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Archives of Gerontology and Geriatrics Dec 2023Any individual may experience accidental falls, particularly older adults. Although robots can prevent falls, knowledge of their fall-preventive use is limited. (Review)
Review
BACKGROUND
Any individual may experience accidental falls, particularly older adults. Although robots can prevent falls, knowledge of their fall-preventive use is limited.
OBJECTIVE
To explore the types, functions, and mechanisms of robot-assisted intervention for fall prevention.
METHODS
A systematic scoping review of global literature published from inception to January 2022 was conducted according to Arksey and O'Malley's five-step framework. Nine electronic databases, namely, PubMed, Embase, CINAHL, IEEE Xplore, the Cochrane Library, Scopus, Web of Science, PsycINFO, and ProQuest, were searched.
RESULTS
Seventy-one articles were found with developmental (n = 63), pilot (n = 4), survey (n = 3), and proof-of-concept (n = 1) designs across 14 countries. Six types of robot-assisted intervention were found, namely cane robots, walkers, wearables, prosthetics, exoskeletons, rollators, and other miscellaneous. Five main functions were observed including (i) detection of user fall, (ii) estimation of user state, (iii) estimation of user motion, (iv) estimation of user intentional direction, and (v) detection of user balance loss. Two categories of mechanisms of robots were found. The first category was executing initiation of incipient fall prevention such as modeling, measurement of user-robot distance, estimation of center of gravity, estimation and detection of user state, estimation of user intentional direction, and measurement of angle. The second category was achieving actualization of incipient fall prevention such as adjust optimal posture, automated braking, physical support, provision of assistive force, reposition, and control of bending angle.
CONCLUSIONS
Existing literature regarding robot-assisted intervention for fall prevention is in its infancy. Therefore, future research is required to assess its feasibility and effectiveness.
Topics: Humans; Aged; Robotics; Cognition
PubMed: 37422967
DOI: 10.1016/j.archger.2023.105117 -
Sports Medicine and Arthroscopy Review Jun 2023The purpose of this study was to determine the effectiveness of virtual reality (VR) in balance training for the prevention of falls in older adults.
OBJECTIVE
The purpose of this study was to determine the effectiveness of virtual reality (VR) in balance training for the prevention of falls in older adults.
METHODS
We included studies with experimental designs, cohort studies, and quasi-experimental studies of older adults who underwent balance training associated with the use of VR for the prevention of falls. The comparison of control and intervention groups in the studies reported statistically significant improvements in terms of balance for VR.
RESULTS
The effects and benefits from the use of VR were seen by the fourth week of intervention, with significant improvements in balance and lower fall rates, the improvements became greater for groups using VR.
CONCLUSIONS
The benefits presented by the studies were related not only to balance but also to fear of falling, reaction time, gait, physical fitness, independence in activities of daily living, muscle strength, and even quality of life.
Topics: Humans; Aged; Accidental Falls; Activities of Daily Living; Quality of Life; Fear; Virtual Reality; Postural Balance
PubMed: 37418173
DOI: 10.1097/JSA.0000000000000367 -
Geriatric Nursing (New York, N.Y.) 2023Worldwide, falls lead to possible complications such as prolonged hospitalization, prolonged bed rest, pressure injuries, fractures and mortality. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Worldwide, falls lead to possible complications such as prolonged hospitalization, prolonged bed rest, pressure injuries, fractures and mortality.
AIMS
The study aimed to evaluate the effectiveness of novel fall prevention strategies that utilized technology in preventing falls.
METHODS
The meta-analysis and systematic review was guided by the Cochrane guidelines for systematic reviews of interventions. The authors searched databases for specified keywords.
RESULTS
A total of 22 studies were included. Interventions included multi-modal fall prevention interventions, camera surveillance, motion sensors and bed/chair exit alarms. Video monitoring was equivocal in reducing fall rates. Exit alarms statistically significantly reduce falls between groups but not within groups. The interventions were not statistically significant in reducing falls with minor injuries but they were statistically significant in reducing falls with serious injuries including fractures.
CONCLUSION
A comprehensive fall prevention care plan, rather than one specific intervention, is necessary to prevent falls effectively.
Topics: Humans; Accidental Falls; Fractures, Bone
PubMed: 37390566
DOI: 10.1016/j.gerinurse.2023.06.004 -
Journal of Patient-reported Outcomes Jun 2023Falls prevention in hospital continues to be a research priority because of the poor health outcomes and financial burdens that can arise. Recently updated World... (Review)
Review
Falls prevention in hospital continues to be a research priority because of the poor health outcomes and financial burdens that can arise. Recently updated World Guidelines for Falls Prevention and Management strongly recommend evaluating patients' concerns about falling as part of a multifactorial assessment. The aim of this systematic review was to evaluate the quality of falls risk perception measures for adults in a hospital setting. This review was conducted using the Consensus-based Standards for the selection of health Measurement Instruments guidelines and provides a comprehensive summary of these instruments, including psychometric properties, feasibility and clinical recommendations for their use. The review followed a prospectively registered protocol, in which a total of ten databases were searched between the years 2002 and 2022. Studies were included if the instruments measured falls risk perception and/or other psychological falls constructs, if they were conducted in a hospital setting and if the target population contained hospital inpatients. A total of 18 studies met the inclusion criteria, encompassing 20 falls risk perception measures. These falls risk perception instruments were grouped into five falls-related constructs: Balance Confidence, Falls Efficacy/Concern, Fear of Falling, Self-Awareness and Behaviour/Intention. Two of the patient reported outcome measures (PROMs) received Class A recommendations (Falls Risk Perception Questionnaire and the Spinal Cord Injury-Falls Concern Scale); however, this rating is only applicable for the populations/context described in the studies. Thirteen PROMs received Class B recommendations, solidifying the need for further validation studies of these PROMs.
Topics: Adult; Humans; Accidental Falls; Fear; Surveys and Questionnaires; Psychometrics; Consensus
PubMed: 37358752
DOI: 10.1186/s41687-023-00603-w -
The Journal of Nutrition, Health & Aging 2023There is little evidence in the literature about the relationship between frailty and falls in older adults. Our objective was to explore the relationship between... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
There is little evidence in the literature about the relationship between frailty and falls in older adults. Our objective was to explore the relationship between frailty and falls, and to analyze the effect factors (e.g., gender, different frailty assessment tools, areas, level of national economic development, and year of publication) of the association between frailty and falls among older adults.
DESIGN
Systematic review and meta-analysis.
SETTING AND PARTICIPANTS
Cohort studies that evaluated the association between frailty and falls in the older adults were included. We excluded any literature outside of cohort studies.
METHODS
We did a systematic literature search of English databases PubMed, Scopus, Web of Science, EBSCOhost, and SciElO, as well as the Chinese databases CNKI, WANFANG, and VIP from 2001 until October 2022. The eligible studies were evaluated for potential bias using the Newcastle-Ottawa Scale (NOS). Study selection, data extraction and assessment of study quality were each conducted by two investigators. In Stata/MP 17.0 software, we calculated pooled estimates of the prevalence of falls by using a random-effects model, Subgroup analysis was conducted based on gender, different frailty assessment tools, areas, level of economic development, and year of publication. The results are presented using a forest plot.
RESULTS
Twenty-nine studies were included in this meta-analysis and a total of 1,093,270 participants aged 65 years and above were enrolled. Among the older adults, frailty was significantly associated with a higher risk for falls, compared with those without frailty (combined RR-relative risk = 1.48, 95% CI-confidence interval: 1.27-1.73, I2=98.9%). In addition, the results of subgroup analysis indicated that men had a higher risk for falls than women among the older adults with frailty (RR 1.94, 95% CI: 1.18-3.2 versus RR 1.44, 95% CI: 1.24-1.67). Subgroup analysis by different frailty assessment tools revealed an increased risk of falls in older adults with frailty when assessed using the Frailty Phenotype (combined RR 1.32, 95%CI: 1.17-1.48), FRAIL score (combined RR 1.82, 95%CI: 1.36-2.43), and Study of Osteoporotic Fractures index (combined RR 1.54, 95%CI: 1.10-2.16). Furthermore, subgroup analysis by areas and level of national economic development found the highest fall risk in Oceania (combined RR 2.35, 95%CI: 2.28-2.43) and the lowest in Europe (combined RR 1.20, 95%CI: 1.05-1.38). Developed countries exhibited a lower fall risk compared to developing countries (combined RR 1.44, 95%CI: 1.21-1.71). Analysis by year of publication showed the highest fall risk between 2013-2019 (combined RR 1.79, 95%CI: 1.45-2.20) and the lowest between 2001-2013 (combined RR 1.21, 95%CI: 1.13-1.29).
CONCLUSION
Frailty represents a significant risk factor for falls in older adults, with the degree of risk varying according to the different frailty assessment tools employed, and notably highest when using the FRAIL scale. Additionally, factors such as gender, areas, level of national economic development, and healthcare managers' understanding of frailty may all impact the correlation between frailty and falls. Thus, it's imperative to select suitable frailty diagnostic tools tailored to the specific characteristics of the population in question. This, in turn, facilitates the accurate identification of frailty in older adults and informs the development of appropriate preventive and therapeutic strategies to mitigate fall risk.
Topics: Female; Humans; Accidental Falls; Frailty; Risk Factors; Fractures, Bone; Cohort Studies
PubMed: 37357334
DOI: 10.1007/s12603-023-1935-8 -
Journal of Safety Research Jun 2023Globally, injuries are a leading cause of mortality and morbidity for adolescents, which disproportionately affect the disadvantaged. To build an investment case for...
INTRODUCTION
Globally, injuries are a leading cause of mortality and morbidity for adolescents, which disproportionately affect the disadvantaged. To build an investment case for adolescent injury prevention, evidence is needed as to effective interventions.
METHODS
A systematic review of peer-reviewed original research published between 2010-2022 was conducted. CINAHL, Cochrane Central, Embase, Medline and PsycINFO databases were searched for studies reporting the effectiveness of unintentional injury prevention interventions for adolescents (10-24 years), with assessment of study quality and equity (e.g., age, gender, ethnicity, socio-economic status).
RESULTS
Sixty-two studies were included; 59 (95.2%) from high-income countries (HIC). Thirty-eight studies (61.3%) reported no aspect of equity. Thirty-six studies (58.1%) reported prevention of sports injuries (commonly neuromuscular training often focused on soccer-related injuries, rule changes and protective equipment). Twenty-one studies (33.9%) reported prevention of road traffic injury, with legislative approaches, commonly graduated driver licensing schemes, found to be effective in reducing fatal and nonfatal road traffic injury. Seven studies reported interventions for other unintentional injuries (e.g., falls).
DISCUSSION
Interventions were strongly biased towards HIC, which does not reflect the global distribution of adolescent injury burden. Low consideration of equity in included studies indicates current evidence largely excludes adolescent populations at increased risk of injury. A large proportion of studies evaluated interventions to prevent sports injury, a prevalent yet low severity injury mechanism. Findings highlight the importance of education and enforcement alongside legislative approaches for preventing adolescent transport injuries. Despite drowning being a leading cause of injury-related harm among adolescents, no interventions were identified.
CONCLUSION
This review provides evidence to support investment in effective adolescent injury prevention interventions. Further evidence of effectiveness is needed, especially for low- and middle-income countries, populations at increased risk of injury who would benefit from greater consideration of equity and for high lethality injury mechanisms like drowning.
Topics: Adolescent; Humans; Drowning; Automobile Driving; Licensure; Accidental Injuries; Athletic Injuries
PubMed: 37330882
DOI: 10.1016/j.jsr.2023.03.005 -
Sports Health 2024Home-based exercise programs are a good strategy to promote benefits to health for people who cannot visit gyms, clinics, or have limited time for physical activity... (Review)
Review
CONTEXT
Home-based exercise programs are a good strategy to promote benefits to health for people who cannot visit gyms, clinics, or have limited time for physical activity outside.
OBJECTIVE
To synthesize the effect of home-based indoor physical activity on psychosocial outcomes and mobility in community-dwelling older adults.
DATA SOURCES
A comprehensive search was conducted in the MEDLINE, PubMed, Embase, SPORTDiscus, Cochrane Library, Scopus, and Google Scholar databases.
STUDY SELECTION
A total of 11 studies (13 publications) were included involving a total of 1004 older adults.
STUDY DESIGN
A systematic review of randomized controlled trials was conducted using the aforementioned 7 databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.
LEVEL OF EVIDENCE
Level 2.
DATA EXTRACTION
Two authors independently selected studies, extracted data, and determined the risk of bias and evidence level using the Grading quality of evidence and strength of recommendations (GRADE) guidelines. We conducted a synthesis without meta-analysis (SWiM) to assess the outcome.
RESULTS
There is moderately certain evidence that home-based exercise programs reduced the fear of falling. Psychosocial (mental health and quality of life) and mobility outcomes may improve after participating in the intervention inside the home.
CONCLUSION
The review found very low to certain evidence that home-based exercises programs improved psychosocial outcomes (mental health and quality of life) and walking speed (mobility). Moderately certain evidence suggests that home-based exercises improved fear of falling.
PROTOCOL REGISTER NUMBER
CRD42020182008.
Topics: Humans; Aged; Accidental Falls; Quality of Life; Independent Living; Fear; Swimming
PubMed: 37329120
DOI: 10.1177/19417381231175665 -
Geriatric Nursing (New York, N.Y.) 2023Diuretic intake increases the risk of falling. However, previous studies have shown inconsistent correlations between diuretics and falls. This meta-analysis aimed to... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Diuretic intake increases the risk of falling. However, previous studies have shown inconsistent correlations between diuretics and falls. This meta-analysis aimed to provide a comprehensive overview of the relationship between diuretic use and risk of falls in older adult individuals.
METHODS
Six databases (Cochrane Library, PubMed, Medline, CINAHL, Web of Science, and EMBASE) were searched from their inception to November 9, 2022. The risk of bias was independently evaluated using the Newcastle-Ottawa Quality Assessment Scale. A comprehensive meta-analysis was used to analyze the eligible studies.
RESULTS
Fifteen articles were analyzed. Studies have shown that diuretics can increase the risk of falls in older adult individuals. The probability of falls in older adult individuals who used diuretics was 1.185 times higher than in those who did not take diuretics.
CONCLUSION
Diuretics were significantly associated with an increased risk of falls.
Topics: Humans; Aged; Accidental Falls; Diuretics; Risk Factors; Bias
PubMed: 37290215
DOI: 10.1016/j.gerinurse.2023.05.009 -
BMC Geriatrics May 2023This study systematically reviewed injury death and causes in the elderly population in China from 2000 to 2020, to prevent or reduce the occurrence of injuries and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This study systematically reviewed injury death and causes in the elderly population in China from 2000 to 2020, to prevent or reduce the occurrence of injuries and death.
METHODS
The CNKI, VIP, Wan Fang, MEDLINE, Embase, SinoMed, and Web of Science databases were searched to collect epidemiological characteristics of injury death among elderly over 60 years old in China from January 2000 to December 2020. Random effects meta-analysis was performed to pool injury mortality rate and identify publication bias, with study quality assessed using the AHRQ risk of bias tool.
RESULTS
(1) A total of 41 studies with 187 488 subjects were included, covering 125 million elderly. The pooled injury mortality rate was 135.58/10 [95%CI: (113.36 to 162.14)/10], ranking second in the total death cause of the elderly. (2)Subgroup analysis showed that male injury death (146.00/10) was significantly higher than that of females (127.90/10), and overall injury mortality increased exponentially with age (R = 0.957), especially in those over 80 years old; the spatial distribution shows that the injury death rate in the central region is higher than that in the east and west and that in the countryside is higher than that in the city; the distribution of death time shows that after entering an aging society (2000-2020) is significantly higher than before (1990-2000). (3) There are more than 12 types of injury death, and the top three are falling, traffic accidents, and suicide.
CONCLUSIONS
China's elderly injury death rate is at a high level in the world, with more males than females, especially after the age of 80. There are regional differences. The main types of injury death are falling, traffic, and suicide. During the 14th Five-Year Plan period, for accidental injuries and death, a rectification list for aging and barrier-free environments was issued.
PROSPERO REGISTRATION
The systematic review was registered in PROSPERO under protocol number CRD42022359992.
Topics: Aged; Aged, 80 and over; Female; Humans; Male; Accidents, Traffic; Big Data; China; East Asian People; Prevalence; Accidental Falls; Suicide, Completed
PubMed: 37259039
DOI: 10.1186/s12877-023-04056-0 -
Age and Ageing May 2023The 16-item Falls Efficacy Scale International (FES-I) is widely used to assess concerns-about-falling. Variants include 7-item Short FES-I, 30-item Iconographical Falls... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The 16-item Falls Efficacy Scale International (FES-I) is widely used to assess concerns-about-falling. Variants include 7-item Short FES-I, 30-item Iconographical Falls Efficacy Scale (Icon FES) and 10-item short Icon FES. No comprehensive systematic review and meta-analysis has been conducted to synthesise evidence regarding the measurement properties of these tools.
OBJECTIVES
To conduct a systematic review and meta-analysis of the measurement properties of four FES-I variants.
METHODS
MEDLINE, Embase, CINAHL Plus, PsycINFO and Web of Science were searched systematically and articles were assessed for eligibility independently. The methodological quality of eligible studies was assessed using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. The quality of measurement properties was assessed using COSMIN criteria for good measurement properties. Where possible, meta-analysis was conducted; otherwise, narrative synthesis was performed. Overall certainty of evidence was rated using a modified Grading of Recommendations, Assessment, Development and Evaluation system approach.
RESULTS
The review included 58 studies investigating measurement properties of the four instruments. There was high-quality evidence to support internal consistency, reliability and construct validity of all instruments. Moderate- to high-certainty evidence suggests one-factor structure of FES-I with two underlying dimensions, one-factor structure of Short FES-I and two-factor structure of Icon FES. There was high-certainty evidence to support the responsiveness of FES-I, with further research needed for the other instruments.
CONCLUSION
There is evidence for excellent measurement properties of all four instruments. We recommend the use of these tools with healthy older people and people at a greater risk of falls due to conditions that might affect mobility and balance.
Topics: Humans; Aged; Accidental Falls; Psychometrics; Reproducibility of Results; Health Status; Checklist
PubMed: 37211363
DOI: 10.1093/ageing/afad055