Falls prevention activities among community-dwelling elderly in the Netherlands: A Delphi study

IntroductionThis study aimed to provide an overview of the current falls prevention activities in community-dwelling elderly with an increased risk of falling in the Netherlands. Therefore, we determined: a) how health professionals detect community-dwelling elderly with an increased risk of falling; b) which falls prevention activities are used by health professionals and why; c) how elderly can be stimulated to participate in falls prevention programs; and d) how to finance falls prevention.MethodsA two-round online Delphi study among health experts was conducted. The panel of experts (n = 125) consisted of community physiotherapists, community nurses, general practitioners, occupational therapists and geriatricians, from all over the Netherlands. The median and Inter Quartile Deviation (IQD) were reported for the questions with 5-point Likert scales, ranging from ‘least’ (1) to ‘most’ (5).ResultsRespectively 68% (n = 85/125) and 58% (n = 72/125) of the panel completely filled in the first and second round questionnaires. According to the panel, regular detection of fall risk of community-dwelling elderly with an increased risk of falling hardly takes place (median = 2 [hardly]; IQD = 1). Furthermore, these elderly are reluctant to participate in annual detection of fall risk (median = 3 [reluctant]; IQD = 1). According to 73% (n = 37/51) of the panel, 0–40% of the elderly with an increased risk of falling are referred to exercise programs. In general, the panel indicated that structural follow-up is often lacking. Namely, after one month (n = 21/43; 49%), three months (n = 24/42; 57%), and six months (n = 27/45; 60%) follow-up is never or hardly ever offered. Participation of elderly in falls prevention programs could be stimulated by a combination of measures. Should a combination of national health education, healthcare counseling, and removal of financial barriers be applied, 41–80% of the elderly is assumed to participate in falls prevention programs (n = 47/64; 73%). None of the panel members indicated full financing of falls prevention by the elderly. A number of individuals are considered key in falls prevention activities, such as the general practitioner, physiotherapist, and informal caregiver.ConclusionThis Delphi study showed clear directions for improving falls prevention activities and how to increase participation rates.     

Accidental falls,health-related quality of life and life satisfaction: A prospective study of the general elderly population

As the physical consequences of accidental falls in the elderly are well-researched, the long-term associations between falls and quality of life and related concepts are less known. The aim of this study was to prospectively examine the long-term relations between falls and health-related quality of life (HRQoL) and life satisfaction (LS) over six years in the general elderly population.     

Posturographic limits of stability can predict the increased risk of falls in elderly patients with instability?

Conclusions: There was a difference in average score of the sensory organization test (SOT) of the case group (elderly instability) compared to the control group (healthy subjects). Cases had worse scores on the limits of stability (LOS) than controls, but were only able to confirm statistically significant differences in the movement velocity.

Objective: To study the LOS of elderly patients with instability vs healthy subjects of the same age to try to explain the increased risk of falls in elderly patients with instability.

Methods: Fifty individuals ≥65 years, 30 cases (at least one of the next inclusion criteria: ≥1 fall in the last 12 months, >15?s or some support in the timed up and go test, composite <68 in SOT, ≥1 fall during production of the SOT) compared to 20 controls. Postural study: SOT and LOS, Smart Equitest Neurocom^® platform. Statistical analysis: t-Student test (p?Result: Mean value of overall balance: patients with instability =56% vs controls =77.1% (p p?=?0.029). The reaction time (cases =1217?s vs controls =1.077?s), excursion (56.95% vs 59.35%) and directional control (56.95% vs 59.35%) differences were not statistically significant.     

Footlift asymmetry during obstacle avoidance in high-risk elderly

OBJECTIVES: To test the hypothesis that vertical footlift asymmetries and low obstacle clearing distance during obstacle avoidance are characteristics of elderly people classified as high risk for falls. DESIGN: Controlled cross-sectional design with two conditions to cue selection of the foot-for-step initiation: sound cue and visual cue. SETTING: Senior independent living facilities. PARTICIPANTS: Eighteen community-dwelling elderly with a history of falling or prolonged Timed Up and Go score greater than 13.5 seconds, 16 elderly with no fall history and Timed Up & Go score of 13.5 seconds or less, and 15 younger subjects. MEASUREMENTS: Video kinematic analysis of bilateral footlift displacement and velocity using reflective markers as subjects stepped over foam obstacles scaled to a maximum tolerated height. RESULTS: High-risk elders contacted the obstacle more frequently and had significantly greater vertical footlift asymmetries adjusted for obstacle/subject height (mean+/-standard error asymmetry index for sound cue 3.25+/-0.42 cm, for visual cue 2.51+/-0.45 cm) than low-risk and younger subjects (P<.001). In low-risk elderly and younger subjects, the asymmetry index approached 0, which indicated symmetrical lower limb movements when stepping over the obstacles. CONCLUSION: High-risk elderly show a marked asymmetry in foot clearance while stepping over an obstacle, with the lag foot clearing the obstacle at a much lower distance than the lead foot. Possible mechanisms responsible for these findings (limited hip extension and deficits in executive cognitive function) are discussed.     

The effect of changing practice on fall prevention in a rehabilitative hospital: the Hospital Injury Prevention Study

OBJECTIVES: To determine whether a change in practice to introduce a multidisciplinary fall-prevention program can reduce falls and injury in nonacute patients in a rehabilitation hospital. DESIGN: A quasi-experimental study. SETTING: Three geriatric wards with a similar design, equipment, staffing levels, and skill mix. PARTICIPANTS: Eight hundred twenty-five consecutive patients. INTERVENTION: The patients' fall-risk status was assessed using the Downton Score. Current practice was maintained on the two control wards (n=550). On the experimental ward (n=275), a fall-prevention program was introduced. A multidisciplinary team met weekly specifically to discuss patients' fall risk and formulate a targeted plan. Patients at risk were identified using wristbands; risk factors were corrected or environmental changes made to enhance safety. MEASUREMENTS: Primary outcomes were number of fallers, recurrent fallers, total falls, patients sustaining injury, and falls per occupied bed days. Secondary outcomes were place of discharge and mortality. RESULTS: Patients were matched for age and risk status. Control wards had proportionally more fallers (20.2% vs 14.2%: P=.033), patients sustaining injury (8.2% vs 4%: P=.025), and total number of falls (170 vs 72: P=.045). These results did not remain significant after controlling for differing length of stay. There was no reduction in recurrent fallers (6.4% vs 4.7%: P=.43) and no effect on place of discharge (home discharges; 57.5% vs 60.7%: P=.41) or mortality (15.3% vs 13.8%: P=.60). CONCLUSION: This study shows that falls might be reduced in a multidisciplinary fall-prevention program, but the results are not definitive because of the borderline significance achieved and the variable length of stay. More research on fall prevention in hospital is required, particularly as to what interventions, if any, are effective at reducing falls in this group of patients.     

A classification tree for predicting recurrent falling in community-dwelling older persons

OBJECTIVES: To develop a classification tree for predicting the risk of recurrent falling in community-dwelling older persons using tree-structured survival analysis (TSSA). DESIGN: A prospective cohort study. SETTING: A community in the Netherlands. PARTICIPANTS: One thousand three hundred sixty-five community-dwelling older persons (>/=65) from the Longitudinal Aging Study Amsterdam (LASA). MEASUREMENTS: In 1995, physical, cognitive, emotional, and social aspects of functioning were assessed. Subsequently, a prospective fall follow-up, specifically on recurrent falls (two falls within 6 months) was conducted for 3 years. RESULTS: The classification tree included 11 end groups differing in risk of recurrent falling based on a minimum of two and a maximum of six predictors. The first split in the tree involved two or more falls versus fewer than two falls in the year preceding the interview. Respondents with two or more falls in the year preceding the interview (n=193) and with at least two functional limitations (n=98) had a 75% risk of becoming a recurrent faller, whereas respondents with fewer than two functional limitations were further divided into a group with regular dizziness (n=11, risk of 68%) and a group with no regular dizziness (n=84, risk of 30%). In respondents with fewer than two falls in the year preceding the interview (n=1,172), the risk of becoming a recurrent faller varied between 9% and 70%. Predictors in this branch of the tree were low performance, low handgrip strength, alcohol use, pain, high level of education, and high level of physical activity. CONCLUSION: This classification tree included 11 end groups differing in the risk of recurrent falling based on specific combinations of a maximum of six easily measurable predictors. The classification tree can identify subjects who are eligible for preventive measures in public health strategies.