The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017

Sustainability of fall prevention exercise programmes for community-dwelling older adults: a scoping review protocol

INTRODUCTION

Falls have financial, emotional and physical implications for ageing individuals and the healthcare system. Evidence-based exercise programmes have been one of the most effective ways of preventing falls in community dwellings for older adults. However, more research is needed to understand how to sustain these programmes. This scoping review protocol describes our plan to investigate the factors influencing the sustainability of community-based fall prevention exercise programmes.

METHODS AND ANALYSIS

Our scoping review will use the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews framework. The studies will have no restrictions, including publication date, language or geographic location. Key search terms concerning programme sustainability and exercise falls prevention will be conducted in Medline, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Academic Search Premier, APA PsycINFO and SPORTDiscus in consultation with an experienced librarian. Once duplicates have been removed, two independent reviewers will conduct title and abstract screening, full-text screening and data extraction. Data from eligible articles will be collated and charted to summarise data into three categories: (1) study description, including publication date, author(s), study location, paper's aim/purpose, study participants, study design and conclusion; (2) data regarding the type of exercise programme will be used using the 16-point checklist Consensus on Exercise Reporting Template; and (3) data regarding sustainability will be organised using domains from the Program Sustainability Assessment Tool. Our results will be charted through the use of Covidence to identify patterns across the studies. Additionally, narrative synthesis will be employed to articulate the study findings.

ETHICS AND DISSEMINATION

As this is a scoping review, we do not require ethics approval. We intend to share our report findings with scientists, healthcare professionals and decision-makers. We will publish our results in reputable scientific journals and present them at relevant conferences.

A comprehensive investigation to examine the factors associated with previous falls, recurrent falls, and concerns about falling among outpatient older individuals: a cross-sectional study

PURPOSE

Although numerous studies have assessed factors associated with falls among older adults, only a few studies have comprehensively evaluated multiple dimensions that may lead to falls. This study aims to investigate in a comprehensive way factors associated with previous falls, previous recurrent falls, and concerns about falling among general geriatrics outpatients.

METHODS

A cross-sectional study was conducted to examine factors associated with falls among older outpatients in accordance with established falls guidelines. The assessment included the following dimensions: sociodemographic, habits, physical activity, sensory, environment, physical examination, cognitive function, mental health status, frailty, sleep quality, functional status, presence of diseases, medication usage, and mobility. Logistic and linear regression models were used.

RESULTS

This study involved 335 older patients (78.8% women with a mean age of 74.5 years). Four out of ten had fallen in the previous year. Over half of the falls resulted in physical injuries and nearly one-third required hospital care. The main factors directly associated with falls were anxiety, visual impairment, number of medications, and environmental risk while being married and walking faster were inversely associated. As for recurrent falls, anticonvulsant use and increased depressive symptoms were directly associated with falls. At least six out of ten older outpatients feared falling, and associated factors were depressive symptoms, difficulties in climbing stairs, visual impairment, sleep problems, sedentarism behavior, hypothyroidism, hypertension and balance and gait abnormalities.

CONCLUSION

Predisposing factors to falls must be identified and included in a broader approach, focused on biologic, behavioral, environmental and socioeconomic dimensions.

Incidence and Associated Risk Factors for Falls in Adults Following Critical Illness: An Observational Study

OBJECTIVE

To explore the incidence of falls and associated risk factors in the first year after hospital discharge in survivors of critical illness.

DESIGN

Prospective single-site observational study.

SETTING

University-affiliated mixed ICU.

PATIENTS

One hundred ICU adults who required invasive ventilation for 48 hours and in an ICU for at least 4 days.

INTERVENTIONS

Not applicable.

MEASUREMENTS AND MAIN RESULTS

Falls were monitored prospectively for 1 year with completion of monthly falls calendars. Falls data included the number of people who had falls/no falls/recurrent falls, falls rate per person per year, and time to first fall. Fall severity was classified according to the Schwenck classification scheme to examine injurious falls requiring medical intervention. Other outcomes considered included assessments of balance, strength, function, cognition, psychologic health, and health-related quality of life. One hundred participants (31% female) were recruited with a mean age of 58.3 ± 16.2 years, and a median ventilation duration of 6.3 days [4.0-9.1]. Sixty-one percent fell at least once in the first year with the majority sustaining two or more falls (81.4%) and one in four sustained an injurious fall requiring medical attention. The falls incidence rate was 4.4 falls per person-year (95% CI, 3.2-5.9), with the highest incidence occurring less than 3 months after hospital discharge (5.9 falls/person-year [95% CI, 4.4-7.8]). Time to first fall or injurious fall was 36 [11-66] and 95 (95% CI, 40-155) days, respectively. Key risk factors for falls at the time of hospital discharge include comorbidities, higher discharge medications, balance, and muscle strength.

CONCLUSIONS

There was a high falls incidence in ICU survivors. The study findings suggest a critical window may exist within the first 3 months after hospital discharge and the need for screening, pharmacological optimization, and exercise training in this patient group.

A societal cost-benefit analysis of falls prevention in community-dwelling older people in the Netherlands

BACKGROUND

Aging populations face rising incidents of falls among older people, leading to increased healthcare costs. Preventive measures can reduce this burden and associated costs. However, implementing falls prevention interventions causes costs for society. In order to gain insight in the balance between investments and gains for society the Societal Cost Benefit Analysis (SCBA) methodology can be applied. We conducted a societal cost-benefit analysis (SCBA) of falls prevention interventions in the Netherlands in order to show the stepwise approach, data sources needed and analyses that characterize this method.

METHODS

We used SCBA to assess falls prevention interventions' costs and benefits for three stakeholders: private health insurance companies, the national government, and local government. We created five healthcare scenarios for falls prevention interventions, involving informal care, primary care, home care, social work, and an integral scenario. Our SCBA model considered all associated costs with case-finding, screening, and recruitment for each scenario, as well as multifactorial falls prevention programs' costs and benefits, such as reduced healthcare expenses and health gains (DALYs).

RESULTS

All scenarios lead to health gains, ranging from 90 averted DALYs in the informal care to 300 in the primary care scenario.The net benefits per 100,000 senior citizens of falls prevention programs range from €0.2- €5.6 million respectively for social care and home care scenario with benefit-cost ratios of respectively 1.1 and 2.5. Sensitivity analysis revealed that a lower age limit accompanied by a low initial fall risk for recruitment significantly influence the SCBA outcomes.

CONCLUSION

Structural implementation of evidence-based falls prevention can provide significant health benefits and net cost savings, supporting its implementation at the societal level. The SCBA offers guidance to policymakers on the optimal falls prevention programs for older people, reducing the disease burden of falls in the Netherlands.

The national and subnational burden of falls and its attributable risk factors among older adults in Iran from 1990 to 2021: findings from the global burden of disease study

BACKGROUND

Falls among older adults (individuals aged 60 and above) are a substantial health issue worldwide. This study aimed to analyze the burden of falls and its attributable risk factors among older adults at the national and subnational levels in Iran over 32 years.

METHODS

Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 data, we estimated the incidence, prevalence, death, and disability-adjusted life-years (DALYs) of falls and its attributable risk factors among older adults by sex, age groups, and socio-demographic index (SDI) in Iran and its provinces. We reported the estimates with their 95% uncertainty intervals (UIs). Rates were reported per 100,000 population.

RESULTS

In 2021 in Iran, the incidence rate of falls among older adults was 1674.0 (95% UI: 1454.9-1897.3), the prevalence rate was 11302.5 (10504.7-12095.7), the death rate was 16.9 (12.9-21.0), and the DALYs rate was 736.3 (647.6-825.4). In 2021, at the subnational level, Qazvin had the highest incidence, death, and DALYs rates for falls with values at 2329.5 (2008.8-2652.1), 24.2 (19.5-29.0), and 965.9 (856.2-1074.6), respectively, while Kohgiluyeh and Boyer-Ahmad had the highest falls prevalence rate at 16043.1 (14918.4-17149.0). In 2021, males had higher prevalence, death, and DALYs rates of falls compared to females, while females had a higher incidence rate. Among the age groups, the 90-94 age group had the highest rates of incidence, prevalence, death, and DALYs from falls. Low bone mineral density was the primary risk factor attributable to the burden of falls. There were significant positive associations between SDI and both the incidence and prevalence rates of falls. Conversely, a significant inverse association was found between SDI and the death rate.

CONCLUSIONS

From 1990 to 2021, the incidence rate of falls has increased significantly among older adults in Iran, necessitating urgent interventions. Implementing nationwide, cost-effective strategies such as exercise programs to improve strength and balance, home hazard modifications, medication reviews to reduce fall-related risks, and routine screening programs for osteoporosis and fall risk assessment can help protect and support older people, minimizing their risk of falls.

Effect of age on major trauma profile and characterisation: Analysis from the national major trauma audit in Ireland

BACKGROUND

Major trauma (MT) is a significant cause of morbidity and mortality worldwide, with older adult patients facing unique challenges due to age-related vulnerabilities and higher risks of falls. This study aimed to investigate differences in trauma characteristics, injury mechanisms, and outcomes of older adults compared to all younger patients with MT on a national level.

METHODS

This retrospective cohort study analysed the national Major Trauma Audit data from 23,765 eligible patients with MT in Ireland of all ages and stratified into two age groups: those under 65 years (n = 12,620) and those aged 65 years or older (n = 11,145). The Major Trauma Audit follows the methodology of National Major Trauma Registry in the UK. Variables assessed included injury severity, comorbidities, length of stay (LOS), and mortality rates. Statistical comparisons were made between the two age groups.

RESULTS

Older adults represent 47 % of the total Irish patient population with MT, with a significantly higher proportion of females (56 %) compared to younger patients (31 %) (P<0.001). Falls of less than two meters were the leading mechanism of injury for older adults (82 %), while road traffic accidents (RTA) were more common among younger patients (25 %). Severe injuries were observed in 34 % of both age groups, but <10 % of older adults were received by a trauma team. Comorbidities were significantly more prevalent in older adults (75 %) compared to 39 % in younger patients, (P<0.001). Median hospital LOS was twelve days for older adults, compared to seven days for younger patients. Mortality rates were significantly higher among the older patient population, who were also more likely to be discharged to long-term care, (P<0.001).

CONCLUSION

In comparison to younger patients, the present study highlights that older adults who experience major trauma are frequently under-triaged as suspected MT, leading to delays in care, inadequate treatment, or worse clinical outcomes.

Psychomotor Speed and Fall Risk in Older Adults with Sarcopenia and Frailty: A Cross-Sectional Study

Background and Objectives: Information on how psychomotor speed is associated with the risk of falling is scarce, even in older adults. Therefore, this study aimed to determine the relationship between falls and psychomotor speed in older adults with sarcopenia and frailty. Materials and Methods: A total of 204 subjects (aged 83 (77-87) years) participated in this study: 161 women (78.9%) and 43 men (21.1%). The history of falls was assessed by asking whether the subject had experienced a fall in the past 12 months. Psychomotor speed was evaluated by reaction time and frequency of movement. Sarcopenia was diagnosed based on the EWGSOP2 criteria. Frailty was confirmed if the participants met ≥3 criteria according to the Fried frailty criteria. The relationship between falls and psychomotor speed was measured using partial correlations. Binary logistic regression analysis was used to assess if psychomotor speed had an impact on falls. Results: Sarcopenia was confirmed in 93 (45.58%) and frailty in 91 (44.6%) subjects. Both sarcopenia and frailty were present in 62 (30.39%) participants. In the sarcopenia and frailty group, falls were related to simple reaction time (r = 0.444, p = 0.002), hand movement frequency in 10 s (r = -0.352, p = 0.014), and in 60 s (r = -0.312, p = 0.026). In women with sarcopenia and frailty, there were relationships between falls and simple reaction time (r = 0.68, p = 0.002), complex reaction time (r = 0.406, p = 0.004), hand movement frequency in 10 s (r = -0.614, p = 0.001), and in 60 s (r = -0.584, p = 0.001). In regression analysis, it was found that each millisecond increase in reaction time was associated with a 1.5% higher fall risk in the participants with sarcopenia (OR: 1.015 [1, 1.031], p = 0.048). Conclusions: This study demonstrates that slower psychomotor speed, particularly reaction time, is linked to a higher risk of falls in older adults with sarcopenia and frailty, especially in women.

Development of a Tool for Comprehensive Balance Assessment Based on Artificial Intelligence and Anomaly Detection

Falls, a major cause of injury and disability, particularly among older adults, present a significant public-health challenge. Existing methods of balance assessment often lack the sensitivity and specificity needed to identify subtle deviations from normal patterns, hindering early intervention. To address this gap, we introduced a novel artificial intelligence-based tool that leverages anomaly detection to provide a comprehensive assessment of balance performance across all age groups. This study evaluated the tool's effectiveness in 163 individuals aged 18-85 years who were assessed using a force platform under four conditions: eyes open and eyes closed on firm and foam surfaces. Data analysis, employing an artificial neural network with 19 socio-anthropometric and postural variables, showed the tool's exceptional accuracy (R = 0.99998) in differentiating among balance profiles. Notably, the model highlighted the significant impact of age and education on balance, with older adults demonstrating increased reliance on visual input, especially when somatosensory information was reduced on foam surfaces. In contrast, younger, more educated individuals exhibited a more integrated sensorimotor approach. These findings demonstrate that our anomaly-detection tool can identify subtle balance impairments often missed by traditional methods, offering valuable insights for personalized fall-risk assessment and intervention. This AI-based approach can provide a holistic assessment of balance, leading to more effective strategies for fall prevention and rehabilitation, particularly in aging populations.

Exercise for Postmenopausal Bone Health - Can We Raise the Bar?

PURPOSE OF REVIEW

This review summarises the latest evidence on effects of exercise on falls prevention, bone mineral density (BMD) and fragility fracture risk in postmenopausal women, explores hypotheses underpinning exercise-mediated effects on BMD and sheds light on innovative concepts to better understand and harness the skeletal benefits of exercise.

RECENT FINDINGS

Multimodal exercise programs incorporating challenging balance exercises can prevent falls. Emerging clinical trial evidence indicates supervised progressive high-intensity resistance and impact training (HiRIT) is efficacious in increasing lumbar spine BMD and is safe and well-tolerated in postmenopausal women with osteoporosis/osteopenia. There remains uncertainty regarding durability of this load-induced osteogenic response and safety in patients with recent fractures. Muscle-derived myokines and small circulating extracellular vesicles have emerged as potential sources of exercise-induced muscle-bone crosstalk but require validation in postmenopausal women. Exercise has the potential for multi-modal skeletal benefits with i) HiRIT to build bone, and ii) challenging balance exercises to prevent falls, and ultimately fractures. The therapeutic effect of such exercise in combination with osteoporosis pharmacotherapy should be considered in future trials.

Frailty Markers and Falls Among US Clergy

Studies examining frailty, physical performance, and falls among the clergy are limited. The objective of the study was to analyze sociodemographic profiles, gait, strength, and falls between diocesan and religious clergy. Participants included eighty-eight male Catholic clergy primarily in the northeast United States. Participants completed a demographic profile and gait velocity and strength measures. Results noted that more diocesan priests were retired (p = .02). Participants with a fall history demonstrated slower gait (p = .001) and weaker grip strength (p = .017) and were more likely to have a fear of falling (p = .009). Findings underscore the importance of fall screening among clergy.

Survival After Orbital Exenteration for Primary Cutaneous Squamous Cell Carcinoma: A Retrospective Cohort Study

BACKGROUND

Locally advanced periorbital cutaneous squamous cell carcinoma (cSCC) may require orbital exenteration, which is highly morbid. As immunotherapy develops, orbit preservation may become widespread, and data benchmarking survival with current standard-of-care surgery and radiotherapy are essential to the integration of this emerging method into modern treatment paradigms. This study aimed to determine the survival of patients after orbital exenteration for cSCC and investigate contributing factors. It was hypothesized that postoperative radiotherapy would be associated with improved survival.

METHODS

This was a retrospective cohort study of patients with T3 and T4 cSCC undergoing orbital exenteration. Survival analysis was performed using Cox proportional hazards.

RESULTS

The study enrolled 40 patients with a median age of 61.5 years who met the criteria. None of the patients had received preoperative radiotherapy. Age (hazard ratio [HR], 1.09; p = 0.019) and residual disease (HR, 9.00; p = 0.003) were associated with worse survival. Postoperative radiotherapy (HR, 0.003; p < 0.001) was associated with improved survival. Perineural, lymphovascular, and bony invasion and T and N stage were not associated with survival. Survival with postoperative radiotherapy was 94 % at 1 year, 87 % at 2 years, and 84 % at 5 years.

CONCLUSIONS

The oncologic outcomes of orbital exenteration with postoperative radiotherapy for locally advanced head and neck cSCC are good. However, amelioration of the morbidity caused by resection of the eye would be ideal. Data to support immunotherapy as a sole therapy are currently limited, but a combination of neoadjuvant immunotherapy and surgical treatment may facilitate orbit-preserving treatment in the future.

Applying both the 30-s and the 5-repetition sit-to-stand tests captures dissimilar groups and a broader spectrum of physical abilities in mobility-limited older individuals: results from the BIOFRAIL study

PURPOSE

We aimed to assess differences among older patients demonstrating low STS performance in the 30 s-STS and/or the 5r-STS.

METHODS

30 s-STS and 5r-STS were used to assess lower limb muscle strength and function in older adults. Analysis involved 376 patients (≥ 65 years) from a geriatric outpatient clinic for fall assessment.

RESULTS

The mean age of patients was 79.8 (± 6.1) years (67% female). In total, 40.6% had low STS performance with 9.3% presenting only low 30 s-STS, 9.8% only low 5r-STS, and 21.5% low STS performance in both tests. Patients with low STS performance in both tests had lower gait speed, were more often frail, and had more prior falls compared to patients with low STS performance in one test only.

CONCLUSION

The two STS tests are not interchangeable, and the use of both STS tests capture a wider range of physical abilities in mobility-limited older adults.

CLINICAL TRIAL REGISTRATION

NCT05795556.

Global Burden of Traumatic Brain Injury in 204 Countries and Territories From 1990 to 2021

INTRODUCTION

This study aimed to evaluate the burden and underlying causes of traumatic brain injury (TBI) in 204 countries and territories from 1990 to 2021.

METHODS

Utilizing data from the Global Burden of Disease 2021 study, which derived estimates of TBI burden from hospital and emergency department records, national surveys, and claims data, the incidence, prevalence, and years lived with disability (YLDs) associated with TBI were analyzed. A comparative analysis of TBI burden by location, age, sex, and sociodemographic index was performed, along with an underlying assessment of 15 major causes contributing to age-standardized incidence rates. Analyses were conducted in 2024.

RESULTS

In 2021, there were 20.84 million (95% uncertainty interval [UI]=18.13, 23.84) incident cases and 37.93 million (95% UI=36.33, 39.77) prevalent cases of TBI globally, resulting in 5.48 million (95% UI=3.87, 7.33) YLDs. While the absolute number increased from 1990 to 2021, age-standardized rates of TBI incidence, prevalence, and YLDs showed a significant decline. These rates generally increased with age and were higher in males than females. The highest age-standardized prevalence and YLD rates were observed in Eastern and Central Europe. Globally, falls were the leading cause of TBI in 2021, followed by road injuries, interpersonal violence, and exposure to mechanical forces.

CONCLUSIONS

Despite declines in age-standardized rates, the total number of TBI cases and associated disabilities has risen since 1990, indicating a persistent global burden. Targeted interventions are urgently needed in high-burden regions like Eastern and Central Europe, with focus on leading causes and vulnerable populations.

Biomechanical adaptation to compensate balance recovery in people with knee osteoarthritis

BACKGROUND

Older adults with knee osteoarthritis are twice as likely to fall compared to healthy counterparts. Furthermore, in healthy older adults, greater trunk flexion is associated with increased falling. While spatio-temporal and strength measures have been connected to balance dysfunction in osteoarthritis, to date no studies have investigated compensation of both upper and lower body kinematics on balance recovery in this population.

METHODS

Forty-eight older people with knee osteoarthritis (age 71.02 ± 6.76 years, 54 % females, BMI 29.10 ± 4.58) and 15 asymptomatic controls (age 72.47 ± 4.81, 27 % females, BMI 26.17 ± 3.06) completed balance recovery during a simulated forwards fall. Ankle, knee, hip, trunk and head kinematics were collected and analysed using three trial types (no additional, cognitive dual-task and physical dual-task). Two-way MANCOVA were conducted to identify group differences in ankle, knee, hip, and trunk angle, and head position (control and knee osteoarthritis), trial differences (no additional, cognitive and physical dual-task) and group by trial differences.

FINDINGS

Postural differences in older adults with knee osteoarthritis included greater knee flexion (p = .02) and lower hip and trunk flexion (p < .01).

INTERPRETATION

Following a simulated fall, older adults with knee osteoarthritis showed greater knee flexion at first contact which might suggest inability to resist forwards motion of the body.The more extended hip in this group and the resulting compensation of the upper body posture may lead to no difference in number of steps taken when compared to controls.

Effectiveness of the Safe Step Digital Exercise Program to Prevent Falls in Older Community-Dwelling Adults: Randomized Controlled Trial

BACKGROUND

Falls among older adults are a significant public health issue due to their high incidence, severe consequences, and substantial economic impact. Exercise programs incorporating balance and functional exercises have been shown to reduce fall rates, but adherence and scaling up the interventions remain challenges. Digital technology offers a promising avenue to deliver this type of exercise, potentially improving exercise adherence and enabling self-management of exercise in the aging population.

OBJECTIVE

This study aims to assess the effectiveness of the Safe Step app, a self-managed, unsupervised, home-based digital exercise program, in reducing fall rates or fall risk in community-dwelling older adults. Additional aims were to describe fall-related injuries in both the exercise and control groups, study attrition, and adherence to the Safe Step exercise program.

METHODS

Community-dwelling individuals, aged 70 years or older, who had experienced falls or a decline in balance in the past year were randomized to either an exercise group using the Safe Step app combined with educational videos, or a control group receiving educational videos alone. Both interventions lasted for 1 year. Information regarding fall events was self-reported monthly through questionnaires. Exercise adherence was monitored through questionnaires every third month. Negative binomial and logistic regression estimated the incidence rate ratio of fall rate and the risk ratio (RR) of experiencing falls, respectively. Fall-related injuries, study attrition, and exercise adherence were reported descriptively.

RESULTS

In total, 1628 people were enrolled in the study, 79% were women, and the mean age was 75.8 (SD 4.4) years (range 70-94 years). The intention-to-treat analysis showed no significant difference in fall rates between the exercise and control groups after 12 months (2.21 falls per person-year in the exercise group and 2.41 in the control group; incidence rate ratio 0.92, 95% CI 0.76-1.11; P=.37). The risk of experiencing at least 1 fall was significantly lower (11%) in the exercise group compared to the control group (53% vs 59.6%; RR 0.89, 95% CI 0.80-0.99; P=.03). No differences were observed regarding the risk of 2 or more falls (34.1% in the exercise group, 37.1% in the control group; RR 0.92, 95% CI 0.79-1.06; P=.23). Injurious fall rates were similar between the exercise and control group. During the trial, 161 (20%) participants from the exercise group and 63 (8%) from the control group formally withdrew. The proportion of exercise group participants meeting the 90-minute weekly exercise goal was 12.7%, 13.4%, 8.6%, and 9.1% at 3, 6, 9, and 12 months, respectively.

CONCLUSIONS

Access to a self-managed unsupervised digital exercise program can be an effective component of a primary fall prevention strategy for community-dwelling older adults. Further research is needed to explore the mediating factors that influence the outcomes and develop strategies that enhance adherence for optimal impact in this population.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03963570; https://clinicaltrials.gov/study/NCT03963570.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2019-036194.

Effects of age, period, and birth cohort on fall-related mortality in older adults in Brazil from 1980 to 2019

Falls in older adults are a major public health problem. This study aimed to estimate the effects of age, period, and birth cohort on fall-related mortality in older adults in Brazil and its geographic regions, by sex, from 1980 to 2019. We conducted an ecological time-series study using data on fall-related deaths in older adults extracted from Brazilian Mortality Information System. Poisson models were adjusted for sex and geographic region to estimate age-period-cohort effects. From 1980 to 2019, Brazil recorded 170,607 fall-related deaths in older adults, with 50.1% occurring in women. More than half of these deaths occurred in the age group of 80 years or older (55%) and in the Southeast Region (52%). We observed an increase in fall-related mortality rates across all age groups and regions, regardless of sex. There was an increased risk of death in all periods after the reference period (2000 to 2004) in all geographic regions and for both sexes. We also observed a gradual increase in mortality risk for men born before 1914 and after 1935 compared to the reference cohort (1930 to 1934). In contrast, we found a protective effect across all birth cohorts for women. There was a consistent increase in fall-related mortality risk among older people in Brazil, posing a public health challenge. The findings highlight the urgent need for implementing public health policies that promotes older adults' health and prevents fall risks to improve this population's quality of life.

Management of fall-risk-increasing drugs in Australian aged care residents: a retrospective cross-sectional study

BACKGROUND

Globally, falls are considered a serious healthcare problem for aged care residents. Fall-risk-increasing drugs (FRIDs) are medications that can increase the risk of falling, given their adverse effects. Medication reviews are advocated to identify potentially inappropriate use of FRIDs. However, their impact on clinical and resident-centered outcomes is unclear. This study explored aged care residents' use of FRIDs and the content of medication review reports concerning these.

METHODS

A retrospective cross-sectional study of medication review reports completed between 1st July 2021 and 30th June 2022 was conducted. Statistical descriptive analysis was used to examine the use of FRIDs (defined as medications listed in the Screening Tool of Older Persons Prescriptions in older adults with high fall risk (STOPPFall)). The resident's medicine experience, identified drug-related problems (DRPs), and related recommendations concerning FRIDs were explored via content analysis. For recommendations to deprescribe FRIDs, clinical situations detailed in the reports were compared to those presented in STOPPFall.

RESULTS

Medication review reports relating to 966 residents were analysed. Of these residents, 83.2% (n = 804) used FRIDs, with 31.2% (n = 301) taking three or more FRIDs. In total, pharmacists made recommendations concerning 2635 identified DRPs, of which 19.7% (n = 520) were the potentially inappropriate use of FRIDs and deprescribing was recommended. The clinical situation for which deprescribing was most frequently recommended was the use of a FRID for an indication of limited clinical benefit 37.9% (n = 197). The clinical situation was not detailed for 130 (25.0%) recommendations to deprescribe FRIDs, and only three reports included the resident's viewpoint on deprescribing.

CONCLUSIONS

FRID use was found to be highly prevalent among aged care residents. Pharmacists frequently identified opportunities to deprescribe FRIDs. However, reports often omitted resident viewpoints and the clinical grounds for deprescribing. Using resident-centered communication in medication review reports could improve their impact on FRID use and resident outcomes.

Does concern about falling predict future falls in older adults? A systematic review and meta-analysis

BACKGROUND

The 2022 World Falls Guidelines recommend assessing concerns (or 'fears') about falling in multifactorial fall risk assessments. However, the evidence base for this recommendation is limited. This review evaluated the evidence for concerns about falling as an independent predictor of future falls, applying the Bradford Hill criteria for causality.

METHODS

Systematic review and meta-analyses were conducted (PROSPERO registration ID: CRD42023387212). MEDLINE, CINAHL Plus, Web of Science and PsycINFO were searched for studies examining associations between baseline concerns about falling and future falls in older adults (minimum 6-month follow-up). Meta-analyses examined associations between concerns about falling and future falls. Risk of bias was assessed using an adapted Newcastle Ottawa Scale for cohort studies, and evidence certainty was rated with GRADE.

RESULTS

About 53 studies, comprising 75,076 participants, were included. Meta-analysis showed significant independent association between baseline concerns and future falls when using the Falls Efficacy Scale-International to assess concerns (full scale version, pooled OR = 1.03 [95% CI = 1.02-1.05] per 1-point increase; short scale version, pooled OR = 1.08 [95% CI = 1.05-1.11]). Significant associations were also observed when using single-item measures of concerns (pooled OR = 1.60 [95% CI = 1.36-1.89] for high vs. low concerns). In contrast, balance confidence (Activities-Specific Balance Confidence Scale) did not predict future falls (pooled OR = 0.97 [95% CI = 0.93-1.01]). Despite 26 studies rated as poor quality, associations were consistent across studies of different quality. The overall certainty of the evidence was rated as moderate.

CONCLUSIONS

Baseline concern about falling is a clear predictor of future falls in older adults, supporting its inclusion in fall risk assessments. Regular assessment of concerns about falling, along with targeted interventions, could help reduce the risk of falls in older adults.

Evaluation of content validity and feasibility of the World Falls Guidelines' three key questions to identify falls among older adult users of home care services in Norway

BACKGROUND

Falls among older adults (65 + years) is an important issue in municipal home care. Screening using the World Falls Guidelines' three key questions (3KQ) is recommended to identify older adults at increased fall risk, but the 3KQ has not been formally tested by healthcare practitioners (HCPs) working in Norwegian municipal home care. The aim of this study was to evaluate the content validity and the feasibility of the 3KQ among HCPs in home care services.

METHODS

Participants were 10 multidisciplinary HCPs working in home care and in low-threshold services of Oslo, Norway. We evaluated the content validity of the 3KQ through individual think-aloud interviews. Next, feasibility was evaluated as follows: We trained HCPs in how to use the 3KQ. HCPs then screened older adults using the 3KQ during a six-week test period, and took pocket-notes of older adults' answers. We conducted two focus groups to explore HCPs' experiences with using the 3KQ. We analysed interview data using reflexive thematic analysis.

RESULTS

Content validity evaluation revealed that HCPs found the 3KQ easy to understand, and potentially timesaving. They experienced the tool as applicable among home care users, and it was particularly useful among new users. Still, HCPs emphasised the necessity of their training on how to best ask the questions and determine appropriate actions based on users' responses. We identified three main themes from the feasibility evaluation: (1) Promoting awareness and action: using the 3KQ helps put falls on the agenda in municipal home care, (2) Obtaining reliable answers: integrating the 3KQ into daily practice is important, and (3) Unlocking insights: the 3KQ as a gateway to supplementary information from users. Most older adults had increased fall risk according to the 3KQ.

CONCLUSIONS

The 3KQ appears feasible for Norwegian municipal home care and may be of value for HCPs who screen new users and users of low-threshold services. Integrated use of the 3KQ may enhance awareness, promote reliable answers, and provide supplementary information useful for decision-making. The study findings may benefit HCPs and managers in home care services, and other stakeholders in implementing fall prevention guidelines in primary care.

TRIAL REGISTRATION

Open Science Framework Identifier https://doi.org/10.17605/OSF.IO/2JFHV . Registered: 11th January 2023.

Remote monitoring of Tai Chi balance training interventions in older adults using wearable sensors and machine learning

Tai Chi, an Asian martial art, is renowned for its health benefits, particularly in promoting healthy aging among older adults, improving balance, and reducing fall risk. However, methodological challenges hinder the objective measurement of adherence to and proficiency in performing a training protocol, critical for health outcomes. This study introduces a framework using wearable sensors and machine learning to monitor Tai Chi training adherence and proficiency. Data were collected from 32 participants with inertial measurement units (IMUs) while performing six Tai Chi movements evaluated and scored for adherence and proficiency by experts. Our framework comprises a model for identifying the specific Tai Chi movement being performed and a model to assess performance proficiency, both employing Random Forest algorithms and features from IMU signals. The movement identification model achieved a micro F1 score of 90.05%. The proficiency assessment models achieved a mean micro F1 score of 78.64%. This study shows the feasibility of using IMUs and machine learning for detailed Tai Chi movement analysis, offering a scalable method for monitoring practice. This approach has the potential to objectively enhance the evaluation of Tai Chi training protocol adherence, learnability, progression in proficiency, and safety in Tai Chi programs, and thus inform training program parameters that are key to achieving optimal clinical outcomes.

Global Burden of Vertebral Fractures and Spinal Cord Injuries Due to Falls From 1990 to 2021: A Population-Based Study

Study DesignMeta-analysis-based calculation.ObjectivesFalls are the primary cause of vertebral fractures and spinal cord injuries (SCI). We aimed to analyze the burden and trends of vertebral fractures and SCI due to falls.MethodsWe extracted data on the incidence, prevalence, and years lived with disability (YLDs) of vertebral fractures and SCI due to falls in 21 regions and 204 countries. Estimated annual percentage changes and the Joinpoint regression analysis was used to assess time trends. And we used the Bayesian Age-Period-Cohort model to project the burden for the next 15 years. Then, We developed smoothed curve models and used Spearman's correlation coefficient to analyze the relationship between the Socio-Demographic Index (SDI) and the burden. Finally, frontier analysis was applied to evaluate the effective differences.ResultsIn 2021, there were 4.73 million new cases of vertebral fractures and 3.67 million prevalent cases, and SCI accounted for .3 million new cases and 6.94 million prevalent cases. Although age-standardized rates (ASRs) showed a declining trend, absolute case numbers increased by more than 50% since 1990. Middle-aged males and elderly females are more vulnerable. A positive correlation was found between SDI and ASRs (P < .001), with higher burdens in high SDI regions. Burdens continue to rise in low and middle SDI regions due to limited healthcare resources and development-related risks.ConclusionsThe global burden of vertebral fractures and SCI continues to grow. Prevention of falls and musculoskeletal degeneration is critical. Urgent action is needed to improve healthcare infrastructure and preventive measures.

Attributable risk factors and trends in global burden of falls from 1990 to 2021: A comprehensive analysis based on Global Burden Of Disease Study 2021

BACKGROUND

Falls are a leading cause of disability-adjusted life years (DALYs) and mobility difficulties. Previous estimates have relied on restricted regional scope and lack a thorough global study. This study, for the first time, examines the evolving trends in the global burden of falls from 1990 to 2021, focusing on geographic variation in disease burden and risk factors, predicting the development of burden of falls. Our aim was to provide information for allocating medical resources, taking health policies into action, and making patient management systems operate better.

METHOD

Data on incident cases, deaths, and DALYs were collected for countries, regions, ages, and sexes worldwide from the Global Burden Disease (GBD) 2021 database. Using R (version 4.3.2), we calculated estimated annual percent changes (EAPCs) for assessing trends in age-standardized rates, visualized risk factors, and predicted the global burden of falls. Joinpoint regression (version 4.9.1.0) was used to identify significant temporal trends and change points.

RESULTS

In 2021, 548.8 million people were affected by falls. There were 215 million incidence, 43.8 million DALYs, and 800,000 deaths caused by falls. The incidence rate of falls increases with age, and sex inequalities exist. Compared with 1990, the age-standardized incidence rate (ASIR), death rate (ASDR), and DALY rate (ASDALYsR) declined despite an increase in absolute numbers. The ASDR and ASDALYsR of falls are expected to decline in the future, whereas the ASIR is expected to rise. The fall burden varied significantly according to region and its sociodemographic index (SDI). Both ASIR (R = 0.510, p < 0.001) and ASDALYsR (R = 0.2762, p < 0.001) were positively correlated with SDI. In contrast, ASDR (R=-0.536, p < 0.001) showed a consistently negative association with SDI. Low bone mineral density, occupational injuries, alcohol use, and smoking emerged as the top factors associated with fall-related DALYs and deaths.

CONCLUSIONS

The overall burden of falls declined between 1990 and 2021, but the future incidence is expected to increase. The global burden of falls remains unchanged and shows significant regional and sex-based differences. Effective prevention and strategies against risk factors are imperative for reducing the future burden.

Fall-related mortality in Spain: trends and disparities by age and gender

BACKGROUND

Falls are a significant public health concern, particularly among older adults. This study aimed to analyse trends in fall-related mortality in Spain from 1999 to 2022, focusing on age and gender disparities.

METHODS

Using a longitudinal ecological study, we analysed trends in fall mortality. Using data from the Spanish National Institute of Statistics, age-standardised mortality rates (ASMRs) were calculated for different age groups and genders. Joinpoint regression analysis was employed to identify significant trends and calculate annual percentage changes in mortality rates.

RESULTS

Fall deaths in Spain surged from 1999 to 2022, with a significant increase in mortality rates. This increase was more pronounced among men than women, and the older adults aged 65 and older accounted for most fall-related deaths. Overall, ASMRs increased with age and were consistently higher for men across all age groups. Men experienced a 1.9% annual increase in ASMRs, with a significant rise starting in 2009. Women's ASMRs increased by 1.8% per year, with a more pronounced increase from 2007 to 2013 before slowing. Among those aged 65 and over, rates increased significantly across most age groups, with the ASMR for men rising by 2.7% per year and for women by 2%.

CONCLUSIONS

Fall mortality in Spain has significantly increased, particularly among older adults and men. The findings underscore the need for targeted fall prevention strategies, especially for high-risk groups. Future interventions should address gender-specific risks and emerging issues in middle-aged adults to effectively reduce fall-related mortality across all age groups.

Hearing Loss and Falls: A Systematic Review and Meta-Analysis

Importance

Falls constitute a significant public health concern worldwide and have been associated with increased morbidity and mortality across all ages. Identifying potentially modifiable risk factors for falls is a key public health priority. Literature surrounding the association between hearing loss (HL) and falls remains inconclusive.

Objective

To conduct a systematic review and meta-analysis to comprehensively synthesize evidence surrounding the impact of HL on falls.

Data Sources

PubMed, Embase, and Cochrane Library from database inception through April 9, 2024.

Study Selection

Observational studies investigating the association between HL and falls were selected. Only studies reporting covariate-adjusted estimates were included to minimize confounding.

Data Extraction and Synthesis

Two independent reviewers evaluated studies for eligibility, extracted data, and assessed the risk of bias of included studies. Using a random-effects model, adjusted estimates were pooled in meta-analyses. Heterogeneity was evaluated using subgroup and sensitivity analyses, and publication bias was assessed.

Main Outcomes and Measures

The cross-sectional odds and longitudinal risk of falls among patients with HL compared with those without HL.

Results

A total of 5 071 935 participants were included from 27 studies; approximately 49.2% of participants were female, and 14 studies were conducted in Asia, 7 in North America, 3 in Europe, and 3 in Oceania, represented by Australia. Patients with HL exhibited an increased cross-sectional odds of falls (odds ratio, 1.51; 95% CI, 1.37-1.67; I2 = 64%) and longitudinal risk of falls (risk ratio, 1.17; 95% CI, 1.06-1.29; I2 = 69%) than those without HL. Further stratification by self-reported or validated hearing assessments, fall reporting duration, continent, community-dwelling adults, and studies adjusting for other sensory deficits identified as fall risk factors by the World Falls Guideline did not change significance. These results remained robust to sensitivity analyses, and publication bias was absent.

Conclusions and Relevance

This systematic review and meta-analysis found that overall, HL may be a risk factor for falls. With a rapidly aging global population, it is crucial to acknowledge the public health concerns surrounding falls and consider if HL could be a potentially modifiable risk factor. Nonetheless, further randomized clinical trials are needed to elucidate any benefit of treating HL on fall prevention.

Better Understanding Rehabilitation of Motor Symptoms: Insights from the Use of Wearables

Movement disorders present a substantial challenge by adversely affecting daily routines and overall well-being through a diverse spectrum of motor symptoms. Traditionally, motor symptoms have been evaluated through manual observational methods and patient-reported outcomes. While those approaches are valuable, they are limited by their subjectivity. In contrast, wearable technologies (wearables) provide objective assessments while actively supporting rehabilitation through continuous tracking, real-time feedback, and personalized physical therapy-based interventions. The aim of this literature review is to examine current research on the use of wearables in the rehabilitation of motor symptoms, focusing on their features, applications, and impact on improving motor function. By exploring research protocols, metrics, and study findings, this review aims to provide a comprehensive overview of how wearables are being used to support and optimize rehabilitation outcomes. To achieve that aim, a systematic search of the literature was conducted. Findings reveal that gait disturbance and postural balance are the primary motor symptoms extensively studied with tremor and freezing of gait (FoG) also receiving attention. Wearable sensing ranges from bespoke inertial and/or electromyography to commercial units such as personal devices (ie, smartwatch). Interactive (virtual reality, VR and augmented reality, AR) and immersive technologies (headphones), along with wearable robotic systems (exoskeletons), have proven to be effective in improving motor skills. Auditory cueing (via smartwatches or headphones), aids gait training with rhythmic feedback, while visual cues (via VR and AR glasses) enhance balance exercises through real-time feedback. The development of treatment protocols that incorporate personalized cues via wearables could enhance adherence and engagement to potentially lead to long-term improvements. However, evidence on the sustained effectiveness of wearable-based interventions remains limited.

The Science of Tai Chi and Qigong and Whole Person Health Part I: Rationale and State of the Science

The emerging paradigm of whole person health shares many core principles with traditional complementary and integrative health frameworks, including Tai Chi and qigong (TCQ). In the Fall of 2023, the Harvard Medical School Osher Center for Integrative Health hosted the inaugural international conference on The Science of Tai Chi for Whole Person Health: Advancing the Integration of Mind-Body Practices into Contemporary Health Care held at Harvard Medical School. A two-part white paper was written to summarize key conference topics, findings, and issues. Part I presented here summarizes the rationale for the conference and synthesizes the state of evidence for TCQ as rehabilitative and preventive tools for a range of clinical conditions, including falls and balance, cognition, mental health, sleep, cardiorespiratory health, musculoskeletal health, cancer, as well as translational evidence related to the neurophysiology, brain and immune function, and biomarkers of inflammation. The state of science of TCQ, viewed through the lens of traditional East Asian health constructs, is also discussed. Part II of this white paper outlines evidence gaps and opportunities and discusses strategies to address challenges in TCQ research, dissemination, and implementation.

Longitudinal association of SGLT2 inhibitors and GLP-1RAs on falls in persons with type 2 diabetes

Low lean body mass increases fall risk. Some diabetes medications, specifically SGLT2 inhibitors and GLP-1RAs, can cause muscle and body mass loss. This study assessed their association on falls in type 2 diabetes patients. An annual fall survey was conducted for up to 5 years on individuals with type 2 diabetes admitted to our department. Fall risk factors were identified using discrete-time survival analysis. The study observed 471 participants over a median period of 2 years. The participants had a median age of 64 years, with a fall incidence rate of 17.1 per 100 person-years. Independent fall predictors identified were fall history, SGLT2 inhibitor use, and age. The odds ratios (95% confidence intervals) for using SGLT2 inhibitors only, GLP-1RAs only, and both combined were 1.80 (1.10-2.92), 1.61 (0.88-2.84), and 2.89 (1.27-6.56), respectively. SGLT2 inhibitor use was an independent risk factor for falls, while GLP-1RAs' effects were not statistically significant. However, the combined use of SGLT2 inhibitors and GLP-1RAs significantly increased the risk of falls. Therefore, it is important to consider this risk when prescribing these medications to people with type 2 diabetes.

Automated abdominal aortic calcification scoring from vertebral fracture assessment images and fall-associated hospitalisations: the Manitoba Bone Mineral Density Registry

Abdominal aortic calcification (AAC), a subclinical measure of cardiovascular disease (CVD) that can be assessed on vertebral fracture assessment (VFA) images during osteoporosis screening, is reported to be a falls risk factor. A limitation to incorporating AAC clinically is that its scoring requires trained experts and is time-consuming. We examined if our machine learning (ML) algorithm for AAC (ML-AAC24) is associated with a higher fall-associated hospitalisation risk in the Manitoba Bone Mineral Density (BMD) Registry. A total of 8565 individuals (94.0% female, age 75.7 ± 6.8 years) who had a BMD and VFA image from DXA between February 2010 and December 2017 were included. ML-AAC24 was categorised based on established categories (ML-AAC24 = low < 2; moderate 2 to < 6; high ≥ 6). Cox proportional hazards models assessed the relationship between ML-AAC24 categories and incident fall-associated hospitalisations obtained from linked health records (mean ± SD follow-up, 3.9 ± 2.2 years). Individuals with moderate (9.6%) and high ML-AAC24 (11.7%) had a greater proportion of fall-associated hospitalisations, compared to those with low ML-AAC24 (6.0%). In age and sex-adjusted models, compared to low ML-AAC24, moderate (HR 1.49, 95% CI 1.24-1.79) and high ML-AAC24 (HR 1.89, 95% CI 1.56-2.28) were associated with greater hazards for a fall-associated hospitalisation. Results were comparable (HR 1.37, 95% CI 1.13-1.65 and HR 1.60, 95% CI 1.31-1.95, respectively) after multivariable adjustment, including prior falls and CVD, as well as medication use. Integrating ML-AAC24 into bone density machine software to identify high risk individuals would opportunistically provide important information on fall and cardiovascular disease risk to clinicians for evaluation and intervention.

Bibliometric-based visualization analysis of hotspots and trends in falls research among older hospitalized patients (2013-2023)

Purpose

We utilized Citespace 6.2 R4 software to visualize and analyze the literature published within the past decade (2013-2023) pertaining to falls in elderly hospitalized patients, with the objective of examining the progression and patterns of focal points within this research domain. Our aim is to offer a valuable reference and foundation for related studies and to provide guidance for healthcare professionals and researchers in advancing further exploration and implementation of strategies for preventing and managing falls in elderly patients.

Methods

We conducted a literature search in the Web of Science database using keywords such as "older hospitalized patients" and "fall" to develop a search strategy that was highly relevant to the topic of falls among older hospitalized patients. We further limited the literature time range to January 1, 2013, to December 31, 2023, to capture the latest research trends over the past decade. In terms of literature type, we focused on "article" and excluded conference papers, reviews, editorials, etc., to ensure the scientific rigor and reliability of the study. During the screening process, we excluded duplicate publications and those documents that were not directly related to falls among older hospitalized patients, such as those primarily discussing falls in other age groups or non-hospital environments. Although our search had no language restrictions, we only included English-language literature to ensure consistency and readability of the language. Additionally, we evaluated the quality of the literature and excluded those with unclear research methods or unreliable results to ensure the reliability of the research findings. Subsequently, we utilized CiteSpace 6.2 R4 software to generate a knowledge map for visualization and analysis.

Results

Our analysis included a total of 321 articles. The results showed that the majority of contributions in this field came from the United States and China, both of which exhibited an intermediary centrality >0.1, indicating their significant influence. Harvard University became the leading institution with the most published articles (n = 8), while Imagama was identified as the most prolific author (n = 6). Moving forward, combining keywords with the strongest citation bursts, it is expected that the research trends in this field in the future will focus on epidemiology, aging, and health-related topics.

Conclusion

Our study presents a comprehensive investigation into the evolution and trends of research focal points regarding falls in elderly hospitalized patients from 2013 to 2023. Our findings reveal a significant increase in attention toward this research area over the past decade, with a growing number of studies being conducted. Fall risk assessment, prevention strategies, rehabilitation interventions, and costs associated with falls have emerged as the primary research focal points within this field. Furthermore, epidemiology, aging population dynamics, and health outcomes continue to be enduring areas of interest for researchers post-2018 and warrant additional emphasis from scholars.

Association of dietary calcium intake with risk of falls in community-dwelling middle-aged and older adults

OBJECTIVES

Although calcium supplementation is reported to play a role in preventing falls, few studies have examined the relationship between dietary intake of calcium and falls. Therefore, this study investigated the association of calcium intake with falls in community-dwelling adults.

DESIGN

Cross-sectional and longitudinal analyses of a prospective cohort study.

SETTING AND PARTICIPANTS

A 5-year follow-up of a community-based cohort study was conducted with participants aged 40 years or older (mean age, 63.1 years). The cross-sectional and longitudinal analyses included 38,566 and 24,066 participants, respectively.

MEASUREMENTS

Dietary calcium intake was assessed using a validated food frequency questionnaire, with energy adjustment. The outcome was any falls in the preceding year, which were recorded in the self-administered questionnaire. The association of calcium intake with falls was estimated by multivariable logistic regression analysis.

RESULTS

The median intake of dietary calcium was 463 mg/day and 577 mg/day in men and women, respectively. In the cross-sectional analysis, lower intake of dietary calcium was associated with falls. The adjusted odds ratio for falls in the lowest quartile versus the highest quartile was found to be 1.29 (95%CI, 1.16, 1.45) in men and 1.12 (95%CI, 1.01, 1.25) in women. The results of the longitudinal analysis were consistent, with the adjusted odds ratio for falls in the lowest quartile versus the highest quartile being 1.20 (95%CI, 1.04, 1.40) in men and 1.23 (95%CI, 1.09, 1.39) in women.

CONCLUSIONS

Lower intake of dietary calcium was associated with a higher risk of falls. Adequate intake of dietary calcium might help to reduce the occurrence of falls.

Injurious Falls before, during, and after Stroke Diagnosis: A Population-based Study

OBJECTIVES

We aimed to examine changes in the incidence of injurious falls before, during, and after stroke, and to identify risk factors of injurious falls before and after stroke diagnosis.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

Within the Swedish Twin Registry, 4431 participants (aged 66.5 ± 10.3 years) with incident stroke and 4431 stroke-free controls (aged 66.5 ± 10.3 years) were identified and matched with cases according to birth year and sex. Cases and controls were retrospectively and prospectively followed for a total of 21 years.

METHODS

Information on the onset of stroke and injurious falls was ascertained from medical records in the National Patient Registry. Data were analyzed using conditional Poisson regression and generalized estimating equation models.

RESULTS

During the 4 to 10 year pre-stroke period, the standardized incidence rates of injurious falls were 4.29-7.53 per 1000 person-years in stroke and 3.97-7.47 per 1000 person-years in control groups. The incidence of injurious falls among participants with stroke was significantly higher compared with non-stroke controls beginning 3 years before stroke [incidence rate ratio (IRR), 1.27; 95% confidence interval (CI), 1.02-1.59], peaked during the year of stroke diagnosis (IRR, 2.55; 95% CI, 2.17-3.01), and declined 4 years after stroke (IRR, 1.42; 95% CI, 1.14-1.77) until reaching a similar level as the controls (IRRs around 1.11-1.56). Former/current smoking, heavy drinking, and overweight were associated with increased falls during the pre-stroke period, and being single and heart disease with falls during the post-stroke period.

CONCLUSIONS AND IMPLICATIONS

Among people with stroke, incidence of injurious falls is significantly elevated already 3 years before stroke diagnosis and lasting until 4 years post-stroke. Risk factors for falls differ pre-stroke and post-stroke. Taking preventive measures may be beneficial in managing both stroke and fall-related risks.

The implications of bioelectrical impedance vector analysis in older adults with hip fractures

OBJECTIVES

This study used bioelectrical impedance vector analysis to assess body composition in older adults with hip fractures, comparing results with reference populations.

STUDY DESIGN

This cross-sectional study included patients aged 65 years or more who had undergone surgery for hip fracture and baseline bioelectrical impedance analysis at 50 kHz. Using raw impedance data, bioelectrical impedance vector analysis was conducted, calculating phase angle and analyzing resistance (R) and reactance (Xc) relative to height (R/H and Xc/H) on RXc graphs.

MAIN OUTCOME MEASURES

Men and women were compared with reference populations using confidence ellipses. Individual vectors were plotted against 50 %, 75 %, and 95 % tolerance ellipses and compared with international references matched for age and body mass index and a young adult group, further differentiated by sarcopenia status.

RESULTS

Among 103 patients with hip fracture (24 men, 79 women), confidence ellipses showed significant differences from reference populations (P < 0.001), with reduced Xc and lower phase angle (men: 4.3 ± 1.5°; women: 3.8 ± 1.0°), consistent with higher R/H and lower Xc/H. Most vectors lay outside the 75 % and 95 % tolerance ellipses, primarily in the lower-right and upper-right quadrants, indicating body cell mass loss and water imbalance. Only 8.3 % of men and 12.7 % of women fell within the 75 % tolerance ellipse of community-dwelling older adults. Sarcopenic patients showed greater rightward displacement, indicating more severe muscle wasting and dehydration.

CONCLUSIONS

Older hip fracture patients showed a distinct pattern on bioelectrical impedance vector analysis indicating frailty and malnutrition. Bioelectrical impedance vector analysis may effectively screen for body composition changes and nutritional status, supporting timely, multidisciplinary interventions.

Relationship Between Sural Nerve Function, Physical Function, and the Ability to Perform Activities of Daily Living in Hospitalized Elderly Patients With Proximal Femoral Fractures: A Prospective Observational Study

Background Falls in older adults, specifically causing proximal femoral fractures, greatly affect daily functioning and life expectancy. Peripheral neuropathy is an established risk factor for falls. However, the relationship between nerve conduction velocity (CV), action potential (AP), and fall risk or functional recovery after rehabilitation is not well understood. This study aimed to clarify whether sural nerve function can predict fall risk and functional improvement in activities of daily living. Methods We assessed elderly patients hospitalized with proximal femoral fractures in a convalescent rehabilitation ward. Sural nerve function was evaluated using the DPNCheck (NeuroMetrix, Inc., Woburn, MA, USA), with additional data collected on demographics, blood tests, medication use at admission and discharge, incidence of falls during hospitalization, physical function (Short Physical Performance Battery, or SPPB), and activities of daily living (Functional Independence Measure, or FIM). Statistical analyses explored the associations between the sural nerve CV/AP and the collected measures. Results In 27 patients (7 men and 20 women), sural nerve CV and AP were significantly correlated with both SPPB and FIM scores. Logistic regression identified FIM toileting as a significant predictor of reduced sural nerve AP (<5 μV; odds ratio: 3.22, p = 0.025). Multiple regression analysis showed that age and AP were significant predictors of the total FIM cognitive scores at discharge, with an adjusted R² of 0.464. Conclusion This study suggests that sural nerve function may help predict functional abilities in patients with proximal femoral fractures, particularly in the FIM motor tasks. Assessing peripheral nerve function can enhance rehabilitation plans by targeting fall risk management and promoting improvements in daily activities.

Hazardous alcohol consumption is associated with an increased occurrence of falls among people with HIV in the PROSPER-HIV Study

OBJECTIVE

Falls are a significant public health concern, particularly among older adults and people with HIV (PWH). This study examines the association between alcohol consumption and falls in PWH.

METHODS

The PROSPER-HIV study recruited PWH from four US sites. Participants were categorized based on Alcohol Use Disorders Identification Test Consumption (AUDIT-C) scores: none, nonhazardous, and hazardous drinking. Data collection included demographics, medical history [i.e. comorbidities, treated hypertension, estimated glomerular filtration rate (eGFR)], alcohol consumption using AUDIT-C, daily alcohol recall in grams, and self-reported falls over the previous year. Physical performance was measured using the Short Performance Physical Battery (SPPB). Statistical analyses included Pearson's correlation and Poisson regression models to estimate fall prevalence ratios, adjusting for confounders (SPPB, comorbidities, treated hypertension, and eGFR).

RESULTS

The study included 315 PWH, aged 52 ± 12 years, with 78% male participants. Thirty-three percentage were classified as nondrinking, 50% nonhazardous, and 17% hazardous drinking. Poisson regression showed a significantly higher risk of falls [prevalence ratio: 2.12, 95% confidence interval (CI) 1.11-4.03] and recurrent falls (prevalence ratio 3.54, 95% CI 1.21-10.3) among hazardous drinking compared with nonhazardous drinking, even after adjusting for confounders. The prevalence ratios for falls per daily intake in grams was not statistically significant.

CONCLUSION

There is a significant association between hazardous alcohol consumption and increased fall risk in PWH using AUDIT-C but not when accessing recall of alcohol consumption in grams.

Key accelerometry measures for understanding walking sway during dual-task exercises

Aim

This study aimed to identify optimal methods of acceleration analysis to accurately detect dual-task-related changes in walking sway.

Methods

Twenty-six healthy adults participated in this study, undergoing various cognitive dual-task conditions while walking. Accelerometers were attached to the lower back to record center-of-mass (COM) acceleration in anterior-posterior (AP) and mediolateral (ML) directions. Data analysis involved multiple computation methods applied to the acceleration data, with comparisons made using different frequency cutoffs and mean referencing.

Results

Analysis revealed significant effects of dual-tasking on walking sway, particularly in AP and combined directions. A 3.5Hz low-pass filter and mean referencing were found effective in capturing these changes. Computation methods, such as root mean square (which quantifies the variability of COM acceleration) and normalized path length (which measures the distance traveled by the COM over time), showed sensitivity to detect changes in sway amplitude during dual-task conditions.

Conclusion

The findings highlight the importance of considering both AP and ML sway in dual-task assessments. Furthermore, the choice of computation method, frequency cutoff, and mean referencing impacted the sensitivity to detect changes in walking sway during dual-tasking. These findings suggest that a 3.5Hz low-pass filter with mean referencing can enhance the sensitivity of dual-task assessments, which could be valuable for clinical balance evaluations or rehabilitation monitoring.

Reproducibility and convergent validity of the blazepod stepping reaction test in older people

INTRODUCTION

Proper balance control requires adaptive stepping, a strategy frequently used to maintain balance at the critical moment of slipping or tripping. Previous studies have confirmed that a slow-stepping reaction is prevalent in older people. Furthermore, those with a slow-stepping reaction are at a higher risk of falling.

AIM

Examine the convergent validity and intra-rater test-retest reproducibility of a novel instrumented stepping reaction test in older adults.

METHODS

The study was observational, encompassing a test-retest design. Main outcome measures included the novel instrumented Blazepod Stepping Reaction Test (BSRT), Mini-BESTest including subcategories (Anticipatory, Reactive Postural control, Sensory orientation, Dynamic gait), Timed Up and Go test (TUG), Choice Stepping Reaction Time test (CSRT), Fear of Falling (FoF), and Fall Status Questionnaire.

RESULTS

Fifty older people (33 women, 17 men), with a mean age of 72.2 (SD=4.2), were enrolled in the study. The mean BSRT test score of the study sample was 15.9 (SD=3.2). The intraclass correlation coefficient value for the intra-rater test-retest reproducibility of the BSRT test was 0.793 (95 %CI, 0.493, 0.912). The SEM and MDC values were 1.446 and 2.36, respectively. A moderate-strong correlation score was found between the BSRT and the TUG (r = -0.670). Moderate correlation scores were found between the BSRT and the Min-BESTest total score, anticipatory postural adjustment, and dynamic gait (r∼0.55). Moderate correlations were found between the BSRT, fear of falling (r = 0.40), the CSRT (r = -0.35), and balance sensory orientation (r = 0.37). No associations were found between the BSRT and reactive postural control.

CONCLUSIONS

The current study supports the convergent validity and test-retest reproducibility of the BSRT in older people.

Perception of Health and Its Predictors Among Saudis at Primary Healthcare Settings in Riyadh: Insights from a Cross-Sectional Survey

Background/Objectives: Despite a link between self-perception of health and morbidity and mortality, data are scarce on factors that can predict one's health perception, particularly in nations like Saudi Arabia. We conducted a needs assessment to evaluate health perception and identify sociodemographic, behavioural, and comorbidity-related factors influencing health perception among Saudi individuals. Methods: We conducted a cross-sectional survey utilizing an electronic questionnaire that was distributed to 14,239 people who visited primary healthcare centers in Riyadh, Saudi Arabia. We used multiple logistic regression to identify predictors of good health. Data was analyzed using SPSS software. Results: About one-third of the individuals (33.7%) perceived to have excellent health and 35.6% perceived to have very good health. Only 2.1% of the study participants perceived to have poor health. Compared to participants younger than 50 years, those aged 50-75 years were 10% less likely to perceive their health as good (AOR: 0.89, 95% CI: 0.82, 0.97). Males were 1.09 times more likely to perceive their health as good than females (AOR: 1.09, 95% CI: 1.01, 1.18). Smokers were 74% less likely than non-smokers to perceive their health as good (AOR: 0.26; 95% CI: 0.24, 0.29). Obese individuals were 20% less likely to perceive their health in good condition than non-obese individuals (AOR: 0.80; 95% CI: 0.65, 0.98) Individuals with heart disease were about 50% less likely to perceive their health as good condition than those without heart disease (AOR: 0.52; 95% CI: 0.40, 0.76). Conclusions: Despite the high frequency of risk factors, we discovered that Saudis perceive their health to be good on average. However, an independent association between older age, females, smoking, obesity, and heart disease with poor health calls for future epidemiological studies incorporating qualitative dimensions to explore why these individuals with specific risk profiles perceive their health as worse than others.

Path model explaining the association between fear of falling and health-related quality of life in (pre-)frail older adults

BACKGROUND

Fear of falling (FoF) is estimated to be prevalent in over 50% of older adults and several studies suggest that it negatively affects health-related quality of life (HrQoL). Unlike previous studies that examined only few mediating variables, this study aimed to develop a more comprehensive path model explaining the association between FoF and HrQoL.

METHODS

A theoretical path model was developed based on existing evidence and expert feedback and fitted to cross-sectional baseline data on 385 community-dwelling (pre-)frail older adults from the PromeTheus randomized controlled trial using robust weighted least squares estimation. FoF and HrQoL were operationalized by the Short Falls Efficacy Scale International and EQ-5D Index, respectively. The model included potential explanatory pathways through physical activity (German Physical Activity Questionnaire for middle-aged and older adults), physical capacity (Short Physical Performance Battery), physical performance (Late-Life Function and Disability Instrument [LLFDI] function component), disability (LLFDI disability component - short form), and affect (visual analogue scales on 'happiness', 'sadness', 'calmness' and 'tension'). Age, sex, education, and previous falls were considered as covariates.

RESULTS

The model demonstrated good fit to the data and the remaining direct effect of FoF on HrQoL was small (β=-0.05). Physical capacity and physical performance were the most important mediators (combined indirect effect of β=-0.17, accounting for > 50% of the total effect). Pathways of minor individual relevance (e.g. through disability or affect) contributed considerably to the total indirect effect when combined. Controlling for sociodemographic data and previous falls only had minor effects on model fit and path coefficients.

CONCLUSION

Physical capacity and physical performance are particularly important levers for reducing the impact of FoF on HrQoL through interventions. However, the other pathways also had a considerable influence when taken together. Hence, research on the association of FoF and HrQol should acknowledge the complexity of causal pathways that may explain this association and not neglect minor pathways. The proposed model should be tested on an alternative sample, using longitudinal data, and extended to include additional explanatory factors (e.g. activity avoidance).

TRIAL REGISTRATION

German Clinical Trials Register, ID: DRKS00024638, https://drks.de/search/en/trial/DRKS00024638 , date of registration: March 11th 2021.

Context makes a difference: a qualitative study exploring how to implement a multifactorial falls prevention intervention in the community

BACKGROUND

Falls are a major problem in community-dwelling older people. Multifactorial falls prevention interventions are recommended as intervention. However, poor implementation impacts successful outcomes of multifactorial falls prevention interventions. The context is critical to understand variation in implementation and clinical outcomes. This study aims to analyze and describe determinants at all levels of the context that influence the implementation of a multifactorial falls prevention intervention in the community in Flanders (Belgium).

METHODS

This study consists of semi-structured interviews with 6 key persons, 3 focus group interviews with healthcare professionals (n = 16), 1 focus group with local policy makers (n = 6) and 4 semi-structured interviews and 1 focus group (n = 3) with older people. The Integrated Checklist of Determinants of Practice (TICD checklist) was used to develop the interview guide and to make sure that there was enough understanding of the contextual determinants at the different domains. The interviews and focus groups were verbatim transcribed and analyzed using the Qualitative Analysis Guide of Leuven (QUAGOL). To clarify themes, data were coded in NVivo 12™.

RESULTS

We identified 4 key themes related to successful implementation of a multifactorial falls prevention intervention in the community setting: (1) stakeholder involvement and participation, (2) Fostering awareness, beliefs, knowledge, and skills for falls prevention, (3) working proactively and (4) communication, collaboration, coordination and financing care. This study identified 33 determinants of the TICD checklist and all 7 domains were represented.

CONCLUSIONS

Understanding the existing structures, norms, policies and contextual factors allows us to proactively tailor the implementation strategies and a multifactorial falls prevention intervention to the community context.

Discriminative ability of instrumented cognitive-motor assessments to distinguish fallers from non-fallers

In older populations, sensitive fall risk assessment tools are important to timely intervene and prevent falls. Instrumented assessments have shown to be superior to standardized fall risk assessments such as the Timed Up and Go Test (TUG) and should capture both motor and cognitive functions. Therefore, the aim was to test novel instrumented assessments with and without a cognitive component. One hundred thirty-seven older adults aged 73.1 ± 7.3 years, 38 categorized as fallers and 99 as non-fallers, conducted five instrumented assessments on the Dividat Senso, a pressure sensitive stepping platform, and three standardized geriatric assessments (TUG, TUG-dual task, 30-s Sit-to-Stand Test (STS)). T-tests were applied to compare the test performance of fallers versus non-fallers. Furthermore, logistic regression analyses and area under the curve (AUC) analyses were performed. Statistically significant differences between fallers and non-fallers were found in the Go/No-Go test (p = .001, d = .72), the TUG (p = .014, d = .48), and the STS (p = .008, d = .51). Only the Go/No-Go test contributed significantly to all regression models. Significant AUC values were found for the Reaction Time Test (RTT) (AUC = .628, p = .023), Go/No-Go (AUC = .673, p = .002), TUG (AUC = .642, p = .012), and STS (AUC = .690, p = .001). The Go/No-Go test measuring inhibition showed the best discriminative ability suggesting added value of instrumented assessments with a cognitive component for clinical fall risk assessment in relatively healthy older adults. The study should be extended with a frailer population, in which TUG and the other instrumented assessments are possibly good predictors as well.

Exploring how falls prevention practitioners assess and manage concerns about falling

BACKGROUND

Concerns about falling (CaF) are common in older adults. They can lead to various negative outcomes, including an increased risk for future falls. The Worlds Falls Guidelines recently published recommendations for assessing and treating CaF. However, the extent to which these guidelines have been adopted into falls prevention practice (in addition to the barriers preventing implementation) are currently unknown.

METHODS

A cross-sectional survey was completed by 114 healthcare professionals working in falls prevention and rehabilitation services in the UK and Ireland. The survey explored their experiences and perceptions regarding the management and assessment of CaF.

RESULTS

Only 39% of respondents reported using the Falls Efficacy Scale-International (FES-I), a tool recommended by the World Falls Guidelines for assessing CaF. Healthcare professionals in hospital settings were significantly less likely to use the FES-I compared to those working in the community (X2 = 6.324, p = 0.043). While there was no significant difference between settings regarding the type of intervention used to manage CaF, only about 50% of participants adopted a holistic approach combining physical and psychological strategies as recommended by the World Falls Guidelines. The most commonly identified barriers to clinical management of CaF were a lack of both time and perceived effective interventions, particularly for those working within hospital settings (X2 = 6.209, p = 0.013 and X2 = 3.752, p = 0.053, respectively).

CONCLUSION

These findings indicate low levels of adoption of the World Falls Guidelines recommendations for assessing and managing CaF, especially in hospital settings. Future work should focus on addressing these barriers to maximise the clinical adoption of these recommendations.

Multidisciplinary care pathways for falls prevention in older adults: visualizing the needs of primary care-based health care professionals

PURPOSE

Multidisciplinary care pathways for falls prevention, which include falls risk stratification, multifactorial falls risk assessment, and management of multidomain interventions, can reduce falls in older adults. However, efficient multidisciplinary falls prevention care is challenging due to issues such as poor communication and role allocation. This study aimed to identify and visualize the multidisciplinary care needs of primary care-based health care professionals (HCPs) for falls prevention in the Netherlands using the novel co-design approach of journey mapping.

METHODS

Online focus groups and interviews (N = 45) were conducted with physical therapists (n = 15), district nurses (n = 9), occupational therapists (n = 7), pharmacists (n = 6), nurse practitioners (n = 5), podiatrists (n = 2), and one general practitioner. HCPs were asked about their interactions, experiences, needs, and barriers with regards to multidisciplinary falls prevention care in a primary care context. Insights were used to visualize a journey map depicting the desired future state of multidisciplinary care pathways for falls prevention.

RESULTS

Journey mapping identified the following needs for effective multidisciplinary falls prevention care: a dedicated case manager after risk stratification, preparatory patient information before the assessment, small multidisciplinary care team for the assessment, patient involvement during intervention management, good communication between HCPs, and a reduction in workload for HCPs.

CONCLUSION

The inclusion of a case manager program for older adults and access to resources to facilitate good communication between HCPs are important to optimize the configuration of multidisciplinary care pathways for falls prevention in actual practice.

Skin tactile perception is associated with longitudinal gait performance in middle-aged and older Japanese community dwellers

BACKGROUND

Skin tactile perception may indicate frailty in older adults. Although gait performance is crucial for diagnosing frailty, its association with skin tactile perception has not yet been explored.

OBJECTIVES

To examine the association between skin tactile perception and changes in step length, cadence, and gait speed in middle-aged and older adults.

DESIGN

A longitudinal study (mean follow-up: 10.8 years) SETTING: Community-based survey PARTICIPANTS: A total of 1,403 middle-aged and older adults (aged 40-79 years, 53.6 % men) from the National Institute for Longevity Sciences-Longitudinal Study of Aging were included in this study. These participants completed the baseline survey (1997-2000) and at least two follow-up surveys (2000-2012), had no history of cerebrovascular disease, rheumatoid arthritis, or Parkinson's disease, and had complete data with no outliers in skin tactile perception measurements.

MEASUREMENTS

Skin tactile perception was assessed using a two-point discrimination test. Step length (cm), cadence (steps/min), and gait speed (m/min) were evaluated on an 11-m walkway at a usual speed.

RESULTS

The mean age of participants was 56.4 years. After full adjustment, mixed-effects models with splines revealed that the association between skin tactile perception and gait parameters varied with age. In adults aged 60 and above, we observed non-linear relationships between skin tactile perception and gait parameters. A consistent inflection point around 10 mm in tactile perception was identified across different age groups and gait parameters.

CONCLUSIONS

Among community-dwelling middle-aged and older Japanese adults, skin tactile perception was associated with changes in gait parameters, particularly in those aged 60 and above. The 10-mm threshold in tactile perception may serve as a critical indicator for predicting changes in gait performance. Skin tactile perception tests may prove clinically useful for screening patients at elevated risk of impaired gait performance.

Relationship between cardiorespiratory fitness and falls in older adults: A population-based study

AIM

The present study investigated the relationship between cardiorespiratory fitness (CRF) and episodes and severity of falls in older adults.

METHODS

This cross-sectional study drew on data from the Brazilian 2019 National Health Survey. The sample consisted of 18 991 older adults (aged ≥60 years). CRF was obtained through a non-exercise model for estimating VO2max, and the people were classified as low, moderate or high CRF. Logistic and multinomial regression models were used. Odds ratios (ORs) and their respective confidence intervals (95% CIs) were calculated.

RESULTS

Older adults with strong CRF are 29% (OR 0.69, 95% CI 0.52-0.92) less likely to suffer falls than those with poor CRF. High levels of CRF were also associated with non-severe falls. However, no associations were found between CRF and severe falls with fractures and medical intervention.

CONCLUSION

Although good CRF levels can reduce the chance of falls, this protection does not extend to falls with more severe consequences, such as fractures and the need to seek medical care. Geriatr Gerontol Int 2025; 25: 167-172.

Adverse childhood experiences, sleep quality/duration and later-life lower extremity function among older adults in China: evidence from CHARLS

OBJECTIVE

This study aimed to explore the relationship between adverse childhood experiences (ACEs), sleep, and lower extremity function in older adults using a nationally representative cohort.

METHODS

This study included 4,439 participants aged 60 years or older (mean age: 67.2 ± 5.7 years) from the China Health and Retirement Longitudinal Study (CHARLS) 2015 national survey and the 2014 Life History Survey. ACEs, sleep duration, and sleep quality were assessed through self-report, and lower extremity function was measured using the Short physical performance battery (SPPB). The relationships between ACEs, sleep, and lower extremity function were analyzed using multivariate linear regression model and restricted cubic splines.

RESULTS

After adjusting for covariates, older adults with four or more ACEs exhibited worse lower extremity function compared to those with no ACEs (β: -0.175). 6-8 h of sleep was associated with improved lower extremity function (β: 0.119), while good sleep quality was also associated with higher lower extremity function scores (β: 0.177). Age-related differences revealed that the association between four or more ACEs and reduced lower extremity function (β: -0.431) was significant only in individuals aged 70 years and older. In the 60-69 years age group, the sleep duration of 6-8 h was significantly related to better lower extremity function (β: 0.150), however, in those aged 70 years and older, more than 8 h of sleep was associated with poorer function (β: -0.378). Furthermore, good sleep quality was associated with better lower extremity function in individuals aged 70 years and older (β: 0.246).

CONCLUSION

ACEs, particularly household mental illness and parental disability, are associated with poorer lower extremity function in older adults. Normal sleep duration and good sleep quality are linked to better lower extremity function and may mitigate the negative effects of ACEs. However, these associations vary by age.

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

BACKGROUND

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

METHODS

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

FINDINGS

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

INTERPRETATION

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

FUNDING

National Research Foundation of Korea.

Clinical characteristics and influencing factors of serious fall injuries among older inpatients: A secondary analysis of multicenter cross-sectional administrative data

BACKGROUND

Inpatient falls are common adverse events in hospitals, particularly among older adults. However, current research on falls in the older population is limited by small sample sizes and reliance on single-center designs without distinguishing the different levels of fall injuries.

OBJECTIVE

To examine the circumstances of falls in older inpatients and investigate the factors influencing serious fall injuries.

DESIGN

A secondary analysis of multicenter cross-sectional administrative data from the China National Database of Nursing Quality (CNDNQ).

SETTING(S)

67 hospitals in Hunan, China.

PARTICIPANTS

5143 fall incidents from 5048 older inpatients were included from January 2019 to December 2022.

METHODS

Descriptive statistics (means, standard deviations, frequencies, and percentages) were used to describe fall characteristics. Given the multilevel data structure, a Generalized Linear Mixed Model (GLMM) with a Logistic link function was employed, treating hospitals and wards as random effects. Univariate and multivariate analyses were conducted.

RESULTS

The prevalences of fall-related injuries and serious fall injuries in this study were 63.3 % and 25.0 %, respectively. Nurse-to-patient ratio at the time of fall ≤0.05 (aOR = 1.522, 95 % CI: 1.297-1.785), female gender (aOR = 1.304, 95 % CI: 1.137-1.497), a lengthy hospital stay (aOR = 1.009, 95 % CI: 1.001-1.018) were associated with an increased risk of serious fall injuries. Surgical (aOR = 0.655, 95 % CI: 0.482-0.889) and orthopedic wards (aOR = 0.649, 95 % CI: 0.449-0.939) exhibited lower risks of serious fall injuries than internal medicine wards. The period from 8:00 to 15:59 was associated with a higher risk of serious fall injuries compared to the period from 0:00 to 7:59 (aOR = 1.416, 95 % CI: 1.171-1.713). Compared to lying, standing (aOR = 2.594, 95 % CI: 1.733-3.883), getting in/out of bed (aOR = 1.403, 95 % CI: 1.009-1.951), walking or rehabilitating (aOR = 3.039, 95 % CI: 2.194-4.208), toileting (aOR = 1.411, 95 % CI: 1.038-1.917), and showering (aOR = 2.170, 95 % CI: 1.391-3.385) were associated with an increased risk of serious fall injuries.

CONCLUSIONS

Fall-related injuries and serious fall injuries are highly prevalent among older inpatients. The study provides insights for targeted fall prevention strategies, improving nursing management and patient safety.

REGISTRATION

Not registered.

Validation of a clinical prediction model for falls in community-dwelling older adults with COPD: A preliminary analysis

BACKGROUND

People with chronic obstructive pulmonary disease (COPD) are at a higher risk of falls. This preliminary study aims to externally validate a previously developed clinical prediction model for falls in community-dwelling older adults with COPD.

METHODS

This was a secondary analysis of a 12-month prospective cohort study. Older adults (≥60 years) with COPD, who reported a fall in the past year and/or had balance concerns, were tracked for 12-month future falls. Baseline predictors included 12-month history of ≥2 falls, total chronic conditions, and Timed Up and Go Dual-Task (TUG-DT) test scores. Model performance was assessed for discrimination (c-statistic), calibration (E:O, CITL, and calibration slope), and clinical value (decision curve analysis).

RESULTS

The study included 89 participants (average age 73 ± 9 years; 83 females; FEV1%predicted = 47%). Of these, 35 (39%) reported ≥1 future fall, totaling 89 falls. The model demonstrated acceptable discrimination (c-statistic = 0.62, CI [0.51,0.72]), and calibration (E:O = 1, CITL = 0, and a calibration slope = 1). Decision curve analysis showed greater clinical value when using the prediction model compared to screening for fall history alone.

CONCLUSIONS

A 12-month history of ≥2 falls, higher total chronic conditions, and worse TUG-DT test scores, predicts falls in community-dwelling older adults with COPD. Larger studies are needed before clinical application.

Fall Detection Method Based on a Human Electrostatic Field and VMD-ECANet Architecture

Falls are one of the most serious health risks faced by older adults worldwide, and they can have a significant impact on their physical and mental well-being as well as their quality of life. Detecting falls promptly and accurately and providing assistance can effectively reduce the harm caused by falls to older adults. This paper proposed a noncontact fall detection method based on the human electrostatic field and a VMD-ECANet framework. An electrostatic measurement system was used to measure the electrostatic signals of four types of falling postures and five types of daily actions. The signals were randomly divided in proportion and by individuals to construct a training set and test set. A fall detection model based on the VMD-ECA network was proposed that decomposes electrostatic signals into modal component signals using the variational mode decomposition (VMD) technique. These signals were then fed into a multichannel convolutional neural network for feature extraction. Information fusion was achieved through the efficient channel attention network (ECANet) module. Finally, the extracted features were input into a classifier to obtain the output results. The constructed model achieved an accuracy of 96.44%. The proposed fall detection solution has several advantages, including being noncontact, cost-effective, and privacy friendly. It is suitable for detecting indoor falls by older individuals living alone and helps to reduce the harm caused by falls.

Depth Perception and Intraocular Differences in Visual Acuities Among Older Spectacle Wearers

Background

Falls impose a heavy financial burden on society, and the incidence is age-related. The correction of refractive errors has been mooted as a valuable procedure to prevent falls. However, depth perception, estimated by stereo acuity tests, is reduced in the older population and has been cited as contributing to the higher incidence of falls in the elderly.

Objective

To explore the clinical relationship between age, interocular differences in the corrected distance and near logMAR visual acuities, refractive errors, axial (eyeball) lengths, pupil sizes, and higher-order ocular aberrations (HOAs) on clinical measures of stereoacuity and aniseikonia in asymptomatic presbyopic habitual spectacle wearers.

Methods

Total amount of 91 subjects underwent clinical assessment of i) subjective refractive error, ii) stereoacuity at 6m and 40cm (Randot Stereotests), iii) aniseikonia at 6m (Awaya test along vertical and horizontal meridian) iv) higher order aberrations (Hartman-Shack aberrometer) v) eyeball length and pupil size (IOL master 700). The Pythagorean theorem was applied to each pair of aniseikonia values to calculate the resultant aniseikonia (AR).

Results

Mean (±sd,95%CI) age of the subjects was 56.2years (±8.10,54.6-57.9). Root mean square (RMS) interocular differences (±sd,95%CI) in spherical refractive errors, axial lengths and pupil sizes were 0.66D(±0.93,0.47-0.85), 0.24mm (±0.33,0.17-0.31), 0.15mm (±0.11,0.12-0.17). The median (mode, interquartile range) values for AR were 2.8(1.0,1.3-4.0). Significant correlations (p<.01) were revealed between: a) log distance stereoacuity (y1), age (x1) and RMS difference in the corrected distance logMAR visual acuity (x2). b) log near stereoacuity (y2), RMS differences in the corrected distance (x2) and near visual acuities (x3). These key associations are best described by: y1=0.011x1+1.101x2+1.553 (r² =0.169, n=91); y2=1.715x2+1.883x3+1.725 (r² = 0.239, n=91).

Conclusion

Stereoacuity is age-related, influenced by interocular differences in the corrected visual acuities but not related to interocular differences in pupil sizes, HOAs or clinical measures of aniseikonia in older habitual spectacle wearers. Assessment of stereoacuity and aniseikonia, in older persons is useful when advising to prevent accidental mis-location and falls.