Health-protective behaviours and risk of fall-related hip fractures: a population-based case-control study

BACKGROUND: Fall-related hip fractures are one of the most common causes of disability and mortality in older age. The study aimed to quantify the relationship between lifestyle behaviours and the risk of fall-related hip fracture in community-dwelling older people. The purpose was to contribute evidence for the promotion of healthy ageing as a population-based intervention for falls injury prevention. METHODS: A case-control study was conducted with 387 participants, with a case-control ratio of 1:2. Incident cases of fall-related hip fracture in people aged 65 and over were recruited from six hospital sites in Brisbane, Australia, in 2003-04. Community-based controls, matched by age, sex and postcode, were recruited via electoral roll sampling. A questionnaire designed to assess lifestyle risk factors, identified as determinants of healthy ageing, was administered at face-to-face interviews. RESULTS: Behavioural factors which had a significant independent protective effect on the risk of hip fracture included never smoking [adjusted odds ratio (AOR): 0.33 (0.12-0.88)], moderate alcohol consumption in mid- and older age [AOR: 0.49 (0.25-0.95)], not losing weight between mid- and older age [AOR: 0.36 (0.20-0.65)], playing sport in older age [AOR: 0.49 (0.29-0.83)] and practising a greater number of preventive medical care [AOR: 0.54 (0.32-0.94)] and self-health behaviours [AOR: 0.56 (0.33-0.94)]. CONCLUSION: With universal exposures, clear associations and modifiable behavioural factors, this study has contributed evidence to reduce the major public health burden of fall-related hip fractures using readily implemented population-based healthy ageing strategies.     

Volunteering as a productive ageing activity: the association with fall-related hip fracture in later life

This paper aims to contribute to the literature on the relationship between productive and healthy ageing as two key theoretical concepts in contemporary ageing. Specifically, volunteering as a productive activity in later life has been associated with social and health benefits for older people. Evidence from the literature has generally focused on global outcomes, such as mortality and self-rated health, or on measures of psychological well-being. This study explored whether volunteering is protective of an important adverse health outcome in later life, that of fall-related hip fracture, utilising data from a case control study of 387 participants. The results showed that volunteer activity in older age remained significantly protective of hip fracture risk [OR: 0.61 (0.38–0.99)], independent of social and physical activity, social support and health status, supporting the hypothesis of a relationship between the concepts of productive and healthy ageing. Whilst further studies are clearly needed to establish causality, these results suggest that health benefits of volunteering in later life might be more extensive than previous studies have shown.     

Predictors of adherence with the recommended use of hip protectors

BACKGROUND: Hip protectors can prevent many hip fractures in older persons at high risk for falling. Few published studies have investigated the use of hip protectors in community-dwelling older persons, and the level of adherence with their use, and predictors of adherence in this setting, are not clear. The aim of this study was to report the predictors of adherence and the level of adherence with the use of hip protectors in frail community-dwelling older women. METHODS: This cohort study of the intervention group of a randomized, controlled trial recruited participants from aged care health services in urban areas of northern Sydney, Australia. Participants were 302 women who were 74 years or older (mean age, 83 years) and who had 2 or more falls or 1 fall requiring hospital admission in the previous year and who lived in their own homes. The main outcome measure was adherence with the use of hip protectors. RESULTS: Adherence was approximately 53% during the 2 years of the study, and hip protectors were worn at the time of 51% of falls. The significant independent predictors of nonadherence with hip protector use were lower self-efficacy for hip protector use (odds ratio [OR], 0.51; 95% confidence interval [CI],.33 to.79), higher number of perceived barriers to hip protector use (OR, 0.52; 95% CI, .38 to.72), and lower self-rated health (OR, 0.71; 95% CI, .55 to.93). CONCLUSIONS: Three easily measured factors independently predicted subsequent adherence with hip protector use. These findings may form the basis for strategies to improve adherence with the use of hip protectors and with other types of treatment or preventive strategies in older persons.     

An evaluation of footwear worn at the time of fall-related hip fracture

BACKGROUND: a range of footwear features have been shown to influence balance in older people, however, little is known about the relationships between inappropriate footwear, falls and hip fracture. OBJECTIVES: to describe the characteristics of footwear worn at the time of fall-related hip fracture and establish whether the features of the shoe influenced the type of fall associated with the fracture. METHODS: 95 older people (average age 78.3 years, SD 7.9) who had suffered a fall-related hip fracture were asked to identify the footwear they were wearing when they fell. Footwear characteristics were then evaluated using a standardised assessment form. Information was also collected on the type and location of fall. RESULTS: the most common type of footwear worn at the time of the fall was slippers (22%), followed by walking shoes (17%) and sandals (8%). Few subjects were wearing high heels when they fell (2%). The majority of subjects (75%) wore shoes with at least one theoretically sub-optimal feature, such as absent fixation (63%), excessively flexible heel counters (43%) and excessively flexible soles (43%). Subjects who tripped were more likely to be wearing shoes with no fixation compared to those who reported other types of falls [chi(2)=4.21, df=1, P=0.033; OR=2.93 (95%CI 1.03-8.38)]. CONCLUSIONS: many older people who have had a fall-related hip fracture were wearing potentially hazardous footwear when they fell. The wearing of slippers or shoes without fixation may be associated with increased risk of tripping. Prospective studies into this proposed association appear warranted.     

Endogenous hormones, muscle strength, and risk of fall-related fractures in older women

BACKGROUND: Among older people, fracture-causing fall often leads to health deterioration. The role of endogenous hormone status and muscle strength on fall-related fracture risk is unclear. This study investigates if, after adjustment for bone density, endogenous hormones and muscle strength would predict fall-related limb fracture incidence in older community-dwelling women followed-up over 10 years. METHODS: As a part of a prospective population-based study, 187 75-year-old women were investigated. Serum estradiol, testosterone, sex hormone binding globulin, and dehydroepiandrosterone sulfate concentrations were analyzed, and isometric muscle strength and bone mineral density were assessed. Fall-related limb fractures were gathered from patient records. RESULTS: Serum estradiol concentration was a significant predictor of fall-related limb fractures. Women with serum estradiol concentrations less than 0.022 nmol/L had a 3-fold risk (relative risk 3.05; 95% confidence interval, 1.26-7.36), and women with estradiol concentrations between 0.022 and 0.066 nmol/L doubled the risk (relative risk 2.24; 95% confidence interval, 0.97-5.19) of fall-related limb fracture compared to the women with estradiol concentrations ()above 0.066 nmol/L. Adjustment for muscle strength and bone mineral density did not materially change the risk estimates. High muscle strength was associated with a low incidence of fall-related limb fractures. CONCLUSIONS: This study showed that in 75-year-old women higher serum estradiol concentration and greater muscle strength were independently associated with a low incidence of fall-related limb fractures even after adjustment for bone density. Our results suggest that hormonal status and muscle strength have their own separate mechanisms protecting from fall-related fractures. This finding is of importance in developing preventive strategies, but calls for further study.     

Health care utilization among older adults with arthritis

OBJECTIVE: To evaluate the effect of arthritis on subsequent 2-year use of health care services and out-of-pocket costs among older adults and determine if comorbidities or economic resources mitigate that effect. METHODS: Data were analyzed from 6230 participants interviewed in 1993 and 1995 in the Asset and Health Dynamic Survey Among the Oldest Old (AHEAD), a national probability sample of community-dwelling adults. Baseline arthritis status was ascertained from the report of an arthritis-related physician's visit or a joint replacement not associated with a hip fracture. The effect of baseline arthritis on the odds of subsequent 2-year health care utilization and high out-of-pocket expenses were estimated from multiple logistic regression controlling for demographic factors, comorbidity, and economic resources. RESULTS: Older adults with arthritis are significantly more likely to have a physician visit (odds ratio [OR] 3.0), hospital admission (OR 1.6), outpatient surgery (OR 1.3), receive home health care (OR 1.6), and have out-of-pocket cost >5000 US dollars (OR 1.6) compared with contemporaries having similar demographics (age, sex, racial/ethnic group, marital status), comorbid conditions, and economic resources (education, income, wealth, health insurance), but not reporting arthritis. CONCLUSIONS: Older adults with symptomatic arthritis reported greater medical utilization and cost compared with people not reporting arthritis. These disparities persisted after accounting for differences in demographics, comorbidities, and economic factors. These findings document greater economic burdens on a personal and societal level among people with arthritis. As individuals, older adults with arthritis spend more out-of-pocket dollars for health care than their contemporaries without arthritis. On a societal level, these findings of greater health care utilization among people with arthritis point to increasing future demands on the US health care system due to demographic increases in the numbers of older adults with arthritis and support policies aimed at improving arthritis prevention and treatment as well as reducing the economic disparities between those with and without arthritis.     

Excess mortality or institutionalization after hip fracture: men are at greater risk than women

OBJECTIVES: To assess 2-year excess mortality or institutionalization risk associated with hip fracture in community-dwelling people aged 60 and over. DESIGN: Cohort study. SETTING: Auckland, New Zealand, from July 1991 to February 1996. PARTICIPANTS: Five hundred sixty-five community-dwelling older people recently hospitalized with a hip fracture and 782 randomly selected controls, frequency matched for age and gender, living in the same catchment area as the cases. MEASUREMENTS: Two-year mortality or institutionalization status. RESULTS: Over half (52.1%) of male hip fracture cases and 12.4% of male controls were dead or institutionalized, compared with 39.2% of female hip fracture cases and 19.7% of female controls. The odds ratio, adjusted for baseline demographic characteristics, medical status, and physical function, for death or institutionalization was 6.89 (95% confidence interval (CI) = 2.75-17.27) for men and 1.48 (95% CI = 1.02-2.19) for women. CONCLUSIONS: For both men and women who incur a hip fracture, the risks of dying or being institutionalized within 2 years are higher than for their peers. The independent effect of hip fracture on this outcome was significantly greater for men than women. The marked influences of prefracture health status, physical limitations, and gender on outcome have important implications for preventative strategies.     

Multimorbidity and functional status in community-dwelling older adults

BackgroundMultimorbidity is common in older people and may contribute to many adverse health events, such as disability. The aim of the study was to investigate how chronic health conditions (single, paired, and grouped) affect functional independence.MethodWe used two samples (a one-time, convenience sample and a nationally representative cross-sectional survey) of community-dwelling people of 65 years old or over, with a total of 2818 subjects in Spain. To assess functional independence, we used the Barthel index, administered as an interview. Information about the presence of 11 chronic health problems was collected by interview or review of their medical chart. Explanatory factor analysis was performed to assess associations between chronic health conditions.ResultsDiabetes mellitus and hypertension emerged as the pair of chronic health conditions that most affected functional status [OR 1.98; 95% CI (1.51–2.60)], followed by visual and hearing impairment. A synergistic effect was found (p < 0.05) for the cardiovascular disease and hypertension pair. Four multimorbidity groups emerged from the factor analysis: sensory and bone; cancer, lung and gastrointestinal; cardiovascular and metabolic; neuropsychiatric disorders. The neuropsychiatric disorders group was the most strongly associated with physical impairment [OR 4.94; 95% CI (2.71–8.99)], followed by the sensory and bones group [OR 1.90; 95% CI (1.56–2.31)].ConclusionDespite its low prevalence, the neuropsychiatric disorders group was most strongly associated with lower functional status. Analysis of the relationship between chronic medical conditions and functional status could be useful to develop primary health care strategies to improve functional independence in older people with comorbidities.     

Residential status and risk of hip fracture.

OBJECTIVE: to examine the association between residential status and risk of hip fracture in older people. DESIGN: population-based case-control study. SETTING: Auckland, New Zealand. SUBJECTS: a random sample of all individuals > or = 60 years, hospitalized with a fracture of the proximal femur between July 1991 and February 1994. Controls were age and gender frequency-matched to the cases, randomly selected from a random sample of general practitioners. MAIN OUTCOME MEASURES: radiographically-confirmed fracture of the proximal femur. Fractures sustained as a result of major trauma, such as in a motor vehicle crash, and those associated with pre-existing pathological conditions were excluded. RESULTS: individuals living in institutions were almost four times more likely to sustain a hip fracture [age- and gender-adjusted odds ratio (OR)=3.8; 95% confidence interval (CI): 3.0-4.8] than those living in private homes. After adjustment for potential confounding factors, the risk of hip fracture associated with living in an institution remained significantly increased (P< 0.0001), although the magnitude of the risk was somewhat diminished (OR=2.2; 95% (CI: 1.5-3.5). CONCLUSIONS: living in an institution is associated with an increased risk of hip fracture in older people. Specific factors that place these individuals at increased risk need to be identified, in order to develop intervention strategies.     

A comparison of different balance tests in the prediction of falls in older women with vertebral fractures: a cohort study

BACKGROUND: people with vertebral fractures are at high risk of developing hip fractures. Falls risk is important in the pathogenesis of hip fractures. AIM: to investigate if balance tests, in conjunction with a falls history, can predict falls in older women with vertebral fractures. METHODS: a cohort study of community-dwelling women aged over 60 years, with vertebral fractures. Balance tests investigated were: 5 m-timed-up-and-go-test (5 m-TUG), timed 10 m walk, TURN180 test (number of steps to turn 180 degrees ), tandem walk, ability to stand from chair with arms folded. Leg extensor power was also measured. OUTCOME MEASURE: fallers (at least one fall in a 12 month follow-up period) versus non-fallers. RESULTS: one hundred and four women aged 63-91 years [mean=78 +/- 7], were recruited. Eighty-six (83%) completed the study. Four variables were significantly associated with fallers: previous recurrent faller (2+ falls) [OR=6.52; 95% CI=1.69-25.22], 5 m-TUG test [OR=1.03; 1.00-1.06], timed 10 m walk [OR=1.07; 1.01-1.13] and the TURN180 test [OR=1.22; 1.00-1.49] [P <0.05]. Multi-variable analysis showed that only two variables, previous recurrent faller [OR=5.60; 1.40-22.45] and the 5 m-TUG test [OR=1.04; 1.00-1.08], were independently significantly associated with fallers. The optimal cut-off time for performing the 5 m-TUG test in predicting fallers was 30 s (area under ROC=60%). Combining previous recurrent faller with the 5 m-TUG improved prediction of fallers [OR=16.79, specificity=100%, sensitivity=13%]. CONCLUSIONS: a previous history of recurrent falls and the inability to perform the 5 m-TUG test within 30 s predicted falls in older women with vertebral fractures. Combining these two measures can predict fallers with a high degree of specificity (although a low sensitivity), allowing the identification of a group of patients suitable for fall and fracture prevention measures.     

Further exploring hip protector use

Objective: To explore hip protector adherence in high‐risk older people. Methods: In‐depth interviews were conducted with 14 older people (and/or their carers) discharged from hospital with hip protectors. Four outpatients were recruited to supplement numbers. Thematic analysis was carried out on the interview data. Results: Hip protector use largely paralleled daily dressing routines, this contributed to periods of disuse and partial adherence. Another factor in abandoning hip protector use was a fatalistic view of an end of life stage, where injury prevention was not actively sought. Committed carers who demonstrated understanding and support were vital in encouraging ongoing use. Conclusion: Daily routines of a lifetime, reluctance to change, and a readiness to endure the potential risk of hip fracture discouraged use of hip protectors. Family and carer support was vital for continuation. These findings can assist with strategies to improve adherence.     

Evaluating the effectiveness of a home-based fall risk reduction program for rural community-dwelling older adults

BACKGROUND: We investigated the effectiveness of a low-cost, multifactor fall risk reduction program in a group of rural community-dwelling older adults. The goal of the program was to provide health care workers and communities with a primary prevention tool that can be used to teach seniors about fall-related risks. The long-term goal of this program is to reduce the incidence of falling among community-dwelling older adults. METHODS: Complete data were collected on 37 community-dwelling subjects, aged 67 to 90, who participated in a 10-week fall risk reduction program. The subjects were randomly assigned to an intervention group or to a control group. The intervention group received fall risk education, home-based exercise programming, nutrition counseling, and environmental hazards education. Both groups completed a variety of physiologic, psychometric, and environmental fall-related risk assessments before and after the intervention period. RESULTS: The intervention group showed statistically significant improvement in balance, bicep endurance, lower extremity power, reduction of environmental hazards, falls efficacy, and nutritious food behavior during the study period. CONCLUSIONS: The low-cost, home-based fall risk reduction program for community-dwelling older adults was effective in reducing some of the studied fall-related risk factors over a 10-week period.     

Concurrent and predictive validity of "getting up from lying on the floor"

BACKGROUND AND AIMS: Older age, higher morbidity and lower functional capacity are associated with fall injuries. Inability to get up from the floor is associated with older age, higher morbidity and lower functional capacity. The purpose of this study was to assess the concurrent and predictive validity of the ability of elderly women to get up from lying on the floor. METHODS: In a random sample of 307 women aged 75 years and over (mean 80.8 years, response rate 74.5%) living in the community, baseline registrations of ability to get up from lying on the floor, health and function were recorded. Serious fall injuries during the subsequent year served as the outcome. RESULTS: 240 (78.2%) managed to get up independently. The highest independent association was with items primarily related to mobility, e.g., ability to climb steps and performance on the Timed Up & Go test (TUG). However, arthrosis of the hip and difficulty with walking indoors were among the variables independently associated with the ability to get up from lying on the floor. During the follow-up year, 50.5% experienced falls, of which one in four resulted in serious injury and one in eight in a fracture. The ability to get up from lying on the floor was a significant predictor of serious fall-related injury (OR 2.1). Among those who experienced a fall, the risk of injury was markedly higher for those unable to rise (OR 3.7). The positive predictive value of being unable to rise for serious injury was 0.30, indicating that nearly one out of three of the elderly women with such problems are predicted to experience a serious fall-related injury during the following 12 months. CONCLUSIONS: The test "get up from lying on the floor" is a marker of failing health and function in the elderly and a significant predictor of serious fall injuries.     

Differing trends in fall-related fracture and non-fracture injuries in older people with and without dementia

ObjectivesTo explore the impact of dementia on the trends in fall-related fracture and non-fracture injuries for older people.MethodsIndividuals aged ≥65 years who were admitted to a NSW hospital for at least an over-night stay for a fall-related injury from 2003 to 2012 were identified. Age-standardised hospitalisation rates, length of stay, access to in-hospital rehabilitation, 30-day and 1-year mortality were examined. Annual percentage change (PAC) over time was calculated using negative binomial regression.ResultsOf the 228,628 fall-related injury hospitalisations, 20.6% were for people with dementia. People with dementia were more likely to be admitted with a hip fracture, and less likely to be admitted with a fracture of the forearm/wrist, and received less in-hospital rehabilitation than people without dementia. Fall-related hip-fracture rates for people with dementia decreased by 4.2% (95%CI −5.6 to −2.7, p < 0.001) per annum; there was no change over time for people without dementia (PAC-0.2%; 95%CI −0.8 to 0.5, p = 0.643). Rates for other fractures decreased by 1.2% (95%CI −1.9 to −0.5, p < 0.001) per annum in people with dementia, while rates increased by 2.2% (95%CI 1.9–2.5, p < 0.001) for people without dementia. By contrast, non-fracture injuries including traumatic brain injury increased significantly for both people with and without dementia.ConclusionRates of fall-related fracture and non-fracture hospitalisations for people with dementia remain higher than for those without dementia. However, fall-related fracture hospitalisation rates have decreased for people with dementia, while there has not been a corresponding decrease in people without dementia.     

Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission

BACKGROUND: The aim of this study was to assess the impact of fear of falling on the health of older people. METHODS: A total of 528 subjects (mean age 77 years) were recruited from two hospitals in Sydney, Australia, and followed for approximately 12 months. Eighty-five subjects died during follow-up, and 31 were admitted to an aged care institution. Tinetti's Falls Efficacy Scale (FES) was successfully administered to 418 subjects as part of the baseline assessment. Among those with baseline FES scores, ability to perform 10 activities of daily living (ADLs) was assessed at baseline and follow-up in 307 subjects, and SF-36 scores were assessed at baseline and follow-up in 90 subjects recruited during the latter part of the study. Falls during follow-up were identified using a monthly falls calendar. RESULTS: Compared with those with a high fall-related self-efficacy (FES score = 100), those with a low fall-related self-efficacy (FES score < or = 75) had an increased risk of falling (adjusted relative risk 2.09, 95% confidence interval [CI] 1.31-3.33). Those with poorer fall-related self-efficacy had greater declines in ability to perform ADLs (p < .001): the total ADL score decreased by 0.69 activities among persons with low FES scores (< or =75) but decreased by only 0.04 activities among persons with FES scores of 100. Decline in ADLs was not explained by the higher frequency of falls among persons with low FES scores. SF-36 scores (particularly scores on the Physical Function and Bodily Pain subscales) tended to decline more among persons with poor fall-related self-efficacy. Nonfallers who said they were afraid of falling had an increased risk of admission to an aged care institution. CONCLUSIONS: Fear of falling has serious consequences for older people. Interventions that successfully reduce fear of falling and improve fall-related self-efficacy are likely to have major health benefits.     

Prevalence, incidence, and risk factors associated with hip fractures in community-dwelling older Mexican Americans: results of the Hispanic EPESE study. Establish Population for the Epidemiologic Study for the Elderly

OBJECTIVES: To determine the rates and risk factors associated with hip fractures in the community-dwelling older Mexican-American population. DESIGN: A prospective survey of a regional probability sample of older Mexican Americans aged 65 and over. SETTING: The 1993-1996 Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE), a probability sample of noninstitutionalized Mexican Americans, aged 65 and over, living in the Southwestern states of Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: In 1993-1994 and in 1995-1996, 2895 persons, aged 65 and over, considered Mexican American, were selected at baseline as a weighted probability sample. Sample weights were used to extrapolate to the estimated 498,176 older Mexican Americans residing in the Southwest US. MEASUREMENTS: Self-reported hip fracture and functional measures by in home interviews. RESULTS: Hip fracture prevalence was 4.0% at baseline. The overall incidence of hip fractures for women was 9.1 fractures/1000 person-years. The incidence rate for men was 4.8 fractures/1000 person-years. Extrapolation from these data to the entire older Mexican American population indicated that approximately 5162 new fractures occurred in the population during the 2 year study period. In women, hip fractures were associated independently with advanced age, not being married/living alone, having had a stroke, limitations with activities of daily living and instrumental activities of daily living. In men, only the latter limitations were associated independently with hip fracture. CONCLUSIONS: This study indicates that older Mexican American people may have hip fracture incidence rates that place them at highest risk among the Hispanic subgroups. In light of a sparse literature on this population, the fracture estimates derived from this work contributes to our understanding of the true fracture estimates in this population. Based on the extrapolated population rates, hip fracture in this population is a significant public health problem. Adequate preventive measures need to be implemented in this growing US population.     

Fall prevention strategy for elderly women wishing to attend community fall prevention programs

AIM: Fall prevention programs for community-dwelling elderly people are carried out as part of disability-postponing programs in Japanese municipalities. This study examined how to design a fall prevention program for community health fair based on the characteristics of fall prevention strategies adopted by community-dwelling elderly women before attending community fall prevention programs. METHODS: One hundred and four community-dwelling elderly women (71.7 +/- 6.3 years old) who were attending community fall prevention programs for the first time were asked about their strategies for fall prevention. Age, regular attendance at outpatient programs, the Tokyo Metropolitan Institute of Gerontology Index, and Timed Up&Go were determined as factors related to whether or not the women had strategies for fall prevention. RESULTS: Sixty-four participants had their own strategies for fall prevention. Multiple logistic regression analysis showed that age (OR = 1.10, 95% CI:1.00-1.21) and regular attendance at outpatient programs (OR = 4.77, 95% CI:1.75-12.98) were significantly related to having fall prevention strategies. Timed Up&Go (OR = 1.42, 95% CI: 0.95-2.13) had a weak relationship to having such strategies (P = 0.085). The most common strategy was behavior such as lifting the toe when walking (n=38, 59.4%), followed by doing regular exercise (n=16, 25.0%). Few of the participants modified their environment (n=2, 3.1%). CONCLUSION: Community fall prevention programs for community-dwelling elderly women can motivate participants to develop interdisciplinary and comprehensive practices for fall prevention.     

Determination of prefracture physical function in community-dwelling people who fracture their hip

BACKGROUND: Prefracture physical function must be accurately determined to set appropriate and attainable goals for rehabilitation following hip fracture. This is especially important for people who were living independently prior to their fracture. This study determines reliability and internal consistency of a prefracture physical function questionnaire (PFPFQ) completed by both patients and knowledgeable informants (KIs). METHODS: A 20-item PFPFQ, including ambulation, transfers, balance, and self-care domains, was developed using focus groups. Community-dwelling patients with a hip fracture (N = 40, 77.9 +/- 8 years) completed the PFPFQ on two occasions during postoperative acute care. Forty KIs were identified by the patients and also completed the PFPFQ on two occasions via telephone interview. Day-to-day reliability of the patients and KIs [intraclass correlation coefficients (ICC)], and internal consistency [Kuder-Richardson coefficient (KR)] of the PFPFQ were determined. RESULTS: Intrarater reliability was high with ICCs (95% confidence interval) of 0.94 (0.89, 0.96) for patients and 0.96 (0.93, 0.98) for KIs. Interrater reliability on occasion 1 had an ICC of 0.81 (0.69, 0.88). Internal consistency of the patient responses on the first occasion was high (KR coefficient = 0.896). CONCLUSIONS: The PFPFQ is a reliable and internally consistent instrument for determining prefracture physical function in community-dwelling people who fracture their hip. In situations where patients with a hip fracture are unable to provide this necessary information, KIs can provide reliable estimates of prefracture function to assist in setting appropriate rehabilitation goals.     

Recovery of physical function after limb injuries in independent older people living at home.

OBJECTIVES: to describe changes in physical functioning after fall-related injuries to the limbs in independently living older people. DESIGN: prospective cohort study, including a pre-injury assessment and post-injury assessments at 8 weeks and 5 and 12 months. SETTING: the study is part of the larger, population-based prospective and longitudinal Groningen Longitudinal Aging Study on the determinants of health-related quality of life of people aged 57 and over, who are living independently in the north of the Netherlands. SUBJECTS: 171 patients who sustained injuries at various sites on the limbs and who had completed all four assessments (66% of the eligible population). Patients were grouped according to injury site. Outcome measure: self-reported grades of difficulties with performing basic and instrumental activities of daily living as measured by the Groningen Activity Restriction Scale. RESULTS: 1 year after the injury, pre-injury (mean) levels of functioning were not regained in any of the groups studied. However, only those with fractures of the wrist or hip experienced a substantial decrease in ability to perform basic and instrumental activities of daily living between baseline and the final assessment. Furthermore, of the 44 subjects with wrist fractures, seven (15.9%) needed help with at least one relevant activity at baseline and 18 (40.9%) at 12 months. Of the 34 subjects with hip fractures, four (11.8%) needed help with at least one activity at baseline and 18 (52.9%) at 12 months. Practically no changes were found in any of the groups after 5 months post-injury. CONCLUSIONS: not only hip fractures, but also wrist fractures may reduce older people's chances of remaining independent. Prospects of further recovery are minimal 5-6 months after the injury.     

Role of physical therapists and aromatherapy for fall prevention in older people: A narrative review

Falls among older people are usually the result of several causes combined. Identifying all the fall-related factors that apply to a particular individual and providing comprehensive multifactorial intervention is recommended for the prevention of falls among older people. However, the overall net benefit of multifactorial intervention in preventing falls is small, and it does not appear to improve fall-related outcomes, such as the number of fall-related injuries. Therefore, we might require new perspectives to overcome this situation. Here, we raise two novel strategies for fall prevention among older people. One is using physical therapists more actively. The other is using aromatherapy for stabilization of older people. Physical therapists should carry out detailed gait assessment and caregiver education. Aromatherapy is effective in improving balance and mental stability in older people. To overcome refractory geriatric syndrome, there is no choice but to eliminate all preconceived ideas before choosing the best fall prevention strategies. Geriatr Gerontol Int 2021; 21: 445–450 .