Falls Among the Community-living Elderly People in Hong Kong: A Retrospective Study

Purpose

To examine the base rate of falls for a group of community-living elderly people in Hong Kong.

Methods

This was a retrospective cross-sectional study of 554 elderly people aged 65 years or above living in various geographical regions of Hong Kong, who had completed assessments at a community centre over a period of 4 months. Participants were recruited by convenience sampling and stratified by age range according to the distribution in Hong Kong population. They were asked to report on their fall history for a period of the 12 months before joining the study.

Results

Of all the participants, 111 reported having fallen during the preceding 12 months. The fall rate was 29%, and the 1-year prevalence of falls was 20%, dropping to 6.3% for two or more falls. Of all the falls, 47.7% occurred indoors whereas 52.3% occurred outdoors. Results showed female gender, Timed Up & Go Test, self-reported history of upper limb fracture, an intake of four or more types of medication, receiving rehabilitation services, and living with a couple only were independent predictors for fallers with at least one fall. There were no significant differences between the number of near-miss experienced by fallers and nonfallers in the past 12 months.

Conclusion

We determined the base rate of falls for a group of community-living elderly people of Hong Kong. Retrospective methods, which ask elderly people living in a community to recall their falls, may be used to identify risks preceding falls and to facilitate early intervention.     

Fatal work‐related falls in the United States, 2003‐2014

Background

Falls are the second leading cause of work‐related fatalities among US workers. We describe fatal work‐related falls from 2003 to 2014, including demographic, work, and injury event characteristics, and changes in rates over time.

Methods

We identified fatal falls from the Bureau of Labor Statistics (BLS), Census of Fatal Occupational Injuries and estimated rates using the BLS Current Population Survey.

Results

From 2003 to 2014, there were 8880 fatal work‐related falls, at an annual rate of 5.5 per million FTE. Rates increased with age. Occupations with the highest rates included construction/extraction (42.2 per million FTE) and installation/maintenance/repair (12.5 per million FTE). Falls to a lower level represented the majority (n = 7521, 85%) compared to falls on the same level (n = 1128, 13%).

Conclusions

Falls are a persistent source of work‐related fatalities. Fall prevention should continue to focus on regulation adherence, Prevention through Design, improving fall protection, training, fostering partnerships, and increasing communication.

     

Differential risk factor profiles for indoor and outdoor falls in older people living at home in Nottingham, UK

The objectives of this work were: to estimate the incidence of falls within an at-risk group of community-dwelling elderly people; to assess the risk factors associated with incident falls; to examine the effects of incident falls on survival. A random sample of 1042 community-dwelling older people in Nottingham (UK) were interviewed in 1985 and survivors re-interviewed at 4-year follow-up. The at-risk group was defined as survivors who had not fallen in the year prior to the baseline interview (n=444). One-year fall recall was assessed using a questionnaire and included physical health, mobility, prescribed drugs and time spent walking. Body-weight and handgrip strength were measured. Eight-year post-fall mortality was recorded. In 1989 117 new fallers were identified. These people fell a total of 233 times in the year prior to re-interview (incidence rate: 524.8 per 1000 person-years at risk; 95% confidence intervals (CI): 473.3–576.3). People aged less than 75 were more likely to fall outdoors than people aged 75and over (2=5.715, df=1, p=0.017). Risk factors associated with falling were: being less healthy (odds ratio (OR): 0.55; p=0.052); having a walking speed in the range stroll/very slow/non-ambulant compared with normal/brisk/fast (OR: 1.99; p<0.01); and number of prescribed drugs (OR: 1.30; p=0.01). When analysed separately, indoor and outdoor falls presented differential risk profiles, with evidence that indoor falls were associated with frailty, while outdoor falls were associated with compromised health status in more active people. In 8-year post-fall monitoring, multiple (3+) fallers and indoor fallers showed a significant excess mortality. The differences in risk factors for, and prognoses following, indoor and outdoor falls, emphasise the complex interactions between intrinsic and extrinsic factors associated with falling among older people.     

Ability of Self-Reported Frailty Components to Predict Incident Disability,Falls, and All-Cause Mortality: Results From a Population-Based Study of Older British Men

Background

Frailty is a state of increased vulnerability to disability, falls, and mortality. The Fried frailty phenotype includes assessments of grip strength and gait speed, which are complex or require objective measurements and are challenging in routine primary care practice. In this study, we aimed to develop a simple assessment tool based on self-reported information on the 5 Fried frailty components to identify older people at risk of incident disability, falls, and mortality.

Age- and gender-specific associations between insomnia and falls in Boston Puerto Rican adults

Purpose

This study evaluated the age- and gender-specific associations between insomnia and falls in community-dwelling Puerto Rican adults, independently of multiple covariates.

Methods

Cross-sectional data were collected from 954 Puerto Ricans, aged 46–79 years, in Boston, Massachusetts. In-person interviews were conducted to collect information on sociodemographics and lifestyle, mental status, medication use, comorbidities, sleep duration, insomnia symptoms, and falls and fractures. Blood and urine samples, and bone density measures were collected to assess C-reactive protein, serum interleukin-6, urinary cortisol, and bone mineral density.

Results

Multivariate robust Poisson regressions suggested that adults with insomnia had a 32 % increased likelihood of having falls (PR 1.32, p < 0.05), after adjustment for multiple covariates. Age and gender modified the effect of insomnia on risk of falls. Insomnia was significantly associated with higher risk of falls in adults of 60 years or older (PR 1.49, p < 0.05) and in women (PR 1.36, p < 0.05), but not in adults younger than 60 years or in men. Insomnia was not associated with recurrent falls or fractures.

Conclusions

Age and gender need to be taken into account when considering treatment of insomnia in preventing geriatric falls. Well-designed evidence-based interventions to treat insomnia and improve sleep quality may reduce the risk of falls in this population.

     

Characteristics of patients who stop falling after a risk-based multidisciplinary intervention initiated in a geriatric day hospital

Background

Multidisciplinary interventions for fallers have provided conflicting results in part due to the diversity of fallers’ profiles.

Objectives

to determine the characteristics of the subgroup of patients with a positive response to a multidisciplinary fall prevention program initiated in a geriatric day hospital.

Design

Prospective observational study in day hospital.

Methods

Patients > 75 years referred for falls during the last 3 months benefited from a multidisciplinary assessment to record their characteristics at baseline and to tailor a risk-based multidisciplinary intervention for fall prevention. Patients free from falls at the 3rd or 6th month were compared to persistent fallers for baseline characteristics.

Results

Sixty-nine patients were assessed at baseline (mean age 85.2 y (SD=0.6)), 44 at the 3rd month and 21 at the 6th month. Baseline characteristics of the patients free from falls at the 3rd month were the lower number of previous non-serious falls (p=0.013), living in nursing home (p=0.045), a higher Berg balance score (p=0.02) and a better mental health-related quality of life (M HQol, p=0.045). On multivariate analysis restricted to home-dwelling patients, the positive predictive factors were less isolation at home (OR=0.028, 95%CI [0–0.813], p=0.037), a lower number of non-serious previous falls (OR= 0.526 [0.309–0.894], p=0.018), a better M HQol (OR=1.205 [1.000–1.452], p=0.050) and a trend for younger age (OR= 0.662, [0.426–1.027], p=0.066).

Conclusion

Being able to call upon a support person (familial or institutional) to apply advice and a less serious risk of falling may be preliminary conditions for success in a multidisciplinary intervention initiated in a day hospital.     

Factors related to urinary incontinence among the Malaysian elderly

Background

Urinary incontinence is a prevalent condition in the elderly that is the spontaneous leakage of urine. It is an age-related problem and increases especially in people aged above 65 years. It can cause many psychological, behavioral, biological, economic and social effects. The treatment of urinary incontinence can reduce morbidity and mortality. Thus, this study aimed to determine the effects of variables including age, ethnicity, gender, education, marital status, body weight, blood elements and nutritional parameters on urinary incontinence among the Malaysian elderly.

Methods

The study was on 2322 non-institutionalized Malaysian elderly. The hierarchy logistic regression analysis was applied to estimate the risk of independent variables for urinary incontinence among respondents.

Results

The findings indicated that approximately 3.80% of subjects had urinary incontinence. In addition, constipation was found a significant factor that increased the risk of urinary incontinence in samples (p=0.006; OR=3.77). The increase in dietary monounsaturated fat (p=0.038; OR=0.59) and plasma triglyceride levels (p=0.029; OR=0.56) significantly reduced the risk of incontinence in subjects. Many of suspected variables including socio-demographic factors, diseases, nutritional minerals, blood components and body weight were non-relevant factors to urinary incontinence in respondents.

Conclusions

Constipation increased the risk of urinary incontinence in subjects, and increase in dietary monounsaturated fat and plasma triglyceride levels decreased the risk.

     

Delivery of nutritious meals to elderly receiving home care: Feasibility and effectiveness

Background/Objectives

Elderly with functional disabilities are at increased risk of inadequate dietary intake. Little is known about the effectiveness of interventions aimed at improving their dietary intake and nutritional status, nor about the determinants of successful implementation. We performed a feasibility study to evaluate the implementation and effectiveness of a home delivery service providing nutritious meals.

Design

Quasi-experimental, with participants allocated to treatment group based on municipality of residence.

Setting and participants

Functionally disabled home-dwelling elderly receiving home care. Intervention: Three-month daily meal service consisting of dinner and snacks (intervention). The control group sustained habitual food intake.

Measurements

Forty-four elderly were included (intervention group: 25, control group: 19). For most aspects of the meal service, approximately 90% of participants indicated being satisfied, and the large majority (70%) was interested in receiving a similar meal service in the future. At the end of the 3-month intervention, the intervention group showed a greater increase than the control group in body weight (P < 0.005), body mass index (P < 0.005), upper leg circumference (P < 0.01) and fat free mass (FFM, P < 0.03). Three months post-intervention, only the increase in FFM remained statistically significant (P < 0.05). Except for calcium intake, no positive intervention effect was observed for any of the other outcomes.

Conclusion

Our study stresses the feasibility as well as the potential of healthy and tasteful meals to support home-dwelling elderly, by showing that a high-quality meal service was highly appreciated and had a rapid effect on FFM.

     

Association of depressive symptoms with recurrent falls: A cross-sectional elderly population based study and a systematic review

Background

Screening of depressive symptoms is recommended in recurrent fallers. Compared to the 30-item and 15-item Geriatric Depression Scales (GDS), the 4-item GDS is easier to administer and quicker to perform. The association between abnormal 4-item GDS score and recurrent falls has not yet been examined, hi addition, while depressive symptoms-related gait instability is well known, the association with recurrent falls has been few studied.

Objective

1) To examine the association between abnormal 4-item GDS score and recurrent falls in community-dwelling older adults using original data from health examination centers (HEC) of French health insurance of Lyon, and 2) to perform a systematic review of studies that examined the association of depressive symptoms with recurrent falls among older adults.

Methods

Firstly, based on a cross-sectional design, 2,594 community-dwellers (mean age 72.1±54years; 49.8% women) were recruited in HEC of Lyon, France. The 4-item GDS score (abnormal if score>l) and recurrent falls (i.e., 2 or more falls in the past year) were used as main outcomes. Secondly, a systematic English and French Medline literature search was conducted on May 28, 2012 with no limit of date using the following Medical Subject Heading (MeSH) terms “Aged OR aged, 80 and over”, “Accidental falls”, “Depressive disorder” and “Reccurence”. The search also included the reference lists of the retrieved articles.

Results

A total of 19.0% (n=494) participants were recurrent fallers in the cross-sectional study. Abnormal 4-item GDS score was more prevalent among recurrent fallers compared to non-recurrent fallers (44.7% versus 25.0%, with P<0.001), and was significantly associated with recurrent falls (Odd ratio (OR)=1.82 with P<0.001 for full model; OR=1.86 with P<0.001 for stepwise backward model). In addition to the current study, the systematic review found only four other studies on this topic, three of them examining the association of depressive symptoms with recurrent falls using 30-item or 15-item GDS. All studies showed a significant association of depressive symptoms with recurrent falls.

Conclusions

The current cross-sectional study shows an association between abnormal 4-item GDS score and recurrent falls. This association of depressive symptoms with recurrent falls was confirmed by the systematic review. Based on these results, we suggest that recurrent falls risk assessment should involve a systematic screening of depressive symptoms using the 4-item GDS.     

Inconsistent results in meta-analyses for the prevention of falls are found between study-level data and patient-level data

Objective

This study seeks to examine whether existing study-level data meta-analysis approaches can be used to produce unbiased and precise effect estimates relative to meta-analyses conducted using patient-level data, where a recurrent event is the outcome of interest.

Study Design and Setting

Data from two studies focusing on the prevention of falls in the hospital setting (N = 1,838 total) was divided into the three hospital sites from which data were collected. Outcome data were considered as recurrent event survival data, single event survival data, count data, rate data, and binary data. A range of analysis approaches were considered.

Results

Andersen-Gill, negative binomial, bootstrap resampling, and modified relative risk analysis approaches produced congruous point estimates of effect, whereas modified relative risk analysis produced considerably smaller standard errors. Pooled effect point estimates derived from these approaches were not consistent when using study-level data as opposed to patient-level data, and 95% confidence intervals were excessively wide when between-study heterogeneity was present.

Conclusion

Conducting meta-analysis using patient-level data (if possible) or presenting results from individual trials without pooling of effect estimates may be preferable to presenting pooled effect estimates from meta-analysis of study-level data, where the outcome is a recurrent event.     

Association of urinary 8-OHdG with lifestyle and body composition in elderly natural disaster victims living in emergency temporary housing

Objectives

Residents who lost land and houses due to disasterous heavy rainfall-related events on July 13, 2004 and the Chuetsu Earthquake on October 23, 2004 were moved to emergency temporary housing. The change in life style due to living under such conditions is assumed to increase oxidative stress level. In this study, we investigated the oxidative stress level in elderly residents of emergency temporary housing, and analyzed its association with lifestyle and body composition following these disasters.

Methods

A noninvasive oxidative stress marker, urinary 8-hydroxydeoxyguanosine (8-OHdG), and body composition were measured in 73 elderly residents of emergency temporary housing.

Results

In the elderly female residents, the urinary 8-OHdG level tended to decrease with time after the disasters. 8-OHdG levels were slightly higher in females than males and significantly higher among those who exercised regularly compared to those who did not, particularly in females. A weak correlation was noted between the urinary 8-OHdG level and muscle ratio in females.

Conclusions

The in vivo oxidative stress level in our study cohort of elderly residents of emergency temporary housing changed following the change in life style, but remained within the normal range. The increase in oxidative stress levels of elderly females was related to menopause. A decrease in estrogen levels due to menopause inhibits its antioxidant effects, which increases 8-OHdG levels. Although it is difficult to determine, a decrease in daily stressors over time following the disaster could be a cause of the decrease in oxidative stress levels. We suggest that the close evaluation of the stress level of disaster victims is desirable, in combination with evidence of antioxidative substances and the psychosocial influence of suffering as a consequence of the disaster.     

Cohort study of institutionalized elderly people: fall risk factors from the nursing diagnosis

Objective:

to determine the incidence of falls in elderly residents of long-stay institutions of the Federal District, to identify the aspects involved in the falls, in terms of risk factors, from the application of scales and the Taxonomy II of NANDA-I, and to define the level of accuracy with its sensitivity and specificity for application in the clinical nursing practice.

Method:

this was a cohort study with the evaluation of 271 elderly people. Cognition, functionality, mobility and other intrinsic factors were evaluated. After six months, the elderly people who fell were identified, with significance analysis then performed to define the risk factors.

Results:

the results showed an incidence of 41%. Of the 271 patients included, 69 suffered 111 episodes of falls during the monitoring period. Risk factors were the presence of stroke with its sequelae (OR: 1.82, 95% CI 1.01 - 3.28, p=.045), presenting more than five chronic diseases (OR: 2.82, 95% CI 1.43 - 5.56, p=.0028), foot problem (OR: 2.45, 95% CI 1.35 - 4.44, p=.0033) and motion (OR: 2.04, 95% CI 1.15 - 3.61, p=.0145).

Conclusion:

the taxonomy has high validity regarding the detection of elderly people at risk of falling and should be applied consistently in the clinical nursing practice.     

Same‐level fall injuries in US workplaces by age group,gender, and industry

Background

As the workforce ages, occupational injuries from falls on the same level will increase. Some industries may be more affected than others.

Methods

We conducted a cross‐sectional study using data from the Bureau of Labor Statistics to estimate same‐level fall injury incidence rates by age group, gender, and industry for four sectors: 1) healthcare and social assistance; 2) manufacturing; 3) retail; and 4) transportation and warehousing. We calculated rate ratios and rate differences by age group and gender.

Results

Same‐level fall injury incidence rates increase with age in all four sectors. However, patterns of rate ratios and rate differences vary by age group, gender, and industry. Younger workers, men, and manufacturing workers generally have lower rates.

Conclusions

Variation in incidence rates suggests there are unrealized opportunities to prevent same‐level fall injuries. Interventions should be evaluated for their effectiveness at reducing injuries, avoiding gender‐ or age‐discrimination and improving work ability.

     

What factors influence older adults to discuss falls with their health‐care providers?

Objective

To identify from the older adults'' perspective, the factors associated with discussion about falls with their general practitioners and other health professionals and the factors associated with initiation of these discussions. We explored the content of and barriers to discussion about falls.

Methods

A prospective cohort study where a baseline cross‐sectional survey was followed by a survey 1 year later. Survey domains were drawn from constructs of behavioural change models. Data from 245 older community dwellers in Victoria, Australia, in the follow‐up survey were used for this study. Survey format consisted of yes and no responses, Likert scale and open/closed‐ended responses.

Results

Few older adults talked with and initiated a talk with their health‐care providers about falls in the follow‐up period. Multiple regression showed anxiety or depression [OR = 2.78, 95% CI (1.21–6.41)], chronic medical conditions such as diabetes [OR = 2.71, 95% CI (1.19–6.17)] and having a self‐reported fall in the last 12 months [OR = 4.26, 95% CI (2.16–8.41)] were associated with discussion of falls with general practitioners. Higher perception of risk of sustaining a serious injury from falling [OR = 1.49 (1.03–2.13)] was associated with discussion about falls with other health professionals. Participants discussed various topics of falls with their health‐care providers. Different barriers to discussion about falls were identified.

Conclusion

Health‐care providers should routinely discuss falls prevention with older adults. Dissemination of evidence‐based advice and followed up with referral during consultations, particularly in general practitioners could advance falls prevention practice. The results could help to develop a conceptual framework to predict the likelihood of falls discussion.     

Sex Differences in the Circumstances Leading to Falls: Evidence From Real-Life Falls Captured on Video in Long-Term Care

Objectives

Falls are a major health concern for older adults. Understanding sex differences in fall circumstances may guide the design of fall management plans specifically to men and women. In this study, analyzed real-life falls captured on video to compare scenarios leading to falls between men and women in 2 long-term care (LTC) facilities.

Why do hospitalized older adults take risks that may lead to falls?

Background

The behaviour of hospitalized older adults can contribute to falls, a common adverse event during and after hospitalization.

Objective

To understand why older adults take risks that may lead to falls in the hospital setting and in the transition period following discharge home.

Design

Qualitative research.

Setting and participants

Hospital patients from inpatient medical and rehabilitation wards (n = 16), their informal caregivers (n = 8), and health professionals (n = 33) recruited from Southern Health hospital facilities, Victoria, Australia.

Main variables studied

Perceived motivations for, and factors contributing to risk taking that may lead to falls.

Main outcome measures

Semi‐structured, in depth interviews and focus groups were used to generate qualitative data. Interviews were conducted both 2 weeks post‐hospitalization and 3 months post‐hospitalization.

Results

Risk taking was classified as; (i) enforced (ii) voluntary and informed and (iii) voluntary and mal informed. Five key factors that influence risk taking behaviour were (i) risk compensation ability of the older adult, (ii) willingness to ask for help, (iii) older adult desire to test their physical boundaries, (iv) communication failure between and within older adults, informal care givers and health professionals and (v) delayed provision of help.

Discussion and Conclusion

Tension exists between taking risks as a part of rehabilitation and the effect it has on likelihood of falling. Health professionals and caregivers played a central role in mitigating unnecessary risk taking, though some older adults appear more likely to take risks than others by virtue of their attitudes.     

Falls,Cognitive Impairment,and Gait Performance: Results From the GOOD Initiative

Objectives

Falls are highly prevalent in individuals with cognitive decline. The complex relationship between falls and cognitive decline (including both subtype and severity of dementia) and the influence of gait disorders have not been studied. This study aimed to examine the association between the subtype (Alzheimer disease [AD] versus non-AD) and the severity (from preclinical to moderate dementia) of cognitive impairment and falls, and to establish an association between falls and gait parameters during the course of dementia.

Systemdynamische Betrachtungen zur Sturzdynamik und -prophylaxe

Background

The problem of falls in older persons is currently a major public health challenge. A deterministic system-dynamics model was developed because fall prediction instruments yield poor forecasts.

Methods

A deterministic model was developed and simulated using well-known fall risk factors, quantitative research results and estimations, and cause-and-effect relationships.

Results

The preconditions for a fall are movement or intention to move (termed“mobility in everyday life”), a risk for falling, and an imbalance between the requirements for movement and the capacity to move. Strength, coordination, and balance were defined as stocks, and cause–effect relationships were integrated into the model. Numerous well-known risk factors for falls were entered into the model and quantified. The simulation of immobilisation demonstrated that the probability for a fall was elevated after immobilisation. On simulation, the model displayed system-dynamic aspects such as time delays, feedback, and nonlinearity.

Conclusion

Using system dynamics and taking well-known factors for falling into consideration, it was possible to develop a deterministic model of fall dynamics and fall prevention that was deemed plausible by practitioners.