Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years - United States, 2012-2018

Examining the role of physical activity in older adults with epilepsy

Epilepsy disproportionately affects older adults due to acquired conditions including stroke, neurodegeneration and head trauma secondary to falls. Current literature lacks adequate representation of specific therapies and considerations for this cohort. Furthermore, older adults are more susceptible to the adverse effects of anti-seizure medications necessitating increased caution when treating. Non-pharmacological interventions, including physical activity (PA), are underrecognized, particularly in older adults where they may be of greatest benefit. The following narrative review describes how older adults are uniquely impacted by epilepsy and associated comorbidities. It examines the current literature with respect to PA in epilepsy and, where available, evidence for PA in older adults. This includes how PA can affect pathogenesis and reduce the incidence of epilepsy onset through the reduction of neuroinflammation. PA may also be utilized by older adults with epilepsy to improve cardiovascular function, seizure control, prevent falls and secondary head injury, as an adjunct treatment for mood disorders and cognitive decline, and to promote general well-being. PA has a large and underappreciated role to play in older adults with epilepsy and is increasingly being recognized by healthcare providers and incorporated into practice guidelines.

Frailty is associated with a history of falls among mobility-limited older adults-cross-sectional multivariate analysis from the BIOFRAIL study

AIM

To identify differences in characteristics between mobility-limited older adults with a history of falls and those at risk of falling but who have not yet fallen.

FINDINGS

Frailty and muscle strength were characteristics distinguishing between older adults with a history of falls and those absent of falls despite an increased risk of falling.

MESSAGE

Frailty should be incorporated alongside handgrip strength (HGS) and sit-to-stand (STS) tests into routine evaluations of mobility-limited older adults referred for fall assessment.

PURPOSE

We aimed to identify differences in characteristics between mobility-limited older adults with a history of falls and those at risk of falling, and to identify the parameter with the strongest predictive value on the risk of falling.

METHODS

Data included anthropometry, HGS, 30-s and 5-reps STS tests, maximal isometric knee extensor strength, gait speed (6 m), postural balance (tandem test), and muscle mass (BIA). Frailty was assessed using the Clinical Frailty Scale (CFS) and sarcopenia was evaluated according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) guidelines. Outcomes of falls (past year), and depression (Geriatric Depression Scale 15) were self-reported.

RESULTS

Totally, 505 mobility-limited older adults (mean age 79.7 ± 6.3 years, 64.8% females) were included. Of these, 400 (79.2%) had experienced one or more falls within the past year (fallers), while 105 (20.8%) had not experienced a fall (at risk). Patients with experienced falls were more likely to feel depressed, had reduced handgrip strength, and reduced performance in both STS tests compared to those who had not fallen. Frailty was the strongest individual parameter associated with a history of prior falls, even after adjusting for covariates such as depression and 30-s STS (aOR 3.80; 95% CI 1.70-8.50).

CONCLUSIONS

Present study identified frailty as a key factor independently associated with a history of falls in this population. Additionally, handgrip strength and STS performance were key characteristics distinguishing between older adults with a history of falls within the past 12 months and those at risk of falling.

TRIAL REGISTRATION

NCT05795556.

Associations between depressive symptoms, activity of daily living, and falls/severe falls: evidence from two prospective longitudinal studies

BACKGROUND

Falls are the second leading cause of unintentional injury deaths globally and are strongly associated with a variety of psychological and physiological factors. Studies have suggested an association between depressive symptoms and fall risk, but the mechanism of action is unclear. This study aimed to investigate the association between depressive symptoms and the risk of falls and severe falls, and to examine whether activities of daily living (ADL) impairment mediates this relationship.

METHODS

This study included 12,440 participants from the China Health and Retirement Longitudinal Study (CHARLS) and 6,627 participants from the English Longitudinal Study of Ageing (ELSA). Depressive symptoms were assessed using the Centre for Epidemiological Studies of Depression Scale (CES-D). Falls were defined as any fall experienced since the last follow-up. Severe falls were defined as falls that required medical treatment. Logistic regression was used to assess the association of depressive symptoms and ADL impairment with the risk of falls/severe falls. Further, we analyzed the mediating role of ADL impairment between depressive symptoms and falls/severe falls.

RESULTS

The proportions of depressive symptoms in the CHARLS and ELSA longitudinal studies were 25.6% and 11.7%, respectively. Depressive symptoms were significantly associated with falls in both longitudinal studies: the OR was 1.78 (95% CI: 1.62, 1.96) for CHARLS and 1.85 (95% CI: 1.57, 2.18) for ELSA. The association between depressive symptoms and severe falls was also significant, with an OR of 1.61 (95% CI: 1.41, 1.85) for CHARLS and 1.74 (95% CI: 1.37, 2.22) for ELSA. The association of depressive symptoms with falls and severe falls remained significant after controlling for ADL impairment. In addition, ADL impairment was significantly associated with fall risk, with ORs of 1.66 (95% CI: 1.49, 1.85) for CHARLS and 2.32 (95% CI: 2.01, 2.68) for ELSA; The association between ADL impairment and severe falls was also significant, with ORs of 1.61 (95% CI: 1.38, 1.87) for CHARLS and 1.75 (95% CI: 1.40, 2.18) for ELSA. Mediation analysis revealed significant mediating effects of ADL impairment in the effect of depressive symptoms on the risk of falls and severe falls, with mediation effects all exceeding 20%, ranging from 22.2 to 27.3%.

CONCLUSIONS

This study revealed the key role of depressive symptoms and ADL impairment in the risk of falls/severe falls in middle-aged and older adults, and highlighted the mediating role of ADL impairment between depressive symptoms and falls/severe falls. In addition, fall risk in the UK was more affected by depressive symptoms than in China. This study provided a scientific basis for the management of depressive symptoms and falls prevention, suggesting the introduction of interventions for ADL impairment in the management of depressive symptoms to reduce the risk of falls and their associated health burden.

CLINICAL TRIAL NUMBER

Not applicable.

Multimorbidity, Muscle Strength, and Falls among Older Mexican Americans

OBJECTIVES

Multimorbidity is linked with an increased risk of falls in older adults. The study objective is to determine the relationship of multimorbidity and muscle strength in falls among older Mexican Americans without a history of falls at baseline.

DESIGN

Longitudinal study.

SETTING AND PARTICIPANTS

This 12-year prospective cohort study included 899 noninstitutionalized Mexican Americans aged ≥75 years residing in Arizona, California, Colorado, New Mexico, and Texas from the Hispanic Established Population for the Epidemiologic Study of the Elderly (HEPESE).

METHODS

Measures include the following: sociodemographics, medical conditions, body mass index, disability, handgrip strength (HGS), depressive symptoms, pain, cognitive function, and multimorbidity (≥2 self-reported medical conditions). Participants at baseline were divided into the following 4 groups: high HGS and multimorbidity (n = 349), low HGS and multimorbidity (n = 263), high HGS and without multimorbidity (n = 181), and low HGS and without multimorbidity (n = 104). Generalized estimating equation models estimated the odds ratio (OR) and 95% CI for falls as a function of multimorbidity and HGS group, controlling for all covariates.

RESULTS

The mean sample age ± SD was 81.0 ± 4.3 years, and 55.9% were female. The OR for falls was 0.70 (95% CI, 0.52-0.94) for those with multimorbidity and high HGS, 0.50 (95% CI, 0.32-0.80) for those without multimorbidity and high HGS, and 0.46 (95% CI, 0.29-0.74) for those without multimorbidity and low HGS, vs those with multimorbidity and low HGS, after controlling for all covariates.

CONCLUSIONS AND IMPLICATIONS

Mexican American older adults with multimorbidity and high HGS had a 30% decreased risk of falls over time. Increasing muscle strength through exercise may help prevent falls among those with multimorbidity.

Economic modelling of fall prevention interventions delivered by community emergency medical services: a decision-tree analysis

BACKGROUND

Fall prevention interventions delivered by specially trained emergency medical services (EMS) clinicians in the homes of patients at high risk for falls have been shown to prevent recurrent falls. However, the cost of implementing this 'community EMS' approach to fall prevention is a barrier to widespread adoption. The objective of this study was to assess whether a community EMS fall prevention intervention results in overall cost savings for the healthcare system.

METHODS

We performed a cost-effectiveness analysis using a decision-tree model of possible outcomes after an index fall in a simulated population of community-dwelling adults aged ≥65 over a 1-year time horizon. Transition probabilities and costs were obtained through literature review. The intervention, delivered in patients' homes by specialised EMS clinicians, consisted of environmental modifications, fall prevention education, referral to occupational and physical therapy, and coordination with the patient's primary care physician. We compared the mean healthcare expenditures per patient among those receiving and not receiving the fall prevention intervention.

RESULTS

The intervention would result in a net cost savings of $964 per patient compared with no intervention, with an incremental cost-effectiveness ratio of -$22 174 per fall prevented (lower cost and more effective). Holding other variables constant, the programme would remain cost-saving if the effectiveness decreased to a 26% reduction in falls or the programme cost increased to $1634 per patient.

CONCLUSIONS

In this economic modelling analysis, a multifactorial fall prevention intervention delivered by community EMS was cost saving to the healthcare system. Healthcare payors should provide financial support and reimbursement for these programmes.

Machine Learning Scoring Reveals Increased Frequency of Falls Proximal to Death in Drosophila melanogaster

Falls are a significant cause of human disability and death. Risk factors include normal aging, neurodegenerative disease, and sarcopenia. Drosophila melanogaster is a powerful model for study of normal aging and for modeling human neurodegenerative disease. Aging-associated defects in Drosophila climbing ability have been observed to be associated with falls, and immobility due to a fall is implicated as one cause of death in old flies. An automated method for quantifying Drosophila falls might facilitate the study of causative factors and possible interventions. Here, machine learning methods were developed to identify Drosophila falls in video recordings of 2D movement trajectories. The study employed existing video of aged flies as they approached death, and young flies subjected to lethal dehydration/starvation stress. Approximately 9 000 frames of video were manually annotated using open-source tools and used as the training set for You Only Look Once (YOLOv4) software. The software was tested on specific hours within a 22 hour video that was originally manually annotated for number of falls per hour and corresponding timestamps. The model predictions were evaluated against the manually-annotated ground truth, revealing a strong correlation between the predicted and actual falls. The frequency of falls per hour increased dramatically 2-4 hours prior to death caused by dehydration/starvation stress, whereas extended periods of increased falls were observed in aged flies prior to death. This automated method effectively quantifies falls in video data without observer bias, providing a robust tool for future studies aimed at understanding causative factors and testing potential interventions.

Developing Community-Level Implementation Networks to Connect Older Adults to Evidence-Based Falls Prevention Programs

BackgroundEvidence-based falls prevention programs are available in many communities, but participation in such programs remains low. This study aimed to develop community-based referral networks of organizations to facilitate the uptake of evidence-based falls prevention programs through engaging older adults at risk for falls with the RememberingWhen™ program and connecting them to evidence-based programs in Midwestern communities.MethodsGuided by the Practical, Robust Implementation and Sustainability Model (PRISM), referral networks were developed in two Midwestern communities (urban and micropolitan) through a seven-step community engagement plan: establishing and operationalizing the State-level Advisory Board (SAB), identifying falls prevention resources, conducting community assessments, developing Local Advisory Groups (LAG), operationalizing the LAG, developing referral network and protocols, and implementing the network. Semistructured interviews guided by the RE-AIM framework were conducted with members of the SAB, LAG, administrators and staff from organizations that participated in networks, and older adult participants.ResultsAfter participating in the development of referral networks, participants felt they learned important skills that they can use to develop additional collaborations and networks in the future, emphasized the benefits of building community capacity among organizations with common missions. Interview data yielded strategies on enhancing the referral network's reach, impact, adoption, implementation efficiency, and maintenance.ConclusionFuture sustainability studies of such networks should explore identified challenges and strategies to sustain efforts. Results highlight the importance of ongoing funds to support the efforts of organizational networks in communities.

Physical and Psychosocial Consequences of Falls in Ambulatory Individuals With Cerebral Palsy by Age and Gross Motor Function

OBJECTIVE

To quantify physical and psychosocial impacts of falls by age and Gross Motor Classification System (GMFCS) level in ambulatory individuals with cerebral palsy (CP).

DESIGN

Cross-sectional survey.

SETTING

Tertiary specialty hospital and online CP communities.

PARTICIPANTS

Ambulatory individuals with CP (N=201 adults; 18-76 years old) or the caregivers of minors (N=180; 5-17 years old).

MAIN OUTCOME MEASURE(S)

Participants completed online surveys to report fall frequency, fall characteristics, injuries, concern about falling (Short Falls Efficacy Scale-International), activity avoidance due to concern about falling (Short Falls Efficacy Scale-International Avoidance Behavior), and psychosocial constructs related to perceived consequences of falling (Consequences of Falling-Damage to Identity subscale).

RESULTS

Most participants fell in the past 12 months (86%). Fall frequency in the past 12 months differed by age (P<.001) and GMFCS level (P=.021). Individuals aged 5-12 years or GMFCS level II reported the most falls. The percentage of participants who experienced a past serious fall-related injury (eg, head/face stitches, concussion, fractures) increased with age (P<.001), affecting 80% of ≥50-year olds. Falls often occurred in the forward direction, when wearing shoes, and during ambulation. Uneven surfaces and fatigue were notable causes. Concern about falling and associated activity avoidance scores differed by age and GMFCS level (all P<.01), both of which were highest for ≥50-year olds and GMFCS level III. Although psychosocial consequences of falls (eg, embarrassment, lost confidence) were elevated across all groups, they did not differ by age or GMFCS level (P=.130, P=.083). Nearly everyone (88%) wished they fell less.

CONCLUSIONS

Falls are common for ambulatory children and adults with CP. Physical and psychosocial consequences of falls were frequent and impacted behavior. Differences observed by age and GMFCS level should be considered in care delivery. Clinically tracking and discussing falls and their repercussions across the lifespan will aid in addressing this under-researched and under-resourced concern of people with CP.

Predicting falls with ultrasound, physical parameters or fall-risk questions among older adults: A prospective cohort study

BACKGROUND

Falls are a significant issue among older adults, leading to morbidity and mortality. Screening for fall risk in the ED is crucial but challenging due to time limitations and patient conditions. Sarcopenia, characterized by muscle loss, is associated with increased fall risk, and ultrasound has been proposed as a non-invasive tool to measure muscle mass in this context.

METHODS

This prospective cohort study enrolled 174 older adults from an urban teaching hospital's EDOU, assessing muscle mass via POCUS, grip strength, Timed Up and Go (TUG) test, and fall risk using the STEADI toolkit. The patients were followed up over six months to assess if they had fallen or not.

RESULTS

Follow-up identified 37 participants (21 %) as patients who fell. There was no significant association between POCUS-measured muscle mass, grip strength, or TUG test performance with future falls. In contrast, STEADI questionnaire responses demonstrated significant differences between patients who fell and did not fall, suggesting its potential utility in predicting fall risk in this population.

CONCLUSION

The simpler tool, the STEADI questionnaire, may offer more practicality in screening fall risk compared to complex ultrasound measurements or physical performance tests among the older in ED.

Comparison of Commonly Used Fall Risk Assessment Tools in Predicting Fall Risk: A Prospective Observational Study in Older Adult Inpatients Over 80 Years of Age

BACKGROUND

Falls and fall-related injuries represent significant public health concerns, yet no reliable and valid assessment tool exists for evaluating fall risk in hospitalized older adults (≥80 years old).

OBJECTIVE

This study compared the discriminative properties of 5 commonly utilized fall risk assessment tools and comprehensive geriatric assessments for fallers and non-fallers among older adult inpatients.

METHODS

Comprehensive geriatric assessments, which included evaluations of fall risk, were conducted on 82 older adult inpatients. The incidence of falls during hospitalization was documented. The analysis compared the consistency of these scales with actual fall incidents, and the predictive values for fall risk were assessed using the areas under the receiver operating characteristic curve.

RESULTS

More than 30 older adult inpatients had a documented history of falls. The incidence of falls recorded in this study was 27.6 per 1000 patient days. The assessment scores of the National Health Commission Fall Scale, Morse Fall Scale, Berg Balance Scale, and Barthel Index revealed that fallers were at a significantly higher risk compared with non-fallers. The Morse Fall Scale showed the best consistency between score and fall occurrence (kappa = 0.461, P = .001). Its area under the receiver operating characteristic curve (AUC) was 0.813 (95% CI 0.676-0.949). The combined AUC for the Morse Fall Scale and Barthel Index was 0.891 (95% CI 0.784-0.998).

CONCLUSIONS

Analysis of these assessment scales indicates that the Morse Fall Scale exhibits the highest predictive value for falls among older adult inpatients aged 80 years and above. Integration of the Barthel Index may enhance the predictive validity.

Falls and Fractures in Patients with Geographic Atrophy: A US Claims Data Analysis

INTRODUCTION

The increased risk of falls in elderly people represents a substantial public health burden that may be compounded by impaired visual acuity. The present study aimed to assess the independent risk of incident falls and fractures in patients with geographic atrophy (GA).

METHODS

This retrospective, noninterventional, cohort study analyzed three US claims datasets (Optum's de-identified Clinformatics® Data Mart Database [Clinformatics®], Merative™ MarketScan® Commercial and Medicare Databases [MarketScan], and IQVIA US PharMetrics® [PharMetrics]). Patients were defined as having at least one International Classification of Diseases, Tenth Revision code (H35.31x3, H35.31x4) for GA. A propensity score-matched control cohort, matched on age, sex, index year, and disease history, was also included. Relative risks (RRs) for incident falls, fractures, and health care resource utilization (HCRU) were calculated between GA and control cohorts.

RESULTS

The Clinformatics®, MarketScan, and PharMetrics datasets included 44,591, 9470, and 27,428 patients with GA, respectively. Across the three databases, mean (SD) age ranged from 75.9 (8.3) to 80.5 (7.2) years, and 61% to 64% were female. The largest subgroup was patients with bilateral GA without subfoveal involvement (35-37%), followed by unilateral GA without subfoveal involvement (23-24%). Risks of falls (RR 1.16-1.36) and fractures (RR 1.17-1.29) in the 4 years following the index date were higher in patients with GA compared with controls. Patients with bilateral GA and subfoveal involvement had the most pronounced increase in risk of falls (RR 1.42-1.49) and fractures (RR 1.33-1.45). Compared to controls, patients with GA also had an increased risk for hospitalization (RR 1.18-1.27), emergency department visits (RR 1.18-1.21), nursing home or assisted living admissions (RR 1.06-1.28), and outpatient visits (RR 1.05-1.08).

CONCLUSION

GA represents an independent risk factor for falls, fractures, and higher HCRU. These data reveal the substantial public health burden of GA associated with the management of falls and fractures.

Assessing Older Adults' Readiness for Adopting Fall Prevention Recommendations Using the Transtheoretical Stages of Change

Objectives: Reducing fall risk requires older adults (age 65+) to adopt effective prevention strategies. This study has three aims: 1) understand Stage of Change (SOC) for three fall prevention strategies; 2) determine strategies older adults' use; and 3) understand which characteristics relate to readiness to take action. Methods: A survey of 1063 older adults assessed fall risk, SOC, and use of fall prevention strategies. Data analysis included descriptive statistics and regression analysis. Results: The most common SOC for older adults by strategy was action for overall fall prevention (61%), contemplation for medication management (45%), and preparation and action for strength/balance (29% each). Believing falls are preventable was most strongly related to being in a Change stage (e.g., action, maintenance) for overall fall prevention (Risk Ratio: 1.4, 95% CI: 1.1, 1.7). Discussion: Health promotion can focus on increasing knowledge of evidence-based fall prevention strategies to encourage older adults to take action.

The Predictive Capacity of the 3-Meter Backward Walk Test for Falls in Older Adults: A Case-Control Analysis

Background: The early detection of fall risk in older adults is crucial for prevention. This study assessed the 3-Meter Backward Walk Test (3m-BWT) as a predictor of falls. Methods: A retrospective observational case-control study was conducted with 483 community-dwelling participants (mean age 76.3 ± 6.5 years), including 101 individuals with a history of falls in the previous 12 months. A standardized battery of functional assessments was applied. Results: Significant differences were observed between fallers and non-fallers across all functional variables (p < 0.001), with fallers demonstrating slower performance on the 3m-BWT (6.8 ± 3.4 s vs. 5.1 ± 1.3 s). The 3m-BWT showed moderate correlations with Short Physical Performance Battery, 5-repetition Sit-to-Stand, gait speed, and 4-Square Step Test, and a moderate-to-strong correlation with Timed Up-and-Go (r = 0.632), even after adjusting for age, sex, and BMI. Although the 3m-BWT exhibited superior discriminative ability compared to other tests (AUC = 0.655), its predictive power in isolation remains limited. The optimal cut-off point was identified at 5.5 s (sensitivity: 59.5%; specificity: 68.6%), while a threshold of <3.5 s yielded high sensitivity (98%) but low specificity, supporting its use in fall risk screening. Conclusions: These findings support the integration of the 3m-BWT as a complementary tool within comprehensive geriatric assessments, particularly in contexts requiring high sensitivity. Given the multifactorial nature of falls, combining the 3m-BWT with other clinical evaluations and fall history is recommended to enhance risk stratification and inform preventive strategies.

Machine learning-based prediction models for falls in hospitalized patients: A systematic review and meta-analysis

OBJECTIVE

To systematically review published machine learning models aimed at predicting the risk of falls among hospitalized patients.

DESIGN

A systematic review and meta-analysis.

METHODS

According to the inclusion and exclusion criteria, we comprehensively searched the database PubMed, EMBASE, Web of Science and The Cochrane library from inception through November 14, 2023. Data extraction followed the CHARMS checklist, and bias risk and applicability were assessed using the PROBAST tool. A meta-analysis was performed utilizing Meta-disc software, with the area under the curve, sensitivity, and specificity serving as the effect measures. Heterogeneity was assessed through the Chi-square test and I2 test.

RESULTS

A systematic search yielded a total of 2007 studies, 14 of which were selected following screening, and 13 of these studies were subjected to quantitative analyses. The incidence rate of inpatient falls ranged from 0.14 % to 50.69 %, with corresponding area under the curve (AUC) values varying between 0.57 and 0.99. Age, multiple drugs, emerged as the most frequently employed predictive factors. While the overall quality of the studies was considered satisfactory, a high risk of bias was identified, primarily attributed to insufficient reporting in the participant and analysis domains. The combined AUC of the 13 predictive models was 0.82, with a sensitivity of 0.69 (95 % CI [0.68-0.7]) and a specificity of 0.70 (95 % CI [0.70-0.71]), indicating robust discriminative performance.

CONCLUSION

Although machine learning models provide an emerging and promising method for predicting hospital falls, they require broader validation to ensure practical applicability. This review highlights the potential drawbacks of current methods, including high risk of bias and low reproducibility, and provides various recommendations on how to address these challenges.

CLINICAL RELEVANCE

Falls are a frequent and significant issue for patients in hospitals, often resulting in severe physical harm and longer hospital stays. This research offers a fresh approach and tool for medical professionals by thoroughly examining how machine learning models can predict falls, aiming to enhance personalized and precise fall risk management.

Associated factors and gender differences of falls in older adults with hypertension: a national cross-sectional survey

Background

Falls have become a crucial public health problem among older adults, especially those with hypertension. However, the current understanding of the risk of falls among them is still insufficient. The purpose of this study was to investigate the factors associated with falls and their gender differences among older adults with hypertension in China.

Methods

Based on the cross-sectional data of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2018 database, this study defined 24 possible associated factors based on the five dimensions of the Health Ecology Model. Binary Logistic Regression Model was used to analyze the impact of each factor on falls among older adults with hypertension.

Results

The prevalence rate of falls in older adults with hypertension in China was 22.60%. Falls are associated with a variety of factors. Specifically, gender, self-rated health, hearing impairment, stroke, instrumental activities of daily living (IADL) disability, basic activities of daily living (BADL) disability, exercise, fresh fruit and taste preference are significant associated factors for falls among older adults with hypertension. Among them, the effects of self-rated health, stroke and exercise on falls are only significant in female with hypertension. The effect of fresh fruit on falls was significant only in men with hypertension.

Conclusion

The findings highlight that the current situation of falls among older adults with hypertension requires attention, necessitating comprehensive measures for prevention and control.

Effect of protein and amino acids supplements on muscle strength and physical performance: A scoping review of randomized controlled trials

Protein and amino acid supplementation is an effective intervention that significantly enhances physical function and reduces frailty and sarcopenia in older adults. This scoping review aims to map and synthesize the available evidence on the effects of various types of protein and amino acid supplementation in this population. Following the PRISMA-ScR guidelines, we conducted a literature search to identify clinical trials examining the effects of protein and amino acid supplementation, with or without physical exercise, on muscle strength, physical performance, and body composition in healthy, frail, or sarcopenic older adults. Our analysis of 80 trials with a total of 5290 participants examines the evidence for the effectiveness of protein supplementation in enhancing muscle strength and body composition. Whey protein, creatine, milk protein, leucine, essential amino acids, and soy protein were the most used types of protein, and our findings indicate that whey protein, creatine, and milk protein yield the best results when used in conjunction with resistance training. Additionally, leucine and milk protein have shown the potential to enhance body composition even without concurrent resistance training. In conclusion, studies on the effectiveness of whey protein in improving muscle strength and body composition in older adults with resistance training are inconsistent. More research is required to explore the potential benefits of soy and leucine-enriched supplements. Protein supplementation's impact on physical performance remains inconclusive. Further studies are needed to determine the effects of protein types and supplementation on muscle-related parameters in older adults.

Global epidemiology of lower limb fractures: Trends, burden, and projections from the GBD 2021 study

BACKGROUND

Lower limb fractures are a significant global public health issue, imposing considerable social and economic burdens. Despite their prevalence, comprehensive analyses of the global epidemiology of lower limb fractures remain scarce. This study aims to address this gap.

METHODS

Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we analyzed four types of lower limb fractures: fractures of foot bones excluding the ankle (FFB), hip fractures (FH), fractures of the patella, tibia or fibula, or ankle (FPTFA), and femur fractures excluding the femoral neck (FF), and conducted a detailed assessment of them.

RESULTS

FPTFA was the most burdensome fracture type, with Slovenia showing the highest age-standardized incidence rate (ASIR), and Saudi Arabia having the highest age-standardized prevalence rate (ASPR) and years lived with disability rate (ASYR). The burden of lower limb fractures increased with age, but FFB and FPTFA showed a "double peak" age distribution, with FFB most common in the 20-24 age group. Lower limb fractures were more prevalent in males among younger individuals and in females among older populations. From 1990 to 2021, the burden of lower limb fractures, excluding FH, decreased (EAPC <1), though the incidence of FF is projected to increase (EAPC = 0.14, 95 % CI 0.1-0.18) over the next decade.

CONCLUSION

Although the global burden of lower limb fractures, excluding FH, has decreased in recent years, vigilance is still needed. Given the projected rise in FF incidence over the next decade, preventive measures should be implemented early.

Examining Factors Influencing Older Adult Engagement in Fall Prevention: A Comparative Analysis Among Stakeholders

BACKGROUND

Falls are a leading cause of fatal and non-fatal injuries for older adults in the United States with significant consequences for health, mobility, and independence. Understanding what barriers influence older adult engagement is essential to facilitating uptake of evidence-based interventions to prevent falls and fall-related injuries.

METHODS

Semi-structured focus groups were held with 59 participants in three stakeholder groups: (1) community-dwelling older adults, (2) caregivers of older adults, and (3) healthcare providers who engage with older adults. Themes that emerged were categorized by the stakeholder group that identified them and evaluated using the social-ecological model and assigned to a level within that framework (individual, interpersonal, community, or societal).

RESULTS

Barriers identified to older adult participation in fall prevention activities had the most themes emerge at the individual-level, which included denial; discomfort avoidance; fear of being a burden; pride; and self-perception. Interpersonal-level themes were the normalization of falls; healthcare provider attitude, behavior, and practices; social support; and well-intentioned family. Finally, the themes observed at the community level included cost; lack of education and awareness; limited healthcare resources; lack of transportation; and healthcare system timing and weaknesses. Some themes were identified across all stakeholder types, while others were recognized by only one or two. The only theme at the societal level was age-related stigma.

CONCLUSIONS

These findings demonstrate a variety of barriers across stakeholder types and provide valuable insights for developing strategies to effectively promote older adult participation in fall prevention activities to reduce falls and enhance healthy aging.

Adverse events, including fractures, among older patients receiving mirogabalin versus pregabalin: A retrospective cohort study using a large claims database in Japan

BACKGROUND

Mirogabalin has a mechanism similar to that of pregabalin in the treatment of neuropathic pain. However, it remains unclear whether these drugs differ in terms of serious side effects, such as fall-related fractures, in older patients. This study aimed to investigate whether mirogabalin is associated with a decrease in adverse events, including fall-related fractures, compared with pregabalin.

METHODS

We performed a retrospective cohort study using the DeSC database, a large administrative claims database in Japan. This study included 130,244 patients ≥65 years taking mirogabalin or pregabalin between April 2019 and May 2021. The primary outcome was defined as the occurrence of fractures or switching to other medications and was compared between those receiving mirogabalin and pregabalin using Kaplan-Meier curves and multivariable Cox proportional hazards models. A sensitivity analysis was performed regarding patients who received mirogabalin or pregabalin without other analgesic medications at the initial dose.

RESULTS

During a median follow-up of 2.8 months, 29,686 (22.8%) and 100,558 (77.2%) received mirogabalin and pregabalin, respectively. The rates of the outcome in the mirogabalin and pregabalin groups were 50.1 and 42.8 per 100 person-years. Cox regression analysis showed that mirogabalin was associated with a lower risk of the outcome (hazard ratio, 0.93; 95% confidence interval, 0.87-1.00). However, sensitivity analysis did not demonstrate a difference in the outcome between the mirogabalin and pregabalin groups without other analgesic medications (hazard ratio, 0.93; 95% confidence interval, 0.86-1.01).

CONCLUSIONS

Our analyses suggest that the outcome may be less likely in the mirogabalin group; however, the difference appears to be clinically insignificant. Further studies are warranted to confirm these findings.

Fall Prevention after Hip and Knee Arthroplasty

Despite the success of total knee arthroplasty and total hip arthroplasty, patients face an increased risk of postoperative falls, often due to surgery-induced changes in muscle strength. Falls can lead to serious consequences, including fractures and reduced quality of life. The majority of falls related to total joint arthroplasty occurs outside the hospital. Effective fall prevention strategies, such as patient education, exercise interventions, environmental modifications, and medication management, are crucial for reducing fall risks and improving patient outcomes. Continued research and innovation in fall prevention are essential for improving patient safety and well-being following joint arthroplasty.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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

Selecting and tailoring implementation strategies for deimplementing fall prevention alarms in US hospitals: a group concept mapping study

OBJECTIVES

Many hospitals use fall prevention alarms, despite the limited evidence of effectiveness. The objectives of this study were (1) to identify, conceptualise and select strategies to deimplement fall prevention alarms and (2) to obtain feedback from key stakeholders on tailoring selected deimplementation strategies for the local hospital context.

METHODS

Hospital staff working on fall prevention participated in group concept mapping (GCM) to brainstorm strategies that could be used for fall prevention alarm deimplementation, sort statements into conceptually similar categories and rate statements based on importance and current use. Hospital staff also participated in site-specific focus groups to discuss current fall prevention practices, strategies prioritised through GCM and theory-informed strategies recommended by the study team, and potential barriers/facilitators to deimplementing fall prevention alarms.

RESULTS

90 hospital staff across 13 hospitals brainstormed, rated and sorted strategies for alarm deimplementation. Strategies that were rated as highly important but underutilised included creating/revising staff roles to support fall prevention (eg, hiring or designating mobility technicians) and revising policies and procedures to encourage tailored rather than universal fall precautions. 192 hospital staff across 22 hospitals participated in site-specific focus groups. Participants provided feedback on each strategy's relevance for their site (eg, if site currently has a mobility technician) and local barriers or facilitators (eg, importance of having separate champions for day and night shift). Findings were used to develop a tailored implementation package for each site that included a core set of strategies (eg, external facilitation, education, audit-and-feedback, champions), a select set of site-specific strategies (eg, designating a mobility technician to support fall prevention) and guidance for how to operationalise and implement each strategy given local barriers and facilitators.

CONCLUSION

Findings from this study can be used to inform future programmes and policies aimed at deimplementing fall prevention alarms in hospitals.

Longitudinal Evaluation of the HABC Monitor Among Trauma Survivors

Purpose

To examine the sensitivity to change of the Healthy Aging Brain Care Monitor (HABC-M) through a longitudinal analytical comparison with reference standards.

Patients and Methods

We used longitudinal data from 120 participants in a multicenter randomized controlled trial evaluating the effectiveness of the Trauma Medical Home (TMH). We used the following reference standards: The depression and anxiety subdomains of the Hospital Anxiety and Depression Scale (HADS), the Patient-Reported Outcomes Measurement Information System Sleep Disturbance Short Form 4a (PROMIS-SF), and the Pain, Enjoyment of Life, and General Activity Scale (PEG). We assessed sensitivity to change using three longitudinal comparative analytical methods. The correlation of the HABC-M score with reference standards' scores over time, the correlation of changes in the HABC-M score with changes in reference standards' scores, and a longitudinal analysis to compare changes in the HABC-M against reference standards' known change categories.

Results

Throughout the six-month period, the HABC-M exhibited moderate to high correlations with the HADS (r = 0.66, p<0.001 for the depression subdomain and r = 0.42, p<0.001 for the anxiety subdomain), the PROMIS-SF (r = 0.57, p<0.001), and the PEG (r = 0.47, p<0.001). The changes in HABC-M significantly correlated with changes in reference standards at various time points. HABC-M scores were significantly different across known change categories established by the four reference standards, with standardized response mean (SRM) values ranging from 1.08 to 1.44.

Conclusion

The HABC-M is capable of monitoring the recovery of older trauma survivors.

Perceived Balance, Balance Performance, and Falls Among Community-Dwelling Older Adults: A Retrospective, Cross-Sectional Study

Objectives: To examine the extent to which older adults' perceived balance, a balance performance test, and fear of falling (FOF) were associated with falls in the last month. Methods: The Health Belief Model served as the theoretical framework. A retrospective, cross-sectional, secondary analysis using data from the National Health and Aging Trends Study was conducted (N = 7499). Results: Multiple logistic regression analysis revealed that the odds of reporting a fall in the past month were 3.3 times (p < .001) greater for participants who self-reported having a balance problem compared to those who did not. The Short Physical Performance Battery and FOF were not uniquely associated with falls. Discussion: Our findings support limited evidence suggesting that older adults' perceived balance is a better predictor of falls than balance performance. Assessing older adults' perceived balance may be a new way to assess older adults' fall risk to prevent future falls.

Nursing-Led targeted strategies for preventing falls in older adults

Falls are common events in hospitalized patients and a leading cause of morbidity and mortality among older adults. Healthcare professionals can positively impact fall rates through nurse-led strategies such as an evidence-based framework addressing age-related risk factors. A quality improvement project supported by the NICHE Leadership Training Program (LTP), titled "See the E, PEEK on Me," was developed to address falls in older adults on a pilot unit at one campus of an academic health system (AHS). Results of the implementation demonstrated a reduction in falls for patients over the age of 65 over a one-year period.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Evaluating the effectiveness of evidence-based falls prevention programs: a study on participant risk levels and program congruency

Background

Falls are a leading cause of injury and injury-related deaths in older adults. A variety of community-delivered, evidence-based, fall risk-reduction programs have been developed and proven effective. These evidence-based fall prevention programs (EBFPP) have been classified along a fall-risk continuum, indicating the target fall-risk level of participants. The congruency between the program's targeted and enrolled fall-risk level of participants is unknown. This study creates a fall-risk classification index, places participants into one of three fall risk categories, and then examines congruency of actual vs. recommended fall-risk of participants, by program.

Methods

Data came from the Healthy Aging Programs Integrated Database, created by the National Council on Aging (NCOA) funded by the Administration for Community Living (ACL) for use by ACL falls prevention program grantees. Using data from a pre-participation survey designed by the ACDL for their grantees, a fall risk index was created. The fall risk levels of the participants were then compared to the fall risk profile of the EBFPPs as identified in NCOA's Evidence-based Falls Prevention Programs Risk Continuum Guidance for Program Selection in which they were enrolled.

Results

Between July 2016 and June 2022, 105,323 older adults participated in one of eight EBFPPs. Participant characteristics varied among programs. Applying the fall risk index to the fall risk sample (31,064 older adults), 29% of participants were identified as being at high risk, 41% at moderate risk, and 30% at low risk. When the fall risk level of participants, by program, was compared to the target risk profile of the associated EBFPP, programs that had a risk profile targeting individuals at moderate to low risk were found to enroll a larger percentage of adults at high risk than expected. All programs enrolled at least some participants at each of the three risk levels.

Conclusion

All eight EBFPPs enrolled participants across all three fall-risk levels with most programs being at least somewhat congruent with the fall-risk program continuum recommendations. More research is needed to better understand inconsistencies between risk-levels of program, target risk-levels, and actual participant risk-level, to guide either adaptations in the risk-level classification or program modifications to accommodate different risk-levels.

Gender differences in the associations of recreational walking with indoor and outdoor falls among older adults-the Healthy Aging and Neighborhood Study (HANS)

Objective

This study examined gender differences in the association between recreational walking and indoor and outdoor fall rates among older adults.

Methods

The Healthy Aging and Neighborhood Study is a prospective cohort that included 716 community-dwelling adults aged 65-95 years in central and northeastern Massachusetts, USA (2018-2023). Recreational walking at baseline was measured by the frequency of walking for exercise for at least 10 min in the participants' neighborhood. Falls were reported on monthly falls calendars, and the circumstances for reported falls were collected via subsequent telephone interviews. Mixed effects negative binomial models were used to estimate gender differences in the associations of recreational walking with rates of indoor and outdoor falls, separately. Models were adjusted for sociodemographic variables, physical health, functional status, lifestyle behaviors, mental health, and fear of falling.

Results

There were 394 (55%) female and 322 (45%) male participants enrolled in the study, and the mean (SD) age was 74.08 (6.29). About 61% of participants engaged in recreational walking at least once weekly. Women had lower outdoor fall rates than men (32 vs. 40 per 100 person-years), while indoor fall rates did not significantly differ by gender (31 vs. 34 per 100 person-years). Women engaging in recreational walking at least once weekly had a 62% lower indoor fall rate [IRR (95% CI): 0.38 (0.21, 0.71)] than those who did not. No significant associations were observed between recreational walking and outdoor falls for both women and men.

Discussion

Among community-dwelling older women, but not men, a higher frequency of recreational walking was associated with lower rates of indoor falls, while no changes were seen with outdoor falls. Increasing recreational walking may be a viable focus for fall prevention programs in the community, especially for older women.

Use of Hearing Aids Embedded with Inertial Sensors and Artificial Intelligence to Identify Patients at Risk for Falling

OBJECTIVE

To compare fall risk scores of hearing aids embedded with inertial measurement units (IMU-HAs) and powered by artificial intelligence (AI) algorithms with scores by trained observers.

STUDY DESIGN

Prospective, double-blinded, observational study of fall risk scores between trained observers and those of IMU-HAs.

SETTING

Tertiary referral center.

PATIENTS

Two hundred fifty participants aged 55-100 years who were at risk for falls.

INTERVENTIONS

Fall risk was categorized using the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) test battery consisting of the 4-Stage Balance, Timed Up and Go (TUG), and 30-Second Chair Stand tests. Performance was scored using bilateral IMU-HAs and compared to scores by clinicians blinded to the hearing aid measures.

MAIN OUTCOME MEASURES

Fall risk categorizations based on 4-Stage Balance, Timed Up and Go (TUG), and 30-Second Chair Stand tests obtained from IMU-HAs and clinicians.

RESULTS

Interrater reliability was excellent across all clinicians. The 4-Stage Balance and TUG showed no statistically significant differences between clinician and HAs. However, the IMU-HAs failed to record a response in 12% of TUG trials. For the 30-Second Chair Stand test, there was a significant difference of nearly one stand count, which would have altered fall risk classification in 21% of participants.

CONCLUSIONS

These results suggest that fall risk as determined by the STEADI tests was in most instances similar for IMU-HAs and trained observers; however, differences were observed in certain situations, suggesting improvements are needed in the algorithm to maximize accurate fall risk categorization.

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.

Back to Basics: The Utility of History and Physical in the Workup of Geriatric Ground-Level Falls

INTRODUCTION

Falls account for nearly ¾ of all trauma in the geriatric population. We hypothesized that history and physical could reliably identify elderly patients with ground-level falls (GLF) who require head and cervical spine imaging.

MATERIALS AND METHODS

Patients of age >65 y with GLF from January, 2018 to December, 2021 at a level 1 trauma center were retrospectively reviewed. Falls from height, transfers, and presentation >48 h post injury were excluded. Primary outcome was head or cervical spine injury defined by (+) computed axial tomography (CT). Data were compared with univariate and multivariate analyses at P < 0.05.

RESULTS

In 825 patients, 275 (33%) were on home anticoagulation or antiplatelet agents, half (51%) were considered frail, and most had at least one comorbidity prior to arrival. In 645 (79%) with a head CT, 174 (27%) were (+) and 20 (11%) required surgical intervention. Head CT changes were associated with male gender, Glasgow Coma Scale (GCS) score < 15, external signs of head injury, and headache, but not pre-existing anticoagulation. In 536 (65%) with cervical spine CT, 32 (6%) were (+) and 5 (17%) required surgery. Only neck symptoms were associated with (+) cervical spine injury.

CONCLUSIONS

In geriatric GLF, normal GCS score with no external signs of head trauma or headache indicates a low likelihood of head injury regardless of pre-existing anticoagulation. Similarly, the absence of neck symptoms suggests a low likelihood of cervical spine injury. Thus, history and physical are reliable in the workup of head and cervical spine injuries after geriatric GLF.

Caregiver beliefs about older adult falls from a nationally representative U.S. sample 2022

INTRODUCTION

Falls represent a prevalent cause of injury, disability, and mortality in the United States among older adults (ages 65+). Falls are not an inherent part of aging and adopting evidence-based fall prevention strategies can reduce fall risk. Caregivers are well-positioned to increase awareness and uptake of fall prevention strategies among older adults but may not be aware of all effective strategies. The objective of this study was to assess caregivers' beliefs and awareness related to older adult falls and evidence-based prevention strategies.

METHODS

Questions about falls were included in the SummerStyles survey, part of the 2022 suite of Porter Novelli ConsumerStyles surveys. Questions covered demographic and health characteristics of respondents, caregiver status, and knowledge of evidence-based fall prevention strategies. We compared demographic, health, and fall prevention knowledge by caregiver status and age.

RESULTS

Caregivers were more likely to be women, 65+, and report low income and fair/poor health compared to non-caregivers. Most (88.8%) caregivers did not believe older adult falls are inevitable. Most caregivers (94.0%) reported knowing at least one evidence-based fall prevention strategy, but many also identified strategies with limited evidence, such as being more careful (75.1%), as effective. Few caregivers recognized interventions like Tai Chi (13.4%) and medication management (23.3%) as effective. However, caregivers often recognized the importance of making homes safer (84.8%) and strength or balance exercises (76.4%).

CONCLUSIONS

Our findings highlight the need for expanded education aimed at caregivers to raise awareness about fall risks and all evidence-based fall prevention strategies.

PRACTICAL APPLICATIONS

Public health efforts can benefit from effectively educating and empowering older adults and their caregivers to play a proactive role in fall prevention and aging without injury. Results can facilitate targeted education and support of caregivers and creation of caregiver-driven programs to address fall risk and prevention.

Predicting admission for fall-related injuries in older adults using artificial intelligence: A proof-of-concept study

AIM

Pre-injury frailty has been investigated as a tool to predict outcomes of older trauma patients. Using artificial intelligence principles of machine learning, we aimed to identify a "signature" (combination of clinical variables) that could predict which older adults are at risk of fall-related hospital admission. We hypothesized that frailty, measured using the 5-item modified Frailty Index, could be utilized in combination with other factors as a predictor of admission for fall-related injuries.

METHODS

The National Readmission Database was mined to identify factors associated with admission of older adults for fall-related injuries. Older adults admitted for trauma-related injuries from 2010 to 2014 were included. Age, sex, number of chronic conditions and past fall-related admission, comorbidities, 5-item modified Frailty Index, and medical insurance status were included in the analysis. Two machine learning models were selected among six tested models (logistic regression and random forest). Using a decision tree as a surrogate model for random forest, we extracted high-risk combinations of factors associated with admission for fall-related injury.

RESULTS

Our approach yielded 18 models. Being a woman was one of the factors most often associated with admission for fall-related injuries. Frailty appeared in four of the 18 combinations. Being a woman, aged 65-74 years and presenting a 5-item modified Frailty Index score >3 predicted admission for fall-related injuries in 80.3% of this population.

CONCLUSION

Using artificial intelligence principles of machine learning, we were able to develop 18 signatures allowing us to identify older adults at risk of admission for fall-related injuries. Future studies using other databases, such as TQIP, are warranted to validate our high-risk combination models. Geriatr Gerontol Int 2025; 25: 232-242.

Psychological Factors Associated with Fear of Falling and Fear of Falling Avoidance Behavior in Older Adults: Results from a National Sample

OBJECTIVES

This study aimed to identify psychological factors and characteristics associated with fear of falling (FOF) and fear of falling avoidance behavior (FFAB) among older adults.

METHODS

This cross-sectional study used data from the National Health and Aging Trends Study (Wave 9, n = 4,977).

RESULTS

We found that increased fall history, more frequent depression and anxiety, and poorer perceived overall health were significantly higher among older adults with FFAB compared to FOF (ps < .001). Perceived overall health, depression, and anxiety explained a significant amount of variance in FOF and FFAB. Lastly, demographic characteristics differ between older adults reporting no FOF/FFAB, FOF, and FFAB.

CONCLUSIONS

FOF and FFAB are prevalent among older adults. Older adults experiencing FFAB had poorer health perceptions, more falls, and more frequent depression and anxiety than those experiencing FOF. The association of psychological factors and demographic characteristics with FOF and FFAB may indicate potential treatment targets. Clinical Implications: Addressing psychological variables, such as health perception, anxiety, and depression among older adults, may mitigate the impact of FOF and the development of FFAB; however, further research is needed.

The relationships among positive coping style, psychological resilience, and fear of falling in older adults

OBJECTIVES

Fear of falling is a psychological issue that adversely impacts the health of elderly individuals. The purpose of this study was to investigate the correlation among positive coping styles, psychological resilience, and fear of falling in older adults. The mediating role of psychological resilience was also investigated.

METHODS

A cross-sectional study was carried out from July 2023 to December 2023. There are 202 older adults from a tertiary hospital in Beijing, China, participated in this study. The general information questionnaire, the Simplified Coping Style Questionnaire, the Chinese version of the Connor-Davidson Resilience Scale, and the Falls Efficacy Scale-International were utilized. Descriptive statistics, Pearson correlation, and structural equation modeling were used for data analysis.

RESULTS

The prevalence of fear of falling in the elderly was 53.00%. Older individuals with a history of falls or fractures had a significantly higher fear of falling (P < 0.05). Fear of falling was inversely connected with psychological resilience and positive coping styles (P < 0.05). Positive coping styles were positively connected with psychological resilience (r = 0.638, P < 0.01). Structural equation modeling showed that psychological resilience fully mediated the effect of positive coping styles on fear of falling (indirect effect estimate = -0.126, 95% CI -0.036 to-0.225; total effect estimate = -0.121, 95% CI -0.028to -0.005).

CONCLUSION

Fear of falling was widespread among older adults and psychological resilience fully mediated the relationship between positive coping styles and fear of falling. Future interventions targeting the fear of falling should consider the enhancement of psychological resilience.

[Longitudinal Transitions of Fall States Based on a Multi-State Markov Model and Their Associated Risk Factors]

Objective

To investigate the transition intensity and transition probabilities of fall states among middle-aged and older adults in China, and to assess the impact of potential risk factors on falls.

Methods

We utilized in the study data from the China Health and Retirement Longitudinal Study (CHARLS) and employed a multi-state Markov model (MSM) to analyze the transition intensity and probabilities between states of no falls or falls without treatment, falls requiring treatment, and death.

Results

A total of 14722 participants were enrolled, with a mean age of (59.4 years ± 9.7 years), and 47.9% were male. The median follow-up period was 9 years (interquartile range [IQR], 7-9 years). At baseline, 12381 participants (84.1%) reported no falls or falls without treatment, while 2341 (15.9%) reported falls requiring treatment. Participants who experienced falls requiring treatment within one follow-up cycle had a 55.2% probability of not falling again or only falling without treatment in the subsequent two years, a 37.6% probability of continuing to experience falls requiring treatment, and a 7.2% probability of death. The risk of transitioning from a state of no falls or falls without treatment to falls requiring treatment increased by 8.6% for every 5-year increase in age. The risk was 35.1% higher for females compared to males. Rural residents had a 10.1% higher risk. Those who were divorced, separated, widowed, or never married had a 20.7% higher risk. Higher degrees of physical function impairment were associated with an increased risk. Depressive symptoms increased the risk by 31.6%. Having one chronic disease raised the risk by 9.6%, while multimorbidity led to a 28.8% increase in risk.

Conclusion

According to the findings of the study, falls are a dynamic process and emphasis should be given to fall prevention for older adults, individuals with a history of fall-related medical visits, those living alone, those with impaired physical function, and those with depressive symptoms.

Older Fallers' Comprehensive Neuromuscular and Kinematic Alterations in Reactive Balance Control: Indicators of Balance Decline or Compensation? A Pilot Study

Background: Falls and fall consequences in older adults are global health issues. Previous studies have compared postural sways or stepping strategies between older adults with and without fall histories to identify factors associated with falls. However, more in-depth neuromuscular/kinematic mechanisms have remained unclear. This study aimed to comprehensively investigate muscle activities and joint kinematics during reactive balance control in older adults with different fall histories. Methods: This pilot observational study recruited six community-dwelling older fallers (≥1 fall in past one year) and six older non-fallers, who received unpredictable translational balance perturbations in randomized directions and intensities during standing. The whole-body center-of-mass (COM) displacements, eight dominant-leg joint motions and muscle electrical activities were collected, and analyzed using the temporal and amplitude parameters. Results: Compared to non-fallers, fallers had significantly: (a) smaller activation rate of the ankle dorsiflexor, delayed activation of the hip flexor/extensor, larger activation rate of the knee flexor, and smaller agonist-antagonist co-contraction in lower-limb muscles; (b) larger knee/hip flexion angles, longer ankle dorsiflexion duration, and delayed timing of recovery in joint motions; and (c) earlier downward COM displacements and larger anteroposterior overshooting COM displacements following unpredictable perturbations (p < 0.05). Conclusions: Compared to non-fallers, fallers used more suspensory strategies for reactive standing balance, which compensated for inadequate ankle/hip strategies but resulted in prolonged recovery. A further longitudinal study with a larger sample is still needed to examine the diagnostic accuracies and training values of these identified neuromuscular/kinematic factors in differentiating fall risks and preventing future falls of older people, respectively.

Impact of Nurse Staffing Levels on Patient Fall Rates: A Retrospective Cross-Sectional Study in General Wards in Japan

Background: Falls are common adverse events among hospitalized patients, affecting outcomes and placing a financial burden on patients and hospitals. This study investigated the relationship between nurse staffing/workload and patient falls during hospitalization. Methods: The patients studied were hospitalized in the general wards (excluding pediatrics and obstetrics/gynecology) of 11 National Hospital Organization institutions between April 2019 and March 2020. The data were obtained from the Diagnosis Procedure Combination Work Record and institutional fall reports. The variables used in the analyses included patient conditions, number of hospitalization cases, emergency hospitalizations, surgeries/examinations, disease composition ratio, patient attributes, hospital stay duration, hospital bed size, and nursing time per patient (day and night) on a ward-day basis. Multivariate analysis was performed to determine the effects of these factors on fall events. Results: A total of 36,209 ward days were analyzed, with falls reported on 2866 days (fall event rate of 9.0%). The mean nursing times per patient were 1.99 h (day) and 1.47 h (night). The nursing time per patient in the fall group compared to the non-fall group showed an odds ratio of 1.19 (p < 0.01) during day shifts and 0.17 (p < 0.02) during night shifts. An increase in nursing time per patient during the night was associated with fewer fall events, whereas during the day, increased nursing time appeared to contribute to more falls. Common background factors that increased nurse staffing and patient falls simultaneously could be suggested to exist during the day. Conclusions: Increased nursing time was correlated with reduced fall incidence, indicating the need for policy improvements in nurse staffing practices in Japan to enhance patient safety and outcomes. Further research is needed to accumulate evidence reflecting policies regarding nurse staffing.

Robots in Nursing Homes: Helping Nurses Detect and Prevent Falls

Falls are a leading cause of morbidity and mortality in older adults, especially among nursing home residents. Falls occur more commonly among older adults with dementia than among those without dementia. Moreover, half of nursing home residents have moderate to severe cognitive impairment. While less than 5% of older adults live in nursing homes, they account for 20% of deaths from falls in this age group. In addition, 78% of older adults who fall need help in getting up from the floor. The consequences of falling, such as prolonged lying on the floor, can produce severe and prolonged health effects. The acute shortage of staff in nursing homes, especially during evening, night and weekend shifts, can delay the detection and response to falls. There are various systems designed to detect falls and alert staff, including those utilizing wearable devices, ambience sensors and cameras (vision) as well as fusion systems. They each have their advantages and drawbacks. In this NIA-funded SBIR grant, we are developing and testing the feasibility of a fall detection and prevention system that addresses the drawbacks of previous systems. We anchor our approach on the deployment of an autonomously navigating robot equipped with a mounted infrared camera and machine learning software designed to detect the risk of falls and falls themselves. The robot will patrol resident rooms during evening and night shifts and alert the staff, allowing them to evaluate the fall risk or fall alert presented by the robot video camera and determine whether indeed a resident has fallen or is at risk of falling, and take appropriate action.

ChatGPT's Attitude, Knowledge, and Clinical Application in Geriatrics Practice and Education: Exploratory Observational Study

BACKGROUND

The increasing use of ChatGPT in clinical practice and medical education necessitates the evaluation of its reliability, particularly in geriatrics.

OBJECTIVE

This study aimed to evaluate ChatGPT's trustworthiness in geriatrics through 3 distinct approaches: evaluating ChatGPT's geriatrics attitude, knowledge, and clinical application with 2 vignettes of geriatric syndromes (polypharmacy and falls).

METHODS

We used the validated University of California, Los Angeles, geriatrics attitude and knowledge instruments to evaluate ChatGPT's geriatrics attitude and knowledge and compare its performance with that of medical students, residents, and geriatrics fellows from reported results in the literature. We also evaluated ChatGPT's application to 2 vignettes of geriatric syndromes (polypharmacy and falls).

RESULTS

The mean total score on geriatrics attitude of ChatGPT was significantly lower than that of trainees (medical students, internal medicine residents, and geriatric medicine fellows; 2.7 vs 3.7 on a scale from 1-5; 1=strongly disagree; 5=strongly agree). The mean subscore on positive geriatrics attitude of ChatGPT was higher than that of the trainees (medical students, internal medicine residents, and neurologists; 4.1 vs 3.7 on a scale from 1 to 5 where a higher score means a more positive attitude toward older adults). The mean subscore on negative geriatrics attitude of ChatGPT was lower than that of the trainees and neurologists (1.8 vs 2.8 on a scale from 1 to 5 where a lower subscore means a less negative attitude toward aging). On the University of California, Los Angeles geriatrics knowledge test, ChatGPT outperformed all medical students, internal medicine residents, and geriatric medicine fellows from validated studies (14.7 vs 11.3 with a score range of -18 to +18 where +18 means that all questions were answered correctly). Regarding the polypharmacy vignette, ChatGPT not only demonstrated solid knowledge of potentially inappropriate medications but also accurately identified 7 common potentially inappropriate medications and 5 drug-drug and 3 drug-disease interactions. However, ChatGPT missed 5 drug-disease and 1 drug-drug interaction and produced 2 hallucinations. Regarding the fall vignette, ChatGPT answered 3 of 5 pretests correctly and 2 of 5 pretests partially correctly, identified 6 categories of fall risks, followed fall guidelines correctly, listed 6 key physical examinations, and recommended 6 categories of fall prevention methods.

CONCLUSIONS

This study suggests that ChatGPT can be a valuable supplemental tool in geriatrics, offering reliable information with less age bias, robust geriatrics knowledge, and comprehensive recommendations for managing 2 common geriatric syndromes (polypharmacy and falls) that are consistent with evidence from guidelines, systematic reviews, and other types of studies. ChatGPT's potential as an educational and clinical resource could significantly benefit trainees, health care providers, and laypeople. Further research using GPT-4o, larger geriatrics question sets, and more geriatric syndromes is needed to expand and confirm these findings before adopting ChatGPT widely for geriatrics education and practice.

An umbrella review of physical-activity therapy and cognitive behavioral therapy in reducing fear of falling among community-dwelling older adults: insights on intervention intensity and duration

Introduction

Data about the impact of varying physical-activity therapy (PAT) intensities and the ideal duration of cognitive behavioral therapy (CBT) on older adults is inadequate. In this umbrella review, we seek to comprehensively synthesize and analyze findings from systematic reviews and meta-analyses regarding the optimal PAT intensity for lowering FOF and the duration of CBT interventions for effectively lowering FOF.

Methods

The PubMed, Web of Science, Cochrane Library, Medline, Embase, and CINAHL databases were searched up to April 2024. AMSTAR 2 was applied to assess the methodological and reporting quality. The quality of evidence for each intervention's effect was evaluated using GRADE guidelines. A further meta-analysis of the primary studies was conducted to evaluate the effects of PAT intensity and CBT duration.

Results

In the 18 included studies, 12 were PAT interventions, 3 were multifactorial, and 3 were CBT interventions. The umbrella review found that PAT and CBT interventions can effectively manage FOF. Comparable improvements were reported with low- and moderate-intensity PAT intervention (p < 0.0001); Significant improvements were observed with CBT immediately post-intervention, in the short-term (<6 months), and in the long-term (≥6 months) (p < 0.0001).

Discussion

Our study revealed that a comprehensive intervention strategy combining low or moderate PAT with CBT interventions is more effective than isolated approaches, as it addresses the multifaceted nature of fear and fall risk. Future research should continue to track the long-term effects of synergistic interventions to optimize fall prevention strategies for older populations.

Systematic review registration

https://www.crd.york.ac.uk/prospero Identifier CRD42024557893.

Cross-sectional analysis of speed-up mechanism in normal gait among healthy older adults with and without falls - Results from the Baltimore Longitudinal Study of Aging

BACKGROUND

Falls in older adults increase the risk of mobility loss. Proper understanding of gait mechanisms related to falls may provide novel solutions for maintaining mobility in older adults.

RESEARCH QUESTION

Identify fall-related gait patterns through analyzing alterations in gait parameters to walk faster than usual pace in older adults.

METHODS

A Total of 519 participants (mean age = 73.12 years; 51.05 % female), including non-fallers (n = 396) and fallers (n = 123), aged 60-96 years were assessed in the Baltimore Longitudinal Study of Aging. Participants completed gait assessments at both usual and fast paces. Range of motions (ROM) for the hip, knee, and ankle joint in the sagittal plane and hip abductor ROM during normal and fast pace gait were measured by 3D motion capture system (Vicon 612). For all gait variables, percentage-changes (PC; (((fast-walking_parameter - usual-walking_parameter) /usual-walking_parameter)*100)) was calculated. Associations of PC for gait speed and PC for other gait parameters were compared between fallers and non-fallers.

RESULTS

Compared to non-fallers, fallers walked with shorter stride, elongated double support time and shorter knee ROM in the faster pace walk (p = 0.044, p = 0.019, and p = 0.036, respectively). PCs of all gait related variables were significantly associated with PC of gait speed in non-fallers (ps < 0.005), while in the fallers, only PC for stride length, cadence, and hip ROM were associated with PC for gait speed (ps < 0.001).

SIGNIFICANCE

Among non-fallers related PC for gait speed was associated with PC across gait parameters suggesting the use of similar biomechanical approaches in usual and fast gait. Compared to non-fallers, fallers demonstrated different mechanisms of transition from usual to fast gait. Evaluating speed-up strategies could provide insight into subtle yet important gait modifications in apparently well-functioning older adults that would help identify individuals at high risk of falling.

Association of Questionnaire-Assessed Fall Risk With Uncontrolled Blood Pressure and Therapeutic Inertia Among Older Adults

Therapeutic inertia (TI), or failure to escalate or initiate BP lowering medications when BP is uncontrolled, increases with advancing age and may in part be due to perceived fall risk. This study examined the association of a fall risk assessment, based on patient response to three questions administered by trained staff, with uncontrolled BP (≥140/90 mmHg) during a clinic visit and with TI during clinic visits with uncontrolled BP among 13 893 patients age ≥ 65 years corresponding to 41 122 primary care visits. Separate generalized linear mixed effects models were used to examine the association of fall risk (low, moderate, and high) with uncontrolled BP and with TI at a clinic visit after adjustment for demographics, comorbidities, and total number of visits. Baseline mean age was 73.0 years (standard deviation [SD] 5.6), 43.3% were men and questionnaire-assessed fall risk severity was low in 73.6%, moderate in 14.3%, and high in 12.2%. Compared to low fall risk, the adjusted odds of uncontrolled BP during a clinic visit were 0.97 (95% CI: 0.89, 1.06) and 0.90 (95% CI: 0.82, 0.98) with moderate and high fall risk, respectively. In contrast, adjusted odds of TI during a clinic visit with BP ≥ 140/90 mmHg was 1.16 (95% CI: 1.01, 1.34) and 1.30 (95% CI: 1.11, 1.52) with moderate and high fall risk, respectively, compared to low fall risk. These findings suggest that perceived fall risk severity may be one of several factors that influence hypertension management in older adults.

Trends in Orthopaedic Surgery on Patients 90 Years Old and Older 2014-2023

Objectives

The United States (US) population is aging with an increasing number of older adults over 90 years old. The primary purpose of this study is to evaluate trends in orthopaedic surgeries in patients 90 years old and greater over the past decade from 2014-2023.

Methods

Patients ≥90 years old at the time of surgery at a single orthopaedic specialty practice from 2014 through 2023 were identified. All patients that underwent nonsurgical treatment were excluded. Surgeries were categorized by musculoskeletal area and procedure type by CPT codes. Musculoskeletal areas include Shoulder, Humerus/Elbow, Forearm/Wrist, Hand/Fingers, Pelvis/Hip, Femur/Knee, Leg/Ankle, Foot/Toes, Spine, Integumentary, Nervous System, and Other.

Results

Over the last decade, 5,291 orthopaedic surgeries were performed on 4,807 patients 90 years old and older (age range 90-107 years old; 75% female). Of these patients, 91% underwent only one surgery while ≥90 years old, while the remaining underwent between two to five surgeries. The number of surgeries each year ranged from 180 to 680 with a positive correlation between year and number of surgeries and a greater than threefold increase in surgeries 2014-2023. The Pelvis and Hip were the primary musculoskeletal areas of surgery, accounting for 69% of surgeries overall, followed by femur and knee (11%) and nervous system (which includes carpal tunnel release, 5.2%). Most surgeries (69%) were for a fracture or dislocation.

Conclusion

There is an increase in volume of orthopaedic surgery on patients ≥90 years old over the last decade between 2014-2023, the majority of which were performed on the hip and pelvis and for fractures or dislocations. As older adults ≥90 years old continue to increase in the population, we project the surgical volume will continue to grow and place a large financial burden on the US healthcare system.

Investigating the impact of oral health status on the prevalence of falls among caregivers and non-caregivers in the United States: A retrospective study

OBJECTIVE

Examining the association between oral health and the prevalence of falls among US caregivers.

BACKGROUND

There is a scarcity of research on the association between oral health status and the prevalence of falls among older adults and caregivers.

MATERIALS AND METHODS

Data from the Behavioral Risk Factor Surveillance System (BRFSS) surveys from 2016 to 2020 were analyzed. The analysis was limited to individuals aged 45 years and older (n = 97 550). The outcome variable was if a person had fallen at least once during the past 12 months. The main predictor variables were the number of teeth removed, the last dentist visit, and caregiver status. Data were analyzed using bivariate descriptive statistics, chi-square tests, and logistic regression to estimate adjusted odds ratios (AORs).

RESULTS

Having one to five teeth removed was linked to an increased prevalence of falls [AOR: 1.13, 95% confidence interval (95% CI): 1.02-1.25, p = .017] and was highest for complete tooth loss (AOR: 1.35, 95% CI: 1.15-1.58, p < .001). Caregivers had increased fall odds (AOR: 1.23, 95% CI: 1.10-1.38, p < .001). Caregivers' prevalence of fall increases with six or more teeth removed (AOR: 1.41, 95% CI: 1.02-1.94, p = .038) and all teeth removed (AOR: 1.47, 95% CI: 1.03-2.09, p = .030). Dental visits in the past year were associated with a 21% reduced fall risk for caregivers (AOR = 0.79, 95% CI: 0.64-0.98, p = .035).

CONCLUSION

The study showed that maintaining good oral health and utilizing dental services may be associated with lower fall risks, particularly among caregivers, suggesting the need for integrating oral health into fall prevention strategies.

Age Is Not Just a Number: The Intersection of Age, Orthopedic Injuries, and Worsening Outcomes Following Low-Energy Falls

BACKGROUND

The purpose of this study is to stratify the age at which older adults are most likely to sustain injuries and major complications resulting from low-energy falls so that fall prevention strategies may be targeted to more susceptible age groups.

METHODS

A consecutive series of 12 709 patients older than 55 years enrolled in an orthopedic trauma registry from October 2014 to April 2021 were reviewed for demographic factors, hospital quality measures, and outcomes. Patients were grouped by age brackets in 5-year intervals. Comparative analyses were conducted across age groups with an additional post hoc analysis comparing the 75- to 79-year-old cohort with others. All statistical analyses were conducted utilizing a Bonferroni-adjusted alpha.

RESULTS

Of the 12 709 patients, 9924 patients (78%) sustained a low-energy fall. The mean age of the cohort was 75.3 (range: 55-106) years and the median number of complications per person was 1.0 (range: 0-7). The proportion of females increased across each age group. The mean Charlson Comorbidity Index increased across each age group, except in the cohort of 90+ years of age. There was a varied distribution of fractures among age groups with the incidence of hip fractures most prominently increasing with age. Complication rates varied significantly between all age groups. Between the ages of 70 to 74 years and 80 to 84 years, there was a 2-fold increase in complication rate, and between the ages of 70 to 74 years and 75 to 79 years, there was a near 2×/1.5×/1.4× increase in inpatient, 30-day, and 1-year mortality rate, respectively. When controlling for confounding demographic variables between age groups, the rates of complications and mortality still differed.

CONCLUSIONS

Fall prevention interventions, while applicable to all older adult patients, could improve outcomes by offering additional resources particularly for individuals between 70 and 80 years of age. These additional resources can help minimize excessive hospitalizations, prolonged lengths of stay, and the detrimental complications that frequently coincide with falls. Although hip fractures are the most common fracture as patients get older, other fractures still occur with frequency, and fall prevention strategies should account for prevention of these injuries as well.