medication classes and the outcome parameter (recurrent fall). Multivariate logistic regression was used to assess the associations after adjustment to potential confounders.

RESULTS: In total 2,258 patients participated in our study, of whom 39 % (873) had sustained two or more falls within the previous year. After adjustment for the potential confounders, drugs for acid-related disorders (adjusted odds ratio [aOR] 1.29; 95 % CI 1.03-1.60), analgesics (aOR 1.22; 95 % CI 1.06-1.41), anti-Parkinson drugs (aOR 1.59; 95 % CI 1.02-2.46), nasal preparations (aOR 1.49; 95 % CI 1.07-2.08), ophthalmologicals (aOR 1.51; 95 % CI 1.10-2.09); antipsychotics (aOR 2.21; 95 % CI 1.08-4.52), and antidepressants (aOR 1.64; 95 % CI 1.13-2.37) remainedstatisticallysignificantlyassociatedwithanEDvisitduetoarecurrentfall.

CONCLUSIONS: Known FRIDs, such as psychotropic drugs, also increase the risk of recurrent falls. However, we foundfourrelativelynewclassesthatshowedsignificantassociationwithrecurrentfalls.Inpart,theseclassesmayactasmarkersoffrailtyandcomorbidity,ortheymayreflectdifferencesintheriskfactorsaffectingtheolder,frailer population that tends to sustain recurrent falls. Further investigation is needed to elucidate causes and ways to prevent recurrent falls.

The impact of combined use of fall-risk medications and antithrombotics on injury severity and intracranial hemorrhage among older trauma patients

Hohmann N, Hohmann L, Kruse M.

Geriatr. Nurs. 2013; ePub(ePub): ePub.

Affiliation:UniversityofCaliforniaSanDiego,SkaggsSchoolofPharmacyandPharmaceuticalSciences,LaJolla,CA,USA;Wellaho-Sanitas,Inc.,SanDiego,CA,USA.Electronicaddress:[email protected].

(Copyright © 2013, Elsevier Publishing) DOI 10.1016/j.gerinurse.2013.09.001 PMID 24080143


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Abstract

PURPOSE:Useoffall-riskmedications(medicationsthatincreaseriskoffallingintheelderlyasdefinedbyBeerscriteria, STOPP/START criteria, and other literature) or antithrombotics is common in the elderly, and the impact of their concomitant use should be assessed in regards to fall injuries. The primary objective of this study is to assess the simultaneous outpatient use of fall-risk medications and antithrombotics in elderly fall-patients, and secondarilytoanalyzetheinjuryseverityscoreandoccurrenceofintracranialhemorrhage.

METHODS: Consecutive chart review at a level 2 trauma center in California, USA from August 01, 2009 to October 31, 2010. Records included 112 patients at least 65 years of age admitted with an outpatient fall. Fisher’s exact and Student’s t-tests were used (alpha 0.05, two-tailed) to examine prescribing patterns, intracranial hemorrhage occurrence, and injury severity score. Regression adjusted for antithrombotic and fall-risk medication type and number, opiate use, co-morbidities, age, and gender.

RESULTS: Thirty-nine percent (44/112) of outpatients were prescribed antithrombotics plus fall-risk medications. The mean injury severity score (ISS) was 13.3 (range 1-26, standard deviation 7.2) for patients taking both medication classes versus 9.7 (range 1-25, standard deviation 7.5) for patients taking antithrombotics alone (p = 0.027). Additionally, in patients over 80 years of age, intracranial hemorrhage occurred more frequently with the use of antithrombotics plus fall-risk medications versus antithrombotics alone (18/29 = 62.1% versus 7/24 =29.2%,p=0.027,oddsratio=3.974,95%confidenceinterval=1.094-15.010).Multivariateanalysesshowedan independent relationship between intracranial hemorrhage occurrence and type of therapy, as well as injury severity score and simultaneous therapy with fall-risk medications and antithrombotics.

CONCLUSION: Simultaneous prescribing of antithrombotics and fall-risk medications is common. For outpatients over 80 years of age, the odds of experiencing a post-fall intracranial hemorrhage are 4 times higher when prescribed antithrombotics plus fall-risk medications compared to antithrombotics alone, and injury severity is higher with combined use of these medication classes.

An exploration of risk for recurrent falls in two geriatric care settings

TariqH,KloseckM,CrillyRG,GutmanisI,GibsonM.

BMC Geriatr. 2013; 13(1): 106.

DOI 10.1186/1471-2318-13-106 PMID 24106879

Abstract

BACKGROUND:Falleventswereexaminedintwodistinctgeriatricpopulationstoidentifyfactorsassociatedwithrepeatfallers,andtoexaminewhetherpatientswhousegaitaids,specificallyawalker,weremorelikelytoexperience repeat falls. Each unit already had a generic program for falls prevention in place.

METHODS: Secondary data analysis was conducted on information collected during the pilot testing of a new quality assurance Incident Reporting Tool between October 2006 and September 2008. The study settings includedanin-patientgeriatricrehabilitationunit(GRU)andalongstayveterans’unit(LSVU)inarehabilitationand long-stay hospital in Ontario. Participants were two hundred and twenty three individuals, aged 65 years or older on these two units, who experienced one or more fall incidents during the study period.

RESULTS:LogisticregressionanalysesshowedthatontheGRUagewassignificantlyassociatedwithrepeatfalls.OntheLSVUfirstfallsinthemorningorlateeveningwereassociatedwithrepeatfalling.Walkerasagaitaidlistedattimeoffirstfallwasnotassociatedwithrepeatfalls.

CONCLUSIONS:Thisstudysuggeststhatdifferentinterventionmaybenecessaryindifferentgeriatricsettingsto identify, for secondary prevention, certain individuals for which the generic programs prove inadequate. Informationcollectionwithaspecificfocusontheissueofrepeatfallsmaybenecessaryforgreaterinsight.

Diabetes and risk of hospitalized fall injury among older adults

YauRK,StrotmeyerES,ResnickHE,SellmeyerDE,FeingoldKR,CauleyJA,VittinghoffE,deRekeneireN,HarrisTB,NevittMC,CummingsSR,ShorrRI,SchwartzAV.

Diabetes Care 2013; ePub(ePub): ePub.



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Affiliation:CentersforDiseaseControlandPrevention/CouncilofStateandTerritorialEpidemiologistsAppliedEpidemiologyFellowshipProgram,Atlanta,Georgia.

(Copyright © 2013, American Diabetes Association) DOI 10.2337/dc13-0429 PMID 24130352

Abstract

OBJECTIVETo determine whether older adults with diabetes are at increased risk of an injurious fall requiring hospitalization.

RESEARCHDESIGNANDMETHODSThelongitudinalHealth,Aging,andBodyCompositionStudyincluded3,075adultsaged70-79yearsatbaseline.HospitalizationsthatincludedICD-9-ClinicalModificationcodesforafallandaninjurywereidentified.Theeffectofdiabeteswithandwithoutinsulinuseontherateoffirstfall-relatedinjuryhospitalizationwasassessedusingproportionalhazardsmodels.

RESULTS At baseline, 719 participants had diabetes, and 117 of them were using insulin. Of the 293 participants whowerehospitalizedforafall-relatedinjury,71haddiabetes,and16wereusinginsulin.Diabeteswasassociatedwithahigherrateofinjuriousfallrequiringhospitalization(hazardratio[HR]1.48[95%CI1.12-1.95])in models adjusted for age, race, sex, BMI, and education. In those participants using insulin, compared with participants without diabetes, the HR was 3.00 (1.78-5.07). Additional adjustment for potential intermediaries, such as fainting in the past year, standing balance score, cystatin C level, and number of prescription medications, accounted for some of the increased risk associated with diabetes (1.41 [1.05-1.88]) and insulin-treated diabetes (2.24 [1.24-4.03]). Among participants with diabetes, a history of falling, poor standing balance score, and A1C level≥8%wereriskfactorsforaninjuriousfallrequiringhospitalization.

CONCLUSIONS Older adults with diabetes, in particular those using insulin, are at greater risk of an injurious fall requiringhospitalizationthanthosewithoutdiabetes.Amongthosewithdiabetes,poorglycemiccontrolmayincrease the risk of an injurious fall.

Association between sleep disturbances and falls among the elderly: Results from the German Cooperative Health Research in the Region of Augsburg-Age study

HelbigAK,DöringA,HeierM,EmenyRT,ZimmermannAK,AutenriethCS,LadwigKH,GrillE,MeisingerC.

Sleep Med. 2013; ePub(ePub): ePub.

Affiliation:InstituteofEpidemiologyII,HelmholtzZentrumMünchen,GermanResearchCenterforEnvironmentalHealth,Neuherberg,Germany.Electronicaddress:[email protected].

(Copyright © 2013, Elsevier Publishing) DOI 10.1016/j.sleep.2013.09.004 PMID 24157099

Abstract

OBJECTIVE: We aimed to examine the association between various sleep disturbances and falls among older indi-vidualsfromthegeneralpopulationwhileconsideringtheinfluenceofageanddizziness.

METHODS: Data were derived from the population-based cross-sectional KORA (Cooperative Health Research in theRegionofAugsburg)-Agestudy,wherebyinformationwasconductedinstandardizedtelephoneinterviewswith4127menandwomenagedα65yearsin2008and2009.Unstratifiedandstratified(byageanddizziness)multivariable logistic regression model analyses were performed.

RESULTS:Themultivariableanalysisshowedamarginallysignificantassociationbetweentroublestayingasleepandα1fallinthepreviousyear(oddsratio[OR],1.23[95%confidenceinterval(CI),1.01-1.50]).Thisassociationwas more pronounced in participants older than the age of 75years (OR, 1.58 [95% CI, 1.16-2.16]) and in individu-alswithoutdizziness(OR,1.35[95%CI,1.04-1.76]).Therewasnoassociationbetweendaytimesleepinessandfalls in the fully-adjusted models, but the odds of falls in the previous year in individuals older than the age of 75yearsweresignificantlyhigherforindividualswithdifficultyfallingasleep.Althoughsleepdurationwasnotassociatedwithfallsinmultivariableanalyseswhenstratifiedbydizziness,sleepdurationof9hdailywassignifi-cantly associated with higher odds of experiencing at least one fall in the previous year.

CONCLUSIONS: Our study suggested that the positive relationship between a trend towards longer sleep duration, trouble falling and staying asleep, and falls is strongest in older individuals and in individuals who did not experi encedizzinessinthepreviousyear.


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Fear of FallingFalls efficacy and self-rated health in older African American adults

TiernanC,LysackC,NeufeldS,GoldbergA,LichtenbergPA.

Arch. Gerontol. Geriatr. 2013; ePub(ePub): ePub.

Affiliation:HussonUniversity,UnitedStates.

(Copyright © 2013, Elsevier Publishing) DOI 10.1016/j.archger.2013.08.005 PMID 24063870

Abstract

Fearoffallingandmobilityrestrictionshaveasignificantnegativeimpactonthequalityoflifeofolderadults.BecauseolderAfricanAmericanadultsareatincreasedriskforvariousmodifiablehealthproblems,understandingpotential constraints on their overall health and mobility is critical in this population. The current study investigatedthisissuebyanalyzingadatasetof449olderAfricanAmericanadults(meanage=72.3years)livinginDetroit.Wecharacterizedandinvestigatedtherelationshipsamongthefollowingfalls-andhealth-relatedvariables:previousfalls,fallsefficacy,mobility,self-ratedhealth(SRH),anddepressionandwell-being.Asawhole,participants reported moderate health and well-being, little depression, few mobility problems (mean=8.4/40), andveryhighfallsefficacy(mean=94.9/100)despitethefactthataquarterofthesampleexperiencedafallwithinthepastyear.Correlationresultsindicatedthatpreviousfalls,fallsefficacy,mobility,SRHanddepressionandwell-beingwereallinter-related.RegressionanalysesrevealedthathigherfallsefficacywasmorecloselyassociatedwithbetterSRHthanwashavingpreviouslyfallen.FindingssuggestthatimprovingfallsefficacyinolderAfricanAmericanadultsmaybebeneficialtotheirmobilityandoverallhealthandwell-being.Further,byasking a single-item SRH question, clinicians may be able to quickly identify older African American adults who havelowfallsefficacyandareathighriskforfalling.

Concern about falling in older women with a history of falls: Associations with health, functional ability, physical activity and quality of life

Patil R, Uusi-Rasi K, Kannus P, Karinkanta S, Sievänen H.

Gerontology 2013; ePub(ePub): ePub.

Affiliation:TheUKKInstituteforHealthPromotionResearch,TampereUniversityHospital,Tampere,Finland.

(Copyright © 2013, Karger Publishers) DOI 10.1159/000354335 PMID 24107382

Abstract

BACKGROUND:Fearoffallinghasbeenlinkedtoactivityrestriction,functionaldecline,decreasedqualityoflifeand increased risk of falling. Factors that distinguish persons with a high concern about falling from those with low concern have not been systematically studied.

OBJECTIVE: This study aimed to expose potential health-related, functional and psychosocial factors that correlate with fear of falling among independently living older women who had fallen in the past year.

METHODS: Baseline data of 409 women aged 70-80 years recruited to a randomised falls prevention trial (DEX) (NCT00986466)wereused.ParticipantswereclassifiedaccordingtotheirlevelofconcernaboutfallingusingtheFallsEfficacyScaleInternational(FES-I).Multinomiallogisticregressionanalyseswereperformedtoexploreassociations between health-related variables, functional performance tests, amount of physical activity, quality of life and FES-I scores.

RESULTS:68%oftheparticipantsreportedamoderatetohighconcern(FES-I≥20)aboutfalls.Multinomiallogisticregressionshowedthathighlyconcernedwomenweresignificantlymorelikelytohavepoorerhealthandqualityoflifeandlowerfunctionalability.Reporteddifficultiesininstrumentalactivitiesofdailyliving,balance,outdoormobility and poorer quality of life contributed independently to a greater concern about falling.

CONCLUSIONS: Concern about falling was highly prevalent in our sample of community-living older women. In particular,poorperceivedgeneralhealthandmobilityconstraintscontributedindependentlytothedifferencebetween high and low concern of falling. Knowledge of these associations may help in developing interventions to reducefearoffallingandactivityavoidanceinoldage.©2013S.KargerAG,Basel.



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Interventions‘They will tell me if there is a problem’: Limited discussion between health professionals, older adults and their caregivers on falls prevention during and after hospitalization

LeeDC,McDermottF,HoffmannT,HainesTP.

Health Educ. Res. 2013; ePub(ePub): ePub.

Affiliation:AlliedHealthResearchUnit,KingstonCentre,MonashHealth,CnrHeathertonRoadandWarrigalRoad,Cheltenham, Victoria 3192, Australia,

(Copyright © 2013, Oxford University Press) DOI 10.1093/her/cyt091 PMID 24045410

Abstract

The objectives of this study were to describe the sources of falls prevention information provided to older adults duringandafterhospitalization,identifyandexplorereasonswhydiscussionaboutfallspreventionmaynottakeplace. Six participant groups were interviewed using semi-structured interviews or focus groups: (i) older patients (n = 16); (ii) caregivers (n = 8); (iii) allied health and nursing professionals (n = 33); (iv) doctors from acute wards (n = 8); (v) doctors from subacute wards (n = 10) and (vi) general practitioners (n = 9). Participants were recruited fromthreeAustralianhospitalsthatprovidedacuteandsubacutein-patientservicestotheolderadults.Generalpractitioners were recruited from the community of Melbourne. Findings showed provision of falls prevention information was dependent on setting of the ward and which health professionals the older adult encountered duringandafterhospitalization.Medicalpractitionerswerereactiveinprovidinginformation,whereasolderadults and their caregivers were passive in seeking falls prevention information. Several barriers in information provisionandinformationseekingwereidentified.Thereisgreatpotentialtoimprovetheconsistencyoffallspreventioninformationprovisiontoolderadultsduringhospitalizationandinpreparationfordischargetoassistwith prevention of falls in this high risk period.

Exergaming for balance training of elderly: State of the art and future developments

VanDiestM,LamothCJ,StegengaJ,VerkerkeGJ,PostemaK.

J. Neuroengineering Rehabil. 2013; 10(1): 101.


Abstract

Fallinjuriesareresponsibleforphysicaldysfunction,significantdisability,andlossofindependenceamongelderly. Poor postural control is one of the major risk factors for falling but can be trained in fall prevention programs.Thesehoweversufferfromlowtherapyadherence,particularlyifpreventionisthegoal.Toprovidea fun and motivating training environment for elderly, exercise games, or exergames, have been studied as balancetrainingtoolsinthepastyears.Thepresentpaperreviewstheeffectsofexergametrainingprogramsonpostural control of elderly reported so far. Additionally we aim to provide an in-depth discussion of technologies andoutcomemeasuresutilizedinexergamestudies.Thirteenpaperswereincludedintheanalysis.Mostofthereviewed studies reported positive results with respect to improvements in balance ability after a training period, yetfewreachedsignificantlevels.Outcomemeasuresforquantificationofposturalcontrolareundercontinuousdispute and no gold standard is present. Clinical measures used in the studies reviewed are well validated yet only give a global indication of balance ability. Instrumented measures were unable to detect small changes in balance ability as they are mainly based on calculating summary statistics, thereby ignoring the time-varying structure of the signals. Both methods only allow for measuring balance after the exergame intervention program. Current developments in sensor technology allow for accurate registration of movements and rapid analysis of signals. We propose to quantify the time-varying structure of postural control during gameplay using low-cost sensor systems. Continuous monitoring of balance ability leaves the user unaware of the measurements and allows for generating user-specificexergametrainingprogramsandfeedback,bothduringonegameandintimeframesofweeksormonths. This approach is unique and unlocks the as of yet untapped potential of exergames as balance training tools for community dwelling elderly.


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Intervention to prevent further falls in older people who call an ambulance as a result of a fall: A protocol for the IPREFER randomised controlled trial

MikolaizakAS,SimpsonPM,TiedemannA,LordSR,CaplanGA,BendallJC,HowardK,CloseJC.

BMC Health Serv. Res. 2013; 13(1): 360.


Abstract

BACKGROUND:Anincreasingnumberoffallsresultinanemergencycallandthesubsequentdispatchofparamedics. In the absence of physical injury, abnormal physiological parameters or change in usual functional status, it could be argued that routine conveyance by ambulance to the Emergency Department (ED) is not the mosteffectiveorefficientuseofresources.Further,itislikelythatnon-conveyedolderfallershavethepotentialtobenefitfromtimelyaccesstofallriskassessmentandintervention.Theaimofthisrandomisedcontrolledtrialistoevaluatetheeffectofatimelyandtailoredfallsassessmentandmanagementinterventiononthenumberofsubsequent falls and fall-related injuries for non-conveyed older fallers.

METHODS: Community dwelling people aged 65 years or older who are not conveyed to the ED following a fall will be eligible to be visited at home by a research physiotherapist. Consenting participants will receive individualised interventionstrategiesbasedonriskfactorsidentifiedatbaseline.Allpre-testmeasureswillbeassessedpriortorandomisation. Post-test measures will be undertaken by a researcher blinded to group allocation 6 months post-baseline. Participants in the intervention group will receive individualised pro-active fall prevention strategies from the clinical researcher to ensure that risk factors are addressed adequately and interventions carried out. The primary outcome measure will be the number of falls recorded by a falls diary over a 12 month period. Secondary outcome measures assessed six months after baseline will include the subsequent use of medical and emergency services and uptake of recommendations. Data will be analysed using the intention-to-treat principle.

DISCUSSION:Asthereiscurrentlylittleevidenceregardingtheeffectivenessorfeasibilityofalternatemodelsofcare following ambulance non-conveyance of older fallers, there is a need to explore assessment and intervention programs to help reduce subsequent falls, related injuries and subsequent use of health care services. By linking existing services rather than setting up new services, this pragmatic trial aims to utilise the health care system in anefficientandtimelymanner.

Leg strength declines with advancing age despite habitual endurance exercise in active older adults

Marcell TJ, Hawkins SA, Wiswell RA.

J. Strength Cond. Res. 2013; ePub(ePub): ePub.

Affiliation:1DepartmentofKinesiology,CaliforniaStateUniversityStanislaus,Turlock,CA95382,2Departmentof Exercise Science, California Lutheran University, Thousand Oaks, CA 91360, 3Department of Biokinesiology, University of Southern California, Los Angeles, CA 90033.

(Copyright © 2013, National Strength and Conditioning Association)

DOI 10.1097/JSC.0000000000000208 PMID 24045633

Abstract

Age-associated loss of muscle mass (sarcopenia) and strength (dynapenia) is associated with a loss of independence that contributes to falls, fractures, and nursing home admissions, while regular physical activity has beensuggestedtooffsettheselosses.Thepurposeofthisstudywastoevaluatetheeffectofhabitualenduranceexerciseonmusclemassandstrengthinactiveolderadults.Alongitudinalanalysisofmusclestrength(≈4.8yrs apart) was performed on 59 men (age at start of study: 58.6±7.3 yr) and 35 women (56.9±8.2 yr) who used endurance running as their primary mode of exercise. There were no changes in fat-free mass while body fat increasedminimally(1.0-1.5%).Trainingvolume(km•wk,d•wk)decreasedinboththemenandwomen.Therewasasignificantlossofbothisometrickneeextension(≈5%/yr)andkneeflexion(≈3.6%/yr)strengthinboththemenandwomen.However,therewasnosignificantchangeineitherisokineticconcentricoreccentrictorqueofthekneeextensors.Ourdatademonstratedasignificantdeclineinisometrickneeextensorandkneeflexorstrength while there were no changes in LBM in this group of very active older men and women. Our data support newerexerciseguidelinesforolderAmericanssuggestingresistancetrainingbeanintegralcomponentofafitnessprogram,andthatrunningalonewasnotsufficienttopreventthelossinmusclestrength(dynapenia)withaging.



17

A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: study protocol for a randomized controlled trial

GschwindYJ,KressigRW,LacroixA,MuehlbauerT,PfenningerB,GranacherU.

BMC Geriatr. 2013; 13(1): 105.


Abstract

BACKGROUND:Withincreasingageneuromusculardeficits(e.g.,sarcopenia)mayresultinimpairedphysicalperformance and an increased risk for falls. Prominent intrinsic fall-risk factors are age-related decreases in balance and strength / power performance as well as cognitive decline. Additional studies are needed to develop specificallytailoredexerciseprogramsforolderadultsthatcaneasilybeimplementedintoclinicalpractice.Thus,theobjectiveofthepresenttrialistoassesstheeffectsofafallpreventionprogramthatwasdevelopedby an interdisciplinary expert panel on measures of balance, strength / power, body composition, cognition, psychosocialwell-being,andfallsself-efficacyinhealthyolderadults.Additionally,thetime-relatedeffectsofdetraining are tested.

METHODS/DESIGN:Healthyoldpeople(N=54)betweentheageof65to80yearswillparticipateinthistrial.The testing protocol comprises tests for the assessment of static / dynamic steady-state balance (i.e., Sharpened RombergTest,instrumentedgaitanalysis),proactivebalance(i.e.,FunctionalReachTest;TimedUpandGoTest),reactive balance (i.e., perturbation test during bipedal stance; Push and Release Test), strength (i.e., hand grip strength test; Chair Stand Test), and power (i.e., Stair Climb Power Test; countermovement jump). Further, body composition will be analysed using a bioelectrical impedance analysis system. In addition, questionnaires for the assessment of psychosocial (i.e., World Health Organisation Quality of Life Assessment-Brief), cognitive (i.e., Mini MentalStateExamination),andfallriskdeterminants(i.e.,FallEfficacyScale--International)willbeincludedinthestudyprotocol.Participantswillberandomizedintotwointerventiongroupsorthecontrol/waitinggroup.After baseline measures, participants in the intervention groups will conduct a 12-week balance and strength / power exercise intervention 3 times per week, with each training session lasting 30 min. (actual training time). One intervention group will complete an extensive supervised training program, while the other intervention group will complete a short version (‘3 times 3’) that is home-based and controlled by weekly phone calls. Post-testswillbeconductedrightaftertheinterventionperiod.Additionally,detrainingeffectswillbemeasured12weeksafterprogramcessation.Thecontrolgroup/waitinggroupwillnotparticipateinanyspecificinterventionduring the experimental period, but will receive the extensive supervised program after the experimental period.

DISCUSSION: It is expected that particularly the supervised combination of balance and strength / power training will improve performance in variables of balance, strength / power, body composition, cognitive function, psychosocialwell-being,andfallsself-efficacyofolderadults.Inaddition,informationregardingfallriskassessment,dose--response-relations,detrainingeffects,andsupervisionoftrainingwillbeprovided.Further,training-induced health-relevant changes, such as improved performance in activities of daily living, cognitive function, and quality of life, as well as a reduced risk for falls may help to lower costs in the health care system. Finally,practitioners,therapists,andinstructorswillbeprovidedwithascientificallyevaluatedfeasible,safe,andeasy-to-administerexerciseprogramforfallprevention.Trialregistration:ClinicalTrials.govIdentifier:NCT01906034.

Factors associated with the completion of falls prevention program

BatraA,PageT,MelchiorM,SeffL,VieiraER,PalmerRC.

Health Educ. Res. 2013; ePub(ePub): ePub.

Affiliation:RobertStempelCollegeofPublicHealthandSocialWork,11200SW8thStreet,Miami,FL33199,USAand AHC3-430, 11200 SW 8th Street, Miami, FL 33199, USA.

(Copyright © 2013, Oxford University Press) DOI 10.1093/her/cyt099 PMID 24122324

Abstract

Fallsandfearoffallingcanaffectindependenceandqualityoflifeofolderadults.Fallspreventionprogramsmay help avoiding these issues if completed. Understanding factors that are associated with completion of falls


18

prevention programs is important. To reduce fear of falling and increase activity levels, a Matter of Balance (MOB) andunAsuntodeEquilibrio(ADE)workshopswereofferedto3420olderadultsinSouthFloridabetween1Octo-ber 2008 and 31 December 2011. Workshops were conducted in English or Spanish over eight, 2-hour sessions. Participants completed a demographic and a pre-post questionnaire. Factors associated with program completion wereidentifiedusinglogisticregression.ForMOB,femalesweremorelikelytocompletetheprogram(OR=2.076,P=0.02).ForADE,females,moderateandextremeinterferencebyfallsinsocialactivitieswerefoundtoaffectcompletion(OR=2.116,P=0.001;OR=2.269,P=0.003andOR=4.133,P=0.008,respectively).Differentfac-tors predicted completion of both programs. Awareness of these factors can help lower the attrition rates, increase benefitsandcosteffectivenessofprogram.Futureresearchneedstoexplorewhycertaingroupshadahigherlikelihood of completing either program.

Effects of a one-year home-based case management intervention on falls in older people: A randomized con-trolled trial

Olsson Möller U, Kristensson J, Midlöv P, Ekdahl C, Jakobsson U.

J. Aging Phys. Act. 2013; ePub(ePub): ePub.

Affiliation:CenterforPrimaryHealthCareResearch,FacultyofMedicine,LundUniversity,Malmö,Sweden.

(Copyright © 2013, Human Kinetics Publishers) DOI unavailable PMID 24152667

Abstract

OBJECTIVES:Toinvestigatetheeffectsofahome-basedone-yearcasemanagementinterventioninolderpeoplewith functional dependency and repeated contact with the healthcare services on self-reported falls and self-reported injurious fall.

METHODS:Thestudywasarandomizedcontrolledtrialwithrepeatedfollow-ups.Thesample(n=153)werecon-secutively and randomly assigned to intervention group (n=80, mean age 81.4) or control group (n=73, mean age 81.6). The intervention group received a case management intervention which comprised monthly home-visits during 12 months by nurses and physiotherapists employing a multifactorial preventive approach.

RESULTS: In the intervention group 96 falls occurred during the intervention period compared with 85 falls in the control group (p=0.900). There were 40 and 38 injurious falls (p=0.669) in the intervention and control groups, respectively.

CONCLUSIONS: This home-based case management intervention was not able to prevent falls or injurious falls.

Reducing falls and fall-related injuries in mental health: A 1-year multihospital falls collaborative

Quigley PA, Barnett SD, Bulat T, Friedman Y.

J. Nurs. Care Qual. 2013; ePub(ePub): ePub.

Affiliation:VISN8PatientSafetyCenterofInquiry(DrsQuigleyandBulatandMsFriedman)andHSR&D/RR&DResearch Center of Excellence (Dr Barnett), James A. Haley Veterans’ Hospital, Tampa, Florida.

(Copyright © 2013, Lippincott Williams and Wilkins) DOI 10.1097/01.NCQ.0000437033.67042.63 PMID 24149183

Abstract

Despite much research on falls occurring on medical-surgical units and in long-term care settings, falls on inpa-tient psychiatry units are understudied. On the basis of fall injury program characteristics across multiple inpatient psychiatry units, we developed and implemented an operational strategic plan to address each falls prevention program element and enhance program infrastructure and capacity. Expert faculty provided lectures, coaching, and mentoring through biweekly conference calls and collaborative e-mail exchange. Findings support continued effortstointegratemeasurestoreduceseriousfall-relatedinjuries.


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You need to be a subscriber to the listserv to send an email that will be distributed to all members of the listserv. Remember to put a short description in the subject line.

Recently some posts to the listserv have bounced due to email address changes, you need to re-subscribe with your new e-mail address and unsubscribe from your old address following the Join the Network instructions as shown on this page.

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

international;• Sharing resources developed and exploration

of opportunities to combine resources in joint initiatives;

• Encouragement of collaborative projects and research;

• Toactasagrouptoinfluencepolicy;• To liaise with NSW Ministry of Health to provide

information on current State/Commonwealth issues in relation to falls and

• Maintenanceofresourcespertinenttothefield.

The main purpose of the network is to share knowledge, expertise and resources on falls prevention for older people.

The NSW Falls Prevention Network activities are part of the implementation of the NSW Falls Prevention Policy funded by the NSW Ministry of Health.

“Falls Prevention is Everyone’s Business®”

Falls Network Informationfallsnetwork.neura.edu.au

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mailto:[email protected]




http://fallsnetwork.neura.edu.au

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