Risk factors for falls among community-dwelling older adults: A systematic review and meta-analysis

Factors influencing fall prevention programmes across three regions of the UK: the challenge of implementing and spreading the Falls Management Exercise (FaME) programme in a complex landscape

BACKGROUND

The occurrence of falls in adults 65+ years remains a common and costly issue worldwide. There is current evidence to suggest that falls can be prevented using evidence-based strength and balance interventions, such as the six-month Falls Management Exercise (FaME) programme. Perspectives of multiple key partners and providers of the FaME programme could inform future implementation and fall prevention strategies.

METHODS

Partners and providers involved in local community fall prevention pathways were purposefully recruited from three geographical areas across the UK. Semistructured interviews were conducted to gain a broad understanding of factors affecting the adoption, implementation and spread of FaME. Data were analysed using an inductive thematic approach and mapped to the Consolidated Framework for Implementation Research (CFIR).

RESULTS

Data from 25 participant interviews and document analysis revealed 11 themes organised within five CFIR domains-the innovation (3), outer setting (3), inner setting (1), characteristics of individuals (1) and process (2).

CONCLUSION

The adoption, implementation and spread of FaME into community settings is complex and faces multiple health system challenges. For adoption and implementation to be facilitated, FaME programmes must demonstrate effectiveness and fit the local needs of those receiving the intervention. For spread to occur, influential decision-makers and funders must support wider programme rollout whilst also securing sufficient expert capacity to deliver the programme and ensure monitoring is in place to determine effectiveness of provision for older adults.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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

Age-Related Cataract Extraction Is Associated With Decreased Falls, Fractures, and Intracranial Hemorrhages in Older Adults

BACKGROUND

Cataract extraction with intraocular lens insertion (CEIOL) is among the most frequently performed surgeries in the United States and is indicated for individuals with age-related cataracts causing visual impairment. The association between CEIOL and falls and hip fractures has been described, but there is a paucity of literature describing the association between CEIOL and various other common morbidity and mortality-increasing age-related traumatic injuries.

METHODS

This retrospective cohort study utilized TriNetX, a health database, to access de-identified electronic medical records. Cohorts of patients aged 60 years and older were identified using diagnostic and procedural codes. Cohort 1 was defined as patients with age-related cataracts who underwent CEIOL within 10 years of documented diagnosis of cataracts. Cohort 2 was defined as patients with age-related cataracts who did not undergo CEIOL within 10 years of documented diagnosis of cataracts. Propensity score matching for demographics and other relevant comorbidities was completed. Chi-square analysis was performed, and data were reported as odds ratios with 95% confidence intervals. Outcomes analyzed included proximal humerus fracture, distal radius fracture, hip fracture, ankle fracture, fall, subdural hemorrhage, and epidural hemorrhage.

RESULTS

Patients who underwent CEIOL demonstrated significantly lower odds of falls (p < 0.0001), proximal humerus fracture (p = 0.016), distal radius fracture (p = 0.0004), hip fracture (p < 0.0001), ankle fracture (p = 0.0002), subdural hemorrhage (p < 0.0001), and epidural hemorrhage (p = 0.006) as compared to patients with a documented diagnosis of age-related cataract without CEIOL.

CONCLUSIONS

CEIOL was significantly associated with decreased falls and reductions in major fall-related injuries among patients with age-related cataracts. These findings strongly support improved screening protocols to detect vision loss secondary to age-related cataracts, as this may decrease the incidence of common major fall-related injuries among patients with age-related cataracts.

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

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

Utilizing machine learning to identify fall predictors in India's aging population: findings from the LASI

BACKGROUND

Depression has a detrimental effect on an individual's mental and musculoskeletal strength multiplying the risk of fall incidents. The current study aims to investigate the association between depression and falls in older adults using machine learning (ML) approach and identify its various predictors.

METHODS

Data for the study was derived from the Longitudinal Ageing Study in India, (LASI) conducted in 2017-18 for people aged 45-years and above. The study was carried out on 44,066 individuals. Depression was measured using the CIDI-SF scale. Bivariate cross-tabulations were used to study the prevalence of falls. And its association with depression and other independent factors were assessed using the novel ML, the Conditional inference trees (CIT) method.

RESULTS

Around 10.8 percent of older adults had fall incidents. CIT model predicted region to be a significant predisposing factor for an older adult to experience falls. Multimorbidity, depression, sleep problems, and gender were other prominent factors. The model predicted that, among depressed older adults, falls incidents were around 80 percent higher than non-depressed.

CONCLUSIONS

An association between falls and depression was observed. Depressive symptoms were associated with an increased risk of falls, even after controlling for other co-factors. The CIT method leveraged us to select the most important variables to predict falls with great precision. To prevent and manage falls among the expanding and diverse older-aged population, a multilevel and cross-sectoral approach is required. Mental health, especially depression, should be dealt with greater precautions. Public health enthusiasts should focus on the physical as well as mental health of the country's older adult population.

Circumstances of clinical fracture events with advancing age in older men

To characterize fracture circumstances by age at time of fracture among community-dwelling older men, we analyzed incident clinical fractures in the Osteoporotic Fractures in Men study. Participants were contacted every 4 mo to identify fractures confirmed by radiographic reports. Fractures were classified as fall- or non-fall-related and further categorized by degree of trauma: minimal (fall from ≤ standing height), moderate (fall on stairs, steps or curb), or severe (fall from > standing height) for fall-related fractures; and minimal (eg, coughing), moderate (eg, collisions with objects during normal activity without falling), or severe (eg, motor vehicle accident) for non-fall-related fractures. Of 2351 clinical fractures in 1424 men during an average follow-up of 9.9 yr, 12.7% occurred at age <75 yr, 15.7% at age 75-79 yr, 26.1% at age 80-84 yr, and 45.5% at age ≥85 yr. A total of 1891 fractures (80.4% of all fractures) were the result of a fall. The proportion of fall-related fractures steadily rose with increasing age at time of fracture, ranging from 65.8% in men <75 yr rising to 84.7% in men ≥85 yr (p < .001). Most fall-related fractures (76.4%) were due to minimal trauma; the proportion of all fractures due to a fall with minimal trauma steadily rose with increasing age (p < .001). In contrast, approximately half of non-fall-related fractures (53.5%) were due to severe trauma. The proportion of all fractures due to severe trauma (whether fall-related or not) declined with advancing age (p < .001). In conclusion, the most frequently occurring fracture circumstance in older men was a fall from ≤standing height. This circumstance was increasingly common with advancing age occurring in 7 of every 10 fractures in men ≥85 yr, while a fracture (fall-related or not) due to severe trauma was less common with advancing age. Findings have implications for development of fracture prevention strategies in older men.

Dementia prevalence within the Kingdom of Saudi Arabia National Guard Health System (2015-2023): An exploratory epidemiological study

BackgroundDementia is recognized as one of the prevalent neurocognitive disorders among older adults in Saudi Arabia, yet research efforts on its prevalence remains limited and fragmented, making it difficult to gain a full understanding of its epidemiology.ObjectiveTo explore dementia epidemiology and associated data within the older population in the sector of National Guard Health System (NGHS), Saudi Arabia.MethodsThis was a multicenter study that utilized medical records from NGHS centers across the country. We included data from all individuals aged 50 years and older who sought medical care between January 1, 2015, and January 1, 2023.ResultsNearly half of the study's participants were men (51.9%), with the majority being diagnosed between the ages of 70-79 years (38.5%) and 80-89 years (31%). Dementia was identified in 3.37% of participants. The most prevalent subtype was late-onset Alzheimer's disease (35.6%), followed by unspecified dementia (18.4%). Significant differences between genders were observed, particularly in the age at diagnosis (p = 0.003) and the prevalence of ischemic strokes as a risk factor (p < 0.001).ConclusionsIn this multicenter study utilizing the NGHS cohort, Alzheimer's disease emerged as the most prevalent subtype of dementia. This research has the potential to influence clinical practices by enhancing the early identification and management of dementia and provides a solid foundation for developing evidence-based policy strategies to tackle the increasing challenges of dementia in Saudi Arabia.

The short- and long-term effects of a fall prevention program on the frequency of falls following total knee replacement: A pragmatic single-blinded randomized controlled trial protocol

BACKGROUND

Falling following total knee replacement (TKR) is a significant issue, and can result in serious fatal and non-fatal injuries. The proposed study aims to investigate the short and long-term effects of integrating a falls prevention program into conventional physiotherapy versus just conventional physiotherapy on the number of falls, and any subsequent effects on balance, and functional ability among TKR patients.

METHODS AND DESIGN

This is a parallel group prospective (52 weeks) randomized single-blinded pragmatic controlled trial conducted at Alrazi Orthopedic Hospital, in Kuwait. Sample size will be 90 pariticpants (45 participants in each group). Particpants will be randomized to intervention or control group. Outcome measures will be collected at baseline, 12 weeks and 52 weeks by investigators who are blinded to treatment allocation. Primary outcome will be fall rate assessed at 52 weeks following the TKR surgery. Secondary outcomes will include knee range of motion, severity of pain, 10-m walk test, Timed Up and Go test, Berg Balance Scale, 30-s sit to stand, patient adherence to home program and patient's satisfaction. Two-way multivariate ANOVA (group × time) will be performed to assess the group (experimental and control group) differences over time (baseline, 12, and 52 weeks).

DISCUSSION

Investigating the physiotherapy programs that could minimize or prevent the risk of falling among TKR patients seems important. The proposed study will be the first step toward determining the exercise program that could be effective in reducing the number of falls among TKR patients.

TRIAL REGISTRATION

ClinicalTrials.gov, Identifier NCT05642260.

Effect of Difference of Sensory Modality in Cognitive Task on Postural Control During Quiet Stance

Cognitive loads impact postural control; however, the specific influence of sensory modalities employed in cognitive tasks during motor-cognitive dual tasks remains unclear. This study investigated the distinct effects of visual and auditory cognitive tasks on static postural control while controlling for differences in task content. Twenty-five healthy young adults were instructed to maintain a quiet stance on a force plate under three cognitive task conditions: a single motor task (control), a paced visual serial addition task (visual), and a paced auditory serial addition task (auditory). Center of pressure (COP) displacements were measured, and both linear (e.g., sway area) and non-linear assessments of postural control were analyzed. Results revealed a significant reduction in sway area during cognitive tasks compared to the control condition. However, under the auditory condition, the power spectrum density of COP displacements in the moderate frequency band was significantly higher than those in the control and visual conditions, accompanied by a notable increase in the mean power frequency. These findings suggest that auditory cognitive load exerts a more significant effect on postural control than visual cognitive load during motor-cognitive dual tasks. This highlights the relevance of sensory modalities in cognitive loads for effective fall-risk assessment.

Effectiveness of PEER Intervention on Older Adults' Physical Activity Time Series Using Smoothing Spline ANOVA

Falls are a major cause of injury among older adults. The Physio-fEedback Exercise pRogram (PEER) combines physio-feedback, cognitive reframing, and guided exercises to reduce fall risk. However, its impact on physical activity (PA) over time is underexplored. Functional time-series analysis offers insight into behavior patterns and sustainability. This preliminary study assessed PEER's effectiveness in improving PA levels immediately and over time. A total of 64 community-dwelling older adults were cluster-randomized into PEER ( N = 33 ) or control groups ( N = 31 ) . Participants wore Fitbit trackers, generating time-series data on activity. The PEER group completed an 8-week program, while the control group received CDC fall prevention pamphlets. PA data were analyzed using smoothing spline analysis of variance (SSANOVA), chosen for its flexibility in modeling complex, non-linear relationships in time-series data and its ability to handle skewed distributions and repeated measures. Unlike traditional parametric models, SSANOVA decomposes temporal trends into interpretable components, capturing both smooth trends and abrupt changes, such as those occurring on group workout days. This capability ensures robust and nuanced analysis of intervention effects. Results showed PEER participants significantly increased evenly and had very active minutes and reduced sedentary behavior during the intervention. No significant effect was found for light active minutes. Specifically, during the intervention period, PEER participants engaged in an average of 6.7% fewer sedentary minutes per day, 13.8% additional fairly active minutes per day, and 2.8% additional very active minutes per day compared to the control group. While the reduction in sedentary minutes and increase in fairly active minutes were not statistically significant, the increase in very active minutes was significant. However, our functional time-series analysis revealed these improvements diminished over the 15-week follow-up, indicating challenges in maintaining PA. In conclusion, PEER boosts PA and reduces sedentary behavior short-term, but strategies are needed to sustain these benefits. In conclusion, PEER boosts PA and reduces sedentary behavior short-term, but strategies are needed to sustain these benefits. Public health policies should emphasize technology-driven fall risk assessments, community-based prevention programs, and initiatives that promote physical activity, home safety, and chronic condition management.

Association of standardized serum 25-hydroxyvitamin D with falls in post-menopausal women

Vitamin D status has long been related to falls risk. In this planned secondary analysis of a vitamin supplementation trial in postmenopausal women, standardized 25-hydroxyvitamin D concentration up to 60 ng/mL was not associated with increased falls. Women with 25(OH)D ≥ 60 ng/mL had higher odds of ≥ 2 falls.

PURPOSE

Falls are common and cause fractures. High circulating 25(OH)D may increase falls risk; thus, recent guidance recommends 25(OH)D not exceed 50 ng/mL. Prior falls studies have not reported standardized 25(OH)D (s25D) data. The purpose of this planned secondary analysis of a 4-year calcium/vitamin D supplementation trial was to evaluate the association of s25D with falls.

METHODS

This study recruited 2,303 postmenopausal women. The analytic dataset consisted of pooled concatenated data from years 2-4 (NTotal = 5,732). Serum 25(OH)D was measured annually and subsequently retrospectively standardized using Vitamin D Standardization Program methods. Falls were recorded by diary. Incidence for ≥ 1 fall and ≥ 2 falls was assessed by s25D group (≤ 20, 20- < 30, 30- < 40, 40- < 50, 50- < 60 and ≥ 60 ng/mL) using multivariable logistic regression.

RESULTS

Mean (SD) baseline s25D was 32.6 ng/mL (8.3) with no difference between supplement and placebo groups. s25D increased to 41.3 ng/mL at year 2 in the supplement group then remained stable. By s25D group, incidence for ≥ 1 fall varied from 22-32% (p = 0.19). For ≥ 2 falls incidence varied (p = 0.03) from 6% (< 20 ng/mL) to 17% (≥ 60 ng/mL.) There was no significant association between s25D and ≥ 1 fall. Those with s25D ≥ 60 ng/mL had a higher adjusted odds of ≥ 2 falls (OR = 1.99 ± 1.2-3.3) compared to women with s25D of 30- < 40 ng/mL.

CONCLUSION

s25D up to 60 ng/mL was not associated with greater risk for ≥ 1 or ≥ 2 falls. Women with a s25D ≥ 60 ng/mL were at higher odds for ≥ 2 falls, however this group included only ~ 2% of study observations; therefore, confirmation in other cohorts is necessary.

The Effects of Ankle and Foot Exercises on Ankle Strength, Balance, and Falls in Older People: A Systematic Review and Meta-Analysis

OBJECTIVE

Ankle-foot control is essential to maintain balance and gait stability. However, there has been limited evidence on the effect of ankle-foot exercises on balance and falls in older people. This study aimed to summarize the effects of ankle-foot exercises on ankle flexibility and strength, balance, mobility, and falls in older people and to identify determining factors for ankle-foot exercises to improve balance and mobility.

METHODS

Cumulative Index to Nursing and Allied Health Literature, Embase, PubMed, and Physiotherapy Evidence Database (PEDro) were searched to identify randomized controlled trials that studied the effects of ankle-foot exercises on ankle control, balance, and falls in older people. The PEDro scale was used to evaluate the methodological quality of the studies. Meta-analyses were done for similar outcomes. The quality of evidence was rated by GRADE.

RESULTS

Sixteen papers (n = 651) were included. Meta-analyses showed that ankle-foot exercises significantly improved ankle plantarflexion strength (SMD = 0.35, 95% CI = 0.04 to 0.65, low-quality evidence), ankle flexibility (SMD = 0.48, 95% CI = -0.01 to 0.96, low-quality evidence), and balance in an eyes-open condition (SMD = 0.41, 95% CI = 0.19 to 0.70, low-quality evidence). There was no significant change in ankle dorsiflexion strength (SMD = 0.29, 95% CI = -0.24 to 0.82, very low-quality evidence), balance under eyes-closed condition (SMD = 0.41, 95% CI = -0.1 to 0.92, very low-quality evidence), and gait speed (SMD = 0.36, 95% CI = -0.24 to 0.96, very low-quality evidence). Two studies reported insignificant findings on fear of falling, fall incidence, and risk of falls.

CONCLUSIONS

Very low- to low-quality evidence showed that ankle-foot exercises effectively improve ankle plantarflexion strength, flexibility, and balance with eyes open, whereas no effect on falls was found. Improvements in balance and gait tend to be associated with improvements in ankle strength and flexibility. Toe-strengthening exercise and training 3 times per week appear to be important for improving balance.

IMPACT

This review suggested that ankle-foot exercises might improve balance in older people. Determining factors leading to improvement in balance and mobility were identified. It paves the ground for further research to study the effect of ankle-foot exercises on fall prevention.

LAY SUMMARY

Ankle and foot exercises appear to be effective in improving ankle plantarflexion strength, flexibility, and balance performance in an eye-open condition. If you are an older adult who wants to improve your balance, your physical therapist may prescribe ankle and foot exercises as a supplemental component in a fall prevention program due to the observed improvements in balance and the safety and ease of the exercise.

Content validation of the nursing diagnosis "Frail Elderly Syndrome (00257)"

OBJECTIVE

To increase the level of evidence available for the nursing diagnosis "Frail Elderly Syndrome 000257" through content validation by nurses with expertise in caring for the elderly.

METHOD

Diagnostic content validation study in accordance with Fehring's proposal composed of two stages: integrative review of the literature according to Whittemore and Knafl's guidelines, which allowed us to update the diagnostic components, and, subsequently, expert consensus study by means of the Delphi method. A total of 61 nurses who met the inclusion criteria were included. A Likert-type questionnaire was used to identify levels of agreement with the respective components. Data distribution analysis was performed. Components >0.80 on the content validity index (CVI) were validated.

RESULTS

Twelve defining characteristics, 10 related factors, 6 risk populations, and 2 associated conditions were validated by experts. Global CVI was determined for clinical indicators.

CONCLUSION

The components of the nursing diagnosis validated by experts in caring for the elderly provide an overview of the phenomenon of frailty in the elderly in hospital settings.

IMPLICATION FOR CLINICAL PRACTICE

This study will provide nurses responsible for elderly care with the necessary tools to FES, enabling them guide and appropriate interventions to prevent complications, minimize risk, enhance the quality of life for older.

DESCRIPTORS

Syndrome; frailty; elderly; nursing, validation study; nursing diagnosis.

Effect of a Health Education Intervention to Reduce Fear of Falling and Falls in Older People: A Cluster Randomized Clinical Trial Protocol

Background/Objectives: Fear of falling (FOF) and falls are prevalent issues among older adults, leading to activity restriction, decreased quality of life, and increased dependency. This study aims to assess the effectiveness of a nurse-led health education intervention to reduce FOF and fall incidence in older adults within primary care settings. Methods: This two-arm, multicenter, parallel, cluster-randomized clinical trial includes ten primary care centers in Spain and will enroll 150 adults over 65 years with FOF, mild or no functional dependence, and independent ambulation. Participants will be randomized to either the intervention group, which will receive five initial group education sessions led by community nurses and a booster session at six months, or the control group, which will receive usual care. Primary outcomes include FOF, assessed using the Short Falls Efficacy Scale-International (FES-I), and fall incidence. Data collection will occur at baseline, one month, six months, and twelve months post intervention. This study has been approved by the Ethics Committee for Research with Medicinal Products at Gregorio Marañón University Hospital in accordance with the Declaration of Helsinki. Expected Outcomes: The health education intervention is expected to significantly reduce both FOF and fall incidence, supporting the integration of FOF management in routine primary care for older adults, with potential benefits for safety and quality of life. Trial Registration: ClinicalTrials.gov: NCT05889910. The study protocol follows CONSORT and SPIRIT guidelines.

Age-Related Influence on Static and Dynamic Balance Abilities: An Inertial Measurement Unit-Based Evaluation

Balance control, a complex sensorimotor skill, declines with age. Assessing balance is crucial for identifying fall risk and implementing interventions in the older population. This study aimed to measure age-dependent changes in static and dynamic balance using inertial measurement units in a clinical setting. This study included 82 healthy participants aged 20-85 years. For the dynamic balance test, participants stood on a horizontally swaying balance board. For the static balance test, they stood on one leg. Inertial measurement units attached to their bodies recorded kinematic data, with average absolute angular velocities assessing balance capabilities. In the dynamic test, the younger participants had smaller average absolute angular velocities in most body parts than those of the middle-aged and older groups, with no significant differences between the middle-aged and older groups. Conversely, in the single-leg stance tests, the young and middle-aged groups outperformed the older group, with no significant differences between the young and middle-aged groups. Thus, dynamic and static balance decline at different stages with age. These results highlight the complementary role of inertial measurement unit-based evaluation in understanding the effect of age on postural control mechanisms, offering valuable insights for tailoring rehabilitation protocols in clinical settings.

Sex Differences in Hypertension and Its Management Throughout Life

BACKGROUND

The prevalence of hypertension and uncontrolled hypertension may differ by age and sex.

METHODS

We included participants in the Atherosclerosis Risk in Communities study at seven study visits over 33 years (visit 1: 15 636 participants; mean age, 54 years; 55% women), estimating sex differences in prevalence of hypertension (systolic blood pressure ≥130 mm Hg; diastolic blood pressure ≥80 mm Hg; or self-reported antihypertension medication use) and uncontrolled hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) using unadjusted and comorbidity-adjusted models.

RESULTS

The prevalence of hypertension increased with age from 40% (ages, 43-46 years) to 93% (ages, 91-94 years). Within hypertensive individuals, the prevalence of uncontrolled hypertension was higher in men (33%) than women (23%) at ages 43 to 46 years but became higher in women than men starting at ages 61 to 64, with 56% of women and 40% men having uncontrolled hypertension at ages 91 to 94. This sex difference was not explained by differences in coronary heart disease, diabetes, body mass index, estimated glomerular filtration rate, number of antihypertension medications, classes of medications, or adherence to medications. In both sexes, uncontrolled hypertension was associated with a higher risk for chronic kidney disease progression (hazard ratio, 1.5 [1.2-1.9]; P=4.5×10-4), heart failure (hazard ratio, 1.6 [1.4-2.0]; P=8.1×10-7), stroke (hazard ratio, 2.1 [1.6-2.8]; P=1.8×10-8), and mortality (hazard ratio, 1.5 [1.3-1.6]; P=6.2×10-19).

CONCLUSIONS

Sex differences in the prevalence of hypertension and uncontrolled hypertension vary by age, with the latter having implications for health throughout the life course.

Sarcopenia definitions and their association with injurious falls in older Swedish women from the Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone fractures (SUPERB) study

Associations between different sarcopenia definitions and the risk of injurious falls were investigated in 75-80-year-old women in the Swedish SUPERB cohort. Only sarcopenia according to the Sarcopenia Definitions and Outcomes Consortium (SDOC) definition was associated with incident injurious falls with and without fractures in older women.

PURPOSE

To investigate the association between three commonly used sarcopenia definitions and the risk of injurious falls in a population of older Swedish women.

METHODS

A total of 2,883 75-80-year-old women with complete data on relevant sarcopenia definitions from the Swedish SUPERB cohort were studied. Sarcopenia was defined based on the Sarcopenia Definitions and Outcomes Consortium (SDOC: low handgrip strength and gait speed), revised European Working Group on Sarcopenia in Older People (EWGSOP2: low appendicular lean mass index (ALMI, dual-energy X-ray absorptiometry (DXA)-derived), appendicular lean mass (kg)/height (m2), hand grip strength (kg), or low chair stand time (s)), and Asian Working Group for Sarcopenia (AWGS: low ALMI and hand grip strength (kg) or low gait speed (m/s)). Questionnaires captured the occurrence of falls in the past 12 months. Incident injurious falls were identified using national registers. Cox regression (hazard ratios (HR) and 95% confidence intervals (CI)) analyses were performed without adjustment and after adjustment for age, body mass index, previous falls, and the Charlson comorbidity index.

RESULTS

During a median (IQR) follow-up time of 7.06 (6.2-7.9) years, there were 491 injurious falls without fracture and 962 injurious falls when also including falls resulting in a fracture. Sarcopenia according to EWGSOP2 and AWGS was not associated with an increased risk of injurious falls. Individuals with sarcopenia defined by SDOC had a higher risk of injurious falls with and without fracture (HR 2.11; 95% CI, 1.63-2.73 and HR, 2.16; 95% CI, 1.55-3.02, respectively).

CONCLUSION

Sarcopenia definitions confined to muscle function and strength such as SDOC, rather than including DXA-determined ALMI (EWGSOP2 and AWGS), are associated with incident injurious falls with and without fractures in older women.

Factors associated with frailty in older people: an umbrella review

BACKGROUND

The number of frail older people is increasing worldwide, and all countries will be confronted with their growing needs for healthcare and social support. The aim of this umbrella review was to summarize the evidence on the factors associated with frailty in older people, using a socioecological approach.

METHODS

PubMed (MEDLINE), Scopus, Web of Science, ScienceDirect, Hinari (research4life), and the Trip database were systematically searched up to April 2023. Systematic reviews of observational studies that explored factors associated with frailty in older adults aged 60 years and over were considered for inclusion. No language, geographical or setting restrictions were applied. However, we excluded systematic reviews that investigated frailty factors in the context of specific diseases. The Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses and the ROBIS tool were used to assess the quality and risk of bias in the included studies.

RESULTS

Forty-four systematic reviews were included, covering 1,150 primary studies with approximately 2,687,911 participants overall. Several risk factors, protective factors and biomarkers were found to be associated with frailty, especially in community-dwelling older people, including 67 significant associations from meta-analyses. The certainty of the evidence was rated as moderate or reached moderate levels for seven factors relevant to older people. These factors include depression (OR 4.66, 95% CI 4.07 to 5.34), loneliness (OR 3.51, 95% CI 2.70 to 4.56), limitations in activities of daily living (OR 2.59, 95% CI 1.71 to 3.48), risk of malnutrition (OR 3.52, 95% CI 2.96 to 4.17), Dietary Inflammatory Index score (OR 1.24, 95% CI 1.16 to 1.33), maximal walking speed (Standardized Mean Difference (SMD) -0.97, 95% CI -1.25 to -0.68), and self-reported masticatory dysfunction (OR 1.83, 95% CI 1.55 to 2.18). Additionally, only greater adherence to a Mediterranean diet showed a high level of evidence (OR 0.44, 95% CI 0.31 to 0.64).

CONCLUSIONS

This umbrella review will provide guidance for prevention strategies and clinical practice by promoting healthy lifestyles and addressing all modifiable risk factors associated with frailty. Future systematic reviews should consider heterogeneity and publication bias, as these were the main reasons for downgrading the level of evidence in our review.

REGISTRATION

PROSPERO 2022, CRD42022328902.

Association between Falls, Fear of Falling and Depressive Symptoms in Community-Dwelling Older Adults

BACKGROUND

Longevity increases pose public health challenges, especially in managing falls and their psychological impacts on older adults. Limited evidence exists on the relationship between a fear of falling (FOF), previous falls, and depressive symptoms among community-dwelling older adults.

OBJECTIVE

To evaluate the association between falls, FOF, and depressive symptoms in community-dwelling older adults.

METHODS

This cross-sectional study, conducted in 2018, included 400 older adults from a Basic Health Unit in São Paulo, Brazil. The Geriatric Depression Scale (GDS-15) and the International Falls Efficacy Scale (FES-I) were used, along with self-report questionnaires on fall history. Linear and logistic regression were used to analyze the relationships between variables.

RESULTS

The mean age was 75.2 (SD = 8.53) years, with 63.2% being female. Depressive symptoms were observed in 18.3% of the participants, while 90.5% reported a fear of falling (FOF). More than half (63.0%) experienced falls, with 49.5% occurring in the last year. Factors such as the female gender, negative health perceptions, and functional dependence were associated with depressive symptoms. Adjusted analyses indicated that both a fear of falling (FOF) (B = 0.043; p = 0.012) and a history of falls (B = 0.725; p = 0.015) were associated with depressive symptoms.

CONCLUSIONS

Falls, FOF, and depressive symptoms are interlinked among older adults, underscoring the need for targeted interventions to improve their mental and physical health.

Cultural Adaptation and Validation of the Ambulatory Self-Confidence Questionnaire (ASCQ), Portuguese (European) Version

In a world where physical activity and social participation are fundamental pillars of a full and healthy life, confidence in walking has emerged as a fundamental aspect to assess, especially for older adults. Therefore, the purpose of this study was to develop a Portuguese (European) version of the Ambulatory Self-Confidence Questionnaire (ASCQ) that was both linguistically and psychometrically adapted. To do so, a translation method was used, followed by an assessment of its validity and reliability. The Portuguese version was completed by 173 older adults. To assess reliability, Cronbach's alpha and intraclass correlation coefficients (ICCs) were used. For sociodemographic and clinical characterization, as well as questionnaire scoring, descriptive statistical analysis was used. Pearson's correlation (r), Student's t-test, and one-way ANOVA were used to analyze criterion and construction validity. The Portuguese interactions with ASCQ were effectively translated and adjusted, revealing exceptional internal consistency and test-retest reliability, as reflected in Cronbach's alpha and ICC values of 0.95. No floor effect was observed; however, a ceiling effect was identified (3.5%). The criterion and construct validity were verified as all the correlations established were statistically significant. The adaptation of the ASCQ to Portuguese culture is adequate, making it valid for use within the Portuguese population.

Health literacy and falls among community-dwelling older people in China: is there a sex difference?

BACKGROUND

Health literacy is one of the important determinants of healthy aging, yet few studies have focused on the association between health literacy and falls.

AIMS

This study aims to explore the relationship between health literacy and falls, with a focus on sex differences among older people in China.

METHODS

This cross-sectional study enrolled 2,144 older people aged ≥ 60 years from Shandong Province, China in 2021. We used general health literacy screening scale to assess health literacy, and collected the incidence of falls in the past year. Logistic regression models were employed to analyze the relationship between health literacy and falls. We investigated the sex differences by subgroup analyses.

RESULTS

The prevalence of adequate health literacy and falls was 21.7% (95% CI: 20.0-23.5%) and 25.4% (95% CI: 23.6-27.3%), respectively. In a fully-adjusted model, adequate health literacy was associated with a lower prevalence of falls in older adults (OR = 0.71, 95%CI: 0.52-0.96). Subgroup analysis revealed sex differences in this relationship (Pfor interaction <0.05). Specifically, the female group showed no significant relationship between health literacy and falls (OR = 0.92, 95% CI: 0.59-1.44); however, the male group demonstrated a robust and significant relationship (OR = 0.58, 95% CI: 0.37-0.90).

CONCLUSIONS

Older people with adequate health literacy have lower prevalence of falls, which appears to differ by sex. This relationship was significant among men but not among women. These findings emphasize the need for policymakers and healthcare providers to consider sex differences when designing and implementing programs aimed at improving health literacy and preventing falls in the older population. Improving health literacy among older women could be a strategic component in bridging sex inequality in falls.

Females Present Reduced Minimum Toe Clearance During Walking As Compared to Males in Active Older Adults

BACKGROUND

Physical decline due to aging has been associated with the risk of falls. Minimum toe clearance (MTC) is a gait parameter that might play a role in the mechanism of tripping and falling. However, it is unclear if there are any sex-related effects regarding MTC as people age. The present study investigated if there are sex-related differences in MTC in older active adults.

METHODS

Twenty-three females and 23 males (F: 65.5 ± 4.8 years; M: 61.9 ± 5.2 years) walked on a treadmill at a preferred walking speed, while kinematic data were obtained at a sampling frequency of 100 Hz and up-sampled to 120 and 240 Hz. MTC was calculated from the kinematics data and evaluated concerning its magnitude (ie, MTC and MTC/leg length), the time between left/right MTC (ie, T-MTC), amount of variability (ie, coefficient of variation [CV] and coefficient of variation modified [CVm]), and temporal structure of variability, that is, the complexity of the time series (ie, MTC α, T-MTC α).

RESULTS

No sex effects were found for MTC/leg length, for the amount of variability (ie, CV and CVm), and for the complexity of the time series (MTC α, T-MTC α). However, females exhibited significantly lower MTC and T-MTC after adjusting for walking speed, mass, and age as covariates.

CONCLUSIONS

The reduced MTC in females suggests a potential sex-related disparity in the risk of tripping and falling among active older adults.

Association between postoperative fall history and toe grip strength in patients after total knee arthroplasty: A prospective observational study

BACKGROUND

Factors associated with falls after total knee arthroplasty (TKA) have been rarely reported. The aim of this study was to identify factors that influence the incidence of falls after TKA, focusing on toe grip strength (TGS) in particular, which has been associated with falls in older adults.

METHODS

217 patients who underwent TKA were included and followed up for 1 year. Main study outcome measures were the presence or absence of falls within 1 year after TKA. Multiple logistic regression analysis was used with postoperative falls as the dependent variable and preoperative falls and postoperative TGS on the affected sides as independent variables.

RESULTS

170 (43 and 127 in the fall and non-fall groups) patients were included in the analysis. The presence of a preoperative falls history before TKA and a weak postoperative affected TGS indicated an increased susceptibility of the patient to fall postoperatively.

CONCLUSIONS

Results of the current study revealed the association between postoperative TGS and postoperative falls. We highlight the importance of preoperative fall monitoring and postoperative TGS evaluation to prevent falls after TKA.

Reframing Communication about Fall Prevention Programs to Increase Older Adults' Intentions to Participate

INTRODUCTION

Falls and fall-related injuries in community-dwelling older adults are a growing global health concern. Despite effective exercise-based fall prevention programs (FPPs), low enrollment rates persist due to negative connotations associated with falls and aging. This study aimed to investigate whether positive framing in communication leads to a higher intention to participate in an FPP among community-dwelling older adults.

METHODS

We conducted a two-sequence randomized crossover study. We designed two flyers, a standard flyer containing standard terminology regarding FPPs for older adults, and a reframed flyer highlighting fitness and activity by reframing 'fall prevention' as an 'exercise program' and 'old' as 'over 65 years'. With a Mann-Whitney U test, we investigated group differences regarding the intention to participate between the flyers. A sensitivity analysis and subgroup analyses were performed. We conducted qualitative thematic analysis on open-ended answers to gain a deeper understanding of participants' intention to participate.

RESULTS

In total, we included 133 participants. Findings indicated a significantly higher intention to participate in the reframed flyer (median = 4; interquartile range = 1-6) compared to the standard flyer (median = 2; interquartile range = 1-4) (p = 0.038). Participants favored more general terms such as 'over 65 years' over 'older adults'. Older adults who were female, not at high fall risk, perceived themselves as not at fall risk, and maintained a positive attitude to aging showed greater receptivity to positively-framed communications in the reframed flyer. Additionally, already being engaged in physical activities and a lack of practical information about the FPP appeared to discourage participation intentions.

DISCUSSION

The results in favor of the reframed flyer provide practical insights for designing and implementing effective (mass-)media campaigns on both (inter)national and local levels, as well as for interacting with this population on an individual basis. Aging-related terminology in promotional materials hinders engagement, underscoring the need for more positive messaging and leaving out terms such as 'older'. Tailored positively framed messages and involving diverse older adults in message development are essential for promoting participation in FPPs across various population subgroups to promote participation in FPPs among community-dwelling older adults.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Perceived Ageism is Associated With Recurrent Falling Among Older Colombian Adults

Literature on the association between ageism and falling among older adults is limited. Using data from the nationwide cross-sectional SABE (Salud, Bienestar y Envejecimiento) Colombia Survey in 2015 with 18,875 participants aged ≥60 years living in the communities, the study aims to evaluate the association between perceived ageism within the family, neighborhood, health services, and public services, and recurrent falling. Participants had a mean age of 69.2 ± 7.1; 56.1% were female. Recurrent falling prevalence was 15%, and experiencing any ageism was 10%. Multivariable logistic regression analyses showed higher odds of recurrent falling for any ageism (OR = 1.81, 95% CI 1.61-2.02, p < .0001). High depressive symptoms mediated 10.1% of the association between any ageism and recurrent falling, followed by low instrumental activities of daily living (9.7%) and multimorbidity (9.3%). Current findings open new areas of gerontological research by expanding the risk factors for falling among older adults to include ageism perceptions.

Multisite Pain and Intensity were Associated with History Fall among Older Adults: A Cross-Sectional Study

Purpose

This study examined the independent associations among multisite pain, pain intensity, and the risk of falls, including a history of falls in the previous 12 months and frequent falls (≥ two falls vs one or two falls) among community-dwelling older adults.

Methods

A cross-sectional design from Wave 2 of the National Social Life, Health, and Aging Project was used. Data on pain intensity and location (45 sites) over the past 4 weeks were collected. Multisite pain was categorized into four groups: none, one, two, and three or more sites. The main outcomes of falls were a history of falls and frequent falls. The covariates included age, sex, race, body mass index, education, medications, and comorbidities.

Results

Among 3,196 participants in Wave 2, 2,697 were included because of missing key variables related to pain and fall history. The prevalence of falls and frequent falls were 30.3% (n = 817) and 12.6% (n = 339), respectively. Multisite pain at ≥ three sites (odds ratio (OR) 2.04, confidence interval (CI) [1.62, 2.57]; p < 0.001) and two sites (OR 1.72, 95% CI [1.30, 2.27]; p < 0.001) was significantly associated with an increased risk of falls. An increase in pain intensity was significantly associated with an increased risk of fall (OR 1.28, 95% CI [1.15, 1.44], p < 0.001), independent of multisite pain. Multisite pain at ≥3 sites (OR 2.19, 95% CI [1.56, 3.07], p < 0.001) and 2 sites (OR 1.54, 95% CI [1.01, 2.34], p = 0.045) was associated with an increased risk of frequent falls. An increase in pain intensity was associated with risk of frequent falls (OR 1.64, 95% CI [1.40, 1.91], p < 0.001), independent of multisite pain.

Conclusion

Multisite pain and pain intensity were associated with a history of falls and frequent falls among older adults, emphasizing the need for routine pain evaluation to develop fall prevention strategies in this population.

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

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

A Survey on Hearing Loss, Dizziness, and Balance Problems as Fall Risk Factors: Responses of Older Adults Seen by Audiologists

BACKGROUND

 Falls are a significant health care concern for older adults in the United States. Audiologists are health care providers who are experts in hearing and vestibular dysfunctions, two areas known to be risk factors for falls. It is not known whether audiology patients consider audiology services to be related to falls or whether they consider audiologists to be a viable resource related to fall-related health care.

PURPOSE

 The purpose of this study was to investigate whether audiology patients consider (1) hearing, dizziness, and balance difficulties as risk factors for falls, and (2) audiologists as health care providers who can address fall risk, assessment, and prevention.

RESEARCH DESIGN

 This was a cross-sectional survey study.

STUDY SAMPLE

 In total, 78 community-dwelling audiology patients aged 60 years or older were included in the study.

INTERVENTION

 Not applicable DATA COLLECTION AND ANALYSIS:  To reach a broad group of participants, online surveys (Qualtrics) and paper-and-pencil surveys (at the university clinic) were used. The analysis included descriptive statistics and independent-samples t-tests.

RESULTS

 Nearly half of participants (48.7%) fell within the preceding year, and almost three-quarters (72.4%) felt falls were an important health care concern for them. Fewer than half (43.4%) considered hearing loss to be a fall risk factor, compared to dizziness (92.2%) and balance problems (97.3%). Slightly over half (53.3%) agreed that audiologists can address falls, fall risk, and prevention. However, only 39.5% would discuss falls with their audiologist, compared to 57.9% for dizziness and balance concerns and 90.5% for hearing concerns. No significant differences were found between participants who reported a recent fall and those who did not.

CONCLUSIONS

 Targeted patient education regarding the audiology scope of practice as it pertains to fall risk and prevention may be warranted, particularly if hearing loss is a modifiable fall risk factor which can be addressed through seeking audiologic services.

Falls and Alzheimer Disease

Falls are the leading cause of injury, disability, and injury-related mortality in the older adult population. Older adults with Alzheimer disease (AD) are over twice as likely to experience a fall compared to cognitively normal older adults. Intrinsic and extrinsic fall risk factors may influence falls during symptomatic AD; intrinsic factors include changes in cognition and impaired functional mobility, and extrinsic factors include polypharmacy and environmental fall hazards. Despite many known fall risk factors, the high prevalence of falls, and the presence of effective fall prevention interventions for older adults without cognitive impairment, effective fall prevention interventions for older adults with AD to date are limited and inconclusive. Falls may precede AD-related cognitive impairment during the preclinical phase of AD, though a narrow understanding of fall risk factors and fall prevention interventions for older adults with preclinical AD limits clinical treatment of falls among cognitively normal older adults with preclinical AD. This mini review explores fall risk factors in symptomatic AD, evidence for effective fall prevention interventions in symptomatic AD, and preclinical AD as an avenue for future falls research, including recommendations for future research directions to improve our understanding of falls and fall risk during preclinical AD. Early detection and tailored interventions to address these functional changes are needed to reduce the risk of falls for those at risk for developing AD. Concerted efforts should be dedicated to understanding falls to inform precision fall prevention strategies for this population.

Epidemiology of work-related fall injuries resulting in hospitalisation: individual and work risk factors and severity

OBJECTIVES

Injuries at work are common and costly for individuals and employers. A common mechanism of workplace injury is through falls, but there have been few epidemiological studies of risk factors. This study aimed to identify patient, work and injury factors associated with injuries causing hospitalisation after falling at work in Victoria, Australia.

METHODS

Data came from work-related hospitalised injury admissions, identified by International Classification of Diseases and Related Health Problems, Tenth Revision Australian Modification codes and compensation status, from Victorian Admitted Episodes Dataset between 1 July 2017 and 30 June 2022. Multivariate logistic regression analyses were conducted to identify factors associated with same-level falls and falls from height.

RESULTS

This study included 42 176 work-related injury admissions: 8669 (20.6%) fall injuries and 33 507 (79.4%) other injuries. Rates of high falls were more common in males than females (0.44 (95% CI: 0.43, 0.46) vs 0.08 (0.08, 0.09) admissions per 1000 employed), while same-level falls were more common in females than males (0.21 (0.20, 0.22) vs 0.18 (0.17, 0.18)). Patients with same-level fall injuries, relative to all other work injuries, were more likely to be older women, and have at least one chronic condition; falls from height were associated with male sex and construction work and more likely to result in intracranial, internal organ injuries and fractures and longer hospital stay than non-fall injuries.

CONCLUSION

Work-related falls were common and relatively severe. Same-level falls are relatively likely to occur in older women, the fastest-growing workplace demographic, and therefore the incidence is expected to increase. Comorbidities are an important fall risk factor. Employers could consider industry-relevant high and same-level fall prevention strategies for reducing the workplace injury burden.

Topic evolution before fall incidents in new fallers through natural language processing of general practitioners' clinical notes

BACKGROUND

Falls involve dynamic risk factors that change over time, but most studies on fall-risk factors are cross-sectional and do not capture this temporal aspect. The longitudinal clinical notes within electronic health records (EHR) provide an opportunity to analyse fall risk factor trajectories through Natural Language Processing techniques, specifically dynamic topic modelling (DTM). This study aims to uncover fall-related topics for new fallers and track their evolving trends leading up to falls.

METHODS

This case-cohort study utilised primary care EHR data covering information on older adults between 2016 and 2019. Cases were individuals who fell in 2019 but had no falls in the preceding three years (2016-18). The control group was randomly sampled individuals, with similar size to the cases group, who did not endure falls during the whole study follow-up period. We applied DTM on the clinical notes collected between 2016 and 2018. We compared the trend lines of the case and control groups using the slopes, which indicate direction and steepness of the change over time.

RESULTS

A total of 2,384 fallers (cases) and an equal number of controls were included. We identified 25 topics that showed significant differences in trends between the case and control groups. Topics such as medications, renal care, family caregivers, hospital admission/discharge and referral/streamlining diagnostic pathways exhibited a consistent increase in steepness over time within the cases group before the occurrence of falls.

CONCLUSIONS

Early recognition of health conditions demanding care is crucial for applying proactive and comprehensive multifactorial assessments that address underlying causes, ultimately reducing falls and fall-related injuries.

Challenges in Delivering Effective Care for Older Persons with Fragility Fractures

Fragility fractures occur because of low-impact trauma or even spontaneously in individuals with osteoporosis. Caring for older persons with fragility fractures can present several challenges due to the unique needs and vulnerabilities of this population. Older individuals commonly have multiple medical conditions, such as osteoporosis, arthritis, cardiovascular diseases, and diabetes. These comorbidities can complicate fracture management and increase the risk of complications. Fracture repair through surgery may be more complex in older patients due to poor bone quality, decreased tissue elasticity, and higher chances of anesthesia complications. In addition, mobility and functional limitations post-fracture are highly prevalent in this population, affecting their independence and increasing their risk of institutionalization. Addressing these challenges requires a multidisciplinary approach involving orthopedic surgeons, geriatricians, physical and rehabilitation physicians, physiotherapists, occupational therapists, dieticians, social workers, and caregivers. Preventive measures, such as fall prevention strategies and osteoporosis management, can also play a vital role in reducing the incidence of fragility fractures in older persons.

A population study on factors associated with unintentional falls among Iranian older adults

INTRODUCTION

Falls among older adults are a significant cause of disability, injury, and death worldwide. The high incidence of falls in older adults, combined with the increased susceptibility to injury of the older adult population, leads to severe global health issues. Further studies are needed to comprehensively evaluate the typical personal and environmental risk factors of falls in the Iranian elderly population. Future preventive strategies and intervention programs will be based on these findings. The study determined the risk factors associated with unintentional falls among a representative sample of older adults living in Tehran, the capital city of Iran.

METHODS

The study design was cross-sectional. The target population was men/women aged 65 years and over from the general population living in 22 different districts of Tehran who were selected by stratified random sampling. The researchers gathered the data using validated questionnaires and observations. The informed consent was obtained from all participants before starting the interview. Multivariate logistic regression analysis examined the association between falls occurring during the past 12 months with demographics/ socioeconomics and fall-related predictor factors.

RESULTS

The risk of falls was higher in women (47.0%) and those aged ≥ 75 years (44.1%). Older adults who were married had their fall risk reduced by 36.4% compared with other types of marital status. Older adults who were illiterate (48.1%), housewives (47.0%), and always had concerns about living expenses (53.9%) tended significantly to have a higher risk of falls. Moreover, participants who live with their family were less likely to fall than those who live alone (36.5% vs. 40.4%). Persons with safe homes were less likely to experience falls than persons with unsafe homes (30.9% vs. 41.4%). The logistic regression analysis showed that the female gender, being worried about living expenses, home safety, functional behavior, and function factors, were independently associated with the risk of falls during the past 12 months.

CONCLUSIONS

Our findings revealed that a wide range of intrinsic and extrinsic risk factors contributed to injurious falls; based on the literature, some are preventable. The present data may be helpful as a starting point and guide future efforts for health providers and policymakers to allocate additional resources and develop proper falls prevention or intervention programs at the community level.

Association of impaired cognitive function with balance confidence, static balance, dynamic balance, functional mobility, and risk of falls in older adults with depression

Objectives

Increased depression severity has been linked to cognitive impairment (CI). Importantly, CI is a known risk factor for impaired balance and falls. Therefore, this study aims to explore the relationship between CI and neuromuscular functions and secondarily it aims to find out if CI is a potential predictor for neuromuscular functions deficits in depressed elderly.

Methods

Eighty-four depressed elderly participated in the study. Assessment for CI symptoms were done using Mini Mental Status Examination (MMSE) in subjects having confirmed depression. Neuromuscular functions such as balance confidence, static and dynamic balance, functional mobility, and fall risk were subjectively assessed using Activities-specific Balance Confidence (ABC) Scale, Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, and Performance Oriented Mobility Assessment (POMA), respectively.

Results

Pearson's analysis revealed that there was moderate positive linear-correlation between MMSE and BBS (R = 0.382, p = <0.001) and between MMSE and ABC (R = 0.229, p = 0.036*). Further, regression analysis (R 2) revealed that MMSE significantly predicted the neuromuscular functions using BBS [F(1, 82) = 14.013, p < 0.001, with an R 2 of 0.146] and ABC [F(1, 82) = 4.545, p= 0.036*, with an R 2 of 0.053].

Conclusion

Results of this study points to an impaired CI as a possible factor in development of neuromuscular function impairment in depressed elderly.

CNN-Based Self-Attention Weight Extraction for Fall Event Prediction Using Balance Test Score

Injury, hospitalization, and even death are common consequences of falling for elderly people. Therefore, early and robust identification of people at risk of recurrent falling is crucial from a preventive point of view. This study aims to evaluate the effectiveness of an interpretable semi-supervised approach in identifying individuals at risk of falls by using the data provided by ankle-mounted IMU sensors. Our method benefits from the cause-effect link between a fall event and balance ability to pinpoint the moments with the highest fall probability. This framework also has the advantage of training on unlabeled data, and one can exploit its interpretation capacities to detect the target while only using patient metadata, especially those in relation to balance characteristics. This study shows that a visual-based self-attention model is able to infer the relationship between a fall event and loss of balance by attributing high values of weight to moments where the vertical acceleration component of the IMU sensors exceeds 5 m/s² during an especially short period. This semi-supervised approach uses interpretable features to highlight the moments of the recording that may explain the score of balance, thus revealing the moments with the highest risk of falling. Our model allows for the detection of 71% of the possible falling risk events in a window of 1 s (500 ms before and after the target) when compared with threshold-based approaches. This type of framework plays a paramount role in reducing the costs of annotation in the case of fall prevention when using wearable devices. Overall, this adaptive tool can provide valuable data to healthcare professionals, and it can assist them in enhancing fall prevention efforts on a larger scale with lower costs.

The association of skeletal muscle energetics with recurrent falls in older adults within the Study of Muscle, Mobility and Aging (SOMMA)

Background

Falls in the older population are a major public health concern. While many physiological and environmental factors have been associated with fall risk, muscle mitochondrial energetics has not yet been investigated.

Methods

In this analysis, 835 Study of Muscle, Mobility and Aging (SOMMA) participants aged 70-94 were surveyed for recurrent falls (2+) after one year. Skeletal muscle energetics were assessed at baseline in vivo using 31 P Magnetic Resonance Spectroscopy (MRS) (ATPmax) and ex vivo by High Resolution Respirometry (HRR) of permeabilized muscle fibers from the vastus lateralis (MaxOXPHOS).

Results

SOMMA participants who reported recurrent falls (12%) had a slower 400m walk gait speed compared to those with 0-1 falls (1.0 +/-0.2 vs. 1.1 +/-0.2, p<.001) and took a greater number of medication in the 30 days before their baseline visit (5.6 +/-4.4 vs. 4.2 +/-3.4, p<0.05). MaxOXPHOS was significantly lower in those who reported recurrent falls (p=0.008) compared to those with one or fewer falls, but there was no significant difference in ATPmax (p=0.369). Neither muscle energetics measure was significantly associated with total number of falls or injurious falls, but recurrent falls were significantly higher with lower MaxOXPHOS (RR=1.33, 95% CI= 1.02-1.73, p=0.033). However, covariates accounted for the increased risk.

Conclusions

Ex vivo maximal muscle mitochondrial energetics were lower in older adults who experienced recurrent falls, but covariates accounted for its association with recurrent fall risk, suggesting this "hallmark of aging" may not be directly implicated in the complex etiology of falls.