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JAMA Jun 2019Whether exercise reduces subsequent falls in high-risk older adults who have already experienced a fall is unknown. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Whether exercise reduces subsequent falls in high-risk older adults who have already experienced a fall is unknown.
OBJECTIVE
To assess the effect of a home-based exercise program as a fall prevention strategy in older adults who were referred to a fall prevention clinic after an index fall.
DESIGN, SETTING, AND PARTICIPANTS
A 12-month, single-blind, randomized clinical trial conducted from April 22, 2009, to June 5, 2018, among adults aged at least 70 years who had a fall within the past 12 months and were recruited from a fall prevention clinic.
INTERVENTIONS
Participants were randomized to receive usual care plus a home-based strength and balance retraining exercise program delivered by a physical therapist (intervention group; n = 173) or usual care, consisting of fall prevention care provided by a geriatrician (usual care group; n = 172). Both were provided for 12 months.
MAIN OUTCOMES AND MEASURES
The primary outcome was self-reported number of falls over 12 months. Adverse event data were collected in the exercise group only and consisted of falls, injuries, or muscle soreness related to the exercise intervention.
RESULTS
Among 345 randomized patients (mean age, 81.6 [SD, 6.1] years; 67% women), 296 (86%) completed the trial. During a mean follow-up of 338 (SD, 81) days, a total of 236 falls occurred among 172 participants in the exercise group vs 366 falls among 172 participants in the usual care group. Estimated incidence rates of falls per person-year were 1.4 (95% CI, 0.1-2.0) vs 2.1 (95% CI, 0.1-3.2), respectively. The absolute difference in fall incidence was 0.74 (95% CI, 0.04-1.78; P = .006) falls per person-year and the incident rate ratio was 0.64 (95% CI, 0.46-0.90; P = .009). No adverse events related to the intervention were reported.
CONCLUSIONS AND RELEVANCE
Among older adults receiving care at a fall prevention clinic after a fall, a home-based strength and balance retraining exercise program significantly reduced the rate of subsequent falls compared with usual care provided by a geriatrician. These findings support the use of this home-based exercise program for secondary fall prevention but require replication in other clinical settings.
TRIAL REGISTRATION
ClinicalTrials.gov Identifiers: NCT01029171; NCT00323596.
Topics: Accidental Falls; Aged; Aged, 80 and over; Exercise Therapy; Female; Follow-Up Studies; Humans; Independent Living; Male; Postural Balance; Resistance Training; Secondary Prevention; Single-Blind Method
PubMed: 31162569
DOI: 10.1001/jama.2019.5795 -
American Family Physician Apr 2000Falls are the leading cause of injury-related visits to emergency departments in the United States and the primary etiology of accidental deaths in persons over the age... (Review)
Review
Falls are the leading cause of injury-related visits to emergency departments in the United States and the primary etiology of accidental deaths in persons over the age of 65 years. The mortality rate for falls increases dramatically with age in both sexes and in all racial and ethnic groups, with falls accounting for 70 percent of accidental deaths in persons 75 years of age and older. Falls can be markers of poor health and declining function, and they are often associated with significant morbidity. More than 90 percent of hip fractures occur as a result of falls, with most of these fractures occurring in persons over 70 years of age. One third of community-dwelling elderly persons and 60 percent of nursing home residents fall each year. Risk factors for falls in the elderly include increasing age, medication use, cognitive impairment and sensory deficits. Outpatient evaluation of a patient who has fallen includes a focused history with an emphasis on medications, a directed physical examination and simple tests of postural control and overall physical function. Treatment is directed at the underlying cause of the fall and can return the patient to baseline function.
Topics: Accidental Falls; Aged; Humans; Patient Education as Topic; Risk Factors; Teaching Materials
PubMed: 10779256
DOI: No ID Found -
Singapore Medical Journal Mar 2020One in three community-dwelling elderly aged ≥ 65 years and one in two aged > 80 years will have at least one fall within a year. Many elderly people are 'silent...
One in three community-dwelling elderly aged ≥ 65 years and one in two aged > 80 years will have at least one fall within a year. Many elderly people are 'silent fallers' who do not report the fall nor seek medical assistance unless they are injured. In Singapore, falls account for 40% of injury-related deaths. Unaddressed risk factors for falls lead to recurrent falls and poor quality of life. Elderly people who have experienced falls and near falls can have a fear of falling, post-fall anxiety syndrome, depression and reduction in activities, with a negative impact on their well-being. Primary care doctors can screen and optimise modifiable risk factors such as poor vision, balance, poor gait, motor weakness, joint disorders, psychotropic drugs, sedatives, anti-hypertension medications, choice of footwear and environment factors. Timely referrals for cataract operations, balance and strengthening exercises, and osteoporosis treatment can reduce the risk of falls and injurious outcomes.
Topics: Accidental Falls; Aged; Aged, 80 and over; Female; Humans; Independent Living; Male; Primary Health Care; Referral and Consultation; Risk Factors; Singapore
PubMed: 32488276
DOI: 10.11622/smedj.2020029 -
Frontiers in Public Health 2022This study aims to clarify the risk factors for falls to prevent severe consequences in older adults. (Meta-Analysis)
Meta-Analysis
AIM
This study aims to clarify the risk factors for falls to prevent severe consequences in older adults.
METHODS
We searched the PubMed, Web of Science, Embase, and Google Scholar databases using the terms "risk factors" OR "predicting factors" OR "predictor" AND "fall" OR "drop" to identify all relevant studies and compare their results. The study participants were divided into two groups, the "fall group" and the "control group", and differences in demographic characteristics, lifestyles, and comorbidities were compared.
RESULTS
We included 34 articles in the analysis and analyzed 22 factors. Older age, lower education level, polypharmacy, malnutrition, living alone, living in an urban area, smoking, and alcohol consumption increased the risk of falls in the aging population. Additionally, comorbidities such as cardiac disease, hypertension, diabetes, stroke, frailty, previous history of falls, depression, Parkinson's disease, and pain increased the risk of falls.
CONCLUSION
Demographic characteristics, comorbidities, and lifestyle factors can influence the risk of falls and should be taken into consideration.
Topics: Aged; Humans; Accidental Falls; Aging; Frailty; Hypertension; Risk Factors
PubMed: 36324472
DOI: 10.3389/fpubh.2022.902599 -
Clinics in Geriatric Medicine May 2019Falls in hospitalized patients are a pressing patient safety concern, but there is a limited body of evidence demonstrating the effectiveness of commonly used fall... (Review)
Review
Falls in hospitalized patients are a pressing patient safety concern, but there is a limited body of evidence demonstrating the effectiveness of commonly used fall prevention interventions in hospitals. This article reviews common study designs and the evidence for various hospital fall prevention interventions. There is a need for more rigorous research on fall prevention in the hospital setting.
Topics: Accident Prevention; Accidental Falls; Aged; Aged, 80 and over; Geriatric Assessment; Hospitalization; Humans; Patient Safety; Risk Assessment
PubMed: 30929888
DOI: 10.1016/j.cger.2019.01.007 -
Revista Gaucha de Enfermagem Feb 2017To identify the risk factors for falls of the community-dwelling elderly in order to update the Taxonomy II of NANDA International. (Review)
Review
OBJECTIVE
To identify the risk factors for falls of the community-dwelling elderly in order to update the Taxonomy II of NANDA International.
METHOD
A systematic literature review based on research using the following platforms: EBSCOHost®, CINAHL and MEDLINE, from December 2010 to December 2014. The descriptors used were (Fall* OR Accidental Fall) AND (Community Dwelling OR Community Health Services OR Primary health care) AND (Risk OR Risk Assessment OR Fall Risk Factors) AND (Fall* OR Accidental Fall) AND (Community Dwelling OR older) AND Nurs* AND Fall Risk Factors.
RESULTS
The sample comprised 62 studies and 50 risk factors have been identified. Of these risk factors, only 38 are already listed in the classification.
CONCLUSIONS
Two new categories of risk factors are proposed: psychological and socio-economical. New fall risk factors for the community-dwelling elderly have been identified, which can contribute to the updating of this nursing diagnosis of the Taxonomy II of NANDA International.
Topics: Accidental Falls; Aged; Humans; Independent Living; Risk Factors
PubMed: 28273251
DOI: 10.1590/1983-1447.2016.04.55030 -
Revista Brasileira de Enfermagem 2021to identify scientific productions on nursing care related to fall risk prevention among hospitalized elderly people. (Review)
Review
OBJECTIVE
to identify scientific productions on nursing care related to fall risk prevention among hospitalized elderly people.
METHODS
an integrative literature review from 2015 to 2019 in the PubMed/MEDLINE, Scopus, Web of Science, LILACS, BDENF, SciELO and CINAHL databases, in Portuguese, English and Spanish. The keywords were elderly, hospitalization, accidents due to falls, nursing care.
RESULTS
thirty-three publications were analyzed. The synthesis of the studies resulted in the categories: Clinical nursing assessments to prevent falls among hospitalized elderly people; Fall risk factors for elderly people; Fall risk prevention strategies for elderly people.
FINAL CONSIDERATIONS
it was found that the scientific knowledge produced on nursing care related to fall risk prevention for hospitalized elderly people evidences the clinical assessment, risk factors and strategies such as nursing care, contributing to foster self-care behavior and promotion security for elderly people.
Topics: Accidental Falls; Aged; Hospitalization; Humans; Nursing Care; Risk Factors
PubMed: 34231780
DOI: 10.1590/0034-7167-2020-0904 -
Wounds : a Compendium of Clinical... Oct 2019Falls are the leading cause of injury, premature institutionalization, and long-term disability in elderly adults worldwide, with a fall-related fatality in the United... (Observational Study)
Observational Study
Falls are the leading cause of injury, premature institutionalization, and long-term disability in elderly adults worldwide, with a fall-related fatality in the United States every 19 minutes.1 According to the Centers for Disease Control and Prevention,2 3 million people over 65 years of age receive emergency room treatment for fall injuries at an average cost of $30 000. The annual cost of fall injuries was more than $50 billion in 2015.1,2 Community-based interventions effective in preventing falls include exercise, medication, and nutritional management as well as improving safety of the local environment.3 Evidence supporting interventions designed to reduce hospital inpatient falls is less clear despite considerable research aimed at reducing this growing problem. Those injured due to falling during a hospital stay incur higher costs, including a 6-day longer hospital stay, than non-fallers.4 Programs have worked to prevent other "never events," such as wound infections or pressure ulcers, but mixed results have been reported for preventing falls or fall-related injuries in hospitals. This month's Evidence Corner reviews a randomized controlled trial (RCT)5 and a prospective observational study6 that offer important clues on how to prevent hospital inpatient falls.
Topics: Accidental Falls; Accidents, Home; Aged; Aged, 80 and over; Cost-Benefit Analysis; Decision Trees; Environment Design; Exercise; Humans; Independent Living; Patient Education as Topic; Prospective Studies; Randomized Controlled Trials as Topic; United States
PubMed: 31730506
DOI: No ID Found -
The Gerontologist Mar 2018Falls are common events for hospitalized older adults, resulting in negative outcomes both for patients and hospitals. The Center for Medicare and Medicaid (CMS) has...
PURPOSE OF THE STUDY
Falls are common events for hospitalized older adults, resulting in negative outcomes both for patients and hospitals. The Center for Medicare and Medicaid (CMS) has placed pressure on hospital administrators by identifying falls as a "never event", resulting in a zero falls goal for many hospitals. Staff nurses are responsible for providing direct care to patients and for meeting the hospital no falls goal. Little is known about the impact of "zero falls" on nurses, patients and the organization.
DESIGN AND METHODS
A qualitative study, using Grounded Dimensional Analysis (GDA) was conducted to explore nurses' experiences with fall prevention in hospital settings and the impact of those experiences on how nurses provide care to fall risk patients. Twenty-seven registered nurses and certified nursing assistants participated in in-depth interviews. Open, axial and selective coding was used to analyze data. A conceptual model which illustrates the impact of intense messaging from nursing administration to prevent patient falls on nurses, actions nurses take to address the message and the consequences to nurses, older adult patients and to the organization was developed.
RESULTS
Intense messaging from hospital administration to achieve zero falls resulted in nurses developing a fear of falls, protecting self and unit, and restricting fall risk patients as a way to stop messages and meet the hospital goal.
IMPLICATIONS
Results of this study identify unintended consequences of fall prevention message on nurses and older adult patients. Further research is needed understand how nurse care for fall risk patients.
Topics: Accidental Falls; Adolescent; Adult; Aged; Attitude of Health Personnel; Female; Hospitalization; Humans; Inpatients; Male; Nurse's Role; Nurses; Qualitative Research; Quality Improvement; Risk Management
PubMed: 28011591
DOI: 10.1093/geront/gnw156 -
Injury Prevention : Journal of the... Dec 2019To determine whether multifactorial falls prevention interventions are effective in preventing falls, fall injuries, emergency department (ED) re-presentations and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine whether multifactorial falls prevention interventions are effective in preventing falls, fall injuries, emergency department (ED) re-presentations and hospital admissions in older adults presenting to the ED with a fall.
DESIGN
Systematic review and meta-analyses of randomised controlled trials (RCTs).
DATA SOURCES
Four health-related electronic databases (Ovid MEDLINE, CINAHL, EMBASE, PEDro and The Cochrane Central Register of Controlled Trials) were searched (inception to June 2018).
STUDY SELECTION
RCTs of multifactorial falls prevention interventions targeting community-dwelling older adults ( ≥ 60 years) presenting to the ED with a fall with quantitative data on at least one review outcome.
DATA EXTRACTION
Two independent reviewers determined inclusion, assessed study quality and undertook data extraction, discrepancies resolved by a third.
DATA SYNTHESIS
12 studies involving 3986 participants, from six countries, were eligible for inclusion. Studies were of variable methodological quality. Multifactorial interventions were heterogeneous, though the majority included education, referral to healthcare services, home modifications, exercise and medication changes. Meta-analyses demonstrated no reduction in falls (rate ratio = 0.78; 95% CI: 0.58 to 1.05), number of fallers (risk ratio = 1.02; 95% CI: 0.88 to 1.18), rate of fractured neck of femur (risk ratio = 0.82; 95% CI: 0.53 to 1.25), fall-related ED presentations (rate ratio = 0.99; 95% CI: 0.84 to 1.16) or hospitalisations (rate ratio = 1.14; 95% CI: 0.69 to 1.89) with multifactorial falls prevention programmes.
CONCLUSIONS
There is insufficient evidence to support the use of multifactorial interventions to prevent falls or hospital utilisation in older people presenting to ED following a fall. Further research targeting this population group is required.
Topics: Accidental Falls; Accidents, Home; Aged; Aged, 80 and over; Emergency Service, Hospital; Environment Design; Hospitalization; Humans; Primary Prevention; Program Development; Program Evaluation; Randomized Controlled Trials as Topic; Risk Assessment; Secondary Prevention
PubMed: 31289112
DOI: 10.1136/injuryprev-2019-043214