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BMC Geriatrics Jun 2024Wearing hip protectors is a measure used to prevent hip fractures caused by falls. However, its protective effect has remained controversial in previous studies. This... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Wearing hip protectors is a measure used to prevent hip fractures caused by falls. However, its protective effect has remained controversial in previous studies. This study provides a rationale for the use of hip protectors by pooling all the current meta-analysis evidence.
METHODS
We conducted an umbrella review of all the current meta-analysis articles about the efficacy of hip protectors to reduce hip fractures and falls in communities and/or institutions. Major databases including EMBASE, Cochrane Library, PubMed and Web of Science, were searched up to June 2022. Two reviewers screened the studies, extracted the data, and conducted the methodological quality assessment independently. The primary outcome was the association statistic (odds ratio (OR), relative risk (RR), etc.) reported in the meta-analysis that quantified the influence of the intervention on hip fractures and falls compared to that of the control group. Narrative synthesis was also conducted. Forest plots and the AMSTAR score were used to describe the results and quality of the pooled literature, respectively.
RESULTS
A total of six meta-analysis articles were included in the study. Hip protectors were effective at reducing hip fractures in older individuals who were in institutions (nursing or residential care settings) but not in communities (RR = 0.70, 95% CI 0.58 to 0.85, I = 42%, P < 0.001) (RR = 1.12, 95% CI 0.94 to 1.34, I = 0%, P = 0.20), and they did not reduce falls (RR = 1.01, 95% CI 0.90 to 1.13, I = 0%, P = 0.89).
CONCLUSIONS
Hip protectors are effective at preventing hip fractures in institutionalized older adults but not in community-dwelling older adults.
TRIAL REGISTRATION
This study has been registered in PROSPERO (PROSPERO ID: CRD42022351773).
Topics: Humans; Hip Fractures; Accidental Falls; Protective Devices; Aged; Meta-Analysis as Topic
PubMed: 38867191
DOI: 10.1186/s12877-024-05122-x -
JMIR Research Protocols Jun 2024Falls in older patients can lead to serious health complications and increased health care costs. Fall risk-increasing drugs (FRIDs) are a group of drugs that may induce... (Randomized Controlled Trial)
Randomized Controlled Trial
Assessing the Efficacy of the ARMOR Tool-Based Deprescribing Intervention for Fall Risk Reduction in Older Patients Taking Fall Risk-Increasing Drugs (DeFRID Trial): Protocol for a Randomized Controlled Trial.
BACKGROUND
Falls in older patients can lead to serious health complications and increased health care costs. Fall risk-increasing drugs (FRIDs) are a group of drugs that may induce falls or increase the tendency to fall (ie, fall risk). Deprescribing is the process of withdrawal from an inappropriate medication, supervised by a health care professional, with the goal of managing polypharmacy and improving outcomes.
OBJECTIVE
This study aims to assess the effectiveness of a deprescribing intervention based on the Assess, Review, Minimize, Optimize, and Reassess (ARMOR) tool in reducing the risk of falls in older patients and evaluate the cost-effectiveness of deprescribing FRIDs.
METHODS
This is an open-label, parallel-group randomized controlled academic trial. Individuals aged 60-80 years who are currently taking 5 or more prescribed drugs, including at least 1 FRID, will be recruited. Demographic data, medical conditions, medication lists, orthostatic hypotension, and fall history details will be collected. Fall concern will be assessed using the Fall Efficacy Scale, and fall risk will be assessed by the Timed Up and Go test and Tinetti Performance-Oriented Mobility Assessment tool. In this study, all treating physicians will be randomized using a stratified randomization method based on seniority. Randomized physicians will do deprescribing with the ARMOR tool for patients on FRIDs. Participants will maintain diaries, and monthly phone follow-ups will be undertaken to monitor falls and adverse events. Physical assessments will be performed to evaluate fall risk every 3 months for a year. The rationality of prescription drugs will be evaluated using the World Health Organization's core indicators.
RESULTS
The study received a grant from the Indian Council of Medical Research-Safe and Rational Use of Medicine in October 2023. The study is scheduled to commence in April 2024 and conclude by 2026. Efficacy will be measured by fall frequency and changes in fall risk scores. Cost-effectiveness analysis will also include the incremental cost-effectiveness ratio calculation. Adverse events related to deprescription will be recorded.
CONCLUSIONS
This trial will provide essential insights into the efficacy of the ARMOR tool in reducing falls among the geriatric population who are taking FRIDs. Additionally, it will provide valuable information on the cost-effectiveness of deprescribing practices, offering significant implications for improving the well-being of older patients and optimizing health care resource allocation. The findings from this study will be pertinent for health care professionals, policy makers, and researchers focused on geriatric care and fall prevention strategies.
TRIAL REGISTRATION
Clinical Trials Registry - India CTRI/2023/12/060516; https://ctri.nic.in/Clinicaltrials/pubview2.php.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
PRR1-10.2196/55638.
Topics: Humans; Accidental Falls; Aged; Deprescriptions; Aged, 80 and over; Female; Male; Middle Aged; Risk Reduction Behavior; Polypharmacy; Cost-Benefit Analysis; Randomized Controlled Trials as Topic
PubMed: 38861709
DOI: 10.2196/55638 -
Scientific Reports Jun 2024Prevention of subsequent fracture is a major public health challenge in the field of osteoporosis prevention and treatment, and older women are at high risk for...
Prevention of subsequent fracture is a major public health challenge in the field of osteoporosis prevention and treatment, and older women are at high risk for osteoporotic fractures. This study aimed to examine factors associated with subsequent fracture in older Chinese women with osteoporosis. We collected data on 9212 older female patients with osteoporotic fractures from 580 medical institutions in 31 provinces of China. Higher odds of subsequent fractures were associated with age of 70-79 years (OR 1.218, 95% CI 1.049-1.414), age ≥ 80 (OR 1.455, 95% CI 1.222-1.732), index fracture site was vertebrae (OR 1.472, 95% CI 1.194-1.815) and hip (OR 1.286, 95% CI 1.041-1.590), index fracture caused by fall (OR 1.822, 95% CI 1.281-2.591), strain (OR 1.587, 95% CI 1.178-2.139), no inducement (OR 1.541, 95% CI 1.043-2.277), and assessed as high risk of fracture (OR 1.865, 95% CI 1.439-2.416), BMD T-score ≤ -2.5 (OR 1.725, 95% CI 1.440-2.067), history of surgery (OR 3.941, 95% CI 3.475-4.471) and trauma (OR 8.075, 95% CI 6.941-9.395). Low risk of fall (OR 0.681, 95% CI 0.513-0.904), use of anti-osteoporosis medication (AOM, OR 0.801, 95% CI 0.693-0.926), and women who had received fall prevention health education (OR 0.583, 95% CI 0.465-0.730) associated with lower risk. The areas under the curve of the prediction model was 0.818. The sensitivity was 67.0% and the specificity was 82.0%. The prediction model showed a good ability to predict the risk of subsequent fracture in older women with osteoporotic fractures and are suitable for early self-measurement which may benefit post-fracture management.
Topics: Humans; Female; Aged; Osteoporotic Fractures; Cross-Sectional Studies; China; Aged, 80 and over; Middle Aged; Risk Assessment; Risk Factors; Bone Density; Accidental Falls; Osteoporosis; East Asian People
PubMed: 38858454
DOI: 10.1038/s41598-024-64170-w -
Clinical Interventions in Aging 2024The risk of falls among the elderly significantly increases, which has become a serious public health concern. Falls can not only lead to serious complications such as...
INTRODUCTION
The risk of falls among the elderly significantly increases, which has become a serious public health concern. Falls can not only lead to serious complications such as fractures and brain injuries but also limit their mobility function, reducing quality of life. Foot intrinsic muscles (FIMs) are an essential part of foot core stability even overall postural stability. This study aimed to investigate the effects of aging on the function of FIMs and to explore the influence of FIMs on postural control in the elderly.
MATERIALS AND METHODS
56 healthy old participants (60-75 years) and 57 healthy young participants (18-29 years) joined this study. An ergoFet dynamometer was used to determine foot muscle strength (Doming, T, T and T), and ankle muscle strength (plantarflexion and dorsiflexion). The morphology of FIMs and extrinsic foot muscle was determined using a Doppler ultrasound system, whereas the postural stability was assessed through Limits of Stability test. Independent samples -test was used to determine the differences in strength and morphological parameters and Spearman correlation analysis was used to determine whether an association existed between muscle strength and postural stability parameters in the elderly.
RESULTS
Compared with young adults, foot muscle strength and ankle muscle strength (Doming, T, T, T, dorsiflexion, and plantarflexion, all p <0.05) and the morphology of foot muscles (all p <0.05) were significantly reduced in the elderly. The strength of FIMs and the limit of stability (r = 0.302-0.424, all p <0.05) were significantly correlated in the elderly.
CONCLUSION
Compared with young adults, the weakness of strength as well as the morphological decline of the intrinsic and extrinsic foot muscles were found in the elderly. In addition, a correlation was observed between FIM's strength and postural stability in the elderly, suggesting their potential role in posture stability.
Topics: Humans; Postural Balance; Middle Aged; Female; Male; Aged; Muscle Strength; Adult; Foot; Muscle, Skeletal; Young Adult; Aging; Muscle Strength Dynamometer; Adolescent; Accidental Falls
PubMed: 38855030
DOI: 10.2147/CIA.S454068 -
Forensic Science International May 2024Forensic reconstruction and scenario evaluation are crucial in investigations of suspicious deaths related to falls from a height. In such cases, distinguishing between...
Forensic reconstruction and scenario evaluation are crucial in investigations of suspicious deaths related to falls from a height. In such cases, distinguishing between accidental falls, being pushed or jumping is an important but difficult task, since objective methods to do so are currently lacking. This paper explores the possibility of repurposing a passive rigid body model of a human from commercially available crash simulation software for forensic reconstruction and scenario evaluation of humans dropping from heights. To use this approach, a prerequisite is that the human body model can produce realistic movements compared to those of a real human, given similar environmental conditions. Therefore, this study assessed the validity of the commercially available Simcenter Madymo Pedestrian Model (MPM) for simulating human fall movements. Experimental kinematic and kinetic data was collected from nine participants, who dropped from a height in three different ways: passively tilting over, getting pushed, and jumping. Next, the performance of the MPM in reproducing the kinematics of the experimental falls was assessed by comparing the orientation of the body 0.3 s after platform release. The results show that the MPM currently does not consistently reproduce the experimentally recorded falling movements across multiple falling conditions and outcome measures. The MPM must therefore be adapted if to be used for forensic reconstruction and scenario evaluation, for example by implementing active movement.
PubMed: 38850615
DOI: 10.1016/j.forsciint.2024.112068 -
Medicine Jun 2024Fall occurrences and the associated risk of injury are debilitating and major health concerns in the older population. Several interventions have been investigated and... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
BACKGROUND
Fall occurrences and the associated risk of injury are debilitating and major health concerns in the older population. Several interventions have been investigated and implemented to address the needs of balance impairments and to reduce the increased risk of falls. This study aimed to compare the effectiveness of the Otago exercise program (OEP) and gaze stability exercises (GSE) on balance and the risk of falls in older adults residing at an old age home facility.
METHODS
Thirty elderly participants were equally and randomly divided into 2 groups: Group OEP received the OEP, and group GSE received GSE for 8 weeks (thrice a week). In addition, both groups also performed core muscle-strengthening exercises. The outcome measures were the Berg balance scale (BBS) and the Fall efficacy scale-International (FES-I).
RESULTS
The interventions resulted in significant improvements (P < .001) in both outcome measures in both groups. The mean pretest BBS scores of groups OEP and GSE increased from 40.4 and 39.2 to the mean post-test scores of 48 and 45.2, respectively. Similarly, the mean pretest FES-I scores of groups OEP and GSE also improved from 39.47 and 40.4 to the mean post-test scores of 32.73 and 36.07. The between-group comparison showed greater improvement (P < .05) in OEP group in both variables.
CONCLUSIONS
OEP and GSE were found to be beneficial rehabilitation programs in improving balance and fear of falls in healthy older adults. However, the OEP was found to be a more effective intervention and may allow better balance and fall prevention improvements.
TRIAL REGISTRATION
The study has been registered in clinicaltrials.gov (ID: NCT05781776; on 23/03/2023).
Topics: Humans; Accidental Falls; Postural Balance; Male; Female; Aged; Exercise Therapy; Fear; Aged, 80 and over
PubMed: 38847714
DOI: 10.1097/MD.0000000000038345 -
MSMR May 2024Mortality surveillance is an important activity for capturing information on a population's health. This retrospective surveillance analysis utilizes administrative data...
Mortality surveillance is an important activity for capturing information on a population's health. This retrospective surveillance analysis utilizes administrative data sources to describe active duty U.S. Army soldiers who died from 2014 to 2019, and calculate mortality rates, assess trends by category of death, and identify leading causes of death within subpopulations. During the surveillance period, 2,530 soldier deaths were reported. The highest crude mortality rates observed during the 6-year surveillance period were for deaths by suicide, followed by accidental (i.e., unintentional injury) deaths. The crude mortality rates for natural deaths decreased significantly over the 6-year period, by an average of 6% annually. The leading causes of death were suicide by gunshot wound, motor vehicle accidents, suicide by hanging, neoplasms, and cardiovascular events. Significant differences were observed in the leading causes of death in relation to demographic characteristics, which has important implications for the development of focused educational campaigns to improve health behaviors and safe driving habits. Current public health programs to prevent suicide should be evaluated, with new approaches for firearm safety considered.
Topics: Humans; Military Personnel; Male; United States; Female; Adult; Population Surveillance; Cause of Death; Young Adult; Retrospective Studies; Suicide; Mortality; Middle Aged; Adolescent; Wounds, Gunshot; Accidents, Traffic
PubMed: 38847619
DOI: No ID Found -
Fa Yi Xue Za Zhi Apr 2024
Topics: Humans; Female; Cerebral Infarction; Aged; Femoral Fractures; Accidental Falls; Stroke; Forensic Pathology
PubMed: 38847046
DOI: 10.12116/j.issn.1004-5619.2023.230801 -
Nihon Ronen Igakkai Zasshi. Japanese... 2024Some studies have reported a higher incidence of falls during winter with similar proportions of indoor and outdoor falls. We investigated the relationship between...
[Association between indoor temperature during winter and falls at home in the past year among community-dwelling older adults: A cross-sectional analysis of the nationwide Smart Wellness Housing survey in Japan].
AIM
Some studies have reported a higher incidence of falls during winter with similar proportions of indoor and outdoor falls. We investigated the relationship between indoor temperature during winter and falls at home in the past year among community-dwelling older adults.
METHODS
This cross-sectional study enrolled 964 individuals of ≥65 years of age in Japan. Participants answered questions about falls (including trips) at home within the past year, and the living room temperature was measured for 2 weeks during winter. Participants were divided into those living in cold (mean temperature near the floor <12°C), slightly cold (12-17.9°C), and warm (≥18°C) houses. The association between indoor temperature (cold vs. slightly cold vs. warm houses) and falls at home in the past year was examined using a logistic regression analysis adjusted for potential confounding factors.
RESULTS
Valid data were obtained from 907 participants (mean age: 72.0±6.3 years), of whom 265,553, and 89 lived in cold, slightly cold, and warm houses, respectively. In the past year, falls occurred once in 325 (35.8%) participants and multiple times in 148 (16.3%) participants. In warm houses, the odds ratio of falling once and multiple times in the past year was 0.49 (p=0.032) and 0.34 (p=0.035), respectively, in comparison to cold houses.
CONCLUSIONS
Living in cold houses may be associated with an increased risk of falling at home among older adults. Maintaining an appropriate indoor thermal environment during winter may reduce the risk of falling among individuals who spend most of their time at home.
Topics: Humans; Aged; Accidental Falls; Cross-Sectional Studies; Male; Female; Seasons; Independent Living; Japan; Temperature; Surveys and Questionnaires; Aged, 80 and over; Housing
PubMed: 38839321
DOI: 10.3143/geriatrics.61.218 -
Aging Clinical and Experimental Research Jun 2024Conducted physically, supervised group-based falls prevention exercise programs have demonstrated effectiveness in reducing the risk of falls among older adults. In this... (Randomized Controlled Trial)
Randomized Controlled Trial
UNLABELLED
Conducted physically, supervised group-based falls prevention exercise programs have demonstrated effectiveness in reducing the risk of falls among older adults. In this study, we aimed to assess the acceptability, feasibility, and effectiveness of a virtual supervised group-based falls prevention exercise program (WE-SURF™) for community-dwelling older adults at risk of falls.
METHOD
A preliminary study utilizing virtual discussions was conducted to assess the acceptability of the program among six older adults. Effectiveness was evaluated in a randomized controlled feasibility study design, comprising 52 participants (mean age: 66.54; SD: 5.16), divided into experimental (n = 26) and control (n = 26) groups. The experimental group engaged in a 6-month WE-SURF™ program, while the control group received standard care along with a fall's prevention education session. Feasibility of the intervention was measured using attendance records, engagement rates from recorded videos, dropouts, attrition reasons, and adverse events.
RESULTS
Preliminary findings suggested that WE-SURF™ was acceptable, with further refinements. The study revealed significant intervention effects on timed up and go (TUG) (η2p:0.08; p < 0.05), single leg stance (SLS) (η2p:0.10; p < 0.05), and lower limb muscle strength (η2p:0.09; p < 0.05) tests. No adverse events occurred during the program sessions, and both attendance and engagement rates were high (> 80% and 8/10, respectively) with minimal dropouts (4%). The WE-SURF™ program demonstrated effectiveness in reducing the risk of falls while enhancing muscle strength and balance.
CONCLUSION
In conclusion, WE-SURF™ was demonstrated to be an acceptable, feasible, and effective virtual supervised group-based exercise program for fall prevention in community-dwelling older adults at risk of falls. With positive outcomes and favourable participant engagement, WE-SURF™ holds the potential for wider implementation. Further research and scaling-up efforts are recommended to explore its broader applicability. (Registration number: ACTRN 12621001620819).
Topics: Humans; Accidental Falls; Aged; Female; Male; Feasibility Studies; Exercise Therapy; Middle Aged; Postural Balance; Independent Living
PubMed: 38836944
DOI: 10.1007/s40520-024-02759-x