Relationships between physical activity, ADL capability and fall risk in community-dwelling Japanese elderly population

Factors related to the use of physical restraints and hand restraints among older adults receiving home care services

OBJECTIVES

Physical restraints and hand restraints are used in medical settings to provide protection and control. However, few studies have investigated their use among community-dwelling older adults. The study explored variables associated with the use of physical restraints and hand restraints among older adults receiving home care services and the reasons behind their use.

METHODS

This cross-sectional study recruited 128 older adults receiving home care services and with catheters. Data were collected regarding demographic characteristics; activities of daily living (ADLs); muscle strength; family function; the use of nasogastric tubes, urinary catheters, and tracheal tubes; and the type and duration of restraint use and the reasons behind such use.

RESULTS

Among the participants, 76% experienced the use of physical restraints, and 34% experienced the use of hand restraints. The variables related to physical restraints were ADLs (adjusted odds ratio [AOR] = 0.95, p = .02) and the presence of a paid caregiver (AOR = 3.33, p = .02). The variables related to hand restraints were ADLs (AOR = 0.93, p = .03), use of a nasogastric tube (AOR = 13.46, p = .03) and the presence of a paid caregiver (AOR = 6.38, p = .02). The primary reasons behind restraint use were to prevent fall and extubation events.

CONCLUSIONS

The use of physical restraints among older adults with catheters may be affected by their functioning in ADLs and the presence of paid caregivers to ensure their safety. Thus, implementing interventions that target functional capabilities and caregiving skills may help reduce the use of restraints.

Retrospective Investigation and Research on Fall Events Among Hospitalized Patients in the Rehabilitation Department

Objective

We investigated the clinical characteristics, fall outcomes, and related factors of falls in patients who were hospitalized in the rehabilitation department, and explored strategies to reduce the incidence of falls and prevent falls in patients.

Methods

Data from 60 patients who fell in the rehabilitation department between 2016 and 2021 were analyzed for clinical characteristics, associated factors, incidence of falls, injuries, and patient demographics. Under the random stratified sampling method, 60 patients who did not fall during the same period were selected as the control group, and relevant data was collected. Measurement data were compared using an independent sample t-test. Enumeration data were compared using chi-squared (χ2) test was employed to compare these data between the two groups. Non-parametric data were analyzed using the Mann-Whitney U-test. Factors potentially influencing falls were scrutinized through both univariate and binary logistic regression analyses.

Results

The median annual incidence of falls among patients who were hospitalized in the rehabilitation department was 0.04%, while the overall fall injury rate was 60%. Falls were most prevalent within 30 days of hospitalization (71.67%). The most common fall-related condition was craniocerebral disease (83.33%). The incidents of falls location of fall were mainly reported in nearby areas of rehabilitation ward (70%). Most accidents occurred between 7:00 a.m.-12:00 p.m. and 3:01 p.m.-6:00 p.m. (63.33%), and dyskinesia was the most common cause of falls (71.67%). There were 39 patients (65.00%) with Barthel Index (BI) scores ranging between 40-60.

Conclusion

Patients in the rehabilitation department had a greater incidence of falls and fall injuries. Within 30 days of admission, patients with moderately dependent craniocerebral disorders and dyskinesia frequently experienced falls during typical daytime shifts in areas characterized by endemic conditions.

Prevalence and risk factors for falls among the community dwelling older adults of Thrissur: A pilot study

Background

According to World Health Organization (WHO) statistics, every year 28-35% of people over 65 years and 32-42% of people over 70 years experience falls. Given that many falls are preventable, can occur in any population, and can result in significant morbidity and mortality, falls are receiving more attention as a major global issue.

Objective

The objectives of this study were as follows: 1. To measure the prevalence of falls among the elderly living in the Thrissur Taluk Health Centre. 2. To identify the risk factors associated with falls in the elderly using the Centre for Disease Control and Prevention, Stopping Elderly Accidents, Deaths and Injuries (CDCs STEADI) 2019 scale and the Timed Up and Go (TUG) scale. 3. To find the association between the risk factors and the prevalence of fall among older people.

Materials and Methods

A cross-sectional study was conducted to find the prevalence of fall among the elderly in Thrissur Taluk Health Centers. CDCs STEADI 2019 fall risk assessment tool was used to assess the risk factors associated with the elderly. TUG test was used to determine gait, balance, strength, and posture.

Results

In our study, we discovered a prevalence of 41 percent of falls among the community-dwelling older adults of Thrissur. This study has shown that the risk of fall was higher among the female elderly population. 88% are found to be at high risk of fall, and 65% of the population were worried about fall.

Conclusion

This study found out a high prevalence of falls among community dwelling older adults.A future study with a larger sample size would be more helpful to confirm the impact of different variables in relation to the risk of fall among the elderly.

Mediation of pain in the association of sleep problems with falls among older adults in India

Body pain, sleep problems and falls are commonly reported among the elderly population. This study aimed to explore the mediating role of pain in the association of sleep problems with fall-outcomes (falls, fall-injury, and multiple falls) among older adults. Cross-sectional data from the baseline survey of Longitudinal Aging Study in India (LASI), 2017-18 were used. The total sample size for the study was 28,285 older adults aged 60 years and above. Falls and fall-related injuries among older adults in the last two years were self-reported. The Jenkins Sleep Scale (JSS-4) was used to assess sleep problems while pain was assessed using questions on whether respondents reported that they were troubled by pain and they required some form of medication or treatment for the relief of pain. Multivariable logistic regression and mediation analyses were conducted to fulfill the study objectives. While 13% older adults suffered from sleep problems, 38.83% were troubled with pain. Additionally, 12.63%, 5.64% and 5.76% older adults reported falls, fall-injury and multiple falls respectively. Older adults who suffered from sleep problems had higher odds of falls [adjusted odds ratio (aOR): 1.43, confidence interval (CI): 1.30-1.58], fall-injuries, [aOR:1.50,CI:1.30-1.73] and multiple falls [aOR:1.41,CI:1.24-1.62]. Similarly, older adults who were troubled with pain were more likely to report falls [aOR:1.80, CI:1.67-1.95], fall-injuries [aOR:1.66, CI:1.48-1.87] and multiple falls [aOR:1.90,CI:1.69-2.12]. The percent of the mediated effect of pain when examining the association between sleep problems and fall outcomes were reported to be 17.10%, 13.56% and 18.78% in case of falls, fall-injuries and multiple falls respectively. The current study finds evidence that pain mediates the association of sleep problems and falls, fall-injuries, and multiple falls among older Indian adults. Both sleep problems and pain are modifiable risk factors that need attention for fall prevention strategies.

Longitudinal association between falls and motoric cognitive risk syndrome among community-dwelling older adults

The motoric cognitive risk (MCR) syndrome is a predementia syndrome associated with dementia and mortality risk. This longitudinal study aimed to investigated the longitudinal association between MCR and falls in older adults, including 3,720 participants in the China Health and Retirement Longitudinal Study. A total of 482 participants (13.0%) met the MCR requirements at baseline. There were 226 incident cases of MCR (13.0%) throughout follow-up (duration: 4 years). Controlling for microsystem factors, a single fall (OR: 2.412, 95 % CI: 1.100-5.290; p < .05) was associated with incident MCR at baseline and to almost 2.0 times (HR: 2.021, 95 % CI: 1.031-3.961; p < .05) more inclined to develop MCR over time, compared to those without falls. These associations remained significant when meso/ exosystem factors and macrosystem factors were included in the analytic models. Falls may be useful in predicting MCR risk in the near future among Chinese older adults.

Prevalence, physical characteristics, and fall risk in older adults with and without possible sarcopenia

BACKGROUND

Recently, the Asian Working Group for Sarcopenia (AWGS) 2019 consensus redefined the sarcopenia including possible sarcopenia, sarcopenia and severe sarcopenia and grip strength cutoff value by sex.

AIMS

This study aimed to assess the prevalence, physical characteristics, physical fitness, and fall risk in older adults living in local communities, with possible sarcopenia using the diagnostic criteria suggested by the AWGS 2WG.

METHODS

A total of 431 participants (123 men and 308 women) aged 65-97 years were enrolled in this study. Based on the diagnostic criteria of possible sarcopenia suggested by AWGS 2, study participants were divided into normal and possible sarcopenia (grip strength: < 28 kg and < 18 kg for men and women, respectively) groups. Independent t-tests and logistic regression analyses were conducted to compare the differences between the two groups.

RESULTS

The possible prevalence of sarcopenia was 23.7%. Possible sarcopenia was present in older adults with lower weight, body mass index (BMI), skeletal muscle mass, and fat-free mass (P < 0.05) than those in the normal group. Older men with possible sarcopenia had poorer upper and lower body strength, aerobic endurance, lower body flexibility, agility and dynamic balance, and a higher fall risk than those in the normal group (P < 0.05). Older women with possible sarcopenia had a 2.5-fold and 3.3-fold higher fall risk than women in the normal group in both an unadjusted model (P = 0.001) and in a model adjusted for age and BMI (P < 0.001). However, there were no significant differences in fall risk among older men.

CONCLUSION

The diagnostic criteria suggested by AWGS 2 may be highly useful for screening for declining physical function.

A Latent Class Analysis of Health-Related Quality of Life in Korean Older Adults

The present study aimed to confirm latent classes in health-related quality of life (HRQOL) in older adults and investigate the characteristics of participants in each class. It aimed to provide basic data to develop interventions for each quality-of-life class by analysing the predictors of each class. Secondary data from a community health survey in G province since 2019 found a total of 41,872 participants. Of them, 9027 were 65 years or older and residing in G Province in 2019, participated in this study. Mplus 8.5 was used to conduct a latent class analysis of five domains of HRQOL. Four latent classes in the HRQOL of older adults, namely, stable type, physical disability type, emotional disability type, and crisis type were found. Certain variables predicted these classes. Based on the findings of the present study, training on functional mobility and balance to prevent falls in older populations and individualised programmes to promote mental health in them should be provided. Moreover, policies should increase medical accessibility and provide social support for older people with low-incomes. Additionally, since physical, psychological, and social health in older adults are inter-connected, a comprehensive care plan is needed to improve their HRQOL.

Incidence and risk factors for falls among community-dwelling elderly subjects on a 1-year follow-up: a prospective cohort study from Ernakulam, Kerala, India

OBJECTIVES

There is limited knowledge regarding epidemiology and risk of falls among the elderly living in low-income and middle-income countries. In this situation, the current study aims to report the incidence of falls and associated risk factors among free living elderly population from Kerala, India.

DESIGN

Prospective cohort study with stratified random cluster sampling.

SETTING

The study location was Ernakulam, Kerala, India, and we collected information via house visits using a questionnaire. During the research, the subjects were followed up prospectively for 1 year by phone at intervals of 3 months and missing subjects were contacted by house visits.

PARTICIPANTS

Community-dwelling elderly above 65 years of age.

RESULTS

We recruited a total of 1000 participants out of which a total of 201 (20.1%) subjects reported a fall during the follow-up. The incidence rate of falls was 31 (95% CI 27.7 to 34.6) per 100 person-years. Female sex (OR 1.48, 95% CI 1.05 to 2.10, p=0.027), movement disorders including Parkinsonism (OR 2.26, 95% CI 1.00 to 5.05, p=0.048), arthritis (OR 1.48, 95% CI 1.05 to 2.09, p=0.026), dependence in basic activities of daily living (OR, 3.49, 95% CI 2.00 to 6.09, p<0.001), not using antihypertensive medications (OR, 1.53, 95% CI 1.10 to 2.13, p=0.012), living alone during daytime (OR 3.27, 95% CI 1.59 to 6.71, p=0.001) and a history of falls in the previous year (OR, 2.25, 95% CI 1.60 to 3.15, p<0.001) predicted a fall in the following year.

CONCLUSIONS

One in five community-dwelling senior citizen fall annually and one in four who fall are prone to fall again in the following year. Interventions targeting falls among the elderly need to focus on modifiable risk factors such as living alone during daytime, movement disorders, arthritis and dependence on basic activities of daily living.

Physical and Psychological Factors Affecting Falls in Older Patients with Arthritis

As the population ages, falls are becoming one of the leading causes of morbidity and mortality. Joint disease (either osteoarthritis or rheumatoid arthritis) is a well-known predictor of falls, and these medical conditions increase in accordance with the aging population. This study aimed to describe individual, physical, and psychological characteristics between older adults with and without a fall history. Further, we aimed to identify statistically significant physical or psychological factors associated with falls by controlling individual variables. We analyzed data from the 2014 Survey of Living Conditions and Welfare Needs of Korean Older Adults. Adults aged 65 years or over with doctor-diagnosed joint disease were eligible. A total of 2707 women and 784 men (n = 3491) were enrolled. Of these, 1174 patients suffered a fall within a year (average number of falls = 2.4). We adopted individual variable-adjusted models and found that limited activities of daily living (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.04-1.87), fear of falling (OR 7.18, 95% CI 4.26-12.09), and depression (OR 1.28, 95% CI 1.09-1.50) significantly increased fall risks on logistic regression analysis. Our findings suggest that physical and psychological factors, especially the fear of falling, need to be addressed to prevent falls in elderly patients with arthritis.

Independence and Caregiver Preferences Among Community-Dwelling Older People in Slovenia: A Cross-Sectional Study

Although Slovenia is becoming an aging society, very little is known about the abilities and needs of home-dwelling older people or their preferences regarding assistance. The aim of the study was to explore the need for assistance in daily activities among older Slovenian people living at home. Older adults aged between 65 and 97 years (N = 358) participated in the cross-sectional survey study. A questionnaire that assessed independence in daily activities and assistance in the home environment was developed. Data were analyzed using descriptive statistics, a nonparametric test (Wilcoxon signed rank test), and the chi-square test. The results showed that older Slovenians were more independent in activities of daily living (ADLs) than instrumental activities of daily living (IADLs). Independence was the highest for using the toilet, feeding, and mobility transfers, and the lowest for bathing. With IADLs, assistance was most often required with shopping and housework; this assistance was usually provided by family members. The provider of assistance was generally compatible with older people’s preferences concerning assistance at home. We found no differences in care preferences between urban and rural settings. Assistance in the home environment was predominantly provided by unpaid helpers, which reflects recent developments in health and social services that put an emphasis on a person’s social network. Due to demographic changes and the decrease in the number of adult children, reliance on close relatives might soon become a challenge. These findings can help policy makers understand older people’s choices and preferences better when planning long-term care.

Comparison of Fall Risk Assessment Tools for Older Indonesian Adults in the Elderly Home and the Community

Introduction: One of the causes of disability among elderly is falling. The ability to predict the risk of falls among this group is important so that the appropriate treatment can be provided to reduce the risk. The objective of this study was to compare the Stopping Elderly Accidents, Deaths, & Injuries (STEADI) Initiative from the Centers for Disease Control and Prevention (CDC) and The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) from the Johns Hopkins University. Methods: This study used the STEADI tool, JHFRAT, Activities-Specific Balance Confidence Scale (ABC), and The Geriatric Depression Scale (GDS). The study areas were in community and elderly home in both public and private sectors and the samples were 427 after cleaning. Results: The results for the STEADI and JHFRAT tools were similar where the respondents at highest risk of falling among women (STEADI: 49%; JHFRAT: 3.4%), in Bandung area (63.5%; 5.4%), in private homes (63.3%; 4.4%), non-schools (54.6%; 6.2%), aged 80 or older (64.8%; 6.7%) and not working (48.9%;3.3%). The regression analysis indicated that there was a significant relationship between the risk factors for falls in the elderly determined by the JHFRAT and STEADI tools: namely, region, type of home, age, disease history, total GDS and ABC averages. Conclusion: Despite the similarity in the risk factors obtained through these assessments, there was a significant difference between the results for the STEADI tool and the JHFRAT. The test strength was 43%. However, STEADI is more sensitive to detect fall risk smong elderly than JHFRATKeywords: Activities-Specific Balance Confidence scale, elderly, fall risk,The Johns Hopkins Fall Risk Assessment Tool, the Stopping Elderly Accidents, Deaths, & Injuries

Risk factors for unintentional injuries among the rural elderly: a county-based cross-sectional survey

This study aimed to provide evidence for the prevention and reduction of unintentional injuries in the rural elderly by analysing epidemiological data of injuries among rural older adults (65⁺) and identifying the involved risk and protective factors. This study analysed all information, including the social demographic characteristics, chronic disease condition, lifestyle, living environment, mental health, activities of daily living and detailed information about the nature of the injuries. Chi-square tests, rank tests and a multivariate logistic regression were performed. The prevalence of unintentional injuries was 44.4%; according to the multivariate regression analysis, ten variables, including gender, floor tiles, cane use, sleeping duration, roughage intake frequency, mental health status, diabetes, arthritis and cataracts, were involved in the injury patterns. Low roughage intake (OR = 2.34, 95% CI 1.64-3.35), the use of a cane (OR = 1.78, 95% CI 1.31-2.41), a sleeping duration of five hours (OR = 1.75, 95% CI 1.27-2.42) and severe mental disorders (OR = 1.61, 95% CI 1.01-2.57) were the top 4 risk factors. In conclusion, we found that unintentional injuries among the rural elderly were closely related to chronic disease, mental health and residence environment. These findings could be beneficial for the prevention of unintentional injuries and for policy makers and health service managers.

Physical activity level and fall risk among community-dwelling older adults

[Purpose] To find the physical activity level and fall risk among the community-dwelling Malaysian older adults and determine the correlation between them. [Subjects and Methods] A cross-sectional study was conducted in which, the physical activity level was evaluated using the Rapid Assessment of Physical Activity questionnaire and fall risk with Fall Risk Assessment Tool. Subjects recruited were 132 community-dwelling Malaysian older adults using the convenience sampling method. [Results] The majority of the participants were under the category of under-active regular light-activities and most of them reported low fall risk. The statistical analysis using Fisher’s exact test did not show a significant correlation between physical activity level and fall risk. [Conclusion] The majority of community-dwelling Malaysian older adults are performing some form of physical activity and in low fall risk category. But this study did not find any significant correlation between physical activity level and fall risk among community-dwelling older adults in Malaysia.

Evaluation and simplification of the occupational slip, trip and fall risk-assessment test

OBJECTIVE

The purpose of this investigation is to evaluate the efficacy of the occupational slip, trip and fall (STF) risk assessment test developed by the Japan Industrial Safety and Health Association (JISHA). We further intended to simplify the test to improve efficiency.

METHODS

A previous cohort study was performed using 540 employees aged ≥50 years who took the JISHA's STF risk assessment test. We conducted multivariate analysis using these previous results as baseline values and answers to questionnaire items or score on physical fitness tests as variables. The screening efficiency of each model was evaluated based on the obtained receiver operating characteristic (ROC) curve.

RESULTS

The area under the ROC obtained in multivariate analysis was 0.79 when using all items. Six of the 25 questionnaire items were selected for stepwise analysis, giving an area under the ROC curve of 0.77.

CONCLUSION

Based on the results of follow-up performed one year after the initial examination, we successfully determined the usefulness of the STF risk assessment test. Administering a questionnaire alone is sufficient for screening subjects at risk of STF during the subsequent one-year period.

The Relationship between Older Adults' Risk for a Future Fall and Difficulty Performing Activities of Daily Living

Functional status is often defined by cumulative scores across indices of independence in performing basic and instrumental activities of daily living (ADL/IADL), but little is known about the unique relationship of each daily activity item with the fall outcome. The purpose of this retrospective study was to examine the level of relative risk for a future fall associated with difficulty with performing various tasks of normal daily functioning among older adults who had fallen at least once in the past 12 months. The sample was comprised of community-dwelling individuals 70 years and older from the 1984-1990 Longitudinal Study of Aging by Kovar, Fitti, and Chyba (1992). Risk analysis was performed on individual items quantifying 6 ADLs and 7 IADLs, as well as 10 items related to mobility limitations. Within a subsample of 1,675 older adults with a history of at least one fall within the past year, the responses of individuals who reported multiple falls were compared to the responses of participants who had a single fall and reported 1) difficulty with walking and/or balance (FRAIL group, n = 413) vs. 2) no difficulty with walking or dizziness (NDW+ND group, n = 415). The items that had the strongest relationships and highest risk ratios for the FRAIL group (which had the highest probabilities for a future fall) included difficulty with: eating (73%); managing money (70%); biting or chewing food (66%); walking a quarter of a mile (65%); using fingers to grasp (65%); and dressing without help (65%). For the NDW+ND group, the most noteworthy items included difficulty with: bathing or showering (79%); managing money (77%); shopping for personal items (75%); walking up 10 steps without rest (72%); difficulty with walking a quarter of a mile (72%); and stooping/crouching/kneeling (70%). These findings suggest that individual items quantifying specific ADLs and IADLs have substantive relationships with the fall outcome among older adults who have difficulty with walking and balance, as well as among older individuals without dizziness or difficulty with walking. Furthermore, the examination of the relationships between items that are related to more challenging activities and the fall outcome revealed that higher functioning older adults who reported difficulty with the 6 items that yielded the highest risk ratios may also be at elevated risk for a fall.

Differences in lifestyle, physical performance and quality of life between frail and robust Brazilian community-dwelling elderly women

AIM

To investigate the lifestyles, physical performance and quality of life (QOL) of frail and robust Brazilian community-dwelling older women, and to identify risk factors for frailty.

METHODS

Frailty was assessed using the Kihon Checklist. Lifestyles were assessed using a questionnaire. Physical performance was assessed by measuring walking speeds, performance on the one-leg stand test and the five-times chair stand test and handgrip strength. QOL was assessed using the Short Form-8 questionnaire. Participants were divided into frail and robust groups based on their total Kihon Checklist scores.

RESULTS

A total of 109 participants (age 70.8 ± 6.87 years) were included in this study (robust n = 85, frail n = 24). Differences in living structures (P < 0.001), financial satisfaction (P = 0.004) and the frequencies with which participants leave the house (P < 0.001) were found between groups. The frail group had more fallers (P = 0.047), and lower engagement in physical activity (P = 0.044), lower body mass indices (P = 0.043) and poorer nutritional status (P = 0.002), whereas robust older people showed better physical performance (walking speed P < 0.001, one-leg stand P = 0.021, handgrip strength P = 0.002) and higher QOL scores (general health P = 0.005, role-physical P = 0.013, bodily pain P = 0.002, vitality P = 0.001, social functioning P = 0.001, role-emotional P = 0.008). Multivariate regression analysis identified a slow usual walking speed and bodily pain as risk factors for frailty.

CONCLUSIONS

Frail participants had higher indices for being housebound, and having financial dissatisfaction, a sedentary lifestyle, falls, and malnutrition. Furthermore, they showed poorer physical performance and QOL. An early, well-focused approach is crucial, especially for older adults who walk slowly and have bodily pain to preserve health and QOL. Geriatr Gerontol Int 2016; 16: 829-835.

Social risk factors for falls among rural Nigerian community-dwelling older adults

AIM

Reports on social risk factors for falls are scarce. This study explored the associations of selected sociodemographic and health variables with falls among rural Nigerian community-dwelling older adults.

METHODS

The present cross-sectional study involved 131 community-dwelling older adults (84 women and 47 men) recruited at an outreach center. Demographic (age, sex and marital status), social (frequency of visiting relations and friends, and number of consistent informal carers) and health (number of comorbid conditions) variables were recorded.

RESULTS

Having fewer than two informal carers (0.26, 95% CI 0.10-0.68) was independently associated with reduced risk for falls. Visiting relations and friends less than twice per week was independently associated with greater risks for falls (3.85, 95% CI 1.42-10.46) and recurrent falls (4.86, 95% CI 1.25-18.85).

CONCLUSIONS

The number of informal carers and frequency of social visits are risk factors for falls in older adults, and need to be taken into consideration in any strategy for fall prevention in older adults. Geriatr Gerontol Int 2015; ●●: ●●-●●.

Development of a new instrument for evaluating leg motions using acceleration sensors (II)

OBJECTIVE

The purpose of this study was to investigate the characteristics of the average acceleration of elderly people during walking.

METHOD

The subject cohort comprised nine men and 21 women aged ≥63 years. Subjects walked a 10-m straight course (walk test) which required stepping over six obstacles (hurdle walk test). The average acceleration was calculated from the accelerograms. Functional reach test scores and the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence, fall risk assessment, fall experience within the last year, and carelessness were used as standard indices to estimate the dynamic postural movement and fall risk.

RESULTS

The average acceleration during the walk test was not significantly correlated with the standard indices. The average accelerations at the lumbar and knee positions clustered with fall experience and carelessness, while those at the ankle and toe positions clustered with the hurdle walk test, TMIG index of competence, and fall risk assessment. Between the high- and low-risk groups classified by the conventional indices, there was a significant difference in the average acceleration at some measurement positions. The receiver operating characteristic analysis showed the possibility to discriminate the high-risk group according to the standard indices with average acceleration.

CONCLUSIONS

The average acceleration during walking may be a composite index that encompasses standard indices and discriminate the high-risk group. As such, it may be a useful tool to estimate the dynamic postural movement and fall risk at all measurement positions.

Episodes of falling among elderly people: a systematic review and meta-analysis of social and demographic pre-disposing characteristics

CONTEXT

The multifactorial nature of falls among elderly people is well-known. Identifying the social-demographic characteristics of elderly people who fall would enable us to define the typical profile of the elderly who are at risk of falling.

OBJECTIVE

We aimed to isolate studies in which the social-demographic risk factors for falls among the elderly have been evaluated and to carry out a meta-analysis by combining the results of all of these selected studies.

METHOD

We did a systematic literature review using the key words "accidental fall / numerical data" and "risk factors." Inclusion criteria entailed the selection of articles with the following characteristics: population of subjects aged 60 years or over, falls that took place in everyday life, and social-demographic risk factors for falls.

RESULTS

3,747 indexed articles published between 1981 and 2007 were identified, and 177 studies with available data were included, of which 129 had data on social-demographic risk factors for falls. Difficulties in activities of daily living (ADL) or in instrumental activities of daily living (IADL) double the risk of falling: The OR and 95% Cl were 2.26 (2.09, 2.45) for disturbance ADL and 2.10 (1.68, 2.64) for IADL. The OR and 95% Cl for Caucasians were 1.68 (0.98 - 2.88) and 0.64 (0.51 - 0.80) for Hispanics. In the subgroup of patients older than eighty, being married protected people from falling with an OR and 95% Cl =0.68 (0.53 - 0.87).

CONCLUSION

Defining factors that create a risk of falling and protect elderly people from falls using social-demographic characteristics lets us focus on an "at risk" population for which a specific program could be developed.

The relationship between time spent outdoors, falls, and fall-risk among the community-dwelling elderly in rural Japan

Falls are a major health concern among the older adults, and physical activity has been linked to fall-risk. This cross-sectional study aimed to identify the relationship between time spent outdoors and the frequency of falls and fall-risk among the older adults in two rural Japanese communities. In Okikamuro, there was a positive correlation between fall-risk and age (r = 0.40, p < 0.001), as well as a slight negative correlation between the time spent outdoors and fall-risk (r = -0.20, p < 0.05). In Iwasaki, there was no correlation between fall-risk and age nor between fall-risk and the time spent outdoors; however, fall-risk was significantly higher in Iwasaki (p < 0.05) than Okikamuro and the time spent outdoors during winter was significantly less (p < .001).