-
Aging Clinical and Experimental Research Mar 2024The aim of this study was to examine the association of body composition, muscle strength, balance, and functional capacity on falls and fall injuries among... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The aim of this study was to examine the association of body composition, muscle strength, balance, and functional capacity on falls and fall injuries among community-dwelling older women.
METHODS
The study comprised of a 2-year randomized controlled trial involving 914 women with an average age of 76.5 (SD = 3.3) years at baseline. The women were assigned to exercise intervention (n = 457) and control groups (n = 457). Clinical measurements were conducted at baseline, 12 months and 24 months.
RESULTS
During the 2-year follow up, total of 546 women (59.7%) sustained a fall. The total number of falls was 1380 and out of these, 550 (40%) of falls were non-injurious and 745 (54%) were injurious. Higher femoral neck bone mineral density (BMD) was associated with a higher overall risk of falls [RR = 2.55 (95% CI = 1.70-3.84, p < 0.001)], but was a protective factor for severe fall injuries [RR = 0.03 (95% CI = 0.003-0.035, p < 0.01)]. Slower Timed Up and Go (TUG) was associated with an increased overall risk of falls [RR = 1.07 (95% CI = 1.05-1.10, p < 0.001)] and injuries requiring medical attention [RR = 1.10 (95% CI = 1.02-1.19, p = 0.02)]. Longer single leg standing time was a protective factor for falls [RR = 0.99 (95% CI = 0.99-1.00, p < 0.01)] and overall injurious falls [RR = 0.99 (95% CI = 0.99-1.00, p = 0.02)].
CONCLUSION
For postmenopausal women with higher femoral neck BMD appear to sustain more falls, but have a lower risk of severe fall injuries. Better TUG and single leg standing time predict lower risk of falls and fall injuries.
Topics: Humans; Female; Aged; Accidental Falls; Exercise; Exercise Therapy; Independent Living; Body Composition; Postural Balance
PubMed: 38512411
DOI: 10.1007/s40520-024-02719-5 -
BMC Medical Informatics and Decision... Nov 2023Falls are one of the most common accidents in medical institutions, which can threaten the safety of inpatients and negatively affect their prognosis. Herein, we...
BACKGROUND
Falls are one of the most common accidents in medical institutions, which can threaten the safety of inpatients and negatively affect their prognosis. Herein, we developed a machine learning (ML) model for fall prediction in patients with acute stroke and compared its accuracy with that of the existing fall risk prediction tool, the Morse Fall Scale (MFS).
METHODS
This is a retrospective nested case-control study. The initial sample size was 8462 admitted to a single cerebrovascular specialty hospital with acute stroke. A total of 156 fall events occurred, and each fall case was randomly matched with six control cases. Six ML algorithms were used, namely, regularized logistic regression, support vector machine, naïve Bayes (NB), k-nearest neighbors, random forest, and extreme-gradient boosting (XGB).
RESULTS
We included 156 in the fall group and 934 in the non-fall group. The mean ages of the fall and non-fall groups were 68.3 (± 12.2) and 65.3 (± 12.9) years old, respectively. The MFS total score was significantly higher in the fall group (54.3 ± 18.3) than in the non-fall group (37.7 ± 14.7). The area under the receiver operating curve (AUROC) of the MFS in predicting falls was 0.76 (0.73-0.79). XGB had the highest AUROC of 0.85 (0.78-0.92), and XGB and NB had the highest F1 score of 0.44.
CONCLUSIONS
The AUROC values of all of ML algorithms were similar to those of the MFS in predicting fall risk in patients with acute stroke, allowing for accurate and efficient fall screening.
Topics: Humans; Case-Control Studies; Retrospective Studies; Bayes Theorem; Machine Learning; Stroke; Algorithms; Hospitals
PubMed: 37915000
DOI: 10.1186/s12911-023-02330-0 -
Frontiers in Neurology 2024To summarize the status and characteristics of the available evidence, research gaps, and future research priorities for preventing falls in stroke patients through...
OBJECTIVE
To summarize the status and characteristics of the available evidence, research gaps, and future research priorities for preventing falls in stroke patients through balance training.
METHODS
We used a scoping review framework. A systematic search of PUBMED, Embase, and Cochrane databases for main articles was conducted. Our study only included articles that on balance training and fall-related indicators in stroke patients. Two researchers independently screened the literature according to the inclusion and exclusion criteria. The data of demographic, clinical characteristics, intervention, sample, and outcome indicators were extracted. The characteristics and limitations of the included literature were comprehensively analyzed.
RESULTS
Of the 1,058 studies, 31 were included. The methods of balance training include regular balance training, Tai Chi, Yoga, task balance training, visual balance training, multisensory training, aquatic balance training, perturbation-based balance training, cognitive balance training, system-based balance training, and robot-assisted balance training. The commonly used outcome measures include clinical balance test, such as Berg balance scale (BBS), Timed Up-and-Go Test (TUG), Fall Risk Index assessment (FRI), Fall Efficacy Scale score (FES), and instrumented balance tests.
CONCLUSION
This scoping review summarizes the existing primary research on preventing falls in stroke patients by balance training. Based on the summary of the existing evidence, the characteristics of balance training and their relation to falls in stroke patients were found. The future researches should explore how to develop personalized training program, the sound combination of various balance training, to more effectively prevent falls.
PubMed: 38375467
DOI: 10.3389/fneur.2024.1167954 -
Journal of the American Medical... Feb 2024To investigate the effect of an exercise program on falls in intermediate and high-level long-term care (LTC) residents and to determine whether adherence, physical... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To investigate the effect of an exercise program on falls in intermediate and high-level long-term care (LTC) residents and to determine whether adherence, physical capacity, and cognition modified outcomes.
DESIGN
Randomized controlled trial.
SETTING AND PARTICIPANTS
Residents (n = 520, aged 84 ± 8 years) from 25 LTC facilities in New Zealand.
METHODS
Individually randomized to Staying UpRight, a physical therapist-led, balance and strength group exercise program delivered for 1 hour, twice weekly over 12 months. The control arm was dose-matched and used seated activities with no resistance. Falls were collected using routinely collected incident reports.
RESULTS
Baseline fall rates were 4.1 and 3.3 falls per person-year (ppy) for intervention and control groups. Fall rates over the trial period were 4.1 and 4.3 falls ppy respectively [P = .89, incidence rate ratio (IRR) 0.98, 95% CI 0.76, 1.27]. Over the 12-month trial period, 74% fell, with 63% of intervention and 61% of the control group falling more than once. Risk of falls (P = .56, hazard ratio 1.08, 95% CI 0.85, 1.36) and repeat falling or fallers sustaining an injury at trial completion were similar between groups. Fall rates per 100 hours walked did not differ between groups (P = .42, IRR 1.15, 95% CI 0.81, 1.63). Program delivery was suspended several times because of COVID-19, reducing average attendance to 26 hours over 12 months. Subgroup analyses of falls outcomes for those with the highest attendance (≥50% of classes), better physical capacity (Short Physical Performance Battery scores ≥8/12), or cognition (Montreal Cognitive Assessment scores ≥ 18/30) showed no significant impact of the program.
CONCLUSIONS/IMPLICATIONS
In intermediate and high-level care residents, the Staying UpRight program did not reduce fall rates or risk compared with a control activity, independent of age, sex, or care level. Inadequate exercise dose because of COVID-19-related interruptions to intervention delivery likely contributed to the null result.
Topics: Aged; Humans; Accidental Falls; COVID-19; Exercise; Exercise Therapy; Long-Term Care; Aged, 80 and over
PubMed: 38042173
DOI: 10.1016/j.jamda.2023.10.022 -
Arthritis Research & Therapy Sep 2023Studies evaluating the association of knee and hip osteoarthritis (OA) with falls and fractures have inconsistent findings. We aimed to investigate associations of... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Studies evaluating the association of knee and hip osteoarthritis (OA) with falls and fractures have inconsistent findings. We aimed to investigate associations of symptomatic and radiographic knee and hip OA with risk of falls, recurrent falls, and fractures.
METHODS
We conducted an electronic search of databases from inception to February 2023. Two authors independently screened studies, extracted data, and assessed the risk of bias using the Newcastle-Ottawa Scale tool in eligible studies. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models.
RESULTS
Of 17 studies included (n = 862849), 2 had a high risk of bias. Among studies that evaluated falls or fractures as outcomes, 7/8 (87.5%) and 5/11 (45.5%) were self-reported, respectively. Both symptomatic knee and hip OA were associated with increased risk of recurrent falls (knee: OR = 1.55, 95% CI 1.10 to 2.18; hip: OR = 1.50, 95% CI 1.28 to 1.75) but not falls or fractures. Radiographic knee OA increased risk of falls (OR = 1.28, 95% CI 1.03 to 1.59) and did not significantly increase risk of recurrent falls (OR = 1.39, 95% CI 0.97 to 1.97) or fractures (OR = 1.22, 95% CI 0.99 to 1.52). Radiographic hip OA decreased the risk of recurrent falls (OR = 0.70, 95% CI 0.51 to 0.96) but had no statistically significant association with fractures (OR = 1.16, 95% CI 0.79 to 1.71).
CONCLUSION
Symptomatic knee and hip OA were both associated with an increased risk of recurrent falls, and radiographic knee OA was associated with an increased risk of falls. No statistically significant associations of radiographic and symptomatic knee or hip OA with fractures were found.
Topics: Humans; Osteoarthritis, Hip; Accidental Falls; Risk Factors; Fractures, Bone; Osteoarthritis, Knee
PubMed: 37770969
DOI: 10.1186/s13075-023-03179-4 -
BMC Cardiovascular Disorders Jul 2023Older adults hospitalized for heart failure (HF) are at risk for falls after discharge. One modifiable contributor to falls is fall risk-increasing drugs (FRIDs)....
BACKGROUND
Older adults hospitalized for heart failure (HF) are at risk for falls after discharge. One modifiable contributor to falls is fall risk-increasing drugs (FRIDs). However, the prevalence of FRIDs among older adults hospitalized for HF is unknown. We describe patterns of FRIDs use and examine predictors of a high FRID burden.
METHODS
We used the national biracial REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a prospective cohort recruited from 2003-2007. We included REGARDS participants aged ≥ 65 years discharged alive after a HF hospitalization from 2003-2017. We determined FRIDs -cardiovascular (CV) and non-cardiovascular (non-CV) medications - at admission and discharge from chart abstraction of HF hospitalizations. We examined the predictors of a high FRID burden at discharge via modified Poisson regression with robust standard errors.
RESULTS
Among 1147 participants (46.5% women, mean age 77.6 years) hospitalized at 676 hospitals, 94% were taking at least 1 FRID at admission and 99% were prescribed at least 1 FRID at discharge. The prevalence of CV FRIDs was 92% at admission and 98% at discharge, and the prevalence of non-CV FRIDs was 32% at admission and discharge. The most common CV FRID at admission (88%) and discharge (93%) were antihypertensives; the most common agents were beta blockers (61% at admission, 75% at discharge), angiotensin-converting enzyme inhibitors (36% vs. 42%), and calcium channel blockers (32% vs. 28%). Loop diuretics had the greatest change in prevalence (53% vs. 72%). More than half of the cohort (54%) had a high FRID burden (Agency for Healthcare Research and Quality (AHRQ) score ≥ 6), indicating high falls risk after discharge. In a multivariable Poisson regression analysis, the factors strongly associated with a high FRID burden at discharge included hypertension (PR: 1.41, 95% CI: 1.20, 1.65), mood disorder (PR: 1.24, 95% CI: 1.10, 1.38), and hyperpolypharmacy (PR: 1.88, 95% CI: 1.64, 2.14).
CONCLUSIONS
FRID use was nearly universal among older adults hospitalized for HF; more than half had a high FRID burden at discharge. Further work is needed to guide the management of a common clinical conundrum whereby guideline indications for treating HF may contribute to an increased risk for falls.
Topics: Humans; Female; Aged; Male; Accidental Falls; Prospective Studies; Hospitalization; Patient Discharge; Heart Failure
PubMed: 37495948
DOI: 10.1186/s12872-023-03401-w -
Journal of Patient Safety Dec 2023The aim of this study was to develop a computerized decision support system (CDSS) that could automatically calculate the risk of falls using electronic medical record...
OBJECTIVES
The aim of this study was to develop a computerized decision support system (CDSS) that could automatically calculate the risk of falls using electronic medical record data and provide evidence-based fall-prevention recommendations based on risk factors. Furthermore, we analyzed the usability and effect of the system on fall-prevention nursing practices.
METHODS
A computerized fall-prevention system was developed according to the system development life cycle, and implemented between March and August 2019 in a single medical unit with a high prevalence of falls. The usability was evaluated 1 month after CDSS implementation. In terms of time and frequency, changes in fall-prevention nursing practices were analyzed using survey data and nursing documentation, respectively. Finally, the incidence of falls before and after system implementation was compared to examine the clinical effectiveness of the CDSS.
RESULTS
According to the usability test, the average ease of learning score (5.083 of 7) was the highest among 4 dimensions. The time spent engaged in fall-prevention nursing care per patient per shift increased, particularly for nursing diagnoses and planning. Moreover, the mean frequency of daily documented fall-prevention interventions per patient also increased. Particularly, nursing statements related to nonspecific interventions such as environmental modifications increased. However, the incidence of falls did not decrease after implementation of the CDSS.
CONCLUSIONS
Although adoption of the computerized system increased the time spent and number of records created in terms of fall-prevention practices in nurses, no improvement in clinical outcomes was observed, particularly in terms of fall rate reduction.
Topics: Humans; Accidental Falls; Risk Factors; Incidence
PubMed: 37922246
DOI: 10.1097/PTS.0000000000001168 -
Journal of Obstetric, Gynecologic, and... May 2024To identify and describe fall risk assessment tools used for women who receive maternity care. (Review)
Review
OBJECTIVE
To identify and describe fall risk assessment tools used for women who receive maternity care.
DATA SOURCES
PubMed, CINAHL Complete, MEDLINE Complete, Cochrane Library, Scopus, SciELO, and Repositórios Científicos de Acesso Aberto de Portugal (RCAAP).
STUDY SELECTION
We considered reports published until November 28, 2022, that included women during pregnancy, childbirth, or the postpartum period; involved the use of fall risk assessment tools, regardless of context; and were published in English, French, Portuguese, or Spanish.
DATA EXTRACTION
We extracted the following data from the included reports: author(s)/year/country, aim/sample, research design/type of report, tool (i.e., the fall risk assessment tool used), findings, reliability, and validity.
DATA SYNTHESIS
We found 13 reports in which the authors addressed nine fall risk assessment tools. Seven of these tools were applied during pregnancy (Kyle's tool, Pregnant Women Information Form and Assessment Scale for Risk of Falling in Pregnant Women, Obstetric Fall Risk Assessment System), labor (Obstetric Fall Risk Assessment System), the postpartum period (Cooksey-Post Obstetric Delivery Fall Risk Assessment, Kyle's tool, Risk of Falling in Post-partum Women (SLOPE), Obstetric Fall Risk Assessment System, Post-epidural Fall Risk Assessment Score, and Maternal Fall Risk Assessment Scale). The Dionne's Egress Test and the Motor Strength Scale do not address the characteristics of the women who receive maternity care. Psychometric characteristics were available for the Pregnant Women Information Form and Assessment Scale for Risk of Falling in Pregnant Women, Post-epidural Fall Risk Assessment Score, Maternal Fall Risk Assessment Scale, and Risk of Falling in Post-partum Women.
CONCLUSION
Some fall risk assessment tools are used to assess women who receive maternity care without proper validation in this specific population. The use of fall risk assessment tools that are validated for women who receive maternity care may help nurses make clinical judgments when assessing fall risk and implement measures for fall prevention.
Topics: Humans; Female; Risk Assessment; Accidental Falls; Pregnancy; Maternal Health Services
PubMed: 38176683
DOI: 10.1016/j.jogn.2023.11.012 -
European Geriatric Medicine Aug 2023Both heart failure and its treatment with diuretics or SGLT2 inhibitors increase fall risk in older adults. Therefore, decisions to continue or deprescribe diuretics or... (Review)
Review
PURPOSE
Both heart failure and its treatment with diuretics or SGLT2 inhibitors increase fall risk in older adults. Therefore, decisions to continue or deprescribe diuretics or SGLT2 inhibitors in older heart failure patients who have fallen are generally highly complex and challenging for clinicians. However, a comprehensive overview of information required for rationale and safe decision-making is lacking. The aim of this clinical review was to assist clinicians in safe (de)prescribing of these drug classes in older heart failure patients.
METHODS
We comprehensively searched and summarized published literature and international guidelines on the efficacy, fall-related safety issues, and deprescribing of the commonly prescribed diuretics and SGLT2 inhibitors in older adults.
RESULTS
Both diuretics and SGLT2 inhibitors potentially cause various fall-related adverse effects. Their fall-related side effect profiles partly overlap (e.g., tendency to cause hypotension), but there are also important differences; based on the currently available evidence of this relatively new drug class, SGLT2 inhibitors seem to have a favorable fall-related adverse effect profile compared to diuretics (e.g., low/absent tendency to cause hyperglycemia or electrolyte abnormalities, low risk of worsening chronic kidney disease). In addition, SGLT2 inhibitors have potential beneficial effects (e.g., disease-modifying effects in heart failure, renoprotective effects), whereas diuretic effects are merely symptomatic.
CONCLUSION
(De)prescribing diuretics and SGLT2 inhibitors in older heart failure patients who have fallen is often highly challenging, but this clinical review paper assists clinicians in individualized and patient-centered rational clinical decision-making: we provide a summary of available literature on efficacy and (subclass-specific) safety profiles of diuretics and SGLT2 inhibitors, and practical guidance on safe (de)prescribing of these drugs (e.g. a clinical decision tree for deprescribing diuretics in older adults who have fallen).
Topics: Aged; Humans; Accidental Falls; Deprescriptions; Diuretics; Heart Failure; Sodium-Glucose Transporter 2 Inhibitors
PubMed: 36732414
DOI: 10.1007/s41999-023-00752-7 -
Frontiers in Immunology 2023Autoimmune diseases are more common among people with unhealthy sleep behaviors, and these conditions have been linked to aging-related bone health. However, there have...
BACKGROUND
Autoimmune diseases are more common among people with unhealthy sleep behaviors, and these conditions have been linked to aging-related bone health. However, there have been few studies that examined the correlation between recently developed sleep patterns based on sleep duration, sleepiness, chronotype, snoring, insomnia, and the incidence of falls and fractures.
METHODS
We used a newly developed sleep pattern with components of sleep 7 to 8 h per day, absence of frequent excessive daytime sleepiness, early chronotype, no snoring, and no frequent insomnia as healthy factors to study their relationship with the incidence of falls and fractures. The analysis was conducted among 289,000 participants from the UK Biobank.
RESULTS
The mean follow-up period was 12.3 years (3.5 million person-years of follow-up), and 12,967 cases of falls and 16,121 cases of all fractures were documented. Compared to participants exhibiting an unfavorable sleep pattern, those adhering to a healthy sleep pattern experienced a 17% and 28% reduction in the risks of incident falls (hazard ratio [HR], 0.83; 95% CI, 0.74-0.93) and all fractures (HR, 0.72; 95% CI, 0.66-0.79) during follow-up. In addition, participants exhibiting a healthy sleep pattern, together with a high genetically determined bone mineral density (BMD), showed the lowest risks of falls and fractures.
CONCLUSION
A healthy sleep pattern was significantly linked to decreased risks of incident falls and fractures. The protective association was not modified by genetically determined BMD.
Topics: Humans; Accidental Falls; Sleep Initiation and Maintenance Disorders; Fractures, Bone; Aging; Sleep
PubMed: 37662961
DOI: 10.3389/fimmu.2023.1234102