Search

Background: Benign paroxysmal positional vertigo (BPPV) patients may experience balance problems in various environmental conditions other than positional dizziness. Therefore, there is a need to investigate the postural control abilities and the ability to use sensory inputs in BPPV patients in different conditions. Objective: The aim of this study was to examine the postural control performance of middle-aged adult BPPV patients in easy and difficult balance tasks, the effect of vestibular stimulation on the maintenance of balance, and the risk of falling, by posturographic evaluation in various conditions. Method: A total of 26 patients diagnosed with posterior canal BPPV and 26 controls were included in the study. Sensory Organization Test (SOT), Vestibular Stimulation Test (VST), and fall risk assessment (FRA) were applied to the participants, respectively. Results: Significant difference was observed in SOT medio-lateral (ML) plane in Conditions 2 and 5 (p < .05). A significant difference was observed in the vestibular score in the SOT ML plane. No significant difference was observed in VST test scores (p > .05). In the FRA test, a significant difference was observed in the energy and gain parameters in the anterio-posterior plane (p < .05). Conclusions: The current study examined postural control abilities of patients with BPPV in extensive external conditions and in both planes, using various sensory perturbations and stimulation. It was thought that while BPPV patients were in the active phase of the disease, their postural control skills in the ML plane decreased and they might be at risk of falling. [ABSTRACT FROM AUTHOR]

Background/aim: Efficient discharge for stroke patients is crucial but challenging. The study aimed to develop early predictive models to explore which patient characteristics and variables significantly influence the discharge planning of patients, based on the data available within 24 h of admission. Design: Prospective observational study. Methods: A prospective cohort was conducted at a university hospital with 523 patients hospitalised for stroke. We built and trained six different machine learning (ML) models, followed by testing and tuning those models to find the best‐suited predictor for discharge disposition, dichotomized into home and non‐home. To evaluate the accuracy, reliability and interpretability of the best‐performing models, we identified and analysed the features that had the greatest impact on the predictions. Results: In total, 523 patients met the inclusion criteria, with a mean age of 61 years. Of the patients with stroke, 30.01% had non‐home discharge. Our model predicting non‐home discharge achieved an area under the receiver operating characteristic curve of 0.95 and a precision of 0.776. After threshold was moved, the model had a recall of 0.809. Top 10 variables by importance were National Institutes of Health Stroke Scale (NIHSS) score, family income, Barthel index (BI) score, FRAIL score, fall risk, pressure injury risk, feeding method, depression, age and dysphagia. Conclusion: The ML model identified higher NIHSS, BI, and FRAIL, family income, higher fall risk, pressure injury risk, older age, tube feeding, depression and dysphagia as the top 10 strongest risk predictors in identifying patients who required non‐home discharge to higher levels of care. Modern ML techniques can support timely and appropriate clinical decision‐making. Relevance to Clinical Practice: This study illustrates the characteristics and risk factors of non‐home discharge in patients with stroke, potentially contributing to the improvement of the discharge process. Reporting Method: STROBE guidelines. [ABSTRACT FROM AUTHOR]

Purpose: Older adults frequently encounter health challenges, such as impaired balance and muscle health, which increase risk of falls. The current study investigated the effectiveness of the proprioceptive neuromuscular facilitation (PNF) technique in improving balance and muscle health among older adults with high fall risk. Method: A total of 160 older adults with high fall risk were randomized into control and intervention groups. Over 6 months, the control group received standard interventions, while the intervention group received the same interventions and additional PNF training. Results: Both groups demonstrated improvements in balance function over time, with the intervention group exhibiting significant improvements in Berg Balance Scale scores, Timed Up and Go test times, and 30-Second Chair Stand Test counts (p < 0.05). Bone density significantly increased in the intervention group compared to the control group (p < 0.05), although no substantial differences in lower limb muscle mass were observed. Satisfaction rates were higher and fall incidents fewer in the intervention group. Conclusion: The PNF technique is effective in enhancing balance function and muscle health in older adults with high fall risk, demonstrating potential in reducing fall risk and improving quality of life among older adults. [Journal of Gerontological Nursing, 50(8), 37–44.] [ABSTRACT FROM AUTHOR]

Falls are among the top 10 causes of years lived with disability in people aged 75 and over. Preventive programs like case management (CM) are crucial. Objectives: To evaluate the effects of a multifactorial fall prevention program based on CM on physical performance, the presence of pain, and the risk of falls and fractures in older people who have suffered falls. Methods: This randomized, single-blind clinical trial with parallel groups, Intervention Group (IG) and Control Group (CG), was composed of 55 older people with a history of falling, living in the community. All participants underwent an initial assessment via video call (containing anamnesis, timed up-and-go test, falls risk score, short physical performance battery, and clinical frax). The IG underwent CM, the physical exercise protocol, and the cognitive stimulation protocol. The CG was monitored through telephone calls and received general health and fall guidance. Results: No significant results were found in the physical capacity, the presence of pain, the risk of falls, or the fractures between the Intervention and Control Groups and between assessments. Conclusion: This program was not effective in improving functional performance, but it was important for characterizing pain and the probability of fracture in the next 10 years in this population. [ABSTRACT FROM AUTHOR]

Background: Falls are a frequent occurrence in older adults in long-term care facilities. Local Problem: At our long-term care facility, the percentage of patients who fell increased from 45% in 2021 to 68% in 2022, indicating a need for an evidence-based solution. Methods: We used an evidence-based quality improvement framework to pilot a tai chi exercise program. Interventions: Residents were invited to participate in the Tai Ji Quan: Moving for Better Balance program for 12 weeks. Classes were 30 minutes long and included a 5-minute warm-up and 5-minute cooldown. Results: Seventy-five residents participated in the tai chi program. There was a significant 32.3% reduction in falls (P =.001). Residents' fall risk scores decreased 14% (P <.001). Conclusions: Implementing a tai chi exercise project may affect falls and decrease the overall fall risk. [ABSTRACT FROM AUTHOR]

Objective: This study examined alignment of subjective balance confidence with Stopping Elderly Accidents, Deaths and Injuries (STEADI) fall risk. Methods: Cross-sectional analysis of 155 community-dwelling adults (60 + y/o) from 2016 to 2018 who completed a STEADI fall assessment. Descriptive statistics, Chi-Square analysis, and biserial point correlations were applied. Results: Adults who overestimate balance confidence, 55.6% (n = 50) reported a fall in the past year, 62.2% (n = 56) were worried about falling, 48.9% (n = 44) felt unsteady when standing/walking, and 70.0% (n = 63) had a score of ≥4 on the Stay Independent Questionnaire (SIQ). Physical performance for these adults were mean TUG score 10.9s (SD = 3.4), mean 30 second chair stands 10.8 (SD = 3.5), and mean 4-stage balance score 3.1 (SD =.76). Discussion: Older adults are more likely to overestimate their subjective balance confidence. Individuals are equally likely to have reported a fall in the past year if they were "at fall risk," regardless of their subjective balance confidence. [ABSTRACT FROM AUTHOR]

The aim of this retrospective, cross-sectional, observational study was to assess the frequency of falls and evaluate the predictive validity of the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) among patients aged ≥65 years, transferred to the rehabilitation ward of a university hospital. The predictive ability was assessed using receiver operating characteristic curve analysis, and the optimal threshold was established using the Youden index. We analyzed the overall cohort (N = 175) with subacute stroke and the subgroup with a low unaffected handgrip strength (HGS; men: <28 kg, women: <18 kg). Overall, 135/175 patients (77.1%) had a low HGS. The fall rate was 6.9% overall and 5.9% for patients with a low HGS. The JHFRAT predictive value was higher for patients with a low HGS than that for the overall cohort, but acceptable in both. The optimal cutoff score for the overall cohort was 11 (sensitivity, 67%; specificity, 68%), whereas that for the subgroup was 12 (sensitivity, 75%; specificity: 72%). These results are expected to aid nurses working in rehabilitation wards in more effectively utilizing JHFRAT outcomes for post-stroke older patients with a low HGS and contribute to the development of more appropriate fall prevention strategies for high-risk patients in the future. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between polypharmacy and the risk of recurrent falls and to assess the fall risk with different pharmacological groups of drugs. Materials and Methods: In this cross-sectional study, falls risk-increasing drugs were defined as cardiovascular drugs, analgesics, central nervous system drugs, endocrine drugs, and others. Falls were evaluated according to their presence during the past 12 months. Two or more falls were recorded as recurrent fallers. Results: Five hundred and eighteen participants had a mean age of 71.9 years (7.5) and 71.0% were female. While 87 (51.4%) participants fell once, 82 (48.5%) participants reported recurrent falls. Two hundred and eighty-eight (55.6%) participants had polypharmacy. The percentage of patients who used at least one potentially inappropriate mediation on admission, as defined by the Beers criteria, was 155 (29.9%). The determinants of the risk of recurrent falls were older age and use of angiotensin-converting enzyme inhibitors (ACE-I) [odds ratio (OR) 1.05: 95% confidence interval (CI) 1.00-1.09 and OR 4.04: 95% CI 1.70-9.60, respectively]. Low handgrip strength (HGS) increased the risk of falls approximately 1.7 times (OR 1.69 95% CI 1.11-2.58). Conclusion: Although the polypharmacy rate of the participants was high, there was no significant relationship between polypharmacy and falling. However, we found low HGS, a component of sarcopenia, as a risk factor for falls, and use of ACE-I and older were risk factors for recurrent falls. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the discriminative properties (discriminative effect, sensitivity, specificity, and cutoff values) of four commonly used balance measures for nonfallers, fallers, and multiple fallers among Turkish community-dwelling older adults. Methods: Three hundred fifty-one community-dwelling older adults (122 fallers and 229 nonfallers) were evaluated with the timed up and go test, functional reach test, one-leg stance test, and Berg Balance Scale (BBS). Results: Timed up and go test and functional reach test were not sensitive in detecting group differences between fallers and nonfallers, and BBS and one-leg stance test had significant but limited discriminative power with cutoff values of 53.5 points and 7.50 s, respectively. In addition, timed up and go test, functional reach test, and one-leg stance test had significant but limited discriminative power, and BBS had acceptable discriminative power for older adults who fell multiple times. Conclusions: These findings suggest that BBS is the most suitable tool for assessing the fall risk of Turkish community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Recently, a short form of the Fullerton Advanced Balance (SF-FAB) scale was reported as a good predictor of falls in older adults. However, we found no evidence regarding its reliability in non-American older adults. Therefore, we aimed to analyze the reliability and homogeneity of the SF-FAB scale to measure postural balance in Iranian older adults. Eighty-five community-dwelling older adults (70.75 ± 4.97 years) performed the SF-FAB test on two occasions 1 week apart. In both instances, four raters assessed the performance on the test. The SF-FAB scale (mean total score: 12.46 ± 3.53) revealed acceptable internal consistency (Cronbach's α =.77), excellent intrarater reliability (intraclass correlation coefficient =.94–.99), and excellent interrater reliability (intraclass correlation coefficient =.92–.99). The overall prediction success rate was 83.5% with correctly classifying 95.6% of nonfallers and 35.3% of fallers. The SF-FAB scale can provide a quick screen of balance status in older adults to trigger referral to clinicians for a more comprehensive assessment. [ABSTRACT FROM AUTHOR]

Many people with chronic stroke (PwCS) exhibit walking balance deficits linked to increased fall risk and decreased balance confidence. One potential contributor to these balance deficits is a decreased ability to modulate mediolateral stepping behavior based on pelvis motion. This behavior, hereby termed mediolateral step modulation, is thought to be an important balance strategy but can be disrupted in PwCS. Are biomechanical metrics of mediolateral step modulation related to common clinical balance measures among PwCS? In this cross-sectional study, 93 PwCS walked on a treadmill at their self-selected speed for 3-minutes. We quantified mediolateral step modulation for both paretic and non-paretic steps by calculating partial correlations between mediolateral pelvis displacement at the start of each step and step width (ρ SW), mediolateral foot placement relative to the pelvis (ρ FP), and final mediolateral location of the pelvis (ρ PD) at the end of the step. We also assessed several common clinical balance measures (Functional Gait Assessment [FGA], Activities-specific Balance Confidence scale [ABC], self-reported fear of falling and fall history). We performed Spearman correlations to relate each biomechanical metric of step modulation to FGA and ABC scores. We performed Wilcoxon rank sum tests to compare each biomechanical metric between individuals with and without a fear of falling and a history of falls. Only ρ FP for paretic steps was significantly related to all four clinical balance measures; higher paretic ρ FP values tended to be observed in participants with higher FGA scores, with higher ABC scores, without a fear of falling and without a history of falls. However, the strength of each of these relationships was only weak to moderate. While the present results do not provide insight into causality, they justify future work investigating whether interventions designed to increase ρ FP can improve clinical measures of post-stroke balance in parallel. • Many people with chronic stroke have reduced walking balance and confidence. • Modulation of mediolateral foot placement may be an important balance strategy. • Paretic foot placement modulation was related to clinical balance measures. [ABSTRACT FROM AUTHOR]

Falls among older people are a major health concern. This study aims to develop a multifactorial fall risk assessment system for older people using a low-cost, markerless Microsoft Kinect. A Kinect-based test battery was designed to comprehensively assess major fall risk factors. A follow-up experiment was conducted with 102 older participants to assess their fall risks. Participants were divided into high and low fall risk groups based on their prospective falls over a 6-month period. Results showed that the high fall risk group performed significantly worse on the Kinect-based test battery. The developed random forest classification model achieved an average classification accuracy of 84.7%. In addition, the individual's performance was computed as the percentile value of a normative database to visualise deficiencies and targets for intervention. These findings indicate that the developed system can not only screen out 'at risk' older individuals with good accuracy, but also identify potential fall risk factors for effective fall intervention. Practitioner summary: Falls are the leading cause of injuries in older people. We newly developed a multifactorial fall risk assessment system for older people utilising a low-cost, markerless Kinect. Results showed that the developed system can screen out 'at risk' individuals and identify potential risk factors for effective fall intervention. [ABSTRACT FROM AUTHOR]

Background. Fall represents one of the highest concerns in the healthcare system, especially in medical rehabilitation settings. However, there is a lack of instruments for the assessment of risk falls in the context of musculoskeletal rehabilitation. Methods. This retrospective multisite study aimed to assess the sensitivity and specificity of four fall risk assessment tools (the Functional Independence Measure, the Fall Risk Assessment, the Schmid Fall Risk Assessment Tool, and the ePA-AC) in predicting falls in patients admitted to musculoskeletal rehabilitation in Swiss inpatient facilities. Results. The data relative to 6970 individuals (61.5% females) were analyzed and 685 (9.83% of patients) fall events were registered. The area under the curve (AUC) relative to the Functional Independence Measure was 0.689, 0.66 for the Fall Risk Assessment, 0.641 for the Schmid Fall Risk Assessment Tool, and 0.675 for the ePA-AC. Among the four tools, the Functional Independence Measure had an acceptable discriminatory power in distinguishing between significant events (i.e., patients' falls) and non-events (no falls). Conclusion. None of the assessed tools showed highly satisfying levels of statistical sensitivity or sensibility. However, the Functional Independence Measure could be used to assess the fall risk assessment in musculoskeletal rehabilitation settings, although with some caution, since this questionnaire was not designed for this diagnostic purpose. We strongly suggest urgently designing a tool for risk assessment that is specific to this population and the rehabilitative setting. [ABSTRACT FROM AUTHOR]

Background: Mobility loss is common in hospitalized older adults, and resources to prevent mobility impairment are finite. Our goal was to use routinely collected data to develop a risk assessment tool that identifies individuals at risk of losing the ability to walk during hospitalization on the first hospital day. Second, we determined if the tool could inform the use of mobility‐preserving interventions. Methods: We included patients admitted to a general medical service, aged ≥65 years, who walked occasionally or frequently on admission (Braden Scale Activity subset > = 3). Patients were considered to have a new mobility impairment if, at discharge, their ability to walk was severely limited or nonexistent or they were confined to bed (Braden Scale Activity subset <3). We used predictors available on the first hospital day to develop (2017–18 cohort) and validate (2019 cohort) a risk assessment tool. We determined the association between predicted risk and therapy use in the validation cohort to highlight the model's clinical utility. Results: 5542 patients were included (median age 76 years, 48% women); 7.6% were discharged unable to walk. The model included 5 predictors: age, medication administrations, Glasgow Coma Scale verbal score, serum albumin, and urinary catheter presence. In the validation cohort, the model discriminated well (c‐statistic 0.75) and was strongly associated with hospital‐acquired mobility impairment (lowest decile 1%, highest decile 25%). In the validation cohort, therapy consultation ordering increased linearly with predicted risk; however, observed mobility impairment increased exponentially. Conclusion: The tool assesses the risk of mobility impairment in all ambulatory hospitalized older adults on the first hospital day. Further, it identifies at‐risk older adults who may benefit from mobility interventions. [ABSTRACT FROM AUTHOR]

Bone fragility is the determinant of the increased risk of minimal trauma fracture and must be treated with a multimodal approach that includes pharmacological therapy, physical exercise, and adequate nutrition. Pharmacological therapy, to date based on the administration of antiresorptive drugs, such as bisphosphonates and denosumab, or osteoanabolic drugs, such as teriparatide and abaloparatide, has shown to be effective in reducing the risk of fracture in osteoporotic patients. In the context of the cellular and molecular mechanisms that regulate bone metabolism, the discovery of the Wnt signaling pathway and its role in bone tissue homeostasis has allowed the identification of sclerostin as an inhibitor of osteoblastic activity and simultaneously as a stimulator of osteoclastic activity. Therefore, the use of a monoclonal antibody, romosozumab, against this protein has been tested as a potential drug with a dual action, stimulating bone neo-apposition and inhibiting bone resorption. The efficacy of romosozumab has been demonstrated in numerous clinical trials against both placebo and other drugs commonly used in the treatment of patients affected by osteoporosis. The advantages of this drug lie above all in its rapid action which makes it particularly suitable in clinical situations where it is necessary to improve bone strength very quickly due to the imminent risk of fragility fracture. Clinical studies and guidelines suggest romosozumab as an initial drug in an ideal sequential approach from osteoanabolic to antiresorptive drugs. Some aspects of cardiovascular safety remain to be fully investigated, therefore its use in osteoporotic patients at high cardiovascular risk should be avoided until further data become available. [ABSTRACT FROM AUTHOR]

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

Aims and Objectives: To develop a simple and reliable assessment tool for predicting falls in acute care settings. Background: Falling injures patients, lengthens hospital stay and leads to the wastage of financial and medical resources. Although there are many potential predictors for falls, a simple and reliable assessment tool is practically necessary in acute care settings. Design: A retrospective cohort study. Methods: The current study was conducted for participants who were admitted to a teaching hospital in Japan. Fall risk was assessed by the modified Japanese Nursing Association Fall Risk Assessment Tool consisting of 50 variables. To create a more convenient model, variables were first limited to 26 variables and then selected by stepwise logistic regression analysis. Models were derived and validated by dividing the whole dataset into a 7:3 ratio. Sensitivity, specificity, and area under the curve for the receiver‐operating characteristic curve were evaluated. This study was conducted according to the STROBE guideline. Results: Six variables including age > 65 years, impaired extremities, muscle weakness, requiring mobility assistance, unstable gait and psychotropics were chosen in a stepwise selection. A model using these six variables with a cut‐off point of 2 with one point for each item, was developed. Sensitivity and specificity >70% and area under the curve >.78 were observed in the validation dataset. Conclusions: We developed a simple and reliable six‐item model to predict patients at high risk of falling in acute care settings. Relevance to Clinical Practice: The model has also been verified to perform well with non‐random partitioning by time and future research is expected to make it useful in acute care settings and clinical practice. Patient or Public Contribution: Patients participated in the study on an opt‐out basis, contributing to the development of a simple predictive model for fall prevention during hospitalisation that can be shared with medical staff and patients in the future. [ABSTRACT FROM AUTHOR]

The adult population in the United States is more physically active and are living longer than prior generations. Due to the advancement in surgical techniques and the increased number of active people, there has been a rise in the number of hip and knee replacement surgeries. This rise in the number of surgeries is expected to continue. Post-surgical care is a critical component to a successful patient recovery. After surgery, patients experience limited mobility while the muscles around the impacted joints need time for inflammation to subside. Physicians and other medical providers are concerned with making sure that patients do not experience falls during this time as it may lead to more serious injuries. A sample dataset of patients who underwent elective hip or knee surgery from January 2014 to March 2020 has been provided to analyze other medical conditions that may contribute to the likelihood of a patient falling. The goal is to identify important factors that can assist in predicting the probability of a patient falling after surgery. [ABSTRACT FROM AUTHOR]

Falls are a significant public health concern for the elderly population. This study investigates the relationship between individual perception of perceived susceptibility to fall risk and fall risk level among elderly adult patients admitted to an acute care setting in a Saudi Arabian hospital. A convenience sample of 150 patients aged 60 to 89 years was enrolled in the study. The perceived susceptibility to fall risk was measured using a scale with high internal consistency (Cronbach's alpha = 0.87). Fall risk was assessed as a dichotomous variable (No Fall Risk or High Fall Risk). The results revealed a significant association between individual perception and fall risk level, with higher perceived susceptibility scores in patients classified as No Fall Risk compared to those in the High Fall Risk group (p < 0.001). The study also explored the impact of demographic variables, frailty, and high-risk medications on fall risk. Binary logistic regression analysis indicated that age and frailty were positively associated with an increased fall risk, while the use of certain high-risk medications was associated with a decreased risk. These findings contribute to the understanding of how individual perceptions and frailty influence fall risk and can inform the development of targeted fall prevention interventions for elderly patients in acute care settings. This research adds to the limited existing literature on perception and fall risk, particularly in the context of the Saudi population, and provides valuable insights for healthcare practitioners seeking to enhance fall prevention programs and patient outcomes. [ABSTRACT FROM AUTHOR]

Context: Falls and loss of autonomy are often attributed in large part to musculoskeletal impairments in later adulthood. Age-related declines in flexibility contribute to late adulthood musculoskeletal impairment. The novel sitting-rising test has been proposed to be a quick, effective screening of musculoskeletal fitness, fall risk, and all-cause mortality in older adults. The timed up and go and 5 times sit-to-stand tests are two of the 3 most evidence-supported performance measures to assess fall risk. Objective: This study aimed to determine if 5 weeks of flexibility training could increase sitting-rising test, timed up and go, and 5 times sit-to-stand scores in community-dwelling older adults. Participants: Forty-seven adults aged 60 years and older (mean age = 66.7 y, SD = 4.1) participated in this study. Participants completed a static stretching protocol consisting of 3 weekly 1-hour stretching sessions. Results: The protocol improved flexibility as seen in sit-and-reach scores and improved scores on all outcome variables. Specifically, there was a significant increase in sitting-rising test scores from preintervention (M = 7.45, SD = 1.45) to postintervention (M = 8.04, SD = 1.36), t(42) = -5.21, P < .001. Timed up and go scores demonstrated a significant decrease from preintervention (M = 8.85, SD = 1.32) to postintervention (M = 8.20, SD = 1.35), t(46) = 5.10, P < .001. Five times sit-to-stand scores demonstrated a significant decrease from preintervention (M = 12.57, SD = 2.68) to postintervention (M = 10.46, SD = 2.06), t(46) = 6.62, P < .001. Finally, significant increases in sit-and-reach scores were associated with improved functional performance (r = -.308, P = .03). Conclusion: Findings suggest that flexibility training can be an effective mode of low-level exercise to improve functional outcomes. Static stretching may help to improve musculoskeletal health, promote autonomy, and decrease mortality in community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Approximately 40-60% of falls in the elderly lead to injuries, resulting in disability and loss of independence. Despite the higher prevalence of falls and morbidity rates in cognitively impaired individuals, most fall risk assessments fail to account for mental status. In addition, successful fall prevention programmes in cognitively normal adults have generally failed in patients with cognitive impairment. Identifying the role of pathological aging on fall characteristics can improve the sensitivity and specificity of fall prevention approaches. This literature review provides a thorough investigation into fall prevalence and fall risk factors, the accuracy of fall risk assessments, and the efficacy of fall prevention strategies in individuals with diverse cognitive profiles. We show that fall-related characteristics differ between cognitive disorders and fall risk assessment tools as well as fall prevention strategies should critically consider each patient's cognitive status to facilitate the identification of fallers at an earlier stage and support clinical decision-making. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To determine predictors of fall events in hospitalized patients with cancer, and identification of fall risk. Methods: An analysis of medical records was conducted together with a review of standardized fall reports of 565 patients admitted between January 1 and December 31, 2020. The collected data were analyzed with the chi-squared test, Fisher exact test, independent t-test, and logistic regression analysis using STATA 17 program. Results: There was a statistically significant increased fall risk; accompanied by a guardian (OR=10.30 CI=2.66~39.94), number of attachment devices (OR=1.30, CI=0.46~0.64), medication (OR=0.17, CI=0.04~0.84), pain (OR=4.73, CI=1.59~14.0), walking problem (OR=29.85, CI=9.31~95.74), chemotherapy (OR=5.20, CI=1.81~14.89), and fall risk score (OR=1.83, CI=1.50~2.24). Conclusion: These findings can serve as academic evidence to support the role of nurses in assessing the risk of fall events/accidents with regard to cancer patients and the development of individually adjusted fall assessment tools. [ABSTRACT FROM AUTHOR]

Background: As a result of falls, older patients experience injury and loss of function, and their length of hospital stay and care costs increase. Aim: This study was conducted to determine fall risks and compare the sensitivity and specificity of three fall risk assessment tools. Methods: Older patients' fall risk levels were determined according to the Itaki, Hendrich-II, and Morse tools within 2 h following their admission to the wards. A methodological design was used in the study, which included 388 hospitalized elderly patients. The mean age of the patients was 72.29 ± 5.6 years, and 57.7% were female. Results: According to the ROC curve values of Sensitivity and 1-Specificity, the cut-off points for the Hendrich-II, Itaki, and Morse fall tools were accepted as 27.5, 8.5, and 6.5, respectively. According to the analysis results, the ratios of the areas under the ROC curve for the Itaki, Morse, and Hendrich-II fall tools were 0.794, 0.773, and 0.724, respectively, which were found to be statistically significant for all three tools (p ≤ 0.001). Conclusions: The Itaki Fall Risk Tool was found to be the most sensitive one among the three instruments in assessing the fall risk of older hospitalized patients. The Itaki Fall Risk Tool was followed by the Morse and Hendrich-II tools, respectively, in terms of sensitivity. [ABSTRACT FROM AUTHOR]

No single tool is able to distinguish fallers from non-fallers. The aim of this study was to detect subacute stroke inpatients at higher risk for falls, predictors for the number of falls and near falls and the impact of these incidents on functional outcome. An observational prospective cohort study comparing clinical differences between non-fallers, onetime and repeat fallers. Bivariate and multivariate Poisson regression analyses with length of stay as an offset variable were conducted. Fallers had mostly intermediate level of impairment and disability (NIHSS, FIM, mRS, the ICF minimal generic data set). The onetime fallers who were oldest, most disabled and most often institutionalised achieved the same functional improvement as the non-fallers, however, after significantly longer inpatient rehabilitation. The repeat fallers who were youngest and had the longest rehabilitation in-stay, achieved equal functioning as the non-fallers having faster motor gain and the greatest overall functional improvement compared to the other two subgroups. Right hemispheric stroke, previous myocardial infarction and shorter time from stroke onset were independent predictors for the number of incidents. In the future, larger studies are recommended to investigate fall rate and different severities of incidents, falls and near falls separately. [ABSTRACT FROM AUTHOR]

Background and Purpose: Falling among older adults is common and can cause chronic health complications. Fear of falling, a lasting concern about falling that can lead an individual to avoid activities he or she can perform, is strongly associated with falling and fall risk. Although White older adults fall more often, Black older adults have more fall risk factors. The purpose of this study was to investigate factors that explain fear of falling and differences between White and Black community-dwelling older adults in fear of falling, balance confidence, and fall risk factors. Methods: Using a cross-sectional, retrospective design, 84 community-dwelling older adults (mean age [SD] = 69.0 [5.2], range: 55-80; White, n = 37, 44%; Black, n = 47, 56%, M/F = 20/64) were assessed. Assessments were conducted in a laboratory for human studies. Fall history and risk factors, and subjective fear of falling, were collected. The Montreal Cognitive Assessment (MoCA), Activities-Specific Balance Confidence (ABC) score, preferred, backward, and fast Gait Speed, Short Form-12 Physical and Mental Component Scores, fear of falling rating scale, and demographics questionnaires were administered. Analyses included a proportional odds logistic regression model to examine which factors predicted ABC score and which factors were associated with subjective fear of falling, 1-way analysis of variance for continuous variables, the Fisher exact test for categorical variables, and the Mann-Whitney-Wilcoxon test for ordinal variables. Results: Black participants had significantly fewer years of education (P =.007), lower MoCA scores (P =.002), and slower fast gait speed (P =.032) than White participants. Black participants reported less subjective fear of falling (P =.043). In the final ABC model (Akaike information criterion 208.26), lower ABC scores were predicted by White race, slower preferred and fast gait speeds, and worse Short Form-12 Mental Composite Scores. Discussion: Despite Black participants demonstrating typical characteristics of higher fall risk including lower cognitive scores, slower gait speed, and lower ABC scores, Black participants reported fewer falls. Understanding racial differences is an important factor in fear of falling and balance confidence. Conclusion: Reasons for racial differences should be examined further in fear of falling and balance confidence to facilitate the development of patient-centered falls prevention physical therapy programs. [ABSTRACT FROM AUTHOR]

Background: Falls are the most prevalent adverse event among hospitalized patients. Multilevel risk factors are associated with falls, yet falls continue. Purpose: To evaluate the relationship between the Johns Hopkins Fall Risk instrument, patient characteristics, and perception of fall risk. Methods: The Johns Hopkins Fall Risk score, patient perception of fall risk, and patient characteristics were analyzed among inpatient adults (n = 201) from 5 acute care units in a large southern California medical center. Results: Bivariate analyses revealed that fall risk was inversely associated with participants' confidence in their ability to perform high fall risk behaviors without help and without falling (P =.018). Conclusions: Perception of fall risk is a promising new indicator in preventing falls. Patient perception of fall risk may elicit a behavior change to help prevent falls. Increased health care provider awareness of patient perception of fall risk may improve fall risk interventions and prevention programs. [ABSTRACT FROM AUTHOR]

Objective: This descriptive and correlational study was conducted to determine the prevalence of falls, fear of falling, and risk factors for falling in older adults living in nursing homes. Materials and Methods: The population of the study was composed of older adults living in a nursing home located in the Central Anatolian Region. No sampling calculation was made in the study. All the older adults living in the institution were intended to be reached. The data of the study were collected using introductory information form, fall behavioral scale for older people, standardized mini-mental state examination (MMSE), timed up and go test (TUG), and Tinetti Balance and Gait Assessment (TBGA). Results: The average age of the older adults included in the study was 77.5±8.8 and 44.2% of them were female. It was determined that the participants fell 1.9±1.08 times on average and 75.2% had the fear of falls. The changes in MMSE score accounted for 16.9% of the fear of falls and the number of falls in older adults (F=11.001; p<0.001; R2=0.169) and the changes in TBGA accounted for 15.8% of the fear of falls and the number of falls of the older adults (F=10.166; p<0.001; R2=0.158). Conclusion: It was determined that the fear of falls and the number of falls were high in the older adults living in the institution. It was concluded that TUG, TBGA and MMSE were significant determinants in explaining the correlation between the fear of falls and the number of falls. [ABSTRACT FROM AUTHOR]

Objective: To analyze the impact of educational intervention on hospitalized patients' perception about fall risk and their associated factors. Methods: This is quasi-experimental research with 157 patients hospitalized in a tertiary-level public institution in northern Ceará, Brazil. Data were collected before and after educational intervention mediated by a booklet on fall prevention. "Risk for falls" Nursing Diagnosis was identified, and the Falls Risk Awareness Questionnaire (FRAQ-Brazil) scale was applied. Data analysis occurred from McNemar's and Wilcoxon tests. Results: In pre-test, the groups were different regarding fall risk perception (p<0.000), in which the group with the least risk had a median of correct answers of 12 (interquartile range=9), while the group higher risk for falls had a median equal to 14 (interquartile range=8). However, in post-test, the groups become homogeneous regarding fall risk perception (p=0.676) with an increase in the median number of correct answers in both. Conclusion: The results found in this study indicate that the educational intervention performance mediated by the booklet is effective to promote improvement in hospitalized patients' fall risk perception. [ABSTRACT FROM AUTHOR]

The aging of the population and the significant health problem represented by falls in the elderly population, promotes a growth in the limitations of the activities of daily living (ADL) of this sector of the population. The development of the medical internet of things, wireless sensors and inertial measurement units (IMU) make it possible to directly and optimally sense patient data in their natural environment without invading their privacy. The purpose of this study is to verify if, through a threshold-based fall detection algorithm, it is possible to accurately distinguish between older people, falls, and the development of ADL, based on the analysis of the linear acceleration and angular velocity variables obtained of the UMI sensor. This information is used to calculate the magnitude of the vector sum (SVM) of the acceleration and angular velocity, as well as the pitch and roll angles. Based on this information, a pilot version of an experimental protocol for the detection of falls in healthy subjects was carried out at the Center of Medical Biophysics. The performance of the algorithm was evaluated by implementing it in the public database CGU-BES Dataset, obtaining a sensitivity of 91.6%, a specificity of 88.3% and an accuracy of 89.4%. [ABSTRACT FROM AUTHOR]

Falls due to stumbles are a major cause of injury for many populations, and as such interventions to reduce fall risk have been a key focus of rehabilitation research. However, dedicated stumble recovery assistance in a powered lowerlimb exoskeleton has yet to be explored as a fall mitigation intervention. Thus young, healthy adults (N ¼ 3) were recruited for a stumble recovery experiment to test the efficacy of knee exoskeleton stumble recovery assistance in improving an impaired stumble recovery response (i.e., the elevating strategy response). Leg weights were attached unilaterally to each participant’s shank to simulate walking and stumble recovery impairment, and a unilateral powered knee exoskeleton was worn on the same leg for walking and stumble recovery assistance. Ultimately, knee exoskeleton stumble recovery assistance served to improve participants’ elevating limb kinematics (i.e., increase thigh and knee motion) and reduce overall fall risk (i.e., reduce trunk motion and improve foot placement) during responses relative to their impaired response (i.e., with the leg weights and no assistance), and relative to their response while receiving only walking assistance. This initial exploration provides a first indication that knee exoskeleton stumble recovery assistance is a viable approach to improving an impaired stumble recovery response, which could serve two important use cases: (1) a safety mechanism for existing exoskeleton wearers, who may be less capable of recovering from stumbles due to the added weight or joint impedance of the device; (2) an external stumble recovery aid for fall-prone populations, such as the elderly or stroke survivors. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to adapt the Wilson‐Sims Fall Scale to Turkish and assess the levels of sensitivity and selectivity. Design and Methods: The scale consisting of two sections and 15 items including age, gender, mental and physical status, elimination, impairments, gait/balance, falls' history, medications, and detox protocol was administered to 750 patients in psychiatric clinic. Findings: The kappa coefficient of the study (K: 0.44, p <.000) showed a moderate agreement. The sensitivity and selectivity rates of the scale were 78.5% and 77.6%, respectively. Positive and negative predictive values were 6.25% and 99.4%. Practice Implications: The scale has acceptable sensitivity and selectivity values. It is best practice to use both Wilson‐Sims and Itaki Scale simultaneously for identification of patients at risk of falling. [ABSTRACT FROM AUTHOR]

With increased age, walking without tripping requires greater cognitive demand. Therefore, it may be beneficial for training interventions to address and incorporate aspects of cognitive load. The purpose of this study was to compare a semi-immersive virtual reality treadmill training (VRTT) and conventional treadmill training (CTT) on obstacle clearance and trip hazard in older adults. Obstacle clearance parameters were measured with foot-mounted inertial measurement units (IMUs) and a Zeno pressure walkway. All data were processed and analyzed through custom Matlab scripts. Obstacle step height mean decreased (p =.003) in the lead limb following both training interventions. Additional significant changes were found in pre- and post-obstacle distance mean following both training interventions. Furthermore, significant correlations were found between demographic, cognitive, and functional mobility assessments and changes in dependent measures. The findings suggest that both the VRTT and CTT interventions may provide a reduction in trip risk in older adults, although through different methods. [ABSTRACT FROM AUTHOR]

Introduction: gait-related falls account for most falls in the elderly. The identification of individuals at risk of falling due to unstable gait requires clinically feasible measures that can detect impairments in gait. Our obiective was to : (1) assess the feasibility for clinical implementation of existing gait stability measures and selected measures to detect gait impairments. Methods: Nine measures were assessed for clinical feasibility, with only the margin of stability(MOS) being selected for evaluation. Ground reactions and motion of the lower body were recorded in fifteen non-disabled and three disabled participants during treadmil walking. Media-lateral MOS was calculated and compared between the non-disabled and disabled participants to evaluate its ability to detect gait impairments. Results: MOS values at heel strike(HS) and at the point between HS and contralateral toe-off with minimum MOS deviated between participants with lower limb impaiments and non-disabled participants. Conclusion: MOS at HS demonstrated the greatest potential to assess fall risk. Additional work is required before MOS can be recommanded for clinical use. [ABSTRACT FROM AUTHOR]

Elderly patients frequently experience poor sleep quality. We aimed to determine its prevalence and risk factors in diabetic elderly patients from Turkey. An observational cross-sectional study of 220 diabetic elderly patients with a mean age of 70.4 ± 5.9 was conducted between June 2019 and December 2019. Pittsburgh Sleep Quality Index (PSQI) questionnaire was used. Patients were divided based on sleep quality into poor (PSQI> 5) and good (PSQI≤ 5) sleep quality groups. Geriatric Depression Scale, Beck Anxiety Inventory, and Hendrich II Fall Risk Model were adopted. The prevalence of poor sleep quality and risk factors were evaluated. Prevalence of poor sleep quality was 58.6%. Poor sleepers were significantly older, were more likely to be divorced, had more comorbidities, and used more medicines (ps<0.05). Longer duration of diabetes, higher incidence of hypoglycemic events, and diabetic complications were significantly associated with poor sleep quality (ps<0.05). Poor sleepers had higher levels of blood glucose and HbA1c levels (ps<0.05). PSQI was significantly correlated with age, HbA1c, duration of diabetes, higher depression, anxiety, and falling risk (ps<0.05). Severe depression, anxiety, and higher falling risk were independent risk factors. Most patients experienced poor sleep quality. It was associated with a longer duration of diabetes, chronic diabetes-related complications, and higher HbA1c levels. Severe depression, anxiety, and higher falling risk were risk factors for poor sleep quality. [ABSTRACT FROM AUTHOR]

Advances in the knowledge of acromegaly are leading to an increase in the survival rate of acromegalic subjects. This study was conducted to evaluate balance control, risk of falls, and peripheral muscle function in acromegalic older adults. Seventeen older subjects with acromegaly (67 [63–73] years) and 20 paired control subjects were evaluated with balance scales, force platform, and knee isokinetic dynamometry tests. There were significant differences between the groups on several balance and gait scales, with a worse performance and greater risk of falls in the acromegalic older adults. Acromegalic older adults had lower values for peak torque, maximum repetition of the total work, and total work during extension at 240°/s. The acromegalic older adults had higher values in the medial-lateral range. Acromegaly subjects had lateral instability that compromises their body balance and increases the risk of falls. Moreover, there was a propensity for muscle fatigue in these individuals. [ABSTRACT FROM AUTHOR]

This study aimed to determine the effects of a functional training and ankle stretching program in triceps surae torque, passive stiffness index, and in the risk for fall indicators in older adults. Twenty women (73.4 ± 7.3 years) were allocated into an intervention or control group. The 12-week intervention consisted of functional training and calf stretching exercises performed twice a week. Measurements of peak passive and active torque, passive stiffness, maximum dorsiflexion angle, and indexes of risk for falls (Timed Up and Go, functional reach test, QuickScreen-test) were collected. There were no significant differences for all variables, except the maximum dorsiflexion angle, which increased in the intervention group from 33.78 ± 8.57° to 38.89 ± 7.52°. The exercise program was not sufficient to enhance performance on functional tests and decrease the risk for falls in older adults. The significant increase in the maximum dorsiflexion indicates a positive impact of stretching exercises. [ABSTRACT FROM AUTHOR]

Falls occur in 33% of older adults each year, some leading to moderate to severe injuries. To reduce falls and fall-related injuries, it is important to identify individuals with subtle risk factors elevating their likelihood of falling. The objective of this study was to determine how postural sway measures differed between fallers and nonfallers under standard and dual-task conditions. Quiet-standing posturography measures were collected from 150 older adults during standard, cognitive, manual, and cognitive+manual tasks, and analyzed through traditional and nonlinear analyses. Of the traditional measures, M/L sway range and 95% confidence ellipse sway area showed statistically significant differences in all 4 test conditions between fallers and nonfallers. Although the manual dual task showed the most stable balance, effect sizes demonstrated larger differences between fallers and nonfallers. Nonlinear analysis revealed M/L sample entropy and M/L a-scaling exponent differentiating between fallers and nonfallers, with the cognitive task demonstrating larger differences. Based on the results, it is recommended to: (1) apply M/L sway range and 95% confidence ellipse area, (2) use the manual task to differentiate between fallers and nonfallers when using traditional analyses, and (3) use the cognitive task and M/L alpha and M/L sample entropy when using nonlinear analyses. [ABSTRACT FROM AUTHOR]

Introduction: Unintentional falls are a leading cause of injury-related hospital visits among Canadians, especially seniors. While certain meteorological conditions are suspected risk factors for fall-related injuries, few studies have quantified these associations across a wider range of age groups and with population-based datasets. Methods: We applied a time-stratified case-crossover study design to characterize associations of highly-spatially-resolved meteorological factors and emergency department (ED) visits for falls, in Ontario, among those aged 5 years and older during the winter months (November to March) between 2011 and 2015. Conditional logistic models were used to estimate the odds ratios (ORs) and their 95% confidence intervals (CIs) for these visits in relation to daily snowfall accumulation, including single-day lags of up to one week before the visit, and daily mean temperature on the day of the visit. Analyses were stratified by age and sex. Results: We identified 761 853 fall-related ED visits. The odds for these visits was increased for most days up to a week after a snowfall of 0.2 cm or greater (OR = 1.05-1.08) compared to days with no snowfall. This association was strongest among adults aged 30 to 64 years (OR = 1.16-1.19). The OR for fall-related ED visits on cold days (less than -9.4 °C) was reduced by 0.05 relative to days with an average daily temperature of 3.0 °C or higher (OR = 0.95; 95% CI: 0.94, 0.96), and this pattern was evident across all ages. There were no substantive differences in the strength of this association by sex. Conclusion: Snowfall and warmer winter temperatures were associated with an increased risk of fall-related ED visits during Ontario winters. These findings are relevant for developing falls prevention strategies and ensuring timely treatment. [ABSTRACT FROM AUTHOR]

Falls often have severe financial and environmental consequences, not only for those who fall, but also for their families and society at large. Identifying fall risk in older adults can be of great use in preventing or reducing falls and fall risk, and preventative measures that are then introduced can help reduce the incidence and severity of falls in older adults. The overall aim of our systematic review was to provide an analysis of existing mechanisms and measures for evaluating fall risk in older adults. The 43 included FRATs produced a total of 493 FRAT items which, when linked to the ICF, resulted in a total of 952 ICF codes. The ICF domain with the most used codes was body function, with 381 of the 952 codes used (40%), followed by activities and participation with 273 codes (28%), body structure with 238 codes (25%) and, lastly, environmental and personal factors with only 60 codes (7%). This review highlights the fact that current FRATs focus on the body, neglecting environmental and personal factors and, to a lesser extent, activities and participation. This over-reliance on the body as the point of failure in fall risk assessment clearly highlights the need for gathering qualitative data, such as from focus group discussions with older adults, to capture the perspectives and views of the older adults themselves about the factors that increase their risk of falling and comparing these perspectives to the data gathered from published FRATs as described in this review. [ABSTRACT FROM AUTHOR]

Purpose: Falls are a significant safety risk in hospitalized patients, but little evidence regarding their significance in obese children are available to date. Aim of the study was to determine whether the Pediatric Obesity Fall‐risk Scale (POFS) is able to discriminate between hospitalized obese pediatric patients at high or low risk of falling, to evaluate its sensitivity and specificity and to analyze if the risk factors considered were actually related to the falling event. Design and Methods: The sample consisted of 301 children and adolescents hospitalized for a body weight reduction program. In this 12‐month study, 14.6% of patients experienced a fall during hospitalization, the fall rate per 1000 patient days being 5.33 for the first and 4.36 for the second 6‐month of the year. The components of the POFS included chronological age, history of falls, body mass index standard deviation score (BMI‐SDS), and the ability to maintain equilibrium. Results: No differences were observed between fallers and nonfallers as far as BMI and BMI‐SDS are concerned. Compared with patients who did not fall, those who fell were significantly younger and shorter and their weights were lower. The POFS identified 85 patients with high and 216 with low falling risk, the two subgroups being comparable for BMI and BMI‐SDS. Compared with patients with low fall‐risk, those with high fall‐risk were significantly younger and shorter and their weights were lower. The sensitivity of the POFS was 61.4%, while the specificity was 77.4%. The positive predictive value of the POFS was 31.8%, while the negative predictive value was 92.1%. The analyses of each POFS component did not show significant differences between fallers and non‐fallers in terms of BMI‐SDS and equilibrium test. Compared with patients who did not fall, those who fell were significantly younger, experienced a fall during the 3 months prior the admission in hospital and their total POFS score was higher. Practice Implications: Preventing falls in hospitalized obese pediatric patients is challenging due to the markedly increased risk of this population and specific fall‐risk assessment tools are required to early identify patients who needs more care, attention, and specific nursing/medical interventions. [ABSTRACT FROM AUTHOR]

We investigated the relationship between physical activity and physical function on the risk of falls over time in a cohort of Mexican-American adults aged 75 and older from the Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE). Participants were divided into four groups according to their level of physical activity and physical function: low physical activity and low physical function (n = 453); low physical activity and high physical function (n = 54); high physical activity and low physical function (n = 307); and high physical activity and high physical function (n = 197). Using generalized linear equation estimation, we showed that participants with high physical activity and low physical function had a greater fall risk over time, followed by the high physical activity and high physical function group. Participants seldom took part in activities that improve physical function. To prevent falls, modifications to physical activity should be made for older Mexican Americans. [ABSTRACT FROM AUTHOR]

The goal of this study was to examine the effects of 3 factors and their interactions on posturography: a period of time to become accustomed to the force platform before the initiation of data collection, presence of a visual fixation point, and participant talking during testing. The postural stability of 30 young adults and 30 older adults was evaluated to determine whether any observed effects were confounded with age. Analysis of variance techniques were used to test all possible combinations of the 3 factors. We hypothesized that all 3 factors would significantly affect postural stability. For both participant groups, the results suggest that a period of time to become accustomed to the force platform before the initiation of data collection and a visual fixation point significantly affect postural control measures, while brief participant talking does not. Despite this, no significant interactions existed suggesting that the effects of these factors, which may occur in clinical testing, do not depend on each other. Our results suggest that inconsistencies in posturography testing methods have the potential to significantly affect the results of posturography, underscoring the importance of developing a standardized testing methodology. [ABSTRACT FROM AUTHOR]

Objective: To compare predictive validity of the Wilson Sims Fall Risk Assessment Tool (WSFRAT) with that of the Morse Fall Scale (MFS) in psychogeriatric inpatients. Methods: Psychogeriatric patients from Shatin Hospital, Tai Po Hospital, Castle Peak Hospital, and United Christian Hospital who had fall incident between April 2019 and April 2020 were identified. Their fall risks were assessed by the WSFRAT and the MFS, and their falls incidents during hospitalisation were recorded. Patients were classified as having high fall risk when their MFS score was ≥45 and when their WSFRAT score was ≥7. Sensitivity, specificity, and positive and negative predictive values of the two scales were calculated. Results: We identified 183 (90 male and 93 female) psychogeriatric patients aged ≥65 years who had fall incident and were assessed by both the WSFRAT and the MFS during the study period. Among the 183 patients, four sustained a fall during hospital stay, giving a prevalence of 2.19%. All four patients were classified as having high risk of fall by WSFRAT, but only two of them were classified so by MFS. The sensitivity of WSFRAT was 100%, which was higher than the 50% by MFS, but specificity of MFS was higher than that of WSFRAT (45.81% vs 54.75%). Conclusion: WSFRAT is a better fall risk assessment scale for psychiatric inpatients than MFS, because of higher sensitivity (100% vs 50%). It has items specific to psychiatric patients and should replace MFS in psychiatric settings. [ABSTRACT FROM AUTHOR]

Background: Food insecurity, as an indicator of socioeconomic disadvantages and a determinant of health, may be associated with injury by increasing risk exposure and hampering risk mitigation. We examined the association between food insecurity and common causes of injury in the general population.Methods: Linking the Canadian Community Health Survey 2005-2017 to National Ambulatory Care Reporting System 2003-2017, this retrospective cohort study estimated incidence of injury-related emergency department (ED) visits by food insecurity status among 212,300 individuals 12 years and above in the Canadian provinces of Ontario and Alberta, adjusting for prior ED visits, lifestyle, and sociodemographic characteristics including income.Results: Compared to those in food-secure households, individuals from moderately and severely food-insecure households had 1.16 (95% confidence interval [CI] 1.07-1.25) and 1.35 (95% CI 1.24-1.48) times higher incidence rate of ED visits due to injury, respectively, after confounders adjustment. The association was observed across sex and age groups. Severe food insecurity was associated with intentional injuries (adjusted rate ratio [aRR] 1.81; 95% CI 1.29-2.53) including self-harm (aRR 1.87; 95% CI 1.03-3.40) and violence (aRR 1.79; 95% CI 1.19-2.67) as well as non-intentional injuries (aRR 1.34; 95% CI 1.22-1.46) including fall (aRR 1.43; 95% CI 1.24-1.65), medical complication (aRR 1.39; 95% CI 1.06-1.82), being struck by objects (aRR 1.43; 95% CI 1.07-1.91), overexertion (aRR 1.31; 95% CI 1.04-1.66), animal bite or sting (aRR 1.60; 95% CI 1.08-2.36), skin piercing (aRR 1.80; 95% CI 1.21-2.66), and poisoning (aRR 1.65; 95% CI 1.05-2.59). Moderate food insecurity was associated with more injuries from violence (aRR 1.56; 95% CI 1.09-2.21), falls (aRR 1.22; 95% CI 1.08-1.37), being struck (aRR 1.20; 95% CI 1.01-1.43), and overexertion (aRR 1.25; 95% CI 1.04-1.50). Moderate and severe food insecurity were associated with falls on stairs and being struck in non-sports settings but not with falls on same level or being struck during sports. Food insecurity was not related to transport injuries.Conclusions: Health inequity by food insecurity status extends beyond diseases into differential risk of injury, warranting policy intervention. Researchers and policymakers need to address food insecurity as a social determinant of injury to improve health equity. [ABSTRACT FROM AUTHOR]

Background: Falls are a frequent health problem with potentially severe consequences among the elderly. Due to the aging HIV population, there is a growing interest in falls as a geriatric syndrome in HIV research and clinical practice. Previous studies found rather high prevalences of falls in this population and focused on biomedical and demographic risk factors for falls. Psychosocial risk factors like stigma, social support or loneliness were not previously assessed as correlates of fall events in this population.Methods: We assessed self-reported fall frequency in the past 12 months in a nationwide sample of 897 community-dwelling people aged 50 years or older living with HIV in Germany using a cross-sectional study design. We calculated odds of any fall for sociodemographic and HIV-related variables in bivariate analyses and for comorbidities, and psychosocial variables in bivariate and adjusted analyses.Results: Eighteen percent of our participants reported at least one fall in the preceding 12 months, 12 % reported recurring falls. A lower socioeconomic status, being single and living alone were significantly associated with a higher risk for falling. An AIDS diagnosis was related to fall risk, but time since diagnosis and a detectable viral load were not. Reporting at least one comorbidity increased fall risk in our sample 2.5 times (95% CI: 1.59; 3.97). The strongest association with fall risk was found for diseases of the central nervous system, heart disease, rheumatism, osteoporosis, and chronic pain. Experienced HIV stigma (AOR: 2.11; 95% CI: 1.58; 2.83) and internalized HIV stigma (AOR: 1.43; 95% CI: 1.12; 1.85), as well as social support (AOR: .92; 95% CI: .86; .99) and loneliness (AOR: 1.51; 95% CI: 1.22; 1.87) were significantly related to fall risk in bivariate and adjusted analyses.Conclusions: We found a low prevalence of falls in our sample of community-dwelling people aging with HIV. Our results show evidence for a strong association between comorbidity and falling, and between psychosocial factors and falling. Especially the strong association between experienced HIV stigma and fall risk is noteworthy and adds falls to the list of health outcomes affected by HIV stigma. [ABSTRACT FROM AUTHOR]

The main aim of the study was to assess the risk of falls, and physical fitness in the group of women aged 60 to 65 years of age suffering from an identified osteoporosis in comparison to a similar group of healthy women. The main question was: What is the level of physical fitness and risk of fall among women with osteoporosis compared to healthy women? The research included 262 women aged 60 to 65 of age: 135 with osteoporosis and 127 healthy ones, living in the Małopolskie and the Świętokrzyskie Provinces of Poland. To assess the level of physical fitness, the Senior Fitness Test (SFT) was used, while the Tinetti POMA (Performance Oriented Mobility Assessment) and Timed Up&Go test (TUG) were used to asses the risk of fall. Significant statistical differences in average results of physical fitness assessment were noticed as regards the following aspects: flexibility of the lower body part p < 0.001; flexibility of the upper body part p < 0.001. Essential differences were demonstrated in assessing the risk of falling with p < 0.01. Women with osteoporosis are marked by a lower physical fitness than healthy women. A higher percentage of great and serious risk of fall was demonstrated among women with osteoporosis. [ABSTRACT FROM AUTHOR]

Background: Higher age and cognitive impairment are associated with a higher risk of falling. Wearable sensor technology may be useful in objectively assessing motor fall risk factors to improve physical exercise interventions for fall prevention. This systematic review aims at providing an updated overview of the current research on wearable sensors for fall risk assessment in older adults with or without cognitive impairment. Therefore, we addressed two specific research questions: 1) Can wearable sensors provide accurate data on motor performance that may be used to assess risk of falling, e.g., by distinguishing between faller and non-faller in a sample of older adults with or without cognitive impairment?; and 2) Which practical recommendations can be given for the application of sensor-based fall risk assessment in individuals with CI? A systematic literature search (July 2019, update July 2020) was conducted using PubMed, Scopus and Web of Science databases. Community-based studies or studies conducted in a geriatric setting that examine fall risk factors in older adults (aged ≥60 years) with or without cognitive impairment were included. Predefined inclusion criteria yielded 16 cross-sectional, 10 prospective and 2 studies with a mixed design. Results: Overall, sensor-based data was mainly collected during walking tests in a lab setting. The main sensor location was the lower back to provide wearing comfort and avoid disturbance of participants. The most accurate fall risk classification model included data from sit-to-walk and walk-to-sit transitions collected over three days of daily life (mean accuracy = 88.0%). Nine out of 28 included studies revealed information about sensor use in older adults with possible cognitive impairment, but classification models performed slightly worse than those for older adults without cognitive impairment (mean accuracy = 79.0%). Conclusion: Fall risk assessment using wearable sensors is feasible in older adults regardless of their cognitive status. Accuracy may vary depending on sensor location, sensor attachment and type of assessment chosen for the recording of sensor data. More research on the use of sensors for objective fall risk assessment in older adults is needed, particularly in older adults with cognitive impairment. Trial registration: This systematic review is registered in PROSPERO (CRD42020171118). [ABSTRACT FROM AUTHOR]

Background Falls incidence increases with age alongside declines in strength and balance. Clinical trials show that the Falls Management Exercise (FaME) programme improves strength and balance, which can reduce falls and improve physical functioning. Objective To determine if the clinical trial efficacy of FaME translates into effectiveness in non-research settings. Design and setting An implementation study of FaME in 10 local authorities across the East Midlands region of England. Subjects Adults aged 65 and over enrolled on a FaME programme. Method Anonymised outcome data collected by the FaME providers were compared at baseline, end of programme and 6 months follow-up using univariate and multivariate analyses. Results For 348 adults enrolled in programmes and analysed, the mean age was 76.8, 73% were female and 143 (41%) completed ≥75% of classes. Overall confidence in balance, fear of falling, functional reach and timed-up-and-go (all P  < 0.001), and turn 180° (P  = 0.008) improved significantly at programme completion versus baseline, but improvements were not maintained 6 months later. Falls risk (FRAT score) and total minutes of physical activity did not change significantly though minutes of strength and balance activity increased by 55% at programme completion and was maintained at 6 months. The falls incidence rate ratio (IRR) was non-significantly lower at programme completion (IRR 0.76, 95% Confidence Interval (CI) 0.48,1.21) and follow-up (IRR 0.82 95% CI 0.48,1.39) versus baseline. Conclusions There is modest translation of FaME efficacy into effectiveness, but not all effects persist after completion. Strategies to aid adherence and exercise maintenance are important to maximise benefits. [ABSTRACT FROM AUTHOR]

Objective This study sought to answer the following questions: What are the reference values of sensorimotor performance for fall risk in community-dwelling adults? How do population norms compare with that of other populations? Are younger adults at risk of falls? Methods In a cross-sectional study design, sensorimotor functions and fall risk scores of community-dwelling adults were assessed and calculated to derive corresponding fall risk categories. Reference values were determined using the average scores by age group. A total of 542 community-dwelling adults were recruited (21–90 years old) across 10-year (21–60 years) and 5-year age groups (>60 years) to obtain a representative sample of community-dwelling adults in Singapore. Five physiological domains were assessed: vision, proprioception, muscle strength, reaction time, and postural balance according to the Physiological Profile Assessment (PPA). Fall risk scores and the corresponding fall risk profiles were generated from an online calculator. Results Sensorimotor performance and PPA fall risk scores were significantly worse for increasing age categories. Females had significantly slower reaction time, lower muscle strength, and higher fall risk. The representative sample of older adults (≥65 years) performed poorer in postural sway (z  = −0.50) and reaction time (z  = −0.55), but better in proprioception (z  = 0.29) and vision (z  = 0.23) compared with Caucasian norms. Among younger adults (21–59 years), 36.8% appeared to exhibit higher fall risk. Conclusion This study presents important reference data and compared sensorimotor functions and physiological fall risk across age groups of community-dwelling adults in a Southeast Asian population. Poor sensorimotor performance and fall risk appear already pertinent in younger adults. Further studies are warranted to improve understanding of fall risk among younger adults. Impact In physical therapist practice, PPA reference values can aid clinicians in the development of targeted interventions tailored towards an individual's physiological risk profile, addressing specific physiological systems that require particular attention. [ABSTRACT FROM AUTHOR]