A multifactorial fall prevention programme in the community-dwelling aged: predictors of adherence

BACKGROUND: Overall adherence rates have usually been reported in fall prevention studies, but predictors of adherence have rarely been described. The aim of this study was to determine the adherence rates and the predictors of adherence in four key activities of a multifactorial fall prevention trial. METHODS: This study is part of a multifactorial fall prevention programme implemented among the 65-year-old or older community-dwelling aged who had fallen at least once during the previous 12 months. Subjects (n = 591) were randomly assigned to an intensive prevention programme or to a counselling group. Four key activities of prevention programme included physical exercise in small groups, psychosocial group activities, lectures and home exercises. Associations between adherence rates and potential predictors were analysed using cumulative logistic regression. RESULTS: The mean adherence rate was 58% in the physical exercise groups, 25% in the psychosocial groups and 33% in lectures. Subjects performed home-exercises on average 11 times per month. In multivariate analyses, infrequent feelings of loneliness, low self-perceived probability of falling at home and good physical functional abilities were significant predictors of active physical exercise group adherence. Good physical and cognitive functional abilities predicted active psychosocial group adherence. Female gender and good physical and cognitive functional abilities predicted more active lecture adherence. CONCLUSION: Persons with the poorest physical, cognitive and psychological functional abilities representing the part of the population at highest risk of falling do not seem reachable in multifactorial risk-based intervention.     

建始县农村学龄儿童跌落伤现况及影响因素分析

目的了解建始县农村学龄儿童跌落伤现况和影响因素,为跌落伤的防治提供科学依据。方法分层整群抽取建始县某乡镇6所中小学校的3~5年级和7~8年级的在校学生进行问卷调查,收集过去一年跌落伤发生的回顾性资料。结果农村学龄儿童跌落伤发生率为7.1%,跌落伤人次发生率为7.4%。跌落伤发生地点前三顺位为家中(35.6%)、学校(30.7%)、道路(19.0%);跌落伤多发生于上肢(37.4%)、下肢(33.1%)、头面部(25.2%);跌落伤多在休闲玩耍(49.7%)和体育活动(17.8%)时发生。跌落伤发生的危险因素为责骂体罚的教育方式;保护因素为女生、非留守儿童、较大年龄段。结论农村学龄儿童跌落伤发生率较高,且是多因素共同作用的结果。提示要加强对危险群体的保护,改变教育方式,以减少跌落伤的发生。     

分级监控体系对预防老年住院患者跌倒的作用

目的：探讨分级监控体系对预防老年患者跌倒的应用效果,保证患者安全。方法：建立三级监控体系、明确各级职责、完善相关制度,规范监控程序,对住院老年患者跌倒实施预前控制、环节控制和终末控制。结果：院内老年患者跌倒发生率由0.2‰下降至0.03‰。结论：分级监控体系对老年住院患者跌倒监控效果良好。     

遵义市农村学龄儿童跌落伤流行病学调查分析

目的 调查西部山区农村学龄儿童跌落伤发生的情况、分析影响因素,为开展儿童跌落伤防控工作提供科学依据。方法 采用多阶段随机抽样方法,调查获得跌落伤的相关信息。结果 抽取遵义市农村学龄儿童共2 854名(男1 437,女1 417),跌落伤年发生率为6.2%(178例),占伤害总人数的37.3%,且年龄差异有统计学意义(P <0.001)。跌落伤发生地点以家里(37.1%)和学校(29.2%)为主;伤害多在玩耍时发生(41.6%);伤害部位以四肢(72.4%)为主,而跌落伤预防相关知识平均掌握率为79.0%。结论 遵义市农村学龄儿童跌落伤发生率较高,是意外伤害的首位原因,且伤害预防相关知识仍不足,提示要全社会共同努力,创建安全环境,切实降低学龄儿童跌落伤的发生率。     

Prevention of viral hepatitis C: assessment of a comic strip-based information campaign targeting adolescents

BACKGROUND: The risk of exposure to hepatitis C virus increases markedly in adolescence, and students are thus a preferential target for information campaigns. The aim of this study was to evaluate the results of a hepatitis C information campaign targeting secondary-school students. METHODS: The study was done in 52 classes of 11 general and vocational secondary schools. Before the information meetings and two months afterwards, the students received an anonymous questionnaire to test their knowledge of hepatitis C. The information session was backed up by a comic strip depicting scenarios involving hepatitis C. RESULTS: The students were aged from 14 to 24 years (mean 15.9 years, SD 0.9 years). Respectively 1509 and 1419 questionnaires were completed before and after the information session. Answers to the first questionnaire showed that the students' knowledge of hepatitis C was poor. Scores improved significantly after the information session, from an overall mean of 6.2 (SD 2.0) to 8.5 (SD 1.7) (p<0.001). The largest score improvement concerned transmission due to illicit drug use, the potential severity of the disease, and lack of a vaccine. The improvement was significantly larger among pupils who said they read the comic strip than among those who did not (p=0.02). CONCLUSIONS: General and vocational secondary school students in France have mediocre knowledge of hepatitis C, particularly its modes of transmission and the lack of a vaccine. Knowledge improved significantly when measured two months after an information session, suggesting that subsequent at-risk behaviours might be reduced.     

A small fraction of patients with repetitive injuries account for a large portion of medical costs

BACKGROUND: The phenomenon of repetitive injuries has been judged to be of limited importance in the public health context. A study was therefore initiated in order to analyse all types of single and repetitive injuries using a longitudinal approach. METHODS: Hospital care, medical costs and risk factors were examined for single and repetitive severe injuries. A cross-sectional survey with a 12-year follow-up was performed. Questionnaire information from a survey of a random sample of the adult population 20-89 years old in 1984 in Stockholm County were linked to the Swedish national inpatient and cause-of-death register up to 1996, inclusive. RESULTS: During the study period 13% of males and 15% of females were hospitalized or deceased as a result of injuries. Persons with three or more injuries comprise 19% of the injuries, but account for 63% of the total number of days of hospital care and medical costs. Injuries related to falls were most common among patients requiring hospital care. Factors such as high age, living alone, stroke earlier, and use of hypnotics and sedatives were especially associated with repetitive injuries. The risk factors for single and repetitive injuries covariate, but the size of the risk is overrepresented for stroke, drugs, self-reported injuries and living alone for two or more injuries. CONCLUSION: These results indicate that subjects with repetitive injuries, and with the observed risk factors for such injuries, should be given extra attention, both in policy and prevention, but also in integrated treatment programmes.     

Determinants of health service use and expenditure among the elderly Finnish population

Background: There is a need to identify significant determinantsof physician and public health nurse visits, hospital in-patientand home care, use of prescribed medication and total expenditureamong elderly people for planning of health policy. Methods:The data were obtained from three annual computer-assisted telephoneinterview surveys in 1992–1994. Each year a systematicsample of approximately 2,300 non-institutionalized people aged25-79 years were interviewed. The 60-79 year old respondentswere included in our analysis (n=1,707); the response ratesin this age group were approximately 75% each year. In thisstudy we tested the suitability of four regression models: Poisson,negative binomial, logit plus zero-truncated Poisson and logitplus zero-truncated negative binomial. Results: The use of servicesincreased with age, particularly hospital in-patient and homecare. Although women were more likely to use services, particularlyprimary care, their share of total expenditure was lower thanthat for men. Significant predictors of higher expenditure wereown personal doctor, other specific doctor, perceived healthstatus, psychosomatic symptoms, chronic illness and difficultiesin functional ability. Those living alone had significantlyhigher expenditures. Conclusion: It emerged that, while a largenumber of elderly people had used services, only a small minorityhad accounted for the majority of expenditure. Although thepersonal doctor system may produce high quality of care, itcannot achieve cost savings.     

2002-2015年上海市浦东新区老年人意外跌落死亡流行特征及趋势分析

目的 了解2002-2015年浦东新区老年人意外跌落死亡的流行特征及其趋势,为制定相应的干预措施提供依据。方法 对2002-2015年浦东新区老年人意外跌落死亡资料进行流行病学分析,采用死亡率、标化死亡率、年度变化百分比(APC)、不同年龄组间变化百分比(PC)等指标对死亡情况进行分析。结果 浦东新区2002-2015年期间60岁以上老年人意外跌落粗死亡率为54.95/10万,标化死亡率为36.70/10万,是浦东新区老年人首位意外伤害死因,占45.74%。14年间老年人意外跌落死亡率呈现逐年下降的趋势(APC=-3.87, Z=-6.41, P<0.001),随年龄增长呈现上升趋势(PC=18.57%, Z=13.45, P<0.001);老年女性意外跌落死亡率高于男性(Z=-10.94, P<0.001),男女意外跌落死亡率均呈下降的趋势(APC_男性=-2.26%, Z_男性=-4.07, P=0.002; APC_女性=-4.70%, Z_女性=-5.68, P<0.001);郊区老年人意外跌落死亡率高于城区(Z=2.32, P=0.022),城郊老年人口意外跌落死亡率均呈下降趋势(APC_城区=-3.14%, Z_城区=-4.72, P<0.001; APC_郊区=-6.14%, Z_郊区=-5.94, P<0.001)。结论 2002-2015年浦东新区老年人意外跌落死亡呈现逐年降低趋势,郊区老年人意外跌落死亡值得关注,应采取进一步的干预措施。     

Effects of residential relocation on mortality and morbidity among elderly people

This study analyses the effects of residential relocation amongelderly people, in terms of mortality and health service consumption.The analyses are based on a register covering 22,579 persons.Analyses at different levels are carried out a logistic regressionanalysis, a longitudinal analysis on a yearly basis and a longitudinalanalysis of consumption in relation to the date of the move.The overall conclusion of the study is that residential relocationamong elderly people does not have any significant effect onmortality or consumption of health services. This conclusionemerges regardless of the choice of indicator and method ofanalysis. However, the study indicates adverse effects in onesubgroup: the death rate among those who were evacuated or whomoved permanently due to urban renewal was higher than amongnon-movers and among those who moved for other reasons.     

Less cases of pneumonia in children requiring hospital treatment: A register-based survey

Background: The aim of this investigation was to describe trendsin the use of hospital services by children on account of pneumoniaduring a period of 22 years from 1972 to 1993. Methods: Allhospital treatment periods concerning children younger than15 years of age with a primary or additional diagnosis of pneumoniain the Finnish population, comprising approximately 1 millionchildren, were collected from the register maintained by theNational Research and Development Centre for Welfare and Health.Results: A total of 79,828 such treatment periods were identified.The figure for 1972 was 4,989 (4.6 periods per 1,000 persons)and that for 1993 was 3,170 (3.3 periods per 1,000 persons),a decrease of 28.3% In the age-specific rate. The highest averagepercentage decrease per year was found in children younger than1 year: 5.7% for boys and 5.6% for girls. The number of hospitalizationdays was 47,997 in 1972 (44.6 per 1,000) and 13,332 in 1993(13.8 per 1,000), a decrease of 68.9%. The length of stay inhospital decreased from 9.6 to 4.1 days for boys and from 9.7to 4.3 days for girls over the same time interval. Conclusion:Cases of pneumonia that require hospital treatment have declinedsubstantially, supporting the notion that a comprehensive sociomedicalapproach can reduce the need for hospital services.     

Health screening among the elderly: A comparison between a postal questionnaire and a personal interview

We analysed answers to 2 types of survey instrument used inpreventive health care for the elderly: face to face interviewand a postal questionnaire. The response rate was high as wasthe answer rate for each item. More people answered the questionnairethan attended the health clinic. Some of the questions requireda graded evaluation which was not defined in detail and thisreduced the reliability. Screening via a questionnaire seemsto be well accepted among the elderly and the method seems suitablefor revealing information about health and social problems,but the formulation of some of the questions must be clearerto avoid different interpretations.     

HIV outbreak among injecting drug users in the Helsinki region: social and geographical pockets

BACKGROUND: Incidence of newly diagnosed HIV infections among injecting drug users (IDUs) in Helsinki rose from 0 per 100,000 inhabitants in 1997 to 2.9 in 1998 and to 11.1 in 1999. Thereafter incidence declined to 2.1 in 2003. METHODS: Data were collected from interviews with HIV-positive IDUs who attended the University Hospital in Helsinki from 1998 until 2003. We studied the sociodemographic profile and spatial distribution of IDUs who were diagnosed in the beginning of the outbreak and those diagnosed later. The indicator for the spatial differentiation within the metropolitan area is % employed males aged 25-64. RESULTS: The outbreak occurred among a marginalized population of IDUs characterized by a long history of injecting drug use (10.7 years), mean age 32 years, homelessness (66.3%), history of imprisonment (74.7%) and psychiatric hospital care (40.6%). Compared with 98 early cases diagnosed during the first 2 years until 2000, 47 recent cases diagnosed after 2001 were 4 years older, and as marginalized. Except for the city centre, both early and recent cases had been living or using drugs in the same deprived neighbourhoods with the highest unemployment rates. Up to 40% of cases in the two big geographical clusters did not have contact with the city centre, where the needle exchange services were available. CONCLUSIONS: The Finnish HIV outbreak is restricted socially to a very marginalized IDU population, and spatially to local pockets of poverty. In low prevalence countries, prevention programs should be targeted early at high-risk areas and populations.     

Epidemiology and prevention of fall injuries among the elderly

The authors examine the problem of falls among the elderly. Due to the steadily increasing 65-and-older population, focus on prevention rather than treatment of falls among them has beneficial economic consequences. The authors discuss possible strategies for preventing such falls. Specifically, they argue that people must use the community organization model to form successful strategies because prevention programs cannot succeed without the participation and support of many individuals and organizations throughout an elderly person's social networks and throughout society.     

Relationships between physical activity,ADL capability and fall risk in community-dwelling Japanese elderly population

Objective The purpose of this study was to clarify the relationships among fall risk, physical activity habits, and ADL capability in a community-dwelling Japanese elderly population. Methods The subjects were 1,407 Japanese aged 65 or older (604 males, 803 females). Fall risk was evaluated using the Falling Assessment Chart of Suzuki et al. (2003). Physical activity habits such as the frequency of leaving the house, the use of transportation, the frequency of physical exercise, and interests were evaluated. ADL capability was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Results Approximately 25% of the subjects had a high fall risk (score of 5 or more). Fall risk increased with age and ADL capability decreased with age. The group with a low fall risk (score<5) had a significantly higher ADL capability than the group with a high fall risk (score≥5). From results of two-way ANCOVA (gender×physical activity habits) with age as the covariate, the fall risk of people who regularly go on leaving the house, exercise, and have interests tended to be low. Further more, the relationships between the scores and physical activity habits were examined by two-way ANCOVA with age and ADL capability as the covariates. There were significant differences in the frequency of leaving the house, and elderly persons who leaved regularly the house, had a low fall risk. Conclusions This study showed that fall risk is closely related to ADL capability, and that the frequency of leaving the house is very important for reducing fall risk.     

Rising incidence of fall-induced injuries among elderly adults

Aim and methods Fall-induced injuries in older people are a major public health concern in modern societies with aging populations. Despite this, very little is known about the population trends in these injuries and long-term follow-ups are lacking. Our aim was to determine the current trends in the number and incidence (per 100,000 persons) of fall-induced injuries in older adults in Finland, an EU country with a well-defined white population of 5.2 million, taking into account all persons 80 years of age or older who were admitted to our hospitals for primary treatment of a first fall injury over the period 1970–2002.Results The number of fall-induced injuries in elderly Finns increased considerably between the years 1970 and 2002: from 1,139 to 11,835 overall (a 10.4-fold rise), and from 927 to 9346 in women (a 10.1-fold rise) and from 212 to 2489 in men (an 11.7-fold rise). In both genders, the age-adjusted incidence of fall-induced injuries also increased during the study period, the incidence being 2711 (women) and 1441 (men) in 1970, and 6681 (women) and 4726 (men) in 2002. Assuming that the observed relatively linear development in the incidence rates of fall-induced injuries in elderly Finnish people continues and that the size of this population increases as predicted, the annual number of Finns aged 80 years or older experiencing a fall-induced injury can be estimated to increase further steeply during the coming three decades, from the above-noted 11,835 to about 42,500 in the year 2030 (a 3.6-fold rise).Conclusion The number of fall-induced injuries among elderly Finns shows an alarming rise with a rate that cannot be explained merely by demographic changes. Wide-scale preventive measures should be urgently adopted to control the rising burden of these injuries.     

Statistical modelling needed to find the effects from a community-based elderly safety promotion program

Background: Multiple control areas and time-series analyseshave been recommended for effect evaluations of community-basedhealth promotion. Large fluctuations, maybe due to chance, amongthe areas and over the years might obscure the interventioneffect. Methods: A quasi-experimental time-series analysis withseveral control areas was performed as an effect evaluationof a community-based elderly safety promotion program. The programwas implemented during 1995–99 in a community in the StockholmMetropolitan area (population +65 years: 5500; number of firsthip fractures in 1995: 60). Four control areas were selectedbased on similar hip fracture-related characteristics as theintervention community, complemented with two larger controlareas. The time series covered 6 years pre-intervention (1990–95)and 6 years post-intervention (1996–2001). The study populationwas divided into two age groups and gender, resulting in 28panels. The first hip fracture incidence was obtained from theSwedish national in-patient register. Results: The time seriesrevealed no discernible pattern, and conventional analyses showedno conclusive results. A multivariate analysis, examining thetime trends by employing the intra-annual and intra-panel variance,revealed the underlying trends in hip fracture rates. Comparisonsbetween predicted numbers of hip fractures in the interventionand control areas was enabled, which resulted in 14 less hipfractures in the intervention community than expected from thecontrol communities. If one extreme value was altered, the resultchanged considerably. Conclusion: Effect evaluations of community-basedhealth promotion programs using time-series from small communitiesmight give faulty results, if statistical modelling is not employed.     

A mixed methods systematic review of informal caregivers' experiences of fall risk among community-dwelling elders with dementia

Evidence on effective fall prevention strategies for community-dwelling elders with dementia is limited, although these elders are at high risk of falling. Informal caregivers may play an essential role in managing fall risk for elders with dementia. Thus, understanding caregiver's experiences is critically important. This systematic review aims to (a) identify caregivers' perceptual, emotional and behavioural responses to fall risk in elders with dementia and (b) examine the outcomes and effects of caregiver behavioural responses. A mixed methods systematic review of 10 databases (PubMed, PsycINFO, CINAHL, Social Service Abstracts, Social Work Abstracts, EMBASE, Web of Science, Scopus, Cochrane Library and TRIP Medical Database) was conducted. We searched English language, peer-review articles (January 1, 1985–March 20, 2020) that met the predefined inclusion/exclusion criteria. Study quality was assessed using the Mixed Methods Appraisal Tool. Data were analysed using thematic synthesis techniques. Twenty-nine studies were included. Six analytic themes were generated concerning caregivers' perceptual, emotional and behavioural responses: (a) fear of the negative health consequences of falls; (b) limited insights into factors contributing to falls; (c) varying expectations of managing fall risk; (d) multi-level efforts; (e) struggling with responsibilities; and (f) inaction and withdrawal. The findings about the outcomes and effects of caregivers' behaviours were synthesised into three analytic themes: (a) multi-faceted outcomes; (b) uncertain and inconsistent evidence; and (c) unclear associations. The study generated new insights in understanding caregivers' responses of fall risk among community-dwelling elders with dementia and identified significant gaps in examining the impact of caregivers' responses and what shapes these responses. Investment in understanding caregivers' perspectives will inform future interventions and policies to reduce negative outcomes for elders, caregivers and care systems.     

Legal access to needles and syringes/needle exchange programmes versus HIV counselling and testing to prevent transmission of HIV among intravenous drug users: a comparative study of Denmark, Norway and Sweden

BACKGROUND: Countries have adopted different strategies to prevent the transmission of HIV among intravenous drug users. Legal access to needles and syringes/needle exchange programmes as part of such a strategy has been heavily debated. HIV counselling and testing has also been part of prevention strategies. The objective of this study was to discuss the effectiveness of legal access to needles and syringes/ needle exchange programmes versus HIV counselling and testing among intravenous drug users (IDUs) as part of HIV prevention strategies. METHODS: Differences in HIV prevention strategies in Denmark, Norway and Sweden among IDUs are described. Outcome variables of effectiveness were HIV incidence rates over time. These were estimated by back calculation methods from 1980 through 1996, using data from the national HIV and AIDS registers. RESULTS: A comparison of HIV prevention strategies in Denmark, Norway and Sweden suggests that a high level of HIV counselling and testing might be more effective than legal access to needles and syringes/needle exchange programmes. Sweden and Norway, with higher levels of HIV counselling and testing, have had significantly lower incidence rates of HIV among IDUs than Denmark where there was legal access to needles and syringes and a lower level of HIV counselling and testing. In Sweden there was no legal access to drug injection equipment. CONCLUSION: Promotion and accessibility of HIV counselling and testing among intravenous drug users should be considered in countries where such a strategy is not adopted or has low priority.     

Cognitive impairment and nocturnal blood pressure fall in treated elderly hypertensives

Objectives We investigated the association between the fall of nocturnal blood pressure (BP) and cognitive impairment in elderly subjects. Methods The study was a cross-sectional survey of 204 elderly subjects who had no cerebrovasucular episodes. Ambulatory BP monitoring and assessments of cognitive functions using the Mini-Mental State Examination (MMSE) were performed at the subjects’ homes. We classified, the subjects treated with antihypertensive drugs into three groups: non-dippers (nocturnal fall<10% of the mean day diastolic BP; n=51), normal dippers (10% to less than 20%; n=58), and extreme dippers (20% or more; n=17). The subjects not treated with antihypertensive drugs were also classified as non-dippers (n=40), normal dippers (n=24), and extreme dippers (n=14). Results The mean age of participants was 75.2±7.2 years, and 126 (61.7%) were being treated with antihypertensive drugs. In the group of antihypertensive drug users, the number with MMSE≤23 was 30 and the adjusted odds ratio for cognitive impairment in those with an extreme dip in diastolic BP (DBP) was 4.18 (95% CI, 1.07–16.40) in reference to the normal dippers. In contrast, no association was observed between cognitive function and nocturnal BP fall in the group no using antihypertensive drugs. Conclusions Cognitive impairment was associated with an extreme dip in DBP in the antihypertensive drug users only. It remains to be seen whether careful monitoring of nighttime BP as well as daytime BP may reduce the risk of cognitive impairment in antihypertensive drug users.