Deaths from Falls Among Persons Aged ≥65 Years - United States, 2007-2016

Dual task reactive balance control in older adults with mild cognitive impairment: does the cognitive task domain make a difference?

Older adults with mild cognitive impairment (OAwMCI) demonstrate higher cognitive-motor interference (CMI) than cognitively intact older adults (CIOA) during dual tasking. However, studies have rarely examined how dual tasking affects reactive balance control in OAwMCI, or the effect of different cognitive task domains. This study compared how four cognitive tasks affected CMI during reactive balance control in OAwMCI vs. CIOA. In this study, 38 OAwMCI [Montreal Cognitive Assessment (MoCA): 18-25] and 38 CIOA (MoCA ≥ 26) were included and exposed to anterior support surface perturbations in single task and while performing four cognitive tasks: two visuomotor tasks (Target, Track), auditory clock test (ACT), and letter number sequencing (LNS). Cognitive tasks were also completed during unperturbed standing. In both single and dual task conditions, OAwMCI had a higher fall rate and lower reactive center of mass (COM) stability than CIOA. Reactive balance performance deteriorated in both groups while performing Target and Track, although was not affected by ACT or LNS. Cognitive performance was lower in dual vs. single task on the Target, Track, and LNS for both groups, although OAwMCI had higher cognitive costs than CIOA. These findings suggest that dual tasking could increase fall risk in both OAwMCI and CIOA, although visuomotor tasks induced greater CMI than executive function/working memory tasks, suggesting greater sharing of resources with reactive balance control. Furthermore, OAwMCI could experience higher CMI due to damage in sensorimotor areas involved in triggering/executing reactive balance responses, along with multidomain cognitive decline. Comprehensive dual task assessments could identify domain-specific cognitive decline in OAwMCI.NEW & NOTEWORTHY Although OAwMCI have higher CMI than CIOA during volitional balance tasks, it is unclear how dual tasking involving different cognitive domains affects reactive balance control in OAwMCI. This study showed that dual tasking could impair reactive balance responses in both CIOA and OAwMCI, although OAwMCI experienced greater performance deteriorations in dual vs. single task conditions. Furthermore, visuomotor tasks induced higher CMI than executive function/working memory tasks, suggesting greater sharing of resources with reactive balance control.

Trends and determinants of falls: A generalized estimating equations modelling approach using serial data from the Geelong Osteoporosis Study

BACKGROUND

With Australia's aging population, the incidence of falls is expected to rise. The proportion of adults aged ≥65 years is projected to increase from 15 % in 2017 to 22 % by 2057, highlighting the growing need for effective fall prevention measures. Therefore, this study aimed to assess fall trends and determinants using repeated follow-up data from a population-based study.

METHODS

This study utilized data from the Geelong Osteoporosis Study (GOS) to analyse fall trends in men and women. Men's data were collected at baseline (2001-2006; n = 1533), 5 years (2006-2011; n = 968), and 15 years (2016-2021; n = 627), while women's data were from 6 years (2001-2003; n = 1014), 10 years (2004-2008; n = 1098), and 15 years (2011-2014; n = 844). Falls data, self-reported for the past 12 months, were age-standardised to the Australian population. Data included self-reported prior fractures, medications, comorbidities, alcohol use, and smoking, along with measured anthropometrics, muscle strength, biochemical tests, and imaging. A multivariable Generalised Estimating Equation model identified fall determinants, reporting adjusted odds ratios (AORs) and 95 % confidence intervals.

RESULTS

In men, the age-adjusted prevalence of falls declined over time, while in women, it initially dropped by 4.2 % before a slight 0.6 % increase. After adjusting for confounders, each additional year of age raised the fall risk by 1 % (AOR = 1.01, 95 % CI: 1.00-1.02). Women had a 52 % higher likelihood of falling than men (AOR = 1.52, 95 % CI: 1.22-1.88). Diabetes increased the risk by 69 % (AOR = 1.69, 95 % CI: 1.23-2.31), while a 1 N/kg increase in hip flexion strength lowered the risk by 3 % (AOR = 0.97, 95 % CI: 0.95-0.99).

CONCLUSION

Men experienced a steady decrease in fall prevalence over time, whereas women displayed a more intricate trend, with falls initially declining before subsequently rising, following a polynomial pattern. The key predictors of falls included age, sex, diabetes and hip flexion strength. Policies should prioritize tailored fall prevention, strength training, and diabetes care integration.

Effects of Noise Exposure on Video Ocular Counter Roll Measurements

PURPOSE

The purpose of this study was to evaluate the effect of noise exposure on otolith function measures of video ocular counter roll (vOCR), ocular vestibular evoked myogenic potential (oVEMP), cervical VEMP (cVEMP), and subjective visual vertical (SVV). Additionally, this study compared the vOCR results with other otolith function measures: cVEMP, oVEMP, and SVV.

METHOD

This was a cross-sectional, between-group prospective study that compared otolith function tests between noise exposure groups. Thirty-three adults between the ages of 40-60 years with no middle ear pathology, history of balance disorder, neurologic pathology, systemic diseases, or receiving ototoxic medications were included in the study. Group 1 included 17 adults (34 ears) with low-risk noise exposure, and Group 2 included 16 adults (32 ears) with high-risk noise exposure. Independent samples t tests were used to assess group mean differences for dependent variables. The independent variable was group with two levels (low risk and high risk). The dependent variables were Noise Exposure Structured Interview (NESI) score, vOCR torsion, cVEMP amplitude, oVEMP amplitude, and SVV angle. Additional analyses were completed using Pearson correlation to evaluate the relationship of vOCR to the other otolith function tests and NESI score to the otolith function tests.

RESULTS

The results indicated significantly decreased vOCR torsion, cVEMP amplitude, and oVEMP amplitude in individuals with high-risk noise exposure compared with those in the low-risk group. Significant correlations were found for NESI scores as well as vOCR and oVEMP measures.

CONCLUSIONS

This study describes the concomitant degeneration of the auditory and vestibular systems from noise exposure affecting otolith function, as measured by audiologic testing and otolith testing. vOCR appears to be sensitive to this degeneration, indicating that vOCR could be used as a vestibular screening measure for patients with noise exposure and/or suspected utricle dysfunction.

Development and Implementation of Strong Foundations, a Digitally Delivered Fall Prevention Program: Usability and Feasibility Pilot Exercise Cohort Study

Background

Falls remain a major public health problem and a significant cause of preventable injury. Maintaining strength and balance by staying active can prevent falls in older adults, and public health advocates support referral to community exercise programs. Given the growth in use and acceptance of technological interfaces, there remains an interest in understanding the role of a synchronous exercise program designed to improve strength, postural alignment, and balance specifically designed to be delivered in a digital environment with respect to usability and feasibility.

Objective

This study aims to design and implement a synchronously delivered digital fall prevention program to adults aged 60 years and older, to understand the usability, feasibility, and attendance.

Methods

The "Strong Foundations" program, a 12-week, live, digitally delivered fall-prevention exercise program was informed from different existing in-person exercises and piloted to older adults who were considered a low fall risk by scores of 4 or less from the Centers for Disease Control and Prevention's (CDC's) Stopping Elderly Accidents and Deaths Initiative (STEADI) Staying Independent questionnaire. The System Usability Scale (SUS) measured usability and feasibility at the completion of this program, and digital measures of age-related function (timed up and go [TUG] and 30-second chair stand [30 CS]) were collected pre- and postintervention. Data were collected in 2021.

Results

A total of 39 older adults were recruited and 38 completed the 12-week program with an average age of 72 years. The average SUS was 80.6, with an 85% attendance rate and an 8.5 (out of 10) self-reported satisfaction score. Digitally collected TUG and 30 CS statistically improved pre- and postintervention by 9% and 24%, respectively; by week 12, 64% (23/36) of participants improved in the timed up and go and 91% (32/35) improved the chair stands.

Conclusions

There was excellent usability and acceptability for Strong Foundations, a novel fall-prevention program designed to be delivered digitally and promising improvement of objective measures of fall risk.

The effects of perturbation intensities on backward slip-falls induced by a split-belt treadmill

Fall-inducing systems have two critical applications. One is to obtain the biomechanical features of falling, and the other is to systematically train individuals and reduce the risk of falling. While the former application necessitates the occurrence of falls, the latter does not require fall-inducing perturbations to be excessively intense. The purposes of the study were to investigate the effects of perturbation intensities (a combination of speeds and durations) on the number of falls, fall rates, and maximum loading forces resulting from slips induced by a split-belt treadmill. Twenty-four young adults (12 males and 12 females) completed 16 randomized trials (12 perturbation trials and 4 false trials). The forces between a safety harness and a rail were used to identify falls and non-falls and to assess the maximum loading force during falls. Although the number of falls, fall rates, and maximum loading force significantly increase as the slipping speed increases for both durations, the relative risk analysis shows that fall risk significantly increases as the slipping speed increases regardless of the duration. These findings may contribute to developing design criteria for controlled perturbations using a split-belt treadmill, aimed at enhancing our understanding of fall biomechanics and informing fall prevention training programs.

Caregiver beliefs about older adult falls from a nationally representative U.S. sample 2022

INTRODUCTION

Falls represent a prevalent cause of injury, disability, and mortality in the United States among older adults (ages 65+). Falls are not an inherent part of aging and adopting evidence-based fall prevention strategies can reduce fall risk. Caregivers are well-positioned to increase awareness and uptake of fall prevention strategies among older adults but may not be aware of all effective strategies. The objective of this study was to assess caregivers' beliefs and awareness related to older adult falls and evidence-based prevention strategies.

METHODS

Questions about falls were included in the SummerStyles survey, part of the 2022 suite of Porter Novelli ConsumerStyles surveys. Questions covered demographic and health characteristics of respondents, caregiver status, and knowledge of evidence-based fall prevention strategies. We compared demographic, health, and fall prevention knowledge by caregiver status and age.

RESULTS

Caregivers were more likely to be women, 65+, and report low income and fair/poor health compared to non-caregivers. Most (88.8%) caregivers did not believe older adult falls are inevitable. Most caregivers (94.0%) reported knowing at least one evidence-based fall prevention strategy, but many also identified strategies with limited evidence, such as being more careful (75.1%), as effective. Few caregivers recognized interventions like Tai Chi (13.4%) and medication management (23.3%) as effective. However, caregivers often recognized the importance of making homes safer (84.8%) and strength or balance exercises (76.4%).

CONCLUSIONS

Our findings highlight the need for expanded education aimed at caregivers to raise awareness about fall risks and all evidence-based fall prevention strategies.

PRACTICAL APPLICATIONS

Public health efforts can benefit from effectively educating and empowering older adults and their caregivers to play a proactive role in fall prevention and aging without injury. Results can facilitate targeted education and support of caregivers and creation of caregiver-driven programs to address fall risk and prevention.

Social and health disparities associated with healthy brain ageing in Brazil and in other Latin American countries

BACKGROUND

Latin American countries present major health-related inequities due to historical, cultural, and social aspects. Recent evidence highlights that factors related to social and health disparities outweigh classic demographic factors in determining healthy brain aging in these populations. However, these analyses have not been conducted with the Brazilian population, the largest and most ethnically diverse population in Latin America.

METHODS

Here, we evaluated demographic, social, and health factors for healthy brain ageing using a machine learning model in a Brazilian population-based cohort (n=9412) and in additional cohorts from other Latin American countries, including Colombia (n=23 694), Chile (n=1301), Ecuador (n=5235), and Uruguay (n=1450).

FINDINGS

In the Brazilian population and other Latin American countries, social and health disparities were more influential than demographic factors for cognition and functional ability. Uniquely in Brazil, education emerged as the primary risk factor impacting cognitive outcomes, diverging from other Latin American countries where mental health symptoms played more prominent roles. In terms of functional ability, Brazil displayed a distinct pattern, with mental health symptoms identified as the primary contributing factor.

INTERPRETATION

Our findings indicate that Brazil converges with other Latin American countries to show that heterogeneous factors impacted more than demographic factors, but also showed a unique set of health factors when compared with other Latin American countries. Therefore, our study emphasises that social and health disparity factors are relevant predictors of healthy brain ageing in Latin America, but population-specific analyses are necessary to identify the specific risk profiles of each country.

FUNDING

None.

TRANSLATIONS

For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.

Estimating hip impact velocity and acceleration from video-captured falls using a pose estimation algorithm

Analyzing video footage of falls in older adults has emerged as an alternative to traditional lab studies. However, this approach is limited by the labor-intensive process of manually labeling body parts. To address this limitation, we aimed to validate the use of the AI-based pose estimation algorithm (OpenPose) in assessing the hip impact velocity and acceleration of video-captured falls. We analyzed 110 videos of 13 older adults (64.0 ± 5.9 years old) falling sideways in an experimental setting. By applying OpenPose to each video, we generated a time series of hip positions in the video, which were then analyzed using custom MATLAB code to calculate hip impact velocity and acceleration. These calculations were compared against ground truth measurements obtained from motion capture systems (VICON for hip impact velocity) and inertial measurement units (MC10 for hip impact acceleration). We examined the agreement between the ground truth and OpenPose measurements in terms of mean of absolute error (MAE), mean of absolute percentage error (MAPE), and bias (mean of error). Results showed that OpenPose had a good accuracy in estimating hip impact velocity with minimal bias (MAE: 0.17 ± 0.13 m/s, MAPE: 7.28 ± 5.21%; percent bias: - 1.27%). However, its estimation of hip impact acceleration (i.e., peak vertical hip acceleration at impact) showed poor accuracy (MAPE: 26.3 ± 19.4%), showing substantial underestimation in instances of high acceleration impacts (> 3.0 g). Further ANOVA analysis revealed OpenPose's ability to discern significant differences in hip impact velocity and acceleration based on the movement response utilized during the fall (e.g., stick-like fall, tuck-and-roll, knee block). This is the first study to validate the use of a pose estimation algorithm for identifying the hip impact kinematics in video-captured falls among older adults. Future validation studies involving diverse camera settings, fall contexts, and biomechanical parameters are warranted to extend this support for using pose estimation algorithms in this field.

Robots in Nursing Homes: Helping Nurses Detect and Prevent Falls

Falls are a leading cause of morbidity and mortality in older adults, especially among nursing home residents. Falls occur more commonly among older adults with dementia than among those without dementia. Moreover, half of nursing home residents have moderate to severe cognitive impairment. While less than 5% of older adults live in nursing homes, they account for 20% of deaths from falls in this age group. In addition, 78% of older adults who fall need help in getting up from the floor. The consequences of falling, such as prolonged lying on the floor, can produce severe and prolonged health effects. The acute shortage of staff in nursing homes, especially during evening, night and weekend shifts, can delay the detection and response to falls. There are various systems designed to detect falls and alert staff, including those utilizing wearable devices, ambience sensors and cameras (vision) as well as fusion systems. They each have their advantages and drawbacks. In this NIA-funded SBIR grant, we are developing and testing the feasibility of a fall detection and prevention system that addresses the drawbacks of previous systems. We anchor our approach on the deployment of an autonomously navigating robot equipped with a mounted infrared camera and machine learning software designed to detect the risk of falls and falls themselves. The robot will patrol resident rooms during evening and night shifts and alert the staff, allowing them to evaluate the fall risk or fall alert presented by the robot video camera and determine whether indeed a resident has fallen or is at risk of falling, and take appropriate action.

Temporal trends and patterns in mortality from falls across 59 high-income and upper-middle-income countries, 1990-2021, with projections up to 2040: a global time-series analysis and modelling study

BACKGROUND

Deaths related to falls are a substantial public health problem worldwide, and insight into trends and differences in global fall-related deaths can be valuable for identifying prevention strategies and developing effective policies. Thus, we aimed to estimate global fall-related mortality rate trends and forecast future fall-related deaths.

METHODS

In this global time-series analysis and modelling study, we investigated temporal trends in fall-related mortality rates from 1990 to 2021 using the WHO Mortality Database, following the GATHER guidelines, and forecasted trends until 2040 across 59 high-income and upper-middle-income countries. We focused on identifying specific patterns of variation in mortality rates across different age groups, sexes, and income levels based on World Bank country classification. We analysed temporal trends and patterns using a locally weighted scatter plot smoother curve presented by age-standardised mortality rates (ASMRs), and future projections were calculated based on Bayesian age-period-cohort analysis. We performed a decomposition analysis to identify variations in fall-related deaths by examining factors such as population growth, ageing, and epidemiological changes.

FINDINGS

Fall-related mortality rates per 100 000 people declined from 23·21 (95% CI 21·30 to 25·12) in 1990 to 11·01 (9·94 to 12·08) in 2009, increasing to 12·50 (10·36 to 14·64) by 2021. Throughout the period from 1990 to 2021, fall-related mortality rates were consistently higher among men, individuals in high-income countries, and older adults. The results represent a clear pattern in fall-related mortality rates according to sex, income level, and age group. ASMRs exhibited varying patterns, with an initial decrease of 43·83% (from 11·54 [95% CI 9·33 to 13·76] in 1990 to 6·48 [95% CI 5·28 to 7·68] in 2005) in upper-middle-income countries with a subsequent rise of 49·69% to 9·70 (9·33 to 13·76) in 2021, with a 17·81% increase among women (from 9·04 in 2009 to 10·65 in 2021), and with a 1434·8% increase in individuals aged 85 years and older (from 5·00 [-4·94 to 14·94] in 1992 to 76·74 [62·10 to 91·39] in 2021). Furthermore, ASMRs showed a positive correlation with Socio-demographic Index (β=42·29 [10·26 to 74·32]; p<0·011), the Environmental Performance Index (β=0·19 [0·05 to 0·33]; p=0·0090), and the reverse Gini coefficient (β=22·58 [0·45 to 44·72]; p=0·046). Projections indicate that the fall-related mortality rate is expected to rise from 14·80 (95% credible intervals, 14·04 to 15·59) per 100 000 people in 2021 to 19·48 (7·02 to 98·84) by 2040. The increase in fall-related deaths from 1990 to 2040 can be attributed to the growth in population, because the absolute number of fall-related deaths has risen despite a declining rate.

INTERPRETATION

Temporal trend in fall-related deaths declined from 1990 to 2009, followed by an increase in 2021. Fall-related deaths among women and individuals aged 85 years and older will continue to increase until 2040, particularly in upper-middle-income countries. Urgent and proactive implementation of targeted interventions and prevention programmes is necessary to reduce fall-related mortality effectively.

FUNDING

National Research Foundation of Korea.

Changes in Emergency Department and Inpatient Encounters for Falls after the Onset of the COVID-19 Pandemic

OBJECTIVE

This study investigates changes in clinical encounters due to falls before and after the onset of the COVID-19 pandemic.

METHODS

De-identified health record data from a large mid-western health system was used to examine the frequency of emergency department (ED) and inpatient (IP) encounters for falls by month among adults age 50+ (N = 485, 886 patients) using joinpoint regression analysis. Also, overall rates before and during the pandemic were compared using log-binomial models.

RESULTS

Fall rates increased following the onset of the COVID-19 pandemic for IP encounters but not for ED encounters. There were no differences by age, gender, race, or nSES. Monthly IP fall rates increased by 0.68% per month both before and after the onset of the COVID-19 pandemic.

CONCLUSION

Pandemics may occur in the future, and interventions are needed to prevent falls in older adults during the next public health emergency.

A framework to automatically detect near-falls using a wearable inertial measurement cluster

Accurate and automatic assessments of body segment kinematics via wearable sensors are essential to provide new insights into the complex interactions between active lifestyle and fall risk in various populations. To remotely assess near-falls due to balance disturbances in daily life, current approaches primarily rely on biased questionnaires, while contemporary data-driven research focuses on preliminary fall-related scenarios. Here, we worked on an automated framework based on accurate trunk kinematics, enabling the detection of near-fall scenarios during locomotion. Using a wearable inertial measurement cluster in conjunction with evaluation algorithms focusing on trunk angular acceleration, the proposed sensor-framework approach revealed accurate distinguishment of balance disturbances related to trips and slips, thereby minimising false detections during activities of daily living. An important factor contributing to the framework's high sensitivity and specificity for automatic detection of near-falls was the consideration of the individual's gait characteristics. Therefore, the sensor-framework presents an opportunity to substantially impact remote fall risk assessment in healthy and pathological conditions outside the laboratory.

Dynapenia-abdominal obesity and mortality risk, is independent effect obscured by age and frailty?:Birjand Longitudinal Aging Study (BLAS)

Background

Abdominal obesity and low muscle strength, known separately as risk factors for mortality, might have a synergistic effect when they co-occur. Dynapenic abdominal obesity (DAO) is a condition defined by the presence of both. However, DAO's independent and combined impact on mortality remains under investigation.

Objective

The objective of the present study was to evaluate the association of dynapenia, abdominal obesity, and dynapenic abdominal obesity with all-cause mortality among community-dwelling older adults.

Methods

This is a longitudinal study with a 5-year follow-up conducted involving 1,354 community-dwelling older adults (≥ 65 years) of the Birjand Longitudinal Aging Study (BLAS). Abdominal obesity and dynapenia were respectively defined based on waist circumference (> 102 cm for men and > 88 cm for women) and grip strength (< 26 kg for men and < 16 kg for women). The sample was divided into four groups: non-dynapenic/non-abdominal obesity (ND/NAO), dynapenic/non-abdominal obesity (D/NAO), non-dynapenic/abdominal obesity (ND/AO), and dynapenic/abdominal obesity (D/AO). The outcome was all-cause mortality registered through four methods: 1- telephone interview with the family of the participants during September 2018 and February 2024, 2- hospital information systems, 3- death registry of the deputy of the Health of Birjand University of Medical Sciences 4- in a subject who died at home or out of hospital death registry was verified by a verbal autopsy performed by a clinician. Univariate and multiple Logistic regression models were used to estimate the risk of all-cause mortality as a function of dynapenia and abdominal obesity in competing events controlled by age, sex, multi-morbidity, and frailty.

Results

The mean age of the study participants was 69.77 ± 7.55 years, and about 703 (51.71%) were female. There was a statistical difference between the alive and the deceased groups in terms of sex, age, multimorbidity, and frailty. Mortality was statistically higher among dynapenic participants (P < 0.001). Unadjusted logistic regression analysis explored the relationship between D/NAO and mortality (OR = 2.18; CI 95% 1.25-3.78). In the adjusted models, no significant relationships were observed. Age and frailty had significant associations with mortality.

Conclusion

While our study found an association between dynapenia without abdominal obesity and increased mortality risk, factors like age and frailty might play a stronger role. These require further investigation to understand the independent effect of dynapenia on mortality fully.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01501-8.

Fall Trajectories in Older Men: Trajectories of Change by Age and Predictors for Future Fall Risk

BACKGROUND

Very little is known about specific trajectories or patterns of falls over time. Using the well-characterized cohort of the Osteoporotic Fractures in Men Study (MrOS), we classified individuals by fall trajectories across age and identified predictors of group assignment based on characteristics at baseline.

METHODS

Using an analysis sample of 5 976 MrOS participants and 15 years of follow-up data on incident falls, we used group-based trajectory models (PROC TRAJ in SAS) to identify trajectories of change. We assessed the association of baseline characteristics with group assignment using 1-way analysis of variance and chi-square tests. Multivariable logistic regression was used to analyze the outcome of the high-risk fall trajectory groups compared to the low-risk groups.

RESULTS

Changes in rates of falls were relatively constant or increasing with 5 distinct groups identified. Mean posterior probabilities for all 5 trajectories were similar and consistently above 0.8 indicating a reasonable model fit. Among the 5 fall trajectory groups, 2 were deemed high risk, those with steeply increasing fall risk and persistently high fall risk. Factors associated with fall risk included body mass index, use of central nervous agents, prior history of diabetes and Parkinson's disease, back pain, grip strength, and physical and mental health scores.

CONCLUSIONS

Two distinct groups of high fall risk individuals were identified among 5 trajectory groups, those with steeply increasing fall risk and persistently high fall risk. Statistically significant characteristics for group assignment suggest that future fall risk of older men may be predictable at baseline.

Factors Associated With Incident and Recurrent Falls Among Men Enrolled in Evidence-Based Fall Prevention Programs: An Examination of Race and Ethnicity

We examined factors associated with incident (one) and recurrent (2+) falls among 7207 non-Hispanic White (NHW) (89.7%), non-Hispanic Black (NHB) (5.0%), and Hispanic (5.3%) men ages ≥60 years with ≥1 chronic conditions, enrolled in an evidence-based fall program. Multinomial and binary regression analyses were used to assess factors associated with incident and recurrent falls. Relative to zero falls, NHB and Hispanic men were less likely to report incident (OR = 0.55, p < .001 and OR = 0.70, p = .015, respectively) and recurrent (OR = 0.41, p < .001 and OR = 0.58, p < .001, respectively) falls. Men who reported fear of falling and restricting activities were more likely to report incident (OR = 1.16, p < .001 and OR = 1.32, p < .001, respectively) recurrent and (OR = 1.46, p < .001 and OR = 1.71, p < .001, respectively) falls. Men with more comorbidities were more likely to report recurrent falls (OR = 1.10, p < .001). Compared to those who experienced one fall, men who reported fear of falling (OR = 1.28, p < .001) and restricting activities (OR = 1.31, p < .001) were more likely to report recurrent falls. Findings highlight the importance of multi-component interventions to prevent falls.

Exploring the impact of lighting sources on walking behavior in obstructed walkways among older adults

The pandemic has reinforced older adults' reliance on their homes and the concept of "aging in place". Changes like reduced physical strength and cognitive deficit, however, have heightened the challenge of simple tasks like obstacle crossing among older adults, let alone when older adults cannot perceive the surroundings well during the nighttime. The study is, therefore, to evaluate the impact of lighting on older adults' obstacle-crossing behavior during the nighttime. Twenty-seven older adults (81 ± 6 yrs., 171 ± 12 cm, 75 ± 20 kg, 14 females) were recruited. Participants were asked to cross over the obstacle in a dark residential environment under point or line light. We found that the line light tended to (1) induce more external rotation of the trailing hip (p = 0.037) and more internal rotation of the leading ankle (p < 0.001) at leading leg liftoff; and (2) result in a more upright and erect posture during stance phase (less hip flexion, p = 0.006) and swing phase of the trailing leg (reduced pelvic flexion, p = 0.038). Postural changes induced by line light demonstrated improved body control, highlighting the influence of spatial information (horizontal & vertical directions) on crossing behavior in dark environments. The findings can provide additional evidence for the design of light systems in both retirement communities and individual homes. This is particularly important when designing built environments for the aging population, in cases where the surroundings may pose challenges such as obstructed walking, and other complex floor conditions.

Ability of Heart Rate Recovery and Gait Kinetics in a Single Wearable to Predict Frailty: Quasiexperimental Pilot Study

BACKGROUND

Aging is a risk factor for falls, frailty, and disability. The utility of wearables to screen for physical performance and frailty at the population level is an emerging research area. To date, there is a limited number of devices that can measure frailty and physical performance simultaneously.

OBJECTIVE

The aim of this study is to evaluate the accuracy and validity of a continuous digital monitoring wearable device incorporating gait mechanics and heart rate recovery measurements for detecting frailty, poor physical performance, and falls risk in older adults at risk of falls.

METHODS

This is a substudy of 156 community-dwelling older adults ≥60 years old with falls or near falls in the past 12 months who were recruited for a fall prevention intervention study. Of the original participants, 22 participants agreed to wear wearables on their ankles. An interview questionnaire involving demographics, cognition, frailty (FRAIL), and physical function questions as well as the Falls Risk for Older People in the Community (FROP-Com) was administered. Physical performance comprised gait speed, timed up and go (TUG), and the Short Physical Performance Battery (SPPB) test. A gait analyzer was used to measure gait mechanics and steps (FRAIL-functional: fatigue, resistance, and aerobic), and a heart rate analyzer was used to measure heart rate recovery (FRAIL-nonfunctional: weight loss and chronic illness).

RESULTS

The participants' mean age was 74.6 years. Of the 22 participants, 9 (41%) were robust, 10 (46%) were prefrail, and 3 (14%) were frail. In addition, 8 of 22 (36%) had at least one fall in the past year. Participants had a mean gait speed of 0.8 m/s, a mean SPPB score of 8.9, and mean TUG time of 13.8 seconds. The sensitivity, specificity, and area under the curve (AUC) for the gait analyzer against the functional domains were 1.00, 0.84, and 0.92, respectively, for SPPB (balance and gait); 0.38, 0.89, and 0.64, respectively, for FRAIL-functional; 0.45, 0.91, and 0.68, respectively, for FROP-Com; 0.60, 1.00, and 0.80, respectively, for gait speed; and 1.00, 0.94, and 0.97, respectively, for TUG. The heart rate analyzer demonstrated superior validity for the nonfunctional components of frailty, with a sensitivity of 1.00, specificity of 0.73, and AUC of 0.83.

CONCLUSIONS

Agreement between the gait and heart rate analyzers and the functional components of the FRAIL scale, gait speed, and FROP-Com was significant. In addition, there was significant agreement between the heart rate analyzer and the nonfunctional components of the FRAIL scale. The gait and heart rate analyzers could be used in a screening test for frailty and falls in community-dwelling older adults but require further improvement and validation at the population level.

Influence of falls, fall-related injuries, and fear of falling on social participation in people aging with long-term physical disability: a cross-sectional study

PURPOSE

This study examined prevalence and relationships among falls, injuries, fear of falling, and social participation in people aging with long-term physical disability (PAwLTPD).

MATERIALS AND METHODS

A convenience sample of 474 PAwLTPD recruited from community agencies and social media as baseline of a longitudinal cohort study. Inclusion criteria: 45-65 years, self-reported physical disability for ≥5 years, and English-speaking. Self-report surveys of physical/mental health, falls in the past year, fear of falling, and Patient-Reported Outcomes Measurement Information System (PROMIS) ability and satisfaction with participation in social roles and activities measures were collected.

RESULTS

Mean age 56.8 years; participants were mostly female (66.7%) and White (61.4%). Nearly 65% reported a fall; 56.6% of falls resulted in injury. Falls and fall-related injuries were associated with worse physical/mental health and presence of >5 health conditions. Seventy-five percent of participants reported fear of falling. Lower ability and satisfaction with participation were found in participants who fell and worried about falls.

CONCLUSIONS

PAwLTPD are at increased risk of falls, fall-related injuries, and fear of falling, which affects their ability to engage in social activities. Future research is needed to understand circumstances associated with falls and to develop effective interventions to address falls in PAwLTPD.

Utility of Torso Imaging for Elderly Patients Sustaining Ground-Level Falls

INTRODUCTION

Computed tomography (CT) of the torso has become increasingly common for assessment of fall patients in the emergency department. Some data suggest that older adults (≥65) may benefit from torso imaging more than younger patients. We sought to evaluate the usage and utility of CT imaging for elderly patients presenting after ground-level falls (GLFs) from 1 meter or less at our level 1 trauma center.

METHODS

Patients ≥18 presenting with GLF in 2015-2019 were included. Data were obtained through chart and trauma registry review. Descriptive statistics were used to summarize the use of CT imaging for patients younger than versus older than 65 y old. Three multivariate logistic regression models with age as a continuous, binary (<65 versus ≥65), or categorical (in multiples of 5) variable were used to investigate whether age is associated with an increased identification of traumatic injury not previously suspected or known based on physical exam (PE) or plain radiograph after GLF.

RESULTS

A total of 522 patients <65 and 673 patients ≥65 y old were included. Older patients were significantly more likely to receive screening chest radiograph, screening pelvic radiograph, brain CT, and neck CT (all P < 0.001), but not torso (chest, abdomen, and pelvis) CT (P = 0.144). On multivariate logistic regression, age was not significantly associated with an increased odds of identification of traumatic injury after torso CT (continuous: adjusted odds ratio [aOR] = 1.01, 95% confidence interval [CI] = 0.99-1.03, P = 0.379; binary: aOR = 0.86, 95% CI = 0.46-1.58, P = 0.619; categorical: aOR = 1.03, 95% CI = 0.94-1.14, P = 0.453). A positive PE was the only variable associated with significantly increased odds of having an abnormal torso CT scan in all models. Only two patients ≥65 y old had injuries identified on torso CT in the context of a negative PE and negative screening imaging.

CONCLUSIONS

The rate of torso injury identification in patients sustaining GLF is not associated with age, but is strongly associated with positive PE findings. In the subset of elderly GLF patients without positive torso PE findings, more conservative use of CT imaging could decrease health-care utilization costs without compromising patient care.

Association between social vulnerability factors and homicide and suicide rates - United States, 2016 - 2020

BACKGROUND

Differences in social and environmental factors contribute to disparities in fatal injury rates. This study assessed the relationship between social vulnerability and homicide and suicide rates across United States counties.

METHODS

County-level age-adjusted homicide and suicide rates for 2016-2020 were linked with data from the Centers for Disease Control and Prevention's 2020 Social Vulnerability Index (SVI), a dataset identifying socially vulnerable communities. We conducted negative binomial regressions to examine the association between SVI and homicide and suicide rates, overall and by Census region/division. We mapped county-level data for SVI and homicide and suicide rates in bivariate choropleth maps.

RESULTS

Overall SVI was associated with homicide rates across U.S. counties. While no association was found for overall SVI and suicide rates, Socioeconomic Status and Racial & Ethnic Minority Status domains were associated. The geographic distribution of SVI and homicide and suicide rates varied spatially; notably, counties in the South had the greatest levels of social vulnerability and greatest homicide rates.

CONCLUSIONS

Our findings demonstrate county-level social vulnerability is associated with homicide rates but may be more nuanced for suicide rates. A modified SVI for injury should include additional social and structural determinants and exclude variables not applicable to injuries.

PRACTICAL APPLICATIONS

This study combines the SVI with homicide and suicide data, enabling researchers to examine related social and environmental factors. Modifying the SVI to include relevant predictors could improve injury prevention strategies by prioritizing efforts in areas with high social vulnerability.

Exploring the control of whole-body angular momentum in young and elderly based on the virtual pivot point concept

While walking, ground reaction forces point from the centre of pressure to the neighbourhood of a focal point, namely the virtual pivot point (VPP), that adjusts angular momentum around the centre of mass (CoM). This study explores how age and speed affect the VPP quality and position during walking. Analysing an experimental dataset reveals high quality of the VPP in the sagittal plane for both young and elderly groups, regardless of speed. However, in the frontal plane, the VPP quality decreases with increasing speed, with elderly participants exhibiting significantly lower quality. Although not a direct measure of balance, VPP quality reflects changes in whole-body angular momentum owing to ageing and speed. Additionally, a template model is used to reproduce the VPP quality and position trends observed in the experiment. Simulation results highlight the sensitivity of VPP quality to leg force feedback and show that changing VPP height has minimal effect on gait speed. Furthermore, energy redistribution occurs through increased hip extension and leg damping, associated with a greater horizontal VPP distance from the CoM, observed in elderly walking. This study shows promise for analysing gait based on VPP, potentially aiding clinical interventions and supporting locomotion in the elderly.

Long-term Trajectories of Low Back Pain in Older Men: A Prospective Cohort Study With 10-Year Analysis of the Osteoporotic Fractures in Men Study

Although low back pain (LBP) may persist or recur over time, few studies have evaluated the individual course of LBP over a long-term period, particularly among older adults. Based on data from the longitudinal Osteoporotic Fractures in Men (MrOS) Study, we aimed to identify and describe different LBP trajectories in older men and characterize members in each trajectory group. A total of 5 976 community-dwelling men (mean age = 74.2) enrolled at 6 U.S. sites were analyzed. Participants self-reported LBP (yes/no) every 4 months for a maximum of 10 years. Latent class growth modeling was performed to identify unique LBP trajectory groups that explained variation in the LBP data. The association of baseline characteristics with trajectory group membership was assessed using univariable and multivariable multinominal logistic regression. A 5-class solution was chosen; no/rare LBP (n = 2 442/40.9%), low frequency-stable LBP (n = 1 040/17.4%), low frequency-increasing LBP (n = 719/12%), moderate frequency-decreasing LBP (n = 745/12.5%), and high frequency-stable LBP (n = 1 030/17.2%). History of falls (OR = 1.52), history of LBP (OR = 6.37), higher physical impairment (OR = 1.51-2.85), and worse psychological function (OR = 1.41-1.62) at baseline were all associated with worse LBP trajectory groups in this sample of older men. These findings present an opportunity for targeted interventions and/or management to older men with worse or increasing LBP trajectories and associated modifiable risk factors to reduce the impact of LBP and improve quality of life.

Traumatic Brain Injury in Admitted Patients with Ocular Trauma

Objectives

To characterize the epidemiology of simultaneous traumatic brain injury (TBI) and ocular trauma.

Materials and Methods

In this retrospective, observational study, de-identified data from patients admitted with ocular trauma and TBI was extracted from the National Trauma Data Bank (2008-2014) using International Classification of Diseases 9th Revision, Clinical Modification diagnostic codes and E-codes relating to injury circumstances. Mechanisms, types of ocular and head injuries, intention, and demographic distribution were determined. Association of variables was calculated with Student’s t and chi-squared tests and logistic regression analysis.

Results

Of 316,485 patients admitted with ocular trauma, 184,124 (58.2%) also had TBI. The mean (standard deviation [SD]) age was 41.8 (23) years. Most were males (69.8%). Race/ethnicity distribution was 68.5% white, 13.3% black, and 11.4% Hispanic patients. The mean (SD) Glasgow Coma Score (GCS) was 12.4 (4.4) and Injury Severity Score (ISS) was 17 (10.6). Frequent injuries were orbital fractures (49.3%) and eye/adnexa contusions (38.3%). Common mechanisms were falls (27.7%) and motor vehicle-occupant (22.6%). Firearm-related trauma (5.2%) had the greatest odds of very severe injury (ISS >24) (odds ratio [OR]: 4.29; p<0.001) and severe TBI (GCS <8) (OR: 5.38; p<0.001). Assault injuries were associated with the greatest odds of mild TBI (OR: 1.36; p<0.001) and self-inflicted injuries with severe TBI (OR: 8.06; p<0.001). Eye/adnexal contusions were most associated with mild TBI (OR: 1.25; p<0.001). Optic nerve/visual pathway injuries had greater odds of severe TBI (OR: 2.91; p<0.001) and mortality (OR: 2.27; p<0.001) than other injuries. Of associated head injuries, the odds of severe TBI were greatest with skull base fractures (OR: 4.07; p<0.001) and mortality with intracerebral hemorrhages (OR: 4.28; p<0.001). Mortality occurred in 5.9% of patients.

Conclusion

TBI occurred in nearly two-thirds of ocular trauma admissions. The mortality rate was low with implications for challenging rehabilitation and long-term disability in survivors.

Mortality due to falls by county, age group, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities

BACKGROUND

Fall-related mortality has increased rapidly over the past two decades in the USA, but the extent to which mortality varies across racial and ethnic populations, counties, and age groups is not well understood. The aim of this study was to estimate age-standardised mortality rates due to falls by racial and ethnic population, county, and age group over a 20-year period.

METHODS

Redistribution methods for insufficient cause of death codes and validated small-area estimation methods were applied to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual fall-related mortality. Estimates from 2000 to 2019 were stratified by county (n=3110) and five mutually exclusive racial and ethnic populations: American Indian or Alaska Native (AIAN), Asian or Pacific Islander (Asian), Black, Latino or Hispanic (Latino), and White. Estimates were corrected for misreporting of race and ethnicity on death certificates using published misclassification ratios. We masked (ie, did not display) estimates for county and racial and ethnic population combinations with a mean annual population of less than 1000. Age-standardised mortality is presented for all ages combined and for age groups 20-64 years (younger adults) and 65 years and older (older adults).

FINDINGS

Nationally, in 2019, the overall age-standardised fall-related mortality rate for the total population was 13·4 deaths per 100 000 population (95% uncertainty interval 13·3-13·6), an increase of 65·3% (61·9-68·8) from 8·1 deaths per 100 000 (8·0-8·3) in 2000, with the largest increases observed in older adults. Fall-related mortality at the national level was highest across all years in the AIAN population (in 2019, 15·9 deaths per 100 000 population [95% uncertainty interval 14·0-18·2]) and White population (14·8 deaths per 100 000 [14·6-15·0]), and was about half as high among the Latino (8·7 deaths per 100 000 [8·3-9·0]), Black (8·1 deaths per 100 000 [7·9-8·4]), and Asian (7·5 deaths per 100 000 [7·1-7·9]) populations. The disparities between racial and ethnic populations varied widely by age group, with mortality among younger adults highest for the AIAN population and mortality among older adults highest for the White population. The national-level patterns were observed broadly at the county level, although there was considerable spatial variation across ages and racial and ethnic populations. For younger adults, among almost all counties with unmasked estimates, there was higher mortality in the AIAN population than in all other racial and ethnic populations, while there were pockets of high mortality in the Latino population, particularly in the Mountain West region. For older adults, mortality was particularly high in the White population within clusters of counties across states including Florida, Minnesota, and Wisconsin.

INTERPRETATION

Age-standardised mortality due to falls increased over the study period for each racial and ethnic population and almost every county. Wide variation in mortality across geography, age, and race and ethnicity highlights areas and populations that might benefit most from efficacious fall prevention interventions as well as additional prevention research.

FUNDING

US National Institutes of Health (Intramural Research Program, National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; Intramural Research Program, National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research).

Assessing the Potential of Technology to Describe Resident and Staff Interactions in Assisted Living Facilities

PURPOSE

Falls are a significant financial burden and health hazard for residents in assisted living facilities (ALFs). However, limited capacity to observe residents has hindered understanding of resident-staff interactions within rooms. The current study aimed to describe nurse-resident interactions using data from a remote technology combining computer vision and staff location tracking.

METHOD

Eighty-three staff working at an urban ALF with 215 residents were trained at the initiation of the study. Remote surveillance devices were installed in 32 residences and staff and resident interactions were tracked over 170 days.

RESULTS

Staff visited residents an average of 20.7 times per day for short durations (mean = 1.08 minutes). Urgent alert response times averaged 3.0 minutes, with faster response times through the mobile application (mean = 2.7 minutes) compared to in-person (mean = 3.3 minutes) response.

CONCLUSION

By better understanding staff activity patterns in ALFs, this study has the potential to improve fall prevention and care for residents in ALFs. [Journal of Gerontological Nursing, 50(7), 7-11.].

Evaluation of a Student Pharmacist-Driven Fall-Prevention Program for Older People

There is limited research on the impact of fall prevention education for older community-living people led by student pharmacists, which includes a medication review to identify Fall Risk-Increasing Drugs (FRIDs). Study objectives were to first assess the knowledge and behavioral intentions of older people after attending a student pharmacist-led fall-prevention program (FPP) and secondly to quantify the number of FRIDs identified during a medication review. Between October 2022 and April 2023, four independent-living facilities and two senior centers served as programming locations. Events began with a fall prevention-focused presentation provided by student pharmacists. Attendees voluntarily filled out surveys to assess their knowledge and behavioral intentions regarding fall prevention. Optional medication reviews were offered. Additional survey questions were asked of medication review participants. If FRIDs were identified, the individual was provided documentation to share with their prescriber. Fall prevention bingo was offered at select events to review educational content and engage those waiting for a medication review. Eighty-six older people attended the presentations; 45 people completed medication reviews across six sites. Survey information was available for 65 presentation attendees and 29 medication review participants. After programming, 64 out of 65 participants stated they felt comfortable speaking to their pharmacist or provider about falls and their medications. Most survey respondents correctly selected which medications increase fall risk. Twenty-two of 29 medication review participants were taking at least one FRID. The FPP described showed positive results through a post-survey evaluation. Participants demonstrated knowledge of fall hazards including medications and a willingness to discuss falls and FRIDs with health professionals. These factors may lead to concrete interventions to avoid falls and their associated health consequences for older people.

Protocol for a home-based self-delivered prehabilitation intervention to proactively reduce fall risk in older adults: a pilot randomized controlled trial of transcranial direct current stimulation and motor imagery

BACKGROUND

Several changes occur in the central nervous system with increasing age that contribute toward declines in mobility. Neurorehabilitation has proven effective in improving motor function though achieving sustained behavioral and neuroplastic adaptations is more challenging. While effective, rehabilitation usually follows adverse health outcomes, such as injurious falls. This reactive intervention approach may be less beneficial than prevention interventions. Therefore, we propose the development of a prehabilitation intervention approach to address mobility problems before they lead to adverse health outcomes. This protocol article describes a pilot study to examine the feasibility and acceptability of a home-based, self-delivered prehabilitation intervention that combines motor imagery (mentally rehearsing motor actions without physical movement) and neuromodulation (transcranial direct current stimulation, tDCS; to the frontal lobes). A secondary objective is to examine preliminary evidence of improved mobility following the intervention.

METHODS

This pilot study has a double-blind randomized controlled design. Thirty-four participants aged 70-95 who self-report having experienced a fall within the prior 12 months or have a fear of falling will be recruited. Participants will be randomly assigned to either an active or sham tDCS group for the combined tDCS and motor imagery intervention. The intervention will include six 40-min sessions delivered every other day. Participants will simultaneously practice the motor imagery tasks while receiving tDCS. Those individuals assigned to the active group will receive 20 min of 2.0-mA direct current to frontal lobes, while those in the sham group will receive 30 s of stimulation to the frontal lobes. The motor imagery practice includes six instructional videos presenting different mobility tasks related to activities of daily living. Prior to and following the intervention, participants will undergo laboratory-based mobility and cognitive assessments, questionnaires, and free-living activity monitoring.

DISCUSSION

Previous studies report that home-based, self-delivered tDCS is safe and feasible for various populations, including neurotypical older adults. Additionally, research indicates that motor imagery practice can augment motor learning and performance. By assessing the feasibility (specifically, screening rate (per month), recruitment rate (per month), randomization (screen eligible who enroll), retention rate, and compliance (percent of completed intervention sessions)) and acceptability of the home-based motor imagery and tDCS intervention, this study aims to provide preliminary data for planning larger studies.

TRIAL REGISTRATION

This study is registered on ClinicalTrials.gov (NCT05583578). Registered October 13, 2022. https://www.

CLINICALTRIALS

gov/study/NCT05583578.

Exploring the Effectiveness of Emergency Medical Services Becoming Active in Fall Prevention: A Literature Review

Falls, particularly among the elderly, are a prevalent and growing healthcare issue in the United States. Individuals who experience falls face heightened morbidity and mortality risks, along with substantial expenses associated with managing any resulting injuries. First responders frequently respond to 911 calls related to falls, with a significant portion of these cases not resulting in hospital or healthcare facility transfers. As such, many fall victims receive treatment without any preventive measures being implemented. The purpose of this review is to explore the current studies that examine whether Emergency Medical Service personnel can effectively act in fall prevention. While earlier studies present conflicting findings, recent research indicates the potential for preventive strategies that go beyond mere referrals.

Comparison of falls and risk factors among older adults in urban villages, urban and rural areas of Shantou, China

Objective

To investigate and compare the differences between the incidence of falls, balance and living environment among older persons in urban villages and other types of residential areas.

Methods

We surveyed 580 older adults living in different types of residential areas in Shantou, China, surveying basic information, fall incidence, balance ability testing of older persons, home environment safety assessment.

Results

The incidence of falls among older people in urban villages (19.54 %) was between urban areas(26.63 %) and rural areas(16.91 %). The influencing factors of falls in different residential types were different. Near-fall, abnormal bowel movement, and impaired balance ability were the risk factors of falls among older persons in urban villages. Divorce/single, fair and poor hearing loss and near-fall were the risk factors of falls in urban older adults. Frailty and impaired balance ability were the risk factors of falls in rural older people.

Conclusions

Risk factors for falls in older people vary according to the characteristics of their living areas and relevant interventions should be targeted according to the characteristics of falls occurring in different residential areas.

Effects of Dalcroze Eurhythmics Exercise Versus Multicomponent Exercise on Physical and Cognitive Function, and Falls in Older Adults: The EPHYCOS Randomized Controlled Trial

Currently, robust evidence is lacking to support one exercise type over another in the prevention of physical and cognitive decline and falls among older adults, primarily because of the lack of comparative trials of proven interventions. Therefore, a 12-month randomized, single-blind, comparative effectiveness trial is conducted, in which 142 older adults at high risk for falls are randomized (1:1) to receive an evidence-based Dalcroze Eurhythmics (DE) exercise program (once weekly, group-based) or an evidence-based multicomponent (MULTI) exercise program incorporating balance, functional, and strength training activities (twice weekly, group- and home-based), for 12 months. The primary outcome is gait variability under dual-task at 12 months. At 12 months, the DE group has significant improvements compared with MULTI group on gait under both dual-task (adjusted β for stride variability: -2.3, 95%CI, -3.1 to -1.4; p < 0.001) and single-task, and on a variety of secondary physical and cognitive/executive function outcomes. The adjusted hazard ratio for falls is 0.58 (95%CI, 0.37 to 0.93) for the DE group compared with MULTI group. In conclusion, DE exercise is more effective than MULTI exercise in improving physical and cognitive function and reducing falls in older adults. The mechanisms underlying DE exercise-induced benefits remain to be fully elucidated.

Shoe sole impedes leg muscle activation and impairs dynamic balance responding to a standing-slip

The shoe sole is identified as a fall risk factor since it may impede the afferent information about the outside world collected by the plantar sensory units. However, no study has directly quantified how the shoe sole compromises body balance and increases fall risk. This study aimed to inspect how the sole affects human balance after an unexpected standing-slip. It was hypothesized that individuals wearing the sole, relative to their barefoot counterparts, would exhibit 1) more impaired stability and 2) disrupted lower limb muscle activation following a standing-slip. Twenty young adults were evenly randomized into two groups: soled and barefoot. The soled group wore a pair of customized 10-mm thick soles, while the other group was bare-footed. Full-body kinematics and leg muscle electromyography (EMG) were collected during a standardized and unexpected standing-slip. The EMG electrodes were placed on the tibialis anterior, gastrocnemius, rectus femoris, and biceps femoris bilaterally. Dynamic stability, spatiotemporal gait parameters, and the EMG latency of the leg muscles were compared between groups. The sole impeded the initiation of the recovery step possibly because it interfered with the accurate detection of the external perturbation and subsequently activated the leg muscles later in the soled group than in the barefoot group. As a result, individuals in the soled group experienced a longer slip distance and were more unstable than the barefoot group at the recovery foot liftoff. The findings of this study could augment our understanding of how the shoe sole impairs body balance and increases the fall risk.

Differences in Falls and Physical Activity in Older Women From Two Generations

BACKGROUND

Falls and physical inactivity increase with age. However, physical activity, falls and their associations in older people born at different times are unclear.

METHODS

Women born 1921-26 and 1946-51 who completed follow-up questionnaires in 1999 (n = 8 403, mean (SD) age: 75 (1) years) and 2019 (n = 7 555; 71 (1) years) in the Australian Longitudinal Study on Women's Health. Self-reported noninjurious and injurious falls in the previous 12 months and weekly amounts and types of physical activity (brisk walking, moderate- and vigorous-intensity) were compared between the cohorts using Chi-square tests. Associations between physical activity, and noninjurious and injurious falls were estimated using multinomial logistic regressions informed by a directed acyclic graph.

RESULTS

A greater proportion of the later (1946-51) cohort (59%) reached 150-300 minutes of weekly physical activity, as recommended by the World Health Organization, compared to the earlier (1921-26) cohort (43%, p < .001). A greater proportion of the later cohort reported noninjurious falls (14% vs 8%). Both cohorts reported similar proportions of injurious falls (1946-51:15%, 1921-26:14%). In both cohorts, participation in 150-300 minutes of physical activity was associated with lower odds of noninjurious falls (adjusted Odds Ratio, 95% CI: 1921-26: 0.66, 0.52-0.84; 1946-51: 0.78, 0.63-0.97) and injurious falls (1921-26: 0.72, 0.60-0.87; 1946-51: 0.78, 0.64-0.96).

CONCLUSIONS

Participation in recommended levels of physical activity was associated with reduced falls in both cohorts. However, generational differences were found with more falls and more physical activities in the women born later. Future studies could examine the reasons contributing to the generational differences.

Improved accuracy and efficiency of primary care fall risk screening of older adults using a machine learning approach

BACKGROUND

While many falls are preventable, they remain a leading cause of injury and death in older adults. Primary care clinics largely rely on screening questionnaires to identify people at risk of falls. Limitations of standard fall risk screening questionnaires include suboptimal accuracy, missing data, and non-standard formats, which hinder early identification of risk and prevention of fall injury. We used machine learning methods to develop and evaluate electronic health record (EHR)-based tools to identify older adults at risk of fall-related injuries in a primary care population and compared this approach to standard fall screening questionnaires.

METHODS

Using patient-level clinical data from an integrated healthcare system consisting of 16-member institutions, we conducted a case-control study to develop and evaluate prediction models for fall-related injuries in older adults. Questionnaire-derived prediction with three questions from a commonly used fall risk screening tool was evaluated. We then developed four temporal machine learning models using routinely available longitudinal EHR data to predict the future risk of fall injury. We also developed a fall injury-prevention clinical decision support (CDS) implementation prototype to link preventative interventions to patient-specific fall injury risk factors.

RESULTS

Questionnaire-based risk screening achieved area under the receiver operating characteristic curve (AUC) up to 0.59 with 23% to 33% similarity for each pair of three fall injury screening questions. EHR-based machine learning risk screening showed significantly improved performance (best AUROC = 0.76), with similar prediction performance between 6-month and one-year prediction models.

CONCLUSIONS

The current method of questionnaire-based fall risk screening of older adults is suboptimal with redundant items, inadequate precision, and no linkage to prevention. A machine learning fall injury prediction method can accurately predict risk with superior sensitivity while freeing up clinical time for initiating personalized fall prevention interventions. The developed algorithm and data science pipeline can impact routine primary care fall prevention practice.

Trauma Demographics and Injury Prevention

Traumatic injury is a leading cause of death in the United States. Risk of traumatic injury varies by sex, age, geography, and race/ethnicity. Understanding the nuances of risk for a particular population is essential in designing, implementing, and evaluating injury prevention initiatives.

Online Monitoring for Human Sit-to-Stand Movement Based on Karush-Kuhn-Tucker Optimized Zonotope Set-Membership Filter

As the global aging population continues to grow, there has been a significant increase in the number of fall-related injuries among the elderly, primarily due to reduced muscle strength and balance control, especially during sit-to-stand (STS) movements. Intelligent wearable robots have the potential to provide fall prevention assistance to individuals at risk, but an accurate and timely assessment of human movement stability is essential. This article presents a fall prediction algorithm for STS movements based on the Karush-Kuhn-Tucker (KKT) optimized zonotope set-membership filter (KKT-ZSMF), enabling real-time assessment of human stability. To quantify the feasible stability region of human STS movement, a mathematical model is proposed based on dynamic stability theory. Additionally, an online fall-prediction approach is developed, utilizing the zonotope set-membership filter to iteratively update the set that represents the instantaneous stability region. The approach incorporates a KKT optimization algorithm to compute the optimal convex hull, thereby enhancing the accuracy and efficiency of the set-membership filter. Experimental validation is conducted with the participation of 13 subjects including 5 elderly subjects, comparing the performance of the proposed KKT-ZSMF algorithm with other relevant methods. The results confirm the accuracy and real-time performance of the KKT-ZSMF algorithm for predicting human STS movement stability, achieving an overall prediction accuracy of 93.49% and a runtime of no more than 7.91 ms. These findings demonstrate the suitability of the algorithm for fall prevention assistance in daily activities.

Circumstances of unintentional fall-related adult deaths: Utah, 2010-2020

OBJECTIVE

Fall-related deaths have been on the rise nationwide. Our objective was to characterise the trend in unintentional fall-related adult deaths in Utah and evaluate the underlying and contributing causes associated with these deaths.

METHODS

We used 2010-2020 Utah death certificate data and included all Utah deaths aged 18 and older with a fall listed on their death records as the underlying or contributing cause of death in the analysis.

RESULTS

From 2010 to 2020, the overall age-adjusted unintentional fall death rate increased 70% from 15.7 to 26.8 per 100 000 person-years, while the overall age-adjusted death rate increase was 12% at the time. On average, the group with falls as one of the contributing causes had 4.9 other contributing causes, while the group with falls as an underlying cause had 3.3; the two averages were statistically different. Incidence of death increased 60% (12.1-19.4 per 100 000) for falls classified as the underlying cause of death and 103% (3.6-7.3 per 100 000) for those with fall as a contributing cause. Coding for the type of fall became more specific with a 30% decrease in unspecified fall (International Classification of Diseases, 10th revision code W19) (5.9-4.1 per 100 000).

CONCLUSION

There was an increasing trend of unintentional fall-related adult deaths in Utah from 2010 to 2020. This increase is consistent with national trends. Our data supports there is more specific reporting of fall deaths, but better reporting alone cannot explain the uptrend. Furthermore, the deaths with falls as contributing causes increased the most, and these individuals have more comorbidities.

The primary care NP's guide to prevention and management of falls in older adults

ABSTRACT

Falls are a growing health concern affecting older adults (defined as ages 65 years and older) that can lead to devastating consequences. NPs in primary care settings play an important role in the prevention and management of older adult falls. Methods and resources to screen for fall risk, assess risk factors, and manage falls in older adults are discussed.

Sex-specific preservation of neuromuscular function and metabolism following systemic transplantation of multipotent adult stem cells in a murine model of progeria

Onset and rates of sarcopenia, a disease characterized by a loss of muscle mass and function with age, vary greatly between sexes. Currently, no clinical interventions successfully arrest age-related muscle impairments since the decline is frequently multifactorial. Previously, we found that systemic transplantation of our unique adult multipotent muscle-derived stem/progenitor cells (MDSPCs) isolated from young mice-but not old-extends the health-span in DNA damage mouse models of progeria, a disease of accelerated aging. Additionally, induced neovascularization in the muscles and brain-where no transplanted cells were detected-strongly suggests a systemic therapeutic mechanism, possibly activated through circulating secreted factors. Herein, we used ZMPSTE24-deficient mice, a lamin A defect progeria model, to investigate the ability of young MDSPCs to preserve neuromuscular tissue structure and function. We show that progeroid ZMPST24-deficient mice faithfully exhibit sarcopenia and age-related metabolic dysfunction. However, systemic transplantation of young MDSPCs into ZMPSTE24-deficient progeroid mice sustained healthy function and histopathology of muscular tissues throughout their 6-month life span in a sex-specific manner. Indeed, female-but not male-mice systemically transplanted with young MDSPCs demonstrated significant preservation of muscle endurance, muscle fiber size, mitochondrial respirometry, and neuromuscular junction morphometrics. These novel findings strongly suggest that young MDSPCs modulate the systemic environment of aged animals by secreted rejuvenating factors to maintain a healthy homeostasis in a sex-specific manner and that the female muscle microenvironment remains responsive to exogenous regenerative cues in older age. This work highlights the age- and sex-related differences in neuromuscular tissue degeneration and the future prospect of preserving health in older adults with systemic regenerative treatments.

Analysis of the Relation Between Balance Control Subsystems: A Structural Equation Modeling Approach

Balance plays a crucial role in human life and social activities. Maintaining balance is a relatively complex process that requires the participation of various balance control subsystems (BCSes). However, previous studies have primarily focused on evaluating an individual's overall balance ability or the ability of each BCS in isolation, without considering how they influence (or interact with) each other. The first study used clinical scales to evaluate the functions of the four BCSes, namely Reactive Postural Control (RPC), Anticipatory Postural Adjustment (APA), Dynamic Gait (DG), and Sensory Orientation (SO), and psychological factors such as fear of falling (FOF). A hierarchical structural equation modeling (SEM) was used to investigate the relationship between the BCSes and their association with FOF. The second study involved using posturography to measure and extract parameters from the center of pressure (COP) signal. SEM with sparsity constraint was used to analyze the relationship between vision, proprioception, and vestibular sense on balance based on the extracted COP parameters. The first study revealed that the RPC, APA, DG and SO indirectly influenced each other through their overall balance ability, and their association with FOF was not the same. APA has the strongest association with FOF, while RPC has the least association with FOF. The second study revealed that sensory inputs, such as vision, proprioception, and vestibular sensing, directly affected each other, but their associations were not identical. Among them, proprioception plays the most important role in the three sensory subsystems. This study provides the first numerical evidence that the BCSes are not independent of each other and exist in direct or indirect interplay. This approach has important implications for the diagnosis and management of balance-related disorders in clinical settings and improving our understanding of the underlying mechanisms of balance control.

Fear of falling in community-dwelling older adults: What their gait acceleration pattern reveals

BACKGROUND

Fear of Falling (FOF) is common among community-dwelling older adults and is associated with increased fall-risk, reduced activity, and gait modifications.

OBJECTIVE

In this cross-sectional study, we examined the relationships between FOF and gait quality.

METHODS

Older adults (N=232; age 77±6; 65 % females) reported FOF by a single yes/no question. Gait quality was quantified as (1) harmonic ratio (smoothness) and other time-frequency spatiotemporal variables from triaxial accelerometry (Vertical-V, Mediolateral-ML, Anterior-Posterior -AP) during six-minute walk; (2) gait speed, step-time CoV (variability), and walk-ratio (step-length/cadence) on a 4-m instrumented walkway. Mann Whitney U-tests and Random forest classifier compared gait between those with and without FOF. Selected gait variables were used to build Support Vector Machine (SVM) classifier and performance was evaluated using AUC-ROC.

RESULTS

Individuals with FOF had slower gait speed (103.66 ± 17.09 vs. 110.07 ± 14.83 cm/s), greater step time CoV (4.17 ± 1.66 vs. 3.72 ± 1.24 %), smaller walk-ratio (0.53 ± 0.08 vs. 0.56 ± 0.07 cm/steps/minute), smaller standard deviation V (0.15 ± 0.06 vs. 0.18 ± 0.09 m/s2), and smaller harmonic-ratio V (2.14 ± 0.73 vs. 2.38 ± 0.58), all p<.01. Linear SVM yielded an AUC-ROC of 67 % on test dataset, coefficient values being gait speed (-0.19), standard deviation V (-0.23), walk-ratio (-0.36), and smoothness V (-0.38) describing associations with presence of FOF.

CONCLUSION

Older adults with FOF have reduced gait speed, acceleration adaptability, walk-ratio, and smoothness. Disrupted gait patterns during fear of falling could provide insights into psychosocial distress in older adults. Longitudinal studies are warranted.

How Healthy Older Adults Enact Lateral Maneuvers While Walking

BACKGROUND

Walking requires frequent maneuvers to navigate changing environments with shifting goals. Humans accomplish maneuvers and simultaneously maintain balance primarily by modulating their foot placement, but a direct trade-off between these two objectives has been proposed. As older adults may rely more on foot placement to maintain lateral balance, they may be less able to adequately adapt stepping to perform lateral maneuvers.

RESEARCH QUESTION

How do older adults adapt stepping to enact lateral lane-change maneuvers, and how do physical and perceived ability influence their task performance?

METHODS

Twenty young (21.7 ± 2.6 yrs) and 18 older (71.6 ± 6.0 yrs) adults walked on a motorized treadmill in a virtual environment. Following an audible and visual cue, participants switched between two parallel paths, centered 0.6 m apart, to continue walking on their new path. We quantified when participants initiated the maneuver following the cue, as well as their step width, lateral position, and stepping variability ellipses at each maneuver step.

RESULTS

Young and older adults did not differ in when they initiated the maneuver, but participants with lower perceived ability took longer to do so. Young and older adults also did not exhibit differences in step width or lateral positions at any maneuver step, but participants with greater physical ability reached their new path faster. While only older adults exhibited stepping adaptations prior to initiating the maneuver, both groups traded off stability for maneuverability to enact the lateral maneuver.

SIGNIFICANCE

Physical and perceived balance ability, rather than age per se, differentially influenced maneuver task performance. Humans must make decisions related to the task of walking itself and do so based on both physical and perceived factors. Understanding and targeting these interactions may help improve walking performance among older adults.

Effectiveness of fall prevention interventions in residential aged care and community settings: an umbrella review

INTRODUCTION

Preventing falls is a priority for aged care providers. Research to date has focused on fall prevention strategies in single settings (e.g., residential aged care (RAC) or community settings). However, some aged care providers deliver care, including fall prevention interventions, across RAC and community settings. We conducted an umbrella review to identify what type of fall prevention interventions had the greatest impact on falls outcomes in RAC and community settings.

METHODS

Five databases were searched for systematic reviews of falls prevention randomised control trials in older adults living in the community or RAC. Data extracted included systematic review methods, population characteristics, intervention characteristics, setting details (RAC or community), and fall-related outcomes (falls, people who have had a fall, fall-related hospitalisations, and fall-related fractures). Review quality was appraised using the Assessment of Multiple Systematic Reviews-2 tool.

RESULTS

One-hundred and six systematic reviews were included; 63 and 19 of these stratified results by community and RAC settings respectively, the remainder looked at both settings. The most common intervention types discussed in reviews included 'exercise' (61%, n = 65), 'multifactorial' (two or more intervention types delivered together) (26%, n = 28), and 'vitamin D' (18%, n = 19). In RAC and community settings, 'exercise' interventions demonstrated the most consistent reduction in falls and people who have had a fall compared to other intervention types. 'Multifactorial' interventions were also beneficial in both settings however demonstrated more consistent reduction in falls and people who fall in RAC settings compared to community settings. 'Vitamin D' interventions may be beneficial in community-dwelling populations but not in RAC settings. It was not possible to stratify fall-related hospitalisation and fall-related fracture outcomes by setting due to limited number of RAC-specific reviews (n = 3 and 0 respectively).

CONCLUSION

'Exercise' interventions may be the most appropriate falls prevention intervention for older adults in RAC and community settings as it is beneficial for multiple fall-related outcomes (falls, fall-related fractures, and people who have had a fall). Augmenting 'exercise' interventions to become 'multifactorial' interventions may also improve the incidence of falls in both settings.

The impact of falls on activities of daily living in older adults: A retrospective cohort analysis

BACKGROUND

Falls contribute to impairments in activities of daily living (ADLs), resulting in significant declines in the quality of life, safety, and functioning of older adults. Understanding the magnitude and duration of the effect of falls on ADLs, as well as identifying the characteristics of older adults more likely to have post-fall ADL impairment is critical to inform fall prevention and post-fall intervention. The purpose of this study is to 1) Quantify the association between falls and post-fall ADL impairment and 2) Model trajectories of ADL impairment pre- and post-fall to estimate the long-term impact of falls and identify characteristics of older adults most likely to have impairment.

METHOD

Study participants were from the Ginkgo Evaluation of Memory Study, a randomized controlled trial in older adults (age 75+) in the United States. Self-reported incident falls and ADL scores were ascertained every 6 months over a 7-year study period. We used Cox proportional hazards analyses (n = 2091) to quantify the association between falls and ADL impairment and latent class trajectory modeling (n = 748) to visualize trajectories of ADL impairment pre-and post-fall.

RESULTS

Falls reported in the previous 6 months were associated with impairment in ADLs (HR: 1.42; 95% CI 1.32, 1.52) in fully adjusted models. Based on trajectory modeling (n = 748), 19% (n = 139) of participants had increased, persistent ADL impairment after falling. Participants who were female, lived in a neighborhood with higher deprivation, or experienced polypharmacy were more likely to have ADL impairment post-fall.

CONCLUSIONS

Falls are associated with increased ADL impairment, and this impairment can persist over time. It is crucial that all older adults, and particularly those at higher risk of post-fall ADL impairment have access to comprehensive fall risk assessment and evidence-based fall prevention interventions, to help mitigate the negative impacts on ADL function.

The effect of transcranial direct current stimulation associated with video game training on the postural balance of older women in the community: A blind, randomized, clinical trial

BACKGROUND

Falls are frequent in older adults and can cause trauma, injury, and death. Fall prevention with virtual reality presents good results in improving postural control. Transcranial Direct Current Stimulation (tDCS) has been used with the same aim; however, the combination of the two techniques has still been little studied.

PURPOSE

To assess whether tDCS can enhance the effect of video game training (VGT) on improving the postural balance of healthy older women.

METHOD

A blinded, randomized, controlled clinical trial was conducted with 57 older women who were randomized to three balance training groups: Control Group (VGT), Anodal Group (VGT combined with anodic tDCS-atDCS), and Sham Group (VGT combined with sham tDCS-stDCS). Balance training was performed twice a week for four weeks, totalizing eight 20-min sessions using VGT associated with tDCS. Postural balance was assessed pre-and post-training and 30 days after the end of the eight sessions using the Mini-Balance Evaluation Systems Test.

RESULTS

Compared to pre-intervention the Mini BEST test increased similarly in the three groups in post-intervention (control: pre 23.7 ± 2.8 to post 27.0 ± 2.2; anodal: pre 24.4 ± 1 to post 27.7 ± 0.8 and sham: pre 24.2 ± 1.9 to post 26.5 ± 1.6; p < 0.001) and follow-up (control: pre 23.7 ± 2.8 to follow-up 26.8 ± 2.3; anodal: pre 24.4 ± 1 to follow-up 27.3 ± 1.4 and sham: pre 24.2 ± 1.9 to follow-up 26.8 ± 1.5; p < 0.001).

CONCLUSION

There was an improvement in the postural balance of the three training groups that were independent of tDCS.

DISCUSSION

Some studies have shown the positive tDCS effects associated with other tasks to improve balance. However, these results convey the effects of only anodic-tDCS compared to sham-tDCS. Possibly, the effect of VGT surpassed the tDCS effects, promoting a ceiling effect from the combination of these two therapies. However, studies with other therapies combined with tDCS for older adults deserve to be investigated, as well as in frail older people.

Cause-Specific Mortality Among Adults Aged ≥65 Years in the United States, 1999 Through 2020

OBJECTIVE

Reports on recent mortality trends among adults aged ≥65 years are lacking. We examined trends in the leading causes of death from 1999 through 2020 among US adults aged ≥65 years.

METHODS

We used data from the National Vital Statistics System mortality files to identify the 10 leading causes of death among adults aged ≥65 years. We calculated overall and cause-specific age-adjusted death rates and then calculated the average annual percentage change (AAPC) in death rates from 1999 through 2020.

RESULTS

The overall age-adjusted death rate decreased on average by 0.5% (95% CI, -1.0% to -0.1%) per year from 1999 through 2020. Although rates for 7 of the top 10 causes of death decreased significantly, the rates of death from Alzheimer disease (AAPC = 3.0%; 95% CI, 1.5% to 4.5%) and from unintentional injuries (AAPC = 1.2%; 95% CI, 1.0% to 1.4%), notably falls (AAPC = 4.1%; 95% CI, 3.9% to 4.3%) and poisoning (AAPC = 6.6%; 95% CI, 6.0% to 7.2%), increased significantly.

CONCLUSION

Public health prevention strategies and improved chronic disease management may have contributed to decreased rates in the leading causes of death. However, longer survival with comorbidities may have contributed to increased rates of death from Alzheimer disease and unintentional falls.

Examining the Role of Physical Function on Future Fall Likelihood in Older Adults With a Fear of Falling, With and Without Activity Restriction

ObjectivesAssess the influence of physical function on balance and future falls in older adults with fear of falling (FOF) and whether activity restriction modifies the contribution to falls. Methods: Analyses utilized data from Baltimore Longitudinal Study of Aging (n = 680) and National Health and Aging Trends Study (n = 4376) community-dwelling older adults. The role of physical function was examined by comparing balance performance and future fall odds before/after controlling for function in older adults with/without FOF. Fall likelihood analyses were repeated with FOF stratified by activity restriction. Results: When controlling for physical function, differences in balance and fall odds secondary to FOF/activity restricting FOF reduced but remained significant. Fall odds secondary to non-activity restricting FOF only slightly decreased. Discussion: Physical function contributes to balance and falls in older adults with FOF, more so in those restricting activity. Reduced balance and increased fall risk persists independent of function suggesting additional contributing factors.

Impact of medication intensification on 30-day hospital readmissions in a geriatric trauma population: A multicenter cohort study

BACKGROUND

Fall-related injuries are a significant health issue that occur in 25% of older adults and account for a significant number of trauma-related hospitalizations. Although medication intensification may increase the risk of hospital readmissions in non-trauma patients, data on a geriatric trauma population are lacking.

OBJECTIVE

The primary objective was to evaluate the effect of medication intensification on 30-day hospital readmissions in geriatric patients hospitalized for fall-related injuries.

METHODS

This multicenter, retrospective cohort study included patients with geriatric who presented to one of three trauma centers within a large, health-system between January 1, 2018 and December 31, 2020. Patients at least 65 years old admitted with a fall-related injury were eligible for inclusion. Patients were grouped according to medication changes at discharge, which included intensified and non-intensified groups. Medication intensification included increased dose(s) or initiation of new agents. The primary outcome was the 30-day hospital readmission rate.

RESULTS

Of the 870 patients included (median [interquartile range, IQR] age, 82 [74-89] years, 522 (60%) female, and 220 (25%) with a previous fall), there were 471 (54%) and 399 (46%) patients in the intensified and non-intensified groups, respectively. The intensified group had a higher 30-day hospital readmission rate (21% intensified vs. 16% non-intensified, p = 0.043; number needed to harm 20) based on an unweighted analysis. According to a weighted propensity score logistic regression, medication intensification was associated with higher 30-day hospital readmissions (24% [95% confidence interval [CI] 19-31%] intensified vs. 15% [95% CI 11-20%] non-intensified, p = 0.018). These results were consistent within competing risk models accounting for death (cause-specific model: hazard ratio [HR] 1.63 [95% CI 1.07-2.49], p = 0.023; Fine-Gray model: HR 1.64 [95% CI 1.07-2.50], p = 0.022).

CONCLUSIONS

In a geriatric trauma population hospitalized after a fall, intensification of medications may pose an increased risk of 30-day hospital readmission.

Improving Older Adults' Functional Health Using the Progressive Stay Strong, Stay Healthy Program

This study assessed the Stay Strong, Stay Healthy (SSSH) level two resistance training program in 406 older adults (69.3 ± 8.1 years). SSSH included 10 exercises completed during 60 minute sessions, which were offered twice weekly for eight weeks. 30-second sit-to-stand (30STS), timed-up-and-go (TUG), flexibility, and balance poses were completed pre/post-SSSH. Paired t-tests with Bonferroni corrections showed the whole group improved 30STS, TUG, flexibility, and total balance scores over time (p < .001). Repeated measures analyses of variance showed both geography and age groups improved 30STS, TUG, flexibility, and total balance scores over time (all time effects p ≤ .039). Independent t-tests showed rural participants improved to a similar or greater absolute extent than their urban neighbors for nearly all measures and all age groups improved to a similar absolute magnitude over time. This study demonstrates SSSH level two improves physical function in older adults and these benefits are similar across geography and age groups.

Development and validation of a machine learning-based fall-related injury risk prediction model using nationwide claims database in Korean community-dwelling older population

BACKGROUND

Falls impact over 25% of older adults annually, making fall prevention a critical public health focus. We aimed to develop and validate a machine learning-based prediction model for serious fall-related injuries (FRIs) among community-dwelling older adults, incorporating various medication factors.

METHODS

Utilizing annual national patient sample data, we segmented outpatient older adults without FRIs in the preceding three months into development and validation cohorts based on data from 2018 and 2019, respectively. The outcome of interest was serious FRIs, which we defined operationally as incidents necessitating an emergency department visit or hospital admission, identified by the diagnostic codes of injuries that are likely associated with falls. We developed four machine-learning models (light gradient boosting machine, Catboost, eXtreme Gradient Boosting, and Random forest), along with a logistic regression model as a reference.

RESULTS

In both cohorts, FRIs leading to hospitalization/emergency department visits occurred in approximately 2% of patients. After selecting features from initial set of 187, we retained 26, with 15 of them being medication-related. Catboost emerged as the top model, with area under the receiver operating characteristic of 0.700, along with sensitivity and specificity rates around 65%. The high-risk group showed more than threefold greater risk of FRIs than the low-risk group, and model interpretations aligned with clinical intuition.

CONCLUSION

We developed and validated an explainable machine-learning model for predicting serious FRIs in community-dwelling older adults. With prospective validation, this model could facilitate targeted fall prevention strategies in primary care or community-pharmacy settings.