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Objective: Both changes in body composition and increased fall risk occur with increasing age. While weight management may be considered a component of falls prevention, the long-term consequences of changes in weight, however, remain uncertain. This prospective study aimed to evaluate the relationship between weight and body composition changes over 5 years with fall occurrence., Design: Prospective cohort study., Setting: Community-dwelling older adults interviewed at baseline (2013-2016) and follow-up (2020-2022) as a part of the Malaysian Elders Longitudinal Research study were included., Participants: Participants who attended face-to-face follow-up visits., Primary and Secondary Outcome Measures: Fall occurrence over 12 months preceding the follow-up visit was determined. Anthropometric, bioimpedance analysis and physical performance measurements were obtained at both time points. Participants were categorised into three groups according to changes in weight and body composition using≥5% increase or decrease in weight to determine loss or gain., Results: Of the 225 participants, aged 71.8±6.8 years, 128 (56.9%) were women. Weight gain was associated with increased fall risk at follow-up compared with stable weight (adjusted rate ratio, aRR (95% confidence interval, CI)=2.86 (1.02-8.02)) following adjustments for age and body mass index (BMI), but this relationship was attenuated by low baseline percentage lean body mass (%LBM) in women. The association was strenghtened after adjusting for age, BMI, and low muscle strength (aRR (95% CI)=2.89 (1.01-8.28)). Weight change did not influence falls risk in men. No difference was observed with changes in percentage body fat and %LBM over time with fall occurrence for both genders., Conclusion: Lower baseline lean body mass influenced the relationship between weight gain and falls longitudinally. Interventions addressing low lean body mass should be considered in the prevention of weight-gain-related falls in older women., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: While metabolic syndrome, falls, and frailty are common health issues among older adults which are likely to be related, the potential interplay between these three conditions has not previously been investigated. We investigated the relationship between metabolic syndrome with falls, and the role of frailty markers in this potential relationship, among community-dwelling older adults., Methods: Data from the first wave Malaysian Elders Longitudinal Research (MELoR) study comprising urban dwellers aged 55 years and above were utilized. Twelve-month fall histories were established during home-based, computer-assisted interviews which physical performance, anthropometric and laboratory measures were obtained during a hospital-based health check. Gait speed, exhaustion, weakness, and weight loss were employed as frailty markers., Results: Data were available for 1415 participants, mean age of 68.56 ± 7.26 years, 57.2% women. Falls and metabolic syndrome were present in 22.8% and 44.2%, respectively. After adjusting for age, sex, and multiple comorbidities, metabolic syndrome was significantly associated with falls in the sample population [odds ratio (OR): 1.33, 95% confidence interval (CI): 1.03; 1.72]. This relationship was attenuated by the presence of slow gait speed, but not exhaustion, weakness, or weight loss., Conclusion: Metabolic syndrome was independently associated with falls among older adults, and this relationship was accounted for by the presence of slow gait speed. Future studies should determine the value of screening for frailty and falls with gait speed in older adults with metabolic syndrome as a potential fall prevention measure.

Objectives: To determine the temporal relationship between the presence of knee pain and knee pain severity identified at baseline with fall risk, fear of falling and changes in instrumental activity of daily living at 12-months follow-up. Methods: This was a prospective study from the Malaysian Elders Longitudinal Research (MELoR) study involving community dwelling older persons aged 55 years and older. The presence of one fall in the preceding 12 months, knee pain, and functional capacity were determined at baseline (2013-2015) and follow-up (2015-2016). Function was determined as loss of at least one of seven instrumental activities of daily living (IADL). Physical performance was evaluated at baseline using the timed-up-and-go (TUG) test. Fear of falling (FoF) was determined using the single question "Are you afraid of falling?" Results: Data were available for 605 participants, mean ( SD ) age = 69.10 (7.24) years. Knee pain was present in 30.2% at baseline. Neither the presence of knee pain nor knee pain severity at baseline were associated with falls at 1-year follow-up. Knee pain was significantly associated with FoF at follow-up [aRR (95%CI) = 1.76 (1.02-3.04)] but not changes in IADL. Among individuals with no falls at baseline, the presence of knee pain was protective of falls at follow-up after adjustment for baseline physical performance [adjusted rate ratio, aRR (95% confidence interval, CI) = 0.35 (0.13-0.97)]. Conclusion: Knee pain is associated with increased FoF at 1.5 years' follow-up within a multi-ethnic population aged 55 years, residing in an urban location in a middle-income South East Asian nation. Interestingly, after differences in muscle strength was accounted for, knee pain was protective against falls at follow-up. Our findings challenge previous assumptions on joint pain and falls and highlights the importance of large prospective studies and further mechanistic research incorporating psychological factors in this area of increasing prominence., (Copyright © 2020 Mat, Kamaruzzaman, Chin and Tan.)

Aim: The identification of risk factors associated with comorbidities and physical fitness might provide pathways for planning therapeutic targets for future falls prevention. Results from large datasets that examined falls risk factors in Asia have been limited. The aim of the present study was to identify the risk factors for falls by pooling data consisting of medical history, physical performance and self-rated health from two large Malaysian epidemiological studies., Methods: Matching variables from the Towards Useful Aging and Malaysian Elders Longitudinal Research datasets related to falls, physical performance and determinants of falls were identified and pooled for analysis. The Timed Up and Go test and dominant handgrip strength tests were used as physical performance measures. Falls were self-reported, and functional status was assessed using activities of daily living., Results: Data of 3935 participants, mean age 68.9 ± 6.8 years, 2127 (54.0%) women and 1807 (46.0%) men were extracted for analyses. In an adjusted model, independent risk factors for falls from this cohort studies were diabetes (OR 1.258), arthritis (OR 1.366), urinary incontinence (OR 1.346), poor self-rated health (OR 1.293), higher body mass index (OR 1.029) and lower handgrip strength (OR 1.234)., Conclusions: Although the risk factors that emerged from our analyses were similar to available studies among older adults, the Timed Up and Go test did not appear as one of the risk factors in the present study that included middle-aged adults. Our findings will require confirmation in a prospective study. Geriatr Gerontol Int 2019; 19: 798-803., (© 2019 Japan Geriatrics Society.)

While the prevalence of falls among Malaysian older adults is comparable to other older populations around the world, little is currently known about fear of falling in Malaysia. The Falls Efficacy Scale International (FES-I) and short FES-I scales to measure fear of falling have not yet been validated for use within the Malaysian population, and are currently not available in Bahasa Malaysia (BM). A total of 402 participants aged ≥63 years were recruited. The questionnaire was readministered to 149 participants, 4 to 8 weeks after the first administration to determine test-retest reliability. The original version of the 7-item short FES-I is available in English, while the Mandarin was adapted from the 16-item Mandarin FES-I. The BM version was translated according to protocol by four experts. The internal structure of the FES-I was examined by factor analysis. The 7-item short FES-I showed good internal reliability and test-retest reliability for English, Mandarin, and BM versions for Malaysia.

Objective: To determine the effectiveness of an individually-tailored multifactorial intervention in reducing falls among at risk older adult fallers in a multi-ethnic, middle-income nation in South-East Asia., Design: Pragmatic, randomized-controlled trial., Setting: Emergency room, medical outpatient and primary care clinic in a teaching hospital in Kuala Lumpur, Malaysia., Participants: Individuals aged 65 years and above with two or more falls or one injurious fall in the past 12 months., Intervention: Individually-tailored interventions, included a modified Otago exercise programme, HOMEFAST home hazards modification, visual intervention, cardiovascular intervention, medication review and falls education, was compared against a control group involving conventional treatment., Primary and Secondary Outcome Measures: The primary outcome was any fall recurrence at 12-month follow-up. Secondary outcomes were rate of fall and time to first fall., Results: Two hundred and sixty-eight participants (mean age 75.3 ±7.2 SD years, 67% women) were randomized to multifactorial intervention (n = 134) or convention treatment (n = 134). All participants in the intervention group received medication review and falls education, 92 (68%) were prescribed Otago exercises, 86 (64%) visual intervention, 64 (47%) home hazards modification and 51 (38%) cardiovascular intervention. Fall recurrence did not differ between intervention and control groups at 12-months [Risk Ratio, RR = 1.037 (95% CI 0.613-1.753)]. Rate of fall [RR = 1.155 (95% CI 0.846-1.576], time to first fall [Hazard Ratio, HR = 0.948 (95% CI 0.782-1.522)] and mortality rate [RR = 0.896 (95% CI 0.335-2.400)] did not differ between groups., Conclusion: Individually-tailored multifactorial intervention was ineffective as a strategy to reduce falls. Future research efforts are now required to develop culturally-appropriate and affordable methods of addressing this increasingly prominent public health issue in middle-income nations., Trial Registration: ISRCTN Registry no. ISRCTN11674947., Competing Interests: The authors have declared that no competing interests exist.

The aim of this study was to determine the relationship between falls and beat-to-beat blood pressure (BP) variability.Continuous noninvasive BP measurement is as accurate as invasive techniques. We evaluated beat-to-beat supine and standing BP variability (BPV) using time and frequency domain analysis from noninvasive continuous BP recordings.A total of 1218 older adults were selected. Continuous BP recordings obtained were analyzed to determine standard deviation (SD) and root mean square of real variability (RMSRV) for time domain BPV and fast-Fourier transform low frequency (LF), high frequency (HF), total power spectral density (PSD), and LF:HF ratio for frequency domain BPV.Comparisons were performed between 256 (21%) individuals with at least 1 fall in the past 12 months and nonfallers. Fallers were significantly older (P = .007), more likely to be female (P = .006), and required a longer time to complete the Timed-Up and Go test (TUG) and frailty walk test (P ≤ .001). Standing systolic BPV (SBPV) was significantly lower in fallers compared to nonfallers (SBPV-SD, P = .016; SBPV-RMSRV, P = .033; SBPV-LF, P = .003; SBPV-total PSD, P = .012). Nonfallers had significantly higher supine to standing ratio (SSR) for SBPV-SD, SBPV-RMSRV, and SBPV-total PSD (P = .017, P = .013, and P = .009). In multivariate analyses, standing BPV remained significantly lower in fallers compared to nonfallers after adjustment for age, sex, diabetes, frailty walk, and supine systolic BP. The reduction in frequency-domain SSR among fallers was attenuated by supine systolic BP, TUG, and frailty walk.In conclusion, reduced beat-to-beat BPV while standing is independently associated with increased risk of falls. Changes between supine and standing BPV are confounded by supine BP and walking speed.

Aim: To determine the dependency scores, long-term mortality and factors associated with mortality in older people presenting to the emergency department (ED) with a fall., Methods: Information on sociodemographics, dependency using the Barthel index and fall characteristics were collected from consecutive patients attending the ED over a 6-month period. Barthel score was reassessed at 12 months. Ten-year mortality data were obtained through the National Registry Department., Results: A total of 198 participants, with a mean age (standard deviation) of 76.2 years (6.3 years) and 74% women, were recruited. Of these, 70% sustained falls indoors, while 49% of falls occurred between 06.00 to 12.00 hours. Total Barthel scores were significantly lower at 1-year follow up compared with baseline (median [interquartile range], 20 [2] vs 18 [5], P < 0.001). Age ≥75 years was significantly associated with mortality at 1, 3, 5 and 10 years (HR 3.12, 95% CI 1.48-6.56; HR 2.32, 95% CI 1.37-3.92; HR 1.87, 95% CI 1.21-2.88; and HR 2.25, 95% CI 1.60-3.17, respectively). Indoor falls (HR 2.54, 95% CI 1.07-6.06; HR 2.01, 95% CI 1.10-3.69), hospital admission (HR 2.16, 95% CI 1.14-4.10; HR 1.84, 95% CI 1.11-3.07) and Barthel ≤18 (HR 2.99, 95% CI 1.39-6.44; HR 2.47, 95% CI 1.40-4.33) were significantly associated with 1-year and 3-year mortality. Hospital admission (HR 1.94, 95% CI 1.24-3.01; HR 1.53, 95% CI 1.06-2.23) and Barthel ≤18 (HR 2.27, 95% CI 1.41-3.66; HR 1.85, 95% CI 1.27-2.68) remained significantly associated with increased mortality at 5 and 10 years., Conclusion: Functional ability is significantly reduced at 1 year after an initial presentation to the ED with a fall. Mortality is increased at 1 and 3 years in fallers who experienced indoor falls. The excess mortality associated with hospital admission and lower disability scores is persistent at 5 and 10 years. The results of the present study are invaluable in prognostication and healthcare decision-making for this group of frail older patients., (© 2015 Japan Geriatrics Society.)

The term polypharmacy has negative connotations due to its association with adverse drug reactions and falls. This spectrum of adverse events widens when polypharmacy occurs among the already vulnerable geriatric population. To date, there is no consensus definition of polypharmacy, and diverse definitions have been used by various researchers, the most common being the consumption of multiple number of medications. Taking multiple medications is considered a risk factor for falls through the adverse effects of drug-drug or drug-disease interactions. Falls studies have determined that taking ≥ 4 drugs is associated with an increased incidence of falls, recurrent falls, and injurious falls. In light of existing evidence, careful and regular medication reviews are advised to reduce the effect of polypharmacy on falls. However, intervention studies on medication reviews and their effectiveness on falls reduction have been scarce. This article reviews and discusses the evidence behind polypharmacy and its association with falls among older individuals, and highlights important areas for future research.

Hypertension is a highly prevalent condition among older people, but many physicians avoid aggressive treatment in this age group due to concerns about adverse effects such as orthostatic hypotension and falls. Orthostatic hypotension, which also increases in prevalence with increasing age, has been considered to be associated with antihypertensive therapy. Both orthostatic hypotension and antihypertensive medications are considered independent yet closely related predictors for falls among older people. The prescription of antihypertensive therapy among the elderly remains a long-standing controversy in geriatric medicine due to ongoing concerns about potential complications such as falls, despite conclusive evidence supporting the treatment of hypertension even among the very elderly. However, recent evidence suggests a dose-dependent relationship between blood pressure lowering therapy and falls among older individuals with preexisting risk factors for falls. In response to the spate of revisions in hypertension treatment targets for older patients in international guidelines and the recent evidence on antihypertensive therapy and falls, this review article examines the complex relationship between hypertension, antihypertensives, orthostatic hypotension, and falls among older patients.

Introduction: osteoarthritis (OA) of knee has been reported as a risk factor for falls and reduced balance in the elderly. This systematic review evaluated the effectiveness of physical therapies in improving balance and reducing falls risk among patients with knee OA., Methods: a computerised search was performed to identify relevant studies up to November 2013. Two investigators identified eligible studies and extracted data independently. The quality of the included studies was assessed by the PeDro score., Results: a total of 15 randomised controlled trials involving 1482 patients were identified. The mean PeDro score was 7. The pooled standardised mean difference in balance outcome for strength training = 0.3346 (95% CI: 0.3207-0.60, P = 0.01 < 0.00001, P for heterogeneity = 0.85, I(2) = 0%). Tai Chi = 0.7597 (95% CI: 0.5130-1.2043, P<=0.0014, P for heterogeneity = 0.26, I(2) = 0%) and aerobic exercises = 0.6880 (95% CI: 0.5704-1.302, P < 0.00001, P for heterogeneity = 0.71, I(2) = 0%). While pooled results for falls risk outcomes in, strength training, Tai chi and aerobics also showed a significant reduction in reduced risk of falls significantly with pooled result 0.55 (95% CI: 0.41-0.68, P < 0.00001, P for heterogeneity = 0.39, I(2) = 6%)., Conclusion: strength training, Tai Chi and aerobics exercises improved balance and falls risk in older individuals with knee OA, while water-based exercises and light treatment did not significantly improve balance outcomes. Strength training, Tai Chi and aerobics exercises can therefore be recommended as falls prevention strategies for individuals with OA. However, a large randomised controlled study using actual falls outcomes is recommended to determine the appropriate dosage and to measure the potential benefits in falls reduction., (© The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

This paper presents a state-of-the-art survey of smartphone (SP)-based solutions for fall detection and prevention. Falls are considered as major health hazards for both the elderly and people with neurodegenerative diseases. To mitigate the adverse consequences of falling, a great deal of research has been conducted, mainly focused on two different approaches, namely, fall detection and fall prevention. Required hardware for both fall detection and prevention are also available in SPs. Consequently, researchers' interest in finding SP-based solutions has increased dramatically over recent years. To the best of our knowledge, there has been no published review on SP-based fall detection and prevention. Thus in this paper, we present the taxonomy for SP-based fall detection and prevention solutions and systematic comparisons of existing studies. We have also identified three challenges and three open issues for future research, after reviewing the existing articles. Our time series analysis demonstrates a trend towards the integration of external sensing units with SPs for improvement in usability of the systems.

Aim: To compare and contrast falls characteristics between older adults with body mass index of 25.0 kg/m² or greater and less than 25.0 kg/m² and to further identify potential underlying mechanisms if differences existed. Subjects and Methods: This was a cross-sectional study using data from fallers identified during the first wave of the Malaysian Elders Longitudinal Research study. Basic demographics, falls characteristics, fear of falling, medical comorbidities, and lifestyle factors were obtained during a home-based computer-assisted interview, while anthropometric measurements, body composition, and physical performance were collected during the hospital-based health check. Results: Of the 302 individuals with 1 or more falls in the previous 12 months, mean age (SD) = 69.6 (7.7) years, 152 individuals (50.3%) were in the body mass index of 25.0 group or greater. Fallers with body mass index of 25.0 or greater were more likely to have fallen in the bedroom and on the stairs (adjusted odds ratio = 2.50; 95% confidence interval, 1.10-5.73) and less likely to fall in the afternoon (adjusted odds ratio = 0.47; 95% confidence interval, 0.26-0.83) after adjustment for potential confounders. Conclusions: Our study suggests that mechanisms of falls may differ in those with excess body weight, who may benefit from specific targeted fall prevention programmes. [ABSTRACT FROM AUTHOR]