This is our final issue for 2013 - Falls Prevention...

NSW Falls Network: A year in review 2

April Falls Day® 2014 3

New Resources and Conferences 4 New resources, websites and upcoming meetings.

Abstacts 5 Recent abstracts from the research literature.

Network Information 16 How to join and communicate through the network.

Inside this Issue

“Wishing you a peaceful joyful and restful Christmas and holiday break”

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FALLS LINKSVolume 8, Issue 6, 2013 Newsletter of the NSW Falls Prevention Network

This is our final issue for 2013

This issue features:

• NSW Falls Network: A year in review

• April Falls Day® 2014

• New Resources

• Recent Abstracts from the research literature

Welcome

“Falls Prevention is everyone’s business®”

Consumer organisations workshop participants: MD Habibullah (CPSA), Louise Bradley (Carers NSW), Esther Vance (NeuRA), Georgene McNeill (Alzheimer’s NSW), Diane Brooks (Older Women’s Network), Susan Horsley (NSW CAG - Mental Health Inc.), Anne Axam (Patient Based Directorate, CEC), Jenny Ly (Arthritis/Osteoporosis NSW), Ian Day (COTA NSW), Ingrid Hutchinson (CEC), Deb Radvan (Facilitator) and Lorraine Lovitt (CEC)

Falls Links Vol 8, Issue 6 , 2013 NSW Falls Prevention Network

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NSW Falls Prevention Network 2013: A year in Review

This year we celebrated 20 years of the NSW Falls Prevention Network. There were a number of highlights this year, including:

• Annual Falls Forum held in May 2013. This forum was attended by 350 professionals. The key focus of this years forum was on collaborative approaches to prevent falls. The Pam Albany Guest Lecture by Professor Lindy Clemson was on Avoiding program drift for positive falls outcomes- the Wisconsin experience. This presentation highlighted the importance of remaining faithful to a program by ensuring that the core components are delivered as intended by the program developers. Professor Clemson used the Stepping On program and the LiFE programs as examples and showed that the fidelity of a program needs to be monitored to ensure the program’s effectiveness.

• Three Rural Forums held in Dubbo, Broken Hill and Batemans Bay and attended by 81, 48 and 98 participants respectively. These forums were well received and participants indicated that they would like to be kept regularly informed on the evidence based research and the provision of practical information and strategies to implement falls prevention initiatives in their work area.

• Consumer organistion workshop in December for representatives from consumer organisations that advocate for or provide support and services to older people and/or their families and carers. These included Alzheimer’s NSW, Arthritis/Osteoporosis NSW, Carers NSW, Combined Pensioners and Superannuants Association, Council on the Ageing NSW, NSW Consumer Advisory Group - Mental Health Inc., Older Women’s Network and Stroke Recovery Association. This workshop provided an overview of falls injury prevention and the resources available and provided an opportunity for discussion of strategies to reach older people, carers and families more effectively on falls prevention.

• Supporting April Falls Day®/Month activities and the production of a special April Falls Links newsletter.

• Prof Marcia Ory presentation on Falls Prevention initiatives in the United States. Supporting the filming of this presentation which discussed the training and implementation of the Otago Exercise Program, Tai Chi, Stepping On and GP education program using the STEADi resource and distribution of 190 CDs.

• NEW: Updated Falls Network website to meet the Australian Government accessibility guidelines to ensure that those people who use assistive technologies for internet access are able to access all the information on this website. The umber of hits to the website have also increased with an average of 400 visits to the website from around 280 unique visitors per week.

• Falls Links newsletters - included articles on the role of Vitamin D in falls prevention, Care Home Falls Screen (CaHFRiS), CEC Falls Prevention Hospital Package and Falls, Dementia and unintended consequences as well as reports on forums and new resources and websites and abstracts from the research literature relevant to falls prevention.

• Discussions on the email list - included normal values for the modified falls efficacy scale, appropriate beds for the acute care setting, dedicated falls prevention and management positions and falls prevention and pharmacy education as well as information on relevant workshops and conferences and new resources.

Falls Network Advisory Group members and Falls Coordinators celebrating 20 years of the network at the Annual Forum

NSW Falls Prevention Network Falls Links Vol 8, Issue 6, 2013

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Medicate right to stay upright

A day for your Health Service to promote Falls Prevention messages to:

• Staff and Patients,

• Families and Carers,

• Community Services and

• General Community

The theme for April Falls Day® 2014 is Medicate right to stay upright: Medications and Falls

Prevention.

Older people are more susceptible to side effects from medications. These side effects can include

drowsiness, dizziness, poor balance, changes to eyesight and can result in a fall. Taking 4 or more

medications regardless of what they are increases a person’s falls risk.

Resources will be produced and available on the CEC website in early 2014. Promotional material

such as Sticky note pads, t-shirts, balloons, lens cloth and pens will be available to order through

Good Gear in early 2014. Information will be sent out via the NSW Falls Prevention Network listserv

in early 2014.

History of April Falls Day®

• April Falls Day® was initiated in the former Northern Sydney Central Coast Area Health

Service (NSCCAHS) to promote falls prevention best practice with staff, community service

providers and the general community.

• The Clinical Excellence Commission (CEC) has supported April Falls Day® since the 1st April

2008 and has arranged for the day/month to be gazetted in the NSW Health Calendar.

Further information and resources will be available in early 2014. If you would like to discuss April

Falls Day please contact Ingrid Hutchinson E: [email protected] or

Ph: 02-9269 5516.

Falls Prevention is everyone’s business®


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New Resources, Websites and Conferences

Report: Trends in fall-related hospitalisations, persons aged 65 years and over, 1998-99 to 2011-12

Understanding which falls and which populations are at risk of the significant consequences of falls is vital for the targeting resources in the future and evaluating the impact of fall prevention strategies.

This report describes the epidemiology of fall-related hospitalisations over a fourteen year period in NSW from 1998 to 2012 by four key indicators:

1) all fall-related hospitalisations,

2) injury hospitalisations,

3) fracture hospitalisations, and

4) non-fracture hospitalisations.

Trend across LHDs are reported to inform falls prevention plans and service planning at the local health district level.

The report can be accessed at:

http://www.neura.edu.au/research/projects/trends-fall-related-hospitalisations-persons-aged-65-years-and-over-nsw-1998-99-20

Closing the Gap ClearinghouseImproving the accessibility of health services in urban and regional settings for Indigenous people

Accessible health services are those that are physically available, affordable (economically accessible), appropriate and acceptable. Even though a wide range of health services exist in most urban and regional centres, they are not necessarily accessible. This paper draws on approximately 30 research studies as well as documented practice experience to explore how to improve accessibility of metropolitan, urban and regional health services for Indigenous Australians.

The report can be accessed at:

http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/ctgc-rs27.pdf

CONFERENCES

Australian and New Zealand Falls Prevention Society6th Biennial Australasian Falls Prevention Conference, Sydney , 16-18 November 2014

http://www.anzfallsprevention.org/conferences.html

Falls and Injury Prevention Group

Trends in fall-related hospitalisations, persons aged 65 years and over,

NSW, 1998-99 to 2011-12

clearinghouse Closing the gap

www.aihw.gov.au/closingthegap

Improving the accessibility of health services in urban and regional settings for Indigenous peopleResource sheet no. 27 produced for the Closing the Gap Clearinghouse

Vicki-Ann Ware

December 2013

Summary

What we know• Accessible health services are those that are physically available, affordable (economic accessibility),

appropriate and acceptable. Health services can be inaccessible if providers do not acknowledge and respect cultural factors, physical barriers and economic barriers, or if the community is not aware of available services.

• There are many strategies for successfully improving Indigenous access to urban and regional health services. Individual service providers need to consult with their local community to identify the specific issues relating to their context and selectively adapt the strategies outlined in this report.

What works

Few evaluations have been set up to specifically assess accessibility. Even so, a rich body of research and documented practice experience suggests that health services can effectively promote the four main facets of accessibility.








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ReviewsSustainability of community-based fall prevention programs: A systematic review

Lovarini M, Clemson L, Dean C.

J. Saf. Res. 2013; 47: 9-17.

Affiliation: Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, NSW 2141, Australia. Electronic address: [email protected].

(Copyright © 2013, U.S. National Safety Council, Publisher Elsevier Publishing)

Abstract

BACKGROUND: Fall prevention programs may be implemented but not sustained. We conducted a systematic review to identify any theories, models, frameworks, influencing factors or interventions for sustaining fall prevention programs in the community.

METHODS: Peer-reviewed publications describing, investigating, or evaluating program sustainability were accessed. A narrative review was conducted to compare and synthesize study findings.

RESULTS: Nineteen publications were included. Three conceptual frameworks were identified describing how programs may be better sustained. While ongoing financial support and the participation of older people were commonly reported influences, other factors specific to the type of program and setting were also reported. Planning, training, and collaboration between program stakeholders may facilitate sustainable programs.

IMPACT ON INDUSTRY: Organizations can use these findings when planning for sustainable programs. However more robust empirical studies are needed to confirm the value of conceptual frameworks, the critical factors and most effective interventions for sustaining community-based fall prevention programs.

Fall detection with body-worn sensors : A systematic review

Schwickert L, Becker C, Lindemann U, Maréchal C, Bourke A, Chiari L, Helbostad JL, Zijlstra W, Aminian K, Todd C, Bandinelli S, Klenk J.

Z. Gerontol. 2013; 46(8): 706-719.

Affiliation: Department of Clinical Gerontology, Robert-Bosch Hospital, Stuttgart, Germany.

(Copyright © 2013, Springer Science+Business Media)

Abstract

BACKGROUND AND AIMS: Falls among older people remain a major public health challenge. Body-worn sensors are needed to improve the understanding of the underlying mechanisms and kinematics of falls. The aim of this systematic review is to assemble, extract and critically discuss the information available in published studies, as well as the characteristics of these investigations (fall documentation and technical characteristics).

METHODS: The searching of publically accessible electronic literature databases for articles on fall detection with body-worn sensors identified a collection of 96 records (33 journal articles, 60 conference proceedings and 3 project reports) published between 1998 and 2012. These publications were analysed by two independent expert reviewers. Information was extracted into a custom-built data form and processed using SPSS (SPSS Inc., Chicago, IL, USA).

RESULTS: The main findings were the lack of agreement between the methodology and documentation protocols (study, fall reporting and technical characteristics) used in the studies, as well as a substantial lack of real-world fall recordings. A methodological pitfall identified in most articles was the lack of an established fall definition. The types of sensors and their technical specifications varied considerably between studies.

CONCLUSION: Limited methodological agreement between sensor-based fall detection studies using body-worn sensors was identified. Published evidence-based support for commercially available fall detection devices is still lacking. A worldwide research group consensus is needed to address fundamental issues such as incident verification, the establishment of guidelines for fall reporting and the development of a common fall definition.

AbstractsRecent abstracts from the research literature


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Physical exercise interventions for improving performance-based measures of physical function in community-dwelling frail older adults: A systematic review and meta-analysis

Giné-Garriga M, Roqué-Fíguls M, Coll-Planas L, Sitja-Rabert M, Salvà A.

Arch. Phys. Med. Rehabil. 2013; ePub(ePub): ePub.

Affiliation: Department of Physical Activity and Sport Sciences, FPCEE Blanquerna. UniversitatRamonLlull, Barcelona, Spain; Department of Physical Therapy, FCS Blanquerna. UniversitatRamonLlull, Barcelona, Spain. Electronic address: [email protected].

(Copyright © 2013, Elsevier Publishing)

Abstract

OBJECTIVE: To conduct a systematic review to determine the efficacy of exercise-based interventions on improving performance-based measures of physical function and markers of physical frailty, in community-dwelling frail older people.

DATA SOURCES: Comprehensive bibliographic searches in Medline, The Cochrane Library, PEDro, and CINAHL databases were conducted (April 2013).

STUDY SELECTION: Randomized clinical trials of community-dwelling older adults, defined as frail according to physical function and physical difficulties in basic activities of daily living (ADL). Included trials had to compare an exercise intervention to a control or another exercise intervention, and assess performance-based measures of physical function such as mobility and gait, or disability in ADL.

DATA EXTRACTION: Two review authors independently screened the search results and performed data extraction and risk of bias assessment. Nineteen trials were included, twelve of them comparing exercise to an inactive control. Most exercise programs were multicomponent.

DATA SYNTHESIS: Meta-analysis was performed for the comparison of exercise versus control with the inverse variance method under the random effects models. When compared to control interventions, exercise has shown to improve normal gait speed (mean difference (MD) 0.07 m/sec, 95%CI 0.04 to 0.09), fast gait speed (MD 0.08 m/sec, 95%CI 0.02 to 0.14), and the Short Physical Performance Battery (MD 2.18, 95%CI 1.56 to 2.80). Results are inconclusive for endurance outcomes, and no consistent effect was observed on balance and the ADL functional mobility. The evidence comparing different modalities of exercise is scarce and heterogeneous.

CONCLUSIONS: Exercise has some benefits in frail older people, although uncertainty still exists with regards to which exercise characteristics (type, frequency, duration) are most effective.

Interventions to reduce the number of falls among older adults with/without cognitive impairment: An exploratory meta-analysis

Guo JL, Tsai YY, Liao JY, Tu HM, Huang CM.

Int. J. Geriatr. Psychiatry 2013; ePub(ePub): ePub.

Affiliation:Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan.

(Copyright © 2013, John Wiley and Sons)

Abstract

OBJECTIVE: This exploratory meta-analysis aimed to examine and compare the effective interventions to prevent falls among institutionalized/non-institutionalized older adults without cognitive impairment with interventions to prevent falls for older adults with cognitive impairment.

DESIGN: A database search identified 111 trials published between January 1992 and August 2012 that evaluated fall-prevention interventions among institutionalized/non-institutionalized older adults with and without cognitive impairment as measured by valid cognition scales.

RESULTS: Exercise alone intervention was similar effective on reducing the numbers of falls among older adults without cognitive impairment regardless of setting (non-institutionalized: OR = 0.783, 95% confidence interval (CI) = 0.656-0.936; p = 0.007 institutionalized: OR = 0.799, 95% CI = 0.646-0.988, p = 0.038). Vitamin D/calcium supplementation had a positive effect on the reduction of numbers of falls among non-institutionalized


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older adults without cognitive impairment (OR = 0.789, 95% CI = 0.631-0.985, p = 0.036), as did home visits and environment modification (OR = 0.751, 95% CI = 0.565-0.998, p = 0.048). Exercise alone, exercise-related multiple interventions, and multifactorial interventions were associated with positive outcomes among both institutionalized and non-institutionalized older adults with cognitive impairment, but studies are limited.

CONCLUSIONS: Single exercise interventions can significantly reduce numbers of falls among older adults with and without cognitive impairment in institutional or non-institutional settings. Vitamin D and calcium supplementation, home visits, and environment modification can reduce the risk of falls among older adults in non-institutional settings. Exercise-related multiple interventions and multifactorial interventions may only be effective for preventing falls in older adults with cognitive impairment.

EpidemiologyIn-hospital mortality and unintentional falls among older adults in the United States

Moudouni DKMM, Phillips CD.

J. Appl. Gerontol. 2013; 32(8): 923-935.

(Copyright © 2013, Sage Publications)

Abstract

PURPOSE OF THE STUDY: To estimate the odds of death associated with documented unintentional falls and acute care hospitalization among older adults in the United States.

DESIGN AND METHOD: Data were abstracted from the 2005 Nationwide Inpatient Sample (NIS) and odds of death were modeled using logistic regression.

RESULTS: The age 65 and older fall rate per 1,000 discharges was 53.0 while the mortality rate for those who fell was 33.2. Older-old (odds ration [OR] = 2.93; confidence interval [CI] = [2.50, 3.43]), men (OR = 1.64, CI = [1.54, 1.75]), and non-White (OR = 1.09; CI = [1.01, 1.19]) had higher odds of death compared to younger-old, women, and Whites. Additional comorbidity (OR = 3.41, CI = [3.05, 3.82]), dehydration (OR = 1.14; CI = [1.05, 1.25]) and intracranial fractures (OR = 4.46; CI = [4.02, 4.95]) resulted in greater odds of death.

IMPLICATIONS: Among older adults who experienced a fall and hospitalization, odds of mortality appear influenced by factors beyond injury severity related to falling. Additional research is necessary to delineate the mechanisms behind these phenomena to inform the public about falls-prevention programs.

Causes and consequences of falls in Parkinson disease patients in a prospective study

Rudzińska M, Bukowczan S, Stożek J, Zajdel K, Mirek E, Chwała W, Wójcik-Pędziwiatr M, Banaszkiewicz K, Szczudlik A.

Neurol. Neurochir. Pol. 2013; 47(5): 423-430.

Affiliation: dr n. med. Magdalena Wójcik-Pędziwiatr, Department of Neurology, Jagiellonian University Medical College, 3 Botaniczna St, 31-503 Krakow, Poland, e-mail: [email protected].

(Copyright © 2013, Termedia Publishing House)

Abstract

BACKGROUND AND PURPOSE: Falls are common events in Parkinson disease (PD) but only a few prospective studies have focused on causes and consequences of falls in PD patients. The aim of the study was prospective analysis of direct causes and consequences of falls in PD patients in comparison to the control group.

MATERIAL AND METHODS: One hundred PD patients and 55 age-matched controls were enrolled in the study. The diagnostic workup in all patients included neurological examination, Unified Parkinson’s Disease Rating Scale, magnetic resonance imaging, electroencephalography, ultrasonography, otolaryngological, ophthalmological and autonomic function examination. During 12 months of follow-up, falls were registered in both groups, direct causes were classified according to the St. Louis and Olanow classification, and consequences were established.

RESULTS: Falls occurred in 54% of PD patients and in 18% of control subjects. Analysis of direct causes of falls revealed that sudden falls were the most common (31%), followed by episodes of freezing and festination (19.6%), neurological and sensory disturbances (mostly vertigo) (12%), environmental factors (12%), postural instability (11%), orthostatic hypotension (4%), and severe dyskinesia (3.6%); 6.19% of falls were unclassified; 22% of

Abstracts ContinuedRecent abstracts from the research literature


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patients had the same etiology of subsequent falls. In PD patients, intrinsic factors were dominant, whereas in the control group intrinsic and extrinsic factors occurred with the same frequency. Every third fall intensified fear of walking. 34% of falls caused injuries; among them bruises of body parts other than the head were most frequent.

CONCLUSIONS: Intrinsic factors are the most common causes of falls in PD. Every third fall intensifies fear of walking and causes injuries.

SexdifferencesincircumstancesandconsequencesofoutdoorandindoorfallsinolderadultsinMOBILIZEBoston cohort study

Duckham RL, Procter-Gray E, Hannan MT, Leveille SG, Lipsitz LA, Li W.

BMC Geriatr. 2013; 13(1): 133.

(Copyright © 2013, BioMed Central)

Abstract

BACKGROUND: Despite extensive research on risk factors associated with falling in older adults, and current fall prevention interventions focusing on modifiable risk factors, there is a lack of detailed accounts of sex differences in risk factors, circumstances and consequences of falls in the literature. We examined the circumstances, consequences and resulting injuries of indoor and outdoor falls according to sex in a population study of older adults.

METHODS: Men and women 65 years and older (N = 743) were followed for fall events from the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston prospective cohort study. Baseline measurements were collected by comprehensive clinical assessments, home visits and questionnaires. During the follow-up (median = 2.9 years), participants recorded daily fall occurrences on a monthly calendar, and fall circumstances were determined by a telephone interview. Falls were categorized by activity and place of falling. Circumstance-specific annualized fall rates were calculated and compared between men and women using negative binomial regression models.

RESULTS: Women had lower rates of outdoor falls overall (Crude Rate Ratio (RR): 0.72, 95% Confidence Interval (CI): 0.56-0.92), in locations of recreation (RR: 0.34, 95% CI: 0.17-0.70), during vigorous activity (RR: 0.38, 95% CI: 0.18-0.81) and on snowy or icy surfaces (RR: 0.55, 95% CI: 0.36-0.86) compared to men. Women and men did not differ significantly in their rates of falls outdoors on sidewalks, streets, and curbs, and during walking. Compared to men, women had greater fall rates in the kitchen (RR: 1.88, 95% CI: 1.04-3.40) and while performing household activities (RR: 3.68, 95% CI: 1.50-8.98). The injurious outdoor fall rates were equivalent in both sexes. Women’s overall rate of injurious indoor falls was nearly twice that of men’s (RR: 1.98, 95% CI: 1.44-2.72), especially in the kitchen (RR: 6.83, 95% CI: 2.05-22.79), their own home (RR: 1.84, 95% CI: 1.30-2.59) and another residential home (RR: 4.65, 95% CI: 1.05-20.66) or other buildings (RR: 2.29, 95% CI: 1.18-4.44).

CONCLUSIONS: Significant sex differences exist in the circumstances and injury potential when older adults fall indoors and outdoors, highlighting a need for focused prevention strategies for men and women.

The relationship between increased body mass index and frailty on falls in community dwelling older adults

Sheehan KJ, O Connell MD, Cunningham C, Crosby L, Kenny RA.

BMC Geriatr. 2013; 13(1): 132.

(Copyright © 2013, BioMed Central)

Abstract

BACKGROUND: The global population is becoming older and more overweight. The inter-relationship between frailty and falls is often seen in the older adult and is associated with poor health outcomes. Little is known about this relationship for those with excess body mass. This study aimed to assess the relationships between BMI, frailty and falls.

METHODS: Frailty, body mass index, clinical and demographic characteristics were assessed at baseline for 606 community dwelling adults aged 60 years and older. Falls were assessed prospectively with a semi-structured telephone interview two years later.


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RESULTS: An increase in BMI contributed significantly to the identification of frail (Odds Ratio: 4.4; 95% Confidence Interval: 1.4, 13.6) older adults. A total of 346 falls by 148 participants were reported at follow up. Those with an increased BMI were significantly less likely to have experienced a fall between baseline and follow up assessments (p = 0.03). Despite these opposing trends a BMI greater than or equal to 30.0 kg.m2 did not alter the relationship between falls and frailty for the current cohort.

CONCLUSIONS: This is the first study to assess the falls-frailty relationship for those with an increased BMI. Obesity was found to be protective against falling but not specifically in frail older adults.

Risk FactorsThe relative contribution of physical and cognitive fall risk factors in people with Parkinson’s disease: A large prospective cohort study

Paul SS, Sherrington C, Canning CG, Fung VS, Close JC, Lord SR.

Neurorehabil. Neural Repair 2013; ePub(ePub): ePub.

Affiliation: 1The University of Sydney, Sydney, New South Wales, Australia.

(Copyright © 2013, American Society of Neurorehabilitation, Publisher Sage Publications)

Abstract

BACKGROUND: In order to develop multifaceted fall prevention strategies for people with Parkinson’s disease (PD), greater understanding of the impact of physical and cognitive performance on falls is required.

OBJECTIVE: We aimed to identify the relative contribution of a comprehensive range of physical and cognitive risk factors to prospectively-measured falls in a large sample of people with PD and develop an explanatory multivariate fall risk model in this group.

METHODS:. MEASURES: of PD signs and symptoms, freezing of gait, balance, mobility, proprioception, leg muscle strength, and cognition were collected on 205 community-dwelling people with PD. Falls were monitored prospectively for 6 months using falls diaries.

RESULTS:. A total of 120 participants (59%) fell during follow-up. Freezing of gait (P < .001), dyskinesia (P = .02), impaired anticipatory and reactive balance (P < .001), impaired cognition (P = .002), reduced leg muscle strength (P = .006), and reduced proprioception (P = .04) were significantly associated with future falls in univariate analyses. Freezing of gait (risk ratio [RR] = 1.03, 95% confidence interval [CI] = 1.00-1.05, P = .02), impaired anticipatory (RR = 1.01, 95% CI = 1.00-1.02, P = .03) and reactive (RR = 1.26, 95% CI = 1.01-1.58, P = .04) balance, and impaired orientation (RR = 1.28, 95% CI = 1.01-1.62, P = .04) maintained significant associations with falls in multivariate analysis.

CONCLUSION: The study findings elucidate important physical and cognitive determinants of falls in people with PD and may assist in developing efficacious fall prevention strategies for this high-risk group.

Declining cognition and falls: Role of risky performance of everyday mobility activities

Fischer BL, Gleason CE, Gangnon RE, Janczewski J, Shea T, Mahoney JE.

Phys. Ther. 2013; ePub(ePub): ePub.

Affiliation: B.L. Fischer, PsyD, Geriatric Research, Education, and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terr, Madison, WI 53705 (USA).

(Copyright © 2013, American Physical Therapy Association)

Abstract

BACKGROUND: Declining cognition is a risk factor for falls among older adults. The extent to which impaired judgment in performance of daily activities increases falls risk is unclear.

OBJECTIVE: To determine if engagement in mobility activities in a risky manner explains the association between declining cognition and rate of falls. DESIGN: Secondary analysis of baseline and prospective data from subjects enrolled in the intervention arm of a randomized clinical trial. METHODS: Two hundred forty five community-dwelling older adults (79% female, mean age 79, SD 8.0) at-risk for falls received physical, cognitive, and



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functional evaluations. Cognition was assessed with the Short Portable Mental Status Questionnaire (SPMSQ). Using interview and in-home assessment data, physical therapists determined whether participants were at-risk when performing mobility-related Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs). Falls were measured prospectively for one year using monthly falls diaries.

RESULTS: Declining cognition was associated with increased number of mobility activities designated as risky (1.5% of mobility activities performed in a risky manner per SPMSQ point) and with increased rate of falls (rate ratio 1.16 for each unit change in SPMSQ score. Risky performance of mobility activities mediated the relationship between cognition and rate of falls. LIMITATIONS: Risk assessment was based on clinical judgment of experienced physical therapists. Cognition was measured with a relatively insensitive instrument, and only selected mobility activities were evaluated.

CONCLUSIONS: Engagement in mobility ADL’s/IADL’s in a risky manner emerged as a link between declining cognition and increased number of falls, suggesting a mechanism through which rate of falls may increase. Specifically, declining cognition is associated with performance of mobility activities in an unsafe manner, thereby increasing risk for falls.

The incidence and risk factors of falls in Parkinson disease: Prospective study

Rudzińska M, Bukowczan S, Stożek J, Zajdel K, Mirek E, Chwała W, Wójcik-Pędziwiatr M, Banaszkiewicz K, Szczudlik A.

Neurol. Neurochir. Pol. 2013; 47(5): 431-437.

Affiliation: dr n. med. Magdalena Wójcik-Pędziwiatr, Department of Neurology, Jagiellonian University Medical College, 3 Botaniczna St, 31-503 Krakow, Poland, e-mail: [email protected].

(Copyright © 2013, Termedia Publishing House)

Abstract

BACKGROUND AND PURPOSE: Although Parkinson disease (PD) patients suffer falls more frequently than other old people, only a few studies have focused on identifying the specific risk factors for falls in PD patients. The aim of this study was to assess the incidence and risk factors of falls in a prospective study in comparison to a control group.

MATERIAL AND METHODS: One hundred patients with PD were recruited to the study along with 55 gender- and age-matched healthy controls. Both groups were examined twice; the second examination took place one year after the first one. Examination of the PD group included: medical history including falls, neurological examination, assessment of the severity of parkinsonism [Unified Parkinson’s Disease Rating Scale (UPDRS), Schwab and England scale (S and E), Hoehn and Yahr scale (H and Y), Mini-Mental State Examination (MMSE)], Hamilton scale and quality of life scales (SF-36, EQ-5D) and Freezing of Gait Questionnaire (FOG-Q). In both groups falls were recorded over the 12 months. Frequent fallers are defined as having more than 3 falls a year.

RESULTS: Over the year falls occurred in 54% of PD patients and 18% of controls. In a prospective study 28% of PD patients fell more frequently than in retrospective analysis. Frequent fallers were found in 20% of patients and in 7% of controls. Fallers showed higher scores in UPDRS, H and Y, S and E, MMSE, and Hamilton scale than non-fallers. Independent risk factors for falls were: age, previously reported falls and higher score in the FOG-Q.

CONCLUSIONS: Falls in PD patients occurred three times more frequently than in controls. Independent risk factors for falls were: high score in FOG-Q, older age and presence of falls in medical history.

The relationship between orthostatic hypotension and falling in older adults

Shaw BH, Claydon VE.

Clin. Auton. Res. 2013; ePub(ePub): ePub.

Affiliation: Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.

(Copyright © 2013, Springer Science+Business Media)

Abstract

Falls are devastating events and are the largest contributor towards injury-related hospitalization of older adults. Orthostatic hypotension (OH) represents an intrinsic risk factor for falls in older adults. OH refers to a significant


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decrease in blood pressure upon assuming an upright posture. Declines in blood pressure can reduce cerebral perfusion; this can impair consciousness, lead to dizziness, and increase the likelihood of a fall. Although theoretical mechanisms linking OH and falls exist, the magnitude of the association remains poorly characterized, possibly because of methodological differences between previous studies. The use of non-invasive beat-to-beat blood pressure monitoring has altered the way in which OH is now defined, and represents a substantial improvement for detecting OH that was previously unavailable in many studies. Additionally, there is a lack of consistency and standardization of orthostatic assessments and analysis techniques for interpreting blood pressure data. This review explores the previous literature examining the relationship between OH and falls. We highlight the impact of broadening the timing, degree, and overall duration of blood pressure measurements on the detection of OH. We discuss the types of orthostatic stress assessments currently used to evaluate OH and the various techniques capable of measuring these often transient blood pressure changes. Overall, we identify future solutions that may better clarify the relationship between OH and falling risk in order to gain a more precise understanding of potential mechanisms for falls in older adults.

Fear of FallingRelationship among fear of falling, physical performance, and physical characteristics of the rural elderly

Park JH, Cho H, Shin JH, Kim T, Park SB, Choi BY, Kim MJ.

Am. J. Phys. Med. Rehabil. 2013; ePub(ePub): ePub.

Affiliation: From the Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea (JHP); and Department of Rehabilitation Medicine (HC, J-HS, TK, S-BP, MJK) and Department of Preventive Medicine (B-YC), Hanyang University College of Medicine, Seoul, South Korea.

(Copyright © 2013, Lippincott Williams and Wilkins)

Abstract

OBJECTIVE: The aim of this study was to evaluate the relationship between the fear of falling, physical performance, and physical characteristics in an elderly population.

DESIGN: This study is a cross-sectional study with 883 community dwellers 60 yrs or older from a rural area. They completed surveys and evaluations including demographics, the Korean version of the Falls Efficacy Scale-International, the Short Physical Performance Battery, the timed up and go (TUG) test, grip strength, and bone mineral density.

RESULTS: The subjects who had experienced a fall showed lower physical performance than those who had not experienced a fall. Regardless of a previous experience of a fall, the score on the Korean version of the Falls Efficacy Scale-International had a positive correlation with TUG time and negative correlations with the score on the Short Physical Performance Battery, grip strength, and bone mineral density. Compared with the group without the fear of falling, the group with the fear of falling showed a lower score on the Short Physical Performance Battery, longer TUG time, weaker grip strength, and lower bone mineral density. The subjects with osteoporosis showed significantly higher scores on the Korean version of the Falls Efficacy Scale-International.

CONCLUSIONS: The experience of falls had a significant relationship with the fear of falling and physical performance, and greater fear of falling was related to poorer physical performance, independent of the experience of falls. This result implies that more attention should be paid to seniors with the fear of falling and the experience of falls, and screening and consequent intervention for fall prevention should be warranted in this population. For this purpose, the TUG test may be recommended as a screening tool because TUG time reflects the fear of falling and the experience of falls as well as physical performance.

Fear of falling after hip fracture in vulnerable older persons rehabilitating in a skilled nursing facility

Visschedijk JH, Caljouw MA, van Balen R, Hertogh CM, Achterberg WP.

J. Rehabil. Med. 2013; ePub(ePub): ePub.

Affiliation: Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2300 RC Leiden, The Netherlands. [email protected], [email protected].

(Copyright © 2013, Foundation for Rehabilitation Information)



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Abstract

OBJECTIVE: To identify factors that explain differences in patients with high and low levels of fear of falling after a hip fracture. Design: Cross-sectional study in 10 skilled nursing facilities in the Netherlands. Patients: A total of 100 patients aged ≥ 65 years admitted to a skilled nursing facility after a hip fracture.

METHODS: Participants were divided into 2 groups; low and high level of fear of falling, based on median Falls Efficacy Score - International. Data relating to factors that might explain fear of falling were collected, including demographic variables, aspects of functioning, psychological factors, and comorbidities. For every factor a univariate logistic regression was conducted. For the multivariate regression model a backward procedure was used in which variables with p < 0.05 were included. RESULTS: Walking ability and activities of daily living before fracture, number of complications, activities of daily living after fracture, anxiety and self-efficacy were significantly associated univariately with fear of falling. Multivariate analysis showed that walking ability before fracture (odds ratio (OR) 0.34, 95% confidence interval (CI) 0.14-0.83), activities of daily living after fracture (OR 0.89, 95% CI 0.80-0.99), and anxiety (OR 1.22, 95% CI 1.05-1.42) were independently associated with fear of falling.

CONCLUSION: Impaired walking ability before fracture, impaired activities of daily living after fracture, and increased anxiety help distinguish between older persons with high and low levels of fear of falling after hip fracture. Because the last 2 factors are modifiable, this information enables the development of specific interventions for older persons with a high level of fear of falling.

Fear of falling is prevalent in older adults with diabetes mellitus but is unrelated to level of neuropathy

Kelly C, Fleischer A, Yalla S, Grewal GS, Albright R, Berns D, Crews R, Najafi B.

J. Am. Podiatr. Med. Assoc. 2013; 103(6): 480-488.

Affiliation: Advocate Illinois Masonic Medical Center, Chicago, IL.

(Copyright © 2013, American Podiatric Medical Association)

Abstract

BACKGROUND: Patients with diabetic peripheral neuropathy (DPN) demonstrate gait alterations compared with their nonneuropathic counterparts, which may place them at increased risk for falling. However, it is uncertain whether patients with DPN also have a greater fear of falling.

METHODS: A voluntary group of older adults with diabetes was asked to complete a validated fear of falling questionnaire (Falls Efficacy Scale International [FES-I]) and instructed to walk 20 m in their habitual shoes at their habitual speed. Spatiotemporal parameters of gait (eg, stride velocity and gait speed variability) were collected using a validated body-worn sensor technology. Balance during walking was also assessed using sacral motion in the mediolateral and anteroposterior directions. The level of DPN was quantified using vibration perception threshold from the great toe.

RESULTS: Thirty-four diabetic patients (mean ± SD: age, 67.6 ± 9.2 years; body mass index, 30.9 ± 5.7; hemoglobin A1c, 7.9% ± 2.3%) with varying levels of neuropathy (mean ± SD vibration perception threshold, 34.6 ± 22.9 V) were recruited. Most participants (28 of 34, 82%) demonstrated moderate to high concern about falling based on their FES-I score. Age (r = 0.6), hemoglobin A1c level (r = 0.39), number of steps required to reach steady-state walking (ie, gait initiation) (r = 0.4), and duration of double support (r = 0.44) were each positively correlated with neuropathy severity (P < .05). Participants with a greater fear of falling also walked with slower stride velocities and shorter stride lengths (r = -0.3 for both, P < .05). However, no correlation was observed between level of DPN and the participant’s actual concern about falling.

CONCLUSIONS: Fear of falling is prevalent in older adults with diabetes mellitus but is unrelated to level of neuropathy.

InterventionsImplementing an evidence-based fall prevention program in an outpatient clinical setting

Li F, Harmer P, Stock R, Fitzgerald K, Stevens J, Gladieux M, Chou LS, Carp K, Voit J.

J. Am. Geriatr. Soc. 2013; ePub(ePub): ePub.


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Affiliation: Oregon Research Institute, Eugene, Oregon.


Abstract

OBJECTIVES: To investigate the dissemination potential of a Tai Ji Quan-based program, previously shown to be efficacious for reducing risk of falls in older adults, through outpatient clinical settings. DESIGN: A single-group pre/post design in which participants attended a twice-weekly Tai Ji Quan training program for 24 weeks.

SETTING: Communities in Lane County, Oregon.

PARTICIPANTS: Independently living individuals (N = 379) aged 65 and older.

MEASUREMENTS: Using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, the primary outcome was the proportion of participating healthcare providers who made referrals. Secondary outcomes were the proportion of referred individuals agreeing to participate and enrolling in the program, and measures of program implementation, maintenance, and effectiveness (on measures of falls, balance, gait, physical performance, and balance efficacy). RESULTS: Of the 252 providers invited to participate, 157 made referrals (62% adoption rate). Of 564 individuals referred, 379 (67% reach) enrolled in the program, which was successfully implemented in senior and community centers with good fidelity, 283 completed the program (75% retention), and 212 of these attended 75% or more of the 48 sessions. Participants reported a reduction in falls, with an incidence rate of 0.13 falls per person-month, and showed significant improvement from baseline in all outcome measures. A 3-month postintervention follow-up indicated encouraging levels of program maintenance among providers, participants, and community centers.

CONCLUSION: Healthcare providers successfully implemented a protocol to refer individuals at risk of falling to a Tai Ji Quan-based program. The evidence-based program appears readily scalable and exportable, with potential for substantial clinical and public health effect.

Anexerciseprogramtopreventfallsininstitutionalizedelderlywithcognitivedeficits:Acrossoverpilotstudy

Desure AR, Peterson K, Gianan FV, Pang L.

Hawaii J. Med. Public Health 2013; 72(11): 391-395.

Affiliation: Hawai’i State Department of Health, County of Maui, Wailuku, HI (A.R.D., L.P.).

(Copyright © 2013, University Clinical, Education and Research Associates (UCERA))

Abstract

Falls are the leading cause of injury among older adults in the United States, with the institutionalized elderly at elevated risk for injury and death. Physical weakness and mental frailty, prevalent in institutionalized elderly, are major risk factors for falls. The purpose of this study was to evaluate a program that addresses both the physical and mental aspects of exercise to reduce falls in institutionalized elderly. Twenty-seven volunteer subjects residing in an assisted living facility participated in the 24 week randomized crossover study. After demographic, fall history, and mental status examinations, subjects were randomly assigned first to ten weeks of either an exercise class or a control group, followed by a four week “washout period” of no activity, then cross assigned to ten weeks as either a control group or exercise class, respectively. Falls as well as mental status changes were monitored during the study. After adjusting for differences in baseline risk between the control and treatment groups, and for potential residual effects of the treatment during the crossover phase, a statistically significant (P = .025) reduction in falls was found during treatment compared to the control periods. No change in mental status was seen. This small, pilot study shows that exercise programs, which emphasize mental strengthening as well as physical fitness, have the potential to reduce falls among mentally impaired, institutionalized seniors.

CONNECT for better fall prevention in nursing homes: Results from a pilot intervention study

Colon-Emeric CS, McConnell E, Pinheiro SO, Corazzini K, Porter K, Earp KM, Landerman L, Beales J, Lipscomb J, Hancock K, Anderson RA

J. Am. Geriatr. Soc. 2013; ePub(ePub): ePub.

Affiliation: Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, North Carolina.



14


Abstract

OBJECTIVES: To determine whether an intervention that improves nursing home (NH) staff connections, communication, and problem solving (CONNECT) would improve implementation of a falls reduction education program (FALLS).

DESIGN: Cluster randomized trial.

SETTING: Community (n = 4) and Veterans Affairs (VA) NHs (n = 4).

PARTICIPANTS: Staff in any role with resident contact (n = 497).

INTERVENTION: NHs received FALLS alone (control) or CONNECT followed by FALLS (intervention), each delivered over 3 months.

CONNECT used storytelling, relationship mapping, mentoring, self-monitoring, and feedback to help staff identify communication gaps and practice interaction strategies. FALLS included group training, modules, teleconferences, academic detailing, and audit and feedback.

MEASUREMENTS: NH staff completed surveys about interactions at baseline, 3 months (immediately after CONNECT or control period), and 6 months (immediately after FALLS). A random sample of resident charts was abstracted for fall risk reduction documentation (n = 651). Change in facility fall rates was an exploratory outcome. Focus groups were conducted to explore changes in organizational learning.

RESULTS: Significant improvements in staff perceptions of communication quality, participation in decision-making, safety climate, caregiving quality, and use of local interaction strategies were observed in intervention community NHs (treatment-by-time effect P = .01) but not in VA NHs, where a ceiling effect was observed. Fall risk reduction documentation did not change significantly, and the direction of change in individual facilities did not relate to observed direction of change in fall rates. Fall rates did not change in control facilities (falls/bed per year: baseline, 2.61; after intervention, 2.64) but decreased by 12% in intervention facilities (falls/bed per year: baseline, 2.34; after intervention, 2.06); the effect of treatment on rate of change was 0.81 (95% confidence interval = 0.55-1.20).

CONCLUSION: CONNECT has the potential to improve care delivery in NHs, but the trend toward improving fall rates requires confirmation in a larger ongoing study.

Olderpeople’sexperiencesoftherapeuticexerciseaspartofafallspreventionservice:SurveyfindingsfromEngland, Wales and Northern Ireland

Buttery AK, Husk J, Lowe D, Treml J, Vasilakis N, Riglin J.

Age Ageing 2013; ePub(ePub): ePub.

Affiliation: Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, UK.

(Copyright © 2013, Oxford University Press)

Abstract

INTRODUCTION: falling, and fear of falling, significantly affect older people and their lifestyle resulting in loss of confidence, restriction of activity and deteriorating quality of life. Multi-factorial assessment and active participation in an evidence-based exercise programme are key interventions to prevent and manage falls.

OBJECTIVE: to examine older people’s experiences of therapeutic exercise as part of a falls prevention service in NHS Trusts in England, Wales and Northern Ireland.

METHODS: a cross-sectional survey targeted patients and staff members delivering exercise interventions for reducing falls. A multi-disciplinary group including patient and staff representatives developed a 20-item patient questionnaire and a 12-item staff questionnaire that were distributed to 94 NHS Trusts (113 participating sites within the NHS Trusts) in October 2011.

RESULTS: response was 57% for the patient sample and 88% for the staff sample. The median (IQR) age of patients was 82 (77-86) years. 72% were women. Two-thirds reported attending group-based therapeutic exercise classes generally of short duration (80% <12 weeks) and low intensity (85% one class per week) at hospitals and community venues. Balance and strength exercises were prescribed; 68% reported using resistance


15

equipment such as ankle weights and/or exercise band. Only 52% reported exercises were made more difficult as they improved. However, patient satisfaction levels were high (95% satisfied or very satisfied). Patients and staff reported limited availability of strength and balance follow-up classes.

CONCLUSION: despite high levels of patient satisfaction therapeutic exercise provision was limited and implementation of evidence-based exercise interventions by healthcare providers is incomplete and varies widely. Patients and staff wanted greater availability of long-term exercise services for falls prevention.

Theeffectsofaugmentedreality-basedOtagoexerciseonbalance,gait,andfallsefficacyofelderlywomen

Yoo HN, Chung E, Lee BH.

J. Phys. Ther. Sci. 2013; 25(7): 797-801.

Affiliation: Department of Physical Therapy, Graduate School of Physical Therapy, Sahmyook University.

(Copyright © 2013, Society of Physical Therapy Science)

Abstract

PURPOSE: The purpose of this study was to determine the effects of augmented reality-based Otago exercise on balance, gait, and falls efficacy of elderly women.

SUBJECTS: The subjects were 21 elderly women, who were randomly divided into two groups: an augmented reality-based Otago exercise group of 10 subjects and an Otago exercise group of 11 subjects.

METHODS: All subjects were evaluated for balance (Berg Balance Scale, BBS), gait parameters (velocity, cadence, step length, and stride length), and falls efficacy. Within 12 weeks, Otago exercise for muscle strengthening and balance training was conducted three times, for a period of 60 minutes each, and subjects in the experimental group performed augmented reality-based Otago exercise.

RESULTS: Following intervention, the augmented reality-based Otago exercise group showed significant increases in BBS, velocity, cadence, step length (right side), stride length (right side and left side) and falls efficacy.

CONCLUSION: The results of this study suggest the feasibility and suitability of this augmented reality-based Otago exercise for elderly women.

Older people’s perceptions of a multifaceted podiatric medical intervention to prevent falls

Menz HB, Spink MJ, Landorf KB, Hill KD, Lord SR.

J. Am. Podiatr. Med. Assoc. 2013; 103(6): 457-464.

Affiliation: Lower Extremity and Gait Studies Program, Faculty of Health Sciences, La Trobe University, Bundoora, VIC, Australia.

(Copyright © 2013, American Podiatric Medical Association)

Abstract

BACKGROUND: Falls are common in older people and are associated with substantial health-care costs. A recent randomized controlled trial of a multifaceted podiatric medical intervention demonstrated a 36% reduction in the fall rate over 12 months. We evaluated the acceptability of and levels of satisfaction with this intervention in the older people who participated in the trial.

METHODS: Participants allocated to the intervention group (which included a home-based program of foot and ankle exercises, assistance with the purchase of safe footwear when necessary, and provision of prefabricated foot orthoses) completed a structured questionnaire 6 months after they had received the intervention. The questions addressed participants’ perceptions of their balance and foot and ankle strength, the perceived difficulty of the exercise program, and the degree of satisfaction with the footwear and orthoses provided.

RESULTS: Of 153 participants, 134 (87.6%) attended the 6-month follow-up assessment and completed the questionnaire. Most participants perceived improvements in balance (62.7%) and foot and ankle strength (74.6%) after 6 months of performing the exercises, and 86.6% considered the difficulty level of the exercises to be “about right.” Most participants reported that they were somewhat or very satisfied with the footwear (92.3%) and orthoses (81.6%) provided.


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NSW Falls Prevention Network BackgroundThe NSW Falls Prevention Network was established in 1993. The role of this network has grown since its inception and now includes:

• Meetings for discussion of falls related issues;• Dissemination of research findings both local and

international;• Sharing resources developed and exploration

of opportunities to combine resources in joint initiatives;

• Encouragement of collaborative projects and research;

• To act as a group to influence policy;• To liaise with NSW Ministry of Health to provide

information on current State/Commonwealth issues in relation to falls and

• Maintenance of resources pertinent to the field.

The main purpose of the network is to share knowledge, expertise and resources on falls prevention for older people.

The NSW Falls Prevention Network activities are part of the implementation of the NSW Falls Prevention Policy funded by the NSW Ministry of Health.

“Falls Prevention is everyone’s business®”

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