Falls and Fall-Related Injuries among Community-Dwelling Adults in the United States

Dual task reactive balance control in older adults with mild cognitive impairment: does the cognitive task domain make a difference?

Older adults with mild cognitive impairment (OAwMCI) demonstrate higher cognitive-motor interference (CMI) than cognitively intact older adults (CIOA) during dual tasking. However, studies have rarely examined how dual tasking affects reactive balance control in OAwMCI, or the effect of different cognitive task domains. This study compared how four cognitive tasks affected CMI during reactive balance control in OAwMCI vs. CIOA. In this study, 38 OAwMCI [Montreal Cognitive Assessment (MoCA): 18-25] and 38 CIOA (MoCA ≥ 26) were included and exposed to anterior support surface perturbations in single task and while performing four cognitive tasks: two visuomotor tasks (Target, Track), auditory clock test (ACT), and letter number sequencing (LNS). Cognitive tasks were also completed during unperturbed standing. In both single and dual task conditions, OAwMCI had a higher fall rate and lower reactive center of mass (COM) stability than CIOA. Reactive balance performance deteriorated in both groups while performing Target and Track, although was not affected by ACT or LNS. Cognitive performance was lower in dual vs. single task on the Target, Track, and LNS for both groups, although OAwMCI had higher cognitive costs than CIOA. These findings suggest that dual tasking could increase fall risk in both OAwMCI and CIOA, although visuomotor tasks induced greater CMI than executive function/working memory tasks, suggesting greater sharing of resources with reactive balance control. Furthermore, OAwMCI could experience higher CMI due to damage in sensorimotor areas involved in triggering/executing reactive balance responses, along with multidomain cognitive decline. Comprehensive dual task assessments could identify domain-specific cognitive decline in OAwMCI.NEW & NOTEWORTHY Although OAwMCI have higher CMI than CIOA during volitional balance tasks, it is unclear how dual tasking involving different cognitive domains affects reactive balance control in OAwMCI. This study showed that dual tasking could impair reactive balance responses in both CIOA and OAwMCI, although OAwMCI experienced greater performance deteriorations in dual vs. single task conditions. Furthermore, visuomotor tasks induced higher CMI than executive function/working memory tasks, suggesting greater sharing of resources with reactive balance control.

Global burden of occupational injury-related transport and unintentional injuries in 204 countries: trends from 1990 to 2021 with a 15-year forecast

OBJECTIVES

This study aimed to estimate the burden of transport and unintentional injuries attributable to occupational injury from 1990 to 2021 and provided a 15-year forecast.

METHODS

Age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years (DALYs) rate (ASDR) attributable to occupational injury were analyzed using the estimated annual percentage change (EAPC) for transport and unintentional injuries from 1990 to 2021. Future injury forecasts were derived using Bayesian age-period-cohort (BAPC) model.

RESULTS

Between 1990 and 2021, ASMR and ASDR from occupational injury-related transport and unintentional injuries declined in most countries. The Republic of Korea saw the largest reductions, with EAPC for transport injuries at -12.40 (ASMR); and -12.01(ASDR), and for unintentional injuries at -10.65; -8.81, respectively. Males consistently had higher mortality and DALYs rates compared to females. Projections indicate that the mortality and DALYs rates will continue to decrease until 2036, suggesting improvements in occupational injury prevention.

CONCLUSIONS

This study found that ASMR and ASDR of occupational injury decreased. The prediction results show that the burden of occupational injury is still heavy and is a major public health problem, which highlights the need for regions to develop measures to reduce the burden of occupational injury.

Evaluation of different fall risk screening tools for risk prediction of ophthalmology inpatients

AIMS AND OBJECTIVES

To evaluate the risk factors for falls in adult ophthalmic inpatients and compare the accuracy and predictability of fall risk screening tools.

METHODS

A prospective cross-sectional study was conducted on a total of 1102 hospitalised patients in ophthalmology ward. Fall risk screening was performed within 8 h of admission using the following tools: Falling Risk Assessment Tool in Ophthalmology Inpatients (FRAT), Morse Fall Scale (MFS), Johns Hopkins fall-risk Assessment Tool (JHFRAT), St Thomas Risk Assessment Tool (STRATIFY), and Hendrich II fall-risk Model (HFRM). Taking the occurrence of falls or the occurrence of falls as a positive standard. The sensitivity, specificity, positive predictive value, negative predictive value and area under the curve of the risk assessment tool were calculated to determine accuracy and predictability.

RESULTS

In this study, 1102 met the inclusion criteria. The mean age was 56.81(58.00) and 536(48.6) were females. 61(5.54%) experienced falling or falling status. STRATIFY had the highest sensitivity(85.2%), followed by FRAT(70.5%). The specificity of MFS was the highest(91.7%), followed by FRAT(69.5%). However, in clinical practice, risk assessment tools are difficult to have high sensitivity and high specificity, so they are more inclined to high-sensitivity assessment tools to avoid missing high-risk groups. According to the evaluation results, FRAT has both good sensitivity and specificity. Furthermore, we identified significant risk factors for falls in ophthalmic patients, such as fall history, visual acuity, age, excretion and gait.

CONCLUSIONS

FRAT was the most suitable fall assessment tool and was essential for reliable screening of people at high risk of ophthalmic falls.

PATIENT OR PUBLIC CONTRIBUTION

After explaining the purpose, the patients received our fall risk assessment and answered the corresponding questionnaire questions.

The effects of perturbation intensities on backward slip-falls induced by a split-belt treadmill

Fall-inducing systems have two critical applications. One is to obtain the biomechanical features of falling, and the other is to systematically train individuals and reduce the risk of falling. While the former application necessitates the occurrence of falls, the latter does not require fall-inducing perturbations to be excessively intense. The purposes of the study were to investigate the effects of perturbation intensities (a combination of speeds and durations) on the number of falls, fall rates, and maximum loading forces resulting from slips induced by a split-belt treadmill. Twenty-four young adults (12 males and 12 females) completed 16 randomized trials (12 perturbation trials and 4 false trials). The forces between a safety harness and a rail were used to identify falls and non-falls and to assess the maximum loading force during falls. Although the number of falls, fall rates, and maximum loading force significantly increase as the slipping speed increases for both durations, the relative risk analysis shows that fall risk significantly increases as the slipping speed increases regardless of the duration. These findings may contribute to developing design criteria for controlled perturbations using a split-belt treadmill, aimed at enhancing our understanding of fall biomechanics and informing fall prevention training programs.

Obstacle contrast modulates gait behavior in younger and older adults

PURPOSE

This study investigated how obstacle contrast altered gait behavior of healthy younger and older adults.

METHODS

Twenty normally sighted adults, 11 older (mean [standard deviation] age, 68.1 [5.1] years) and 9 younger (mean [standard deviation] age, 21.1 [2.1] years), walked along a 6-m, black carpeted walkway and stepped over a single obstacle positioned 4 m from the start. The obstacle varied in height (0 [no obstacle], 1, and 19 cm) and contrast (6% ["low"] and 90% ["high"] Michelson contrast). Each subject completed 10 trials for each of the 5 conditions in an unblocked, random order. Lower limb kinematics were recorded using 13 motion capture cameras. Visual acuity and contrast sensitivity were measured. A repeated-measures analysis of variance was used to assess age group differences in trail toe position before crossing, lead and trail foot clearance over the obstacle, lead heel position after crossing, and obstacle crossing speed. Planned comparisons were done with Bonferroni correction. Independent t tests were used to compare vision and survey variables between groups.

RESULTS

Visual acuity was similar in both groups (p=0.17), although contrast sensitivity was better in the younger than older adults (p=0.001). Main effects were found for age: compared with younger adults, older adults showed a farther back trail foot position, greater trail foot clearance, closer lead heel position, and slower obstacle crossing speed (p<0.001 for all effects). Main effects were found for obstacle contrast: compared with low-contrast obstacles, for high-contrast obstacles, the trail foot position was farther back, both lead and trail foot clearance were greater, and lead heel position was closer (p<0.024 for all effects).

CONCLUSIONS

Obstacle contrast impacts gait behavior for younger and older adults. It is possible that the visual characteristics of an obstacle are enhanced for high-contrast obstacles, causing changes to gait behavior that may increase safety.

Empowering Fall Prevention Through Integrated Lifestyle Medicine Strategies-From Recognition of Fall Risks to Implementation of Prevention of Falls for all in Practice

Falls remain the leading cause of unintentional injuries across all age groups, prompting many emergency room visits. The annual estimated cost associated with falls is believed to exceed 100 billion dollars. In addressing this trend, health professional team members emerge as key players and can assume a crucial role in bridging the gap between lifestyle medicine and fall prevention. By imparting strategies aligned with the 6 pillars of lifestyle medicine, these professionals can educate individuals on risk factors, assess fall risk, and offer activities to mitigate the likelihood of future falls. This collaborative approach empowers all to take immediate and informed action, fostering a proactive stance against the prevalent issue of fall-related injuries. Through the background and practical strategies described in this paper, health professionals of various disciplines will have access to tools and knowledge to enhance their role in preventing falls using the lens of lifestyle medicine.

Yoga Practice as a Potential Sarcopenia Prevention Strategy in Indonesian Older Adults: A Cross-Sectional Study

Background

Sarcopenia is characterized by the progressive loss of skeletal muscle mass and poses a significant health challenge for older adults by increasing the risk of disability and decreasing quality of life. Yoga considers as a low-risk and beneficial exercise for older adults. This research aims to evaluate the potential of yoga practice as a preventive strategy against sarcopenia in Indonesian older adults.

Methods

An observational cross-sectional research was conducted including 41 older adults aged 60-87 years. The research focused on key biomarkers and functional assessments, including serum insulin-like growth factor 1 (IGF-1) levels, telomere length, gait speed, hand grip strength, and SARC-F questionnaire scores.

Results

The results showed that participants aged 71-80 years who practiced yoga for more than a year had significantly higher IGF-1 levels (p=0.04). While improvements in gait speed, hand grip strength, and SARC-F scores were observed, these changes were not statistically significant, and no significant differences were found in telomere length.

Conclusion

Yoga in older adults was associated with higher IGF-1 levels and potential improvements in upper and lower extremity strength, though these findings were not statistically significant and did not influence telomere length. Yoga practice shows potential as an emerging adjuvant option but can not be applied as a single strategy for sarcopenia prevention in older adults.

The Mobility and Voiding Exercises in Older Women with Urinary Incontinence (MoVEonUp) randomized controlled trial: study protocol and rationale

BACKGROUND

Urgency urinary incontinence (UUI), a risk factor for falls, affects 40% of women over the age of 70 years. Multicomponent interventions have the potential to decrease the risk of falls and urinary symptoms in women. We previously designed and conducted a pilot study of a multicomponent, theory-driven intervention in women with UUI. The Mobility and Voiding Exercises in Older Women with Urinary Incontinence (MoVEonUp) Trial will assess the efficacy of this intervention to decrease falls and urinary incontinence in community-dwelling older women.

METHODS

In the MoVEonUp Trial, 314 women ages ≥ 70 years with UUI will be randomized to the intervention group or an attention control group. Women randomized to the intervention will participate in a home-based multicomponent program consisting of strength and balance training, bladder training with urge suppression strategies, and a home hazard assessment by an occupational therapist. Women in the control group will receive an educational booklet on falls prevention and behavioral treatment for urinary incontinence. Outcomes of falls, urinary incontinence, physical function, functional limitations, and mobility will be measured at 3, 6, 9, and 12 months.

DISCUSSION

This study will determine if a home-based multicomponent program reduces the risk of falls and improves incontinence among older women with UUI. If the intervention is efficacious, it will help address the critical need to reduce falls in this population via an intervention that can be implemented in the home setting.

CLINICAL TRIAL REGISTRATION

NCT05375344.

Global, regional, and national burden of injuries, and burden attributable to injuries risk factors, 1990 to 2019: results from the Global Burden of Disease study 2019

OBJECTIVES

In this study, the trends and current situation of the injury burden as well as attributable burden to injury risk factors at global, regional, and national levels based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 are presented.

STUDY DESIGN

To assess the attributable burden of injury risk factors, the data of interest on data sources were retrieved from the Global Health Data Exchange (GHDx) and analyzed.

METHODS

Cause-specific death from injuries was estimated using the Cause of Death Ensemble model in the GBD 2019. The burden attributable to each injury risk factor was incorporated in the population attributable fraction to estimate the total attributable deaths and disability-adjusted life years. The Socio-demographic Index (SDI) was used to evaluate countries' developmental status.

RESULTS

Globally, there were 713.9 million (95% uncertainty interval [UI]: 663.8 to 766.9) injuries incidence and 4.3 million (UI: 3.9 to 4.6) deaths caused by injuries in 2019. There was an inverse relationship between age-standardized disability-adjusted life year rate and SDI quintiles in 2019. Overall, low bone mineral density was the leading risk factor of injury deaths in 2019, with a contribution of 10.5% (UI: 9.0 to 11.6) of total injuries and age-standardized deaths, followed by occupational risks (7.0% [UI: 6.3-7.9]) and alcohol use (6.8% [UI: 5.2 to 8.5]).

CONCLUSION

Various risks were responsible for the imposed burden of injuries. This study highlighted the small but persistent share of injuries in the global burden of diseases and injuries to provide beneficial data to produce proper policies to reach an effective global injury prevention plan.

Factors Associated With Incident and Recurrent Falls Among Men Enrolled in Evidence-Based Fall Prevention Programs: An Examination of Race and Ethnicity

We examined factors associated with incident (one) and recurrent (2+) falls among 7207 non-Hispanic White (NHW) (89.7%), non-Hispanic Black (NHB) (5.0%), and Hispanic (5.3%) men ages ≥60 years with ≥1 chronic conditions, enrolled in an evidence-based fall program. Multinomial and binary regression analyses were used to assess factors associated with incident and recurrent falls. Relative to zero falls, NHB and Hispanic men were less likely to report incident (OR = 0.55, p < .001 and OR = 0.70, p = .015, respectively) and recurrent (OR = 0.41, p < .001 and OR = 0.58, p < .001, respectively) falls. Men who reported fear of falling and restricting activities were more likely to report incident (OR = 1.16, p < .001 and OR = 1.32, p < .001, respectively) recurrent and (OR = 1.46, p < .001 and OR = 1.71, p < .001, respectively) falls. Men with more comorbidities were more likely to report recurrent falls (OR = 1.10, p < .001). Compared to those who experienced one fall, men who reported fear of falling (OR = 1.28, p < .001) and restricting activities (OR = 1.31, p < .001) were more likely to report recurrent falls. Findings highlight the importance of multi-component interventions to prevent falls.

Assessing Static Balance, Balance Confidence, and Fall Rate in Patients with Heart Failure and Preserved Ejection Fraction: A Comprehensive Analysis

Chronic heart failure (CHF) is a complex clinical syndrome, associated with frailty, higher fall rates, and frequent hospitalizations. Heart Failure (HF) and preserved ejection fraction (HFpEF) is defined as a condition where a patient with HF have a diagnosis of left ventricular ejection fraction (LVEF) of ≥ 50%. The risk of HFpEF increases with age and is related to higher non-cardiovascular mortality. The aim of this study was to evaluate static balance and examine the effect of task difficulty on the discriminating power of balance control between patients with HFpEF (Patients with HFpEF) and their healthy controls. Moreover, the associations between static balance parameters, balance confidence, falls, lean muscle mass, and strength were assessed. Seventy two patients with HFpEF (mean age: 66.0 ± 11.6 years) and seventy two age- and gender-matched healthy individuals (mean age: 65.3 ± 9.5 years) participated in this study. Participants underwent a 30 s bilateral stance (BS) test and a 20 s Tandem-Romberg stance (TRS) on a force platform, evaluating the Range and Standard Deviation of Center of Pressure (COP) displacement parameters in both axes. Balance confidence was evaluated by the Activities-Specific Balance Confidence (ABC) Scale, and the number of falls during the last year was recorded. Lower limb strength was measured using an isokinetic dynamometer, isometric leg strength, and a Sit-to-Stand test. Bioelectrical impedance analysis was conducted to assess lean fat mass, lean fat mass index, and lean%. Patients with HFpEF presented with lower static balance in BS and TRS compared to healthy controls (p < 0.05), lower balance confidence by 21.5% (p < 0.05), and a higher incidence of falls by 72.9% (p < 0.05). BS was a better descriptor of the between-group difference. Furthermore, static balance, assessed in controlled lab conditions, was found to have little if no relationship to falls, strength, lean muscle mass, and balance confidence. Although no correlation was noted between the static balance parameters and falls, the fall rate was related to balance confidence, age, muscle strength, and lean fat.

Correlation between postural stability and fall risk in trans-femoral amputees due to muscle fatigue

[Purpose] This study aimed to establish a connection between postural stability and falling in individuals with transfemoral amputation (TFA), particularly with muscle fatigue. [Participants and Methods] Fourteen participants were recruited. Muscle fatigue was induced using a sit-to-stand (STS) fatigue protocol. Pre-fatigue and post-fatigue assessments were conducted using the Biodex Balance System (BBS). [Result] The findings of the study revealed significant increases in the postural stability index between the pre-fatigue and post-fatigue conditions for the TFA group, particularly in the overall stability index (OSI) and anterior-posterior stability index (APSI) components. The mean postural stability index scores for the TFA group exhibited a percentage increase of 65.2% for OSI, 52.7% for APSI, and 50% for medial-lateral stability index (MLSI). Furthermore, the TFA fall risk index surged by 61.4%. Regarding the relationships observed, a significant correlation emerged between fall risk and both OSI and APSI. [Conclusion] These findings underscore the impact of muscle fatigue on postural stability and an increase in fall risk among TFA. By mitigating the effects of muscle fatigue, therapists can play an important role in reducing the risk of falls and promoting better postural stability in this population.

Hip Strength, Change of Direction, and Falls in Recreational Pickleball Players

Background

While a high incidence of pickleball-related falls is reported, little is known regarding factors differentiating persons with and without a fall history during play.

Purpose

This study aimed to determine differences between recreational pickleball players who fell while playing and those who did not. Additional aims were to determine reasons for falling and to investigate associations among assessed factors.

Study design

Cross-sectional study.

Methods

Participants completed a survey reporting age, fall history, and reasons for falling during play. Hip abduction strength, single leg squat form, ankle dorsiflexion, and change of direction time using a modified T-test on a pickleball court (i.e. pickleball T-test) were assessed.

Results

Among the 92 individuals participating in the study, 42% reported a fall while playing and 30% reported falling more than once. Leading reasons for reported falls were lunging and moving backward. Participants who reported falling were significantly older (z = -2.60, p = 0.009) and slower on the pickleball T-test (z = -2.10, p = 0.036) than those who did not report falling. Hip abduction strength was not associated with fall history but was associated with faster time on the pickleball T-test (left rs = -.41, p < 0.001, right rs = -.48, p < 0.001). Single leg squat form and dorsiflexion were not related to fall history.

Conclusion

Falls are common among recreational pickleball players, particularly older players. Fall prevention programs for pickleball players should be considered including multi-directional lunging, lower extremity strength and power development, and change of direction training that includes moving backward.

Level of evidence

2.

Delirium Mediated the Association Between a History of Falls and Short-Term Mortality Risk in Critically Ill Ischemic Stroke Patients

Patients with ischemic stroke have an increased propensity to fall, resulting in significant physical and psychological distress. This study examined the association between falls in the 3 months prior to intensive care unit (ICU) admission and mortality within 28 days among 2950 adult ICU patients diagnosed with ischemic stroke from 2008 to 2019, focusing on the potential mediating role of delirium. The primary outcomes were short-term mortality (28, 60, and 90 days) and the risk of delirium. Each patient was followed for at least 1 year. Delirium was primarily assessed using the Confusion Assessment Method for the ICU and by reviewing nursing notes. Group differences between patients with and without a history of falls were compared using the Wilcoxon rank-sum test or the chi-squared test. Cox proportional risk or logistic regression models were used to explore the association between fall history and outcomes, and causal mediation analysis was performed. Results showed that patients with a recent fall history had a significantly increased risk of 28-day (hazard ratio [HR]: 1.62, 95% confidence interval [CI]: 1.35-1.94), 60-day (HR: 1.67, 95% CI: 1.42-1.98), and 90-day mortality (HR: 1.66, 95% CI: 1.41-1.95), as well as an increased risk of delirium (odds ratio: 2.00, 95% CI: 1.66-2.42). Delirium significantly mediated the association between fall history and 28-day mortality (total effect: HR: 1.77, 95% CI: 1.45-2.16; natural indirect effect: HR: 1.12, 95% CI: 1.05-1.21; proportion mediated: 24.6%). These findings suggest that ischemic stroke patients with a recent fall have an increased risk of short-term mortality, partly mediated by delirium. Strategies aimed at preventing delirium may potentially improve prognosis in this patient population.

Factors leading to falls in transfemoral prosthesis users: a case series of prosthesis-side stumble recovery responses

BACKGROUND

Falls due to stumbling are prevalent for transfemoral prosthesis users and may lead to increased injury risk. This preliminary case series analyzes the transfemoral prosthesis user stumble recovery response to highlight key deficits in current commercially-available prostheses and proposes potential interventions to improve recovery outcomes.

METHODS

Six transfemoral prosthesis users were perturbed on their prosthetic limb at least three times while walking on a treadmill using obstacle perturbations in early, mid and late swing. Kinematic data were collected to characterize the response, while fall rate and key kinematic recovery metrics were used to assess the quality of recovery and highlight functional deficits in current commercially-available prostheses.

RESULTS

Across all participants, 13 (54%) of the 24 trials resulted in a fall (defined as > 50% body-weight support) with all but one participant (83%) falling at least once and two participants (33%) falling every time. In contrast, in a previous study of seven young, unimpaired, non-prosthesis users using the same experimental apparatus, no falls occurred across 190 trials. For the transfemoral prosthesis users, early swing had the highest rate of falling at 64%, followed by mid-swing at 57%, and then late swing at 33%. The trend in falls was mirrored by the kinematic recovery metrics (peak trunk angle, peak trunk angular velocity, forward reach of the perturbed limb, and knee angle at ground contact). In early swing all four metrics were deficient compared to non-prosthesis user controls. In mid swing, all but trunk angular velocity were deficient. In late swing only forward reach was deficient.

CONCLUSION

Based on the stumble recovery responses, four potential deficiencies were identified in the response of the knee prostheses: (1) insufficient resistance to stance knee flexion upon ground contact; (2) insufficient swing extension after a perturbation; (3) difficulty initiating swing flexion following a perturbation; and (4) excessive impedance against swing flexion in early swing preventing the potential utilization of the elevating strategy. Each of these issues can potentially be addressed by mechanical or mechatronic changes to prosthetic design to improve quality of recovery and reduce the likelihood a fall.

Bayesian semi-parametric inference for clustered recurrent events with zero inflation and a terminal event

Recurrent events are common in clinical studies and are often subject to terminal events. In pragmatic trials, participants are often nested in clinics and can be susceptible or structurally unsusceptible to the recurrent events. We develop a Bayesian shared random effects model to accommodate this complex data structure. To achieve robustness, we consider the Dirichlet processes to model the residual of the accelerated failure time model for the survival process as well as the cluster-specific shared frailty distribution, along with an efficient sampling algorithm for posterior inference. Our method is applied to a recent cluster randomized trial on fall injury prevention.

Unintentional injuries and falls in populations in Russia. The Ural eye and medical study and the Ural very old study

Background

To explore the prevalence of self-reported unintentional injuries and falls (UIFs) in medium-aged and old populations in Russia and factors associated with them.

Methods

Two population-based studies (Ural Eye and Medical Study (UEMS), Ural Very Old Study (UVOS)) were carried out urban and rural areas in Bashkortostan/Russia. They consisted of 5899 individuals (age: 40+ years) and 1526 participants (age: 85+ years), respectively. We assessed previous falls as part of an interview with standardized questions, conducted in the framework of a series medical and ophthalmological assessments.

Results

In the UEMS with 5894 individuals (age:59.0 ± 10.7 years), UIF prevalence was 1101/5894 (18.7 %; 95 % confidence interval (CI)CI:17.7,19.7), with 1,2,3,4,5,6,7,8,9, or 10+ UIFs reported by 766 (69.6 %),146 (13.3 %),56 (1.4 %),15 (1.4 %),19 (1.7 %),3 (0.3 %),2 (0.2 %),1 (0.01 %), and 10 (0.9 %) participants, respectively. The UIFs had occurred as outdoor incidents (n = 594; 53.8 %), at home (n = 162; 14.7 %), on the road or traffic accidents (n = 109; 9.9 %), at work (n = 77; 7.0 %), during garden work (n = 24; 2.2 %) or as falls from a higher level (n = 17; 1.5 %) or from house roofs (n = 16; 1.4 %). In 100 (1.7 % of the total study population; 9.1 % of the group with UIFs) participants, low vision was reported as a major cause for the UIF. Higher UIF prevalence was associated (multivariable analysis) with older age (odds ratio (OR):1.01; 95%CI:1.005,1.02;P < 0.001), urban region of habitation (OR:1.59; 95%CI:1.37,1.85;P = 0.001), higher smoking package number (OR:1.01; 95%CI:1.004,1.01;P = 0.001), longer waist circumference (OR:1.01; 95%CI:1.002,1.01;P = 0.008), higher prevalence of a history of arthritis (OR:1.38; 95%CI:1.18,1.62;P < 0.001) and backache (OR:1.73; 95%CI:1.49,2.02;P < 0.001), and higher depression score (OR:1.05; 95%CI:1.03,1.07;P < 0.001). Out of 1525 UVOS participants (age:88.8 ± 2.9 years; range:85-103.1 years), the UIF prevalence was 780/1525 (51.1 %; 95%CI: 48.6, 53.6), with 390 (50.0 %), 116 (14.8 %), 49 (6.3 %), 12 (1.5 %), 8 (1.0 %), 2 (0.3 %), 4 (0.5 %), 1 (0.1 %), and 15 (1.9 %) participants reported about 1,2,3,4,5,6,7,8,9,or 10+ UIFs, respectively. The UIFs had occurred as outdoor incidents (n = 386; 25.3 %), at home (n = 214; 14.0 %), on the road or traffic accidents (n = 22; 1.4 %), at work (n = 21; 1.4 %), during garden work (n = 10; 0.7 %) or as falls from a higher level (n = 11; 0.7 %) or from house roofs (n = 1; 0.1 %). A higher UIC prevalence correlated with female sex (OR:1.65; 95%CI:1.30,2.09;P < 0.001) and Russian ethnicity (OR:1.26; 95%CI:1.02,1.56;P = 0.03).

Conclusions

UIFs have occurred to a substantial part of the adult and very old population in Russia.

Walking on a Balance Beam as a New Measure of Dynamic Balance to Predict Falls in Older Adults and Patients with Neurological Conditions

BACKGROUND

Beam walking is a new test to estimate dynamic balance. We characterized dynamic balance measured by the distance walked on beams of different widths in five age groups of healthy adults (20, 30, 40, 50, 60 years) and individuals with neurological conditions (i.e., Parkinson, multiple sclerosis, stroke, age: 66.9 years) and determined if beam walking distance predicted prospective falls over 12 months.

METHODS

Individuals with (n = 97) and without neurological conditions (n = 99, healthy adults, age 20-60) participated in this prospective longitudinal study. Falls analyses over 12 months were conducted. The summed distance walked under single (walking only) and dual-task conditions (walking and serial subtraction by 7 between 300 to 900) on three beams (4, 8, and 12-cm wide) was used in the analyses. Additional functional tests comprised grip strength and the Short Physical Performance Battery.

RESULTS

Beam walking distance was unaffected on the 12-cm-wide beam in the healthy adult groups. The distance walked on the 8-cm-wide beam decreased by 0.34 m in the 20-year-old group. This reduction was ~ 3 × greater, 1.1 m, in the 60-year-old group. In patients, beam walking distances decreased sharply by 0.8 m on the 8 versus 12 cm beam and by additional 1.6 m on the 4 versus 8 cm beam. Beam walking distance under single and dual-task conditions was linearly but weakly associated with age (R2 = 0.21 for single task, R2 = 0.27 for dual-task). Age, disease, and beam width affected distance walked on the beam. Beam walking distance predicted future falls in the combined population of healthy adults and patients with neurological conditions. Based on receiver operating characteristic curve analyses using data from the entire study population, walking ~ 8.0 of the 12 m maximum on low-lying beams predicted future fallers with reasonable accuracy.

CONCLUSION

Balance beam walking is a new but worthwhile measure of dynamic balance to predict falls in the combined population of healthy adults and patients with neurological conditions. Future studies are needed to evaluate the predictive capability of beam walking separately in more homogenous populations. Clinical Trial Registration Number NCT03532984.

Validation of the Saga Fall Injury Risk Model

Background: Predicting fall injuries can mitigate the sequelae of falls and potentially utilize medical resources effectively. This study aimed to externally validate the accuracy of the Saga Fall Injury Risk Model (SFIRM), consisting of six factors including age, sex, emergency transport, medical referral letter, Bedriddenness Rank, and history of falls, assessed upon admission. Methods: This was a two-center, prospective, observational study. We included inpatients aged 20 years or older in two hospitals, an acute and a chronic care hospital, from October 2018 to September 2019. The predictive performance of the model was evaluated by calculating the area under the curve (AUC), 95% confidence interval (CI), and shrinkage coefficient of the entire study population. The minimum sample size of this study was 2,235 cases. Results: A total of 3,549 patients, with a median age of 78 years, were included in the analysis, and men accounted for 47.9% of all the patients. Among these, 35 (0.99%) had fall injuries. The performance of the SFIRM, as measured by the AUC, was 0.721 (95% CI: 0.662-0.781). The observed fall incidence closely aligned with the predicted incidence calculated using the SFIRM, with a shrinkage coefficient of 0.867. Conclusions: The external validation of the SFIRM in this two-center, prospective study showed good discrimination and calibration. This model can be easily applied upon admission and is valuable for fall injury prediction.

The effect of visual sensory interference during multitask obstacle crossing in younger and older adults

When older adults step over obstacles during multitasking, their performance is impaired; the impairment results from central and/or sensory interference. The purpose was to determine if sensory interference alters performance under low levels of cognitive, temporal, and gait demand, and if the change in performance is different for younger versus older adults. Participants included 17 younger adults (20.9±1.9 years) and 14 older adults (69.7±5.4 years). The concurrent task was a single, simple reaction time (RT) task: depress button in response to light cue. The gait task was stepping over an obstacle (8 m walkway) in three conditions: (1) no sensory interference (no RT task), (2) low sensory interference (light cue on obstacle, allowed concurrent foveation of cue and obstacle), or (3) high sensory interference (light cue away from obstacle, prevented concurrent foveation of cue and obstacle). When standing, the light cue location was not relevant (no sensory interference). An interaction (sensory interference by task, p<0.01) indicated that RT was longer for high sensory interference during walking, but RT was not altered for standing, confirming that sensory interference increased RT during obstacle approach. An interaction (sensory interference by age, p<0.01) was observed for foot placement before the obstacle: With high sensory interference, younger adults placed the trail foot closer to the obstacle while older adults placed it farther back from the obstacle. The change increases the likelihood of tripping with the trail foot for younger adults, but with the lead limb for older adults. Recovery from a lead limb trip is more difficult due to shorter time for corrective actions. Overall, visual sensory interference impaired both RT and gait behavior with low levels of multitask demand. Changes in foot placement increased trip risk for both ages, but for different limbs, reducing the likelihood of balance recovery in older adults.

Shoe sole impedes leg muscle activation and impairs dynamic balance responding to a standing-slip

The shoe sole is identified as a fall risk factor since it may impede the afferent information about the outside world collected by the plantar sensory units. However, no study has directly quantified how the shoe sole compromises body balance and increases fall risk. This study aimed to inspect how the sole affects human balance after an unexpected standing-slip. It was hypothesized that individuals wearing the sole, relative to their barefoot counterparts, would exhibit 1) more impaired stability and 2) disrupted lower limb muscle activation following a standing-slip. Twenty young adults were evenly randomized into two groups: soled and barefoot. The soled group wore a pair of customized 10-mm thick soles, while the other group was bare-footed. Full-body kinematics and leg muscle electromyography (EMG) were collected during a standardized and unexpected standing-slip. The EMG electrodes were placed on the tibialis anterior, gastrocnemius, rectus femoris, and biceps femoris bilaterally. Dynamic stability, spatiotemporal gait parameters, and the EMG latency of the leg muscles were compared between groups. The sole impeded the initiation of the recovery step possibly because it interfered with the accurate detection of the external perturbation and subsequently activated the leg muscles later in the soled group than in the barefoot group. As a result, individuals in the soled group experienced a longer slip distance and were more unstable than the barefoot group at the recovery foot liftoff. The findings of this study could augment our understanding of how the shoe sole impairs body balance and increases the fall risk.

Age-Related Risk of Serious Fall Events and Opioid Analgesic Use

Importance

Opioid analgesics may be associated with increased risk of falls, particularly among older adults.

Objective

To quantify the age-related risk of serious fall events among adults prescribed opioids by opioid exposure, time from initiation, and daily dose.

Design, Setting, and Participants

This population-based cohort study conducted in New South Wales, Australia, used data linking national pharmaceutical claims to national and state datasets, including information on sociodemographic characteristics, clinical characteristics, medicines use, health services utilization, and mortality (POPPY II study). It included adults (18 years or older) who initiated prescription opioid treatment, which was defined as no prior dispensing during the preceding 365 days, between January 1, 2005, and December 31, 2018. Data were analyzed from February to June 2023.

Exposure

Time-dependent periods of opioid exposure were evaluated from dispensing records.

Main Outcome and Measures

Serious fall events identified from emergency department, hospitalization, and mortality records. Negative binomial models were used to assess associations between time-dependent opioid exposure (overall, by time from initiation, and by dose), age, and risk of fall events. Models were adjusted for known fall risk factors, including other fall risk-increasing drugs, frailty risk, and prior serious fall events.

Results

The cohort comprised 3 212 369 individuals who initiated prescription opioid treatment (1 702 332 women [53%]; median [IQR] age at initiation, 49 [32-65] years). Overall, 506 573 serious fall events were identified, including 5210 fatal falls. During exposure to opioids, the risk of serious fall events was elevated among all age groups; compared with the group aged 18 to 44 years, this risk was highest among those 85 years or older (adjusted incident rate ratio, 6.35; 95% CI, 6.20-6.51). Across all age groups, the first 28 days following opioid initiation was a time of increased serious fall risk; this risk increased with age. Among individuals aged 18 to 84 years, associations were identified between higher daily opioid doses and serious fall events.

Conclusions and Relevance

The results of this cohort study suggest that prescription opioids were associated with increased risk of serious fall events among adults of all ages, with individuals 85 years or older at greatest risk. These risks should be considered when prescribing opioids, particularly for individuals with preexisting risk factors or when opioids are prescribed at higher doses. Targeted falls prevention efforts may be most effective within the first month following opioid initiation.

Comparison across age groups of causes, circumstances, and consequences of falls among individuals living in Canada: A cross-sectional analysis of participants aged 45 to 85 years from the Canadian Longitudinal Study on Aging

Falls are a leading cause of injury-related deaths and hospitalizations among Canadians. Falls risk has been reported to be increased in individuals who are older and with certain health conditions. It is unclear whether rurality is a risk factor for falls. This study aimed to investigate: 1) fall profiles by age group e.g., 45 to 54 years, 55 to 64 years, 65 to 74 years, 75 to 85 years; and 2) falls profiles of individuals, by age group, living in rural versus urban areas of Canada. Data (N = 51,338) from the Canadian Longitudinal Study on Aging was used to examine the relationship between falls and age, rurality, chronic conditions, need for medical attention, and fall characteristics (manner, location, injury). Self-reported falls within a twelve-month period occurred in only 4.8% (single fall) and 0.8% (multiple falls) of adults. Falls were not related to rural residence or age, but those with memory impairment, multiple sclerosis, as well as other chronic conditions such as mood disorder, anxiety disorder, and hyperthyroidism not often thought to be associated with falls, were also more likely to fall. Older individuals were more likely to fall indoors or fall while standing or walking. In contrast, middle-aged individuals were more likely to fall outdoors or while exercising. Type of injury was not associated with age, but older individuals were more likely to report hospitalization after a fall. This study shows that falls occur with a similar frequency in individuals regardless of age or urban/rural residence. Age was associated with fall location and activity. A more universally applicable multi-facted approach, rather than one solely based on older age considerations, to screening, primary prevention and management may reduce the personal, social, and economic burden of falls and fall-related injuries.

Balance measures of mini and brief balance evaluation system tests for Iranian population

Introduction

Falling is a serious problem for all ages. There are several tests to assess balance. Mini-BESTest and brief-BESTest are balance tests for which there are no normative values for Iranian people. We aimed to provide the normative values of mini-BESTest and brief-BESTest among healthy Iranian adults.

Methods

A cross-sectional study was designed. Three hundred healthy adults (150 males and 150 females) in six age groups (18-29, 30-39, 40-49, 50-59, 60-69, +70 years) completed the tests using Persian mini-BESTest and brief-BESTest. Normative values were calculated for age groups.

Results

Normative values of mini-BESTest and brief- BESTest decreased significantly with age (from 27 to 21.9 for mini-BESTest and from 22.9 to 15.4 for brief BESTest). There were no significant differences between genders except for females in 30-39 and 40-49 years age groups which scored better on brief-BESTest and mini-BESTest, respectively. Males had significantly scored better in brief- BESTest in 60-69 and ≥ 70 age groups.

Conclusions

The normative values of the mini-BESTest and brief-BESTest provided for healthy Iranian adults can help clinicians when assessing subjects with balance dysfunction.

Knowledge, Attitudes, and Practices of Nurses toward Risk Factors and Prevention of Falls in Older Adult Patients in a Large-Sized Tertiary Care Setting

The objective was to assess the knowledge, attitudes, and practices of nurses toward the prevention of falls in older hospitalized patients. A cross-sectional study employing a 54-item questionnaire was conducted on 370 nurses at a tertiary care referral center. The mean age of the study population was 36.3 ± 7.7 years, with the majority being females (282; 76.8%). Most of them had attended fall prevention training (335; 90.5%). More than 98% knew fall prevention policies and safety goals, according to their response to a fall and risk assessment, but were less aware of the risk factors of falls, such as recurrent falls (61%), depression (44%), and lower-extremity numbness (40.5%). Similarly, 99% had positive attitudes toward risk assessment, fall prevention intervention, and response to a fall. Around 55% thought they were responsible for patients' falls, and 96% felt the need to undergo more training on fall prevention. Furthermore, 92% strictly followed fall prevention policies and 85.4% followed the color-coding system for high-risk patients. Despite the preventive measures in place, 33% encountered patient falls, and 82.2% experienced unwitnessed patient fall incidents in their units. Although the nurses had higher levels of knowledge about the policies, they lacked information on the risk factors. There is a significant scope that warrants great attention concerning the adherence to guidelines and the provision of fall prevention training programs, with a focus on the intrinsic causative factors of falls.

A Segmented Regression Analysis of Household Income and Recurrent Falls Among Adults in a National Cohort Study

Falls can have life-altering consequences for older adults, including extended recovery periods and compromised independence. Higher household income may mitigate the risk of falls by providing financial resources for mobility tools, remediation of environmental hazards, and needed supports, or it may buffer the impact of an initial fall on subsequent risk through improved assistance and care. Household income has not had a consistently observed association with falls in older adults; however, a segmented association may exist such that associations are attenuated above a certain income threshold. In this study, we utilized segmented negative binomial regression analysis to examine the association between household income and recurrent falls among 2,302 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study recruited between 2003 and 2007. Income-fall association segments separated by changes in slope were considered. Model results indicated a 2-segment association between household income and recurrent falls in the past year. In the range below the breakpoint, household income was negatively associated with the rate of recurrent falls across all age groups examined; in a higher income range (from $20,000-$49,999 to ≥$150,000), the association was attenuated (weaker negative trend) or reversed (positive trend). These findings point to potential benefits of ensuring that incomes for lower-income adults exceed the threshold needed to confer a reduced risk of recurrent falls.

Nomogram for Predicting the Risk Factors for Falls in Older People: A Secondary Data Analysis Based on the 2021 Community Health Survey

This study aimed to identify the risk factors for falls among older individuals living at home in a community and develop a nomogram to predict falls. This study included 74 492 people aged 65 years or older who participated in the 2021 Community Health Survey conducted in Korea. The data analysis methods used included the Rao-Scott χ2 test, a complex sample t-test, and complex binary logistic regression using SPSS 26.0. Using logistic regression analysis, a fall-risk prediction nomogram was created based on regression coefficients, and the reliability of the nomogram was calculated using a receiver operating characteristic (ROC) curve and values of the area under the curve (AUC). The fall incidence rate among older adults was 16.4%. Factors affecting the subject's fall experience included being more than 85 years old (OR = 1.40); living alone (OR = 1.13); receiving basic welfare (OR = 1.18); subjective health status (OR = 1.72); number of days spent walking (OR = 0.98); obesity (OR = 1.08); severe depression (OR = 2.84); sleep duration time (OR = 1.11); experiencing cognitive decline (OR = 1.34); and diabetes (OR = 1.12). In the nomogram, the depression score exhibited the greatest discriminatory power, followed by subjective health status, gender, experience of cognitive decline, age, basic livelihood security, adequacy of sleep, living alone, diabetes, and number of days of walking. The AUC value was 0.66. An intervention plan that comprehensively considers physical, psychological, and social factors is required to prevent falls in older adults. The nomogram developed in this study will help local health institutions assess all these risk factors for falling and create and implement systematic education and intervention programs to prevent falls and fall-related injuries among older individuals.

Walking to Prevent Fear of Falling Among Community-Dwelling Older Adults: A Scoping Review

The current review sought to identify and synthesize the evidence on available interventions that include walking and their impact on fear of falling (FOF) among community-dwelling older adults without cognitive impairment. A 10-year search was conducted (January 2012 to January 2022) in two peer-reviewed databases. A total of 116 articles were identified, and 22 articles were reviewed. Most studies included multicomponent walking interventions, such as walking and another type of intervention or exercise. Among the different questionnaires to assess FOF, the Falls Efficacy Scale-International was the most used in 77.3% (n = 17) of studies. In addition to walking, interventions to reduce FOF mainly included balance training, lower extremity strengthening, cardio or aerobic exercises, or a combination of these exercises. Further research is needed to evaluate the impact of unidimensional walking interventions, as well as those that incorporate psychological and technological elements targeted to FOF prevention and management. [Journal of Gerontological Nursing, 50(1), 15-21.].

Trends and risk factors among adults admitted to the emergency department with fall-related eye injuries

BACKGROUND/PURPOSE

Eye injuries can happen to people of any age and for many reasons; among these is a fall. The aims of this study were to: (1) examine trends among fall-related eye injuries in working-age and older adults admitted to the emergency department (ED) from 2012 to 2021; and (2) investigate and compare the risk factors associated with fall-related eye injuries between working-age adults and older adults.

DESIGN

We examined a retrospective cohort in the 2012-2021 National Electronic Injury Surveillance System (NEISS) databases. We used the Cochran-Armitage test for trend to determine the fall-related eye injury trend from 2012 to 2021. The associations among fall-related eye injuries, demographics, accident-related environments, and disposition, were analyzed using multivariable logistic regression analysis.

RESULTS

Among the total of 1,290,205 adults with eye injuries from 2012 to 2021, the incidence rate of fall-related eye injuries was higher in older adults (ranged from 9.0% to 17.4%) than in working-age adults (ranged from 3.7% to 7.1%). Over consecutive years, the number and annual incident rate of both working-age and older adults experiencing fall-related eye injuries increased significantly (all p ≤0.001). Patients who were female (odds ratio [OR] = 1.60, 95% confidence interval [CI] = 1.39-1.83), Black/African American (OR = 1.76, 95% CI = 1.47-2.10) had significantly higher odds of fall-related eye injuries. The highest odds ratios found among all of the reported product categories for the fall-related eye injuries were an accident with home structures such as doors (OR = 12.65, 95% CI = 10.00-16.01) and an accident with home furnishings (OR = 11.65, 95% CI = 9.18-14.78) compared to an accident with workshop equipment. Patients who experienced fall-related eye injuries were more likely to be hospitalized/ have an inpatient stay (OR = 7.41, 95% CI = 5.78-9.52) after the ED treatment than those who treated and released after ED visit.

CONCLUSION

Among Americans treated in the ED for injury, fall-related eye injuries are increasingly common, especially among older adults, and associated with a need for inpatient care. Therefore, these findings suggest opportunities to investigate fall prevention and eye protection interventions, especially in the home setting.

Traumatic cubitus valgus consequent of distal humeral fracture: Two case studies from the Holocene Later Stone Age in southern Africa

OBJECTIVES

Distal fractures of the humerus and their complications have rarely been described or analysed in the palaeopathological literature. The objective of this study was to evaluate two cases of distal humeral fracture with associated cubitus valgus observed in two individuals from the context of the Later Stone Age (LSA) in southern Africa.

MATERIALS

Skeletal remains of two individuals. A middle-aged female radiocarbon dated to c.160 BP and a middle-aged male radiocarbon dated to c.2 300 BP.

METHODS

Remains were macroscopically and radiographically assessed for injury.

RESULTS

Both cases presented with healed antemortem injury to the right elbow attributed to possible falls. Distal humeral fracture resulted in non-union of the lateral epicondyle with extensive morphological changes to the elbow joint including an increased carrying angle. Morphological and osteoarthritic changes suggest a survival period of several years post-injury.

SIGNIFICANCE

Cubitus valgus following traumatic injury has rarely been reported amongst historic or prehistoric populations. The described injuries would have had physical and functional consequences, raising questions relating to probable care received during the healing process. The elbow injuries would have resulted in restricted motion and instability of the elbow joint, with a high likelihood of ulnar neuropathy.

LIMITATIONS

The contextual information for these individuals is limited and do not permit broader population level study.

SUGGESTIONS FOR FURTHER RESEARCH

Formal biomechanical analysis including cross-sectional geometry analysis will provide further information regarding complications and strengthen the diagnosis of ulnar neuropathy. Further research is necessary on the prevalence and complications of humeral fracture.

Modifiable fall risk factors among older adults with advanced cancer: Secondary analysis of a cluster-randomized clinical trial

INTRODUCTION

Older adults with cancer have unique fall risk factors related to their disease and treatment such as polypharmacy and neurotoxic treatments. In this secondary analysis, we identified modifiable risk factors associated with future falls among older adults with advanced cancers.

MATERIALS AND METHODS

Data were from the COACH study (ClinicalTrials.gov: NCT02107443; PI: Mohile). Patients were age ≥ 70, had stage III/IV solid tumor or lymphoma, ≥1 geriatric assessment impairment, and were receiving palliative intent treatment. Falls were self-reported at baseline (in the past six months), four to six weeks, three months, and six months. We generated inverse probability weights to account for mortality-related loss to follow-up and applied these in generalized linear mixed models to estimate incidence rate ratios.

RESULTS

Of 541 patients (mean age: 77, standard deviation [SD]: 5.27), 140 (26%) reported prior falls at baseline, and 467 (86%) had falls data for ≥1 follow-up timepoint. Of those, 103 (22%) reported at least one fall during the follow-up period, and 112 (24%) had incomplete follow-up due to death. In fully adjusted models, prior falls and impaired Timed Up and Go score were associated with higher incidence of falls over 6 months.

DISCUSSION

We identified several potentially modifiable fall risk factors in older adults with advanced cancers. Future studies should consider ways to integrate fall risk assessment into ongoing cancer care and intervene to reduce falls in this population.

Standing Blood Pressure and Risk of Falls, Syncope, Coronary Heart Disease, and Mortality

BACKGROUND

ACC/AHA guidelines caution against the use of antihypertensive therapy in the setting of low standing systolic BP (SBP) < 110 mm Hg due to unclear benefits.

METHODS

The Atherosclerosis Risk in Communities (ARIC) Study measured supine and standing SBP in adults aged 45-64 years between 1987 and 1989. We used Cox regression to evaluate the associations of low standing SBP (<110 mm Hg) with risk of falls, syncope, coronary heart disease (CHD), and mortality through December 31, 2019. Falls and syncope were ascertained by hospitalization and outpatient claims; CHD events were adjudicated. Associations were examined overall and in strata of hypertension stage, 10-year atherosclerotic cardiovascular disease (ASCVD) risk, age, and sex.

RESULTS

Among 12,467 adults followed a median of 24 years (mean age at enrollment 54.1 ± 5.8 years, 55% women, 26% Black adults), 3,000 (24%) had a standing SBP < 110 mm Hg. A standing SBP < 110 mm Hg compared to standing SBP ≥ 110 mm Hg was not significantly associated with falls or syncope, and was associated with a lower risk of CHD events and mortality with HRs of 1.02 (95% CI 0.94, 1.11), 1.02 (0.93, 1.11), 0.88 (0.80, 0.97), and 0.91 (0.86, 0.97), respectively. There were no clinically meaningful differences when stratified by hypertension stage, 10-year ASCVD risk, age, and sex.

CONCLUSIONS

In this community-based population, low standing SBP was common and not significantly associated with falls or syncope, but was associated with a lower risk of CHD and mortality. These findings do not support screening for low standing BP as a risk factor for adverse events.

Sources of Facial Injury Across Age Groups: A Nationwide Overview Using the National Electronic Injury Surveillance System Database

BACKGROUND

Facial trauma comprises a significant portion of injuries that occur each year in the United States, with injuries ranging from lacerations to complex facial fractures. This study aims to provide a broad epidemiologic overview of facial trauma in the United States to direct preventative safety measures.

METHODS

A cross-sectional study was conducted utilizing the National Electronic Injury Surveillance System database to identify the weighted national incidence of facial injuries from 2017 to 2021. Descriptive and inferential statistical analysis was used to compare the demographics of patients, the settings where the injury occurred, and the products resulting in the injury.

RESULTS

A total of 8,465,538 out of 64,312,132 weighted encounters involved facial injuries. Less than 10 years was the highest-represented age group (36.8%). The most frequent disposition was treated and released (91.1%), with increasing age associated with higher rates of hospitalization (odds ratio: 1.04, P < 0.001). Cases predominantly occurred at home (49.0%), and the most common type of injury was laceration (36.5%). At-home injuries increased with age, comprising 39.2% of facial injuries for 21 to 40 years, 52.0% for 41 to 64 years, and 58.0% for older than 65 years. Building structures (21.4%) were the most prevalent source of injury, composed predominantly of floors (58.3%) and ceilings and walls (10.4%).

CONCLUSIONS

There is an understated burden of at-home facial injuries across all age groups, beyond the pediatric and geriatric population. Fall prevention and home environmental hazards education could benefit all ages, reducing the incidence of facial trauma.

Epidemiology of Dog Walking-Related Injuries among Adults Presenting to US Emergency Departments, 2001-2020

PURPOSE

Dog walking is a popular daily activity, yet information regarding its injury burden is limited. This study describes the epidemiology of injuries related to leash-dependent dog walking among adults presenting to US emergency departments from 2001 to 2020.

METHODS

A retrospective analysis was performed using the National Electronic Injury Surveillance System database to identify adults (≥18 yr) presenting to US emergency departments with leash-dependent dog walking-related injuries between 2001 and 2020. Outcomes included annual estimates of injury incidence, injury characteristics, and risk factors for sustaining a fracture or traumatic brain injury (TBI). Weighted estimates and 95% confidence intervals (CI) were generated using National Electronic Injury Surveillance System sample weights.

RESULTS

Between 2001 and 2020, an estimated 422,659 adults presented to US emergency departments with injuries related to leash-dependent dog walking. The annual incidence increased more than fourfold during this period ( n = 7282 vs n = 32,306, P < 0.001). Most patients were women (75%) and adults age 40 to 64 yr (47%), with a mean age of 53 ± 0.5 yr. Patients commonly injured their upper extremity (51%) and were injured while falling when pulled or tripped by the leash (55%). The three most common injuries were finger fracture (6.9%), TBI (5.6%), and shoulder sprain/strain (5.1%). On multivariate analysis, fracture risk among dog walkers was higher in adults age ≥65 yr (odds ratio [OR], 2.1; 95% CI, 1.8-2.5) and women (OR, 1.5; 95% CI, 1.3-1.7). Risk of TBI was also elevated among older dog walkers (OR, 1.6; 95% CI, 1.3-2.0).

CONCLUSIONS

Dog walking is associated with a considerable and rising injury burden. Dog owners should be informed of this injury potential and advised on risk-reduction strategies.

Trends in Mortality From Poisonings, Firearms, and All Other Injuries by Intent in the US, 1999-2020

Importance

Although deaths due to external causes are a leading cause of mortality in the US, trends over time by intent and demographic characteristics remain poorly understood.

Objective

To examine national trends in mortality rates due to external causes from 1999 to 2020 by intent (homicide, suicide, unintentional, and undetermined) and demographic characteristics. External causes were defined as poisonings (eg, drug overdose), firearms, and all other injuries, including motor vehicle injuries and falls. Given the repercussions of the COVID-19 pandemic, US death rates for 2019 and 2020 were also compared.

Design, Setting, and Participants

Serial cross-sectional study using national death certificate data obtained from the National Center for Health Statistics and including all external causes of 3 813 894 deaths among individuals aged 20 years or older from January 1, 1999, to December 31, 2020. Data analysis was conducted from January 20, 2022, to February 5, 2023.

Exposures

Age, sex, and race and ethnicity.

Main Outcomes and Measures

Trends in age-standardized mortality rates and average annual percentage change (AAPC) in rates calculated by intent (suicide, homicide, unintentional, and undetermined), age, sex, and race and ethnicity for each external cause.

Results

Between 1999 and 2020, there were 3 813 894 deaths due to external causes in the US. From 1999 to 2020, poisoning death rates increased annually (AAPC, 7.0%; 95% CI, 5.4%-8.7%). From 2014 to 2020, poisoning death rates increased the most among men (APC, 10.8%; 95% CI, 7.7%-14.0%). During the study period, poisoning death rates increased in all the racial and ethnic groups examined; the most rapid increase was among American Indian and Alaska Native individuals (AAPC, 9.2%; 95% CI, 7.4%-10.9%). During the study period, death rates for unintentional poisoning had the most rapid rate of increase (AAPC, 8.1%; 95% CI, 7.4%-8.9%). From 1999 to 2020, firearm death rates increased (AAPC, 1.1%; 95% CI, 0.7%-1.5%). From 2013 to 2020, firearm mortality increased by an average of 4.7% annually (95% CI, 2.9%-6.5%) among individuals aged 20 to 39 years. From 2014 to 2020, mortality from firearm homicides increased by an average of 6.9% annually (95% CI, 3.5%-10.4%). From 2019 to 2020, mortality rates from external causes accelerated further, largely from increases in unintentional poisoning, and homicide due to firearms and all other injuries.

Conclusions and Relevance

Results of this cross-sectional study suggest that from 1999 to 2020, death rates due to poisonings, firearms, and all other injuries increased substantially in the US. The rapid increase in deaths due to unintentional poisonings and firearm homicides is a national emergency that requires urgent public health interventions at the local and national levels.

Effects of Physical Activity Interventions on Strength, Balance and Falls in Middle-Aged Adults: A Systematic Review and Meta-Analysis

BACKGROUND

Weak lower body strength and balance impairments are fundamental risk factors for mobility impairments and falls that can be improved by physical activity (PA). Previous meta-analyses have focused on these risk factors in adults aged ≥ 65 years. Yet, the potential of PA for improving these risk factors in middle-aged populations has not been systematically investigated. This systematic review and meta-analysis aim to examine the effect of general and structured PA on lower limb strength, postural balance and falls in middle-aged adults.

METHODS

A computerized systematic literature search was conducted in the electronic databases MEDLINE, CINAHL, Web of Science and Cochrane Library. PA intervention types were classified according to the ProFaNE taxonomy. Randomized controlled trials exploring the effects of PA on strength (e.g., leg press one-repetition-maximum), balance (e.g., single limb stance) and falls (e.g., fall rates) in adults aged 40-60 years were systematically searched and included in a network analysis. Moderator analyses were performed for specific subgroups (age, sex, low PA). The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database (PEDro) Scale.

RESULTS

Out of 7170 articles screened, 66 studies (median PEDro score 5) with 3387 participants were included. Strong, significant effects on muscle strength were found for strength (SMD = 1.02), strength-aerobic (SMD = 1.41), strength-endurance (SMD = 0.92) and water-based (SMD = 1.08) training (52 studies, I² = 79.3%). Strength training (SMD = 1.16), strength-aerobic (SMD = 0.98) and 3D training (SMD = 1.31) improved postural balance (30 studies, I² = 88.1%). Moderator analyses revealed significant effects of specific intervention types on certain subgroups and subdomains of strength and balance. No studies were found measuring falls.

CONCLUSIONS

Structured PA interventions in middle-aged adults improve strength and balance outcomes related to functional impairments and falls. Strength training increases both strength and balance and can be recommended to prevent age-related functional decline. However, the interpretability of the results is limited due to considerable heterogeneity and the overall low methodological quality of the included studies. Long-term trials are needed to determine the preventive potential of PA on strength, balance and falls. This meta-analysis may inform guidelines for tailored training during middle age to promote healthy aging. Prospero registration: CRD42020218643.

Drug Utilisation Review among Geriatric Patients with Noncommunicable Diseases in a Primary Care Setting in Malaysia

A prospective cross-sectional study was conducted to analyse the drugs prescribed to the elderly population with noncommunicable diseases and to determine the polypharmacy at a primary care clinic in Negeri Sembilan, Malaysia. The study was conducted for 6 months at the primary care clinic of Gemas. Geriatric patients above the age of 65 and diagnosed with noncommunicable diseases were included upon providing written informed consent. The majority of the geriatric patients were between 65 and 69 years (mean: 69.72 ± 2.85) and prescribed 4 or more medications (mean: 5.18 ± 0.64, p = 0.007). More than 95% (n = 295) of the geriatrics were found to have multimorbidity, in which around 45% (n = 139) had type-2 diabetes together with hypertension and dyslipidaemia. Combination therapy was prescribed to more than 97% (n = 302) of the elderly, whereas cardiovascular and endocrine medications were the most commonly prescribed. Ten prescriptions were found to have drug-related problems, prescribing cascade (80%), lack of medicine optimisation (10%), and inappropriate prescription (10%). In this study, the majority of the elderly had multimorbidity; polypharmacy was commonly seen among geriatric patients. Polypharmacy is the biggest threat to the elderly population, as it increases the chances of falls and fall-related injuries. Medicine optimisation and deprescribing will reduce the chances of drug-related problems and morbidity and mortality associated with polypharmacy and over-consumption of medications. Hence, the study recommends the health fraternity look for medication optimisation and deprescribing to reduce the future complications associated with polypharmacy.

Fall Risk in Adult Family Practice Non-Attenders: A Cross-Sectional Study from Slovenia

Introduction

Not much is known about the fall risk among the adult population of those who rarely visit doctors. We wanted to determine the prevalence of increased fall risk in a population of family practice non-attenders and the factors associated with it.

Methods

We included participants from family medicine practices in this cross-sectional study. To be included in the study, the participants had to be adults living in the community (home-dwelling people) who had not visited their chosen family physician in the last five years (non-attenders). The identification of the eligible persons was done through a search of electronic medical records, which yield 2,025 non-attenders. Community nurses collected data in the participants’ homes. The outcome measure was increased fall risk as assessed by the Morse fall scale: increased risk (≥25) vs. no risk.

Results

The sample consisted of 1,945 patients (96.0% response rate) with a mean age of 60.4 years (range 20.5 to 99.7 years). An increased fall risk was determined in 482 or 24.8% (95% CI: [22.9, 26.8]) of the patients. The multivariate model showed a significant association of increased fall risk with higher age (p<0.001), lower systolic blood pressure (p=0.047), poor family function (p=0.016), increased risk of malnutrition (p=0.013), higher number of chronic diseases (p=0.027), higher pain intensity (p<0.001), lower self-assessment of current health (p=0.002), and higher dependence in daily activities (p<0.001).

Conclusion

Non-attenders may have an increased risk of falling which depends on their health status and age. The inclusion of community nurses in primary healthcare teams could be of use not only to identify the non-attenders’ health needs, but also to better manage their health, especially the factors that were identified to be associated with greater fall risk.

Environmental interventions for preventing falls in older people living in the community

BACKGROUND

Falls and fall-related injuries are common. A third of community-dwelling people aged over 65 years fall each year. Falls can have serious consequences including restricting activity or institutionalisation. This review updates the previous evidence for environmental interventions in fall prevention.

OBJECTIVES

To assess the effects (benefits and harms) of environmental interventions (such as fall-hazard reduction, assistive technology, home modifications, and education) for preventing falls in older people living in the community.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, other databases, trial registers, and reference lists of systematic reviews to January 2021. We contacted researchers in the field to identify additional studies.

SELECTION CRITERIA

We included randomised controlled trials evaluating the effects of environmental interventions (such as reduction of fall hazards in the home, assistive devices) on falls in community-residing people aged 60 years and over.   DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Our primary outcome was rate of falls.

MAIN RESULTS

We included 22 studies from 10 countries involving 8463 community-residing older people. Participants were on average 78 years old, and 65% were women. For fall outcomes, five studies had high risk of bias and most studies had unclear risk of bias for one or more risk of bias domains. For other outcomes (e.g. fractures), most studies were at high risk of detection bias. We downgraded the certainty of the evidence for high risk of bias, imprecision, and/or inconsistency.  Home fall-hazard reduction (14 studies, 5830 participants) These interventions aim to reduce falls by assessing fall hazards and making environmental safety adaptations (e.g. non-slip strips on steps) or behavioural strategies (e.g. avoiding clutter).  Home fall-hazard interventions probably reduce the overall rate of falls by 26% (rate ratio (RaR) 0.74, 95% confidence interval (CI) 0.61 to 0.91; 12 studies, 5293 participants; moderate-certainty evidence); based on a control group risk of 1319 falls per 1000 people a year, this is 343 (95% CI 118 to 514) fewer falls. However, these interventions were more effective in people who are selected for higher risk of falling, with a reduction of 38% (RaR 0.62, 95% CI 0.56 to 0.70; 9 studies, 1513 participants; 702 (95% CI 554 to 812) fewer falls based on a control risk of 1847 falls per 1000 people; high-certainty evidence). We found no evidence of a reduction in rate of falls when people were not selected for fall risk (RaR 1.05, 95% CI 0.96 to 1.16; 6 studies, 3780 participants; high-certainty evidence). Findings were similar for the number of people experiencing one or more falls. These interventions probably reduce the overall risk by 11% (risk ratio (RR) 0.89, 95% CI 0.82 to 0.97; 12 studies, 5253 participants; moderate-certainty evidence); based on a risk of 519 per 1000 people per year, this is 57 (95% CI 15 to 93) fewer fallers. However, for people at higher risk of falling, we found a 26% decrease in risk (RR 0.74, 95% CI 0.65 to 0.85; 9 studies, 1473 participants), but no decrease for unselected populations (RR 0.99, 95% CI 0.92 to 1.07; 6 studies, 3780 participants) (high-certainty evidence). These interventions probably make little or no important difference to health-related quality of life (HRQoL) (standardised mean difference 0.09, 95% CI -0.10 to 0.27; 5 studies, 1848 participants; moderate-certainty evidence). They may make little or no difference to the risk of fall-related fractures (RR 1.00, 95% 0.98 to 1.02; 2 studies, 1668 participants), fall-related hospitalisations (RR 0.96, 95% CI 0.87 to 1.06; 3 studies, 325 participants), or in the rate of falls requiring medical attention (RaR 0.91, 95% CI 0.58 to 1.43; 3 studies, 946 participants) (low-certainty evidence). The evidence for number of fallers requiring medical attention was unclear (2 studies, 216 participants; very low-certainty evidence). Two studies reported no adverse events. Assistive technology Vision improvement interventions may make little or no difference to the rate of falls (RaR 1.12, 95% CI 0.84 to 1.50; 3 studies, 1489 participants) or people experiencing one or more falls (RR 1.09, 95% CI 0.79 to 1.50) (low-certainty evidence). We are unsure of the evidence for fall-related fractures (2 studies, 976 participants) and falls requiring medical attention (1 study, 276 participants) because the certainty of the evidence is very low. There may be little or no difference in HRQoL (mean difference 0.40, 95% CI -1.12 to 1.92) or adverse events (falls while switching glasses; RR 1.00, 95% CI 0.98 to 1.02) (1 study, 597 participants; low-certainty evidence). Results for other assistive technology - footwear and foot devices, and self-care and assistive devices (5 studies, 651 participants) - were not pooled due to the diversity of interventions and contexts.  Education  We are uncertain whether an education intervention to reduce home fall hazards reduces the rate of falls or the number of people experiencing one or more falls (1 study; very low-certainty evidence). These interventions may make little or no difference to the risk of fall-related fractures (RR 1.02, 95% CI 0.96 to 1.08; 1 study, 110 participants; low-certainty evidence).  Home modifications We found no trials of home modifications that measured falls as an outcome for task enablement and functional independence.

AUTHORS' CONCLUSIONS

We found high-certainty evidence that home fall-hazard interventions are effective in reducing the rate of falls and the number of fallers when targeted to people at higher risk of falling, such as having had a fall in the past year and recently hospitalised or needing support with daily activities. There was evidence of no effect when interventions were targeted to people not selected for risk of falling. Further research is needed to examine the impact of intervention components, the effect of awareness raising, and participant-interventionist engagement on decision-making and adherence.  Vision improvement interventions may or may not impact the rate of falls. Further research is needed to answer clinical questions such as whether people should be given advice or take additional precautions when changing eye prescriptions, or whether the intervention is more effective when targeting people at higher risk of falls. There was insufficient evidence to determine whether education interventions impact falls.

The timing and amplitude of the muscular activity of the arms preceding impact in a forward fall is modulated with fall velocity

Protective arm reactions have been shown to be an important injury avoidance mechanism in unavoidable falls. Protective arm reactions have been shown to be modulated with fall height, however it is not clear if they are modulated with impact velocity. The aim of this study was to determine if protective arm reactions are modulated in response to a forward fall with an initially unpredictable impact velocity. Forward falls were evoked via sudden release of a standing pendulum support frame with adjustable counterweight to control fall acceleration and impact velocity. Thirteen younger adults (1 female) participated in this study. Counterweight load explained more than 89% of the variation of impact velocity. Angular velocity at impact decreased (p < 0.001), drop duration increased from 601 ms to 816 ms (p < 0.001), and the maximum vertical ground reaction force decreased from 64%BW to 46%BW (p < 0.001) between the small and large counterweight. Elbow angle at impact (129 degrees extension), triceps (119 ms) and biceps (98 ms) pre-impact time, and co-activation (57%) were not significantly affected by counterweight load (p-values > 0.08). Average triceps and biceps EMG amplitude decreased from 0.26 V/V to 0.19 V/V (p = 0.004) and 0.24 V/V to 0.11 V/V (p = 0.002) with increasing counterweight respectively. Protective arm reactions were modulated with fall velocity by reducing EMG amplitude with decreasing impact velocity. This demonstrates a neuromotor control strategy for managing evolving fall conditions. Future work is needed to further understand how the CNS deals with additional unpredictability (e.g., fall direction, perturbation magnitude, etc.) when deploying protective arm reactions.

Frequency and Predictors of Falls Among Adults With Heart Failure: A Prospective Study

OBJECTIVE

Adults with heart failure (HF) may be at high risk for falling due to age, comorbidities and frailty; however, few studies have examined falls in HF. The purpose of this study was to quantify the frequency and predictors of falls over 1 year among adults with HF.

METHODS

We conducted a prospective study of adults with New York Heart Association (NYHA) functional class I-IV HF. After baseline assessment of physical frailty and clinical characteristics, participants self-reported falls every 3 months during 1 year. Comparative statistics were used to identify baseline differences between those who fell vs those who did not. A stepwise negative binomial regression model was used to identify predictors of fall rate over 1 year.

RESULTS

The sample (n = 111) was 63.4 ± 15.7 years old, 48% were women, 28% had HF with preserved ejection fraction, and 41% were frail. Over 1 year, 43 (39%) of participants reported at least 1 fall and 28 (25%) of participants reported 2+ falls. Among those who fell, 29 (67%) reported injurious falls. Those who fell had significantly higher body mass indexes and were more likely to have NYHA class III/IV, type 2 diabetes and HF with preserved ejection fraction and to meet slowness and physical exhaustion criteria than those who did not fall. The fall rate was elevated among those with type 2 diabetes and those meeting the slowness and physical exhaustion criteria for physical frailty.

CONCLUSIONS

Nearly 40% of adults with HF experienced a fall within 1 year. Screening for comorbidities, slowness and exhaustion may help to identify those at risk for a fall.

The association of moderate-to-vigorous and light-intensity physical activity on static balance in middle-aged and older-aged adults

BACKGROUND

Falls are the leading cause of injury among adults ≥ 65 years of age. Participation in physical activity (PA) is associated with improved balance, though it is impact in the middle-age population is not well understood.

AIM

The purpose of the current study was to examine the influence of PA intensity on static balance in middle-aged and older aged individuals.

METHODS

Included were middle-aged adults (40-64 years) and older adults (≥ 65 years) from the 2003-2004 years of the National Health and Nutrition Evaluation Survey. Light physical activity (LPA) and moderate-vigorous physical activity (MVPA) were collected via accelerometer and static balance via the Romberg Test of Standing Balance.

RESULTS

No significant odds ratio relationship was found between MVPA or LPA and having good static balance in the middle-aged population; 1.04 (95% CI 0.95, 1.13) p = 0.427 and 1.05 (95% CI 0.97, 1.14) p = 0.182, respectively. Whereas, in older adults, every 60-min increase in LPA was significantly associated with 28% higher odds of good balance (95% CI 1.15, 1.41; p < 0.001), and every 10-min increase in MVPA with 25% higher odds of good balance (95% CI 1.08, 1.45; p = 0.006).

DISCUSSION

LPA and MVPA were not associated with good static balance in middle-aged adults, but in older adults LPA was significantly associated with good static balance.

CONCLUSION

A significant relationship is found between age and fall risk, which is a major concern in the aging population.

Injuries and outcomes resulting due to falls in elderly patients presenting to the Emergency Department of a tertiary care hospital - a cohort study

BACKGROUND

Fall injuries and trauma-related hospitalizations are the most common causes of injury and in-hospital stay amongst the elderly population. After the age of 65, the severity and frequency of fall-related problems increases; the repercussions are challenging for senior citizens, caregivers, and healthcare professionals. This study aims to determine the injuries and outcomes resulting from falls in elderly patients presenting to Emergency Department of a tertiary care hospital.

METHODS

A cohort study design was used. All elderly patients aged ≥ 60 years who visit the Emergency Department with a history of a fall as a primary complaint presenting to the ED of a tertiary care hospital in Karachi, Pakistan were included. A purposive sampling strategy was used to enroll 318 patients from August 2021 to February 2022. The outcome was risk of mortality. Each individual was followed for 90 days to study the outcome. A multivariable logistic regression was applied to check the association between the outcome and covariates. Crude and adjusted risk ratios were reported. A p-value ≤ 0.05 was considered significant.

RESULTS

Of the 318 participants, 265 (83.3%) were fall injury patients with comorbidities. More than half of the patients in both groups were female [32 (60.4%) & 146 (55.1%)]. Eyeglasses were used by most of the fall patients both without and with comorbidities [21 (39.6%) & 152 (57.4%) p 0.018]. There were multiple reasons for a fall including imbalance/dizziness, which was reported by one third of participants in both groups [15 (28.3%) & 77 (29.1%)] followed by a fall from stairs/steps/escalator [15 (28.3%) & 44 (16.6%) p 0.005]. At the end of one month, of those who had a comorbidity 20 (7.5%) expired. The risk of mortality among fall related injuries in elderly patients who were more than 80 years was 1.48 times (95% CI: 1.20-2.10) more likely when compared to those patients who were younger than 80 years.

CONCLUSION

Efforts should be made to improve management of the underlying etiology of falls to prevent them in future. The factors that contribute to falls should be identified. Strategies and interventions should be planned to mitigate this risk of fall in elderly to improve their quality of life.

Relationship between postural stability and fall risk in young adult after lower limb muscle fatigue

Introduction: Muscle fatigue can reduce body balance and activity of daily living tasks. Therefore, this study aims to identify the correlation between postural stability and fall risk due to muscle fatigue. The components in postural stability include Overall Stability Index (OSI), Anterior-Posterior Stability Index (APSI), and Mediolateral Stability Index (MLSI). Design and Methods: A total of seven healthy adults aged 31.1±7.4 years were recruited in this study. The sit-to-stand (STS) protocol was used to induce lower limb muscle fatigue, while postural stability and fall risk were assessed using the Biodex Balance System (BBS) before and after muscle fatigue. Result: The result showed a significant increase in postural stability index after fatigue only for OSI with p<0.05, while no significant difference was found on APSI and MLSI with p=0.157 and p=0.109 respectively. However, the mean score for the postural stability index showed an increase in percentage with 47.8% in OSI, 26.3% in APSI and 46.8% in MLSI.  Furthermore,fall risk showed no significant differences with p=0.149, but the mean score data increased by 16.7% after fatigue. The correlation between fall risk and OSI was significant with p<0.05, while MLSI had a significant negative correlation with APSI (p<0.05). Conclusions: Based on the results, the young adults had reduced overall postural stability but were less affected by fall risk after muscle fatigue. The positive correlation between OSI and fall risk indicated that their overall postural stability can induce the fall risk after muscle fatigue. Therefore, young adults need to be aware of their fatigue symptoms during prolonged exercise that can increase fall risk potential.

Simulation Versus Written Fall Prevention Education in Older Hospitalized Adults: A Randomized Controlled Study

Using a randomized controlled, non-blinded, two-group design, differences in fall risk assessment, post-discharge sustainable fall risk changes, fall events and re-hospitalization were examined in 77 older adults who received a simulation (n = 36) or written (n = 41) education intervention. Between-group differences and changes in pre- versus post-fall risk assessment scores were examined using Pearson's chi-square, Wilcoxon rank sum or Fisher's exact tests (categorical variables) and two-sample t-tests (continuous variables). There were no statistically significant differences between groups in demographic characteristics. Patients who received simulation education had higher fall risk post-assessment scores than the written education group, p = .022. Change in fall risk assessment scores (post-vs.-pre; 95% confidence intervals) were higher in the simulation group compared to the written education group, 1.43 (0.37, 2.50), p = .009. At each post-discharge assessment, fall events were numerically fewer but not significantly different among simulation and education group participants. There were no statistically significant between-group differences in re-hospitalization.

Fall Risk, Sleep Behavior, and Sleep-Related Movement Disorders in Young Urbanites Exposed to Air Pollution

BACKGROUND

Quadruple aberrant hyperphosphorylated tau, amyloid-β, α-synuclein, and TDP-43 pathology had been documented in 202/203 forensic autopsies in Metropolitan Mexico City ≤40-year-olds with high exposures to ultrafine particulate matter and engineered nanoparticles. Cognition deficits, gait, equilibrium abnormalities, and MRI frontal, temporal, caudate, and cerebellar atrophy are documented in young adults.

OBJECTIVE

This study aimed to identify an association between falls, probable Rapid Eye Movement Sleep Behavior Disorder (pRBD), restless leg syndrome (RLS), and insomnia in 2,466 Mexican, college-educated volunteers (32.5±12.4 years).

METHODS

The anonymous, online study applied the pRBD and RLS Single-Questions and self-reported night-time sleep duration, excessive daytime sleepiness, insomnia, and falls.

RESULTS

Fall risk was strongly associated with pRBD and RLS. Subjects who fell at least once in the last year have an OR = 1.8137 [1.5352, 2.1426] of answering yes to pRBD and/or RLS questions, documented in 29% and 24% of volunteers, respectively. Subjects fell mostly outdoors (12:01 pm to 6:00 pm), 43% complained of early wake up hours, and 35% complained of sleep onset insomnia (EOI). EOI individuals have an OR of 2.5971 [2.1408, 3.1506] of answering yes to the RLS question.

CONCLUSION

There is a robust association between falls, pRBD, and RLS, strongly suggesting misfolded proteinopathies involving critical brainstem arousal and motor hubs might play a crucial role. Nanoparticles are likely a significant risk for falls, sleep disorders, insomnia, and neurodegenerative lethal diseases, thus characterizing air particulate pollutants' chemical composition, emission sources, and cumulative exposure concentrations are strongly recommended.

Anticholinergic burden measures, symptoms, and fall-associated risk in older adults with polypharmacy: Development and validation of a prognostic model

BACKGROUND

Anticholinergic burden has been associated with adverse outcomes such as falls. To date, no gold standard measure has been identified to assess anticholinergic burden, and no conclusion has been drawn on which of the different measure algorithms best predicts falls in older patients from general practice. This study compared the ability of five measures of anticholinergic burden to predict falls. To account for patients' individual susceptibility to medications, the added predictive value of typical anticholinergic symptoms was further quantified in this context.

METHODS AND FINDINGS

To predict falls, models were developed and validated based on logistic regression models created using data from two German cluster-randomized controlled trials. The outcome was defined as "≥ 1 fall" vs. "no fall" within a 6-month follow-up period. Data from the RIME study (n = 1,197) were used in model development, and from PRIMUM (n = 502) for external validation. The models were developed step-wise in order to quantify the predictive ability of anticholinergic burden measures, and anticholinergic symptoms. In the development set, 1,015 patients had complete data and 188 (18.5%) experienced ≥ 1 fall within the 6-month follow-up period. The overall predictive value of the five anticholinergic measures was limited, with neither the employed anticholinergic variable (binary / count / burden), nor dose-dependent or dose-independent measures differing significantly in their ability to predict falls. The highest c-statistic was obtained using the German Anticholinergic Burden Score (0.73), whereby the optimism-corrected c-statistic was 0.71 after interval validation using bootstrapping and 0.63 in the external validation. Previous falls and dizziness / vertigo had the strongest prognostic value in all models.

CONCLUSIONS

The ability of anticholinergic burden measures to predict falls does not appear to differ significantly, and the added value they contribute to risk classification in fall-prediction models is limited. Previous falls and dizziness / vertigo contributed most to model performance.

Home Modifications for Older Adults: A Systematic Review

While ≧10,000 Americans turn 65 years old every day, only 10% of American homes are "aging ready." Unsafe homes can exacerbate disability, lead to falls, and increase the likelihood of hospitalization. With increased investments in home and community-based services, public health stakeholders are considering home modifications to promote successful aging. While several home modification models exist, there is significant heterogeneity between models and no consensus on critical features. PubMed, EMBASE, and Web of Science were reviewed and twelve randomized controlled trials of home modifications for older adults were identified and evaluated for model structure, reported outcomes, and risk of bias. Overall, occupational therapist-driven home modifications supplemented with clinical, physical activity, and/or behavioral components saw the greatest success. This systematic review discusses the components of these models, highlights particularly effective and frequently used features, and the practice and research needed to create effective next-generation home modification models which promote healthy longevity.

Sex Differences in Falls: The Mediating Role of Gait Stability Ratio and Body Balance in Vulnerable Older Adults

This study, conducted on a large sample of older adults at elevated fall risk (1), aimed to verify statistical differences in gait stability ratio (GSR) and body balance (BB) according to sex, (2) to examine and compare GSR and BB performance between older adult fallers and non-fallers, (3) to determine an association between GSR and BB according to the history of falls, and (4) to explore whether GSR and BB mediate the association between sex and falls. We included 619 individuals (69.8 ± 5.6 years) living in the Autonomous Region of Madeira, Portugal. The frequency of falls was obtained by self-report. BB was determined by the Fullerton Advanced Balance scale, while GSR was established by dividing cadence by gait speed and data collected during the 50-foot walk test. Males indicated a lower prevalence of falls in the last 12 months (23.6%), while females had a higher score (48.7%), as well as a lower balance performance (p < 0.001) and higher GSR scores (p < 0.001). Lower BB control (p < 0.001), as well as higher GSR, were more expressive for fallers (p < 0.001). We found a large, negative and significant correlation between GSR and BB for historical falls (r = −0.560; p < 0.001), and between male and female cohorts (r = −0.507; p < 0.001). The total effect of sex on falls mediated by GSR and BB was 16.4%. Consequently, GSR and BB mediated this association by approximately 74.0% and 22.5%, respectively.