Soft tissue injury resulting from falling predicts a future major falling injury in the home dwelling elderly

Effects of WiiActive exercises on fear of falling and functional outcomes in community-dwelling older adults: a randomised control trial

BACKGROUND

the study compares the effects of a Nintendo Wii exercise programme and a standard Gym-based exercise intervention on fear of falling, knee strength, physical function and falls rate in older adults.

METHODS

eighty community-dwelling adults aged 60 years and above with short physical performance battery score of 5-9 points and modified falls efficacy scale (MFES) score of ≤9 points participated in the parallel-group randomised trial. Each intervention arm involved an hour of intervention per week, totalling 12 sessions over 12 weeks. Besides 1-year fall incidence, the participants were evaluated on MFES, knee extensor strength (KES), timed-up-and-go test, gait speed, 6-minute walk test and narrow corridor walk test at weeks 13 and 24.

RESULTS

at week 13, between interventions, the effect of MFES changes did not reach statistical significance (difference = -0.07 point, 95% CI -0.56 to 0.42, P = 0.78); at week 24, the Wii group showed statistically significant effects over the Gym group (difference = 0.8 point, 95% CI 0.27 to 1.29, P < 0.01). For KES, the two groups did not differ statistically at week 13 (difference = -2.0%, 95% CI -5.6 to -1.7, P = 0.29); at week 24, the Gym group had greater strength gains than the Wii group (difference = -5.1%, 95% CI -8.7 to -1.5, P < 0.01). No between-group differences were observed for other outcome measures.

CONCLUSION

on completion of a 12-week Nintendo Wii exercise programme, there was no significant benefit seen on fear of falling when compared to a standard Gym-based exercise intervention; however, post-intervention there was an apparent reduction in fear of falling in the group allocated to Wii training, despite knee strength apparently improving more in those allocated to the Gym. It is possible that long-term gains after using the Wii might be due to a carry-over effect.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, ACTRN12610000576022.

Novel use of the Wii Balance Board to prospectively predict falls in community-dwelling older adults

BACKGROUND

The Wii Balance Board has received increasing attention as a balance measurement tool; however its ability to prospectively predict falls is unknown. This exploratory study investigated the use of the Wii Balance Board and other clinical-based measures for prospectively predicting falls among community-dwelling older adults.

METHODS

Seventy-three community-dwelling men and women, aged 60-85years were followed-up over a year for falls. Standing balance was indexed by sway velocities measured using the Wii Balance Board interfaced with a laptop. Clinical-based measures included Short Physical Performance Battery, gait speed and Timed-Up-and-Go test. Multivariable regression analyses were used to assess the ability of the Wii Balance Board measure to complement the TUG test in fall screening.

FINDINGS

Individually, the study found Wii Balance Board anteroposterior (odds ratio 1.98, 95% CI 1.16 to 3.40, P=0.01) and mediolateral (odds ratio 2.80, 95% CI 1.10 to 7.13, p=0.03) sway velocity measures predictive of prospective falls. However, when each velocity measure was adjusted with body mass index and Timed-Up-and-Go, only anteroposterior sway velocity was predictive of prospective falls (odds ratio 2.21, 95% CI 1.18 to 4.14). A faster anteroposterior velocity was associated with increased odds of falling. Area-under-the-curves for Wii Balance Board sway velocities were 0.67 and 0.71 for anteroposterior and mediolateral respectively.

INTERPRETATION

The Wii Balance Board-derived anteroposterior sway velocity measure could complement existing clinical-based measures in predicting future falls among community-dwelling older adults.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry number: ACTRN12610001099011.

Effects of fall injury type and discharge placement on mortality, hospitalization, falls, and ADL changes among older people in Taiwan

A longitudinal study was conducted to investigate the effects of injury type and discharge placement on mortality, falls, hospital admissions, and changes in activities of daily living (ADLs) over a 12-month period among older fallers. Of 762 community-dwelling people aged 65 years or older who visited an emergency department (ED) of a general hospital in Taiwan due to a fall, 273 sustained a hip fracture, 157 had a vertebral fracture, 47 had a distal forearm fracture, 102 had a traumatic brain injury, and 183 had soft-tissue injuries. Results showed that, compared to patients with a soft-tissue injury, those with TBI had significantly higher risks of dying (rate ratio (RR)=3.59) and hospital admissions (RR=3.23) and better improvement in ADLs (1.93 points) at 6 months post-injury, and those who sustained a hip fracture (4.26 and 4.41 points), a vertebral fracture (3.81 and 3.83 points), or a distal-forearm fracture (2.80 and 2.80 points) had significantly better improvement in ADLs at 6 and 12 months post-injury. Patients discharged to a nursing home had a significantly increased risk of death (RR=2.08) and hospital admission (RR=2.05) than those returning to their usual residence during the first year post-injury. No significant differences in the occurrence of falls during the first post-injury year were found among patients with different injury types or between those with different discharge placements. In conclusion, among the five major fall injury types in older people, TBIs result in the highest risk of death and hospital admissions, while hip and vertebral fractures exhibited the largest improvement during the first year after injury. Additionally, nursing home care may be associated with increased risks of death and hospital admissions than home care. In addition to primary prevention of falls, further research to investigate mechanisms leading to TBIs during a fall is needed to facilitate effective secondary fall-prevention programs for older people.

Evaluation of the Frails' Fall Efficacy by Comparing Treatments (EFFECT) on reducing fall and fear of fall in moderately frail older adults: study protocol for a randomised control trial

BACKGROUND

Falls are common in frail older adults and often result in injuries and hospitalisation. The Nintendo® Wii™ is an easily available exercise modality in the community which has been shown to improve lower limb strength and balance. However, not much is known on the effectiveness of the Nintendo® Wii™ to improve fall efficacy and reduce falls in a moderately frail older adult. Fall efficacy is the measure of fear of falling in performing various daily activities. Fear contributes to avoidance of activities and functional decline.

METHODS

This randomised active-control trial is a comparison between the Nintendo WiiActive programme against standard gym-based rehabilitation of the older population. Eighty subjects aged above 60, fallers and non-fallers, will be recruited from the hospital outpatient clinic. The primary outcome measure is the Modified Falls Efficacy Scale and the secondary outcome measures are self-reported falls, quadriceps strength, walking agility, dynamic balance and quality of life assessments.

DISCUSSIONS

The study is the first randomised control trial using the Nintendo Wii as a rehabilitation modality investigating a change in fall efficacy and self-reported falls. Longitudinally, the study will investigate if the interventions can successfully reduce falls and analyse the cost-effectiveness of the programme.

Genetic Factors and Susceptibility to Falls in Older Women

OBJECTIVES

To determine whether genetic influences account for individual differences in susceptibility to falls in older women.

DESIGN

Prospective twin cohort study.

SETTING

Research laboratory and residential environment.

PARTICIPANTS

Ninety-nine monozygotic (MZ) and 114 dizygotic (DZ) female twin pairs aged 63 to 76 from the Finnish Twin Cohort study.

MEASUREMENTS

The participants recorded their falls on a calendar for an average+/-standard deviation of 344+/-41 days. Reported falls were verified via telephone interview, and circumstances, causes, and consequences of the fall were asked about.

RESULTS

The total number of falls was 434, of which 188 were injurious; 91 participants had two or more falls. Casewise concordance was 0.61 (95% confidence interval (CI)=0.49-0.72) for MZ twins and 0.49 (95% CI=0.37-0.62) for DZ twins for at least one fall, 0.38 (95% CI=0.23-0.53) for MZ and 0.33 (95% CI=0.17-0.50) for DZ twins for at least one injurious fall, and 0.43 (95% CI=0.26-0.60) for MZ and 0.36 (95% CI=0.17-0.55) for DZ twins for recurrent falls. On average, the proportion of familial influences accounting for the individual differences in susceptibility to at least one fall was 30% and to recurrent falls was 40%; nongenetic familial and nonfamilial factors alone accounted for susceptibility to at least one injurious fall.

CONCLUSION

In community-dwelling older women, familial factors underlie the risk of falling but not the risk of injurious falls.

Muscle Weakness and Falls in Older Adults: A Systematic Review and Meta-Analysis

OBJECTIVES

To evaluate and summarize the evidence of muscle weakness as a risk factor for falls in older adults.

DESIGN

Random-effects meta-analysis.

SETTING

English-language studies indexed in MEDLINE and CINAHL (1985-2002) under the key words aged and accidental falls and risk factors; bibliographies of retrieved papers.

PARTICIPANTS

Fifty percent or more subjects in a study were aged 65 and older. Studies of institutionalized and community-dwelling subjects were included.

MEASUREMENTS

Prospective cohort studies that included measurement of muscle strength at inception (in isolation or with other factors) with follow-up for occurrence of falls.

METHODS

Sample size, population, setting, measure of muscle strength, and length of follow-up, raw data if no risk estimate, odds ratios (ORs), rate ratios, or incidence density ratios. Each study was assessed using the validity criteria: adjustment for confounders, objective definition of fall outcome, reliable method of measuring muscle strength, and blinded outcome measurement.

RESULTS

Thirty studies met the selection criteria; data were available from 13. For lower extremity weakness, the combined OR was 1.76 (95% confidence interval (CI)=1.31-2.37) for any fall and 3.06 (95% CI=1.86-5.04) for recurrent falls. For upper extremity weakness the combined OR was 1.53 (95% CI=1.01-2.32) for any fall and 1.41 (95% CI=1.25-1.59) for recurrent falls.

CONCLUSION

Muscle strength (especially lower extremity) should be one of the factors that is assessed and treated in older adults at risk for falls. More clinical trials are needed to isolate whether muscle-strengthening exercises are effective in preventing falls.