Circumstances of fall-related injuries by age and gender among community-dwelling adults in the United States

Age-Related differences in arm acceleration and center of mass control during a slip incident

Arm abduction motion can help reduce lateral center of mass (CoM) excursion and restore balance within the frontal plane during slip perturbations. This study aimed to quantify and compare frontal plane arm kinematics and their relationship with CoM control between older and younger adults experiencing a slip. Eleven older adults (age: 72.0 ± 5.0 years) and eleven younger adults (age: 25.5 ± 6.1 years) underwent an induced slip perturbation while walking. Although peak arm abduction angles were similar between groups, younger adults achieved peak arm abduction significantly earlier (542 ± 67 ms) compared to older adults (853 ± 509 ms; p = 0.03). Additionally, younger adults exhibited significantly higher peak arm abduction acceleration compared to older adults (3593.21 ± 1144.80 vs. 2309.83 ± 1428.48 degrees/s2; p = 0.03). Younger adults also demonstrated significantly reduced lateral CoM excursion relative to older adults (4.6 ± 3.5 cm vs. 10.47 ± 6.6 cm; p < 0.01). Peak arm abduction acceleration negatively correlated with lateral CoM excursion (r = -0.52, p < 0.02), indicating that rapid arm movements are associated with improved balance control. A regression analysis confirmed arm abduction acceleration as a significant predictor of lateral CoM displacement (p = 0.005) meaning every 1000 degrees/s2 increase in arm acceleration results in an approximate 2 cm decrease in lateral CoM displacement during a slip. These findings suggest older adults' diminished arm acceleration in response to slips potentially compromises their ability to stabilize their CoM effectively, highlighting a possible target for fall-prevention interventions.

An Exploration of the Effects of Gait Speed and Joint Movements on Minimum Toe Clearance Across the Lifespan: A Cross-Sectional Study

The effect of gait speed on minimum toe clearance (MTC) amount may vary across the lifespan due to changes in joint relationships, potentially affecting trip-related fall risk in older adults. We evaluated whether age influences the relationship between gait speed and MTC amount, as well as between joint movements and MTC amount. Optical motion capture data was collected on 62 participants between the ages of 20 and 83 years during 25 gait trials at self-selected normal, fast, and slow speeds. Multilevel models were used for data analysis. Gait speed was associated with a 0.13 cm increase in MTC amount for every meter per second increase in gait speed with other factors constant and was unaffected by age. Ankle dorsi-plantarflexion, knee and hip flexion-extension, and stance hip abduction-adduction changed the MTC amount by 0.05, 0.02, 0.04, and 0.04 cm, respectively, for each degree of joint movement, with other factors constant, and was unaffected by age. Age did not affect the relationship between gait speed and MTC amount, nor the relationship of joint moments with MTC, indicating that these factors may not be associated with trip-related fall risk with healthy aging.

Trends and determinants of falls: A generalized estimating equations modelling approach using serial data from the Geelong Osteoporosis Study

BACKGROUND

With Australia's aging population, the incidence of falls is expected to rise. The proportion of adults aged ≥65 years is projected to increase from 15 % in 2017 to 22 % by 2057, highlighting the growing need for effective fall prevention measures. Therefore, this study aimed to assess fall trends and determinants using repeated follow-up data from a population-based study.

METHODS

This study utilized data from the Geelong Osteoporosis Study (GOS) to analyse fall trends in men and women. Men's data were collected at baseline (2001-2006; n = 1533), 5 years (2006-2011; n = 968), and 15 years (2016-2021; n = 627), while women's data were from 6 years (2001-2003; n = 1014), 10 years (2004-2008; n = 1098), and 15 years (2011-2014; n = 844). Falls data, self-reported for the past 12 months, were age-standardised to the Australian population. Data included self-reported prior fractures, medications, comorbidities, alcohol use, and smoking, along with measured anthropometrics, muscle strength, biochemical tests, and imaging. A multivariable Generalised Estimating Equation model identified fall determinants, reporting adjusted odds ratios (AORs) and 95 % confidence intervals.

RESULTS

In men, the age-adjusted prevalence of falls declined over time, while in women, it initially dropped by 4.2 % before a slight 0.6 % increase. After adjusting for confounders, each additional year of age raised the fall risk by 1 % (AOR = 1.01, 95 % CI: 1.00-1.02). Women had a 52 % higher likelihood of falling than men (AOR = 1.52, 95 % CI: 1.22-1.88). Diabetes increased the risk by 69 % (AOR = 1.69, 95 % CI: 1.23-2.31), while a 1 N/kg increase in hip flexion strength lowered the risk by 3 % (AOR = 0.97, 95 % CI: 0.95-0.99).

CONCLUSION

Men experienced a steady decrease in fall prevalence over time, whereas women displayed a more intricate trend, with falls initially declining before subsequently rising, following a polynomial pattern. The key predictors of falls included age, sex, diabetes and hip flexion strength. Policies should prioritize tailored fall prevention, strength training, and diabetes care integration.

Burden of falls in China, 1992-2021 and projections to 2030: a systematic analysis for the global burden of disease study 2021

Background

The escalating burden of falls in China necessitates a detailed examination to elucidate its dynamics and trends. Using data from the Global Burden of Disease Study (GBD) 2021, this research assessed the burden of falls in China.

Methods

Data from GBD 2021 were analyzed using Joinpoint regression to identify long-term trends. The impact of mortality and disability-adjusted life years (DALYs) rate for falls was investigated through the age-period-cohort model. Additionally, a decomposition analysis was performed to ascertain the distinct impacts of population growth, aging, and epidemiological changes on the burden of falls from 1992 to 2021. Furthermore, this study employed both the BAPC and Nordpred models to project future burdens of falls.

Results

From 1992 to 2021 in China, the age-standardized rates of falls showed divergent trends. Prevalence and incidence rates increased, while mortality rates generally decreased. Males consistently exhibited higher rates than females. The rates of prevalence, incidence, and mortality exhibit a sharp increase beyond the age of 75 in 2021. Decomposition analysis identified aging as the primary driver of increased prevalence and mortality, particularly in females. Joinpoint regression analysis revealed fluctuating trends in prevalence and incidence with periods of increase and decline, and a general decrease in mortality except during brief intervals. DALYs and years of life lost (YLLs) rates generally decreased, with intervals of stabilization and minor increases, while years lived with disability (YLDs) showed significant fluctuations. By 2030, the projected DALYs rate for falls is expected to rise to approximately 547.4 per 100,000. Fractures of the lower extremity predominated as the leading cause of disability post-fall, with hip fractures increasingly contributing to disability among the older adult. Additionally, from 1992 to 2021, the population attributable fraction (PAF) of low bone mineral density for DALYs due to falls increased to 23.2%, with the PAF reaching 33.3% among women in 2021.

Conclusion

Falls continue to significantly burden public health in China. Our findings highlight the urgent need to develop targeted prevention and intervention strategies that cater to the country's unique demographic characteristics, aiming to mitigate the growing public health impact of falls.

Multimodal Factors Affect Longitudinal Changes in Dynamic Balance in Community-Dwelling Older Adults

Purpose

Dynamic balance, an important contributor to fall risk in older adults, involves maintaining the center of pressure while in locomotive states and is. Fall risk appraisal (FRA) is defined as assessing an older adult's awareness of their physiological and perceived fall risk. This longitudinal study aimed to evaluate how multimodal factors predict fluctuations in dynamic balance in community-dwelling low-income older adults, utilizing fear of falling (FoF), static balance, fall history, and moderate-to-vigorous physical activity (MVPA).

Patients and Methods

The longitudinal study included 140 community-dwelling, low-income older adults, with 124 women and 16 men. FoF was assessed using the Short Falls Efficacy Scale International (Short FES-I) and static balance using BTracks Balance Test (BBT). Both were utilized to define FRA Distance, an integrated quantification of physiological and perceived balance deficits. MVPA was assessed using accelerometers, fall history using self-report, and dynamic balance using the Timed Up and Go (TUG) test. The study was conducted at 4 timepoints at T1 (baseline), T2 (2 months), T3 (4 months), and T4 (6 months).

Results

Using mixed effects multilevel models, TUG scores were predicted by time, %MVPA, and FRA distance ratio. The effect of FRA distance ratio was primarily driven by FoF, and the effect of %MVPA varied by age. Additionally, while fall history did not show a predictive relationship with TUG scores, it did predict FRA distance.

Conclusion

Dynamic balance fluctuated over time and was influenced by multimodal factors, namely MVPA and FRA, which captured the interplay between static balance and FoF. Fall history did not directly predict dynamic balance but played a role in FRA, implicating the subjective effects of fall history. These findings demonstrate how physical activity, FRA, and their interactions can predict changes in dynamic balance. Future work can utilize the results to evaluate low-cost interventions for community-dwelling older adults.

The association between zero-crossing temperatures and accidents due to icy conditions

AIMS

Rising temperatures lead to milder winters in Scandinavia. In certain regions, this could increase the number of winter days that fluctuate around 0°C (zero crossings). It has been frequently suggested that there is a higher risk of icy conditions during such days, which may lead to a predisposition to falls and road traffic accidents. Here, we examine the association between number of days with zero crossings and the number of hospitalisations and outpatient visits due to falls related to ice or snow or transport accidents.

METHODS

We used Poisson regression to examine the association between the number of days with zero crossings and the incidence of inpatient and outpatient visits related to falls due to ice and snow and to transport accidents during 2001-2017 in the Swedish cities of Stockholm, Malmö and Umeå.

RESULTS

We found a positive and significant association between the number of days of zero crossings and the number of in- and outpatient cases due to falls related to ice and snow. These associations were strongest in Umeå but less obvious in Stockholm and Malmö. In terms of injuries related to transport accidents, we saw a significant association between inpatient cases and number of zero crossings in Stockholm but not in Malmö or Umeå.

CONCLUSIONS

An increased number of zero crossings may increase out- and inpatient visits related to falls due to ice and snow or transport accidents. This effect is more pronounced in the northern city of Umeå than in Malmö, a city in Sweden's southern-most region.

Gender Differences in Joint Biomechanics During Obstacle Crossing with Different Heights

Identifying gender-related gait changes offers valuable insights into the role of gender in motor control. It is anticipated that more difficult gait tasks (obstacle crossing) may reveal gender-specific effects on gait parameters. The present study aimed to explore the gait adaptations of male and female participants when stepping over obstacles of 0 cm, 13 cm, 19 cm, and 26 cm in height. A total of 12 male and 12 female participants were recruited. The Vicon motion capture system and AMTI force plates were utilized to obtain the gait parameters. Moreover, spatiotemporal parameters were investigated. Two-way repeated ANOVA (gender × obstacle height) and three-way repeated ANOVA (gender × obstacle height × leg) were performed to compare gait parameters, respectively. Correlations between maximum joint angle and obstacle height were also evaluated. Significant interactions were observed for leading leg swing time, maximum hip extension angle, maximum knee flexion angle, and maximum ankle plantarflexion angle (gender × obstacle height). There were some differences in gait parameters between males and females in the unobstructed gait, and these changes became more evident as obstacle height increased. This study also identified significant differences in gait parameters between leading and trailing legs when stepping over the obstacle.

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.

Prevalence of indications of alcohol and drug use among patients treated for injurious falls by Emergency Medical Services in the USA

OBJECTIVE

The association between alcohol consumption and increased injuries from falls is well established, but there is a lack of data on the prevalence of substance use by fall type. This study aims to describe the distribution of alcohol and drug involvement in injurious falls.

METHODS

Using the 2019 National Emergency Medical Services (EMS) Information System data set, we identified 1 854 909 patients injured from falls requiring an EMS response and determined the fall location (eg, indoors or on street/sidewalk). We analysed data on the EMS clinician's notation of alcohol or drug involvement and Glasgow Coma Scale.

RESULTS

Overall, for 7.4% of injurious falls, there was a notation of substance use: 6.5% for alcohol alone, 0.6% for drugs and 0.3% for alcohol and drugs. 21.2% of falls that occurred on a street or sidewalk had a notation of substance use. Substance use prevalence was highest, at 30.3%, in the age group 21-64 years, for falls occurring on streets and sidewalks, without syncope or heat illness as contributing factors. Reported substance use involvement was more frequent for men compared with women for each location type. Glasgow Coma Scale scores indicative of moderate or severe trauma were more prevalent among falls involving alcohol and/or drugs.

CONCLUSIONS

Overall, one in five injurious falls on streets and sidewalks and requiring EMS attention involved substance use, and these numbers likely underestimate the true burden. As cities seek to expand nightlife districts, design strategies to protect pedestrians from falls should be enacted.

Characteristics of falls in Japanese community-dwelling older adults

OBJECTIVE

Understanding the characteristics of falls among older adults is necessary to prevent them. These characteristics include questions such as when (month and time), where (places), who (age), what (injury), why (trigger), and how (direction) the falls occur. The objective of this study was to identify the characteristics of falls in individuals aged 65-74 years (young-old), 75-84 years (old-old), and ≥85 years (oldest-old).

METHODS

We conducted an observational mail survey among community-dwelling older adults in Japan and collected detailed information on the incidence of falls over the past 3 years. The month, time, location, trigger, direction, and resulting trauma of each fall were analyzed and compared across the different age groups (young-old, old-old, and oldest-old).

RESULTS

A total of 1695 falls among 1074 community-dwelling older adults were analyzed in this study. Falls were frequent during May and October as well as during the winter season from December to February, especially between 10:00 a.m. and 11:00 a.m. These fall characteristics were consistent across all the age groups. There was a higher incidence of outdoor falls among relatively young older adults, which were typically caused by tripping or slipping. However, as one progresses with age, there is a higher incidence of falls indoors, typically due to loss of balance or leg entrapment. Approximately 60% of older fallers experience some form of injury due to falls, with fractures considered the most serious, occurring in ≈10% of all falls.

CONCLUSION

We clarified the characteristics of falls including the "when, where, who, what, why, and how" of the fall. A future challenge is to use this valuable information to develop effective fall prevention programs for older populations worldwide. Geriatr Gerontol Int 2024; 24: 1181-1188.

Association between arteriosclerosis, hemodynamic indices, and the risk of falls: receiver operating characteristic curve analysis for different indices in older individuals

Objective

This study aimed to assess the risk factors for falls and evaluate the correlation between arteriosclerosis, hemodynamic indices, and the risk of falls in older individuals.

Method

This cross-sectional study included 920 individuals aged 60 and above from the cadre ward of the First Hospital of Jilin University. Data were obtained from the comprehensive geriatric assessment database of the cadre ward. Ankle-brachial indices (ABI) and brachial-ankle pulse wave velocity (baPWV) were measured using an OMRON arteriosclerosis detection device. Hemodynamic indices were assessed using the CSM3100 thoracic impedance hemodynamic detection system. Fall risk was evaluated with the fall risk assessment tool.

Results

Significant differences in age, weight, education, smoking status, alcohol consumption, cognitive impairment, malnutrition, daily living abilities, depressive state, baPWV, ABI (all p < 0.001), systolic pressure, heart rate, cardiac stroke volume, and systemic vascular resistance were observed among the three groups (p = 0.011, p = 0.035, p = 0.005, p = 0.016). Ordinal logistic regression analysis indicated that the probability of an increase in fall risk by one level was 2.069 times higher for each unit decrease in educational background. Additionally, fall risk increased by 2.492 times for each additional year of age, 55.813 times for each unit of weight, 3.208 times for smoking status, 3.610 times for alcohol consumption, 4.665 times for cognitive impairment, 2.247 times for malnutrition, 2.596 times for ABI, 2.092 times for heart rate, and 1.586 times for cardiac stroke volume. The receiver operating characteristic curve analysis for fall risk in older individuals demonstrated that ABI was superior to heart rate and systemic vascular resistance in predicting the occurrence of falls.

Conclusion

Our findings indicate that age, weight, educational background, smoking status, alcohol consumption, cognitive impairment, malnutrition, ABI, systolic blood pressure, heart rate, and cardiac stroke volume are associated with an increased risk of falls in older adults. Moreover, arteriosclerosis and hemodynamic parameters may aid in the early identification of fall risk among older individuals.

Clinical trauma severity of indoor and outdoor injurious falls requiring emergency medical service response

BACKGROUND

Injurious falls represent a significant public health burden. Research and policies have primarily focused on falls occurring indoors despite evidence that outdoor falls account for 47-58% of all falls requiring some medical attention. This study described the clinical trauma severity of indoor versus outdoor injurious falls requiring Emergency Medical Services (EMS) response.

METHODS

Using the 2019 National Emergency Medical Services Information System (NEMSIS) dataset, we identified the location of patients injured from falls that required EMS response. We classified injury severity using (1) the Revised Trauma Score for Triage (T-RTS): ≤ 11 indicated the need for transport to a Trauma Center; (2) Glasgow Coma Scale (GCS): ≤ 8 and 9-12 indicated severe and moderate neurologic injury; and (3) patient clinical acuity by EMS: Dead, Critical, Emergent, Low.

RESULTS

Of 1,854,909 encounters for patients with injurious falls, the vast majority occurred indoors (n = 1,596,860) compared to outdoors (n = 152,994). For patients who fell indoors vs outdoors on streets or sidewalks, the proportions were comparable for moderate or severe GCS scores (3.0% vs 3.9%), T-RTS scores indicating need for transport to a Trauma Center (5.2% vs 5.9%) and EMS acuity rated as Emergent or Critical (27.7% vs 27.1%). Injurious falls were more severe among male patients compared to females and males injured by falling on streets or sidewalks had higher percentages for moderate or severe GCS scores (5.2% vs 1.9%) and T-RTS scores indicating the need for transport to a Trauma Center (7.3% vs 3.9%) compared to falling indoors. Young and middle-aged patients who fell on streets or sidewalks had higher proportions for a T-RTS score indicating the need for Trauma Center care compared to those in this subgroup who fell indoors. Yet older patients injured by falling indoors were more likely to have a T-RTS score indicating the need for transport to a Trauma Center than older patients who fell on streets or sidewalks.

CONCLUSIONS

There was a similar proportion of patients with severe injurious falls that occurred indoors and outdoors on streets or sidewalks. These findings suggest the need to determine outdoor environmental risks for outdoor falls to support location-specific interventions.

Mortality due to falls by county, age group, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities

BACKGROUND

Fall-related mortality has increased rapidly over the past two decades in the USA, but the extent to which mortality varies across racial and ethnic populations, counties, and age groups is not well understood. The aim of this study was to estimate age-standardised mortality rates due to falls by racial and ethnic population, county, and age group over a 20-year period.

METHODS

Redistribution methods for insufficient cause of death codes and validated small-area estimation methods were applied to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual fall-related mortality. Estimates from 2000 to 2019 were stratified by county (n=3110) and five mutually exclusive racial and ethnic populations: American Indian or Alaska Native (AIAN), Asian or Pacific Islander (Asian), Black, Latino or Hispanic (Latino), and White. Estimates were corrected for misreporting of race and ethnicity on death certificates using published misclassification ratios. We masked (ie, did not display) estimates for county and racial and ethnic population combinations with a mean annual population of less than 1000. Age-standardised mortality is presented for all ages combined and for age groups 20-64 years (younger adults) and 65 years and older (older adults).

FINDINGS

Nationally, in 2019, the overall age-standardised fall-related mortality rate for the total population was 13·4 deaths per 100 000 population (95% uncertainty interval 13·3-13·6), an increase of 65·3% (61·9-68·8) from 8·1 deaths per 100 000 (8·0-8·3) in 2000, with the largest increases observed in older adults. Fall-related mortality at the national level was highest across all years in the AIAN population (in 2019, 15·9 deaths per 100 000 population [95% uncertainty interval 14·0-18·2]) and White population (14·8 deaths per 100 000 [14·6-15·0]), and was about half as high among the Latino (8·7 deaths per 100 000 [8·3-9·0]), Black (8·1 deaths per 100 000 [7·9-8·4]), and Asian (7·5 deaths per 100 000 [7·1-7·9]) populations. The disparities between racial and ethnic populations varied widely by age group, with mortality among younger adults highest for the AIAN population and mortality among older adults highest for the White population. The national-level patterns were observed broadly at the county level, although there was considerable spatial variation across ages and racial and ethnic populations. For younger adults, among almost all counties with unmasked estimates, there was higher mortality in the AIAN population than in all other racial and ethnic populations, while there were pockets of high mortality in the Latino population, particularly in the Mountain West region. For older adults, mortality was particularly high in the White population within clusters of counties across states including Florida, Minnesota, and Wisconsin.

INTERPRETATION

Age-standardised mortality due to falls increased over the study period for each racial and ethnic population and almost every county. Wide variation in mortality across geography, age, and race and ethnicity highlights areas and populations that might benefit most from efficacious fall prevention interventions as well as additional prevention research.

FUNDING

US National Institutes of Health (Intramural Research Program, National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; Intramural Research Program, National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research).

Prevalence of indications of alcohol and drug use among patients treated for injurious falls by Emergency Medical Services

Objective

To describe the distribution of alcohol and drug involvement in injurious falls by location and subtype of fall.

Methods

Using the 2019 National Emergency Medical Services Information System (NEMSIS) dataset we identified 1,854,909 patients injured from falls requiring an Emergency Medical Services (EMS) response and determined the fall location (e.g. indoors or on street/sidewalk) and the EMS clinician's notation of alcohol or drug involvement. We analyzed substance involvement by fall subtype, location of fall and patient demographics.

Results

Overall, for 7.4% of injurious falls there was a notation of substance use: 6.5% for alcohol alone, 0.6% for drugs and 0.3% for alcohol and drugs. 21.2% of falls that occurred on a street or sidewalk had a notation of substance use; alcohol use alone for 18.5% of falls, drugs alone for 1.7% of falls and alcohol and drugs for 0.9% of falls. Substance use prevalence was highest, at 30.3%, in the age group 21 to 64 years, for falls occurring on streets and sidewalks, without syncope or heat illness as contributing factors; alcohol use alone for 26.3%, drugs alone for 2.6%, and alcohol and drugs for 1.4%. Reported substance use involvement was more frequent for men compared to women for each location type.

Conclusions

Overall, 1-in-5 injurious falls on streets and sidewalks and requiring EMS attention involved substance use, and these numbers likely underestimate the true burden. As cities seek to expand nightlife districts, design strategies to protect pedestrians from falls should be enacted.

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.

Clinical Trauma Severity of Indoor and Outdoor Injurious Falls Requiring Emergency Medical Service Response

Background

Injurious falls represent a significant public health burden. Research and polices have primarily focused on falls occurring indoors despite evidence that outdoor falls account for 47-58% of all falls requiring some medical attention. This study compared the clinical trauma severity of indoor versus outdoor injurious falls requiring Emergency Medical Services (EMS) response.

Methods

Using the 2019 National Emergency Medical Services Information System (NEMSIS) dataset, we identified the location of patients injured from falls that required EMS response. We classified injury severity using 1) the Revised Trauma Score for Triage (T-RTS): ≤ 11 indicated the need for transport to a Trauma Center; 2) Glasgow Coma Scale (GCS): ≤8 and 9-12 indicated moderate and severe neurologic injury; and 3) patient clinical acuity by EMS: Dead, Critical, Emergent, Low.

Results

Of 1,854,909 encounters for patients with injurious falls, the vast majority occurred indoors (n=1,596,860) compared to outdoors (n=152,994). The proportions of patients with moderate or severe GCS scores, were comparable between those with indoor falls (3.0%) and with outdoor falls on streets or sidewalks (3.8%), T-RTS scores indicating need for transport to a Trauma Center (5.2% vs 5.9%) and EMS acuity rated as Emergent or Critical (27.7% vs 27.1%).Injurious falls were more severe among male patients compared to females: and males injured by falling on streets or sidewalks had higher percentages for moderate or severe GCS scores (4.8% vs 3.6%) and T-RTS scores indicating the need for transport to a Trauma Center (7.3% vs 6.5%) compared to indoor falls. Young and middle-aged patients whose injurious falls occurred on streets or sidewalks were more likely to have a T-RTS score indicating the need for Trauma Center care compared to indoor falls among this subgroup. Yet older patients injured by falling indoors were more likely to have a T-RTS score indicating the need for Trauma Center than older patients who fell on streets or sidewalks.

Conclusions

There was a similar proportion of patients with severe injurious falls that occurred indoors and on streets or sidewalks. These findings suggest the need to determine outdoor environmental risks for outdoor falls to support location-specific interventions.

Branching Out: A Retrospective Review of Tree Fall-Related Trauma

Introduction Falls from trees (FFTs), although rare, represent a significant public health concern due to the severe consequences they can impose. Such incidents, while statistically uncommon across the wider population, have the potential to cause drastic, lasting alterations in patients' lives. The severity of these events is often substantial, highlighted by high Injury Severity Scores (ISSs) and prolonged hospital length of stay (LOS), which brings to light the urgent need for preventive strategies and heightened awareness. Our study aims to present a current epidemiological understanding of the patterns, nature, and severity of injuries caused by FFTs. Additionally, it provides an analysis and comparison of data obtained from a de-identified trauma database of patients presenting after FFTs. Methods This review presents data from a trauma registry system detailing trauma admissions from March 31, 2016, to December 27, 2021, at the Desert Regional Medical Center in Palm Springs, California, United States, a designated Level 1 trauma center. Throughout this period of nearly five years and eight months, a total of 3,148 patients were recorded to have visited the emergency department due to falls. Specifically, the study zeroes in on the subset of patients who were admitted after experiencing FFTs. From the comprehensive retrospective examination, it was noted that among the 3,148 fall incidents, there were 50 cases that involved FFTs. Results This retrospective analysis focused on 50 patients treated at the emergency department after FFTs, with a predominantly male demographic profile of 49 (98%) and an average age of 44 years. Hospitalization was required for the vast majority (44%), with approximately one-third necessitating ICU care. Surgical procedures were necessary for 35 (70%) of these cases. Upon discharge, 36 (72% of patients) were able to return home. Vertebral fractures were the most frequent injury, present in 24 (22% of admissions), followed closely by soft tissue injuries at 23 (21%). The mean ISS was 11, although those with extended hospital stays of over 10 days had higher ISS scores of 16, in contrast to an ISS of 10 for those with shorter stays. Conclusions FFTs constitute a lesser-known category of trauma-related injuries in the broader spectrum of fall-related incidents. Although relatively infrequent, these incidents result in significant injury burdens. The objective of this review is to compile and summarize the existing body of literature on FFTs. It involves an in-depth analysis of admission, discharge, and demographic data related to FFTs, highlighting the significant consequences associated with such accidents. Additionally, this review incorporates an analysis of a specialized dataset dedicated to injuries resulting from FFTs, facilitating a comparative assessment against current research in this field.

Association between physical activity and health-related quality of life among adults in China: the moderating role of age

Objective

The aim of the study was to examine the association between physical activity (PA) and health-related quality of life (HRQOL) among adults and explore the role of age in the association between PA and HRQOL in Shandong, China.

Methods

We investigated the relationship between PA and HRQOL and examined the moderated role of age in this association among adults with different age groups and physical activity levels. Data were obtained from the sixth China National Health Services Survey conducted in Shandong province in 2018. The multi-stage-stratified cluster random sampling method was used to selected respondents, with individuals aged 18 and above included in the present study. The tool of assessing HRQOL was the three-level EuroQol Five Dimensions Questionnaire (EQ-5D-3L).

Results

The study found PA was significantly related to HRQOL (P < 0.05). The interaction analysis indicated that the relationship between PA and HRQOL was significantly different across young, middle-aged, and older adults (P < 0.05). Older adults with the sufficient PA (coefficient = 0.090, 95%CI: [0.081, 0.100]) and active PA (coefficient = 0.057, 95%CI: [0.043, 0.072]) had significantly higher HRQOL compared with young and middle-aged groups.

Conclusion

PA was positively associated with HRQOL among the adults. Age played a moderate role between the association between PA and HRQOL. Guidelines for PA should be specifically tailored to adults of different age groups in order to enhance their HRQoL.

Removing home hazards for older adults living in affordable housing: A stepped-wedge cluster-randomized trial

BACKGROUND

Falls are the leading cause of injury, disability, premature institutionalization, and injury-related mortality among older adults. Home hazard removal can effectively reduce falls in this population but is not implemented as standard practice. This study translated an evidence-based home hazard removal program (HARP) for delivery in low-income senior apartments to test whether the intervention would work in the "real world."

METHODS

From May 1, 2019 to December 31, 2020, a stepped-wedge cluster-randomized trial was used to implement the evidence-based HARP among residents with high fall risk in 11 low-income senior apartment buildings. Five clusters of buildings were randomly assigned an intervention allocation sequence. Three-level negative-binomial models (repeated measures nested within individuals, individuals nested within buildings) were used to compare fall rates between treatment and control conditions (excluding a crossover period), controlling for demographic characteristics, fall risk, and time period.

RESULTS

Among 656 residents, 548 agreed to screening, 435 were eligible (high fall risk), and 291 agreed to participate and received HARP. Participants were, on average, 72 years, 67% female, and 76% Black. Approximately 95.4% of fall prevention strategies and modifications implemented were still used 3 months later. The fall rate (per 1000 participant-days) was 4.87 during the control period and 4.31 during the posttreatment period. After adjusting for covariates and secular trend, there was no significant difference in fall rate (incidence rate ratio [IRR] 0.97, 95% CI 0.66-1.42). After excluding data collected during a hiatus in the intervention due to COVID-19, the reduction in fall rate was not significant (IRR 0.93, 95% CI 0.62-1.40).

CONCLUSIONS

Although HARP did not significantly reduce the rate of falls, this pragmatic study showed that the program was feasible to deliver in low-income senior housing and was acceptable among residents. There was effective collaboration between researchers and community agency staff.

Mapping sex and gender differences in falls among older adults: A scoping review

BACKGROUND

There is growing recognition of the importance of sex and gender differences within falls literature, but the characterization of such literature is uncertain. The aim of this scoping review was to (1) map the nature and extent of falls literature examining sex or gender differences among older adults, and (2) identify gaps and opportunities for further research and practice.

METHODS

We used a scoping review methodology. Eligible studies included participants with a mean age of ≥ 60 years and study aims specifying falls and either sex or gender concepts. MEDLINE, Embase, CINAHL, Ageline, and Psychinfo databases were searched from inception to March 2, 2022. Records were screened and charted by six independent reviewers. Descriptive and narrative reports were generated.

RESULTS

A total of 15,266 records were screened and 74 studies were included. Most studies reported on sex and gender differences in fall risk factors (n = 52, 70%), incidence/prevalence (n = 26, 35%), fall consequences (n = 22, 30%), and fall characteristics (n = 15, 20%). The majority of studies (n = 70, 95%) found significant sex or gender differences in relation to falls, with 39 (53%) identifying significant sex differences and 31 (42%) identifying significant gender differences. However, only three (4%) studies defined sex or gender concepts and only nine (12%) studies used sex or gender terms appropriately. Fifty-six (76%) studies had more female participants than males. Four (5%) were intervention studies. Studies did not report falls in line with guidelines nor use common fall definitions.

CONCLUSION

Sex and gender differences are commonly reported in falls literature. It is critical for future research to use sex and gender terms appropriately and include similar sample sizes across all genders and sexes. In addition, there is a need to examine more gender-diverse populations and to develop interventions to prevent falls that address sex and gender differences among older adults.

Circumstances of unintentional fall-related adult deaths: Utah, 2010-2020

OBJECTIVE

Fall-related deaths have been on the rise nationwide. Our objective was to characterise the trend in unintentional fall-related adult deaths in Utah and evaluate the underlying and contributing causes associated with these deaths.

METHODS

We used 2010-2020 Utah death certificate data and included all Utah deaths aged 18 and older with a fall listed on their death records as the underlying or contributing cause of death in the analysis.

RESULTS

From 2010 to 2020, the overall age-adjusted unintentional fall death rate increased 70% from 15.7 to 26.8 per 100 000 person-years, while the overall age-adjusted death rate increase was 12% at the time. On average, the group with falls as one of the contributing causes had 4.9 other contributing causes, while the group with falls as an underlying cause had 3.3; the two averages were statistically different. Incidence of death increased 60% (12.1-19.4 per 100 000) for falls classified as the underlying cause of death and 103% (3.6-7.3 per 100 000) for those with fall as a contributing cause. Coding for the type of fall became more specific with a 30% decrease in unspecified fall (International Classification of Diseases, 10th revision code W19) (5.9-4.1 per 100 000).

CONCLUSION

There was an increasing trend of unintentional fall-related adult deaths in Utah from 2010 to 2020. This increase is consistent with national trends. Our data supports there is more specific reporting of fall deaths, but better reporting alone cannot explain the uptrend. Furthermore, the deaths with falls as contributing causes increased the most, and these individuals have more comorbidities.

Falls From Heights: A Retrospective Review of Roof Fall-Related Trauma

Background Falls from roofs (FFRs), while constituting just a segment of all falls, pose a significant public health issue. They not only impact individuals in their daily lives but also pose an increased risk in the construction field. The consequences of these falls range broadly, from minor bruises to serious harm, potentially leading to chronic disability or fatality. For the general populace, such falls might happen during simple activities like maintenance, with outcomes varying from fractures to critical head or spinal injuries. In construction, where elevated work is the norm, the likelihood and potential severity of falls are significantly greater. Construction workers face the threat of falls regularly, with these mishaps often resulting in enduring disabilities that affect both life quality and work capability. Methodology This study presents data from a trauma registry system, covering trauma admissions from March 31, 2016, to December 27, 2021, at a level 1 trauma center (Desert Regional Medical Center, Palm Springs, CA). During this five-year and eight-month period, a total of 3,148 patients presented to the emergency department after a fall. This study focuses on patients admitted after an FFR. A retrospective analysis of this data showed that out of these 3,148 patients, 75 presented after an FFR. Results In this retrospective analysis of 75 patients presenting to the emergency department after an FFR, the patient profile was predominantly male (70, 93%), with an average age of 51 years. Hospitalization was required for the majority of the patients (70, 93%), with a third necessitating intensive care unit (ICU) care. The necessity for surgical procedures was high at 57 (76%). Upon discharge, 8 (11%) patients were moved to acute rehabilitation. Injuries to the extremities were most common, accounting for 21% (36) of cases, in contrast to facial injuries at 8% (15). Upper extremity fractures were the most prevalent presenting injury at 31% (50), while lower extremity fractures were the least at 6% (9). The overall Injury Severity Score (ISS) averaged 12, with patients having hospital length of stays (LOSs) over 10 days presenting higher ISS scores (18) compared to those with shorter stays (ISS of 11). There was no significant difference in ISS between patients aged 60 and above compared to younger patients. Conclusions FFRs represent a substantial cause of injury in both the construction industry and residential settings. This study aims to provide an overview and summary of the existing literature on FFRs, present effective fall prevention methods, and underscore the considerable consequences of such injuries on both construction workers and homeowners. Additionally, it includes an analysis of a dataset detailing injuries resulting from roof-related falls, offering a comparison to existing research.

A National Study on the Comparative Burden of Pedestrian Injuries from Falls Relative to Pedestrian Injuries from Motor Vehicle Collisions

Pedestrian injuries from falls are an understudied cause of morbidity. Here, we compare the burden of pedestrian injuries from falls occurring on streets and sidewalks with that from motor vehicle collisions. Data on injurious falls on streets and sidewalks, and pedestrian-motor vehicle collisions, to which Emergency Medical Services responded, along with pedestrian and incident characteristics, were identified in the 2019 National Emergency Medical Services Information System database. In total, 118,520 injurious pedestrian falls and 33,915 pedestrians-motor vehicle collisions were identified, with 89% of the incidents occurring in urban areas. Thirty-two percent of pedestrians struck by motor vehicles were coded as Emergent or Critical by Emergency Medical Services, while 19% of pedestrians injured by falls were similarly coded. However, the number of pedestrians whose acuity was coded as Emergent or Critical was 2.1 times as high for injurious falls as compared with pedestrians-motor vehicle collisions. This ratio was 3.9 for individuals 50 years and older and 6.1 for those 65 years and older. In conclusion, there has been substantial and appropriate policy attention given to preventing pedestrian injuries from motor vehicles, but disproportionately little to pedestrian falls. However, the population burden of injurious pedestrian falls is significantly greater and justifies an increased focus on outdoor falls prevention, in addition to urban design, policy, and built environment interventions to reduce injurious falls on streets and sidewalks, than currently exists across the USA.

A Systematic Review of the Long-Term Effects of Using Smartphone- and Tablet-Based Rehabilitation Technology for Balance and Gait Training and Exercise Programs

Recent advances in wearable motion sensors, mobile devices, the Internet of Things, and telecommunications have created new potential for telerehabilitation. Recognizing that there is no systematic review of smartphone- or tablet-based balance and gait telerehabilitation technology for long-term use (i.e., four weeks or more), this systematic review summarizes the effects of smartphone- or tablet-based rehabilitation technology on balance and gait exercise and training in balance and gait disorders. The review examined studies written in English published from 2013 to 2023 in Web of Science, Pubmed, Scopus, and Google Scholar. Of the 806 studies identified, 14 were selected, and the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was applied to evaluate methodological quality. The systematic review concluded that all 14 studies found balance and gait performance improvement after four weeks or more of balance and gait telerehabilitation. Ten of the 14 studies found that carry-over effects (improved functional movements, muscle strength, motor capacity, cognition, and reduced fear of falling and anxiety levels) were maintained for weeks to months. The results of the systematic review have positive technical and clinical implications for the next-generation design of rehabilitation technology in balance and gait training and exercise programs.

Nonfatal and Fatal Falls Among Adults Aged ≥65 Years - United States, 2020-2021

In the United States, unintentional falls are the leading cause of injury and injury death among adults aged ≥65 years (older adults). Patterns of nonfatal and fatal falls differ by sex and state. To describe this variation, data from the 2020 Behavioral Risk Factor Surveillance System and 2021 National Vital Statistics System were used to ascertain the percentage of older adults who reported falling during the previous year and unintentional fall-related death rates among older adults. Measures were stratified by demographic characteristics, U.S. Census Bureau region, and state. In 2020, 14 million (27.6%) older adults reported falling during the previous year. The percentage of women who reported falling (28.9%) was higher than that among men (26.1%). The percentage of older adults who reported falling ranged from 19.9% (Illinois) to 38.0% (Alaska). In 2021, 38,742 (78.0 per 100,000 population) older adults died as the result of unintentional falls. The unintentional fall-related death rate was higher among men (91.4 per 100,000) than among women (68.3). The fall-related death rate among older adults ranged from 30.7 per 100,000 (Alabama) to 176.5 (Wisconsin). CDC's Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative recommends that health care providers screen and assess older adults for fall risk and intervene using effective preventive strategies.

Characterizing Fall Circumstances in Community-Dwelling Older Adults: A Mixed Methods Approach

BACKGROUND

Understanding fall circumstances can help researchers better identify causes of falls and develop effective and tailored fall prevention programs. This study aims to describe fall circumstances among older adults from quantitative data using conventional statistical approaches and qualitative analyses using a machine learning approach.

METHODS

The MOBILIZE Boston Study enrolled 765 community-dwelling adults aged 70 years and older in Boston, MA. Occurrence and circumstances of falls (ie, locations, activities, and self-reported causes of falls) were recorded using monthly fall calendar postcards and fall follow-up interviews with open- and close-ended questions during a 4-year period. Descriptive analyses were used to summarize circumstances of falls. Natural language processing was used to analyze narrative responses from open-ended questions.

RESULTS

During the 4-year follow-up, 490 participants (64%) had at least 1 fall. Among 1 829 falls, 965 falls occurred indoors and 804 falls occurred outdoors. Commonly reported activities when the fall occurred were walking (915, 50.0%), standing (175, 9.6%), and going down stairs (125, 6.8%). The most commonly reported causes of falls were slip or trip (943, 51.6%) and inappropriate footwear (444, 24.3%). Using qualitative data, we extracted more detailed information on locations and activities, and additional information on obstacles related to falls and commonly reported scenarios such as "lost my balance and fell."

CONCLUSIONS

Self-reported fall circumstances provide important information on both intrinsic and extrinsic factors contributing to falls. Future studies are warranted to replicate our findings and optimize approaches to analyzing narrative data on fall circumstances in older adults.

A National Study on the Comparative Burden of Pedestrian Injuries from Falls Relative to Pedestrian Injuries from Motor Vehicle Collisions

Pedestrian injuries from falls are an understudied cause of morbidity. Here we compare the burden of pedestrian injuries from falls occurring on streets and sidewalks with that from motor vehicle collisions. Data on injurious falls on streets and sidewalks, and pedestrian-motor vehicle collisions, to which Emergency Medical Services responded, along with pedestrian and incident characteristics, were identified in the 2019 National Emergency Medical Services Information System database. In total, 129,343 injurious falls and 33,910 pedestrians-motor vehicle collisions were identified, with 89% of the incidents occurring in urban areas. Thirty two percent of pedestrians struck by motor vehicles were coded as Emergent or Critical by Emergency Medical Services, while 20% of pedestrians injured by falls were similarly coded. However, the number of pedestrians whose acuity was coded as Emergent or Critical was 2.33 times as high for injurious falls as compared with pedestrians-motor vehicle collisions. This ratio was nearly double at 4.3 for individuals 50 years and older, and almost triple at 6.5 for those 65 years and older. In conclusion, there has been substantial and appropriate policy attention given to preventing pedestrian injuries from motor vehicles, but disproportionately little to pedestrian falls. However, the population burden of injurious pedestrian falls is significantly greater and justifies an increased focus on outdoor falls prevention, in addition to urban design, policy and built environment interventions to reduce injurious falls on streets and sidewalks, than currently exists across the U.S.

Comparison of Finger, Hand, and Wrist Injuries in the US Air Force to US Workers

OBJECTIVE

Fingers, hands, and wrists (FHW) are the most frequently injured body parts in work-related injuries. This study described and compared FHW injuries among enlisted, officer, and civilian US Air Force (USAF) personnel to those in the US workforce.

METHODS

All work-related, noncombat FHW injuries (≥1 lost workday) and demographics among USAF personnel and US workforce (2008-2018) were included. The USAF FHW injury rates were age adjusted to the US employment and compared by sex, source, event, and nature of the injuries.

RESULTS

Finger, hand, and wrist injuries were significantly lower among the USAF personnel and among females. In both populations, FHW injuries from falls were higher and increased with age group among females. Males had higher overall FHW injuries from contact with objects and equipment.

CONCLUSIONS

Prevention efforts should focus on understanding risk factors and sharing successful prevention activities.

Risky behavior during stair descent for young adults: Differences in men versus women

Injuries commonly occur on stairs, with high injury rates in young adults, especially young women. High injury rates could result from physiological and/or behavioral differences; this study focuses on behaviors. The purposes of this observational study were (1) to quantify young adult behaviors during stair descent and (2) to identify differences in stair descent behavior for young adult men versus women. Young adult pedestrians (N = 2,400, 1,470 men and 930 women) were videotaped during descent of two indoor campus staircases, a short staircase (2 steps) and a long staircase (17 steps). Behaviors during stair descent were coded by experimenters. Risky behaviors observed on the short staircase included: No one used the handrail, 16.1% used an electronic device, and 16.4% had in-person conversations. On the long staircase: 64.8% of pedestrians did not use the handrail, 11.9% used an electronic device, and 14.5% had in-person conversations. Risky behaviors observed more in women included: less likely to use the handrail (long staircase), more likely to carry an item in their hands (both staircases), more likely to engage in conversation (both staircases), and more likely to wear sandals or heels (both staircases) (p≤0.05). Protective behaviors observed more in women included: less likely to skip steps (both staircases), and more likely to look at treads during transition steps (long staircase) (p≤0.05). The number of co-occurring risky behaviors was higher in women: 1.9 vs 2.3, for men vs women, respectively (p<0.001). Five pedestrians lost balance but did not fall; four of these pedestrians lost balance on the top step and all five had their gaze diverted from the steps at the time balance was lost. The observed behaviors may be related to the high injury rate of stair-related falls in young adults, and young women specifically.

Correlation analysis between body composition, serological indices and the risk of falls, and the receiver operating characteristic curve of different indexes for the risk of falls in older individuals

Objective

This study assessed the risk factors for falls and evaluated the correlation between body composition, serological indices, and the risk of falls in older individuals.

Method

This cross-sectional study included 387 individuals ≥60 years of age in the cadre ward of the First Hospital of Jilin University. The information used in this study was obtained from the comprehensive geriatric assessment database of the cadre ward. The body composition of the individuals was measured by bioelectrical impedance analysis using an InBody S10 device. We assessed fall risk using the fall risk assessment tool. Individuals with ≤2 points were placed in the low-risk group, those with 3-9 points were placed in the medium-risk group, and those with ≥10 points were placed in the high-risk group.

Results

Differences in age, educational background, height, cognitive impairment, malnutrition, ability of daily living, depression, diastolic blood pressure, heart rate, intracellular water, total body moisture, water ratio, limb moisture (right and left, upper and lower), trunk moisture, fat-free weight, arm girth, body cell mass, skeletal muscle mass, limb muscle (right and left, upper and lower), appendicular skeletal muscle mass index (ASMI), sarcopenia, hemoglobin level, hematocrit level, aspartate aminotransferase level, albumin level, anemia, and hypoproteinemia were observed among the three groups (p < 0.001, p = 0.002, p = 0.006, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.008, p = 0.010). Ordinal logistic regression analysis showed that the probability of the fall risk increasing by one level was 1.902 times higher for each unit of decrease in educational background, respectively. In addition, the probability of the fall risk increasing by one level was 2.971, 3.732, 3.804, 1.690 and 2.155 times higher for each additional unit of age, cognitive impairment, lower limb edema, decreased skeletal muscle mass, and sarcopenia, respectively.

Conclusion

Our findings suggest that educational background, age, cognitive impairment, lower limb edema, decreased skeletal muscle mass, and sarcopenia were associated with falls in older individuals. Body composition and serological indices can assist in the early identification of falls in the older people.

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.

Activities and risk factors associated with fall-related injuries among US Army soldiers

INTRODUCTION

Falls/near falls are the second leading cause of hospitalisation and outpatient visits among US Army soldiers. While numerous studies have evaluated fall-related or near fall-related injuries among elderly adults, few have evaluated this association among young adults. The objective of this study is to describe the characteristics and risk factors associated with fall-related or near fall-related injuries among male US Army soldiers.

METHODS

This is a cross-sectional study of male US Army Airborne Division soldiers (n=5187). Electronic surveys captured demographic, lifestyle, physical training (PT), fitness and injury data during spring/summer of 2016. Multiple logistic regression was used to identify independent risk factors of fall-related or near fall-related injuries, adjusting for potential confounders.

RESULTS

Primary findings indicated that activities and risk factors associated with fall-related or near fall-related injuries among soldiers included younger age (≤35 years), holding a job that required minimal lifting activities, slower 2-mile run times and not running during personal PT.

CONCLUSIONS

The findings from this study suggest that male US Army soldiers and other physically active men may benefit from (1) obtaining and/or maintaining higher aerobic endurance and muscular strength, and (2) training focused on preventing fall-related injuries during PT, road marching and sports/recreational activities. Moreover, prevention strategies and education should further target younger soldiers (≤35 years old), as younger age is not modifiable.

Upward perturbations trigger a stumbling effect

BACKGROUND

Vertical perturbations are one major cause of falling. Incidentally, while conducting a comprehensive study comparing effects of vertical versus horizontal perturbations, we commonly observed a stumbling-like response induced by upward perturbations. The present study describes and characterizes this stumbling effect.

METHODS

Fourteen individuals (10 male; 27 ± 4 yr) walked self-paced on a treadmill embedded in a moveable platform and synchronized to a virtual reality system. Participants experienced 36 perturbations (12 types). Here, we report only on upward perturbations. We determined stumbling based on visual inspection of recorded videos, and calculated stride time and anteroposterior, whole-body center of mass (COM) distance relative to the heel, i.e., COM-to-heel distance, extrapolated COM (xCOM) and margin of stability (MOS) before and after perturbation.

RESULTS

From 68 upward perturbations across 14 participants, 75% provoked stumbling. During the first gait cycle post-perturbation, stride time decreased in the perturbed foot and the unperturbed foot (perturbed = 1.004 s vs. baseline = 1.119 s and unperturbed = 1.017 s vs. baseline = 1.125 s, p < 0.001). In the perturbed foot, the difference was larger in stumbling-provoking perturbations (stumbling: 0.15 s vs. non-stumbling: 0.020 s, p = 0.004). In addition, the COM-to-heel distance decreased during the first and second gait cycles after perturbation in both feet (first cycle: 0.58 m, second cycle: 0.665 m vs. baseline: 0.72 m, p-values<0.001). During the first gait cycle, COM-to-heel distance was larger in the perturbed foot compared to the unperturbed foot (perturbed foot: 0.61 m vs. unperturbed foot: 0.55 m, p < 0.001). MOS decreased during the first gait cycle, whereas the xCOM increased during the second through fourth gait cycles post-perturbation (maximal xCOM at baseline: 0.5 m, second cycle: 0.63 m, third cycle: 0.66 m, fourth cycle: 0.64 m, p < 0.001).

CONCLUSIONS

Our results show that upward perturbations can induce a stumbling effect, which - with further testing - has the potential to be translated into balance training to reduce fall risk, and for method standardization in research and clinical practice.

Dual-tasking interference is exacerbated outdoors: A pilot study

Introduction

Walking while texting can create gait disturbances that may increase fall risk, especially in outdoors environment. To date, no study has quantified the effect of texting on motor behavior using different dynamic tasks in outdoor environments. We aimed to explore the impact of texting on dynamic tasks in indoor and outdoor environments.

Methods

Twenty participants (age 38.3 ± 12.5 years, 12 F) had a Delsys inertial sensor fixed on their back and completed walk, turn, sit-to-stand, and stand-to-sit subtasks with and without texting in both indoor and outdoor environments.

Results

While there was no difference in texting accuracy (p = 0.3), there was a higher dual-tasking cost in walking time with texting outdoors than indoors (p = 0.008).

Discussion

Dual tasking has a greater impact on walking time outdoors compared to an indoor environment. Our findings highlight the importance of patient education concerning dual-tasking and pedestrian safety in clinical settings.

A methodology for the public health surveillance and epidemiologic analysis of outdoor falls that require an emergency medical services response

BACKGROUND

Falls are a common cause of injury with significantly associated medical costs yet public health surveillance of injuries from falls is underdeveloped. In addition, the epidemiologic understanding of outdoor falls, which have been reported to account for 47% of all injurious falls, is scant. Here we present methods to use emergency medical services (EMS) data as a public health surveillance tool for fall injuries, including those that occur secondary to syncope and heat illness, with a focus on the scope and epidemiology of outdoor fall injuries.

METHODS

Using the 2019 National Emergency Medical Services Information System (NEMSIS) data, we developed an approach to identify EMS encounters for fall injuries, syncope and heat illness. NEMSIS variables used in our algorithm included the EMS respondent's impression of the encounter, the reported major symptoms and the cause of injury. With these data we identified injuries from falls and, using the NEMSIS data on the location of the encounter, we identified fall injuries as occurring indoors or outdoors. We present the descriptive epidemiology of the identified patients.

RESULTS

There were 1,854,909 injuries from falls that required an EMS response identified in the NEMSIS data, with 4% of those injuries secondary to episodes of syncope (n = 73,126) and heat illness. Sufficient data were available from 94% of injurious falls that they could be assigned to indoor or outdoor locations, with 9% of these fall injuries occurring outdoors. Among fall injuries identified as occurring outdoors, 85% occurred on streets and sidewalks. Patient age was the primary sociodemographic characteristic that varied by location of the injurious fall. Sixty-six percent of fall injuries that occurred indoors were among those age 65 years or older, while this figure was 34% for fall injuries occurring outdoors on a street or sidewalk.

CONCLUSION

The occurrence of outdoor fall injuries identified in the NEMSIS data were substantially lower than reported in other data sets. However, numerically fall injuries occurring outdoors represent a substantial public health burden. The strengths and weaknesses of using this approach for routine public health surveillance of injuries from falls, syncope and heat illness are discussed.

Validating the ability of a portable shoe-floor friction testing device, NextSTEPS, to predict human slips

Measuring shoe-floor friction is critical for assessing the safety of footwear products. Portable devices for measuring coefficient of friction (COF) are needed. This study introduces such a device and evaluates its ability to predict human slip events across shoe designs. A portable device (18 kg) was utilized to measure 66 unique shoe-floor-fluid coefficients of friction (COF). Consistent with the shoes, flooring, and fluid contaminants from the COF tests, participants (n = 66) were unexpectedly exposed to the fluid while walking. Slip predictions were made based on a separate training data set. Slip predictions were made prospectively and using logistic regression analyses. The slip predictions were valid (p < 0.001), 91% sensitive, and 64% specific. The logistic regression fit also revealed that the COF values predicted slip outcomes (p = 0.006). This device is expected to expand the capacity of researchers, product developers, forensic engineers, and safety professionals to prevent slips and enhance human safety.

Disparities in traumatic brain injury-related deaths-United States, 2020

INTRODUCTION

Traumatic brain injury (TBI) affects how the brain functions and remains a prominent cause of death in the United States. Although preventable, anyone can experience a TBI and epidemiological research suggests some groups have worse health outcomes following the injury.

METHODS

We analyzed 2020 multiple-cause-of-death data from the National Vital Statistics System to describe TBI mortality by geography, sociodemographic characteristics, mechanism of injury (MOI), and injury intent. Deaths were included if they listed an injury International Classification of Diseases, Tenth Revision (ICD-10) underlying cause of death code and a TBI-related ICD-10 code in one of the multiple-cause-of-death fields.

RESULTS

During 2020, 64,362 TBI-related deaths occurred and age-adjusted rates, per 100,000 population, were highest among persons residing in the South (20.2). Older adults (≥75) displayed the highest number and rate of TBI-related deaths compared with other age groups and unintentional falls and suicide were the leading external causes among this older age group. The age-adjusted rate of TBI-related deaths in males was more than three times the rate of females (28.3 versus 8.4, respectively); further, males displayed higher numbers and age-adjusted rates compared with females for all the principal MOIs that contributed to a TBI-related death. American Indian or Alaska Native, Non-Hispanic (AI/AN) persons had the highest age-adjusted rate (29.0) of TBI-related deaths when compared with other racial and ethnic groups. Suicide was the leading external cause of injury contributing to a TBI-related death among AI/AN persons.

PRACTICAL APPLICATION

Prevention efforts targeting older adult falls and suicide are warranted to reduce disparities in TBI mortality among older adults and AI/AN persons. Effective strategies are described in CDC's Stopping Elderly Accidents, Deaths, & Injuries (STEADI) initiative to reduce older adult falls and CDC's Preventing Suicide: A Technical Package of Policy, Programs, and Practices for the best available evidence in suicide prevention.

Effects of exercise habituation and aging on the intersegmental coordination of lower limbs during walking with sinusoidal speed change

Background

The time courses of the joint elevation angles of the thigh, shank, and foot in one stride during walking can be well approximated by a “plane” in a triaxial space. This intersegmental coordination (IC) of the lower limb elevation angles is referred to as the planar covariation law. We examined the effects of exercise habituation and aging on the thickness of the IC plane of the lower limbs under sinusoidal speed changing conditions.

Methods

Seventeen sedentary young (SY), 16 active young (AY), and 16 active elderly (AE) adults walked on a treadmill in accordance with a sinusoidal speed changing protocol at 120, 60, and 30 s periods with an amplitude of ± 0.56 m·s⁻¹. Motion of the lower limbs from the sagittal direction was recorded to calculate the elevation angles of the lower limbs. When the best-fit IC plane was determined, the smallest standard deviation of the IC plane was considered as the anteroposterior gait variability of the lower limbs. The coefficient of variance of the step width was also quantified to evaluate the lateral step variability (CV_SW).

Results

The standard deviation of the IC plane was significantly greater in the order of SY, AY, and AE, regardless of the sinusoidal wave periods of the changing speed. The CV_SW was not significantly different among the three groups.

Conclusions

Exercise habituation influences anteroposterior gait variability of the lower limbs, but not lateral step variability, even in young adults. Given these, gait adaptability for sinusoidal speed changes does not always decline with aging.

Trial registration

UMIN000031456 (R000035911; registered February 23, 2018).

Supplementary Information

The online version contains supplementary material available at 10.1186/s40101-022-00298-w.

Barefoot walking is more stable in the gait of balance recovery in older adults

BACKGROUND

Perturbation-based balance training on a treadmill is an emerging method of gait stability training with a characteristic task nature that has had positive and sustained effects on balance recovery strategies and fall reduction. Little is known about the effects produced by shod and barefoot walking. We aimed to investigate which is more appropriate, shod or barefoot walking, for perturbation-based balance training in older adults.

METHODS

Fourteen healthy older adults (age: 68.29 ± 3.41 years; body height: 1.76 ± 0.10 m; body mass: 81.14 ± 14.52 kg) performed normal and trip-like perturbed walking trials, shod and barefoot, on a treadmill of the Gait Real-time Analysis Interactive Lab. The marker trajectories data were processed by Human Body Model software embedded in the Gait Offline Analysis Tool. The outcomes of stride length variability, stride time variability, step width variability, and swing time variability were computed and statistically analyzed by a two-way repeated-measures analysis of variance (ANOVA) based on gait pattern (normal gait versus perturbed recovery gait) and footwear condition (shod versus barefoot).

RESULTS

Footwear condition effect (p = 0.0310) and gait pattern by footwear condition interaction effect (p = 0.0055) were only observed in swing time variability. Gait pattern effects were detected in all four outcomes of gait variability.

CONCLUSIONS

Swing time variability, independent of gait speed, could be a valid indicator to differentiate between footwear conditions. The lower swing time variability in perturbed recovery gait suggests that barefoot walking may be superior to shod walking for perturbation-based balance training in older adults.

Co-occurrences of fall-related factors in adults aged 60 to 85 years in the United States National Health and Nutrition Examination Survey

A broad set of factors are associated with falling (e.g., age, sex, physical activity, vision, health), but their co-occurrence is understudied. Our objectives were to quantify the number and pattern of co-occurring fall-related factors. Data were obtained from the U.S. National Health and Nutrition Examination Survey (N = 1,957, 60–85 years). Twenty fall-related factors were included (based on previous research), covering a wide range including cognitive, motor, sensory, health, and physical activity measures. The number and pattern of co-occurring fall-related factors were quantified with logistic regression and cluster analyses, respectively. Most participants (59%) had ≥4 fall-risk factors, and each additional risk factor increased the odds of reporting difficulty with falling by 1.28. The identified clusters included: (1) healthy, (2) cognitive and sensory impaired, and (3) health impaired. The mean number of co-occurring fall-related factors was 3.7, 3.8, and 7.2, for clusters 1, 2, and 3, respectively (p<0.001). These observations indicate that co-occurrence of multiple fall-risk factors was common in this national sample of U.S. older adults and the factors tended to aggregate into distinct clusters. The findings support the protective effect of physical activity on fall-risk, the association between gait speed and falls, and the detrimental effect of health-related factors on difficulty with falls (e.g., arthritis, prescription medications). Cluster analyses revealed a complex interplay between sex and BMI that may alter the role of BMI in the etiology of falls. Cluster analyses also revealed a large detrimental effect of health-related factors in cluster 3; it is important to extend current fall interventions (typically focused on balance, flexibility, strength, cognitive, fear factors) to include health-related interventions that target factors such as BMI and arthritis.

Disparities in Vision Impairment and Eye Diseases among Early Late-Life Women: The Study of Women's Health Across the Nation, Michigan Site

OBJECTIVE

To quantify the burden of vision impairment (VI) and ocular conditions among early late-life women.

METHODS

Women (n = 254, mean age 66.0 years) participated in a comprehensive vision assessment. Visual acuity (VA) and ocular disorders (diabetic retinopathy, macular degeneration, hypertensive retinopathy, glaucoma and cataracts) were defined clinically. Race, economic strain and education were self-reported.

RESULTS

The prevalence of presenting VI (VA 20/40 or worse) was 11.0% and 75% of that was correctable (best-corrected VI 2.8%). Black women and those with greater economic strain or less education had a higher prevalence of presenting VI. These disparities were no longer present after considering best-corrected VI. Ocular disease prevalence ranged from 3.3% (age-related macular degeneration) to 30.2% (hypertensive retinopathy), but most participants were unaware of their ocular diagnosis.

CONCLUSION

The discordance of presenting versus best-corrected VI and lack of knowledge of ocular conditions suggests a need for increased vision services. Access to optimal vision correction may attenuate differences across sociodemographic groups.

Gender Differences in Older Adults' Perceptions of Falls and Fall Prevention

AIM

To explore gender differences in older adults' perceptions about preventing falls.

BACKGROUND

Falls are a major problem for older adults and health care systems and a challenge to the aging population. Consideration of older adults' perceptions of fall prevention is needed to increase their engagement in evidence-based prevention strategies.

METHOD

A qualitative analysis of secondary data was performed.

RESULTS

Three major themes emerged: We've Seen It, Women Are Caregivers, and Men Are Analyzing Risks and Modifying Behaviors. The men and women in this study shared information about falls and fall prevention in alignment with traditional role expectations. The women learned about falling through their roles as caregivers and prevented falls by controlling extrinsic risk factors indoors such as holding onto handrails on stairs or making home modifications. The men demonstrated an analytical approach to reducing risk such as employing improved safety measures during outdoors activities as a responsibility to maintain independence.

IMPLICATIONS

The different perceptions of men and women influence what they do to engage in fall prevention. Health care professionals need to consider gender differences and take an individualized approach that includes allowing older adults to share their experiences, acknowledging their successful fall prevention behaviors, and validating and addressing their concerns.

M, Srivastava S. Cross-sectional associations of physical frailty with fall, multiple falls and fall-injury among older Indian adults: Findings from LASI, 2018

BACKGROUND

Although there has been a range of studies that focused on physical frailty and associated fall outcomes within developed countries, similar studies from developing countries have been limited. This study aimed to examine the relationship between physical frailty and the prevalence of falls, multiple falls and fall-related injuries among the ageing population within the Indian context.

METHODS

Individual-level data from the first wave of the Longitudinal Aging Study in India (LASI) with 28,285 older adults aged 60 years and above (male 48.9%) was used for this study. Physical frailty was assessed through the physical frailty phenotype adapted from Fried's criteria. Multivariable logistic regression was employed to examine the association of frailty status with falls, multiple falls, and fall-related injuries among Indian older adults.

RESULTS

The prevalence of frailty was found to be 29.94% within the sample and frail older adults had a higher prevalence of falls (15.43% vs 11.85%), multiple falls (7.73% vs 5.25%), and fall related injuries (6.68% vs 5.29%). The odds of falling among frail older adults were significantly higher in reference to the odds of falling among non-frail older adults [aOR: 1.24; CI: 1.09-1.41]. Similarly, the odds of multiple falls among frail older adults were significantly higher in reference to the odds of multiple falls among non-frail older adults [aOR: 1.24; CI: 1.05-1.48]. Moreover, the odds of fall-related injury among frail older adults were significantly higher in reference to the odds of fall-related injury among non-frail older adults [aOR: 1.21; CI: 1.01-1.45]. Falls, multiple falls and fall-related injuries were found to be significantly associated with employment and poor self-rated health, whereas, females and lone living older adults had a significantly higher likelihood of suffering from falls and multiple falls.

CONCLUSION

Older individuals with physical frailty were found to be at increased risk of falls, multiple falls and fall-related injuries in India. The findings of our study also have important clinical implications in the measures undertaken to reduce falls and enable future healthcare practitioners and policymakers to factor in the key determinant of physical frailty.

Lower extremity joint compensatory effects during the first recovery step following slipping and stumbling perturbations in young and older subjects

BACKGROUND

The lower extremity may play a crucial role in compensating for gait perturbations. The study aimed to explore the mechanism of perturbation compensation by investigating the gait characteristics and lower extremity joint moment effects in young (YS) and older subjects (OS) during the first recovery gait following slipping (slipping_Rec1) and stumbling (stumbling_Rec1).

METHOD

An automatic perturbation-triggered program was developed using D-Flow software based on the Gait Real-time Analysis Interactive Lab to induce the two aforementioned perturbations. Marker trajectories and ground reaction forces were recorded from 15 healthy YS (age: 26.53 ± 3.04 years; body height: 1.73 ± 0.07 m; body mass: 66.81 ± 11.44 kg) and 15 healthy OS (age: 68.33 ± 3.29 years; body height: 1.76 ± 0.10 m; body mass: 81.13 ± 13.99 kg). The Human Body Model was used to compute the variables of interest. One-way analysis of variance and independent samples t-test statistical analyses were performed.

RESULTS

In slipping_Rec1 and stumbling_Rec1, the change in gait pattern was mainly reflected in a significant increase in step width, no alterations in step length and stance/swing ratio were revealed. Based on perturbed task specificity, lower extremity joint moments increased or decreased at specific phases of the gait cycle in both YS and OS in slipping_Rec1 and stumbling_Rec1 compared to normal gait. The two perturbed gaits reflected the respective compensatory requirements for the lower extremity joints, with both sagittal and frontal joint moments producing compensatory effects. The aging effect was not reflected in the gait pattern, but rather in the hip extension moment during the initial stance of slipping_Rec1.

CONCLUSIONS

Slipping appears to be more demanding for gait recovery than stumbling. Gait perturbation compensatory mechanisms for OS should concentrate on ankle strategy in the frontal plane and counter-rotation strategy around the hip.

A retrospective cohort study of factors associated with severity of falls in hospital patients

Severity of falls in hospital patients are threat to patient safety which can result in a financial burden on the patient’s family and health care services. Both patient specific and environmental and organisational factors are associated with severity of falls in hospital. It is important to continuously analyse the factors associated with severity of fall which can inform the implementation of any fall preventive strategies. This study aims to identify factors associated with the severity of falls in hospitalised adult patients in Western Australia. This study involved a retrospective cohort analysis of inpatient falls records extracted from the hospital’s Clinical Incident Database from May 2014 to April 2019. Severity of falls were classified as three Severity Assessment Code (SAC): SAC 1 was “high” causing serious harm or death; SAC 2 was “medium” causing moderate or minor harm; and SAC 3 was “low” indicating no harm. Univariable and multivariable generalised ordinal logistic regression models were used to quantify the magnitude of effects of the potential risk factors on severity of falls at 5% level of significance and reported the crude odds and adjusted odds ratio of falling at a higher severity level. There were 3705 complete reported cases of falls with the average age of the patients was 68.5 ± 17.0 years, with 40.2% identified as female. The risk of falling at a higher level of severity increased by patient age over 50 years. Females were 15.1% more likely to fall at higher severity level compared to females. Fall incidents occurred during toileting and showering activities and incidents in a communal area were 14.5% and 26% more likely to occur at a higher severity respectively. Similarly, depression (167%), influence of alcohol or illicit drugs (more than 300%), use of medications (86%) and fragile skin (75%) significantly increased the odds of falling at higher level of severity. Identification of underlying risk factors associated with fall severity provides information which can guide nurses and clinicians to design and implement effective interventional strategies that mitigate the risk of serious fall injuries. The results suggest that fall prevention strategies should target patients with these risk factors to avoid severity of falls.

Gender Differences in Personal and Situational Risk Factors for Traumatic Brain Injury Among Older Adults

OBJECTIVE

To investigate differences between older men and women in Taiwan in personal and situational risk factors for sustaining a traumatic brain injury (TBI) versus soft-tissue injury (STI) due to a fall.

DESIGN

Matched case-control study.

PARTICIPANTS AND SETTINGS

Cases were defined as patients with a primary diagnosis of TBI due to a fall and were identified from those 60 years or older who visited the emergency department (ED) of 3 university-affiliated hospitals in 2015. Matched by the same hospital ED, gender, and time of falling, 3 controls who had no TBI and who had sustained only soft-tissue injury (STI) due to falling were selected for comparison with each case. Personal factors and situational exposures were compared between the control and case groups. In total, 96 cases and 288 controls in men and 72 cases and 216 controls in women participated in this study.

MAIN MEASURES

Personal factors (sociodemographic and lifestyle factors, medical characteristics, and functional abilities) and situational exposures (location, activities before the fall, center-of-mass change, type of fall, falling direction, protective response, and impact during the fall).

RESULTS

In men, after adjusting for other variables, older age (odds ratio [OR] = 1.04), regular alcohol use (OR = 2.03), an indoor fall (OR = 1.92), activity of getting in/out of bed (OR = 2.56), a fall due to dizziness (OR = 4.09), and falling backward (OR = 2.95) were independently associated with a higher odds of TBI. In women, an older age (OR = 1.03), the presence of Parkinson disease (OR = 10.4), activities of toileting (OR = 2.50), getting in/out of bed (OR = 4.90), and negotiating stairs (OR = 7.13), a fall due to dizziness (OR = 5.05), and falling backward (OR = 2.61) were independently associated with a higher odds of TBI.

CONCLUSIONS

Our results demonstrated similarities and differences in personal and situational risk factors for fall-related TBIs versus STIs between older men and women, and gender differences should be considered when developing intervention strategies.

Impact of pathological conditions on postural reflex latency and adaptability following unpredictable perturbations: A systematic review and meta-analysis

BACKGROUND

Pathological conditions can impair responses to postural perturbations and increase risk of falls.

RESEARCH QUESTION

To what extent are postural reflexes impaired in people with pathological conditions and can exercise interventions shorten postural reflexes?

METHODS

MEDLINE, EMBASE, Scopus, SportDiscus and Web of Science were systematically searched for articles comparing muscle activation onset latency in people with pathological conditions to healthy controls following unpredictable perturbations including the effect of exercise interventions (registration: CRD42020170861).

RESULTS

Fifty-three articles were included for systematic review. Significant delays in muscle activity onset following perturbations were evident in people with multiple sclerosis (n = 7, mean difference [MD]: 22 ms, 95% confidence interval [CI]: 11, 33), stroke (n = 10, MD: 34 ms, 95% CI: 19, 49), diabetes (n = 2, MD: 19 ms, 95% CI: 10, 27), HIV (n = 3, MD: 9 ms, 95% CI: 4, 14), incomplete spinal cord injury (n = 2, MD: 57 ms, 95% CI: 33, 80) and back and knee pain (n = 7, MD: 12 ms, 95% CI: 6, 18), but not in people with Parkinson's disease (n = 10) or cerebellar dysfunction (n = 4). Following exercise interventions, the paretic limb of stroke survivors (n = 3) displayed significantly faster muscle activation onset latency compared to pre-exercise (MD: -13 ms, 95% CI: -24, -4), with no significant changes in Parkinson's disease (n = 3).

CONCLUSIONS

This systematic review demonstrated that postural reflexes are significantly delayed in people with multiple sclerosis (+22 ms), stroke (+34 ms), diabetes (+19 ms), HIV (+9 ms), incomplete spinal cord injury (+57 ms), back and knee pain (+12 ms); pathological conditions characterized by impaired sensation or neural function. In contrast, timing of postural reflexes was not impaired in people with Parkinson's disease and cerebellar dysfunction, confirming the limited involvement of supraspinal structures. The meta-analysis showed exercise interventions can significantly shorten postural reflex latencies in stroke survivors (-14 ms), but more research is needed to confirm this finding and in people with other pathological conditions.

Incidences and circumstances of falls among women following total hip arthroplasty on long-term follow-up

BACKGROUND

Patients who undergo total hip arthroplasty have an increased risk of falls during the first postoperative year. However, it is unclear whether patients after total hip arthroplasty will continue to be at high risk of falls more than 1 year postoperatively. To better understand whether the risk of falls changes after a 1-year period, we investigated the incidences and circumstances of falls in women patients for 5 years after total hip arthroplasty.

METHODS

This longitudinal prospective cohort study analyzed 65 women with severe hip osteoarthritis who underwent total hip arthroplasty. The incidences and circumstances of falls before total hip arthroplasty and at 1, 2, and 5 years postoperatively were investigated. We assessed the Harris Hip Score and evaluated hip pain and ambulatory ability using a self-administered questionnaire.

RESULTS

The incidences of at least one fall were 30.8%, 26.2%, 23.1%, and 30.8% before and 1, 2, and 5 years after surgery, respectively. Among the circumstances of falls from pre-surgery to 5 years post-surgery, there was a significant difference in the direction of falls; however, there were no significant differences in the location, time, cause, and type of injury. Most falls occurred indoors by tripping or loss of balance during the daytime. Among the participants who had falls almost half sustained injuries, and approximately 10% of falls resulted in fractures each year. Although self-reported hip pain, ambulation, and the Harris Hip Score significantly improved in women after total hip arthroplasty compared to pre-surgery, there was no significant difference in the incidences of falls from 1 to 5 years post-surgery.

CONCLUSION

Women who underwent total hip arthroplasty continued to have an increased risk of falls and fall-induced injuries for 5 years postoperatively. Preventive measures against falling to reduce fall-induced injuries in the long term are required for women after total hip arthroplasty.

Sex Differences in Orthostatic Tolerance Are Mainly Explained by Blood Volume and Oxygen Carrying Capacity

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The reduced orthostatic tolerance (OT) that is characteristic of the female sex may be explained by multiple phenotypic differences between sexes. This study aimed to elucidate the mechanistic role of blood volume (BV) and oxygen carrying capacity on sex differences in OT.