Incidence, risk factors and consequences of falling injuries among the community-dwelling elderly in Shihpai, Taiwan

Prevalence of falls and associations with family functioning among community-dwelling older adults in Guangzhou, China

Introduction

Falls are the primary cause of unintentional fatalities among individuals aged 65 and older. Enhancing research on fall prevention among older adults is an urgent priority. Consequently, this study aims to investigate the prevalence and influencing factors of falls among community-dwelling older adults in Guangzhou, China, with a particular emphasis on the impact of family functioning.

Methods

We used a multi-stage stratified cluster random sampling technique to successfully survey 2,399 individuals aged 65 and above across 11 districts in Guangzhou City. Data on sociodemographic characteristics, health and lifestyle factors, and fall incidents were collected through telephone interviews. Chi-square tests, Lasso regression, and logistic regression were utilized to pinpoint fall risk factors. Association rule mining uncovered the relationships between falls and associated variables.

Results

A total of 390 participants reported experiencing falls, the prevalence of falls among older adults was 16.3% (95%CI: 14.82% ~ 17.78%). Logistic regression analysis identified several risk factors for falls among older adults: female [OR = 1.511, 95%CI (1.188-1.922)], age 85 years and older [OR = 2.332, 95%CI (1.447-3.758)], stroke [OR = 1.821, 95%CI (1.038-3.192)], hypoglycemia [OR = 1.639, 95%CI (1.228-2.186)], visual impairment [OR = 1.418, 95%CI (1.097-1.833)], need to be cared for [OR = 1.722, 95%CI (1.339-2.215)], chronic pain [OR = 1.663, 95%CI (1.302-2.124)], and anxiety [OR = 1.725, 95%CI (1.243-2.395)]. In addition, it was shown that a well-functioning family was a protective factor against falls [OR = 0.589, 95%CI (0.44-0.789)].

Conclusion

The prevalence of falls among community-dwelling older adults in Guangzhou City was high, and the influencing factors were complex. It is recommended to develop and implement comprehensive intervention measures for high-risk groups, including those who are females, older adults, and suffer from chronic diseases while paying special attention to the care of family members for older adults.

Dual Sensory Impairment Predicts an Increased Risk of Postdischarge Falls in Older Patients

OBJECTIVES

The purpose of this study was to determine the associations of vision impairment, hearing impairment, and comorbid vision and hearing impairment [ie, dual sensory impairment (DSI)] on admission to hospital with falls within 3 months of discharge in older patients.

DESIGN

This prospective multicenter study included patients admitted to and discharged from geriatric wards at 3 university hospitals and 1 national medical center in Japan between October 2019 and July 2023.

SETTING AND PARTICIPANTS

Of 1848 individuals enrolled during the study period, 1141 were excluded, leaving 707 for inclusion in the analysis.

METHODS

Participants' background factors were compared in terms of whether they had a fall during the 3 months postdischarge. Logistic regression analysis was then performed using the presence or absence of falls after discharge as the objective variable. Three models were created using vision impairment, hearing impairment, and DSI as covariates. Other covariates included physical function, cognitive function, and depression. In addition, logistic regression analysis was performed with falls during hospitalization as the objective variable.

RESULTS

DSI was significantly more common in the falls group (P = .004). Logistic regression analysis showed that the risk of falls after discharge was higher in patients with DSI (odds ratio 3.432, P = .006) than in those with vision or hearing impairment alone. When adjusted for physical function, cognitive function, depression, and discharge location, DSI was significantly associated with an increased risk of falls after discharge (odds ratio 3.107, P = .021). The association between DSI and falls during hospitalization did not reach statistical significance, but a trend was observed.

CONCLUSIONS AND IMPLICATIONS

This study is the first to show an association between DSI and falls after discharge. Simple interventions for patients with DSI may be effective in preventing falls, and we suggest that they be actively implemented early during hospitalization.

Associations between type 2 diabetes mellitus and risk of falls among community-dwelling elderly people in Guangzhou, China: a prospective cohort study

BACKGROUND

Several studies have demonstrated that older adults with type 2 diabetes mellitus (T2DM) have a higher risk of falls compared to those without T2DM, which may lead to disability and a lower quality of life. While, limited prospective studies have quantified the associations in southern China. We conducted a longitudinal cohort study to quantify the associations between T2DM and falls and investigate the risk factors of falls among community-dwelling elderly people in Guangzhou, China.

METHODS

The population-based study included 8800 residents aged 65 and over in 11 counties of Guangzhou at baseline in 2020 and then prospectively followed up through 2022. Of 6169 participants had complete follow-up and were included in the present study. A fall event was identified by self-reported. The Cox regression was applied to quantify the associations between T2DM and falls, and hazard ratios (HRs) were calculated to the factors associated with falls among participants.

RESULTS

The median follow-up time for participants was 2.42 years. During the follow-up period, the incidence of falls among all participants was 21.96%. After adjusting for covariates in Cox regression models, T2DM remained a significant risk factor for falls, with HR of 1.781 (95% CI: 1.600-1.983) in the unadjusted covariates model and 1.757 (1.577-1.957) in the adjusted covariates model. Female (1.286, 1.136-1.457), older age (≥ 80: 1.448, 1.214-1.729), single marital status (1.239, 1.039-1.477), lower education level (primary school and below: 1.619, 1.004-1.361), hypertension (1.149, 1.026-1.286) and stroke (1.619, 1.176-2.228) were associated with a higher risk of falls, whereas everyday physical exercise (0.793, 0.686-0.918) was associated with a lower risk of falls.

CONCLUSION

Falls are common, with risks between T2DM and falls quantified and several factors investigated in the longitudinal cohort study among community-dwelling elderly people in Guangzhou, China. Targeted action on the risk factors may reduce the burden of falls in elderly people with T2DM in the future.

Falls among community-dwelling older adults in the Philippines and Viet Nam: Results from nationally representative samples

Falls are a significant public health issue globally. However, studies with nationally representative samples have yet to be done to understand falls among older adults in the Philippines and Viet Nam. Using a biopsychosocial perspective, this study investigated the prevalence of falls and their associated factors among community-dwelling older adults in these countries. Cross-sectional data were drawn from the baseline survey of the Longitudinal Study of Ageing and Health in the Philippines (2018, N = 4,606) and the Longitudinal Study of Ageing and Health in Viet Nam (2018, N = 4,378). The outcome variables were any falls in the past year. Independent variables included sociodemographic factors (age, sex, education, living in urban areas, living alone, social network size), biophysical factors (vision, chronic conditions, functional impairments, pain locations, insomnia symptoms, sleep medications, grip strength, walking speed, postural control), and psychological factors (depressive symptoms). Descriptive analysis and logistic regression analysis were used to analyze the data. The results showed that 17.7 % and 7.3 % of older Filipino and Vietnamese adults fell in the year before the study. Significant factors associated with the odds of any falls among Filipino older adults were having a higher level of education, living in urban areas, living with others, experiencing more functional impairments, reporting one or more pain locations, and having poor grip strength. In Viet Nam, having more chronic conditions, experiencing more functional impairments, and reporting two or more pain locations were found to be associated with higher odds of any falls. The population in the Philippines and Viet Nam is aging rapidly. Findings from this study are timely in identifying at-risk individuals and preparing for effective fall prevention strategies.

Prevalence of falls, injury from falls and associations with chronic diseases among community-dwelling older adults in Guangzhou, China: a cross-sectional study

Introduction

As a developing country with the largest older adult population in the world, strengthening the research on falls among the older adults is undoubtedly an urgent item in China. This study aimed to explore the prevalence and risk factors associated with falls and injury from falls among community-dwelling older adults in Guangzhou, China, particularly focusing on their associations with chronic diseases.

Methods

A total of 1,629 participants aged 65 years and above were selected from 11 counties in Guangzhou by the multi-stage stratified random sampling method in 2021. Socio-demographic characteristics, health and lifestyle factors, the status of falls, and injury from falls were measured by structured questionnaires through face-to-face interviews. Chi-square tests and logistic regression analysis were used to identify factors associated with falls and injury from falls. Chord diagrams were used to explore their associations with chronic diseases.

Results

A total of 251 participants (15.41%, 95% CI: 13.98%-17.25%) reported falls, and 162 participants (9.46%, 95% CI:7.72%-11.55%) indicated an injury from falls. Logistic regression analysis showed the results as follows: female patients (adjusted OR = 1.721, 95% CI: 1.681-1.761) aged ≥80 years (1.910, 1.847-1.975), unemployed (1.226, 1.171-1.284), uninsured (1.555, 1.448-1.671), average monthly household income of 2,001-4,000 CNY (1.878, 1.827-1.930), number of services provided by the community health center ≥13 times per year (1.428, 1.383-1.475), illness within 2 weeks (1.633, 1.595-1.672), high-intensity physical activity (2.254, 2.191-2.32), sedentary (1.094, 1.070-1.117), and number of chronic disease illnesses ≥3 (1.930, 1.870-1.993). Meanwhile, those risk factors were also associated with injury from falls. The older adults with medium-intensity physical activity were at lower risk (0.721, 0.705-0.737) of falls and higher risk (1.086, 1.057-1.117) of being injured from falls. Chord diagrams showed the correlations between chronic diseases and falls and injury from falls among community-dwelling older adults in Guangzhou, China.

Conclusion

The high prevalence of falls is found among community-dwelling older adults in Guangzhou, China, which is related to multiple factors such as demographic variables, lifestyle, and health status, especially for chronic diseases. Therefore, targeted interventions should be developed and implemented urgently.

Correlation analysis of physical fitness and its impact on falls in 2130 community- dwelling older adults: a retrospective cross-sectional study

BACKGROUND

As the community-dwelling population ages in Taiwan, concerns regarding long-term care have grown more urgent. Physical fitness plays a key role in enabling community-dwelling older adults to independently complete daily tasks and avoid falling accidents. However, the effect of physical fitness on falls and other fitness-related factors remains poorly understood.

METHODS

In this retrospective cross-sectional study, 2130 community-dwelling older adults were recruited from a rural region of Taiwan. Each of these participants completed a demographics interview and frailty questionnaire and reported their history of falls. We evaluated each participant's height and body weight measurements, calf circumference, bone mass density, and results on the grip strength, single-leg standing, chair sit-and-reach, 8-ft up-and-go, 30-second chair stand, 2-minute step, 30-second arm curl, 6-m walk, and back scratch tests to determine their overall physical fitness, which consisted of their body composition, muscular strength and endurance, flexibility, and cardiopulmonary fitness.

RESULTS

The prevalence of falls in the preceding year among the older adults surveyed was 20.8%, and the resultant hospitalization rate was 10.9%. The older adults who were more physically active in the past week, had regular exercise habits, lived with family, and had no history of hospitalization due to falls, exhibited greater performance on the physical fitness tests. Three time fallers exhibited lower levels of overall physical fitness than did those who had not fallen. The nonfallers outperformed the fallers in grip strength (participants who had not fallen and those who had fallen once, twice, or three times in the preceding year: 24.66 ± 0.19 vs. 23.66 ± 0.35 vs. 20.62 ± 0.71 vs. 22.20 ± 0.90 kg) and single-leg standing duration (19.38 ± 0.39 vs. 16.33 ± 0.78 vs. 13.95 ± 1.67 vs. 12.34 ± 1.82 seconds).

CONCLUSIONS

Exercise habits, living status, hospitalization due to falls, and amount of exercise were all associated with physical fitness in community-dwelling older adults. The results of all of the assessments indicated that the participants who had fallen three times exhibited lower levels of physical fitness than did those who had not fallen in the previous year. Physical measurements, including grip strength and single-leg standing duration, are associated with an individual's risk of falling, which indicates that they should be considered in the development of geriatric physical fitness and fall-prevention programs.

Association Between Sensory Loss and Falls Among Middle-Aged and Older Chinese Population: Cross-Sectional and Longitudinal Analyses

Introduction: Previous studies have suggested that sensory loss is linked to falls. However, most of these studies were cross-sectional designed, focused on single sensory loss, and were conducted in developed countries with mixed results. The current study aims to investigate the longitudinal relationship between hearing loss (HL), vision loss (VL) and dual sensory loss (DSL) with falls among middle-aged and older Chinese population over 7 years. Methods: The data was obtained from the China Health and Retirement Longitudinal Survey (CHARLS). In total, 7,623 Chinese older adults aged over 45 were included at baseline 2011 in this study. Self-reported falls and HL/VL/DSL were accepted. Other confounding variables included age, sex, BMI, educational level, marital status, various physical disorders and lifestyles. The impact of baseline sensory status on baseline prevalence of falls and incident falls over 7 years were assessed using logistic regression analyses. A logistic mixed model was used to assess the association between time-varying sensory loss with incident falls over 7 years after adjusted with multi-confounding factors. Results: Single and dual sensory loss groups had significantly higher prevalence of falls compared to no sensory loss (NSL) group (DSL: 22.4%, HL: 17.4%, VL: 15.7%, NSL: 12.3%). Baseline HL (OR: 1.503, 95% CI: 1.240-1.820), VL (OR: 1.330, 95% CI: 1.075-1.646) and DSL (OR: 2.061, 95% CI: 1.768-2.404) were significantly associated with prevalence of falls. For longitudinal observation over 7 years, baseline HL/DSL and persistence of all types of sensory loss were associated with incidence of falls. Time-varying HL (OR: 1.203, 95% CI: 1.070-1.354) and DSL (OR: 1.479, 95% CI: 1.343-1.629) were associated with incident falls after adjusted with multi-confounders, while VL was not. Conclusion: HL and DSL are significantly associated with both onset and increased incidence of falls over 7 year's observation in middle-aged and elderly Chinese population. Persistence or amelioration of sensory loss status could exert divergent influences on incidence of falls, which should be considered in the development of falls-prevention public health policies for aging population.

Exploring the Recent Trends in Management of Dementia and Frailty: Focus on Diagnosis and Treatment

Dementia and frailty increase health adversities in older adults, which are topics of growing research interest. Frailty is considered to correspond to a biological syndrome associated with age. Frail patients may ultimately develop multiple dysfunctions across several systems, including stroke, transient ischemic attack, vascular dementia, Parkinson's disease, Alzheimer's disease, frontotemporal dementia, dementia with Lewy bodies, cortico-basal degeneration, multiple system atrophy, amyotrophic lateral sclerosis, and Creutzfeldt-Jakob disease. Patients with dementia and frailty often develop malnutrition and weight loss. Rigorous nutritional, pharmacological, and non-pharmacological interventions generally are required for these patients, which is a challenging issue for healthcare providers. A healthy diet and lifestyle instigated at an early age can reduce the risk of frailty and dementia. For optimal treatment, accurate diagnosis involving clinical evaluation, cognitive screening, essential laboratory evaluation, structural imaging, functional neuroimaging, and neuropsychological testing is necessary. Diagnosis procedures best apply the clinical diagnosis, identifying the cause(s) and the condition(s) appropriate for treatment. The patient's history, caregiver's interview, physical examination, cognitive evaluation, laboratory tests, and structural imaging should best be involved in the diagnostic process. Varying types of physical exercise can aid the treatment of these disorders. Nutrition maintenance is a particularly significant factor, such as exceptionally high-calorie dietary supplements and a Mediterranean diet to support weight gain. The core purpose of this article is to investigate trends in the management of dementia and frailty, focusing on improving diagnosis and treatment. Substantial evidence builds the consensus that a combination of balanced nutrition and good physical activity is an integral part of treatment. Notably, more evidence-based medicine knowledge is required.

History of Falls, Dementia, Lower Education Levels, Mobility Limitations, and Aging Are Risk Factors for Falls among the Community-Dwelling Elderly: A Cohort Study

Background: Falling is a serious issue among elderly community dwellers, often resulting in disability. We aimed to investigate the risk factors for falls among elderly community dwellers. Methods: We recruited 232 participants from multiple community learning and care centers, who provided their information through questionnaires. They were divided into two groups, according to their falling events after a 1-year follow-up. Univariate and multivariate logistic regressions were used for statistical analysis. Results: A total of 64 participants reported a fall at the 1-year follow-up. The falling group comprised older and single people with lower education levels, higher rates of dementia, a history of falls, lower scores on the Mini-Mental State Examination, and more disability functions when compared to the non-falling group (all p < 0.05). The regression model showed that a history of falls (OR: 62.011; p < 0.0001), lower education levels (OR: 4.088; p = 0.039), mild dementia (OR: 20.729; p = 0.028), older age (OR: 1.176; p < 0.0001), walking for 300 m (OR: 4.153; p = 0.030), and running for 30 m (OR: 3.402; p = 0.015) were 1-year risk factors for falls. Conclusion: A history of falling, low education levels, aging, mild dementia, and certain mobility limitations were strong risk factors for future falling accidents in elderly Taiwanese community dwellers.

Comparing the Effects of Single-Task versus Dual-Task Balance Training on Gait Smoothness and Functional Balance in Community-Dwelling Older Adults: A Randomized Controlled Trial

To compare the effects of single- versus dual-task balance training on the gait smoothness and balance of community-dwelling older adults, 69 volunteers were randomized to single-, dual-task training, and control (no intervention) groups. Exercises were received in 18 sessions through 6 weeks. The gait smoothness was measured by the harmonic ratio of trunk accelerations using a triaxial accelerometer. Balance performance was assessed through the Fullerton Advanced Balance scale, Timed Up and Go test, Activities-specific Balance Confidence, and gait speed. After the trial, all variables improved significantly in the training groups. Moreover, differences in the mean change of all variables, except the Timed Up and Go test, were statistically significant between the interventional groups and the control group, but no significant difference was reported between the two training groups. This study suggests that balance training can improve gait smoothness as well as balance status in healthy older adults.

Validation of the short falls efficacy scale-international for Taiwanese community-dwelling older adults: Associations with fall history, physical frailty, and quality of life

The FES-I is widely used to measure the fear of falling. However, studies linking the Chinese version of the FES-I to frailty and quality of life among older adults are still limited. Thus, this study examined the association of the full 16-item FES-I and the 7-item short FES-I with fall history, physical frailty, and quality of life among older Taiwanese adults. A total of 751 community-dwelling older adults in Taipei City participated in this study. Data analyses included logistic and linear regression models. The 16-item and the short FES-I were strongly correlated (Spearman rho = 0.963), and both scales are reliable. The 7-item FES-I was positively associated with fall history and physical frailty and negatively associated with the physical (b = -0.65, p < 0.001) and mental (b = -0.59, p < 0.001) components of health-related quality of life, independent of physical frailty. Thus, the short FES-I can be used to increase the feasibility of health screenings of older adults in Chinese-speaking contexts.

Risk factors of falls and the gender differences in older adults with diabetes at outpatient clinics

AIMS

To explore the risk factors of falls and the gender differences based on demographic and disease characteristics, physical capability, and fear of falling in older adults with diabetes visiting outpatient clinics in Taiwan.

DESIGN

Cross-sectional design.

METHODS

A total of 485 patients with type 2 diabetes aged between 65 and 80 years were recruited from three endocrine outpatient clinics in Taiwan. Demographic and disease characteristics, fall history in the previous one year and fear of falling were collected by a self-reported questionnaire. Calf circumference, handgrip strength, one-leg standing and time up-and-go tests were all performed to assess the physical capability of participants. Data were collected from May 2019 to May 2020.

RESULTS

Female gender (OR = 1.75), handgrip strength (OR = 2.43) and fear of falling (OR = 3.38) were important risk factors of falls overall, although fear of falling (OR = 4.69) was the only important risk factor of falls in males, while handgrip strength (OR = 3.48) and fear of falling (OR = 2.86) were important risk factors of falls in females. The sensitivity of simultaneous screening handgrip strength and fear of falling were 85.7, 86.4 and 86.2 in males, females and older adults overall with diabetes, respectively.

CONCLUSION

Fear of falling was an important risk factor of falls in both genders, especially in males. Handgrip strength was an important risk factor of falls specifically for females. By simultaneously screening fear of falling and handgrip strength, risk of falls in older adults with diabetes at outpatient clinics could be identified in a more timely manner. Impact Nurses could periodically and simultaneously assess fear of falling and handgrip strength of older adults with diabetes at outpatient clinics. For those are identified at risk of falls on either fear of falling or handgrip strength, nurses could provide corresponding interventions to reduce the fear of falling or improve muscle strength to prevent such falls.

Developing a Scoring Model to Predict the Risk of Injurious Falls in Elderly Patients: A Retrospective Case-Control Study in Multicenter Acute Hospitals

PURPOSE

Injurious falls seriously threaten the safety of elderly patients. Identifying risk factors for predicting the probability of injurious falls is an important issue that still needs to be solved urgently. We aimed to identify predictors and develop a nomogram for distinguishing populations at high risk of injurious falls from older adults in acute settings.

PATIENTS AND METHODS

A retrospective case-control study was conducted at three hospitals in Shanghai, China. Elderly patients with injurious falls from January 2014 to December 2018 were taken as cases, and control patients who did not have falls were randomly matched based on the admission date and the department. The data were collected through a medical record review and adverse events system. The original data set was randomly divided into a training set and a validation set at a 7:3 ratio. A nomogram was established based on the results of the univariate analysis and multivariate logistic regression analysis, and its discrimination and calibration were verified to confirm the accuracy of the prediction. The cut-off value of risk stratification was determined to help medical staff identify the high-risk groups.

RESULTS

A total of 115 elderly patients with injurious falls and 230 controls were identified. History of fractures, orthostatic hypotension, functional status, sedative-hypnotics and level of serum albumin were independent risk factors for injurious falls in elderly patients. The C-indexes of the training and validation sets were 0.874 (95% CI: 0.784-0.964) and 0.847 (95% CI: 0.771-0.924), respectively. Calibration curves were drawn and showed acceptable predictive performance. The cut-off values of the training and validation sets were 146.3 points (sensitivity: 73.7%; specificity: 87.5%) and 157.2 points (sensitivity: 69.2%; specificity: 85.5%), respectively.

CONCLUSION

The established nomogram facilitates the identification of high-risk populations among elderly patients, providing a new assessment tool to forecast the individual risk of injurious falls.

The Relationship between Self-Rated Economic Status and Falls among the Elderly in Shandong Province, China

(1) Background: Older people are more vulnerable and likely to have falls and the consequences of these falls place a heavy burden on individuals, families and society. Many factors directly or indirectly affect the prevalence of falls. The aims of this study were to understand the prevalence and risk factors of falls among the elderly in Shandong, China; the relationship between economic level and falls was also preliminary explored. (2) Methods: Using a multi-stage stratified sampling method, 7070 elderly people aged 60 and over were selected in Shandong Province, China. General characteristics and a self-rated economic status were collected through face to face interviews. Chi-square tests, rank sum tests and two logistic regression models were performed as the main statistical methods. (3) Results: 8.59% of participants reported that they had experienced at least one fall in the past half year. There was a significant difference in experienced falls regarding gender, residence, marital status, educational level, smoking, drinking, hypertension, diabetes, coronary disease, and self-reported hearing. The worse the self-rated economic status, the higher the risk of falling, (poor and worried about livelihood, OR = 3.60, 95%; CI = 1.76–7.35). (4) Conclusions: Women, hypertension, diabetes and self-reported hearing loss were identified as the risk factors of falls in the elderly. The difference of economic level affects the falls of the elderly in rural and urban areas. More fall prevention measures should be provided for the elderly in poverty.

Incidence, risk factors and economic burden of fall-related injuries in older Chinese people: a systematic review

OBJECTIVE

China's population is ageing and fall-related injury in older Chinese people is a growing public health concern. This review aims to synthesise existing evidence on the incidence, risk factors and economic burden of fall-related injury among older Chinese people to inform health service planning.

METHODS

A systematic search of literature on falls and injury among older people living in China was performed in six electronic databases including both English and Chinese databases. Results were combined using narrative synthesis due to the heterogeneity of included studies.

RESULTS

A total of 93 studies from Mainland China, Taiwan and Hong Kong were included in this review. Most of these studies were descriptive; 82 reported the incidence of fall-related injury among older Chinese people, 7 studies examined the risk factors for fall-related injury and 22 studies described the economic burden of fall-related injury. The incidence of fall-related injury reported among older Chinese people ranged from 0.6% to 19.5%. Risk factors significantly associated with fall-related injury among older Chinese included older age, female sex, walking aid use, living environments, chronic disease, medication usage, visual impairment and a fall direction other than forward. The cost of fall-related injury among older Chinese people ranged from US$16 to US$3812 per person per fall.

CONCLUSION

Falls-related injuries are a significant public health issue for older Chinese people. Further studies using prospective design to identify risk factors and the economic burden of fall-related injuries are needed.

Influence of functional, psychological, and environmental factors on falls among community-dwelling older adults in Hong Kong

AIM

The growth of the ageing population has been rapid. However, this ageing population is not homogeneous; individuals have different levels of functionality and psychosocial status, and some are members of at-risk or high-risk groups. As such, studies on the functional, psychological, and environmental factors of falls among community-dwelling older adults are imperative. By investigating the effect of life satisfaction, as well as environmental and functional factors, on falls among community-dwelling older adults in Hong Kong, this study aims to address this concern.

METHODS

The study recruited 249 participants. Both self-reported questionnaires and home safety assessments were administrated.

RESULTS

Logistic regression analysis showed that life satisfaction and instrumental activities of daily living were significant predictors of falls. Significant differences between fallers and non-fallers were found in functional and psychological areas. The presence of home hazards was low and not associated with falls in this population. However, this variable was negatively associated with life satisfaction and predicted by one of its domains, satisfaction of possession.

CONCLUSION

These results can help health-care and social service providers to identify the needs and types of support required for effective fall prevention and to better tailor and target community intervention for older adults.

Orthostatic Hypotension and Falls in Older Adults: A Systematic Review and Meta-analysis

OBJECTIVES

Orthostatic hypotension is a potential risk factor for falls in older adults, but existing evidence on this relationship is inconclusive. This study addresses the association between orthostatic hypotension and falls.

DESIGN

Systematic review and meta-analysis of the cross-sectional and longitudinal studies assessing the association between orthostatic hypotension and falls, as preregistered in the PROSPERO database (CRD42017060134).

SETTING AND PARTICIPANTS

A literature search was performed on February 20, 2017, in MEDLINE (from 1946), PubMed (from 1966), and EMBASE (from 1947) using the terms orthostatic hypotension, postural hypotension, and falls. References of included studies were screened for other eligible studies. Study selection was performed independently by 2 reviewers using the following inclusion criteria: published in English; mean/median age of the population ≥65 years; blood pressure measurement before and after postural change; and assessment of the association of orthostatic hypotension with falls. The following studies were excluded: conference abstracts, case reports, reviews, and editorials. Data extraction was performed independently by 2 reviewers.

MEASURES

Unadjusted odds ratios of the association between orthostatic hypotension and falls were used for pooling using a random effects model. Studies were rated as high, moderate, or low quality using the Newcastle-Ottawa Scale.

RESULTS

Out of 5646 studies, 63 studies (51,800 individuals) were included in the systematic review and 50 studies (49,164 individuals) in the meta-analysis. Out of 63 studies, 39 were cross-sectional and 24 were longitudinal. Orthostatic hypotension was positively associated with falls (odds ratio 1.73, 95% confidence interval 1.50-1.99). The result was independent of study population, study design, study quality, orthostatic hypotension definition, and blood pressure measurement method.

CONCLUSIONS AND IMPLICATIONS

Orthostatic hypotension is significantly positively associated with falls in older adults, underpinning the clinical relevance to test for an orthostatic blood pressure drop and highlighting the need to investigate orthostatic hypotension treatment to potentially reduce falls.

A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls?

Maintaining or improving quality of life (QoL) is a key outcome of clinical interventions in older people. Fear of falling (FoF) is associated with activity restriction as well as with poorer physical and cognitive functions and may be an important contributor to a diminished QoL. The objectives of this systematic review were to determine i) the effect of FoF on QoL in older people, ii) whether the association between these two constructs depends on the use of specific conceptualizations and measurement instruments, and iii) the role of fall events as mediating factor in this relationship. Four electronic databases (PubMed, EMBASE, CINAHL, and Cochrane Library) were searched from their inceptions to February 2018. Thirty mostly cross-sectional studies in nearly 30.000 people (weighted mean age 75.6 years (SD =6.1); 73% women) were included. FoF was associated with QoL in most studies, and this association appeared to be independent of the conceptualization of FoF. Moreover, this relationship was independent of falls people experienced which seemed to have a lower impact. FoF should be considered not only as by-product of falls and targeted interventions in parts different from those to reduce falls are likely required. Studies are needed showing that reducing FoF will lead to increased QoL.

Relationship between muscle strength and fall episodes among the elderly: the Yilan study, Taiwan

Background

Fall episodes are not unusual among community residents, especially the elderly, and lower muscle strength is an important issue to address in order to prevent falls.

Methods

A community health survey was conducted in a suburban area of Taiwan, and 1067 older adults were selected for enrollment in the present study. All the enrolled subjects had been visited at their homes; the subjects’ strength of both hands and muscle mass of both legs were measured and well-established questionnaires were finished by certificated paramedic staffs.

Results

The incidence of fall episodes in the previous 1 year in the Yilan elderly population was 15.1%, and the female predominance was significant. A significantly higher prevalence of cataracts was found in group who experienced a fall in the past year (64% vs. 54.9% in the non-fall group). Mild or more severe dementia was much more prevalent in the group who experienced a recent fall (33.8% vs. 25.7% in the non-fall group). The strength of both hands tested as the physical function was 17.6 ± 8.0 kg in the recent fall group, significantly weaker than that in the non-fall group (20.7 ± 8.7 kg). Multivariate regression analysis revealed a greater weekly exercise duration and greater strength of both hands reduced the occurrence of falls among the whole and the female population. The standardized effect sizes of hand grip strength between both groups, not trivial, were 0.29 and 0.37 for the total population and the female subpopulation respectively.

Conclusions

Less weekly exercise duration and weaker muscle strength were f ound to be independent risk factors of fall episode(s) in an elderly Taiwanese population, especially in the female sub-population. Muscle strength, measured by average of both hands grip strength, was the most significantly factor of one-year fall episode(s) accessed retrospectively.

Falls After Ophthalmological Surgery Experience Among the Community-Dwelling Elderly in Japan

Community-dwelling elderly are likely to fall even after ophthalmological surgery. To identify the association between falls and ophthalmological surgery and screening experiences among the community-dwelling elderly in Japan, a cross-sectional descriptive study examined 159 community-dwelling people aged ≥ 65 years about an extensive physical assessment, health status, experience of falls, and ophthalmic situations. In this city, the study identified an association between falls and both ophthalmological surgery experience and voluntary attendance at ophthalmic screening among the community-dwelling elderly. Japanese public health nurses should be a bridge between community-dwelling elderly and ophthalmologists in the community to promote attendance at ophthalmic screening.

Mobility and Muscle Strength Together are More Strongly Correlated with Falls in Suburb-Dwelling Older Chinese

Falls are common in older adults and result in adverse outcomes. Impaired mobility and poor muscle strength have been consistently identified as the main contributors to falls. We choose three easy-to-perform tests (i.e. Timed Up and Go test (TUGT), walking speed (WS) and grip strength (GS)) in order to assess mobility and muscle strength to further define their relationship with falls. This study is cross-sectional, consisting of 1092 residents over 60-year-old; 589 were female. 204 (18.68%) participants reported falling at least once in the past year. It was found that, of the three tests evaluated independently, a TUGT < 9.1750 s had the strongest association with fewer falls. When evaluating these tests as pairs, the combination of a TUGT < 9.1750 s and a WS < 0.9963 m/s was the best protective indicator of falls after adjusting for age, sex and other variables. When evaluating all three tests in conjunction with each other, the combination of a TUGT < 9.1750 s, a WS < 0.9963 m/s, and a GS > 0.3816 was most correlated with less possibility of falls. The combination of a better TUGT performance, a stronger GS, and a slower WS is the most strongly correlated with less possibility of falls.

Orthostatic Hypotension and Elevated Resting Heart Rate Predict Low-Energy Fractures in the Population: The Malmö Preventive Project

Background

Autonomic disorders of the cardiovascular system, such as orthostatic hypotension and elevated resting heart rate, predict mortality and cardiovascular events in the population. Low-energy-fractures constitute a substantial clinical problem that may represent an additional risk related to such autonomic dysfunction.

Aims

To test the association between orthostatic hypotension, resting heart rate and incidence of low-energy-fractures in the general population.

Methods and Results

Using multivariable-adjusted Cox regression models we investigated the association between orthostatic blood pressure response, resting heart rate and first incident low-energy-fracture in a population-based, middle-aged cohort of 33 000 individuals over 25 years follow-up.

The median follow-up time from baseline to first incident fracture among the subjects that experienced a low energy fracture was 15.0 years. A 10 mmHg orthostatic decrease in systolic blood pressure at baseline was associated with 5% increased risk of low-energy-fractures (95% confidence interval 1.01–1.10) during follow-up, whereas the resting heart rate predicted low-energy-fractures with an effect size of 8% increased risk per 10 beats-per-minute (1.05–1.12), independently of the orthostatic response. Subjects with a resting heart rate exceeding 68 beats-per-minute had 18% (1.10–1.26) increased risk of low-energy-fractures during follow-up compared with subjects with a resting heart rate below 68 beats-per-minute. When combining the orthostatic response and resting heart rate, there was a 30% risk increase (1.08–1.57) of low-energy-fractures between the extremes, i.e. between subjects in the fourth compared with the first quartiles of both resting heart rate and systolic blood pressure-decrease.

Conclusion

Orthostatic blood pressure decline and elevated resting heart rate independently predict low-energy fractures in a middle-aged population. These two measures of subclinical cardiovascular dysautonomia may herald increased risks many years in advance, even if symptoms may not be detectable. Although the effect sizes are moderate, the easily accessible clinical parameters of orthostatic blood pressure response and resting heart rate deserve consideration as new risk predictors to yield more accurate decisions on primary prevention of low-energy fractures.

Impact of comorbidity on 6-month hospital readmission and mortality after hip fracture surgery

OBJECTIVES

Impact of comorbidity on risk of readmission and death after hip fracture surgery has not been sufficiently explored. We planned to investigate the role of common diseases in predicting adverse events during recovery after hip surgery.

PATIENTS AND METHODS

We prospectively evaluated 272 consecutive patients (age, 82.6±8.9 years; 196 females, 72.1%) who underwent acute surgery for hip fracture at a regional university hospital. Baseline comorbidity and hospital stay were analysed. Number, timing and reasons for readmissions as well as mortality within 6 months after hospital discharge were recorded. An age- and sex-adjusted logistic regression model was applied to assess relations between comorbidity and relative risk of rehospitalisation or death.

RESULTS

Hypertension (44%), cognitive disorders (26%), and ischaemic heart disease (19%) were the most common comorbidities. The mean length-of-postoperative-stay was 12.7±7.9 days. Eighty-six patients (32%) were readmitted to hospital within 6 months from initial discharge and 36 patients (13%) died during that period. Increased risk of readmission was associated with hypertension (odds ratio (OR): 2.0, 95%CI, 1.2-1.9, p=0.009), and pacemaker treatment (OR: 6.6, 95%CI, 1.7-26.3, p=0.007), while there was a tendency towards readmission among men with prostate disease (OR: 5.0, 95%CI, 0.9-27.2, p=0.06). In contrast, mortality was predicted by ischaemic heart disease (OR: 2.2, 95%CI, 1.0-4.9, p=0.05), and malignancy (OR: 2.5, 95%CI, 1.1-5.7, p=0.04).

CONCLUSIONS

Common comorbidities are associated with higher risk of rehospitalisation and mortality following hip fracture surgery in the elderly. This information may be useful in postoperative risk assessment and prevention of negative outcomes.

Men older than 50 yrs are more likely to fall than women under similar conditions of health, body composition, and balance

OBJECTIVE

The aim of this study was to analyze the contribution of sex to the occurrence of falls, accounting for comorbidities and differences in physical fitness.

DESIGN

This was a cross-sectional study of 587 community-dwelling adults who were older than 50 yrs. Falls, comorbidities (number of diseases and physical impairments), and physical fitness (body composition, lower and upper body strength and flexibility, agility, aerobic endurance, and balance) were evaluated via questionnaires, bioimpedance, and Fullerton batteries, respectively.

RESULTS

Compared with the men, the women presented a 10% higher fall prevalence, 1.7 more diseases/impairments, 10% more body fat, 26% less lean body mass, and poorer physical capacity (P < 0.05). Multivariate logistic regression revealed that male sex (odds ratio [OR], 2.723; 95% confidence interval [CI], 1.190-6.230) increased the likelihood of falling, after adjustment for comorbidities (OR, 1.213; 95% CI, 1.109-1.328), lean mass (OR, 0.958; 95% CI, 0.927-0.989), fat mass (OR, 1.053; 95% CI, 1.021-1.086), and balance (OR, 0.942; 95% CI, 0.914-0.971), which were the main risk factors of falls.

CONCLUSIONS

Women are more susceptible to falling, presumably because they have poorer health and physical fitness than do men. However, when the values for comorbidities, lean and fat body mass, and balance were similar, the men demonstrated a higher probability of falling. Age is not a significant risk factor of falls under favorable conditions of health, body composition, and balance.

Fall risk and prevention needs assessment in an older adult Latino population: a model community global health partnership

BACKGROUND

The impact of falls in older adults presents a significant public health burden. Fall risk is not well-described in Latino populations nor have fall prevention programs considered the needs of this population.

OBJECTIVES

The objectives of this study were to develop a needs assessment of falls in older adult Latinos at a community center (CC), determine fall prevention barriers and strengths in this population, determine the level of interest in various fall prevention methods, and provide medical students an opportunity for participation in a culturally diverse community project.

METHODS

A cross-sectional survey was conducted with a convenience sample of older adult program participants. The survey was developed in collaboration with both partners. CC participants were approached by the interviewer and asked to participate. They were read the survey in their preferred language and their answers were recorded. Data were analyzed using descriptive statistics.

RESULTS

We conducted 103 interviews. We found that 54% of participants had fallen in the last year, and of those 21% required medical care, 81% were afraid of falling again, and 66% considered themselves at risk for falling again. Of all respondents, 52% had 5 or more of the 10 surveyed risk factors for falling; 4% had no risk factors. Of all respondents, 75% were afraid of falling. Talking with health care providers and participating in an exercise class were the preferred methods of health information delivery (78% and 65%, respectively).

CONCLUSION

Older adult Latinos in this selected population frequently fall and are worried about falling. Risk factors are prevalent. A fall prevention program is warranted and should include exercise classes and a connection with local primary care providers. A partnership between an academic organization and a CC is an ideal collaboration for the future development of prevention program.

Epidemiological study of orthopedic injuries in hemodialysis patients in Taiwan: a fixed cohort survey, 2004-2008

BACKGROUND

The burden of chronic kidney disease (CKD) is a growing concern worldwide. The prevalence of hemodialysis in Taiwan is the highest in the world, and this may increase the prevalence of orthopedic fractures. The aim of this study was to explore the incidences of various orthopedic injuries and the related risk factors.

METHODS

A nationwide prospective study based on the Taiwan National Health Insurance dataset was conducted during 2004-2008. A total of 82,491 CKD patients were selected as the fixed cohort population. The International Classification of Diseases 9-CM diagnosis codes and treatment codes were identified as the inclusion criteria for orthopedic injury.

RESULTS

A total of 82,491 Taiwanese people with CKD were identified in 2004, and 4915 orthopedic injuries occurred during the 5-year follow-up period. The cumulative incidences of orthopedic injuries were 42.56‰ for lower limb fractures, and 12.93‰, 3.27‰, and 1.64‰ for upper limb fractures, vertebrae fractures, and joint dislocations, respectively. All three types of orthopedic fractures were more common in the oldest age stratum (≥65 years old). In the CKD patients, the risk ratio of osteoporosis was 3.47 (95% confidence interval, 3.10-3.89) for all orthopedic injuries. Patients of advanced age, the female gender, and those with high comorbidity were also at significant risk of sustaining orthopedic fractures.

CONCLUSION

The results from this Taiwanese CKD cohort support the strong influence of aging and osteoporosis on all kinds of orthopedic injuries. The postponing of osteoporosis may need to be taken into consideration for the prevention of orthopedic injury among CKD patients undergoing hemodialysis.

Health-enabling technologies for the elderly--an overview of services based on a literature review

BACKGROUND

Services for the elderly based on health-enabling technologies promise to contribute significantly to the efficiency and effectiveness of future health care. Due to this promise, over the last years the scientific community has designed a complex variety of these valuable innovations. A systematic overview of the developed services would help to better understand their opportunities and limitations.

OBJECTIVE

To obtain a systematic overview of services for the elderly based on health-enabling technologies and to identify archetypical service categories.

METHODS

We conducted a literature review using PubMed and retrieved 1447 publications. We stepwise reduced this list to 27 key publications that describe typical service archetypes.

RESULTS

We present six archetypical service categories, namely handling adverse conditions, assessing state of health, consultation and education, motivation and feedback, service ordering and social inclusion and describe their implementation in current research projects.

A review of orthostatic blood pressure regulation and its association with mood and cognition

AIMS

This paper will review literature that examines the psychological and neuropsychological correlates of orthostatic blood pressure regulation.

RESULTS

The pattern of change in systolic blood pressure in response to the shift from supine to upright posture reflects the adequacy of orthostatic regulation. Orthostatic integrity involves the skeletal muscle pump, neurovascular compensation, neurohumoral effects and cerebral flow regulation. Various physiological states and disease conditions may disrupt these mechanisms. Clinical and subclinical orthostatic hypotension has been associated with impaired cognitive function, decreased effort, reduced motivation and increased hopelessness as well as dementia, diabetes mellitus, and Parkinson's disease. Furthermore, inadequate blood pressure regulation in response to orthostasis has been linked to increased depression and anxiety as well as to intergenerational behavioral sequalae.

CONCLUSIONS

Identifying possible causes and consequences of subclinical and clinical OH are critical in improving quality of life for both children and older adults.

Early postural blood pressure response and cause-specific mortality among middle-aged adults

Orthostatic hypotension (OH) is associated with increased total mortality but contribution of specific death causes has not been thoroughly explored. In this prospective study, authors followed up 32,068 individuals without baseline history of cancer or cardiovascular disease (69% men; mean age, 46 years; range, 26-61 years) over a period of 24 years. Hazard ratios (HRs) for total and cause-specific mortality associated with presence of OH and by quartiles of postural systolic blood pressure response (∆SBP) were assessed using multivariate adjusted Cox regression model. A total of 7,145 deaths (22.3%, 9.4 deaths/1,000 person-years) occurred during follow-up. Those with OH (n = 1,943) had higher risk of death due to injury (HR, 1.88; 1.37-2.57) and neurological disease (HR, 2.21; 1.39-3.51). Analogically, risk of death caused by injury and neurological disease increased across the quartiles of ∆SBP from hyper- (Q1(SBP), +8.5 ± 4.7 mmHg) to hypotensive response (Q4(SBP), -13.7 ± 5.7 mmHg; HR, 1.32; 1.00-1.72, and 1.84; 1.20-2.82, respectively) as did also risk of death due to respiratory disease (Q4(SBP) vs. Q1(SBP): HR, 1.53; 1.14-2.04). In contrast, risk curve for cerebrovascular death was U-shaped with nadir in the mildly hypotensive 3rd quartile of ∆SBP (-5.0 ± 0.1 mmHg, Q3(SBP) vs. Q1(SBP): HR, 0.75; 0.54-1.03; P for linear trend = 0.021). Additionally, cardiovascular mortality was increased among 5,805 rescreened participants (mean age, 53 years; 9.8% OH positive: HR, 1.54; 1.24-1.89, and Q4(SBP) vs. Q1(SBP): 1.27; 1.02-1.57, respectively). In summary, increased mortality predicted by blood pressure fall on standing is associated with injuries, neurodegenerative, and respiratory diseases, as well as with cardiovascular disease in older adults. Moreover, both increase and pronounced decrease of SBP during early orthostasis indicate higher risk of cerebrovascular death.

Falls incidence, risk factors, and consequences in Chinese older people: a systematic review

Falls incidence in Chinese older people has been reported to be approximately half that of Caucasian populations. It is possible that the falls risk factor profile may differ significantly between Caucasian and Chinese populations, and a better understanding of this reported difference in incidence and associated risk factors may influence potential approaches to future intervention. A systematic literature review was conducted using the EMBase, Medline, Chinese Electronic Periodical Services, and WanFangdata databases to collate and evaluate the studies that have addressed the incidence and risk factors for falls in Chinese older people. Twenty-one studies conducted in China, Hong Kong, Macao, Singapore, and Taiwan met the inclusion criteria. Fall rates ranged between 14.7% and 34% per annum (median 18%). In the four prospective studies, injuries were reported by 60% to 75% of those reporting falls, with fractures constituting 6% to 8% of all injuries. One hundred thirty-two variables were identified as fall risk factors, with commonly reported factors being female sex, older age, use of multiple medications, gait instability, fear of falling, and decline in activities of daily living. The findings reveal a consistently lower incidence of self-reported falls in Chinese older people than in Caucasian older people, although the types and prevalence of risk factors were not dissimilar from those found in studies of Caucasian older people. A greater understanding of the health, behavioral, and lifestyle factors that influence fall rates in Chinese populations is required for elucidating fall prevention strategies in Chinese and non-Chinese older people.