Effectiveness of a programme delivered in a falls clinic in preventing serious injuries in high-risk older adults: A pre- and post-intervention study

Incidence and clinical characteristics of fall-related injuries among older inpatients at a tertiary grade a hospital in Shandong province from 2018 to 2020

Background

Falls are an important cause of injury and death of older people. Hence, analyzing the multifactorial risk of falls from past cases to develop multifactorial intervention programs is clinically significant. However, due to the small sample size, there are few studies on fall risk analysis of clinical characteristics of fallers, especially among older hospitalized patients.

Methods

We collected data on 153 inpatients who fell (age ≥ 60 years) from the hospital nursing adverse event reporting system during hospitalization at Shandong Provincial Hospital Affiliated to Shandong First Medical University, China, from January 2018 to December 2020. Patient characteristics at the time of the fall, surrounding environment, primary nurse, and adverse fall events were assessed. The enumeration data were expressed as frequency and percentage, and the chi-squared was performed between recurrent fallers and single fallers, and non-injurious and injurious fall groups.

Results

Cross-sectional data showed 18.3% of the 153 participants experienced an injurious fall. Compared with single fallers, a large proportion of older recurrent fallers more often experienced preexisting conditions such as cerebrovascular disease or taking hypoglycemic drugs. They were exposed to higher risks and could experience at least 3 fall times in 3 months. Besides, the credentials of their responsible nurses were often higher. Factors that increased the risk of a fall-related injury were hypoglycemic drugs (OR 2.751; 95% CI 1.114–6.795), and nursing adverse events (OR 47.571; 95% CI 14.392–157.247). Older inpatients with bed rails (OR 0.437; 95% CI 0.190–1.005) or falling at the edge of the bed (OR 0.365; 95% CI 0.138–0.964) were less likely to be injured than those without bed rails or not falling at the edge of the bed. Fall risks were significantly correlated with more severe fall-related injuries. Older patients with moderate (OR 5.517; CI 0.687–44.306) or high risk (OR 2.196; CI 0.251–19.219) were more likely to experience fall-related injuries than those with low risk.

Conclusions

Older inpatient falls are an ongoing challenge in hospitals in China. Our study found that the incidence of fall-related injuries among inpatients aged ≥ 60 years remained at a minor level. However, complex patient characteristics and circumstances can contribute to fall-related injuries.

This study provides new evidence on fall-related injuries of older inpatients in China. Based on the factors found in this study, regular fall-related injury epidemiological surveys that investigate the reasons associated with the injuries were crucial when considering intervention measures that could refine fall-related injuries. More prospective studies should be conducted with improved and updated multidisciplinary fall risk assessment and comprehensive geriatric assessment as part of a fall-related injury prevention protocol.

Effects of a Modified Tap Dance Program on Ankle Function and Postural Control in Older Adults: A Randomized Controlled Trial

Older adults are at a high risk of falling due to age-related degradations in physical fitness. This study aimed to examine the effects of a modified tap dance program (MTD) on ankle function and postural control in older adults. Forty-four healthy older adults (mean age = 64.1 years, with 9 men) were recruited from local communities and were randomly divided into the MTD group and the control (CON) group. The MTD group received 12 weeks of MTD training 3 times per week for 30 min per session. Outcomes were measured using the five times sit-to-stand test (FTSST) for ankle strength, the universal goniometer for ankle range of motion, and the Footscan^® to trace the center of pressure. Results revealed significant improvements in FTSST in the MTD group (mean difference = 1.01), plantar flexion (left = 9.10, right = 10.0). In addition, the MTD group displayed significantly more improvements at midtest than the CON group in FTSST (mean difference = 1.51) and plantar flexion (mean difference: left = 6.10; right = 4.5). Therefore, the MTD can be an effective exercise program for ankle function improvement, but it has limited effects on improving postural control among healthy older adults.

The effectiveness of a recurrent fall prevention program applied to elderly people undergoing fracture treatment

BACKGROUND

Worldwide 30-40% of people aged of 65 and over fall each year. It is important to develop preventive interventions for falls in the elderly to prevent injuries leading to mortality and morbidity.

OBJECTIVES

This study evaluated the effectiveness of a recurrent fall prevention program in elderly individuals undergoing fracture treatment.

METHODS

A pretest-posttest intervention study. A recurrent fall prevention program including assessment of fall risk factors, education on falls and home modifications was developed for elderly people undergoing fracture treatment for 52 patients.

RESULTS

In the first evaluation before the delivery of the recurrent fall prevention program, the number of risk factors was 17.63 ± 3.40 as mean ± standart deviation. Following implementation of the fall prevention program, the number of risk factors decreased to 15.73 ± 3.19 in the first follow-up and decreased to 14.92 ± 3.06 in the second follow-up. Knowledge scores increased to 6.09 ± 1.65 in the first follow-up and to 6.71 ± 1.53 in the second follow-up, while it was 5.50 ± 1.54 in first evaluation. The differences between follow-ups were statistically significant. During the 3-month study period, 15.4% of participants experienced fall.

CONCLUSION

The recurrent fall prevention program was effective in reducing fall-related risk factors and increase fall knowledge. Health care professionals should assess older people for fall risk factors and increase their awareness for falls.

The Role of the Podiatrist in Assessing and Reducing Fall Risk: An Updated Review

Falls present a tremendous challenge to health care systems. This article reviews the literature from the previous 5 years (2014-2019) in terms of methods to assess fall risk and potential steps that can be taken to reduce fall risk for patients visiting podiatric clinics. With regard to assessing fall risk, we discuss the role of a thorough medical history and podiatric assessments of foot problems and deformities that can be performed in the clinic. With regard to fall prevention we consider the role of shoe modification, exercise, pain relief, surgical interventions, and referrals.

Cortical reactive balance responses to unexpected slippages while walking: a pilot study

Understanding how the human brain cortex behaves when the dynamical balance is unexpectedly challenged can be useful to enable fall prevention strategies during daily activities. In this respect, we designed and tested a novel methodological approach to early detect modifications of the scalp-level signals when steady walking is perturbed. Four young adults were asked to manage unexpected bilateral slippages while steadily walking at their self-selected speed. Lower limb kinematics, electromyographic (EMG) and electroencephalographic (EEG; 13 channels from motor and sensory-motor cortex areas) signals were synchronously recorded. EMG signals from Vastus Medialis (both sides) were used to trigger the analysis of the EEG before and after the perturbation onset. Cortical activity was then assessed and compared pre vs. post perturbation. Specifically, for each gait cycle, the rate of variation of the EEG power spectrum density, named m, was used to describe the cortical responsiveness in five bands of interests: ϑ (4-7 Hz), α (8-12 Hz), β I, β II, β III rhythms (13-15, 15-20, 18-28 Hz). Results revealed a sharp increment of m early after the onset of the perturbation (perturbed step) compared to steady locomotion, for all rhythms. This cortical behavior disappeared during the recovery step. This study promisingly supports the evidence that the proposed approach can distinguish between steady walking and early reactive balance recovery, paving the way for the EEG-based monitoring of the fall risk during daily activities.