Falls among the Community-Living Elderly People in Hong Kong: A Retrospective Study

Stigma and the use of umbrellas, hiking poles and walking sticks to aid walking in Hong Kong

Background

The use of walking aids is widely acknowledged as one of the most relied-on forms of assistive technology. Using stick-shaped devices, such as a cane, is often the entrance for many people to the world of assistive technologies, often accompanied by the negative stigma associated with ageing and disability.

Objectives

This study investigated the perception of disability and needs of the Hong Kong population using walking aids, aiming to inform device design and service provision.

Methods

We observed 391 individuals using cane-like devices in their natural environment and conducted semi-structured interviews with 28 participants to understand stigma, barriers to acquisition, training, and design requirements.

Results

Half of the interviewees (50%, n = 14) did not feel disabled when using a walking stick, while 39% felt slightly disabled. 56% of the observed sample used non-medical-looking aids like hiking poles or umbrellas. Most interviewees (79%) purchased off-the-shelf devices, but less than half received seller support in choosing appropriate aids.

Conclusion

The feelings associated with using walking sticks and similar devices are mostly positive. There is a preference in Hong Kong for using devices without a medical appearance to aid walking, such as umbrellas and hiking poles. There is a need to raise awareness of the risks of using umbrellas to aid walking and empower the user to make informed decisions when purchasing walking aid devices. In addition, there is a need to support the supply chain of walking aids, including umbrellas and hiking poles, to provide more information on device use, misuse, training, and maintenance.

Effectiveness of telehealth in preventive care: a study protocol for a randomised controlled trial of tele-exercise programme involving older people with possible sarcopenia or at risk of fall

BACKGROUND

Continuous loss of muscle mass and strength are the consequences of the ageing process, which increase the risk of falls among older people. Falls can lead to severe consequences such as bone fractures and hampered physical and psychological well-being. Regular exercise is the key to reversing muscle atrophy and relieving sarcopenia. However, the frailty of older people and the recent COVID-19 pandemic may affect their confidence to leave home to attend classes in the community. A feasible and effective alternative should be explored.

METHODS

The primary objective is to evaluate the effectiveness of tele-exercise (TE) in relation to physical functioning and exercise adherence among community-dwelling older people at risk of falls in comparison with a community-based group (CB). The secondary objective includes evaluating older people's experience with tele-exercise, emphasizing their psychological welfare, social well-being, and acceptance of the telehealth approach. The design, conduct, and report follow the SPIRIT guidelines (Standard Protocol Items: recommended items to address in a Clinical Trial Protocol and Related Documents). Older people will be recruited from 10 local community centres in Hong Kong and randomly allocated into two groups. All participants will attend the exercise training 3 days per week for 3 months but the mode of delivery will differ, either online as the tele-exercise group (TE) or face-to-face as the community-based group (CB). The outcome measures include muscle strength, physical function, exercise adherence and dropout rate, psychological and social well-being will be assessed at the baseline, and the 3rd, 6th and 12th month. Some participants will be invited to attend focus group interviews to evaluate their overall experience of the tele-exercise training.

DISCUSSION

Tele-exercise reduces the barriers to exercise, such as time constraints, inaccessibility to facilities, and the fear of frail older people leaving their homes. Promoting an online home-based exercise programme for older people can encourage them to engage in regular physical activity and increase their exercise adherence even when remaining at home. The use of telehealth can potentially result in savings in cost and time. The final findings will provide insights on delivering exercise via telehealth to older people and propose an exercise delivery and maintenance model for future practice.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ( https://www.chictr.org.cn/hvshowprojectEN.html?id=219002&v=1.1 ), registration number: ChiCTR2200063370. Registered on 5 September 2022.

Risk factors for falls among community-dwelling older adults: A systematic review and meta-analysis

Background and objective

The prevalence of falls among older adults living in the community is ~30% each year. The impacts of falls are not only confined to the individual but also affect families and the community. Injury from a fall also imposes a heavy financial burden on patients and their families. Currently, there are different reports on the risk factors for falls among older adults in the community. A retrospective analysis was used in this study to identify risk factors for falls in community-dwelling older adults. This research aimed to collect published studies to find risk factors for falls in community-dwelling older adults.

Methods

We searched for literature from the founding of PubMed, EMBASE, the Cochrane Library, the Web of Science, the China National Knowledge Infrastructure (CNKI), the China Science and Technology Periodicals Database (VIP), and the Wanfang database until September 2022. The studies were selected using inclusion and exclusion criteria. We collected information from relevant studies to compare the impact of potential risk factors such as age, female gender, fear of falling, history of falls, unclear vision, depression, and balance disorder on falls among community-dwelling older adults.

Results

A total of 31 studies were included with 70,868 community seniors. A significant risk factor for falls in the community of older adults was dementia (2.01, 95% CI: 1.41-2.86), age (1.15, 95% CI: 1.09-1.22), female gender (1.52, 95% CI: 1.27-1.81), fear of falling (2.82, 95% CI: 1.68-4.74), history of falls (3.22, 95% CI: 1.98-5.23), vision unclear (1.56, 95% CI: 1.29-1.89), depression (1.23, 95% CI: 1.10-1.37), and balance disorder (3.00, 95% CI: 2.05-4.39).

Conclusion

This study provides preliminary evidence that falls among community-dwelling older adults are associated with factors such as age, female gender, fear of falling, history of falls, unclear vision, depression, and balance disorders. The results of this research may help improve clinician awareness, risk stratification, and fall prevention among community-dwelling older adults.

Systematic review registration

identifier INPLASY2022120080.

Factors associated with fall risk of community-dwelling older people: A decision tree analysis

Objective

To examine the predictive attributes for accidental falls in community-dwelling older people in Hong Kong using decision tree analysis.

Methods

We recruited 1151 participants with an average age of 74.8 years by convenience sampling from a primary healthcare setting to carry out the cross-sectional study over 6 months. The whole dataset was divided into two sets, namely training set and test set, which respectively occupied 70% and 30% of the whole dataset. The training dataset was used first; decision tree analysis was used to identify possible stratifying variables that could help to generate separate decision models.

Results

The number of fallers was 230 with 20% 1-year prevalence. There were significant differences in gender, use of walking aids, presence of chronic diseases, and co-morbidities including osteoporosis, depression, and previous upper limb fractures, and performance in the Timed Up and Go test and the Functional Reach test among the baselines between the faller and non-faller groups. Three decision tree models for the dependent dichotomous variables (fallers, indoor fallers, and outdoor fallers) were generated, with overall accuracy rates of the models of 77.40%, 89.44% and 85.76%, respectively. Timed Up and Go, Functional Reach, body mass index, high blood pressure, osteoporosis, and number of drugs taken were identified as stratifying variables in the decision tree models for fall screening.

Conclusion

The use of decision tree analysis for clinical algorithms for accidental falls in community-dwelling older people creates patterns for decision-making in fall screening, which also paves the way for utility-based decision-making using supervised machine learning in fall risk detection.

A qualitative investigation exploring neighbourhood environment, risks and fear of falling, and fall prevention strategies among urban-dwelling older adults in a high-density city

Falls in older adulthood can have serious consequences. It is therefore important to identify ways to prevent falls, particularly from the voice of older adults. Bottom-up qualitative exploration of the perspectives of older adults can provide rich insights that can help inform the development of effective fall prevention programmes. However, currently there is a dearth of such empirical data, especially among urban-dwelling older adults in high-density cities where fall rates are high. The current study aimed to examine qualitatively perceptions of neighbourhood physical environment in relation to falls, perceived risks and fear of falling, and strategies and behaviours for fall prevention in a sample of urban-dwelling older adults in the high-density city of Hong Kong. Face-to-face semi-structured in-depth interviews were conducted with 50 community-dwelling older adults. Interviews were transcribed verbatim and analysed using thematic analysis techniques. Five general themes were revealed: risks and circumstances of falls, consequences of falls, fear of falling and its consequences, neighbourhood environment, and strategies and behaviours of fall prevention. While older adults discussed the risks of falling and held a fear of falling, these beliefs were mixed. In addition to fall prevention strategies (e.g. keep balance), current findings highlighted the importance of establishing protective factors (e.g. flat and even walking paths) and reducing risk factors (e.g. neighbourhood clutter) in neighbourhood environments. For urban-dwelling older adults in high-density cities, current findings highlight the importance of focusing efforts at the built environment level in addition to strategies and behaviours of fall prevention at the individual level.

Seasonal pattern of single falls and recurrent falls amongst community-dwelling older adults first applying for long-term care services in Hong Kong

BACKGROUND

few studies had investigated seasonal pattern of recurrent falls.

OBJECTIVE

to examine seasonal pattern of both single and recurrent falls amongst community-dwelling older adults first applying for long-term care (LTC) services.

METHODS

a cohort of 89,100 community-dwelling Hong Kong older adults aged 65 and over first applying for LTC services from 2005 to 2014 was obtained. Logistic regression models were used to examine seasonal pattern in single and recurrent falls, whilst controlling for gender, age and year.

RESULTS

amongst 89,100 older adults, about 32% fell in past 90 days. Amongst the fallers, 34% fell recurrently. In 2014, the incidences of all fall, single fall and recurrent fall were 1.95, 0.80 and 1.15 per person-years, respectively. For single falls, the 90-day fall risk was highest during November to February with an odds ratio (OR) of 1.29 (95% confidence interval [CI] 1.19-1.41), compared with the lowest one during July to October. For recurrent falls, the highest OR for 90-day risk was highest during November to February (1.46, 95% CI 1.31-1.64) as well.

CONCLUSIONS

single and recurrent falls both peaked during winter months. Interventions, such as implementing educational publicity and sending reminder to older adults in fall season, may be considered.

Fall-Risk-Increasing Drugs: A Systematic Review and Meta-analysis: III. Others

BACKGROUND AND OBJECTIVE

The use of psychotropic medication and cardiovascular medication has been associated with an increased risk of falling. However, other frequently prescribed medication classes are still under debate as potential risk factors for falls in the older population. The aim of this systematic review and meta-analysis is to evaluate the associations between fall risk and nonpsychotropic and noncardiovascular medications.

METHODS AND DESIGN

A systematic review and meta-analysis. A search was conducted in Medline, PsycINFO, and Embase. Key search concepts were "falls," "aged," "medication," and "causality." Studies were included that investigated nonpsychotropic and noncardiovascular medications as risk factors for falls in participants ≥60 years or participants with a mean age ≥70 years. A meta-analysis was performed using the generic inverse variance method, pooling unadjusted and adjusted odds ratio (OR) estimates separately.

RESULTS

In a qualitative synthesis, 281 studies were included. The results of meta-analysis using adjusted data were as follows (a pooled OR [95% confidence interval]): analgesics, 1.42 (0.91-2.23); nonsteroidal anti-inflammatory drugs (NSAIDs), 1.09 (0.96-1.23); opioids, 1.60 (1.35-1.91); anti-Parkinson drugs, 1.54 (0.99-2.39); antiepileptics, 1.55 (1.25-1.92); and polypharmacy, 1.75 (1.27-2.41). Most of the meta-analyses resulted in substantial heterogeneity that did not disappear after stratification for population and setting in most cases. In a descriptive synthesis, consistent associations with falls were observed for long-term proton pump inhibitor use and opioid initiation. Laxatives showed inconsistent associations with falls (7/20 studies showing a positive association).

CONCLUSION

Opioid and antiepileptic use and polypharmacy were significantly associated with increased risk of falling in the meta-analyses. Long-term use of proton pump inhibitors and opioid initiation might increase the fall risk. Future research is necessary because the causal role of some medication classes as fall-risk-increasing drugs remains unclear, and the existing literature contains significant limitations.

Burden and Correlates of Falls among Rural Elders of South India: Mobility and Independent Living in Elders Study

AIM

Falls are an important contributor to loss of function, morbidity, and mortality in elders. Little is known about falls in Indian populations. The objective of this cross-sectional report was to identify the prevalence and correlates of falls in a cohort of 562 rural southern Indian men and women.

METHODS

Risk factors included demographics, anthropometrics, self-reported health, medical history, physical function, vision, depression, and lifestyle. Odds ratios were calculated using logistic regression.

RESULTS

71 (13%) subjects reported at least 1 fall in the past year. Prevalence was higher among women (17%) than men (8%), P = 0.003. Sex and age showed significant interaction (P = 0.04) whereby falls prevalence increased with age among women but decreased among men. Correlates of falls among men included a history of osteoarthritis (OA) (odds ratio (OR): 6.91; 95% CI: 1.4-33.1), depression (OR:9.6; 3.1-30.1), and greater height (OR per 1 standard deviation increase: 2.33; 1.1-5.1). Among women, poor physical performance (OR: 3.33; 1.13-9.86) and history of cardiovascular disease (CVD) (OR: 2.42; 1.01-5.80) were independently associated with falls.

IMPLICATIONS

Prevalence of falls in elderly South Indians was lower than published reports from western countries and likely reflects low exposure to fall risks. Patterns with age differed in men and women and may reflect sex differences in the accuracy of age recall. Presence of comorbidities specifically OA, CVD, and depression was independent correlate of falling.

An Occupational Therapy Fall Reduction Home Visit Program for Community-Dwelling Older Adults in Hong Kong After an Emergency Department Visit for a Fall

OBJECTIVES

To investigate the effects of an occupational therapy fall reduction home visit program for older adults admitted to the emergency department (ED) for a fall and discharged directly home.

DESIGN

Single-blind, multicenter, randomized, controlled trial.

SETTINGS

EDs in three acute care hospitals in Hong Kong.

PARTICIPANTS

Individuals aged 65 and older who had fallen (N = 311).

INTERVENTIONS

After screening for eligibility, 204 consenting individuals were randomly assigned to an intervention group (IG) and received a single home visit from an occupational therapist (OT) within 2 weeks after discharge from the hospital or a control group (CG) and received a well-wishing visit from a research assistant not trained in fall prevention.

MEASUREMENTS

Both groups were followed for 12 months through telephone calls made every 2 weeks by blinded assessors with a focus on the frequency of falls. Another blinded assessor followed up on their status with telephone calls 4, 8, and 12 months after ED discharge. Prospective fall records on hospital admissions were retrieved from electronic databases; 198 individuals were followed for 1 year on an intention-to-treat basis.

RESULTS

The percentage of fallers over 1 year was 13.7% in the IG (n = 95) and 20.4% in the CG (n = 103). There were significant differences in the number of fallers (P = .03) and the number of falls (P = .02) between the two groups over 6 months. Significant differences were found in survival analysis for first fall at 6 months (log-rank test 5.052, P = .02) but not 9 or 12 months.

CONCLUSION

One OT visit after a fall was more effective than a well-wishing visit at reducing future falls at 6 months. A booster OT visit at 6 months is suggested.

Effect of Cyber-Golfing on Balance Amongst the Elderly in Hong Kong: A Pilot Randomised Trial

Background/Objective

Recent evidence showed that golf can develop balance amongst the elderly. This study aimed at evaluating if exergaming, in particular cyber-golfing, can be a feasible and inexpensive alternative to this valuable exercise.

Methods

Twenty healthy community-dwelling elderly were recruited, and they were randomly assigned to either the experimental group (n = 10) or the control group (n = 10). Daily cyber-golfing training for 2 weeks was assigned to the participants of the experimental group, where regular table games with equal lengths and durations were arranged for the control group.

Results

The results revealed that the participants in the experimental group showed significantly better post-training performances in the functional-reach test, F(2,17) = 5.16, p = .04, and single-leg-stance test, F(2,17) = 5.32, p = .03, than those in the control group.

Conclusion

The results of this study suggest that cyber-golfing might be an alternative to golfing, which is capable of enhancing balance ability amongst community-dwelling elderly. The potential of exergaming as a clinical tool for geriatric rehabilitation was discussed.

Ocorrência de quedas em idosos não institucionalizados: revisão sistemática da literatura

Revisão sistemática da literatura com o objetivo de identificar a ocorrência de quedas de idosos residentes na comunidade. Utilizando o portal CAPES, realizou-se busca nas bases de dados Academic Search (EBSCO), SciELO e Science Direct (ELSEVIER); e uma busca adicional na base de dados Lecturas Educación Física y Deportes, do site EFDEPORTES. Foram encontrados, com os descritores utilizados, 247 artigos publicados no período de 2000 a 2011. Foram excluídos 230 que não atenderam a um ou mais dos critérios de inclusão. Incluíram-se no estudo 17 artigos, sendo 12 transversais, dois de coorte prospectiva, dois de pesquisa de base populacional e um de coorte retrospectiva. A amostra total envolvida nos estudos foi de 114.911 sujeitos, com média de idade de aproximadamente 70 anos, distribuídos em sete países: Brasil, Estados Unidos, Espanha, Itália, Nigéria, Turquia e China. A ocorrência de quedas variou de 15,9 a 56,3%, com mediana de 28,50%. Embora apresente variação, a ocorrência de quedas na população idosa que reside na comunidade é alta.

The Effectiveness of the Exercise Education Programme on Fall Prevention of the Community-dwelling Elderly: A Preliminary Study

Objective

The purpose is to identify the effects of the exercise education programme on fall prevention of community-dwelling elderly.

Methods

A single blind preliminary randomized control trial was conducted. Participants (N = 10) in the experimental group was assigned to an exercise education programme which consisted of 28 sessions, 30∼40 minutes per day for 4 weeks and a self-management telephone monitoring programme once every two days. Participants (N = 8) in the control group received no intervention. The effectiveness of exercise education programme was measured by fall index, balance confidence scale, and balance scale.

Results

The fall risks decreased from moderate to minimum in the experimental group (p < .001). Balance confidence scores increased, especially 6 items measured statistically significant increases (p < .05). However, balance scores did not show statistically significant improvement.

Conclusion

The exercise education programme might be effective for fall prevention of community-dwelling elderly.