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Background: Obesity is associated with an increased risk of falls in older women. However, it is not certain whether factors commonly associated with obesity and falls mediate this risk., Research Question: Do lower-limb muscle quality, foot loads and postural control mediate the relationship between obesity and falls in women aged 60 years and older?, Methods: At baseline, 246 female participants underwent obesity screening (BMI≥30 kg/m²), and measurements of muscle quality (isokinetic dynamometer and dual-energy X-ray absorptiometry), foot loads (pressure platform) and postural balance (force platform). Incident falls were recorded at the end of the 18-month follow-up period via participant recall. To test whether, and to what extent, biomechanical factors mediated the relationship between obesity and falls, the Natural Indirect Effects (NIE), Natural Direct Effect (NDE) and proportion mediated were calculated using the counterfactual approach. Significance level was set at p < .05., Results: 204 participants (83 %) completed the follow-up. As expected, obesity was associated with a higher risk of being a faller (RR: 2.13, 95 % CI: 1.39-3.27). Using the counterfactual approach, only specific torque (NIE: 1.11, 95 % CI: 1.01-1.38) and flatfoot (NIE: 1.10, 95 % CI: 1.01-1.32) were significant mediators of the relationship between obesity and falls. Specific torque and flatfoot mediated 19 % and 21 % of the relationship, respectively., Significance: Lower-limb muscle quality (specific torque) and foot loads (flatfoot) mediate the relationship between obesity and falls in older women. The inclusion of muscle strengthening and podiatry interventions as part of a fall prevention program may benefit this population., Competing Interests: Declaration of Competing Interest The authors have no conflict., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: To compare the socio-demographic characteristics and type of injury sustained, the use of hospital resources and rates of hospitalisation by injury type, and survival following fall injuries to older Aboriginal people and non-Indigenous Australian people hospitalised for fall-related injuries., Design: Population-based retrospective cohort data linkage study. Setting, participants: New South Wales residents aged 50 years or more admitted to a public or private NSW hospital for a fall-related injury during 1 January 2003 - 31 December 2012., Main Outcome Measures: Proportions of patients with defined injury types, mean hospital length of stay (LOS), 30-day mortality, age-standardised hospitalisation rates and age-adjusted rate ratios, 28-day re-admission rates., Results: There were 312 758 fall-related injury hospitalisations for 234 979 individuals; 2660 admissions (0.85%) were of Aboriginal people. The proportion of hospitalisations for fall-related fracture injuries was lower for Aboriginal than for non-Indigenous Australians (49% v 60% of fall-related hospitalisations; P < 0.001). The major injury type for Aboriginal patients was non-fracture injury to head or neck (19% of hospitalisations); for non-Indigenous patients it was hip fractures (18%). Age-adjusted LOS was lower for Aboriginal than for non-Indigenous patients (9.1 v 14.0 days; P < 0.001), as was 30-day mortality (2.9% v 4.2%; P < 0.001). For Aboriginal people, fall injury hospitalisations increased at an annual rate of 5.8% (95% CI, 4.0-7.7%; P < 0.001); for non-Indigenous patients, the mean annual increase was 2.5% (95% CI, 2.1-3.0; P < 0.001)., Conclusions: The patterns of injury and outcomes of fall injury hospitalisations were different for older Aboriginal people and other older Australians, suggesting that different approaches are required to prevent and treat fall injuries.

Objective: To compare trends, causes, and outcomes of fall-related traumatic brain injury (TBI) between community-dwelling (CD) individuals and residential aged care facility (RACF) residents., Methods: Hospitalisation and RACF administrative data for 6635 individuals aged ≥65 years admitted to all NSW hospitals for fall-related TBI from 2008-2009 to 2012-2013 were linked., Results: Of the 6944 hospitalisations, 20.8% were for RACF residents. Age-standardised hospitalisation rates were almost fourfold higher for RACF residents than CD individuals (standardised rate ratio 3.7; 95% CI 3.4-4.1); but increased at a similar annual rate of 9.2% (95% CI 0.3-19.0) and 7.2% (95% CI 5.6-8.9), respectively. Compared to CD individuals: a higher proportion of falls in RACF residents were furniture-related (21.4% vs 9.9%); resulted in haemorrhage (82.5% vs 73.7%); and death (23.1% vs 14.9%). Overall, 7.7% of hospitalisations for CD individuals resulted in new permanent RACF placement., Conclusion: Residential aged care facility residents have higher hospitalisation rates and poorer health outcomes than their CD counterparts., (© 2017 AJA Inc.)

Objective: This population-based study investigates the influence of geographical location on hospital admissions, utilisation and outcomes for fall-related injury in older adults, adjusting for age, sex and comorbidities., Methods: A linked dataset of all admissions of NSW residents aged 65 and older, hospitalised at least once for a fall-related injury between 2003 and 2012, was used to estimate rates of hospitalisations, total lengths-of-stay, 28-day readmissions, and 30-day mortalities. These were standardised for age, sex, comorbidity, and remoteness., Results: Compared to urban residents, rural residents were hospitalised less (p<0.0001) and hospitalisation rates increased at a lower rate (0.8% vs 2.6% per year) from 2003 to 2012. Rural residents had a shorter median total length of stay (5 vs 7 days, p<0.0001), a higher 28-day readmission rate (18.9% vs 17.0%, p<0.0001) and higher 30-day mortality (5.0% vs 4.9%, p=0.0046)., Conclusions: Over the study period, rural residents of NSW had lower rates of fall-related injury hospitalisation and a lower annual increase in hospitalisation rates compared to urban residents. When hospitalised, rural residents had a shorter length-of-stay, but higher rates of readmission and mortality. These differences existed following standardisation., Implications: This study highlights the need for further research to characterise and explain this variability., (© 2016 Public Health Association of Australia.)

Obesity has been associated with an increased risk of falls among older people. However, it is not certain whether factors commonly associated with falls and/or obesity mediate this risk. This research examines whether specific diseases, sedentary behavior, mood, pain, and medication use mediate the association between obesity and falls. A representative sample of community-living individuals aged 65+ years in New South Wales (NSW), Australia were surveyed regarding their experience of falls, height, weight, lifestyle and general health within a 12 month period. Intervening variable effects were examined using Freedman and Schatzkin's difference in coefficients tests and regression analyses were used to estimate relative risks. Obesity was associated with a 25% higher risk (95%confidence interval (CI) 1.11-1.41; p<0.0003) of having fallen in the previous 12 months compared to non-obese individuals. The strongest mediators of the association between obesity and falls were sleeping tablets (t=-5.452; p<0.0001), sitting for more than 8h per day on weekdays (t=5.178; p<0.0001), heart disease/angina (t=3.526; p<0.0001), anti-depressant use (t=3.102; p=0.002), moderate/extreme anxiety or depression (t=3.038; p=0.002), and diabetes (t=3.032; p=0.002). Sedentary behavior, chronic health conditions and medication use were identified as mediators for the association between obesity and falls in community living older people. Interventions aimed at weight reduction and increased activity may have benefits not only for fall prevention, but also for the mediating health, mood and lifestyle factors identified here., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: To examine the age-specific population prevalence and predictors of uptake of home modifications and exercise to prevent falls in the NSW older population., Methods: A total of 5,681 respondents were asked questions on fall prevention activities as part of the 2009 NSW Falls Prevention Survey. RESULTS were weighted to represent the NSW population. Regression analysis was used to determine factors associated with uptake of interventions., Results: Overall, 28.9% of the older population have modified their home, and 35.1% increased exercise to prevent falls. Main predictors of home modification were being aged 85+ (RR 2.04, 95% CI 1.76-2.35) and physiotherapy/occupational therapy intervention (RR 1.57, 95% CI 1.22-2.01). Main predictors of increasing exercise were physiotherapy/OT intervention (RR 2.12, 95% CI 1.86-2.42) and medical advice (RR 1.45, 95% CI1.32-1.60). Older respondents (RR 0.68, 95% CI 0.57-0.81) and those with fair/poor health (RR 0.86, 95% CI 0.77-0.96) were less likely to report increased exercise., Conclusion: More than one-quarter of the older population of NSW report having made modifications to their home and one-third increased exercise to prevent falls. There was a clear gradient of increased uptake of home modifications with increasing age, with the reverse trend for increased exercise., Implication: Although fall prevention initiatives are having an impact at the population level, targeted strategies for high-risk groups are still required., (© 2014 Public Health Association of Australia.)

Objectives: To determine whether overweight and obese individuals have higher reported fall and fall injury risk than individuals of healthy weight, and to examine the influence of BMI on health, quality of life and lifestyle characteristics of fallers., Methods: A representative sample of community-based individuals aged 65 years and older in New South Wales was surveyed regarding their history of falls, height, weight, lifestyle and general health within a 12-month period., Results: Obese individuals had a 31% higher risk of having fallen, but no higher risk of a fall-related injury compared to healthy-weight individuals. Obese fallers also had a 57% higher risk of believing nothing could be done to prevent falls; a 41% higher risk of using four or more medications; a 30% higher risk of experiencing moderate or extreme pain or discomfort; were 26% less likely have walked for two or more hours in the last week; and were less likely to think they were doing enough physical activity., Conclusions: Older obese individuals have an increased risk of falls and obese fallers have a higher prevalence of pain and inactivity than fallers of a healthy weight., Implications: A decrease in sedentary lifestyle and regular weight-bearing exercise may reduce fall risk in older obese individuals., (© 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia.)

Introduction: Traumatic brain injury is of particular concern in the older population. We aimed to examine the trends in hospitalisations, causes and consequences of TBI in older adults in New South Wales, Australia., Methods: TBI cases from 1 July 1998 to 30 June 2011 were identified from hospitalisation data for all public and private hospitals in NSW. Direct aged standardised admission rates were calculated. Negative binomial regression modelling was used to examine the statistical significance of changes in trend over time., Results: There were 12,564 hospitalisations for TBI over the 13 year study period. Hospitalisation rates for TBI among the older population increased by 7.2% (95% CI 6.4-8.0, p<.0001) per year from 65.3/100,000 to 151.8/100,000. [corrected]. Males had a consistently higher hospitalisation rate. Just under one third of all hospitalisations were for adults aged 85 years and over. Traumatic subdural haemorrhage (42.9%), concussive injury (24.1%) and traumatic subarachnoid haemorrhage (12.7%) were the most common type of injury. Falls were the most common cause of TBI (82.9%). Rates of fall-related TBI increased by 8.4% (95% CI 7.5-9.3, p<.001) per year, whilst non-fall related head injury increased by 2.1% (95% CI 0.9-3.3, p<.0001) per year. The majority of falls were as a result of a fall on the same level and occurred at home. 13% of hospitalisations resulted in death, and the majority occurred in those who sustained a traumatic subdural haemorrhage., Conclusions: The rapid increase in hospitalised TBI is being predominantly driven by falls in the oldest old and the greatest increase predominantly in intracranial haemorrhages, highlighting the need for future research to quantify the risk versus benefit of anticoagulant therapies., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Study Design: Observational study and cross-sectional survey., Objectives: To develop a scale assessing concern about falling in people with spinal cord injuries who are dependent on manual wheelchairs, and to evaluate psychometric properties of this new scale., Setting: Community and hospitals, Australia., Methods: The Spinal Cord Injury-Falls Concern Scale (SCI-FCS) was developed in consultation with SCI professionals. The SCI-FCS addressed concern about falling during 16 activities of daily living associated with falling and specific to people with SCI. One hundred and twenty-five people with either acute or chronic SCI who used manual wheelchairs were assessed on the SCI-FCS and asked questions related to their SCI and overall physical abilities. A subgroup of 20 people was reassessed on the SCI-FCS within 7 days., Results: The SCI-FCS had excellent internal and test-retest reliability (Cronbach's alpha=0.92, intra-class correlation coefficient (ICC)=0.93). Factor analysis revealed three underlying dimensions of the SCI-FCS addressing concern about falling during activities that limit hand support and require movement of the body's centre of mass. The discriminative ability of the SCI-FCS between different diagnostic groups indicated good construct validity. Subjects with a high level of SCI, few previous falls, dependence in vertical transfers and poor perceived sitting ability demonstrated high levels of concern about falling., Conclusions: This study suggests that the SCI-FCS is a valid and reliable tool for assessing concern about falling in people with SCI dependent on manual wheelchairs. The SCI-FCS could also assist in determining the effectiveness of fall minimization programs.