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Physical Therapy Jul 2020Falls are the leading cause of injuries among older adults, and trips and slips are major contributors to falls. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Falls are the leading cause of injuries among older adults, and trips and slips are major contributors to falls.
OBJECTIVE
The authors sought to compare the effectiveness of adding a component of surface perturbation training to usual gait/balance training for reducing falls and fall-related injury in high-risk older adults referred to physical therapy.
DESIGN
This was a multi-center, pragmatic, randomized, comparative effectiveness trial.
SETTING
Treatment took place within 8 outpatient physical therapy clinics.
PATIENTS
This study included 506 patients 65+ years of age at high fall risk referred for gait/balance training.
INTERVENTION
This trial evaluated surface perturbation treadmill training integrated into usual multimodal exercise-based balance training at the therapist's discretion versus usual multimodal exercise-based balance training alone.
MEASUREMENTS
Falls and injurious falls were assessed with a prospective daily fall diary, which was reviewed via telephone interview every 3 months for 1 year.A total of 211/253 (83%) patients randomized to perturbation training and 210/253 (83%) randomized to usual treatment provided data at 3-month follow-up. At 3 months, the perturbation training group had a significantly reduced chance of fall-related injury (5.7% versus 13.3%; relative risk 0.43) but no significant reduction in the risk of any fall (28% versus 37%, relative risk 0.78) compared with usual treatment. Time to first injurious fall showed reduced hazard in the first 3 months but no significant reduction when viewed over the entire first year.
LIMITATIONS
The limitations of this trial included lack of blinding and variable application of interventions across patients based on pragmatic study design.
CONCLUSION
The addition of some surface perturbation training to usual physical therapy significantly reduced injurious falls up to 3 months posttreatment. Further study is warranted to determine the optimal frequency, dose, progression, and duration of surface perturbation aimed at training postural responses for this population.
Topics: Accidental Falls; Aged; Exercise Therapy; Female; Gait; Humans; Male; Physical Therapy Modalities; Postural Balance
PubMed: 31998949
DOI: 10.1093/ptj/pzaa023 -
The New England Journal of Medicine Jul 2020Injuries from falls are major contributors to complications and death in older adults. Despite evidence from efficacy trials that many falls can be prevented, rates of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Injuries from falls are major contributors to complications and death in older adults. Despite evidence from efficacy trials that many falls can be prevented, rates of falls resulting in injury have not declined.
METHODS
We conducted a pragmatic, cluster-randomized trial to evaluate the effectiveness of a multifactorial intervention that included risk assessment and individualized plans, administered by specially trained nurses, to prevent fall injuries. A total of 86 primary care practices across 10 health care systems were randomly assigned to the intervention or to enhanced usual care (the control) (43 practices each). The participants were community-dwelling adults, 70 years of age or older, who were at increased risk for fall injuries. The primary outcome, assessed in a time-to-event analysis, was the first serious fall injury, adjudicated with the use of participant report, electronic health records, and claims data. We hypothesized that the event rate would be lower by 20% in the intervention group than in the control group.
RESULTS
The demographic and baseline characteristics of the participants were similar in the intervention group (2802 participants) and the control group (2649 participants); the mean age was 80 years, and 62.0% of the participants were women. The rate of a first adjudicated serious fall injury did not differ significantly between the groups, as assessed in a time-to-first-event analysis (events per 100 person-years of follow-up, 4.9 in the intervention group and 5.3 in the control group; hazard ratio, 0.92; 95% confidence interval [CI], 0.80 to 1.06; P = 0.25). The rate of a first participant-reported fall injury was 25.6 events per 100 person-years of follow-up in the intervention group and 28.6 events per 100 person-years of follow-up in the control group (hazard ratio, 0.90; 95% CI, 0.83 to 0.99; P = 0.004). The rates of hospitalization or death were similar in the two groups.
CONCLUSIONS
A multifactorial intervention, administered by nurses, did not result in a significantly lower rate of a first adjudicated serious fall injury than enhanced usual care. (Funded by the Patient-Centered Outcomes Research Institute and others; STRIDE ClinicalTrials.gov number, NCT02475850.).
Topics: Accidental Falls; Accidental Injuries; Aged; Aged, 80 and over; Female; Hospitalization; Humans; Incidence; Independent Living; Male; Patient Care Management; Precision Medicine; Risk Assessment; Risk Factors
PubMed: 32640131
DOI: 10.1056/NEJMoa2002183 -
Frontiers in Public Health 2023Documentation is an important measure for the management of fall risk because it concentrates the attention of professionals, raises awareness of the existence of fall... (Review)
Review
Documentation is an important measure for the management of fall risk because it concentrates the attention of professionals, raises awareness of the existence of fall risk factors, and promotes action to eliminate or minimize them. This study aimed to map the evidence on information to document episodes of falls in older adults. We opted for a scoping review, which followed the Joanna Briggs Institute protocol for this kind of study. The research question that guided the research strategy was "What recommendations emerge from the research on the documentation of falls of the older person?" The inclusion criteria defined were older adults who had at least one fall; nursing documentation after a fall has occurred; and nursing homes, hospitals, community, and long-term care. The search was performed on the following platforms: MEDLINE, CINAHL, Scopus, and Cochrane Database of Systematic Reviews in January 2022 and allowed the identification of 854 articles, which after analysis resulted in a final sample of six articles. The documentation of fall episodes should answer the following questions: Who? What? When? Where? How? Doing what? What was said? What were the consequences? and What has been done? Despite the recommendations for the documentation of fall episodes as a preventive measure for their recurrence, there are no studies evaluating the cost-effectiveness of this measure. Future studies should explore the association between fall documentation, fall recurrence prevention programs, and their impact on the prevalence rate of the second and subsequent falls, as well as the severity of injuries and fear of falling.
Topics: Aged; Humans; Accidental Falls; Fear; Hospitals; Risk Factors; Systematic Reviews as Topic
PubMed: 37200991
DOI: 10.3389/fpubh.2023.1067243 -
Sensors (Basel, Switzerland) Jul 2014Falls and fall-related injuries are major incidents, especially for elderly people, which often mark the onset of major deterioration of health. More than one-third of... (Review)
Review
Falls and fall-related injuries are major incidents, especially for elderly people, which often mark the onset of major deterioration of health. More than one-third of home-dwelling people aged 65 or above and two-thirds of those in residential care fall once or more each year. Reliable fall detection, as well as prevention, is an important research topic for monitoring elderly living alone in residential or hospital units. The aim of this study is to review the existing fall detection systems and some of the key research challenges faced by the research community in this field. We categorize the existing platforms into two groups: wearable and ambient devices; the classification methods are divided into rule-based and machine learning techniques. The relative merit and potential drawbacks are discussed, and we also outline some of the outstanding research challenges that emerging new platforms need to address.
Topics: Accidental Falls; Accidents, Home; Aged; Environment Design; Humans
PubMed: 25046016
DOI: 10.3390/s140712900 -
Chinese Journal of Traumatology =... Mar 2021Trauma has been called the neglected disease of modern society. According to WHO, fall is the second major cause of trauma or deaths resulting from unintentional...
PURPOSE
Trauma has been called the neglected disease of modern society. According to WHO, fall is the second major cause of trauma or deaths resulting from unintentional accidents. The aim of this study was to investigate the different types of fall according to International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) in hospitalized patients visiting specialized accident and trauma hospitals of Mashhad, Iran.
METHODS
This was a cross sectional retrospective study performed between March 20, 2013 and March 20, 2014. The research population consisted of all medical records of patients for fall injuries in three specialized accident and trauma hospitals. ICD-10 was adopted to categorize all types of falls (w00-w19). The results obtained were analyzed by SPSS 16.
RESULTS
Altogether 7,448 cases were included. The codes w18 (fall on same level) and w09 (fall involving playground equipment) with the frequencies of 1,856 and 1,303, respectively in both genders had the maximum number of falls. The maximum percentage of mortality has been related to "fall on and from ladder"," fall from cliff "and "fall on same level involving ice and snow".
CONCLUSION
As falls can cause irrecoverable injuries including mortality of people, thus health authorities and policymakers should take preventive measures given the causes of falls and the root of this type of injuries, so that the costs resulting from this cause and its injuries can be reduced.
Topics: Accidental Falls; Accidental Injuries; Adolescent; Adult; Aged; Cross-Sectional Studies; Female; Hospitalization; Humans; International Classification of Diseases; Iran; Male; Middle Aged; Retrospective Studies; Young Adult
PubMed: 33622588
DOI: 10.1016/j.cjtee.2021.01.001 -
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 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Feb 2021With the aging of population structure, the age-related balance dysfunction increases gradually, and the injuries related fall are increasing, which cause a serious... (Review)
Review
With the aging of population structure, the age-related balance dysfunction increases gradually, and the injuries related fall are increasing, which cause a serious social and economic burden. In addition, dizziness or vertigo is very common clinically, and these patients also have a higher risk of falling. In order to reduce the incidence of falls, targeted prevention measures are urgently needed. In this paper, the risk assessment, preventive measures and rehabilitation strategies of falls are systematically expounded, it is hoped that it will be helpful for the prevention and treatment of falls.
Topics: Accidental Falls; Aging; Dizziness; Humans; Postural Balance; Vertigo
PubMed: 33540989
DOI: 10.13201/j.issn.2096-7993.2021.02.004 -
Tremor and Other Hyperkinetic Movements... 2022The significance of falls and their repercussions in Parkinson's disease has been extensively researched. However, despite potentially serious effects on health and... (Review)
Review
BACKGROUND
The significance of falls and their repercussions in Parkinson's disease has been extensively researched. However, despite potentially serious effects on health and quality of life and negative impact on the healthcare system, there is not a sufficient understanding of the role of falls in hyperkinetic movement disorders (HKMDs). This review aims to provide an overview of the prevalence of falls, injuries, and preventive measures in the most common HKMDs.
METHODS
Studies up to May 1, 2022 were searched in PubMed using Medical Subjects Headings of relatively prevalent HKMDs associated with the terms "accidental falls", "injuries", "fractures", and "accident prevention".
RESULTS
In our review of 37 studies out of 155, we found evidence that for several HKMDs, such as spinocerebellar ataxia, essential tremor, Huntington's disease, and dystonia, fall risk is increased. Falls were reported in up to 84% of spinocerebellar ataxia patients, 59% of essential tremor patients, and 79% of Huntington's patients, with 65% of the latter falling frequently. Injuries occurred in up to 73% in Huntington and 74% in ataxia patients. Most of the common diseases characterized by HKMDs were investigated for both fall causes and consequences, but prevention studies were limited to spinocerebellar ataxia and Huntington's disease.
DISCUSSION
The limited available data suggest that patients with several HKMDs can be considered to be at increased risk of falling and that the consequences can be serious. As a result, physicians should be advised to include fall exploration in their routine workup and provide advice for safer mobility. In general, more research into fall-related concerns in HKMDs is necessary.
HIGHLIGHTS
In contrast to Parkinson's disease, the prevalence of accidental falls, their repercussions, and preventive strategies are under-investigated in hyperkinetic movement disorders (HKMDs). Several HKMDs such as essential tremor, ataxia, and Huntington's disease have reported fall rates of up to 84% and fall-related injury rates of up to 74%. Therefore, routine examinations of HKMD patients should include a fall exploration and provide advice on safe mobility.
Topics: Humans; Accidental Falls; Essential Tremor; Parkinson Disease; Huntington Disease; Hyperkinesis; Quality of Life; Ataxia; Spinocerebellar Ataxias
PubMed: 36303814
DOI: 10.5334/tohm.709 -
International Journal of Environmental... May 2021Falls account for a high proportion of the safety accidents experienced by hospitalized children. This study aims to analyze the contents and effects of fall prevention... (Meta-Analysis)
Meta-Analysis Review
Falls account for a high proportion of the safety accidents experienced by hospitalized children. This study aims to analyze the contents and effects of fall prevention programs for pediatric inpatients to develop more adaptable fall prevention programs. A literature search was performed using PubMed (including Medline), Science Direct, CINAHL, Embase, and Cochrane. We included articles published from the inception of each of the databases up to 31 March 2019. A total of 1725 results were reviewed according to the inclusion and exclusion criteria, and nine studies were selected. Data were analyzed using descriptive statistics and the Comprehensive Meta-Analysis program. Four of the nine studies divided their participants into a high-risk fall group and a low-or medium-risk fall group, and all studies used a high-risk sign/sticker as a common protocol guideline for its high-risk fall group. The odds ratio of 0.95 (95% Cl 0.550-1.640) for the fall prevention program in seven studies was not statistically significant. To develop a standardized fall prevention program in the future, randomized control trial studies that can objectively measure the fall rate reduction effect of the integrated fall prevention program need to be expanded.
Topics: Accidental Falls; Child; Humans; Inpatients; Randomized Controlled Trials as Topic
PubMed: 34072495
DOI: 10.3390/ijerph18115853 -
Journal of Applied Gerontology : the... Jul 2019The purpose of this study was to document results of State funded fall prevention clinics on rates of self-reported falls and fall-related use of health services.
PURPOSE
The purpose of this study was to document results of State funded fall prevention clinics on rates of self-reported falls and fall-related use of health services.
METHODS
Older adults participated in community-based fall prevention clinics providing individual assessments, interventions, and referrals to collaborating community providers. A pre-post design compares self-reported 6-month fall history and fall-related use of health care before and after clinic attendance.
RESULTS
Participants ( N = 751) were predominantly female (82%) averaging 81 years of age reporting vision (75%) and mobility (57%) difficulties. Assessments revealed polypharmacy (54%), moderate- to high-risk mobility issues (39%), and postural hypotension (10%). Self-reported preclinic fall rates were 256/751(34%) and postclinic rates were 81/751 (10.8%), ( p = .0001). Reported use of fall-related health services, including hospitalization, was also significantly lower after intervention.
IMPLICATIONS
Evidence-based assessments, risk-reducing recommendations, and referrals that include convenient exercise opportunities may reduce falls and utilization of health care services. Estimates regarding health care spending and policy are presented.
Topics: Accidental Falls; Accidents, Home; Aged; Aged, 80 and over; Community Health Services; Evidence-Based Practice; Exercise; Female; Health Care Costs; Hospitalization; Humans; Independent Living; Male; Middle Aged; Self Report
PubMed: 28737101
DOI: 10.1177/0733464817721113